Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

A Time to Laugh: Religious Humor in Contemporary Russia

Contemporary Russian religious humor continues the tradition of this spiritual and selfsacrificial laughter. The anecdotes that are gathered here make fun not only of religion and its characteristic attributes, but of human imperfections and shortcomings, which manifest themselves in relation to various aspects of worship. Everything is good in moderation, including religious zeal that is not the goal by itself, but the instrument of spiritual and moral development. There is a proverbial saying in Russia—force a fool to pray to God and he will beat his forehead. Many anecdotes portray in a comic light this certain pseudo-piety, the eternal human intention to follow the letter of religion to the detriment of its spirit, while remaining the same stingy, calculating, deceitful, vain, and lustful creatures that care not a bit about their own inner transformation. Religious anecdotes mock blind imitation of the authorities, literal (and often absurd) interpretation of the Scriptures, inappropriate claims to sainthood, and the insatiable desire to use God and religion in self-interest. Religious humor, therefore, purifies human souls from the filth of intolerance and fanaticism. It awakens respect and compassion toward those people who profess another faith or hold different views and opinions, and belong to diverse races, nations, classes and civilizations. Thus, religious humor teaches us to love and appreciate religion in ourselves and not ourselves in religion—an attitude needed in our contemporary post-Cold War world, stricken by the fever of religious terrorism

Learning to Teach in the Digital Age: Enacted Encounters with Materiality

This study looked at teacher responses to the maker movement in a K-12 school. Guiding questions asked how teaching practices engaged with digital making and learning tools and materials; and whether teaching was changing as a result. This was as a qualitative, single-case study with multiple units of analysis. The study site was an independent K-12 girls school in a major metropolitan area of the Northeastern United States. Twenty-two teachers and administrators participated, selected for maximum variation across academic domain, age and length of service. Interviews and observations followed a sociomaterial disposition that was interwoven with new materialism and posthumanism. Methods were inspired by narrative inquiry and actor-network theory. Findings suggested that digital making and learning pedagogies were stabilizing at the school, but not in a linear way; and that the teaching practices that most robustly engaged the ethos of 21st century learning enacted a kind of knowing sometimes discussed by artists, poets, musicians and other innovators. This observation leads to the proposition that a different kind of language might be needed to adequately describe the effects of digital making and learning on teaching practice

The contribution of Tomas Maldonado to the scientific approach to design at the beginning of computational era THE CASE OF THE HFG OF ULM

ABSTRACT: Nowadays the use of computational design processes in architecture is a common practice which is currently recovering a set of theories connected to computer science developed in the 60`s and 70`s. Back then, such pioneering experiences were carried out by an interest in employing scientific principles and methodologies in architectural design, which, with the help of computers, were developed in Research Centres mainly located in the USA and the UK. Looking into this period, this paper investigates the relevance of the German design school of the Hochschule für Gestaltung of Ulm to the birth of computation in architecture. Even though there were no computers in the school, this paper argues that the innovative pedagogies introduced by a group of distinct professors built clear foundations that can be understood as being at the basis of further computational approaches in architecture. This paper focuses on the remarkable work done by Tomas Maldonado. His contribution was paramount in the emergence of analogical ways of computer design thinking. This analysis ultimately wants to emphasize how the HfG Ulm’s role and its scientific approach have paved the way for the onset of the computational era in architecture

Wilderness on the Page

This essay explores the role that literature can play in a rethinking of Western culture\u27s relationship with the natural environment

Forget Photography Chapter 1

Forgetting photography attempts to develop a systematic method for revealing the limits and prescriptions of thinking with photography, which no amount of revisionism of post-photographic theory can get beyond. The world urgently needs to unthink photography and go beyond it in order to understand the present constitution of the image as well as the reality or world it shows. Forgetting photography will require a different way of organizing knowledge about the visual in culture that involves crossing different knowledges of visual culture, technologies, and mediums. It will also involve thinking differently about routine and creative labor and its knowledge practices within the institutions and organization of visual reproduction

Entrepreneurial Roles Along a Cycle of Discovery

The literature on entrepreneurship recognizes a variety of entrepreneurial roles, and the question arises what roles are played when and by whom.In this article, roles are attributed to different stages of innovation and organizational development.A central theme is the relation between discontinuity, in radical innovation (exploration), and continuity, in application, diffusion and adaptation (exploitation).Use is made of a concept of a 'cycle of discovery', which seeks to explain how exploration leads on to exploitation, and how exploitation may yield exploration, in a step-by-step development towards radical innovation.Parallel to this there are processes of organisational development.entrepreneurship;innovation;discovery;organizational learning

Mad spaces

Paper presented at COMMON-PLACE Seminar, The Lighthouse, Glasgo