Leapspace iii - References ii

Regards the two other references listed by Leapspace in the previous post:

Jones, P. (2009) Socio-technical structures, 4Ps and hodges' model. Nursing and Clinical Informatics: Socio-Technical Approaches. https://doi.org/10.4018/978-1-60566-234-3.ch011 

Jones, P. (2011) Socio-technical structures, 4Ps and hodges' model. Clinical Technologies: Concepts, Methodologies, Tools and Applications. https://doi.org/10.4018/978-1-60960-561-2.ch215 

The doi links above lead to a page where to read the 'View Full Text HTML', or 'PDF' you need a login. This suggests a paywall(?), but the paper can be found here:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1842543&rec=1&srcabs=886584&alg=7&pos=3

These are not the original reference or title:

Jones, P. (2009) Socio-Technical Structures, the Scope of Informatics and Hodges’ model, IN, Staudinger, R., Ostermann, H., Bettina Staudinger, B. (Eds.), Handbook of Research in Nursing Informatics and Socio-Technical Structures, Idea Group Publishing, Inc. Chap. 11, pp. 160-174.

I am unable to check fully, but it appears in 2011, the paper was republished in another collection. It is nice to have a 'bovine' experience, with a lesson about copyright, open access, and predatory publishing. Alteration of titles is bound to result in repetition, confounding the accuracy of publication metrics and indices?

I am not going to add the second reference to the blog's bibliography.

vi Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

The rest of the book is practice-based which is a strength. Chapter 18 has three clinical illustrations, were reflection and self-reflection is brought to fore. Especially so, as it pointed out that the 'clinical situation/encounter' introduces its own 'vagaries', or noise which can impact the 'quality of the bond between clinician and patient'. Rapport is the key. 

I was still missing 'complexity' and its dynamics, but I'm sure of the following:

If this was discussed - could be represented then the book would be theory-laden and I and other would-be readers would not be able to understand.

I still think Hodges' model can help, and in chapter 19 picked out 'manifold' (p.113), as if doing so, manifests something more esoteric. There is something here, the author noting the need to shift from individual to group perspectives. So, yes I think we can do more than embrace 'complexity' (p.114).

On page 116 there is discussion of the sometimes sudden path to recovery, 'probably common but often not comprehended'. Please pardon the naivety, but I scribbled 'hidden in complexity, what would (say) the three(?) equations be?'. For a book published in 2023 'artificial intelligence' is not indexed. This might be one area that AI could assist, given the progress in formal mathematics (but see below p.183!)? Algorithm is mentioned throughout the book. Further reading here, informed me that engaging with a reading group on 'Philosophical Counselling' is worthwhile. It is!

Part IX had me wondering if the debate about typical and complex cases, there is a slight of perspective going on? You can end up with paradoxes in terms of an individual's needs, criteria, risk, 'need for admission'. Which I must think about! Chapter 20 has three further reading texts on abductive reasoning. There's an appeal(?) on page 129 for an appropriate treatment model, well that is my take. Collaborative care and stepped care models are suggested. But with acknowledgement that:

'In truth, all models currently available may involve a defect in continuity within or between systems'. p.129.

I beg to differ. A role of Hodges' model is to help frame aspects of care through time, to facilitate and assure continuity.

Part X tackles the required precision in assessment, hence recourse to mathematics and statistics. The next two chapters may be useful for early career researchers and yet looking over our shoulders what is ai offering here? In Case 1 I was impressed by the suggestion of a health record that is over 70 years old. Not impossible of course, but I thought of the Lloyd George envelopes, their hospital equivalents, other paper sources and inevitable scanning this would entail here in the UK? Of interest to research is the creation and validation of complexity profiling inventories (tools) not just that, but their self-assessment form of delivery. And, yes in summary chapter 24:

'We are still left with the challenge of rating the patients' severely compromised health situations where "health" includes social, emotional, and financial well-being.' p.143.

'How do you factor this interpersonal situation into your complexity equation?' p.144.

Yes, how indeed? 

The realities of research of dealt with - funding for the development of tools a problem universally. The references here concern biopsychosocial complexity. Chapter 25 describes abstraction, and hiding detail, which is of great interest here. DSM-5 criteria for major depressive disorder are listed (DSM-6 may be released in 2029?). 

In chapter 25 the authors are once stymied by 'how to include (integrate? PJ) four dimensions, three time periods,and assorted assessment items in a single assessment.' 

As noted the four domains are here again (p.151): medical, psychological, social and care delivery and on page 153, introducing chapter 26, limitations of complexity assessment tools. Parity as in 'parity of esteem' is not indexed and I don't recall having read this, but this is well represented in later deliberations on variables #2. You will find psychosis, but not in depth or severity.

 In 'Creation of a New Model for Clinical Practice' (Chapter 31) identity is stressed, as a prompt to encompass those variables that contribute to preserving the person - what is humanistic. Allied with manifold, identity is a 'coi' for me, concept of interest - for this same reason. On page 172: the authors observe they 'are left with the question of whether there are acceptably accurate clinical models that are simpler and more straightforward than ours? We believe the answer is no!'. I believe there is a way, and a model to help 'keep the life in clinical work' - not take it out. There is a sense that Chapter 32 seeks what I was looking for above: as they explore random variable and 'sample spaces' descriptively - over a page.

Ah! 'Artificial intelligence' is found in text p.183. I'm surprised an editor, proofreader aloud the following sentence to go unchallenged?

