Managing health care in the digital world:A comparative analysis

Recently, most reforms affecting healthcare systems have focused on improving the quality of care and containing costs. This has led many scholars to advocate the adoption of Health Information systems, especially electronic medical records, by highlighting their potential benefits. This study is based on a comparative analysis using a multiple method approach to examine the implementation of the same electronic medical record system at two different hospitals. Its findings offer insights into the processes of the adoption of innovation and its implementation in a healthcare context. The need to innovate, the decision to innovate, the implementation process and consequently, the results produced are quite distinctive at each study site. This comparative case study reveals that what appears to be the same can be quite different: this can be due to several conditions at the organization, the organization’s characteristics, and the process of implementation adopted. We need to understand these elements in order to be able to plan and manage such programs in the future

Primary extraskeletal osteosarcoma of the post-hepatic caudal vena cava in a dog—Case report

Extraskeletal osteosarcoma (EOSA) in dogs is a rare malignant mesenchymal tumor of somatic soft tissues or more commonly visceral organs with a poor prognosis. In dogs, EOSAs have been described as arising from multiple locations, but differently from humans, never from a main vessel. In this report, we describe the first case of an EOSA arising from the post-hepatic caudal vena cava in a 7-year-old male neutered mix breed dog. This report focuses on the description of the diagnostic challenges to obtain a preoperative diagnosis, highlights the importance of histopathology for a correct diagnosis, and introduces a new differential diagnosis for an animal presenting with a suspected thrombus of the vena cava

Demostración de resultado económico: percepción del comando da aeronáutica de Brasil

No ano de 2010, uma alteração no quadro normativo brasileiro introduziu a Demonstração do Resultado Econômico (DRE) para o setor público, que busca comparar custos internos de produção com valores de mercado, segundo o conceito de custo de oportunidade. Este estudo procura analisar as possíveis respostas estratégicas dos gestores , buscando perceber se a cultura contábil existente no País permite a aceitação do novo instrumento. Por meio das percepções dos agentes públicos do Comando da Aeronáutica (Comaer), no Brasil, conclui-se que a resposta estratégica dos entrevistados tende para a atitude de aceitação da nova rotina, demonstrando traços de menor conservadorismo e maior interesse pela evidenciação de resultados.In 2010, a change in the Brazilian accounting regulatory framework introduced the Demonstração do Resultado Econômico (DRE) [Economic Income Statement] for the public sector, which seeks to compare the internal costs of production to market values, according to the concept of opportunity cost. This study aims to analyse the possible strategic responses of managers and tries to understand if the existing accounting culture in Brazil facilitates the introduction of the new statement. By means of perceptions of officials of the Aeronautical Command (Comaer), in Brazil, it is possible to conclude that the strategic response of respondents is closer to acceptance of the new routine, showing traces of less conservatism and greater interest for displaying results.En el año 2010, una modificación del cuadro normativo brasileño introdujo la Demostración del Resultado Económico (DRE) para el sector público, que busca comparar los costos internos de producción con los valores del mercado, según el concepto de costo de oportunidad. Este estudio tiene como objetivo analizar las posibles respuestas estratégicas de los gestores, con el fin de percibir si la cultura contable existente en el país permite la aceptación del nuevo instrumento. Por medio de las percepciones de los agentes públicos del Comando da Aeronáutica (Comaer), en Brasil, se concluyó que la respuesta estratégica de los entrevistados tiende a aceptar la nueva rutina, mostrando rasgos de menos conservadurismo y más interés por la manifestación de resultados.Fundação para a Ciência e a Tecnologia (FCT

Modelling Patient Behaviour Using IoT Sensor Data: a Case Study to Evaluate Techniques for Modelling Domestic Behaviour in Recovery from Total Hip Replacement Surgery

The UK health service sees around 160,000 total hip or knee replacements every year and this number is expected to rise with an ageing population. Expectations of surgical outcomes are changing alongside demographic trends, whilst aftercare may be fractured as a result of resource limitations. Conventional assessments of health outcomes must evolve to keep up with these changing trends. Health outcomes may be assessed largely by self-report using Patient Reported Outcome Measures (PROMs), such as the Oxford Hip or Oxford Knee Score, in the months up to and following surgery. Though widely used, many PROMs have methodological limitations and there is debate about how to interpret results and definitions of clinically meaningful change. With the development of a home-monitoring system, there is opportunity to characterise the relationship between PROMs and behaviour in a natural setting and to develop methods of passive monitoring of outcome and recovery after surgery. In this paper, we discuss the motivation and technology used in long-term continuous observation of movement, sleep and domestic routine for healthcare applications, such as the HEmiSPHERE project for hip and knee replacement patients. In this case study, we evaluate trends evident in data of two patients, collected over a 3-month observation period post-surgery, by comparison with scores from PROMs for sleep and movement quality, and by comparison with a third control home. We find that accelerometer and indoor localisation data correctly highlight long-term trends in sleep and movement quality and can be used to predict sleep and wake times and measure sleep and wake routine variance over time, whilst indoor localisation provides context for the domestic routine and mobility of the patient. Finally, we discuss a visual method of sharing findings with healthcare professionals

