Étude multicentrique des facteurs influençant l’adoption d’un dossier clinique informatisé hospitalier par des infirmières

À l’instar de plusieurs systèmes de santé, les centres hospitaliers québécois ont amorcé l’informatisation du dossier patient sous forme papier pour la transition vers un dossier clinique informatisé (DCI). Ce changement complexe s’est parfois traduit par des répercussions sur les pratiques de soins, la sécurité et la qualité des soins offerts. L’adoption de la part des utilisateurs de technologies de l’information (TI) est considérée comme un facteur critique de succès pour la réalisation de bénéfices suite au passage à un DCI. Cette étude transversale multicentrique avait pour objectifs d’examiner des facteurs explicatifs de l’adoption, de l’utilisation réelle d’un DCI, de la satisfaction des infirmières et de comparer les résultats au regard du sexe, de l’âge, de l’expérience des infirmières et des stades de déploiement du DCI. Un modèle théorique s’appuyant sur la Théorie unifiée de l’adoption et de l’utilisation de la technologie a été développé et testé auprès d’un échantillon comptant 616 infirmières utilisant un DCI hospitalier dans quatre milieux de soins différents. Plus particulièrement, l’étude a testé 20 hypothèses de recherche s’intéressant aux relations entre huit construits tels la compatibilité du DCI, le sentiment d’auto-efficacité des infirmières, les attentes liées à la performance, celles qui sont liées aux efforts à déployer pour adopter le DCI, l'influence sociale dans l’environnement de travail, les conditions facilitatrices mises de l’avant pour soutenir le changement et ce, relativement à l’utilisation réelle du DCI et la satisfaction des infirmières. Au terme des analyses de modélisation par équations structurelles, 13 hypothèses de recherche ont été confirmées. Les résultats tendent à démontrer qu’un DCI répondant aux attentes des infirmières quant à l’amélioration de leur performance et des efforts à déployer, la présence de conditions facilitatrices dans l’environnement de travail et un DCI compatible avec leur style de travail, leurs pratiques courantes et leurs valeurs sont les facteurs les plus déterminants pour influencer positivement l’utilisation du DCI et leur satisfaction. Les facteurs modélisés ont permis d’expliquer 50,2 % de la variance des attentes liées à la performance, 52,9 % des attentes liées aux efforts, 33,6 % de l’utilisation réelle du DCI et 54,9 % de la satisfaction des infirmières. La forte concordance du modèle testé avec les données de l’échantillon a notamment mis en lumière l’influence des attentes liées à la performance sur l’utilisation réelle du DCI (r = 0,55 p = 0,006) et sur la satisfaction des infirmières (r = 0,27 p = 0,010), des conditions facilitatrices sur les attentes liées aux efforts (r = 0,45 p = 0,009), de la compatibilité du DCI sur les attentes liées à la performance (r = 0,39 p = 0,002) et sur celles qui sont liées aux efforts (r = 0,28 p = 0,009). Les nombreuses hypothèses retenues ont permis de dégager l’importance des effets de médiation captés par le construit des attentes liées à la performance et celui des attentes liées aux efforts requis pour utiliser le DCI. Les comparaisons fondées sur l’âge, l’expérience et le sexe des répondants n’ont décelé aucune différence statistiquement significative quant à l’adoption, l’utilisation réelle du DCI et la satisfaction des infirmières. Par contre, celles qui sont fondées sur les quatre stades de déploiement du DCI ont révélé des différences significatives quant aux relations modélisées. Les résultats indiquent que plus le stade de déploiement du DCI progresse, plus on observe une intensification de certaines relations clés du modèle et une plus forte explication de la variance de la satisfaction des infirmières qui utilisent le DCI. De plus, certains résultats de l’étude divergent des données empiriques produites dans une perspective prédictive de l’adoption des TI. La présente étude tend à démontrer l’applicabilité des modèles et des théories de l’adoption des TI auprès d’infirmières œuvrant en centre hospitalier. Les résultats indiquent qu’un DCI répondant aux attentes liées à la performance des infirmières est le facteur le plus déterminant pour influencer positivement l’utilisation réelle du DCI et leur satisfaction. Pour la gestion du changement, l’étude a relevé des facteurs explicatifs de l’adoption et de l’utilisation d’un DCI. La modélisation a aussi mis en lumière les interrelations qui évoluent en fonction de stades de déploiement différents d’un DCI. Ces résultats pourront orienter les décideurs et les agents de changement quant aux mesures à déployer pour optimiser les bénéfices d’une infostructure entièrement électronique dans les systèmes de santé.

