The association between concomitant use of serotonergic antidepressants and lithium-induced polyuria. A multicenter medical chart review study.

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Wilting, I; Egberts, A C G; Movig, K L L; Laarhoven, J H M van; Heerdink, E R; Nolen, W A

2008-07-01

A previous study aimed at revealing the prevalence and determinants of lithium induced polyuria suggested an increased risk of polyuria (urine volume > or =3 L/24 h) in those using serotonergic antidepressants next to lithium. The objective of our study was to re-evaluate this secondary finding in another study population. We performed a multicenter medical chart review study in patients using lithium in whom a 24-hour urine volume had been determined. We included 116 patients, twelve (26%)of the 46 patients with polyuria used serotonergic antidepressants compared to ten (14%) of the 70 patients without polyuria. We found an increased risk of polyuria in lithium users concurrently using serotonergic antidepressants (oddsratio 2.86; 95% confidence interval 1.00-8.21), adjusted for age, gender, use of antiepileptics and thyreomimetics. Our results confirm the previous secondary finding of an increased risk of polyuria in patients using serotonergic antidepressants next to lithium. Physicians should take this into account when evaluating polyuria in patients using lithium and when choosing an antidepressant in patients using lithium.

Patterns in Patient Access and Utilization of Online Medical Records: Analysis of MyChart

Science.gov (United States)

2018-01-01

Background Electronic patient portals provide a new method for sharing personal medical information with individual patients. Objective Our aim was to review utilization patterns of the largest online patient portal in Canada's largest city. Methods We conducted a 4-year time-trend analysis of aggregated anonymous utilization data of the MyChart patient portal at Sunnybrook Health Sciences Centre in Ontario, Canada, from January 1, 2012, through December 31, 2015. Prespecified analyses examined trends related to day (weekend vs weekday), season (July vs January), year (2012 vs 2015), and an extreme adverse weather event (ice storm of December 20-26, 2013). Primary endpoints included three measures of patient portal activity: registrations, logins, and pageviews. Results We identified 32,325 patients who registered for a MyChart account during the study interval. Time-trend analysis showed no sign of attenuating registrations over time. Logins were frequent, averaged 734 total per day, and showed an increasing trend over time. Pageviews mirrored logins, averaged about 3029 total per day, and equated to about 5 pageviews during the average login. The most popular pageviews were clinical notes, followed by laboratory results and medical imaging reports. All measures of patient activity were lower on weekends compared to weekdays (P<.001) yet showed no significant changes related to seasons or extreme weather. No major security breach, malware attack, or software failure occurred during the study. Conclusions Online patient portals can provide a popular and reliable system for distributing personal medical information to active patients and may merit consideration for hospitals. PMID:29410386

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques.

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Chien, Tsair-Wei; Chou, Ming-Ting; Wang, Wen-Chung; Tsai, Li-Shu; Lin, Weir-Sen

2012-05-15

Few studies discuss the indicators used to assess the effect on cost containment in healthcare across hospitals in a single-payer national healthcare system with constrained medical resources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system. A custom Excel-VBA routine to record the distances of standard deviations (SDs) from the central line (the mean over the previous 12 months) of a control chart was used to construct and scale annual medical expenditures sequentially from 2000 to 2009 for 421 hospitals in Taiwan to generate the ICC. The ICC was then used to evaluate Taiwan's year-based convergent power to remain unchanged in hospital-provided constrained medical services. A bubble chart of SDs for a specific month was generated to present the effects of using control charts in a national healthcare system. ICCs were generated for Taiwan's year-based convergent power to constrain its medical services from 2000 to 2009. All hospital groups showed a gradually well-controlled supply of services that decreased from 0.772 to 0.415. The bubble chart identified outlier hospitals that required investigation of possible excessive reimbursements in a specific time period. We recommend using the ICC to annually assess a nation's year-based convergent power to constrain medical services across hospitals. Using sequential control charts to regularly monitor hospital reimbursements is required to achieve financial control in a single-payer nationwide healthcare system.

A scoping review of the potential for chart stimulated recall as a clinical research method.

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Sinnott, Carol; Kelly, Martina A; Bradley, Colin P

2017-08-22

Chart-stimulated recall (CSR) is a case-based interviewing technique, which is used in the assessment of clinical decision-making in medical education and professional certification. Increasingly, clinical decision-making is a concern for clinical research in primary care. In this study, we review the prior application and utility of CSR as a technique for research interviews in primary care. Following Arksey & O'Malley's method for scoping reviews, we searched seven databases, grey literature, reference lists, and contacted experts in the field. We excluded studies on medical education or competence assessment. Retrieved citations were screened by one reviewer and full texts were ordered for all potentially relevant abstracts. Two researchers independently reviewed full texts and performed data extraction and quality appraisal if inclusion criteria were met. Data were collated and summarised using a published framework on the reporting of qualitative interview techniques, which was chosen a priori. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines informed the review report. From an initial list of 789 citations, eight studies using CSR in research interviews were included in the review: six from North America, one from the Netherlands, and one from Ireland. The most common purpose of included studies was to examine the influence of guidelines on physicians' decisions. The number of interviewees ranged from seven to twenty nine, while the number of charts discussed per interview ranged from one to twelve. CSR gave insights into physicians' reasoning for actions taken or not taken; the unrecorded social and clinical influences on decisions; and discrepancies between physicians' real and perceived practice. Ethical concerns and the training and influence of the researcher were poorly discussed in most of the studies. Potential pitfalls included the risk of recall, selection and observation biases. Despite the proven validity

Falls documentation in nursing homes: agreement between the minimum data set and chart abstractions of medical and nursing documentation.

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Hill-Westmoreland, Elizabeth E; Gruber-Baldini, Ann L

2005-02-01

To assess the agreement between falls as recorded in the Minimum Data Set (MDS) and fall events abstracted from chart documentation of elderly nursing home (NH) residents. Secondary analysis of data from a longitudinal panel study. Fifty-six randomly selected NHs in Maryland stratified by facility size and geographic region. Four hundred sixty-two NH residents, aged 65 and older, in NHs for 1 year. Falls were abstracted from resident charts and compared with MDS fall variables. Fall events data obtained from other sources of chart documentation were matched for the corresponding periods of 30 and 180 days before the 1-year MDS assessment date. For a 30-day period, concordance between the MDS and chart abstractions of falls occurred in 65% of cases, with a kappa coefficient of 0.29 (Pfalls the MDS missed indicated that these residents had significantly more activity of daily living impairment and significantly less unsteady gait and cane/walker use. The MDS underreported falls. Nurses completing MDS assessments must carefully review residents' medical records for falls documentation. Future studies should use caution when employing MDS data as the only indicator of falls.

Concordance of self-reported and medical chart information on cancer diagnosis and treatment

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Shu Xiao Ou

2011-05-01

Full Text Available Abstract Background Self-reported information is an important tool for collecting clinical information for epidemiologic studies and in clinical settings where electronic medical records are not employed and shared. Methods Using data collected from the Shanghai Breast Cancer Survival Study (SBCSS, a population-based, prospective cohort study of 5,042 women diagnosed with breast cancer in Shanghai, China, we compared the concordance of patient questionnaire responses to a survey administered approximately 6 months after cancer diagnosis with medical chart information obtained from the diagnostic hospitals for several disease and treatment-related variables. Results Of 5,042 SBCSS participants, medical chart information was available for 4,948 women (98.1%. Concordance between patient self-reported and medical chart information was high for the majority of disease-related variables, including: diagnosing hospital (agreement: 98.7%, kappa: 0.99, type of surgery conducted (94.0%, 0.53, ER/PR status (94.5%, 0.91, and tumor position (98.2%, 0.97, as well as for important calendar dates, such as date of diagnosis, surgery, and first chemotherapy treatment. The 10 most commonly used chemotherapeutic drugs were all reported with agreement rates of at least 82%, with associated kappa values that ranged from 0.41 for calcium folinate to 0.76 for vinorelbine. Conclusions Our study found high validity for patient self-reported information for a variety of disease and treatment-related variables, suggesting the utility of self-reports as an important source of clinical information for both epidemiological research and patient care.

A Multisite Survey Study of EMR Review Habits, Information Needs, and Display Preferences among Medical ICU Clinicians Evaluating New Patients.

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Nolan, Matthew E; Cartin-Ceba, Rodrigo; Moreno-Franco, Pablo; Pickering, Brian; Herasevich, Vitaly

2017-10-01

The electronic chart review habits of intensive care unit (ICU) clinicians admitting new patients are largely unknown but necessary to inform the design of existing and future critical care information systems. We conducted a survey study to assess the electronic chart review practices, information needs, workflow, and data display preferences among medical ICU clinicians admitting new patients. We surveyed rotating residents, critical care fellows, advanced practice providers, and attending physicians at three Mayo Clinic sites (Minnesota, Florida, and Arizona) via email with a single follow-up reminder message. Of 234 clinicians invited, 156 completed the full survey (67% response rate). Ninety-two percent of medical ICU clinicians performed electronic chart review for the majority of new patients. Clinicians estimated spending a median (interquartile range (IQR)) of 15 (10-20) minutes for a typical case, and 25 (15-40) minutes for complex cases, with no difference across training levels. Chart review spans 3 or more years for two-thirds of clinicians, with the most relevant categories being imaging, laboratory studies, diagnostic studies, microbiology reports, and clinical notes, although most time is spent reviewing notes. Most clinicians (77%) worry about overlooking important information due to the volume of data (74%) and inadequate display/organization (63%). Potential solutions are chronologic ordering of disparate data types, color coding, and explicit data filtering techniques. The ability to dynamically customize information display for different users and varying clinical scenarios is paramount. Electronic chart review of historical data is an important, prevalent, and potentially time-consuming activity among medical ICU clinicians who would benefit from improved information display systems. Schattauer GmbH Stuttgart.

Quality assurance in a radiation oncology unit: the chart round experience

International Nuclear Information System (INIS)

Fogarty, G.B.; Peters, L.J.; Hornby, C.; Ferguson, H.M.

2001-01-01

Quality assurance ensures that planned treatments eventuate. Programmes must include feedback loops to promptly correct any shortfall in predetermined standards. In March 1999, a weekly Chart Round was introduced to verify that certain items relevant to quality care were being completed for patients of the Head and Neck Radiotherapy Unit at the Peter MacCallum Cancer Institute. The experience was reviewed after 1 year and it was found that the initiation of Chart Rounds has assisted in raising the level of item completion from 80% to 99% in similar groups of patients treated before and after the initiation of the Chart Round. Initiation of the Chart Round has also provided a useful forum for in-house peer-review, education and effective real-time communication between medical and allied health personnel, all of which has further added to the quality of patient care. Copyright (2001) Blackwell Science Pty Ltd

Prevalence of multimorbidity in medical inpatients.

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Schneider, Florian; Kaplan, Vladimir; Rodak, Roksana; Battegay, Edouard; Holzer, Barbara

2012-03-09

To validate the estimates of the prevalence of multimorbidity based on administrative hospital discharge data, with medical records and chart reviews as benchmarks. Retrospective cohort study. Medical division of a tertiary care teaching hospital. A total of 170 medical inpatients admitted from the emergency unit in January 2009. The prevalence of multimorbidity for three different definitions (≥2 diagnoses, ≥2 diagnoses from different ICD-10 chapters, and ≥2 medical conditions as defined by Charlson/Deyo) and three different data sources (administrative data, chart reviews, and medical records). The prevalence of multimorbidity in medical inpatients derived from administrative data, chart reviews and medical records was very high and concurred for the different definitions of multimorbidity (≥2 diagnoses: 96.5%, 95.3%, and 92.9% [p = 0.32], ≥2 diagnoses from different ICD-10 chapters: 86.5%, 90.0%, and 85.9% [p = 0.46], and ≥2 medical conditions as defined by Charlson/Deyo: 48.2%, 50.0%, and 46.5% [p = 0.81]). The agreement of rating of multimorbidity for administrative data and chart reviews and administrative data and medical records was 94.1% and 93.0% (kappa statistics 0.47) for ≥2 diagnoses; 86.0% and 86.5% (kappa statistics 0.52) for ≥2 diagnoses from different ICD-10 chapters; and 82.9% and 85.3% (kappa statistics 0.69) for ≥2 medical conditions as defined by Charlson/Deyo. Estimates of the prevalence of multimorbidity in medical inpatients based on administrative data, chart reviews and medical records were very high and congruent for the different definitions of multimorbidity. Agreement for rating multimorbidity based on the different data sources was moderate to good. Administrative hospital discharge data are a valid source for exploring the burden of multimorbidity in hospital settings.

Medication Review and Transitions of Care: A Case Report of a Decade-Old Medication Error.

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Comer, Rachel; Lizer, Mitsi

2017-10-01

A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

Peer chart audits: A tool to meet Accreditation Council on Graduate Medical Education (ACGME competency in practice-based learning and improvement

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Patel Sangnya

2007-07-01

Full Text Available Abstract Background The Accreditation Council on Graduate Medical Education (ACGME supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus. Methods A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin from the charts of patients followed by their physician peers. No formal feedback or education was provided. Results Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33% (p = 0.001, 26% (from 45% to 71% (p Conclusion Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial.

Diabetes Self-Management Education and Medical Nutrition Therapy Improve Patient Outcomes: A Pilot Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions through Retrospective Chart Review.

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Marincic, Patricia Z; Hardin, Amie; Salazar, Maria V; Scott, Susan; Fan, Shirley X; Gaillard, Philippe R

2017-08-01

Diabetes self-management education (DSME) and medical nutrition therapy (MNT) improve patient outcomes; poor reimbursement limits access to care. Our aim was to develop methodology for tracking patient outcomes subsequent to registered dietitian nutritionist interventions, document outcomes for patients with type 2 diabetes attending an American Diabetes Association-recognized program, and obtain outcome data to support reimbursement and public policy initiatives to improve patient access to DSME and MNT. Retrospective chart review. A random sample of 100 charts was chosen from the electronic medical records of patients with type 2 diabetes completing DSME and individualized MNT, June 2013 to 2014. Data were extracted on body mass index (calculated as kg/m 2 ), weight, hemoglobin A1c, blood glucose, and lipids. Mixed-model analysis of variance was used to determine differences between means for continuous variables; McNemar's tests and γ-statistic trend analysis were used to assess frequency of patients reaching glycemic targets. Significant weight loss was observed from baseline (94.3±21.1 kg) to end of program (91.7±21.2 kg [-1.6±3.9 kg]; P0.05). Significant hemoglobin A1c reduction was observed from baseline (8.74%±2.30%) to end of program (6.82%±1.37% [-1.92%±2.25%]; Phemoglobin A1c targets (≤7.0%) vs 27% at baseline (P=0.008). When stratified by diet alone and diet plus drug therapy, patients exhibited a 1.08%±1.20% (Phemoglobin A1c, respectively. Triglycerides decreased from baseline 181.6±75.5 mg/dL (2.0±0.9 mmol/L) to 115.8±48.1 mg/dL (1.3±0.5mmol/L) (P=0.023). High-density lipoprotein increased from 41.4±12.4 mg/dL (1.1±0.3 mmol/L) to 47.3±12.4 mg/dL (1.2±0.3 mmol/L) (P=0.007). Retrospective chart review provides an operational model for abstracting existing patient outcome data subsequent to registered dietitian nutritionist interventions. In support of universal reimbursement and patient access to DSME with supplemental individualized

Transformation of medical education through Decentralised Training Platforms: a scoping review.

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Mlambo, Motlatso; Dreyer, Abigail; Dube, Rainy; Mapukata, Nontsikelelo; Couper, Ian; Cooke, Richard

2018-03-01

Medical education in South Africa is facing a major paradigm shift. The urgency to increase the number of suitable, qualified and socially accountable health sciences graduates has brought to the fore the need to identify alternative training platforms and learning environments, often in rural areas. Subsequently, the focus has now shifted towards strengthening primary health care and community based health services. This scoping review presents a synopsis of the existing literature on decentralized training platform (DTP) strategies for medical education internationally, outlining existing models within it and its impact. This scoping review followed Arksey and O'Malley's framework outlining five stages: (i) identification of a research question, (ii) identification of relevant studies, (iii) study selection criteria, (iv) data charting, and (v) collating, summarizing and reporting results. The literature for the scoping review was found using online databases, reference lists and hand searched journals. Data were charted and sorted inductively according to key themes. A final review included 59 articles ranging over the years 1987-2015 with the largest group of studies falling in the period 2011-2015 (47.5%). Studies mostly employed quantitative (32.2%), qualitative (20.3%), systematic/literature review (18.6%) and mixed methods research approaches (11.9%). The scoping review highlighted a range of DTP strategies for transforming medical education. These include training for rural workforce, addressing context specific competencies to promote social accountability, promoting community engagement, and medical education partnerships. Viable models of DTP include community based education, distributed community engaged learning, discipline based clinical rotations, longitudinal clerkships and dedicated tracks focusing on rural issues. Shorter rural placements and supplemental rural tracks are also described. This scoping review showed a considerable amount of

Multivariate Statistical Process Control Charts: An Overview

OpenAIRE

Bersimis, Sotiris; Psarakis, Stelios; Panaretos, John

2006-01-01

In this paper we discuss the basic procedures for the implementation of multivariate statistical process control via control charting. Furthermore, we review multivariate extensions for all kinds of univariate control charts, such as multivariate Shewhart-type control charts, multivariate CUSUM control charts and multivariate EWMA control charts. In addition, we review unique procedures for the construction of multivariate control charts, based on multivariate statistical techniques such as p...

Documentation of psychotropic PRN medication administration: An evaluation of electronic health records compared with paper charts and verbal reports.

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Martin, Krystle; Ham, Elke; Hilton, Zoe

2018-05-12

To describe the documentation of pro re nata (PRN) medication for anxiety, and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., De Marinis, Piredda, Pascarella et al., 2009) and considerable information missing (e.g., Marinis et al., 2010). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker, Lovell, & Harris, 2008). The project was a mixed method, two-phase study that collected data from two sites. In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be done through training, using structured report templates, and switching to electronic databases. This article is protected by copyright. All rights reserved. This article is

32 CFR 728.93 - Chart of adjuncts.

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2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Chart of adjuncts. 728.93 Section 728.93 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Adjuncts to Medical Care § 728.93 Chart of...

A retrospective chart review of pirfenidone-treated patients in Sweden: the REPRIS study

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Carl Magnus Sköld

2016-07-01

Full Text Available Background: Idiopathic pulmonary fibrosis (IPF is a chronic, progressive lung disease that usually results in respiratory failure and death. Pirfenidone was approved as the first licensed therapy for IPF in Europe based on phase III trials where patients with a forced vital capacity (FVC >50% of predicted were included. The aim of this study was to characterise patients treated with pirfenidone in Swedish clinical practice and to describe the adherence to the reimbursement restriction since reimbursement was only applied for patients with FVC below 80% of predicted. Methods: This was a retrospective, observational chart review of IPF patients treated with pirfenidone from three Swedish university clinics. Patients initiated on treatment during the period 28 June 2012 to 20 November 2014 were included. Data on patient characteristics, basis of diagnosis, treatment duration, quality of life, and adverse drug reactions (ADRs were collected from medical charts. Results: Forty-four patients were screened and 33 were included in the study. The mean treatment duration from start of pirfenidone until discontinuation or end of study was 38 weeks. At the initiation of pirfenidone treatment, FVC was 62.7% (12.1 [mean (SD], diffusion capacity (DLco was 45.1% (13.8 of predicted, and the ratio of forced expiratory volume on 1 sec (FEV1 to FVC was 0.78 (0.1. The percentage of patients with an FVC between 50 and 80% was 87%. Ten of the patients had ADRs including gastrointestinal and skin-related events, cough and signs of impaired hepatic function, but this led to treatment discontinuation in only two patients. Conclusion: Data from this chart review showed that adherence to the Swedish reimbursement restriction was followed in the majority of patients during the study period. At the start of pirfenidone treatment, lung function, measured as FVC, was lower in the present cohort of Swedish IPF patients compared with other registry and real-life data. About a

Sticker charts: a method for improving adherence to treatment of chronic diseases in children.

Science.gov (United States)

Luersen, Kara; Davis, Scott A; Kaplan, Sebastian G; Abel, Troy D; Winchester, Woodrow W; Feldman, Steven R

2012-01-01

Poor adherence is a common problem and may be an underlying cause of poor clinical outcomes. In pediatric populations, positive reinforcement techniques such as sticker charts may increase motivation to adhere to treatment regimens. To review the use of sticker charts to improve adherence in children with chronic disease, Medline and PsycINFO searches were conducted using the key words "positive reinforcement OR behavior therapy" and "adherence OR patient compliance" and "child." Randomized controlled retrospective cohort or single-subject-design studies were selected. Studies reporting adherence to the medical treatment of chronic disease in children using positive reinforcement techniques were included in the analysis. The systematic search was supplemented by identifying additional studies identified through the reference lists and authors of the initial articles found. Positive reinforcement techniques such as sticker charts increase adherence to medical treatment regimens. In several studies, this effect was maintained for months after the initial intervention. Better adherence correlated with better clinical outcomes in some, but not all, studies. Few studies examining the use of sticker charts were identified. Although single-subject-design studies are useful in establishing the effect of a behavioral intervention, larger randomized controlled trials would help determine the precise efficacy of sticker chart interventions. Adherence to medical treatments in children can be increased using sticker charts or other positive reinforcement techniques. This may be an effective means to encourage children with atopic dermatitis to apply their medications and improve clinical outcomes. © 2012 Wiley Periodicals, Inc.

Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

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Latour Judith

2009-07-01

Full Text Available Abstract Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs. Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT, were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis. Results Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%. Indicators for the appropriateness of care showed less reliability. Conclusion Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT

Treatment Changes in Patients With Moderate to Severe Psoriasis: A Retrospective Chart Review.

Science.gov (United States)

Smith, Jaclyn A; Wehausen, Brooke; Richardson, Irma; Zhao, Yang; Li, Yunfeng; Herrera, Vivian; Feldman, Steven R

Psoriasis treatment involves topical medications, oral medications, phototherapy, and/or biologics. The treatments used depend on a myriad of factors that change over time. To characterise the frequency of and reasons for treatment changes in patients with moderate to severe psoriasis. A chart review examined treatment changes at 902 visits by 116 patients seen between January 1, 2010, and June 30, 2015, for moderate to severe psoriasis and the physicians' justifications for those changes. 'Treatment change' was defined as switching between, adding, or removing medication classes or switching within the oral or biologic class. There were 221 visits with treatment changes identified, and a change occurred every 4.1 visits. On average, there were 1.2 treatment changes per year. Patients treated for at least 1 year averaged 1 treatment change every 16 months. The most common type of change was from one biologic to another biologic (24.9%), followed by adding a nonbiologic to a biologic (18.6%). The most common reason for switching was poor control or flare of psoriasis. Affordability was a more common problem for biologics than for nonbiologic treatments. Biologic treatment options provide a major improvement over older systemic treatments, but patients still undergo frequent treatment changes to help control their disease.

A review of electronic medical record keeping on mobile medical service trips in austere settings.

Science.gov (United States)

Dainton, Christopher; Chu, Charlene H

2017-02-01

Electronic medical records (EMRs) may address the need for decision and language support for Western clinicians on mobile medical service trips (MSTs) in low resource settings abroad, while providing improved access to records and data management. However, there has yet to be a review of this emerging technology used by MSTs in low-resource settings. The aim of this study is to describe EMR systems designed specifically for use by mobile MSTs in remote settings, and accordingly, determine new opportunities for this technology to improve quality of healthcare provided by MSTs. A MEDLINE, EMBASE, and Scopus/IEEE search and supplementary Google search were performed for EMR systems specific to mobile MSTs. Information was extracted regarding EMR name, organization, scope of use, platform, open source coding, commercial availability, data integration, and capacity for linguistic and decision support. Missing information was requested by email. After screening of 122 abstracts, two articles remained that discussed deployment of EMR systems in MST settings (iChart, SmartList To Go), and thirteen additional EMR systems were found through the Google search. Of these, three systems (Project Buendia, TEBOW, and University of Central Florida's internally developed EMR) are based on modified versions of Open MRS software, while three are smartphone apps (QuickChart EMR, iChart, NotesFirst). Most of the systems use a local network to manage data, while the remaining systems use opportunistic cloud synchronization. Three (TimmyCare, Basil, and Backpack EMR) contain multilingual user interfaces, and only one (QuickChart EMR) contained MST-specific clinical decision support. There have been limited attempts to tailor EMRs to mobile MSTs. Only Open MRS has a broad user base, and other EMR systems should consider interoperability and data sharing with larger systems as a priority. Several systems include tablet compatibility, or are specifically designed for smartphone, which may be

Charlson comorbidity index derived from chart review or administrative data: agreement and prediction of mortality in intensive care patients

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Stavem K

2017-06-01

Full Text Available Knut Stavem,1–3 Henrik Hoel,4 Stein Arve Skjaker,5 Rolf Haagensen6 1Institute of Clinical Medicine, University of Oslo, Oslo, 2Department of Pulmonary Medicine, Medical Division, 3Health Services Research Unit, Akershus University Hospital, Lørenskog, 4Department of Surgery, Sykehuset Innlandet Kongsvinger, Kongsvinger, 5Section of Orthopaedic Emergency, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, 6Department of Anaesthesiology, Surgical Division, Akershus University Hospital, Lørenskog, Norway Purpose: This study compared the Charlson comorbidity index (CCI information derived from chart review and administrative systems to assess the completeness and agreement between scores, evaluate the capacity to predict 30-day and 1-year mortality in intensive care unit (ICU patients, and compare the predictive capacity with that of the Simplified Acute Physiology Score (SAPS II model.Patients and methods: Using data from 959 patients admitted to a general ICU in a Norwegian university hospital from 2007 to 2009, we compared the CCI score derived from chart review and administrative systems. Agreement was assessed using % agreement, kappa, and weighted kappa. The capacity to predict 30-day and 1-year mortality was assessed using logistic regression, model discrimination with the c-statistic, and calibration with a goodness-of-fit statistic.Results: The CCI was complete (n=959 when calculated from chart than from administrative data (n=839. Agreement was good, with a weighted kappa of 0.667 (95% confidence interval: 0.596–0.714. The c-statistics for categorized CCI scores from charts and administrative data were similar in the model that included age, sex, and type of admission: 0.755 and 0.743 for 30-day mortality, respectively, and 0.783 and 0.775, respectively, for 1-year mortality. Goodness-of-fit statistics supported the model fit.Conclusion: The CCI scores from chart review and administrative data showed good agreement

Results of chart reviews conducted to evaluate primary care patients seen by second and third year family medicine residents for potential adverse polypharmacy

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Chang LF

2007-06-01

Full Text Available Objective: To determine the prescribing patterns of family medicine residents for patients aged more than 60 years with 2 or more chronic diseases and seen at least twice in a 12 month timeframe.Methods: This is a descriptive analysis which was based on chart reviews. The setting was the University of Illinois-Rockford Family Practice Residency. Patients aged 60 years with 2 or more chronic diseases who were seen at least twice by second and third year residents.Results: Findings from this chart review include: 28.8% of the prescribed medications were not effective for the documented condition, 26.3% of the prescribed doses were incorrect, and 44.5% of the drugs prescribed were not the least expensive alternative.Discussion: This preliminary study suggests a need for a focused intervention with family medicine residents regarding inappropriate polypharmacy issues with older patients.

Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis: A Retrospective Chart Review.

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Selhorst, Mitchell; Fischer, Anastasia; Graft, Kristine; Ravindran, Reno; Peters, Eric; Rodenberg, Richard; Welder, Eric; MacDonald, James

2017-05-01

The purposes of this study were (1) to determine whether the duration of rest before referral to physical therapy (PT) affects the time to make a full return to activity for patients with an acute spondylolysis, (2) to assess the safety of an early referral to PT in patients with an acute spondylolysis. Retrospective chart review. Hospital-based sports medicine clinic. The medical charts of 196 adolescent athletes (mean age = 14.3 ± 1.8 years) with an acute spondylolytic injury met the inclusion criteria and were reviewed. Patients were subgrouped based on physician referral to PT. An aggressive referral group (10 weeks). Duration of rest before clearance to a full return to activity and the frequency of adverse reactions during the course of treatment. Safety was assessed by calculating the risk of experiencing an adverse reaction in each group. Median days to a full return to activity for aggressive referral group (115.5 days, interquartile range 98-150 days) and conservative referral group (140.0 days, interquartile range 114.5-168 days) were significantly different (P = 0.002). Eleven patients had adverse reactions during the course of treatment. The risk of adverse reaction was not statistically significant between groups (P = 0.509). Patients with acute spondylolysis in the aggressive referral group were able to make a full return activity almost 25 days sooner. No differences in the risk of adverse reactions were noted between aggressive and conservative referral groups.

Chart Audit and Chart Stimulated Recall as Methods of Needs Assessment in Continuing Professional Health Education.

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Affleck, Louise; Jennett, Penny

1998-01-01

Chart audit (assessment of patient medical records) is a cost-effective continuing-education needs-assessment method. Chart stimulated recall, in which physicians' memory of particular cases is stimulated by records, potentially increases content validity and exploration of clinical reasoning as well as the context of clinical decisions. (SK)

Pelvic floor physical therapy for lifelong vaginismus: a retrospective chart review and interview study.

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Reissing, Elke D; Armstrong, Heather L; Allen, Caroline

2013-01-01

Pelvic floor physical therapy is used in the treatment of sexual pain disorders; however, women with lifelong vaginismus have not yet been included in treatment studies or have not been differentiated from women with acquired vaginismus and/or dyspareunia. This retrospective chart review and interview study was intended to obtain initial information on physical therapy interventions, course, and outcome in women who have never been able to experience vaginal intercourse. The files of 53 women, consecutively treated at one physical therapy clinic, were included in the chart review; 13 of these women volunteered to be interviewed. The chart review revealed significant pelvic floor pathology and an average treatment course of 29 sessions. Internal manual techniques were found to be most effective, followed by patient education, dilatation exercises, and home exercises. Although participants were very satisfied with the physical therapy, some symptoms, such as pain, anxiety/fear, and pelvic floor tension remained and scores on the Female Sexual Distress Scale and Female Sexual Function Index indicated clinical levels of sexual distress and impaired sexual function after treatment. Although there appears to be no linear relation between symptom reduction and healthy sexual function, this initial information suggests that physical therapy may be a promising treatment option for some women with lifelong vaginismus and merits further evaluation.

Sertraline May Improve Language Developmental Trajectory in Young Children with Fragile X Syndrome: A Retrospective Chart Review

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Tri Indah Winarni

2012-01-01

Full Text Available Young children with fragile X syndrome (FXS often experience anxiety, irritability, and hyperactivity related to sensory hyperarousal. However, there are no medication recommendations with documented efficacy for children under 5 years old of age with FXS. We examined data through a chart review for 45 children with FXS, 12–50 months old, using the Mullen Scales of Early Learning (MSEL for baseline and longitudinal assessments. All children had clinical level of anxiety, language delays based on MSEL scores, and similar early learning composite (ELC scores at their first visit to our clinic. Incidence of autism spectrum disorder (ASD was similar in both groups. There were 11 children who were treated with sertraline, and these patients were retrospectively compared to 34 children who were not treated with sertraline by chart review. The baseline assessments were done at ages ranging from 18 to 44 months (mean 26.9, SD 7.99 and from 12 to 50 months (mean 29.94, SD 8.64 for treated and not treated groups, respectively. Mean rate of improvement in both expressive and receptive language development was significantly higher in the group who was treated with sertraline (<0.0001 and =0.0071, resp.. This data supports the need for a controlled trial of sertraline treatment in young children with FXS.

Off the Charts: Medical documentation and selective redaction in the age of transparency.

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McCarthy, Matthew William; de Asua, Diego Real; Gabbay, Ezra; Fins, Joseph J

2018-01-01

A growing demand for transparency in medicine has the potential to strain the doctor-patient relationship. While information can empower patients, unrestricted patient access to the electronic medical record may have unintended consequences. Medical documentation is often written in language that is inaccessible to people without medical training, and without guidance, patients have no way to interpret the constellation of acronyms, diagnoses, treatments, impressions, and arguments that appear throughout their own chart. Additionally, full transparency may not allow physicians the intellectual or clinical freedom they need to authentically express questions, problematic impressions, and concerns about the patient's clinical and psychosocial issues. This article examines the ethical challenges of transparency in the digital era and suggests that selective redaction may serve as a means to maintain transparency, affirm physician's discretion, and uphold the core values of the doctor-patient relationship amidst disruptive technological change.

Changes in body weight and body mass index among psychiatric patients receiving lithium, valproate, or topiramate: an open-label, nonrandomized chart review.

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Chengappa, K N Roy; Chalasani, L; Brar, Jaspreet S; Parepally, H; Houck, Patricia; Levine, Joseph

2002-10-01

Subsets of psychiatric patients gain excess body weight while receiving mood-stabilizing agents such as lithium carbonate or valproate sodium. Patients who gain excess weight may discontinue therapy, with severe consequences. Among the newer anticonvulsant agents, topiramate is a candidate agent for bipolar disorder and is associated with weight loss when used as adjunctive treatment. This open-label, nonrandomized, chart-review study assessed changes in body weight and body mass index (BMI) in patients receiving topiramate, lithium, or valproate. Data were extracted from the medical charts of patients admitted in 1999 and 2000 to a state psychiatric hospital with either schizophrenia, schizoaffective disorder, bipolar disorder, or other psychiatric diagnoses who were prescribed valproate, lithium, or topiramate and were reviewed for changes in body weight and BMI. The use of concomitant psychotropic medicines was recorded (eg, antipsychotic agents, antidepressant agents, other mood stabilizers such as gabapentin or carbamazepine). Continuous variables were analyzed using a factorial analysis of variance and the Student t test. Contingency statistics were used to analyze categorical variables. A total of 214 patients were included in the chart review (123 men, 91 women; mean age, 39.4 years). Significantly more women than men received topiramate (P = 0.004). Patients receiving either lithium or valproate gained a mean (SD) of 6.3 (9.0) kg and 6.4 (9.0) kg, respectively, whereas patients receiving topiramate lost a mean 1.2 (6.3) kg (F = 11.54, df = 2,198; P 8% of their baseline body weight (8.2% [11.5%] for lithium-treated patients and 8.5% [11.9%] for valproate-treated patients), whereas topiramate-treated patients lost 0.7% (7.2%) of their body weight (F = 9.93, df= 2,198; P weight loss and a reduction in BMI. This advantage of topiramate may promote long-term adherence to treatment among psychiatric patients and possibly decrease the medical risks associated

An integrative review of the literature on registered nurses' medication competence.

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Sulosaari, Virpi; Suhonen, Riitta; Leino-Kilpi, Helena

2011-02-01

The aim of this integrative literature review was to describe registered nurses' medication competence. The objectives of the literature review were to chart the need for future studies and use the results for instrument development. Nurses play a vital role in different phases of a patient's medication process and thus need adequate competence to fulfil their role. Research on nurses' level of medication competence in different competency areas has been published. However, previous studies have lacked a comprehensive or integrated definition or description of medication competence in nursing. Integrative literature review. The integrative literature review followed five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation. Eligible articles were identified via systematic literature search of research and evidence-based--databases. Twenty-one studies met the selection criteria. Eleven competency areas that constitute nurses' medication competence were identified: (1) anatomy and physiology, (2) pharmacology, (3) communication, (4) interdisciplinary collaboration, (5) information seeking, (6) mathematical and medication calculation, (7) medication administration, (8) medication education, (9) assessment and evaluation, (10) documentation and (11) promoting medication safety as part of patient safety. The analysis revealed three major categories which integrate these competency areas: (1) decision making competence, (2) theoretical competence and (3) practical competence. Medication competence requires a solid knowledge base and the ability to apply that knowledge in real-life situations during often complex and dynamic patient medication processes. Decision making competence was found to be an important and integral part of a nurses' theoretical and practical competence. These main competence categories integrated all of the 11 competency areas identified in this review. It is important to determine

Growth charts of human development

NARCIS (Netherlands)

Van Buuren, Stef

2014-01-01

This article reviews and compares two types of growth charts for tracking human development over age. Both charts assume the existence of a continuous latent variable, but relate to the observed data in different ways. The D-score diagram summarizes developmental indicators into a single aggregate

21 CFR 886.1150 - Visual acuity chart.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Visual acuity chart. 886.1150 Section 886.1150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1150 Visual acuity chart. (a) Identification...

Medical Practitioners Act 2007: the increased medical record burden.

LENUS (Irish Health Repository)

Byrne, D

2010-03-01

New medical record keeping obligations are implemented by the Medical Practitioners Act (2007), effective July 2009. This audit, comprising review of 347 medical entries in 257 charts on one day, investigated compliance with the Act together with the general standard of medical record keeping. The Medical Council requirement was absent all but 3 (0.9%) of entries; there was no unique identifier or signature in 28 (8%) and 135 (39%) of entries respectively. The case for change is discussed.

ICAO Aeronautical chart production: aerodrome obstruction charts from small–format aerial digital imagery

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Jorge Padro Molina

2012-11-01

Full Text Available Aeronautical charts and aerodrome obstruction charts, provide information about obstacles around the airport, so pilots and air traffic controllers can comply with the procedures and limitations of its utilization. Safety in aviation demands updated and precise aeronautical charts production, adopting the standards of the International Civil Aviation Organization (ICAO. In this paper the methodology employed to generate obstruction charts for five airports in Mexico, using aerial digital imagery obtained with small–format cameras, is described. Through two aerial surveys on each airport, from 10 000 and 5 000 feet above ground level, two orthomosaics were generated covering the airport influence area, the runway, and the obstacle limitation surfaces: approach/Take–off climb, transitional, inner horizontal, and conical. Using stereopair photointerpretation most of the obstacles were identified, and by means of the orthomosaics; aerodrome charts, and aerodrome obstruction charts types A, B and C, were generated. Using satellite geodetic receivers, 18 points were surveyed on each runway in order to obtain its dimensions, and to establish ground control points for mosaics generation. Throughout detailed field work, height and location of the obstacles were verified, and finally, after several reviewing processes by aeronautical authorities, generation of ICAO charts was concluded when all airport maps were integrated in a Geographical Information System.

A comparison of intimate partner violence and associated physical injuries between cohabitating and married women: a 5-year medical chart review

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Janet Yuen-Ha Wong

2016-11-01

Full Text Available Abstract Background Cohabitation, referring to a co-residential romantic relationship between two intimate partners without a marriage license, has become widely accepted in contemporary societies. It has been found that cohabitating women have a higher risk of experiencing intimate partner violence (IPV than married women. However, as yet, no studies have investigated the level and pattern of IPV-associated physical injuries and its mental health impact on cohabitating women. Therefore, we aim to compare IPV-associated physical injuries between cohabitating and married women by conducting a review of 5-year medical records from the emergency departments of two major public hospitals in Hong Kong. Methods This is a retrospective cohort study. Using two computerized systems, we identified the medical charts of 1011 women who had experienced IPV and presented at emergency departments between 2010 and 2014, of which, 132 were cohabitating and 833 were married. Results Cohabitating women were significantly younger (p-value < .0001 and had obtained a higher educational level (p-value = .008 than married women. After adjusting for those two variables, the logistic regression models showed that cohabitating women were approximately 2.1 times more likely than married women to present with head, neck, or facial injuries (OR = 2.1, 95% CI = 1.30–3.40, p = .002, and the risk of having multiple injuries in different locations (head, neck, face, torso, limbs was almost twice that for cohabitating women compared with married women (OR = 1.82, 95% CI = 1.25–2.65, p = .001. Furthermore, cohabitating women were almost two times as likely as married women to experience more than one method of physical violence (OR = 1.72, 95% CI = 1.18–2.51, p = .005. There were no significant differences regarding mental health, police reporting, and discharge plans. Conclusions Owing to recent social changes to the family

Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: a chart review

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Tybor David J

2005-12-01

Full Text Available Abstract Background The condition of obesity has become a significant public health problem in the United States. In children and adolescents, the prevalence of overweight has tripled in the last 20 years, with approximately 16.0% of children ages 6–19, and 10.3% of 2–5 year olds being considered overweight. Considerable research is underway to understand obesity in the general pediatric population, however little research is available on the prevalence of obesity in children with developmental disorders. The purpose of our study was to determine the prevalence of overweight among a clinical population of children diagnosed with attention deficit hyperactivity disorder (ADHD and autism spectrum disorders (ASD. Methods Retrospective chart review of 140 charts of children ages 3–18 years seen between 1992 and 2003 at a tertiary care clinic that specializes in the evaluation and treatment of children with developmental, behavioral, and cognitive disorders. Diagnostic, medical, and demographic information was extracted from the charts. Primary diagnoses of either ADHD or ASD were recorded, as was information on race/ethnicity, age, gender, height, and weight. Information was also collected on medications that the child was taking. Body mass index (BMI was calculated from measures of height and weight recorded in the child's chart. The Center for Disease Control's BMI growth reference was used to determine an age- and gender-specific BMI z-score for the children. Results The prevalence of at-risk-for-overweight (BMI >85th%ile and overweight (BMI > 95th%ile was 29% and 17.3% respectively in children with ADHD. Although the prevalence appeared highest in the 2–5 year old group (42.9%ile, differences among age groups were not statistically significant. Prevalence did not differ between boys and girls or across age groups (all p > 0.05. For children with ASD, the overall prevalence of at-risk-for-overweight was 35.7% and prevalence of overweight

Statistical process control charts for monitoring military injuries.

Science.gov (United States)

Schuh, Anna; Canham-Chervak, Michelle; Jones, Bruce H

2017-12-01

An essential aspect of an injury prevention process is surveillance, which quantifies and documents injury rates in populations of interest and enables monitoring of injury frequencies, rates and trends. To drive progress towards injury reduction goals, additional tools are needed. Statistical process control charts, a methodology that has not been previously applied to Army injury monitoring, capitalise on existing medical surveillance data to provide information to leadership about injury trends necessary for prevention planning and evaluation. Statistical process control Shewhart u-charts were created for 49 US Army installations using quarterly injury medical encounter rates, 2007-2015, for active duty soldiers obtained from the Defense Medical Surveillance System. Injuries were defined according to established military injury surveillance recommendations. Charts display control limits three standard deviations (SDs) above and below an installation-specific historical average rate determined using 28 data points, 2007-2013. Charts are available in Army strategic management dashboards. From 2007 to 2015, Army injury rates ranged from 1254 to 1494 unique injuries per 1000 person-years. Installation injury rates ranged from 610 to 2312 injuries per 1000 person-years. Control charts identified four installations with injury rates exceeding the upper control limits at least once during 2014-2015, rates at three installations exceeded the lower control limit at least once and 42 installations had rates that fluctuated around the historical mean. Control charts can be used to drive progress towards injury reduction goals by indicating statistically significant increases and decreases in injury rates. Future applications to military subpopulations, other health outcome metrics and chart enhancements are suggested. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Implementation of a consent for chart review and contact and its impact in one clinical centre.

