Qualitative study exploring the phenomenon of multiple electronic prescribing systems within single hospital organisations

BACKGROUND: A previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital. Our objectives were to describe the rationale for having multiple EP systems within a single hospital, and to explore perceptions of stakeholders about the advantages and disadvantages of multiple systems including any impact on patient safety. METHODS: Hospitals were selected from previous census respondents. A decision matrix was developed to achieve a maximum variation sample, and snowball sampling used to recruit stakeholders of different professional backgrounds. We then used an a priori framework to guide and analyse semi-structured interviews. RESULTS: Ten participants, comprising pharmacists and doctors and a nurse, were interviewed from four hospitals. The findings suggest that use of multiple EP systems was not strategically planned. Three co-existing models of EP systems adoption in hospitals were identified: organisation-led, clinician-led and clinical network-led, which may have contributed to multiple systems use. Although there were some perceived benefits of multiple EP systems, particularly in niche specialities, many disadvantages were described. These included issues related to access, staff training, workflow, work duplication, and system interfacing. Fragmentation of documentation of the patient's journey was a major safety concern. DISCUSSION: The complexity of EP systems' adoption and deficiencies in IT strategic planning may have contributed to multiple EP systems use in the NHS. In the near to mid-term, multiple EP systems may remain in place in many English hospitals, which may create challenges to quality and patient safety.Peer reviewe

Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals:a questionnaire study

Background: ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned.Methods: a descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated.Results: we obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity.Conclusions: whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activitie

Aktive Schwingungsreduktion an einem elastischen Fahrweg unter bewegter Masse

[no abstract

Sistematização do processo de projeto em automação de máquinas cartezianas com acionamento eletromecânico: ênfase no posicionamento

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico, Programa de Pós-Graduação em Engenharia Mecânica, Florianópolis, 2009A sistematização proposta é uma tentativa para disponibilizar procedimentos organizados que permitam desenvolver projetos de máquinas automatizadas novas e projetos de melhoramento em máquinas existentes, com ênfase em posicionamento, desde a identificação das necessidades do cliente até a modelagem e simulação da concepção de máquina. Esta sistematização resulta da análise de um conjunto de trabalhos de pesquisa e esenvolvimento realizados ao longo de mais de duas décadas no Laboratório de Hardware (LHW/UFSC) relacionados com procedimentos utilizados para desenvolver projetos de automação de máquinas (com posicionamento eletromecânico/eletrônico) aos quais foi adaptada uma metodologia específica, derivada da metodologia de projeto de produtos industriais em desenvolvimento no Núcleo de Desenvolvimento do Produto do (NEDIP/UFSC). A sistemática proposta nesse trabalho visa oferecer aos projetistas procedimentos, métodos e ferramentas para o desenvolvimento de projetos de Automação de Máquinas, facilitando o melhor entendimento global do problema, maior segurança na escolha das concepções alternativas, considerando critérios técnicos e econômicos, entre outros. Visa-se potencializar o processo de projeto em automação de máquinas de modo que, nas fases de projeto detalhado e de implementação, reduzam-se as mudanças necessárias, causadoras de ônus e atrasos ao projeto. A sistemática proposta é constituída por doze atividades, as quais permitirão projetar uma máquina automatizada, começando desde a criação da uma idéia de máquina até a modelagem e simulação de uma concepção definitiva para o projeto. Ela permite desenvolver as especificações do projeto, criar concepções alternativas para a estrutura e os componentes da máquina, dimensionar os acionamentos, analisar financeira e economicamente a aquisição da máquina e determinar a escolha das concepções de máquinas adequadas por meio de procedimentos de avaliação. A sistemática proposta foi avaliada por meio da aplicação de suas diretivas no desenvolvimento de um eixo de movimento translativo para uma máquina laser para corte de chapas. A aplicação demonstra as vantagens da sistemática apresentada, comparado ao desenvolvimento convencional

Effects of Early Warning Emails on Student Performance

We use learning data of an e-assessment platform for an introductory mathematical statistics course to predict the probability of passing the final exam for each student. Subsequently, we send warning emails to students with a low predicted probability to pass the exam. We detect a positive but imprecisely estimated effect of this treatment, suggesting the effectiveness of such interventions only when administered more intensively.Comment: arXiv admin note: text overlap with arXiv:1906.0986

Differential roles of ArfGAP1, ArfGAP2, and ArfGAP3 in COPI trafficking

The formation of coat protein complex I (COPI)–coated vesicles is regulated by the small guanosine triphosphatase (GTPase) adenosine diphosphate ribosylation factor 1 (Arf1), which in its GTP-bound form recruits coatomer to the Golgi membrane. Arf GTPase-activating protein (GAP) catalyzed GTP hydrolysis in Arf1 triggers uncoating and is required for uptake of cargo molecules into vesicles. Three mammalian ArfGAPs are involved in COPI vesicle trafficking; however, their individual functions remain obscure. ArfGAP1 binds to membranes depending on their curvature. In this study, we show that ArfGAP2 and ArfGAP3 do not bind directly to membranes but are recruited via interactions with coatomer. In the presence of coatomer, ArfGAP2 and ArfGAP3 activities are comparable with or even higher than ArfGAP1 activity. Although previously speculated, our results now demonstrate a function for coatomer in ArfGAP-catalyzed GTP hydrolysis by Arf1. We suggest that ArfGAP2 and ArfGAP3 are coat protein–dependent ArfGAPs, whereas ArfGAP1 has a more general function

Regelung eines elastischen Fahrwegs unter Verwendung eines variablen Beobachters

  &nbsp