Electronic health records (EHRs)' purpose is to facilitate the documentation of patient data and to improve the exchange of information between the professionals involved in a patient's care.
To ...investigate occupational health (OH) physicians' experiences of EHRs and the factors hampering work.
An electronic questionnaire was sent to physicians working in OH services in April 2017 and a total of 342 OH physicians participated in the study. The results were reported as quantities and percentages. The survey text was analysed using data-driven content analysis.
The respondents considered their EHR stable in terms of technical features but the routine tasks with EHR were not straightforward. Also, the documentation of patient data for statistical purposes took an unreasonable amount of time and the access to patient data from other organizations was poor. Instead, a well-functioning feature of EHRs were electronic prescriptions. The factors, which hampered respondents' work, were constant or frequent time pressure, too little time to do their job properly and a stress caused by uncompleted tasks.
This study showed that the usability problems of EHRs were the slowness, unexpected downtimes and difficulties in obtaining patient data. Also, respondents felt very often a lack of time in their work. OH physicians' work is best supported by EHRs that consider their specific role in healthcare, i.e. the assessment of work ability, the co-ordination of care and rehabilitation and support for return to work.
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the ...impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.
Despite the increasing availability of direct-to-consumer (DTC) genetic testing, it is currently unclear how such services are regulated in Europe, due to the lack of EU or national legislation ...specifically addressing this issue. In this article, we provide an overview of laws that could potentially impact the regulation of DTC genetic testing in 26 European countries, namely Austria, Belgium, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, the Netherlands and the United Kingdom. Emphasis is placed on provisions relating to medical supervision, genetic counselling and informed consent. Our results indicate that currently there is a wide spectrum of laws regarding genetic testing in Europe. There are countries (e.g. France and Germany) which essentially ban DTC genetic testing, while in others (e.g. Luxembourg and Poland) DTC genetic testing may only be restricted by general laws, usually regarding health care services and patients’ rights.
Preimplantation genetic diagnosis (PGD) aims to safeguard the reproductive confidence of couples who have an increased risk of having a child with a serious hereditary disease. Non-directive genetic ...counselling is an essential part of PGD. Lately, performance of PGD for some new and non-medical indications, such as selecting for a tissue-matching embryo for a saviour sibling, or sex-selection for family-balancing, has raised ethical concerns. Who decides when to perform PGD, and for which conditions? The European member states have very diverse regulation on PGD. Some countries totally ban PGD, while the others keep close track of the new applications. The people in need of PGD seek it in the other member states. These cross-border treatments cause psychological stress and pose many so far unresolved legal questions. The individuals need more information about all the aspects of PGD. This article analyses contemporary indications for PGD in Europe and relevant ethical discussion, and second, shows the diversity in regulation and reflects the consequences thereof.
The members of the Public and Professional Policy Committee (PPPC) and the Patenting and Licensing Committee (PLC) of ESHG who were involved in setting up these recommendations were Segolene Ayme ...(Paris, France), Gert Matthijs (Leuven, Belgium), Violetta Anastasiadou (Nicosia, Cyprus), Fatmahan Atalar (Istanbul, Turkey), Suzanne Braga (Berne, Switzerland), John Burn (Newcastle upon Tyne, UK), Jean-Jacques Cassiman (Leuven, Belgium), Martina Cornel (Amsterdam, The Netherlands), Domenico Coviello (Milano, Italy), Gerry Evers-Kiebooms (Leuven, Belgium), Philippe Gorry (Bordeaux, France), Shirley Hodgson (London, UK), Helena Kaeaeriaeinen (Turku, Finland), Gyoergy Kosztolanyi (Pecs, Hungary), Ulf Kristoffersson (Lund, Sweden), Milan Macek Jr (Prague, Czech Republic), Christine Patch (London, UK), Joerg Schmidtke (Hannover, Germany), Jorge Sequeiros (Porto, Portugal), Dominique Stoppa- Lyonnet (Paris, France), Lisbeth Tranebjaerg (Copenhagen, Denmark), Veronica van Heyningen (Edinburgh, UK) and Gert-Jan van Ommen (Leiden, The Netherlands).Patents for inventions can be beneficial for society, if they drive innovation and promote progress. In most areas, the patenting system works satisfactorily. However, it must be recognized that in some instances it can also be problematic; this is the case in the field of genetics, and particularly in the area of genetic testing. As patents should serve their original purpose (promoting innovation through a fair reward system for the inventors), the European Society of Human Genetics (ESHG) suggests ways to improve the mechanisms that already form part of the patents system as a whole. In brief, the ESHG recommends limiting the breadth of the claims in genetic patents and, more practically, to reduce the number of patents by limiting the patentable subject matter, thereby improving the quality of the patents that will eventually be granted. There is also a suggestion to redefine the concept of utility in patent law, by taking account of downstream clinical experience. The ESHG sees no harm in the patenting of novel technical tools for genetic testing (eg PCR or chip technologies), as they can promote investment and still allow for invention around them. Many disputes between supporters of the patenting system and the public revolve around ethical issues. The European Patent Office should consider the benefit of having an ethics committee to consider issues of major interest, such as patents applied to genes. The problem of licensing should also be addressed. Practically, this means supporting the Organisation for Economic Co-operation and Development guidelines, which prescribe that licenses should be non- exclusive and easily obtainable, both in practical and in financial terms. To promote this, the practical exploration of alternative models for licensing, like patent pools and clearinghouses, is a prerequisite. To better track developments in this field, the establishment of a voluntary reporting system, whereby geneticists could report on any issues related to new and/or old patents or licenses in the light of service provision to patients, would be worthwhile. Finally, the ESHG is calling upon all stakeholders to start the process of developing a code of conduct for partners with patents, covering ethical aspects as well as smooth licensing arrangements.
Patents for inventions can be beneficial for society, if they drive innovation and promote progress. In most areas, the patenting system works satisfactorily. However, it must be recognized that in ...some instances it can also be problematic; this is the case in the field of genetics, and particularly in the area of genetic testing. As patents should serve their original purpose (promoting innovation through a fair reward system for the inventors), the European Society of Human Genetics (ESHG) suggests ways to improve the mechanisms that already form part of the patents system as a whole. In brief, the ESHG recommends limiting the breadth of the claims in genetic patents and, more practically, to reduce the number of patents by limiting the patentable subject matter, thereby improving the quality of the patents that will eventually be granted. There is also a suggestion to redefine the concept of utility in patent law, by taking account of downstream clinical experience. The ESHG sees no harm in the patenting of novel technical tools for genetic testing (eg PCR or chip technologies), as they can promote investment and still allow for invention around them. Many disputes between supporters of the patenting system and the public revolve around ethical issues. The European Patent Office should consider the benefit of having an ethics committee to consider issues of major interest, such as patents applied to genes. The problem of licensing should also be addressed. Practically, this means supporting the Organisation for Economic Co-operation and Development guidelines, which prescribe that licenses should be non-exclusive and easily obtainable, both in practical and in financial terms. To promote this, the practical exploration of alternative models for licensing, like patent pools and clearinghouses, is a prerequisite. To better track developments in this field, the establishment of a voluntary reporting system, whereby geneticists could report on any issues related to new and/or old patents or licenses in the light of service provision to patients, would be worthwhile. Finally, the ESHG is calling upon all stakeholders to start the process of developing a code of conduct for partners with patents, covering ethical aspects as well as smooth licensing arrangements.
