Success factors for hospital information system implementation in public university hospitals

Hospital Information System (HIS) could help the delivery of high quality health services and improve patient care and patient safety. The development and the adoption of the system need to commence if high quality patient care is to be provided. However, successful HIS implementation is not an easy task and it depends on multiple factors such as adequate computer skills, lack of training and education. Despite the presence of a literature on nurse’s satisfaction on HIS, there is still a controversy over the success of HIS implementation. The input from the Information and Organisation culture, Trust and the nurses themselves, have not been considered. The aim of this study therefore, is to identify the success factors that influence a successful HIS implementation and to propose a research model which could fulfil the objective. Based on DeLone and Mc Lean's information, a success model system with an addition of four additional factors namely the Information culture, Organisational cultures, Trust and User quality was developed in this study. Employing a quantitative research methodology, this study began by conducting a pilot study involving 160 nurses from a university hospital to validate the reliability of the questionnaire to be used. Then, 1200 questionnaires were distributed to seven public university hospitals in Iran and 1028 (86%) usable responses were used for analysis. The covariance-based on structural equation modelling using STATA was employed to evaluate the model. Findings revealed that fourteen out of sixteen proposed hypotheses are significant on successful HIS implementation. The Information quality, Service quality, Organisation culture and the Information culture were among the most influential constructs in the final model. As the study was empirically tested in the Iranian setting, it contributes to theoretical and practical aspect of research especially in the Iranian public university hospital context

Heterogeneity in risk factors for ductal and lobular breast carcinomas: A case–control study

Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of the breast are the most common histological subtypes of breast cancer. However, the associations and heterogeneity between histological subtypes and their risk factors are not well established. This study aimed to investigate risk factors for IDC and ILC. This case-control study included 1009 incident breast cancer cases and 1009 hospital controls, frequency-matched by age. Data were obtained from the patients’ medical files and an interview administered via a questionnaire. Multinomial logistic regression was used and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The heterogeneity of the associations was assessed using the Wald test. Family history of breast cancer was associated with IDC (OR 2.64, 95% CI: 1.97-3.55) but not ILC (OR 0.81, 95% CI: 0.42-1.57; P for heterogeneity <0.001). Conversely, a history of miscarriage was associated with ILC (OR 1.71, 95% CI: 1.17-2.51) but not IDC (OR 1.18, 95% CI: 0.95-1.46; P for heterogeneity = 0.04). Similarly, type 2 diabetes was associated with ILC but not IDC (P for heterogeneity = 0.02). Age at first delivery and breastfeeding were significantly associated with IDC but not ILC, though P values for heterogeneity did not reach the significance level. Deliberate weight loss and age at menarche were significantly associated with ILC but not IDC (P for heterogeneity ≥ 0.27). Smoking, history of benign breast disease and BMI were associated with both subtypes. The present study supports the hypothesis that IDC and ILC are etiologically distinct tumors

The global and regional prevalence of hepatitis C and B co-infections among prisoners living with HIV: a systematic review and meta-analysis.

BackgroundHepatitis B virus (HBV) and hepatitis C virus (HCV) infections are common among individuals with human immune deficiency virus (HIV) infection worldwide. In this study, we did a systematic review and meta-analysis of the published literature to estimate the global and regional prevalence of HCV, HBV and HIV coinfections among HIV-positive prisoners.MethodsWe searched PubMed via MEDLINE, Embase, the Cochrane Library, SCOPUS, and Web of science (ISI) to identify studies that reported the prevalence of HBV and HCV among prisoners living with HIV. We used an eight-item checklist for critically appraisal studies of prevalence/incidence of a health problem to assess the quality of publications in the included 48 cross-sectional and 4 cohort studies. We used random-effect models and meta-regression for the meta-analysis of the results of the included studies.ResultsThe number of the included studies were 50 for HCV-HIV, and 23 for HBV-HIV co-infections. The pooled prevalence rates of the coinfections were 12% [95% confidence interval (CI) 9.0-16.0] for HBV-HIV and 62% (95% CI 53.0-71.0) for HCV-HIV. Among HIV-positive prisoners who reported drug injection, the prevalence of HBV increased to 15% (95% CI 5.0-23.0), and the HCV prevalence increased to 78% (95% CI 51.0-100). The prevalence of HBV-HIV coinfection among prisoners ranged from 3% in the East Mediterranean region to 27% in the American region. Also, the prevalence of HCV-HIV coinfections among prisoners ranged from 6% in Europe to 98% in the East Mediterranean regions.ConclusionsOur findings suggested that the high prevalence of HBV and HCV co-infection among HIV-positive prisoners, particularly among those with a history of drug injection, varies significantly across the globe. The results of Meta-regression analysis showed a sliding increase in the prevalence of the studied co-infections among prisoners over the past decades, rising a call for better screening and treatment programs targeting this high-risk population. To prevent the above coinfections among prisoners, aimed public health services (e.g. harm reduction via access to clean needles), human rights, equity, and ethics are to be seriously delivered or practiced in prisons. Protocol registration number: CRD42018115707 (in the PROSPERO international)