Search results for: Individual patient data

Authors: Petr Vcelak, Jana Kleckova

Abstract:

Our Medicine-oriented research is based on a medical data set of real patients. It is a security problem to share patient private data with peoples other than clinician or hospital staff. We have to remove person identification information from medical data. The medical data without private data are available after a de-identification process for any research purposes. In this paper, we introduce an universal automatic rule-based de-identification application to do all this stuff on an heterogeneous medical data. A patient private identification is replaced by an unique identification number, even in burnedin annotation in pixel data. The identical identification is used for all patient medical data, so it keeps relationships in a data. Hospital can take an advantage of a research feedback based on results.

Keywords: DASTA, De-identification, DICOM, Health Level Seven, Medical data, OCR, Personal data

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Authors: N. R. N. Idris, S. Baharom

Abstract:

A meta-analysis may be performed using aggregate data (AD) or an individual patient data (IPD). In practice, studies may be available at both IPD and AD level. In this situation, both the IPD and AD should be utilised in order to maximize the available information. Statistical advantages of combining the studies from different level have not been fully explored. This study aims to quantify the statistical benefits of including available IPD when conducting a conventional summary-level meta-analysis. Simulated meta-analysis were used to assess the influence of the levels of data on overall meta-analysis estimates based on IPD-only, AD-only and the combination of IPD and AD (mixed data, MD), under different study scenario. The percentage relative bias (PRB), root mean-square-error (RMSE) and coverage probability were used to assess the efficiency of the overall estimates. The results demonstrate that available IPD should always be included in a conventional meta-analysis using summary level data as they would significantly increased the accuracy of the estimates.On the other hand, if more than 80% of the available data are at IPD level, including the AD does not provide significant differences in terms of accuracy of the estimates. Additionally, combining the IPD and AD has moderating effects on the biasness of the estimates of the treatment effects as the IPD tends to overestimate the treatment effects, while the AD has the tendency to produce underestimated effect estimates. These results may provide some guide in deciding if significant benefit is gained by pooling the two levels of data when conducting meta-analysis.

Keywords: Aggregate data, combined-level data, Individual patient data, meta analysis.

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Authors: Guilherme Ribeiro, Alexandre Oliveira, Antonio Ferreira, Shyam Visweswaran, Gregory Cooper

Abstract:

Patient-specific models are instance-based learning algorithms that take advantage of the particular features of the patient case at hand to predict an outcome. We introduce two patient-specific algorithms based on decision tree paradigm that use AUC as a metric to select an attribute. We apply the patient specific algorithms to predict outcomes in several datasets, including medical datasets. Compared to the patient-specific decision path (PSDP) entropy-based and CART methods, the AUC-based patient-specific decision path models performed equivalently on area under the ROC curve (AUC). Our results provide support for patient-specific methods being a promising approach for making clinical predictions.

Keywords: Approach instance-based, area Under the ROC Curve, Patient-specific Decision Path, clinical predictions.

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Authors: Jeroen S. de Bruin, Karin Schindler, Christian Schuh

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With increasingly more mobile health applications appearing due to the popularity of smartphones, the possibility arises that these data can be used to improve the medical diagnostic process, as well as the overall quality of healthcare, while at the same time lowering costs. However, as of yet there have been no reports of a successful combination of patient-generated data from smartphones with data from clinical routine. In this paper we describe how these two types of data can be combined in a secure way without modification to hospital information systems, and how they can together be used in a medical expert system for automatic nutritional classification and triage.

Keywords: Data integration, disease-related malnutrition, expert systems, mobile health.

