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1.
This paper describes the findings of a literature review conducted on the current usage, lessons, and limitations of e-learning for undergraduate medical education with an emphasis on synchronous delivery in the first 2 years. The review was conducted as part of an initiative to expand the UBC undergraduate medical program in British Columbia, Canada. The 50 e-learning articles included in the review described the deployment of various types of e-learning technology and content in different settings. The seven videoconferencing articles provided product information, health education examples, and innovative approaches. The six review articles provided general guidelines and trends on e-learning in undergraduate medical education in United States and Europe. Overall, while the literature is informative, there are few reported studies that address distributed synchronous learning in these undergraduate programs. 相似文献
2.
Prior research on technology usage had largely overlooked the issue of user resistance or barriers to technology acceptance.
Prior research on the Electronic Medical Records had largely focused on technical issues but rarely on managerial issues.
Such oversight prevented a better understanding of users’ resistance to new technologies and the antecedents of technology
rejection. Incorporating the enablers and the inhibitors of technology usage intention, this study explores physicians’ reactions
towards the electronic medical record. The main focus is on the barriers, perceived threat and perceived inequity. 115 physicians
from 6 hospitals participated in the questionnaire survey. Structural Equation Modeling was employed to verify the measurement
scale and research hypotheses. According to the results, perceived threat shows a direct and negative effect on perceived
usefulness and behavioral intentions, as well as an indirect effect on behavioral intentions via perceived usefulness. Perceived
inequity reveals a direct and positive effect on perceived threat, and it also shows a direct and negative effect on perceived
usefulness. Besides, perceived inequity reveals an indirect effect on behavioral intentions via perceived usefulness with
perceived threat as the inhibitor. The research finding presents a better insight into physicians’ rejection and the antecedents
of such outcome. For the healthcare industry understanding the factors contributing to physicians’ technology acceptance is
important as to ensure a smooth implementation of any new technology. The results of this study can also provide change managers
reference to a smooth IT introduction into an organization. In addition, our proposed measurement scale can be applied as
a diagnostic tool for them to better understand the status quo within their organizations and users’ reactions to technology
acceptance. By doing so, barriers to physicians’ acceptance can be identified earlier and more effectively before leading
to technology rejection. 相似文献
3.
This literature review explores the current evidence related to use of the Internet by hospice patients or families and palliative
care/hospice professionals. The research questions guiding this study pertain to the current Internet-based interventions
in hospice and palliative care and the evidence of their effectiveness. Six studies were identified as a result of an extensive
literature review. These studies included research about web-based clinical interventions for patients, and patients’, caregivers’
and hospice/palliative care providers’ use of the Internet. The majority of interventions involve accessing information via
the Internet. Participants among the studies included patients, caregivers/family members, and health care professionals.
Findings overall indicate effectiveness of Internet-based interventions. Both patients and professionals are using the Internet
to find answers to healthcare questions, communicate, and/or deliver healthcare interventions. 相似文献
4.
Nikolaos Preve 《Journal of medical systems》2011,35(6):1375-1392
Wireless Sensor Network (WSN) can be deployed to monitor the health of patients suffering from critical diseases. Also a wireless
network consisting of biomedical sensors can be implanted into the patient’s body and can monitor the patients’ conditions.
These sensor devices, apart from having an enormous capability of collecting data from their physical surroundings, are also
resource constraint in nature with a limited processing and communication ability. Therefore we have to integrate them with
the Grid technology in order to process and store the collected data by the sensor nodes. In this paper, we proposed the SEnsor
Grid Enhancement Data Management system, called SEGEDMA ensuring the integration of different network technologies and the
continuous data access to system users. The main contribution of this work is to achieve the interoperability of both technologies
through a novel network architecture ensuring also the interoperability of Open Geospatial Consortium (OGC) and HL7 standards.
According to the results, SEGEDMA can be applied successfully in a decentralized healthcare environment. 相似文献
5.
Rune Fensli Jan Gunnar Dale Philip O’Reilly John O’Donoghue David Sammon Torstein Gundersen 《Journal of medical systems》2010,34(4):767-775
This paper investigates the benefits of using less intrusive wireless technologies for heart monitoring. By replacing well
established heart monitoring devices (i.e. Holter) with wireless ECG based Body Area Networks (BAN), improved healthcare performance
can be achieved, reflected in (1) high quality ECG recordings during physical activities and (2) increased patient satisfaction.
