Knowledge Barriers to Diffusion of Telemedicine

Telemedicine is one proposed solution to problems of accessibility, quality, and costs of medical care. Although telemedicine applications have proliferated in recent years, their diffusion has remained low in terms of the volume of consultations. In this study, Attewell’s (1992) theory of knowledge barriers is extended to explain why diffusion of telemedicine remains low. In case studies of telemedicine programs in three world- renowned medical centers in Boston, Massachusetts, we find that, in addition to technical knowledge barriers, as suggested by Attewell, there are economic, organizational, and behavioral knowledge barriers that inhibit the diffusion of telemedicine. The lowering of these barriers entails intensive learning efforts by proponents of applications within adopter organizations. They need to develop technically feasible, medically valid, reimbursable, and institutionally supported applications in order to justify the value of telemedicine and engender frequent and consistent use by physicians

Entrepreneur Or Intermediary: The Nature of the Relationship Manager\u27s Job

A new liaison role between Information Systems (IS) and users, the relationship manager (RM), has recently emerged.Accordingtotheprescriptiveliterature,RMsaddvaluebydeepunderstanding ofthebusinessestheyserve and technologyleadership. Little is known, however, about their actual work practices. Is the RM an intermediary, filtering information and sometimes misinformation, from clients to IS, or do they play more pivotal roles as entrepreneurs and change agents? This article addresses these questions by studying four RMs in four different industries. The RMs were studied using the structured observation methodology employed by Mintzberg (CEOs), Ives and Olson (MIS managers), and Stephens et al. (CIOs). The findings suggest that while RMs spend less time communicating with users than one would expect, they are leaders, often mavericks, in the entrepreneurial work practices necessary to build partnerships with clients and to make the IS infrastructure more responsive to client needs

Bridging the IS-Line Interface: The Role of the Relationship Manager

IS Organizations are increasingly focusing on managing the interface between themselves and their clients within organizations to improve not only the level of customer service but also the utilization of firm investments in hardware and software. Several organizations have recently created full-time specialized positions, often termed \u27Relationship Manager\u27 to manage the relationship between IS and Line groups. This paper presents the results of an exploratory study to understand the role of the \u27Relationship Manager\u27(RM) and how people in these positions deliver value to IS and Line groups in the organization. Our findings are that the role of the RMs is complex, requiring a focus on the coordination of activities across the IS-Line interface in the short run while marshaling organizational energy towards initiatives that position the firm favorably in the medium and long term. Combining an intimate knowledge of the organization with expertise in IT, the RMs utilize their influential positions in the informal network within the firm to create and capitalize on opportunities to champion innovation and enable change

The Dark Side of Information and Communication Technologies: The View from the Industry-Level of Analysis

The Year 2000 problem spurred companies to rethink investments in information and communication technologies (ICT). Many used the Y2K problem as an opportunity to renew ICT infrastructures, to install integrated enterprise packages, and to pursue new opportunities for ICT-enabled value such as e-commerce, supply chain management, and customer relationship management. Some evidence suggests that these efforts have had substantial payoffs in terms of shareholder value. But can such firm-level benefits persist when competitors catch up or when the success of leaders drives inefficient producers out of business? This panel features NSF-funded researchers whose studies have examined the impacts of ICT at the industry-level of analysis. They show significant industry-level ICT-enabled impacts with potentially negative implications for the firms competing within industries. In the Information Systems field, the ability to gain competitive advantage with ICT has long been an important theme. Although some researchers warned that ICT might contribute to the destruction of competitive advantage, by far the majority of the discourse has centered on how individual firms should invest in ICT. When taking an industry-level view of ICT-enabled competitive advantage, however, we can see its potential dark side. Among the risks ICT poses to the firms in an industry are these: • Fundamentally reducing the cost structure of an industry such that some firms can no longer compete and that others experience squeezed margins • Destruction of in-house competencies (e.g., through radical process change or business process outsourcing) • Investments in ICT are required as a condition of doing business without providing any bottom-line benefits • Increased dependency on external ICT providers leading to business inflexibility and lack of ICT knowledg

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Genome-wide association meta-analysis of 78,308 individuals identifies new loci and genes influencing human intelligence

Intelligence is associated with important economic and health-related life outcomes1. Despite intelligence having substantial heritability2 (0.54) and a confirmed polygenic nature, initial genetic studies were mostly underpowered3,4,5. Here we report a meta-analysis for intelligence of 78,308 individuals. We identify 336 associated SNPs (METAL P < 5 × 10−8) in 18 genomic loci, of which 15 are new. Around half of the SNPs are located inside a gene, implicating 22 genes, of which 11 are new findings. Gene-based analyses identified an additional 30 genes (MAGMA P < 2.73 × 10−6), of which all but one had not been implicated previously. We show that the identified genes are predominantly expressed in brain tissue, and pathway analysis indicates the involvement of genes regulating cell development (MAGMA competitive P = 3.5 × 10−6). Despite the well-known difference in twin-based heritability2 for intelligence in childhood (0.45) and adulthood (0.80), we show substantial genetic correlation (rg = 0.89, LD score regression P = 5.4 × 10−29). These findings provide new insight into the genetic architecture of intelligence