'But, as will be discussed, these computer techniques have their limitations based on their lack of flexibility.' 

I was genuinely surprised to read this. Plus, again on ai on page 185: 'Making inferences is not reliably their domain.' I think I would look more at the human-ai interface. And the status of ai within psychiatry as opposed to medicine, but that is also another (parity - divide) debate. Things really are complex now on so many fronts: ethics especially.

Perhaps I am looking for the cookbook formula as introduced for chapter 35 clinical judgement. The further reading is combined with critical thinking. More detail on the empirical-collaborative method is welcome. When I read 'illustrated' I take this literally. Again I can disagree twice on page 220. I know Hodges' model is not validated, but it can - with practice(?) - do this light (simple) or heavy (complex) lifting. 

The warning about dogma needs to be repeated regularly. It is rather like the need for nurses to revisit their profession, role and work as relates to the law. Is Hodges' model an over-valued idea? Am I guilty of thinking I'm an expert? A problem with that view is that any assumed expertise is stretched across the whole model. So if anything there is a shallowness, but this means that I see my particular scope of practice, as other colleagues / professions see theirs. Here in the UK of late, this seems to have become rather blurred. 

In closing with this and achieving a "real-life" understanding of a case, with synthesis - path analysis diagram, the author's underline the value of their book which I have enjoyed and informed my preparation for WCCS26 (more to follow there). The authors can perhaps be reassured that all practitioners have a means to achieve their paradigm shift as described here - with added value and values.

There is a missed word: "of the situation ['with'?] him" on page 114. And revision needed re. text beginning with 'his boyish Paul McCartney "mop-top" ... on page 214. Spelling error on 216 'retu(r)ning'. 

Thanks again to Daniela and colleagues at SpringerNature for the review copy.

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

v Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

Chapter 11 held promise in the title 'Formalising the Clinical Field'.

If anyone is interested, formalisation is what I would like to focus upon - using Hodges' model - over the next several years (taking nothing for granted). If truth be told, I'd be stressed as if (true) formalisation was discovered here, I may find this is beyond me, but this is the course I have chosen.

There was nothing new, the 'clinical illustrations' continued. The reading is worthwhile, in trying to define complexity, or what constitutes a 'complex case', hence 'Each new entry expands the complexity and gravity of the case, moving it beyond "plain vanilla" of a single medical or socially based condition'. I was reminded here of the user personas used in developing online communities. And in health the way personalised detail gets lost as personal details - emotional content gets lost (necessarily) as data is aggregated. The chapter revists the definition of clinical complexity.

'So, how does this information fit with our tentative understanding of clinical complexity as "the potential for progress toward health recovery in the context of a particular set of diagnoses and available treatments" (Kathol et al. 2018)? The phrase "particular set of diagnoses" could be replaced by "clinical challenges?" After all, where do you fit cultural considerations or family disjunctions here? Neither are diagnoses per se. Both have typically been relegated to the periphery of diagnostic considerations. Instead, they are elements in a loose matrix of clinical influencers.' p.76. [My emphasis].

Well, Hodges' model provides an ideal place for cultural considerations and family disjunctions. But replacing 'particular set of diagnoses' with 'clinical challenges' will be met with a challenge itself. This serves my purpose in advocating for Hodges' model, if challenges across the model's four care/knowledge domains can be seen as 'clinical'.

Identity morphism

Part VI on Subjectivity and Intersubjectivity is an important lesson to look; then look again - beyond the (basic!) subjective-objective dichotomy. You want patients - clients to recover quickly. The clinical illustrations are helpfully carried forward, as per the longevity their being 'complex' portends. The fact that in a clinical conference, social aspects are barely mentioned is one rationale for use of Hodges' model in practice. What has not been discussed? For 'Seth' a case formulation is raised, (I sketched a 'simple'  triangle) and the limited conceptual scope acknowledged above (p.80). Reading, I did wonder what a new edition might look like given developments in the USA? Would it make a difference? There a question about to categorise one client. And I scribbled 'identity' in the summary for the subjectivity between client and clinician.

I've always liked archaic terms^ and here cussedness springs to mind as the authors seem compelled to return to the issue of a definition for complexity. You could say - they can't put it to bed! 'Lifestyle' is not indexed. But it is clear that the adopted lifestyle of many clients also compounds, contributes to the clinically complex presentation. Case, condition, set of sign/symptoms, state of affairs, situation - all may be simple or complex. On page 87 regards Mark: 'The management challenge of this situation is evident. The situation itself is not medically complex. However, managing it is.'

When I read the aforementioned formalisation (chapter 11), I thought logic might follow, a specific illustration? Abduction is a teaser introducing chapter 14. It is chapter 15 that inference including abduction is usefully discussed:

'Abduction goes further than obtaining general and specific logical conclusions. Abduction seeks explanations beyond logic. The clinician listens to the utterances of a patient and integrates word meanings and word referents with other gathered data. The clinician abductively decodes information and concocts potential explanations for the words of the patient that fit with aggregated clinical findings. This rational processing results in what the clinician considers the best explanation for the information at hand. However, other explanations remain as viable until and unless eliminated by subsequent data. The clinician using abductive reasoning always maintains an openness to changing explanations and an intention to expunge unsatisfactory conclusions as accumulating data dictate [1].' p.96.

