Organization’s Quality Maturity as a Vehicle for EHR Success

In health care industry, EHR has been advocated to improve care quality. The journey toward the development and adaptation of EHR should be holistic and integrate all the EHR’s building blocks-health record management, business process improvement (BPI), collaboration and innovation, change management, user governance, etc.—that are intertwined together as like the links of a chain to improve quality of health care services. These cornerstones that shares common features with quality principles will pave the way for implementing EHR. To go along with quality features and take advantage of quality principles namely “quality maturity” builds a solid foundation for adaptation of EHR. Therefore, the recent theories of EHR success go far beyond technical rationales and focus on organizational and managerial factors in quality improvement. The milestone of quality concept in information system success is revealed in Delone and Mclean’s model which launches system quality, information quality, service quality, as distinct elements of the IS success. EHR is a means to an end -to improve quality within enterprises- based on quality approaches. In this regards, more research should be conducted to investigate the relationship between of organization’s quality maturity and EHR development success.     

Web 2.0 Systems Supporting Childhood Chronic Disease Management: Design Guidelines Based on Information Behaviour and Social Learning Theories

Self-directed learning denotes that the individual is in command of what should be learned and why it is important. In this study, guidelines for the design of Web 2.0 systems for supporting diabetic adolescents’ every day learning needs are examined in light of theories about information behaviour and social learning. A Web 2.0 system was developed to support a community of practice and social learning structures were created to support building of relations between members on several levels in the community. The features of the system included access to participation in the culture of diabetes management practice, entry to information about the community and about what needs to be learned to be a full practitioner or respected member in the community, and free sharing of information, narratives and experience-based knowledge. After integration with the key elements derived from theories of information behaviour, a preliminary design guideline document was formulated.     

Influence of Dentistry Students’ e-Learning Satisfaction: A Questionnaire Survey

Dental school graduates operating on patients without having had sufficient practice in school is potentially dangerous to the patients. In order to minimize this danger, it is necessary to establish a virtual learning environment for students. In this study, we incorporated DentSim, a clinical dentistry simulator, into an e-Learning platform. In addition to overcoming the time and space constraints on learning, DentSim can simulate clinical conditions. It also allows students to practice reading case histories and inspecting and diagnosing patients. To construct the research model for this study, we incorporated the four major factors for measuring e-Learner satisfaction—‘learner interface’, ‘learning community’, ‘content’ and ‘personalization’ with the variable of ‘intention to use’. The subjects were 350 dental students studying at the College of Oral Medicine. The structural equation modeling (SEM) results showed that Factors that influenced ‘intention to use’ include ‘learner interface’, ‘learning community’ and ‘personalization’, and ‘intention to use’ affect ‘e-Learner satisfaction’ with the system.     

A Mobile Nursing Information System Based on Human-Computer Interaction Design for Improving Quality of Nursing

A conventional Nursing Information System (NIS), which supports the role of nurse in some areas, is typically deployed as an immobile system. However, the traditional information system can’t response to patients’ conditions in real-time, causing delays on the availability of this information. With the advances of information technology, mobile devices are increasingly being used to extend the human mind’s limited capacity to recall and process large numbers of relevant variables and to support information management, general administration, and clinical practice. Unfortunately, there have been few studies about the combination of a well-designed small-screen interface with a personal digital assistant (PDA) in clinical nursing. Some researchers found that user interface design is an important factor in determining the usability and potential use of a mobile system. Therefore, this study proposed a systematic approach to the development of a mobile nursing information system (MNIS) based on Mobile Human-Computer Interaction (M-HCI) for use in clinical nursing. The system combines principles of small-screen interface design with user-specified requirements. In addition, the iconic functions were designed with metaphor concept that will help users learn the system more quickly with less working-memory. An experiment involving learnability testing, thinking aloud and a questionnaire investigation was conducted for evaluating the effect of MNIS on PDA. The results show that the proposed MNIS is good on learning and higher satisfaction on symbol investigation, terminology and system information.     

