知识模式转换在医学科技创新中的作用

医学科技创新是医院赖以生存与发展的动力,医学科技创新的过程也是医学知识模式不断转换的过程,本文从知识模式转换的视角,探讨知识管理对医学科技创新的意义与作用     

Healthcare communication distress scale: Pilot factor analysis and validity

ObjectiveTo develop psychometrically an evidence-based, patient-centred measure of patient-practitioner communication. We explored the underlying constructs of a self-report questionnaire measuring adult patients’ enduring perceptions of their emotional experiences when communicating with primary healthcare practitioners.MethodsA cross-sectional on-line survey included 16 items from a piloted questionnaire, as well as existing measures of generalised anxiety, psychological distress, and body vigilance. Exploratory factor analysis and hierarchical multiple regression were used to explore underlying constructs in an Australian sample (N = 220).ResultsA 6-item communication distress factor and a 3-item environmental arousal factor were supported, indicating good face validity and internal consistency. Bivariate correlations support convergent and discriminant validity for both factors. Hierarchical analysis exploring predictors of communication distress included sex, age, and chronic condition status; and scores on body vigilance, anxiety, distress, and environmental arousal in healthcare. Environmental arousal was the most important significant predictor of communication distress.ConclusionThe patient communication questionnaire can be developed into a brief scale to measure patient distress associated with engaging with, and communicating in, healthcare settings.Practice implicationsA brief self-report measure to identify patients’ communication distress and environmental arousal could assist in clinical practice and provide useful data in healthcare communication research.     

Healthcare assistants in general practice: practical and conceptual issues of skill-mix change.

The emergence of healthcare assistants (HCAs) in general practice raises questions about roles and responsibilities, patients' acceptance, cost-effectiveness, patient safety and delegation, training and competence, workforce development, and professional identity. There has been minimal research into the role of HCAs and their experiences, as well as those of other staff working with HCAs in general practice. Lessons may be learned from their role and evidence of their effectiveness in hospital settings. Such research highlights blurred and contested role boundaries and threats to professional identity, which have implications for teamwork, quality of patient care, and patient safety. In this paper it is argued that transferability of evidence from hospital settings to the context of general practice cannot be assumed. Drawing on the limited research in general practice, the challenges and benefits of developing the HCA role in general practice are discussed. It is suggested that in the context of changing skill-mix models, viewing roles as fluid and dynamic is more helpful and reflective of individuals' experiences than endeavouring to impose fixed role boundaries. It is concluded that HCAs can make an increasingly useful contribution to the skill mix in general practice, but that more research and evaluation are needed to inform their training and development within the general practice team.     

医用物理学教学中培养学生创新能力探究

培养高素质创新型医学人才是高等医学院校当前面临的一项现实而紧迫的任务。医用物理学是物理学和医学相结合形成的一门交叉学科,是高等医学院校开设的一门必修的基础课。培养学生创新能力是医用物理学课程教学的重要内容。本文从重视学生思维训练,培养学生个性发展,构造学生创新平台和机制三方面探讨医用物理学课程教学中培养学生创新能力的方法和途径。     

Do-it-yourself Healthcare: The current landscape,prospects and consequences

The wider availability and increasing use of mHealth tools – covering health applications, smartphone plug-ins and gadgets is significant for healthcare. This trend epitomises broader trajectories in access to and delivery of healthcare, with greater consumer involvement and decentralisation. This shift may be conceptualised as ‘do-it-yourself Healthcare’ – allowing consumers to monitor and manage their health, and guide their healthcare consumption. Technology that enables data collection by patients informs them about vital health metrics, giving them more control over experiences of health or illness. The information can be used alone as empowered consumers or together with healthcare professionals in an environment of patient-centred care. Current evidence suggests a large scope for do-it-yourself Healthcare, given the availability of technologies, whilst mHealth tools enhance diagnostics, improve treatment, increase access to services and lower costs. There are, however, limitations to do-it-yourself Healthcare. Notably, its evidence base is less well developed than the availability of technologies to facilitate it. A more complex model and understanding is needed to explain motivations for and consequences of engaging in do-it-yourself Healthcare. That said, its introduction alongside existing medicine may improve quality and reduce costs – potentially improving health system sustainability whilst future generations – tomorrow's middle-aged and the elderly, will become more conducive to its spread.     