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Authors: Nevena Stolba, A Min Tjoa

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Evidence-based medicine is a new direction in modern healthcare. Its task is to prevent, diagnose and medicate diseases using medical evidence. Medical data about a large patient population is analyzed to perform healthcare management and medical research. In order to obtain the best evidence for a given disease, external clinical expertise as well as internal clinical experience must be available to the healthcare practitioners at right time and in the right manner. External evidence-based knowledge can not be applied directly to the patient without adjusting it to the patient-s health condition. We propose a data warehouse based approach as a suitable solution for the integration of external evidence-based data sources into the existing clinical information system and data mining techniques for finding appropriate therapy for a given patient and a given disease. Through integration of data warehousing, OLAP and data mining techniques in the healthcare area, an easy to use decision support platform, which supports decision making process of care givers and clinical managers, is built. We present three case studies, which show, that a clinical data warehouse that facilitates evidence-based medicine is a reliable, powerful and user-friendly platform for strategic decision making, which has a great relevance for the practice and acceptance of evidence-based medicine.

Keywords: data mining, data warehousing, decision-support systems, evidence-based medicine.

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Authors: M. Tsirintani

Abstract:

The article is proposing a base plan for the future Patient Care Information Systems in a changing health care environment where it is necessary to assure quality patient care services and reducing cost and where new technology trends give the opportunities to develop clinical applications and services patient focused according to new business objectives.

Keywords: Health care management, planning patient care information system.

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Authors: Saimir Heta, Kers Kapa, Rialda Xhizdari, Ilma Robo

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Despite the existence of different dental specialties, the dentist-patient relationship is unique, in the very fact that the treatment is performed by one doctor and the patient identifies the malpractice presented as part of that doctor's practice; this is in complete contrast to cases of medical treatments where the patient can be presented to a team of doctors, to treat a specific pathology. The rules of dental ethics are almost the same as the rules of medical ethics. The appearance of dental malpractice affects exactly this two-party relationship, created on the basis of professionalism, without deviations in this direction, between the dentist and the patient, but with very narrow individual boundaries, compared to cases of medical malpractice. Malpractice can have different reasons for its appearance, starting from professional negligence, but also from the lack of professional knowledge of the dentist who undertakes the dental treatment. It should always be seen in perspective that we are not talking about the individual - the dentist who goes to work with the intention of harming their patients. Malpractice can also be a consequence of the impossibility, for anatomical or physiological reasons of the tooth under dental treatment, to realize the predetermined dental treatment plan. On the other hand, the dentist himself is an individual who can be affected by health conditions, or have vices that affect the systemic health of the dentist as an individual, which in these conditions can cause malpractice. So, depending on the reason that led to the appearance of malpractice, the method of treatment from a legal point of view also varies, for the dentist who committed the malpractice, evaluating the latter if the malpractice came under the conditions of applying the rules of dental ethics. The deviation from the predetermined dental plan is the minimum sign of malpractice and the latter should not be definitively related only to cases of difficult dental treatments. The identification of the reason for the appearance of malpractice is the initial element, which makes the difference in the way of its treatment, from a legal point of view, and the involvement of the dentist in the assessment of the malpractice committed, must be based on the legislation in force, which must be said to have their specific changes in different states. Malpractice should be referred to, or included in the lectures or in the continuing education of professionals, because it serves as a method of obtaining professional experience in order not to repeat the same thing several times, by different professionals.

Keywords: Dental ethics, malpractice, negligence, legal basis, continuing education, dental treatments.

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Authors: Dennys Robson Girardi, Hugo Bulegon, Claudia Maria Moro Barra

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Leprosy is an infectious disease caused by Mycobacterium Leprae, this disease, generally, compromises the neural fibers, leading to the development of disability. Disabilities are changes that limit daily activities or social life of a normal individual. When comes to leprosy, the study of disability considered the functional limitation (physical disabilities), the limitation of activity and social participation, which are measured respectively by the scales: EHF, SALSA and PARTICIPATION SCALE. The objective of this work is to propose an on-line monitoring of leprosy patients, which is based on information scales EHF, SALSA and PARTICIPATION SCALE. It is expected that the proposed system is applied in monitoring the patient during treatment and after healing therapy of the disease. The correlations that the system is between the scales create a variety of information, presented the state of the patient and full of changes or reductions in disability. The system provides reports with information from each of the scales and the relationships that exist between them. This way, health professionals, with access to patient information, can intervene with techniques for the Prevention of Disability. Through the automated scale, the system shows the level of the patient and allows the patient, or the responsible, to take a preventive measure. With an online system, it is possible take the assessments and monitor patients from anywhere.