Development of a Health Management Support System for Patients with Diabetes Mellitus at Home

Recently, a patient with diabetes mellitus (DM) type 2 has been increasing in Japan. The patient should be managed not only by a specialist but also by himself focusing his attention on the improvement of his lifestyle at home. In the present study, we tried to develop a health management support system by which a diabetic patient in early stage can easily enter his daily life information, i.e. the biological information such as the data of blood sugar levels and blood pressure levels etc., the information of exercise and diet and send the information to the medical institution with a personal digital assistant (PDA). Afterwards, the patient can receive health instruction information by the physician in charge for self-care at his home with a PDA. The daily life information sent from the patient is stored in a server installed at the medical institution and analyzed. The physician can obtain the results of analysis by using a PC and send the instruction information necessary for patient management to the patient at home by using e-mail after diagnosing the patient’s condition by the system. To evaluate usability of the developed patient information input system with a PDA, an experiment was conducted by corporation of 20 volunteers who were possible self management and whose age’s range from 20s to 60s by questionnaire survey. As a result, almost examinees answered that lifestyle information could be easily entered by the sense like a mobile-phone and lots of positive opinions were obtained.     

An Implementation of Wireless Medical Image Transmission System on Mobile Devices

The advanced technology of computing system was followed by the rapid improvement of medical instrumentation and patient record management system. The typical examples are hospital information system (HIS) and picture archiving and communication system (PACS), which computerized the management procedure of medical records and images in hospital. Because these systems were built and used in hospitals, doctors out of hospital have problems to access them immediately on emergent cases. To solve these problems, this paper addressed the realization of system that could transmit the images acquired by medical imaging systems in hospital to the remote doctors’ handheld PDA’s using CDMA cellular phone network. The system consists of server and PDA. The server was developed to manage the accounts of doctors and patients and allocate the patient images to each doctor. The PDA was developed to display patient images through remote server connection. To authenticate the personal user, remote data access (RDA) method was used in PDA accessing the server database and file transfer protocol (FTP) was used to download patient images from the remove server. In laboratory experiments, it was calculated to take ninety seconds to transmit thirty images with 832 × 488 resolution and 24 bit depth and 0.37 Mb size. This result showed that the developed system has no problems for remote doctors to receive and review the patient images immediately on emergent cases.     

Validation of serological tests forHelicobacter pylori infection in an Irish population

Background Serological tests forHeilcobacter pylori using laboratory and ‘office’ formats are commonly used, easy to perform, inexpensive and widely available. Local validation of test performance is required.

Aims  

This study examined the performance of a laboratory and ‘office’ ELISA in a population of Irish dyspeptics presenting for endoscopy.     

数字化医院运营绩效评价指标体系的应用研究

本文从应用入手,着重研究依托医院网络信息资源,结合医院管理实际,按照绩效评价理论和方法,编制设计绩效评价指标体系应遵循的原则、实施步骤与指标体系架构。     

Computer-Aided Intelligent System for Diagnosing Pediatric Asthma

Asthma is a lung chronic inflammatory disorder estimated between 1.4% and 27.1% in different area of the world. Result of various studies show that asthma is usually underdiagnosed especially in developing countries, because of limitations on access to medical specialists and laboratory facilities. In this paper, we report on the development and evaluation of a novel patient-based fuzzy system that promotes the diagnosis method of asthma. The design of this application addresses five critical issues included: 1) modular representation of asthma diagnostic variables regard to patients’ perception of the disease, 2) algorithmic approaches conducting inference of diagnosing based on patient’s response to questions, 4) front-end mechanism for capturing data from patient, 5) output for both patient and physician regard to asthma possibility. for the system output score (0–10) the efficacy of this system calculated in the study sample included 139 asthmatic patients and 139 non-asthmatic patients (age range 6–18) reinforce the sensitivity of 88% and specificity of 100% for cut off value 0.7.     

Irish contributions to the origins of antibiotics

Background  Pasteur commented that if we could intervene in the antagonism observed between some bacteria, it would offer ‘perhaps the greatest hopes for therapeutics.’ Some Irish scientists were crucially involved in the eventual realization of these hopes. Research  The earliest of these was John Tyndall, whose 1881 book, ‘Floating matter in the air in relation to putrefaction and infection,’ brought about general acceptance of Pasteur’s germ theory. Sir Almroth Wright, a TCD graduate, who discovered the first vaccine against typhoid fever, recruited Alexander Fleming to the London hospital where he discovered penicillin. Sequence of events  This happened when Fleming was replicating an experiment originally carried out by Bigger, Boland and O’Meara in TCD. One of Fleming’s cultures was accidentally contaminated by a mould containing penicillin which came from the collection of Charles La Touche, an Irish mycologist who was researching whether cobwebs caused asthma in the same hospital, and who later taught in UCD. This is an expanded version of a lecture to the Royal Academy of Medicine in Ireland. Much of the author’s research on which it is based was published in Research Policy 29:679–710, (2000) and the Journal of the History of Medicine and Allied Sciences 59(3):441–462 (2004).     

