bluuebunny/crossref_metadata_2025 huggingface dataset:
Vibrancy of Childhood Things
Authors: Tesar Marek , Arndt Sonja
Published: March 2016

In this article, we explore the “vibrancy of matter” and “things” in early childhood education. We use Bennett’s and others’ ideas on the political ecology of place in a philosophical examination of vibrant entanglements of “things,” “thing-hoods,” and childhoods. We work with Bennett’s challenge to shift from thinking solely about “think-power” to also consider “thing-power” and “thing-hood” to take the call for-of things seriously within young children’s place. Matter has agency that behaves in non-predictable ways, in assemblages, aggregates of powers, and forces and things impacting, shaping, and molding other matter and things. Children’s daily connectedness with this vibrancy of matter plays out in the territory of their early years settings as we illustrate through the well-loved stories of Pinocchio and Little Otik. We examine these dead-alive, wooden-thing-materialities as vibrant thing-hoods with agency and power in a theoretical re-reading of Foucauldian thought through new materialist philosophies. This article offers an alternative reading of conceptions of power, discourse, and matter. It provokes further openings and becomings in fresh entanglements, relationships, and responses by conceptualizing them through particular materialities of childhood stories.
The Empirical and the New Empiricisms
Authors: St. Pierre Elizabeth A.
Published: March 2016

The premise of this article is that social science researchers often rush to application, to empirical method and methodology, before studying the history, philosophy, and politics of various empiricisms. Because there are incompatibilities between the empiricisms of different systems of thought, it is dangerous to attempt new empirical work without having studied the old empiricisms, lest those incompatibilities produce weak, fundamentally flawed scholarship. To help prevent such confusions, this article briefly describes two empiricisms commonly used in social science research—logical empiricism and the empiricism of phenomenology—as well as Deleuze and Guattari’s transcendental empiricism, which is being used in much new empirical inquiry.
Does Rapid Diffusion of HbA1c Testing Affect Amputation Rates?
Authors: Bekelis Kimon , Gottlieb Daniel , Newhall Karina , Faerber Adrienne , Goodney Phillip
Published: March 2016

Background:

The association of speed of diffusion of Hemoglobin A1C (hbA1c) testing with temporal changes in outcomes of primary importance to patients with diabetes, such as amputation, remains an issue of debate. We investigated these correlations.

Methods:

We performed a retrospective cohort study of diabetics, based on Medicare fee-for-service claims data from 2002 to 2012. We examined the association of the rate of diffusion of HbA1c testing with changes in amputation rates. Our unit of analysis was the hospital referral region (HRR), a definition of tertiary care markets defined in the Dartmouth Atlas of Health Care.

Results:

From the 11 096 270 diabetics followed in our study for a mean follow-up of 4.1 years, 106 340 (0.96%) underwent lower extremity amputations. The speed of diffusion of HbA1c testing had a moderate association with the speed of diffusion of lower extremity amputations, after adjusting for multiple factors including baseline regional amputation and testing rates (adjusted difference, −0.7%; 95% confidence interval, −1.0% to −0.3%). The risk-adjusted HRR-level speed of diffusion of testing demonstrated significant correlation with the risk-adjusted HRR-level diffusion of amputations ( r = .250, P < .001).

Conclusions:

We observed a moderate association of the speed of diffusion of HbA1c testing with the speed of diffusion of lower extremity amputations among Medicare patients with diabetes. Improvements in performance on quality metrics such as HbA1c testing may not immediately translate into tangible patient outcomes.
Addressing Power in Conversation
Authors: Lorenzetti Liza A. , Azulai Anna , Walsh Christine A.
Published: March 2016

The World Café (TWC), used as an effective conversational tool around the world, shares several tenets with other participatory approaches to learning and development. It has not been critiqued, however, for its insufficient attention to reflexivity, power differentials, and structural inequalities within its process, specifically in relation to TWC facilitators. As a group of women from diverse social locations and backgrounds committed to the pursuit of social justice, we sought this opportunity to explore and investigate the transformative learning capacities of TWC, with the broader goal of enhancing its usability in education and community settings. We reviewed and critiqued TWC conversation approach, suggesting stronger links to liberatory education and transformative learning theories. Using a participatory action research process leading to cocreated knowledge, we developed an Emancipatory Learning Charter, a new tool that can enhance the transformative learning potential of TWC.
The Gift Relationship: Discovering Gift Exchange in Interpersonal Practice
Authors: Brown Christopher Basil
Published: March 2016