Healthcare technology management competency and its impacts on IT-healthcare partnerships development

Objective

This study presents a conceptual model to investigate the healthcare technology management (HTM) competency required by healthcare IS professionals and the impact of such competency in gaining strategic advantages through information technology (IT) by development of partnerships with people from different divisions of healthcare organizations.

Methods

First, a scale to measure HTM competency was developed and validated, then it was used to collect the large-scale survey data. Second, the partial least squares (PLS) method was used to empirically test the conceptual model and hypotheses through the large-scale survey data collected.

Results

The empirical results support the proposed structure for HTM competency encompassing the four skills/knowledge domains: healthcare organization overview, external knowledge networking, healthcare technology integration, and management and interpersonal. The findings indicate that HTM competency positively influences the attitudes of information system (IS) professionals towards their willingness to develop partnerships with healthcare professionals.

Conclusions

The findings improve our understanding of the concept of HTM competency and its influence on IT-healthcare partnerships. The conceptual model of HTM is of particular value to those concerned with skills/knowledge training and competency development for IS professionals in healthcare organizations. Healthcare organizations can develop HTM profiles for individual IS professionals in accordance with their own organization contexts. Executive management can take advantage of such HTM profiles to assist in making succession-planning decisions by evaluating the competency levels and development needs of their employees.     

How Consumers and Physicians View New Medical Technology: Comparative Survey

Background

As a result of the digital revolution coming to medicine, a number of new tools are becoming available and are starting to be introduced in clinical practice.

Objective

We aim to assess health care professional and consumer attitudes toward new medical technology including smartphones, genetic testing, privacy, and patient-accessible electronic health records.

Methods

We performed a survey with 1406 health care providers and 1102 consumer responders.

Results

Consumers who completed the survey were more likely to prefer new technologies for a medical diagnosis (437/1102, 39.66%) compared with providers (194/1406, 13.80%; P<.001), with more providers (393/1406, 27.95%) than consumers (175/1102, 15.88%) reporting feeling uneasy about using technology for a diagnosis. Both providers and consumers supported genetic testing for various purposes, with providers (1234/1406, 87.77%) being significantly more likely than consumers (806/1102, 73.14%) to support genetic testing when planning to have a baby (P<.001). Similarly, 91.68% (1289/1406) of providers and 81.22% (895/1102) of consumers supported diagnosing problems in a fetus (P<.001). Among providers, 90.33% (1270/1406) were concerned that patients would experience anxiety after accessing health records, and 81.95% (1149/1406) felt it would lead to requests for unnecessary medical evaluations, but only 34.30% (378/1102; P<.001) and 24.59% (271/1102; P<.001) of consumers expressed the same concerns, respectively. Physicians (137/827, 16.6%) reported less concern about the use of technology for diagnosis compared to medical students (21/235, 8.9%; P=.03) and also more frequently felt that patients owned their medical record (323/827, 39.1%; and 30/235, 12.8%, respectively; P<.001).

Conclusions

Consumers and health professionals differ significantly and broadly in their views of emerging medical technology, with more enthusiasm and support expressed by consumers.     

信息技术对急救医学发展的影响和我国急救医学的创新策略

随着社会生产力和科学技术的高速发展，交通事故、生产事故、自然灾害、社会突发事件、中毒事件以及心脑血管急、危重症的发生等已成为世界各国面临的社会问题。因此，如何充分利用现代化的信息技术为社会人类提供方便、快捷、有效的急救医疗服务，已成为当今急救医学发展的主要方向。本文简述信息技术对急救医学发展的影响，并提出我国急救医学的创新策略。     

Examining the role of collaboration in studies of health information technologies in biomedical informatics: A systematic review of 25 years of research

