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This case report presents an elderly male patient who on diagnosis with a large oropharyngeal tumour had no specific symptomatology apart from severe obstructive sleep apnoea. Histopathology revealed the tumour to be an adult rhabdomyoma, a rare but benign tumour arising from striated muscle cells. The tumour obstructed most of the oropharyngeal space and almost occluded the patient’s airway when lying in a supine position. The patient was deemed operable, and the tumour was excised in toto using a transoral robotic surgery system. On follow-up, the patient had a severe reduction of apnoeas/hypopnoeas and felt subjectively ‘reborn’. This is to our knowledge the first case where an adult rhabdomyoma is removed using a robot-assisted approach, thus presenting a new and viable option when considering removal of benign tumours of the pharynx leading to a very minor degree of morbidity for the patients.

Practitioners perceive research on global software engineering as useful, yet they rarely read academic articles on the topic. Instead, they look to books, blogs, colleagues, forums, and their own experiences for solutions. Making research more relevant to practice requires a new mindset.

Societal changes are forcing us to reconsider how healthcare is delivered and ICT can support this reimagining of healthcare delivery. One of the emerging trends in this area is Connected Health. However, the evaluation of Connected Health technologies is crucial to assess whether their implementation has had a positive impact on healthcare delivery. To support this assessment process, we developed, an exploratory framework for the evaluation of Connected Health technologies in healthcare settings. This framework was developed after having critically appraised the existing findings of health information system evaluation studies. It also builds on previous models of Information Systems evaluation, in particular, the Information Systems Success Model. Our framework incorporates the concept of assessment from multiple perspectives. Furthermore, the framework identifies the primary stakeholders and extends the assessment based on their concerns. Finally, we elaborate on the framework, detailing its application to a Connected Health solution for primary care based dementia patients in Ireland.

Context. Clinical pathway support system can ease the clinician burden by prompting appropriate actions at different stages of a patient consultation. However, while the attitudes of clinicians towards the use of these systems are overwhelmingly positive, system designers still encounter significant challenges to their use in the clinical enviroment. Aims. To explore the role of support systems in healthcare and whether the concept of decision support for clinical pathways is valid. Method. We conducted nineteen evaluations, interviews and questionnaires, with patient-facing healthcare professionals on the use of support systems in a clinical setting. Results. The results highlighted the perceived benefits and weaknesses of support systems. These results are presented as a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis. Conclusions. While the logic of support systems in healthcare is evident, in the reality of clinical practice, other factors influence the success of these systems. This has significant implications for the acceptability and the relevance of support systems. The successful implementation and judicious use of these systems will need to develop an understanding of practitioner concerns.

Different clinicians may do the same work in different ways, depending on their preferences and level of expertise. The nature and amount of clinical support required also varies with the knowledge level of the clinician: novice clinicians may require guidance at each and every stage of the process, while experienced clinicians like to have a free hand and need guidance only when in doubt. We describe a descriptive support system, where guidance is provided only when asked, rather than actively prescribing a list of actions at every stage of the clinical process. The system infers the state of the clinical pathway for a patient by examining the state of information in the Electronic Record that is created or modified during the patient treatment process, therefore, the clinician does not have to notify the system of every action he does while treating a patient, but the system can keep track of patient treatment so that appropriate guidance can be provided when needed.

HighlightsWe described a detailed qualitative study on software product line scoping and requirements engineering.We examine weaknesses regarding the iterativeness, adaptability, and communication.Agile methods can mitigate the iterativeness, adaptability, and communication weaknesses. Software product line (SPL) engineering has been applied in several domains, especially in large-scale software development. Given the benefits experienced and reported, SPL engineering has increasingly garnered interest from small to medium-sized companies. It is possible to find a wide range of studies reporting on the challenges of running a SPL project in large companies. However, very little reports exist that consider the situation for small to medium-sized enterprises and these studies try develop universal truths for SPL without lessons learned from empirical evidence need to be contextualized. This study is a step towards bridging this gap in contextual evidence by characterizing the weaknesses discovered in the scoping (SC) and requirements (RE) disciplines of SPL. Moreover, in this study we conducted a case study in a small to medium sized enterprises (SMEs) to justify the use of agile methods when introducing the SPL SC and RE disciplines through the characterization of their bottlenecks. The results of the characterization indicated that ineffective communication and collaboration, long iteration cycles, and the absence of adaptability and flexibility can increase the effort and reduce motivation during project development. These issues can be mitigated by agile methods.

peer-reviewed Twelve years ago a group of practitioners and researchers came together to try to solve problems relating specifically to Global Software Engineering (GSE) practice. This paper aims to assess whether the many hundreds of GSE research papers written over this period have had an impact on practice. We conducted semi-structured interviews with senior managers and project managers from ten companies, four of which are large multinationals (three in Fortune 100); four are medium sized enterprises, and two are small startups. GSE research is perceived as useful by industry with all participants stating that studying the subject would improve GSE performance; but all were unanimous in saying they did not read articles on GSE. Practitioners go to books, blogs, colleagues, forums, experience reports of 1-2 pages in length, or depend on their own experience to solve problems in GSE. Controversially, many didn’t see GSE as separate from general project management. Practitioners don’t want frameworks; they want patterns of context specific help. While dissemination techniques need to be improved, that is not sufficient. Experience-based advice is just as important.

The purpose of this article was to assess our experience with the facial artery musculomucosal (FAMM) flap technique for reconstruction of the oral cavity after tumour ablation. We also introduce new surgical developments for this technique.We retrospectively examined 22 cases involving FAMM flap surgery during the period from July 2007 to December 2009, focusing on postoperative complications and flap survival. We describe a new method for closing the donor defect using the buccal fat pad, as well as a method for harvesting a broader flap than is traditionally described.Among the 22 cases studies, seven (32%) experienced postoperative complications. However, 57% of these cases had undergone preoperative radiotherapy. The complications we observed included problems relating to integration, partial necrosis and bleeding. There were no reported complications relating to the donor site.The FAMM flap is a suitable technique for reconstruction following tumour ablation. Our study also suggests that while preoperative radiotherapy is a contraindication for this treatment, neck dissection surgery is not.

peer-reviewed Connected Health involves the use of ICT to improve healthcare quality and outcomes. In a connected heath environment, stakeholders can struggle to make best use of this information coming from a variety of sources. Given this, we are investigating the challenge of how to use available infor-mation to make informed decisions about the care pathway which the patient should follow to ensure that prevention and treatment services are efficient and effective. In this paper, we outline our research into care pathway and infor-mation modelling in a Connected Health setting. The research is currently un-derway, and follows a series of stages using sources in industry and academia. In this paper, we present an overview of the project work packages including an explanation on how the different stages of the research form a continuum in which the developed models will be continually adjusted. We describe how empirical evidence will be used in the development of the models through fol-lowing an evolutionary multi-method research approach.

peer-reviewed Attempts to extend process management to support pathways in the health domain have not been as successful as workflow for routine business processes. In part this is due to the dynamic nature of knowledge-intensive work such as care pathways: the actions performed change continuously in response to the knowledge developed by those actions. Also, care pathways involve significant informal communications between those involved in caring for the patient and between these carers and the patient / patient family which are difficult to capture. We propose using an approach to supporting care pathways that embraces these difficulties. Rather than attempting to capture every nuance of individual activities, we seek to facilitate communication and coordination among knowledge workers to disseminate knowledge and pathway expertise throughout the organization.