Joseph Osuji

An experimental comparison of fuzzy logic and analytic hierarchy process for medical decision support systems

The task of medical diagnosis is a complex one, considering the level vagueness and uncertainty management, especially when the disease has multiple symptoms. A number of researchers have utilized the fuzzy-analytic hierarchy process (fuzzy-AHP) methodology in handling imprecise data in medical diagnosis and therapy. The fuzzy logic is able to handle vagueness and unstructuredness in decision making, while the AHP has the ability to carry out pairwise comparison of decision elements in order to determine their importance in the decision process. This study attempts to do a case comparison of the fuzzy and AHP methods in the development of medical diagnosis system, which involves basic symptoms elicitation and analysis. The results of the study indicate a non-statistically significant relative superiority of the fuzzy technology over the AHP technology. Data collected from 30 malaria patients were used to diagnose using AHP and fuzzy logic independent of one another. The results were compared and found to covary strongly. It was also discovered from the results of fuzzy logic diagnosis covary a little bit more strongly to the conventional diagnosis results than that of AHP.

Clinical decision support system (DSS) in the diagnosis of malaria: A case comparison of two soft computing methodologies

The purpose of this study is to make the case for the utility of decision support systems (DSS) in the diagnosis of malaria and to conduct a case comparison of the effectiveness of the fuzzy and the AHP methodologies in the medical diagnosis of malaria, in order to provide a framework for determining the appropriate kernel in a fuzzy-AHP hybrid system. The combination of inadequate expertise and sometimes the vague symptomatology that characterizes malaria, exponentially increase the morbidity and mortality rates of malaria. The task of arriving at an accurate medical diagnosis may sometimes become very complex and unwieldy. The challenge therefore for physicians who have limited experience investigating, diagnosing, and managing such conditions is how to make sense of these confusing symptoms in order to facilitate accurate diagnosis in a timely manner. The study was designed on a working hypothesis that assumed a significant difference between these two systems in terms of effectiveness and accuracy in diagnosing malaria. Diagnostic data from 30 patients with confirmed diagnosis of malaria were evaluated independently using the AHP and the fuzzy methodologies. Results were later compared with the diagnostic conclusions of medical experts. The results of the study show that the fuzzy logic and the AHP system can successfully be employed in designing expert computer based diagnostic system to be used to assist non-expert physicians in the diagnosis of malaria. However, fuzzy logic proved to be slightly better than the AHP, but with non-significant statistical difference in performance.

Understanding the factors that determine registered nurses' turnover intentions.

Turnover among registered nurses (RNs) produces a negative impact on the health outcomes of any health care organization. It is also recognized universally as a problem in the nursing profession. Little is known about the turnover intentions and career orientations of RNs working in Calgary, Alberta, Canada. The aim of this study is to contribute to the knowledge of and to advance the discussion on the turnover of nursing professionals. The study population consisted of RNs employed in the five major hospitals in Calgary. There were 193 surveys returned, representing a response rate of 77.2%. The results show that age and education have a negative effect on turnover intention. Education was found to have a significant negative effect on career satisfaction but not on job satisfaction and organizational commitment. Length of service has a significant negative effect on turnover intention. Role ambiguity has significant highly negative effect on career satisfaction. Growth opportunity and supervisor support have a very significant positive effect on job satisfaction, career satisfaction, and organizational commitment. External career opportunities and organizational commitment do not seem to have a significant effect on turnover intention. Career satisfaction, on the other hand, had negative significant effects on turnover intention.

''More than the house'': a Canadian perspective on housing stability

Purpose – The challenges of achieving housing stability are examinable from a variety of locations and perspectives, resulting in a range of solutions and recommendations for practice. Attending to the experiences and understandings of both service users and service providers within a broad environmental scan, one can obtain a more complete picture of how housing stability can be supported and sustained. The purpose of this research is to better understand the practical landscape, human relationships, interdisciplinary understandings and everyday activities of housing stability. Design/methodology/approach – The paper draws on thematic analysis from expert informant interviews conducted during an environmental scan of housing options and facilities for those who have been labelled ‘‘hard to house’’ in a large, ethnically-diverse urban city in western Canada. Interviews of selected service users yielded information on their perspectives of the barriers and facilitators of housing stability. Parallel interviews of service providers and/or policy makers were also conducted, and responses compared and contrasted with those of service users. Findings – Three interconnected patterns on the path to housing stability were experienced by the expert informants, and are explored herein. The overlapping and developmental themes ‘‘more than a house,’’ ‘‘finding support,’’ and ‘‘connecting multiple supports’’ are discussed. Conditions and realities of coordinated support need, particularly for those deemed ‘‘hard to house’’ because of addictions or mental health problems were revealed by the expert informants in this study. Research limitations/implications – Thematic analysis of the parallel interviews brought the landscape of housing stability into clearer focus and contributed to practice recommendations. This qualitative research approach was not intended to provide generalizable findings, but rather sheds light on particular experiences and understandings in ways that may contribute to further research. The themes identified may resonate in differing circumstances having arisen from the more generalized practical realities and social conditions which warrant an ongoing analysis. Practical implications – The analysis revealed an ongoing gap of support for the management and coordination of the often complex requirements of support for housing stability for service users. Various service agencies, providing houses, providing financial aid, providing health and social support need to ‘‘connect multiple levels of support’’ something identified as an all too often missing link in achieving housing stability. Recommendations include recognizing the necessity of multiple sectors working together with multiple sites and layers of support, in particular for those who experience addictions or mental health problems. More tailored support, follow up and recognition of the potential for instability is a particular practical implication of the study. Invigorating a coordinative, case management role, with a view to bridging and bringing together seemingly disparate sectors and service providers are relevant practical implications of this study.

