Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool.

BACKGROUND: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. OBJECTIVE: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. METHODS: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. RESULTS: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting. CONCLUSIONS: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.

Pivotal Trial Demographic Representation and Clinical Development Times for Oncology Therapeutics.

This study evaluates whether FDA-approved novel cancer therapeutics supported by pivotal trials with adequate representation of minoritized groups were associated with slower clinical development times than those with inadequate representation.

The Relationship Between Pharmaceutical Innovation and Cancer Mortality in Spain, From 1999 to 2016.

OBJECTIVES: To investigate the relationship across cancer sites between pharmaceutical innovation and changes in cancer mortality in Spain during the period between 1999 and 2016. METHODS: I investigated whether the cancer sites for which more new drugs were authorized had larger reductions in mortality from 1999 to 2016 in Spain, controlling for the lagged change in cancer incidence. The principal measure of pharmaceutical innovation is the long-run change in the mean vintage (year of initial authorization in Spain) of the drugs for the treatment of a cancer previously authorized in Spain. RESULTS: The 1999 to 2016 increase in mean age at death tended to be larger, and the 1999 to 2016 increase in the number of deaths and life-years lost before the ages 65 years, 75 years, and 85 years tended to be smaller for cancer sites that had larger current or lagged increases in drug vintage. Pharmaceutical innovation was associated with a 2.77-year increase in mean age at death from cancer from 1999 to 2016-96% of the observed increase. New drug authorization during the previous 17 years were associated with a reduction in the number of life-years lost before the age of 75 years in 2016 of 333 000. Under the assumption that the association between pharmaceutical innovation and mortality reduction is causal, estimated drug expenditure per life year before the age of 75 years gained in 2016 from new cancer drugs that were authorized between 2000 and 2016 was €3269. CONCLUSIONS: The cancer sites for which there were more pharmaceutical innovation-more new drugs authorized-had larger 1999 to 2016 reductions in mortality in Spain, controlling for the lagged change in cancer incidence.

Potencialidades e limitações do Prontuário Eletrônico do Cidadão (PEC) enquanto ferramenta de gestão de cuidado e planejamento: avaliação a nível nacional e local / Potentials and limitations of the Electronic Citizen Record (PEC) as a care management and planning tool: assessment at national and local level

O objetivo desse estudo foi analisar as potencialidade e limitações do Prontuário Eletrônico do Cidadão (PEC) e comparar com os indicadores assistenciais de saúde bucal da Atenção Básica a nível nacional e de um município no interior do estado da Paraíba. A coleta de dados foi dividida em dois momentos: primeiro foram coletadas informações dos relatórios do e-SUS PEC presentes no site eletrônico e-Gestor do Departamento da Atenção Básica do Ministério da Saúde, referentes às equipes de saúde bucal das USF e em seguida a aplicação de um questionário estruturado para avaliar a aceitação, a facilidade e o uso do Prontuário Eletrônico do Cidadão (PEC) pelos cirurgiões dentistas cadastrados no município. Nos resultados, as regiões do Norte e Nordeste apresentaram os menores coeficientes de resolutividade (46,6 e 50,6) e com maior cobertura de primeira consulta odontológica (9,5 e 9,3), entretanto com maiores valores para exodontias (14,2 e 13,1); quanto à proporção de procedimentos preventivos observados, nota-se que o grau de priorização de cuidados de prevenção é alto em todas as regiões. Em nível local foram observadas variações significativas entre as USF; quanto ao uso do PEC 73,1% concordam que encontram mais rápido o prontuário no formato eletrônico e 61,5% concordam que o PEC otimiza seu processo de trabalho, já em relação ao manuseio do sistema 76,9% concordaram ser fácil. Portanto, existe uma disparidade de primeira consulta odontológica com a conclusão dos tratamentos e apesar de ser alta a cobertura de primeiro atendimento, mesmo assim, não é suficiente para evitar agravos dos problemas de saúde bucal, bem como o PEC é uma importante ferramenta que proporciona melhor assistência ao paciente, auxilia no atendimento, ajuda no planejamento de cuidados em saúde, facilita o acesso de dados (AU).

