Os temas pertinentes à introdução e à difusão do Método de Ponseti para o Tratamento do pé torto congênito no Brasil são discutidos. O Método Ponseti é baseado na confecção de gessos seriados de forma específica, tenotomia do Achillis, e manutenção da correção com órtese de abdução. Este tratamento era diferente do tratamento então vigente no país, baseado em maior tempo de confecção de gessos e realização de uma cirurgia extensa do pé. A difusão do Método Ponseti é analisada de forma cronológica, com ênfase na história de sua difusão no Brasil e no mundo a partir da Universidade de Iowa, na influência da Internet, e no Programa de treinamento de ortopedistas denominado Ponseti Brasil. Dados populacionais foram utilizados como avaliação da difusão do Método Ponseti antes do Programa de Treinamento. Quatro formas de avaliação direta do impacto do Programa de Treinamento são propostas: a reação dos participantes, o questionamento dos participantes sobre sua prática clínica após um ano do Programa, a avaliação dos participantes com relação ao tratamento do pé torto em duas cidades do Programa, São Luis e Teresina, e apresentações de casuísticas de nove serviços de ortopedia brasileira em um Painel Nacional no Curso Ponseti Avançado realizado dois anos após o Programa Ponseti Brasil. Para corroborar as informações sobre difusão, as publicações em países em desenvolvimento são discutidas, como ampliações da indicação do Método Ponseti. A tendência da literatura médica sobre pé torto congênito é analisada, por bases de dados em língua inglesa e bases de dados latino-americanas, e também são revisados os anais dos congressos nacionais da Sociedade Brasileira de Ortopedia e Traumatologia (CBOT Congresso Brasileiro de Ortopedia e Traumatologia) e Congresso Brasileiro de Ortopedia Pediátrica para observar a apresentação de trabalhos sobre tratamento pelo Método Ponseti e tratamento cirúrgico do pé torto. A difusão também é discutida em outros países, organizações não governamentais, com relação à visão dos pais e com relação aos custos do tratamento. A difusão do Método no Brasil é considerada na fase de expansão, e sua discussão pode trazer elementos que auxiliem a incorporação dessa tecnologia no Sistema Único de Saúde / Introduction and diifusion of Ponseti Method for congenital clubfoot treatment in Brazil are discussed. Ponseti Method is based on specific serial casting, Achillis tenotomy and use of abduction brace to maintain correction. This was different from standard treatment in Brazil at that time, based in many more months of serial casting and an extensive foot surgery. The Ponseti Method difusion is analized in a cronologic manner, with focus in the history of its difusion in Brazil and in the world, beginning in University of Iowa. Internet influence is discussed, as well as the Program Ponseti Brasil for training orthopaedic surgeons in Ponseti clubfoot treatment. Populational data were used to evaluate Ponseti Method difusion, before the Training Program. Four manners of direct evaluation of the impact of the Training Program are presented: the participants´reaction, enquiries about clinical practice with Ponseti Method after one year, evaluation of the impact of the Training Program in two cities, São Luis and Tesesina, and case series presentations of nine Brazilian Orthopaedic Clinics in a national panel in the Advanced Ponseti Course, two years after the Training ProgramPonseti Brasil. To reinforce information about difusion, publications in developing countries are discussed, extending indications for use of the Ponseti Method. Tendencies of medical literature about clubfoot treatment were analized, through written english and latinoamerican databases, and proceedings of two national meetings Brazilian Orthopaedic Meeting and Brazilian Pediatric Orthopaedic Meeting were revised to evaluate presentations about clubfoot treatment (Ponseti and surgical). Difusion is also discussed in other countries, non governamental organizations, related to parents perspective, and related to costs of treatment. Difusion of Ponseti Method is considered in expansion phase, and its discussion can help in the incorporation of this tecnology into the SUS (Sistema Único de Saúde Brazilian Health System)

