Why is it difficult to implement e-health initiatives? A qualitative study

<b>Background</b> The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.<p></p> <b>Methods</b> We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT).<p></p> <b>Results</b> Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization.<p></p> <b>Conclusions</b> Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning

Self-Testing Produces Superior Recall of Both Familiar and Unfamiliar Muscle Information

Dozens of studies have found learning strategies based on the “testing effect” promote greater recall than those that rely solely on reading; however, the advantages of testing are often only observed after a delay (e.g., 2–7 days later). In contrast, our research, which has focused on kinesiology students learning kinesiology information that is generally familiar to them, has consistently demonstrated that testing-based strategies produce greater recall both immediately and after a delay. In an attempt to understand the discrepancies in the literature, the purpose of the present study was to determine if the time-related advantages of a testing-based learning strategy vary with one\u27s familiarity with the to-be-learned information. Participants used both read-only and testing-based strategies to repeatedly study three different sets of information: 1) previously studied human muscle information (familiar information), 2) a mix of previously studied and previously unstudied human muscle information (mixed information), and 3) previously unstudied muscle information that is unique to sharks (unfamiliar information). Learning was evaluated via free recall assessments administered immediately after studying and again after a 1-wk delay and a 3-wk delay. Across those three assessments, the read-only strategy resulted in mean scores of 29.26 ± 1.43, 15.17 ± 1.29, and 5.33 ± 0.77 for the familiar, mixed, and unfamiliar information, respectively, whereas the testing-based strategy produced scores of 34.57 ± 1.58, 16.90 ± 1.31, and 8.33 ± 0.95, respectively. The results indicate that the testing-based strategy produced greater recall immediately and up through the 3-wk delay regardless of the participants\u27 level of familiarity with the muscle information

The Benefit of Self-Testing and Interleaving for Synthesizing Concepts Across Multiple Physiology Texts

A testing-based learning strategy is one that relies on the act of recalling (i.e., testing) information after exposure, and interleaving is a strategy in which the learning materials are presented in a serial order (e.g., texts 1, 2, 3, 1, 2, 3, 1, 2, 3) versus a blocked order (e.g., texts 1, 1, 1, 2, 2, 2, 3, 3, 3). Although both learning strategies have been thoroughly investigated, few studies have examined their additive effect with higher-order cognitive tasks such as the ability to identify themes across multiple texts, and none of those did so using physiology information. The purpose of the present study was to compare recall and thematic processing across five different physiology texts. Participants were randomly assigned to learn the texts using one of the following four learning strategies: 1) study-study-study (S-S-S) using a blocked order, 2) S-S-S using an interleaved order, 3) study-test-study (S-T-S) using a blocked order, and 4) S-T-S using an interleaved order. Over the course of the following week, the S-T-S groups had more stable recall of key text ideas compared with the S-S-S groups, and the S-T-S group had more stable recall of thematic information than the S-S-S group when interleaving was used as the presentation order

Use of marrow scintigraphy to confirm compensatory marrow rather than active myeloma

We present the case of a 40-year-old male with multiple myeloma for whom bone marrow scintigraphy was utilized to help differentiate between active bony myelomatous disease versus treated lesions with compensatory marrow uptake. This case demonstrates technetium (Tc-99m) sulfur colloid imaging as an inexpensive technique to quickly distinguish between active focal bone disease and reactive marrow