The objective of this study was to analyze and compare the potentialities and limitations of the Citizen's Electronic Record (PEC) with the oral health care indicators of Primary Care at national level and of a municipality in the interior of the state of Paraíba. Data collection will take place in two stages: first, information will be collected from the e-SUS PEC reports present on the e-Gestor website of the Department of Primary Care of the Ministry of Health, referring to the USF oral health teams, and then to application of a specific and objective questionnaire to assess acceptance, ease and use of the Citizen's Electronic Record (PEC) by dentists registered in the municipality. The results show that the Northeast and North have the lowest resolubility coefficients (46.6 and 50.6) and the highest coverage of the first dental appointment (9.5 and 9.3), however with higher values for extractions (14.2 and 13.1); as for the proportion of preventive procedures observed, it is noted that the degree of prioritization of preventive care is high in all regions and at the local level, significant variations were observed between USF; regarding the use of the PEC, 76.9% did not receive qualification or training, 23.1% always experience difficulties when handling it and 46.2% are sometimes able to operate all the functions of the system. Therefore, there is a disparity between the first dental visit and the completion of treatments and, despite the high coverage of the first visit, even so, it is not enough to avoid worsening oral health problems, as well as the PEC is an important tool that provides better patient care, assist with care, help with health care planning, facilitate data access (AU).

Assessing Definitions and Incentives Adopted for Innovation for Pharmaceutical Products in Five High-Income Countries: A Systematic Literature Review.

BACKGROUND: The concept of health care innovation varies across organizations and countries. Harmonizing the definitions of innovation can augment the discovery of new therapies, minimize costs, and streamline drug development and approval processes. A systematic literature review (SLR) was conducted to gather insights surrounding different elements of innovation in the USA, the UK, France, Germany, and Japan. The SLR identified studies that have defined innovation and captured the types of incentives provided to promote innovation. METHODS: The MEDLINE, Embase, and EconLit databases were searched via the OVID SP platform on October 22, 2020. A secondary desk search literature review was performed to identify additional information of interest in regional languages: French, German, and Japanese. All the relevant literature in English was screened using the Linguamatics natural language processing (NLP) tool, except for articles from EconLit, which were screened manually using structured search strategies. Articles that describe a definition of innovation or refer to a definition of innovation published were included. All full-text articles were reviewed manually, and two reviewers independently screened the full texts for eligibility. RESULTS: After screening, 90 articles were considered to meet the SLR objectives. The most common dimension of innovation identified was therapeutic benefit as a measure of innovation, followed by newness and novelty aspects of innovations. Incentives around exclusivities were found to be the most prevalent in the data set, followed by rewards and premiums. Among the different therapy areas, the largest number of innovations was targeted at oncology. CONCLUSIONS: This SLR highlights the lack of a unified definition of innovation among regulatory authorities and health technology assessment bodies in five countries, and variation in the types of incentives associated with innovation. The targeted countries cover different dimensions of definition and incentives of innovation at varying levels, with a few focused on specific therapy areas. Harmonization and consensus for innovation would be needed across countries because drug development is a global undertaking. This SLR envisages a more holistic approach to evaluation, wherein the value provided to patients and health systems is accounted for. The results of this SLR will help to promote broader discussion among different stakeholders and decision makers across countries to identify gaps in policies and develop sustainable strategies to promote innovation for pharmaceutical products.

Análise de particularidades da participação lusófona em uma Rede de Conhecimentos em Enfermagem / Análisis de las particularidades de la participación lusófona en una Red de Conocimientos de Enfermería / Analysis of the particularities of Lusophone participation in a Nursing Knowledge Network