Strukturell avbildning med ultraljud kan användas för att upptäcka sjukdomar och störningar i kroppen. För att ställa tillförlitliga diagnoser räcker det inte alltid med en strukturell avbildning utan ibland krävs det även fysiologisk information. Vid användning av funktionell avbildning med ultraljud kan den informationen mätas i kroppens olika fysiologiska system.   Systemen består av funktionellt olika enheter och kallas för motoriska enheter i skelettmuskulatur. Vid sjukdomar som ateroskleros (åderförkalkning) kan dessa enheter vara så kallade kärlplack, som består av vävnad med varierande egenskaper och medicinsk relevans. Möjligheten att kunna analysera funktionella enheter i system som dessa kan bidra mycket till diagnostisering av sjukdomar och störningar.   Den här studien presenterar en metod för att hitta naturliga kluster av funktionella enheter i skelettmuskulatur, från 3D-data inhämtat med ultraljudssekvenser.   I studien genererades syntetiska data från en modell som simulerar sekvenser av aktionspotentialer i kontraherande muskelvävnad. Datat bearbetades med förbehandlingar och klusteranalys och resultaten utvärderades med siluettkoefficienter. Kombinationer av fyra förbehandlingssätt och två klustringsalgoritmer jämförs i studien. Även tester på riktigt ultraljudsdata av muskelkontraktioner utfördes.   Den bästa kombinationen av förbehandling och klustringsalgoritm gav goda resultat och använder datanormalisering samt temporal bandpassfiltrering som förbehandling tillsammans med hierarkisk Complete Linkage-klustring. Den var dessutom relativt okänslig för störningar i datat. Resultaten från riktigt ultraljudsdata gav en grov indelning av områden i muskeln som visuellt överensstämmer med anatomin i den strukturella bilden. / Structural imaging using ultra sound can be used to detect diseases and disorders in the body. It’s not always enough to structurally image these detections for accurate diagnosis, sometimes physiologically functional information is needed. By using functional imaging, this information can be measured in various physiological systems throughout the body.   The systems are built up by functionally different units. In skeletal muscle these units are called motor units and in cases of disease, like atherosclerosis, they can be arterial plack. The placks have a tissue composition of various properties and clinical relevance. If functional units could be analyzed in systems like these, much could be contributed to diagnosis of diseases and disorders.   In this study, a method of detecting natural clusters of functional units in skeletal muscle, using 3D data collected from ultrasound sequences, is presented.   Using a model that simulates a series of actions potentials in contracting muscle tissue, synthetic data was generated. During analysis the data was preprocessed and clustered, the results were analyzed using silhouette coefficients. In this study, combinations of four methods of preprocessing and two clustering algorithms are compared. Real ultrasound data of contracting muscle tissue was also examined.   A combination of preprocessing and clustering that clustered the data particularly well used data normalization and temporal passband filtering for preprocessing together with hierarchical Complete Linkage clustering. It also seemed to be relatively unaffected by noise. Clustering of the real ultrasound data resulted in a coarse sorting of the different areas of the muscle that corresponds to the anatomy seen in structural images.

Bakgrund: Outsourcing är inget nytt fenomen då transaktionskostnadsteorin formades 1937 som beskrev att företag bör vända sig till marknaden i de fall detta gynnade företaget ekonomiskt. Sedan dess har teorier kring outsourcing förändrats och i dag handlar outsourcing om att kunna fokusera på företagets kärnkompetens och vilka möjligheter och risker outsourcing medför. Läkemedelsbranschen har på senare år börjat outsourca forskning och produktutveckling, vilka ses som kärnprocesser. Det råder därför delade meningar om branschen faktiskt har en kärnprocess. Syfte: Syftet med denna uppsats är att förstå hur och varför läkemedelstillverkningsbranschen outsourcar, om de outsourcade processerna har koppling till företags kärnprocesser och hur outsourcing faktiskt påverkar företaget, både monetärt och icke-monetärt. Metod: Det empiriska materialet insamlades med både kvantitativ och kvalitativ metod. En enkätundersökning genomfördes för att få en generell bild av hur läkemedelstillverkningsbranschen outsourcar för att sedan genomföra tre intervjuer för att få djupare kunskap om varför företag gjort de angivna val kring outsourcing. De intervjuade företagen valdes ut genom ett typiskt urval där företag valdes som svarat utifrån vissa bestämda kriterier. Slutsats: Uppsatsen har belyst att den vanligaste processen att outsourca är tillverkning, men att även forskning och produktutveckling outsourcas till viss del. Detta berodde på att företag upplevde resurs- och