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Druce, Irena; Ooi, T C; McGuire, Debbie; Sorisky, Alexander; Malcolm, Janine

2015-05-01

Informed consent and protection of patient confidentiality are central to the conduction of clinical research. Consent for chart review and contact (CCRC) allows a patient chart to be screened for research by persons outside the direct circle-of-care and for the patient to be contacted regarding potential studies. This study describes the process of implementation and benefits of such a consent. We present a descriptive report of a CCRC document that was created and presented to patients over a 3.5-year period at a tertiary care Endocrinology and Metabolism centre. To assess the potential impact of such a document on patient recruitment, the basic demographics of patients who did and did not consent were compared. In addition, we compared the recruitment rate at our centre, using our novel approach, with that at other centres for an ongoing study of patients with type 1 diabetes. A large proportion (6501/8025, or 81%) of patients gave their consent for chart review. Patients who denied consent were more likely to be women and older. Compared with other centres, our centre recruited at the highest rate for a known study of patients with type 1 diabetes. The majority (46/60, or 76.7%) of patients were recruited via the novel approach. Consent for chart review and contact addresses several important ethical issues regarding the use of patient clinical information for research purposes. Our study demonstrated how such a process can be implemented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

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Mosam Phirke

2015-01-01

Full Text Available Background: Electroconvulsive therapy (ECT is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26% showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.

Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial.

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Gidwani, Risha; Nguyen, Cathina; Kofoed, Alexis; Carragee, Catherine; Rydel, Tracy; Nelligan, Ian; Sattler, Amelia; Mahoney, Megan; Lin, Steven

2017-09-01

Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency. We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close. Scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028). To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout. © 2017 Annals of Family Medicine, Inc.

Transversus abdominis plane block in renal allotransplant recipients: A retrospective chart review.

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Gopwani, S R; Rosenblatt, M A

2016-01-01

The efficacy of the transversus abdominis plane (TAP) block appears to vary considerably, depending on the surgical procedure and block technique. This study aims to add to the existing literature and provide a more clear understanding of the TAP blocks role as a postoperative analgesic technique, specifically in renal allotransplant recipients. A retrospective chart review was conducted by querying the intraoperative electronic medical record system of a 1200-bed tertiary academic hospital over a 5 months period, and reviewing anesthetic techniques, as well as postoperative morphine equivalent consumption. Fifty renal allotransplant recipients were identified, 13 of whom received TAP blocks while 37 received no regional analgesic technique. All blocks were performed under ultrasound guidance, with 20 mL of 0.25% bupivacaine injected in the transversus abdominis fascial plane under direct visualization. The primary outcome was postoperative morphine equivalent consumption. Morphine consumption was compared with the two-tailed Mann-Whitney U -test. Continuous variables of patient baseline characteristics were analyzed with unpaired t -test and categorical variables with Fischer Exact Test. A P consumption was found in the group that received the TAP block at 6 h (2.46 mg vs. 7.27 mg, P = 0.0010), 12 h (3.88 mg vs. 10.20 mg, P = 0.0005), 24 h (6.96 mg vs. 14.75 mg, P = 0.0013), and 48 h (11 mg vs. 20.13 mg, P = 0.0092). The TAP block is a beneficial postoperative analgesic, opiate-sparing technique in renal allotransplant recipients.

Quality Assurance Peer Review Chart Rounds in 2011: A Survey of Academic Institutions in the United States

International Nuclear Information System (INIS)

Lawrence, Yaacov Richard; Whiton, Michal A.; Symon, Zvi; Wuthrick, Evan J.; Doyle, Laura; Harrison, Amy S.; Dicker, Adam P.

2012-01-01

Purpose: In light of concerns regarding the quality of radiation treatment delivery, we surveyed the practice of quality assurance peer review chart rounds at American academic institutions. Methods and Materials: An anonymous web-based survey was sent to the chief resident of each institution across the United States. Results: The response rate was 80% (57/71). The median amount of time spent per patient was 2.7 minutes (range, 0.6–14.4). The mean attendance by senior physicians and residents was 73% and 93%, respectively. A physicist was consistently present at peer review rounds in 66% of departments. There was a close association between attendance by senior physicians and departmental organization: in departments with protected time policies, good attendance was 81% vs. 31% without protected time (p = 0.001), and in departments that documented attendance, attending presence was 69% vs. 29% in departments without documentation (p 75% of institutions, whereas dosimetric details (beams, wedges), isodose coverage, intensity-modulated radiation therapy constraints, and dose–volume histograms were always peer reviewed in 63%, 59%, 42%, and 50% of cases, respectively. Chart rounds led to both minor (defined as a small multileaf collimator change/repeated port film) and major (change to dose prescription or replan with dosimetry) treatment changes. Whereas at the majority of institutions changes were rare (<10% of cases), 39% and 11% of institutions reported that minor and major changes, respectively, were made to more than 10% of cases. Conclusion: The implementation of peer review chart rounds seems inconsistent across American academic institutions. Brachytherapy and radiosurgical procedures are rarely reviewed. Attendance by senior physicians is variable, but it improves when scheduling clashes are avoided. The potential effect of a more thorough quality assurance peer review on patient outcomes is not known.

Subject, function, and trend in medical ethics research: a comparative study of Chinese and non-Chinese literature using bibliometrics.

Science.gov (United States)

Jiang, Lanhui; Shen, Jiantong; Li, Youping; Deng, Shaolin; Wu, Taixiang; Chen, Baoqing; Xie, Zhiyi; Qin, Chaoyi; Yu, Zhiyuan; Qin, Chuan; Huang, Jin; Liu, Xuemei; Li, Yan; Jiang, Jie

2012-05-01

To perform a comparative quantitative and qualitative analysis of Chinese and non-Chinese medical ethics literature using systematic research and literature analysis in order to discern research trends in the area and provide baseline data as a reference for relevant decision making and further study. We retrieved articles using MeSH terms and keywords related to medical ethics in PubMed and CNKI, and then constructed a set of charts by applying word co-occurrence, The Pathfinder Networks algorithms, an included subject chart, a research field relationship chart, and strategy coordination charts. The total of number of papers retrieved from PubMed was six times that retrieved from CNKI. Outside China, medical ethics has been studied in eight fully shaped subject fields, including morals, ethical review, physician-patient relationships, clinical trials, euthanasia, ethics education, clinical ethics, and health policy. In contrast, medical ethics research in China is still confined to five subject fields: morals, physician-patient relations, medical ethics education, ethical review, and medical research. Medical ethics research outside China emphasizes the application of medical ethics to solve emerging problems in clinical and medical research. It is mainly centered on morals, ethical review, and physician-patient relations. By comparison, medical ethics research in China places greater emphasis on morals and medical education. In order to narrow this gap between China and other countries, we should broaden the research scope of medical ethics and add more applied research, such as ethical review and medical education. © 2012 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Electronic growth charts: watching our patients grow.

Science.gov (United States)

Murphy, Cynthia A; Carstens, Kimberly; Villamayor, Precy

2005-01-01

Pediatric Growth Charts have been used in the pediatric community since 1977. The first growth charts were developed by the National Center for Health Statistics as a clinical tool for health care professionals. The growth charts, revised in 2000, by the Center for Disease Control consists of a series of percentile curves for selected body measurements in children [1]. Capitalizing on the benefits of our Electronic Medical Record (EMR), and as a byproduct of nursing electronic documentation of routine heights, weights, and frontal occipital circumferences, our system plots the routine measurements without additional intervention by the staff. Clinicians can view the graphs online or generate printed reports as needed during routine examination for outpatient or hospitalized care. This abstract outlines the background, design process, programming rules utilized to plot growth curves, and the evaluation of the electronic CDC growth charts in our organization.

SU-E-T-408: Evaluation of the Type and Frequency of Variations Discovered During Routine Secondary Patient Chart Review

International Nuclear Information System (INIS)

Hardin, M; Harrison, A; Lockamy, V; Li, J; Peng, C; Potrebko, P; Yu, Y; Doyle, L; Cao, J

2015-01-01

Purpose: Desire to improve efficiency and throughput inspired a review of our physics chart check procedures. Departmental policy mandates plan checks pre-treatment, after first treatment and weekly every 3–5 days. This study examined the effectiveness of the “after first” check with respect to improving patient safety and clinical efficiency. Type and frequency of variations discovered during this redundant secondary review was examined over seven months. Methods: A community spreadsheet was created to record variations in care discovered during chart review following the first fraction of treatment and before the second fraction (each plan reviewed prior to treatment). Entries were recorded from August 2014 through February 2015, amounting to 43 recorded variations out of 906 reviewed charts. The variations were divided into categories and frequencies were assessed month-to-month. Results: Analysis of recorded variations indicates an overall variation rate of 4.7%. The initial rate was 13.5%; months 2–7 average 3.7%. The majority of variations related to discrepancies in documentation at 46.5%, followed by prescription, plan deficiency, and dose tracking related variations at 25.5%, 12.8%, and 12.8%, respectively. Minor variations (negligible consequence on patient treatment) outweighed major variations 3 to 1. Conclusion: This work indicates that this redundant secondary check is effective. The first month spike in rates could be due to the Hawthorne/observer effect, but the consistent 4% variation rate suggests the need for periodical re-training on variations noted as frequent to improve awareness and quality of the initial chart review process, which may lead to improved treatment quality, patient safety and increased clinical efficiency. Utilizing these results, a continuous quality improvement process following Deming’s Plan-Do-Study-Act (PDSA) methodology was generated. The first iteration of this PDSA was adding a specific dose tracking

SU-E-T-408: Evaluation of the Type and Frequency of Variations Discovered During Routine Secondary Patient Chart Review

Energy Technology Data Exchange (ETDEWEB)

Hardin, M; Harrison, A; Lockamy, V; Li, J; Peng, C; Potrebko, P; Yu, Y; Doyle, L; Cao, J [Thomas Jefferson University, Philadelphia, PA (United States)

2015-06-15

Purpose: Desire to improve efficiency and throughput inspired a review of our physics chart check procedures. Departmental policy mandates plan checks pre-treatment, after first treatment and weekly every 3–5 days. This study examined the effectiveness of the “after first” check with respect to improving patient safety and clinical efficiency. Type and frequency of variations discovered during this redundant secondary review was examined over seven months. Methods: A community spreadsheet was created to record variations in care discovered during chart review following the first fraction of treatment and before the second fraction (each plan reviewed prior to treatment). Entries were recorded from August 2014 through February 2015, amounting to 43 recorded variations out of 906 reviewed charts. The variations were divided into categories and frequencies were assessed month-to-month. Results: Analysis of recorded variations indicates an overall variation rate of 4.7%. The initial rate was 13.5%; months 2–7 average 3.7%. The majority of variations related to discrepancies in documentation at 46.5%, followed by prescription, plan deficiency, and dose tracking related variations at 25.5%, 12.8%, and 12.8%, respectively. Minor variations (negligible consequence on patient treatment) outweighed major variations 3 to 1. Conclusion: This work indicates that this redundant secondary check is effective. The first month spike in rates could be due to the Hawthorne/observer effect, but the consistent 4% variation rate suggests the need for periodical re-training on variations noted as frequent to improve awareness and quality of the initial chart review process, which may lead to improved treatment quality, patient safety and increased clinical efficiency. Utilizing these results, a continuous quality improvement process following Deming’s Plan-Do-Study-Act (PDSA) methodology was generated. The first iteration of this PDSA was adding a specific dose tracking

Evaluation of a hybrid paper-electronic medication management system at a residential aged care facility.

Science.gov (United States)

Elliott, Rohan A; Lee, Cik Yin; Hussainy, Safeera Y

2016-06-01

Objectives The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18min to 98h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers' orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care

What is known about the patient's experience of medical tourism? A scoping review

Science.gov (United States)

2010-01-01

Background Medical tourism is understood as travel abroad with the intention of obtaining non-emergency medical services. This practice is the subject of increasing interest, but little is known about its scope. Methods A comprehensive scoping review of published academic articles, media sources, and grey literature reports was performed to answer the question: what is known about the patient's experience of medical tourism? The review was accomplished in three steps: (1) identifying the question and relevant literature; (2) selecting the literature; (3) charting, collating, and summarizing the information. Overall themes were identified from this process. Results 291 sources were identified for review from the databases searched, the majority of which were media pieces (n = 176). A further 57 sources were included for review after hand searching reference lists. Of the 348 sources that were gathered, 216 were ultimately included in this scoping review. Only a small minority of sources reported on empirical studies that involved the collection of primary data (n = 5). The four themes identified via the review were: (1) decision-making (e.g., push and pull factors that operate to shape patients' decisions); (2) motivations (e.g., procedure-, cost-, and travel-based factors motivating patients to seek care abroad); (3) risks (e.g., health and travel risks); and (4) first-hand accounts (e.g., patients' experiential accounts of having gone abroad for medical care). These themes represent the most discussed issues about the patient's experience of medical tourism in the English-language academic, media, and grey literatures. Conclusions This review demonstrates the need for additional research on numerous issues, including: (1) understanding how multiple information sources are consulted and evaluated by patients before deciding upon medical tourism; (2) examining how patients understand the risks of care abroad; (3) gathering patients' prospective and retrospective

Management of eight labor and delivery patients dependent on buprenorphine (Subutex™: A retrospective chart review [version 2; referees: 2 approved

Directory of Open Access Journals (Sweden)

Solina Tith

2018-02-01

Full Text Available Background: Opioid use during pregnancy is a growing concern in the United States. Buprenorphine has been recommended by “The American College of Obstetrics and Gynecology” as an alternative to methadone to decrease risks associated with the use of illicit opioids during pregnancy. The partial μ-opioid agonists’ unique pharmacology, including its long half time and high affinity to the μ-opioid receptor, complicates patient management in a highly kinetic, and often urgent field like obstetric anesthesia. We reviewed our management and outcomes in this medically complex population. Methods: An Institutional Review Board (IRB approved retrospective chart review was conducted of women admitted to the University of Washington Medical Center Labor and Delivery unit from July 2012 to November 2013 using buprenorphine. All deliveries, including intrauterine fetal demise, were included. Results: Eight women were admitted during this period to our L&D floor on buprenorphine. All required peri-partum anesthetic management either for labor and/or cesarean delivery management. Analgesic management included dilaudid or fentanyl PCA and/or continued epidural infusion, and in one instance ketamine infusion, while the pre-admission buprenorphine regimen was continued. Five babies were viable, two women experienced intrauterine fetal death at 22 and 36 weeks gestational age (GSA, respectively, and one neonate died shortly after delivery due to a congenital diaphragmatic hernia. Conclusions: This case series illuminates the medical complexity of parturients using buprenorphine. Different treatment modalities in the absence of evidence-based guidelines included additional opioid administration and continued epidural analgesia. The management of post-cesarean pain in patients on partial μ-opioid agonists remains complex and variable, and evidence-based guidelines could be useful for clinicians to direct care.

Software tool for physics chart checks.

Science.gov (United States)

Li, H Harold; Wu, Yu; Yang, Deshan; Mutic, Sasa

2014-01-01

Physics chart check has long been a central quality assurance (QC) measure in radiation oncology. The purpose of this work is to describe a software tool that aims to accomplish simplification, standardization, automation, and forced functions in the process. Nationally recognized guidelines, including American College of Radiology and American Society for Radiation Oncology guidelines and technical standards, and the American Association of Physicists in Medicine Task Group reports were identified, studied, and summarized. Meanwhile, the reported events related to physics chart check service were analyzed using an event reporting and learning system. A number of shortfalls in the chart check process were identified. To address these problems, a software tool was designed and developed under Microsoft. Net in C# to hardwire as many components as possible at each stage of the process. The software consists of the following 4 independent modules: (1) chart check management; (2) pretreatment and during treatment chart check assistant; (3) posttreatment chart check assistant; and (4) quarterly peer-review management. The users were a large group of physicists in the author's radiation oncology clinic. During over 1 year of use the tool has proven very helpful in chart checking management, communication, documentation, and maintaining consistency. The software tool presented in this work aims to assist physicists at each stage of the physics chart check process. The software tool is potentially useful for any radiation oncology clinics that are either in the process of pursuing or maintaining the American College of Radiology accreditation.

Statistical process control charts for attribute data involving very large sample sizes: a review of problems and solutions.

Science.gov (United States)

Mohammed, Mohammed A; Panesar, Jagdeep S; Laney, David B; Wilson, Richard

2013-04-01

The use of statistical process control (SPC) charts in healthcare is increasing. The primary purpose of SPC is to distinguish between common-cause variation which is attributable to the underlying process, and special-cause variation which is extrinsic to the underlying process. This is important because improvement under common-cause variation requires action on the process, whereas special-cause variation merits an investigation to first find the cause. Nonetheless, when dealing with attribute or count data (eg, number of emergency admissions) involving very large sample sizes, traditional SPC charts often produce tight control limits with most of the data points appearing outside the control limits. This can give a false impression of common and special-cause variation, and potentially misguide the user into taking the wrong actions. Given the growing availability of large datasets from routinely collected databases in healthcare, there is a need to present a review of this problem (which arises because traditional attribute charts only consider within-subgroup variation) and its solutions (which consider within and between-subgroup variation), which involve the use of the well-established measurements chart and the more recently developed attribute charts based on Laney's innovative approach. We close by making some suggestions for practice.

Medication prescribing errors in the medical intensive care unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Science.gov (United States)

Sada, Oumer; Melkie, Addisu; Shibeshi, Workineh

2015-09-16

Medication errors (MEs) are important problems in all hospitalized populations, especially in intensive care unit (ICU). Little is known about the prevalence of medication prescribing errors in the ICU of hospitals in Ethiopia. The aim of this study was to assess medication prescribing errors in the ICU of Tikur Anbessa Specialized Hospital using retrospective cross-sectional analysis of patient cards and medication charts. About 220 patient charts were reviewed with a total of 1311 patient-days, and 882 prescription episodes. 359 MEs were detected; with prevalence of 40 per 100 orders. Common prescribing errors were omission errors 154 (42.89%), 101 (28.13%) wrong combination, 48 (13.37%) wrong abbreviation, 30 (8.36%) wrong dose, wrong frequency 18 (5.01%) and wrong indications 8 (2.23%). The present study shows that medication errors are common in medical ICU of Tikur Anbessa Specialized Hospital. These results suggest future targets of prevention strategies to reduce the rate of medication error.

Medical documentation: part of the solution, or part of the problem? A narrative review of the literature on the time spent on and value of medical documentation.

Science.gov (United States)

Clynch, Neil; Kellett, John

2015-04-01

Even though it takes up such a large part of all clinicians' working day the medical literature on documentation and its value is sparse. Medline searches combining the terms medical records, documentation, time, and value or efficacy or benefit yielded only 147 articles. This review is based on the relevant articles selected from this search and additional studies gathered from the personal experience of the authors and their colleagues. Documentation now occupies a quarter to half of doctors' time yet much of the information collected is of dubious or unproven value. Most medical records departments still use the traditional paper chart, and there is considerable debate on the benefits of electronic medical records (EMRs). Although EMRs contains a lot more information than a paper record clinicians do not find it easy to getting useful information out of them. Unlike the paper chart narrative is difficult to enter into most EMRs so that they do not adequately communicate the patient's "story" to clinicians. Recent innovations have the potential to address these issues. Although documentation is widespread throughout the health care industry there has been almost no formal research into its value, on how to enhance its value, or on whether the time spent on it has negative effects on patient care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Clozapine Titration for People in Early Psychosis: A Chart Review and Treatment Guideline.

Science.gov (United States)

Ballon, Jacob S; Ashfaq, Hera; Noordsy, Douglas L

2018-06-01

The use of clozapine, particularly in young people, is often limited by early treatment-emergent adverse effects including drowsiness and lethargy. Concerns about adverse effects, medication adherence, and the need for blood monitoring often impede the use of clozapine in this population, leading to repeated trials of less effective medications. Current clozapine dosing recommendations are based on people further in the course of their illness and thus reflect different responsiveness and sensitivities to antipsychotic medication. As such, there is a need for evidence-based guidelines for titration and dosing of clozapine among people in early psychosis. We performed a chart review of 14 people treated with clozapine within our early psychosis team. Data regarding dose titration, response, time to discontinuation, symptom severity, weight gain, and other adverse effects were gathered at clozapine initiation, 3 months, and last available visit on clozapine. People treated with slow titration within their first year of psychosis onset achieved sustained response at very low maintenance doses (mean dose = 81 mg/d, mean duration of treatment = 200 weeks) compared with slow titration with longer duration of illness (mean dose = 350 mg/d, mean duration of treatment = 68 weeks) or standard dose titration in early psychosis (mean dose = 112 mg/d, mean duration of treatment = 38 weeks). The most common adverse effects in all groups were weight gain and sedation, with the groups requiring higher mean doses reporting a broader range of adverse effects. There was no apparent difference in the clinical global impression for severity or improvement between the slow titration and standard titration groups in people with early psychosis. These observations are synthesized into a proposed treatment guideline for use of clozapine among people in early psychosis. We describe development of a slow titration approach to initiating clozapine among people in early psychosis. This

The effect of rapid response teams on end-of-life care: A retrospective chart review

Science.gov (United States)

Tam, Benjamin; Salib, Mary; Fox-Robichaud, Alison

2014-01-01

BACKGROUND: A subset of critically ill patients have end-of-life (EOL) goals that are unclear. Rapid response teams (RRTs) may aid in the identification of these patients and the delivery of their EOL care. OBJECTIVES: To characterize the impact of RRT discussion on EOL care, and to examine how a preprinted order (PPO) set for EOL care influenced EOL discussions and outcomes. METHODS: A single-centre retrospective chart review of all RRT calls (January 2009 to December 2010) was performed. The effect of RRT EOL discussions and the effect of a hospital-wide PPO set on EOL care was examined. Charts were from the Ontario Ministry of Health and Long-Term Care Critical Care Information Systemic database, and were interrogated by two reviewers. RESULTS: In patients whose EOL status changed following RRT EOL discussion, there were fewer intensive care unit (ICU) transfers (8.4% versus 17%; PEOL status following the introduction of an EOL PPO, from 20% (before) to 31% (after) (PEOL status following RRT-led EOL discussion was associated with reduced ICU transfers and enhanced access to palliative care services. Further study is required to identify and deconstruct barriers impairing timely and appropriate EOL discussions. PMID:25299222

Monitoring Compliance to Promote Quality Assurance: Development of a Mental Health Clinical Chart Audit Tool in Belize, 2013.

Science.gov (United States)

Winer, Rachel A; Bennett, Eleanor; Murillo, Illouise; Schuetz-Mueller, Jan; Katz, Craig L

2015-09-01

Belize trained psychiatric nurse practitioners (PNPs) in the early 1990s to provide mental health services throughout the country. Despite overwhelming success, the program is limited by lack of monitoring, evaluation, and surveillance. To promote quality assurance, we developed a chart audit tool to monitor mental healthcare delivery compliance for initial psychiatric assessment notes completed by PNPs. After reviewing the Belize Health Information System electronic medical record system, we developed a clinical audit tool to capture 20 essential components for initial assessment clinical notes. The audit tool was then piloted for initial assessment notes completed during July through September of 2013. One hundred and thirty-four initial psychiatric interviews were audited. The average chart score among all PNPs was 9.57, ranging from 3 to 15. Twenty-three charts-or 17.2%-had a score of 14 or higher and met a 70% compliance benchmark goal. Among indicators most frequently omitted included labs ordered and named (15.7%) and psychiatric diagnosis (21.6%). Explicit statement of medications initiated with dose and frequency occurred in 47.0% of charts. Our findings provide direction for training and improvement, such as emphasizing the importance of naming labs ordered, medications and doses prescribed, and psychiatric diagnoses in initial assessment clinical notes. We hope this initial assessment helps enhance mental health delivery compliance by prompting creation of BHIS templates, development of audits tools for revisit follow-up visits, and establishment of corrective actions for low-scoring practitioners. These efforts may serve as a model for implementing quality assurance programming in other low resource settings.

A critical review of the hypothesis of a medieval origin for portolan charts

NARCIS (Netherlands)

Nicolai, R.

2014-01-01

Portolan charts are nautical charts, which appear suddenly in the thirteenth century Mediterranean world, without any discernable development path or predecessors. These charts are remarkable for the high degree of realism and accuracy with which they render the coastlines of their core coverage

Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

OpenAIRE

Mosam Phirke; Harshal Sathe; Nilesh Shah; Sushma Sonavane; Anup Bharati; Avinash DeSousa

2015-01-01

Background: Electroconvulsive therapy (ECT) is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014...

Reason for hospital admission: a pilot study comparing patient statements with chart reports.

Science.gov (United States)

Berger, Zackary; Dembitzer, Anne; Beach, Mary Catherine

2013-01-01

Providers and patients bring different understandings of health and disease to their encounters in the hospital setting. The literature to date only infrequently addresses patient and provider concordance on the reported reason for hospitalization, that is, whether they express this reason in similar ways. An agreement or common ground between such understandings can serve as a basis for future communication regarding an illness and its treatment. We interviewed a convenience sample of patients on the medical wards of an urban academic medical center. We asked subjects to state the reason why their doctors admitted them to the hospital, and then compared their statement with the reason in the medical record. We defined concordance on reported reason for hospitalization as agreement between the patient's report and the reason abstracted from the chart. We interviewed and abstracted chart data from a total of 46 subjects. Concordance on reported reason for hospitalization was present in 24 (52%) and discordance in 17 (37%); 5 patients (11%) could not give any reason for their hospitalization. Among the 17 patients whose report was discordant with their chart, 12 (71%) reported a different organ system than was recorded in the chart. A significant proportion of medical inpatients could not state their physicians' reason for admission. In addition, patients who identify a different reason for hospitalization than the chart often give a different organ system altogether. Providers should explore patient understanding of the reason for their hospitalization to facilitate communication and shared decision making.

Limited Documentation and Treatment Quality of Glycemic Inpatient Care in Relation to Structural Deficits of Heterogeneous Insulin Charts at a Large University Hospital.

Science.gov (United States)

Kopanz, Julia; Lichtenegger, Katharina M; Sendlhofer, Gerald; Semlitsch, Barbara; Cuder, Gerald; Pak, Andreas; Pieber, Thomas R; Tax, Christa; Brunner, Gernot; Plank, Johannes

2018-02-09

Insulin charts represent a key component in the inpatient glycemic management process. The aim was to evaluate the quality of structure, documentation, and treatment of diabetic inpatient care to design a new standardized insulin chart for a large university hospital setting. Historically grown blank insulin charts in use at 39 general wards were collected and evaluated for quality structure features. Documentation and treatment quality were evaluated in a consecutive snapshot audit of filled-in charts. The primary end point was the percentage of charts with any medication error. Overall, 20 different blank insulin charts with variable designs and significant structural deficits were identified. A medication error occurred in 55% of the 102 audited filled-in insulin charts, consisting of prescription and management errors in 48% and 16%, respectively. Charts of insulin-treated patients had more medication errors relative to patients treated with oral medication (P international standards, a new insulin chart was developed to overcome these quality hurdles.

Maintenance Electroconvulsive Therapy in Severe Bipolar Disorder: A Retrospective Chart Review.

Science.gov (United States)

Santos Pina, Laura; Bouckaert, Filip; Obbels, Jasmien; Wampers, Martien; Simons, Wim; Wyckaert, Sabien; Sienaert, Pascal

2016-03-01

The aim of this study was to evaluate the effectiveness of continuation and maintenance electroconvulsive therapy (C/M-ECT) in patients with bipolar or schizoaffective disorder. We reviewed the charts of all patients diagnosed with a bipolar or schizoaffective disorder treated with C/M-ECT from August 2009 until December 2013. We gathered demographic data and treatment variables (electrode placement, stimulus dose, and concomitant use of medication; number of C/M-ECT sessions; and number of new ECT courses). Primary outcome measure was the number of hospitalization days during C/M-ECT as compared with an equal period before starting the index course. Twenty women (64.5%) and 11 men (35.5%) with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition bipolar disorder (n = 22, 71%) or schizoaffective disorder (n = 9, 29%) received C/M-ECT. The mean (SD) age was 51.23 (14.86; range, 28-74) years. Before the start of the index ECT, patients had a mean of 290 hospitalization days (248.4 days, full hospitalization; 41.6 days, partial hospitalization), whereas during C/M-ECT, they had a mean of 214.7 hospitalization days (85.4 days, full hospitalization; 129.3 days, partial hospitalization). The number of readmissions before ECT was 2.13, whereas during C/M-ECT, it decreased to 1.48. Only the decrease in number of full hospitalization days was significant. Most patients (n = 23, 74.19%) needed an acute course of ECT during M-ECT. Maintenance ECT seems to significantly reduce the number of full hospitalization days in patients with severe bipolar or schizoaffective disorder.

Scoping review protocol: education initiatives for medical psychiatry collaborative care.

Science.gov (United States)

Shen, Nelson; Sockalingam, Sanjeev; Abi Jaoude, Alexxa; Bailey, Sharon M; Bernier, Thérèse; Freeland, Alison; Hawa, Aceel; Hollenberg, Elisa; Woldemichael, Bethel; Wiljer, David

2017-09-03

The collaborative care model is an approach providing care to those with mental health and addictions disorders in the primary care setting. There is a robust evidence base demonstrating its clinical and cost-effectiveness in comparison with usual care; however, the transitioning to this new paradigm of care has been difficult. While there are efforts to train and prepare healthcare professionals, not much is known about the current state of collaborative care training programmes. The objective of this scoping review is to understand how widespread these collaborative care education initiatives are, how they are implemented and their impacts. The scoping review methodology uses the established review methodology by Arksey and O'Malley. The search strategy was developed by a medical librarian and will be applied in eight different databases spanning multiple disciplines. A two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing collaborative care education initiative for healthcare providers. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardised form. The extracted data will undergo a 'narrative review' or a descriptive analysis of the contextual or process-oriented data and simple quantitative analysis using descriptive statistics. Research ethics approval is not required for this scoping review. The results of this scoping review will inform the development of a collaborative care training initiative emerging from the Medical Psychiatry Alliance, a four-institution philanthropic partnership in Ontario, Canada. The results will also be presented at relevant national and international conferences and published in a peer-reviewed journal. © Article author(s) (or their employer(s) unless otherwise stated in

Medication Errors - A Review

OpenAIRE

Vinay BC; Nikhitha MK; Patel Sunil B

2015-01-01

In this present review article, regarding medication errors its definition, medication error problem, types of medication errors, common causes of medication errors, monitoring medication errors, consequences of medication errors, prevention of medication error and managing medication errors have been explained neatly and legibly with proper tables which is easy to understand.

Using an electronic medical record to improve communication within a prenatal care network.

Science.gov (United States)

Bernstein, Peter S; Farinelli, Christine; Merkatz, Irwin R

2005-03-01

In 2002, the Institute of Medicine called for the introduction of information technologies in health care settings to improve quality of care. We conducted a review of hospital charts of women who delivered before and after the implementation of an intranet-based computerized prenatal record in an inner-city practice. Our objective was to assess whether the use of this record improved communication among the outpatient office, the ultrasonography unit, and the labor floor. The charts of patients who delivered in August 2002 and August 2003 and received their prenatal care at the Comprehensive Family Care Center at Montefiore Medical Center were analyzed. Data collected included the presence of a copy of the prenatal record in the hospital chart, the date of the last documented prenatal visit, and documentation of any prenatal ultrasonograms performed. Forty-three charts in each group were available for review. The prenatal chart was absent in 16% of the charts of patients from August 2002 compared with only 2% in August 2003 charts (P intranet-based prenatal chart significantly improves communication among providers.

Physician medical direction and clinical performance at an established emergency medical services system.

Science.gov (United States)

Munk, Marc-David; White, Shaun D; Perry, Malcolm L; Platt, Thomas E; Hardan, Mohammed S; Stoy, Walt A

2009-01-01

Few developed emergency medical services (EMS) systems operate without dedicated medical direction. We describe the experience of Hamad Medical Corporation (HMC) EMS, which in 2007 first engaged an EMS medical director to develop and implement medical direction and quality assurance programs. We report subsequent changes to system performance over time. Over one year, changes to the service's clinical infrastructure were made: Policies were revised, paramedic scopes of practice were adjusted, evidence-based clinical protocols were developed, and skills maintenance and education programs were implemented. Credentialing, physician chart auditing, clinical remediation, and online medical command/hospital notification systems were introduced. Following these interventions, we report associated improvements to key indicators: Chart reviews revealed significant improvements in clinical quality. A comparison of pre- and post-intervention audited charts reveals a decrease in cases requiring remediation (11% to 5%, odds ratio [OR] 0.43 [95% confidence interval (CI) 0.20-0.85], p = 0.01). The proportion of charts rated as clinically acceptable rose from 48% to 84% (OR 6 [95% CI 3.9-9.1], p < 0.001). The proportion of misplaced endotracheal tubes fell (3.8% baseline to 0.6%, OR 0.16 [95% CI 0.004-1.06], (exact) p = 0.05), corresponding to improved adherence to an airway placement policy mandating use of airway confirmation devices and securing devices (0.7% compliance to 98%, OR 714 [95% CI 64-29,334], (exact) p < 0.001). Intravenous catheter insertion in unstable cases increased from 67% of cases to 92% (OR 1.31 [95% CI 1.09-1.71], p = 0.004). EMS administration of aspirin to patients with suspected ischemic chest pain improved from 2% to 77% (OR 178 [95% CI 35-1,604], p < 0.001). We suggest that implementation of a physician medical direction is associated with improved clinical indicators and overall quality of care at an established EMS system.

Evaluation of a diagnostic flow chart applying medical thoracoscopy, adenosine deaminase and T-SPOT.TB in diagnosis of tuberculous pleural effusion.

Science.gov (United States)

He, Y; Zhang, W; Huang, T; Wang, X; Wang, M

2015-10-01

To evaluate a diagnostic flow chart applying medical thoracoscoy (MT), adenosine deaminase (ADA) and T-SPOT.TB in diagnosis of tuberculous pleural effusion (TPE) at a high TB burden country. 136 patients with pleural effusion (PE) were enrolled and divided into TPE and Non-TPE group. MT (histology), PE ADA and T-SPOT.TB were conducted on all patients. ROC analysis was performed for the best cut-off value of PE ADA in detection of TPE. The diagnostic flow chart applying MT, ADA and T-SPOT.TB was evaluated for improving the limitations of each diagnostic method. ROC analysis showed that the best cut-off value of PE ADA was 30U/L. The sensitivity and specificity of these tests were calculated respectively to be: 71.4% (58.5%-81.6%) and 100% (95.4-100.0%) for MT, 92.9% (83.0-97.2%) and 68.8% (57.9-77.9%) for T-SPOT.TB, and 80.0% (69.6-88.1%) and 92.9% (82.7-98.0%) for PE ADA. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value of the diagnostic flow chart were 96.4% (87.9-99.0%), 96.3% (89.6-98.7%), 25.714, 0.037, 97.4 and 94.9, respectively. The diagnostic flow chart applying MT, ADA and T-SPOT.TB is an accurate and rapid diagnostic method in detection of TPE.

AMDIS and CHART update. 1

International Nuclear Information System (INIS)

Murakami, I.; Kato, T.; Igarashi, A.

2002-10-01

A working group for updating atomic and molecular collision data in the NIFS database AMDIS (electron scattering) and CHART (ion scattering) has been organized. This group has searched and reviewed literatures for collecting relevant atomic data with are to be included into the database. This is a summary report of the activities of this working group. (author)

Decentralised training for medical students: a scoping review

Directory of Open Access Journals (Sweden)

Marietjie de Villiers

2017-11-01

Full Text Available Abstract Background Increasingly, medical students are trained at sites away from the tertiary academic health centre. A growing body of literature identifies the benefits of decentralised clinical training for students, the health services and the community. A scoping review was done to identify approaches to decentralised training, how these have been implemented and what the outcomes of these approaches have been in an effort to provide a knowledge base towards developing a model for decentralised training for undergraduate medical students in lower and middle-income countries (LMICs. Methods Using a comprehensive search strategy, the following databases were searched, namely EBSCO Host, ERIC, HRH Global Resources, Index Medicus, MEDLINE and WHO Repository, generating 3383 references. The review team identified 288 key additional records from other sources. Using prespecified eligibility criteria, the publications were screened through several rounds. Variables for the data-charting process were developed, and the data were entered into a custom-made online Smartsheet database. The data were analysed qualitatively and quantitatively. Results One hundred and five articles were included. Terminology most commonly used to describe decentralised training included ‘rural’, ‘community based’ and ‘longitudinal rural’. The publications largely originated from Australia, the United States of America (USA, Canada and South Africa. Fifty-five percent described decentralised training rotations for periods of more than six months. Thematic analysis of the literature on practice in decentralised medical training identified four themes, each with a number of subthemes. These themes were student learning, the training environment, the role of the community, and leadership and governance. Conclusions Evident from our findings are the multiplicity and interconnectedness of factors that characterise approaches to decentralised training. The student

SU-E-T-138: Automated Chart Review Module Including Cross-Vendor Data Transfer Verification Developed for IHE-RO Initiative

Energy Technology Data Exchange (ETDEWEB)

Brewer, M; Gordon, C [Franciscan St Margaret Health, Hammond, IN (United States); Tien, C [Community Hospital, Munster, IN (United States)

2015-06-15

Purpose: To follow the Integrating Healthcare Enterprise - Radiation Oncology (IHE-RO) initiative of proper cross-vendor technology integration, an automated chart checker (ACC) was developed. ACC compares extracted data from an approved patient plan in the Eclipse treatment planning system (TPS) against data existing in the Mosaiq treatment management system (TMS). ACC automatically analyzes these parameters using built-in quality checklists to provide further aid in chart review. Methods: Eclipse TPS data are obtained using Eclipse scripting API (ESAPI) while Mosaiq TMS data are obtained from a radiotherapy-treatment-planning (RTP) file. Using this information, ACC identifies TPS-TMS discrepancies in 18 primary beam parameters including MU, energy, jaw positions, gantry angle, table angle, accessories, and bolus for up to 31 beams. Next, approximately 40 items from traditional quality checklists are evaluated such as prescription consistency, DRR graticule placement, plan approval status, global max dose, and dose tracking coefficients. Parameters were artificially modified to determine if ACC would detect an error in data transfer and to test each component of quality checklists. Results: Using ESAPI scripting and RTP file-processing, ACC was able to properly aggregate data from TPS and TMS for up to 31 beams. Errors were artificially introduced into each plan parameter, and ACC was able to successfully detect all of them within seconds. Next, ACC was able to successfully detect mistakes in the chart by identifying deviations with its quality checklists, within seconds. Conclusion: ACC effectively addresses the potential issue of faulty cross-vendor data transfer, as described by IHE-RO. In addition, ACC was also able to detect deviations from its built-in quality checklists. ACC is already an invaluable tool for efficient and standardized chart review and will continue to improve as its incorporated checklists become more comprehensive.

SU-E-T-138: Automated Chart Review Module Including Cross-Vendor Data Transfer Verification Developed for IHE-RO Initiative

International Nuclear Information System (INIS)

Brewer, M; Gordon, C; Tien, C

2015-01-01

Purpose: To follow the Integrating Healthcare Enterprise - Radiation Oncology (IHE-RO) initiative of proper cross-vendor technology integration, an automated chart checker (ACC) was developed. ACC compares extracted data from an approved patient plan in the Eclipse treatment planning system (TPS) against data existing in the Mosaiq treatment management system (TMS). ACC automatically analyzes these parameters using built-in quality checklists to provide further aid in chart review. Methods: Eclipse TPS data are obtained using Eclipse scripting API (ESAPI) while Mosaiq TMS data are obtained from a radiotherapy-treatment-planning (RTP) file. Using this information, ACC identifies TPS-TMS discrepancies in 18 primary beam parameters including MU, energy, jaw positions, gantry angle, table angle, accessories, and bolus for up to 31 beams. Next, approximately 40 items from traditional quality checklists are evaluated such as prescription consistency, DRR graticule placement, plan approval status, global max dose, and dose tracking coefficients. Parameters were artificially modified to determine if ACC would detect an error in data transfer and to test each component of quality checklists. Results: Using ESAPI scripting and RTP file-processing, ACC was able to properly aggregate data from TPS and TMS for up to 31 beams. Errors were artificially introduced into each plan parameter, and ACC was able to successfully detect all of them within seconds. Next, ACC was able to successfully detect mistakes in the chart by identifying deviations with its quality checklists, within seconds. Conclusion: ACC effectively addresses the potential issue of faulty cross-vendor data transfer, as described by IHE-RO. In addition, ACC was also able to detect deviations from its built-in quality checklists. ACC is already an invaluable tool for efficient and standardized chart review and will continue to improve as its incorporated checklists become more comprehensive

FusionCharts Beginner's Guide The Official Guide for FusionCharts Suite

CERN Document Server

Nadhani, Sanket; Bhattacharya, Shamasis

2012-01-01

The book is written as a practical, step-by-step guide to using FusionCharts Suite. The book not only teaches you the fundamentals and implementation of FusionCharts Suite, but also makes you the data visualization guru among your friends and colleagues by teaching how to select the right chart type and usability tips. Filled with examples, code samples and practical tips in a no-nonsense way, the book is a breeze to read.This book is both for beginners and advanced web developers who need to create interactive charts for their web applications. No previous knowledge of FusionCharts Suite is a

A Retrospective Chart Review of 10 Hz Versus 20 Hz Repetitive Transcranial Magnetic Stimulation for Depression

Directory of Open Access Journals (Sweden)

Kristie L. DeBlasio

2012-12-01

Full Text Available We performed a retrospective chart review to examine the progress of patients with depression who received different frequencies of repetitive transcranial magnetic stimulation (rTMS delivered to the left dorsolateral prefrontal cortex (DLPFC. rTMS is a safe and effective alternative treatment for patients with various psychological and medical conditions. During treatment, a coil delivering a time-varying magnetic pulse placed over the scalp penetrates the skull, resulting in clinical improvement. There were 47 patients and three distinct treatment groups found: 10 Hz, 20 Hz, and a separate group who received both frequencies (10/20 Hz. The primary outcome indicator was the difference in Beck Depression Inventory–II (BDI-II scores. Secondary outcomes included categorical indicators of remission, response, and partial response rates as assessed with the BDI-II. In all 3 groups, the majority of patients had depression that remitted, with the highest rate occurring in the 20 Hz group. There were similar response rates in the 10 Hz and 20 Hz groups. There were no patients in the 10/20 Hz group whose depression responded and the highest partial response and nonresponse rates occurred in this group. Although within-group differences were significant from baseline to end of treatment, there were no between-group differences.

Hypnosis for treatment of insomnia in school-age children: a retrospective chart review

Directory of Open Access Journals (Sweden)

Slothower Molly P

2006-08-01

Full Text Available Abstract Background The purposes of this study are to document psychosocial stressors and medical conditions associated with development of insomnia in school-age children and to report use of hypnosis for this condition. Methods A retrospective chart review was performed for 84 children and adolescents with insomnia, excluding those with central or obstructive sleep apnea. All patients were offered and accepted instruction in self-hypnosis for treatment of insomnia, and for other symptoms if it was felt that these were amenable to therapy with hypnosis. Seventy-five patients returned for follow-up after the first hypnosis session. Their mean age was 12 years (range, 7–17. When insomnia did not resolve after the first instruction session, patients were offered the opportunity to use hypnosis to gain insight into the cause. Results Younger children were more likely to report that the insomnia was related to fears. Two or fewer hypnosis sessions were provided to 68% of the patients. Of the 70 patients reporting a delay in sleep onset of more than 30 minutes, 90% reported a reduction in sleep onset time following hypnosis. Of the 21 patients reporting nighttime awakenings more than once a week, 52% reported resolution of the awakenings and 38% reported improvement. Somatic complaints amenable to hypnosis were reported by 41%, including chest pain, dyspnea, functional abdominal pain, habit cough, headaches, and vocal cord dysfunction. Among these patients, 87% reported improvement or resolution of the somatic complaints following hypnosis. Conclusion Use of hypnosis appears to facilitate efficient therapy for insomnia in school-age children.