PurposeOur objective was to identify and examine studies of collaboration in relation to the use of health information technologies (HIT) in the biomedical informatics field.MethodsWe conducted a systematic literature review of articles through PubMed searches as well as reviewing a variety of individual journals and proceedings. Our search period was from 1990–2015. We identified 98 articles that met our inclusion criteria. We excluded articles that were not published in English, did not deal with technology, and did not focus primarily on individuals collaborating.ResultsWe categorized the studies by technology type, user groups, study location, methodology, processes related to collaboration, and desired outcomes. We identified three major processes: workflow, communication, and information exchange and two outcomes: maintaining awareness and establishing common ground. Researchers most frequently studied collaboration within hospitals using qualitative methods.DiscussionBased on our findings, we present the “collaboration space model”, which is a model to help researchers study collaboration and technology in healthcare. We also discuss issues related to collaboration and future research directions.ConclusionWhile collaboration is being increasingly recognized in the biomedical informatics community as essential to healthcare delivery, collaboration is often implicitly discussed or intertwined with other similar concepts. In order to evaluate how HIT affects collaboration and how we can build HIT to effectively support collaboration, we need more studies that explicitly focus on collaborative issues.     

医疗设备数字化技术档案系统的设计与应用

本文探讨了医院医疗设备数字化技术档案系统的设计与应用.运用计算机网络系统,建立医疗设备健康档案,对设备实行动态管理,以提高设备使用率,为科学利用设备提供决策依据.     

The building bridges initiative in health sciences and medical education: Fostering connections between Brazil and the United States

Building Bridges is an outreach initiative that has focused upon effectuating increased communication among biomedical scientists, educators, and students in Brazil and the United States—the countries with the greatest number of medical schools in the Americas. It has been a developing project over the last 6 years, and has involved faculty, students, and civic leaders from many universities in the two countries. This Special Issue of The Anatomical Record is a continuation of the Building Bridges initiative, and brings to the fore attention onto some of the creative research being done in biomedical science, evolutionary science, biomedical education, and current health topics in Brazil. Fostering open routes of communication among scientists is a core humanistic value that is at the heart of progress and is the center of our actions. This paper reviews the history of the Building Bridges Initiative.     

Clinical information technology in hospitals: a comparison between the state of Iowa and two provinces in Canada

Despite the growing interest in adopting information technology (IT) in healthcare, the degree of technology sophistication varies among healthcare organizations. Changes in the health care sector and continuous pressure to improve the quality of care have driven the evolution of IT in hospitals. This paper provides an overview of clinical IT sophistication in a sample of U.S. hospitals, and compares clinical IT capacities in this sample with a sample of Canadian hospitals. The instrument used for the comparison measures three clinical dimensions of IT sophistication: functional sophistication, technological sophistication and integration level. Clinical areas that were considered include patient management, patient care activities and clinical support activities. The comparison between hospitals in Iowa and Canada shows differences in clinical IT sophistication between the two settings. Hospitals in Iowa appear to have more technologies but fewer computerized processes and integration of patient management activities. Technological sophistication however, was low in both samples. Our findings confirm the construct validity of the measurement instrument and show initial evidence of its generalizability. More initiatives using the instrument would lead to enhancement in IT assessment tools that can be used for evaluation of IT in relation to patient management and quality outcomes.     

Innovative use of the integrative review to evaluate evidence of technology transformation in healthcare

Healthcare is in a period significant transformational activity through the accelerated adoption of healthcare technologies, new reimbursement systems that emphasize shared savings and care coordination, and the common place use of mobile technologies by patients, providers, and others. The complexity of healthcare creates barriers to transformational activity and has the potential to inhibit the desired paths toward change envisioned by policymakers. Methods for understanding how change is occurring within this complex environment are important to the evaluation of delivery system reform and the role of technology in healthcare transformation. This study examines the use on an integrative review methodology to evaluate the healthcare literature for evidence of technology transformation in healthcare. The methodology integrates the evaluation of a broad set of literature with an established evaluative framework to develop a more complete understanding of a particular topic. We applied this methodology and the framework of punctuated equilibrium (PEq) to the analysis of the healthcare literature from 2004 to 2012 for evidence of technology transformation, a time during which technology was at the forefront of healthcare policy. The analysis demonstrated that the established PEq framework applied to the literature showed considerable potential for evaluating the progress of policies that encourage healthcare transformation. Significant inhibitors to change were identified through the integrative review and categorized into ten themes that describe the resistant structure of healthcare delivery: variations in the environment; market complexity; regulations; flawed risks and rewards; change theories; barriers; ethical considerations; competition and sustainability; environmental elements, and internal elements. We hypothesize that the resistant nature of the healthcare system described by this study creates barriers to the direct consumer involvement and engagement necessary for transformational change. Future policies should be directed at removing these barriers by demanding and emphasizing open technologies and unrestricted access to data versus as currently prescribed by technology vendors, practitioners, and policies that perpetuate market equilibrium.     