Resumo Objetivo Descrever o exercício conceitual de reflexão sobre as possibilidades e particularidades da participação das Escolas de Enfermagem e Faculdades de Enfermagem lusófonas na Rede de Conhecimentos em Enfermagem. Método Análise das informações obtidas em um levantamento de recursos institucionais de acordo com o marco conceitual proposto por Prug e Prusak sobre rede de conhecimentos. A ponderação de aspectos positivos e negativos - analisando o aprendizado com as informações - levou em consideração as possíveis soluções para um plano de ação. Resultados Tanto nas ações institucionais para suportar a pesquisa em Enfermagem como nos benefícios almejados com a participação na Rede existe o interesse na internacionalização da pesquisa e no trabalho colaborativo. Com a ampliação dos horizontes da ciência da Enfermagem lusófona, este trabalho visa aumentar o impacto da pesquisa e agilizar a divulgação e a utilização dos resultados, tanto na educação como na clínica. Conclusão e Implicações para a prática A participação das referidas instituições oferece inúmeras possibilidades de demonstrar originalidade, criatividade e perícia de sua prática docente e de pesquisa, favorecendo o compartilhamento de ideias e práticas. A prática de produção científica, por docentes e discentes, pode ser aprimorada pelo refinamento de modos de pensar, criar, produzir e disseminar.

Resumen Objetivo Describir el ejercicio conceptual de reflexión de las posibilidades y particularidades de la participación de facultades de Enfermería de lengua portuguesa en la Red de Conocimientos de Enfermería. Método Análisis de datos obtenidos de un sondeo de recursos institucionales bajo el marco conceptual de Prug y Prusak sobre la red de conocimiento. El planteamiento de aspectos positivos y negativos del aprendizaje abarcó soluciones para elaborar un plan de acción. Resultados En las acciones institucionales de apoyo a la investigación en Enfermería y los beneficios aspirados con la participación en la Red, existe un interés por la internacionalización de la investigación y el trabajo colaborativo -que tiene como objetivo aumentar el impacto de la investigación, estimular la divulgación y el aprovechamiento de los resultados en la enseñanza y la clínica, con la ampliación de los horizontes de la Enfermería de instituciones de habla portuguesa. Conclusión e Implicaciones en la práctica La Red ofrece numerosas posibilidades para las instituciones participantes respecto a la demostración de originalidad, creatividad y experiencia en la práctica docente y de investigación, fomentando el intercambio de ideas y prácticas. La práctica de la producción científica por profesores y estudiantes puede verse mejorada por la reflexión, creación, producción y difusión de conocimientos.

Abstract Objective To describe the conceptual exercise of reflecting on the possibilities and particularities of the participation of Lusophone schools of nursing in the Nursing Knowledge Network. Method An analysis was conducted using information obtained from an environmental scan of institutional resources following the conceptual framework by Prug and Prusak on the knowledge networks. The learnings reported in the analysis are based on the collected information and reflections on the positive and negative aspects of participation, while proposing possible solutions for an action plan. Results There is interest in the internationalization of research and collaborative work both as institutional actions to support nursing research and potential benefits due to participation in the Network. The collaborative work has potential to increase the impact of research, expedite dissemination and use of results both in education and in clinical practice, broadening the horizons of Lusophone nursing science. Conclusion and Implications for practice Participation of these institutions in the Network offers numerous possibilities to demonstrate the originality, creativity and expertise of their teaching and research practice, encouraging the sharing of ideas and practices. The practice of scientific production in all its scenarios by educators and students can be improved through refined ways of thinking, creating, producing, and disseminating knowledge.

As startups no contexto da organização capitalista financeira e as subjetividades empreendedoras / Startups in the context of financial capitalist organization and entrepreneurial subjectivities / Startups en el contexto de la organización capitalista financiera y subjetividades emprendedoras

As startups são empresas que apresentam modelos de negócios marcados pela inovação, rapidez, flexibilidade e alta capacidade de adaptação aos mercados. Atuando em diferentes setores socioeconômicos, elas prometem criar e transformar produtos e serviços. A emergência e disseminação dessas empresas ocorrem em um momento histórico de mudanças iniciadas a partir de 1970 e marcadas pelas crises geradas com o esgotamento do paradigma da sociedade urbano industrial. No Brasil, o número desse modelo de negócio apresentou uma expansão expressiva, alcançando a marca de 13.374 nos últimos cinco anos. Atento a esse cenário, o objetivo desta pesquisa consistiu em compreender como sujeitos, grupos e instituições atribuem sentidos à experiência de trabalho nas chamadas startups. Na parte teórica, as condições sociais e econômicas que possibilitaram a emergência e disseminação das startups são analisadas em uma perspectiva crítica. A parte empírica, por sua vez, apresenta depoimentos de empreendedores relatando o contexto geral de atuação nas startups. Ao final deste artigo, conclui-se que há uma instrumentalização capitalística de componentes subjetivos específicos selecionados e colocados em circulação para fortalecer o modo de produção capitalista financeirizado.(AU)

