Organizational Strategies for the Adoption of Electronic Medical Records: Toward an Understanding of Outcome Variation in Nursing Homes

[Excerpt] An important element in president-elect Obama\u27s economic stimulus proposal is his plan to invest a significant proportion of federal dollars in installing electronic medical records (EMR) in U.S. healthcare institutions. In emphasizing the need for EMR, Obama is following the advice of numerous healthcare experts who have pointed out that the healthcare sector lags behind other industries in the use of computer technology. They believe the widespread use of EMR would help reduce medical errors, control the costs of healthcare, and lead to significant improvements in the quality of care Americans receive. In this paper we present preliminary results of an ongoing study of the introduction of EMR in 20 nursing homes in the New York City area. Although most observers believe EMR holds great promise for the improvement of healthcare, in fact recent studies have found mixed evidence regarding the effect of EMR on patient outcomes. The evidence we have gathered to date suggests that whether EMR has beneficial effects on the costs and quality of healthcare depends very much on the purposes and objectives nursing home managers and administrators intend to achieve through its use. That is, management strategy and style, we believe, strongly influences healthcare outcomes associated with technological innovation

Exploration of The Duality Between Generalized Geometry and Extraordinary Magnetoresistance

We outline the duality between the extraordinary magnetoresistance (EMR), observed in semiconductor-metal hybrids, and non-symmetric gravity coupled to a diffusive $U(1)$ gauge field. The corresponding gravity theory may be interpreted as the generalized complex geometry of the semi-direct product of the symmetric metric and the antisymmetric Kalb-Ramond field: ($g_{\mu\nu}+\beta_{\mu\nu}$). We construct the four dimensional covariant field theory and compute the resulting equations of motion. The equations encode the most general form of EMR within a well defined variational principle, for specific lower dimensional embedded geometric scenarios. Our formalism also reveals the emergence of additional diffusive pseudo currents for a completely dynamic field theory of EMR. The proposed equations of motion now include terms that induce geometrical deformations in the device geometry in order to optimize the EMR. This bottom-up dual description between EMR and generalized geometry/gravity lends itself to a deeper insight into the EMR effect with the promise of potentially new physical phenomena and properties.Comment: 13 pages and 6 figures. Revised/edited for clarity and purpose. Several references added. Updated title based on suggestions and comments received. Version accepted for publication in Phys.Rev.

Is transcription of data on antiretroviral treatment from electronic to paper-based registers reliable in Malawi?

SETTING: Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi. OBJECTIVE: To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This was done to inform the Ministry of Health on the reliability of the paper-based system as backup in case of EMR failure. DESIGN: Retrospective analysis of routine programme data. RESULTS: A total of 31 763 registrations and 2922 deaths in the EMR were compared with those in the paper registers. In one hospital, up to 24% of overall case registrations were missing from the paper registers. At other sites, the differences were minor and included duplicate patients who should have been classified as ‘transfer in’ patients in the paper register. There were major differences in the number of registered deaths in two of the five facilities. CONCLUSION: There are varying degrees of agreement between the EMR and paper registers which compromise the use of the latter as a backup solution in case of EMR failure. The reasons for this unreliability and ways forward to address the problem are discussed

Optimization of the extraordinary magnetoresistance in semiconductor-metal hybrid structures for magnetic-field sensor applications

Semiconductor-metal hybrid structures can exhibit a very large geometrical magnetoresistance effect, the so-called extraordinary magnetoresistance (EMR) effect. In this paper, we analyze this effect by means of a model based on the finite element method and compare our results with experimental data. In particular, we investigate the important effect of the contact resistance $\rho_c$ between the semiconductor and the metal on the EMR effect. Introducing a realistic $\rho_c=3.5\times 10^{-7} \Omega{\rm cm}^2$ in our model we find that at room temperature this reduces the EMR by 30% if compared to an analysis where $\rho_c$ is not considered.Comment: 4 pages; manuscript for MSS11 conference 2003, Nara, Japa

Impact of L-carnitine and selenium treatment on testicular apoptosis in rats exposed to 2.45 GHz microwave energy

Objective: It has been suggested that electromagnetic radiation (EMR) by wireless devices (2.45 GHz) induces testicular apoptosis. We investigated if supplemental selenium (Se) and L-carnitine may reduce this adverse effect. Material: Twelve-week old maleWistar albino rats were used in this study. Twenty-four rats were equally divided into four groups which were named as: sham group, EMR-only, EMR+L-carnitine (1.5 mg L-carnitine/ kg/day) and EMR+Se (1.5 mg Se/kg/ every other day). Results: The level of Bcl-2, Bax, caspase-3 and -8 were compared and a significant difference was found between the sham and EMR-only groups (p < 0.05), and Bcl-2, Bax, caspase-3 and -8 expressions increased in the EMR-only group. The level of Bcl-2, Bax, tumour necrosis factor-alpha (TNF-α), caspase- 3 and -8 were compared and a significant difference was found between the sham and EMR+L-carnitine groups (p < 0.05) and Bcl-2, Bax, TNF-α, caspase-3 and -8 expressions increased in the EMR+L-carnitine group. The level of Bcl-2, Bax, TNF-α, caspase-3 and -8 were compared and a significant difference was found between the sham and EMR+Se groups (p < 0.05) and Bcl-2, Bax, TNF-α, caspase-3 and -8 expressions increased in the EMR+Se group. When the expression of caspase-8 was compared, a significant difference was found between the EMR-only and EMR+Se groups (p < 0.05). Caspase-8 expression decreased in EMR+Se group compared with EMR-only group. Conclusion: Electromagnetic radiation exposure resulted in testicular apoptosis in rats, mainly by the intrinsic pathways by down-regulated expression of caspase-8. Reduction in the activation of the intrinsic pathway of apoptosis was found higher with selenium administration compared with L-carnitine administration

Acceptance model of electronic medical record

This paper discusses acceptance issues of Electronic Medical Record System (EMR), particularly in Malaysia. A detailed overview of EMR and its benefits are firstly discussed. A number of acceptance models are scrutinized. Then factors affecting EMR acceptance are put forward. Finally, before proposing an EMR acceptance model, an instrument formed by adapting and then finding its factors loading is presented

The effect of alcohol on the performance of lipase-immobilized enzymatic membrane reactor for esterification of (R,S)-ketoprofen

The effect of alcohols on the performance of lipase-immobilized enzymatic membrane reactor (EMR) for enantioselective esterification of (R,S)-ketoprofen has been studied. In this work, mixed solvent medium was used and the (R)-ketoprofen was reacted with the different alcohols in the presence of immobilized lipase B from Candida antartica, leaving the target product (S)-ketoprofen in its unreacted form. The alcohols involved in the reactions were ethanol, butanol, heptanol and 2-ethoxyethanol. The chain length of alcohol was found to significantly affect the performance of the esterification in EMR. Through the alcohols screening, the esterification reaction using ethanol in EMR showed higher initial rate, conversion, enzyme enantioselectivity, enantiomeric excess of substrate (ees) and enantiomeric excess of product (eep). However the results with butanol showed less inhibition effect on a wider range of temperatur