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Silsand L.,the Artic University of Norway | Ellingsen G.,the Artic University of Norway
Journal of the Association of Information Systems | Year: 2014

While the mechanisms of generification during implementation and use of large-scale systems are well known, this paper extends and analyzes the notion into the design phase of generic systems and provides insight into the associated socio-technical key mechanisms at play. The paper draws on the information infrastructure literature, and emphasizes how generic systems' designs always face infrastructural challenges and opportunities in the development process. The paper illustrates how a vendor solved the infrastructural challenges by (to a large degree) lending on local practice, translating perspectives, and carefully adjusting their design strategy over time. We argue that our findings have implications for practice because they underscore the malleability of the collaboration process between vendor and users. First, we suggest that designing a generic system calls for a flexible vendor willing to change and adjust the development strategy along with the evolving project. Second, to strengthen the user-developer collaboration, we highly recommend giving the user-participants, at the very early stage of a development project, a basic understanding of software design, and raising their skills in making precise contextual narratives. Third, we emphasize the importance of the project management's engagement in recruiting clinical personnel and in making it possible for the clinicians to participate in the project. Empirically, the paper presents the initial stages of a large electronic patient record (EPR) development project that has been running from 2012 in the North Norwegian health region and is due to finish in 2016. Source

Steigen S.E.,University Hospital of North Norway | Steigen S.E.,University of Tromso | Holm N.R.,the Artic University of Norway | Butt N.,University of Tromso | And 6 more authors.
Scandinavian Cardiovascular Journal | Year: 2014

Objectives. Patients previously treated with coronary stents may suffer an acute coronary syndrome (ACS) without any evidence of thrombus formation on coronary angiography (CAG). This may be due to partial, nonocclusive stent thrombosis with microembolization. In this paper, we illustrate possible mechanisms both with optical coherence tomography (OCT) and histology. Design. We present two cases with ACS from very late stent thrombosis who have been previously treated with first-generation drug-eluting stents (DES). Results. The first patient had ACS 15 months after DES implantation. The angiogram (CAG) was near normal with slight peri-stent contrast staining. OCT revealed abnormalities including thrombus not visible on CAG. These are findings that may explain the ACS. The second patient had subclinical episodes with chest pain after DES implantation. The patient died from stent thrombosis in a DES. Postmortem histological examination of the coronary arteries revealed stent struts with little or no neointimal coverage, persistent peri-strut fibrin deposition, inflammatory cells, malapposition, and small luminal platelet-rich thrombi. Old spotty myocardial infarctions were found in the supplied territory possibly caused by earlier episodes of embolizing thrombus. Conclusions. In patients with previous implanted DES presenting with ACS, OCT may detect abnormalities and thrombus formation not visible on CAG. Such findings may impact the treatment strategy in these patients. © 2014 Informa Healthcare. Source

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