Encountering the deeper flows of human experience and glimpsing the touch of the divine on the human soul offer guides and companions rich reflective content for their ongoing formation. This is a precious gift which pilgrims constantly place before their companions, though at times it remains ‘unwrapped’. Through offering a supervision narrative, this paper provides a phenomenological description of such a gift exchange.
Improvements in impaired GABA and GAD65/67 production in the spinal dorsal horn contribute to exercise-induced hypoalgesia in a mouse model of neuropathic pain
Authors: Kami Katsuya , Taguchi, MS Satoru , Tajima Fumihiro , Senba Emiko
Published: March 2016

Background

Physical exercise effectively attenuates neuropathic pain, and multiple events including the inhibition of activated glial cells in the spinal dorsal horn, activation of the descending pain inhibitory system, and reductions in pro-inflammatory cytokines in injured peripheral nerves may contribute to exercise-induced hypoalgesia. Since fewer GABAergic hypoalgesic interneurons exist in the dorsal horn in neuropathic pain model animals, the recovery of impaired GABAergic inhibition in the dorsal horn may improve pain behavior. We herein determined whether the production of gamma-aminobutyric acid (GABA) and glutamic acid decarboxylase (GAD) in the dorsal horn is restored by treadmill running and contributes to exercise-induced hypoalgesia in neuropathic pain model mice. C57BL/6 J mice underwent partial sciatic nerve ligation (PSL). PSL-Runner mice ran on a treadmill at 7 m/min for 60 min/day, 5 days/week, from two days after PSL.

Results

Mechanical allodynia and heat hyperalgesia developed in PSL-Sedentary mice but were significantly attenuated in PSL-Runner mice. PSL markedly decreased GABA and GAD65/67 levels in neuropils in the ipsilateral dorsal horn, while treadmill running inhibited these reductions. GABA+ neuronal nuclei+ interneuron numbers in the ipsilateral dorsal horn were significantly decreased in PSL-Sedentary mice but not in PSL-Runner mice. Pain behavior thresholds positively correlated with GABA and GAD65/67 levels and GABAergic interneuron numbers in the ipsilateral dorsal horns of PSL-Sedentary and -Runner mice.

Conclusions

Treadmill running prevented PSL-induced reductions in GAD65/67 production, and, thus, GABA levels may be retained in interneurons and neuropils in the superficial dorsal horn. Therefore, improvements in impaired GABAergic inhibition may be involved in exercise-induced hypoalgesia.
One-time intrathecal triamcinolone acetonide application alters the redox potential in cerebrospinal fluid of progressive multiple sclerosis patients: a pilot study
Authors: Müller Thomas , Herrling Thomas , Lütge Sven , Lohse Lutz , Öhm Gabi , Jung Katinka
Published: March 2016

Introduction:

Cerebrospinal fluid analysis may provide insight into the interplay between chronic inflammation and response to treatment.

Objectives:

To demonstrate the impact of one intrathecal triamcinolone injection on the redox potential and on ascorbyl radical appearance in the cerebrospinal fluid of chronic progressive multiple sclerosis patients.

Methods:

A total of 16 patients received 40 mg triamcinolone. Electron-spin resonance spectroscopy measured the oxidation range after copper ion [Cu (II)] addition and ascorbyl-radical bioavailability.

Results:

There was an increase of Cu (II) ion absorption, which reflects an augmented content of reduced proteins. Ascorbyl radicals were present in contrast to healthy controls according to the literature.

Conclusion:

Intrathecal steroid application alters the redox potential in cerebrospinal fluid. Our findings support the beneficial role of steroids on oxidative stress generally demonstrated by ascorbyl radical appearance. Reactive oxygen species decline is necessary for an upregulated production of reduced proteins.
Risk factors for infectious readmissions following radical cystectomy: results from a prospective multicenter dataset
Authors: Hemal Sij , Krane Louis S. , Richards Kyle A. , Liss Michael , Kader A. Karim , Davis Ronald L.
Published: March 2016

Introduction:

Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer. This procedure has a high rate of perioperative complications, many of which are infectious in nature. The objective of our study was to evaluate demographic, intrinsic and extrinsic patient variables associated with developing readmission within 30 days due to infectious complications following RC.

Methods:

We acquired data available from the American College of Surgeons National Surgical Quality Improvement Program. We queried this dataset to identify all patients who underwent RC for muscle-invasive malignant disease (CPT 188.x) in 2012 based on CPT coding. Logistic regression analysis was used to investigate the relationship between preoperative variables and readmissions for infectious complications.

