What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation

Background: Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Methods: Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff and members of the boards of directors (n=30). We used a constant comparative approach to develop a framework for guiding implementation. Findings: We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as ‘positions’. The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related with the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning. Discussion: Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships and an organizational ethos of transparency and accountability need to considered when exploring the readiness of a hospital to adopt CDSSs.This work is supported by the Italian Ministry of Health (GR-2009-1606736), Regione Lombardia (D.R.G. IX/4340 26/10/2012), and the Wellcome Trust (WT097899)

25th Annual Computational Neuroscience Meeting: CNS-2016

Abstracts of the 25th Annual Computational Neuroscience Meeting: CNS-2016 Seogwipo City, Jeju-do, South Korea. 2–7 July 201

Late Onset Diaphragmatic Hernia: A Forgotten Etiology of Recurrent Vomiting in the Adolescent Population

Koren Hyogene Kwag,1 Mojdeh Habibi Zoham,1 Brande Brown,1 Andy Sohn,2 Sebron Harrison,3 Ariel Brandwein1 1Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA; 2Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA; 3Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USACorrespondence: Koren Hyogene Kwag, Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA, Tel +1 718 780-5970, Fax +1 718 780-3266, Email [email protected]: Diaphragmatic hernia is a rare disorder in adolescents with oftentimes delayed diagnosis due to late-onset and non-specific clinical manifestations. In this report, we present a case of diaphragmatic hernia in an 18-year-old male, where initial diagnosis was complicated by confounding factors of type 1 diabetes mellitus and cannabinoid hyperemesis syndrome. This case highlights the importance of having a high index of suspicion for diaphragmatic hernia in patients with nonspecific gastrointestinal symptoms to ensure timely recognition and surgical intervention.Keywords: diaphragmatic hernia, Bochdalek hernia, Morgagni hernia, type 1 diabetes mellitus, cannabinoid hyperemesis syndrome, vomiting, gastrointestinal symptom

Quantum Dots in an Amphiphilic Polyethyleneimine Derivative Platform for Cellular Labeling, Targeting, Gene Delivery, and Ratiometric Oxygen Sensing

Amphiphilic polyethyleneimine derivatives (amPEIs) were synthesized and used to encapsulate dozens of quantum dots (QDs). The QD-amPEI composite was similar to 100 nm in hydrodynamic diameter and had the slightly positive outer surface that suited well for cellular internalization. The QD-amPEI showed very efficient QD cellular labeling with the labeled cell fluorescence intensity more than 10 times higher than conventional techniques such as Lipofectamine-assisted QD delivery. QD-amPEI was optimal for maximal intracellular QD delivery by the large QD payload and the rapid endocytosis kinetics. QD-amPEI platform technology was demonstrated for gene delivery, cell-specific labeling, and ratiometric oxygen sensing. Our QD amPEI platform has two partitions: positive outer surface and hydrophobic inside pocket. The outer positive surface was further exploited for gene delivery and targeting. Co-delivery of QDs and GFP silencing RNAs was successfully demonstrated by assembling siRNAs to the outer surfaces, which showed the transfection efficiency an order of magnitude higher than conventional gene transfections. Hyaluronic acids were tethered onto the QD amPEI for cell-specific targeted labeling which showed the specific-to-nonspecific signal ratio over 100. The inside hydrophobic compartment was further applied for cohosting oxygen sensing phosphorescence Ru dyes along with QDs. The QD-Ru-amPEI oxygen probe showed accurate and reversible oxygen sensing capability by the ratiometric photoluminescence signals, which was successfully applied to cellular and spheroid models.X113726sciescopu