135 research outputs found
Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study.
No full textOBJECTIVE: To evaluate a national programme to develop and implement centrally stored electronic summaries of patients' medical records. DESIGN: Mixed-method, multilevel case study. SETTING: English National Health Service 2007-10. The summary care record (SCR) was introduced as part of the National Programme for Information Technology. This evaluation of the SCR considered it in the context of national policy and its frontline implementation and use in three districts. Participants and methods Quantitative data (cumulative records created nationally plus a dataset of 416 325 encounters in participating primary care out-of-hours and walk-in centres) were analysed statistically. Qualitative data (140 interviews including policy makers, managers, clinicians, and software suppliers; 2000 pages of ethnographic field notes including observation of 214 clinical consultations; and 3000 pages of documents) were analysed thematically and interpretively. RESULTS: Creating individual SCRs and supporting their adoption and use was a complex, technically challenging, and labour intensive process that occurred more slowly than planned. By early 2010, 1.5 million such records had been created. In participating primary care out-of-hours and walk-in centres, an SCR was accessed in 4% of all encounters and in 21% of encounters where one was available; these figures were rising in some but not all sites. The main determinant of SCR access was the identity of the clinician: individual clinicians accessed available SCRs between 0 and 84% of the time. When accessed, an SCR seemed to support better quality care and increase clinician confidence in some encounters. There was no direct evidence of improved safety, but findings were consistent with a rare but important positive impact on preventing medication errors. SCRs sometimes contained incomplete or inaccurate data, but clinicians drew judiciously on these data along with other sources. SCR use was not associated with shorter consultations or reduction in onward referral. Successful introduction of SCRs depended on interaction between multiple stakeholders from different worlds (clinical, political, technical, commercial) with different values, priorities, and ways of working. The programme's fortunes seemed to turn on the ability of change agents to bridge these different institutional worlds, align their conflicting logics, and mobilise implementation effort. CONCLUSIONS: Benefits of centrally stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale
A direct interaction between fascin and microtubules contributes to adhesion dynamics and cell migration
No full textFascin is an actin-binding and bundling protein that is highly upregulated in most epithelial cancers. Fascin promotes cell migration and adhesion dynamics in vitro and tumour cell metastasis in vivo. However, potential non-actin bundling roles for fascin remain unknown. Here we show for the first time that fascin can directly interact with the microtubule cytoskeleton and that this does not depend upon fascin-actin bundling. Microtubule binding contributes to fascin-dependent control of focal adhesion dynamics and cell migration speed. We also show that fascin forms a complex with focal adhesion kinase (FAK) and Src, and that this signalling pathway lies downstream of fascin-microtubule association in the control of adhesion stability. These findings shed light on new non actin-dependent roles for fascin and may have implications for the design of therapies to target fascin in metastatic disease
Likelihood-based inference for correlated diffusions
No full textWe address the problem of likelihood based inference for correlated diffusion processes using Markov chain Monte Carlo (MCMC) techniques. Such a task presents two interesting problems. First, the construction of the MCMC scheme should ensure that the correlation coefficients are updated subject to the positive definite constraints of the diffusion matrix. Second, a diffusion may only be observed at a finite set of points and the marginal likelihood for the parameters based on these observations is generally not available. We overcome the first issue by using the Cholesky factorisation on the diffusion matrix. To deal with the likelihood unavailability, we generalise the data augmentation framework of Roberts and Stramer (2001 Biometrika 88(3):603-621) to d-dimensional correlated diffusions including multivariate stochastic volatility models. Our methodology is illustrated through simulation based experiments and with daily EUR /USD, GBP/USD rates together with their implied volatilities.Markov chain Monte Carlo, Multivariate stochastic volatility, Multivariate CIR model, Cholesky Factorisation
Evaluation of outreach clinics held by specialists in general practice in England