kunskapsbrist inom de outsourcade processerna. Studien fann även att sambandet mellan anledningen till och utfallet av outsourcing var svagt. Däremot hamnade den ökade lönsamheten sist inom båda kategorierna. Det påvisades också att det är svårt att definiera en kärnprocess till branschen med anledning av den diversifiering som i dag karaktäriserar branschen. Däremot framkom produktutveckling som den vanligaste kärnprocessen inom företag, där det visade sig att företag inte tenderar att outsourca sin kärnprocess. / Background: Outsourcing is not a new phenomenon. Transaction cost theory was formed in 1937, which described that companies should transfer activities externally when this benefited companies financially. Since then, theories of outsourcing have changed and today, it has been switched to outsourcing of core competencies and a discussion of both opportunities and risks. In recent years the pharmaceutical industry has started to outsource their research and product development, which is considered a core process. Due to this there is a debate whether or not the industry has a core process. Purpose: The purposes of this thesis are to understand how and why the pharmaceutical manufacturing industry is outsourcing, how the outsourced processes relate to their core processes and how outsourcing affects the companies, both monetary and non-monetary. Method: The empirical evidence was gathered with both quantitative and qualitative methods. Firstly, a survey was conducted to get a general picture of how the pharmaceutical manufacturing industry outsources which was then followed by three interviews to gain an in-depth knowledge of why companies have made specified decisions regarding outsourcing. The companies were selected according to a number of specific criteria. Conclusion: The thesis has highlighted that manufacturing is the most common process of outsourcing, but also that research and product development is outsourced to some extent. This was due to the fact that companies experienced resource and knowledge shortage in the outsourced processes. The study also found that the relation between the reason and the outcome of outsourcing was weak. However, the increased profitability ended last in both categories. It was also found that it is difficult to define a core process within the industry due to the diversification that today characterizes the industry. On the other hand, product development appear to be the most common core process within companies, where it also shows that companies tend not to outsource their core process.

Las técnicas ablativas basadas en energía por radiofrecuencia (RF) se emplean con el fin de lograr un calentamiento seguro y localizado en el tejido biológico. En los últimos años ha habido un rápido crecimiento en el número de nuevos procedimientos médicos que hacen uso de dichas técnicas, lo cual ha ido acompañado de la aparición de nuevos diseños de electrodos y protocolos de aplicación de energía. Sin embargo, existen todavía muchas incógnitas sobre el verdadero comportamiento electro-térmico de los aplicadores de energía, así como de la interacción energía-tejido en aplicaciones concretas. El principal propósito de esta Tesis Doctoral es adquirir un mejor conocimiento de los fenómenos eléctricos y térmicos involucrados en los procesos de calentamiento de tejidos biológicos mediante corrientes de RF. Esto permitirá, por un lado, mejorar la eficacia y seguridad de las técnicas actualmente empleadas en la clínica en campos tan diferentes como la cirugía cardiaca, oncológica o dermatológica; y por otro, sugerir mejoras tecnológicas para el diseño de nuevos aplicadores. La Tesis Doctoral combina dos metodologías ampliamente utilizadas en el campo de la Ingeniería Biomédica, como son el modelado computacional (matemático) y la experimentación (ex vivo e in vivo). En cuanto al área cardiaca, la investigación se ha centrado, por una parte, en mejorar la ablación intraoperatoria de la fibrilación auricular por aproximación epicárdica, es decir, susceptible de ser realizada de forma mínimamente invasiva. Para ello, se ha estudiado mediante modelos matemáticos un sistema de medida de la impedancia epicárdica como método de valoración de la cantidad de grasa previo a la ablación. Por otra parte, se ha estudiado cómo mejorar la ablación de la pared ventricular por aproximación endocárdica-endocárdica (septo interventricular) y endocárdica-epicárdica (pared libre del ventrículo). Con este objetivo, se han comparado mediante modelado por computador la eficacia de los modos de ablación bipolar y unipolar en términos de la transmuralidad de