Technological innovation in health organizations. The integration of the computerized nursing record in Switzerland: a sociological analysis

L’oggetto di questa tesi è l’innovazione tecnologica nelle organizzazioni sanitarie, in particolare mi soffermerò sulla cartella informatizzata infermieristica e le sue implicazioni con il lavoro di cura e le pratiche professionali infermieristiche. La metodologia scelta è un approccio mixed-method, è stato somministrato un questionario organizzato su un modello basato su 4 fattori determinanti: risorse, micro-rilevanza, micro-proprietà, macro-rilevanza, che permette di misurare l’adottabilità di un sistema informativo . È stata osservata la correlazione tra determinanti e le causalità, con l’utilizzo di metodi di regressione lineare. Per rilevare ed approfondire come l’innovazione tecnologica entra in relazione con i processi professionali ed organizzativi degli attori organizzativi, sono stati effettuati 5 focus group. Il contesto studiato è nella Svizzera italiana si tratta di un ospedale multisito che comprende nove istituti di cura. L’analisi è stata sviluppata in tre fasi: nella prima sono stati analizzati i dati provenienti dai questionari, successivamente le informazioni ottenute tramite i focus group, ed infine sono stati indentificati, temi e dati convergenti combinati ed analizzati attraverso un approccio misto. I risultati hanno permesso di identificare la micro-rilevanza come la variabile fondamentale per redire e valutare l’adottabilità di un sistema informativo in ambiente sanitario, e la micro-proprietà come seconda variabile per importanza. Dall’indagine qualitativa sono emersi temi come l’informazione, tempo, relazioni interpersonali, che caratterizzano i cambiamenti nelle pratiche professionali, e sono poi stati incrociati con dei sottogruppi di variabili tratti dal questionario. In conclusione l’adottabilità di un sistema informativo, deve comprendere modifiche dell’organizzazione, implica cambiamenti del ruolo e della cultura infermieristica e deve essere accompagnata da attività di formazione ai diversi attori coinvolti.The subject of this thesis is technological innovation in health organizations, in particular I will focus on the computerized nursing record and its implications with nursing work and nursing professional practices. The chosen methodology is a mixed-method approach, a questionnaire was administered on a model based on 4 determining factors: resources, micro-relevance, micro-property, macro-relevance, which allows to measure the adoptability of an information system . The correlation between determinants and causalities was observed, using linear regression methods. To detect and study how technological innovation relates to the professional and organizational processes of the organizational actors, 5 focus groups were carried out. The studied context is in Italian Switzerland, it is a multi-site hospital that includes nine nursing institutions. The analysis was developed in three phases: in the first one the data from the questionnaires were analyzed, then the information obtained through the focus groups, and finally they were identified, themes and convergent data combined and analyzed through a mixed approach. The results made it possible to identify the micro-relevance as the fundamental variable for predicting and evaluating the adoptability of an information system in the healthcare environment, and the micro-property as the second variable in importance. Qualitative research has revealed themes such as information, time, interpersonal relationships, which characterize changes in professional practices, and were then crossed with sub-groups of variables taken from the questionnaire. In conclusion, the adoptability of an information system, must include changes to the organization, implies changes in the role and culture of nursing and must be accompanied by training activities for the various actors involved

Do prior intra-articular injections impact on the risk of periprosthetic joint infection in patients undergoing total hip arthroplasty? A meta-analysis of the current evidences with a focus on the timing of injection before surgery

Purpose: Intra-articular injection is a well-established and increasingly used treatment for the patient with mild-to-moderate hip osteoarthritis. The objectives of this literature review and meta-analysis are to evaluate the effect of prior intra-articular injections on the risk of periprosthetic joint infection (PJI) in patients undergoing total hip arthroplasty (THA) and to try to identify which is the minimum waiting time between hip injection and replacement in order to reduce the risk of infection. Methods: The database of PubMed, Embase, Google Scholar and Cochrane Library was systematically and independently searched, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To assess the potential risk of bias and the applicability of the evidence found in the primary studies to the review, the Newcastle-Ottawa scale (NOS) was used. The statistical analysis was performed by using the software 'R' version 4.2.2. Results: The pooling of data revealed an increased risk of PJI in the injection group that was statistically significative (P = 0.0427). In the attempt to identify a 'safe time interval' between the injection and the elective surgery, we conducted a further subgroup analysis: in the subgroup 0-3 months, we noted an increased risk of PJI after injection. Conclusions: Intra-articular injection is a procedure that may increase the risk of developing periprosthetic infection. This risk is higher if the injection is performed less than 3 months before hip replacement

