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Article ; Online: Golden opportunities for clinical decision support in an era of team-based healthcare.

Dexter, Paul R / Schleyer, Titus

AMIA ... Annual Symposium proceedings. AMIA Symposium

2022 Volume 2021, Page(s) 372–377

Abstract: Computerized clinical decision support (CDS) will be essential to ensuring the safety and efficiency of new care delivery models, such as the patient-centered medical home. CDS will help empower non-physician team members, coordinate overall team efforts, ...

Abstract	Computerized clinical decision support (CDS) will be essential to ensuring the safety and efficiency of new care delivery models, such as the patient-centered medical home. CDS will help empower non-physician team members, coordinate overall team efforts, and facilitate physician oversight. In this article, we discuss common clinical scenarios that could benefit from CDS optimized for team-based healthcare, including (1) low-acuity episodic illness, (2) diagnostic workup of new onset symptoms, (3) chronic care, (4) preventive care, and (5) care coordination. CDS that maximally supports teams may be one of biomedical informatics' best opportunities to decrease health care costs, improve quality, and increase clinical capacity.
MeSH term(s)	Decision Support Systems, Clinical ; Delivery of Health Care ; Health Facilities ; Humans ; Patient-Centered Care
Language	English
Publishing date	2022-02-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	1942-597X
ISSN (online)	1942-597X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Feature engineering from medical notes: A case study of dementia detection.

Ben Miled, Zina / Dexter, Paul R / Grout, Randall W / Boustani, Malaz

Heliyon

2023 Volume 9, Issue 3, Page(s) e14636

Abstract: Background and objectives: Medical notes are narratives that describe the health of the patient in free text format. These notes can be more informative than structured data such as the history of medications or disease conditions. They are routinely ... ...

Abstract	Background and objectives: Medical notes are narratives that describe the health of the patient in free text format. These notes can be more informative than structured data such as the history of medications or disease conditions. They are routinely collected and can be used to evaluate the patient's risk for developing chronic diseases such as dementia. This study investigates different methodologies for transforming routine care notes into dementia risk classifiers and evaluates the generalizability of these classifiers to new patients and new health care institutions. Methods: The notes collected over the relevant history of the patient are lengthy. In this study, TF-ICF is used to select keywords with the highest discriminative ability between at risk dementia patients and healthy controls. The medical notes are then summarized in the form of occurrences of the selected keywords. Two different encodings of the summary are compared. The first encoding consists of the average of the vector embedding of each keyword occurrence as produced by the BERT or Clinical BERT pre-trained language models. The second encoding aggregates the keywords according to UMLS concepts and uses each concept as an exposure variable. For both encodings, misspellings of the selected keywords are also considered in an effort to improve the predictive performance of the classifiers. A neural network is developed over the first encoding and a gradient boosted trees model is applied to the second encoding. Patients from a single health care institution are used to develop all the classifiers which are then evaluated on held-out patients from the same health care institution as well as test patients from two other health care institutions. Results: The results indicate that it is possible to identify patients at risk for dementia one year ahead of the onset of the disease using medical notes with an AUC of 75% when a gradient boosted trees model is used in conjunction with exposure variables derived from UMLS concepts. However, this performance is not maintained with an embedded feature space and when the classifier is applied to patients from other health care institutions. Moreover, an analysis of the top predictors of the gradient boosted trees model indicates that different features inform the classification depending on whether or not spelling variants of the keywords are included. Conclusion: The present study demonstrates that medical notes can enable risk prediction models for complex chronic diseases such as dementia. However, additional research efforts are needed to improve the generalizability of these models. These efforts should take into consideration the length and localization of the medical notes; the availability of sufficient training data for each disease condition; and the variabilities resulting from different feature engineering techniques.
Language	English
Publishing date	2023-03-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e14636
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Article ; Online: Feature engineering from medical notes: A case study of dementia detection

Ben Miled, Zina / Dexter, Paul R. / Grout, Randall W. / Boustani, Malaz

Heliyon. 2023 Mar., v. 9, no. 3 p.e14636-

2023

Abstract: Medical notes are narratives that describe the health of the patient in free text format. These notes can be more informative than structured data such as the history of medications or disease conditions. They are routinely collected and can be used to ... ...