la lesión en la pared ventricular. En lo que respecta al área de cirugía oncológica, la investigación se ha centrado en la resección hepática asistida por RF. Las técnicas de calentamiento por RF deberían ser capaces de minimizar el sangrado intraoperatorio y sellar vasos y ductos mediante la creación de una necrosis coagulativa por calentamiento. Si este calentamiento se produce en las cercanías de grandes vasos, existe un problema potencial de daño a la pared de dicho vaso. En este sentido, se ha evaluado con modelos matemáticos y experimentación in vivo si el efecto del flujo de sangre dentro de un gran vaso es capaz de proteger térmicamente su pared cuando se realiza una resección asistida por RF en sus cercanías. Además, se ha realizado un estudio computacional y experimental ex vivo e in vivo del comportamiento electro-térmico de aplicadores de RF bipolares internamente refrigerados, puesto que representan una opción más segura frente a los monopolares en la medida en que las corrientes de RF fluyen casi exclusivamente por el tejido biológico situado entre ambos electrodos. Respecto al área dermatológica, la investigación se ha centrado en mejorar el tratamiento de enfermedades o desórdenes del tejido subcutáneo (tales como lipomatosis, lipedema, enfermedad de Madelung y celulitis) mediante el estudio teórico de la dosimetría correcta en cada caso. Para ello, se han evaluado los efectos eléctricos, térmicos y termo-elásticos de dos estructuras diferentes de tejido subcutáneo durante el calentamiento por RF, y se ha cuantificado el daño térmico producido en ambas estructuras tras dicho calentamiento / González Suárez, A. (2014). Computational Models and Experimentation for Radiofrequency-based Ablative Techniques [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/36502 / TESIS

Epilepsy affects up to 1% of the world's population and approximately 2.5 million people in the United States. A considerable portion (30%) of epilepsy patients are refractory to antiepileptic drugs (AEDs), and surgery can not be an effective candidate if the focus of the seizure is on the eloquent cortex. To overcome the problems with existing solutions, a notable portion of biomedical research is focused on developing an implantable or wearable system for automated seizure detection and control. Seizure detection algorithms based on signal rejection algorithms (SRA), deep neural networks (DNN), and neighborhood component analysis (NCA) have been proposed in the IoMT framework. The algorithms proposed in this work have been validated with both scalp and intracranial electroencephalography (EEG, icEEG), and demonstrate high classification accuracy, sensitivity, and specificity. The occurrence of seizure can be controlled by direct drug injection into the epileptogenic zone, which enhances the efficacy of the AEDs. Piezoelectric and electromagnetic micropumps have been explored for the use of a drug delivery unit, as they provide accurate drug flow and reduce power consumption. The reduction in power consumption as a result of minimal circuitry employed by the drug delivery system is making it suitable for practical biomedical applications. The IoMT inclusion enables remote health activity monitoring, remote data sharing, and access, which advances the current healthcare modality for epilepsy considerably.

MedTech firms experience barriers when entering the healthcare sector, although their solutions could solve healthcare challenges. The study provides a conceptual framework for MedTech firms' business environment including institutional alignments and misalignments. These insights support MedTech firms' business model development when aiming for successful commercialization. The research is conducted with a multiple case study analyzing MedTech firms' and healthcare organizations' perspective regarding the business environment and relationship dynamics. The study generated three main findings. Firstly, an organizational and institutional logic analysis outlined essential problem areas where MedTech firms and healthcare organizations align differently. Secondly, suggestions on how the MedTech firm can respond to the identified problem areas through their business model are presented. Thirdly, the study provides an example of how social- and business literature can be connected to understand complex business environments. In contrast to a majority of prior research, the study is designed for the MedTech firm's perspective where the final result answering how the business model can be improved based on healthcare organizational and business insights.

No description available.

