The adoption of healthcare information systems within public hospitals in Kurdistan region of Iraq

In Iraq, government reports stated that the ‎adoption of Healthcare Information Systems ‎‎(HIS) is still low and below the aspirations of the ‎government despite the investments in the system ‎development. For this reason, there was a need to ‎explore and investigate the actual issues that ‎influence the adoption of HIS, and to examine the ‎effect of different dimensions (i.e. the individual, ‎technological, organizational and environmental) ‎on the adoption of HIS in Iraq. The main objective of the study is to explore the ‎factors that affect the adoption of HIS among ‎healthcare practitioners within Kurdistan Region ‎of Iraq (KRI) public hospitals. Furthermore, ‎another goal was to examine the influence of ‎different dimensions on the healthcare ‎practitioners’ adoption behavior in order to ‎produce the essential knowledge regarding HIS ‎adoption. The study used a mixed method approach. The ‎data collection started with a qualitative study ‎using semi-structured interviews with eight ‎healthcare professionals and then followed by a ‎quantitative study that was conducted among 551 ‎respondents using self-administered ‎questionnaires. The qualitative study resulted in 26 themes that ‎were elicited from the interviews. Moreover, the ‎findings of the quantitative study indicated that ‎the adoption of HIS was significantly influenced ‎by different individual, technological, ‎organizational and the environmental dimensions ‎collectively. The study revealed the actual issues (i.e. the ‎individual, technological, organizational and ‎environmental) facing the adoption of HIS within ‎the study’s new context through the qualitative ‎investigation. Moreover, a comprehensive and ‎holistic model based on the Unified Theory of ‎Acceptance and Use of Technology (UTAUT) ‎was presented. The study presented the essential ‎knowledge and information to the literature, ‎healthcare practitioners and researchers in Iraq ‎regarding the issue of HIS adoptio

Factors affecting adoption of eHealth in Egypt

This research investigates the factors that affect technology acceptance in the eHealth domain with regard to Egypt. It also focuses on the impact of the perceptions and attitudes of online privacy, due to the sensitivity of healthcare information, and trust, in addition to the other technology acceptance factors affecting acceptance of eHealth in Egypt. The aims of the research were to (i) understand the impact of general attitudes to online privacy and associated concerns on the acceptance and uptake of eHealth services, and (ii) to develop an enhanced technology acceptance model that takes into consideration factors pertaining to technology acceptance adopted from the UTAUT Model as well as online privacy, online trust and Internet experience factors. Results from a questionnaire survey of a randomly selected sample of computer literate members of the general public revealed interesting correlations between users’ acceptance of eHealth services and attitudes to online privacy, indicating that users’ general attitudes to online privacy negatively affect eHealth acceptance. Factors pertaining to the UTAUT model such (performance expectancy, effort expectancy, and facilitating conditions) have a positive impact on potential acceptance. Furthermore, factors of online trust and Internet experience and exposure also show a positive impact on eHealth technology acceptance. Questions used to measure eHealth technology acceptance were adapted to the eHealth domain as well as to the Egyptian culture in order to reflect potential users’ understanding of eHealth concepts. The Unified Theory of Acceptance and Use of Technology (UTAUT) model (Venkatesh et al., 2003) was used as a foundation for testing factors of technology acceptance. Linked issues such as e-privacy threats such unauthorized use of personal information, privacy policies and regulations, and possible links with existing technology acceptance models in the eHealth context were also investigated. The research concluded that these additional factors of privacy and trust are relevant to technology acceptance in the eHealth context, and should be included in technology acceptance models. The results of this research, in terms of recommendations made for eHealth, will directly benefit the Egyptian government; commercial services and eHealth researchers among others

From worry to hope : an ethnography of midwife – woman interactions in the antenatal appointment