Abstract	Medical notes are narratives that describe the health of the patient in free text format. These notes can be more informative than structured data such as the history of medications or disease conditions. They are routinely collected and can be used to evaluate the patient's risk for developing chronic diseases such as dementia. This study investigates different methodologies for transforming routine care notes into dementia risk classifiers and evaluates the generalizability of these classifiers to new patients and new health care institutions. The notes collected over the relevant history of the patient are lengthy. In this study, TF-ICF is used to select keywords with the highest discriminative ability between at risk dementia patients and healthy controls. The medical notes are then summarized in the form of occurrences of the selected keywords. Two different encodings of the summary are compared. The first encoding consists of the average of the vector embedding of each keyword occurrence as produced by the BERT or Clinical BERT pre-trained language models. The second encoding aggregates the keywords according to UMLS concepts and uses each concept as an exposure variable. For both encodings, misspellings of the selected keywords are also considered in an effort to improve the predictive performance of the classifiers. A neural network is developed over the first encoding and a gradient boosted trees model is applied to the second encoding. Patients from a single health care institution are used to develop all the classifiers which are then evaluated on held-out patients from the same health care institution as well as test patients from two other health care institutions. The results indicate that it is possible to identify patients at risk for dementia one year ahead of the onset of the disease using medical notes with an AUC of 75% when a gradient boosted trees model is used in conjunction with exposure variables derived from UMLS concepts. However, this performance is not maintained with an embedded feature space and when the classifier is applied to patients from other health care institutions. Moreover, an analysis of the top predictors of the gradient boosted trees model indicates that different features inform the classification depending on whether or not spelling variants of the keywords are included. The present study demonstrates that medical notes can enable risk prediction models for complex chronic diseases such as dementia. However, additional research efforts are needed to improve the generalizability of these models. These efforts should take into consideration the length and localization of the medical notes; the availability of sufficient training data for each disease condition; and the variabilities resulting from different feature engineering techniques.
Keywords	case studies ; dementia ; health services ; models ; patients ; prediction ; risk ; BERT ; Clinical BERT ; UMLS ; Medical notes ; EMR
Language	English
Dates of publication	2023-03
Publishing place	Elsevier Ltd
Document type	Article ; Online
Note	Use and reproduction
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e14636
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Compliance with Policies and Guidelines on Student Affairs and Services

Dexter Paul D. Dioso

Philippine Social Science Journal, Vol 1, Iss

2018 Volume 1

Abstract: This mixed methods sequential explanatory research examined the extent of compliance with the Policies and Guidelines on Student Affairs and Services. The instrument was adapted from the framework of the Philippine Commission on Higher Education CMO 9, ... ...

Abstract	This mixed methods sequential explanatory research examined the extent of compliance with the Policies and Guidelines on Student Affairs and Services. The instrument was adapted from the framework of the Philippine Commission on Higher Education CMO 9, series of 2013. The results revealed a high extent of compliance where the provisions of Student Affairs and Services are complied moderately extensive and are functioning well. There was no significant difference in the assessments between the implementers and recipients. Student affairs and services addressed the needs and interests of the students through the quality of service delivery and the opportunities to develop their academic and extra-curricular interests. They provided opportunities for the conduct of activities, discipline, and other services that promote a positive learning environment and the formation of values. The result of the study was the basis for the Management Development Program to attain the best quality of academic support services.
Keywords	Compliance ; Discipline ; Formation of Values ; Learning Environment ; Student Affairs ; Student Services ; History (General) ; D1-2009 ; Social sciences (General) ; H1-99
Subject code	027
Language	English
Publishing date	2018-12-01T00:00:00Z
Publisher	University of Negros Occidental-Recoletos Graduate School
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Transforming primary medical research knowledge into clinical decision.

Dexter, Paul R / Grout, Randall W / Embi, Peter J

AMIA ... Annual Symposium proceedings. AMIA Symposium

2021 Volume 2020, Page(s) 358–362

Abstract: While the utility of computerized clinical decision support (CCDS) for multiple select clinical domains has been clearly demonstrated, much less is known about the full breadth of domains to which CCDS approaches could be productively applied. To explore ...

Abstract	While the utility of computerized clinical decision support (CCDS) for multiple select clinical domains has been clearly demonstrated, much less is known about the full breadth of domains to which CCDS approaches could be productively applied. To explore the applicability of CCDS to general medical knowledge, we sampled a total of 500 primary research articles from 4 high-impact medical journals. Employing rule-based templates, we created high-level CCDS rules for 72% (361/500) of primary medical research articles. We subsequently identified data sources needed to implement those rules. Ourfindings suggest that CCDS approaches, perhaps in the form of non-interruptive infobuttons, could be much more broadly applied. In addition, our analytic methods appear to provide a means of prioritizing and quantitating the relative utility of available data sources for purposes of CCDS.
MeSH term(s)	Biomedical Research ; Computers ; Decision Support Systems, Clinical ; Humans ; Information Storage and Retrieval ; Translational Medical Research
Language	English
Publishing date	2021-01-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1942-597X
ISSN (online)	1942-597X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Racial disparities in the pharmacological treatment of insomnia: A time-to-event analysis using real-world data.

