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

Structures and Aggregation of the Methylamine−Borane Molecules, MenH3−nN·BH3 (n = 1−3), Studied by X-ray Diffraction, Gas-Phase Electron Diffraction, and Quantum Chemical Calculations

The structures of the molecules methylamine-borane, MeH(2)N.BH(3), and dimethylamine-borane, Me(2)HN.BH(3), have been investigated by gas-phase electron diffraction (GED) and quantum chemical calculations. The crystal structures have also been determined for methylamine-, dimethylamine-, and trimethylamine-borane, Me(n)H(3-n)N.BH(3) (n = 1-3); these are noteworthy for what they reveal about the intermolecular interactions and, particularly, the N-H...H-B dihydrogen bonding in the cases where n = 1 or 2. Hence, structures are now known for all the members of the ammonia- and amine-borane series Me(n)H(3-n)N.BH(3) (n = 0-3) in both the gas and solid phases. The structural variations and energetics of formation of the gaseous adducts are discussed in relation to the basicity of the Me(n)H(3-n)N fragment. The relative importance of secondary interactions in the solid adducts with n = 0-3 has been assessed by the semi-classical density sums (SCDS-PIXEL) approach

Anbaufaktoren beeinflussen Fusarien und Mykotoxine in Schweizer Gerste

Die Analyse von 440 Gerstenproben aus den Jahren 2013 und 2014 und der dazugehörigen agronomischen Daten (Sorte, Bodenbearbeitung, Fruchtfolge etc.) ergab, dass das Vorkommen des Pilzes Fusarium graminearum und des Mykotoxins Deoxynivalenol in Gerste durch verschiedene Anbaufaktoren beeinflusst wird. Nicht nur Einzelfaktoren, sondern die Kombination aus verschiedenen Faktoren, z. B. Vorfrucht und Bodenbearbeitung, müssen berücksichtigt werden, um das Befallsrisiko zu reduzieren. Daher sollte stets das gesamte Produktionssystem untersucht werden, um Einflussfaktoren zu erkennen. Dabei ist nicht die Art des Anbausystems (biologisch, extensiv, gemäss ökologischem Leistungsnachweis ÖLN) entscheidend, sondern die Unterschiede innerhalb der Anbausysteme. Den stärksten befallsfördernden Effekt zeigte die Vorfurcht Mais. Die Kombination mit anderen Faktoren, wie reduzierter Bodenbearbeitung oder dem Anbau von Mais in zwei aufeinanderfolgenden Jahren, verstärkten diesen Effekt. Es zeigte sich zudem, dass Sommergerste im Vergleich zu Wintergerste weniger stark befallen war. In Proben, die ohne Fungizide und Wachstumsregulatoren oder mit verhaltener Stickstoffdüngung angebaut wurden, waren Befall und Mykotoxinkonzentrationen geringer