Results:

Of the 961 patients undergoing cystectomy for malignancy, 159 (17%) required readmission for any indications at a median of 16 days (interquartile range 13–22 days) postoperatively. We identified 71 of a total of 159 (45%) readmissions, which were due to infectious complications. Smoking was more prevalent in the patient population readmitted for an infectious complication compared with the patient population readmitted for a non-infectious complication (37% versus 25%; p = 0.03). Using logistic regression analysis smoking was associated with a significant risk for readmission due to an infectious cause (odds ratio 2.28, 95% confidence interval 1.82–2.97, p = 0.02). Readmission due to an infectious etiology was not associated with other perioperative factors including type of urinary diversion, sex, duration of operation, hypertension, or recent weight loss.

Conclusion:

Readmission following RC is a common occurrence and infectious complications drive readmission in almost half of the cases. Current smoking was the only independent risk factor for an infectious readmission. Counseling patients in smoking cessation prior to the procedure may provide an avenue for quality improvement to limit readmissions.
Ten questions on prosthetic shoulder infection
Authors: Pinder Elizabeth M , Ong Joshua CY , Bale R Stephen , Trail Ian A
Published: March 2016

Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes.
Regulating Genetic Privacy in the Online Health Information Era
Authors: Magnusson Roger S
Published: March 2016

As the clinical implications of the genetic components of disease come to be better understood, there is likely to be a significant increase in the volume of genetic information held within clinical records. As patient health care records, in turn, come on-line as part of broader health information networks, there is likely to be considerable pressure in favour of special laws protecting genetic privacy. This paper reviews some of the privacy challenges posed by electronic health records, some government initiatives in this area, and notes the impact that developments in genetic testing will have upon the ‘genetic content’ of e-health records. Despite the sensitivity of genetic information, the paper argues against a policy of ‘genetic exceptionalism’, and its implications for genetic privacy laws.
The Use of Clinical Classifications in the Nordic Countries
Authors: Persson Kristina Bränd , Virtanen Martti , Smedby Björn
Published: March 2016

This article gives an overview of the current use of the main clinical classifications in the Nordic countries. A brief introduction describes the background and content of Nordic co-operation in the areas of health statistics and health-related classifications. The use of the current international classifications is well established in the Nordic countries. Some Nordic classifications have been developed in co-operation with maintenance and updating performed as a joint Nordic responsibility.
Preparing for New Health Privacy Legislation in Rural Australia
Authors: Draper Diane
Published: March 2016

This Rural Professional Practice item describes the benefits of a collaborative, regional approach to implementing new health privacy legislation. Videoconferencing has been adopted to surmount the problems of long-distance communication between the Privacy Officers of 11 regional health services spread throughout a large region of south-eastern Australia.
The Pharmacy Management Information System at the Department of Veterans' Affairs
Authors: Moss Elizabeth , Peck Robert , Corkhill Anthony
Published: March 2016

This article describes the pharmacy management information systems environment currently being implemented at the Australian Department of Veterans' Affairs (DVA), and focuses on the objectives and design of the medication management program's management of information. As the system is new, it is too early to predict the difference that it will make to the operations and policy initiatives within the Medication Management section. The anticipated benefits are discussed. The user reaction, and the uses of these management data, are part of an ongoing benefits realisation study and the subject of a future article.
A Classification of Service Types and Glossary of Terminology for Non-Government Mental Health Services
Authors: Wood Christie , Pennebaker Duane
Published: March 2016

This article presents a defined classification of non-government community mental health services designed for reporting by the non-government sector. Initial classification involved review of the relevant literature, advisory committee consultation and content analysis of the Department of Health, Western Australia's service specifications and service contracts. A proposed classification was evaluated by a sample of 50 non-government service providers via focus groups and telephone interviews for internal validity and applicability. The revised classification was validated by Victorian government and non-government providers. The final validated classification contained one service class, seven service types and seven service sub-types, accompanied by a glossary of terms.
Determinants of Job Satisfaction and Effectiveness among Health Information Administration Professionals in Kuwait
Authors: Enezi Naser Al , Shah Makhdoom Ali , Chowdhury Rafiqul Islam , Amatayakul Margret
Published: March 2016

Job satisfaction and organisational effectiveness among health information administration professionals were analysed in relation to selected background, work environment and organisational characteristics. The data comprised a 15% ( n = 171) random sample of health information administration professionals in Kuwait, of whom 91.2% ( n = 156) responded. It was found that remuneration compatible with qualifications, opportunity for continuing education, and work experience had a significant and positive relationship to job satisfaction. It was concluded that the provision of continuing education, availability of orientation and job description, effective supervision, and remuneration compatible with qualifications are facilitators of job satisfaction and organisational effectiveness.
Health Information Management Practice in Sri Lanka
Authors: Gamage U.S.H.
Published: March 2016

