Adhésion thérapeutique du patient chronique: des concepts a la prise en charge ambulatoire [Medication adherence in chronic patients: from its concepts to its management in primary care].

Medication nonadherence is common and its determinants are diverse. Adherence is influenced by many parameters, such as patient's self-efficacy, knowledge of health risk, outcome expectations, benefits of change, and barriers and facilitators. The sociocognitive theory helps professionals to structure their approach and to support patients in managing their treatment. Professionals need skills and time, and benefit from coordination in care, in particular between physicians and pharmacists. This article presents the key elements of a medication adherence program as well as tools and some useful questions.

Knowledge management for systems biology a general and visually driven framework applied to translational medicine

Background: To enhance our understanding of complex biological systems like diseases we need to put all of the available data into context and use this to detect relations, pattern and rules which allow predictive hypotheses to be defined. Life science has become a data rich science with information about the behaviour of millions of entities like genes, chemical compounds, diseases, cell types and organs, which are organised in many different databases and/or spread throughout the literature. Existing knowledge such as genotype - phenotype relations or signal transduction pathways must be semantically integrated and dynamically organised into structured networks that are connected with clinical and experimental data. Different approaches to this challenge exist but so far none has proven entirely satisfactory. Results: To address this challenge we previously developed a generic knowledge management framework, BioXM™, which allows the dynamic, graphic generation of domain specific knowledge representation models based on specific objects and their relations supporting annotations and ontologies. Here we demonstrate the utility of BioXM for knowledge management in systems biology as part of the EU FP6 BioBridge project on translational approaches to chronic diseases. From clinical and experimental data, text-mining results and public databases we generate a chronic obstructive pulmonary disease (COPD) knowledge base and demonstrate its use by mining specific molecular networks together with integrated clinical and experimental data. Conclusions: We generate the first semantically integrated COPD specific public knowledge base and find that for the integration of clinical and experimental data with pre-existing knowledge the configuration based set-up enabled by BioXM reduced implementation time and effort for the knowledge base compared to similar systems implemented as classical software development projects. The knowledgebase enables the retrieval of sub-networks including protein-protein interaction, pathway, gene - disease and gene - compound data which are used for subsequent data analysis, modelling and simulation. Pre-structured queries and reports enhance usability; establishing their use in everyday clinical settings requires further simplification with a browser based interface which is currently under development.

How can we teach EBM in clinical practice? : an analysis of barriers to implementation of on-the-job EBM teaching and learning.

Introduction: Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries. Methods: A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier. Results: The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries. Conclusion: Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

Knowledge management: uncovering risky gaps underlying the criticisms and moving to another perspective

The comments related to the sustainability of knowledge management (KM) have shown signs that it possibly can be a discourse which determines a quick style, but otherwise have also allowed the building of a better understanding about the limits and weaknesses of the knowlege management. In addition to the criticisms, the conceptual bases of knowledge management have been undermined by a contradictory combination of paradigms; there are also contradictions between the theoretical perspective jubjacent to the knwoledge management and its operationality. As a way of minimizing the possibility that the knowledge management may be turned into an umbrella concept and fail, it is suggested that its approaches embody a more interpretative perspective, taking up the role of an instrument which enables and facilitates the processes and practices in building up knowledge and information, enhancing their focus on the support to the establishment of human competences in order to deal intelligently with the present overcharge of information resources and need for building up information in the organizations.

Knowledge, processes and relationships in organizational change: Understanding how to facilitate management of intellectual capital in diverse organization structures and cultures.

This study examined relationships of organizational dependencies, change management and developed intellectual knowledge resources, in different intellectual capital based development programs on ICT-sector. Study was carried out in a research context, where high degree of external organizational contingencies existed and lots of changes in several development programs had taken place in the last years. From a scientific perspective the main contribution was that evidence between relationships of organizational dependencies, change model portfolio and developed knowledge resources could be suggested. From managerial perspective the primary implication was that in situations where sustainable competitive advantage is pursued by means of increasing knowledge based productivity of labor, firms should seek to pursue organizational settings where external dependencies have minimal amount of effect.

The Human Resources Strategy as the Key to Success of Knowledge Management in Companies Implementing New Technologies in the City of Montería

Knowledge management has been one of the topics of greatest interest in the field of organizational studies in recent years. The objective of this research is to analyze the adoptionof knowledge management practices and their relation to human resource policies. The study was carried out in companies operating in the city of Monteria from a quantitative analysis.

Barreras en el acceso a la dirección escolar : diferencias entre profesoras y directoras de centros de Educación Infantil y Primaria. 'Barriers in the access to school management : differences between teachers and head-teachers from early childhood and elementary education schools'.

Resumen tomado de la publicación. Con el apoyo económico del departamento MIDE de la UNED

Barriers to adapt eCommerce by rural microenterprises in Sweden : a case study

Research has shown that small and medium-sized enterprises (SMEs) are rapidly adopting the e-commerce. However, there is nearly no research into how microenterprises are adopting eCommerce. Present paper focus on microenterprise adaption of eCommerce in terms of barriers in relation to already known research on SMEs. A case study, carried out by 12 microenterprises to find out barriers to adapt eCommerce had been done. The empirical results show that the microenterprises share most of the barriers to adapt the eCommerce with studies of SMEs, but also reveal additional factors affecting adaptation option of eCommerce; supplier agreement, communication and customer strategy. Conclusions are that microenterprises need additional support and communication and customer strategy to adapt eCommerce, depending of their requirement and needs of eCommerce.

Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

The Approach To The Administrative Mapping In Knowledge Management For Portugal Libraries

In the study of theoretical trends in Administration, the management of information follows the development of theories of Administration; constant-adaptations are suffered. Information Science as Museums, Archives and Libraries, understands and concerns itself with the changes wrought in these endeavour of the knowledge society as new forms of communication and integration. They interact in ways such as to maximize access to information and facilitate improvement on their structural environment. The research aims at identifies the requirements and specifications of an information system for knowledge management in the public's library enviromnent and proposes to achieve a pre-defined structure for the implementation of administration management. The research is conducted with public's library of the metropolian region of the North's Portugal. In the improvement of systems theoretical administrative trends become management decisions and result in the ultimate success of the organization.

Measuring Knowledge Management: A Strategic Approach to Library Information Services

In the study of theoretical trends in Administration, the management of information follows the development of theories of Administration; constant-adaptations are suffered. Information Science area understands and concerns itself with the changes wrought in these endeavour of the knowledge society as new forms of communication and integration. The libraries interact in ways that maximize access to information and facilitate the improvement on their structural environment as strategic approach for your services. The research aims at identifying the requirements and specifications of an information system for knowledge management in the public’s library environment and proposes to achieve a pre-defined structure for the implementation of administration management. The research is conducted with public’s library of the metropolitan region of the North’s Portugal. Portugal libraries are institutions that operate in the social process of their communities reflecting the society and its organic sphere of informational performance. These libraries have developed the organizational theories to make a framework easily for effective management practices and have been using their produced knowledge in the optimization of their actions. In the improvement of systems, theoretical administrative trends become management decisions and result in the ultimate success of the organization. In order to achieve its objectives the study verified an economy based on knowledge management, and its production emphasizes the human capital that permeates the condition of the information in support for the development of communities.

Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records.

BACKGROUND: We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria. METHODS: We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content. RESULTS: All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified. CONCLUSION: If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.