In Search of Immortality: The Political Economy of Anti-aging Medicine

Anti-aging medicine is characterised by significant ‘hype’, hope and promise. This article examines the conditions giving rise to and sustaining this field. It questions its key premises, highlights the politico-economic ‘drivers’ of its innovations, and identifies the key actor networks sustaining its practices. As the article argues, it is highly questionable whether the viability of anti-aging medicine can be sustained as a discrete field of practice in the longer term. The instability of this field stems from its reliance on a faulty epistemological premise: that aging is a disease requiring technological intervention. In addition, anti-aging medicine is dependent on a series of fragile links and destabilising tendencies that threaten its long-term future. As sweeping promises regarding the ‘revolutionary’ potential of anti-aging medicine are made, financial, industry, government and public support becomes ever more contingent upon those utopian promises being realised. For reasons we discuss, this may not be possible. The article concludes by exploring the future of anti-aging medicine, highlighting a number of potential alternative scenarios.     

Quality improvement of diabetes care using flow sheets in family health practice

OBJECTIVE: To show that the use of a flow sheet would improve performance of family physicians in diabetes care. METHODS: This is a one-year intervention study conducted in 7 family practice clinics in Taif Armed Forces Hospitals, Taif, Saudi Arabia from March 2006 to June 2007. Diabetic flow sheet was developed based on the clinical practice guidelines of Canada for the management of type 2 diabetes. Patients' records were selected by systematic random sampling technique. RESULTS: Four hundred and fourteen medical records of patients with type 2 diabetes were included in the study. Compliance with the quality indicators was audited using 9 quality improvement indicators. Significant improvement was detected in the indicators of body mass index, glycosylated hemoglobin, microalbuminuria, lipid profile, retinoscopy, foot examination, and peripheral neuropathy examination. CONCLUSION: Flow sheet can be effective in improving quality of care not only for diabetes but also for other chronic conditions.     

Parallel Algorithm to Analyze the Brain Signals: Application on Epileptic Spikes

In the current work, we have proposed a parallel algorithm for the recognition of Epileptic Spikes (ES) in EEG. The automated systems are used in biomedical field to help the doctors and pathologist by producing the result of an inspection in real time. Generally, the biomedical signal data to be processed are very large in size. A uniprocessor computer is having its own limitation regarding its speed. So the fastest available computer with latest configuration also may not produce results in real time for the immense computation. Parallel computing can be proved as a useful tool for processing the huge data with higher speed. In the proposed algorithm ‘Data Parallelism’ has been applied where multiple processors perform the same operation on different part of the data to produce fast result. All the processors are interconnected with each other by an interconnection network. The complexity of the algorithm was analyzed as Θ((n + δn) / N) where, ‘n’ is the length of the input data, ‘N’ is the number of processor used in the algorithm and ‘δn’ is the amount of overlapped data between two consecutive intermediate processors (IPs). This algorithm is scalable as the level of parallelism increase linearly with the increase in number of processors. The algorithm has been implemented in Message Passing Interface (MPI). It was tested with 60 min recorded EEG signal data files. The recognition rate of ES on an average was 95.68%.     

血液透析中心信息管理系统的开发和临床实践

目的：探讨血液透析中心信息化建设中系统的设计、实现和临床实践。方法：在自主开发血透机、水处理机等相关设备的硬件接入系统的基础上,对病人信息、血透数据、上机排班信息、记录单据、统计分析及评估要求进行调研分析,设计和开发血液透析中心信息管理系统来辅助管理血透中心的运行、管理、治疗行为。结果：建立了完整的血液透析临床辅助支持信息系统,监控、采集存储、归档患者信息,实现患者的“全过程管理”（whole process management）;计算机辅助血液透析中心实现上机、排班、记录的信息化、自动化,有效提高医务人员效率;通过互联网与省市质量控制中心数据共享,实现各级医疗单位的血透工作规范化和标准化;通过二级库房的信息化管理,实现血透耗材使用的可追溯性;通过对治疗效果的评估,及时调整治疗方案以提高治疗质量。结论：该系统的使用,对于血液透析中心提高工作效率,降低医疗风险,辅助医疗举证有十分重要的意义。     