Mindfulness-Based Online Intervention to Improve Quality of Life in Late-Stage Bipolar Disorder:A Randomized Clinical Trial

Objective: Adjunctive psychological interventions improve outcomes in bipolar disorder (BD), but people in latter stages likely have different clinical needs. The objective here was to test the hypothesis that for people with ≥⃒ 10 episodes of BD, a brief online mindfulness-based intervention (ORBIT 2.0) improves quality of life (QoL) relative to a Psychoeducation control. Method: A rater-masked, pragmatic superiority randomized clinical trial compared ORBIT 2.0 with active control. Both interventions were 5-week coach-supported programs with treatment as usual continued. Inclusion criteria included age 18–65 years, confirmed diagnosis of BD, and history of ≱ 10 episodes. Measures were collected at baseline, postintervention, and 3 and 6-month follow-ups. The main outcome was QoL, measured on the Brief Quality of Life in Bipolar Disorder (Brief QoL.BD) at 5 weeks, using intentiont treat analyses. Results: Among N = 302 randomized participants, the primary hypothesis was not supported (Treatment × Time β = −0.69, 95% CI [−2.69, 1.31], p =.50). The main effect of Time was not significant in either condition, indicating no improvement in either group. Recruitment was feasible, the platform was safe, both interventions were highly acceptable, but usage was suboptimal. Post hoc analyses found both interventions effective for participants not in remission from depression at baseline.Conclusions: In people with late-stage BD, an online mindfulness-based intervention was not superior to psychoeducational control in improving QoL. Online delivery was found to be safe and acceptable.Future interventions may need to be higher intensity, address engagement challenges, and target more symptomatic individual

How is the New Public Management applied in the occupational health care system? - decision-makers' and OH personnel's views in Finland

<p>Abstract</p> <p>Background</p> <p>In many countries occupational health care system is in change. Occupational health studies are mainly focused on occupational health substance and content. This study offers new perspectives on municipal OHS and its operations from management perspective.</p> <p>Aim</p> <p>The aim of this study is to analyse how New Public Management (NPM) doctrines are applied in the Finnish occupational health care system (OHS). The main focus is to describe and compare the views of decision-makers' and OH workers within the framework of NPM.</p> <p>Methods</p> <p>The data were collected by semi-structured interviews from 17 municipal decision-makers' and 26 municipal OH workers. Data was analyzed by examining coded data in a theory-driven way according to Hood's doctrine of NPM.</p> <p>Results</p> <p>The doctrines were not as compatible with the OH personnel view as with the decision-makers' view. Decision-makers and OH personnel highlighted the strict criteria required for operation evaluation. Moreover, decision-makers strongly accentuated professional management in the public sector and the reorganization of public sector units. These were not equally relevant in OH personnel views. In OH personnel views, other doctrines (more attention to performance and accomplishments, emphasizing and augmentation of the competition and better control of public expense and means test) were not similarly in evidence, only weak evidence was observed when their importance viewed as medium by decision-makers. Neither of the respondents group kept the doctrine of management models of the private sector relevant.</p> <p>Conclusions</p> <p>The NPM and Hoods doctrine fitted well with OH research. The doctrine brought out view differences and similarities between decision-makers and OH personnel. For example, policymakers highlighted more strongly the structural change by emphasizing professional management compared to OH personnel. The need for reorganization of municipal OH, regardless of different operational preconditions, was obvious for both decision-makers and OH personnel. The adaptation of more clarify management to a municipal context is not trouble-free. The municipality systemic structure, complex operational environment, and reconciliation of political and officer authority set challenges to management of municipalities.</p

Theory of mind and emotion understanding predict moral development in early childhood

The current study utilized longitudinal data to investigate how theory of mind (ToM) and emotion understanding (EU) concurrently and prospectively predicted young children's moral reasoning and decision making. One hundred twenty-eight children were assessed on measures of ToM and EU at 3.5 and 5.5 years of age. At 5.5 years, children were also assessed on the quality of moral reasoning and decision making they used to negotiate prosocial moral dilemmas, in which the needs of a story protagonist conflict with the needs of another story character. More sophisticated EU predicted greater use of physical- and material-needs reasoning, and a more advanced ToM predicted greater use of psychological-needs reasoning. Most intriguing, ToM and EU jointly predicted greater use of higher-level acceptance-authority reasoning, which is likely a product of children's increasing appreciation for the knowledge held by trusted adults and children's desire to behave in accordance with social expectations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79217/1/026151009X483056.pd