Startups are companies that have business models characterized by innovation, speed, flexibility, and a high capacity to adapt to markets. Operating in different socioeconomic sectors, they promise to create and transform products and services. The emergence and dissemination of these companies occur at a historical moment of changes that began from 1970 and are marked by the crises generated by the exhaustion of the paradigm of industrial urban society. In Brazil, the number of businesses in this model showed a significant expansion, reaching 13,374 companies in the last five years. Attentive to this scenario, the objective of this research was to understand how subjects, groups, and institutions attribute meanings to the work experience in so-called startups. In the theoretical part, the social and economic conditions that enabled the emergence and dissemination of startups are analyzed in a critical perspective. The empirical part presents entrepreneurs reporting the general context of action in startups. At the end of this article, it is concluded that there is a capitalistic instrumentalization of specific subjective components that are selected and put into circulation to strengthen the financed capitalist production.(AU)

Las startups son empresas que tienen modelos de negocio marcados por la innovación, la velocidad, la flexibilidad y una alta capacidad de adaptación a los mercados. Desde diferentes sectores socioeconómicos, las startups prometen crear y transformar productos y servicios. La aparición y difusión de estas empresas se produce en un momento histórico de cambios que comenzó a partir de 1970 y que está marcado por crisis generadas por el agotamiento del paradigma de la sociedad urbana industrial. En Brasil, estas empresas se expandieron significativamente alcanzando la marca de 13.374 empresas en los últimos cinco años. En este escenario, el objetivo de esta investigación fue entender cómo los sujetos, grupos e instituciones atribuyen significados a la experiencia laboral en las startups. En la parte teórica, se analizan las condiciones sociales y económicas que permitieron el surgimiento y la difusión de las startups en una perspectiva crítica. La parte empírica presenta testimonios de emprendedores que informan sobre el trabajo en startups. La investigación concluye que hay una instrumentalización capitalista de componentes subjetivos específicos que se seleccionan y ponen en circulación para fortalecer el modo de producción capitalista financiero.(AU)

Difusão da Lei Geral da Micro e Pequena Empresa em municípios paulistas / Difusión de la Ley General de las Micro y Pequeñas Empresas en los municipios de São Paulo / Diffusion of the Micro and Small Business Law in municipalities of São Paulo

Resumo Este artigo tem como objeto de análise a implantação da Lei Complementar nº 123, de 2006 (LC nº 123/2006), que instituiu o Estatuto Nacional da Microempresa e da Empresa de Pequeno Porte (MPE), por municípios paulistas. Utilizou-se o referencial teórico de difusão de políticas públicas tendo como objetivo estudar seu processo de adoção, observando os diferentes contextos e momentos de coerção previstos na legislação federal. Com base nas discussões teóricas relacionadas com o mecanismo de difusão chamado de coerção, respondeu-se a seguinte pergunta: qual é a influência do mecanismo de coerção vertical na difusão da Lei Geral da MPE nos municípios paulistas? A técnica "análise de sobrevivência" foi aplicada para identificar fatores explicativos da difusão da política, considerando variáveis de desenho institucional, políticas e partidárias, efeito vizinhança, necessidade da política, organizações/atores sociais e fatores estruturais. Os resultados demonstram que, conforme varia o desenho institucional de coerção, mudam os fatores explicativos da difusão dessa política na ponta, de modo que os aspectos locais, incluindo atores sociais, fatores regionais e questões estruturais, importam para a difusão, variando conforme o contexto coercitivo.