Characterization of Probability Distributions Using the Residual Entropy Function

The present study on the characterization of probability distributions using the residual entropy function. The concept of entropy is extensively used in literature as a quantitative measure of uncertainty associated with a random phenomenon. The commonly used life time models in reliability Theory are exponential distribution, Pareto distribution, Beta distribution, Weibull distribution and gamma distribution. Several characterization theorems are obtained for the above models using reliability concepts such as failure rate, mean residual life function, vitality function, variance residual life function etc. Most of the works on characterization of distributions in the reliability context centers around the failure rate or the residual life function. The important aspect of interest in the study of entropy is that of locating distributions for which the shannon’s entropy is maximum subject to certain restrictions on the underlying random variable. The geometric vitality function and examine its properties. It is established that the geometric vitality function determines the distribution uniquely. The problem of averaging the residual entropy function is examined, and also the truncated form version of entropies of higher order are defined. In this study it is established that the residual entropy function determines the distribution uniquely and that the constancy of the same is characteristics to the geometric distribution

Some concepts and models usefulninthe analysis of discrete life time data

This thesis entitled Reliability Modelling and Analysis in Discrete time Some Concepts and Models Useful in the Analysis of discrete life time data.The present study consists of five chapters. In Chapter II we take up the derivation of some general results useful in reliability modelling that involves two component mixtures. Expression for the failure rate, mean residual life and second moment of residual life of the mixture distributions in terms of the corresponding quantities in the component distributions are investigated. Some applications of these results are also pointed out. The role of the geometric,Waring and negative hypergeometric distributions as models of life lengths in the discrete time domain has been discussed already. While describing various reliability characteristics, it was found that they can be often considered as a class. The applicability of these models in single populations naturally extends to the case of populations composed of sub-populations making mixtures of these distributions worth investigating. Accordingly the general properties, various reliability characteristics and characterizations of these models are discussed in chapter III. Inference of parameters in mixture distribution is usually a difficult problem because the mass function of the mixture is a linear function of the component masses that makes manipulation of the likelihood equations, leastsquare function etc and the resulting computations.very difficult. We show that one of our characterizations help in inferring the parameters of the geometric mixture without involving computational hazards. As mentioned in the review of results in the previous sections, partial moments were not studied extensively in literature especially in the case of discrete distributions. Chapters IV and V deal with descending and ascending partial factorial moments. Apart from studying their properties, we prove characterizations of distributions by functional forms of partial moments and establish recurrence relations between successive moments for some well known families. It is further demonstrated that partial moments are equally efficient and convenient compared to many of the conventional tools to resolve practical problems in reliability modelling and analysis. The study concludes by indicating some new problems that surfaced during the course of the present investigation which could be the subject for a future work in this area.

Some bivariate life time models in discrete time"

The term reliability of an equipment or device is often meant to indicate the probability that it carries out the functions expected of it adequately or without failure and within specified performance limits at a given age for a desired mission time when put to use under the designated application and operating environmental stress. A broad classification of the approaches employed in relation to reliability studies can be made as probabilistic and deterministic, where the main interest in the former is to device tools and methods to identify the random mechanism governing the failure process through a proper statistical frame work, while the latter addresses the question of finding the causes of failure and steps to reduce individual failures thereby enhancing reliability. In the probabilistic attitude to which the present study subscribes to, the concept of life distribution, a mathematical idealisation that describes the failure times, is fundamental and a basic question a reliability analyst has to settle is the form of the life distribution. It is for no other reason that a major share of the literature on the mathematical theory of reliability is focussed on methods of arriving at reasonable models of failure times and in showing the failure patterns that induce such models. The application of the methodology of life time distributions is not confined to the assesment of endurance of equipments and systems only, but ranges over a wide variety of scientific investigations where the word life time may not refer to the length of life in the literal sense, but can be concieved in its most general form as a non-negative random variable. Thus the tools developed in connection with modelling life time data have found applications in other areas of research such as actuarial science, engineering, biomedical sciences, economics, extreme value theory etc.

