scholarly journals Networked information technologies and patient safety: a protocol for a realist synthesis

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Justin Keen ◽  
Joanne Greenhalgh ◽  
Rebecca Randell ◽  
Peter Gardner ◽  
Justin Waring ◽  
...  
Keyword(s):  
Patient Safety ◽  
Information Technologies ◽  
Realist Synthesis ◽  
Health Economy ◽  
Clinical Practices ◽  
Range Theory ◽  
Widespread Belief ◽  
Underlying Mechanisms ◽  
Clinical Risks ◽  
Shed Light

Abstract Background There is a widespread belief that information technologies will improve diagnosis, treatment and care. Evidence about their effectiveness in health care is, however, mixed. It is not clear why this is the case, given the remarkable advances in hardware and software over the last 20 years. This review focuses on interoperable information technologies, which governments are currently advocating and funding. These link organisations across a health economy, with a view to enabling health and care professionals to coordinate their work with one another and to access patient data wherever it is stored. Given the mixed evidence about information technologies in general, and current policies and funding, there is a need to establish the value of investments in this class of system. The aim of this review is to establish how, why and in what circumstances interoperable systems affect patient safety. Methods A realist synthesis will be undertaken, to understand how and why inter-organisational systems reduce patients’ clinical risks, or fail to do so. The review will follow the steps in most published realist syntheses, including (1) clarifying the scope of the review and identifying candidate programme and mid-range theories to evaluate, (2) searching for evidence, (3) appraising primary studies in terms of their rigour and relevance and extracting evidence, (4) synthesising evidence, (5) identifying recommendations, based on assessment of the extent to which findings can be generalised to other settings. Discussion The findings of this realist synthesis will shed light on how and why an important class of systems, that span organisations in a health economy, will contribute to changes in patients’ clinical risks. We anticipate that the findings will be generalizable, in two ways. First, a refined mid-range theory will contribute to our understanding of the underlying mechanisms that, for a range of information technologies, lead to changes in clinical practices and hence patients’ risks (or not). Second, many governments are funding and implementing cross-organisational IT networks. The findings can inform policies on their design and implementation. Systematic review registration PROSPERO CRD42017073004

scholarly journals Effects of interorganisational information technology networks on patient safety: a realist synthesis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036608
Author(s):  
Justin Keen ◽  
Maysam Ali Abdulwahid ◽  
Natalie King ◽  
Judy M Wright ◽  
Rebecca Randell ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Good Evidence ◽  
Realist Synthesis ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Beneficial Effects ◽  
Nominal Groups ◽  
Clinical Risks ◽  
At Home

ObjectiveHealth services in many countries are investing in interorganisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home.DesignRealist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews.Eligibility criteriaThe coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital.Information sources17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts.OutcomesChanges in patients’ clinical risks.ResultsWe did not find any detailed accounts of the sequences of events that policymakers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories.There is good evidence that there are problems with the coordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high-quality evidence about safety-related outcomes associated with the deployment of interoperable networks.ConclusionsEmpirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the sociotechnical nature of coordination problems.PROSPERO registration numberCRD42017073004.

scholarly journals Peran Perawat Dalam Meningkatkan Keselematan Pasien Dirumah Sakit

2020 ◽  
Author(s):  
intan
Keyword(s):  
Patient Safety ◽  
Near Miss ◽  
Clinical Risks