The author's empirical-collaborative (E-C) approach spans the book. They might find that Hodges' model as a conceptual framework can seamlessly fit with E-C. A reference on Bayesian Statistics. Lee PM (2013), plus further reading is listed.

There is a spelling mistake p.73; 'contacted a disease'?

One more post to follow ... may add here also.

Thanks again to Daniela and colleagues at SpringerNature for the review copy. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948. 

Image:

https://krossovochkin.com/posts/2020_04_26_category_theory/ 

 

^Which is ok, I'm a grandad now. 

iv Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

After a first mention on page 23, it is chapter 6 that discusses "awe" - the chapter's title. I wrote (in light pencil!) 'It keeps you going'. This is deeper than job satisfaction, but in healthcare is a contributing factor. And different again to (clinical) intution (with many mentions), which recurs, despite (or due to) its subjective nature.

Within its 3.5 pages you will find 'interpersonal awe', Piaget's 'accomodation', the neuroscience of awe, and humility. From a physiological and experiences with short-sightedness and vision, I have applied the concept of accommodation over the years. All this, quite rightly, places emphasis upon the therapeutic relationship. Even since the book's publication in 2023, this relationship has grown in importance.

'The sense of awe is an emotional reaction to events characterized as "vast" or to experienced stimuli outside the domain of the usual and prototypical. A sense of "awe" is often described by scientists who peer through telescopes (immensity) or who observe the uniqueness and expansiveness of the microscopic world. A similar emotional reaction can ocur with respect to the overwhelming experience of the clinician processing the complexity of intertwined variables experienced with a patient. When interpersonal awe occurs, it potentially opens the mind of the clinician to enhanced information gathering, cognitive processing, and empathic understanding.' p.49.

I often feel obliged to apologise that the spiritual does not have a concrete home in Hodges' model. Personally, it is INTRA- and interpersonal. Our religious beliefs, and committments were they apply. Unfortunately, the spiritual is often expressed politically: 'shock and awe'(?). Socially, the spiritual is manifest in the world's religions, our cultures and upbringing, recognition of others - in our communities, the media, ability to 'see' beauty, experience empathy, rapport and shared emotions. On twitter I've often written -

(SPIRITUAL [Intra- Interpersonal; Sciences; Political; Sociology] )

So, Hodges' model is embedded within - should be viewed as surrounded by the spiritual. 

Chapter 7, 'Clinical Decision-Making' utilises the thought of Daniel Kahneman. I like the use of ratiocinations here. I do try to bear in mind the 'traps' afforded by Hodges' model. To be clear, it is not the only clinical cognitive tool I have used. For some reason, against ratiocinations I scribbled 'running the axes, or the corridors of care'. Formal training brought to mind training to assure the marking of student's work (if still needed!), and mentoring student nurses. Case-based learning features here, and in the conclusion: CBL 'will be the central element of this book and will involve actual patients with pronounced biopsychosocial complexities.' p.56. How I wish there was an extra reference (a #16) here: clinical decision-making is fundamentally political; both reflectively and reflexively.

Part V then begins (p.59) on further technical considerations with chapter 8 Introduction to Clinical Complexity. A shift is flagged from a linear, logical-based approach to mix of logic and clinical content. At two pages I did hope for more: biological complexity and resolution left me hungry for more. There is however a key learning point on p.62, re. resolution; that of suffering. Connected to this and a well made point is priorities and what is clinically important and any contrast for the clinical team and the patient.

In a BASIC program from the 1980s on the 'Nursing Process' (essentially p.11 in the book, and somewhere on W2tQ?) I'd included a woman, medical ward with chest pain, who was agitated and couldn't explain herself that well. It wasn't delerium, but we eventually found out she was alone at home and worried about a cat. Attention and listening are not in the index, but should be in all clinical texts. An essential ingredient in the aforementioned reflective/reflexive aspect of interpersonal exchange. In the summary for C8 it was good to read of constellations. Our forebears joined the stars to provide meaning and explanation for what was life, being and experience for them, who had passed, and who was to follow. Without that political domain, the meaning is incomplete, may be repeatedly mistaken. How impoverished [we are / are we] as a result?

 Chapter 9 starts to present the clinical model, with clinical illustrations - case examples. The focus here is underrepresented factors. There is always an issue about granularity in how much data/information is needed for a comprehensive assessment/evaluation. A paragraph considers The problem of simplication. A question is raised:

'How can a clinician think of all the contributing factors on the spur of the moment, the point at which many if not most clinical decisions are made? Our guess is that your response, as a reader, may be to wipe your brow and decide to return to "treatment as usual." reverting to comfortable algorithms.' p.67.

This 'treatment as usual' is surely institutional in origin? Back to the 'political' again. Well I can think of a way to frame, apprehend all the contributing factors and on the spur of the moment. Healthcare is inherently situated. Healthcare professionals need to proceed with care, especially with constant reference to statistics and algorithms. Hodges' model can provide an anchorage, a safe harbour even if the visit is fleeting. These harbour fees, or dues, service charges are negligible.

 In Chapter 10 brings the complexcity of the clinical "field", once more through a case illustration, a woman with chronic schizophrenia, complexity based on clinical diagnosis. The process of diagnosis (and a medical matter) is largely a matter of data reduction, a means to simplify, and provide an avenue to aggregate and group. There is a history lesson in the development of hospitals, even as in the UK bed numbers have seen whole scale reductions. Interestingly (for further study), of course, diagnosis is also a way to abstract away details. The problem is that although this makes the unknown a known, it is binding when it comes to complexity. It ties down a flux, a dynamic that doesn't just want to be free it is constantly changing and may also achieve a more ordered state. The authors try to get to grips with this, they highlight housing, employment, comorbidity and how these may prevent recovery. All this as they seek to define complexity in clinical terms. No easy task: itself part of the problem.

