Understanding the multidimensionality of information systems use:A study of nurses' use of a mandated electronic medical record system

This study outlines the findings of a qualitative study designed to develop an understanding of nurses’ experiences using an electronic medical record system (EMR) in a mandatory usage context. Drawing upon the Unified Theory of Acceptance and Use of Technology, a combined deductive/inductive research approach was adopted to study nurses working in an urban hospital system. This approach allowed for an in-depth study of the nature and structure of mandated information systems (IS) use in a healthcare context. We found that understanding the relationship between key technology acceptance constructs and system use required a multidimensional conceptualization of usage – something not commonly found in the IS literature. We identified three facets important to gaining a holistic understanding of nurses’ use of EMR technology: time spent using the system, timing of use, and mode of use. We empirically demonstrate that the dimensions of IS use can be mandated and internalized to varying degrees even within the same organization, and that the predictors of use can be differentially associated with the dimensions of use given the degree of the mandate

Change management: The case of the elite sport performance team

The effective and efficient implementation of change is often required for both successful performance and management survival across a host of contemporary domains. However, although of major theoretical and practical significance, research to date has overlooked the application of change management (hereafter CM) knowledge to the elite sport performance team environment. Considering that the success of ‘off-field’ sports businesses are largely dependent on the performances of their ‘on-field’ team, this article explores the application of current CM theorizing to this specific setting and the challenges facing its utility. Accordingly, we identify the need and importance of developing theory specific to this area, with practical application in both sport and business, through examination of current knowledge and identification of the domain's unique, dynamic and contested properties. Markers of successful change are then suggested to guide initial enquiry before the article concludes with proposed lines of research which may act to provide a valid and comprehensive theoretical account of CM to optimize the research and practice of those working in the field

Multicenter randomized trial of carpal tunnel release with ultrasound guidance versus mini-open technique

BACKGROUND: Comparative studies of carpal tunnel release with ultrasound guidance (CTR-US) vs. mini-open CTR (mOCTR) are limited, prompting development of this randomized trial to compare efficacy and safety of these techniques. RESEARCH DESIGN AND METHODS: Patients were randomized (2:1) to CTR-US or mOCTR, treated by experienced hand surgeons (median previous cases: 12 CTR-US; 1000 mOCTR), and followed for 3 months. RESULTS: Among 149 randomized patients, 122 received CTR-US ( CONCLUSIONS: The efficacy and safety of CTR-US were comparable to mOCTR despite less previous surgical experience with CTR-US. The choice of CTR technique should be determined by shared decision-making between patient and physician. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT05405218

Non-Anatomic Proximal Realignment for Recurrent Patellar Dislocation Does Not Sufficiently Prevent Redislocation

Several operative techniques have been described for recurrent patellar dislocation. Clinical results vary depending on the procedure and indication. The present study aimed to evaluate the clinical outcome of Insall’s proximal realignment for recurrent patellar dislocation at mid-term follow-up. Forty-five patients were reviewed with a mean follow-up period of 49 months after having undergone Insall’s procedure. Outcome measures included reports of redislocations, complications, patient-reported outcome scores (Kujala, Tegner activity scale) and subjective assessment. No statistically significant improvements (p < 0.05) in patient-reported outcome measures were noted. Sixteen patients (35%) had poor to fair results using the Kujala score. Subjective assessment revealed that 12 patients (27%) were dissatisfied with the outcome of their surgery and would not undergo the same procedure. Ten patients (22%) had suffered from redislocation at the latest follow-up. In 4 cases (9%), intra-articular knee hematoma occurred which required arthroscopic intervention. The overall mid-term outcome of the present study shows low patient satisfaction. Non-anatomic realignment for recurrent patellar dislocation does not adequately prevent redislocation

Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: Reliability of standard radiographs, CT scans, and 3D virtual reality images

