Suchergebnisse

What is the nature of the process of implementing a new technology? How should the dynamics of implementing a new technology be studied? What research methods are best-suited to the study of complex issues of social and organizational impacts arising from the implementation of a new technology? Client-server computing represents a significant new technology that has not been a focus of research investigations. As companies pursue client-server technology as a replacement for legacy computing systems, there is a need to provide practitioners with grounded research that discover patterns of organizational and social dynamics that influence the successful outcome of a transition to this new technology. This article suggests that naturalistic research studies can formulate realistic business foundations for the successful implementation of client-server computing.

BACKGROUND: In the central west NSW region, there are variations in population density, socioeconomic status and ethnicity. AIMS: Compare and contrast the maternal characteristics and pregnancy outcomes of an obstetric population in central west New South Wales to district, state and national data. MATERIALS AND METHODS: A prospective cross‐sectional study involving 625 pregnant women who attended Orange or Bathurst public hospitals for obstetric ultrasounds. The women were 16 years and older and were greater than 16 weeks pregnant with a single fetus. Maternal characteristics and pregnancy outcomes were compared to district, state and national data. Descriptive comparisons and hypothesis testing were undertaken and P values or confidence intervals were provided where appropriate. RESULTS: The average maternal age was 27.5 years, 24.6% of the women smoked during pregnancy, 31.7% of deliveries were by caesarean, 52.4% of live births were female, 7.8% of babies were born preterm and the mean live birthweight was 3297 g. Four per cent of the participants were indigenous. CONCLUSIONS: Analysis of a regional sample indicated differences in indigenous population distribution, maternal age and smoking when compared to broader statistics. This has local implications for education, workforce, government and public health planning.

Background and Objectives: There is a paucity of integrated knowledge regarding legal considerations required to ensure patient safety through safe medicines management. This study explores the legal considerations surrounding medicines management, providing a synthesis of existing knowledge. An integrative systematic review of the current international knowledge was performed. Materials and Methods: The search encompassed the online databases of PubMed (including Medline), Scopus, CINAHL, and Web of Science using MeSH terms and relevant keywords relating to the legal considerations of medicines management in healthcare settings. Results: The search process led to the identification of 6051 studies published between 2010 and 2020, of which six articles were found to be appropriate for data analysis and synthesis based on inclusion criteria. Research methods were varied and included qualitative interviews, mixed-methods designs, retrospective case reports and cross-sectional interrupted time-series analysis. Their foci were on the delegation of medicines management, pharmacovigilance and reporting of adverse drug reactions (ADRs) before and after legislation by nurses, physicians and pharmacists, medico-legal litigation, use of forced medication and the prescription monitoring program. Given the heterogenicity of the studies in terms of aims and research methods, a meta-analysis could not be performed and, therefore, our review findings are presented narratively under the categories of 'healthcare providers' education and monitoring tasks', 'individual and shared responsibility', and 'patients' rights'. Conclusion: This review identifies legal aspects surrounding medicines management, including supervision and monitoring of the effects of medicines; healthcare providers' knowledge and attitudes; support and standardised tools for monitoring and reporting medicines' adverse side effects/ADRs; electronic health record systems; individual and shared perceptions of responsibility; recognition of nurses' roles; ...

Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the "pharmaceuticalization" of medical practice has often resulted in treatment "at a distance", with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers' literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource—the adverse drug reaction profile (ADRe). The profile identifies and documents patients' signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.