In the summary for chapter 10 it was encouraging to see the cultural aspects for the person and group emphasised, plus how identical demographic factors can still result in disimilar prognoses, hence the importance to 'see' the person and their respective 'self-management'. 

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

Glossaries - calques, standards and what is, or can be canonical?

Post Marrakech and WCCS26 I'm still contemplating on matters 'complex' and 'complexity', across complex systems and complex care. We humans (and this one in-particular) have a penchant for compunding complexity, adding complications. Our languages are a case in point. 

As the conference demonstrated mathematical is central to the discovery of chaotic and complex systems. Maths itself preempted the discovery of the Lorenz System, and the Mandelbrot Set.

Efforts to look at Hodges' model mathematically has resulted in a small draft comparative glossary (4-5 terms). In addition to the history of chemistry and its adaptation of mathematical symbols, I soon came across complex numbers, complex dynamics, complex mathematics (don't worry I know my limits). But, symplectic geometry! What is that?

Apparently, 'The term "symplectic" is a calque of "complex" introduced by Hermann Weyl in 1939.'
(https://en.wikipedia.org/wiki/Symplectic).

So, over decades of ward meetings, reviews, care plans it was symplectic patients, symplectic care and situations all the time? Where am I heading with this? Probably nowhere in particular. There's still the risk of a meeting c/o gravity with the floor. I've been fascinated with the way words such as design and architecture are conjoined and added to things that do not qualify, at least from the purists perspective. This is joy of languages, they change constantly. 

Familiar with 'standard' in the clinical and informatics sense; 'canonical (form)' has come up within maths. It occurs in health too:

Graham, M., Winter, A. K., Ferrari, M., Grenfell, B., Moss, W. J., Azman, A. S., Metcalf, C. J. E., & Lessler, J. (2019). Measles and the canonical path to elimination. Science, 364(6440), 584–587. https://www.jstor.org/stable/26649426 

Sepehri, A. (2015). A Critique of Grossman’s Canonical Model of Health Capital. International Journal of Health Services, 45(4), 762–778. http://www.jstor.org/stable/45140527

Lee, H.-S., Paik, M. C., & Lee, J. H. (2009). Estimating a Multivariate Familial Correlation Using Joint Models for Canonical Correlations: Application to Memory Score Analysis from Familial Hispanic Alzheimer’s Disease Study. Biometrics, 65(2), 463–469. http://www.jstor.org/stable/25502307 

Voit, E. O. (2000). Canonical Modeling: Review of Concepts with Emphasis on Environmental Health. Environmental Health Perspectives, 108, 895–909. https://doi.org/10.2307/3454323 

 

Goddu, A. (1985). The Effect of Canonical Prohibitions on the Faculty of Medicine at the University of Paris in the Middle Ages. Medizinhistorisches Journal, 20(4), 342–362. http://www.jstor.org/stable/25803849

 In drawing up a glossary, and starting with a blank sheet (that is not Hodges' model) this is all worth consideration. Could Hodges' model find a place as a canonical form - even clinically?

Joining the digital dots across primary care and integrated care

My partner and I both received a letter today from our respective GPs. An invitation for a 'FREE LUNG HEALTH CHECK'.

Overleaf is an information sheet in landscape about the health check, plus three more sides of A4, similarly formatted - inviting trifold presentation.

After the 'Re. ......' an opening sentence asks: 'Have you ever been a smoker?'

Suddenly, I was dragged backwards through his-tory (some things don't change); not one history, but several:

INDIVIDUAL

|

    INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

My personal and life experience  and not just since my teens . . .

The letter states: **If you have never smoked, you are not eligible for this service**

My mother and father  smoked when I was a child and my siblings.    They got the message early 1980s.    'Society' smoked back then!     Once old enough, I refused to go to the corner shop.   Into the 1990s, patients, smoking (some chain-smoking) on admission, long-stay and other clinical areas. As a community mental health nurse, I learned diplomatic and health promoting skills when in the car, giving a patient a lift to hospital. And, when visiting their home where I was, of course, usually, a guest.

I wondered what has happened to the GP's records? To the primary care clinical record ? The custodians of my health record, that they should need to ask that question?    Or, does confidentiality tie some bureaucratic knots?   Where is 'integrated care' and its driver 'clinical informatics'?  The letter included the NHS Number.    Don't get me wrong, I/we appreciate the obvious effort here, even if the chronology is confusing, or,  speaks of afterthought? The letters are dated 19/06/2025. I must admit I haven't accessed my GP record, checking it for accuracy.   If anything, this is a prompt to do so. And seek a general medical.

Previously: 'smoking' : 'winwick'

Chatbot therapists c/o The Sunday Times

It wasn't that long along ago, I tweeted about the prospect of our clinical information systems 'listening' and autotranscribing one-to-one clinical contacts and even formal psychotherapy sessions. How time flies!