Keywords: Leprosy, Medical Informatics, Decision SupportSystem, Disability.

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Authors: Chryssa Thermolia, Ekaterini S. Bei, Stelios Sotiriadis, Kostas Stravoskoufos, Euripides G.M. Petrakis

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Moving into a new era of healthcare, new tools and devices are developed to extend and improve health services, such as remote patient monitoring and risk prevention. In this concept, Internet of Things (IoT) and Cloud Computing present great advantages by providing remote and efficient services, as well as cooperation between patients, clinicians, researchers and other health professionals. This paper focuses on patients suffering from bipolar disorder, a brain disorder that belongs to a group of conditions called affective disorders, which is characterized by great mood swings. We exploit the advantages of Semantic Web and Cloud Technologies to develop a patient monitoring system to support clinicians. Based on intelligently filtering of evidence-knowledge and individual-specific information we aim to provide treatment notifications and recommended function tests at appropriate times or concluding into alerts for serious mood changes and patient’s nonresponse to treatment. We propose an architecture as the back-end part of a cloud platform for IoT, intertwining intelligence devices with patients’ daily routine and clinicians’ support.

Keywords: Bipolar disorder, intelligent systems patient monitoring, semantic web technologies, IoT.

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Authors: Nálevka Petr

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Many contemporary telemedical applications rely on regular consultations over the phone or video conferencing which consumes valuable resources such as the time of the doctors. Some applications or treatments allow automated diagnostics on the patient side which only notifies the doctors in case a significant worsening of patient’s condition is measured. Such programs can save valuable resources but an important implementation issue is how to ensure effective and cheap diagnostics on the patient side. First, specific diagnostic devices on patient side are expensive and second, they need to be user-˜friendly to encourage patient’s cooperation and reduce errors in usage which may cause noise in diagnostic data. This article proposes the use of modern smartphones and various build-in or attachable sensors as universal diagnostic devices applicable in a wider range of telemedical programs and demonstrates their application on a case-study – a program for schizophrenic relapse prevention.

Keywords: Smartphones, Actigraphy, Telemedicine, In-home Diagnostics

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Authors: Ondřej Bayer

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The paper evaluates the ongoing reform of VAT in the Czech Republic in terms of impacts on individual households. The main objective is to analyse the impact of given changes on individual households. The adopted method is based on the data related to household consumption by individual household quintiles; obtained data are subjected to micro-simulation examining. Results are discussed in terms of vertical tax justice. Results of the analysis reveal that VAT behaves regressively and a sole consolidation of rates at a higher level only increases the regression of this tax in the Czech Republic.

Keywords: Consolidation of rates, household quintiles, tax impact, VAT.

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Authors: O. O. Obe, V. Balanica, E. Neagoe

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The effects of hypertension are often lethal thus its early detection and prevention is very important for everybody. In this paper, a neural network (NN) model was developed and trained based on a dataset of hypertension causative parameters in order to forecast the likelihood of occurrence of hypertension in patients. Our research goal was to analyze the potential of the presented NN to predict, for a period of time, the risk of hypertension or the risk of developing this disease for patients that are or not currently hypertensive. The results of the analysis for a given patient can support doctors in taking pro-active measures for averting the occurrence of hypertension such as recommendations regarding the patient behavior in order to lower his hypertension risk. Moreover, the paper envisages a set of three example scenarios in order to determine the age when the patient becomes hypertensive, i.e. determine the threshold for hypertensive age, to analyze what happens if the threshold hypertensive age is set to a certain age and the weight of the patient if being varied, and, to set the ideal weight for the patient and analyze what happens with the threshold of hypertensive age.

Keywords: Neural Network, hypertension, data set, training set, supervised learning.

