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

Diagnostic de charge polluante en cave vinicole par coopération de modèles et contraintes flexibles

International audienceA diagnosis method is suggested for estimating the pollution charge of wineries during grape-picking. It is made of the following steps: 1) grapes input and water consumption during recent years, 2) pollution charge measurement, 3) pollution charge calculation with data base, 4) calculation of differences between fuzzy estimations of respectively the pollution charge estimated by the data base, and the pollution charge estimated by sample analysis, 5) diagnosis of pollution charge.Une méthode de diagnostic est suggérée pour estimer la charge polluante des vendanges. Elle comprend les étapes suivantes: 1) apports de raisins et consommations d'eau au cours des années précédentes, 2) mesure de charge polluante, 3) calcul de charge polluante à partir de la base de données, 4) calcul de l'écart par nombre flou entre la charge polluante respectivement estimée par la base de données et par la mesure, 5) diagnostic de charge polluante

The Phytopathogen Dickeya dadantii (Erwinia chrysanthemi 3937) Is a Pathogen of the Pea Aphid

Dickeya dadantii (Erwinia chrysanthemi) is a phytopathogenic bacterium causing soft rot diseases on many crops. The sequencing of its genome identified four genes encoding homologues of the Cyt family of insecticidal toxins from Bacillus thuringiensis, which are not present in the close relative Pectobacterium carotovorum subsp. atrosepticum. The pathogenicity of D. dadantii was tested on the pea aphid Acyrthosiphon pisum, and the bacterium was shown to be highly virulent for this insect, either by septic injury or by oral infection. The lethal inoculum dose was calculated to be as low as 10 ingested bacterial cells. A D. dadantii mutant with the four cytotoxin genes deleted showed a reduced per os virulence for A. pisum, highlighting the potential role of at least one of these genes in pathogenicity. Since only one bacterial pathogen of aphids has been previously described (Erwinia aphidicola), other species from the same bacterial group were tested. The pathogenic trait for aphids was shown to be widespread, albeit variable, within the phytopathogens, with no link to phylogenetic positioning in the Enterobacteriaceae. Previously characterized gut symbionts from thrips (Erwinia/Pantoea group) were also highly pathogenic to the aphid, whereas the potent entomopathogen Photorhabdus luminescens was not. D. dadantii is not a generalist insect pathogen, since it has low pathogenicity for three other insect species (Drosophila melanogaster, Sitophilus oryzae, and Spodoptera littoralis). D. dadantii was one of the most virulent aphid pathogens in our screening, and it was active on most aphid instars, except for the first one, probably due to anatomical filtering. The observed difference in virulence toward apterous and winged aphids may have an ecological impact, and this deserves specific attention in future research

Effects of Bacillus thuringiensis δ-Endotoxins on the Pea Aphid (Acyrthosiphon pisum)▿

Four Bacillus thuringiensis δ-endotoxins, Cry3A, Cry4Aa, Cry11Aa, and Cyt1Aa, were found to exhibit low to moderate toxicity on the pea aphid, Acyrthosiphon pisum, in terms both of mortality and growth rate. Cry1Ab was essentially nontoxic except at high rates. To demonstrate these effects, we had to use exhaustive buffer-based controls

Dickeya dadantii, a pathogen in symbiontland... : the experimental infection of the pea aphid by the plant pathogen Erwinia chrysanthemi

National audienc

Elaboration d'un guide methodologique pour estimer la charge polluante d'une cave vinicole

Available from INIST (FR), Document Supply Service, under shelf-number : GR 1760 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc

: Expérimenter, conjecturer et raisonner en Mathématiques

National audienceCette brochure est une réédition revue et augmentée de la brochure éponyme. Elle s'adresse aux enseignants, aux formateurs d'enseignants, aux chercheurs sur l'enseignement, et aussi à toute personne intéressée par une activité mathématique ludique.Elle propose des situations de recherche pour la classe (SiRC) qui ont été construites et analysées pendant plusieurs années par le groupe "Logique raisonnement et SiRC" de l'IREM de Grenoble et par l'équipe de recherche "Maths à Modeler".Toutes ces situations ont été expérimentées avec des élèves du Primaire et du Secondaire, avec des étudiants, et en formation initiale et continue d'enseignants. L'ouvrage décrit précisément le matériel pour les situations, des scénarios possibles pour la réalisation en classe et des propositions de gestion, accompagnés d'analyses didactiques décrivant les enjeux d'apprentissage réalisables. Pour chaque situation, une "fiche élève" est proposée. Pour chacune de ces situations, sont donnés des éléments de résolution et une analyse didactique consistant pour l'essentiel à répondre aux questions suivantes : quelles connaissances sont nécessaires pour chercher et résoudre ces problèmes, quelles sont les solutions et les procédures de résolution accessibles aux élèves, quels apprentissages sont mis en jeu