The occurrence of adverse events potentially attributable to nursing care in medical units: cross sectional record review.

Science.gov (United States)

D'Amour, Danielle; Dubois, Carl-Ardy; Tchouaket, Eric; Clarke, Sean; Blais, Régis

2014-06-01

Ensuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institutional or broader level. Furthermore, methodologies have differed from one study to another, making benchmarking difficult. The aim of this study was to describe the frequencies of six adverse events widely considered in the literature to be nursing-sensitive outcomes and to estimate the degree to which these events could be attributed to nursing care. Cross-sectional review of charts of 2699 patients hospitalized on 22 medical units in 11 hospitals in Quebec, Canada. The events included: pressure sores, falls, medication administration errors, pneumonias, urinary infections, and inappropriate use of restraints. Experienced nurse reviewers abstracted patients' charts based on a grid developed for the study. Patient-level risk for at least one of these six adverse events was 15.3%, ranging from 9% to 28% across units. Of the 412 patients who experienced an event, 30% experienced two or more, for a total of 568 events. The risk of experiencing an adverse event with consequences was 6.2%, with a unit-level range from 3.2% to 13.5%. Abstractors concluded that 76.8% of the events were attributable to nursing care. While the measurement approach adopted here has limitations stemming from reliance on review of documentation, it provided a practical means of assessing several nursing-sensitive adverse events simultaneously. Given that patient safety issues are so complex, tracking their prevalence and impact is important, as is finding means of evaluating progress in reducing them. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Taking note of the perceived value and impact of medical student chart documentation on education and patient care.

Science.gov (United States)

Friedman, Erica; Sainte, Michelle; Fallar, Robert

2010-09-01

To determine the extent of restrictions to medical student documentation in patients' records and the opinions of medical education leaders about such restrictions' impact on medical student education and patient care. Education deans (n = 126) of medical schools in the United States and Canada were surveyed to determine policies regarding placement of medical student notes in the patient record, the value of medical students' documentation in the medical record, and the use of electronic medical records (EMRs) for patient notes. The instrument was a 23-item anonymous Web survey. Seventy-nine deans responded. Over 90% believed student notes belong in medical records, but only 42% had a policy regarding this. Ninety-three percent indicated that without student notes, student education would be negatively affected. Fewer (56%) indicated that patient care would be negatively affected. Most thought limiting students' notes would negatively affect several other issues: feeling a part of the team (96%), preparation for internship (95%), and students' sense of involvement (94%). Half (52%) reported that fourth-year students could place notes in paper charts at "all" affiliated hospitals, and 6% reported that fourth-year students could do so at "no" hospitals. Although students' ability to enter notes in patients' records is believed to be important for student education, only about half of all hospitals allow all students' notes in the EMR. Policies regarding placement of student notes should be implemented to ensure students' competency in note writing and their value as members of the patient care team.

A chart review of human immunodeficiency virus status in patients admitted with psychosis in Durban, South Africa

Directory of Open Access Journals (Sweden)

Sellwane M. Mere

2018-04-01

Full Text Available Background: Comorbid human immunodeficiency virus (HIV infection among patients with psychotic disorders is associated with a poorer outcome. Understanding the association of HIV infection with demographic and clinical variables may provide clues to modify risk factors and outcomes. Aim: To describe and compare the socio-demographic and clinical profile of patients admitted with psychotic disorders with and without HIV infection. Method: A retrospective chart review of 100 adult patients consecutively admitted with psychosis and HIV infection and compared to 101 patients with psychosis without HIV infection. Results: HIV-infected patients with psychotic disorders were more likely to be females (74.0%, younger than 50 years (94.0% and less likely to have secondary education than HIV- negative patients with psychotic disorders (56.0% vs. 72.0%. HIV-infected patients were also less likely to be diagnosed as having schizophrenia (33.0%, had higher rates of medical (73.0% and psychiatric (21.0% comorbid disorders and were less likely to report lifetime nicotine and cannabis use (p = 0.047 and p = 0.011. HIV-negative patients with psychotic disorders were more likely to be readmitted to the unit in the next 12 months (p < 0.05. HIV-infected patients with psychotic disorders had increased abnormal haematological results (33.0%. Conclusion: Patients with psychotic disorders and HIV infection had several negative prognostic factors such as younger age, increased rates of medical and psychiatric comorbidity, abnormal haematological results and longer length of admission periods. This suggests the need to target HIV prevention programmes at young females with mental illness and provide an integrated healthcare service with medical and psychiatric assessment and care for patients with HIV and psychosis.

Newly diagnosed exudative age-related macular degeneration treated with pegaptanib sodium monotherapy in US community-based practices: medical chart review study

Directory of Open Access Journals (Sweden)

Xu Xiao

2010-02-01

Full Text Available Abstract Background Studies have shown that early detection and treatment of neovascular age-related macular degeneration (NV-AMD can delay vision loss and blindness. The objective of this study was to evaluate the efficacy/safety of intravitreal pegaptanib sodium monotherapy in treatment-naïve subjects with newly diagnosed NV-AMD and to gain insight into characteristics of lesions treated in community-based practices. Methods From seven private US practices, charts were retrospectively reviewed on 73 subjects with previously untreated subfoveal choroidal NV-AMD treated with their first dose of pegaptanib monotherapy on/after 4/1/2005 through 6/5/2006, receiving ≥4 treatments at 6-week intervals over 21 weeks. Primary endpoint: mean visual acuity (VA change from baseline to month 6. Results 75% of lesions were occult, and 82% were subfoveal. From baseline to month 6, mean VA change was -0.68 lines; 58% and 16% gained ≥0 and ≥3 lines of VA, and 70% were responders ( Conclusion Pegaptanib is effective in real-world patients with treatment-naïve NV-AMD in uncontrolled community-based retina practices.

Mandibular Fracture Patterns at a Medical Center in Central Taiwan: A 3-Year Epidemiological Review.

Science.gov (United States)

Lin, Fu-Yu; Wu, Chao-I; Cheng, Hsu-Tang

2017-12-01

Mandibular fractures constitute a major portion of maxillofacial trauma and may lead to considerable functional and aesthetic sequelae if treatment is inadequate or delayed. An epidemiology study on mandibular fractures may guide the preventive efforts of the Taiwan public health care system. Therefore, a retrospective review was conducted at a medical center in central Taiwan to evaluate the current mandibular fracture epidemiology.The medical records and digitized radiographs of 198 patients who received treatment for mandibular fractures during a 3-year period (from October 2010 to September 2013) at a medical center in central Taiwan were reviewed to obtain demographic and injury data.The average age was 29.4 years (3-82 years). Patients aged 21 to 30 years sustained the most mandibular fractures (62 patients, 31.3%). The overall sex distribution (male to female) ratio was 1.8. Motor-vehicle accidents (MVAs) were the most common mechanism of injury (162 patients, 82%), and scooter and motorcycle riders wearing partial-coverage helmets constituted the majority of patients. A chart review identified 198 patients with 335 mandibular fractures; 113 patients (57.1%) had multiple mandibular fractures. The most common fracture sites were the symphysis and parasymphysis regions (38.9%), followed by the condyle (26.0%), angle (14.3%), body (14.3%), and ramus (6.6%).MVAs are the major cause of mandibular fractures in central Taiwan, and patients aged Taiwan. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Antiepileptic drug use and the occurrence of pressure ulcers among bedridden institutionalized elderly patients: a retrospective chart review.

Science.gov (United States)

Arinzon, Zeev; Zeilig, Gabriel; Berner, Yitshal N; Adunsky, Abraham

2005-09-01

Phenytoin (PH) is indicated primarily for the control of grand mal and psychomotor seizures. However, topical PH has been used for the treatment of various types of ulcers, including pressure ulcers. The aim of this study was to investigate the possibility of a relationship between the use of oral PH and the prevalence of pressure ulcers among bedridden institutionalized elderly patients. This retrospective chart review was conducted in a state-run urban geriatric medical center in Israel and involved long-term bedridden institutionalized patients who were receiving chronic antiepileptic medication during the 7-year period between January 1996 and December 2003. The prevalence of pressure ulcers in patients who received treatment with PH alone or in combination with other antiepileptic drugs was compared with that in patients who received antiepileptic agents other than PH. The study analyzed data from the medical charts of 153 patients, 72 of whom received PH alone or in combination with other antiepileptic drugs, and 81 of whom received antiepileptic agents other than PH. Patients' mean (SD) age was 78.5 (7.2) years; 106 (69.3%) were women. All patients were totally dependent with respect to activities of daily living (mean Katz score, 2.0 [2.0]) and had severe cognitive decline (mean Mini-Mental State Examination score, 3.5 [3.3]). Pressure ulcers occurred in 9.7% of PH recipients and 27.2% of non-PH recipients (P = 0.006; chi2 = 7.55). In PH recipients, 85.7% of pressure ulcers were of mild to moderate severity (stage I or II), compared with 59.1% of ulcers in non-PH recipients; the difference between groups was not statistically significant. Four (18.2%) non-PH recipients and no PH recipients had stage IV pressure ulcers. In the PH group, 71.4% of patients had a pressure ulcer in only 1 anatomic location, compared with 22.7% of the non-PH group (P = 0.023; chi2 = 5.13); 28.6% of PH recipients and 63.6% of non-PH recipients had pressure ulcers in 2 or 3

Medication reconciliation is a prerequisite for obtaining a valid medication review

DEFF Research Database (Denmark)

Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup

2013-01-01

The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-related problems (DRPs), denoted errors.......The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-related problems (DRPs), denoted errors....

Gender Variance Among Youth with Autism Spectrum Disorders: A Retrospective Chart Review.

Science.gov (United States)

Janssen, Aron; Huang, Howard; Duncan, Christina

2016-01-01

Purpose: Increasing clinical evidence suggests an overrepresentation of gender variance (GV) among patients with autism spectrum disorders (ASDs). This retrospective chart review aims to contribute to the existing literature on co-occurring ASD and gender dysphoria (GD). We compare the rate of parent-reported GV in patients with an ASD diagnosis to that of parent-reported GV in a normative nonreferred data set. Methods: Child Behavior Checklist (CBCL) charts were collected from 492 children and adolescents (409 natal males and 83 natal females) aged 6-18 years who have received a diagnosis of ASD at the New York University Child Study Center. Parent-reported GV was determined through endorsement of CBCL sex item 110, which assesses the presence of gender-related issues. We calculated the odds ratio of endorsement of item 110 between our ASD sample and the CBCL sample data. Results: The subjects diagnosed with ASD were 7.76 times more likely to report GV than the CBCL sample. This finding was statistically significant. About 5.1% of the patients in the ASD group and 0.7% of the CBCL nonreferred group endorsed sex item 110. 5.1% of natal males and 4.8% of natal females endorsed sex item 110. Neither gender nor age influenced the rate of endorsement. Conclusion: This finding supports the growing research suggesting a heightened co-occurrence rate of ASD and GD. Focus should be placed upon improving our understanding of the nature of this co-occurrence and on gender identity development within the atypical development of ASD.

Fine motor and self-care milestones for individuals with Down syndrome using a Retrospective Chart Review.

Science.gov (United States)

Frank, K; Esbensen, A J

2015-08-01

Developmental milestone markers for fine motor and self-care skills among children with Down syndrome (DS) are either minimal, anecdotal or out-of date. Our goal was to produce normative expectations for the development of fine motor and self-care milestones specific to children with DS. A cross-sectional retrospective chart review was completed on 274 children with DS seen at a specialty clinic that ranged in age from 4 months to 18 years. Specific skills were assessed at occupational therapy assessments as either present or absent, including fine motor, handwriting, scissor usage, self-feeding and clothing management. Fine motor milestones describing when 10-30% ('early achievers') and 75-95% ('representative achievement') of children with DS had mastered each skill were developed based upon descriptive review. As the fine motor and self-care skills advanced in complexity, the range of ages for documented skill acquisition was observed to increase. Age ranges for the mastery of fine motor developmental milestones for early and representative achievement were developed based upon descriptive analysis of cross-sectional retrospective clinical chart reviews. That the age range for mastering fine motor and self-care skills broadens as children with DS get older is in agreement with what is identified in the DS behavioural phenotype with regard to variable motor skills overall. These fine motor and self-care developmental milestone markers contribute to the field by informing parents, caregivers and healthcare providers of potential fine motor and self-care outcomes and describing normative development for children with DS. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

A retrospective chart review to assess the safety of nonablative fractional laser resurfacing in Fitzpatrick skin types IV to VI.

Science.gov (United States)

Clark, Charlotte M; Silverberg, Jonathan I; Alexis, Andrew F

2013-04-01

Laser resurfacing in patients with Fitzpatrick skin phototypes (SPT) IV to VI is associated with a higher risk of pigmentary alteration. There is a paucity of studies evaluating optimum treatment parameters for fractional lasers in darkly pigmented skin types. This is a retrospective review of medical records for patients with SPT IV to VI who were treated with a 1,550 nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550; Solta Medical, Hayword, CA). Data were collected from patient charts and the clinic laser logbook from January 2008 to January 2012. The frequency of treatment-associated postinflammatory hyperpigmentation (PIH) and treatment settings used were evaluated. A total of 115 total laser sessions (45 patients) were included in our analysis. Five of the sessions (4%) were accompanied by PIH, 2 of which occurred in a single patient. Only 1 episode of PIH lasted longer than 1 month (2 months). Two of the 5 cases had only transient PIH (≤7 days), one of which was reported by the patient and not clinically evident on examination. The 1,550 nm erbium-doped fractional laser is well tolerated in SPT IV to VI. Fractional laser resurfacing, with the settings used and pretreatment and posttreatment hydroquinone 4% cream, was associated with a low risk of PIH in darker skin types.

Assessing adherence to accepted national guidelines for immigrant and refugee screening and vaccines in an urban primary care practice: a retrospective chart review.

Science.gov (United States)

Waldorf, Barbara; Gill, Christopher; Crosby, Sondra S

2014-10-01

In the United States, 38.5 million people are foreign-born, one in three arriving since 2000. Health issues include high rates of hepatitis B, humanimmunodeficiency virus infection, parasitic infections, and M. tuberculosis. We sought to determine rates of provider adherence to accepted national guidelines for immigrant and refugee health screening and vaccines done at the primary care clinics at Boston Medical Center. Randomized, retrospective chart review of foreign born patients in the primary care clinics. We found low screening and immunization rates that do not conform to CDC/ACIP guidelines. Only 43 % of immigrant patients had tuberculosis screening, 36 % were screened for HIV and hepatitis B, and 33 % received tetanus vaccinations. Organizational changes incorporating multi-disciplinary approaches such as creative use of nursing staff, protocols, standing orders, EMR reminders, and web based educational tools can contribute to better outcomes by identifying patients and improving utilization of guidelines.

MO-A-BRB-00: Electronic Charting in EBRT and Brachytherapy

International Nuclear Information System (INIS)

2015-01-01

The process of converting to an electronic chart for radiation therapy can be daunting. It requires a dedicated committee to first research and choose appropriate software, to review the entire documentation policy and flow of the clinic, to convert this system to electronic form or if necessary, redesign the system to more easily conform to the electronic process. Those making the conversion and those who already use electronic charting would benefit from the shared experience of those who have been through the process in the past. Therefore TG262 was convened to provide guidance on electronic charting for external beam radiation therapy and brachytherapy. This course will present the results of an internal survey of task group members on EMR practices in External Beam Radiation Therapy as well as discuss important issues in EMR development and structure for both EBRT and brachytherapy. Learning Objectives: Be familiarized with common practices and pitfalls in development and maintenance of an electronic chart in Radiation Oncology Be familiarized with important issues related to electronic charting in External Beam Radiation Therapy Be familiarized with important issues related to electronic charting in Brachytherapy

Use of risk medication for stomach ulcers and stomach protection relating to ulcer occurrence after bariatric surgery

NARCIS (Netherlands)

Sezgi, B.; Damhof, M. A.; Faneyte, L. F.; Van Der Palen, J.; Krens, L. L.

2017-01-01

OBJECTIVE: To assess the influence of risk medication and proton pump inhibitor use on ulcer-free survival in patients after bariatric surgery. DESIGN Retrospective cohort study. METHODS By using a retrospective chart review, information was collected about the use of medication among 631 patients

Concordance of chart and billing data with direct observation in dental practice.

Science.gov (United States)

Demko, Catherine A; Victoroff, Kristin Zakariasen; Wotman, Stephen

2008-10-01

The commonly used methods of chart review, billing data summaries and practitioner self-reporting have not been examined for their ability to validly and reliably represent time use and service delivery in routine dental practice. A more thorough investigation of these data sources would provide insight into the appropriateness of each approach for measuring various clinical behaviors. The aim of this study was to assess the validity of commonly used methods such as dental chart review, billing data, or practitioner self-report compared with a 'gold standard' of information derived from direct observation of routine dental visits. A team of trained dental hygienists directly observed 3751 patient visits in 120 dental practices and recorded the behaviors and procedures performed by dentists and hygienists during patient contact time. Following each visit, charts and billing records were reviewed for the performed and billed procedures. Dental providers characterized their frequency of preventive service delivery through self-administered surveys. We standardized the observation and abstraction methods to obtain optimal measures from each of the multiple data sources. Multi-rater kappa coefficients were computed to monitor standardization, while sensitivity, specificity, and kappa coefficients were calculated to compare the various data sources with direct observation. Chart audits were more sensitive than billing data for all observed procedures and demonstrated higher agreement with directly observed data. Chart and billing records were not sensitive for several prevention-related tasks (oral cancer screening and oral hygiene instruction). Provider self-reports of preventive behaviors were always over-estimated compared with direct observation. Inter-method reliability kappa coefficients for 13 procedures ranged from 0.197 to 0.952. These concordance findings suggest that strengths and weaknesses of data collection sources should be considered when investigating

Growth Charts (For Parents)

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Growth Charts KidsHealth / For Parents / Growth Charts What's in ... Problem? Print en español Tablas de crecimiento About Growth Charts Look at any class picture, and you' ...

CREATING AND AUDITING A NEW ELECTRONIC CONTINUOUS INFUSION PRESCRIPTION CHART FOR A PAEDIATRIC CRITICAL CARE UNIT.

Science.gov (United States)

Siu, Emily; Sadasivam, Kalaimaran; Christiansen, Nanna

2016-09-01

Prescription errors, including continuous infusion prescriptions are one major source of concern in the paediatric population. Evidence suggests that use of an electronic or web-based calculator could minimise these errors. In our paediatric critical care unit (PCCU) we have created an electronic continuous infusion prescription chart to target errors in this area and conducted an audit to assess its effect on error reduction. To create an electronic continuous infusion prescription chart and audit its effect on prescription errors. Similar electronic continuous infusion prescription charts were evaluated. A Choice of electronic formats were considered and excel was chosen for its simplicity and flexibility. The choice of medications to be included, dilution method, and dosage range was agreed between PCCU consultant, pharmacy and nursing staff. Formulas for calculating each medication infusion was created and validated for different age and weight ranges by at least 2 PCCU trained pharmacists, accounting for capping at certain age and weight bands as appropriate for the medication. These were programmed into the spreadsheet for automatic calculation using inputted age and weight for the selected medications. Continuous infusion prescriptions were audited 6 months before and after implementation in April 2015 of this electronic chart. Parameters audited include medication dose, infusion rate, concentration, route, legibility, and missing or incorrect patient details. A trial period of 4 weeks preceded implementation. The electronic continuous infusion prescription form was created and used on PCCU. Hand written prescriptions had higher error rate (30.7%) as compared to electronic charts (0.7%) with a p-value <0.002. No errors were found in electronic prescriptions in regards to dose, volume and rate calculation. The use of an electronic continuous infusion prescription chart has been successfully set up and used on PCCU. Its use has significantly reduced continuous

What is known about the effects of medical tourism in destination and departure countries? A scoping review

Science.gov (United States)

2010-01-01

Background Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. Growth in the popularity of this practice has resulted in a significant amount of attention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort to systematically synthesize what is known about the effects of this phenomenon. This article presents the findings of a scoping review examining what is known about the effects of medical tourism in destination and departure countries. Methods Drawing on academic articles, grey literature, and media sources extracted from18 databases, we follow a widely used scoping review protocol to synthesize what is known about the effects of medical tourism in destination and departure countries. The review design has three main stages: (1) identifying the question and relevant literature; (2) selecting the literature; and (3) charting, collating, and summarizing the data. Results The large majority of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North, focusing on the flow of patients from high income nations to lower and middle income countries. This greatly shapes any discussion of the effects of medical tourism on destination and departure countries. Five interrelated themes that characterize existing discussion of the effects of this practice were extracted from the reviewed sources. These themes frame medical tourism as a: (1) user of public resources; (2) solution to health system problems; (3) revenue generating industry; (4) standard of care; and (5) source of inequity. It is observed that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation. Conclusions Given its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a highly significant and

What is known about the effects of medical tourism in destination and departure countries? A scoping review

Directory of Open Access Journals (Sweden)

Snyder Jeremy

2010-11-01

Full Text Available Abstract Background Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. Growth in the popularity of this practice has resulted in a significant amount of attention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort to systematically synthesize what is known about the effects of this phenomenon. This article presents the findings of a scoping review examining what is known about the effects of medical tourism in destination and departure countries. Methods Drawing on academic articles, grey literature, and media sources extracted from18 databases, we follow a widely used scoping review protocol to synthesize what is known about the effects of medical tourism in destination and departure countries. The review design has three main stages: (1 identifying the question and relevant literature; (2 selecting the literature; and (3 charting, collating, and summarizing the data. Results The large majority of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North, focusing on the flow of patients from high income nations to lower and middle income countries. This greatly shapes any discussion of the effects of medical tourism on destination and departure countries. Five interrelated themes that characterize existing discussion of the effects of this practice were extracted from the reviewed sources. These themes frame medical tourism as a: (1 user of public resources; (2 solution to health system problems; (3 revenue generating industry; (4 standard of care; and (5 source of inequity. It is observed that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation. Conclusions Given its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a

What is known about the effects of medical tourism in destination and departure countries? A scoping review.

Science.gov (United States)

Johnston, Rory; Crooks, Valorie A; Snyder, Jeremy; Kingsbury, Paul

2010-11-03

Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. Growth in the popularity of this practice has resulted in a significant amount of attention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort to systematically synthesize what is known about the effects of this phenomenon. This article presents the findings of a scoping review examining what is known about the effects of medical tourism in destination and departure countries. Drawing on academic articles, grey literature, and media sources extracted from18 databases, we follow a widely used scoping review protocol to synthesize what is known about the effects of medical tourism in destination and departure countries. The review design has three main stages: (1) identifying the question and relevant literature; (2) selecting the literature; and (3) charting, collating, and summarizing the data. The large majority of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North, focusing on the flow of patients from high income nations to lower and middle income countries. This greatly shapes any discussion of the effects of medical tourism on destination and departure countries. Five interrelated themes that characterize existing discussion of the effects of this practice were extracted from the reviewed sources. These themes frame medical tourism as a: (1) user of public resources; (2) solution to health system problems; (3) revenue generating industry; (4) standard of care; and (5) source of inequity. It is observed that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation. Given its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a highly significant and contested phenomenon. This is especially

Comparison of medication reconciliation and medication review: errors and clinical importance

DEFF Research Database (Denmark)

Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup

2013-01-01

in the patient record and the EMS. 15% of the discrepancies were potentially serious or fatal, 62% were potentially significant and 23% were potentially non-significant. A total of 129 DRPs were identified by medication review, 1.7 per patient. The most frequent DRPs were sub therapeutic dosage, inappropriate......Introduction: The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-re­lated problems (DRPs), denoted errors. Material and methods: This was a retrospective study conducted at the Department...... of Cardiology, Hillerød Hos­pital. Medication reconciliation compared the prescriptions in patient records, an electronic medication system (EMS) and in discharge summaries (DS). The medication review was based on the EMS. The two methods were performed on the same data material. To assess the clinical...

Surface Prognostic Charts

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National Oceanic and Atmospheric Administration, Department of Commerce — Surface Prognostic Charts are historical surface prognostic (forecast) charts created by the United States Weather Bureau. They include fronts, isobars, cloud, and...

Chart review of acute myocardial infarction at a district hospital in KwaZulu-Natal, South Africa

Directory of Open Access Journals (Sweden)

Roland Chetty

2016-03-01

Full Text Available Background: Incidence and prevalence of non-communicable diseases, including ischaemic heart disease (IHD and associated acute myocardial infarction (AMI, are increasing in South Africa. Local studies are needed as contextual factors, such as healthcare systems, gender and ethnicity, may affect presentation and management. In AMI, reviews on time between onset of chest pain and initiation of urgent treatment are useful, as delays in initiation of thrombolytic treatment significantly increase morbidity and mortality. Aim: The aim of the study was to determine the profile and management of patients admitted with ischaemic chest pain.Setting: The study was carried out in a busy urban-based district hospital in KwaZulu-Natal, South Africa. The population served is poor, and patients are mainly Indian with associated high risk of IHD. Methods: A chart review of all patients seen at the hospital with acute ischaemic chest pain between 01 March and 31 August 2014 was undertaken. Results: More male than female patients were admitted, with a wide variation in age. Most eligible patients received required thrombolytic intervention within an acceptable time period after arrival at hospital. Conclusion: Chest pain and AMI were a relatively common presentation at the study site, and urgent diagnosis and initiation of fibrinolytic therapy are essential. The encouraging door-toneedle time may have been influenced by the availability of specialist family physicians, trained as ‘expert generalists’ to provide appropriate care in a variety of settings and consultant support to junior staff. The role of the family physician and primary healthcare doctor in primary prevention are re-emphasised through the study findings. Keywords: Acute myocardial infarction; KwaZulu-Natal; district hospital; Asian population; hospital chart review; door-to-needle-time

Positive predictive value between medical-chart body-mass-index category and obesity versus codes in a claims-data warehouse.

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Caplan, Eleanor O; Kamble, Pravin S; Harvey, Raymond A; Smolarz, B Gabriel; Renda, Andrew; Bouchard, Jonathan R; Huang, Joanna C

2018-01-01

To evaluate the positive predictive value of claims-based V85 codes for identifying individuals with varying degrees of BMI relative to their measured BMI obtained from medical record abstraction. This was a retrospective validation study utilizing administrative claims and medical chart data from 1 January 2009 to 31 August 2015. Randomly selected samples of patients enrolled in a Medicare Advantage Prescription Drug (MAPD) or commercial health plan and with a V85 claim were identified. The claims-based BMI category (underweight, normal weight, overweight, obese class I-III) was determined via corresponding V85 codes and compared to the BMI category derived from chart abstracted height, weight and/or BMI. The positive predictive values (PPVs) of the claims-based BMI categories were calculated with the corresponding 95% confidence intervals (CIs). The overall PPVs (95% CIs) in the MAPD and commercial samples were 90.3% (86.3%-94.4%) and 91.1% (87.3%-94.9%), respectively. In each BMI category, the PPVs (95% CIs) for the MAPD and commercial samples, respectively, were: underweight, 71.0% (55.0%-87.0%) and 75.9% (60.3%-91.4%); normal, 93.8% (85.4%-100%) and 87.8% (77.8%-97.8%); overweight, 97.4% (92.5%-100%) and 93.5% (84.9%-100%); obese class I, 96.9 (90.9%-100%) and 97.2% (91.9%-100%); obese class II, 97.0% (91.1%-100%) and 93.0% (85.4%-100%); and obese class III, 85.0% (73.3%-96.1%) and 97.1% (91.4%-100%). BMI categories derived from administrative claims, when available, can be used successfully particularly in the context of obesity research.

Control Charts in Healthcare Quality Improvement A Systematic Review on Adherence to Methodological Criteria

NARCIS (Netherlands)

Koetsier, A.; van der Veer, S. N.; Jager, K. J.; Peek, N.; de Keizer, N. F.

2012-01-01

Objectives: Use of Shewhart control charts in quality improvement (QI) initiatives is increasing. These charts are typically used in one or more phases of the Plan Do Study Act (PDSA) cycle to monitor summaries of process and outcome data, abstracted from clinical information systems, over time. We

Development of disease-specific growth charts in Turner syndrome and Noonan syndrome

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Tsuyoshi Isojima

2017-12-01

Full Text Available Many congenital diseases are associated with growth failure, and patients with these diseases have specific growth patterns. As the growth patterns of affected individuals differ from those of normal populations, it is challenging to detect additional conditions that can influence growth using standard growth charts. Disease-specific growth charts are thus very useful tools and can be helpful for understanding the growth pattern and pathogenesis of congenital diseases. In addition, disease-specific growth charts allow doctors to detect deviations from the usual growth patterns for early diagnosis of an additional condition and can be used to evaluate the effects of growth-promoting treatment for patients. When developing these charts, factors that can affect the reliability of the charts should be considered. These factors include the definition of the disease with growth failure, selection bias in the measurements used to develop the charts, secular trends of the subjects, the numbers of subjects of varying ages and ethnicities, and the statistical method used to develop the charts. In this review, we summarize the development of disease-specific growth charts for Japanese individuals with Turner syndrome and Noonan syndrome and evaluate the efforts to collect unbiased measurements of subjects with these diseases. These charts were the only available disease-specific growth charts of Turner syndrome and Noonan syndrome for Asian populations and were developed using a Japanese population. Therefore, when these charts are adopted for Asian populations other than Japanese, different growth patterns should be considered.

Development of disease-specific growth charts in Turner syndrome and Noonan syndrome.

Science.gov (United States)

Isojima, Tsuyoshi; Yokoya, Susumu

2017-12-01

Many congenital diseases are associated with growth failure, and patients with these diseases have specific growth patterns. As the growth patterns of affected individuals differ from those of normal populations, it is challenging to detect additional conditions that can influence growth using standard growth charts. Disease-specific growth charts are thus very useful tools and can be helpful for understanding the growth pattern and pathogenesis of congenital diseases. In addition, disease-specific growth charts allow doctors to detect deviations from the usual growth patterns for early diagnosis of an additional condition and can be used to evaluate the effects of growth-promoting treatment for patients. When developing these charts, factors that can affect the reliability of the charts should be considered. These factors include the definition of the disease with growth failure, selection bias in the measurements used to develop the charts, secular trends of the subjects, the numbers of subjects of varying ages and ethnicities, and the statistical method used to develop the charts. In this review, we summarize the development of disease-specific growth charts for Japanese individuals with Turner syndrome and Noonan syndrome and evaluate the efforts to collect unbiased measurements of subjects with these diseases. These charts were the only available disease-specific growth charts of Turner syndrome and Noonan syndrome for Asian populations and were developed using a Japanese population. Therefore, when these charts are adopted for Asian populations other than Japanese, different growth patterns should be considered.

eLearning: a review of Internet-based continuing medical education.

Science.gov (United States)

Wutoh, Rita; Boren, Suzanne Austin; Balas, E Andrew

2004-01-01

The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes. Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database of Systematic Reviews (third quarter, 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, and other information about educational content and format. Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; only three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME. The results demonstrate that Internet-based CME programs are just as effective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be performed to assess how long these new learned behaviors could be sustained. eLearning will continue to evolve as new innovations and more interactive modes are incorporated into learning.

Adverse Drug Events caused by Serious Medication Administration Errors

Science.gov (United States)

Sawarkar, Abhivyakti; Keohane, Carol A.; Maviglia, Saverio; Gandhi, Tejal K; Poon, Eric G

2013-01-01

OBJECTIVE To determine how often serious or life-threatening medication administration errors with the potential to cause patient harm (or potential adverse drug events) result in actual patient harm (or adverse drug events (ADEs)) in the hospital setting. DESIGN Retrospective chart review of clinical events that transpired following observed medication administration errors. BACKGROUND Medication errors are common at the medication administration stage for hospitalized patients. While many of these errors are considered capable of causing patient harm, it is not clear how often patients are actually harmed by these errors. METHODS In a previous study where 14,041 medication administrations in an acute-care hospital were directly observed, investigators discovered 1271 medication administration errors, of which 133 had the potential to cause serious or life-threatening harm to patients and were considered serious or life-threatening potential ADEs. In the current study, clinical reviewers conducted detailed chart reviews of cases where a serious or life-threatening potential ADE occurred to determine if an actual ADE developed following the potential ADE. Reviewers further assessed the severity of the ADE and attribution to the administration error. RESULTS Ten (7.5% [95% C.I. 6.98, 8.01]) actual adverse drug events or ADEs resulted from the 133 serious and life-threatening potential ADEs, of which 6 resulted in significant, three in serious, and one life threatening injury. Therefore 4 (3% [95% C.I. 2.12, 3.6]) serious and life threatening potential ADEs led to serious or life threatening ADEs. Half of the ten actual ADEs were caused by dosage or monitoring errors for anti-hypertensives. The life threatening ADE was caused by an error that was both a transcription and a timing error. CONCLUSION Potential ADEs at the medication administration stage can cause serious patient harm. Given previous estimates of serious or life-threatening potential ADE of 1.33 per 100

Medication Errors in the Southeast Asian Countries: A Systematic Review.

Directory of Open Access Journals (Sweden)

Shahrzad Salmasi

Full Text Available Medication error (ME is a worldwide issue, but most studies on ME have been undertaken in developed countries and very little is known about ME in Southeast Asian countries. This study aimed systematically to identify and review research done on ME in Southeast Asian countries in order to identify common types of ME and estimate its prevalence in this region.The literature relating to MEs in Southeast Asian countries was systematically reviewed in December 2014 by using; Embase, Medline, Pubmed, ProQuest Central and the CINAHL. Inclusion criteria were studies (in any languages that investigated the incidence and the contributing factors of ME in patients of all ages.The 17 included studies reported data from six of the eleven Southeast Asian countries: five studies in Singapore, four in Malaysia, three in Thailand, three in Vietnam, one in the Philippines and one in Indonesia. There was no data on MEs in Brunei, Laos, Cambodia, Myanmar and Timor. Of the seventeen included studies, eleven measured administration errors, four focused on prescribing errors, three were done on preparation errors, three on dispensing errors and two on transcribing errors. There was only one study of reconciliation error. Three studies were interventional.The most frequently reported types of administration error were incorrect time, omission error and incorrect dose. Staff shortages, and hence heavy workload for nurses, doctor/nurse distraction, and misinterpretation of the prescription/medication chart, were identified as contributing factors of ME. There is a serious lack of studies on this topic in this region which needs to be addressed if the issue of ME is to be fully understood and addressed.

Growth charts for children with Ellis–van Creveld syndrome

Science.gov (United States)

Eilers, Paul H. C.; Lawrence, Kate; Hennekam, Raoul C. M.; Versteegh, Florens G. A.

2010-01-01

Ellis–van Creveld (EvC) syndrome is a congenital malformation syndrome with marked growth retardation. In this study, specific growth charts for EvC patients were derived to allow better follow-up of growth and earlier detection of growth patterns unusual for EvC. With the use of 235 observations of 101 EvC patients (49 males, 52 females), growth charts for males and females from 0 to 20 years of age were derived. Longitudinal and cross-sectional data were collected from an earlier review of growth data in EvC, a database of EvC patients, and from recent literature. To model the growth charts, the GAMLSS package for the R statistical program was used. Height of EvC patients was compared to healthy children using Dutch growth charts. Data are presented both on a scale for age and on a scale for the square root of age. Compared to healthy Dutch children, mean height standard deviation score values for male and female EvC patients were −3.1 and −3.0, respectively. The present growth charts should be useful in the follow-up of EvC patients. Most importantly, early detection of growth hormone deficiency, known to occur in EvC, will be facilitated. PMID:20830486

Growth charts for children with Ellis-van Creveld syndrome.

Science.gov (United States)

Verbeek, Sabine; Eilers, Paul H C; Lawrence, Kate; Hennekam, Raoul C M; Versteegh, Florens G A

2011-02-01

Ellis-van Creveld (EvC) syndrome is a congenital malformation syndrome with marked growth retardation. In this study, specific growth charts for EvC patients were derived to allow better follow-up of growth and earlier detection of growth patterns unusual for EvC. With the use of 235 observations of 101 EvC patients (49 males, 52 females), growth charts for males and females from 0 to 20 years of age were derived. Longitudinal and cross-sectional data were collected from an earlier review of growth data in EvC, a database of EvC patients, and from recent literature. To model the growth charts, the GAMLSS package for the R statistical program was used. Height of EvC patients was compared to healthy children using Dutch growth charts. Data are presented both on a scale for age and on a scale for the square root of age. Compared to healthy Dutch children, mean height standard deviation score values for male and female EvC patients were -3.1 and -3.0, respectively. The present growth charts should be useful in the follow-up of EvC patients. Most importantly, early detection of growth hormone deficiency, known to occur in EvC, will be facilitated.

APPLICATION OF U-CHART AND C-CHART IN TECHNOLOGICAL PROCESS OF PRIMARY WOOD PROCESSING

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Damjan Stanojević

2014-01-01

Full Text Available Control charts are statistical methods of quality control. Basically it is a graph where the abscissa represents the order of control, and the ordinate is marked with parameter values, which are controled by samples over a certain size. Using charts determine varying quality and also related the stability and capacity of the production process in relation to the established control limits. Dr. Schuchardt, which can be regarded as the creator of control charts, says that their mission: to maintain the production process in a state of control, to lead the production process into a state of control, to show that the state of control has been achieved. According to Dr. Schuchardt „for a phenomenon is said to be controlled if based on current data we can predict, at least within certain limits, how the phenomenon will change in the future. Here, under certain prediction within limits means that we can determine, at least approximately, the probability that the phenomenon is found within the given limits“. Control charts for attribute quality characteristics are: p- control chart, m- control chart, u- control chart, c- control chart.

[Ethic review on clinical experiments of medical devices in medical institutions].

Science.gov (United States)

Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

2011-07-01

Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

A Retrospective Chart Review of Contraceptive Use among Adolescents with Opioid Use Disorder.

Science.gov (United States)

Handy, Caitlin J; Lange, Hannah L H; Manos, Brittny E; Berlan, Elise D; Bonny, Andrea E

2018-04-01

To describe contraceptive use among female adolescents initiating outpatient treatment for opioid use disorder. Retrospective chart review. Outpatient clinic providing medication-assisted treatment for substance use disorders to adolescents and young adults. Nonpregnant female adolescents who presented for treatment from January 1, 2013 to January 31, 2016 (N = 123). None. Prescription contraceptive use at baseline and initiation of a new method within 90 days. Of 123 female adolescents who presented for treatment of opioid use disorder, 113 (91.9%) reported sexual activity and 80 (65.0%) were not using prescription contraception at intake. Previous pregnancy was reported by 43 (35.0%) and 20 (16.3%) were positive for a sexually transmitted infection. Contraceptive counseling was not documented for 73 (59.3%) patients. Among patients with no prescription contraception at baseline, 56 of 80 (70.0%) initiated a method within the study window. Significant predictors (odds ratio [OR]; 95% confidence interval) of contraceptive initiation included previous pregnancy (8.6; 1.39-52.99), education of less than a high school diploma/general equivalency diploma (7.4; 1.63-33.41), and return for follow-up visit (9.8; 2.18-43.69). Young women who presented for opioid use disorder treatment were at high risk of adverse reproductive health outcomes. Most were sexually active and not using prescription contraception. Findings underscore the need for contraceptive counseling in this patient population. Optimally, these services would be provided in conjunction with substance use treatment. Improved contraceptive counseling documentation will allow evaluation of effective contraceptive counseling strategies for adolescents with opioid use disorders and might serve to inform future interventions. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

A comparative study of ICU patient diaries vs. hospital charts

DEFF Research Database (Denmark)

Egerod, Ingrid; Christensen, Doris

2010-01-01

Intensive care survivors often suffer from memory disorders, and some go on to develop anxiety, depression, and posttraumatic stress. Since the 1980s nurses have written diaries for intensive care patients to help them understand their illness and come to terms with their experiences after...... discharge. The central question we posed in this study was: Why do nurses write diaries in addition to conventional charting in the medical record? To answer this question, we compared intensive care diaries and hospital charts using textual analysis and narrative theory. The aims of our study were...... to compare patient diaries and hospital charts to explore (a) what each documentation instrument has to offer patients in their quest to make sense of their illness, and (b) why it is worthwhile for nurses to sustain the practice of writing diaries. The study findings show that the diary is coherent...

Value of pharmacist medication interviews on optimizing the electronic medication reconciliation process.

Science.gov (United States)

Lee, Audrey; Varma, Arjun; Boro, Maureen; Korman, Nancy

2014-06-01

Few studies have explored the impact of using different methods for obtaining accurate medication histories on medication safety. This study was conducted to compare the accuracy and clinical impact of pharmacist medication histories obtained by electronic medical record review (EMRR) alone with those obtained by direct interviews combined with EMRR. This 18-week prospective study included patients who were admitted to the Inpatient Medicine Service at the study institution and who had a pharmacist-conducted medication reconciliation EMRR within 48 hours of hospital admission. A chart review was performed to collect data to determine whether differences existed in the number of discrepancies, recommendations, and medication errors between the EMRR alone group compared to the EMRR combined with the patient interview group. Five hundred thirteen discrepancies were identified with the EMRR group compared to 986 from the combined EMRR and patient interview group (P < .001). Significantly more recommendations were made in the combination interview group compared to the EMRR alone group (260 vs 97; P < .001). Fewer medication errors were identified for the EMRR alone group compared to the combination interview group (55 vs 134; P < .001). The most common errors were omitted medications followed by extra dose/failure to discontinue therapy and wrong dose/frequency errors. Pharmacist-conducted admission medication interviews combined with EMRR can potentially identify harmful medication discrepancies and prevent medication errors.

Methadone for the treatment of Prescription Opioids Dependence. A retrospective chart review.

Science.gov (United States)

Barrio, Pablo; Ezzeldin, Mohamed; Bruguera, Pol; Pérez, Ana; Mansilla, Sara; Fàbrega, Marina; Lligoña, Anna; Mondón, Sílvia; Balcells, Mercè

2016-06-14

Prescription opioids (PO) addiction is increasing to an epidemic level. Few studies exist regarding its treatment. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone. We conducted a retrospective assessment of all patients admitted to a psychiatry ward for PO detoxification using methadone between 2010 and 2013. The assessment and description was carried out during a 3-month follow-up period after their discharge. Although this is a retrospective chart review, our exploration included sociodemographic and treatment variables in addition to the abstinence rates for the whole sample. Eleven patients were included, mostly women (81.8%), with a median age of 50 years. The median duration of dependence was 8 years. Dependence on other substances and psychiatric comorbidities were high. Eight patients were monitored during three months. Of these, 7 (87.5%) were abstinent after that period. The results suggest that methadone deserves further exploration as a potentially efficacious treatment option for PO dependence.

[Ophthalmologic reading charts : Part 2: Current logarithmically scaled reading charts].