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

AI therapy chatbots 'Conventional'  Counselling / Psychotherapies Mental health - illness Issue of: 'Titles' I can call myself ... therapist, nurse ...	(New) Evidence-based Workflow: intake, assesses needs, booking into care, offers CBT based on guidelines. Uses a person's details, asks questions to identify the likely problem ... clinical
Empathy: Human - Machine Public safety DEMAND <-> supply Access to Therapy: Untreated? Other AI solutions - Slingshot AI	validation Regulatory approval Limbic AI unvalidated 'solutions' risk of a huge industry setback

My source: Danny Fortson, Chatbot therapists are here. But who's keeping them in line? The Sunday Times, August 17, 2025, p.4.

The online article is behind a paywall, but there is a related podcast (with advertising):

https://shows.acast.com/dannyinthevalley/episodes/the-man-behind-the-nhs-mental-health-bot

See also: 'AI' : 'ethics' : 'expert system, language'

AI Health 2025 Friday November 7th 2025

AI Health 2025

Friday November 7th 2025

At the BCS London Office
Ground Floor, 25 Copthall Avenue, London, EC2R 7BP (near Moorgate underground)

Organised by BCS-SGAI

BCS-SGAI, the British Computer Society Specialist Group on Artificial Intelligence was founded in June 1980. Its mission is: "To foster achievement, capability and awareness in both business and research in Artificial Intelligence, and to promote the interests of the related community". It is one of Europe's longest established groups working to support the community of artificial intelligence developers and users and is the organiser of one of the longest running annual series of AI conferences in Europe: the AI-20xx series.

In England, 189 out of 208 (91%) hospital trusts are using electronic health records (EHRs) bringing opportunities and challenges and for Artificial Intelligence (AI). In the morning, there will be a session about EHRs with speakers from UK (animal health records), France (European Health Data Space infrastructure for the use and exchange of EHRs), and Spain (personal health records). Before lunch break, there will be a brief 101 hands-on tutorial about Neuro-Symbolic AI with short exercises. In the afternoon, there will be a session about clinical decision support, exemplifying the use of AI-based healthcare technologies. Come along if you are interested in AI and its potential in healthcare.

There will be Certificates of Attendance for those who register and attend the event.

We hope that you will come and join us, and that you enjoy this new offering from the BCS SGAI.

Dr. Mercedes Arguello Casteleiro (BCS SGAI)*

https://www.bcs-sgai.org/health2025/

Please see link above for programme and speaker details.

*.. And my source - BCS SGAI.

Seeking UK Healthcare Workers: online pilot study on daily communications

C/o Olga Lainidi @LainidiO

Post Graduate Researcher and Teaching Fellow in Psychology @ University of Leeds

'I’m looking for UK Healthcare Workers to help me pilot an online study on daily communications in healthcare. Please fill in the expression of interest form if you want to find out more.'

Introduction to the study plans below from:

https://forms.office.com/e/5H84WqqTtT


UK Healthcare Staff - Daily Communications & Wellbeing at work

Thank you for your interest in this research study, which is part of a PhD project at the University of Leeds. The study explores how healthcare workers communicate about things that matter at work on a day-to-day basis, and how these decisions relate to their wellbeing. If you're a UK-based healthcare worker and would like to receive more information or take part in the study, please complete the short form below. This form helps us check eligibility and ensure we include a range of roles and experiences. It takes less than 2 minutes to complete. Completing this form does not commit you to participating - it simply lets us know you're interested and happy to be contacted. All information will be kept confidential and stored securely. Thank you for your time and interest!

The study has received ethical approval by the School of Psychology Ethics Committe, University of Leeds (2841 - 28/04/2025)

https://forms.office.com/e/5H84WqqTtT

My source:

https://x.com/LainidiO/status/1931414872840970470

I look f/w to learning of future findings and outputs.

RCN Congress 2025 iv - AI & quality improvement

Discussion: Artificial intelligence in nurse education &

Discussion: The role of nursing staff in quality improvement

We'll cover two agenda items in this post. First, resistance is futile in the apparent rise and ubiquity of artificial intelligence.

Discussion: Artificial intelligence in nurse education

Here is, another thing 'we need to get right'. Without checking, I'm sure I posted/tweeted about 'essay factories'. Now Generative AI has put the automated generation of academic essays on steroids. If a student is not motivated to learn, enthusiastic about their seemingly chosen course of study and the professional reward to be earned, then we are in trouble. Public and patient safety are at risk. AI, is however is here to stay - change and help us prosper(?). AI and GenAI are tools, just another step forward, an advance on finger tips, palms, stick, chalk, pencil, and pen. The brief for the discussion includes, with specific points emboldened:

'... Additionally, AI-driven simulations and virtual reality scenarios can provide hands-on experience in a controlled environment, enabling students to practice and refine their skills with greater confidence. 

Creating an engaging and supportive learning environment is key to helping nursing students embrace AI. HEIs can introduce AI concepts early in the curriculum and provide ongoing training and resources. Encouraging collaboration and open discussions about the benefits and challenges of AI can further enhance students' confidence in using these tools.

By taking these steps, nursing education can seamlessly integrate AI, ensuring future nurses are equipped to excel in an evolving health care landscape.

To effectively integrate AI into nursing education, RCN Wales, for example, advocates for higher education institutions (HEIs) to equip students with the skills to continually enhance their digital and biotechnological literacy, ensuring they meet their programme outcomes.

HEIs can incorporate regular assessments and feedback mechanisms to monitor a student’s progress and determine where AI tools add the most value.' . . .