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Authors: Leslie Beale

Abstract:

Being a patient with a chronic disease is both a physical and emotional experience. The ability to recognize a patient’s emotional health is an important part of a health care provider’s skills. For the purposes of this paper, emotional health is viewed as the way that we feel, and the way that our feelings affect us. Understanding the patient’s emotional health leads to improved provider-patient relationships and health outcomes. For example, when a patient first hears his or her diagnosis from a provider, they might find it difficult to cope with their emotions. Struggling to cope with emotions interferes with the patient’s ability to read, understand, and act on health information and services. As a result, the patient becomes more frustrated and confused, creating barriers to accessing healthcare services. These barriers are challenging for both the patient and their healthcare providers. There are five basic emotions that are part of who we are and are always with us: fear, anger, sadness, joy, and compassion. Living with a chronic disease however can cause a patient to experience and express these emotions in new and unique ways. Within the provider-patient relationship, there needs to be an understanding that each patient experiences these five emotions and, experiences them at different times. In response to this need, the paper highlights a health promotion framework for patients with chronic disease. This framework emphasizes the emotional health of patients.

Keywords: Health promotion, emotional health, patients with chronic disease, patient-centered care.

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Authors: Yi-Yun Ko, Der-Ming Liou

Abstract:

The Electronic Health Record (EHR) system is very general and we should pay more attention to a patient-s privacy. The patient-s consent is one of the elements when dealing with privacy topics. This study focuses on the creating and managing of patient consent. The integration of the HL7 standards and the IHE BPPC profile provides a base for the creation of patient consent. Establishing the platform offers the patients a way to create, revoke or update their consents. Through this platform, they can manage their consents in an easier manner.

Keywords: consent, EHR, HL7, IHE

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Authors: Gabriela Lindemann, Danilo Schmidt, Thomas Schrader, Dietmar Keune

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The amount and heterogeneity of data in biomedical research, notably in interdisciplinary fields, requires new methods for the collection, presentation and analysis of information. Important data from laboratory experiments as well as patient trials are available but come out of distributed resources. The Charité - University Hospital Berlin has established together with the German Research Foundation (DFG) a new information service centre for kidney diseases and transplantation (Open European Nephrology Science Centre - OpEN.SC). Beside a collaborative aspect to create new research groups every single partner or institution of this science information centre making his own data available is allowed to search the whole data pool of the various involved centres. A core task is the implementation of a non-restricting open data structure for the various different data sources. We decided to use a modern RDF model and in a first phase transformed original data coming from the web-based Electronic Patient Record database TBase©.

Keywords: Medical databases, Resource Description Framework (RDF), metadata repository.

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Authors: J. Bouchard, B. Prosperi, G. Bavre, M. Daudé, E. Jeandupeux

Abstract:

Young patients suffering from Cerebral Palsy are facing difficult choices concerning heavy surgeries. Diagnosis settled by surgeons can be complex and on the other hand decision for patient about getting or not such a surgery involves important reflection effort. Proposed software combining prediction for surgeries and post surgery kinematic values, and from 3D model representing the patient is an innovative tool helpful for both patients and medicine professionals. Beginning with analysis and classification of kinematics values from Data Base extracted from gait analysis in 3 separated clusters, it is possible to determine close similarity between patients. Prediction surgery best adapted to improve a patient gait is then determined by operating a suitable preconditioned neural network. Finally, patient 3D modeling based on kinematic values analysis, is animated thanks to post surgery kinematic vectors characterizing the closest patient selected from patients clustering.

Keywords: Cerebral Palsy, Clustering, Crouch Gait, 3-D Modeling.

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Authors: Nazaket Gazieva

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Voice biometric data associated with physiological, psychological and other factors are widely used in forensic phonoscopy. There are various methods for identifying and verifying a person by voice. This article explores the minimum speech signal data as individual parameters of a speech signal. Monozygotic twins are believed to be genetically identical. Using the minimum data of the speech signal, we came to the conclusion that the voice imprint of monozygotic twins is individual. According to the conclusion of the experiment, we can conclude that the minimum indicators of the speech signal are more stable and reliable for phonoscopic examinations.