Better outcomes for mother and baby observed in 'midwifery continuity of carer' programmes are attributed to positive midwife-woman relationships formed within these models, but this effect is not fully understood. Like midwife-led care, continuity of midwifery carer in Australia continues not to be seen as mainstream. To advocate for and better understand this continuity of carer model, this study used video ethnography framed by feminism and a critical approach. Midwife-woman interactions in a number of late pregnancy antenatal appointments were observed and filmed. These were at two Sydney hospitals with either the midwifery continuity of carer programme or in standard maternity care. Focus groups and interviews were undertaken. Thematic and content analysis techniques were used. Worry was a common feature of the antenatal appointment. It reflects the worry pregnant women report: worry about pregnancy, their baby, uncertainty about birth and transition to motherhood. 'Dysfunctional' or 'iatrogenic' worry occurred with system-focused midwives invested in standardised/medicalised tasks, whereas 'functional' worry occurred with woman-centred midwives invested in the woman. Hope creation was also seen, although less frequently. It occurred when worry was moderated and linked with adaptation of standardised and medicalised appointment factors, including environment, time, and midwife investment (how she interacted with the woman). Regardless of where they worked, some midwives were 'adaptive experts', but in most instances the midwives in continuity had greater opportunity to adapt. This adaptation resulted in midwife-woman interactions being bidirectional and shared, with discussing and storytelling taking place, rather than one-way midwife telling. These shared interactions created connection, or reflected the connection created by continuity of carer. This study showed the benefit of the midwifery continuity of carer programme. It provided opportunity for midwives to adapt, worry was moderated, and women appeared more hopeful. Being more hopeful may enable women to better manage their labours and parenting, creating these improved outcomes

Les conséquences inattendues de l'utilisation de la télésanté et l'implication des citoyens-patients dans le développement des services au Québec

L’introduction de la télésanté dans l’offre des soins et services implique des changements et des transformations importants, attendus ou inattendus, de diverses natures, et ce à différents niveaux : sociopolitique, économique, organisationnel, clinique, professionnel, culturel, humain, légal, éthique et technologique. Certains enjeux sensibles associés à la télésanté révèlent le fossé existant entre une vision historique, dite techniciste (ou solutionniste), et les attentes, besoins et contextes des utilisateurs en ce qui a trait à sa vraie utilité et valeur ajoutée pour eux. Il est, en effet, à constater que dans l’histoire de l’évolution de la télésanté, notamment au Québec, les citoyens-patients sont les grands absents des décisions relatives au développement des services, alors que leur implication pourrait constituer un levier important pour éclairer la décision. De plus, il y a un manque important de travaux ayant questionné les conséquences multidimensionnelles et systémiques, attendues ou inattendues, négatives ou positives, de la télésanté sur les individus et groupes (ex. patients, communautés, professionnels), les organisations ainsi que sur les systèmes de santé. Cette thèse, composée de deux volets complémentaires, a pour finalité : 1) d’identifier les conséquences inattendues multidimensionnelles et multiniveaux de dix projets innovants et d’envergure de télésanté qui ont été implantés au Québec ; et 2) d’explorer la possibilité d’impliquer les citoyens-patients dans les décisions relatives au développement des services de télésanté selon la perspective croisée des différentes parties prenantes concernées au Québec. Pour le premier volet, soit l’étude des conséquences inattendues de la télésanté, nous avons effectué une analyse secondaire des données d’évaluation de 10 projets innovants et structurants ayant été implantés au Québec sur une période de 22 ans. Les données ont fait l’objet d’une analyse qualitative thématique en prenant pour assise le modèle des conséquences inattendues des technologies d’information en santé (adapté de Bloomrosen et al., 2011). Pour le deuxième volet, soit l’étude de l’implication des citoyens-patients dans le développement des services de télésanté au Québec, des entrevues semi-dirigées ont été menées auprès de 29 informateurs clés. Une analyse qualitative thématique des données a été effectuée en s’appuyant sur un cadre conceptuel intégrateur dérivé des théories de diffusion des innovations (adapté de Greenhalgh et al., 2004). Le premier volet a permis de constater que la télésanté requiert de nombreux ajustements, changements et négociations, souvent sous-estimés dans les étapes de planification des projets de télésanté. De plus, la télésanté peut être à l’origine de nombreuses conséquences inattendues, positives ou négatives, qui touchent aussi bien les individus, les groupes, les organisations que le système de santé dans sa globalité. Le deuxième volet démontre que l’implication des citoyens-patients dans le développement des services de télésanté se réfère davantage à une idée théorique qu’à une pratique réelle dans les organisations et le système de santé du Québec, ce qui lui confère encore un statut d’innovation pour de nombreux acteurs. Malgré les nombreuses incertitudes et les questionnements qui l’accompagnent, cette perspective est perçue comme pouvant éclairer la prise de décision et aider à implanter des services de télésanté harmonieux et socialement responsables, tout en impulsant l’innovation dans les organisations et le système de santé. Par ailleurs, les résultats ont montré que l’implication des citoyens-patients dans la prise de décision est fortement tributaire de nombreuses conditions organisationnelles et systémiques interdépendantes. Ils ont permis de constater un grand fossé entre le monde de la recherche sur la question et celui de la prise de décision, d’où le besoin d’un transfert soutenu des connaissances pour une meilleure traduction des connaissances dans l’actionThe introduction of telehealth in the delivery of healthcare and services involves significant, attended or unintended, changes and transformations of various kinds and at different levels: socio-political, economic, organizational, clinical, professional, cultural, human, legal, ethical and technological. The sensitivity of certain issues associated with telehealth points to the gap between a historical vision, known as a technicist (or solutionist), and the actual expectations, needs and contexts of users with respect to its real usefulness and added value for them. It should indeed be noted that in the history of the evolution of telehealth, especially in Quebec, citizen-patients were the major absentees in decisions relating to the development of the services, whereas their involvement could constitute an important lever to inform decisions. In addition, there is a significant lack of research that has addressing the multidimensional and systemic, attended or unintended, negative or positive, consequences of telehealth on individuals and groups (e.g., patients, communities, and professionals), organizations, and health systems. This thesis, composed of two complementary components, aims to: 1) identify the multidimensional and multilevel unintended consequences of ten innovative and large scale telehealth projects that have been implemented in Quebec; and 2) explore the possibility of involving citizen-patients in decisions concerning the development of telehealth services in the cross-perspective of the different stakeholders concerned in Quebec. We used a predominantly qualitative approach. For the first part, the study of the unintended consequences of telehealth, we conducted a secondary analysis of the evaluation data of 10 innovative and structuring projects having been implemented in Quebec, over a 22-year period. The data were the subject of a thematic qualitative analysis based on the model of the unintended consequences of health information technologies (adapted from Bloomrosen et al., 2011). For the second part, the study of citizenpatient involvement in the development of telehealth services in Quebec, semi-structured interviews were conducted with 29 key informants. A thematic qualitative analysis of the data was carried out based on an integrative conceptual framework derived from the diffusion of innovation theories (adapted from Greenhalgh et al., 2004). The first part found that telehealth requires many adjustments, changes and negotiations, which are often underestimated in the planning stages of telehealth projects. In addition, telehealth could be the source of many unintended consequences, sometimes harmful, that affect individuals and groups, health organizations, and the health system as a whole. The second part helped show that citizen-patient involvement in the development of telehealth services is more of a theoretical idea than a real practice in Quebec's organizations and health system, which places it still at the stage of innovation for many shareholders. It remains that despite the many uncertainties and questions that accompany it, this perspective is seen as potentially informing decision-making and helping to implement harmonious and socially responsible telehealth services, this while driving innovation in organizations and the health system. In addition, the results showed that citizen-patient involvement in decision-making is highly dependent on many interrelated organizational and systemic conditions. The gap between research on the issue and decision-making has also emerged, pointing out the need for sustained knowledge transfer for a better translation of knowledge into action