Holler, Emma / Campbell, Noll L / Boustani, Malaz / Dexter, Paul / Ben Miled, Zina / Owora, Arthur

Sleep health

2023 Volume 9, Issue 2, Page(s) 128–135

Abstract: Objective: Examine the association between race and time to pharmacologic treatment of insomnia in a large multi-institutional cohort.: Methods: Retrospective analysis of electronic medical records from a regional health information exchange. ... ...

Abstract	Objective: Examine the association between race and time to pharmacologic treatment of insomnia in a large multi-institutional cohort. Methods: Retrospective analysis of electronic medical records from a regional health information exchange. Eligible patients included adults with at least one healthcare visit per year from 2010 to 2019, a new insomnia diagnosis code during the study period, and no prior insomnia diagnosis codes or medications. A Cox frailty model was used to examine the association between race and time to an insomnia medication after diagnosis. Results: In total, 9557 patients were analyzed, 7773 (81.3%) of whom where White, 1294 (13.5%) Black, 238 (2.5%) Other, and 252 (2.6%) unknown race. About 6.2% of Black and 8% of Other race patients received an order for a Food and Drug Administration-approved insomnia medication after diagnosis compared with 13.5% of White patients. Black patients were significantly less likely to have an order for a Food and Drug Administration-approved insomnia medication at all time points (adjusted hazard ratio [aHR] range: 0.37-0.73), and patients reporting Other race were less likely to have received an order at 2 (aHR 0.51, 95% confidence interval [CI] 0.28-0.94), 3 (aHR 0.33, 95% CI 0.13-0.79), and 4 years (aHR 0.21, 95% CI 0.06-0.71) of follow-up. Similar results were observed in a sensitivity analysis including off-label medications. Conclusions: Patients belonging to racial minority groups are less likely to be prescribed an insomnia medication than White patients after accounting for sociodemographic and clinical factors. Further research is needed to determine the extent to which patient preferences and physician perceptions affect these prescribing patterns and investigate potential disparities in nonpharmacologic treatment.
MeSH term(s)	Adult ; Humans ; Black People/statistics & numerical data ; Minority Groups/statistics & numerical data ; Racial Groups/statistics & numerical data ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders/drug therapy ; Sleep Initiation and Maintenance Disorders/epidemiology ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data ; Hypnotics and Sedatives/administration & dosage ; Hypnotics and Sedatives/therapeutic use ; Practice Patterns, Physicians'/statistics & numerical data ; Time-to-Treatment/statistics & numerical data ; White/statistics & numerical data ; United States/epidemiology
Chemical Substances	Hypnotics and Sedatives
Language	English
Publishing date	2023-02-27
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2813299-3
ISSN	2352-7226 ; 2352-7218
ISSN (online)	2352-7226
ISSN	2352-7218
DOI	10.1016/j.sleh.2023.02.002
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Satisfaction of Students and Parents on School Services of Catholic Schools in Southern Antique

Alda Luz N. Laureta / Dexter Paul D. Dioso

Philippine Social Science Journal, Vol 3, Iss

2020 Volume 2

Abstract: Service quality is among the determinants that define customer satisfaction, and customer satisfaction can lead to continued customer loyalty. Understanding students' and parents' satisfaction with the student services can help the school identify their ... ...

Abstract	Service quality is among the determinants that define customer satisfaction, and customer satisfaction can lead to continued customer loyalty. Understanding students' and parents' satisfaction with the student services can help the school identify their strengths and pinpoint the area that can be improved. In the Philippines, part of Catholic education is the high standard of school services. These services include the library, instructional services, information and orientation service, guidance and counseling, student organization/government and activities, student discipline, student publication, admission services, scholarship and financial assistance, food services, health services, and safety and security. Measuring the students' and parents' satisfaction level of satisfaction on school services may help maintain Catholic education's quality. Hence, the study intends to measure and compare the students' and parents' level of satisfaction with all the school services offered in Catholic schools in southern Antique for the school year 2019-2020.
Keywords	Education ; Management ; Satisfaction ; School Services ; Parents ; Students ; Descriptive-Comparative ; Catholic Schools ; Antique ; History (General) ; D1-2009 ; Social sciences (General) ; H1-99
Subject code	370 ; 028
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	University of Negros Occidental-Recoletos Graduate School
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Awareness and Practices of Distributed Leadership among Public Elementary School Teachers