Resumen Este artículo analiza la implementación de la Ley General de las Micro y Pequeñas Empresas por parte de los municipios de São Paulo. Se utilizó la teoría de la difusión de políticas, con el objetivo de estudiar el proceso de adopción de esta política pública, observando los diferentes contextos y momentos de coerción previstos en la legislación federal. A partir de las discusiones teóricas relacionadas con el mecanismo de difusión denominado coerción, se respondió a la siguiente pregunta: ¿cuál es la influencia del mecanismo de coacción vertical en la difusión de la mencionada ley en los municipios de São Paulo? Se aplicó la técnica de análisis de supervivencia para identificar factores explicativos de la difusión de políticas, considerando variables institucionales, políticas y partidarias, efecto barrio, necesidad de políticas, organizaciones/actores sociales y factores estructurales. Los resultados muestran que a medida que varía el diseño institucional de coerción, los factores explicativos de la difusión de esta política al final cambian, de modo que los aspectos locales, incluidos los actores sociales, los factores regionales y los problemas estructurales importan para la difusión, variando de acuerdo con el contexto coercitivo.

Abstract This article analyzes the implementation of the General Law for Micro and Small Business by municipalities in São Paulo. The theory of policy diffusion was used to study the process of adopting this public policy in the different contexts of coercion. The article presents theoretical discussions on the diffusion mechanism "coercion" and answers the question: what is the influence of the vertical coercion mechanism in the diffusion of the General Law in the municipalities of São Paulo? The survival analysis technique was applied to identify explanatory factors of policy diffusion, considering institutional, political, and party design variables, neighborhood effect, internal needs, organizations/social actors, and structural factors. The results show that as the institutional rules of coercion vary, the explanatory factors of the diffusion change so that local aspects, including social actors, regional factors, and structural issues, matter for the diffusion, varying according to the coercive context.

Long-Term Trends in Obesity Prevalence by Socio-Economic Group in Five European Countries and the USA: The Relevance of the Diffusion of Innovations Theory.

INTRODUCTION: Cross-national comparison suggests that the timing of the obesity epidemic differs across socio-economic groups (SEGs). Similar to the smoking epidemic, these differences might be described by the diffusion of innovations theory, which states that health behaviours diffuse from higher to lower SEGs. However, the applicability of the diffusion of innovations theory to long-term time trends in obesity by SEG is unknown. We studied long-term trends in the obesity prevalence by SEG in England, France, Finland, Italy, Norway, and the USA and examined whether trends are described by the diffusion of innovations theory. METHODS: Obesity prevalence from 1978 to 2019 by educational level, sex, and age group (25+ years) from health surveys was harmonized, age-standardized, Loess-smoothed, and visualized. Prevalence rate differences were calculated, and segmented regression was performed to obtain annual percentage changes, which were compared over time and across SEGs. RESULTS: Obesity prevalence among lower educated groups has exceeded that of higher educated groups, except among American men, in all countries throughout the study period. A comparable increase across educational levels was observed until approximately 2000. Recently, obesity prevalence stagnated among higher educated groups in Finland, France, Italy, and Norway and lower educated groups in England and the USA. DISCUSSION: Recent trends in obesity prevalence by SEG are mostly in line with the diffusion of innovations theory; however, no diffusion from higher to lower SEGs at the start of the epidemic was found. The stagnation among higher SEGs but not lower SEGs suggests that the latter will likely experience the greatest future burden.

Next generation single-molecule techniques: Imaging, labeling, and manipulation in vitro and in cellulo.

Owing to their unique abilities to manipulate, label, and image individual molecules in vitro and in cellulo, single-molecule techniques provide previously unattainable access to elementary biological processes. In imaging, single-molecule fluorescence resonance energy transfer (smFRET) and protein-induced fluorescence enhancement in vitro can report on conformational changes and molecular interactions, single-molecule pull-down (SiMPull) can capture and analyze the composition and function of native protein complexes, and single-molecule tracking (SMT) in live cells reveals cellular structures and dynamics. In labeling, the abilities to specifically label genomic loci, mRNA, and nascent polypeptides in cells have uncovered chromosome organization and dynamics, transcription and translation dynamics, and gene expression regulation. In manipulation, optical tweezers, integration of single-molecule fluorescence with force measurements, and single-molecule force probes in live cells have transformed our mechanistic understanding of diverse biological processes, ranging from protein folding, nucleic acids-protein interactions to cell surface receptor function.

