RESUMEN
Internet security threats are evolving toward more targeted and focused attacks.Increasingly, organized crime is involved and they are interested in identity theft. Physicians who use Internet in their practice are at risk for being invaded. We studied 16 physician practices in Southern Ontario for their readiness to manage internet security threats. Overall, physicians have an over-inflated sense of preparedness. Security practices such as maintaining a firewall and conducting regular virus checks were not consistently done.
Asunto(s)
Seguridad Computacional , Internet , Administración de la Práctica Médica , Recolección de Datos , Administración de Consultorio , Consultorios MédicosRESUMEN
As experience with Electronic Medical Record (EMR) implementations increases, new knowledge is gained on how to make these implementations more successful. Recently, several new conceptual frameworks described in the literature provide a richer understanding of what makes an EMR implementation successful. Using the systematic review process, we attempt to integrate the various frameworks into an over-arching framework that is comprehensive, yet pragmatic.
Asunto(s)
Sistemas de Registros Médicos Computarizados , Innovación Organizacional , Literatura de Revisión como AsuntoRESUMEN
Managing Type 1 Diabetes Mellitus is a challenging feat especially for young patients. It is a tedious and demanding disease which requires painful self-monitoring and injections multiple times per day. Many patients are unable to achieve good blood sugar control, in spite of strong evidence that good control leads to better outcomes. Many caregivers believe that more communication between caregivers and patients could lead to better control. This paper describes a tool that was developed to improve communication between caregivers and patients, its testing, how it failed to achieve its outcomes and recommendations for improvement.
Asunto(s)
Automonitorización de la Glucosa Sanguínea/instrumentación , Computadoras de Mano , Diabetes Mellitus Tipo 1/terapia , Niño , Falla de Equipo , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Electronic medical records (EMRs) are increasingly becoming a necessary tool in health care. Given their potential to influence every aspect of health care, there has been surprisingly little rigorous research applied to this important piece of emerging health technology. An initial phase of the COMPETE study, which is examining the impact of EMRs on efficiency, quality of care and privacy concerns, involved a rigorous "critical pathway" approach to EMR selection for the study. A multidisciplinary team with clinical, technical and research expertise led an 8-stage evaluation process with direct input from user physicians at each stage. An iterative sequence of review of EMR specifications and features, live product demonstrations, site visits, and negotiations with vendors led to a progressive narrowing of the field of eligible EMR systems. Final scoring was based on 3 main themes of clinical usability, data quality and support/vendor issues. We believe that a rigorous, multidisciplinary process such as this is required to maximize success of any EMR implementation project.
Asunto(s)
Sistemas de Registros Médicos Computarizados , Programas Informáticos , HumanosRESUMEN
Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically.
Asunto(s)
Sistemas de Registros Médicos Computarizados , Administración de la Práctica Médica/organización & administración , Actitud del Personal de Salud , Actitud hacia los Computadores , Médicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To determine the needs of community family physicians regarding electronic patient records (EPRs). DESIGN: A comprehensive survey was sent to 101 community family physicians in Hamilton, Ontario, who had expressed an interest in EPRs. RESULTS: 46 physicians responded (46%). 87% felt that an EPR would result in their providing better patient care. A wide variety of items were deemed to be important to be included on the EPR "front page". Desired functionality emphasized labs, medications, consultation, hospital follow-up and health maintenance. Family physicians tended to prefer templates to other data entry methods such as typing and dictating. Respondents were more willing to view information from the hospital than to let the hospital view information from their own offices. CONCLUSION: This survey provided useful information on the perceived EPR needs of community-based family physicians. It will be repeated post-computerization.
Asunto(s)
Medicina Familiar y Comunitaria , Sistemas de Registros Médicos Computarizados , Actitud hacia los Computadores , Seguridad Computacional , Confidencialidad , Recolección de Datos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Sistemas de Registros Médicos Computarizados/organización & administración , OntarioRESUMEN
The folC gene from mutant strain SF4 was cloned into a pUC19 plasmid. Expression of the mutant gene from the lac promoter of the plasmid complemented the auxotrophy for methionine of the SF4 strain. The only difference in sequence between the mutant and wild-type genes was a G925A base change resulting in an A309T amino acid change. The mutant enzyme had a 30-fold higher Km for 10-formyltetrahydrofolate as well as a 60-fold higher Km for glutamate and a 200-fold higher Km for dihydropteroate of the dihydrofolate synthetase activity. Site-specific mutagenesis was used to substitute other amino acids at codon 309. Mutants with glycine, isoleucine, and valine substitutions at this position, when expressed from multicopy plasmids, complemented the SF4 strain. The glycine mutant had properties similar to the wild-type enzyme, whereas the isoleucine and valine mutants had properties similar to the threonine mutant, SF4. Mutant genes with arginine, glutamate, and leucine substitutions, which did not complement the SF4 strain, could complement a folC deletion strain, but produced smaller colonies on complex plates and did not grow on minimal medium. In the deletion strain, an increasing requirement for folate product supplements was observed as the folylpolyglutamate synthetase-dihydrofolate synthetase activities of the complementing mutants decreased.
Asunto(s)
Escherichia coli/enzimología , Mutación , Péptido Sintasas/metabolismo , Proteínas de Escherichia coli , Prueba de Complementación Genética , Cinética , Complejos Multienzimáticos , Mutagénesis Sitio-Dirigida , Péptido Sintasas/genética , PlásmidosRESUMEN
The folC gene of Escherichia coli, cloned in a pUC19 vector, was mutagenized by progressive deletions from both the 5' and the 3' ends and by TAB linker insertion. A number of 5'-deleted genes, which had the initiator ATG codon removed, produced a truncated gene product, in reduced amounts, from a secondary initiation site. The most likely position of this site at a GTG codon located 35 codons downstream of the normal start site. This product could complement the folC mutation in E. coli strain SF4 as well as a strain deleted in the folC gene. The specific activity of extracts of the mutant enzyme are 4-16% that of the wild type enzyme for the folylpolyglutamate synthetase activity and 6-19% for the dihydrofolate synthetase activity. The relative amount of protein expressed by the mutant, compared to the wild type, in maxicells was comparable to the relative specific activity, suggesting that the kcat of the mutant enzyme is similar to that of the wild type. Mutants with up to 14 amino acids deleted from the carboxy terminal could still complement the folC deletion mutant. Seven out of ten linker insertions dispersed through the coding region of the gene showed complementation of the folC mutation in strain SF4 but none of these insertion mutants were able to complement the strain containing a deleted folC gene. None of the carboxy terminal or linker insertion mutants had a specific activity greater than 0.5% that of the wild type enzyme. The dihydrofolate synthetase and folylpolyglutamate synthetase activities behaved similarly in all mutants, both retaining a large fraction of the wild type activity in the amino terminal deletions and both being very low in the carboxy terminal deletions and linker insertion mutants. These studies are consistent with a single catalytic site for the two activities catalyzed by this enzyme.