Health information system development in Sri Lanka has generally been a low priority. Weaknesses exist in many areas, including vital registration, and hospital information such as inpatient and outpatient morbidity and mortality data. Lapses in hospital information systems are mainly due to incomplete patient medical records; non-availability, inaccuracy and illegibility of the final diagnoses on the front sheets; shortage of trained statistical staff; lack of supervision at all levels; and lack of facilities at medical record departments. WHO's South-East Asian Regional Organization, in collaboration with the Australian National Centre in Classification in Health, has developed a group of trainers who conduct MR/HIM and ICD-10 training courses within the country.
Assessing the Concordance of Trauma Registry Data and Hospital Records
Authors: McKenzie Kirsten , Walker Sue , Besenyei Andrea , Aitken Leanne M , Allison Bridget
Published: March 2016

This study examined the concordance of trauma registry and hospital records in Queensland in 1998. The design involved a retrospective review of records and documentation comparison. Demographic variables from the registry were matched to hospital data to obtain admission/diagnoses data. There were four main types of error identified which included: failure to identify relevant patients, inappropriate inclusion of patients, insufficient/inaccurate data in hospital records, and insufficient/inaccurate data in the trauma registry. Of the 87 cases with data quality issues, 63% were due to Queensland Trauma Registry (QTR) data errors, 5% were due to hospital data errors, and in 32% of cases the source of errors was undetermined. Of the potential 1759 trauma cases from 1998, 12 cases should have been included in the registry that were not, 71 cases should not have been included in the registry, and 4 cases were removed from the study due to insufficient or inaccurate hospital record data. Overall, a concordance rate of approximately 95% was found between the trauma registry records and the hospital records.
Morbidity Data Quality Initiatives in Ireland
Authors: Bramley Michelle , Reid Beth
Published: March 2016

In 2004, the Hospital In-Patient Enquiry and National Perinatal Reporting System (HIPE & NPRS) Unit of the Economic and Social Research Institute in Ireland requested a review of its coder training programs and data quality initiatives, primarily because of the decision to implement a major change in the morbidity classification in January 2005. In August 2004, the authors conducted a formative evaluation using qualitative methods to assess the Unit's programs. A number of opportunities for building on the solid framework the Unit has implemented were identified. The preceding paper focused on the Unit's coder training programs (Bramley & Reid 2005). In this paper, the Unit's data quality initiatives are examined.
Factors Influencing Diffusion of Electronic Medical Records: A Case Study in Three Healthcare Institutions in Japan
Authors: Ochieng Otieno George , Hosoi Ryozo
Published: March 2016

This study examines the effect of three factors: information technology (IT) skills of healthcare workers, present status of computerisation in their organisations, and workers' attitudes on the diffusion of electronic medical records (EMRs) in the healthcare environment. Data were obtained from a self-questionnaire distributed to 390 healthcare workers.

The study finds that respondents need an expanded EMR capability to include decision support systems and reminder systems, and that diffusion of EMR is heavily influenced by attitudes of healthcare workers. However, targeted training of healthcare workers is needed to foster positive attitudes about EMR, and build confidence in the benefits of these systems.
Multiple Perspectives on the Impact of Electronic Ordering on Hospital Organisational and Communication Processes
Authors: Georgiou Andrew , Westbrook Johanna , Braithwaite Jeffrey , Iedema Rick
Published: March 2016

Electronic ordering systems provide many potential benefits for improving the efficiency and effectiveness of healthcare delivery. They also have major implications for organisational and communication processes within hospitals. We undertook a qualitative study using focus groups and interviews with doctors, nurses, IT managers, and pathology laboratory managers to investigate the impact of the system on their work processes and relations within a major teaching hospital. This study revealed that the new electronic ordering system involved major alterations to the information management processes within the hospital, which in turn affected communication processes and work relations.
The Hospital Mortality Project: A Tool for Using Administrative Data for Continuous Clinical Quality Assurance
Authors: Mukhtar S Aqif , Hoffman Neville E , MacQuillan Gerry , Semmens James B
Published: March 2016