A small scale clinical trial was conducted to compare both technologies and the results illustrate that the wireless ECG monitor
was able to detect ECG signals intended for arrhythmia diagnostics. Furthermore, from a patient’s perspective, both technologies
were evaluated using three dimensions, namely; hygienic aspects, physical activity, and skin reactions. Results demonstrate
that the wireless ECG BAN showed better performance, especially regarding the hygienic aspects. It was also favourable for
use during physical activities, and the signal quality of the wireless sensor system demonstrated good performance regarding
signal noise and artefact disturbances. This paper concludes that wireless cardiac monitoring systems have significant benefits
from a patient’s perspective, and further clinical trials should be conducted to further evaluate the new ECG based BAN system,
to identify the possibility of widespread adoption and utilisation of wireless technology for arrhythmia diagnostics. 相似文献
6.
7.
Wang Huaizhang 《中国结合医学杂志》1999,5(2):101-104
Objective: To probe the relationship between survival period and immune function of hepatic carcinoma patients after embolization chemotherapy.Methods: One hundred and eight patients of hepatocarcinoma were randomly divided into three groups. Group A was treated by embolization
chemotherapy (ECT) alone, immunotherapy and Chinese herbal medicine were given to Group B and C respectively after ECT.Results: The short-term effective rate of Group A, B and C was 61.1%, 83.3% and 80.6% respectively, the three-year survival rate
28.6%, 39.1% and 47.3%, and the median survival time 11 months, 17 months and 15 months respectively. Observation on immune
function after treatment showed that patients who received ECT alone had a lower immunity while those who received immunotherapy
or Chinese herbal medicine had a strengthened immunity.Conclusion: Survival period of hepatocarcinoma patients is related with their immune function, strengthening patients’ immunity could
extend their survival period relatively. 相似文献
8.
Healthcare in America continues to be of paramount importance, and one of the most highly debated public policy issues of
our time. With annual expenditures already exceeding $2.4 trillion, and yielding less than optimal results, it stands to reason
that we must turn to promising tools and solutions, such as information technology (IT), to improve service efficiency and
quality of care. Presidential addresses in 2004 and 2008 laid out an agenda, framework, and timeline for national health information
technology investment and development. A national initiative was long overdue. This report we show that advancements in both
medical technologies and information systems can be capitalized upon, hence extending information systems usage beyond data
collection to include administrative and decision support, care plan development, quality improvement, etc. In this paper
we focus on healthcare services for palliative patients. We present the development and preliminary accounts of a successful
initiative in the Medical Center of Central Georgia where footprints information technology was modified and integrated into
the hospital’s palliative care service and existing EMR systems. The project provides evidence that there are a plethora of
areas in healthcare in which innovative application of information systems could significantly enhance the care delivered
to loved ones, and improve operations at the same time.. 相似文献
9.
Objective: Our study aimed to identify factors affecting patient satisfaction. Data: The study was conducted at a training hospital in Turkey. The final sample consisted of 302 inpatients. In this study, patient
satisfaction was examined using a survey questionnaire with 22 questions collected under five dimensions. Method: Factor analysis was used to group 22 questions measuring patients’ satisfaction questions into certain dimensions. Then,
structural equation model (SEM) was performed to determine the influence of patient characteristics on patient satisfaction.
Results: Our analysis showed the questionnaire has an appropriate reliability and validity. The structural equation model (SEM) was
used to determine those factors which could affect patient satisfaction. The results of SEM analysis showed that 15% of the
total variance in patients’ satisfaction was explained by the model. The SEM analysis found that variables of education and
type of clinic (surgical vs. non-surgical) were significant on patient satisfaction. Persons with a higher level of education
were less satisfied when compared to those with a lower level of education. Surgical patients are more satisfied with the
care they received when compared to non-surgical patients. Conclusion: The education level of patients and the type of clinics had a significant influence on patient satisfaction. 相似文献
10.
The time and spatial constraints of face-to-face learning often affect nursing staff’s inclination to enroll in ladder system
training classes. Hence, their competence in clinical care may be unable to meet the requirements of the hospitals they work
at. The e-learning mechanism offers a way to overcome such constraints. However, the differences in learners’ achievement
and satisfaction between traditional face-to-face and non-synchronized e-learning classes in the nursing clinical ladder system
have not been thoroughly investigated. In this study, 155 nursing personnel serving at the case hospital, enrolled in N1/N2
ladder courses, were invited to participate as the subjects. The results showed that those who attended face-to-face learning
classes reported higher satisfaction but achieved less in class than those in the e-learning class. The factors which influence
the subjects’ satisfaction with e-learning were investigated and summarized. 相似文献
11.
Background Little is known about the economic impact of diabetic foot ulceration in the Irish healthcare setting.
Aim Audit of diabetic foot ulcer admissions in St James’s Hospital between April 2001 and March 2002.
Methods Hospital charts were reviewed and costs were calculated on the length of patients’ hospital stay and the cost of individual
investigations performed.