Die Transplantation eines Organes ist in der Medizin oftmals die letzte Möglichkeit zur Behandlung einer terminalen Organinsuffizienz. Das grundlegende Problem der internationalen Transplantationsmedizin ist die stetig wachsende Diskrepanz zwischen Bedarf und Angebot von Transplantaten. Die Situation wird dramatisiert durch einen Trend der Marginalisierung von Spenderorganen. Marginale Spenderorgane werden häufig aufgrund mangelnder Möglichkeiten zur Funktionsbewertung verworfen. Die Technik der ex-vivo Organperfusion kann maschinell physiologienahe Bedingungen bereitstellen, um ein isoliertes Transplantat zu rekonditionieren und sogar eine Bewertung seines Zustands zu ermöglichen. Perfusionsprozesse sind organsystemindividuell durch eine hohe Komplexität ihrer biologisch-technisch verkoppelten Vorgänge gekennzeichnet. Für nutzer- und sicherheitsorientierte, klinisch taugliche Perfusionssysteme ist eine Prozessautomatisierung unumgänglich. Hier sind in klassischer anwendungsindividueller Entwicklung hohe Kosten die Folge. Auf Basis von Recherchen zum aktuellen Stand von Medizin und Technik konnten Eigenschaften von Perfusionsprozessen für die Organsysteme Herz, Lunge, Leber und Niere bestimmt werden. Aus ähnlichen Anwendungen der extrakoporalen Lebensunterstützung sind Erkenntnisse zur Systemautomatisierung zusammengetragen worden. In Fortführung der Arbeit sind die Organperfusionsprozesse abstrahiert und verallgemeinert worden. Beteiligte Prozessgrößen, sowie deren funktioneller Verkopplungen wurden identifiziert und evaluiert, um schließlich eine generalisierte, organunabhängige Strategie zur dezentralen Mehrgrößenregelung abzuleiten. Die abgeleitete Regelungsstrategie wurde folgend speziell für die ex-vivo Nierenperfusion umgesetzt. Dazu wurde zunächst auf Basis des generalisierten Organperfusionsprozesses ein Gerätesystem zur Nierenperfusion abgeleitet, entwickelt und aufgebaut. Für das entstandene Perfusionssystem wurden Modellbildungen und Parameteridentifikationen des Temperatursystems, des hämodynamischen Systems und des Blutgassystems durchgeführt. Die entstandenen Zustandsraummodelle wurden jeweils in Simulink implementiert und mittels realer Perfusionsexperimente an Schweinenieren im Tiermodell validiert. Simulativ und analytisch wurden für die drei Subsysteme Regelungsstrategien zur robusten Einzelgrößenregelung entwickelt und im realen Perfusionssystem implementiert. Im Zuge von weiteren Perfusionsexperimenten im Tiermodell konnten die Regelungen ebenfalls validiert und deren Robustheit im Mehrgrößenfall evaluiert werden. Die Erkenntnisse der speziellen Umsetzung des generalisierten Mehrgrößenregelungsansatzes zur Organperfusion wurden auf die Organsysteme Herz, Lunge und Leber projiziert. Die Hypothese dieser Arbeit, dass eine organübergreifende generalisierte Regelungsstrategie zur ex-vivo Perfusion bei Nutzung mit verschiedenen speziellen Organsystemen tauglich ist, konnte bestätigt werden. Auf dieser Basis ist eine vereinfachte und kostenreduzierte Entwicklung von Perfusionssystemen für verschiedene Organsysteme möglich. / In many cases the transplantation of an organ is the last way to treat a terminal organ insuffiency. The basic problem of international transplant medicine is a continiously increasing gap between the demand and the proposal of sufficient organ grafts. The situation is compounded by the actual trend of marginalization of organ grafts. Marginal donor grafts often are discarded due to absent options to test their vitality and viability. The technique of ex-vivo organ perfusion provides near physiologic conditions in order to recondition and even to evaluate the state of an isolated organ graft. Perfusion processes are organ individual characterized by highly complex coupled biological-technical processes. For achieving an user- and safety-focussed, clinical suitable perfusion system, an automation of the system is inavoidable. Within classical development of technologies, high costs were following. On the base of research according to the actual status quo of medicine and technology, characteristics of the perfusion processes for the heart, the lungs, the liver and the kidneys could be determined. Knowledge about similar processes of extracorporeal life support were gathered. Subsequently the organ perfusion processes were abstracted and generalized. Participating process values, as well as their couplings, were identified and evaluated in order to extract a generalized, organ independent strategy for decentral multivariable control. The extracted control strategy was then transfered specificly for ex-vivo kidney perfusion. Therefore a device for ex-vivo kidney perfusion was developed and built from the generalized organ perfusion process. According to the implemented device, the temperature system, the hemodynamic system and the blood gas system were modelled mathematically and parameter estimations were performed. The resulted state space models were implemented to Simulink and validated by comparing simulations to the results of experiments on real procine kidneys. Within the simulations and based on analytical methods, robust single variable control strategies for the control of the three subsystems temperature, hemodynamic and blood gases were developed and implemented into the real kidney perfusion device. During further perfusion experiments within the large animal model, the control strategies could be validated an their robustness could be evaluated in the multivariable case. The findings of the special implementation of the generalized multivariableapproach for organ perfusion were projected on the organ systems heart, lungs and liver. The hypothesis of this work, in detail, that a generalized, organ independent control strategy for organ perfusion processes is suitable for the use with several special organ systems, could be confirmed. On this basis, simplified and cost reduced developments of perfusion systems for different organ systems are possible.