Characterizations of Life Distributions Using Conditional Expectations of Doubly (Interval) Truncated Random Variables

In this article, we study reliability measures such as geometric vitality function and conditional Shannon’s measures of uncertainty proposed by Ebrahimi (1996) and Sankaran and Gupta (1999), respectively, for the doubly (interval) truncated random variables. In survival analysis and reliability engineering, these measures play a significant role in studying the various characteristics of a system/component when it fails between two time points. The interrelationships among these uncertainty measures for various distributions are derived and proved characterization theorems arising out of them

Characterizations of some continuous distributions using partial moments

Inthis paper,we define partial moments for a univariate continuous random variable. A recurrence relationship for the Pearson curve using the partial moments is established. The interrelationship between the partial moments and other reliability measures such as failure rate, mean residual life function are proved. We also prove some characterization theorems using the partial moments in the context of length biased models and equilibrium distributions

Bivariate distributions with weighted marginals and reliablity modelling

In this paper, a family of bivariate distributions whose marginals are weighted distributions in the original variables is studied. The relationship between the failure rates of the derived and original models are obtained. These relationships are used to provide some characterizations of specific bivariate models

Properties of Equilibrium Distributions of Order n

The present work is intended to discuss various properties and reliability aspects of higher order equilibrium distributions in continuous, discrete and multivariate cases, which contribute to the study on equilibrium distributions. At first, we have to study and consolidate the existing literature on equilibrium distributions. For this we need some basic concepts in reliability. These are being discussed in the 2nd chapter, In Chapter 3, some identities connecting the failure rate functions and moments of residual life of the univariate, non-negative continuous equilibrium distributions of higher order and that of the baseline distribution are derived. These identities are then used to characterize the generalized Pareto model, mixture of exponentials and gamma distribution. An approach using the characteristic functions is also discussed with illustrations. Moreover, characterizations of ageing classes using stochastic orders has been discussed. Part of the results of this chapter has been reported in Nair and Preeth (2009). Various properties of equilibrium distributions of non-negative discrete univariate random variables are discussed in Chapter 4. Then some characterizations of the geo- metric, Waring and negative hyper-geometric distributions are presented. Moreover, the ageing properties of the original distribution and nth order equilibrium distribu- tions are compared. Part of the results of this chapter have been reported in Nair, Sankaran and Preeth (2012). Chapter 5 is a continuation of Chapter 4. Here, several conditions, in terms of stochastic orders connecting the baseline and its equilibrium distributions are derived. These conditions can be used to rede_ne certain ageing notions. Then equilibrium distributions of two random variables are compared in terms of various stochastic orders that have implications in reliability applications. In Chapter 6, we make two approaches to de_ne multivariate equilibrium distribu- tions of order n. Then various properties including characterizations of higher order equilibrium distributions are presented. Part of the results of this chapter have been reported in Nair and Preeth (2008). The Thesis is concluded in Chapter 7. A discussion on further studies on equilib- rium distributions is also made in this chapter.

Reliability Estimation of Open Source Software based Computational Systems

Software systems are progressively being deployed in many facets of human life. The implication of the failure of such systems, has an assorted impact on its customers. The fundamental aspect that supports a software system, is focus on quality. Reliability describes the ability of the system to function under specified environment for a specified period of time and is used to objectively measure the quality. Evaluation of reliability of a computing system involves computation of hardware and software reliability. Most of the earlier works were given focus on software reliability with no consideration for hardware parts or vice versa. However, a complete estimation of reliability of a computing system requires these two elements to be considered together, and thus demands a combined approach. The present work focuses on this and presents a model for evaluating the reliability of a computing system. The method involves identifying the failure data for hardware components, software components and building a model based on it, to predict the reliability. To develop such a model, focus is given to the systems based on Open Source Software, since there is an increasing trend towards its use and only a few studies were reported on the modeling and measurement of the reliability of such products. The present work includes a thorough study on the role of Free and Open Source Software, evaluation of reliability growth models, and is trying to present an integrated model for the prediction of reliability of a computational system. The developed model has been compared with existing models and its usefulness of is being discussed.

The Wrong Kind of Lean: Over-Commitment and Under-Represented Skills on Technology Teams

This paper reports on results from five companies in the aerospace and automotive industries to show that over-commitment of technical professionals and under-representation of key skills on technology development and transition teams seriously impairs team performance. The research finds that 40 percent of the projects studied were inadequately staffed, resulting in weaker team communications and alignment. Most importantly, the weak staffing on these teams is found to be associated with a doubling of project failure rate to reach full production. Those weakly staffed teams that did successfully insert technology into production systems were also much more likely than other teams to have development delays and late engineering changes. The conclusion suggests that the expense of project failure, delay and late engineering changes in these companies must greatly out-weigh the savings gained from reduced staffing costs, and that this problem is likely going to be found in other technology-intensive firms intent on seeing project budgets as a cost to be minimized rather than an investment to be maximized.

