Towards a deeper understanding of meaningful use in electronic health records.

OBJECTIVE: The purpose of this study was to identify and analyse the US Health Sector concept of the 'Meaningful Use' of electronic health records (EHR's) based on the wide diversity of discourses in the published literature. Meaningful Use is defined as 'use of digital medical and health records to improve quality, safety and efficiency of patient health information'. METHODS: Herman Dooyeweerd's philosophical suite of aspects was the chosen research tool used to analyse seminal papers concerning the Meaningful Use of EHRs. The methodology included the identification of the criteria for choosing the papers: application of the criteria to the literature and then selection of the papers and finally the application of Dooyeweerd's aspects to the papers in order to analyse and classify the motivations of the authors. RESULTS: As a result of the aspectual analysis of the relevant texts in the seminal papers, two aspects were identified, one as primary and another one as secondary. In addition, the analytic aspect was repeated twice as the primary aspect. Although there were a number of papers distinctively centred on different aspects, overlaps and similarities were also clearly identified. DISCUSSION: Dooyeweerd's philosophy is useful in helping to affirm the factors that are important to the authors of the seminal papers and the philosophy helps us to accommodate this diversity in a unique way, therefore enhancing our understanding of approaches in the area. CONCLUSION: By employing the lens of Dooyeweerd's aspects, the study enhances the understanding of diversity in one discipline and could potentially provide a new system for the classification of diversity within other related disciplines.

Object familiarity and acculturation do not explain performance difference between Spanish-English bilinguals and English monolinguals on the Boston Naming Test.

This study investigates bilingual performance on the English and Spanish Boston Naming Tests (BNTs) while controlling for object familiarity and U.S. acculturation. Previous studies suggest that bilingualism negatively affects naming skill; however, object familiarity, which may be culturally influenced, and U.S. acculturation level have not been formally investigated. The current sample comprised 74 well-acculturated bilinguals and 52 English monolinguals. Participants judged their familiarity with BNT objects and later named the objects in either English or Spanish. Both groups rated BNT objects to be comparably familiar. However, bilinguals underperformed relative to monolinguals. In fact, those bilinguals born and raised in the USA and educated solely under English instruction were unable to match monolinguals' superior naming performance. These results underscore a language disadvantage in naming even for native-born, highly acculturated, English proficient bilinguals and suggest that the BNT is language specific and perhaps unsuitable for testing bilingual populations.

The effects of prenatal stress on alpha4 beta2 and alpha7 hippocampal nicotinic acetylcholine receptor levels in adult offspring.

Prenatal stress in humans is associated with psychiatric problems in offspring such as anxiety, depression, and schizophrenia. These same illnesses are also associated with neuronal nicotinic acetylcholine receptor (nAChR) dysfunction. Despite the known associations between prenatal stress exposure and offspring mental illness, and between mental illness and nAChR dysfunction, it is not known whether prenatal stress exposure impacts neuronal nAChRs. Thus, we tested the hypothesis that maternal stress alters the development of hippocampal alpha4 beta2 (α4ß2∗) and alpha7 (α7∗) nicotinic receptor levels in adult offspring. Female Sprague-Dawley rats experienced unpredictable variable stressors two to three times daily during the last week of gestation. At weaning (21 days) the offspring of prenatally stressed (PS) and nonstressed (NS) dams were assigned to same-sex PS or NS groups. In young adulthood (56 days), the brains of offspring were collected and adjacent sections processed for quantitative autoradiography using [125I]-epibatidine (α4ß2* nicotinic receptor-selective) and [125I]-α-bungarotoxin (α-BTX; α7* nicotinic receptor-selective) ligands. We found that PS significantly increased hippocampal α4ß2* nAChRs of males and females in all subfields analyzed. In contrast, only females showed a trend toward PS-induced increases in α7* nAChRs in the dentate gyrus. Interestingly, NS females displayed a significant left-biased lateralization of α7* nAChRs in the laconosum moleculare of area CA1, whereas PS females did not, suggesting that PS interfered with normal lateralization patterns of α7* nAChRs during development. Taken together, our results suggest that PS impacts the development of hippocampal nAChRs, which may be an important link between PS exposure and risk for neuropsychiatric illness.

A thematic review and a policy-analysis agenda of Electronic Health Records in the Greek National Health System.

The increasing pressure to improve healthcare outcomes and reduce costs is driving the current agenda of governments at worldwide level and calls for a fundamental reform of the status quo of health systems. This is especially the case with the Greek NHS (National Health System), a system in continuous crisis, and with the recent ongoing financial turbulence under intensive scrutiny. Technological innovations and Electronic Health Records (EHR) in particular, are recognised as key enablers in mitigating the existing burdens of healthcare. As a result, EHR is considered a core component in technology-driven reform processes. Nonetheless, the successful implementation and adoption of EHR proves to be a challenging task due to a mixture of technological, organisational and political issues. Drawing upon experiences within the European Union (EU) healthcare setting and the Greek NHS the paper proposes a conceptual framework as a policy-analysis agenda for EHR interventions in Greece. While the context of discussion is Greece, the paper aims to also derive useful insights to healthcare policy-makers around the globe.