Algorithms for hierarchical and semi-partitioned parallel scheduling

International audienceWe propose a model for scheduling jobs in a parallel machine setting that takes into account the cost of migrations by assuming that the processing time of a job may depend on the specific set of machines among which the job is migrated. For the makespan minimization objective, the model generalizes classical scheduling problems such asunrelated parallel machine scheduling, as well as novel ones such as semi-partitioned and clustered scheduling. In the case of a hierarchical family of machines, we derive a compact integer linear programming formulation of the problem andleverage its fractional relaxation to obtain a polynomial-time 2- approximation algorithm. Extensions that incorporate memory capacity constraints are also discussed

ANALISI DELL’INDICE DI INTERAZIONE BAMBINO-PETS IN FATTORIA ZOOANTROPOLOGICA: STUDIO PILOTA

INTRODUZIONE - La didattica applicata alla zooantropologia prevede un’attuazione in campo educativo e pedagogico dei principi zooantropologici; essa si prefigge un duplice obiettivo: di ridurre il gap relazionale tra animali e giovani generazioni e di recuperare i contenuti e le valenze della relazione, al fine dell’utilizzo pedagogico ed educativo. Nasce un nuovo modello educativo che pone al centro delle strutture pedagogiche l’animale, non più come oggetto da sfruttare, ma come soggetto che aiuti il bambino nella sua crescita educativa (1,2). In quest’ottica generale, la Fattoria Zooantropologica sembra essere un buon sistema in grado di permettere la “fruizione” da parte di bambini e\o soggetti con disabilità di questo modello relazionale e di consentire, altresì, attività e terapie assistite con gli animali (3,4). La Fattoria Zooantropologica offre l’opportunità di attivare la relazione reciproca in un ambiente nuovo, attraente e confortevole tra il fruitore e l’animale che giova di un habitat naturale e familiare. L’esperienza diretta permette ai bambini di usare tutti i loro sensi per imparare: più i bambini vedono, toccano, odorano, sentono, gustano, più imparano (5,6). Partendo da questi presupposti, lo studio si è posto l’obiettivo di effettuare una valutazione del gradimento delle differenti specie animali, attraverso l’analisi degli indici di interazione dei bambini rispetto agli animali presenti in fattoria, al fine di fornire delle linee guida nella scelta del pet in relazione ad una amplificazione delle risposte cognitive ed emozionali del bambino

Small Deletion at the 7q21.2 Locus in a CCM Family Detected by Real-Time Quantitative PCR

Cerebral cavernous malformations (CCMs) represent a common autosomal dominant disorder that predisposes patients to haemorrhagic strokes and focal neurological signs. About 56% of the hereditary forms of CCMs have been so far associated with mutations in the KRIT1 (Krev Interaction Trapped 1) gene, located at 7q21.2 (CCM1 locus). We described the complete loss of 7q21.2 locus encompassing the KRIT1 gene and 4 flanking genes in a CCM family by using a dense set of 12 microsatellite markers. The complete loss of the maternal copy of KRIT1 gene region was confirmed by Real-Time Quantitative Polymerase Chain Reaction (RT-QPCR) and the same approach was used for expression analysis. Additional RT-QPCR analysis showed the extension of the deletion, for a total of 700 kb, to the adjacent downstream and upstream-located genes, MTERF, AKAP9, CYP51A1, as well as a partial loss of the ANKIB1 gene. Here we report the molecular characterization of an interstitial small genomic deletion of the 7q21.2 region in a CCMs affected family, encompassing the KRIT1 gene. Our findings confirm the loss of function mechanism for the already known CCM1 locus, without any evident involvement of the other deleted genes. Moreover, our investigations highlight the usefulness of the RT-QPCR to the molecular characterization of the breakpoints genomic deletions and to the identification of internal deleted genes involved in the human genetic diseases

Identification of tumor-associated cassette exons in human cancer through EST-based computational prediction and experimental validation

Background: Many evidences report that alternative splicing, the mechanism which produces mRNAs and proteins with different structures and functions from the same gene, is altered in cancer cells. Thus, the identification and characterization of cancer-specific splice variants may give large impulse to the discovery of novel diagnostic and prognostic tumour biomarkers, as well as of new targets for more selective and effective therapies. Results: We present here a genome-wide analysis of the alternative splicing pattern of human genes through a computational analysis of normal and cancer-specific ESTs from seventeen anatomical groups, using data available in AspicDB, a database resource for the analysis of alternative splicing in human. By using a statistical methodology, normal and cancer-specific genes, splice sites and cassette exons were predicted in silico. The condition association of some of the novel normal/tumoral cassette exons was experimentally verified by RT-qPCR assays in the same anatomical system where they were predicted. Remarkably, the presence in vivo of the predicted alternative transcripts, specific for the nervous system, was confirmed in patients affected by glioblastoma. Conclusion: This study presents a novel computational methodology for the identification of tumor-associated transcript variants to be used as cancer molecular biomarkers, provides its experimental validation, and reports specific biomarkers for glioblastoma