Preventive maintenance models with random maintenance quality

In real-world environments it is usually difficult to specify the quality of a preventive maintenance (PM) action precisely. This uncertainty makes it problematic to optimise maintenance policy.-This problem is tackled in this paper by assuming that the-quality of a PM action is a random variable following a probability distribution. Two frequently studied PM models, a failure rate PM model and an age reduction PM model, are investigated. The optimal PM policies are presented and optimised. Numerical examples are also given.

The price of risk in construction projects: contingency approximation model (CAM)

Little attention has been focussed on a precise definition and evaluation mechanism for project management risk specifically related to contractors. When bidding, contractors traditionally price risks using unsystematic approaches. The high business failure rate our industry records may indicate that the current unsystematic mechanisms contractors use for building up contingencies may be inadequate. The reluctance of some contractors to include a price for risk in their tenders when bidding for work competitively may also not be a useful approach. Here, instead, we first define the meaning of contractor contingency, and then we develop a facile quantitative technique that contractors can use to estimate a price for project risk. This model will help contractors analyse their exposure to project risks; and help them express the risk in monetary terms for management action. When bidding for work, they can decide how to allocate contingencies strategically in a way that balances risk and reward.

DGGE with genomic DNA: Suitable for detection of numerically important organisms but not for identification of the most abundant organisms

Identification of all important community members as well as of the numerically dominant members of a community are key aspects of microbial community analysis of bioreactor samples. A systematic study was conducted with artificial consortia to test whether denaturing gradient gel electrophoresis (DGCE) is a reliable technique to obtain such community data under conditions where results would not be affected by differences in DNA extraction efficiency from cells. A total of 27 consortia were established by mixing DNA extracted from Escherichia coli K12, Burkholderia cepacia and Stenotrophomonas maltophilia in different proportions. Concentrations of DNA of single organisms in the consortia were either 0.04, 0.4 or 4 ng/mu l. DGGE-PCR of genomic DNA with primer sets targeted at the V3 and V6-V8 regions of the 16S rDNA failed to detect the three community members in only 7% of consortia, but provided incorrect information about dominance or co-dominance for 85% and 89% of consortia with the primer sets for the V6-V8 and V3 regions, respectively. The high failure rate in detection of dominant B. cepacia with the primers for the V6-V8 region was attributable to a single nucleoticle primer mismatch in the target sequences of both, the forward and reverse primer. Amplification bias in PCR of E. coli and S. maltophilia for the V6-V8 region and for all three organisms for the V3 region occurred due to interference of genomic DNA in PCR-DGGE, since a nested PCR approach, where PCR-DGGE was started from mixtures of 16S rRNA genes of the organisms, provided correct information about the relative abundance of original DNA in the sample. Multiple bands were not observed in pure culture amplicons produced with the V6-V8 primer pair, but pure culture V3 DGGE profiles of E. coli, S. maltophilia and B. cepacia contained 5, 3 and 3 bands, respectively. These results demonstrate DGGE was suitable for identification of all important community members in the three-membered artificial consortium, but not for identification of the dominant organisms in this small community. Multiple DGGE bands obtained for single organisms with the V3 primer pair could greatly confound interpretation of DGGE profiles. (C) 2008 Elsevier Ltd. All rights reserved.

A unified view on lifetime distributions arising from selection mechanisms

In this paper, we formulate a flexible density function from the selection mechanism viewpoint (see, for example, Bayarri and DeGroot (1992) and Arellano-Valle et al. (2006)) which possesses nice biological and physical interpretations. The new density function contains as special cases many models that have been proposed recently in the literature. In constructing this model, we assume that the number of competing causes of the event of interest has a general discrete distribution characterized by its probability generating function. This function has an important role in the selection procedure as well as in computing the conditional personal cure rate. Finally, we illustrate how various models can be deduced as special cases of the proposed model. (C) 2011 Elsevier B.V. All rights reserved.

The complementary exponential power lifetime model

In this paper we propose a new lifetime distribution which can handle bathtub-shaped unimodal increasing and decreasing hazard rate functions The model has three parameters and generalizes the exponential power distribution proposed by Smith and Bain (1975) with the inclusion of an additional shape parameter The maximum likelihood estimation procedure is discussed A small-scale simulation study examines the performance of the likelihood ratio statistics under small and moderate sized samples Three real datasets Illustrate the methodology (C) 2010 Elsevier B V All rights reserved