Evidence-Based Practice for the Athletic Training Profession

As evidence-based practice (EBP) becomes a necessity in athletic training, it is essential to recognize current barriers and modes of accessibility to information for enhancement of clinical decision-making. Furthermore, the effectiveness of educational interventions (EI) to enhance knowledge of EBP concepts must be investigated. The aim of Project I was to assess attitudes and beliefs, perceived barriers, and accessibility to resources of EBP among athletic trainers (AT). Project II was designed to investigate the effect of an EI on enhancing AT\u27s knowledge of EBP concepts. Project III explored ATs\u27 experiences of the EI and whether it elicited changes within their educational or clinical practices. The Evidence-Based Concepts Assessment (EBCA) was utilized in Project I to survey 1,209 athletic training educators, clinicians, and post-professional students. Overall, participants agree (3.27) EBP has various benefits to clinical practice and disagree (2.23) that there are negative perceptions associated with EBP. Clinical prediction rules (22.1%) and Cochrane databases (22.8%) were the two resources with the least direct access. Time (76.6%) and availability of EBP mentors (69.6%) were the two most prevalent barriers towards implementation of EBP. Project II consisted of the development of 10 online modules focusing on various EBP concepts; these online modules were assessed through a randomized controlled trial design among 164 athletic training educators, clinicians, and students. Composite scores on the Evidence-Based Practice Knowledge Assessment prior to implementation phase did not differ between the control and experimental group (MCPre=30.12±5.73, M EPre=30.65±5.93); however, the experimental group (M EPost=36.35±8.58) obtained significantly higher scores (P=0.013) on the post-assessment compared to the control group (MCPost=30.99±6.33). No differences were identified between time instances within the control group ( P=0.080); however the experimental group obtained significantly higher scores on the post-assessment than the pre-assessment (P\u3c0.001). The 25 ATs (12 educators, 13 clinicians) interviewed six months following the implementation of the online modules identified knowledge gain and enhanced importance of EBP as beneficial outcomes of the modules. Educators described a positive impact on teaching as well as the ability to instill value and practice of EBP among students. Clinicians reported an enhanced ability to implement EBP following the modules, but that the EI did not directly impact behavioral changes within daily clinical practice. Strategies to incorporate EBP throughout the athletic training profession were also identified

