Finding the 'sweet spot' between customisation and workflows when optimising ePrescribing systems:a multisite qualitative study

OBJECTIVES: The introduction of ePrescribing systems offers the potential to improve the safety, quality and efficiency of prescribing, medication management decisions and patient care. However, an ePrescribing system will require some customisation and configuration to capture a range of workflows in particular hospital settings. This can be part of an optimisation strategy, which aims at avoiding workarounds that lessen anticipated safety and efficiency benefits. This paper aims to identify ePrescribing optimisation strategies that can be translated into hospitals in different national settings. We will explore the views of professionals on the impact of configuration and customisation on workflow. DESIGN: This paper draws on 54 qualitative interviews with clinicians, pharmacists and informatics professionals with experience of optimising ePrescribing systems in eight hospital sites and one health system, in four different countries. Interview transcripts were analysed using an inductive thematic analysis. SETTING: Secondary and tertiary care hospitals in the UK, USA and mainland Europe. PARTICIPANTS: Fifty-four healthcare workers with expertise in clinical informatics. RESULTS: Five identified themes following thematic analysis showed that optimisation of ePrescribing systems can involve configuration and/or customisation. This can be a strategy to combat workarounds and to respond to local policy, safety protocols and workflows for particular patient populations. However, it can result in sites taking on responsibility for training and missing out on vendor updates. Working closely with vendors and other users can mitigate the need for extensive system modification and produce better outcomes. CONCLUSIONS: Modifying an ePrescribing system remains key to enhancing patient safety, and better captured workflow remains key to optimisation. However, we found evidence of an increasingly cautious approach to both customisation and configuration among system users. This has led to users seeking to make less changes to the system

Protocol for a qualitative study to identify strategies to optimise hospital ePrescribing systems

Introduction Electronic prescribing (ePrescribing) is a key area of development and investment in the UK and across the developed world. ePrescribing is widely understood as a vehicle for tackling medication-related safety concerns, improving care quality and making more efficient use of health resources. Nevertheless, implementation of an electronic health record does not itself ensure benefits for prescribing are maximised. We examine the process of optimisation of ePrescribing systems using case studies to provide policy recommendations based on the experiences of digitally mature hospital sites.Methods and analysis Qualitative interviews within six digitally mature sites will be carried out. The aim is to capture successful optimisation of electronic prescribing (ePrescribing) in particular health systems and hospitals. We have identified hospital sites in the UK and in three other developed countries. We used a combination of literature reviews and advice from experts at Optimising ePrescribing in Hospitals (eP Opt) Project round-table events. Sites were purposively selected based on geographical area, innovative work in ePrescribing/electronic health (eHealth) and potential transferability of practices to the UK setting. Interviews will be recorded and transcribed and transcripts coded thematically using NVivo software. Relevant policy and governance documents will be analysed, where available. Planned site visits were suspended due to the COVID-19 pandemic.Ethics and dissemination The Usher Research Ethics Group granted approval for this study. Results will be disseminated via peer-reviewed journals in medical informatics and expert round-table events, lay member meetings and the ePrescribing Toolkit (http://www.eprescribingtoolkit.com/)—an online resource supporting National Health Service (NHS) hospitals through the ePrescribing process

Credibility of subgroup analyses by socioeconomic status in public health intervention evaluations:An underappreciated problem?

There is increasing interest amongst researchers and policy makers in identifying the effect of public health interventions on health inequalities by socioeconomic status (SES). This issue is typically addressed in evaluation studies through subgroup analyses, where researchers test whether the effect of an intervention differs according to the socioeconomic status of participants. The credibility of such analyses is therefore crucial when making judgements about how an intervention is likely to affect health inequalities, although this issue appears to be rarely considered within public health. The aim of this study was therefore to assess the credibility of subgroup analyses in published evaluations of public health interventions. An established set of 10 credibility criteria for subgroup analyses was applied to a purposively sampled set of 21 evaluation studies, the majority of which focussed on healthy eating interventions, which reported differential intervention effects by SES. While the majority of these studies were found to be otherwise of relatively high quality methodologically, only 8 of the 21 studies met at least 6 of the 10 credibility criteria for subgroup analysis. These findings suggest that the credibility of subgroup analyses conducted within evaluations of public health interventions’ impact on health inequalities may be an underappreciated problem. Keywords: Health inequalities, Health inequities, Equity and public health interventions, Policy impact by socioeconomic statu