The increasing demand for greater clinical accountability requires development of convenient tools to measure healthcare safety and quality, which are able to provide information contemporaneously. The purpose of this paper is to describe the development of the Hospital Mortality Project, a quality assurance initiative designed to encourage and facilitate clinical accountability for hospital mortality by all clinical departments and clinicians. The project was carried out in two stages. Part 1: After registration of in-hospital patient deaths (1 May 2004 to 31 December 2007), the consultant in charge of patient care was notified and requested to assign the death to a predefined category. This categorisation leads to further investigation as appropriate. Part 2: Hospital administrative data from 1 April 1997 to 31 December 2007 were used to assess a defined index, the Hospital Mortality Index (HMI), which was the expressed in the form of an Attribute Control Chart ( p-CHART) and then used as a performance indicator for hospital departments and clinicians. Summary data are reported to the clinical departments and to the hospital executive via the Quality Improvement Committee on quarterly basis. The clinical review was complete for 2,990 of 3,132 (95%) inpatient deaths till 31 December 2007, while a further 142 (5%) deaths are still in the process of being reviewed as of 7 April 2008. The median age of all the cases was 78 years (IQR 67-86) of which 1,657 (53%) were male. The Poisson regression analysis showed that since 1997 departments with a minimum of 100 deaths in total showed no clinically significant change in HMI over time. The Hospital Mortality Project provides a simple and efficient tool to analyse data for clinical managers to facilitate accountability.
Professional Practice and Innovation: Identifying and Flagging Children and Young People under State Guardianship on the Patient Administration System (PAS)
Authors: Drake Tanya , Sydes Belinda
Published: March 2016

In December 2006 a data matching trial was undertaken in partnership between Women's and Children's Hospital (WCH) and Families South Australia (SA), the state child welfare agency, to identify children and young people under guardianship of the Minister for Families and Communities with those already registered on the WCH Patient Administration System (PAS). By identifying this group of children, a priority health response could be initiated to improve their health and wellbeing. The data supplied by Families SA identified 1,683 children currently under guardianship. Data were compared against the WCH PAS, which identified that 72% ( n = 1,212) of these matched with patients who were already registered on the PAS. There were 28% ( n = 471) that did not match; these individuals were registered on the PAS so that if they did present to the hospital the appropriate measures could be taken to ensure they received the necessary treatment and follow-up.
Hospital Planning: The Risks of Basing the Future on Past Data
Authors: Leggat Sandra G
Published: March 2016

Planning for capital development of public hospitals in Victoria is guided by a multi-stage process with comprehensive data analysis and thorough approval processes at each of the stages. The long development timeframes and the limitations in the data available to project service utilisation may negatively impact upon the service planning processes, and in some cases newly developed hospitals have not been sufficiently planned to meet community needs. This paper suggests that service utilisation forecasts derived from administrative databases require a more detailed verification process than currently exists. The process requires consideration of the drivers of demand to document the core assumptions about the future drivers, benchmarks with other jurisdictions, epidemiological, comparative and corporate needs assessment to explain the differences in utilisation rates, and sensitivity analysis. Given the cost of hospital construction and the rate of change in the healthcare sector, it is important that future hospital planning processes do not accept current utilisation trends as valid for future planning without this level of verification.
The Coding Conundrum: A Workplace Perspective
Authors: Postle Barbara , Koeldnik Nadia , Miocevich Tanya
Published: March 2016

Over the last few decades clinical coding has grown in complexity and importance in the eyes of bureaucrats, administrators and clinicians, as new uses for this valuable resource are constantly being identified. Anecdotal evidence suggests that many Australian hospitals are currently experiencing difficulty in both recruiting and retaining clinical coders. The current shortage of clinical coders is a national problem, rather than being peculiar to any one state, and has a multitude of causes. This paper discusses a wide range of issues that have been identified as being relevant to this situation, and they are elaborated from a number of viewpoints, including that of health information management. In this article suggestions for changes that could help rectify this situation are made.
Semantic Interoperability, E-Health and Australian Health Statistics
Authors: Goodenough Sally
Published: March 2016

E-health implementation in Australia will depend upon interoperable computer systems to share information and data across the health sector. Semantic interoperability, which preserves the meaning of information and data when it is shared or re-purposed, is critical for safe clinical care, and also for any re-use of the information or data for other purposes. One such re-use is for national health statistics. Usable statistics rely on comparable and consistent data, and current practice is to use agreed national data standards to achieve this. The standardisation and interoperability needed to support e-health should also provide strong support for national health statistics. This report discusses some of the semantic interoperability issues involved in moving from the current data supply process for national health statistics to an e-health-enabled future.
Healthcare Strategic Planning as Part of National and Regional Development in the Israeli Galilee: A Case Study of the Planning Process
Authors: Peled Ronit , Schenirer Jerry
Published: March 2016