Computer-aided learning has matured greatly since the 1980s and 1990s. AI and GenAI mark the seeming leap in progress over the past two years, with governments, professional bodies and society having to adjust and quickly. We need to watch how simulation, and virtual reality and other approaches to learning are applied, to assure the quality, safety and learning experience provided to students. There appears to be a risk in mental health nursing curricula being 'diminished'. Interpersonal skills are critical in psychiatric and psychological care. This might afford the advocates of technically-laden solutions to side-step the nuances of face-to-face human interaction. Amid the pursuit of what is mechanistic, let us value the humanistic also.

The biotechnical, is one a several literacies to keep sight of. AI, is of course bound up in bio-political concerns, that are still emerging. The 'health care landscape' is plural too: consider the patient's home, a ward, out-patient department, e-consultation, e-learning intervention, brief psychotherapy, occupational health, carceral care, and field hospital, veterans, migrant - refugee health and the homeless.

There's more, and references and a reading list are also provided on the above link.

Discussion: The role of nursing staff in quality improvement

'Quality improvement is about making a difference to patients by improving safety, effectiveness, and experience of care.

All nursing staff should have the abilities and support to become involved in addressing health care pressures, utilising their expertise in the profession as leaders, not only in care delivery, but also within the system. However, the work of nursing staff to deliver quality improvement is often limited to opportunities that are dependent on staffing, seniority and availability. 

Nurses’ willingness to attend training is often superseded by patient demand making attendance impossible. Other health care colleagues undertake work on research and service improvement alongside their role and as a requirement for their revalidation, this is not the case for nursing staff who don’t get these opportunities.

Consider the benefits of the nursing workforce undertaking quality improvement, conducting local research, reorganising working environments, translating or updating patient materials, trialling novel approaches to care or addressing health inequalities. These skills would not only improve the quality of care we provide but also prepare the nurse to influence and change systems throughout their career.

This is relevant UK-wide. Scotland's 2030 vision for nurses, states an intention to equip nurses with quality improvement tools and support, but only nurses in non-hands-on roles. NHS Wales offers quality improvement training through e-learning  via the ESR to health care professionals, in Wales. In Northern Ireland training is available, but only for Band 7 and above.'

What is the role of all nurses to get involved in quality improvement?'

There is a point with IT security that if it was 100% assured with all the prospective log-ins of an average user, would we ever get any 'real' work done? Does the same apply to research? I have heard this as an argument in practice; and a response to a drive for quality improvement too. Data takes time to collect, especially to answer new questions. Such arguments were also fielded when models of nursing were spoke of with eye-rolls and sighs of experience. Quality improvement is a fight, opportunities and resources can be found, especially if a culture of research is nurtured and sustained. What questions does a ward, unit, team have currently? What queries might new starters, newly qualified, students, and placement candidates provoke? If my reference to fighting seems strong; the fight is for time. The raw truth is in the NHS that quality improvement, research and supervision (in its various forms) are in competition, in the absence of coherent integration.

In bold above, the discussion includes:

'trialling novel approaches to care or addressing health inequalities'.

I wonder what that springs to mind? More seriously, we need be aware of what happens to 'quality'; in whatever educational form it is encountered and experienced. 

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

interpersonal skills informal / formal education QUALITY lifelong learning	biotechnical landscape quality improvement - clinical supervision?
inequity social preparedness for AI/GenAI	inequality management supervision?

RCN Congress 2025 ii - Losing direct nursing skills

No longer an issue for me, but in the mix of careers: health, education, work - professional; employees often find that they are pulled away from what originally brought them to their chosen career. "I want to help people, care for them, make them better." Especially, if they are ambitious, seek better pay and prospects, for themselves and (a) their family. 

This was an issue and tension for discussion at the RCN Congress:

'Climbing the ladder often means leaving the “bedside”, this is something that can leave mixed emotions for the individual. As a result, we are losing years of clinical experience and expertise which could impact on the future training and on-the-job development for early career or inexperienced colleagues.

The secondary issue that arises with nurses leaving the bedside is skill decay, where a person loses the skills developed in the clinical area through lack of everyday practice. This is being increasingly acknowledged in health care literature (Maehle, 2017). However, the biggest barrier is the resulting lack of confidence in personal skills and ability, particularly where someone is now seen as a senior colleague by those at the bedside.' cont. ...

Discussion - Losing direct nursing skills

I didn't make notes but reflected on how your 'basic training' (for me ...) registered mental nurse (RMN) and state registered nurse (SRN) provides the foundation for professional (and lifelong?) learning? This is, after all, what continuing professional development and post-registration refer to. I did realise that in returning to mental health nursing after qualifying as a SRN, I would surrender much learning - instead of consolidating.

Lecture 101, sets in train the scope of your theory and practice. This is why, and where I see Hodges' model having a role at this point in our professional education, whatever the discipline, or profession. Congress included a resolution for debate: Physician associates. 

We really do need to get this right. Get it wrong, and the quality of care and safety of the public are threatened. If existing standards and professional relationships are perturbed, the effects can be long-lasting and (grossly) injurious. Especially at a time of increasing demographic pressures globally for health systems and services.

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

1. Is the divide represented by parity of esteem in healthcare MIND :: BODY associated with the fact that in mental illness patients do not ordinarily need to be nursed, cared for in bed?	png image from pngtree.com
2. But, wait! What does history, medical sociology have to say?	3. Is the 'bed' the signifier of instititionalised care? It appears to be. The pejorative term 'big bins' seems to epitomise the mechanisation of care. In prisons do they throw away the key?