Evidence-Based Practice in Clinical Social Work

Evidence-based practice (EBP) is a major shaping influence in clinical social work practice, in relation to economic policies, and in professional education. The definition of EBP remains contested; professionals still fail to distinguish EBP as a practice decision-making process from a list of treatments that have some type of research support (which are correctly called empirically supported treatments). All mental health practitioners should understand what EBP is, what it is not, and how it shapes both client options and their own practice experiences. This book explores EBP in depth and in detail. Our focus includes case exemplars that show how the EBP decision-making process is done in practice. There are many recent books about evidence-based practice in social work and in other mental health professions. In reviewing these books, it appeared to us that most of the books on EBP have been written by researchers, bringing a particular point of view and expertise to the technicalities of EBP. These books are important to social workers and other mental health professionals because EBP involves a lot of technical details about research design, methods, and interpretation that are not always covered in other social work texts. On the other hand, the lack of a more direct practice and clinical viewpoint seemed to leave out a lot of the day-to-day realities clinical social workers confront in learning and using EBP in practice. Recent books also lacked much in the way of a broad and critical perspective on EBP as a social movement shaping policy, agency practice, and views of what constitutes “good” research. As we explored other books as resources for our students and for our own practice, we missed both a larger or meta-perspective on EBP and a lack of attention to doing it in clinical practice. This book seeks to illustrate through several cases how important clinical knowledge and expertise are in doing EBP well. We seek to introduce the core ideas and practice of EBP and then illustrate them by applying the concepts and processes to real-world cases. We also take a critical look at how EBP has been implemented in practice, education, and policy. Eight years after we wrote the first edition of this book, EBP continues to be a major influence on clinical practice. Some areas of the book, particularly the research evidence used in our case examples, needed to be updated and mad

The First 25 Years of the Bled eConference: Themes and Impacts

The Bled eConference is the longest-running themed conference associated with the Information Systems discipline. The focus throughout its first quarter-century has been the application of electronic tools, migrating progressively from Electronic Data Interchange (EDI) via Inter-Organisational Systems (IOS) and eCommerce to encompass all aspects of the use of networking facilities in industry and government, and more recently by individuals, groups and society as a whole. This paper reports on an examination of the conference titles and of the titles and abstracts of the 773 refereed papers published in the Proceedings since 1995. This identified a long and strong focus on categories of electronic business and corporate perspectives, which has broadened in recent years to encompass the democratic, the social and the personal. The conference\u27s extend well beyond the papers and their thousands of citations and tens of thousands of downloads. Other impacts have included innovative forms of support for the development of large numbers of graduate students, and the many international research collaborations that have been conceived and developed in a beautiful lake-side setting in Slovenia

Mammography

In this volume, the topics are constructed from a variety of contents: the bases of mammography systems, optimization of screening mammography with reference to evidence-based research, new technologies of image acquisition and its surrounding systems, and case reports with reference to up-to-date multimodality images of breast cancer. Mammography has been lagged in the transition to digital imaging systems because of the necessity of high resolution for diagnosis. However, in the past ten years, technical improvement has resolved the difficulties and boosted new diagnostic systems. We hope that the reader will learn the essentials of mammography and will be forward-looking for the new technologies. We want to express our sincere gratitude and appreciation?to all the co-authors who have contributed their work to this volume

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

Background Flexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme. Aim To conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation. Objectives (1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes? Data sources Searches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search. Design Mapping review and rapid, systematic evidence syntheses. Setting Care homes with and without nursing in high-income countries. Review methods Published literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses. Results Seven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising. Limitations This review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded. Conclusions This review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation. Future work Future work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context. Study registration This study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938. Funding The National Institute for Health Research Health Services and Delivery Research programme