Keselamatan pasien atau patient safety merupakan sistem pelayanan rumah sakit yang memberikan asuhan pasien secara lebih aman. Termasuk didalamnya prosedur : mengukur (assessing) risiko, identifikasi, dan pengelolaan risiko terhadap pasien, pelaporan dan analisis insiden, kemampuan untuk menindaklanjuti insiden serta menerapkan solusi untuk mengurangi serta meminimalisasi risiko yang juga melalui komunikasi dengan pasien. Dapat dikatakan bahwa fokus utama patient safety adalah upaya yang dilakukan untuk menghindari terjadinya kesalahan.(1) WHO mengestimasikan, 1 dari 10 pasien dirugikan selama mendapatkan pelayanan kesehatan di rumah sakit yang terjadi di negara-negara maju. Sedangkan di negara-negara berkembang, peluang pasien untuk dirugikan selama menerima perawatan kesehatan di rumah sakit lebih tinggi dibandingkan negara-negara industri. Risiko kejadian infeksi dalam pelayanan kesehatan di negara-negara berkembang 20 kali lebih besar dibandingkan negaranegara maju.(2) Masalah kesehatan terkait patient safety pun kerap dikeluhkan di Indonesia. Departemen Kesehatan Republik Indonesia menyatakan bahwa data KTD, terlebih pada Kejadian Nyaris Cedera (Near Miss) masih sangat langka dalam pelaporan, namun terjadi peningkatan tuduhan terhadap malpraktik. Jika dibandingkan dengan negara-negara maju seperti Amerika dan Inggris yang memiliki standar pelayanan kesehatan lebih baik dari Indonesia, dapat dibayangkan angka KTD dan kesalahan medis yang terjadi di Indonesia dapat lebih besar pula.(3) Pelayanan gawat darurat merupakan salah satu komponen pelayanan rumah sakit yang dilaksanakan di Instalasi Gawat Darurat (IGD). Adapun fungsi IGD adalah menyelenggarakan pelayanan asuhan medis dan asuhan keperawatan serta pelayanan pembedahan darurat bagi pasien yang datang dengan gawat darurat medis. Sebagai unit pelayanan yang menanggulangi penderita gawat darurat, IGD merupakan high clinical risks areas, oleh karena itu pelayanan di IGD harus dikelola sedemikian rupa sehingga pasien mendapatkan perawatan yang baik dan aman, salah satu upaya untuk mewujudkan pelayanan yang aman adalah kembali lagi dengan penerapan patient safety yang baik di IGD.(4) Belum terdapat data mengenai kejadian terkait keselamatan pasien (patient safety) di IGD yang lengkap dan akurat di Indonesia, namun berdasarkan data Komite Keselamatan Pasien Rumah Sakit.

Application of Bow-tie methodology to improve patient safety

2016 ◽  
Vol 29 (4) ◽  
pp. 425-440 ◽  
Author(s):  
Zhaleh Abdi ◽  
Hamid Ravaghi ◽  
Mohsen Abbasi ◽  
Bahram Delgoshaei ◽  
Somayeh Esfandiari
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Blood Stream Infection ◽  
Improve Patient Safety ◽  
Blood Stream ◽  
Clinical Settings ◽  
Content Type ◽  
Clinical Risks ◽  
Improve Patient ◽  
Bow Tie

Purpose – The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach – Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings – In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value – The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

Earth System Dynamic Intelligence - ESDI

2021 ◽  
Author(s):  
Rui A. P. Perdigão
Keyword(s):  
Information Technologies ◽  
Complex Problem ◽  
System Dynamic ◽  
Stochastic Dynamic ◽  
Earth System ◽  
Dynamic Information ◽  
Information Theoretic ◽  
Hybrid Techniques ◽  
Process Understanding ◽  
Shed Light

Earth System Dynamic Intelligence (ESDI) entails developing and making innovative use of emerging concepts and pathways in mathematical geophysics, Earth System Dynamics, and information technologies to sense, monitor, harness, analyze, model and fundamentally unveil dynamic understanding across the natural, social and technical geosciences, including the associated manifold multiscale multidomain processes, interactions and complexity, along with the associated predictability and uncertainty dynamics. The ESDI Flagship initiative ignites the development, discussion and cross-fertilization of novel theoretical insights, methodological developments and geophysical applications across interdisciplinary mathematical, geophysical and information technological approaches towards a cross-cutting, mathematically sound, physically consistent, socially conscious and operationally effective Earth System Dynamic Intelligence. Going beyond the well established stochastic-dynamic, information-theoretic, artificial intelligence, mechanistic and hybrid techniques, ESDI paves the way to exploratory and disruptive developments along emerging information physical intelligence pathways, and bridges fundamental and operational complex problem solving across frontier natural, social and technical geosciences. Overall, the ESDI Flagship breeds a nascent field and community where methodological ingenuity and natural process understanding come together to shed light onto fundamental theoretical aspects to build innovative methodologies, products and services to tackle real-world challenges facing our planet.

