Patient care systems: do they meet the needs of nursing?

A consulting firm has interviewed nursing executives at 24 hospitals throughout the country assessing nursing automation needs and comparing two of the top 10 patient care systems vendors on a wide range of variables. Nursing involvement in system selection is vital.     

HIS: shouldn't they make hospitals more effective, efficient providers of care?

Computer systems ought to make hospitals run more smoothly, but the ideal sometimes doesn't jibe with the reality. One hospital CEO reminds the industry that form should follow function.     

How do thermal conditions in intensive care units affect the health and well-being of intensivists?

This study presents situational risk scenarios to predict the potential implications of predicted and perceived thermal configurations on the health and well-being of health care professionals in intensive care units (ICUs). Nine ICUs were selected, and thermal variables were collected; simultaneously, 128 health care professionals were interviewed to assess their perceptions, satisfaction, and health conditions related to their workplace environment. In scenarios with thermal comfort (either predicted or perceived), the risk of exposure to physical and psychological symptoms was reduced. This effect also extends to predictions and perceptions tending toward slightly cooler temperatures. In situations with a predicted mean vote below −1.5 and above 0.5, symptom complaints increased, even when the health care professionals perceived their environment as thermally comfortable, with the most extreme cases generating an increase of up to 27% in the baseline probability. Adjusting the workplace environment to be thermally comfortable can reduce symptom complaints.     

On special families of morphisms related to δ-matching and don't care symbols

The δ-matching problem is a special version of approximate pattern-matching, motivated by applications in musical information retrieval, where the alphabet Σ is an interval of integers. We investigate relations between δ-matching and pattern-matching with don't care symbol ∗ (a symbol matching every symbol, including itself). We show that the δ-matching is reducible to k instances of pattern-matching with don't cares. We investigate how the numbers δ and k are related by introducing δ-distinguishing families of morphisms. The size of corresponds to k. We show that for minimal families we have .     

A reflexive analysis of ‘context’ in privacy research: Two case studies in HIV care

Privacy is a much discussed and politically charged topic in contemporary healthcare. Yet, studying the actual privacy practices of healthcare professionals and patients remains extremely challenging. In this paper we reflect on our experiences using qualitative methods in two projects on HIV care, the first researching internet use by a particular group of patients, and the second looking at issues of information technology integration in hospitals. Our aim in doing so is to highlight some of the opportunities and challenges involved in including an explicit focus on ‘context’ in qualitative privacy research in healthcare. We suggest that adopting a more reflexive approach to the way methods are used in relation to ‘context’ in privacy-related HCI research provides opportunities for understanding how different ‘privacy contexts’ are enacted in and through our research practices in different environments.     

That's nice, but what does IT do? Evaluating the impact of bar coded medication administration by measuring changes in the process of care

Health information technology (IT) is widely endorsed as a way to improve key health care outcomes, particularly patient safety. Applying a human factors approach, this paper models more explicitly how health IT might improve or worsen outcomes. The human factors model specifies that health IT transforms the work system, which transforms the process of care, which in turn transforms the outcome of care. This study reports on transformations of the medication administration process that resulted from the implementation of one type of IT: bar coded medication administration (BCMA). Registered nurses at two large pediatric hospitals in the US participated in a survey administered before and after one of the hospitals implemented BCMA. Nurses’ perceptions of the administration process changed at the hospital that implemented BCMA, whereas perceptions of nurses at the control hospital did not. BCMA appeared to improve the safety of the processes of matching medications to the medication administration record and checking patient identification. The accuracy, usefulness, and consistency of checking patient identification improved as well. In contrast, nurses’ perceptions of the usefulness, time efficiency, and ease of the documentation process decreased post-BCMA. Discussion of survey findings is supplemented by observations and interviews at the hospital that implemented BCMA.

Relevance to industry

By considering the way that IT transforms the work system and the work process a practitioner can better predict the kind of outcomes that the IT might produce. More importantly, the practitioner can achieve or prevent outcomes of interest by using design and redesign aimed at controlling work system and process transformations.     