Keywords: Biometric voice prints, fundamental frequency, phonogram, speech signal, temporal characteristics.

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Authors: Yasar Guneri Sahin, Mehmet Cudi Okur

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Assessment of IEP (Individual Education Plan) is an important stage in the area of special education. This paper deals with this problem by introducing computer software which process the data gathered from application of IEP. The software is intended to be used by special education institution in Turkey and allows assessment of school and family trainings. The software has a user friendly interface and its design includes graphical developer tools.

Keywords: Disabled individual, software for education, assessment of education, special education.

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Authors: Radoslav Židek, Veronika Šidlová, Radovan Kasarda, Birgit Fuerst-Waltl

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Machine learning represents a set of topics dealing with the creation and evaluation of algorithms that facilitate pattern recognition, classification, and prediction, based on models derived from existing data. The data can present identification patterns which are used to classify into groups. The result of the analysis is the pattern which can be used for identification of data set without the need to obtain input data used for creation of this pattern. An important requirement in this process is careful data preparation validation of model used and its suitable interpretation. For breeders, it is important to know the origin of animals from the point of the genetic diversity. In case of missing pedigree information, other methods can be used for traceability of animal´s origin. Genetic diversity written in genetic data is holding relatively useful information to identify animals originated from individual countries. We can conclude that the application of data mining for molecular genetic data using supervised learning is an appropriate tool for hypothesis testing and identifying an individual.

Keywords: Genetic data, Pinzgau cattle, supervised learning.

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Authors: Dalvin D. Hill, Hector M. Castro Garcia

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A growing number of individuals utilize wearable devices on a daily basis. The usage and functionality of these wearable devices vary from user to user. One popular usage of said devices is to track health-related activities that are typically stored on a device’s memory or uploaded to an account in the cloud; based on the current trend, the data accumulated from the wearable device are stored in a standalone location. In many of these cases, this health related datum is not a factor when considering the holistic view of a user’s health lifestyle or record. This health-related data generated from wearable and Internet of Things (IoT) devices can serve as empirical information to a medical provider, as the standalone data can add value to the holistic health record of a patient. This paper proposes a solution to incorporate the data gathered from these wearable and IoT devices, with that a patient’s Personal Health Record (PHR) stored within the confines of a Health Information Exchange (HIE).

Keywords: Electronic health record, health information exchanges, Internet of Things, personal health records, wearable devices, wearables.

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Authors: V. Balanica, W. I. D. Rae, M. Caramihai, S. Acho, C. P. Herbst

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Mammographic images and data analysis to facilitate modelling or computer aided diagnostic (CAD) software development should best be done using a common database that can handle various mammographic image file formats and relate these to other patient information. This would optimize the use of the data as both primary reporting and enhanced information extraction of research data could be performed from the single dataset. One desired improvement is the integration of DICOM file header information into the database, as an efficient and reliable source of supplementary patient information intrinsically available in the images. The purpose of this paper was to design a suitable database to link and integrate different types of image files and gather common information that can be further used for research purposes. An interface was developed for accessing, adding, updating, modifying and extracting data from the common database, enhancing the future possible application of the data in CAD processing. Technically, future developments envisaged include the creation of an advanced search function to selects image files based on descriptor combinations. Results can be further used for specific CAD processing and other research. Design of a user friendly configuration utility for importing of the required fields from the DICOM files must be done.

Keywords: Database Integration, Mammogram Classification, Tumour Classification, Computer Aided Diagnosis.

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Authors: Fahad Shahbaz Khan, Rao Muhammad Anwer, Olof Torgersson

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The vast amount of information hidden in huge databases has created tremendous interests in the field of data mining. This paper examines the possibility of using data clustering techniques in oral medicine to identify functional relationships between different attributes and classification of similar patient examinations. Commonly used data clustering algorithms have been reviewed and as a result several interesting results have been gathered.

Keywords: Oral Medicine, Cluto, Data Clustering, Data Mining.

