Understanding the Digital Disruption of Health Care: An Ethnographic Study of Real-Time Multidisciplinary Clinical Behavior in a New Digital Hospital.

BACKGROUND: Understanding electronic medical record (EMR) implementation in digital hospitals has focused on retrospective "work as imagined" experiences of multidisciplinary clinicians, rather than "work as done" behaviors. Our research question was "what is the behavior of multidisciplinary clinicians during the transition to a new digital hospital?" OBJECTIVES: The aim of the study is to: (1) Observe clinical behavior of multidisciplinary clinicians in a new digital hospital using ethnography. (2) Develop a thematic framework of clinical behavior in a new digital hospital. METHODS: The setting was the go-live of a greenfield 182-bed digital specialist public hospital in Queensland, Australia. Participants were multidisciplinary clinicians (allied health, nursing, medical, and pharmacy). Clinical ethnographic observations were conducted between March and April 2021 (approximately 1 month post-EMR implementation). Observers shadowed clinicians in real-time performing a diverse range of routine clinical activities and recorded any clinical behavior related to interaction with the digital hospital. Data were analyzed in two phases: (1) content analysis using machine learning (Leximancer v4.5); (2) researcher-led interpretation of the text analytics to generate contextual meaning and finalize themes. RESULTS: A total of 55 multidisciplinary clinicians (41.8% allied health, 23.6% nursing, 20% medical, 14.6% pharmacy) were observed across 58 hours and 99 individual patient encounters. Five themes were derived: (1) Workflows for clinical documentation; (2) Navigating a digital hospital; (3) Digital efficiencies; (4) Digital challenges; (5) Patient experience. There was no observed harm attributable to the digital transition. Clinicians primarily used blended digital and paper workflows to achieve clinical goals. The EMR was generally used seamlessly. New digital workflows affected clinical productivity and caused frustration. Digitization enabled multitasking, clinical opportunism, and benefits to patient safety; however, clinicians were hesitant to trust digital information. CONCLUSION: This study improves our real-time understanding of the digital disruption of health care and can guide clinicians, managers, and health services toward digital transformation strategies based upon "work as done."

Enhanced Refractive Index Sensitivity through Combining a Sol-Gel Adsorbate with a TiO2 Nanoimprinted Metasurface for Gas Sensing.

We combine a gas-adsorbent microporous hybrid silica layer and a dense TiO2 Mie resonator array (metasurface), both obtained by sol-gel deposition and nanoimprint lithography, to form nanocomposite systems with high sensitivity for refractive index (RI) variations induced by gas adsorption. Using optical transduction based on direct specular reflection, we show spectral shifts of 4470 nm/RIU corresponding to 0.2 nm/ppm gas (air concentration) and reflection intensity changes of R* = 17 (R/RIU) and 0.55 × 10-3 R/ppm (air concentration). The metasurface is composed of hexagonally arranged TiO2 nanopillar arrays, whereas the surrounding sensitive material is a class II microporous hybrid silica, containing methyl and phenyl covalently bonded organic functions. This hybrid layer shows efficient adsorption capability of volatile organic molecules such as isopropanol, which is used to induce slight variations of RI around the TiO2 antennas. Specular reflectance variations at 45° incidence and refractive index measurements are performed using a spectroscopic ellipsometer. The presence of the titania metasurface enhances the signal by almost an order of magnitude with respect to the 2D counterpart (simulated as an effective medium approximation) and is attributed to the antenna effect, enhancing the interaction of the confined electromagnetic wave with the sensitive microporous medium. This sol-gel nanocomposite system presents many advantages such as high throughput and low-cost elaboration of elements and a high chemical, mechanical, and thermal resistance, ensuring high stability as a potential gas-sensitive nanocomposite layer for long periods. This work is a case study of improving the sensitivity of sol-gel gas-sensitive materials in optical transduction, which will be exploited in further works to develop artificial noses.

The effects of splinting on shoulder function in adult burns.

INTRODUCTION: Exercises are commonly prescribed to improve shoulder range following axillary burns, but the effect of additional splinting is unclear. AIM: To compare splinting and exercise to exercise alone in adults with axillary burns. METHOD: Prospective randomised study allocating participants to a splinting (n=27) or no splinting group (n=25). Outcomes measured at six and twelve weeks were shoulder abduction and flexion range, quality of life using the Burn Specific Health Scale-Brief (BSHS-B) questionnaire and upper limb function using the Upper Extremity Functional Index (UEFI) and the Grocery Shelving Task (GST). RESULTS: At week twelve, there was no difference between groups for shoulder abduction (mean difference 0°, 95% CI -22 to 22°), flexion (mean difference 2°, 95% CI -18 to 23°), BSHS-B (mean difference -2 points, 95% CI -23 to 18 points), UEFI (mean difference -3 points, 95% CI -19 to 14 points) and GST (mean difference -9s, 95% CI -20 to 3s). Adherence to splinting decreased from 77% of participants at week one to 16% at week twelve. CONCLUSION: Shoulder splints did not improve clinical outcomes in this study population and low adherence rates suggest splinting may be unacceptable to patients and makes drawing firm conclusions difficult.

Outcomes of a shoulder treatment flowchart in patients with axillary burns.

The purpose of this study was to evaluate the effects of a structured shoulder treatment flowchart on range of motion (ROM) and function of the upper limb in patients at high and low risk of contracture after an axillary burn injury. Consecutive patients with axillary burns were managed according to a structured pathway based on risk of contracture. Those patients with deep partial- or full-thickness burns to more than one area of the axilla or requiring more than one split skin graft were classified as high risk; these patients underwent a more aggressive approach to splinting and exercise. Measurements of shoulder ROM and functional ability (upper extremity functional index) were made at admission, hospital discharge, and at 12 weeks postdischarge. Twenty patients (19 men) with an average age of 39 years and a median TBSA of 20% were recruited. Median length of stay was 18 days. Ten patients were classified as high risk. Both low-risk and high-risk patients showed good range of movement outcomes at discharge and 12 weeks, with no significant differences between risk groups (abduction at 12 weeks, mean [SD]: 168° [22°] vs 166° [28°], P = .60; flexion at 12 weeks, mean [SD]: 172° [20°] vs 167° [31°], P = .60, respectively). There were no differences in functional outcomes at 12 weeks postdischarge. Use of a shoulder treatment pathway was associated with good shoulder ROM and functional capacity in patients at high and low risk of axillary contracture.