Users' perspectives of barriers and facilitators to implementing EHR in Canada: A study protocol

<p>Abstract</p> <p>Background</p> <p>In Canada, federal, provincial, and territorial governments are developing an ambitious project to implement an interoperable electronic health record (EHR). Benefits for patients, healthcare professionals, organizations, and the public in general are expected. However, adoption of an interoperable EHR remains an important issue because many previous EHR projects have failed due to the lack of integration into practices and organizations. Furthermore, perceptions of the EHR vary between end-user groups, adding to the complexity of implementing this technology. Our aim is to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators influencing the adoption of an interoperable EHR among its various users and beneficiaries.</p> <p>Methods</p> <p>First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to the implementation of the EHR. Standardized literature search and data extraction methods will be used. Studies' quality and relevance to inform decisions on EHR implementation will be assessed. For each group of EHR users identified, barriers and facilitators will be categorized and compiled using narrative synthesis and meta-analytical techniques. The principal factors identified for each group of EHR users will then be validated for its applicability to various Canadian contexts through a two-round Delphi study, involving representatives from each end-user groups. Continuous exchanges with decision makers and periodic knowledge transfer activities are planned to facilitate the dissemination and utilization of research results in policies regarding the implementation of EHR in the Canadian healthcare system.</p> <p>Discussion</p> <p>Given the imminence of an interoperable EHR in Canada, knowledge and evidence are urgently needed to prepare this major shift in our healthcare system and to oversee the factors that could affect its adoption and integration by all its potential users. This synthesis will be the first to systematically summarize the barriers and facilitators to EHR adoption perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. This comprehensive and rigorous strategy could be replicated in other settings.</p

Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review

<p>Abstract</p> <p>Background</p> <p>Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users.</p> <p>Methods</p> <p>Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users.</p> <p>Results</p> <p>Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities.</p> <p>Conclusions</p> <p>This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.</p

PMTIC - Plan Mobilisateur des Technologies de l'Information et de la Communication

Projet de recherche-action visant la formation des demandeurs d'emploi en Région Wallonne.PMTI

PMTIC - Plan Mobilisateur des Technologies de l'Information et de la Communication

Projet de recherche-action visant la formation des demandeurs d'emploi en Région Wallonne.PMTI

Sensory and physicochemical evolution of tropical cooked peeled shrimp inoculated by Brochothrix thermosphacta and Lactococcus piscium CNCM I-4031 during storage at 8 degrees C

Document Type : Proceedings Paper Conference Date : AUG 30-SEP 03, 2010 Conference Location : Copenhagen, DENMARK Conference Sponsor : Int Comm Food Microbiol & Hyg (ICFMH)International audienceThis study investigated the sensory quality and physicochemical evolution (pH, glucose,L-lactic acid, biogenic amine, free amino-acids and volatile compounds) during storage at 8 degrees C of cooked peeled shrimp inoculated with the specific spoilage bacteria Brochothrix thermosphacta alone or mixed with the protective strain Lactococcus piscium CNCM I-4031. Growth of both bacteria was monitored at regular intervals during storage by microbial counts and the thermal temperature gradient gel electrophoresis (TTGE) technique. Bacterial counts showed that L. piscium and B. thermosphacta inoculated at 7 log CFU/g and 3 log CFU/g were well adapted to shrimp, reaching a maximum level of 9 log CFU/g after 4 days and 10 days respectively. In mixed culture, the growth of B. thermosphacta was reduced by 3.2 +/- 0.1 log CFU/g. The TTGE technique allowed monitoring the colonisation of the strains on the shrimp matrix and confirming the dominance of L. piscium in mixed culture throughout the experiment. Sensory analysis confirmed that B. thermosphacta spoiled the product after 11 days, when its cell number attained 8 log CFU/g with the emission of strong butter/caramel off-odours. This sensory profile could be linked to the production of 2,3 butanedione, cyclopentanol, 3-methylbutanol, 3-methylbutanal, 2-methylbutanal, 4-methyl-3-chloro-3-pentanol and ethanol, which were produced in more significant quantities in the B. thermosphacta batch than in the batches in which the protective strain was present. On the contrary, TVBN and TMA were not suitable as quality indicators for B. thermosphacta spoilage activity. In the products where the protective L. piscium strain was present, no adverse effect on sensory quality was noted by the sensory panels. Moreover, biogenic amine assessment did not show any histamine or tyramine production by this strain, underlining its safety profile. Both strains produced lactic acid (1850 mg/kg in L. piscium and B. thermosphacta batch on days 3 and 10 respectively; 3830 mg/kg on day 7 in mixed culture) and the pH decrease from 6.6 +/- 0.0 to 5.9 +/- 0.1 was similar in all batches. Lactic acid production or competition for free amino-acid was not involved in the inhibition mechanism; however rapid glucose consumption by L. piscium could partially explain the growth limitation of the spoilage micro-organism. This study demonstrated the spoilage characteristic of B. thermosphacta and the usefulness of L. piscium as a bioprotective culture for tropical cooked peeled shrimp without any adverse effect on the sensory quality of the product. (C) 2011 Elsevier B.V. All rights reserved

Aortic Isthmus Flow Recording Predicts the Outcome of the Recipient Twin after Laser Coagulation in Twin-Twin Transfusion Syndrome