Background and purpose: Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction. Accurate and reproducible methods to visualize and document bone tunnel placement are therefore important. We evaluated the reliability of standard radiographs, CT scans, and a 3-dimensional (3D) virtual reality (VR) approach in visualizing and measuring ACL reconstruction bone tunnel placement. Methods: 50 consecutive patients who underwent single-bundle ACL reconstructions were evaluated postoperatively by standard radiographs, CT scans, and 3D VR images. Tibial and femoral tunnel positions were measured by 2 observers using the traditional methods of Amis, Aglietti, Hoser, Stubli, and the method of Benereau for the VR approach. Results: The tunnel was visualized in 50-82% of the standard radiographs and in 100% of the CT scans and 3D VR images. Using the intraclass correlation coefficient (ICC), the inter- and intraobserver agreement was between 0.39 and 0.83 for the standard femoral and tibial radiographs. CT scans showed an ICC range of 0.49-0.76 for the inter- and intraobserver agreement. The agreement in 3D VR was almost perfect, with an ICC of 0.83 for the femur and 0.95 for the tibia. Interpretation: CT scans and 3D VR images are more reliable in assessing postoperative bone tunnel placement following ACL reconstruction than standard radiographs. Copyright

Understanding sport clubs as sport policy implementers

The original publication is available at: http://dx.doi.org/10.1080/17430430802196553This article aims at developing a theoretical framework for analysing the implementation of sport policy, as it is conducted by voluntary sport clubs at grass root level. First, three options are presented and discussed: (i) a classical top-down implementation model, (ii) the governance theory of policy tools, and (iii) the Advocacy Coalition Framework. Second, the theoretical perspectives are discussed, and criticized for failing to take sufficiently into account the implementing body of sport policy, namely the voluntary sport clubs. In that respect, an alternative theoretical framework is suggested as a possible solution for analysing the implementation of sport policy; which is the translation perspective of neo-institutionalism. It stresses that, if elements of central policy influence the implementation process at the local level, it does so by the active import, interpretation and implementation of it in the local context. The autonomy of the local sport club in relation to central policy is reinforced by the fact that the activity in sport clubs is mainly done on a voluntary basi

Radiological informed consent in cardiovascular imaging: towards the medico-legal perfect storm?

Use of radiation for medical examinations and tests is the largest manmade source of radiation exposure. No one can doubt the immense clinical and scientific benefits of imaging to the modern practice of medicine. Every radiological and nuclear medicine examination confers a definite (albeit low) long-term risk of cancer, but patients undergoing such examinations often receive no or inaccurate information about radiological dose exposure and corresponding risk directly related to the radiological dose received. Too detailed information on radiological dose and risk may result in undue anxiety, but information "economical with the truth" may violate basic patients' rights well embedded in ethics (Oviedo convention 1997) and law (97/43 Euratom Directive 1997). Informed consent is a procedure needed to establish a respectful and ethical relation between doctors and patients. Nevertheless, in an "ideal" consent process, the principle of patient autonomy in current radiological practice might be reinforced by making it mandatory to obtain explicit and transparent informed consent form for radiological examination with high exposure (≥ 500 chest x-rays). The form may spell-out the type of examination, the exposure in effective dose (mSv), derived from reference values in guidelines or – better – from actual values from their department. The dose equivalent might be also expressed in number of chest radiographs and the risk of cancer as number of extra cases in the exposed population, derived from most recent and authorative guidelines (e.g., BEIR VII Committee, release 2006). Common sense, deontological code, patients'rights, medical imaging guidelines, Euratom law, all coherently and concordantly encourage and recommend a justified, optimized, responsible and informed use of testing with ionizing radiation. Although the idea of informed consent for radiation dose does not seem to be on the immediate radar screen at least in the US, the current practice clashes against these guidelines and laws

Fact and fiction in housing research: utilizing the creative imagination

As much of our conceptual framework is informed by the experience of the imagination, there is much to be learnt from a study of various creative forms. Narrative fiction can be one such form, allowing us to gain a useful insight into complex features of social life. The purpose of this article is to investigate the treatment of housing issues in contemporary literature in order to gain insights into attitudes, experiences and interpretations from the perspective of a broad cultural milieu. Discussions of professionalism, housing tenure and homelessness have tended to be conducted within a narrow framework and adopted orthodox modes of evaluation. Consequently, the neglect of housing within a wider cultural context has reinforced the isolation of housing issues. The article argues that although discussions of housing and housing policy have been seriously limited within the contemporary novel, there are a number of key insights that can be gained from a discussion of issues within a fictional setting