Results Thirty patients were admitted with diabetic foot ulceration as the primary complaint. Amputation was performed in eight patients,
two patients with a non-healing ulcer died. The average duration of each hospital admission was 20.3±30.7 days. Net in-hospital
expenditure was ∈704,689, an average of ∈23,489.63 per hospital admission.
Conclusions The management of diabetic foot ulceration has a significant economic impact on the Irish healthcare budget. Treatment should
therefore be focused on primary prevention through specialised foot clinics and a multidisciplinary team approach to reduce
this economic burden. 相似文献
12.
Literature related to chief information officer (CIO) in the developed countries during the past 20 years has been reviewed
to identify the future trends of the position. The literature shows that CIO is a growing position in the healthcare industry
that has achieved much popularity because today’s healthcare has a great focus on information management and technology and
that CIO can be future powerful strategist for healthcare organizations. Therefore, a model for an ideal healthcare CIO based
on lesson learned from literature was suggested. It seems that in the developed countries, CIOs will achieve many opportunities
to come in the highest executive teams of healthcare organizations and may undertake CEO roles. 相似文献
13.
Vaishali N. Patel Rina V. Dhopeshwarkar Alison Edwards Yolanda Barrón Jeffrey Sparenborg Rainu Kaushal 《Journal of medical systems》2012,36(3):1043-1052
In order to characterize consumer support for electronic health information exchange (HIE) and personal health records (PHRs)
in a community where HIE is underway, we conducted a survey of English speaking adults who visited primary care practices
participating in a regional community-wide clinical data exchange, during August, 2008. Amongst the 117 respondents, a majority
supported physicians’ use of HIE (83%) or expressed interest in potentially using PHRs (76%). Consumers’ comfort sending personal
information electronically over the Internet and their perceptions regarding the potential benefits of HIE were independently
associated with their support for HIE. Consumers’ prior experience using the Internet to manage their healthcare, perceptions
regarding the potential benefits of PHRs and college education were independently associated with potential PHR use. Bolstering
consumer support for HIE and PHRs will require addressing privacy and security concerns, demonstrating clinical benefits,
and reaching out to those who are less educated and computer literate. 相似文献
14.
Alanoud M. Aleidi Nouf J. Alayed Htoon M. Alduraibi Najd S. Alqassimi Amal A. Ismail 《Saudi medical journal》2020,41(10):1076
Objectives:To assess phosphate binders’ usage, knowledge regarding their utilization, and adherence among hemodialysis patients in Qassim, Saudi Arabia.Methods:A prospective cross-sectional study conducted at 4 dialysis centers in Qassim, Saudi Arabia with inclusion of 237 patients’ undergoing hemodialysis between November 2018 to January 2019. The study involved interviewing the patients, reviewing their medical records for biomarkers used to assess kidney function, and assessing the patients’ knowledge-based regarding dietary phosphate control, as well as adherence to phosphate binders’ usage.Results:Out of 237 included patients, male to female ratio was 54:46. The prevalence of prescribing non-calcium phosphate binders was 82.7% whereas prescribing calcium phosphate binders was 73.8%. A total of 63% of patients showed a medium level of adherence to phosphate binders. Although adherence level was not poor, therapeutic efficacy was affected by other factors such as administration time adherence positively correlated with the serum phosphate level (p=0.00).Conclusion:Phosphate binders usage is frequent among hemodialysis patients in Qassim centers. Circulating phosphate level was affected by the extent of patients’ knowledge of dietary control and adherence to the usage of phosphate binders. Thus, we recommend enhancing patient education in reference to high- and low- phosphate-rich diet to take wise dietary decisions, lower pill burden, and improve adherence toward the control of hyperphosphatemia 相似文献
15.
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. 相似文献
16.
Sung-Huai Hsieh I-Ching Hou Po-Hsun Cheng Ching-Ting Tan Po-Chao Shen Kai-Ping Hsu Sheau-Ling Hsieh Feipei Lai 《Journal of medical systems》2010,34(5):947-958
Patients’ safety is the most essential, critical issue, however, errors can hardly prevent, especially for human faults. In
order to reduce the errors caused by human, we construct Electronic Health Records (EHR) in the Health Information System
(HIS) to facilitate patients’ safety and to improve the quality of medical care. During the medical care processing, all the
tasks are based upon physicians’ orders. In National Taiwan University Hospital (NTUH), the Electronic Health Record committee
proposed a standard of order flows. There are objectives of the standard: first, to enhance medical procedures and enforce
hospital policies; secondly, to improve the quality of medical care; third, to collect sufficient, adequate data for EHR in
the near future. Among the proposed procedures, NTUH decides to establish a web-based mobile electronic medication administration
record (ME-MAR) system. The system, build based on the service-oriented architecture (SOA) as well as embedded the HL7/XML
standard, is installed in the Mobile Nursing Carts. It also implement accompany with the advanced techniques like Asynchronous
JavaScript and XML (Ajax) or Web services to enhance the system usability. According to researches, it indicates that medication
errors are highly proportion to total medical faults. Therefore, we expect the ME-MAR system can reduce medication errors.