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Authors: Ashish Dhamaniya, Satish Chandra

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Speed and traffic volume data are collected on different sections of four lane and six lane roads in three metropolitan cities in India. Speed data are analyzed to fit the statistical distribution to individual vehicle speed data and all vehicles speed data. It is noted that speed data of individual vehicle generally follows a normal distribution but speed data of all vehicle combined at a section of urban road may or may not follow the normal distribution depending upon the composition of traffic stream. A new term Speed Spread Ratio (SSR) is introduced in this paper which is the ratio of difference in 85^th and 50^th percentile speed to the difference in 50^th and 15^th percentile speed. If SSR is unity then speed data are truly normally distributed. It is noted that on six lane urban roads, speed data follow a normal distribution only when SSR is in the range of 0.86 – 1.11. The range of SSR is validated on four lane roads also.

Keywords: Normal distribution, percentile speed, speed spread ratio, traffic volume.

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Authors: L. Parisi

Abstract:

A method which allows a diabetic quadriplegic patient that has had four limb amputations (above the knee and elbow) to self-administer injections of insulin has been designed. The aim of this research project is to improve a quadriplegic patient’s selfmanagement, affected by diabetes, by designing a suitable device for self-administering insulin. The quadriplegic patient affected by diabetes has to be able to selfadminister insulin safely and independently to guarantee stable healthy conditions. The device also should be designed to adapt to a number of different varying personal characteristics such as height and body weight.

Keywords: Robotics, diabetes, quadriplegia, self-management.

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Authors: S. Impey, D. Berry, S. Furtado, M. Galvin, L. Grogan, O. Hardiman, L. Hederman, M. Heverin, V. Wade, L. Douris, D. O'Sullivan, G. Stephens

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Healthcare is a knowledge-rich environment. This knowledge, while valuable, is not always accessible outside the borders of individual clinics. This research aims to address part of this problem (at a study site) by constructing a maximal data set (knowledge artefact) for motor neurone disease (MND). This data set is proposed as an initial knowledge base for a concurrent project to develop an MND patient data platform. It represents the domain knowledge at the study site for the duration of the research (12 months). A knowledge elicitation method was also developed from the lessons learned during this process - the WICKED method. WICKED is an anagram of the words: eliciting and confirming data, information, knowledge, wisdom. But it is also a reference to the concept of wicked problems, which are complex and challenging, as is eliciting expert knowledge. The method was evaluated at a second site, and benefits and limitations were noted. Benefits include that the method provided a systematic way to manage data, information, knowledge and wisdom (DIKW) from various sources, including healthcare specialists and existing data sets. Limitations surrounded the time required and how the data set produced only represents DIKW known during the research period. Future work is underway to address these limitations.

Keywords: Healthcare, knowledge acquisition, maximal data sets, action design science.

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Authors: S.S.Mohanavalli, Sheila Anand

Abstract:

This paper proposes a novel architecture for At- Home medical care which enables senior citizens, patients with chronic ailments and patients requiring post- operative care to be remotely monitored in the comfort of their homes. This architecture is implemented using sensors and wireless networking for transmitting patient data to the hospitals, health- care centers for monitoring by medical professionals. Patients are equipped with sensors to measure their physiological parameters, like blood pressure, pulse rate etc. and a Wearable Data Acquisition Unit is used to transmit the patient sensor data. Medical professionals can be alerted to any abnormal variations in these values for diagnosis and suitable treatment. Security threats and challenges inherent to wireless communication and sensor network have been discussed and a security mechanism to ensure data confidentiality and source authentication has been proposed. Symmetric key algorithm AES has been used for encrypting the data and a patent-free, two-pass block cipher mode CCFB has been used for implementing semantic security.

Keywords: data confidentiality, integrity, remotemonitoring, source authentication

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Authors: M. Daoud-Marrakchi, S. Fendri-Elouze, Ch. Ill, B. Bejar-Ghadhab

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The aim of this research is to propose a Measurement Scale for Patient Satisfaction (MSPS) in the context of Tunisian private clinics. This scale is developed using value management methods and is validated by statistic tools with SPSS.