Science.gov (United States)

Radner, W

2016-12-01

To analyze currently available reading charts regarding print size, logarithmic print size progression, and the background of test-item standardization. For the present study, the following logarithmically scaled reading charts were investigated using a measuring microscope (iNexis VMA 2520; Nikon, Tokyo): Eschenbach, Zeiss, OCULUS, MNREAD (Minnesota Near Reading Test), Colenbrander, and RADNER. Calculations were made according to EN-ISO 8596 and the International Research Council recommendations. Modern reading charts and cards exhibit a logarithmic progression of print sizes. The RADNER reading charts comprise four different cards with standardized test items (sentence optotypes), a well-defined stop criterion, accurate letter sizes, and a high print quality. Numbers and Landolt rings are also given in the booklet. The OCULUS cards have currently been reissued according to recent standards and also exhibit a high print quality. In addition to letters, numbers, Landolt rings, and examples taken from a timetable and the telephone book, sheet music is also offered. The Colenbrander cards use short sentences of 44 characters, including spaces, and exhibit inaccuracy at smaller letter sizes, as do the MNREAD cards. The MNREAD cards use sentences of 60 characters, including spaces, and have a high print quality. Modern reading charts show that international standards can be achieved with test items similar to optotypes, by using recent technology and developing new concepts of test-item standardization. Accurate print sizes, high print quality, and a logarithmic progression should become the minimum requirements for reading charts and reading cards in ophthalmology.

Time contour expression of limited range phenomena on stack chart; Jugo chart jo deno kyokuchi gensho jikan contour

Energy Technology Data Exchange (ETDEWEB)

Kametani, T

1997-05-27

Time contour expression of limited range phenomena on stack chart is examined for further improvement on the result of the ultimate interpretation in the seismic reflection survey. The policy is made clear from the beginning that local phenomena are to be discussed, and data prior CMP stacking is interpreted in detail. For this purpose, it is effective to make use of the time contour expression in the midpoint-offset plane simultaneously with the CMP and COP panels. For the review of data prior to CMP stacking, it is convenient to use the CMP (CDP) stacking chart in which the data is arranged methodically. In this chart, all the channels which are crude data prior to stacking are plotted on midpoint-offset coordinates, which plane is called the MOD (Midpoint Offset Domain) panel. Various panels can be chosen unrestrictedly, and their mutual relations can be easily grasped. When data points are given a time axis, they can be expressed in a time contour. Studies are conducted about the underground structure, multiple reflection paths divided by it, and characteristics of detour reflection attributable to faults. 4 refs., 9 figs.

Supracricoid hemilaryngopharyngectomy for selected pyriform sinus carcinoma patients – a retrospective chart review

Directory of Open Access Journals (Sweden)

Yiotakis Ioannis E

2009-08-01

Full Text Available Abstract Background The aim of this study is to assess the functional and oncologic results of supracricoid hemilaryngopharyngectomy and report our experience in the technique, local control and overall survival rates. Materials and methods 18 selected patients with pyriform sinus cancer treated by supracricoid hemilaryngopharyngectomy in a University Hospital setting. Retrospective chart review was used to assess functional and oncologic results of the procedure. Results The actuarial 5 year survival rate in our study was 55.56% and the actuarial neck recurrence rate was 16.67%. All patients were successfully decannulated. Aspiration pneumonia was the most common postoperative complication (22.23% and was treated mostly conservatively. One patient required a temporary gastrostomy but no patient needed total laryngectomy in the postoperative period. Conclusion Supracricoid hemilaryngopharyngectomy in experienced hands is a reliable technique for selected patients with pyriform sinus cancer.

Spectral Imaging of Portolan Charts

Science.gov (United States)

France, Fenella G.; Wilson, Meghan A.; Ghez, Anita

2018-05-01

Spectral imaging of Portolan Charts, early nautical charts, provided extensive new information about their construction and creation. The origins of the portolan chart style have been a continual source of perplexity to numerous generations of cartographic historians. The spectral imaging system utilized incorporates a 50 megapixel mono-chrome camera with light emitting diode (LED) illumination panels that cover the range from 365 nm to 1050 nm to capture visible and non-visible information. There is little known about how portolan charts evolved, and what influenced their creation. These early nautical charts began as working navigational tools of medieval mariners, initially made in the 1300s in Italy, Portugal and Spain; however the origin and development of the portolan chart remained shrouded in mystery. Questions about these early navigational charts included whether colorants were commensurate with the time period and geographical location, and if different, did that give insight into trade routes, or possible later additions to the charts? For example; spectral data showed the red pigment on both the 1320 portolan chart and the 1565 Galapagos Islands matched vermillion, an opaque red pigment used since antiquity. The construction of these charts was also of great interest. Spectral imaging with a range of illumination modes revealed the presence of a "hidden circle" often referred to in relation to their construction. This paper will present in-depth analysis of how spectral imaging of the Portolans revealed similarities and differences, new hidden information and shed new light on construction and composition.

A paediatric X-ray exposure chart

Energy Technology Data Exchange (ETDEWEB)

Knight, Stephen P, E-mail: stephen.knight@health.qld.gov.au [Department of Medical Imaging, Royal Children' s Hospital, Brisbane, Queensland (Australia)

2014-09-15

The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies – body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior–posterior (AP)/posterior–anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes.

Costs of conventional radical radiotherapy versus continuous hyperfractionated accelerated radiotherapy (CHART) in the treatment of patients with head and neck cancer or carcinoma of the bronchus. Medical Research Council CHART Steering Committee.

Science.gov (United States)

Coyle, D; Drummond, M F

1997-01-01

The objective of this study was to compare the costs of treatment with continuous hyperfractionated accelerated radiotherapy (CHART) and those of conventional radiotherapy for patients with (1) head and neck cancer and (2) carcinoma of the bronchus. The study was conducted concurrently with two multicentre randomized controlled trials. Data were collected on the use of hospital and community service resources and patients' travel for treatment. Data on resource use up to 3 months after entry to the study were available for 526 head and neck patients (314 receiving CHART and 212 conventional therapy) and 284 bronchus patients (175 CHART and 109 conventional therapy). For patients with head and neck cancer, CHART cost Pounds 1092 (P hostel facilities. The results of this cost analysis will help to facilitate a decision about whether the benefits of CHART, as determined by the clinical trials, are worth the additional costs of hospital-based resource use. The collection of detailed patient-specific resource-use data from a number of centres allows the determination of ways for reducing the cost differential between therapies and making CHART a more cost effective treatment alternative.

Paediatric Northern Score centile charts for the chest radiograph in cystic fibrosis

International Nuclear Information System (INIS)

McCormick, J.; Conway, S.P.; Mehta, A.

2007-01-01

Aim: To create the first national centile charts for the chest radiograph Northern Score using the UK Cystic Fibrosis (CF) Database (UKCFD). Materials and methods: All active patients for 2002 from the UKCFD were analysed in 1-year cohorts from 0 to 18 years. Northern Score results from the annual review forms were used to construct centile lines for the 5th, 25th, 50th, 75th, 95th centiles. Results: There were 1806 patients with recorded Northern Score data for 2002 (927 male patients, male:female ratio 1.05). The centile chart demonstrates a quasi-linear rise throughout childhood. A Northern Score in excess of age in years equates to >95th centile in school-aged CF patients. Conclusion: This centile chart provides a disease-specific reference range for monitoring individual patients or for evaluating therapeutic change using the dominant chest radiograph scoring system in the UK. Patients, parents and clinicians may find these useful during the annual review process

Fractional smith chart theory

KAUST Repository

Shamim, Atif

2011-03-01

For the first time, a generalized Smith chart is introduced here to represent fractional order circuit elements. It is shown that the standard Smith chart is a special case of the generalized fractional order Smith chart. With illustrations drawn for both the conventional integer based lumped elements and the fractional elements, a graphical technique supported by the analytical method is presented to plot impedances on the fractional Smith chart. The concept is then applied towards impedance matching networks, where the fractional approach proves to be much more versatile and results in a single element matching network for a complex load as compared to the two elements in the conventional approach. © 2010 IEEE.

MO-A-BRB-02: Considerations and Issues in Electronic Charting for Brachytherapy

International Nuclear Information System (INIS)

Richardson, S.

2015-01-01

The process of converting to an electronic chart for radiation therapy can be daunting. It requires a dedicated committee to first research and choose appropriate software, to review the entire documentation policy and flow of the clinic, to convert this system to electronic form or if necessary, redesign the system to more easily conform to the electronic process. Those making the conversion and those who already use electronic charting would benefit from the shared experience of those who have been through the process in the past. Therefore TG262 was convened to provide guidance on electronic charting for external beam radiation therapy and brachytherapy. This course will present the results of an internal survey of task group members on EMR practices in External Beam Radiation Therapy as well as discuss important issues in EMR development and structure for both EBRT and brachytherapy. Learning Objectives: Be familiarized with common practices and pitfalls in development and maintenance of an electronic chart in Radiation Oncology Be familiarized with important issues related to electronic charting in External Beam Radiation Therapy Be familiarized with important issues related to electronic charting in Brachytherapy

INIS: Terminology charts

Energy Technology Data Exchange (ETDEWEB)

NONE

1970-08-01

This document is one in a series of publications known as the INIS Reference Series. It is to be used in conjunction with the INIS indexing manual and the INIS thesaurus for the preparation of input to the INIS database. The thesaurus and terminology charts in their first edition (Rev.0) were produced as the result of an agreement between the International Atomic Energy Agency (IAEA) and the European Atomic Energy Community (Euratom). Except for minor changes the terminology and the interrelationships between terms are those of the December 1969 edition of the Euratom Thesaurus. The purpose of the terminology harts is to display the descriptors of the thesaurus in the context of their hierarchical and other semantic relationships. Hierarchically related terms are grouped in clusters, each representing one of the principal concepts of a subject field. The descriptors are grouped around or under the broadest term of the clusters which is printed in upper case. The hierarchical relationships within the clusters are shown by the arrangement of the terms in smaller boxes within the larger boxes circumscribing the clusters. The clusters are connected by lines of various thickness, representing the other (mostly non-hierarchical) relationships. These connections are the equivalent to 'see also' and 'related term' cross-references. The thickness of the lines represents the strength of the semantic relations, or, in the practice of a retrieval system the probability that one term replacing a connected term in a query, will still yield pertinent references. The figures accompanying the descriptors represent their frequency of assignment to the first 987,000 documents stored in the Euratom system (May 1970). They are presented in order to show the relative importance of the descriptors within the subject field. The asterisks (*) accompanying descriptors in the charts refer to descriptors, for which a scope note can be found in the INIS: Thesaurus at the time the charts went

INIS: Terminology charts

International Nuclear Information System (INIS)

1970-08-01

This document is one in a series of publications known as the INIS Reference Series. It is to be used in conjunction with the INIS indexing manual and the INIS thesaurus for the preparation of input to the INIS database. The thesaurus and terminology charts in their first edition (Rev.0) were produced as the result of an agreement between the International Atomic Energy Agency (IAEA) and the European Atomic Energy Community (Euratom). Except for minor changes the terminology and the interrelationships between terms are those of the December 1969 edition of the Euratom Thesaurus. The purpose of the terminology harts is to display the descriptors of the thesaurus in the context of their hierarchical and other semantic relationships. Hierarchically related terms are grouped in clusters, each representing one of the principal concepts of a subject field. The descriptors are grouped around or under the broadest term of the clusters which is printed in upper case. The hierarchical relationships within the clusters are shown by the arrangement of the terms in smaller boxes within the larger boxes circumscribing the clusters. The clusters are connected by lines of various thickness, representing the other (mostly non-hierarchical) relationships. These connections are the equivalent to 'see also' and 'related term' cross-references. The thickness of the lines represents the strength of the semantic relations, or, in the practice of a retrieval system the probability that one term replacing a connected term in a query, will still yield pertinent references. The figures accompanying the descriptors represent their frequency of assignment to the first 987,000 documents stored in the Euratom system (May 1970). They are presented in order to show the relative importance of the descriptors within the subject field. The asterisks (*) accompanying descriptors in the charts refer to descriptors, for which a scope note can be found in the INIS: Thesaurus at the time the charts went

Evaluation of STAT medication ordering process in a community hospital.

Science.gov (United States)

Abdelaziz, Hani; Richardson, Sandra; Walsh, Kim; Nodzon, Jessica; Schwartz, Barbara

2016-01-01

In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE) orders vs. non-physician entered (NPE) orders). Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16-63; porder processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process.

Surgical management of Dupuytren's contracture in Europe: regional analysis of a surgeon survey and patient chart review.

Science.gov (United States)

Dias, J; Bainbridge, C; Leclercq, C; Gerber, R A; Guerin, D; Cappelleri, J C; Szczypa, P P; Dahlin, L B

2013-03-01

We explored regional variations in the surgical management of patients with Dupuytren's contracture (DC) in 12 European countries using a surgeon survey and patient chart review. Twelve countries participated: Denmark, Finland, Sweden (Nordic region); Czech Republic, Hungary, Poland (East); France, Germany, the Netherlands, UK (West); Italy, Spain (Mediterranean). For the survey, a random sample of orthopaedic/plastic surgeons (n = 687) with 3-30 years' experience was asked about DC procedures performed during the previous 12 months. For the chart review (n = 3357), information from up to five consecutive patients was extracted. Descriptive statistics are reported. Ninety-five per cent of all surgeons used fasciectomy for DC, followed by fasciotomy (70%), dermofasciectomy (38%) and percutaneous needle fasciotomy (35%). Most surgeons were satisfied with fasciectomy over other procedures. Recommended time away from work and duration of physical therapy increased with the invasiveness of the procedure. The intra-operative complication rate was 4.0%; the postoperative complication rate was 34%. Overall, ≥ 97% of the procedures were rated by surgeons as having a positive outcome. Across all regions, 54% of patients had no nodules or contracture after the procedures. Only 2% of patients required retreatment within the first year of surgery. Important inter- and intraregional differences in these aspects of patient management are described. Understanding current regional treatment patterns and their relationships to country-specific health systems may facilitate earlier identification of, and intervention for, DD and help to optimise the overall treatment for patients with this chronic condition. © 2013 Blackwell Publishing Ltd.

Medical Illustration

Science.gov (United States)

... as medical books, journals, magazines, pharma or biotech marketing, films, online video, exhibits, posters, wall charts, educational ... of the health career profession with strong communication skills, medical illustrators work closely with clients to interpret ...

Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

Science.gov (United States)

Alagiakrishnan, Kannayiram; Wilson, Patricia; Sadowski, Cheryl A; Rolfson, Darryl; Ballermann, Mark; Ausford, Allen; Vermeer, Karla; Mohindra, Kunal; Romney, Jacques; Hayward, Robert S

2016-01-01

Background Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. Methods Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR). The “Seniors Medication Alert and Review Technologies” (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed. Results Analysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check. Conclusion While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers’ Criteria in

WWW chart of the nuclides

International Nuclear Information System (INIS)

Huang Xiaolong; Zhou Chunmei; Zhuang Youxiang; Zhao Zhixiang; Golashvili, T.V.; Chechev, V.P.

2000-01-01

WWW chart of the nuclides was established on the basis of the latest evaluations of nuclear structure and decay data. By viewing WWW chart of the nuclides, one can retrieve the fundamental data of nuclide such as atomic mass, abundance, spin and parity; the decay mode, branching ratio, half-life and Q-value of radioactive nuclide, energy and intensity of strong γ-ray, etc. The URL (Uniform Resource Locator) of WWW chart of the nuclides is: http://myhome.py.gd.cn/chart/index,asp

A Systematic Chart Review of Inpatient Population with Childhood Dissociative Disorder

Science.gov (United States)

Prabhuswamy, Mukesh; Jairam, Rajeev; Srinath, Shoba; Girimaji, Satish; Seshadri, Shekhar P.

2006-01-01

Objective: To study the socio-demographic factors, clinical characteristics, and long-term outcome of dissociative disorders in inpatient children and adolescents. Methods: Chart data of forty-four subjects (8-15 years) with a diagnosis of dissociative disorder admitted to a specialist Child and Adolescent Psychiatry (CAP) unit between September…

Assessment of dizziness among older patients at a family practice clinic: a chart audit study

Directory of Open Access Journals (Sweden)

Pimlott Nicholas JG

2005-01-01

Full Text Available Abstract Background Dizziness is a common complaint among the elderly with a prevalence of over 30% in people over the age of 65. Although it is a common problem the assessment and management of dizziness in the elderly is challenging for family physicians. There is little published research which assesses the quality of dizziness assessment and management by family physicians. Methods We conducted a retrospective, chart audit study of patients with dizziness attending the Sunnybrook Family Practice Center of Sunnybrook and Women's College Health Sciences Center (SWCHSC in Toronto. We audited a random sample of 50 charts of patients from 310 eligible charts. Quality indicators across all dizziness subtypes were assessed. These quality indicators included: onset and course of symptoms; symptoms in patients' own words; number of medications used; postural blood pressure changes; symptoms of depression or anxiety; falls; syncope; diagnosis; outcome; specialty referrals. Quality indicators specific to each dizziness subtype were also audited. Results 310 charts satisfied inclusion criteria with 20 charts excluded and 50 charts were randomly generated. Documentation of key quality indicators in the management of dizziness was sub-optimal. Charts documenting patients' dizziness symptoms in their own words were more likely to have a clinical diagnosis compared to charts without (P = 0.002. Conclusions Documentation of selected key quality indicators could be improved, especially that of patients' symptoms in their own words.

The Hill Chart Calculation for Pelton Runner Models using the HydroHillChart - Pelton Module Software

Directory of Open Access Journals (Sweden)

Adelina Bostan

2015-07-01

Full Text Available The Pelton turbines industrial design is based on the hill chart characteristics obtained by measuring the models. Primary data measurements used to obtain the hill chart can be processed graphically, by hand or by using graphic programs respectively CAD programs; the HydroHillChart - Pelton module software is a specialized tool in achieving the hill chart, using interpolation cubic spline functions. Thereby, based on measurements of several models of Pelton turbines, a computerized library, used to design industrial Pelton turbines can be created. The paper presents the universal characteristics calculated by using the HydroHillChart - Pelton module software for a series of Pelton runners.

MO-A-BRB-03: Integration Issues in Electronic Charting for External Beam Therapy

International Nuclear Information System (INIS)

Sutlief, S.

2015-01-01

The process of converting to an electronic chart for radiation therapy can be daunting. It requires a dedicated committee to first research and choose appropriate software, to review the entire documentation policy and flow of the clinic, to convert this system to electronic form or if necessary, redesign the system to more easily conform to the electronic process. Those making the conversion and those who already use electronic charting would benefit from the shared experience of those who have been through the process in the past. Therefore TG262 was convened to provide guidance on electronic charting for external beam radiation therapy and brachytherapy. This course will present the results of an internal survey of task group members on EMR practices in External Beam Radiation Therapy as well as discuss important issues in EMR development and structure for both EBRT and brachytherapy. Learning Objectives: Be familiarized with common practices and pitfalls in development and maintenance of an electronic chart in Radiation Oncology Be familiarized with important issues related to electronic charting in External Beam Radiation Therapy Be familiarized with important issues related to electronic charting in Brachytherapy

Growth charts of human development.

Science.gov (United States)

van Buuren, Stef

2014-08-01

This article reviews and compares two types of growth charts for tracking human development over age. Both charts assume the existence of a continuous latent variable, but relate to the observed data in different ways. The D-score diagram summarizes developmental indicators into a single aggregate score measuring global development. The relations between the indicators should be consistent with the Rasch model. If true, the D-score is a measure with interval scale properties, and allows for the calculation of meaningful differences both within and across age. The stage line diagram describes the natural development of ordinal indicators. The method models the transition probabilities between successive stages of the indicator as smoothly varying functions of age. The location of each stage is quantified by the mid-P-value. Both types of diagrams assist in identifying early and delayed development, as well as finding differences in tempo. The relevant techniques are illustrated to track global development during infancy and early childhood (0-2 years) and Tanner pubertal stages (8-21 years). New reference values for both applications are provided. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

SMART AERONAUTICAL CHART MANAGEMENT SYSTEM DESIGN

Directory of Open Access Journals (Sweden)

M. E. Pakdil

2015-10-01

Full Text Available Civil aviation is developing rapidly, and the number of domestic and international operations is increasing exponentially every year than the previous one. Airline companies with increased air traffic and the number of passengers increase the demand of new aircrafts. An aircraft needs not only fuel but also pilot and aeronautical information (charts, digital navigation information, flight plan, and etc. to perform flight operation. One of the most important components in aeronautical information is the terminal chart. Authorized institution in every state is responsible to publish their terminal charts for certain periods. Although these charts are produced in accordance with ICAO’s Annex 4 and Annex 15, cartographic representation and page layout differs in each state’s publication. This situation makes difficult to read them by pilots. In this paper, standard instrument departure (SID charts are analysed to produce by use of cutting-edge and competitive technologies instead of classical computer-aided drawing and vector based graphic applications that are currently used by main chart producers. The goal is to design efficient and commercial chart management system that is able to produce aeronautical charts with same cartographic representation for all states.

"Waiting for DAAs": A retrospective chart review of patients with untreated hepatitis C in Rwanda.

Directory of Open Access Journals (Sweden)

Neil Gupta

Full Text Available Access to treatment for hepatitis C virus (HCV in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs, highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs.We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65, and 149 (58.9% were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09-1.17, but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus.Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa.

Control of control charts

NARCIS (Netherlands)

Sri Nurdiati, S.N.

2005-01-01

Although the Shewhart chart is widely used in practice because of its simplicity, applying this control chart to monitor the mean of a process may lead to two types of problems. The first concerns the typically unknown parameters involved in the distribution, while the second concerns the validity

International chart of the nuclides. 2001

International Nuclear Information System (INIS)

Golashvili, T.V.; Kupriyanov, V.M.; Lbov, A.A.

2002-01-01

The International Chart of Nuclides - 2001 has been developed taking into account the data obtained in 1998-2001. Unlike widespread nuclide charts the present Chart of Nuclides contains EVALUATED values of the main characteristics. These values are supplied with the standard deviations. (author)

Shewhart control charts in new perspective

NARCIS (Netherlands)

Albers, Willem/Wim; Kallenberg, W.C.M.

2007-01-01

The effects of estimating parameters and the violation of the assumption of normality when dealing with control charts are discussed. Corrections for estimating errors and extensions of the normal control chart to parametric and nonparametric charts are investigated. The underlying theory is

NNDC Chart of Nuclides

International Nuclear Information System (INIS)

Sonzogni, A.

2008-01-01

The National Nuclear Data Center has recently developed an interactive chart of nuclides, http://www.nndc.bnl.gov/chart/, that provides nuclear structure and decay data. Since its implementation, it has proven to be one of the most popular web products. The information presented is derived from the ENSDF and Nuclear Wallet Card databases. Experimentally known nuclides are represented by a cell in chart with the number of neutrons on the horizontal axis and the number of protons on the vertical axis. The color of the cell is used to indicate the ground state half-life or the ground state predominant decay mode. (author)

Flowcharting with D-charts

Science.gov (United States)

Meyer, D.

1985-01-01

A D-Chart is a style of flowchart using control symbols highly appropriate to modern structured programming languages. The intent of a D-Chart is to provide a clear and concise one-for-one mapping of control symbols to high-level language constructs for purposes of design and documentation. The notation lends itself to both high-level and code-level algorithmic description. The various issues that may arise when representing, in D-Chart style, algorithms expressed in the more popular high-level languages are addressed. In particular, the peculiarities of mapping control constructs for Ada, PASCAL, FORTRAN 77, C, PL/I, Jovial J73, HAL/S, and Algol are discussed.

The use of quality control performance charts to analyze cesarean delivery rates nationally.

LENUS (Irish Health Repository)

Turner, Michael J

2012-02-01

OBJECTIVE: To examine the use of quality control performance charts to analyze cesarean rates nationally. METHODS: Information on cesarean rates was obtained for all 19 Irish maternity hospitals receiving state funding in 2009. All women who underwent cesarean delivery of a live or stillborn infant weighing 500 g or more between January 1 and December 31 were included. Deliveries were classified as elective or emergency. Individual hospitals were not identified in the analysis. RESULTS: The mean rates per hospital of elective and emergency cesarean were 12.9+\\/-2.6% (n=9337) and 13.8+\\/-3.0% (n=9989), respectively-giving an overall mean rate of 26.7+\\/-4.2% (n=19326) per hospital. Cesarean rates were normally distributed. Using a quality control performance chart with a cutoff 2 standard deviations from the mean, 1 hospital was above the normal range for both total and elective cesareans, indicating that its pre-labor obstetric practices warrant clinical review. Another hospital had a mean emergency cesarean rate above the normal range, indicating that its labor ward practices warrant review. CONCLUSION: Quality control performance charts can be used to analyze cesarean rates nationally and, thus, to identify hospitals at which obstetric practices should be reviewed.

Medication use and associated risk of falling in a geriatric outpatient population.

Science.gov (United States)

Freeland, Kathryn N; Thompson, Amy N; Zhao, Yumin; Leal, Julie E; Mauldin, Patrick D; Moran, William P

2012-09-01

Studies have shown that approximately one third of community-dwelling people aged 65 years and older will experience a fall each year. Many studies indicate that use of multiple medications may put patients at an increased risk of falling, but few studies have been conducted to correlate the number of medications with the risk of falls. To determine the medications most frequently used in patients aged 65 years or older who have experienced a fall within the past year, with particular attention to type or number of medications most commonly associated with multiple falls or a fall with injury. We conducted a chart review in an outpatient internal medicine clinic over a 13-month period. A total of 118 patients 65 years of age or older who were taking 4 or more medications and had experienced at least 1 fall in the previous 12 months were included. Data relating to sex, age, race, diagnoses, medications, and number and type of falls were obtained during the chart review. The primary end point of the study was number and type of medications most commonly used in patients experiencing a fall. A total of 116 patients were examined for trends in fall risk. A logistic regression model and receiver operating characteristic curve demonstrated significant fall risk with the addition of medications, with patients experiencing a 14% increase in fall risk with the addition of each medication beyond a 4-medication regimen (OR 1.14; 95% CI 1.02 to 1.27; p = 0.027). The addition of medications is associated with a significant increase in risk of falls in elderly patients, regardless of drug class. Further studies are needed to assess the possible increased risk of falls with increasing number of medications.

Drug-related problems identified in medication reviews by Australian pharmacists

DEFF Research Database (Denmark)

Stafford, Andrew C; Tenni, Peter C; Peterson, Gregory M

2009-01-01

OBJECTIVE: In Australia, accredited pharmacists perform medication reviews for patients to identify and resolve drug-related problems. We analysed the drug-related problems identified in reviews for both home-dwelling and residential care-facility patients. The objective of this study was to exam......OBJECTIVE: In Australia, accredited pharmacists perform medication reviews for patients to identify and resolve drug-related problems. We analysed the drug-related problems identified in reviews for both home-dwelling and residential care-facility patients. The objective of this study....... These reviews had been self-selected by pharmacists and submitted as part of the reaccreditation process to the primary body responsible for accrediting Australian pharmacists to perform medication reviews. The drug-related problems identified in each review were classified by type and drugs involved. MAIN...... OUTCOME MEASURE: The number and nature of drug-related problems identified in pharmacist-conducted medication reviews. RESULTS: There were 1,038 drug-related problems identified in 234 medication reviews (mean 4.6 (+/-2.2) problems per review). The number of problems was higher (4.9 +/- 2.0 vs. 3.9 +/- 2...

Big Data and Dementia: Charting the Route Ahead for Research, Ethics, and Policy.

Science.gov (United States)

Ienca, Marcello; Vayena, Effy; Blasimme, Alessandro

2018-01-01

Emerging trends in pervasive computing and medical informatics are creating the possibility for large-scale collection, sharing, aggregation and analysis of unprecedented volumes of data, a phenomenon commonly known as big data. In this contribution, we review the existing scientific literature on big data approaches to dementia, as well as commercially available mobile-based applications in this domain. Our analysis suggests that big data approaches to dementia research and care hold promise for improving current preventive and predictive models, casting light on the etiology of the disease, enabling earlier diagnosis, optimizing resource allocation, and delivering more tailored treatments to patients with specific disease trajectories. Such promissory outlook, however, has not materialized yet, and raises a number of technical, scientific, ethical, and regulatory challenges. This paper provides an assessment of these challenges and charts the route ahead for research, ethics, and policy.

de Sitter relativity in static charts

Energy Technology Data Exchange (ETDEWEB)

Cotaescu, Ion I. [West University of Timisoara, Timisoara (Romania)

2018-02-15

The relative geodesic motion in static (and spherically symmetric) local charts on the (1 + 3)-dimensional de Sitter spacetimes is studied in terms of conserved quantities. The Lorentzian isometries are derived, relating the coordinates of the local chart of a fixed observer with the coordinates of a mobile chart considered as the rest frame of a massive particle freely moving on a timelike geodesic. The time dilation and Lorentz contraction are discussed pointing out some notable features of the de Sitter relativity in static charts. (orig.)

Descriptive study of perioperative analgesic medications associated with general anesthesia for dental rehabilitation of children.

Science.gov (United States)

Carter, Laura; Wilson, Stephen; Tumer, Erwin G

2010-01-01

The purpose of this retrospective chart review was to document sedation and analgesic medications administered preoperotively, intraoperatively, and during postanesthesia care for children undergoing dental rehabilitation using general anesthesia (GA). Patient gender, age, procedure type performed, and ASA status were recorded from the medical charts of children undergoing GA for dental rehabilitation. The sedative and analgesic drugs administered pre-, intra-, and postoperatively were recorded. Statistical analysis included descriptive statistics and cross-tabulation. A sample of 115 patients with a mean age of 64 (+/-30) months was studied; 47% were females, and 71% were healthy. Over 80% of the patients were administered medications primarily during pre- and intraoperative phases, with fewer than 25% receiving medications postoperatively. Morphine and fentanyl were the most frequently administered agents intraoperatively. The procedure type, gender, and health status were not statistically associated with the number of agents administered. Younger patients, however, were statistically more likely to receive additional analgesic medications. Our study suggests that a minority of patients have postoperative discomfort in the postanesthesia care unit; mild to moderate analgesics were administered during intraoperative phases of dental rehabilitation.

Burnout in medical students: a systematic review.

Science.gov (United States)

Ishak, Waguih; Nikravesh, Rose; Lederer, Sara; Perry, Robert; Ogunyemi, Dotun; Bernstein, Carol

2013-08-01

Burnout is a state of mental and physical exhaustion related to work or care-giving activities. Distress during medical school can lead to burnout, with significant consequences, particularly if burnout continues into residency and beyond. The authors reviewed literature pertaining to medical student burnout, its prevalence, and its relationship to personal, environmental, demographic and psychiatric factors. We ultimately offer some suggestions to address and potentially ameliorate the current dilemma posed by burnout during medical education. A literature review was conducted using a PubMed/Medline, and PsycInfo search from 1974 to 2011 using the keywords: 'burnout', 'stress', 'well-being', 'self-care', 'psychiatry' and 'medical students'. Three authors agreed independently on the studies to be included in this review. The literature reveals that burnout is prevalent during medical school, with major US multi-institutional studies estimating that at least half of all medical students may be affected by burnout during their medical education. Studies show that burnout may persist beyond medical school, and is, at times, associated with psychiatric disorders and suicidal ideation. A variety of personal and professional characteristics correlate well with burnout. Potential interventions include school-based and individual-based activities to increase overall student well-being. Burnout is a prominent force challenging medical students' well-being, with concerning implications for the continuation of burnout into residency and beyond. To address this highly prevalent condition, educators must first develop greater awareness and understanding of burnout, as well as of the factors that lead to its development. Interventions focusing on generating wellness during medical training are highly recommended. © 2013 John Wiley & Sons Ltd.

Medication safety programs in primary care: a scoping review.

Science.gov (United States)

Khalil, Hanan; Shahid, Monica; Roughead, Libby

2017-10-01

Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. The current review considered participants of any age and any condition using care obtained from any primary care services. We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. We considered all quantitative studied published in English. A three-step search strategy was utilized in this review. Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome

Weighing Rain Gauge Recording Charts

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Weighing rain gauge charts record the amount of precipitation that falls at a given location. The vast majority of the Weighing Rain Gauge Recording Charts...

Separation from supported employment: a retrospective chart review study.

Science.gov (United States)

West, Michael; Targett, Pamela; Wehman, Paul; Cifu, Gabriella; Davis, Jacob

2015-01-01

The objective of this study was to examine job separations from supported employment (SE). The aim was to identify the types and nature of separations and precipitating events leading to the separation. A retrospective chart review methodology was utilized. The study was conducted in a metropolitan area in the Southeast United States by a university-based SE program. Participants were 47 SE clients who had been placed into and separated from 67 jobs. Using a coding form, information regarding the type of separation and issues that preceded the separation were recorded. Data were aggregated using descriptive statistics. The largest number of separations was due to termination, followed by resignation and mutual consent of the employer and employee. The mean number of issues leading to the separation was 2.2, ranging from one to five. Only eight positive issues were found (compared to 116 negative and 20 neutral), the most prevalent being entry into an educational or training program. Common negative issues included poor work performance, attendance and punctuality problems, conflicts with the supervisor, and social and behavioral issues. The findings of this study illustrate the need to address job retention issues during the job development process, finding the most appropriate person-job fit and workplace culture for each client. The findings also support the need for vigilant and regular communication between the SE program and employers to intervene quickly when problems arise. Separation from Supported Employment (SE) SE is an evidence-based employment practice that has been shown effective across multiple disability groups. Studying job separations can provide valuable information for improving service. Locating the best person-job fit, as well as frequent contract with employers, can help prevent unnecessary job loss.

“Waiting for DAAs”: A retrospective chart review of patients with untreated hepatitis C in Rwanda

Science.gov (United States)

Gupta, Neil; Kabahizi, Jules; Mukabatsinda, Constance; Walker, Timothy David; Musabeyezu, Emmanuel; Kiromera, Athanase; Steiner, Kevin; Mukherjee, Joia; Nsanzimana, Sabin; Mbituyumuremyi, Aimable

2017-01-01

Background Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs. Methods and findings We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09–1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus. Conclusions Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub

Economic evaluation of pharmacist-led medication reviews in residential aged care facilities.

Science.gov (United States)

Hasan, Syed Shahzad; Thiruchelvam, Kaeshaelya; Kow, Chia Siang; Ghori, Muhammad Usman; Babar, Zaheer-Ud-Din

2017-10-01

Medication reviews is a widely accepted approach known to have a substantial impact on patients' pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities.

NOAA Raster Navigational Charts (RNC)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — NOAA, National Ocean Service, Office of Coast Survey, Marine Chart Division is responsible to build and maintain a suite of more than 1000 nautical charts that are...

Construction and validation of a Tamil logMAR chart.

Science.gov (United States)

Varadharajan, Srinivasa; Srinivasan, Krithica; Kumaresan, Brindha

2009-09-01

To design, construct and validate a new Tamil logMAR visual acuity chart based on current recommendations. Ten Tamil letters of equal legibility were identified experimentally and were used in the chart. Two charts, one internally illuminated and one externally illuminated, were constructed for testing at 4 m distance. The repeatability of the two charts was tested. For validation, the two charts were compared with a standard English logMAR chart (ETDRS). When compared to the ETDRS chart, a difference of 0.06 +/- 0.07 and 0.07 +/- 0.07 logMAR was found for the internally and externally illuminated charts respectively. Limits of agreement between the internally illuminated Tamil logMAR chart and ETDRS chart were found to be (-0.08, 0.19), and (-0.07, 0.20) for the externally illuminated chart. The test - retest results showed a difference of 0.02 +/- 0.04 and 0.02 +/- 0.06 logMAR for the internally and externally illuminated charts respectively. Limits of agreement for repeated measurements for the internally illuminated Tamil logMAR chart were found to be (-0.06, 0.10), and (-0.10, 0.14) for the externally illuminated chart. The newly constructed Tamil logMAR charts have good repeatability. The difference in visual acuity scores between the newly constructed Tamil logMAR chart and the standard English logMAR chart was within acceptable limits. This new chart can be used for measuring visual acuity in the literate Tamil population.

A standardized, uniform and universal dental chart for documenting state of dentition before anaesthesia.

Science.gov (United States)

Gatt, S P; Aurisch, J; Wong, K

2001-02-01

It is vital to have adequate and precise documentation of the condition of a patient's dentition before commencing an anaesthetic. The incidence of dental damage during anaesthesia is not low. To the authors' knowledge, there is no standardized method used by anaesthetists to document the state of a patient's dentition. We propose the introduction of a standardized uniform dental chart to enable anaesthetists to accurately document the condition of their patients' teeth. This vital information can be easily obtained during the preanaesthetic assessment. With the increase in medical litigation and demands for adequate documentation, we believe this chart can become an invaluable part of every hospital's preanaesthetic assessment form. The dental chart is to be offered as a service to anaesthetists in the form of a copyright-free "Freeware" computer diskette or adhesive sticker and will be downloadable from the internet.

Chart Series

Data.gov (United States)

U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) offers several different Chart Series with data on beneficiary health status, spending, operations, and quality...

The development and organizational format of a radiotherapy patient treatment chart

International Nuclear Information System (INIS)

Bynum, S.; McMurry, H.

1989-01-01

An important and time consuming responsibility of the Dosimetrist is to ensure and supervise accurate recording of delivered dose and treatment methods. With the rapidly growing complexity of technology, data, treatment protocol regimens and treatment methods, the need for accurate recording in a clearly arranged fashion has become imperative not only for daily patient treatment, but also for legal purposes. This paper describes the process of designing a patient treatment chart based on a review of charts already in use in various departments and aided by the input of all members of the Radiation Oncology treatment team at University of North Carolina, Chapel Hill

Medication communication through documentation in medical wards: knowledge and power relations.

Science.gov (United States)

Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

2014-09-01

Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals. © 2013 John Wiley & Sons Ltd.

Big Data and Dementia: Charting the Route Ahead for Research, Ethics, and Policy

Directory of Open Access Journals (Sweden)

Marcello Ienca

2018-02-01

Full Text Available Emerging trends in pervasive computing and medical informatics are creating the possibility for large-scale collection, sharing, aggregation and analysis of unprecedented volumes of data, a phenomenon commonly known as big data. In this contribution, we review the existing scientific literature on big data approaches to dementia, as well as commercially available mobile-based applications in this domain. Our analysis suggests that big data approaches to dementia research and care hold promise for improving current preventive and predictive models, casting light on the etiology of the disease, enabling earlier diagnosis, optimizing resource allocation, and delivering more tailored treatments to patients with specific disease trajectories. Such promissory outlook, however, has not materialized yet, and raises a number of technical, scientific, ethical, and regulatory challenges. This paper provides an assessment of these challenges and charts the route ahead for research, ethics, and policy.

Establishment of Electronic Chart-based Stroke Registry System in a Medical System in Taiwan

Directory of Open Access Journals (Sweden)

Tsong-Hai Lee

2011-08-01

Full Text Available To establish a prospective, real-time, self-sustainable stroke registry system, we incorporated a registry with an electronic chart to create an electronic chart-based stroke registry system in November 2006. The International Classification of Diseases Ninth Revision code (430–437 was used to auto-enroll stroke patients admitted to neurology departments. Clinical information was written by doctors, nursing information was recorded by nurses, and basic patient information was entered by administrative departments. Numerical data and the date and time of any studies were auto-downloaded from the hospital computer. In total, 212 items were auto-downloaded, including basic patient information, laboratory blood test and examination results, and the date and time of imaging and special intervention. The stroke scales (121 items, National Institutes of Health Stroke Scale, Barthel index, and modified Rankin scale were designed to be auto-adjusted to reduce incompatibility. The 95 items with pull-down options were used to specify the contents. This registry system can be time-, labor- and money-saving with secured data accuracy.

Radar Chart

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Radar Chart collection is an archived product of summarized radar data. The geographic coverage is the 48 contiguous states of the United States. These hourly...

A systematic review of patient medication error on self-administering medication at home.

Science.gov (United States)

Mira, José Joaquín; Lorenzo, Susana; Guilabert, Mercedes; Navarro, Isabel; Pérez-Jover, Virtudes

2015-06-01

Medication errors have been analyzed as a health professionals' responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients themselves (or their caregivers) make mistakes in the administration of the medication. The epidemiology of patient medication errors (PEs) has been scarcely reviewed in spite of its impact on people, on therapeutic effectiveness and on incremental cost for the health systems. This study reviews and describes the methodological approaches and results of published studies on the frequency, causes and consequences of medication errors committed by patients at home. A review of research articles published between 1990 and 2014 was carried out using MEDLINE, Web-of-Knowledge, Scopus, Tripdatabase and Index Medicus. The frequency of PE was situated between 19 and 59%. The elderly and the preschooler population constituted a higher number of mistakes than others. The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs. The majority of these mistakes have no negative consequences. Health literacy, information and communication and complexity of use of dispensing devices were identified as causes of PEs. Apps and other new technologies offer several opportunities for improving drug safety.

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre.

Science.gov (United States)

Summers, Alexander; Ruderman, Carly; Leung, Fok-Han; Slater, Morgan

2017-09-22

Studies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre. A retrospective chart review of the electronic medical records of the St. Michael's Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed. Among 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%. Trade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees' clinical knowledge and decision-making.

Italian cardiovascular mortality charts of the CUORE project: are they comparable with the SCORE charts?

LENUS (Irish Health Repository)

Donfrancesco, Chiara

2010-08-01

The aim of this study was to build risk charts for the assessment of cardiovascular mortality of the CUORE project, an Italian longitudinal study, and to compare them with the systematic coronary risk evaluation (SCORE) project charts for low risk European countries.

Pharmacist medication reviews to improve safety monitoring in primary care patients.

Science.gov (United States)

Gallimore, Casey E; Sokhal, Dimmy; Zeidler Schreiter, Elizabeth; Margolis, Amanda R

2016-06-01

Patients prescribed psychotropic medications within primary care are at risk of suboptimal monitoring. It is unknown whether pharmacists can improve medication safety through targeted monitoring of at risk populations. Access Community Health Centers implemented a quality improvement pilot project that included pharmacists on an integrated care team to provide medication reviews for patients. Aims were to determine whether inclusion of a pharmacist performing medication reviews within a primary care behavioral health (PCBH) practice is feasible and facilitates safe medication use. Pharmacists performed medication reviews of the electronic health record for patients referred for psychiatry consultation. Reviews were performed 1-3 months following consultation and focused on medications with known suboptimal monitoring rates. Reviews were documented within the EHR and routed to the primary care provider. Primary outcome measures were change in percentage up-to-date on monitoring and AIMS assessment, and at risk of experiencing drug interaction(s) between baseline and 3 months postreview. Secondary outcome was provider opinion of medication reviews collected via electronic survey. Reviews were performed for 144 patients. Three months postreview, percentage up-to-date on recommended monitoring increased 18% (p = .0001), at risk for drug interaction decreased 20% (p improved safety monitoring of psychotropic medications. Results identify key areas for improvement that other clinics considering integration of similar pharmacy services should consider. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Expanding Group Peer Review: A Proposal for Medical Education Scholarship.