This article describes a systematic process of geographic and strategic planning for healthcare services as a part of a regional development plan in the Israeli Galilee. The planning process consisted of three stages: (a) assessment of needs, demand and existing resources; (b) prioritisation of initiatives; and (c) scheduling of theoretical priorities. For many years the region has suffered from inequities and inequalities regarding the availability and accessibility of a regional healthcare system, resulting in high mortality and morbidity rates and low quality of life. The aim of the healthcare strategic plan was to suggest initiatives and actions to be taken in order to improve healthcare provision and the health and wellbeing of local residents.
Advocating a Quality Assurance Model for the Implementation of E-Health Solutions in Rural South Africa
Authors: Ruxwana Nkqubela L , Herselman Marlien E , Pottas Dalenca , Ouma Stella
Published: March 2016

This companion-discussion paper advocates the need for a quality assurance model for successful acquisition of e-health solutions in rural healthcare centres. We argue that the quality of the entire system is highly influenced by the quality of the processes used to acquire, develop, implement and maintain it. Central to these processes is the incorporation of user participation that adopts a ‘bottom-up’ rather than a ‘top-down’ approach. We present a selection of literature of relevance to the research work in progress, with a view to understanding ways in which quality assurance methodologies can be used to add value and ensure high quality care and service delivery in rural South Africa.
Damages Claim for Wrongful Birth Due to a Systems Failure
Authors: Mair Judith
Published: March 2016

Health professionals are well versed in the need to have systems in place which avoid mishaps happening to patients due to human error or breakdown in communications: for example, legal actions for damages for operations wrongfully performed on patients due to a failure in the identification process; surgery involving the wrong limb or organ; medications being given to the wrong patient. Hospitals set in place systems by which a patient's name and procedures to be performed are checked multiple times throughout the patient's stay. This process is particularly vital when a patient is undergoing a surgical procedure which will be performed under anaesthesia. Nevertheless, systems failures continue to occur resulting in claims for damages by affected patients.
The Application of Data Mining to Explore Association Rules between Metabolic Syndrome and Lifestyles
Authors: Huang Yi Chao
Published: March 2016

This study used an efficient data mining algorithm, called DCIP (the data cutting and inner product method), to explore association rules between the lifestyles of factory workers in Taiwan and the metabolic syndrome. A total of 1,216 workers in four companies completed a lifestyle questionnaire. Results of the questionnaire survey were integrated into the workers' health examination reports to form an attribute database of the metabolic syndrome. Among the association rules derived by DCIP, 80% of those on the list of the top 15 highest support counts are corroborated by medical literature or by healthcare professionals. These findings prove that data mining is a valid and effective research method, and that larger sample sizes will likely produce more accurate associations connecting the metabolic syndrome to specific lifestyles. The rules already verified can serve as a reference guide for the health management of factory workers. The remaining 20%, while still lacking hard evidence, provide fertile ground for future research.
The Concept of ‘Intent’ within Australian Coronial Data: Factors Affecting the National Coronial Information System's Classification of Mortality Attributable to Intentional Self-Harm
Authors: Dodds Leonie , Robinson Kerin M. , Daking Leanne , Paul Lindsay
Published: March 2016

within Australia all unexpected deaths are investigated by the Coroners Court; specifically, the coroner investigates the identity of the deceased and the cause and circumstances of death. This ‘unexpected death’ category inevitably includes cases of self-harm and suicide. Concerns regarding the accurate reporting of national suicide statistics resulted in a review of the coding process undertaken by the Australian Bureau of Statistics (ABS), which produces the national statistics, and a formal Commonwealth Government Senate Inquiry in 2009. This article reflects data and opinions collected prior to the Senate Inquiry or the adjustment of the ABS coding processes, and explores the role of the Coroner in determining the intent of the deceased person and the role the National Coronial Information System (NCIS) 1 database plays in the provision of this information. At the Case Notification and Case Closure stages of the coronial process, administrative coders abstract from the coronial file the ‘intent’ of the deceased and enter the data into relevant administrative systems (which upload to the NCIS). The relevant intent code in the NCIS is ‘Intentional Self-Harm’, which incorporates deliberate actions of self-harm and suicide. A mixed-method study was employed to investigate anecdotal reports of a problematic coronial coding process surrounding this category of cases. A sample of Australian coroners ( n=16), and of the national population of NCIS coders (n=36), were surveyed using separate instruments, and an unobtrusive case review of sampled NCIS cases ( n= 127) reflecting nine key mechanisms-of-death, was undertaken. Each Australian state and territory has its own Coroners Act, none of which provides legislative direction regarding the determination of intent by the coroner. Neither the coroner-respondents nor the coders favoured a standard proforma to record ‘intent’. In order to inform their classificatory decision-making regarding the deceased's ‘intent’, the coders need to abstract extensively from the entire case file, scrutinising documentary materials from different investigators. They rely primarily on the police report at Case Notification and the coroner's finding at Case Completion. Coders do not generally perceive the classification of ‘intent’ to be problematic; however, despite NCIS-provided coder (technical) support materials, there exist inconsistent coder work practices and, sometimes, absent documentary evidence reflecting lack of information for ascertainment and interpretation by the coroner, investigators, and forensic experts on the ‘intent’ of the deceased. The gap between what a coroner is legally required to document regarding ‘intent’ and what society needs to know for statistical and preventive purposes, seems problematic to bridge.
Factors Influencing Nurses' Acceptance of Hospital Information Systems in Iran: Application of the Unified Theory of Acceptance and Use of Technology
Authors: Sharifian Roxana , Askarian Fatemeh , Nematolahi Mohtaram , Farhadi Payam
Published: March 2016