No full textObjectives: To measure the processes of care, health benefits and costs of outreach clinics held by hospital specialists in primary care settings.Design: The study was designed as a case-referent (comparative) study in which the features of 19 outreach clinics (cases) were compared with matched outpatient clinics (controls). The measuring instruments were self administered questionnaires. Patients were followed up at six months to reassess health status. The specialties included in the study were cardiology, ENT, general medicine, general surgery, gynaecology and rheumatology.Setting: Specialist outreach clinics in general practice in England, with matched outpatient clinic controls.Subjects: Consecutive patient attenders in the outreach and outpatient clinics, their specialists, the outreach patients' general practitioners, practice managers and trust accountants. Patients' response rate at baseline: 78% (1420).Main outcome measures: Patient satisfaction, doctors' attitudes, processes and health outcomes, costs.Results: Outreach patients were more satisfied with the processes of their care than outpatients, their access to specialist care was better than that for outpatients and they were more likely to be discharged. Doctors reported that the main advantages of the outreach clinic were improved patient access to specialists and convenience for patients, in comparison with outpatients, and most GPs and specialists felt the outreach clinic was "worthwhile". At six month follow up, the health status of the outreach sample had significantly improved more than that of the outpatients on all eight sub-scales of the HSQ-12, but this was probably because of their better starting point at baseline. The impact of outreach on health outcomes was small. The NHS costs of outreach were significantly higher than outpatients. An increase in outreach clinic size would reduce cost per patient, but would lead to the loss of most of the clinics' benefits.Conclusions: While the process of care was of higher quality in outreach than in outpatients, and the efficiency of care was also greater in the latter, the effect on patients' health outcomes was small. Responsiveness to patients' views and preferences is an essential component of good quality service provision. However, the greater cost of outreach raises the issue of whether improvements in the quality and efficiency of health care, without a substantial impact on health outcomes, is money well spent in a publicly funded health service. On the other hand, the real costs of outreach in comparison with outpatients clinics can probably only be truly estimated in a longitudinal study with a resource based costing model derived from documented patient attendances and treatment costs over time in relation to longer term outcome (for example, at a two year end point)
Health informatics education for clinicians and managers - What's holding up progress?
No full textThis paper reports outcomes of a national survey of health informatics (HI) education and training carried out in the UK. A questionnaire to elicit details of HI and IT skills teaching was derived from a national consensus document (Learning to Manage Health Information, LtMHI). Forms were sent to all pre-qualification medical and nursing schools and to a stratified sample of postgraduate and post-registration programmes. Three case studies were carried out in acute hospital trusts to gain insight into opportunities for continuing professional development in health informatics and IT. Our evidence suggests that in the UK, health informatics is not yet integrated into the clinical curriculum. Nearly all the pre-qualification courses made some provision for teaching IT skills. Nonetheless, many respondents felt that students did not receive sufficient training. There was considerable variation in the amount of HI teaching provided in the different educational sectors. The case studies suggested very little HI training was provided for clinical staff and take-up of provision was not monitored. A number of factors are holding up progress, the most important being a lack of staff with the knowledge and skills to provide academic leadership. The paper outlines some steps that need to be taken to ensure health informatics is embedded in all clinical curricula. © 2003 Elsevier Ireland Ltd. All rights reserved
Clasp-mediated microtubule bundling regulates persistent motility and contact repulsion in Drosophila macrophages in vivo
No full textP. Martin and W. Wood contributed equally to this paperDrosophila melanogaster macrophages are highly migratory cells that lend themselves beautifully to high resolution in vivo imaging experiments. By expressing fluorescent probes to reveal actin and microtubules, we can observe the dynamic interplay of these two cytoskeletal networks as macrophages migrate and interact with one another within a living organism. We show that before an episode of persistent motility, whether responding to developmental guidance or wound cues, macrophages assemble a polarized array of microtubules that bundle into a compass-like arm that appears to anticipate the direction of migration. Whenever cells collide with one another, their microtubule arms transiently align just before cell–cell repulsion, and we show that forcing depolymerization of microtubules by expression of Spastin leads to their defective polarity and failure to contact inhibit from one another. The same is true in orbit/clasp mutants, indicating a pivotal role for this microtubule-binding protein in the assembly and/or functioning of the microtubule arm during polarized migration and contact repulsion.Peer reviewe
Weak consistency of the Euler method for numerically solving stochastic differential equations with discontinuous coefficients
No full textWe prove that, under appropriate conditions, the sequence of approximate solutions constructed according to the Euler scheme converges weakly to the (unique) solution of a stochastic differential equation with discontinuous coefficients. We also obtain a sufficient condition for the existence of a solution to a stochastic differential equation with discontinuous coefficients. These results are then applied to justify the technique of simulating continuous-time threshold autoregressive moving-average processes via the Euler scheme.Good integrators Martingale differences Threshold ARMA processes
Nurses and Computers: An international perspective on how nurses are, and how they would like to be, using ICT in the workplace, and the support they consider that they need.