Optimizing usability and signal capture: a proactive risk assessment for the implementation of a wireless vital sign monitoring system

Wearable vital sign monitors are a promising step towards optimal patient surveillance, providing continuous data to allow for early detection and treatment of patient deterioration. However, as wearable monitors become more widely adopted in healthcare, there is a corresponding need to carefully design the implementation of these tools to promote their integration into clinical workflows and defend against potential misuse and patient harm. Prior to the roll-out of these monitors, our multidisciplinary team of clinicians, clinical engineers, information technologists and research investigators conducted a modified Healthcare Failure Mode and Effect Analysis (HFMEA), a proactive evaluation of potential problems which could be encountered in the use of a wireless vital signs monitoring system. This evaluation was accomplished by focussing on the identification of procedures and actions that would be required during the devices’ regular usage, as well as the implementation of the system as a comprehensive process. Using this method, the team identified challenges that would arise throughout the lifecycle of the device and developed recommendations to address them. This proactive risk assessment can guide the implementation of wearable patient monitors, optimising the use of innovative health information technology.     

New e-service development in the homecare sector: beyond implementing a radical technology

PURPOSE: This paper explores the constituents of and challenges related to the innovation of technology-based services in the long-term homecare sector. METHODS: This research used purposeful extreme case sampling, a mixed methods approach to research that included focus groups and interviews, to learn from the experiences of an innovative telehomecare project. The paper uses a framework that integrates service management; information systems innovation and medical informatics theory. RESULTS: The findings indicate that the claimed and the rather abstract benefits of the technology espoused by information technology vendors were difficult to transform into a service concept. The organization studied is still struggling with conflicts between technological possibilities on the one hand, and the prevailing service delivery systems and user preferences on the other. Decisions about the extent to which the service needs to be reengineered, what non-technology resources are required, what should be the role of the consumer in the new care process and identifying who is actually the primary beneficiary and user of the new service remain. CONCLUSIONS: A comprehensive development model and 'mindfulness' is necessary for radical service innovation in the long-term homecare sector. Creating new services that exploit the capability of radical technical innovations requires organizational development and the use of many non-technology innovations and resources. To understand what combinations of technological and non-technological resources can provide sustainable benefit, all key internal and external stakeholders must be involved from the beginning of the project.     

Changing Panorama for Surveillance of Device-Associated Healthcare Infections: Challenges faced in Implementation of Current Guidelines

Healthcare-associated infections (HAI) are preventable in up to 30% of patients with evidence-based infection prevention and control (IPC) activities. IPC activities require effective surveillance to generate data for the HAI rates, defining priority areas, identifying processes amenable for improvement and institute interventions to improve patient’s safety. However, uniform, accurate and standardised surveillance methodology using objective definitions can only generate meaningful data for effective execution of IPC activities. The highly exhaustive, complex and ever-evolving infection surveillance methodology pose a challenge for effective data capture, analysis and interpretation by ground level personnel. The present review addresses the gaps in knowledge and day-to-day challenges in surveillance faced by infection control team for effective implementation of IPC activities.     

Introduction to histology through the use of familiar objects: Innovative teaching module

To introduce first-year medical students to fundamental concepts in histology and facilitate interpretation of two-dimensional images in the context of the three-dimensional nature of the object, a simple teaching module consisting of active exercises plus group discussions, using familiar objects from everyday use, was planned. In the process of mentally reconstructing sections through familiar objects, and representing in diagrams the appearance of these sections, students learned the use of common histology terms; the value of studying sections in series and at different planes; and spatial relationships of a) a nucleus within a cell, and b) tissue components within solid and hollow organs. Their understanding of these concepts was found to be good when evaluated by a multiple-choice-questions test, suggesting that this is an effective method for introducing beginners to fundamentals of histology. Clin. Anat. 10:333–336, 1997. © 1997 Wiley-Liss, Inc.