Water hydraulic systems use water instead of oil as a pressure medium. Microbial growth in the system may restrict the applicability this technology. The effects of fluid-flow velocity and water ...quality on microbial growth and biofilm formation were studied with a pilot-scale water hydraulic system. The fluid-flow velocities were 1.5–5.2
m/s and the corresponding shear stresses 9.1–84
N/m
2. The fluid-flow velocity had an insignificant effect on the total bacterial numbers and the numbers of viable heterotrophic bacteria in the pressure medium. Microbial attachment occurred under high shear stresses. The fluid-flow velocity did not affect the biofilm formation in the tank. Increase in the flow velocity decreased the bacterial densities on the pipe surfaces indicating preferable biofilm formation on areas with low flow velocity. Using ultrapure water as the pressure medium decreased the total cell numbers and resulted in slower growth of bacteria in the pressure medium. Lowering the nutrient concentration retarded biofilm formation but did not affect the final cell densities. The decreasing pressure medium nutrient concentration favoured microbial attachment in the tank instead of the pipelines. In conclusion, microbial growth and biofilm formation in water hydraulic systems cannot be controlled by the fluid-flow velocity or the quality of the pressure medium.
The purpose of this study was to examine changes in counsellor trainees' ways of responding to clients' messages after four weeks of Peer Group Consultation (PGC) training Soini, Jämsä, & Kuusisto, ...2006. Scaffolding and consultation of skilled performance. In K. Thompson J. Liukkonen, & T. Jaakkola (Eds.), Promotion of motor skills in sports and physical education (pp. 70-80). Jyväskylä: University of Jyväskylä, Department of Sport Sciences. Publications 6/2006. PGC training focuses on learning-specific client-centred skills; applying practice sessions with feedback; specific skills training; and a group review of videoed performances of the trainees. Pre-training results show that trainees use self-disclosure and suggestion as their primary way of communicating with the client, focusing on explanations behind the client problems. Post-training results show a significant decrease in the use of self-disclosure, and an increase in the use of reflection; indicating improvement in the counsellor trainees' client-centredness. Overall, results indicate that PGC training can be an effective method in increasing trainees' client-centred responses and reducing counsellor-centred responses.
Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the ...impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively-parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.
We know less about subglacial meltwater flow properties in distributed inefficient and semi-efficient systems in comparison to those of ice marginal eskers and proglacial environments. While previous ...studies have indicated the overall common presence of upper-flow-regime (UFR) bedforms in glacigenic settings, facies expressions of subglacial meltwater flows remain poorly documented. Three ca. 3 m deep and up to 70 m long trenches excavated across a triangle-shaped subglacial landform called a murtoo in a Lateglacial to Holocene meltwater route in SW Finland provide a detailed window into sedimentary structures presumably formed ca. 40–50 km away from the coeval subaqueous margin of the Fennoscandian Ice Sheet (FIS). The aim of this paper is to document small-scale bedforms, which formed subglacially by meltwater flow and to characterize the proximal and central parts of the studied murtoo during its early evolutionary phase. We defined seven main facies types that characterize the depositional processes of the unit. Overall, the studied deposits reflect increasing meltwater delivery through time and are characterized by abrupt lateral changes in sedimentary structures and grain size. While the initial deposits are dominated by massive and horizontally laminated silt with sand lenses interpreted as lower-flow-regime deposits, the latter sediments are characterized by sinusoidal stratification, sigmoidal cross-stratification and scours with backsets or chaotic fill interpreted as deposits of antidunes, humpback dunes, chutes-and-pools and cyclic steps of the upper-flow regime. The upper-flow-regime bedforms developed on a 1 m high and 15 m long bed slope and are associated with the formation of a short-lived enlarged water-filled cavity or pond, where supercritical density flows allowed for the deposition of upper-flow regime bedforms. The final coarse-grained murtoo head-bar development, characterized by planar-cross stratified gravel and pebbly sand, indicates avalanche processes that were controlled by grain size.
Our results confirm that the core of the murtoo is depositional and meltwater processes played a key role in its deposition. Despite the subglacial setting with a subaqueous ice-sheet margin, the meltwater flow was not permanently characterized by pipe-flow conditions. Overall, the findings contribute to the understanding of semi-distributed subglacial meltwater systems during the retreat of a continental ice sheet (FIS) in a rapidly warming climate.
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