Implementation of a Patient Charting System: Challenges Encountered and Tactics Adopted in a Burn Center

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. In this light, the aim of this study is to provide a deeper understanding of how clinical information systems are being implemented by emphasizing research efforts on the dynamic nature of the process, that is, the “how” and “why” of what happened. Using a case study methodology, we examined the implementation of a patient charting system in the Burn Center of a large, not-for-profit, teaching hospital. Based on an in-depth examination of this implementation, several insights are offered to those who have responsibility for managing complex and risky clinical information system implementation projects.     

Staged bilateral thalamic electrode implantation utilizing frameless stereotactic guidance.

Deep brain stimulation (DBS) for medically intractable Parkinson's disease (PD) is well established, but carries the inconveniences of frame-based neurosurgery. Previous reports have demonstrated that ventricular shunt placement and some functional procedures can be accurately performed using frameless stereotaxy. We present a report indicating that staged deep brain electrode placement can be accurate and efficacious using a frameless skull-mounted guide.     

Selective attention to facial emotion and identity in schizophrenia.

The selective attention to facial emotion and identity was investigated in 12 patients with schizophrenia and 12 healthy participants. Both patients and controls were required to perform two classification tasks (according either to identity or emotion). Two separate values for identity (person A/person B) and for emotion (fear/anger) were used. When the classification task was on one dimension, the other dimension was either correlated, constant, or orthogonal (Garner WR. The Processing of Information and Structure. Potomac, MD: Erlbaum, 1974, Garner WR. Interaction of stimulus dimensions in concept and choice processes. Cognitive Psychology 1976;8:98-123). Results indicated that both patients and healthy participants had an asymmetrical pattern of performance: they were able to selectively attend to the identity of the face presented, regardless of the emotion expressed on the face, but variation in identity interfered with the classification of facial emotion. Moreover, a correlational study indicated that the identity interference on emotion classification for schizophrenic patients covaried with the severity of their negative symptoms. The selective attention competencies in schizophrenia and the independence hypothesis of emotion and face recognition are discussed in the framework of current face recognition models.     

Measurement of tibial torsion--a new technique applicable to ultrasound and computed tomography.

A new method for measuring tibial torsion is described which can be applied to both ultrasound (US) and computed tomography (CT). The method has been validated in dry tibiae by comparison with direct measurements and with Jend's established CT method. In clinical practice a good statistical level of agreement has been demonstrated between the values obtained from US and CT scans. Both compared well with values obtained using Jend's CT technique. The use of US avoids exposure to radiation and is therefore suited to studying young subjects and controls and making repeat measurements.     

Glycemic Carbohydrate: An International Perspective

Attention to the different types of carbohydrates and their role in health and disease is relatively recent. FAO and WHO jointly published a report on carbohydrates in human nutrition in 1998, with a number of recommendations about increasing carbohydrate intake as a sound approach to the prevention of obesity. The glycemic index (GI) was recommended as a means of classifying foods on the basis of their potential for raising blood glucose; this concept was based on the understanding that the state of hyperglycemia that is observed following the intake of certain high-GI carbohydrate foods could constitute a risk factor for diseases of lifestyle.     

Are NHS primary care performance indicator scores acceptable as markers of general practitioner quality?

BACKGROUND: In 2002 the Department of Health published a list of 20 indicators to judge the performance of the 302 primary care organisations (PCOs) in England during 2001-2002. General practitioners (GPs) have expressed doubts about the relevance, applicability and evidence base of these indicators for actual practice. AIMS: To fashion NHS performance indicators to be acceptable and relevant to practicing GPs. DESIGN OF STUDY: A Delphi technique followed by simple mathematical modelling. METHODS: We asked a group of 24 senior GP educators to place the Department of Health performance indicators in rank order as markers of quality in general practice. We found just seven indicators comprised 73% of the markers chosen and all seven were chosen by over three-quarters of the responders. Using a simple 'sign test' system, we then calculated a composite points score for all 302 PCOs. RESULTS: We found that there were almost twice as many PCOs at the upper and lower ends of performance and fewer in the middle than we predicted theoretically. The results suggest that pan-PCO or practice factors account for the low performance scores of 16 of 35 PCOs with extremely poor performance and for the high scores of 17 of the 36 PCOs with extremely high performance. CONCLUSION: We have developed a method that shows how numerous Department of Health performance indicators can be merged into a single composite performance score. We show that this composite performance score is easy to derive, simple to interpret, is acceptable to GPs, and has face validity.     

Agreement between staff and service users concerning the clientele's mental health needs: a Quebec study.

OBJECTIVES: This article examines the differences found between clientele with severe mental health problems and their key health workers in terms of assessing service users' needs in 6 Quebec service areas. METHOD: We questioned 165 pairs of users and staff, using the Camberwell Assessment of Needs questionnaire. The profile of serious and overall problems encountered by clientele from each of the sites was compared. RESULTS: The sites with the greatest degree of user-staff agreement in identifying problems were also the ones where users considered that local services best met their needs. CONCLUSIONS: The study demonstrated that, in needs assessment, major differences exist between the perceptions of users and their key workers in the various sites. These differences can be explained in part by users' individual characteristics, by types of needs, by local particularities, and by service use.     

Thioethers as urinary metabolites of thiophene and monobromothiophenes.

1. Thiophene and its two monobromo derivatives were administered to rats and the amounts of thioether excreted in urine were measured by an assay based on Ellman's reagent. This assay, which involves extraction and hydrolysis, was validated by determining extraction and hydrolysis efficiencies for several authentic thioethers including N-acetyl-S-(2-thienyl)-L-cysteine, a previously reported metabolite of thiophene and 2-bromothiophene. 2. The thioethers present in urine of animals dosed with thiophenes have been examined chromatographically. Contrary to previous reports, the present work indicates that S-substituted, N-acetyl-L-cysteines (mercapturic acids) are not important thioether metabolites of thiophene in rats, and the small quantity of such compounds formed does not include either of the two simple S-thienyl derivatives. 3. The two monobromo thiophenes form higher proportions of thioethers than does thiophene, and one of these thioethers, arising from 3-bromothiophene, was identified, chromatographically, as N-acetyl-S-(3-thienyl)-L-cysteine.