Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2010
Finite element comparison of different growth sparring instrumentation systems for the early treatment of idiopathic scoliosis.
Fusionless growth sparring implants seek to restore spinal alignment through the early intervention of pediatric scoliosis. Amongst a growing number of concepts, the stainless steel (SS) staple, flexible tether and shape memory alloy (SMA) staple have demonstrated their validity by retarding convex vertebral growth while modifying spinal alignment. The purpose of this study was to explore the biomechanics of these devices in a human scoliotic finite element model (FEM) constructed from patient data. ⋯ Initial and long term modifications of coronal spinal alignment following simulated growth was respectfully 28 degrees to 62 degrees in non-instrumented model and patient data, 28 degrees to 31 degrees with SS staple, 23 degrees to 31 degrees with flexible tether, and 27 degrees to 34 degrees with SMA staple. The interpretation of such methods suggests that the long term correction, achieved via growth modulation, would benefit from improved control of asymmetrical stresses within the growth plates. From a biomechanical perspective, fusionless growth sparring techniques for the early treatment of idiopathic scoliosis show promising preliminary results.
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This study addresses the question of the respective impact of organizational vs. technical environment variables on the collaborative aspects of healthcare work situations. It analyzes the physicians-nurses communications during the medication use process, according to both the organization of their work and their technical environment. ⋯ The study (i) presents the identification and description of the communications' processes involving doctors-nurses face-to-face communications and the supports that mediate medication information and (ii) focuses on the amount of face-to-face communications depending on the organization of work and the technical system used. The analyses demonstrate that the organizational variables have a larger impact than the technical environment on the quality and quantity of the communications and cooperation activities.
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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.
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Stud Health Technol Inform · Jan 2010
Socio-technical challenges in implementing safe patient handovers.
Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. Drawing on three ethnographic case studies we identify and discuss socio-technical issues which must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover and data standards and system integration warrant ongoing research in socio-technical aspects of care handovers.
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Stud Health Technol Inform · Jan 2010
The IT-infrastructure of a biobank for an academic medical center.
For high quality research in biomedicine an operable biobank is essential. In order to make optimal use of the material and the huge amount of data a sustainable IT-infrastructure is indispensable. Therefore, we developed a concept for the IT-infrastructure of a biobank for an academic medical center. ⋯ Our results indicate that the IT-infrastructure plays a pivotal role in successfully establishing a biobank. Several aspects of the IT-infrastructure are similarly found in other areas as, e.g. data protection and storage and quality management. Finally, we conclude that although a research database is not required for operating a biobank, the need for it will definitely emerge, especially with regard to personalized medicine and high-throughput gene expression analysis.