International audienc

L’alimentation des premiers agropasteurs du Néolithique : apport de l’étude des microrestes du tartre dentaire des individus de la Roussille (Auvergne)

National audienceThe Neolithic, a major episode in human history, is marked by the domestication of plant and animal species, the beginnings of agriculture, and significant demographic growth. The ANR WomenSOFar project (ANR-21-CE03-0008) aims to identify the status of women through how they move, eat, work, and care for the young. As part of this research project, an innovative and exploratory approach involving the analysis of micro-remains contained in dental calculus was carried out. The objectives were to test the interest of this still embryonic approach in France and to provide insights into the dietary habits of Neolithic communities in La Roussille (Vertaizon, Puy-de-Dôme), in addition to data from other paleoecological and bioarchaeological disciplines.The studied site, La Roussille, is located in Auvergne and has the particularity of being composed of a habitation area and a burial zone, dated to approximately 4600 to 4300 years BCE. Dental calculus samples from 7 individuals, including 2 males, 4 females, and 1 of unknown sex, were analyzed at the University College of Dublin, Ireland. Dental calculus samples were decalcified using the EDTA method before being studied under an optical microscope. Micro-remains were identified through publications and reference books. The main elements found were phytoliths, microscopic siliceous bodies produced by plants as a defense against attacks such as herbivory, as well as animal cells, micro-charcoal, pollen, and fungal spores. These initial results raise questions about the representativeness of the different types of elements identified in this matrix and the use of teeth as a tool.Wolfgang Haak, Stéphane Rottier, Guillaume Leduc, Gwenaëlle GoudeLe Néolithique, épisode majeur de l’histoire Humaine est marqué par la domestication des espèces végétales et animales, les débuts de l’agriculture et une croissance démographique significative. Le projet ANR WomenSOFar (21-CE03-0008) vise à identifier le statut des femmes à travers la façon dont elles se déplacent, se nourrissent, travaillent et prennent soin des jeunes. Dans le cadre de ce projet de recherche, une approche novatrice et exploratoire, consistant en l’analyse des micro-restes contenus dans le tartre dentaire, a été réalisée. Les objectifs étaient de tester l’intérêt de cette approche jusqu’à présent embryonnaire en France et de proposer des éléments de réponse au régime alimentaire des communautés néolithiques de La Roussille (Vertaizon, Puy-de-Dôme) en addition aux données d’autres disciplines paléoécologiques et archéobiologiques. Le site étudié, La Roussille, se situe en Auvergne et il présente la particularité d’être composé d’un habitat et d’un zone funéraire, datée d’environ 4600 à 4300 ans avant notre ère. Les échantillons de tartre dentaire de 7 individus, dont 2 hommes, 4 femmes, et 1 de sexe inconnu, ont été analysés (University College of Dublin, Irlande). Les échantillons de tartre dentaire ont été décalcifiés selon la méthode EDTA, avant d’être étudiés au microscope optique. Les microrestes ont été identifiés grâce à des publications et livres de référence. Les principaux éléments retrouvés étaient des phytolithes, corps microscopiques siliceux produits par les plantes en guise de défense contre des attaques telle que l’herbivorie, mais aussi des cellules animales, des microcharbons, des pollen ou encore des spores de champignon. Ces premiers résultats interrogent sur la représentativité des différents types d’éléments identifiés dans cette matrice et l’utilisation des dents en tant qu’outil

L’alimentation des premiers agropasteurs du Néolithique : apport de l’étude des microrestes du tartre dentaire des individus de la Roussille (Auvergne)

National audienceLe Néolithique, épisode majeur de l’histoire Humaine est marqué par la domestication des espèces végétales et animales, les débuts de l’agriculture et une croissance démographique significative. Le projet ANR WomenSOFar (21-CE03-0008) vise à identifier le statut des femmes à travers la façon dont elles se déplacent, se nourrissent, travaillent et prennent soin des jeunes. Dans le cadre de ce projet de recherche, une approche novatrice et exploratoire, consistant en l’analyse des microrestes contenus dans le tartre dentaire, a été réalisée. Les objectifs étaient de tester l’intérêt de cette approche jusqu’à présent embryonnaire en France et de proposer des éléments de réponse au régime alimentaire des communautés néolithiques de La Roussille (Vertaizon, Puys-de-Dôme) en addition aux données d’autres disciplines paléoécologiques et archéobiologiques. Le site étudié, La Roussille, se situe en Auvergne et il présente la particularité d’être composé d’un habitat et d’un zone funéraire, datée d’environ 4600 à 4300 ans avant notre ère. Les échantillons de tartre dentaire de 7 individus, dont 2 hommes, 4 femmes, et 1 de sexe inconnu, ont été analysés (University College of Dublin, Irlande). Les échantillons de tartre dentaire ont été décalcifiés selon la méthode EDTA, avant d’être étudiés au microscope optique. Les microrestes ont été identifiés grâce à des publications et livres de référence. Les principaux éléments retrouvés étaient des phytolithes, corps microscopiques siliceux produits par les plantes en guise de défense contre des attaques telle que l’herbivorie, mais aussi des cellules animales, des micro-charbons, des pollen ou encore des spores de champignon. Ces premiers résultats interrogent sur la représentativité des différents types d’éléments identifiés dans cette matrice et l’utilisation des dents en tant qu’outil