Science.gov (United States)

Dumenco, Luba; Engle, Deborah L; Goodell, Kristen; Nagler, Alisa; Ovitsh, Robin K; Whicker, Shari A

2017-02-01

After participating in a group peer-review exercise at a workshop presented by Academic Medicine and MedEdPORTAL editors at the 2015 Association of American Medical Colleges Medical Education Meeting, the authors realized that the way their work group reviewed a manuscript was very different from the way by which they each would have reviewed the paper as an individual. Further, the group peer-review process yielded more robust feedback for the manuscript's authors than did the traditional individual peer-review process. This realization motivated the authors to reconvene and collaborate to write this Commentary to share their experience and propose the expanded use of group peer review in medical education scholarship.The authors consider the benefits of a peer-review process for reviewers, including learning how to improve their own manuscripts. They suggest that the benefits of a team review model may be similar to those of teamwork and team-based learning in medicine and medical education. They call for research to investigate this, to provide evidence to support group review, and to determine whether specific paper types would benefit most from team review (e.g., particularly complex manuscripts, those receiving widely disparate initial individual reviews). In addition, the authors propose ways in which a team-based approach to peer review could be expanded by journals and institutions. They believe that exploring the use of group peer review potentially could create a new methodology for skill development in research and scholarly writing and could enhance the quality of medical education scholarship.

The Conjugate Acid-Base Chart.

Science.gov (United States)

Treptow, Richard S.

1986-01-01

Discusses the difficulties that beginning chemistry students have in understanding acid-base chemistry. Describes the use of conjugate acid-base charts in helping students visualize the conjugate relationship. Addresses chart construction, metal ions, buffers and pH titrations, and the organic functional groups and nonaqueous solvents. (TW)

Comparison of accuracy of physical examination findings in initial progress notes between paper charts and a newly implemented electronic health record.

Science.gov (United States)

Yadav, Siddhartha; Kazanji, Noora; K C, Narayan; Paudel, Sudarshan; Falatko, John; Shoichet, Sandor; Maddens, Michael; Barnes, Michael A

2017-01-01

There have been several concerns about the quality of documentation in electronic health records (EHRs) when compared to paper charts. This study compares the accuracy of physical examination findings documentation between the two in initial progress notes. Initial progress notes from patients with 5 specific diagnoses with invariable physical findings admitted to Beaumont Hospital, Royal Oak, between August 2011 and July 2013 were randomly selected for this study. A total of 500 progress notes were retrospectively reviewed. The paper chart arm consisted of progress notes completed prior to the transition to an EHR on July 1, 2012. The remaining charts were placed in the EHR arm. The primary endpoints were accuracy, inaccuracy, and omission of information. Secondary endpoints were time of initiation of progress note, word count, number of systems documented, and accuracy based on level of training. The rate of inaccurate documentation was significantly higher in the EHRs compared to the paper charts (24.4% vs 4.4%). However, expected physical examination findings were more likely to be omitted in the paper notes compared to EHRs (41.2% vs 17.6%). Resident physicians had a smaller number of inaccuracies (5.3% vs 17.3%) and omissions (16.8% vs 33.9%) compared to attending physicians. During the initial phase of implementation of an EHR, inaccuracies were more common in progress notes in the EHR compared to the paper charts. Residents had a lower rate of inaccuracies and omissions compared to attending physicians. Further research is needed to identify training methods and incentives that can reduce inaccuracies in EHRs during initial implementation. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Medication review in hospitalised patients to reduce morbidity and mortality

DEFF Research Database (Denmark)

Christensen, Mikkel; Lundh, Andreas

2013-01-01

Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug related harms and poorer adherence. The concept of medication review is a key element in improving the quality of prescribing and the prevention of adverse drug events. While no generally...... accepted definition of medication review exists, it can be defined as a systematic assessment of the pharmacotherapy of an individual patient that aims to evaluate and optimise patient medication by a change (or not) in prescription, either by a recommendation or by a direct change. Medication review...

Gendered specialities during medical education: a literature review

NARCIS (Netherlands)

Alers, M.; Leerdam, L. van; Dielissen, P.; Lagro-Janssen, A.

2014-01-01

The careers of male and female physicians indicate gender differences, whereas in medical education a feminization is occurring. Our review aims to specify gender-related speciality preferences during medical education. A literature search on gender differences in medical students' speciality

Difficulties indiagnosis of Asperger’s syndrome – aretrospective chart review

Directory of Open Access Journals (Sweden)

Magdalena Grygo

2013-06-01

Full Text Available Asperger’s syndrome is a neurodevelopmental disorder from the group of autistic spectrum disorders. Objective: The authors describe the group of children diagnosed with Asperger’s syndrome, treated in the Department of Child Psychiatry or in the Child Psychiatry Outpatient Clinic. The aim of the study was to evaluate the patients’ age when they were diagnosed and the reason for seeking the clinician’s help by parents. Method: A retrospective chart review of children (n = 35 diagnosed with Asperger’s syndrome. Age and reason for the first contact with the specialist, number of health facilities where the patient was treated before diagnosis, age at which the diagnosis was made, the period between the patient’s first contact with the specialist and diagnosis, and the first diagnoses in hospitalized children were analysed. Results: The median age of diagnosis was 11.75 ± 3.29 years, 5 ± 3.44 years after the chil‑ dren’s first contact with the specialist (psychiatrist or psychologist. Before the diagnosis, the patients were treated in different health facilities and often diagnosed with attention deficit/hyperactivity disorder or disruptive behaviour. Conclusions: The results may indicate the major diagnostic difficulties which clinicians are facing or may be the result of insufficient knowledge among various groups of specialists on the Asperger’s syndrome. The results were compared to the results of the research conducted in the USA and Great Britain.

Self-Medication Practice with Nonprescription Medication among University Students: a review of the literature

Directory of Open Access Journals (Sweden)

Dedy Almasdy

2011-09-01

Full Text Available Objective: To review the literature relating to self-medicationpractice with nonprescription medication among universitystudents.Methods: A narrative review of studies on self-medicationpractice with nonprescription medication among universitystudent was performed. An extensive literature search wasundertaken using indexing services available at UniversitiSains Malaysia (USM library. The following keywords wereused for the search: self-care, self-medication, over-thecountermedicine, nonprescription medicine, minor illnesses,minor ailment, university population and communitypharmacy. Electronic databases searched were Science Direct,Medline, ISI Web of Knowledge, Inside Web, JSTOR, SpringerLink, Proquest, Ebsco Host and Google Scholar. Theseelectronic databases were searched for full text paperspublished in English.Results: Eleven studies were identified. In general, the reviewhas shown that self-medication practice with nonprescriptionmedication highly prevalence among university students. Thereasons for self-medication are vary among this populationand the main symptoms leading to self-medication areheadache or minor pain; fever, flu, cough, or cold; anddiarrhoea.The common medication is analgesic, antipyreticproducts, cough and cold remedies, anti allergy andvitamins or minerals. The sources of the medicines arepharmacy, home medicine cabinet, supermarket/shopand other person such as family, friend, neighbours andclassmates. The sources of drug information are familymember, previous experience, pharmacy salesman,doctor or nurse, advertisement and others. The reviewalso has shown that the self-medication practice couldhave many problems.Conclusions: The review provides insights about theself-medication practices among the university students.These practices were highly prevalence among universitystudents. The symptoms leading to self-medication arevary, thus the medication used and the medicationsources. It needs an adequate drug information

A multicenter, retrospective chart review study comparing index therapy change rates in open-angle glaucoma or ocular hypertension patients newly treated with latanoprost or travoprost-Z monotherapy.

Science.gov (United States)

Fain, Joel M; Kotak, Sameer; Mardekian, Jack; Bacharach, Jason; Edward, Deepak P; Rauchman, Steven; Brevetti, Teresa; Fox, Janet L; Lovelace, Cherie

2011-06-13

Because latanoprost and the original formulation of travoprost that included benzalkonium chloride (BAK) have been shown to be similar with regard to tolerability, we compared initial topical intraocular pressure (IOP)-lowering medication change rates in patients newly treated with latanoprost or travoprost-Z monotherapy. At 14 clinical practice sites, medical records were abstracted for patients with a diagnosis of open-angle glaucoma or ocular hypertension and who were ≥40 years of age, had a baseline and at least one follow-up visit, and had no prior history of ocular prostaglandin use. Data regarding demographics, ocular/systemic medical histories, clinical variables, therapy initiations and reasons for changes, adverse events, and resource utilization were recorded from randomly chosen eligible charts. Primary outcomes were rates of and reasons for changing from the initial therapy within six months and across the full study period (1000 days). Data from 900 medical charts (latanoprost, 632; travoprost-Z, 268) were included. For both cohorts, average follow-up was >1 year. Cohorts were similar with regard to age (median ~67 years), gender distribution (>50% female), and diagnosis (~80% with open-angle glaucoma). Within six months, rates of index therapy change for latanoprost versus travoprost-Z were 21.2% (134/632) and 28.7% (77/268), respectively (p = 0.0148); across the full study period, rates were 34.5% (218/632) and 45.2% (121/268), respectively (p = 0.0026). Among those who changed their index therapy, insufficient IOP control was the most commonly reported reason followed by adverse events; hyperemia was the most commonly reported adverse event at index therapy change. In this "real world" study of changes in therapy in patients prescribed initial monotherapy with latanoprost with BAK or travoprost-Z with SofZia, medication changes were common in both treatment groups but statistically significantly more frequent with travoprost-Z.

Review of online educational resources for medical physicists.

Science.gov (United States)

Prisciandaro, Joann I

2013-11-04

Medical physicists are often involved in the didactic training of graduate students, residents (both physics and physicians), and technologists. As part of continuing medical education, we are also involved in maintenance of certification projects to assist in the education of our peers. As such, it is imperative that we remain current concerning available educational resources. Medical physics journals offer book reviews, allowing us an opportunity to learn about newly published books in the field. A similar means of communication is not currently available for online educational resources. This information is conveyed through informal means. This review presents a summary of online resources available to the medical physics community that may be useful for educational purposes.

Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations.

Science.gov (United States)

Kraus, Sarah K; Sen, Sanchita; Murphy, Michelle; Pontiggia, Laura

2017-01-01

To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR) program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%), non-formulary omission (16.2%), dose discrepancy (10.1%), and frequency discrepancy (4.1%). Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations

Directory of Open Access Journals (Sweden)

Kraus SK

2017-06-01

Full Text Available Objectives: To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. Methods: A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Results: Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%, non-formulary omission (16.2%, dose discrepancy (10.1%, and frequency discrepancy (4.1%. Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. Conclusion: A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

A systematic review of publications studies on medical tourism.

Science.gov (United States)

Masoud, Ferdosi; Alireza, Jabbari; Mahmoud, Keyvanara; Zahra, Agharahimi

2013-01-01

Medical tourism for any study area is complex. Using full articles from other databases, Institute for Scientific Information (ISI), Science Direct, Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained using descriptive statistics and content analysis categories were analyzed. Among the 28 articles reviewed, 11 cases were a kind of research articles, three cases were case studies in Mexico, India, Hungary, Germany, and Iran, and 14 were case studies, review documents and data were passed. The main topics of study included the definition of medical tourism, medical tourists' motivation and development of medical tourism, ethical issues in medical tourism, and impact on health and medical tourism marketing. The findings indicate the definition of medical tourism in various articles, and medical tourists are motivated. However, most studies indicate the benefits of medical tourism in developing countries and more developed countries reflect the consequences of medical tourism.

Impact of Pharmacist-Conducted Comprehensive Medication Reviews for Older Adult Patients to Reduce Medication Related Problems.

Science.gov (United States)

Kiel, Whitney J; Phillips, Shaun W

2017-12-31

Older adults are demanding increased healthcare attention with regards to prescription use due in large part to highly complex medication regimens. As patients age, medications often have a more pronounced effect on older adults, negatively impacting patient safety and increasing healthcare costs. Comprehensive medication reviews (CMRs) optimize medications for elderly patients and help to avoid inappropriate medication use. Previous literature has shown that such CMRs can successfully identify and reduce the number of medication-related problems and improve acute healthcare utilization. The purpose of this pharmacy resident research study is to examine the impact of pharmacist-conducted geriatric medication reviews to reduce medication-related problems within a leading community health system in southwest Michigan. Furthermore, the study examines type of pharmacist interventions made during medication reviews, acute healthcare utilization, and physician assessment of the pharmacist's value. The study was conducted as a retrospective post-hoc analysis on ambulatory patients who received a CMR by a pharmacist at a primary care practice. Inclusion criteria included patients over 65 years of age with concurrent use of at least five medications who were a recent recipient of a CMR. Exclusion criteria included patients with renal failure, or those with multiple providers involved in primary care. The primary outcome was the difference in number of medication-related problems, as defined by the START and STOPP Criteria (Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons' Prescriptions). Secondary outcomes included hospitalizations, emergency department visits, number and type of pharmacist interventions, acceptance rate of pharmacist recommendations, and assessment of the pharmacist's value by clinic providers. There were a total of 26 patients that received a comprehensive medication review from the pharmacist and were compared to a

Air Emissions Sources, Charts and Maps

Data.gov (United States)

U.S. Environmental Protection Agency — Air Emissions provides (1) interactive charts supporting national, state, or county charts, (2) county maps of criteria air pollutant emissions for a state, and (3)...

Pharmacist-led medication review in an acute admissions unit

DEFF Research Database (Denmark)

Hansen, Trine Graabæk; Bonnerup, Dorthe Krogsgaard; Kjeldsen, Lene Juel

2015-01-01

of principles and methodologies, and the practical procedure is seldom described in detail, which makes reproducing study findings difficult. The objective of this paper is to provide a detailed description of a procedure developed and used for pharmacist-led medication review in acute admissions units......) collection of information about the patient's medical treatment, (3) patient interview, (4) critical examination of the patient's medications and (5) recommendations for the hospital physician.Conclusions We have provided a detailed description of a procedure for pharmacist-led medication review. We do so...

Making SPC easier with zone control charts

International Nuclear Information System (INIS)

Lanning, B.

1995-01-01

The zone control chart is a simple, easy to learn statistical process control (SPC) tool that can be applied to any process where the data are normally distributed. Several Shewhart runs rules are incorporated into a simple scoring system, with a single rule to determine when a process is out of control. Zone charts have average run lengths (ARLs) for detecting shifts in the process mean which, for most cases, are uniformly better than the standard control charts. This paper presents the simplified methodology behind the zone control chart

Google Charts Testing | CRDI - Centre de recherches pour le ...

International Development Research Centre (IDRC) Digital Library (Canada)

Google Charts Testing. The following item is a demo of Google GeoChart. Please note that geo chart can only recognize country name or city name rather than location or address (that is google my map's expertise). Additionally, Geo chart does support title and legend. To render geo chart properly, please get a ...

NOAA Seamless Raster Navigational Charts (RNC)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The NOAA Seamless Raster Chart Server provides a seamless collarless mosaic of the NOAA Raster Navigational Charts (RNC). The RNC are a collection of approximately...

Marketing medicines: charting the rise of modern therapeutics through a systematic review of adverts in UK medical journals (1950-1980).

Science.gov (United States)

Green, A Richard; Haddad, Peter M; Aronson, Jeffrey K

2018-02-14

To examine how pharmaceutical products that were first marketed between 1950 and 1980 were promoted to physicians through advertisements and briefly review advertising regulations and accuracy of the advertisements in the light of modern knowledge. We systematically reviewed advertisements promoting drugs for specific therapeutic areas, namely central nervous system disorders (anxiety and sleep disorders, depression, psychoses, and Parkinson's disease), respiratory disorders, cardiovascular disorders, and gastrointestinal disorders. We examined about 800 issues of the British Medical Journal (1950-1980) and about 150 issues of World Medicine (1965-1984). Advertising material was minimally regulated until the mid-1970s. Many drugs were marketed with little preclinical or clinical knowledge and some with the expectation that prescribers would obtain further data. The peak of advertising occurred in parallel with the surge in the release of novel drugs during the 1960s, but declined markedly after the mid-1970s. Advertisements generally contained little useful prescribing information. The period we investigated saw the release of many novel pharmaceuticals in the therapeutic areas we examined, and many (or their class successors) still play important therapeutic roles, including benzodiazepines, tricyclic antidepressants, phenothiazines, levodopa, selective and non-selective β-adrenoceptor antagonists, thiazide diuretics, β-adrenoceptor agonists, and histamine H 2 receptor antagonists. Advertising pharmaceuticals in the BMJ and World Medicine in 1950-1980 was poorly regulated and often lacked rigour. However, advertisements were gradually modified in the light of increasing clinical pharmacological knowledge, and they reflect an exciting period for the introduction of many drugs that continue to be of benefit today. © 2018 The British Pharmacological Society.

Top Medical Education Studies of 2016: A Narrative Review.

Science.gov (United States)

Fromme, H Barrett; Ryan, Michael S; Darden, Alix; D'Alessandro, Donna M; Mogilner, Leora; Paik, Steve; Turner, Teri L

2018-02-06

Education, like clinical medicine, should be based on the most current evidence in the field. Unfortunately, medical educators can be overwhelmed by the sheer volume and range of resources for this literature. This article provides an overview of 15 articles from 2016 that the authors consider the top articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership and expertise across the continuum of pediatric medical education, used an iterative 3-stage process to review more than 6339 abstracts published in 2016. This process was designed to identify a small subset of articles that were most relevant to educational practices and most applicable to pediatric medical education. In the first 2 stages, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the articles that best met these criteria. In the final stage, all articles were discussed using a group consensus model to select the final articles included in this review. This article presents summaries of the 15 articles that were selected. The results revealed a cluster of studies related to observed standardized clinical encounters, self-assessment, professionalism, clinical teaching, competencies/milestones, and graduate medical education management strategies. We provide suggestions on how medical educators can apply the findings to their own practice and educational settings. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Qualitative Literature Review of the Prevalence of Depression in Medical Students Compared to Students in Non-medical Degrees.

Science.gov (United States)

Bacchi, Stephen; Licinio, Julio

2015-06-01

The purpose of this study is to review studies published in English between 1 January 2000 and 16 June 2014, in peer-reviewed journals, that have assessed the prevalence of depression, comparing medical students and non-medical students with a single evaluation method. The databases PubMed, Medline, EMBASE, PsycINFO, and Scopus were searched for eligible articles. Searches used combinations of the Medical Subject Headings medical student and depression. Titles and abstracts were reviewed to determine eligibility before full-text articles were retrieved, which were then also reviewed. Twelve studies met eligibility criteria. Non-medical groups surveyed included dentistry, business, humanities, nursing, pharmacy, and architecture students. One study found statistically significant results suggesting that medical students had a higher prevalence of depression than groups of non-medical students; five studies found statistically significant results indicating that the prevalence of depression in medical students was less than that in groups of non-medical students; four studies found no statistically significant difference, and two studies did not report on the statistical significance of their findings. One study was longitudinal, and 11 studies were cross-sectional. While there are limitations to these comparisons, in the main, the reviewed literature suggests that medical students have similar or lower rates of depression compared to certain groups of non-medical students. A lack of longitudinal studies meant that potential common underlying causes could not be discerned, highlighting the need for further research in this area. The high rates of depression among medical students indicate the continuing need for interventions to reduce depression.

Strategic Review of Medical Training and Career Structure Interim Report

OpenAIRE

Department of Health (Ireland)

2013-01-01

Click here to download Strategic Review of Medical Training and Career Structure Interim Report PDF 44kb Click here to download Strategic Review of Medical Training and Career Structure Terms of Reference PDF 59KB

A systematic review of publications studies on medical tourism

Science.gov (United States)

Masoud, Ferdosi; Alireza, Jabbari; Mahmoud, Keyvanara; Zahra, Agharahimi

2013-01-01

Introduction: Medical tourism for any study area is complex. Materials and Methods: Using full articles from other databases, Institute for Scientific Information (ISI), Science Direct, Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained using descriptive statistics and content analysis categories were analyzed. Results: Among the 28 articles reviewed, 11 cases were a kind of research articles, three cases were case studies in Mexico, India, Hungary, Germany, and Iran, and 14 were case studies, review documents and data were passed. The main topics of study included the definition of medical tourism, medical tourists’ motivation and development of medical tourism, ethical issues in medical tourism, and impact on health and medical tourism marketing. Conclusion: The findings indicate the definition of medical tourism in various articles, and medical tourists are motivated. However, most studies indicate the benefits of medical tourism in developing countries and more developed countries reflect the consequences of medical tourism. PMID:24251287

Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals

Directory of Open Access Journals (Sweden)

Rasmussen TB

2018-04-01

Full Text Available Thomas Bøjer Rasmussen, Sinna Pilgaard Ulrichsen, Mette Nørgaard Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Background: Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes.Objective: The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses.Materials and methods: We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations.Results: Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals’ estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54. In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease.Conclusion: The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most

prepare_taxa_charts.py: A Python program to automate generation of publication ready taxonomic pie chart images from QIIME.

Science.gov (United States)

Lakhujani, Vijay; Badapanda, Chandan

2017-06-01

QIIME (Quantitative Insights Into Microbial Ecology) is one of the most popular open-source bioinformatics suite for performing metagenome, 16S rRNA amplicon and Internal Transcribed Spacer (ITS) data analysis. Although, it is very comprehensive and powerful tool, it lacks a method to provide publication ready taxonomic pie charts. The script plot_taxa_summary . py bundled with QIIME generate a html file and a folder containing taxonomic pie chart and legend as separate images. The images have randomly generated alphanumeric names. Therefore, it is difficult to associate the pie chart with the legend and the corresponding sample identifier. Even if the option to have the legend within the html file is selected while executing plot_taxa_summary . py , it is very tedious to crop a complete image (having both the pie chart and the legend) due to unequal image sizes. It requires a lot of time to manually prepare the pie charts for multiple samples for publication purpose. Moreover, there are chances of error while identifying the pie chart and legend pair due to random alphanumeric names of the images. To bypass all these bottlenecks and make this process efficient, we have developed a python based program, prepare_taxa_charts . py , to automate the renaming, cropping and merging of taxonomic pie chart and corresponding legend image into a single, good quality publication ready image. This program not only augments the functionality of plot_taxa_summary . py but is also very fast in terms of CPU time and user friendly.

The Significant Incidents and Close Calls in Human Space Flight Chart: Lessons Learned Gone Viral

Science.gov (United States)

Wood, Bill; Pate, Dennis; Thelen, David

2010-01-01

This presentation will explore the surprising history and events that transformed a mundane spreadsheet of historical spaceflight incidents into a popular and widely distributed visual compendium of lessons learned. The Significant Incidents and Close Calls in Human Space Flight Chart (a.k.a. The Significant Incidents Chart) is a popular and visually captivating reference product that has arisen from the work of the Johnson Space Center (JSC) Safety and Mission Assurance (S&MA) Flight Safety Office (FSO). It began as an internal tool intended to increase our team s awareness of historical and modern space flight incidents. Today, the chart is widely recognized across the agency as a reference tool. It appears in several training and education programs. It is used in familiarization training in the JSC Building 9 Mockup Facility and is seen by hundreds of center visitors each week. The chart visually summarizes injuries, fatalities, and close calls sustained during the continuing development of human space flight. The poster-sized chart displays over 100 total events that have direct connections to human space flight endeavors. The chart is updated periodically. The update process itself has become a collaborative effort. Many people, spanning multiple NASA organizations, have provided suggestions for additional entries. The FSO maintains a growing list of subscribers who have requested to receive updates. The presenters will discuss the origins and motivations behind the significant incidents chart. A review of the inclusion criteria used to select events will be offered. We will address how the chart is used today by S&MA and offer a vision of how it might be used by other organizations now and in the future. Particular emphasis will be placed on features of the chart that have met with broad acceptance and have helped spread awareness of the most important lessons in human spaceflight.

Influence of Continuing Medical Education on Rheumatologists' Performance on National Quality Measures for Rheumatoid Arthritis.

Science.gov (United States)

Sapir, Tamar; Rusie, Erica; Greene, Laurence; Yazdany, Jinoos; Robbins, Mark L; Ruderman, Eric M; Carter, Jeffrey D; Patel, Barry; Moreo, Kathleen

2015-12-01

In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists' performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits. Twenty community-based rheumatologists across the United States were recruited to participate in the QI education program and chart audits. Charts were retrospectively audited before (n = 160 charts) and after (n = 160 charts) the rheumatologists participated in a series of accredited QI-focused educational activities that included private audit feedback, small-group webinars, and online- and mobile-accessible print and video activities. The charts were audited for patient demographics and the rheumatologists' documented performance on the 6 quality measures for RA included in the Physician Quality Reporting System (PQRS). In addition, charts were abstracted for documentation of patient counseling about medication benefits/risks and adherence, lifestyle modifications, and quality of life; assessment of RA medication side effects; and assessment of RA medication adherence. Mean rates of documented performance on 4 of the 6 PQRS measures for RA were significantly higher in the post-education versus baseline charts (absolute increases ranged from 9 to 24% of patient charts). In addition, after the intervention, significantly higher mean rates were observed for patient counseling about medications and quality of life, and for assessments of medication side effects and adherence (absolute increases ranged from 9 to 40% of patient charts). This pragmatic study provides preliminary evidence for the positive influence of QI-focused education in helping rheumatologists improve

Comparing Melanoma Invasiveness in Dermatologist- versus Patient-Detected Lesions: A Retrospective Chart Review

Directory of Open Access Journals (Sweden)

Cindy L. Lamerson

2012-01-01

Full Text Available This study examined whether patient-identified melanomas were more advanced than dermatologist-identified tumors at routine clinic visits, and whether a personal or family history of skin cancer was associated with patterns of detection. A retrospective chart review was performed on melanoma patients (N=201 in a private dermatology clinic. Variables included age, gender, pattern of detection (i.e., patient or a board certified dermatologist, personal or family history of skin cancer, skin type, and previous sun exposure, as well as tumor location and severity. Dermatologist-diagnosed melanomas were less invasive (P<0.0005, and more likely present on the chest, back, and legs (P<0.01. Conversely, patient-identified lesions were more likely to occur on the face, neck and scalp, be associated with younger patients, and a family history of melanoma, but not other types of skin cancer (P<0.01. In a post-hoc analysis examining these factors as predictors of tumor invasiveness, only diagnostic source was significant. Specifically, dermatologist-identified tumors were significantly less invasive than patient-identified tumors. Although age, family history, and tumor location played roles in the early detection of melanomas, the most important factor was diagnostic source. Thus, board-certified dermatologists play a key role in the early detection of malignant melanoma.

Medication management policy, practice and research in Australian residential aged care: Current and future directions.

Science.gov (United States)

Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

2017-02-01

Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Qualities of dental chart recording and coding.

Science.gov (United States)

Chantravekin, Yosananda; Tasananutree, Munchulika; Santaphongse, Supitcha; Aittiwarapoj, Anchisa

2013-01-01

Chart recording and coding are the important processes in the healthcare informatics system, but there were only a few reports in the dentistry field. The objectives of this study are to study the qualities of dental chart recording and coding, as well as the achievement of lecture/workshop on this topic. The study was performed by auditing the patient's charts at the TU Dental Student Clinic from July 2011-August 2012. The chart recording mean scores ranged from 51.0-55.7%, whereas the errors in the coding process were presented in the coder part more than the doctor part. The lecture/workshop could improve the scores only in some topics.

The making of Andersen’s liquefaction chart

OpenAIRE

Sabaliauskas, Tomas; Ibsen, Lars Bo

2017-01-01

Andersen’s chart (Andersen & Berre, 1999) is a graphical method of observing cyclic soil response. It allows observing soil response to various stress amplitudes that can lead to liquefaction, excess plastic deformation stabilizing soil response.The process of obtaining the original chart has been improved. Algorithm based approximation is introduced. Pore pressure dependent ultimate bearing capacity normalization factor is introduced to normalize the chart.

[Medical image compression: a review].

Science.gov (United States)

Noreña, Tatiana; Romero, Eduardo

2013-01-01

Modern medicine is an increasingly complex activity , based on the evidence ; it consists of information from multiple sources : medical record text , sound recordings , images and videos generated by a large number of devices . Medical imaging is one of the most important sources of information since they offer comprehensive support of medical procedures for diagnosis and follow-up . However , the amount of information generated by image capturing gadgets quickly exceeds storage availability in radiology services , generating additional costs in devices with greater storage capacity . Besides , the current trend of developing applications in cloud computing has limitations, even though virtual storage is available from anywhere, connections are made through internet . In these scenarios the optimal use of information necessarily requires powerful compression algorithms adapted to medical activity needs . In this paper we present a review of compression techniques used for image storage , and a critical analysis of them from the point of view of their use in clinical settings.

Comparison of reading speed with 3 different log-scaled reading charts.

Science.gov (United States)

Buari, Noor Halilah; Chen, Ai-Hong; Musa, Nuraini

2014-01-01

A reading chart that resembles real reading conditions is important to evaluate the quality of life in terms of reading performance. The purpose of this study was to compare the reading speed of UiTM Malay related words (UiTM-Mrw) reading chart with MNread Acuity Chart and Colenbrander Reading Chart. Fifty subjects with normal sight were randomly recruited through randomized sampling in this study (mean age=22.98±1.65 years). Subjects were asked to read three different near charts aloud and as quickly as possible at random sequence. The charts were the UiTM-Mrw Reading Chart, MNread Acuity Chart and Colenbrander Reading Chart, respectively. The time taken to read each chart was recorded and any errors while reading were noted. Reading performance was quantified in terms of reading speed as words per minute (wpm). The mean reading speed for UiTM-Mrw Reading Chart, MNread Acuity Chart and Colenbrander Reading Chart was 200±30wpm, 196±28wpm and 194±31wpm, respectively. Comparison of reading speed between UiTM-Mrw Reading Chart and MNread Acuity Chart showed no significant difference (t=-0.73, p=0.72). The same happened with the reading speed between UiTM-Mrw Reading Chart and Colenbrander Reading Chart (t=-0.97, p=0.55). Bland and Altman plot showed good agreement between reading speed of UiTM-Mrw Reading Chart with MNread Acuity Chart with the Colenbrander Reading Chart. UiTM-Mrw Reading Chart in Malay language is highly comparable with standardized charts and can be used for evaluating reading speed. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

HydroHillChart – Francis module. Software used to Calculate the Hill Chart of the Francis Hydraulic Turbines

Directory of Open Access Journals (Sweden)

Dorian Nedelcu

2015-07-01

Full Text Available The paper presents the Hydro Hill Chart - Francis module application, used to calculate the hill chart of the Pelton, Francis and Kaplan hydraulic turbine models, by processing the data measured on the stand. After describing the interface and menu, the input data is graphically presented and the universal characteristic for measuring scenarios ao=const. and n11=const is calculated. Finally, the two calculated hill charts are compared through a graphical superimposition of the isolines.

Transmission Line Adapted Analytical Power Charts Solution

Science.gov (United States)

Sakala, Japhet D.; Daka, James S. J.; Setlhaolo, Ditiro; Malichi, Alec Pulu

2017-08-01

The performance of a transmission line has been assessed over the years using power charts. These are graphical representations, drawn to scale, of the equations that describe the performance of transmission lines. Various quantities that describe the performance, such as sending end voltage, sending end power and compensation to give zero voltage regulation, may be deduced from the power charts. Usually required values are read off and then converted using the appropriate scales and known relationships. In this paper, the authors revisit this area of circle diagrams for transmission line performance. The work presented here formulates the mathematical model that analyses the transmission line performance from the power charts relationships and then uses them to calculate the transmission line performance. In this proposed approach, it is not necessary to draw the power charts for the solution. However the power charts may be drawn for the visual presentation. The method is based on applying derived equations and is simple to use since it does not require rigorous derivations.

The Adverse Drug Event Collaborative: a joint venture to measure medication-related patient harm.

Science.gov (United States)

Seddon, Mary E; Jackson, Aaron; Cameron, Chris; Young, Mary L; Escott, Linda; Maharaj, Ashika; Miller, Nigel

2012-01-25

To measure the extent of patient harm caused by medications (rate of Adverse Drug Events) in three DHBs, using a standardised trigger tool method. Counties Manukau, Capital and Coast and Canterbury DHBs decided to work collaboratively to implement the ADE Trigger Tool (TT). Definitions of ADE were agreed on and triggers refined. A random sample of closed charts (from March 2010 to February 2011) was obtained excluding patients who were admitted for <48 hours, children under the age of 18 and psychiatric admissions. In each DHB trained reviewers scanned these in a structured way to identify any of the 19 triggers. If triggers were identified, a more detailed, though time-limited review of the chart was done to determine whether an ADE had occurred. The severity of patient harm was categorised using the National Coordinating Council for Medication Error Reporting and Prevention Index. No attempt was made to determine preventability of harm and ADEs from acts of omission were excluded. The ADE TT was applied to 1210 charts and 353 ADE were identified, with an average rate of 28.9/100 admissions and 38/1,000 bed days. 94.5% of the ADE identified were in the lower severity scales with temporary harm, however in 5 patients it was considered that the ADE contributed to their death, 9 required an intervention to sustain life and 4 suffered permanent harm. The most commonly implicated drugs were morphine and other opioids, anticoagulants, antibiotics, Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and diuretics. Patients who suffered an ADE were more likely to be female, older with more complex medical illnesses, and have a longer length of stay. The rate of medication-related harm identified by the ADE TT is considerably higher than that identified through traditional voluntary reporting mechanisms. The ADE TT provides a standardised measure of harm over time that can be used to determine trends and the effect of medication safety improvement programmes. This study not

Chart of the nuclides - Strasbourg 1990

International Nuclear Information System (INIS)

Antony, M.S.

1991-01-01

Data were compiled for a nuclide chart over the last two years. The compilation is complete to the end of September 1990. The chart includes about 30000 data. Decay modes are represented by colours. Announcement capabilities and prices are given. (G.P.) 3 refs

Obtaining the Andersen's chart, triangulation algorithm

DEFF Research Database (Denmark)

Sabaliauskas, Tomas; Ibsen, Lars Bo

Andersen’s chart (Andersen & Berre, 1999) is a graphical method of observing cyclic soil response. It allows observing soil response to various stress amplitudes that can lead to liquefaction, excess plastic deformation or stabilizing soil response. The process of obtaining the original chart has...

49 CFR 236.718 - Chart, dog.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Chart, dog. 236.718 Section 236.718 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF... OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Definitions § 236.718 Chart, dog. A...

Resource utilization in children with tuberous sclerosis complex and associated seizures: a retrospective chart review study.

Science.gov (United States)

Lennert, Barb; Farrelly, Eileen; Sacco, Patricia; Pira, Geraldine; Frost, Michael

2013-04-01

Seizures are a hallmark manifestation of tuberous sclerosis complex, yet data characterizing resource utilization are lacking. This retrospective chart review was performed to assess the economic burden of tuberous sclerosis complex with neurologic manifestations. Demographic and resource utilization data were collected for 95 patients for up to 5 years after tuberous sclerosis complex diagnosis. Mean age at diagnosis was 3.1 years, with complex partial and infantile spasms as the most common seizure types. In the first 5 years post-diagnosis, 83.2% required hospitalization, 30.5% underwent surgery, and the majority of patients (90.5%) underwent ≥3 testing procedures. In 79 patients with a full 5 years of data, hospitalizations, intensive care unit stays, diagnostic testing, and rehabilitation services decreased over the 5-year period. Resource utilization is cost-intensive in children with tuberous sclerosis complex and associated seizures during the first few years following diagnosis. Improving seizure control and reducing health care costs in this population remain unmet needs.

Book Reviews | Naidu | South African Medical Journal

African Journals Online (AJOL)

Book Review 1. Book Title: The Histogenesis of Thyroid Cancer. Book Author: N Simionescu. Illustrated. £9.0.0. London: William Heinemann Medical Books. 1970. Book Review 2. Book Title: The Hypertensive Vascular Crisis. An experimental study. Book Author: F.B. Byrom. Illustrated. £1.10.0. London: William Heinemann ...

U.S. Pacific Command > Organization > Organization Chart

Science.gov (United States)

Responsibility USPACOM Previous Commanders Organization Organization Chart Media News Flickr Photos Video Directory Media Inquiries Home : Organization : Organization Chart About DoD DoD Careers Join the Military

Smart Book Charts

Science.gov (United States)

Chinnapongse, Ronald L.

2015-01-01

Smart book charts for TPSM: Heatshield for Extreme Entry Environment Technology (HEEET), Conformal Ablative TPS (CA-TPS), 3D Woven Multifunctional Ablative TPS (3D MAT), and Adaptable, Deployable, Entry and Placement Technology (ADEPT).

Evaluation of medical records maintenance quality in dental medical organizations of Kazan

Directory of Open Access Journals (Sweden)

A K Lapina

2018-02-01

Full Text Available Aim. Improvement of the quality control of dental medical organizations when diagnosing dentoalveolar anomalies and deformities. Methods. A retrospective analysis of an orthodontic patient’s medical record maintenance at the dental clinics of Kazan. Results. Only 30.7% of all the verified documentation were established to be most thoroughly and correctly filled. Information about the obligatory medical insurance policy was indicated only in 2 cards out of all the verified documentation. In all orthodontic patient medical records the fringe benefit category code was absent. The name of the insurance organization in which a patient was unsured, was available only in 2.3% of the cards. Patient’s passport data were available only in 14 (15.9% cards, and the type of payment for services was registered only in 38 (43.2%. The diagnosis established by a referring medical organization was indicated only in 7 (8% of the records. When examining the dental rows of patients, their dimensions and apical bases of the jaws, the shape of the dentition were indicated in 40.9% of the documentation. The contact of adjacent teeth was described in 36.4% of all cases, presence of diastema between the upper jaw incisors was represented in 30.7% of the medical charts of orthodontic patients. The diastema between the lower jaw incisors was reflected in 25 (28.4% medical charts of orthodontic patients. Based on the doctor’s notes in the medical records, it is difficult to understand whether the whole necessary list of diagnostic measures had been performed to the patient in order to confirm this or that orthodontic pathology. Such filling of the medical chart of orthodontic patient at times makes the experts doubt in the correctness of diagnosis of a certain patient. Conclusion. Doctors-orthodontists do not pay enough attention to the collection of anamnesis of the disease, evaluation of the nature of complaints, as well as use of basic and additional methods of

Chart of the nuclides

International Nuclear Information System (INIS)

Yoshizawa, Y.; Horiguchi, T.; Yamada, M.

1980-01-01

In this chart, four colors are use to classify nuclides according to their half-lives. The different symbols are also to show the decay modes and their percentage in each nuclide. Four tables are provided on the back of the chart. Table 1 is the ordinary periodic Table. Table 2 provides fundamental constants used for nuclear physics. Tables 3 lists the physical constants (mean density, ionization potential, melting point, and boiling point) of all elements. Table 4 provides the gamma-ray intensity standards. Half-lives, energy, relative intensity, and intensity per decay are list for 33 nuclides. (J.P.N.)

Electroconvulsive therapy for treating schizophrenia: a chart review of patients from two catchment areas

DEFF Research Database (Denmark)

Kristensen, Diana; Bauer, Jeanett; Pedersen, Ida Hageman

2011-01-01

To examine disease and treatment characteristics of patients with schizophrenia treated with electroconvulsive therapy (ECT). We examined charts from 79 patients diagnosed with schizophrenia (n = 55), persistent delusional disorders (n = 7), and schizoaffective disorders (n = 17) between 2003...

Eligibility criteria in systematic reviews published in prominent medical journals: a methodological review.

Science.gov (United States)

McCrae, Niall; Purssell, Edward

2015-12-01

Clear and logical eligibility criteria are fundamental to the design and conduct of a systematic review. This methodological review examined the quality of reporting and application of eligibility criteria in systematic reviews published in three leading medical journals. All systematic reviews in the BMJ, JAMA and The Lancet in the years 2013 and 2014 were extracted. These were assessed using a refined version of a checklist previously designed by the authors. A total of 113 papers were eligible, of which 65 were in BMJ, 17 in The Lancet and 31 in JAMA. Although a generally high level of reporting was found, eligibility criteria were often problematic. In 67% of papers, eligibility was specified after the search sources or terms. Unjustified time restrictions were used in 21% of reviews, and unpublished or unspecified data in 27%. Inconsistency between journals was apparent in the requirements for systematic reviews. The quality of reviews in these leading medical journals was high; however, there were issues that reduce the clarity and replicability of the review process. As well as providing a useful checklist, this methodological review informs the continued development of standards for systematic reviews. © 2015 John Wiley & Sons, Ltd.

47 CFR 73.333 - Engineering charts.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false Engineering charts. 73.333 Section 73.333 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES FM Broadcast Stations § 73.333 Engineering charts. This section consists of the following Figures 1, 1a, 2, and...

Inclusion of extremes of prematurity in ventricular index centile charts.

Science.gov (United States)

Boyle, M; Shim, R; Gnanasekaran, R; Tarrant, A; Ryan, S; Foran, A; McCallion, N

2015-06-01

To assess the relationship between ventricular index (VI) measurements and postmenstrual age in preterm infants and to generate centile charts and normal ranges for frontal horn ratio (FHR) for a large contemporary cohort of preterm infants. A retrospective cohort study of 253 infants with birth gestation less than 32 weeks admitted between January 2009 and December 2011 to a tertiary NICU in Ireland. A total of 816 cranial ultrasounds were reviewed. Data collected were grouped according to postmenstrual age at the time of scan from 23 weeks to 45 weeks. Median values for VI show a general trend to increase with gestation. FHR did not significantly change with postmenstrual age at scan with a median value of 0.31. There is a slight increase in VI as gestation at the time of scans increases. These results provide the basis for updated centile charts which we propose for current practice.

A multicenter, retrospective chart review study comparing index therapy change rates in open-angle glaucoma or ocular hypertension patients newly treated with latanoprost or travoprost-Z monotherapy

Directory of Open Access Journals (Sweden)

Edward Deepak P

2011-06-01

Full Text Available Abstract Background Because latanoprost and the original formulation of travoprost that included benzalkonium chloride (BAK have been shown to be similar with regard to tolerability, we compared initial topical intraocular pressure (IOP-lowering medication change rates in patients newly treated with latanoprost or travoprost-Z monotherapy. Methods At 14 clinical practice sites, medical records were abstracted for patients with a diagnosis of open-angle glaucoma or ocular hypertension and who were ≥40 years of age, had a baseline and at least one follow-up visit, and had no prior history of ocular prostaglandin use. Data regarding demographics, ocular/systemic medical histories, clinical variables, therapy initiations and reasons for changes, adverse events, and resource utilization were recorded from randomly chosen eligible charts. Primary outcomes were rates of and reasons for changing from the initial therapy within six months and across the full study period (1000 days. Results Data from 900 medical charts (latanoprost, 632; travoprost-Z, 268 were included. For both cohorts, average follow-up was >1 year. Cohorts were similar with regard to age (median ~67 years, gender distribution (>50% female, and diagnosis (~80% with open-angle glaucoma. Within six months, rates of index therapy change for latanoprost versus travoprost-Z were 21.2% (134/632 and 28.7% (77/268, respectively (p = 0.0148; across the full study period, rates were 34.5% (218/632 and 45.2% (121/268, respectively (p = 0.0026. Among those who changed their index therapy, insufficient IOP control was the most commonly reported reason followed by adverse events; hyperemia was the most commonly reported adverse event at index therapy change. Conclusions In this "real world" study of changes in therapy in patients prescribed initial monotherapy with latanoprost with BAK or travoprost-Z with SofZia, medication changes were common in both treatment groups but statistically

Two-dimensional phase fraction charts

International Nuclear Information System (INIS)

Morral, J.E.