Orexin-A Prevents Lipopolysaccharide-Induced Neuroinflammation at the Level of the Intestinal Barrier

In states of intestinal dysbiosis, a perturbation of the normal microbiome composition, the intestinal epithelial barrier (IEB) permeability is increased as a result of the disruption of the epithelial tight junction protein network, in which occludin is mostly affected. The loss of IEB integrity promotes endotoxemia, that is, bacterial lipopolysaccharide (LPS) translocation from the intestinal lumen to the circulatory system. This condition induces an enhancement of pro-inflammatory cytokines, which leads to neuroinflammation through the gut-brain axis. Orexin-A (OX-A), a neuropeptide implicated in many physiological functions and produced mainly in the brain lateral hypothalamic area, is expressed also in several peripheral tissues. Orexin-producing neurons have been found in the myenteric plexus to project to orexin receptor 1 (OX-1R)-expressing enterocytes of the intestinal villi. In the present study we investigated the protective role of OX-A against LPS-induced increase of IEB permeability and microglia activation in both an in vivo and in vitro model of the gut-brain axis. By exploiting biochemical, immunocytochemical, immunohistochemical, and functional approaches, we demonstrate that OX-A preserves the IEB and occludin expression, thus preventing endotoxemia and subsequent neuroinflammation

Scheduling Real-time Mixed-criticality Jobs

International audienceMany safety-critical embedded systems are subject to certification requirements; some systems may be required to meet multiple sets of certification requirements, from different certification authorities. Certification requirements in such "mixed-criticality'' systems give rise to interesting scheduling problems, that cannot be satisfactorily addressed using techniques from conventional scheduling theory. In this paper, we study a formal model for representing such mixed-criticality workloads. We demonstrate first the intractability of determining whether a system specified in this model can be scheduled to meet all its certification requirements, even for systems subject to merely two sets of certification requirements. Then we quantify, via the metric of processor speedup factor, the effectiveness of two techniques, reservation-based scheduling and priority-based scheduling, that are widely used in scheduling such mixed-criticality systems, showing that the latter of the two is superior to the former. We also show that the speedup factors we obtain are tight for these two techniques

Appendiceal-sigmoid fistula presenting in a man with ulcerative colitis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ulcerative colitis is a chronic disease characterized by diffuse mucosal inflammation limited to the colon. It mostly affects young adults, yet a large number of middle-aged and older patients with ulcerative colitis have also been reported.</p> <p>Case presentation</p> <p>A 58-year-old Caucasian man presented to our hospital in August 2006 with continuous and diffuse abdominal pain, meteorism, fever and bloody diarrhea. He had a two-year history of ulcerative colitis. Our patient was treated with intravenous medical therapy. As his condition worsened, he underwent surgery. An explorative laparotomy revealed that the entire colon was distended and pus was found around an appendiceal-sigmoid fistula.</p> <p>Conclusions</p> <p>Therapy for ulcerative colitis <b/>is a rapidly evolving field, with many new biological agents under investigation that are likely to change therapeutic strategies radically in the next decade. Indications for surgery are intractability (49%), stricture, dysplasia, toxic colitis, hemorrhage and perforation. To the best of our knowledge, this is the first case of an appendiceal-sigmoid fistula in a patient affected by ulcerative colitis reported in the literature. Fistulae between the appendix and the sigmoid tract are rarely reported in cases of diverticular disease and appendicitis.</p

Two novel PRNP truncating mutations broaden the spectrum of prion amyloidosis

Truncating mutations in PRNP have been associated with heterogeneous phenotypes ranging from chronic diarrhea and neuropathy to dementia, either rapidly or slowly progressive. We identified novel PRNP stop-codon mutations (p.Y163X, p.Y169X) in two Italian kindreds. Disease typically presented in the third or fourth decade with progressive autonomic failure and diarrhea. Moreover, one proband (p.Y163X) developed late cognitive decline, whereas some of his relatives presented with isolated cognitive and psychiatric symptoms. Our results strengthen the link between PRNP truncating mutations and systemic abnormal PrP deposition and support a wider application of PRNP screening to include unsolved cases of familial autonomic neuropathy