Implantação do prontuário eletrônico à luz da teoria da difusão da inovação: estudo de caso / Implementation of the electronic medical record based on the theory of the innovation diffusion: a case study / Implantación del historial clínico electrónico en vista de la teoría de la difusión de la innovación: estudio de caso

OBJETIVO: analisar a difusão do Prontuário Eletrônico do Cidadão em equipes de saúde da família de um município da Região Oeste de Minas Gerais. MÉTODO: estudo de caso, abordagem qualitativa, fundamentado na Teoria da Difusão da Inovação. Realizamos 17 entrevistas estruturadas com profissionais e observações do cotidiano de trabalho de 08 equipes de saúde da família envolvidas na utilização do prontuário eletrônico do cidadão. Os dados foram analisados por meio da Análise de Conteúdo modali-dade Temático-Categorial. RESULTADOS: os participantes reconheceram o prontuário eletrônico do cidadão como mais vantajoso do que a tecnologia anterior: compatível com suas necessidades, não é uma tecnologia complexa. Apesar do pouco tempo de experimentação, foram reconhecidos os resultados e as contribuições da tecnologia. CONCLUSÃO: o prontuário eletrônico do cidadão, em seu processo de difusão, tem-se conformado como uma inovação potencialmente transformadora do cotidiano de trabalho, favorecendo a aceitação. Entretanto, há fragilidades a serem superadas.

OBJECTIVE: To analyze the diffusion of the Electronic Medical Record of the Citizen within family health teams at a district in the West Region of Minas Gerais State. METHOD: A case study, qualitative approach, based on the Innovation Diffusion Theory. We carried out 17 structured interviews with professionals and observations of the daily routine of eight family health teams that used the Electronic Medical Record of the Citizen (EMRC). Data were analyzed by means of Content Analysis, the Thematic-Categorical modality. RESULTS: The participants identified the Electronic Medical Record of the Citizen as more advantageous than the previous technology ­ compatible with their needs, not a complex technology. Despite the short experimentation period, the results and the contributions of this technology were acknowledged. CONCLUSION: Over its diffusion period, the Electronic Medical Record of the Citizen has been proving to be a potentially able innovation to transform daily activities, furthering receptive attitudes. Nevertheless, there are fragile situations to be overcome

OBJETIVO: analizar la difusión del "Prontuário Electrônico do Cidadão" (Historial Clínico Electrónico del Ciudadano) en equipos de salud de la familia de un municipio de la región oeste del estado brasileño de Minas Gerais. MÉTODO: estudio de caso, enfoque cualitativo, basado en la teoría de la difusión de la innovación. Se llevaron a cabo 17 entrevistas estructuradas con profesionales y observaciones de la vida laboral diaria de 8 equipos de salud de la familia que participan en el uso del historial clínico electrónico del ciudadano. Los datos se analizaron por medio del análisis de contenido, modalidad temático categorial. RESULTADOS: los participantes reconocieron que el historial clínico electrónico del ciudadano es más ventajoso que la tecnología anterior: compatible con sus necesidades, no es una tecnología compleja. A pesar del corto tiempo de experi-mentación, ya se han reconocido los resultados y las contribuciones de la tecnología. CONCLUSIÓN: el historial clínico electrónico del ciudadano, en su proceso de difusión, se ha configurado como una innovación potencialmente transformadora en la vida laboral cotidiana, favoreciendo su aceptación. Sin embargo, hay puntos débiles que superar.

Vein Graft Tympanoplasty: How a Transiently Used Graft Material Transformed Middle Ear Surgery.

The inception of medial grafting as a technique for tympanic membrane repair was a critical milestone in the history of otology. John Shea introduced the medial graft technique and the use of vein grafts for tympanoplasty in 1960 after realizing that the vein grafts that he used to repair the oval window after stapedectomy could also be utilized to repair tympanic membrane perforations. At the time, tympanoplasty often utilized skin grafts, which required placement of the graft lateral to the tympanic membrane annulus. Placement of the graft medial to the tympanic membrane annulus allowed for more efficient surgery and avoided the complications associated with lateral grafting, such as blunting and lateralization. The introduction of vein grafts in tympanoplasty prompted a fundamental shift in technique from lateral to medial grafting, paving the way for decades of innovation in tympanoplasty.