1984-01-01

A phase fraction chart is a graphical representation of the amount of each phase present in a system as a function of temperature, composition or other variable. Examples are phase fraction versus temperature charts used to characterize specific alloys and as a teaching tool in elementary texts, and Schaeffler diagrams used to predict the amount of ferrite in stainless steel welds. Isothermal-transformation diagrams (TTT diagrams) are examples that give phase (or microconstituent) amount versus temperature and time. The purpose of this communication is to discuss the properties of two-dimensional phase fraction charts in more general terms than have been reported before. It is shown that they can represent multi-component, multiphase equilibria in a way which is easier to read and which contains more information than the isotherms and isopleths of multi-component phase diagrams

Barograms / Barograph Charts

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Barograms are weekly rectangular charts recording barometric pressure at a given station. The barograph is an instrument that makes a continuous pen and ink trace of...

Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review

Science.gov (United States)

Shahid, Abu SMSB; Shahunja, K. M.; Bardhan, Pradip Kumar; Faruque, Abu Syeed Golam; Shahrin, Lubaba; Das, Sumon Kumar; Barua, Dipesh Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

2017-01-01

Background Severely malnourished children aged under five years requiring hospital admission for diarrheal illness frequently develop ileus during hospitalization with often fatal outcomes. However, there is no data on risk factors and outcome of ileus in such children. We intended to evaluate predictive factors for ileus during hospitalization and their outcomes. Methodology/Principal findings This was a retrospective chart review that enrolled severely malnourished children under five years old with diarrhea, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh between April 2011 and August 2012. We used electronic database to have our chart abstraction from previously admitted children in the hospital. The clinical and laboratory characteristics of children with (cases = 45), and without ileus (controls = 261) were compared. Cases were first identified by observation of abnormal bowel sounds on physical examination and confirmed with abdominal radiographs. For this comparison, Chi-square test was used to measure the difference in proportion, Student’s t-test to calculate the difference in mean for normally distributed data and Mann-Whitney test for data that were not normally distributed. Finally, in identifying independent risk factors for ileus, logistical regression analysis was performed. Ileus was defined if a child developed abdominal distension and had hyperactive or sluggish or absent bowel sound and a radiologic evidence of abdominal gas-fluid level during hospitalization. Logistic regression analysis adjusting for potential confounders revealed that the independent risk factors for admission for ileus were reluctance to feed (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.24–8.39, p = 0.02), septic shock (OR = 3.62, 95% CI = 1.247–8.95, pp = 0.04). Mortality was significantly higher in cases compared to controls (22% vs. 8%, pp = 0.20). In a separate regression analysis model, after

Assessment of the use of xerogenic medications for chronic medical and dental conditions among adult day health participants.

Science.gov (United States)

Lam, Annie; Kiyak, Asuman; Gossett, Allison M; McCormick, Lawrence

2009-10-01

To describe the health conditions, dental problems, and use of xerogenic medications among dental patients in adult day health (ADH) centers. Cross-sectional descriptive study. ADH centers in King County, Washington. ADH clients who were patients of a mobile dental service. Pharmacist-conducted chart reviews and in-person medication reviews with patients. Demographic description, mean numbers of medical and dental problems, medications, xerogenic medications used per subject, and identification of xerogenic medications by therapeutic class. At five sites, 97 patients were interviewed (average age 73.8 +/- 11.8 years, 61% female); ethnicities included: Asian-American (37.1%), Caucasian (30.9%), Russian (29%), and African-American (3%). Mean numbers of chronic health problems, medications, and xerogenic medications per patient were 5.2 +/- 2.7, 10.9 +/- 4.4, and 3.3 +/- 1.8, respectively. Antidepressants were the most commonly used xerogenic medication, followed by antipsychotics, antiemetics, analgesics, and antihistamines. Among 74 patients who received dental treatment, 33 (44.6%) wore dentures. Among 58 patients with teeth, a mean number of 2.8 dental problems per patient was identified. Dental caries (51.7%) was the most prevalent problem, followed by periodontitis (29.3%), soft tissue lesions (10.3%), gingivitis (5.2%), and candidiasis (3.4%). Multiple systemic diseases, use of multiple xerogenic medications, and poor oral health were prevalent among the ADH clients in this study. However, self-reports of dry mouth were unrelated to number of xerogenic medications or oral conditions. Further research is needed to determine the association between self-reported dry mouth, chronic health conditions, use of xerogenic medications, tooth loss, and/or denture use.

15 CFR 738.3 - Commerce Country Chart structure.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Commerce Country Chart structure. 738.3 Section 738.3 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade... COMMERCE CONTROL LIST OVERVIEW AND THE COUNTRY CHART § 738.3 Commerce Country Chart structure. (a) Scope...

Preparation of exposures charts for X-ray tubes

International Nuclear Information System (INIS)

Zoofan, B.

1988-01-01

An exposure chart is a fundamental graph which provides guidance of the exposure conditions in relation to the thickness for a given specimen. It must be prepared specially for the X-ray unit and the type of the film to be used. Although exposure charts are available for each particular X-ray tube from its manufacturer, individual radiographic laboratory should be able to prepare its own exposure charts in a precise manner. Here a typical procedure to prepare such a chart is provided in a practical way with some necessary recommendations

A PIP chart for nuclear plant safety

International Nuclear Information System (INIS)

Suzuki, Tatsujiro; Yamaoka, Taiji

1992-01-01

While it is known that social and political aspects of nuclear safety issues are important, little study has been done on identifying the breadth of stakeholders whose policies have important influences over nuclear plant safety in a comprehensive way. The objectives of this study are to develop a chart that visually identifies important stakeholders and their policies and illustrates these influences in a hierarchical representation so that the relationship between stakeholders and nuclear safety will be better understood. This study is based on a series of extensive interviews with major stakeholders, such as nuclear plant managers, corporate planning vice presidents, state regulators, news media, and public interest groups, and focuses on one US nuclear power plant. Based on the interview results, the authors developed a conceptual policy influence paths (PIP) chart. The PIP chart illustrates the hierarchy of influence among stakeholders. The PIP chart is also useful in identifying possible stakeholders who can be easily overlooked without the PIP chart. In addition, it shows that influence flow is circular rather than linear in one direction

Methods to achieve high interrater reliability in data collection from primary care medical records.

Science.gov (United States)

Liddy, Clare; Wiens, Miriam; Hogg, William

2011-01-01

We assessed interrater reliability (IRR) of chart abstractors within a randomized trial of cardiovascular care in primary care. We report our findings, and outline issues and provide recommendations related to determining sample size, frequency of verification, and minimum thresholds for 2 measures of IRR: the κ statistic and percent agreement. We designed a data quality monitoring procedure having 4 parts: use of standardized protocols and forms, extensive training, continuous monitoring of IRR, and a quality improvement feedback mechanism. Four abstractors checked a 5% sample of charts at 3 time points for a predefined set of indicators of the quality of care. We set our quality threshold for IRR at a κ of 0.75, a percent agreement of 95%, or both. Abstractors reabstracted a sample of charts in 16 of 27 primary care practices, checking a total of 132 charts with 38 indicators per chart. The overall κ across all items was 0.91 (95% confidence interval, 0.90-0.92) and the overall percent agreement was 94.3%, signifying excellent agreement between abstractors. We gave feedback to the abstractors to highlight items that had a κ of less than 0.70 or a percent agreement less than 95%. No practice had to have its charts abstracted again because of poor quality. A 5% sampling of charts for quality control using IRR analysis yielded κ and agreement levels that met or exceeded our quality thresholds. Using 3 time points during the chart audit phase allows for early quality control as well as ongoing quality monitoring. Our results can be used as a guide and benchmark for other medical chart review studies in primary care.

Medical hyperspectral imaging: a review

Science.gov (United States)

Lu, Guolan; Fei, Baowei

2014-01-01

Abstract. Hyperspectral imaging (HSI) is an emerging imaging modality for medical applications, especially in disease diagnosis and image-guided surgery. HSI acquires a three-dimensional dataset called hypercube, with two spatial dimensions and one spectral dimension. Spatially resolved spectral imaging obtained by HSI provides diagnostic information about the tissue physiology, morphology, and composition. This review paper presents an overview of the literature on medical hyperspectral imaging technology and its applications. The aim of the survey is threefold: an introduction for those new to the field, an overview for those working in the field, and a reference for those searching for literature on a specific application. PMID:24441941

Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

Science.gov (United States)

Berghout, Mathilde A; Fabbricotti, Isabelle N; Buljac-Samardžić, Martina; Hilders, Carina G J M

2017-01-01

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness.

Science.gov (United States)

de la Garza, Santiago; Phuoc, Vania; Throneberry, Steven; Blumenthal-Barby, Jennifer; McCullough, Laurence; Coverdale, John

2017-08-01

One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials. Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous. None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.

What motivates medical students to select medical studies: a systematic literature review.

Science.gov (United States)

Goel, Sonu; Angeli, Federica; Dhirar, Nonita; Singla, Neetu; Ruwaard, Dirk

2018-01-17

There is a significant shortage of health workers across and within countries. It is of utmost importance to determine the factors that motivate students to opt for medical studies. The objective of this study is to group and review all the studies that investigated the motivational factors that underpin students' selection of medical study in recent years. The literature search was carried out by two researchers independently in PubMed, Google Scholar, Wiley and IndMED databases for articles published from year 2006 till 2016. A total of 38 combinations of MeSH words were used for search purpose. Studies related to medical students and interns have been included. The application of inclusion and exclusion criteria and PRISMA guidelines for reporting systematic review led to the final selection of 24 articles. The majority of the studies (n = 16; 66.6%) were from high-income countries followed by an equal number from upper-middle and lower-middle income countries (n = 4,16.7%). None of the studies were from low-income countries. All of the studies were cross-sectional in nature. The main motivating factors that emerged were scientific (interest in science / medicine, social interest and academia, flexible work hours and work independence), societal (prestige, job security, financial security) and humanitarian (serving the poor and under priviledged) in high-, upper-middle and lower-middle income countries, respectively. The findings were comparable to Maslow's hierarchy of needs theory of motivation. This systematic review identifies the motivational factors influencing students to join medical studies in different parts of the globe. These factors vary per country depending on the level of income. This study offers cues to policy makers and educators to formulate policy in order to tackle the shortage of health workers, i.e. medical doctors. However, more research is needed to translate health policy into concrete and effective measures.

Digital Mapping Charting and Geodesy analysis Program (DMAP) Review of Technical Initiatives for FY03

National Research Council Canada - National Science Library

Breckenridge, John

2003-01-01

The Naval DMAP serves as a technical representative for the Oceanographer of the Navy, NO96 to address significant issues relevant to the Navy's use and development of digital Mapping, Charting & Geodesy (MC&G) data...

High-dose estrogen as salvage hormonal therapy for highly refractory metastatic breast cancer: a retrospective chart review.

Science.gov (United States)

Mahtani, Reshma L; Stein, Alisha; Vogel, Charles L

2009-01-01

High-dose estrogens (HDEs) are an efficacious but widely overlooked treatment option for patients with metastatic breast cancer (MBC). This is due in part to the introduction of tamoxifen in the 1970s, which was proven to be equivalent in efficacy and associated with fewer adverse events (AEs). The aim of this study was to report our experience with the use of HDE in postmenopausal women with advanced breast cancer. Local institutional review board approval was obtained to conduct a retrospective chart review of patients with MBC treated with HDEs at the Boca Raton Comprehensive Cancer Center, Boca Raton, Florida, from 2001 through March 2009. Demographic information, response rates, and tolerability profiles were collected. Of the 426 patients with MBC identified, we found 26 patients with MBC who were prescribed HDEs as a treatment in any line of therapy for advanced breast cancer. The median age at the start of HDE therapy was 59 years (range, 42-92 years). Three of the 26 patients (11.5%) were human epidermal growth factor receptor 2-positive determined via fluorescent in situ hybridization analysis. With the exception of 1 patient who had received no prior systemic treatment for metastatic disease, all patients received multiple lines of treatment (both chemotherapy and hormonal treatments) in the advanced setting (median, 7 lines; range, 0-12) prior to the initiation of HDE. Five of 20 patients (25%) with measurable metastatic disease (visceral and/or soft tissue metastases) had objective antitumor responses defined as either a partial response (PR) or a complete response (CR). Four additional patients (20%) had prolonged stable disease (SD) for > or =6 months. Three of 6 patients (50%) with nonmeasurable metastatic disease (bone-only) had prolonged SD for > or =6 months. Clinical benefit rate (defined as CR + PR + SD > or =6 months) for all patients was 46% (12/26), with a median duration of 10 months. Overall median progression-free survival for the 26

Evaluation of statistical control charts for on-line radiation monitoring

International Nuclear Information System (INIS)

Hughes, L.D.; DeVol, T.A.

2008-01-01

Statistical control charts are presented for the evaluation of time series radiation counter data from flow cells used for monitoring of low levels of 99 TcO 4 - in environmental solutions. Control chart methods consisted of the 3-sigma (3σ) chart, the cumulative sum (CUSUM) chart, and the exponentially weighted moving average (EWMA) chart. Each method involves a control limit based on the detector background which constitutes the detection limit. Both the CUSUM and EWMA charts are suitable to detect and estimate sample concentration requiring less solution volume than when using a 3? control chart. Data presented here indicate that the overall accuracy and precision of the CUSUM method is the best. (author)

Stocking chart for upland central hardwoods

Science.gov (United States)

Martin E. Dale; Donald E. Hilt

1989-01-01

The upland hardwoods stocking chart, introduced by Gingrich in 1967, has become one of the forest manager's most useful tools. The chart allows you to determine the condition of the present stand in relation to a stocking standard. The stocking of a stand is extremely helpful in prescribing various silvicultural treatments such as intermediate thinnings,...

Enhanced identification of eligibility for depression research using an electronic medical record search engine.

Science.gov (United States)

Seyfried, Lisa; Hanauer, David A; Nease, Donald; Albeiruti, Rashad; Kavanagh, Janet; Kales, Helen C

2009-12-01

Electronic medical records (EMRs) have become part of daily practice for many physicians. Attempts have been made to apply electronic search engine technology to speed EMR review. This was a prospective, observational study to compare the speed and clinical accuracy of a medical record search engine vs. manual review of the EMR. Three raters reviewed 49 cases in the EMR to screen for eligibility in a depression study using the electronic medical record search engine (EMERSE). One week later raters received a scrambled set of the same patients including 9 distractor cases, and used manual EMR review to determine eligibility. For both methods, accuracy was assessed for the original 49 cases by comparison with a gold standard rater. Use of EMERSE resulted in considerable time savings; chart reviews using EMERSE were significantly faster than traditional manual review (p=0.03). The percent agreement of raters with the gold standard (e.g. concurrent validity) using either EMERSE or manual review was not significantly different. Using a search engine optimized for finding clinical information in the free-text sections of the EMR can provide significant time savings while preserving clinical accuracy. The major power of this search engine is not from a more advanced and sophisticated search algorithm, but rather from a user interface designed explicitly to help users search the entire medical record in a way that protects health information.

Square chart of nuclides with the best coordinates

International Nuclear Information System (INIS)

Wang Yuying

2001-01-01

It analyzes upper limiting feature of even Z=60-82 in different charts of nuclides. It has illustrated that the break line of upper limiting Z=60-82 in the chart of nucleus with proton number Z and neutron number N, parameters Z and H (=N-Z), two new parameters S(=2Z-N) and H, and parameters K (=S-H) and H, in proper order, it shows that the break line trends from the left lower to the right upper, the line alternates with horizontal and vertical, and the line trends from the right lower to the left upper. Here it finds that the square chart of nuclides places the middle among these charts. It shows that nuclei distribution is concentrated, so are scope of whole region of nuclides in the different charts of nuclides

The role of the electronic medical record (EMR in care delivery development in developing countries: a systematic review

Directory of Open Access Journals (Sweden)

Faustine Williams

2008-07-01

Conclusions The potential of EMR systems to transform medical care practice has been recognised over the past decades, including the enhancement of healthcare delivery and facilitation of decisionmaking processes. Some benefits of an EMR system include accurate medication lists, legible notes and prescriptions and immediately available charts. In spite of challenges facing the developing world such as lack of human expertise and financial resource, most studies have shown how feasible it could be with support from developed nations to design and implement an EMR system that fits into this environment.

The cost of bariatric medical tourism on the Canadian healthcare system.

Science.gov (United States)

Sheppard, Caroline E; Lester, Erica L W; Karmali, Shahzeer; de Gara, Christopher J; Birch, Daniel W

2014-05-01

Medical tourists are defined as individuals who intentionally travel from their home province/country to receive medical care. Minimal literature exists on the cost of postoperative care and complications for medical tourists. The costs associated with these patients were reviewed. Between February 2009 and June 2013, 62 patients were determined to be medical tourists. Patients were included if their initial surgery was performed between January 2003 and June 2013. A chart review was performed to identify intervention costs sustained upon their return. Conservatively, the costs of length of stay (n = 657, $1,433,673.00), operative procedures (n = 110, $148,924.30), investigations (n = 700, $214,499.06), blood work (n = 357, $19,656.90), and health professionals' time (n = 76, $17,414.87) were summated to the total cost of $1.8 million CAD. The absolute denominator of patients who go abroad for bariatric surgery is unknown. Despite this, a substantial cost is incurred because of medical tourism. Future investigations will analyze the cost effectiveness of bariatric surgery conducted abroad compared with local treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

Color Charts, Esthetics, and Subjective Randomness

Science.gov (United States)

Sanderson, Yasmine B.

2012-01-01

Color charts, or grids of evenly spaced multicolored dots or squares, appear in the work of modern artists and designers. Often the artist/designer distributes the many colors in a way that could be described as "random," that is, without an obvious pattern. We conduct a statistical analysis of 125 "random-looking" art and design color charts and…

The evolving story of medical emergency teams in quality improvement.

Science.gov (United States)

Amaral, André Carlos Kajdacsy-Balla; Shojania, Kaveh G

2009-01-01

Adverse events affect approximately 3% to 12% of hospitalized patients. At least a third, but as many as half, of such events are considered preventable. Detection of these events requires investments of time and money. A report in a recent issue of Critical Care used the medical emergency team activation as a trigger to perform a prospective standardized evaluation of charts. The authors observed that roughly one fourth of calls were related to a preventable adverse event, which is comparable to the previous literature. However, while previous studies relied on retrospective chart reviews, this study introduced the novel element of real-time characterization of events by the team at the moment of consultation. This methodology captures important opportunities for improvements in local care at a rate far higher than routine incident-reporting systems, but without requiring substantial investments of additional resources. Academic centers are increasingly recognizing engagement in quality improvement as a distinct career pathway. Involving such physicians in medical emergency teams will likely facilitate the dual roles of these as a clinical outreach arm of the intensive care unit and in identifying problems in care and leading to strategies to reduce them.

Minimal impact of an electronic medical records system.

Science.gov (United States)

Tall, Jill M; Hurd, Marie; Gifford, Thomas

2015-05-01

Electronic medical records (EMRs) implementation in hospitals and emergency departments (EDs) is becoming increasingly more common. The purpose of this study was to determine the impact of an EMR system on patient-related factors that correlate to ED workflow efficiency. A retrospective chart review assessed monthly census reports of all patients who registered and were treated to disposition during conversion from paper charts to an EMR system. The primary outcome measurement was an analysis of the time of registration to discharge or total ED length of stay as well as rate of those who left without being seen, eloped, or left against medical advice. These data were recorded from 3 periods, for 18 months: before installation of the EMR system (pre-EMR), during acclimation to the EMR, and post acclimation (post-EMR). A total of 61626 individual patient records were collected and analyzed. The total ED length of stay across all patient subtypes was not significantly affected by the installation of the hospital-wide EMR system (P = .481); however, a significant decrease was found for patients who were admitted to the hospital from the ED (P .25). Installation of a hospital-wide EMR system had minimal impact on workflow efficiency parameters in an ED. Copyright © 2015 Elsevier Inc. All rights reserved.

Conflations of Marital Status and Sanity: Implicit Heterosexist Bias in Psychiatric Diagnosis in Physician-Dictated Charts at a Midwestern Medical Center

Science.gov (United States)

Metzl, Jonathan M.; McClelland, Sara I.; Bergner, Erin

2016-01-01

This paper discusses the role of gender role conformity in psychiatric determinants of well-being after of the depathologization of homosexuality from the DSM. In order to examine the heterosexualizing of sanity in U.S. psychiatric and popular cultures, we analyze archived psychiatrist-dictated patient charts from outpatient psychiatric clinics from a Midwestern medical center (n = 45). We highlight ways physicians deployed heteronormative gender expectations to describe and treat women’s and men’s depressive illness and implicitly construed troubled female-male relationships and sexual encounters as indices of psychopathology. We theorize how evolving connections between the heteronormal and the psychiatric normal performed some of the same regulatory functions, as did the DSM, coding particular gender performances and partner choices as mentally healthy while relegating others to the realm of disease. Only here, focusing on the mainstream instead of the marginalized kept the ideological work of these scripts hidden from view. PMID:27354850

"Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

LENUS (Irish Health Repository)

Walsh, E K

2012-02-01

Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

"Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

LENUS (Irish Health Repository)

Walsh, E K

2010-09-01

Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

Review of Designs for Haptic Data Visualization.

Science.gov (United States)

Paneels, Sabrina; Roberts, Jonathan C

2010-01-01

There are many different uses for haptics, such as training medical practitioners, teleoperation, or navigation of virtual environments. This review focuses on haptic methods that display data. The hypothesis is that haptic devices can be used to present information, and consequently, the user gains quantitative, qualitative, or holistic knowledge about the presented data. Not only is this useful for users who are blind or partially sighted (who can feel line graphs, for instance), but also the haptic modality can be used alongside other modalities, to increase the amount of variables being presented, or to duplicate some variables to reinforce the presentation. Over the last 20 years, a significant amount of research has been done in haptic data presentation; e.g., researchers have developed force feedback line graphs, bar charts, and other forms of haptic representations. However, previous research is published in different conferences and journals, with different application emphases. This paper gathers and collates these various designs to provide a comprehensive review of designs for haptic data visualization. The designs are classified by their representation: Charts, Maps, Signs, Networks, Diagrams, Images, and Tables. This review provides a comprehensive reference for researchers and learners, and highlights areas for further research.

Research trends in studies of medical students' characteristics: a scoping review.

Science.gov (United States)

Jung, Sung Soo; Park, Kwi Hwa; Roh, HyeRin; Yune, So Jung; Lee, Geon Ho; Chun, Kyunghee

2017-09-01

The purpose of this study is to investigate domestic and international research trends in studies of medical students' characteristics by using the scoping review methods. This study adopted the scoping review to assess papers on the characteristics of medical students. The procedure of research was carried out according to the five steps of the scoping review. The full texts of 100 papers are obtained and are read closely, after which suitable 88 papers are extracted by us for this research. The review is mapped by the year of the study, source, location, author, research design, research subject, objective, and key results. The frequency is analyzed by using Microsoft Excel and SPSS. We found 70 papers (79.5%) on a single medical school, 15 (17.0%) on multiple medical schools, and three (3.4%) on mixed schools, including medical and nonmedical schools. Sixty-nine (79.5%) were cross-sectional studies and 18 (20.5%) were longitudinal studies. Eighty-two papers (93.2%) adopted questionnaire surveys. We summarized research trends of studies on medical students in Korea and overseas by topic, and mapped them into physical health, mental health, psychological characteristics, cognitive characteristics, social characteristics, and career. This study provides insights into the future directions of research for the characteristics of medical students.

Research trends in studies of medical students’ characteristics: a scoping review

Science.gov (United States)

2017-01-01

The purpose of this study is to investigate domestic and international research trends in studies of medical students’ characteristics by using the scoping review methods. This study adopted the scoping review to assess papers on the characteristics of medical students. The procedure of research was carried out according to the five steps of the scoping review. The full texts of 100 papers are obtained and are read closely, after which suitable 88 papers are extracted by us for this research. The review is mapped by the year of the study, source, location, author, research design, research subject, objective, and key results. The frequency is analyzed by using Microsoft Excel and SPSS. We found 70 papers (79.5%) on a single medical school, 15 (17.0%) on multiple medical schools, and three (3.4%) on mixed schools, including medical and nonmedical schools. Sixty-nine (79.5%) were cross-sectional studies and 18 (20.5%) were longitudinal studies. Eighty-two papers (93.2%) adopted questionnaire surveys. We summarized research trends of studies on medical students in Korea and overseas by topic, and mapped them into physical health, mental health, psychological characteristics, cognitive characteristics, social characteristics, and career. This study provides insights into the future directions of research for the characteristics of medical students. PMID:28870017

Research trends in studies of medical students’ characteristics: a scoping review

Directory of Open Access Journals (Sweden)

Sung Soo Jung

2017-09-01

Full Text Available The purpose of this study is to investigate domestic and international research trends in studies of medical students’ characteristics by using the scoping review methods. This study adopted the scoping review to assess papers on the characteristics of medical students. The procedure of research was carried out according to the five steps of the scoping review. The full texts of 100 papers are obtained and are read closely, after which suitable 88 papers are extracted by us for this research. The review is mapped by the year of the study, source, location, author, research design, research subject, objective, and key results. The frequency is analyzed by using Microsoft Excel and SPSS. We found 70 papers (79.5% on a single medical school, 15 (17.0% on multiple medical schools, and three (3.4% on mixed schools, including medical and nonmedical schools. Sixty-nine (79.5% were cross-sectional studies and 18 (20.5% were longitudinal studies. Eighty-two papers (93.2% adopted questionnaire surveys. We summarized research trends of studies on medical students in Korea and overseas by topic, and mapped them into physical health, mental health, psychological characteristics, cognitive characteristics, social characteristics, and career. This study provides insights into the future directions of research for the characteristics of medical students.

A new Snellen's visual acuity chart with 'Indian' numerals.

OpenAIRE

Al-Salem, M

1987-01-01

'Indian' numerals, which are popular among the Arab population, were used to devise a new Snellen's visual acuity chart. The new chart has the advantages of a reading chart. It keeps the patient's interest, does not miss alexic patients, and is quicker to perform. It is also devoid of the many disadvantages of a kinetic response chart (the capital E letter or Landolt's broken rings), especially that of the limited option of test objects.

MEDICAL AUDIT OF CHILDREN WITH AMBIGUOUS GENITALIA- REVIEW OF CHILDREN TREATED OVER 18 YEARS

Directory of Open Access Journals (Sweden)

Praburam P. M

2015-10-01

Full Text Available Introduction: The survival of a newborn or a child presenting with ambiguous genitalia depends upon the timely diagnosis and institution of appropriate medical care. We undertook this study with the aim to determine if appropriate clinical and confirmatory diagnosis was arrived on time and if the treatment instituted was relevant and satisfactory. Methods: All children who were evaluated for ambiguous genitalia under the Department of Pediatric Endocrinology over the preceding 18 years were invited for a review. Data including time taken to make a clinical diagnosis, time taken to confirm the diagnosis, reasons for delay if any, and appropriateness of the sex assigned for rearing and treatment instituted were collected from the charts. Patients were evaluated for adequacy of response to treatment, compliance, problems encountered if any and subjective parental satisfaction. Results: A total of 165 children were diagnosed to have conditions with ambiguous genitalia and were called for a review. 33 children attended the review. 15 were being raised as boys and 18 as girls. 12 children had virilising congenital adrenal hyperplasia (CAH, 6 had cryptorchidism, 6 had hypospadias, 3 had complete and 1 had partial testicular feminisation, 2 had mixed gonadal dysgenesis (MGD, 2 had hypogonadism and 1 was a true hermaphrodite. An appropriate clinical diagnosis was made in 30childrenon the day one and a final confirmatory diagnosis was made within a month in 23. Conclusion: In most conditions presenting with ambiguous genitalia, a clinical and confirmatory diagnosis can be made in a short duration. Initiation of appropriate treatment results in favourable outcomes in terms of growth sexual identity and adaptation.

Karlsruhe nuclide chart - new 9. edition 2015

Energy Technology Data Exchange (ETDEWEB)

Soti, Zsolt [European Commission, Joint Research Centre (JRC), Institute for Transuranium Elements (ITU), Postfach 2340, DE-76125 Karlsruhe, (Germany); Magill, Joseph; Pfennig, Gerda; Derher, Raymond [Nucleonica GmbH, c/o European Commission, Postfach 2340, DE-76125 Karlsruhe, (Germany)

2015-07-01

Following the success of the 8. Edition of the Karlsruhe Nuclide Chart 2012, a new edition is planned for 2015. Since the 2012 edition, more than 100 nuclides have been discovered and about 1400 nuclides have been updated. In summary, the new 9. edition contains decay and radiation data on approximately 3230 ground state nuclides and 740 isomers from 118 chemical elements. The accompanying booklet provides a detailed explanation of the nuclide box structure used in the Chart. An expanded section contains many additional nuclide decay schemes to aid the user to interpret the highly condensed information in the nuclide boxes. The booklet contains - in addition to the latest values of the physical constants and physical properties - a periodic table of the elements, tables of new and updated nuclides, and a difference chart showing the main changes in the Chart graphically. (authors)

Karlsruhe nuclide chart - new 9. edition 2015

International Nuclear Information System (INIS)

Soti, Zsolt; Magill, Joseph; Pfennig, Gerda; Derher, Raymond

2015-01-01

Following the success of the 8. Edition of the Karlsruhe Nuclide Chart 2012, a new edition is planned for 2015. Since the 2012 edition, more than 100 nuclides have been discovered and about 1400 nuclides have been updated. In summary, the new 9. edition contains decay and radiation data on approximately 3230 ground state nuclides and 740 isomers from 118 chemical elements. The accompanying booklet provides a detailed explanation of the nuclide box structure used in the Chart. An expanded section contains many additional nuclide decay schemes to aid the user to interpret the highly condensed information in the nuclide boxes. The booklet contains - in addition to the latest values of the physical constants and physical properties - a periodic table of the elements, tables of new and updated nuclides, and a difference chart showing the main changes in the Chart graphically. (authors)

WE-AB-201-02: TPS Commissioning and QA: A Process Orientation and Application of Control Charts

International Nuclear Information System (INIS)

Sharpe, M.

2015-01-01

. The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG #5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations

WE-AB-201-02: TPS Commissioning and QA: A Process Orientation and Application of Control Charts

Energy Technology Data Exchange (ETDEWEB)

Sharpe, M. [The Princess Margaret Cancer Centre - UHN (Canada)

2015-06-15

. The recommendations of MPPG #5 and practical implementation strategies (Jennifer Smilowitz) The recently published recommendations from Task Group No. 244, Medical Physics Practice Guideline on Commissioning and QA of Treatment Planning Dose Calculations: Megavoltage Photon and Electron Beams will be presented. The recommendations focus on the validation of commissioning data and dose calculations. Tolerance values for non-IMRT beam configurations are summarized based on established criteria and data collected by the IROC. More stringent evaluation criteria for IMRT dose calculations are suggested to test the limitations of the TPS dose algorithms for advanced delivery conditions. The MPPG encourages users to create a suite of validation tests for dose calculation for various conditions for static photon beams, heterogeneities, IMRT/VMAT and electron beams. This test suite is intended to be used for subsequent testing, including TPS software upgrades. In the past, the recommendations of some reports have not been widely implemented due to practical limitations. Implementation strategies, tools and processes developed by multiple centers for efficient and “do-able” MPPG #5 testing will be presented, as well as a discussion on the overall validation experience. Learning Objectives: Identify some of the key documents relevant for TPS commissioning and QA Understand strategies for testing TPS software Gain a practical knowledge of the Gamma test criteria Increase familiarity with the process of commissioning a TPS Learn about the use of Control Charts for TPS QA Review the role of the TPS in the overall planning process Increase awareness of the link between TPS QA and chart checking Gain an increased appreciation for the importance of interdisciplinary communication Understand the new recommendations from MPPG #5 on TPS Dose Algorithm Commissioning and QC/QA Learn practical implementation processes and tools for MPPG #5 validation recommendations.

Speech Recognition for Medical Dictation: Overview in Quebec and Systematic Review.

Science.gov (United States)

Poder, Thomas G; Fisette, Jean-François; Déry, Véronique

2018-04-03

Speech recognition is increasingly used in medical reporting. The aim of this article is to identify in the literature the strengths and weaknesses of this technology, as well as barriers to and facilitators of its implementation. A systematic review of systematic reviews was performed using PubMed, Scopus, the Cochrane Library and the Center for Reviews and Dissemination through August 2017. The gray literature has also been consulted. The quality of systematic reviews has been assessed with the AMSTAR checklist. The main inclusion criterion was use of speech recognition for medical reporting (front-end or back-end). A survey has also been conducted in Quebec, Canada, to identify the dissemination of this technology in this province, as well as the factors leading to the success or failure of its implementation. Five systematic reviews were identified. These reviews indicated a high level of heterogeneity across studies. The quality of the studies reported was generally poor. Speech recognition is not as accurate as human transcription, but it can dramatically reduce turnaround times for reporting. In front-end use, medical doctors need to spend more time on dictation and correction than required with human transcription. With speech recognition, major errors occur up to three times more frequently. In back-end use, a potential increase in productivity of transcriptionists was noted. In conclusion, speech recognition offers several advantages for medical reporting. However, these advantages are countered by an increased burden on medical doctors and by risks of additional errors in medical reports. It is also hard to identify for which medical specialties and which clinical activities the use of speech recognition will be the most beneficial.

An Artist in the University Medical Center. Review.

Science.gov (United States)

James, A. Everette, Jr.

1991-01-01

Reviews "An Artist in the University Medical Center" (M. Lesser, New Orleans: Tulane University Press, 1989), in which the artist captures the human side of the complex Tulane Medical Center in New Orleans (Louisiana). The interplay of drawings, etchings, watercolors, and prose conveys traditions of nurturing in the hospital. (SLD)

Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward

DEFF Research Database (Denmark)

Buck, Thomas Croft; Gronkjaer, Louise Smed; Duckert, Marie-Louise

2013-01-01

OBJECTIVE: Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians' in obtaining medication histories by performing medication reconciliation an...... reconciliation and focused medication reviews. Further randomized, controlled studies including a larger number of patients are required to elucidate whether these observations are of significance and of importance for securing patient safety....... and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients. METHODS: This observational study was conducted over a 7 week period in the geriatric ward at Odense...... University Hospital, Denmark. Two pharmacy technicians conducted medication reconciliation and prescribing reviews at the time of patients' admission to the ward. The reviews were conducted according to standard operating procedures developed by a clinical pharmacist and approved by the Head of the Geriatric...

Inaccurate Dental Charting in an Audit of 1128 General Dental Practice Records.

Science.gov (United States)

Brown, Nathan L; Jephcote, Victoria E L

2017-03-01

Fourteen dentists at different practices in the UK assessed the dental charts of 1128 patients who were new to the dentist but not new to the practice; 44% of the dental charts were found to be inaccurate. Inaccuracy of the individual practice-based charts ranged between 16% for the best performing practices to 83% for the worst: 5% of dental charts had too many teeth charted and 5% had too few teeth charted; 13% of charts had missed amalgam restorations and 18% had missed tooth-coloured restorations; 5% of charts had amalgam restorations recorded but with the surfaces incorrect (eg an MO restoration charted but a DO restoration actually present); 9% of charts had tooth-coloured restoration surfaces incorrectly recorded. For 7.5% of charts, amalgams were charted but not actually present. Other inaccuracies were also noted. The authors reinforce the requirements of the GDC, the advice of defence organizations, and the forensic importance of accurate dental charts. Clinical relevance: Dental charting forms part of the patient’s dental records, and the GDC requires dentists to maintain complete and accurate dental records.

A Review of Long-Term Pain Relief after Genicular Nerve Radiofrequency Ablation in Chronic Knee Osteoarthritis.

Science.gov (United States)

Iannaccone, Ferdinand; Dixon, Samuel; Kaufman, Andrew

2017-03-01

Studies of radiofrequency ablation (RFA) of genicular nerves have reportedly significantly decreased pain up to 3 months post ablation, but no longer term effects have been reported. We performed an analysis of long-term pain relief of 31 RFA procedures of the genicular nerves to analyze the degree of pain relief past 3 months, culminating at 6 months. Chart review and study design was approved by Newark Health Sciences Institutional Review Board (IRB). Chart review and follow-up was performed on all patients who underwent genicular nerve RFA during the period of February 2014 through August of 2015. During this inclusion period 41 genicular nerve RFAs were performed on 31 patients, 5 patients received RFA procedure in both knees. Patient follow-up was performed via telephone interview or in-office visit at least 3 months and 6 months post RFA. Procedures were performed in Medical Special Procedures at University Hospital in Newark, NJ, and the Pain Management Center at Overlook Medical Arts Center in Summit, NJ. Chart review and study design was approved by Newark Health Sciences IRB. Chart review was performed from February 2014 and continued through August 2015. Patient follow-up was conducted at 3 and at least 6 months post treatment to gauge degree of pain relief (0 - none, 100% - complete), their current day's pain score, other treatment modalities tried before RFA, and the medications used. Patients were asked to quantify their satisfaction with procedure length, pre-procedure anxiety, complications, and if they would recommend this procedure to others. Primary and secondary goals were the duration of pain relief after RFA, the quality of pain relief, and the efficacy of our approach for RFA of genicular nerves versus prior published techniques. At 3 month follow-up, the average pain relief was 67% improvement from baseline knee pain, 0% being no relief and 100% being complete relief, and average 0 - 10 pain score was 2.9. At 6 month follow-up, of those who

User compliance with documenting on a track and trigger-based observation and response chart: a two-phase multi-site audit study.

Science.gov (United States)

Elliott, Doug; Allen, Emily; McKinley, Sharon; Perry, Lin; Duffield, Christine; Fry, Margaret; Gallagher, Robyn; Iedema, Rick; Roche, Michael

2017-12-01

To examine user compliance and completeness of documentation with a newly designed observation and response chart and whether a rapid response system call was triggered when clinically indicated. Timely recognition and responses to patient deterioration in hospital general wards remain a challenge for healthcare systems globally. Evaluating practice initiatives to improve recognition and response are required. Two-phase audit. Following introduction of the charts in ten health service sites in Australia, an audit of chart completion was conducted during a short trial for initial usability (Phase 1; 2011). After chart adoption as routine use in practice, retrospective and prospective chart audits were conducted (Phase 2; 2012). Overall, 818 and 1,058 charts were audited during the two phases respectively. Compliance was mixed but improved with the new chart (4%-14%). Contrary to chart guidelines, numbers rather than dots were written in the graphing section in 60% of cases. Rates of recognition of abnormal vital signs improved slightly with new charts in use, particularly for higher levels of surveillance and clinical review. Based on local calling criteria, an emergency call was initiated in 33% of cases during the retrospective audit and in 41% of cases with the new chart. User compliance was less than optimal, limiting full function of the chart sections and compliance with local calling criteria. Overcoming apparent behavioural and work culture barriers may improve chart completion, aiding identification of abnormal vital signs and triggering a rapid response system activation when clinical deterioration is detected. © 2017 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

Directory of Open Access Journals (Sweden)

Alagiakrishnan K

2016-01-01

Full Text Available Kannayiram Alagiakrishnan,1 Patricia Wilson,2 Cheryl A Sadowski,3 Darryl Rolfson,1 Mark Ballermann,4,5 Allen Ausford,6,7 Karla Vermeer,7 Kunal Mohindra,8 Jacques Romney,9 Robert S Hayward10 1Department of Medicine, Division of Geriatric Medicine, 2Department of Medicine, 3Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 4Chief Medical Information Office, Alberta Health Services, 5Division of Critical Care, Department of Medicine, University of Alberta, 6Department of Family Medicine, University of Alberta, 7Lynwood Family Physician, 8eClinician EMR, Alberta Health Services-Information Systems, 9Department of Medicine, Division of Endocrinology, 10Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada Background: Elderly people (aged 65 years or more are at increased risk of polypharmacy (five or more medications, inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS within an electronic medical record (EMR could improve medication safety.Methods: Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR. The “Seniors Medication Alert and Review Technologies” (SMART intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages and active (order-entry alerts prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed.Results: Analysis of

Tactile acuity charts: a reliable measure of spatial acuity.

Science.gov (United States)

Bruns, Patrick; Camargo, Carlos J; Campanella, Humberto; Esteve, Jaume; Dinse, Hubert R; Röder, Brigitte

2014-01-01

For assessing tactile spatial resolution it has recently been recommended to use tactile acuity charts which follow the design principles of the Snellen letter charts for visual acuity and involve active touch. However, it is currently unknown whether acuity thresholds obtained with this newly developed psychophysical procedure are in accordance with established measures of tactile acuity that involve passive contact with fixed duration and control of contact force. Here we directly compared tactile acuity thresholds obtained with the acuity charts to traditional two-point and grating orientation thresholds in a group of young healthy adults. For this purpose, two types of charts, using either Braille-like dot patterns or embossed Landolt rings with different orientations, were adapted from previous studies. Measurements with the two types of charts were equivalent, but generally more reliable with the dot pattern chart. A comparison with the two-point and grating orientation task data showed that the test-retest reliability of the acuity chart measurements after one week was superior to that of the passive methods. Individual thresholds obtained with the acuity charts agreed reasonably with the grating orientation threshold, but less so with the two-point threshold that yielded relatively distinct acuity estimates compared to the other methods. This potentially considerable amount of mismatch between different measures of tactile acuity suggests that tactile spatial resolution is a complex entity that should ideally be measured with different methods in parallel. The simple test procedure and high reliability of the acuity charts makes them a promising complement and alternative to the traditional two-point and grating orientation thresholds.

Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review.

Science.gov (United States)

Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe; Skou Thomsen, Ann Sofia; Konge, Lars

2015-07-27

Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence. To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. Based on inclusion criteria, 52 studies were included in this review. These studies assessed a total of 6520 apps. Studies dealt with a variety of medical specialties and topics. As much as 28 studies assessed expert involvement, which was found in 9-67% of the assessed apps. Thirty studies (including 6 studies that also assessed expert involvement) assessed adherence of app content to current medical evidence. Thirteen studies found that 10-87% of the assessed apps adhered fully to the compared evidence (published studies, recommendations, and guidelines). Seventeen studies found that none of the assessed apps (n=2237) adhered fully to the compared evidence. Most medical mobile phone apps lack expert involvement and do not adhere to relevant medical evidence.

Customized versus population-based birth weight charts for the detection of neonatal growth and perinatal morbidity in a cross-sectional study of term neonates.

Science.gov (United States)

Carberry, Angela E; Raynes-Greenow, Camille H; Turner, Robin M; Jeffery, Heather E

2013-10-15

Customized birth weight charts that incorporate maternal characteristics are now being adopted into clinical practice. However, there is controversy surrounding the value of these charts in the prediction of growth and perinatal outcomes. The objective of this study was to assess the use of customized charts in predicting growth, defined by body fat percentage, and perinatal morbidity. A total of 581 term (≥37 weeks' gestation) neonates born in Sydney, Australia, in 2010 were included. Body fat percentage measurements were taken by using air displacement plethysmography. Objective composite measurements of perinatal morbidity were used to identify neonates who had poor outcomes; these data were extracted from medical records. The value of customized charts was assessed by calculating positive predictive values, negative predictive values, and odds ratios with 95% confidence intervals. Customized versus population-based charts did not improve the prediction of either low body fat percentage (59% vs. 66% positive predictive value and 87% vs. 89% negative predictive value, respectively) or high body fat percentage (48% vs. 53% positive predictive value and 90% vs. 89% negative predictive value, respectively). Customized charts were not better than population-based charts at predicting perinatal morbidity (for customized charts, odds ratio = 1.02, 95% confidence interval: 1.01, 1.04; for population-based charts, odds ratio = 1.03, 95% confidence interval: 1.01, 1.05) per percentile decrease in birth weight. Customized birth weight charts do not provide significant improvements over population-based charts in predicting neonatal growth and morbidity.