Keywords: Functional analysis, Patient satisfaction, Questionnaire, Reliability, Validity.

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Authors: Maria L. McLeod

Abstract:

This study examines the ways in which cancer patient narratives are portrayed and framed on the websites of three leading U.S. cancer care centers – The University of Texas MD Anderson Cancer Center in Houston, Memorial Sloan Kettering Cancer Center in New York, and Seattle Cancer Care Alliance. Thirty patient stories, 10 from each cancer center website blog, were analyzed using qualitative and quantitative textual analysis of unstructured data, documenting common themes and other elements of story structure and content. Patient narratives were coded using grounded theory as the basis for conducting emergent qualitative research. As part of a systematic, inductive approach to collecting and analyzing data, recurrent and unique themes were examined and compared in terms of positive and negative framing, patient agency, and institutional praise. All three of these cancer care centers are teaching hospitals, with university affiliations, that emphasize an evidence-based scientific approach to treatment that utilizes the latest research and cutting-edge techniques and technology. The featured cancer stories suggest positive outcomes based on anecdotal narratives as opposed to the science-based treatment models employed by the cancer centers. An analysis of 30 sample stories found skewed representation of the “cancer experience” that emphasizes positive outcomes while minimizing or excluding more negative realities of cancer diagnosis and treatment. The stories also deemphasize patient agency, instead focusing on deference and gratitude toward the cancer care centers, which are cast in the role of savior.  

Keywords: Cancer framing, cancer narratives, survivor stories, patient narratives.

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Authors: Pradeep Kumar, Shibashish Chakraborty, Sasadhar Bera

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In the anticipation of demand fluctuations, services cannot be inventoried and hence it creates a difficult problem in marketing of services. The inability to meet customers (patients) requirements in healthcare context has more serious consequences than other service sectors. In order to meet patient requirements in the current uncertain environment, healthcare organizations are seeking ways for improved service delivery. Flexibility provides a mechanism for reducing variability in service encounters and improved performance. Flexibility is defined as the ability of the organization to cope with changing circumstances or instability caused by the environment. Patient satisfaction is an important performance outcome of healthcare organizations. However, the paucity of information exists in healthcare delivery context to examine the impact of flexibility on patient satisfaction and behavioral intention. The present study is an attempt to develop a conceptual foundation for investigating overall impact of flexibility on patient satisfaction and behavioral intention. Several dimensions of flexibility in healthcare context are examined and proposed to have a significant impact on patient satisfaction and intention. Furthermore, the study involves a critical examination of determinants of patient satisfaction and development of a comprehensive view the relationship between flexibility, patient satisfaction and behavioral intention. Finally, theoretical contributions and implications for healthcare professionals are suggested from flexibility perspective.

Keywords: Healthcare, flexibility, patient satisfaction, behavioral intention.

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Authors: Ibrahim A. Alkali

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There is no reservation on the outstanding contribution of patient families in restoration of hospitalised patients, hence their consideration as essential component of hospital ward regimen. The psychological and emotional support a patient requires has been found to be solely provided by the patient’s family. However, consideration of their presence as one of the major functional requirements of an inpatient setting design have always been a source of disquiet, especially in developing countries where policies, norms and protocols of healthcare administration have no consideration for the patients’ family. This have been a major challenge to the hospital ward facilities, a concern for the hospital administration and patient management. The study therefore is aimed at obtaining a consensus opinion on the best approach for family integration in the design of an inpatient setting.  A one day visioning charrette involving Architects, Nurses, Medical Doctors, Healthcare assistants and representatives from the Patient families was conducted with the aim of arriving at a consensus opinion on practical design approach for sustainable family integration. Patient’s family are found to be decisive character of hospital ward regimen that cannot be undermined. However, several challenges that impede family integration were identified and subsequently a recommendation for an ideal approach. This will serve as a guide to both architects and hospital management in implementing much desired Patient and Family Centred Care.

Keywords: Caregiving, Inpatient setting, Integration, Patient Families.

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