Mempelajari Proses Produksi Wire Harness Dan Studi Kasus Serta Perawatan Pada Mesin Cheker KCM Di CV. HIJ

Wire harness adalah salah satu komponen yang sangat penting dalam kendaraan roda dua dan roda empat yang berfungsi untuk mengalirkan arus listrik dan sinyal pada kendaraan bermotor. CV. HIJ adalah salah satu perusahaan yang bergerak di bidang automotive. Perusahaan ini memproduksi berbagai jenis wire harness untuk beberapa perusahaan di Indonesia, salah suanya yaitu YAMAHA dan HONDA. Mesin cheker KCM merupakan alat yang digunakan untuk pengecekan arus listrik dan sinyal. Mesin cheker adalah tahapan yang sangat penting dalam proses pembuatan wire harness. Berdasarkan latar belakang, penelitian ini difokuskan pada alur proses produksi wire harness, mesin cheker KCM untuk mempelajari perbaikan dan perawatan mesin cheker KCM, dan mencari sebab-akibat pada pin mesin cheker menggunakan metode diagram fishbone. Fungsi diagram fishbone bertujuan mencari sebab-akibat dari terjadinya pin patah yang dialami pada mesin cheker KCM. Analisis menggunakan 4 faktor dari 6 faktor utama, karena hanya ada 4 faktor yang mempengaruhi saat melakukan proses pengecekan arus wire. Hasil dari analisis yang telah dilakukan maka didapatkan proses produksi wire harness melewati 7 tahap proses, yaitu: housing, assembly, cheker, tie back, insulock, visual inpection, dan prea deal. Penyebab dari pin patah ada 4 faktor, yaitu: material, mesin, metode, dan manusia. Dari 4 faktor yang paling besar mempengaruhi pin pata adalah manusia disebabkan oleh kurangnya training dan perilaku yang kurang bagus dalam bekerja. Mesin cheker di CV. HIJ memiliki 10 preventive daily maintenance atau perawatan pencegahan. Perawatan pencegahan pada perusahaan belom digunakan secara maksimal dan ada point tambaha menurut penulis yaitu cara memasukan pin dengan tepat. Bertujuan untuk meminimalisirkan kerusakan pada mesin cheker KCM

The role of hypoxia in glioblastoma invasion

Glioblastoma multiforme (GBM), a grade IV astrocytoma, is the most common and deadly type of primary malignant brain tumor, with a patient's median survival rate ranging from 15 to 17 months. The current treatment for GBM involves tumor resection surgery based on MRI image analysis, followed by radiotherapy and treatment with temozolomide. However, the gradual development of tumor resistance to temozolomide is frequent in GBM patients leading to subsequent tumor regrowth/relapse. For this reason, the development of more effective therapeutic approaches for GBM is of critical importance. Low tumor oxygenation, also known as hypoxia, constitutes a major concern for GBM patients, since it promotes cancer cell spreading (invasion) into the healthy brain tissue in order to evade this adverse microenvironment. Tumor invasion not only constitutes a major obstacle to surgery, radiotherapy, and chemotherapy, but it is also the main cause of death in GBM patients. Understanding how hypoxia triggers the GBM cells to become invasive is paramount to developing novel and more effective therapies against this devastating disease. In this review, we will present a comprehensive examination of the available literature focused on investigating how GBM hypoxia triggers an invasive cancer cell phenotype and the role of these invasive proteins in GBM progression.info:eu-repo/semantics/publishedVersio