Memory-type control charts for monitoring the process dispersion

NARCIS (Netherlands)

Abbas, N.; Riaz, M.; Does, R.J.M.M.

2014-01-01

Control charts have been broadly used for monitoring the process mean and dispersion. Cumulative sum (CUSUM) and exponentially weighted moving average (EWMA) control charts are memory control charts as they utilize the past information in setting up the control structure. This makes CUSUM and

National Forecast Charts

Science.gov (United States)

code. Press enter or select the go button to submit request Local forecast by "City, St" or Prediction Center on Twitter NCEP Quarterly Newsletter WPC Home Analyses and Forecasts National Forecast to all federal, state, and local government web resources and services. National Forecast Charts

The medication process in a psychiatric hospital

DEFF Research Database (Denmark)

Soerensen, Ann Lykkegaard; Lisby, Marianne; Nielsen, Lars Peter

2013-01-01

Purpose: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. Methods: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits in the w......Purpose: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. Methods: A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits...... in the wards collecting dispensed drugs; and (3) chart reviews. All errors, except errors in discharge summaries, were assessed for potential consequences by two clinical pharmacologists. Setting: Three psychiatric wards with adult patients at Aalborg University Hospital, Denmark, from January 2010–April 2010...... process are common in psychiatric wards to an extent which resembles error rates in somatic care. Despite a substantial proportion of errors with potential to harm patients, very few errors were considered potentially fatal. Medical staff needs greater awareness of medication safety and guidelines related...

A Review of Medical Emergencies in Dental Practice | Uyamadu ...

African Journals Online (AJOL)

A Review of Medical Emergencies in Dental Practice. ... are those adverse medical events that may present in the course of dental treatment. ... be available in a dental clinic, outline the prevention and management of such emergencies, ...

Medication-overuse headache: a perspective review

Science.gov (United States)

Westergaard, Maria Lurenda; Munksgaard, Signe Bruun; Bendtsen, Lars; Jensen, Rigmor Højland

2016-01-01

Medication-overuse headache (MOH) is a debilitating condition in which frequent and prolonged use of medication for the acute treatment of pain results in the worsening of the headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1–2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic medication. Stress reduction and lifestyle interventions may support the change towards rational pain medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health. PMID:27493718

A New Attribute Control Chart using Multiple Dependent State Repetitive Sampling

KAUST Repository

Aldosari, Mansour Sattam; Aslam, Muhammad; Jun, Chi-Hyuck

2017-01-01

In this manuscript, a new attribute control chart using multiple dependent state repetitive sampling is designed. The operational procedure and structure of the proposed control chart is given. The required measures to determine the average run length (ARL) for in-control and out-of-control processes are given. Tables of ARLs are reported for various control chart parameters. The proposed control chart is more sensitive in detecting a small shift in the process as compared to the existing attribute control charts. The simulation study shows the efficiency of the proposed chart over the existing charts. An example is given for the illustration purpose.

A New Attribute Control Chart using Multiple Dependent State Repetitive Sampling

KAUST Repository

Aldosari, Mansour Sattam

2017-03-25

In this manuscript, a new attribute control chart using multiple dependent state repetitive sampling is designed. The operational procedure and structure of the proposed control chart is given. The required measures to determine the average run length (ARL) for in-control and out-of-control processes are given. Tables of ARLs are reported for various control chart parameters. The proposed control chart is more sensitive in detecting a small shift in the process as compared to the existing attribute control charts. The simulation study shows the efficiency of the proposed chart over the existing charts. An example is given for the illustration purpose.

HydroHillChart – Pelton module. Software used to Calculate the Hill Chart of the Pelton Hydraulic Turbines

OpenAIRE

Dorian Nedelcu; Adelina Bostan; Florin Peris-Bendu

2015-01-01

The paper presents the HydroHillChart - Pelton module application, used to calculate the hill chart of the Pelton hydraulic turbine models, by processing the data measured on the stand. In addition, the tools offered by the application such as: interface, menu, input data, numerical and graphical results, etc. are described.

Screening efficacy of a simplified logMAR chart

Directory of Open Access Journals (Sweden)

Naganathan Muthuramalingam

2016-04-01

Aim: This study evaluates the efficacy of a simplified logMAR chart, designed for VA testing over the conventional Snellen chart, in a school-based vision-screening programme. Methods: We designed a simplified logMAR chart by employing the principles of the Early Treatment Diabetic Retinopathy Study (ETDRS chart in terms of logarithmic letter size progression, inter-letter spacing, and inter-line spacing. Once the simplified logMAR chart was validated by students in the Elite school vision-screening programme, we set out to test the chart in 88 primary and middle schools in the Tiruporur block of Kancheepuram district in Tamil Nadu. One school teacher in each school was trained to screen a cross-sectional population of 10 354 primary and secondary school children (girls: 5488; boys: 4866 for VA deficits using a new, simplified logMAR algorithm. An experienced paediatric optometrist was recruited to validate the screening methods and technique used by the teachers to collect the data. Results: The optometrist screened a subset of 1300 school children from the total sample. The optometrist provided the professional insights needed to validate the clinical efficacy of the simplified logMAR algorithm and verified the reliability of the data collected by the teachers. The mean age of children sampled for validation was 8.6 years (range: 9–14 years. The sensitivity and the specificity of the simplified logMAR chart when compared to the standard logMAR chart were found to be 95% and 98%, respectively. Kappa value was 0.97. Sensitivity of the teachers’ screening was 66.63% (95% confidence interval [CI]: 52.73–77.02 and the specificity was 98.33% (95% CI: 97.49–98.95. Testing of VA was done under substandard illumination levels in 87% of the population. A total of 10 354 children were screened, 425 of whom were found to have some form of visual and/or ocular defect that was identified by the teacher or optometrist. Conclusion: The simplified logMAR testing algorithm

Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit.

Science.gov (United States)

Lazaryan, Moran; Abu-Kishk, Ibrahim; Rosenfeld-Yehoshua, Noa; Berkovitch, Sofia; Toledano, Michal; Reshef, Iris; Kanari, Tal; Ziv-Baran, Tomer; Berkovitch, Matitiahu

2016-01-01

One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available. To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU). A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded. The review time for one medical record was 8.9 (95% CI, 6.9-10.9) min. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11) min. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8) and 12 (9-15) min, respectively, for patients with psychiatric-neurologic disorders compared to those without (p = 0.032). Usually, a daily workload of 240 min was needed for the pharmacist accompanying the round in contrast to 108 min per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9%, and made no comment on 36.9% of the recommendations. Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

The making of Andersen’s liquefaction chart

DEFF Research Database (Denmark)

Sabaliauskas, Tomas; Ibsen, Lars Bo

Andersen’s chart (Andersen & Berre, 1999) is a graphical method of observing cyclic soil response. It allows observing soil response to various stress amplitudes that can lead to liquefaction, excess plastic deformation stabilizing soil response.The process of obtaining the original chart has been...

47 CFR 73.699 - TV engineering charts.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false TV engineering charts. 73.699 Section 73.699 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Television Broadcast Stations § 73.699 TV engineering charts. This section consists of the following Figures...

Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.

Science.gov (United States)

Fried, Terri R; Niehoff, Kristina M; Street, Richard L; Charpentier, Peter A; Rajeevan, Nallakkandi; Miller, Perry L; Goldstein, Mary K; O'Leary, John R; Fenton, Brenda T

2017-10-01

To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. Randomized clinical trial. Primary care clinics at a Veterans Affairs Medical Center. Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The

Chart of nuclides relating to neutron activation

International Nuclear Information System (INIS)

Okada, Minoru

1981-09-01

This chart is for frequent use in the prediction of the product species of neutron activation. The first edition of the chart has been made in 1976 after the repeated trial preparation. It has the following good points. (1) Any letter in chart is as large as one can read easily. [This condition has been obtained by the selection of items to be shown in chart. They are the name (the symbol of element, mass number, and half-life) of nuclide or of isomer, and the type of decay.]. (2) Decay product has been shown indirectly for branchings with two-step decay via short-lived daughter in an excited state. [This matter has been realized by use of the new mode of indication.] (3) Nuclides shown in chart are (a) naturally occurring nuclides and (b) nuclides formed from naturally occurring nuclides through one of the following reactions: (n, γ), (n, n'), (n, p), (n, α), (n, 2n), (n, pn), (n, 3n), (n, αn), (n, t), (n, 3 He), (n, 2p), and (n, γ)(n, γ). In the revision of the first edition, some modes of indication have become a little simpler, and the isomers of shorter half-lives (0.1 - 1 μs) have been added. (author)

The use of Facebook in medical education--a literature review.

Science.gov (United States)

Pander, Tanja; Pinilla, Severin; Dimitriadis, Konstantinos; Fischer, Martin R

2014-01-01

The vogue of social media has changed interpersonal communication as well as learning and teaching opportunities in medical education. The most popular social media tool is Facebook. Its features provide potentially useful support for the education of medical students but it also means that some new challenges will have to be faced. This review aimed to find out how Facebook has been integrated into medical education. A systematical review of the current literature and grade of evidence is provided, research gaps are identified, links to prior reviews are drawn and implications for the future are discussed. The authors searched six databases. Inclusion criteria were defined and the authors independently reviewed the search results. The key information of the articles included was methodically abstracted and coded, synthesized and discussed in the categories study design, study participants'phase of medical education and study content. 16 articles met all inclusion criteria. 45-96% of health care professionals in all phases of their medical education have a Facebook profile. Most studies focused on Facebook and digital professionalism. Unprofessional behavior and privacy violations occurred in 0.02% to 16%. In terms of learning and teaching environment, Facebook is well accepted by medical students. It is used to prepare for exams, share online material, discuss clinical cases, organize face-to-face sessions and exchange information on clerkships. A few educational materials to teach Facebook professionalism were positively evaluated. There seems to be no conclusive evidence as to whether medical students benefit from Facebook as a learning environment on higher competence levels. Facebook influences a myriad of aspects of health care professionals, particularly at undergraduate and graduate level in medical education. Despite an increasing number of interventions, there is a lack of conclusive evidence in terms of its educational effectiveness. Furthermore, we

Examination of Routine Use of Prenatal Weight Gain Charts as a Communication Tool for Providers.

Science.gov (United States)

Aguilera, Marijo; Sidebottom, Abbey C; McCool, Brigitte R

2017-10-01

Objectives In 2009 the IOM revised prenatal weight gain guidelines. The primary purpose of this pilot study was to assess if provider education and use of prenatal weight gain charts to track weight gain and counsel patients was associated with better patient and provider knowledge and communication about the guidelines. Methods A prospective non-randomized study conducted in four OB practices (two control, two intervention). Data sources included provider surveys (n = 16 intervention, 21 control), patient surveys (n = 332), and medical records. Intervention clinics received provider education on the IOM guidelines and used patient education materials and prenatal weight gain charts to track weight gain and as a counseling tool. Comparison clinics received no education and did not use the charts or patient education information. Results More patients at intervention clinics (92.3%) reported that a provider gave them advice about weight gain, compared to patients from comparison clinics (66.4%) (p gain (83.1 vs. 64.3%, p = 0.007). Intervention clinic patients were more likely to have knowledge of the guidelines indicated by 72.3% reporting a target weight gain amount within the guidelines versus 50.4% of comparison patients (p gain charts resulted in higher patient reported communication about weight gain from their provider, higher patient satisfaction with those discussions, and better knowledge of the appropriate target weight gain goals.

Nuclear industry chart

International Nuclear Information System (INIS)

Anon.

1975-01-01

As part of a survey on Switzerland a pull-out organisation chart is presented of the nuclear industry showing Swiss government bodies and industrial concerns. Their interests, connections with each other and their associations with international and other national organizations and firms are indicated. (U.K.)

Medical leaders or masters?—A systematic review of medical leadership in hospital settings

Science.gov (United States)

Fabbricotti, Isabelle N.; Buljac-Samardžić, Martina; Hilders, Carina G. J. M.

2017-01-01

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal–and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal ‘leaders’ in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care. PMID:28910335

Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review.

Science.gov (United States)

Chisti, Mohammod Jobayer; Shahid, Abu Smsb; Shahunja, K M; Bardhan, Pradip Kumar; Faruque, Abu Syeed Golam; Shahrin, Lubaba; Das, Sumon Kumar; Barua, Dipesh Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

2017-05-01

Severely malnourished children aged under five years requiring hospital admission for diarrheal illness frequently develop ileus during hospitalization with often fatal outcomes. However, there is no data on risk factors and outcome of ileus in such children. We intended to evaluate predictive factors for ileus during hospitalization and their outcomes. This was a retrospective chart review that enrolled severely malnourished children under five years old with diarrhea, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh between April 2011 and August 2012. We used electronic database to have our chart abstraction from previously admitted children in the hospital. The clinical and laboratory characteristics of children with (cases = 45), and without ileus (controls = 261) were compared. Cases were first identified by observation of abnormal bowel sounds on physical examination and confirmed with abdominal radiographs. For this comparison, Chi-square test was used to measure the difference in proportion, Student's t-test to calculate the difference in mean for normally distributed data and Mann-Whitney test for data that were not normally distributed. Finally, in identifying independent risk factors for ileus, logistical regression analysis was performed. Ileus was defined if a child developed abdominal distension and had hyperactive or sluggish or absent bowel sound and a radiologic evidence of abdominal gas-fluid level during hospitalization. Logistic regression analysis adjusting for potential confounders revealed that the independent risk factors for admission for ileus were reluctance to feed (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.24-8.39, p = 0.02), septic shock (OR = 3.62, 95% CI = 1.247-8.95, p<0.01), and hypokalemia (OR = 1.99, 95% CI = 1.03-3.86, p = 0.04). Mortality was significantly higher in cases compared to controls (22% vs. 8%, p<0.01) in univariate analysis; however, in

SynopSIS: integrating physician sign-out with the electronic medical record.

Science.gov (United States)

Sarkar, Urmimala; Carter, Jonathan T; Omachi, Theodore A; Vidyarthi, Arpana R; Cucina, Russell; Bokser, Seth; van Eaton, Erik; Blum, Michael

2007-09-01

Safe delivery of care depends on effective communication among all health care providers, especially during transfers of care. The traditional medical chart does not adequately support such communication. We designed a patient-tracking tool that enhances provider communication and supports clinical decision making. To develop a problem-based patient-tracking tool, called Sign-out, Information Retrieval, and Summary (SynopSIS), in order to support patient tracking, transfers of care (ie, sign-outs), and daily rounds. Tertiary-care, university-based teaching hospital. SynopSIS compiles and organizes information from the electronic medical record to support hospital discharge and disposition decisions, daily provider decisions, and overnight or cross-coverage decisions. It reflects the provider's patient-care and daily work-flow needs. We plan to use Web-based surveys, audits of daily use, and interdisciplinary focus groups to evaluate SynopSIS's impact on communication between providers, quality of sign-out, patient continuity of care, and rounding efficiency. We expect SynopSIS to improve care by facilitating communication between care teams, standardizing sign-out, and automating daily review of clinical and laboratory trends. SynopSIS redesigns the clinical chart to better serve provider and patient needs. (c) 2007 Society of Hospital Medicine.

Tactile acuity charts: a reliable measure of spatial acuity.

Directory of Open Access Journals (Sweden)

Patrick Bruns

Full Text Available For assessing tactile spatial resolution it has recently been recommended to use tactile acuity charts which follow the design principles of the Snellen letter charts for visual acuity and involve active touch. However, it is currently unknown whether acuity thresholds obtained with this newly developed psychophysical procedure are in accordance with established measures of tactile acuity that involve passive contact with fixed duration and control of contact force. Here we directly compared tactile acuity thresholds obtained with the acuity charts to traditional two-point and grating orientation thresholds in a group of young healthy adults. For this purpose, two types of charts, using either Braille-like dot patterns or embossed Landolt rings with different orientations, were adapted from previous studies. Measurements with the two types of charts were equivalent, but generally more reliable with the dot pattern chart. A comparison with the two-point and grating orientation task data showed that the test-retest reliability of the acuity chart measurements after one week was superior to that of the passive methods. Individual thresholds obtained with the acuity charts agreed reasonably with the grating orientation threshold, but less so with the two-point threshold that yielded relatively distinct acuity estimates compared to the other methods. This potentially considerable amount of mismatch between different measures of tactile acuity suggests that tactile spatial resolution is a complex entity that should ideally be measured with different methods in parallel. The simple test procedure and high reliability of the acuity charts makes them a promising complement and alternative to the traditional two-point and grating orientation thresholds.

Burnout in medical students: a systematic review of experiences in Chinese medical schools

Directory of Open Access Journals (Sweden)

Wang Michael Chunming

2017-11-01

Full Text Available Abstract Background To identify the: extent to which medical students in China experience burnout; factors contributing to this; potential solutions to reduce and prevent burnout in this group; and the extent to which the experiences of Chinese students reflect the international literature. Methods Systematic review and narrative synthesis. Key words, synonyms and subject headings were used to search five electronic databases in addition to manual searching of relevant journals. Titles and abstracts of publications between 1st January 1989-31st July 2016 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesised. Results Thirty-three studies were eligible and included in the review. Greater levels of burnout were generally identified in males, more senior medical students, and those who already experienced poorer psychological functioning. Few studies explored social or contextual factors influencing burnout, but those that did suggest that factors such as the degree of social support or the living environment surrounding a student may be a determinant of burnout. Conclusions Greater understanding of the social and contextual determinants of burnout amongst medical students in China is essential towards identifying solutions to reduce and prevent burnout in this group.

Burnout in medical students: a systematic review of experiences in Chinese medical schools.

Science.gov (United States)

Chunming, Wang Michael; Harrison, Reema; MacIntyre, Raina; Travaglia, Joanna; Balasooriya, Chinthaka

2017-11-16

To identify the: extent to which medical students in China experience burnout; factors contributing to this; potential solutions to reduce and prevent burnout in this group; and the extent to which the experiences of Chinese students reflect the international literature. Systematic review and narrative synthesis. Key words, synonyms and subject headings were used to search five electronic databases in addition to manual searching of relevant journals. Titles and abstracts of publications between 1st January 1989-31st July 2016 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesised. Thirty-three studies were eligible and included in the review. Greater levels of burnout were generally identified in males, more senior medical students, and those who already experienced poorer psychological functioning. Few studies explored social or contextual factors influencing burnout, but those that did suggest that factors such as the degree of social support or the living environment surrounding a student may be a determinant of burnout. Greater understanding of the social and contextual determinants of burnout amongst medical students in China is essential towards identifying solutions to reduce and prevent burnout in this group.

Run charts revisited: a simulation study of run chart rules for detection of non-random variation in health care processes.

Science.gov (United States)

Anhøj, Jacob; Olesen, Anne Vingaard

2014-01-01

A run chart is a line graph of a measure plotted over time with the median as a horizontal line. The main purpose of the run chart is to identify process improvement or degradation, which may be detected by statistical tests for non-random patterns in the data sequence. We studied the sensitivity to shifts and linear drifts in simulated processes using the shift, crossings and trend rules for detecting non-random variation in run charts. The shift and crossings rules are effective in detecting shifts and drifts in process centre over time while keeping the false signal rate constant around 5% and independent of the number of data points in the chart. The trend rule is virtually useless for detection of linear drift over time, the purpose it was intended for.

A review of teaching skills development programmes for medical students.

Science.gov (United States)

Marton, Gregory E; McCullough, Brendan; Ramnanan, Christopher J

2015-02-01

The CanMEDS role of Scholar requires that medical trainees develop their skills as medical educators. The development of teaching skills in undergraduate medical students is therefore desirable, especially in view of the teaching obligations in residency programmes. The goal of this review was to identify the characteristics and outcomes of programmes designed to develop the teaching skills of undergraduate medical students. The authors searched medical literature databases using combinations of the search terms 'medical student', 'teacher', 'teaching skills', 'peer teaching', 'near-peer teaching' and 'student as teacher'. Twenty papers fit the predetermined search criteria, which included original characterisations of specific programmes involving undergraduate medical students. Three types of initiative were identified in the reviewed articles: peer teaching programmes; teaching workshops, and community outreach programmes. The majority of study participants were students in Years 3 and 4. Subjective self-evaluation by participants using Likert scale-based surveys was by far the most commonly used method of measuring project outcomes. Objective, quantitative teaching-related outcomes were rarely noted in the reports reviewed. Self-perceived improvements in teaching skills were noted by participants in most of the reports. Other perceived benefits included increases in organisational skills, knowledge and confidence in giving feedback. Although several types of programmes have been shown to subjectively improve the teaching skills of undergraduate medical students, characterisation of the objective outcomes of these initiatives is lacking and requires further study. © 2015 John Wiley & Sons Ltd.

Factors associated with dropout in medical education: a literature review.

Science.gov (United States)

O'Neill, Lotte Dyhrberg; Wallstedt, Birgitta; Eika, Berit; Hartvigsen, Jan

2011-05-01

Medical school dropout may have negative consequences for society, patients, the profession, schools and dropouts. To our knowledge, the literature dealing with dropout from medical school has never been systematically and critically appraised. This review aimed to systematically and critically review studies dealing with factors found to be associated with dropping out of medical school. A systematic critical literature review of the international peer-reviewed research literature on medical education was performed. A primary search was conducted and subsequently supplemented with ancestry and descendancy searches. The population of interest was medical students and the outcome was dropout. Abstract/title screening and quality assessment were performed by two independent researchers. Studies were assessed on six domains of quality: study participation; study attrition; predictor measurement; measurement of and accounting for confounders; outcome measurement, and analysis. Only studies that accounted for confounding were included in the final analysis. Of 625 studies found, 48 were quality-assessed and 13 of these were eventually included based on their fulfilment of our quality-related criteria. A range of entry qualifications seemed to be associated with greater chances of a student dropping out (odds ratio [OR] = 1.65-4.00). Struggling academically in medical school may be strongly associated with dropout. By contrast, no specific pattern of demographic variables was particularly important in relation to dropout. The effects of socio-economic, psychological and educational variables on dropout were not well investigated. More research into causal models and theory testing, which considers the effects of education, organisation and institution, is necessary if we are to learn more about how we can actively prevent medical student withdrawal. © Blackwell Publishing Ltd 2011.

A review of m-health in medical imaging.

Science.gov (United States)

Perera, Chandrashan Mahendra; Chakrabarti, Rahul

2015-02-01

The increasing capabilities of camera-equipped mobile phones have led to a growing body of evidence regarding their use in medical imaging across a broad range of medical specialties. This article reviews the current evidence for the use of mobile health (m-health) in medical imaging. We performed a structured review of the published literature regarding m-health in medical imaging using the Medline, PubMed, and Web of Science databases (January 2002-August 2013). The two authors independently extracted data regarding type of specialty, purpose, and study design of publications. In total, 235 articles were identified. The majority of studies were case reports or noncomparative product validation studies. The greatest volume of publications originated in the fields of radiology (21%), dermatology (15%), laboratory techniques (15%), and plastic surgery (12%). Among these studies, m-health was used as diagnostic aids, for patient monitoring, and to improve communication between health practitioners. With the growing use of mobile phones for medical imaging, considerations need to be given to informed consent, privacy, image storage and transfer, and guidelines for healthcare workers and patients. There are several novel uses of mobile devices for medical imaging that show promise across a variety of areas and subspecialties of healthcare. Currently, studies are mostly exploratory in nature. To validate these devices, studies with higher methodological rigor are required.

HydroHillChart – Pelton module. Software used to Calculate the Hill Chart of the Pelton Hydraulic Turbines

Directory of Open Access Journals (Sweden)

Dorian Nedelcu

2015-07-01

Full Text Available The paper presents the HydroHillChart - Pelton module application, used to calculate the hill chart of the Pelton hydraulic turbine models, by processing the data measured on the stand. In addition, the tools offered by the application such as: interface, menu, input data, numerical and graphical results, etc. are described.

Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review.

Science.gov (United States)

Kruse, Clemens Scott; Beane, Amanda

2018-02-05

Health information technology (HIT) has been introduced into the health care industry since the 1960s when mainframes assisted with financial transactions, but questions remained about HIT's contribution to medical outcomes. Several systematic reviews since the 1990s have focused on this relationship. This review updates the literature. The purpose of this review was to analyze the current literature for the impact of HIT on medical outcomes. We hypothesized that there is a positive association between the adoption of HIT and medical outcomes. We queried the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE) by PubMed databases for peer-reviewed publications in the last 5 years that defined an HIT intervention and an effect on medical outcomes in terms of efficiency or effectiveness. We structured the review from the Primary Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and we conducted the review in accordance with the Assessment for Multiple Systematic Reviews (AMSTAR). We narrowed our search from 3636 papers to 37 for final analysis. At least one improved medical outcome as a result of HIT adoption was identified in 81% (25/37) of research studies that met inclusion criteria, thus strongly supporting our hypothesis. No statistical difference in outcomes was identified as a result of HIT in 19% of included studies. Twelve categories of HIT and three categories of outcomes occurred 38 and 65 times, respectively. A strong majority of the literature shows positive effects of HIT on the effectiveness of medical outcomes, which positively supports efforts that prepare for stage 3 of meaningful use. This aligns with previous reviews in other time frames. ©Clemens Scott Kruse, Amanda Beane. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.02.2018.

Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit

Directory of Open Access Journals (Sweden)

Moran Lazaryan

2016-08-01

Full Text Available Background: One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available.Objective: To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU. Methods: A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded.Results: The review time for one medical record was 8.9 (95% CI, 6.9-10.9 minutes. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11 minutes. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8 and 12 (9-15 minutes, respectively, for patients with psychiatric-neurologic disorders compared to those without (p=0.032. Usually, a daily workload of 240 minutes was needed for the pharmacist accompanying the round in contrast to 108 minutes per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9% and made no comment on 36.9% of the recommendations. Conclusion: Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

Systematic literature review of hospital medication administration errors in children

Directory of Open Access Journals (Sweden)

Ameer A

2015-11-01

Full Text Available Ahmed Ameer,1 Soraya Dhillon,1 Mark J Peters,2 Maisoon Ghaleb11Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; 2Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK Objective: Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs during this process have been documented and thought to be preventable. In pediatric medicine, doses are usually administered based on the child's weight or body surface area. This in turn increases the risk of drug miscalculations and therefore MAEs. The aim of this review is to report MAEs occurring in pediatric inpatients. Methods: Twelve bibliographic databases were searched for studies published between January 2000 and February 2015 using “medication administration errors”, “hospital”, and “children” related terminologies. Handsearching of relevant publications was also carried out. A second reviewer screened articles for eligibility and quality in accordance with the inclusion/exclusion criteria. Key findings: A total of 44 studies were systematically reviewed. MAEs were generally defined as a deviation of dose given from that prescribed; this included omitted doses and administration at the wrong time. Hospital MAEs in children accounted for a mean of 50% of all reported medication error reports (n=12,588. It was also identified in a mean of 29% of doses observed (n=8,894. The most prevalent type of MAEs related to preparation, infusion rate, dose, and time. This review has identified five types of interventions to reduce hospital MAEs in children: barcode medicine administration, electronic prescribing, education, use of smart pumps, and standard concentration. Conclusion: This review has identified a wide variation in the prevalence of hospital MAEs in children. This is attributed to

46 CFR 232.3 - Chart of accounts.

Science.gov (United States)

2010-10-01

... stated in any revision to generally accepted accounting principles, the meaning of the latter shall... UNIFORM FINANCIAL REPORTING REQUIREMENTS § 232.3 Chart of accounts. (a) Purpose of accounts. A contractor shall use this chart of accounts as a guide for preparing the financial statements and for other...

33 CFR 164.33 - Charts and publications.

Science.gov (United States)

2010-07-01

...) PORTS AND WATERWAYS SAFETY NAVIGATION SAFETY REGULATIONS § 164.33 Charts and publications. (a) Each vessel must have the following: (1) Marine charts of the area to be transited, published by the National... tables published by private entities using data provided by the National Ocean Service. (ii) Tidal...

Robust Control Charts for Time Series Data

NARCIS (Netherlands)

Croux, C.; Gelper, S.; Mahieu, K.

2010-01-01

This article presents a control chart for time series data, based on the one-step- ahead forecast errors of the Holt-Winters forecasting method. We use robust techniques to prevent that outliers affect the estimation of the control limits of the chart. Moreover, robustness is important to maintain

Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes

DEFF Research Database (Denmark)

Hansen, Trine Graabæk; Kjeldsen, Lene Juel

2013-01-01

Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality...... and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE......, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100...

Cultivation and Implementation of Community-Engaged Pharmacy Services in a Free Clinic to Enhance Care for the Medically Underserved

Directory of Open Access Journals (Sweden)

Emmeline Tran, Pharm.D. Candidate

2013-01-01

Full Text Available Partnerships between community free clinics and academic medical centers improve patient outcomes and enhance learning opportunities for students. A community-academic partnership between the Maliheh Free Clinic and the University of Utah College of Pharmacy was formed to fulfill a community need for pharmacy services, to promote interdisciplinary patient care, and to provide an experiential opportunity for students. The Maliheh Free Clinic based in Salt Lake City, Utah provides free primary health care to uninsured individuals who live 150% below federal poverty guidelines. Three pharmacy services were developed and implemented. These include: 1 clinic chart reviews which involve written recommendations following a comprehensive assessment of the patient’s chart examining his or her disease states and the appropriateness of his or her medications; 2 medication reconciliations and discussion of pharmacy-related recommendations with patients during Diabetes Day, an inclusive interdisciplinary patient appointment that addresses important aspects of diabetes care; and 3 an insulin dose adjustment service through a collaborative practice agreement with the clinic to monitor a patient’s blood glucose levels and adjust his or her medications accordingly on a weekly basis.

Using Statistical Process Control to Drive Improvement in Neonatal Care: A Practical Introduction to Control Charts.

Science.gov (United States)

Gupta, Munish; Kaplan, Heather C

2017-09-01

Quality improvement (QI) is based on measuring performance over time, and variation in data measured over time must be understood to guide change and make optimal improvements. Common cause variation is natural variation owing to factors inherent to any process; special cause variation is unnatural variation owing to external factors. Statistical process control methods, and particularly control charts, are robust tools for understanding data over time and identifying common and special cause variation. This review provides a practical introduction to the use of control charts in health care QI, with a focus on neonatology. Copyright © 2017 Elsevier Inc. All rights reserved.

Discontinuing the Use of PRN Intramuscular Medication for Agitation in an Acute Psychiatric Hospital.

Science.gov (United States)

Hayes, Ariel; Russ, Mark J

2016-03-01

This study examined the impact of eliminating intramuscular PRN medication for agitation on patient and staff safety in an acute psychiatric inpatient setting. The current retrospective chart review investigated the use of PRN medications (oral and intramuscular) to treat acute agitation, including aggression, and related outcomes before and after a mandated change in PRN practice that required real time physician input before administration of intramuscular medications. The use of both oral and intramuscular PRN medications dramatically decreased following implementation of the mandated change in practice. In particular, the use of intramuscular PRNs for agitation decreased by about half. Despite this decrease, the assault rate in the hospital was unchanged, and the utilization of restraint and seclusion continued to decrease. It is possible to reduce the utilization of PRN medications for agitation without broadly compromising safety on acute care psychiatric inpatient units.

Reflection in Medical Diagnosis: A Literature Review

OpenAIRE

Mamede, Silvia; Schmidt, Henk G.

2017-01-01

Purpose: Reflection in medical diagnosis has been said to prevent errors by minimizing flaws in clinical reasoning. This claim, however, has been much disputed. While some studies show reflective reasoning to improve diagnostic performance, others find it to add nothing. This paper presents a narrative review of the literature on reflection in medical diagnosis aimed at addressing two questions: (1) how reflective reasoning has been conceived in this literature; and (2) what is the effect of ...

[Growth charts: Impact on the prevalence of nutritional disorders].

Science.gov (United States)

Polo Martín, P; Abellan, J J; Nájar Godoy, M I; Álvarez de Laviada Mulero, T

2015-05-01

The references used to assess child growth in Spain are the graphs of the Orbegozo Foundation and the charts of the World Health Organization (WHO). The objective of this study is to analyze the differences between the two charts for weight, height and body mass index, and assess their relevance to identify growth or nutritional problems. The values of the extreme percentiles of height, weight and body mass index for each sex from 0 to 10 years in both charts are compared. For each value Absolute differences and Z scores are calculated for each value. To evaluate the impact on the prevalence of the various nutritional or growth disorders the location of the value of the respective percentiles of in each of the charts were assessed. Significant differences were observed between the 3th percentile of height and weight, 97th of weight, and 85th and 97th of body mass index. Marked differences were observed for the extreme values of body mass index. During the first years, the Orbegozo charts overestimate the prevalence of malnutrition (between 2% and 19% depending on age and sex) compared to the WHO charts. In subsequent ages Orbegozo underestimates WHO between 0.7% and 2.89%. Orbegozo underestimates the prevalence of overweight (between 2.5% and 14.8%) compared to the WHO charts. The 97th percentile of Body mass index in the Orbegozo charts corresponds in most cases with WHO percentiles above 99.99%. The two charts analyzed have significant differences from a clinical and the public health point of view, in the estimation of overweight/obesity and malnutrition. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Robust control charts in statistical process control

NARCIS (Netherlands)

Nazir, H.Z.

2014-01-01

The presence of outliers and contaminations in the output of the process highly affects the performance of the design structures of commonly used control charts and hence makes them of less practical use. One of the solutions to deal with this problem is to use control charts which are robust

Improvement of WWW chart of the nuclides interface

International Nuclear Information System (INIS)

Okamoto, Tsutomu; Minato, Futoshi; Iwamoto, Osamu; Koura, Hiroyuki

2016-03-01

The booklet 'chart of the nuclides' is issued every 4 years since 1976 from Nuclear Data Center, Japan Atomic Energy Agency. The chart of the nuclides for WWW (World Wide Web) was developed in 1999 in order to be available from the Internet browser. The Internet connection speeds, browser functions and JavaScript libraries has, however, progressed at present compared with the Internet technology in those days. In connection with the release of the 2014 edition of the chart of the nuclides, the interface of the WWW chart of the nuclides has been improved by introducing new Internet technologies aiming at enhancing convenience on accessibilities via browsers. We introduced a scrolling screen that would make capabilities of easy screen movement on a map with the addition of the drag scrolling function. Considering smart phone access, the light-weight edition which introduced automatic switch was prepared. The new system results in reduction in access time and usefulness in mobile environment. The method of making figures of the chart was reconsidered due to addition of new decay schemes to the 2014 edition. SVG (Scalable Vector Graphics) was adopted so as to make figures easily. It is concluded that the accessibilities of WWW chart of the nuclides are substantially improved from the previous version by introducing the new technologies. (author)

MEDICAL vs. MEDICAL AND SURGICAL TREATMENT FOR BRUCELLA ENDOCARDITIS: A REVIEW OF THE LITERATURE

Science.gov (United States)

Keshtkar-Jahromi, Maryam; Razavi, Seyed-Mostafa; Gholamin, Sharareh; Keshtkar-Jahromi, Marzieh; Hossain, Mian; Sajadi, Mohammad

2012-01-01

This review was undertaken to determine the role of surgery in the treatment of brucella endocarditis. All English and French articles reporting brucella endocarditis (1966–2011) in Pubmed, Google and Scopus were reviewed. 308 cases were identified and Linear and Logistic regression was performed. Surgery improved outcomes by decreasing mortality from 32.7% in the medical treatment only group to 6.7% in the combined surgical and medical treatment group (p<.001). This association was still significant while controlling for other contributing factors. In the absence of a controlled trial, we recommend the utmost vigilance and consideration of surgical management in treating such patients. PMID:23102495

Academic and Socio-demographic Causes of Medical Student's underachievement in Iranian Medical Schools: A Systematic Review

Directory of Open Access Journals (Sweden)

Keivan Dolati

2016-05-01

Full Text Available The academic performance of medical students seems to influence and be influenced by various factors. Identification of the factors that would influence the academic performance may help to modify some of these factors which may be reflecting positively on student’s GPA. Therefore, the objective of present study was to examine the effects of factors such as the student’s demographic data, educational and socio-cultural factors on the academic underachievement of Iranian medical students. In this systematic review study, all the papers related to the investigation of the causes of academic underachievement in case of the Iranian medical students, that were published during the period between 1996 and 2015, were recorded and reviewed. To carry out this purpose, all the Iranian journals and some of the scientific databases such as IranMedex, SID, Magiran, and MedLib, and foreign databases such as PubMed, Web of Science, Google Scholar, ERIC, and Science Direct, were used to search the keywords academic underachievement, medical students, educational status, and education progress. After searching mentioned databases, 218 papers were recorded, 97 of which were unrelated and were omitted during the initial review. After omitting the unrelated papers, 121 papers were reviewed by authors independently, and after the omission of the papers not possessing the criteria to enter the study, 65 papers remained, and finally, after complete reviewing procedure, 10 studies entered the analysis. In conclusion, being married, having second jobs, residing in a dormitory, admission to university by the privilege, low educational level of the parents, long interval between receiving diploma and entering university, male sex, age, not having educational planning and motivation skills, and absence from the classes are the main educational barriers among medical students resulted in underachievement.

Nurses' clinical reasoning practices that support safe medication administration: An integrative review of the literature.

Science.gov (United States)

Rohde, Emily; Domm, Elizabeth

2018-02-01

To review the current literature about nurses' clinical reasoning practices that support safe medication administration. The literature about medication administration frequently focuses on avoiding medication errors. Nurses' clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses' clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance. An integrative literature review was guided by Whittemore and Knafl's (Journal of Advanced Nursing, 5, 2005 and 546) five-stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.'s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery. Health databases were accessed and systematically searched for research reporting nurses' clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence-Based Practice Rating Scale©. Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses' use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed. Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that

Dental Charting. Learning Activities, Unit Tests, Progress Chart, and Work Sheet.

Science.gov (United States)

Texas Univ., Austin. Center for Occupational Curriculum Development.

These materials are part of a series dealing with skills and information needed by students in dental assisting. The individualized student materials are suitable for classroom, laboratory, or cooperative training programs. These student materials, designed to be used with the Dental Charting Student Manual, consist of learning activities, unit…

Weldability charts for constructional steels

International Nuclear Information System (INIS)

Ion, J C; Ashby, M F

2012-01-01

The weldability of materials is still a poorly understood concept; a quantitative assessment remains elusive. The variables associated with welding are reduced here into two groups - processing parameters and material properties - from which two characteristic indices are defined and used as the basis of weldability charts. For the case of constructional steels, a carbon equivalent characterises both heat affected zone hardenability and the maximum hardness developed after solid state phase transformations. The welding process is characterised by its energy input. A mathematical model is used to establish relationships between the indices, which are displayed on charts as contours of microstructure and hardness.

CDC Child Growth Charts

Data.gov (United States)

U.S. Department of Health & Human Services — CDC child growth charts consist of a series of percentile curves that illustrate the distribution of selected body measurements in U.S. children. Pediatric growth...

Visualizing a Procedure with Nassi-Schneiderman Charts.

Science.gov (United States)

Weiss, Edmond H.

1990-01-01

Argues that Nassi-Schneiderman (NS) charts, when used to diagram human procedures, can eliminate prose ambiguities. Asserts that these devices provide most of the advantages of decision tables and trees. Suggests using NS charts in testing the logic and completeness of traditional procedures, or even in place of many traditional publications. (SG)

Development and clinical application of a color pediatric visual acuity chart

Directory of Open Access Journals (Sweden)

Shu-Guo Yin

2014-12-01

Full Text Available AIM: To introduce a new color pediatric visual acuity chart and its clinical application.METHODS:The color pediatric visual acuity chart was designed based on principle of visual angle. The optotype on the color chart had graphics. The progression rate of optotype size between 2 lines was 10(101/2 and 1.2589. A regular geometric progression of optotype sizes and distribution was employed to arrange 8 lines with 11 optotype on the color chart. The testing distance was 3m. The visual acuity score could be recorded as logarithm of the minimum angle of resolution notation or decimal notation. The reliability of naked distant measurements with this new chart was tested in one eye of 100 children(4 ～6 years oldtaking the Chinese national standard logarithm visual acuity chart standard. RESULTS: The color pediatric visual acuity chart and logarithmic chart controls, visual acuity test results that in the two groups had no significant difference(t=1.2671, P>0.05. Two sets of vision data existed positive correlation(r=0.924, PCONCLUSION:Children are easier to accept used new color pediatric visual acuity chart to inspect vision. New chart is reliability and apply to children's vision screening.

Office of Adolescent Health medical accuracy review process--helping ensure the medical accuracy of Teen Pregnancy Prevention Program materials.

Science.gov (United States)

Jensen, Jo Anne G; Moreno, Elizabeth L; Rice, Tara M

2014-03-01

The Office of Adolescent Health (OAH) developed a systematic approach to review for medical accuracy the educational materials proposed for use in Teen Pregnancy Prevention (TPP) programs. This process is also used by the Administration on Children, Youth, and Families (ACYF) for review of materials used in the Personal Responsibility Education Innovative Strategies (PREIS) Program. This article describes the review process, explaining the methodology, the team implementing the reviews, and the process for distributing review findings and implementing changes. Provided also is the definition of "medically accurate and complete" as used in the programs, and a description of what constitutes "complete" information when discussing sexually transmitted infections and birth control methods. The article is of interest to program providers, curriculum developers and purveyors, and those who are interested in providing medically accurate and complete information to adolescents. Published by Elsevier Inc.

The Implications of Diagnosis of Small for Gestational Age Fetuses Using European and South Asian Growth Charts: An Outcome-Based Comparative Study

Directory of Open Access Journals (Sweden)

Gianpaolo Maso

2014-01-01

Full Text Available The antenatal condition of small for gestational age (SGA is significantly associated with perinatal morbidity and mortality and it is known that there are significant differences in birth weight and fetal size among different populations. The aim of our study was to assess the impact on outcomes of the diagnosis of SGA according to Bangladeshi and European antenatal growth charts in Sri Lankan population. The estimated fetal weight before delivery was retrospectively reviewed according to Bangladeshi and European growth references. Three groups were identified: Group 1-SGA according to Bangladeshi growth chart; Group 2-SGA according to European growth chart but not having SGA according to Bangladeshi growth chart; Group 3-No SGA according to both charts. There was a difference in prevalence of SGA between Bangladeshi and European growth charts: 12.7% and 51.7%, respectively. There were statistically significant higher rates in emergency cesarean section, fetal distress in labour, and intrauterine death (P<0.001 in Group 1 compared with Group, 2 and 3. No differences of outcomes occurred between Groups 2 and 3. Our study demonstrated that only cases diagnosed as SGA according to population-based growth charts are at risk of adverse outcome. The use of inappropriate prenatal growth charts might lead to misdiagnosis and potential unnecessary interventions.