Previously: 'RCN' : 'skills' : 'beds'.

Also at Congress was the RCN Northwest Multicultural Group, which may be of interest if you are UK based (and not just in the NW). The following is edited from an email ...

Dear All,

I would like to congratulate everyone for an amazing Congress 2025 and take this opportunity to welcome the new members. It was really lovely to meet all of you in person.

Please see below the link to the webpage of multicultural group:

https://www.rcn.org.uk/northwest/Get-Involved/NW-Multicultural-Group

I will be sharing the details of the next meeting and other information via the group and email.

Kind regards,

Olanike Babalola (She/Her/Hers)
Chair/Cofounder RCN Northwest Multicultural Group
Email: olanike.babalola AT reps.rcn.org.uk

HC@AIxIA AI&Health May Seminar: 'Building Trustworthy AI for Health'

Dear Madam/Sir,

This is to officially announce the MAY 2025 seminar of the "AI & Health: Seminars 2025" series as hosted by HC@AIxIA, i.e., the "Artificial Intelligence for Healthcare" working group of the Italian Association for Artificial Intelligence.

*** Save the date: 12 MAY 2025. 3:30 CET ***

We hope you will attend and participate in the discussion on the relevant topics that will be presented and by our speakers. Feel free to share this with those potentially interested.

Link for participating: https://bit.ly/hc-2025-05 (PLEASE CHECK the site https://aixia.it/en/gruppi/hc/ for any changes or updates) - Please find some details below, and a poster attached.

== May 2025 seminar ==
2025 May 12 - 3:30PM CET

Prof. Barbara Di Camillo, Department of Information Engineering, University of Padova, Italy

Title: Building Trustworthy AI for Health: Robust and Generalizable Models with a Focus on Challenging Cases

Abstract: To make artificial intelligence useful in real clinical settings, it is crucial that AI tools follow the principles of trustworthy AI. This means ensuring the accuracy and reliability of the results, defining the areas where the results are valid, and making sure the predictions are understandable. This approach ensures that humans remain at the center of the decision-making process. BRAINTEASER (https://brainteaser.health/) is a data science project that uses artificial intelligence to help patients with amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS), along with their doctors. In the presentation, I will show how, during the development of the machine learning methods within the project, we took into account the robustness and generalizability of the model, and how we identified and characterized the subjects for whom making predictions is more challenging.

Short Bio: Barbara Di Camillo is full professor in computer science with the Department of Information Engineering, University of Padova. Her research activity is centered in the development and application of advanced modeling, data mining and machine learning methods for high-throughput biological data analysis in the field of Bioinformatics and Systems Biology. In particular, she has developed and applied different methods for robust biomarker discovery, predictive modeling and clustering of clinical data and next generation sequencing data. She has also a great expertise in the development and application of differential equation based models, Boolean and Bayesian Networks for modeling the relationships between the variables and the pathways along which they influence the disease progression.

Flyer: https://drive.google.com/open?id=15badJ0Nfj8lrA0gZdFc9aOGeR3pelms-&usp=drive_fs

====

Some notes
Serving as coordinators of the working group on AI for Healthcare of the Italian Association of Artificial Intelligence (AIxIA, see: https://aixia.it/en/gruppi/hc/), part of our commitment consists of fostering contamination and collaboration between AI researchers and experts and operators in Medicine and Healthcare; in particular, we aim to contribute in building a two-way road for informing healthcare operators about AI results and opportunities, while also raising awareness among AI researchers about challenges and problems in medicine and healthcare.
Therefore, the 2025 seminar series, in the trail of the 2024 edition, will feature a number of experts presenting research results, projects, best practices, ideas, and more to a mixed audience of AI researchers and healthcare operators.

Thank you for your interest in the AI & Health seminar series and the HC@AIxIA working group, and see you soon!

Sincerely,
Francesco Calimeri, Mauro Dragoni, Fabio Stella
(coordinators of the HC@AIxIA working group)

Call - Special issue: Learning from Multiple Data Sources for Decision Making in Health Care

The increasing availability of digital data, along with recent developments in Artificial Intelligence, especially in the Machine Learning and Deep Learning fields, led the scientific community to debate whether data alone is sufficient for decision making and scientific exploration. We focus the attention on the healthcare domain, where peculiar issues affect data: indeed, data are usually collected under heterogeneous conditions (i.e., different populations, regimes, and sampling methods), suffer missingness – very often not at random – and their use is strongly constrained by privacy issues. In such a complex setting, this special issue challenges computer scientists to contribute to the above debate by designing and developing innovative methodological approaches, for solving complex decision-making problems in health care, leveraging on observational data.

Topics of interest include, but are not limited to, the following with an emphasis on novel generalizable methods applied to the healthcare domain:

• Causal discovery from multiple data sets.
• Federated causal discovery.
• Causal discovery from heterogeneous data sets.
• Transportability of causal models and inference.
• Neuro-symbolic approaches to learn from heterogeneous data sources.
• Continual learning on streams from multiple data sources.
• Computational intelligent strategies to support causal inference.
• Edge computing for decision making in healthcare.
• Integrative AI methodologies.
• Distributed inference methods.
• Continual Learning.
• Knowledge Discovery and Integration.
• Combination of deductive approaches with ML models.
• Combination of ontologies and/or knowledge-bases with ML to support decision making.