No full textThe use of IT in nursing (nursing informatics) is increasing, and has the potential to improve patient care. Research, and the experience of the author, have shown however that nurses lack basic IT skills and informatics knowledge. This study sought to explore what nurses’ want from IT in the workplace, and how pre-registration education can help to prepare nurses for working in this changing environment.
The study, undertaken in New Zealand, a country also seeking to drive forwards its use of IT in healthcare, found that nurses want systems that save them time, and equipment readily available at the patients’ bedside. Nurses who had recently completed their pre-registration programmes tended to have better skills than nurses who had trained some time ago. Nurses who lacked skills, or confidence, wanted support available that understood the role of nurse, and could provide help when it was needed.
Nursing schools in New Zealand tend to have a lecturer leading nursing informatics. Nursing informatics is included in pre-registration education programmes, and I was able to see several innovative developments supporting this. Qualified nurses and students generally considered that pre-registration programmes should include information security, legal and ethical issues and supporting patients in meeting their information needs as well as basic IT skills
1972 Jay-Cee-An BJC -- Page [116]
No full textPhotographs of BJC freshmenSeidel. Cheryl L.
Seidel. Ronald J.
Seidel. Terry L.
Sei ler. Joanne H.
Seizler, Marilyn
Sevre. Jocelyn C.
Sheldon. Robert D.
Shephard. Barbara L.
Silbernagel. Paul J.
Skjod. Krislyn A.
Smith. Gordon L.
Smith. Susan J.
Smith. Thomas W.
Snort land. Jan S.
Solberg. Richard R.
Splonskowski, Marvin
Sprvnczyn.nyk. Douglas G.
Stefan. Ronald G.
Steffen. Debbie A.
Steidler. Mary Jo
Stein. Joseph A.
Stein. Sharon A.
Steinbrueck. Mary E.
Steiner. Gail E.
Steinle. Pamela J.
Stenehjern. Wayne K.
Stephan. Dean
Stickland. Barbara L.
Still. Dannie G.
Stone. Diane K.
Stoy. Michael W.
Strudinger. William K.
Stramer. Sharon E.
Strand. Renae
Strande mo. Robert R.
Stroh. Bernhard G.
Stubstad. Wayne C.
Stumpf. Michael L.
Sullivan. Darrell B.
Swendsen. Jeanette
Tumasky. Samuel M.
Telin. Patricia L.
Tello. Kathleen S.
Terslin. Palle
Teske. Denise D.
Tetzloff. Duane .-\.
Tetzloff. Lelinda \1.
Thoernke. Scott R.
Thorn. Linda Faith
Thomason. Jean A.
Thompson. John G.
Thompson. Marlyce D.
Thompson. Roger E.
Thompson. Ryan J.
Thompson. William C.
Thorson. \Iary J.
Thune. Patricia A..
Tosseth, Gloria J.
To\\ ne. Cynthia R.
Tracy. Kevin P.
Tschosik. \lary A.
Lelrnen. Patricia K.
Chlman. \lary K
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