Jasmine P. Yulo / Dexter Paul D. Dioso

Philippine Social Science Journal, Vol 3, Iss

2020 Volume 2

Abstract: The field of school leadership has been continuously increasing in demands and had currently occupied the idea of distributed leadership. Distributed leadership is leadership that is "stretched over leaders and followers, which is beneficial in settings ... ...

Abstract	The field of school leadership has been continuously increasing in demands and had currently occupied the idea of distributed leadership. Distributed leadership is leadership that is "stretched over leaders and followers, which is beneficial in settings such as schools (Bonneville, 2017). The call for teachers as leaders in school to help implement the K-12 educational system had engaged them to take on collaborative roles. Thus, the study intended to describe the level of awareness and extent of practices of distributed leadership in terms of types such as collaborative, collective, and coordinated as assessed by public elementary school teachers. Moreover, it determined whether a significant relationship existed between the level of awareness and demographic profile and the extent of practices and demographic profile of teachers. Also, it intended to determine if there is a significant relationship between the awareness and practices of distributed leadership.
Keywords	Education ; Management ; Distributed Leadership ; Awareness ; Practices ; Public Elementary School Teachers ; Descriptive-Correlational ; Himamaylan City ; History (General) ; D1-2009 ; Social sciences (General) ; H1-99
Subject code	370
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	University of Negros Occidental-Recoletos Graduate School
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Teaching Competence of Public School Teachers in the Light of the Philippine Professional Standards for Teachers

Rodelyn E. Malunes / Dexter Paul D. Dioso

Philippine Social Science Journal, Vol 3, Iss

2020 Volume 2

Abstract: The teaching competence of teachers is highly regarded as the core of every educational endeavor. Educators worldwide are greatly challenged to gradually develop a more complex teaching competence due to the demand for highly skilled graduates in the ... ...

Abstract	The teaching competence of teachers is highly regarded as the core of every educational endeavor. Educators worldwide are greatly challenged to gradually develop a more complex teaching competence due to the demand for highly skilled graduates in the global market. Consequently, the Department of Education adopted the Philippine Professional Standards for Teachers (PPST) as a quality assurance tool in implementing the K to 12 Curriculum. The domains of the PPST comprised the complete competency that guarantees a manifestation of globally best teaching practices. Hence, the paper assessed the level of teaching competence of public elementary school teachers in the Division of Bacolod City during the school year 2019-2020, when grouped according to educational attainment, teaching experience, and assessor's designation. Also, it analyzed whether a significant difference exists in the areas of teaching competence and demographics.
Keywords	Education ; Management ; Teaching Competence ; Professional Standards ; Public School Teachers ; Descriptive-Comparative ; Bacolod City ; History (General) ; D1-2009 ; Social sciences (General) ; H1-99
Subject code	370
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	University of Negros Occidental-Recoletos Graduate School
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Leadership Style Practices of Principals and Organizational Commitment Profile of Employees of Dioceasan Catholic Schools

Vivian M. Magallanes / Dexter Paul D. Dioso

Philippine Social Science Journal, Vol 3, Iss

2020 Volume 2

Abstract: The principals play a vital role in the success of the schools. The leadership style practices of the principals can have a wedge on the commitment of employees. Keeping committed teachers is a challenge faced by educational leaders. Hence, the paper ... ...

Abstract	The principals play a vital role in the success of the schools. The leadership style practices of the principals can have a wedge on the commitment of employees. Keeping committed teachers is a challenge faced by educational leaders. Hence, the paper describes the extent of leadership style practices and employees' organizational commitment profile in Antique Diocesan Catholic Schools (ADCS) during the school year 2019-2020. Likewise, it explores the significant difference in principals' leadership style practices as perceived by the employees when grouped according to demographics. Also, it determines the relationship that exists in the extent of leadership style practices and organizational commitment profile of employees.
Keywords	Education ; Management ; Leadership Style Practices ; Organizational Commitment ; Descriptive-Correlational ; Catholic School ; Antique ; History (General) ; D1-2009 ; Social sciences (General) ; H1-99
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	University of Negros Occidental-Recoletos Graduate School
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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