In addition, we evaluate ME-MAR can assist nurses or healthcare practitioners to administer, manage medication properly. This
successful experience of developing the NTUH ME-MAR system can be easily applied to other related system. Meanwhile, the SOA
architecture of the system can also be seamless integrated to NTUH or other HIS system. 相似文献
17.
Electronic medical records can be defined as a digital format of the traditionally paper-based anamneses, which contains the
history of a patient such as his somewhat illness, current health problems, and his chronic treatments. An electronic anamnesis
is meant to make the patient’s health information more conveniently accessible and transferable between different medical
institutions and also easier to be kept quite a long time. Because of such transferability and accessibility of electronic
anamneses, we can use less resource than before on storing the patients’ medical information. This also means that medical
care providers could save more funds on record-keeping and access a patient’s medical background directly since shown on the
computer screen more quickly and easily. Overall, the service quality has seemingly improved greatly. However, the usage of
electronic anamneses involves in some concerned issues such as its related law declaration, and the security of the patient’s
confidential information. Because of these concerns, a secure medical networking scheme is taking into consideration. Nowadays,
the administrators at the medical institutions are facing more challenges on monitoring computers and network systems, because
of dramatic advances in this field. For instance, a trusted third party is authorized to access some medical records for a
certain period of time. In regard to the security purpose, all the electronic medical records are embedded with both of the
public-key infrastructure (PKI) cryptography and the digital signature technique so as to ensure the records well-protected.
Since the signatures will be invalid due to the revocation or time expiration, the security of records under this premise
would turn into vulnerable. Hence, we propose a re-signing scheme, whose purpose is to make a going-expired digital signature
been resigned in time, in keeping with the premise of not conflicting with the laws, morals, and privacy while maintaining
the security of the electronic medical records. 相似文献
18.
Background To determine the impact of neurological consultations on the care of hospital in-patients and to ascertain patients’ perceptions,
referrals were prospectively recorded over a 6-month period. The neurology team’s view and changes suggested to management
were documented. All referred patients’ notes were reviewed at 6 months and the impact of a neurology referral was determined.
Results Two hundred and fifty-four (254) referrals were seen. There was a significant change in diagnosis in 55%, and in management
in nearly 70%. Neurological referral facilitated earlier discharge for 65% patients. Thirty-seven of 163 patients contacted
at 6 months did not know they were seen by a neurologist. Of those who knew, 57% felt referral had aided in their diagnosis
and 86% felt it had aided treatment.
Conclusions Neurological consultations can make a significant difference to in-patient management. Early referral may lead to early discharge.
Patient satisfaction was high but not without criticism. 相似文献
19.
Steurbaut K Colpaert K Van Hoecke S Steurbaut S Danneels C Decruyenaere J De Turck F 《Journal of medical systems》2012,36(3):1403-1416
The computerization of Intensive Care Units provides an overwhelming amount of electronic data for both medical and financial
analysis. However, the current tarification, which is the process to tick and count patients’ procedures, is still a repetitive,
time-consuming process on paper. Nurses and secretaries keep track manually of the patients’ medical procedures. This paper
describes the design methodology and implementation of automated tarification services. In this study we investigate if the
tarification can be modeled in service oriented architecture as a composition of interacting services. Services are responsible
for data collection, automatic assignment of records to physicians and application of rules. Performance is evaluated in terms
of execution time, cost evaluation and return on investment based on tracking of real procedures. The services provide high
flexibility in terms of maintenance, integration and rules support. It is shown that services offer a more accurate, less
time-consuming and cost-effective tarification. 相似文献
20.
James A. Bahensky Marcia M. Ward Kwame Nyarko Pengxiang Li 《Journal of medical systems》2011,35(4):599-607
Small rural hospitals face considerable financial and personnel resource shortages which hinder their efforts to implement
complex health information technology (HIT) systems. A survey on the use of HIT was completed by 85% of Iowa’s 82 Critical
Access Hospitals (CAH). Analyses indicate that low IT staffing in CAHs is a barrier to implementing HIT solutions. CAHs with
fewer staff tend to employ alternative business strategies. There is a clear relationship between having IT staff at a CAH
and the types of technologies used. Many CAHs report having difficulty expanding upon HIT functionalities due to the challenges
of finding IT staff with healthcare expertise. Most CAHs are in the transition point of planning for or beginning implementation
of complex clinical information systems. Strategies for addressing these challenges will need to evolve as the HIT investments
by rural hospitals race to keep pace with the goals for the nation. 相似文献