Jonathan Osborne (1794–1864) and his recognition of conduction aphasia in 1834

In 1833 an accomplished 26-year-old linguist suffered a non-paralytic stroke. After he recovered, though he could utter a variety of syllables with ease, he spoke an unintelligible jargon that caused him to be mistaken as a foreigner. He was examined repeatedly over the course of a year by Jonathan Osborne (1794–1864), a Dublin physician and professor of materia medica, who found that the patient understood whatever was said to him, that he could read and write fluently, but had difficulty repeating words read to him or in reading aloud. Osborne recommended that he learn to speak English, his natural language, de novo and over 8 months measured his considerable improvement. To explain the patient’s singular difficulty in repeating spoken words Osborne argued it was ‘highly probable that, having been conversant with five languages, the muscular apparatus ranged among them, forming a kind of polyglot jargon [that was] wholly unintelligible’ and the patient was ‘unable to penetrate into and select the contents of the store according as the [words] were required’. The discrepancy between comprehension and repetition was later termed conduction aphasia.     

医院BI分析体系构建研究

目的：医院要实现业务信息智慧洞察的目标,必须使用适当的技术架构平台来支持业务数据分析系统。方法：应用数据仓库和商业智能技术,集成医院各类数据资源,实现医院各类管理指标的预警监控,并提供多维综合分析平台。结果：应用商业智能技术,分析挖掘医院运营各个方面的信息数据,通过预警监控、多维联机分析等技术手段,能够有效地提升医院的医疗质量,提高医院科学管理水平,辅助管理层决策。结论：商业智能将成为信息化应用的新热点。     

Clinical Information System Availability and Use in Urban and Rural Hospitals

Clinical information systems (CIS) capture clinical data to support more efficient and effective decision making and clinical care delivery. Only a few estimates of CIS availability and use in hospitals are available nationally. The purpose of the current research is to examine differences in CIS availability and use between urban and rural hospitals. A survey addressing this purpose was completed by 74 (63.7%) of Iowa hospitals. Rural hospitals lag behind urban hospitals in terms of many CIS applications. More than 80% of the urban hospitals, but only between 30 and 40% of the rural hospitals, reported using computers to collect basic clinical information for potential use in an electronic medical record (EMR) and computerized provider order entry (CPOE) system. Comparison of CIS within one state’s urban and rural hospitals sheds light on variation in clinical support applications, decision support, and electronic medical record “readiness” in these settings.     

Rejuvenation’s Return: Anti-aging and Re-masculinization in Biomedical Discourse on the ‘Aging Male’

Since the late 1990s, a constellation of professional associations, journals and health promotion materials has emerged that has constructed the ‘aging male’ as a medical problem. Central to this construction has been a revival of a hormonal model of the male body in which anti-aging is linked to the restoration of masculinity. In this paper I revisit the association of aging and demasculinization that animated the rejuvenation movement of the early 20th century, and contrast this with the initial mainstream medical interest in testosterone therapy in the mid-20th century. Then I will demonstrate how the association between anti-aging and re-masculinization has been given new life in the remedicalized ‘andropause’, and as a contemporary focus on maintaining life-long virility has emerged as an important indicator of ‘health aging’.     

Post-tonsillectomy bleeding: a regional hospital experience

Introduction  Post-tonsillectomy bleeding (PTB) is still one of the most common complications of tonsillectomy. The rate of PTB varies with different methods. Methods  We retrospectively reviewed all charts of patients who underwent tonsillectomy in a regional hospital. Results  Post-tonsillectomy bleeding occurred in 33 patients (6.68%); 3 experienced primary haemorrhage and 30 had secondary haemorrhage. The rate of PTB was higher in males and in the over 15-year group (9.41%). The commonest surgical techniques used were cold steel dissection with bipolar diathermy for haemostasis (55.87%). The lowest PTB was observed with ‘cold steel and ties technique’ (3.14%). Operations which used bipolar diathermy throughout had the highest level of haemorrhage (8.47%). Conclusion  In conclusion, the overall risk of bleeding is related to surgical technique. A ‘hot’ technique had a higher risk of bleeding than ‘cold’ technique.