Use of Visual Narrative Illustrations to Teach Pathophysiology Concepts to Nursing Students.

BACKGROUND The care of patients with acute and chronic illnesses requires nurses to fully understand the underlying pathophysiology associated with disease processes. Although mastering a pathophysiology course is a strong predictor of student success in nursing programs, it is a course with which students and new nurses most often struggle. METHOD The authors describe a teaching innovation--visual narrative illustration (VNI)--and demonstrate how VNIs are used to teach complex pathophysiology concepts to nursing students. RESULTS The consistent positive feedback regarding the VNIs that have already been implemented in the pathophysiology course prompted the authors to systematically and formally study the impact of this innovative approach on student learning and knowledge retention. CONCLUSION Use of VNI is an innovative teaching strategy that has the potential to augment other course materials and bridge some of the knowledge gaps that challenge nursing students from fully understanding pathophysiologic concepts.

Professional Socialization: A Grounded Theory of the Clinical Reasoning Processes That RNs and LPNs Use to Recognize Delirium

Delirium is an acute disorder of attention and cognition. It affects half of older adults in acute care settings and is a cause of increasing mortality and costs. Registered nurses (RNs) and licensed practical nurses (LPNs) frequently fail to recognize delirium. The goals of this research were to identify the reasoning processes that RNs and LPNs use to recognize delirium, to compare their reasoning processes, and to generate a theory that explains their clinical reasoning processes. Theoretical sampling was employed to elicit data from 28 participants using grounded theory methodology. Theoretical coding culminated in the emergence of Professional Socialization as the substantive theory. Professional Socialization emerged from participants’ responses and was based on two social processes, specifically reasoning to uncover and reasoning to report. Professional Socialization makes explicit the similarities and variations in the clinical reasoning processes between RNs and LPNs and highlights their main concerns when interacting with delirious patients.

History of abuse and the experience of homelessness: a framework for assisting women overcome housing instability

Purpose – The purpose of this paper is to explore the lived experiences of women without children experiencing housing instability and homelessness in Calgary, Canada; and narratives of what triggered their journeys were constructed according to the tenets of hermeneutic phenomenology, and suggest a framework for assisting these women. Design/methodology/approach – The design for this study is qualitative, approached through hermeneutic phenomenology rooted in Gadamerian philosophical hermeneutics (Gadamer, 2004). Hermeneutic phenomenology, as a research method has provided insight into understanding phenomena and human experiences that are important to human science professionals. Findings – The experience of homelessness for women without children started while they still lived at home, but after they lost all sense of “being at home” as a consequence of identifiable negative home experiences, such as abuse. The effects or impacts of stable childhood or adult home experiences and the implications of such in contributing to the feelings of homelessness were pervasive in the stories told by these women. Practical implications – Access to housing does not mean getting out of the feeling of homelessness, because the trauma that triggers the experience for the clients often last for a life time. Long-term engagement with the client will be synonymous to increasing the possibility that they can be stabilized permanently. Resources dedicated to these clients must be tailored to each client’s needs, with strong agency collaboration with the mainstream systems. Social implications – Community health nurses and other support workers for individuals experiencing homelessness need to build bridges with inter-professional groups to close the gap created by societal attitudes toward women and domestic abuse survivors through advocacy and education, especially in countries where women are still treated as second class citizens. Originality/value – Although there has been a considerable amount of research conducted on the determinants of homelessness and housing instabilities in women or their pathways into homelessness, the plight of women without children and their experiences while homeless have received little attention in literature. This study explored the lived experiences of women without children experiencing homelessness and narratives of what triggered their journeys were constructed according to the tenets of hermeneutic phenomenology, and suggest a framework for assisting these women.