D-alanine metabolism via D-Ala aminotransferase by marine Gammaproteobacteria , Pseudoalteromonas sp. CF6-2

2021 ◽  
Author(s):  
Yang Yu ◽  
Jie Yang ◽  
Zhao-Jie Teng ◽  
Li-Yuan Zheng ◽  
Qi Sheng ◽  
...  
Keyword(s):  
Amino Acid ◽  
Marine Bacteria ◽  
Gene Knockout ◽  
Underlying Mechanism ◽  
Dominant Group ◽  
Seawater Samples ◽  
Underlying Mechanisms ◽  
Biochemical Analyses ◽  
Global Oceans ◽  
Shed Light

As the most abundant D-amino acid (DAA) in the ocean, D-alanine (D-Ala) is a key component of peptidoglycan in bacterial cell wall. However, the underlying mechanisms of bacterial metabolization of D-Ala through microbial food web remain largely unknown. In this study, the metabolism of D-Ala by marine bacterium Pseudoalteromonas sp. CF6-2 was investigated. Based on genomic, transcriptional and biochemical analyses combined with gene knockout, D-Ala aminotransferase was found to be indispensable for the catabolism of D-Ala in strain CF6-2. Investigation on other marine bacteria also showed that D-Ala aminotransferase gene is a reliable indicator for their ability to utilize D-Ala. Bioinformatic investigation revealed that D-Ala aminotransferase sequences are prevalent in genomes of marine bacteria and metagenomes, especially in seawater samples, and Gammaproteobacteria represents the predominant group containing D-Ala aminotransferase. Thus, Gammaproteobacteria is likely the dominant group to utilize D-Ala via D-Ala aminotransferase to drive the recycling and mineralization of D-Ala in the ocean. IMPORTANCE As the most abundant D-amino acid in the ocean, D-Ala is a component of marine DON (Dissolved organic nitrogen) pool. However, the underlying mechanism of bacterial metabolization of D-Ala to drive the recycling and mineralization of D-Ala in the ocean is still largely unknown. The results in this study showed that D-Ala aminotransferase is specific and indispensable for D-Ala catabolism in marine bacteria, and that marine bacteria containing D-Ala aminotransferase genes are predominantly Gammaproteobacteria widely distributed in global oceans. This study reveals marine D-Ala utilizing bacteria and the mechanism of their metabolization of D-Ala. The results shed light on the mechanisms of recycling and mineralization of D-Ala driven by bacteria in the ocean, which are helpful in understanding oceanic microbial-mediated nitrogen cycle.

Information Technology (IT) and the Healthcare Industry

2011 ◽  
pp. 65-83 ◽  
Author(s):  
Marilyn M. Helms ◽  
Rita Moore ◽  
Mohammad Ahmadi
Keyword(s):  
Patient Safety ◽  
Information Technologies ◽  
New Technologies ◽  
Improve Patient Safety ◽  
Analysis Tool ◽  
Healthcare Industry ◽  
Patient Privacy ◽  
Legal Compliance ◽  
Lack Of Information ◽  
Use Of The Internet

The healthcare industry is under pressure to improve patient safety, operate more efficiently, reduce medical errors, and provide secure access to timely information while controlling costs, protecting patient privacy, and complying with legal guidelines. Analysts, practitioners, patients and others have concerns for the industry. Using the popular strategic analysis tool of strengths, weaknesses, opportunities, and threats analysis (SWOT), facing the healthcare industry and its adoption of information technologies (IT) are presented. Internal strengths supporting further industry investment in IT include improved patient safety, greater operational efficiency, and current investments in IT infrastructure. Internal weaknesses, however, include a lack of information system integration, user resistance to new technologies and processes, and slow adoption of IT. External opportunities including increased use of the Internet, a favorable national environment, and a growing call for industry standards are pressured by threats of legal compliance, loss of patient trust, and high cost of IT.

scholarly journals Function and Benefits of Natural Competence in Cyanobacteria: From Ecology to Targeted Manipulation

Life ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 249
Author(s):  
Alexandra M. Schirmacher ◽  
Sayali S. Hanamghar ◽  
Julie A. Z. Zedler
Keyword(s):  
Photosynthetic Bacteria ◽  
Molecular Mechanisms ◽  
Natural Competence ◽  
Genetic Potential ◽  
Cyanobacterial Species ◽  
A Cell ◽  
Foreign Dna ◽  
Underlying Mechanisms ◽  
Globally Distributed ◽  
Shed Light