Prevalence of work-related musculoskeletal and non-musculoskeletal injuries in health care workers: the implications for work disability management

To compare the prevalence of musculoskeletal and non-musculoskeletal injuries in a cohort of workers in Manitoba health care sector, who made injury claims between 2002 and 2012. A retrospective study, using secondary data from WCB Manitoba. Logistic regression was used to determine odds ratios for nature of work-related injuries among different groups of workers. Idiopathic work-related musculoskeletal disorders (WMSD) constituted 74.6% of all the injury claims. Injury risks varied between worker groups, and a significant difference was found within the female group, χ² = 13.4, p = 0.0094, but not among the males. Compared to the married, single workers were more likely to experience traumatic than idiopathic injuries (OR = 1.72, CI, 1.28, 2.29), and much higher risk of traumatic injuries than non-WMSD (OR = 1.93, CI, 1.31, 2.84). Work-related injury risks vary significantly across occupations and worker groups, with idiopathic injuries being higher in high physical tasks.

Practitioner Summary: To compare musculoskeletal and non-musculoskeletal injuries among workers in health care sector, and explore the implications for work disability management. Retrospective study, using workers’ compensation claims data. The risk of idiopathic work-related musculoskeletal disorders continue to be high compared to traumatic and non-musculoskeletal disorders, particularly in tasks that involved high physical activities.     

Robots in aged care: a dystopian future?

In this paper I describe a future in which persons in advanced old age are cared for entirely by robots and suggest that this would be a dystopia, which we would be well advised to avoid if we can. Paying attention to the objective elements of welfare rather than to people’s happiness reveals the central importance of respect and recognition, which robots cannot provide, to the practice of aged care. A realistic appreciation of the current economics of the aged care sector suggests that the introduction of robots into an aged care setting will most likely threaten rather than enhance these goods. I argue that, as a result, robotics for aged care is likely to transform aged care in accordance with a trajectory that leads towards this dystopian future even when this is not the intention of the engineers involved. While an argument can be made for the use of robots in aged care where the people being cared for have chosen to allow robots in this role, I suggest that overemphasising this possibility risks rendering it a self-fulfilling prophecy, depriving those being cared for of valuable social recognition, and failing to provide respect for older persons by allowing the options available to them to be shaped by the design choices of others.     

Design and evaluation of a device worn for fall detection and localization: Application for the continuous monitoring of risks incurred by dependents in an Alzheimer’s care unit

The Homecare project, which is part of a research project funded by the French National Research Agency (ANR), aims to define a new multi-sensor monitoring system for the elderly with cognitive disabilities in a care unit. Two subjects were recruited to participate to experimental trials. The main objective of this project is to design and test a complete monitoring system at a real site. It is a new clinical and technical approach which is complex to implement: Homecare is intended to propose a possible technical solution, demonstrate its feasibility and illustrate its use working at a protected site. The system consists of a motion sensor network deployed on the ceiling to monitor motion and an electronic patch worn by the subjects to identify them and detect falls. In order to locate tagged subjects inside the care unit, a network of anchor points is used. From these positions and movement data, an analysis algorithm detects an abnormal situation and alerts the nursing staff in real time. A Web application allows the medical staff to access movements and alarms. The complete monitoring system has been functioning for several months and continuously monitors two patients around the clock. In this paper, we present the implementation of the system, the method of localization inside the care unit, and the characterization of the fall detector, and we show certain results relating to activity data.     

Caregivers’ attitudes toward potential robot coworkers in elder care

Technological advances in robotics increase progressively. Elder care is one of the work areas which have potential to involve robotic workforce. So, it is important to focus on interaction between humans and potential robot workers to prepare the organization for possible challenges. The current study examined the relationships between trust in robots and anthropomorphism of robots, intention to work with robots and preference of automation levels. For this purpose, 102 caregivers who work for elder care in a nursing home (aged between 19 and 40) participated in an experimental study. According to the results, anthropomorphism of robots did not make any difference in terms of trust in them. Trust in robots was significantly related to intention to work and preference of automation levels. Organizations may consider employees’ trust in robots as an important factor before adapting them to workplace area.

     

Nurses’ reactions to alarms in a neonatal intensive care unit

Neonatal intensive care units (NICUs), like other intensive care units, are intended to provide immediate responses to any change in the patients condition. Patient-monitoring alarms and alarms from other medical equipment are very common in these units, and most alarms have no clinical significance. This study addresses the question of how alarms affect nurses actions by measuring the occurrence of alarms from different causes in a NICU, recording the nurses reactions, and analyzing the relationship between the alarms and the actions. The results show that nurses often do not respond directly to alarms, but, rather, use them as additional sources of information in their ongoing flow of actions. The probabilities for their responding to an alarm depend on the causes of the alarm, its duration, and the characteristics of the patient. These findings support the view that experienced nurses dynamically adjust their activities according to the information they receive from alarm systems and other sources, and that they combine their reactive actions with the periodic performance of routine tasks.     

