Studies in health technology and informatics
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In the last few years, Electronic Health Record (EHR) systems have received a great attention in the literature, as well as in the industry. They are expected to lead to health care savings, increase health care quality and reduce medical errors. This interest has been accompanied by the development of different standards and frameworks to meet EHR challenges. ⋯ Second, the current security profiles for more complex security requirements are oversimplified, vague and do not consider architectural design. This recently changed to some extend e.g., with the introduction of newly published white papers regarding privacy [5] and access control [9]. In order to solve the first problem we utilize results of previous studies conducted in the area of security-aware IHE-based systems and the state-of-the-art Security-as-a-Service approach as a convenient methodology to group domain-wide security needs and overcome the end point security shortcomings.
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Stud Health Technol Inform · Jan 2010
Determinants of clinical information system post-adoption success.
The diffusion of information technology (IT) in healthcare systems to support clinical processes makes the evaluation of physician and nurse post-adoption an important challenge for clinical information systems (CIS). This paper examines the relationships between the determinants of success of a CIS based on an expectation-confirmation paradigm in a cross-sectional survey performed at the Sherbrooke University Hospital (CHUS). 32.2% (161) of physicians and 27.1% (352) of nurses responded to the survey questionnaires. Results suggested that physician and nurse satisfaction is determined differently according to post-adoption expectations: compatibility, confirmation of expectations, usefulness, ease of use, and support. ⋯ Confirmation of expectations was strongly associated with each post-adoption expectation and positions its importance in CIS design and redesign. This study draws attention to the differences between physician and nurse perceptions of information technology and emphasizes post-adoption evaluation to measure CIS success. Physicians and nurses post-adoption expectations were key factors to warn again potential discontinuance.
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Stud Health Technol Inform · Jan 2010
A myoelectric-controlled virtual hand for the assessment and treatment of phantom limb pain in trans-radial upper extremity amputees: a research protocol.
At least 90% of individuals of limb amputees experience phantom limb pain (PLP). Recent clinical research suggests that providing patients with the mirror image representation of the amputated limb may alleviate PLP. However, mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. ⋯ The proposed system allows the patient to directly control the virtual limb by recognizing stump muscle patterns recorded with EMG sensors. The hypothesis behind this strategy is that the VR image of the amputated limb induces better limb imagery than the reflected image of their intact limb and, therefore, is more effective in reducing PLP. A research protocol to test this hypothesis is described.
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Kim, aged 3 years, lies asleep, waiting for a miracle. Outside her room, the nurses on the night shift pad softly through the half-lighted corridors, stopping to count breaths, take pulses, or check the intravenous pumps. In the morning, Kim will have her heart fixed. ⋯ No crowd holds its breath tonight; but wouldn't they if they knew? From: Berwick DM. Controlling variation in health care: a consultation from Walter Shewhart. Medical Care 1991; 29: 1212-1225.
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Hospitalized patients receive countless doses of medications through manually programmed infusion pumps. Many medication errors are the result of programming incorrect pump settings. When used appropriately, smart pumps have the potential to detect some programming errors. ⋯ Acceptable programming limits of dose rate increases in addition to initial drug doses for 23 high-risk medications are monitored. During 22.5 months in a 24 bed ICU, 970 alerts (4% of 25,040 doses, 1.4 alerts per day) were generated for pump settings programmed outside acceptable limits of which 137 (14%) were found to have prevented potential harm. Monitoring pump programming at the system level rather than the pump provides access to additional patient data in the EMR including previous dosage levels, other concurrent medications and caloric intake, age, gender, vitals and laboratory results.