User acceptance is a precondition for successful implementation of hospital information systems (HISs). Increasing investment in information technology by healthcare organisations internationally has made user acceptance an important issue in technology implementation and management. Despite the increased focus on hospital information systems, there continues to be user resistance. The present study aimed to investigate the factors affecting hospital information systems nurse-user acceptance of HISs, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), in the Shiraz University of Medical Sciences teaching hospitals. A descriptive-analytical research design was employed to study nurses' adoption and use of HISs. Data collection was undertaken using a cross-sectional survey of nurses (n=303). The research model was examined using the LISREL path confirmatory modeling. The results demonstrated that the nurses' behavioural intention (BI) to use hospital information systems was predicted by Performance Expectancy (PE) (β= 2.34, p<0.01), Effort Expectancy (EE) (β= 2.21, p<0.01), Social Influence (SI) (β= 2.63, p<0.01) and Facilitating Conditions (FC) (β= 2.84, p<0.01). The effects of these antecedents of BI explained 72.8% of the variance in nurses' intention to use hospital information systems (R2 = 0.728). Application of the research model suggested that nurses' acceptance of HISs was influenced by performance expectancy, effort expectancy, social influence and facilitating conditions, with performance expectancy having the strongest effect on user intention.
Maternity Patients' Access to Their Electronic Medical Records: Use and Perspectives of a Patient Portal
Authors: Forster Megan , Dennison Kerrie , Callen Joanne , Georgiou Andrew , Westbrook Johanna I.
Published: March 2016

Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 ( n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response rate of 8.1%; 80/985). The majority of respondents indicated they would use the portal and access their EMR for future pregnancies (86.2%; 69/80). Approximately half looked at their EMR after a visit with their care provider (51.3%); 41/80) and 37.5% (30/80) viewed their EMR before, to prepare for their visit. The majority (65.8%) thought that the EMR improved their ability to understand and recall appointments and almost half (48.1%) thought that with the EMR they were less likely to repeat pregnancy information to caregivers. This study provides the first Australian evidence of a patient portal system, tied to an EMR, working effectively in a maternity care context. It provides new evidence that portals can deliver benefits to maternity patients in terms of providing quick and easy access to current personal and general health information and support patients in their ability to recall and prepare for appointments.
Information Technology Skills and Training Needs of Health Information Management Professionals in Nigeria: A Nationwide Study
Authors: Adeleke Ibrahim Taiwo , Lawal Adedeji Hakeem , Adio Razzaq Adetona , Adebisi AbdulLateef Adisa
Published: March 2016

There is a lack of effective health information management systems in Nigeria due to the prevalence of cumbersome paper-based and disjointed health data management systems. This can make informed healthcare decision making difficult. This study examined the information technology (IT) skills, utilisation and training needs of Nigerian health information management professionals. We deployed a cross-sectional structured questionnaire to determine the IT skills and training needs of health information management professionals who have leadership roles in the nation's healthcare information systems ( n=374). It was found that ownership of a computer, level of education and age were associated with knowledge and perception of IT. The vast majority of participants (98.8%) acknowledged the importance and relevance of IT in healthcare information systems and many expressed a desire for further IT training, especially in statistical analysis. Despite this, few (8.1 %) worked in settings where such systems operate and there exists an IT skill gap among these professionals which is not compatible with their roles in healthcare information systems. To rectify this anomaly they require continuing professional development education, especially in the areas of health IT. Government intervention in the provision of IT infrastructure in order to put into practice a computerised healthcare information system would therefore be a worthwhile undertaking.
Stakeholder Analysis for Adopting a Personal Health Record Standard in Korea
Authors: Kang Min-Jeoung , Jung Chai Young , Kim Soyoun , Boo Yookyung , Lee Yuri , Kim Sundo , Choi Yeonmi , Lee Eui-Kyung , Kim Sukil
Published: March 2016

Background:

Interest in health information exchanges (HIEs) is increasing. Several countries have adopted core health data standards with appropriate strategies.