Peer Review Process:

All submitted papers will undergo a rigorous peer-review process featuring at least two reviewers. All submissions should follow the guidelines for authors available at the Journal of Biomedical Informatics website (http://www.elsevier.com/locate/yjbin). JBI’s editorial policy outlined on that page will be strictly enforced by special issue reviewers.

Note that JBI emphasizes the publication of papers that introduce innovative and generalizable methods of interest to the informatics community. Specific applications can be described to motivate the methodology being introduced, but papers that focus solely on a specific application are not suitable. A few examples of papers focused on methods previously published in JBI include: Kyrimi, et al. [1], Huang, et al. [2], Kocbek et al. [3], Houston et al. [4], García Del Valle et al. [5], Graudenzi et al. [6] and Sims et al. [7].

In particular, the authors of [1] showed the relevance of causal models and expert knowledge to develop credible models, i.e., capable of achieving good predictive performances when transported from the study cohort to the target population. Furthermore, [2] tackles the relevant issue of partially overlapping variables when data are collected from multiple data sources. This problem is extremely relevant both in theoretical and practical terms for decision making in the healthcare sector.

The contribution provided in [3] stressed the importance of working in a multi-source context by demonstrating how the linking of different repositories can improve the overall understanding of patients' conditions. Similarly, in [4] the authors extended this concept by introducing a methodology to evaluate to audit the data quality of the sources exploited by healthcare information systems. Then, in [5] the multi-source concept is transferred within the multi-modal environment and the authors surveyed the importance of considering different modalities to obtain a better disease understanding.

The works in [6] and [7] focuses on the importance of data. In [6] a data integration framework is defined for characterizing the metabolic deregulations that distinguish cancer phenotypes, by projecting RNA-seq data onto metabolic networks without the need for metabolic measurements; in [7] a biomedical informatics method is introduced that uses multiple public health data sources to perform surveillance of methadone-related adverse drug events. Interestingly, even if patient data are not linked between different data sources, results show that the integration of multiple public data sources can capture more cases and provide more clinical details than individual data sources alone.

Key requirements for JBI ML papers in addition to presenting novel methods (not simply application of existing methods to a new healthcare domain) are as follows: 1) projects must have clinicians involved in research question/problem formulation, defining input data, and assessing the results. 2) An explanation (with clinicians) of how the proposed method would fit into the clinical workflow is expected. It must be translational to practice. 3) Data sets should preferably be collected from hospitals after the research question was formulated, thus avoiding the use of available data (MIMIC) to define a very wide research problem that could potentially be answered with available open datasets (as an example: detecting if someone has COVID from Chest X-Rays would not be acceptable, as the gold standard test is the laboratory test). 4) As for explainability, SHAP values and related diagrams would not be enough: the paper should clearly describe and explain how clinicians use the visualization to make decisions. For further details please refer to https://www.sciencedirect.com/journal/journal-of-biomedical-informatics/publish/guide-for-authors.

Further details available -

Submission process, Questions, and References 

My source: 

https://aixia.it/en/gruppi/hc/

Dramatherapy i - thresholds, liminality and wounded healers

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

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Group

A personal journey The 'wounded healer' - Halifax (1982) ".. it is the experience of our own wounding that will enable us to engage with our clients in a healing process". p.15.

"Therefore we can begin to understand that rather than the drama being the chaos, the drama is both the container of the chaos and the means of exploring it. Accompanying our groups through such dangerous territory may seem too frightening for the dramatherapist to contemplate, let alone the client". p.15.

"The attributes of liminality or of liminal personae (threshold people) are necessarily ambiguous, since this condition and these people elude or slip through the network of classifications that normally locate places and position in cultural space. Liminal entities are neither here nor there: they are betwixt and between the positions assigned and arrayed by law, custom, convention and ceremonial. As such their ambiguous and indeterminate attributes are expressed by a rich variety of symbols in the many societies that ritualise social and cultural transitions. This liminality is likened frequently to - death, being in the womb, to invisibility, to darkness, to bisexuality, to the wilderness and to an eclipse of the sun or the moon". p.14.

"The 'illness/treatment' model has by its nature to emphasise what the patient cannot do rather than what he might be able to do; to emphasise that what requires to be done is carried out by others rather than what the patient might do for him/herself". p.262. Power as exercised (degrees of freedom?) through the therapeutic turn: the history of therapies; social, industrial, occupational, physical, drama, psychotherapy et al. ...

Turner, V. (1969) The Ritual Process. Structure and Anti-Structure. Routledge, London. cited in Jennings, S. (1987) Dramatherapy and Groups, Chap. 1. pp.1-18. In Jennings, S. (Ed.), (1987) Dramatherapy. Theory and Practice for Teachers and Clinicians. Routledge, London. p.14.

Mitchell, R. (1987) Dramatherapy in In-patient Psychiatric Settings, Chap. 12. pp.257-276. In Jennings, S. (Ed.), (1987) Dramatherapy. Theory and Practice for Teachers and Clinicians. Routledge, London. p.14.

In theoretical terms, Mitchell also describes the creative model, the learning model and the therapeutic model (p.265).

Halifax, J. (1982) Shaman: the wounded healer. Thames and Hudson, London [England].

Previously: theatre , threshold , liminal