Using conceptual work products of health care to design health IT

This paper introduces a new, model-based design method for interactive health information technology (IT) systems. This method extends workflow models with models of conceptual work products. When the health care work being modeled is substantially cognitive, tacit, and complex in nature, graphical workflow models can become too complex to be useful to designers. Conceptual models complement and simplify workflows by providing an explicit specification for the information product they must produce. We illustrate how conceptual work products can be modeled using standard software modeling language, which allows them to provide fundamental requirements for what the workflow must accomplish and the information that a new system should provide. Developers can use these specifications to envision how health IT could enable an effective cognitive strategy as a workflow with precise information requirements. We illustrate the new method with a study conducted in an outpatient multiple sclerosis (MS) clinic. This study shows specifically how the different phases of the method can be carried out, how the method allows for iteration across phases, and how the method generated a health IT design for case management of MS that is efficient and easy to use.     

Membrane-associated mucins of the ocular surface: New genes,new protein functions and new biological roles in human and mouse

The mucosal glycocalyx of the ocular surface constitutes the point of interaction between the tear film and the apical epithelial cells. Membrane-associated mucins (MAMs) are the defining molecules of the glycocalyx in all mucosal epithelia. Long recognized for their biophysical properties of hydration, lubrication, anti-adhesion and repulsion, MAMs maintain the wet ocular surface, lubricate the blink, stabilize the tear film and create a physical barrier to the outside world. However, it is increasingly appreciated that MAMs also function as cell surface receptors that transduce information from the outside to the inside of the cell. A number of excellent review articles have provided perspective on the field as it has progressed since 1987, when molecular cloning of the first MAM was reported. The current article provides an update for the ocular surface, placing it into the broad context of findings made in other organ systems, and including new genes, new protein functions and new biological roles. We discuss the epithelial tissue-equivalent with mucosal differentiation, the key model system making these advances possible. In addition, we make the first systematic comparison of MAMs in human and mouse, establishing the basis for using knockout mice for investigations with the complexity of an in vivo system. Lastly, we discuss findings from human genetics/genomics, which are providing clues to new MAM roles previously unimagined. Taken together, this information allows us to generate hypotheses for the next stage of investigation to expand our knowledge of MAM function in intracellular signaling and roles unique to the ocular surface.     

临床护士获取信息焦虑程度的现状调查及影响因素分析

目的调查临床护士获取信息焦虑程度的现状,并分析信息焦虑程度的影响因素。方法采用便利抽样法进行横断面调查,选取2020年4—6月南京市4家综合性医院的339名临床护士作为研究对象,采用一般资料调查问卷及信息焦虑量表进行调查研究。共发放问卷339份,回收有效问卷324份,有效回收率为95.58%。结果324名临床护士信息焦虑量表总分为(100.96±19.83)分,条目均分为(2.69±0.25)分,各维度条目均分从高到低依次为信息需求、信息利用能力、检索系统质量、信息检索能力、认知类型和知识结构。多重线性回归分析结果显示,年龄、职称、文化程度以及医院等级是影响临床护士信息焦虑程度的主要因素(P<0.05)。结论年龄、职称、文化程度以及医院等级均为临床护士信息焦虑程度的主要影响因素,护理管理者应培养临床护士的信息获取意识,增强其自主获取信息的能力,以此减轻其获取信息的焦虑程度。     

护士档案信息管理系统的设计与效用

2008年5月12日《护士条例》颁布实施后,我国临床护士人力紧缺的状况正在逐步改善,护士队伍数量迅速增加,这队护士档案信息的管理也提出了更高的要求.我院是一所三级甲等综合性教学医院,现阶段开床位1 283张,护士794名,2008年以来新聘用护士354名.我院护理部自2010年10月起,结合我院护理人员的实际情况,在临床调研的基础上,开发研制了电子“护士档案信息管理系统”,实现了信息化、无纸化档案管理,为我院科学、规范、快捷、准确地管理护士档案工作提供了便利,现介绍如下.     

On measurements and their quality: Paper 3: Post hoc pooling and errors of discreteness

This is the third in a short series of papers on measurement theory and practice with particular relevance to research in nursing, midwifery, and healthcare. In this paper I demonstrate how the decisions we make regarding the post hoc treatment of our measurements impact the quality of our data and influence the validity of the inferences we draw from them. I address two variations of this practice, pooling data over response options found on self-report measures, and transforming measurements of continuous variables, such as age, into ranges or ordered categories. The problems inherent in this practice are examined using concepts from information theory. Pooling more precise measurements into less precise ones creates errors of discreteness that introduce unpredictable (positive or negative) bias in our results.     

Why common carrier and network neutrality principles apply to the Nationwide Health Information Network (NWHIN)

The Office of the National Coordinator will be defining the architecture of the Nationwide Health Information Network (NWHIN) together with the proposed HealtheWay public/private partnership as a development and funding strategy. There are a number of open questions—for example, what is the best way to realize the benefits of health information exchange? How valuable are regional health information organizations in comparison with a more direct approach? What is the role of the carriers in delivering this service? The NWHIN is to exist for the public good, and thus shares many traits of the common law notion of ‘common carriage’ or ‘public calling,’ the modern term for which is network neutrality. Recent policy debates in Congress and resulting potential regulation have implications for key stakeholders within healthcare that use or provide services, and for those who exchange information. To date, there has been little policy debate or discussion about the implications of a neutral NWHIN. This paper frames the discussion for future policy debate in healthcare by providing a brief education and summary of the modern version of common carriage, of the key stakeholder positions in healthcare, and of the potential implications of the network neutrality debate within healthcare.     

The application of technology acceptance and diffusion of innovation models in healthcare informatics

There have been many attempts to apply previously developed models of technology acceptance and the diffusion of innovations; however the models have weaknesses in predicting the behaviour of individuals and organisations, particularly within the complex health domain. The insights recent work on these models offer is relevant to health informatics development and innovation and need to be considered in the development of organisational strategies. This paper analyses the merits of several relevant models and explores their potential significance for the success or otherwise of health related Information Technology projects, highlighting their weaknesses in relation to the lack of differentiation between technological and human factors which limit their applicability in practice.     

Food Addiction: An Evolving Nonlinear Science

The purpose of this review is to familiarize readers with the role that addiction plays in the formation and treatment of obesity, type 2 diabetes and disorders of eating. We will outline several useful models that integrate metabolism, addiction, and human relationship adaptations to eating. A special effort will be made to demonstrate how the use of simple and straightforward nonlinear models can and are being used to improve our knowledge and treatment of patients suffering from nutritional pathology. Moving forward, the reader should be able to incorporate some of the findings in this review into their own practice, research, teaching efforts or other interests in the fields of nutrition, diabetes, and/or bariatric (weight) management.     

层级管理模式在医院信息技术人员管理中的应用

以解放军第187中心医院信息科网络信息中心的技术人员为研究对象,实施层级管理模式,从人员层级设置、分工模式、分层培训、评价指标等方面具体介绍层级化管理模式的实施方法。结果表明实施层级管理后,服务满意率及考试优秀率均明显高于层级管理前。