Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review

Background  

Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users.     

Neurophysiological Testing to Assess Penile Sensory Nerve Damage After Radical Prostatectomy

IntroductionRadical prostatectomy (RP) can lead to erectile dysfunction due to surgical injury of the cavernous nerves. However, there is no simple, objective test to evaluate cavernous nerve damage caused by RP in clinical practice.AimTo assess the value of the measurement of penile thermal and vibratory sensory thresholds to reflect cavernous nerve damage caused by RP.MethodsWe included 42 consecutive patients who underwent RP with cavernous nerve sparing (laparoscopic approach, N = 12) or without cavernous nerve sparing (laparoscopic, N = 13; retropubic, N = 11; or transperineal, N = 6). Penile thermal (warm and cold) and vibratory sensory thresholds were measured twice, together with the Erectile Dysfunction Symptom Score (EDSS), 1 month before and 2 months after RP.Main Outcome MeasuresPenile sensory thresholds for warm, cold, and vibration sensations.ResultsPenile sensory thresholds for warm (P < 0.0001) and cold (P < 0.0001) sensations significantly increased after non‐nerve‐sparing RP, but not after nerve‐sparing RP. Vibration threshold only increased after transperineal non‐nerve‐sparing RP (P = 0.031). EDSS values were significantly increased in all groups of patients 2 months after surgery.ConclusionsSensory nerve fibers carrying penile skin sensations travel with the cavernous nerves in the pelvis. Therefore, testing these sensations may help to evaluate the extent of cavernous nerve damage caused by RP. In this series, post‐operative changes in penile sensory thresholds differed with the surgical technique of RP, as the cavernous nerves were preserved or not. The present results support the value of quantitative penile sensory threshold measurement to indicate RP‐induced cavernous nerve injury. Yiou R, De Laet K, Hisano M, Salomon L, Abbou C‐C, and Lefaucheur J‐P. Neurophysiological testing to assess penile sensory nerve damage after radical prostatectomy. J Sex Med 2012;9:2457–2466.