Unity in diversity: electronic patient record use in multidisciplinary practice

In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a year-long, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

Physicians in leadership: the association between medical director involvement and staff-to-patient ratios

In a hospital environment that demands a careful balance between commercial and clinical interests, the extent to which physicians are involved in hospital leadership varies greatly. This paper assesses the influence of the extent of this involvement on staff-to-patient ratios. Using data gathered from 604 hospitals across Germany, this study evidences the positive relationship between a full-time medical director (MD) or heavily involved part-time MD and a higher staff-to-patient ratio. The data allows us to control for a range of confounding variables, such as size, rural/urban location, ownership structure, and case-mix. The results contribute to the sparse body of empirical research on the effect of clinical leadership on organizational outcomes.

Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

Physical properties of a hybrid and a nanohybrid dental light-cured resin composite.

This work was aimed at the study of some physical properties of two current light-cured dental resin composites, Rok (hybrid) and Ice (nanohydrid). As filler they both contain strontium aluminosilicate particles, however, with different size distribution, 40 nm-2.5 mum for Rok and 10 nm-1 mum for Ice. The resin matrix of Rok consists of UDMA, that of Ice of UDMA, Bis-EMA and TEGDMA. Degree of conversion was determined by FT-IR analysis. The flexural strength and modulus were measured using a three-point bending set-up according to the ISO-4049 specification. Sorption, solubility and volumetric change were measured after storage of composites in water or ethanol/water (75 vol%) for 1 day, 7 or 30 days. Thermogravimetric analysis was performed in air and nitrogen atmosphere from 30 to 700 degrees C. Surface roughness and morphology of the composites was studied by atomic force microscopy (AFM). The degree of conversion was found to be 56.9% for Rok and 61.0% for Ice. The flexural strength of Rok does not significantly differ from that of Ice, while the flexural modulus of Rok is higher than that of Ice. The flexural strengths of Rok and Ice did not show any significant change after immersion in water or ethanol solution for 30 days. The flexural modulus of Rok and Ice did not show any significant change either after immersion in water for 30 days, while it decreased significantly, even after 1 day immersion, in ethanol solution. Ice sorbed a higher amount of water and ethanol solution than Rok and showed a higher volume increase. Thermogravimetric analysis showed that Rok contains about 80 wt% inorganic filler and Ice about 75 wt%.