Objective:

This study was conducted to determine the feasibility of a continuity of care record (CCR) as the standard for an electronic version of the official transfer note and the HIE in Korean healthcare.

Method:

A technical review of the CCR standard and analysis of stakeholders' views were undertaken. Transfer notes were reviewed and matched with CCR standard categories. The standard for the Korean coding system was selected. Stakeholder analysis included an online survey of members of the Korean Society of Medical Informatics, a public hearing to derive opinions of consumers, doctors, vendors, academic societies and policy makers about the policy process, and a focus group meeting with EMR vendors to determine which HIE objects were technically applicable.

Results:

Data objects in the official transfer note form matched CCR standards. Korean Classification of Diseases, Korean Standard Terminology of Medicine, Electronic Data Interchange code (EDI code), Logical Observation Identifiers Names and Codes, and Korean drug codes (KD code) were recommended as the Korean coding standard. ‘Social history’, ‘payers’, and ‘encounters’ were mostly marked as optional or unnecessary sections, and ‘allergies’, ‘alerts’, ‘medication list’, ‘problems/diagnoses’, ‘results’, and ‘procedures’ as mandatory. Unlike the US, ‘social history’ was considered optional and ‘advance directives’ mandatory. At the public hearing there was some objection from the Korean Medical Association to the HIE on legal grounds in terms of intellectual property and patients’ personal information. Other groups showed positive or neutral responses. Focus group members divided CCR data objects into three phases based on predicted adoption time in CCR: (i) immediate adoption; (ii) short-term adoption (‘alerts’, ‘family history’); and (iii) long-term adoption (‘results’, ‘advanced directives’, ‘functional status’, ‘medical equipment’, ‘vital signs’, ‘plan of care’, ‘social history’).

Conclusion:

There were no technical problems in generating the CCR standard document from EMRs. Matters of concern that arose from study results should be resolved with time and consultation.
A Systematic Literature Review on Security and Privacy of Electronic Health Record Systems: Technical Perspectives
Authors: Rezaeibagha Fatemeh , Win Khin Than , Susilo Willy
Published: March 2016

Background:

Even though many safeguards and policies for electronic health record (EHR) security have been implemented, barriers to the privacy and security protection of EHR systems persist.

Objective:

This article presents the results of a systematic literature review regarding frequently adopted security and privacy technical features of EHR systems.

Method:

Our inclusion criteria were full articles that dealt with the security and privacy of technical implementations of EHR systems published in English in peer-reviewed journals and conference proceedings between 1998 and 2013; 55 selected studies were reviewed in detail. We analysed the review results using two International Organization for Standardization (ISO) standards (29100 and 27002) in order to consolidate the study findings.

Results:

Using this process, we identified 13 features that are essential to security and privacy in EHRs. These included system and application access control, compliance with security requirements, interoperability, integration and sharing, consent and choice mechanism, policies and regulation, applicability and scalability and cryptography techniques.

Conclusion:

This review highlights the importance of technical features, including mandated access control policies and consent mechanisms, to provide patients' consent, scalability through proper architecture and frameworks, and interoperability of health information systems, to EHR security and privacy requirements.
Rural and Remote Dental Services Shortages: Filling the Gaps through Geo-Spatial Analysis Evidence-Based Targeting
Authors: Shiikha Yulia , Kruger Estie , Tennant Marc
Published: March 2016

Background:

Australia has a significant mal-distribution of its limited dental workforce. Outside the major capital cities, the distribution of accessible dental care is at best patchy.

Objective:

This study applied geo-spatial analysis technology to locate gaps in dental service accessibility for rural and remote dwelling Australians, in order to test the hypothesis that there are a few key location points in Australia where further dental services could make a significant contribution to ameliorating the immediate shortage crisis.

Method:

A total of 2,086 dental practices were located in country areas, covering a combined catchment area of 1.84million square kilometers, based on 50 km catchment zones around each clinic. Geo-spatial analysis technology was used to identify gaps in the accessibility of dental services for rural and remote dwelling Australians. An extraction of data was obtained to analyse the integrated geographically-aligned database.

Results:

Resolution of the lack of dental practices for 74 townships (of greater than 500 residents) across Australia could potentially address access for 104,000 people. An examination of the socio-economic mix found that the majority of the dental practices (84%) are located in areas classified as less disadvantaged. Output from the study provided a cohesive national map that has identified locations that could have health improvement via the targeting of dental services to that location.

Conclusion:

The study identified potential location sites for dental clinics, to address the current inequity in accessing dental services in rural and remote Australia.