Natural competence is the ability of a cell to actively take up and incorporate foreign DNA in its own genome. This trait is widespread and ecologically significant within the prokaryotic kingdom. Here we look at natural competence in cyanobacteria, a group of globally distributed oxygenic photosynthetic bacteria. Many cyanobacterial species appear to have the genetic potential to be naturally competent, however, this ability has only been demonstrated in a few species. Reasons for this might be due to a high variety of largely uncharacterised competence inducers and a lack of understanding the ecological context of natural competence in cyanobacteria. To shed light on these questions, we describe what is known about the molecular mechanisms of natural competence in cyanobacteria and analyse how widespread this trait might be based on available genomic datasets. Potential regulators of natural competence and what benefits or drawbacks may derive from taking up foreign DNA are discussed. Overall, many unknowns about natural competence in cyanobacteria remain to be unravelled. A better understanding of underlying mechanisms and how to manipulate these, can aid the implementation of cyanobacteria as sustainable production chassis.

scholarly journals Cytokines and Other Mediators in Alopecia Areata

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Stamatis Gregoriou ◽  
Dafni Papafragkaki ◽  
George Kontochristopoulos ◽  
Eustathios Rallis ◽  
Dimitrios Kalogeromitros ◽  
...  
Keyword(s):  
Alopecia Areata ◽  
Stress Hormones ◽  
Disease Onset ◽  
Hla Antigens ◽  
Hair Follicles ◽  
Strong Component ◽  
Underlying Mechanisms ◽  
As Stress ◽  
Shed Light

Alopecia areata, a disease of the hair follicles with multifactorial etiology and a strong component of autoimmune origin, has been extensively studied as far as the role of several cytokines is concerned. So far, IFN-, interleukins, TNF-, are cytokines that are well known to play a major role in the pathogenesis of the disease, while several studies have shown that many more pathways exist. Among them, MIG, IP-10, BAFF, HLA antigens, MIG, as well as stress hormones are implicated in disease onset and activity. Within the scope of this paper, the authors attempt to shed light upon the complexity of alopecia areata underlying mechanisms and indicate pathways that may suggest future treatments.

scholarly journals Disambiguating “Mechanisms” in Pharmacy: Lessons from Mechanist Philosophy of Science

2020 ◽  
Vol 17 (6) ◽  
pp. 1833 ◽  
Author(s):  
Ahmad Yaman Abdin ◽  
Claus Jacob ◽  
Lena Kästner
Keyword(s):  
Philosophy Of Science ◽  
Contemporary Philosophy ◽  
Scientific Diagrams ◽  
Multi Level ◽  
Multiple Levels ◽  
Underlying Mechanisms ◽  
In Vivo Effects ◽  
Shed Light

Talk of mechanisms is ubiquitous in the natural sciences. Interdisciplinary fields such as biochemistry and pharmacy frequently discuss mechanisms with the assistance of diagrams. Such diagrams usually depict entities as structures or boxes and activities or interactions as arrows. While some of these arrows may indicate causal or componential relations, others may represent temporal or operational orders. Importantly, what kind of relation an arrow represents may not only vary with context but also be underdetermined by empirical data. In this manuscript, we investigate how an analysis of pharmacological mechanisms in terms of producing and underlying mechanisms—as discussed in the contemporary philosophy of science—may shed light on these issues. Specifically, we shall argue that while pharmacokinetic mechanisms usually describe causal chains of production, pharmacodynamics tends to focus on mechanisms of action underlying the in vivo effects of a drug. Considering the action of thyroid gland hormones in the human body as a case study, we further demonstrate that pharmacodynamic schemes tend to incorporate entities and interactions on multiple levels. Yet, traditional pharmacodynamic schemes are sketched “flat”, i.e., non-hierarchically. We suggest that transforming flat pharmacodynamic schemes into mechanistic multi-level representations may assist in disentangling the different kinds of mechanisms and relations depicted by arrows in flat schemes. The resulting Baumkuchen model provides a powerful and practical alternative to traditional flat schemes, as it explicates the relevant mechanisms and relations more clearly. On a more general note, our discussion demonstrates how pharmacology and related disciplines may benefit from applying concepts from the new mechanist philosophy to guide the interpretation of scientific diagrams.

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