Neue Technologien der additiven Fertigung läuten auch im Bereich der Medizin, Medizintechnik und der biomedizinischen Forschung eine neue Ära ein: Über verschiedene Fertigungsverfahren wie lithographische Techniken oder Laser-Sintering ist es bereits jetzt möglich, aus biokompatiblen Materialien entsprechend eines spezifischen Designs und ohne zusätzlich nötige Fertigungsmasken dreidimensionale Implantate in anatomischer oder patienten-individueller Geometrie herzustellen. Großes Potential ergibt sich daraus beispielsweise für Lösungen zu orthopädischen Fragestellungen: Hierzu gehören u.a. die potentielle Korrektur von Fehlbildungen im mund-, kiefer- und gesichtschirurgischen Bereich, der Ersatz größerer Knochendefekte sowie der Ausgleich von kleineren Gelenkdefekten. Letztere beschreiben die Anwendung am Gelenkknorpel-Knochen-Übergang, um Eingriffen zur Implantation einer Totalendoprothese zu entgehen oder diese ggf. hinauszuzögern. Aus diesem Grund finden für entsprechende zukünftige, klinische Konzepte, sowie in den entsprechenden Forschungsbereichen unterschiedlichste Fertigungsmethoden Anwendung. Die additive Fertigung hat nicht nur das Design und die aufbauende Fabrikation von patientenindividuellen Titanimplantaten (Gander et al. 2015) durch Spritzgussverfahren revolutioniert, sondern auch den schnellen Aufbau von Strukturen aus thermoplastischen Polymeren (Probst et al. 2010) und weicheren Materialien durch extrusionsbasierte Techniken ermöglicht. Diese über Rapid Prototyping erhaltenen, individuellen Objekte können im Vergleich zu konventionellen Verfahren sehr schnell und ohne Materialausschuss auch in Kleinserien und Einzelanfertigungen individuell gefertigt werden. Die essentielle Aufgabe für den klinischen Einsatz liegt hier in der Herstellung patientenindividueller Implantate. Allerdings sind die Technologien ebenso hinsichtlich spezifischer Gewebemodelle für forschungsrelevante Fragestellungen, die mittel- bis langfristig zu Erfolgen für die biomedizinische Patientenversorgung beitragen können, von großer Bedeutung. Um hierbei eine Lücke zwischen den individualisierten, bezüglich ihrer äußeren Geometrie spezifisch designten Implantaten und einer intrinsischen Funktionalität zu schaffen, greift die biomedizinische Forschung auf die Kombination von Ansätzen aus dem Tissue Engineering (Langer & Vacanti, 1993) und den Vorteilen der additiven Fertigung sowie der damit verbundenen Konstruktion von anatomischen Geometrien zurück. Das Forschungsfeld und die Methoden der sog. Biofabrikation (Groll et al. 2016; Moroni et al. 2018) bringen die Vorteile und Konzepte dieser doch unterschiedlichen Wissenschaftsfelder zusammen, indem sie biologische Komponenten in den Fabrikationsprozess einbeziehen. [... aus der Einleitung]

The number of deaths due to medical errors in hospitals ranges from 44,000 to 98,000 yearly. More than 7,000 of these deaths have taken place due to medication errors. This project evaluated the implementation of an automated medication dispensing cabinet or PYXIS machine in a 25-bed upper Midwestern critical access hospital. Lewin's stage theory of organizational change and Roger's diffusion of innovations theory supported the project. Nursing staff members were asked to complete an anonymous, qualitative survey approximately 1 month after the implementation of the PYXIS and again 1 year later. Questions were focused on the device and its use in preventing medication errors in the hospital. In addition to the surveys that were completed, interviews were conducted with the pharmacist, the pharmacy techs, and the director of nursing 1 year after implementation to ascertain perceptions of the change from paper-based medication administration to use of the automated medication dispensing cabinet. Medication errors before, during, and after the PYXIS implementation were analyzed. The small sample and the small number of medication errors allowed simple counts and qualitative analysis of the data. The staff members were generally satisfied with the change, although they acknowledged workflow disruption and increased medication errors. The increase in medication errors may be due in part to better documentation of errors during the transition and after implementation. Social change in practice was supported through the patient safety mechanisms and ongoing process changes that were put in place to support the new technology. This project provides direction to other critical access hospitals regarding planning considerations and best practices in implementing a PYXIS machine.