Sign what you really care about – Secure BGP AS-paths efficiently

The de facto inter-domain routing protocol, Border Gateway Protocol (BGP), plays a critical role in the reliability of the Internet routing system. However, the system may also be devastated by forged BGP routes that are generated by malicious attacks or mis-configurations. This security problem has attracted considerable attention, and although several solutions has been proposed, none of them have been widely deployed due to weaknesses such as high computational cost or potential security vulnerability. This paper proposes Fast Secure BGP (FS-BGP), an efficient mechanism that can secure AS-paths and prevent prefix hijacking by signing critical AS-path segments. We prove that FS-BGP achieves a similar level of security as S-BGP, but with much higher efficiency. Compared with S-BGP, the cost of signing and verification in FS-BGP can be reduced by orders of magnitude, as demonstrated in our experiments using BGP UPDATE data collected from real backbone routers. Indeed, the signing and verification can be accomplished as fast as the most bursty BGP UPDATE arrivals, which implies that FS-BGP will hardly delay the propagation of routing information.     

Some applications of matrices to location of zeros of polynomials†

In previous papers classical theorems on location of zeros of a polynomial with respect to the left half plane Γ₁ or the unit circle Γ₂ have been reformulated more simply in terms of appropriate companion matrices. It is shown how this work can be extended to the problem of zero location with respect to more general regions Γ of the complex plane. The first approach is to apply the bilinear transformation to the given polynomial, so that for example Γ₁ can be mapped into Γ₂ and a matrix representation of this is derived. An alternative method is discussed which relies on transformation of Γ into Γ₂. Some examples illustrate how any theorem involving Hurwitz-typc minors can be expressed in companion matrix terms, with a consequent halving of the orders of the determinants involved.     

Don’t care in SMT: building flexible yet efficient abstraction/refinement solvers

This paper describes a method for combining “off-the-shelf” SAT and constraint solvers for building an efficient Satisfiability Modulo Theories (SMT) solver for a wide range of theories. Our method follows the abstraction/refinement approach to simplify the implementation of custom SMT solvers. The expected performance penalty by not using an interweaved combination of SAT and theory solvers is reduced by generalising a Boolean solution of an SMT problem first via assigning don’t care to as many variables as possible. We then use the generalised solution to determine a thereby smaller constraint set to be handed over to the constraint solver for a background theory. We show that for many benchmarks and real-world problems, this optimisation results in considerably smaller and less complex constraint problems. The presented approach is particularly useful for assembling a practically viable SMT solver quickly, when neither a suitable SMT solver nor a corresponding incremental theory solver is available. We have implemented our approach in the ABsolver framework and applied the resulting solver successfully to an industrial case-study: the verification problems arising in verifying an electronic car steering control system impose non-linear arithmetic constraints, which do not fall into the domain of any other available solver.     

Measurement of the Kernels of a Non-linear System of Finite Order†

A method of measuring the Volterra kernels of a finite-order non-linear system is presented. The kernels are obtained individually as a multi-dimensional impulse response. The multi-dimensional kernel transforms also can be obtained by the method described. As an extension, a technique of obtaining the Volterra kernels from a multi-dimensional step response is presented. This technique is useful for non-linear systems which can be considered to be of a given finite order for only a limited range of input amplitudes.     

The Implementation of Graphic Display of FAS

The principle of the fire alarm system and the implementation techniques of its computer graphic display are presented. With the help of the designing thoughts and technology of OOP, a Fire Alarm System (FAS) has been developed by using visual C++ language. The system has been put into use in many important buildings and has played an important role in monitoring and controlling the fire.     

Visualization of curvature plots and evaluation of fairness: an analysis of the effect of ‘scaling’

Changing the aspect-ratio (scale) of a graphical plot significantly affects the “messages” getting across to a viewer. This is true also for curvature plots and other graphs currently used in Curve & Surface Modeling to evaluate fairness. In particular, the sharp corners appearing in such graphs, employed as local fairness indicators by current practices, are significantly affected by nonuniform scaling. A detailed study of this phenomenon is presented offering specific guidelines for correctly “reading” curvature plots.