Self-medication practice in Ethiopia: a systematic review

Directory of Open Access Journals (Sweden)

Ayalew MB

2017-03-01

Full Text Available Mohammed Biset Ayalew Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: Self-medication patterns vary among different populations, and are influenced by many factors. No review has been done that comprehensively expresses self-medication practice in Ethiopia. The aim of this study was to provide an overview of the literature on self-medication practice in Ethiopia.Materials and methods: Databases (PubMed, Google Scholar, ResearchGate, and Hinari were searched for published studies on the practice of self-medication in Ethiopia without restriction in the year of publication or methodology. Some studies were also identified through manual Google search. Primary search terms were “self medication”, “Ethiopia”, “self care”, “non-prescription”, “OTC drug use”, “drug utilization”, and “drug hoarding”. Studies that measured knowledge only or attitude only or beliefs only and did not determine the practice of self-medication were excluded.Results: The database search produced a total of 450 papers. After adjustment for duplicates and inclusion and exclusion criteria, 21 articles were found suitable for the review. All studies were cross-sectional in nature. The prevalence of self-medication varied from 12.8% to 77.1%, with an average of 36.8%. Fever/headache, gastrointestinal tract diseases, and respiratory diseases were the commonest illnesses/symptoms for which self-medication was taken. The major reasons for practicing self-medication were previous experience of treating a similar illness and feeling that the illness was mild. Analgesics/antipyretics, antimicrobials, gastrointestinal drugs, and respiratory drugs were the common drug classes used in self-medication. Mainly, these drugs were obtained from drug-retail outlets. The use of self-medication was commonly suggested by pharmacy professionals and friends

Comparison of customised growth charts v. standard population

African Journals Online (AJOL)

pregnant diabetic population using population-based growth charts and customised growth charts. Methods. ... Of the patients, 44 had type 1, 66 type 2 and 173 gestational diabetes. The growth of .... with diabetic ketoacidosis, of whom one.

Structural barriers in access to medical marijuana in the USA-a systematic review protocol.

Science.gov (United States)

Valencia, Celina I; Asaolu, Ibitola O; Ehiri, John E; Rosales, Cecilia

2017-08-07

There are 43 state medical marijuana programs in the USA, yet limited evidence is available on the demographic characteristics of the patient population accessing these programs. Moreover, insights into the social and structural barriers that inform patients' success in accessing medical marijuana are limited. A current gap in the scientific literature exists regarding generalizable data on the social, cultural, and structural mechanisms that hinder access to medical marijuana among qualifying patients. The goal of this systematic review, therefore, is to identify the aforementioned mechanisms that inform disparities in access to medical marijuana in the USA. This scoping review protocol outlines the proposed study design for the systematic review and evaluation of peer-reviewed scientific literature on structural barriers to medical marijuana access. The protocol follows the guidelines set forth by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. The overarching goal of this study is to rigorously evaluate the existing peer-reviewed data on access to medical marijuana in the USA. Income, ethnic background, stigma, and physician preferences have been posited as the primary structural barriers influencing medical marijuana patient population demographics in the USA. Identification of structural barriers to accessing medical marijuana provides a framework for future policies and programs. Evidence-based policies and programs for increasing medical marijuana access help minimize the disparity of access among qualifying patients.

Finding charts for southern IRAS galaxies

International Nuclear Information System (INIS)

Sutherland, W.J.; Maddox, S.J.; Saunders, W.

1991-01-01

Using the APM Galaxy Survey, we have generated a collection of finding charts for 4614 sources with non-stellar colours in the IRAS Faint Source Catalogue south of δ= -17.5 o . Over 90 per cent of the sources are reliably identified with an optical object, and we provide 1-arcsec positions and B J magnitudes for these. We will provide paper copies of the charts on request, at a small charge to cover photocopying costs. (author)

The European chart of territorial planning

International Nuclear Information System (INIS)

1998-01-01

In this chapter the European chart of territorial planning is included. This European chart contains next chapters: Introduction; The mission of the territorial planning; The basic aims; Realization of aims of the territorial planning; The confirmation of the European co-operation. In the Appendix the Specific aims: (1) The village territory; (2) The urban territory; (3) The boundary territory; (4) The mountain territory; (5) The structurally weak territory; (6) The decaying territory; (7) The coastal territories and islands

Professional burnout among medical students: Systematic literature review and meta-analysis.

Science.gov (United States)

Erschens, Rebecca; Keifenheim, Katharina Eva; Herrmann-Werner, Anne; Loda, Teresa; Schwille-Kiuntke, Juliane; Bugaj, Till Johannes; Nikendei, Christoph; Huhn, Daniel; Zipfel, Stephan; Junne, Florian

2018-04-14

This systematic review and meta-analysis aim to summarize the available evidence on the prevalence of professional burnout among medical students. The review was performed according to the PRISMA guidelines. Databases were systematically searched for peer-reviewed articles, reporting burnout among medical students published between 2000 and 2017. The meta-analysis was conducted on the available data on burnout rates in medical students measured with the Maslach Burnout Inventory (MBI-HSS). Fifty-eight out of 3006 studies were found eligible for inclusion. Twelve of these studies met the criteria for meta-analysis. Weighted mean values for the three sub-dimensions of the MBI-HSS were M = 22.93 (SD = 10.25) for Emotional Exhaustion, M = 8.88 (SD = 5.64) for Depersonalization, and M = 35.11 (SD = 8.03) for Personal Accomplishment. Prevalence rates for professional burnout ranged from 7.0% to 75.2%, depending on country-specific factors, applied instruments, cutoff-criteria for burnout symptomatology. This review underlines the burden of burnout among medical students. Future research should explicitly focus on specific context factors and student group under investigation. Such efforts are necessary to control for context-dependent confounders in research on medical students' mental health impairment to enable more meaningful comparisons and adequate prevention strategies.

An Exponentially Weighted Moving Average Control Chart for Bernoulli Data

DEFF Research Database (Denmark)

Spliid, Henrik

2010-01-01

of the transformation is given and its limit for small values of p is derived. Control of high yield processes is discussed and the chart is shown to perform very well in comparison with both the most common alternative EWMA chart and the CUSUM chart. The construction and the use of the proposed EWMA chart......We consider a production process in which units are produced in a sequential manner. The units can, for example, be manufactured items or services, provided to clients. Each unit produced can be a failure with probability p or a success (non-failure) with probability (1-p). A novel exponentially...... weighted moving average (EWMA) control chart intended for surveillance of the probability of failure, p, is described. The chart is based on counting the number of non-failures produced between failures in combination with a variance-stabilizing transformation. The distribution function...

Great Lakes Ice Charts

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Charts show ice extent and concentration three times weekly during the ice season, for all lakes except Ontario, from the 1973/74 ice season through the 2001/2002...

Chesapeake Highway Advisories Routing Traffic, Chart, Business Plan

Science.gov (United States)

1996-10-01

THE BUSINESS PLAN IS ORGANIZED INTO FOUR MAJOR SECTIONS. THE FIRST SECTION IS INTRODUCTORY IN NATURE AND PROVIDES BACKGROUND INFORMATION ON ITS AND THE CHART PROGRAM IN MARYLAND. IT INCLUDES THE CHART MISSION, GOALS AND OBJECTIVES, AS WELL AS OVERVIE...

What do we know about Canadian involvement in medical tourism? A scoping review

Science.gov (United States)

Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Kingsbury, Paul

2011-01-01

Background Medical tourism, the intentional pursuit of elective medical treatments in foreign countries, is a rapidly growing global industry. Canadians are among those crossing international borders to seek out privately purchased medical care. Given Canada’s universally accessible, single-payer domestic health care system, important implications emerge from Canadians’ private engagement in medical tourism. Methods A scoping review was conducted of the popular, academic, and business literature to synthesize what is currently known about Canadian involvement in medical tourism. Of the 348 sources that were reviewed either partly or in full, 113 were ultimately included in the review. Results The review demonstrates that there is an extreme paucity of academic, empirical literature examining medical tourism in general or the Canadian context more specifically. Canadians are engaged with the medical tourism industry not just as patients but also as investors and business people. There have been a limited number of instances of Canadians having their medical tourism expenses reimbursed by the public medicare system. Wait times are by far the most heavily cited driver of Canadians’ involvement in medical tourism. However, despite its treatment as fact, there is no empirical research to support or contradict this point. Discussion Although medical tourism is often discussed in the Canadian context, a paucity of data on this practice complicates our understanding of its scope and impact. PMID:22046228

What do we know about Canadian involvement in medical tourism?: a scoping review.

Science.gov (United States)

Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Kingsbury, Paul

2011-01-01

Medical tourism, the intentional pursuit of elective medical treatments in foreign countries, is a rapidly growing global industry. Canadians are among those crossing international borders to seek out privately purchased medical care. Given Canada's universally accessible, single-payer domestic health care system, important implications emerge from Canadians' private engagement in medical tourism. A scoping review was conducted of the popular, academic, and business literature to synthesize what is currently known about Canadian involvement in medical tourism. Of the 348 sources that were reviewed either partly or in full, 113 were ultimately included in the review. The review demonstrates that there is an extreme paucity of academic, empirical literature examining medical tourism in general or the Canadian context more specifically. Canadians are engaged with the medical tourism industry not just as patients but also as investors and business people. There have been a limited number of instances of Canadians having their medical tourism expenses reimbursed by the public medicare system. Wait times are by far the most heavily cited driver of Canadians' involvement in medical tourism. However, despite its treatment as fact, there is no empirical research to support or contradict this point. Although medical tourism is often discussed in the Canadian context, a paucity of data on this practice complicates our understanding of its scope and impact.

A retrospective chart study: The pathway to a diagnosis for adults referred for ASD assessment

NARCIS (Netherlands)

Geurts, H.M.; Jansen, M.D.

2012-01-01

Charts of 125 adults (18 to 82 years), referred to an autism expert team for Autism Spectrum Disorder (ASD) assessment, were reviewed to explore the pathway to an adulthood ASD diagnosis. The participants first contacted the mental health care clinic at a median age of 19 years (range 2 to 78

Technology-assisted education in graduate medical education: a review of the literature

OpenAIRE

Jwayyed, Sharhabeel; Stiffler, Kirk A; Wilber, Scott T; Southern, Alison; Weigand, John; Bare, Rudd; Gerson, Lowell W

2011-01-01

Studies on computer-aided instruction and web-based learning have left many questions unanswered about the most effective use of technology-assisted education in graduate medical education. Objective We conducted a review of the current medical literature to report the techniques, methods, frequency and effectiveness of technology-assisted education in graduate medical education. Methods A structured review of MEDLINE articles dealing with "Computer-Assisted Instruction," "Internet or World W...

Medical Rehabilitation in Natural Disasters: A Review.

Science.gov (United States)

Khan, Fary; Amatya, Bhasker; Gosney, James; Rathore, Farooq A; Burkle, Frederick M

2015-09-01

To present an evidence-based overview of the effectiveness of medical rehabilitation intervention in natural disaster survivors and outcomes that are affected. A literature search was conducted using medical and health science electronic databases (PubMed, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO) up to September 2014. Two independent reviewers selected studies reporting outcomes for natural disaster survivors after medical rehabilitation that addressed functional restoration and participation. Two reviewers independently extracted data and assessed the methodologic quality of the studies using the Critical Appraisal Skills Program's appraisal tools. A meta-analysis was not possible because of heterogeneity among included trials; therefore, a narrative analysis was performed for best evidence synthesis. Ten studies (2 randomized controlled trials, 8 observational studies) investigated a variety of medical rehabilitation interventions for natural disaster survivors to evaluate best evidence to date. The interventions ranged from comprehensive multidisciplinary rehabilitation to community educational programs. Studies scored low on quality assessment because of methodologic limitations. The findings suggest some evidence for the effectiveness of inpatient rehabilitation in reducing disability and improving participation and quality of life and for community-based rehabilitation for participation. There were no data available for associated costs. The findings highlight the need to incorporate medical rehabilitation into response planning and disaster management for future natural catastrophes. Access to rehabilitation and investment in sustainable infrastructure and education are crucial. More methodologically robust studies are needed to build evidence for rehabilitation programs, cost-effectiveness, and outcome measurement in such settings. Copyright © 2015 American Congress of Rehabilitation Medicine

Portal film charts for a 6 MV linear accelerator

International Nuclear Information System (INIS)

Faermann, S.; Regev, E.; Leser, Y.

1990-01-01

Localization errors frequently arise in the portal film technique due to over-or underdevelop films, for high energy radiotherapy machines. To guarantee the accuracy and reproducibility of the localization film technique portal film charts were introduced into the routine planning for the Mevatron 6MV linear accelerator of the Beilinson Radiotherapy Dept. Maintaining reproducible film processor conditions, two films were used: medical X-ray film Curix RPI Agfa and localization film X-OMAT TL Kodak, combined with front and rear copper screens of 0.5 mm thickness each. The sensitometric curves for each film-screen combination were obtained (optical density as function of cassette dose). The least square fitted O.D. curve was used to obtain the cassette dose which produces an O.D. of 1.6. A theoretical equation for the calculation of the dose at the cassette positions, beyond a water phantom, as function of field size, SSD, patient thickness and patient to cassette separation, was experimentally checked with a 0.6 cc Farmer ionization chamber coupled to a 2570 Farmer dosimeter. As a result portal film charts (expressed in MU) were constructed as a function of FS, air-gap and patient-thickness, and the best partition dose for the double-exposure technique was also established. The patients dose in the double exposure technique was compared to that delivered in diagnostic radiology procedures. (author)

Large-scale retrieval for medical image analytics: A comprehensive review.

Science.gov (United States)

Li, Zhongyu; Zhang, Xiaofan; Müller, Henning; Zhang, Shaoting

2018-01-01

Over the past decades, medical image analytics was greatly facilitated by the explosion of digital imaging techniques, where huge amounts of medical images were produced with ever-increasing quality and diversity. However, conventional methods for analyzing medical images have achieved limited success, as they are not capable to tackle the huge amount of image data. In this paper, we review state-of-the-art approaches for large-scale medical image analysis, which are mainly based on recent advances in computer vision, machine learning and information retrieval. Specifically, we first present the general pipeline of large-scale retrieval, summarize the challenges/opportunities of medical image analytics on a large-scale. Then, we provide a comprehensive review of algorithms and techniques relevant to major processes in the pipeline, including feature representation, feature indexing, searching, etc. On the basis of existing work, we introduce the evaluation protocols and multiple applications of large-scale medical image retrieval, with a variety of exploratory and diagnostic scenarios. Finally, we discuss future directions of large-scale retrieval, which can further improve the performance of medical image analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review.

Directory of Open Access Journals (Sweden)

Mohammod Jobayer Chisti

2017-05-01

Full Text Available Severely malnourished children aged under five years requiring hospital admission for diarrheal illness frequently develop ileus during hospitalization with often fatal outcomes. However, there is no data on risk factors and outcome of ileus in such children. We intended to evaluate predictive factors for ileus during hospitalization and their outcomes.This was a retrospective chart review that enrolled severely malnourished children under five years old with diarrhea, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh between April 2011 and August 2012. We used electronic database to have our chart abstraction from previously admitted children in the hospital. The clinical and laboratory characteristics of children with (cases = 45, and without ileus (controls = 261 were compared. Cases were first identified by observation of abnormal bowel sounds on physical examination and confirmed with abdominal radiographs. For this comparison, Chi-square test was used to measure the difference in proportion, Student's t-test to calculate the difference in mean for normally distributed data and Mann-Whitney test for data that were not normally distributed. Finally, in identifying independent risk factors for ileus, logistical regression analysis was performed. Ileus was defined if a child developed abdominal distension and had hyperactive or sluggish or absent bowel sound and a radiologic evidence of abdominal gas-fluid level during hospitalization. Logistic regression analysis adjusting for potential confounders revealed that the independent risk factors for admission for ileus were reluctance to feed (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.24-8.39, p = 0.02, septic shock (OR = 3.62, 95% CI = 1.247-8.95, p<0.01, and hypokalemia (OR = 1.99, 95% CI = 1.03-3.86, p = 0.04. Mortality was significantly higher in cases compared to controls (22% vs. 8%, p<0.01 in univariate analysis; however

PACS 2000: quality control using the task allocation chart

Science.gov (United States)

Norton, Gary S.; Romlein, John R.; Lyche, David K.; Richardson, Ronald R., Jr.

2000-05-01

Medical imaging's technological evolution in the next century will continue to include Picture Archive and Communication Systems (PACS) and teleradiology. It is difficult to predict radiology's future in the new millennium with both computed radiography and direct digital capture competing as the primary image acquisition methods for routine radiography. Changes in Computed Axial Tomography (CT) and Magnetic Resonance Imaging (MRI) continue to amaze the healthcare community. No matter how the acquisition, display, and archive functions change, Quality Control (QC) of the radiographic imaging chain will remain an important step in the imaging process. The Task Allocation Chart (TAC) is a tool that can be used in a medical facility's QC process to indicate the testing responsibilities of the image stakeholders and the medical informatics department. The TAC shows a grid of equipment to be serviced, tasks to be performed, and the organization assigned to perform each task. Additionally, skills, tasks, time, and references for each task can be provided. QC of the PACS must be stressed as a primary element of a PACS' implementation. The TAC can be used to clarify responsibilities during warranty and paid maintenance periods. Establishing a TAC a part of a PACS implementation has a positive affect on patient care and clinical acceptance.

Incidence and cost of medications dispensed despite electronic medical record discontinuation.

Science.gov (United States)

Baranowski, Patrick J; Peterson, Kristin L; Statz-Paynter, Jamie L; Zorek, Joseph A

2015-01-01

To determine the incidence and cost of medications dispensed despite discontinuation (MDDD) of the medications in the electronic medical record within an integrated health care organization. Dean Health System, with medical clinics and pharmacies linked by an electronic medical record, and a shared health plan and pharmacy benefits management company. Pharmacist-led quality improvement project using retrospective chart review. Electronic medical records, pharmacy records, and prescription claims data from patients 18 years of age or older who had a prescription filled for a chronic condition from June 2012 to August 2013 and submitted a claim through the Dean Health Plan were aggregated and cross-referenced to identify MDDD. Descriptive statistics were used to characterize demographics and MDDD incidence. Fisher's exact test and independent samples t tests were used to compare MDDD and non-MDDD groups. Wholesale acquisition cost was applied to each MDDD event. 7,406 patients met inclusion criteria. For 223 (3%) patients with MDDD, 253 independent events were identified. In terms of frequency per category, antihypertensive agents topped the list, followed, in descending order, by anticonvulsants, antilipemics, antidiabetics, and anticoagulants. Nine medications accounted for 59% (150 of 253) of all MDDD events; these included (again in descending order): gabapentin, atorvastatin, simvastatin, hydrochlorothiazide, lisinopril, warfarin, furosemide, metformin, and metoprolol. Mail-service pharmacies accounted for the highest incidence (5.3%) of MDDD, followed by mass merchandisers (4.6%) and small chains (3.9%). The total cost attributable to MDDD was $9,397.74. Development of a technology-based intervention to decrease the incidence of MDDD may be warranted to improve patient safety and decrease health care costs.

A Combined Control Chart for Identifying Out–Of–Control Points in Multivariate Processes

Directory of Open Access Journals (Sweden)

Marroquín–Prado E.

2010-10-01

Full Text Available The Hotelling's T2 control chart is widely used to identify out–of–control signals in multivariate processes. However, this chart is not sensitive to small shifts in the process mean vec tor. In this work we propose a control chart to identify out–of–control signals. The proposed chart is a combination of Hotelling's T2 chart, M chart proposed by Hayter et al. (1994 and a new chart based on Principal Components. The combination of these charts identifies any type and size of change in the process mean vector. Us ing simulation and the Average Run Length (ARL, the performance of the proposed control chart is evaluated. The ARL means the average points within control before an out–of–control point is detected, The results of the simulation show that the proposed chart is more sensitive that each one of the three charts individually

47 CFR 73.599 - NCE-FM engineering charts.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false NCE-FM engineering charts. 73.599 Section 73.599 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Noncommercial Educational FM Broadcast Stations § 73.599 NCE-FM engineering charts. This...

What motivates medical students to select medical studies : A systematic literature review

NARCIS (Netherlands)

Goel, Sonu; Angeli, F.; Dhirar, Nonita; Singla, Neetu; Ruwaard, Dirk

2018-01-01

Background: There is a significant shortage of health workers across and within countries. It is of utmost importance to determine the factors that motivate students to opt for medical studies. The objective of this study is to group and review all the studies that investigated the motivational

Retrospective chart review of obesity and episodic and chronic illness among rural Mexican-American adolescents accessing rural health clinic services.

Science.gov (United States)

Champion, Jane Dimmitt; Pierce, Sherrie; Collins, Jennifer L

2015-06-01

Obesity impacts the physical and psychological health of children and adolescents, and is a risk factor for development of episodic and chronic illness. Rural Mexican-American adolescents are at risk for obesity and associated chronic illnesses.The study used a retrospective chart review of data collected routinely in a rural health clinic setting from 1 January 2005 to 31 December 2010 to assess incidence of overweight/obesity status and episodic or chronic illness among Mexican-American adolescents aged 12-18 years. Analyses included body mass index, age, gender, and episodic or chronic illness diagnoses. Two hundred twelve charts were audited; women (n = 114, 53.8%), men (n = 98 46.2%); normal (n = 105, 49.5%), overweight/obese (n = 107, 50.5%). There were more female normal (n = 61, 53.5%) vs. overweight/obese (n = 53, 46.5%). More male overweight/obese (n = 54, 55.1%) than normal weight (n = 44, 44.9%). Age at first documented overweight/obesity status occurred in early adolescence (median = 13 years, mode = 12 years). Chronic illness incidence was higher among men than women, and overweight/obese vs. normal weight adolescents and in sub-categorizations by weight and specific illness. Incidence of episodic illness was higher among women than men, with variation by weight and specific illness. Disproportionately high incidence of episodic or chronic illness and overweight/obesity identified among rural Mexican-American adolescents compels intervention modification to improve effectiveness. © 2014 Wiley Publishing Asia Pty Ltd.

Sustained Medication Reduction Following Unilateral VIM Thalamic Stimulation for Essential Tremor.

Science.gov (United States)

Resnick, Andrew S; Okun, Michael S; Malapira, Teresita; Smith, Donald; Vale, Fernando L; Sullivan, Kelly; Miller, Amber; Jahan, Israt; Zesiewicz, Theresa

2012-01-01

Deep brain stimulation (DBS) is an increasingly utilized therapeutic modality for the management of medication refractory essential tremor (ET). The aim of this study was to determine whether DBS allowed for anti-tremor medication reduction within the year after the procedure was performed. We conducted a retrospective chart review and telephone interviews on 34 consecutive patients who had been diagnosed with ET, and who had undergone unilateral DBS surgery. Of the 34 patients in our cohort, 31 patients (91%) completely stopped all anti-tremor medications either before surgery (21 patients, 62%) or in the year following DBS surgery (10 patients, 29%). Patients who discontinued tremor medications before DBS surgery did so because their tremors either became refractory to anti-tremor medication, or they developed adverse events to tremor medications. Patients who stopped tremor medications after DBS surgery did so due to sufficient tremor control. Only three patients (9%) who were taking tremor medications at the time of surgery continued the use of a beta-blocker post-operatively for the purpose of hypertension management in all cases. The data from this study indicate that medication cessation is common following unilateral DBS for ET.

Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review.

Directory of Open Access Journals (Sweden)

Anam Parand

Full Text Available Medications are mostly taken in patients' own homes, increasingly administered by carers, yet studies of medication safety have been largely conducted in the hospital setting. We aimed to review studies of how carers cause and/or prevent medication administration errors (MAEs within the patient's home; to identify types, prevalence and causes of these MAEs and any interventions to prevent them.A narrative systematic review of literature published between 1 Jan 1946 and 23 Sep 2013 was carried out across the databases EMBASE, MEDLINE, PSYCHINFO, COCHRANE and CINAHL. Empirical studies were included where carers were responsible for preventing/causing MAEs in the home and standardised tools used for data extraction and quality assessment.Thirty-six papers met the criteria for narrative review, 33 of which included parents caring for children, two predominantly comprised adult children and spouses caring for older parents/partners, and one focused on paid carers mostly looking after older adults. The carer administration error rate ranged from 1.9 to 33% of medications administered and from 12 to 92.7% of carers administering medication. These included dosage errors, omitted administration, wrong medication and wrong time or route of administration. Contributory factors included individual carer factors (e.g. carer age, environmental factors (e.g. storage, medication factors (e.g. number of medicines, prescription communication factors (e.g. comprehensibility of instructions, psychosocial factors (e.g. carer-to-carer communication, and care-recipient factors (e.g. recipient age. The few interventions effective in preventing MAEs involved carer training and tailored equipment.This review shows that home medication administration errors made by carers are a potentially serious patient safety issue. Carers made similar errors to those made by professionals in other contexts and a wide variety of contributory factors were identified. The home care

A novel income security intervention to address poverty in a primary care setting: a retrospective chart review.

Science.gov (United States)

Jones, Marcella K; Bloch, Gary; Pinto, Andrew D

2017-08-17

To examine the development and implementation of a novel income security intervention in primary care. A retrospective, descriptive chart review of all patients referred to the Income Security Heath Promotion service during the first year of the service (December 2013-December 2014). A multisite interdisciplinary primary care organisation in inner city Toronto, Canada, serving over 40 000 patients. The study population included 181 patients (53% female, mean age 48 years) who were referred to the Income Security Health Promotion service and engaged in care. The Income Security Health Promotion service consists of a trained health promoter who provides a mixture of expert advice and case management to patients to improve income security. An advisory group, made up of physicians, social workers, a community engagement specialist and a clinical manager, supports the service. Sociodemographic information, health status, referral information and encounter details were collected from patient charts. Encounters focused on helping patients with increasing their income (77.4%), reducing their expenses (58.6%) and improving their financial literacy (26.5%). The health promoter provided an array of services to patients, including assistance with taxes, connecting to community services, budgeting and accessing free services. The service could be improved with more specific goal setting, better links to other members of the healthcare team and implementing routine follow-up with each patient after discharge. Income Security Health Promotion is a novel service within primary care to assist vulnerable patients with a key social determinant of health. This study is a preliminary look at understanding the functioning of the service. Future research will examine the impact of the Income Security Health Promotion service on income security, financial literacy, engagement with health services and health outcomes. © Article author(s) (or their employer(s) unless otherwise stated in

On the Mathematics behind the CUSUM Control Charts

DEFF Research Database (Denmark)

Madsen, Henrik

1998-01-01

This paper describes the mathematics behind CUSUM control charts. An introduction to CUSUM charts is found in (Madsen 1998).CUSUM charts are well suited for checking a measuring system in operation for any departure from some target or specified values. In general they can be used for:- detecting...... a drift (or shift in the level) of the measuring system, and- detecting a change of the precision of the measuring system.In both cases the CUSUM procedure contains methods for estimating the shift such that maintenance (e.g. recalibration) can take place.The CUSUM procedure is described in ISO/CD 7871...

Teaching history taking to medical students: a systematic review.

Science.gov (United States)

Keifenheim, Katharina E; Teufel, Martin; Ip, Julianne; Speiser, Natalie; Leehr, Elisabeth J; Zipfel, Stephan; Herrmann-Werner, Anne

2015-09-28

This paper is an up-to-date systematic review on educational interventions addressing history taking. The authors noted that despite the plethora of specialized training programs designed to enhance students' interviewing skills there had not been a review of the literature to assess the quality of each published method of teaching history taking in undergraduate medical education based on the evidence of the program's efficacy. The databases PubMed, PsycINFO, Google Scholar, opengrey, opendoar and SSRN were searched using key words related to medical education and history taking. Articles that described an educational intervention to improve medical students' history-taking skills were selected and reviewed. Included studies had to evaluate learning progress. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Seventy-eight full-text articles were identified and reviewed; of these, 23 studies met the final inclusion criteria. Three studies applied an instructional approach using scripts, lectures, demonstrations and an online course. Seventeen studies applied a more experiential approach by implementing small group workshops including role-play, interviews with patients and feedback. Three studies applied a creative approach. Two of these studies made use of improvisational theatre and one introduced a simulation using Lego® building blocks. Twenty-two studies reported an improvement in students' history taking skills. Mean MERSQI score was 10.4 (range 6.5 to 14; SD = 2.65). These findings suggest that several different educational interventions are effective in teaching history taking skills to medical students. Small group workshops including role-play and interviews with real patients, followed by feedback and discussion, are widespread and best investigated. Feedback using videotape review was also reported as particularly instructive. Students in the early preclinical state might profit from approaches helping

Appreciating the broad clinical features of SMAD4 mutation carriers: a multi-center chart review

OpenAIRE

Wain, K.E.; Ellingson, M.S.; McDonald, J.; Gammon, A.; Roberts, M.; Pichurin, P.; Winship, I.; Riegert-Johnson, D.; Weitzel, J. N.; Lindor, N.M.

2014-01-01

Heterozygous loss-of-function (LOF) SMAD4 mutations are associated with juvenile polyposis syndrome (JP) and hereditary hemorrhagic telangiectasia (HHT). Some carriers exhibit symptoms of both conditions, leading to the name JP-HHT syndrome. Three families have been reported with connective tissue abnormalities. In order to better understand the spectrum and extent of clinical findings in SMAD4 carriers, medical records of 34 patients (20 families) from five clinical practices were reviewed. ...

A critical review of the core medical training curriculum in the UK: A medical education perspective.

Science.gov (United States)

Laskaratos, Faidon-Marios; Gkotsi, Despoina; Panteliou, Eleftheria

2014-01-01

This paper represents a systematic evaluation of the Core Medical Training Curriculum in the UK. The authors critically review the curriculum from a medical education perspective based mainly on the medical education literature as well as their personal experience of this curriculum. They conclude in practical recommendations and suggestions which, if adopted, could improve the design and implementation of this postgraduate curriculum. The systematic evaluation approach described in this paper is transferable to the evaluation of other undergraduate or postgraduate curricula, and could be a helpful guide for medical teachers involved in the delivery and evaluation of any medical curriculum.

Impact of early in-hospital medication review by clinical pharmacists on health services utilization.

Directory of Open Access Journals (Sweden)

Corinne M Hohl

Full Text Available Adverse drug events are a leading cause of emergency department visits and unplanned admissions, and prolong hospital stays. Medication review interventions aim to identify adverse drug events and optimize medication use. Previous evaluations of in-hospital medication reviews have focused on interventions at discharge, with an unclear effect on health outcomes. We assessed the effect of early in-hospital pharmacist-led medication review on the health outcomes of high-risk patients.We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in British Columbia, Canada. We incorporated a clinical decision rule into emergency department triage pathways, allowing nurses to identify patients at high-risk for adverse drug events. After randomly selecting the first eligible patient for participation, clinical pharmacists systematically allocated subsequent high-risk patients to medication review or usual care. Medication review included obtaining a best possible medication history and reviewing the patient's medications for appropriateness and adverse drug events. The primary outcome was the number of days spent in-hospital over 30 days, and was ascertained using administrative data. We used median and inverse propensity score weighted logistic regression modeling to determine the effect of pharmacist-led medication review on downstream health services use.Of 10,807 high-risk patients, 6,416 received early pharmacist-led medication review and 4,391 usual care. Their baseline characteristics were balanced. The median number of hospital days was reduced by 0.48 days (95% confidence intervals [CI] = 0.00 to 0.96; p = 0.058 in the medication review group compared to usual care, representing an 8% reduction in the median length of stay. Among patients under 80 years of age, the median number of hospital days was reduced by 0.60 days (95% CI = 0.06 to 1.17; p = 0.03, representing 11% reduction in the median length of stay

Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

Science.gov (United States)

Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Greene, Laurence; Patel, Barry; Higgins, Peter D R

2016-07-01

Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.

Pharmacist-led discharge medication counselling: A scoping review.

Science.gov (United States)

Bonetti, Aline F; Reis, Wálleri C; Lombardi, Natália Fracaro; Mendes, Antonio M; Netto, Harli Pasquini; Rotta, Inajara; Fernandez-Llimos, Fernando; Pontarolo, Roberto

2018-04-24

Discharge medication counselling has produced improved quality of care and health outcomes, especially by reducing medication errors and readmission rates, and improving medication adherence. However, no studies have assembled an evidence-based discharge counselling process for clinical pharmacists. Thus, the present study aims to map the components of the pharmacist-led discharge medication counselling process. We performed a scoping review by searching electronic databases (Pubmed, Scopus, and DOAJ) and conducting a manual search to identify studies published up to July 2017. Studies that addressed pharmacist-led discharge medication counselling, regardless of the population, clinical conditions, and outcomes evaluated, were included. A total of 1563 studies were retrieved, with 75 matching the inclusion criteria. Thirty-two different components were identified, and the most prevalent were the indication of the medications and adverse drug reactions, which were reported in more than 50% of the studies. The components were reported similarly by studies from the USA and the rest of the world, and over the years. However, 2 differences were identified: the use of a dosage schedule, which was more frequent in studies published in 2011 or before and in studies outside the USA; and the teach-back technique, which was used more frequently in the USA. Poor quality reporting was also observed, especially regarding the duration of the counselling, the number of patients, and the medical condition. Mapping the components of the pharmacist-led discharge counselling studies through a scoping review allowed us to reveal how this service is performed around the world. Wide variability in this process and poor reporting were identified. Future studies are needed to define the core outcome set of this clinical pharmacy service to allow the generation of robust evidence and reproducibility in clinical practice. © 2018 John Wiley & Sons, Ltd.

Metabolic and infectious pathologies in Brazilian medical literature: a review.

Science.gov (United States)

Rocha-e-Silva, Mauricio

2010-06-01

This review of original reports on metabolic and infectious diseases that were recently published in Brazilian journals is designed to inform the readership of CLINICS about their content. I conducted a search in PubMed for original research articles (clinical or basic research) recently published (2008-2009) by Brazilian medical and biological periodicals. Papers on metabolic pathologies were retrieved by searching for appropriate keywords such as metabolic syndrome and obesity. Papers on infectious disease were obtained by entering 15 different keywords for the most commonly occurring pathologies. Review articles, editorials, letters to the editor, and case reports were manually excluded. Selected titles were then categorized into appropriate sub-categories. This search produced a total of 123 articles, which filtered down to 72 articles after eliminating editorials, review articles, letters to the Editor and case reports. Reviewed periodicals were Arquivos Brasileiros de Cardiologia, Arquivos Brasileiros de Endocrinologia e Metabologia, Brazilian Journal of Biological and Medical Research, Brazilian Journal of Infectious Diseases, Jornal de Pediatria, Jornal de Pneumologia, Revista da Associação Médica Brasileira, Revista da Escola de Enfermagem da Universidade de São Paulo, and São Paulo Medical Journal. The articles were then briefly summarized.

Use of methylphenidate among medical students: a systematic review

Directory of Open Access Journals (Sweden)

Guilherme Finger

2013-06-01

Full Text Available OBJECTIVE: To review the effects of methylphenidate on cognitive enhancement, memory, and performance in medical students. METHODS: A review of four databases (LILACS, PubMed, ScienceDirect, and SciELO, analyzing the title and of all articles published between 1990 and 2012 in English, Portuguese, and Spanish. Selected articles were read in entirety, including in the review those that met the established criteria. RESULTS: The prevalence of use among medical students reached 16%, with no gender difference. Most students began using the drug after entering the university, and the reasons cited to justify it are related to enhancing academic performance. CONCLUSION: There is no evidence in the literature that the use of methylphenidate is beneficial in terms of memory or learning. The drug simply increases wakefulness and alertness, reducing the time of sleep.

Negative Binomial charts for monitoring high-quality processes

NARCIS (Netherlands)

Albers, Willem/Wim

Good control charts for high quality processes are often based on the number of successes between failures. Geometric charts are simplest in this respect, but slow in recognizing moderately increased failure rates p. Improvement can be achieved by waiting until r > 1 failures have occurred, i.e. by

Book Reviews | Naidu | South African Medical Journal

African Journals Online (AJOL)

Book Review 1. Book Title: Medical Radionuclides: Radiation Dose and Effects. Book Authors: R. J. Cloutier, C. L. Edwards & W. S. Snyder (Ed.) Pp. ix + 528. Illustrated. $3.00. Oak Ridge, Tenn.: US Atomic Energy Commission. 1970. Available from Clearinghouse for Federal Scientific and Technical Information, Springfield, ...

'What is not written does not exist': the importance of proper documentation of medication use history.

Science.gov (United States)

Silvestre, Carina Carvalho; Santos, Lincoln Marques Cavalcante; de Oliveira-Filho, Alfredo Dias; de Lyra, Divaldo Pereira

2017-10-01

Medications are perceived as health risk factors, because they might cause damage if used improperly. In this context, an adequate assessment of medication use history should be encouraged, especially in transitions of care to avoid unintended medication discrepancies (UMDs). In a case-controlled study, we investigated potential risk factors for UMDs at hospital admission and found that 150 (42%) of the 358 patients evaluated had one or more UMDs. We were surprised to find that there was no record of a patient and/or relative interview on previous use of medication in 117 medical charts of adult patients (44.8%). Similarly, in the medical charts of 52 (53.6%) paediatric patients, there was no record of parents and/or relatives interviews about prior use of medications. One hundred thirty-seven medical charts of adult patients (52.4%) and seventy-two medical charts of paediatric patients (74.2%) had no record about medication allergies and intolerances. In other words, there was a lack of basic documentation regarding the patient's medication use history. As patients move between settings in care, there is insufficient tracking of verbal and written information related to medication changes, which results in a progressive and cumulative loss of information, as evidenced by problems associated with clinical transfers and medication orders. Proper documentation of medication information during transfer is a key step in the procedure; hence, it should be rightly performed. It remains unclear whether interviews, and other investigations about medication use history have been performed but have not been recorded as health-care data. Therefore, it is crucial to the improvement of medication use safety that documentation of all drug-related information-even if not directly related to the actual event-become routine practice in health-care organizations, since 'what is not written does not exist'.

A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department.

Science.gov (United States)

Schauer, Steven G; Cunningham, Cord W; Fisher, Andrew D; DeLorenzo, Robert A

2017-12-01

Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration. Project Design This was a quality assurance project that monitored training of combat medics to administer parenteral medications and to ensure patient safety. Combat medics were provided training that included direct supervision during medication administration. Once proficiency was demonstrated, combat medics would prepare the medications under direct supervision, followed by indirect supervision during administration. As part of the quality assurance and safety processes, combat medics were required to document all medication administrations, supervising provider, and unexpected adverse events. Additional quality assurance follow-up occurred via complete chart review by the project lead. Data During the project period, the combat medics administered the following medications: ketamine (n=13), morphine (n=8), ketorolac (n=7), fentanyl (n=5), ondansetron (n=4), and other (n=6). No adverse events or patient safety events were reported by the combat medics or discovered during the quality assurance process. In this limited case series, combat medics safely administered parenteral medications under indirect provider supervision. Future research is needed to further develop this training model for both the military and civilian setting. Schauer SG , Cunningham C W, Fisher AD , DeLorenzo RA . A pilot project demonstrating that combat medics can safely administer parenteral medications in the emergency department. Prehosp Disaster Med. 2017;32(6):679-681.

48 CFR 252.245-7000 - Government-furnished mapping, charting, and geodesy property.

Science.gov (United States)

2010-10-01

... mapping, charting, and geodesy property. 252.245-7000 Section 252.245-7000 Federal Acquisition Regulations..., charting, and geodesy property. As prescribed in 245.107-70, use the following clause: Government-Furnished Mapping, Charting, and Geodesy Property (DEC 1991) (a) Definition—Mapping, charting, and geodesy (MC&G...

Is video review of patient encounters an effective tool for medical student learning? A review of the literature

Directory of Open Access Journals (Sweden)

Hammoud MM

2012-03-01

Full Text Available Maya M Hammoud1, Helen K Morgan1, Mary E Edwards2, Jennifer A Lyon2, Casey White31Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Health Sciences Center Libraries, University of Florida, Gainesville, FL, USA; 3Graduate Medical Education, Faculty Affairs and Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USAPurpose: To determine if video review of student performance during patient encounters is an effective tool for medical student learning.Methods: Multiple bibliographic databases that include medical, general health care, education, psychology, and behavioral science literature were searched for the following terms: medical students, medical education, undergraduate medical education, education, self-assessment, self-evaluation, self-appraisal, feedback, videotape, video recording, televised, and DVD. The authors examined all abstracts resulting from this search and reviewed the full text of the relevant articles as well as additional articles identified in the reference lists of the relevant articles. Studies were classified by year of student (preclinical or clinical and study design (controlled or non-controlled.Results: A total of 67 articles met the final search criteria and were fully reviewed. Most studies were non-controlled and performed in the clinical years. Although the studies were quite variable in quality, design, and outcomes, in general video recording of performance and subsequent review by students with expert feedback had positive outcomes in improving feedback and ultimate performance. Video review with self-assessment alone was not found to be generally effective, but when linked with expert feedback it was superior to traditional feedback alone.Conclusion: There are many methods for integrating effective use of video-captured performance into a program of learning. We recommend combining student self-assessment with feedback

Economic impact of medication error: a systematic review.

Science.gov (United States)

Walsh, Elaine K; Hansen, Christina Raae; Sahm, Laura J; Kearney, Patricia M; Doherty, Edel; Bradley, Colin P

2017-05-01

Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error. PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed. A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population. Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Interactive SIGHT: textual access to simple bar charts

Science.gov (United States)

Demir, Seniz; Oliver, David; Schwartz, Edward; Elzer, Stephanie; Carberry, Sandra; Mccoy, Kathleen F.; Chester, Daniel

2010-12-01

Information graphics, such as bar charts and line graphs, are an important component of many articles from popular media. The majority of such graphics have an intention (a high-level message) to communicate to the graph viewer. Since the intended message of a graphic is often not repeated in the accompanying text, graphics together with the textual segments contribute to the overall purpose of an article and cannot be ignored. Unfortunately, these visual displays are provided in a format which is not readily accessible to everyone. For example, individuals with sight impairments who use screen readers to listen to documents have limited access to the graphics. This article presents a new accessibility tool, the Interactive SIGHT (Summarizing Information GrapHics Textually) system, that is intended to enable visually impaired users to access the knowledge that one would gain from viewing information graphics found on the web. The current system, which is implemented as a browser extension that works on simple bar charts, can be invoked by a user via a keystroke combination while navigating the web. Once launched, Interactive SIGHT first provides a brief summary that conveys the underlying intention of a bar chart along with the chart's most significant and salient features, and then produces history-aware follow-up responses to provide further information about the chart upon request from the user. We present two user studies that were conducted with sighted and visually impaired users to determine how effective the initial summary and follow-up responses are in conveying the informational content of bar charts, and to evaluate how easy it is to use the system interface. The evaluation results are promising and indicate that the system responses are well-structured and enable visually impaired users to answer key questions about bar charts in an easy-to-use manner. Post-experimental interviews revealed that visually impaired participants were very satisfied with

Medication Adherence Apps: Review and Content Analysis.

Science.gov (United States)

Ahmed, Imran; Ahmad, Niall Safir; Ali, Shahnaz; Ali, Shair; George, Anju; Saleem Danish, Hiba; Uppal, Encarl; Soo, James; Mobasheri, Mohammad H; King, Dominic; Cox, Benita; Darzi, Ara

2018-03-16

Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date. The aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps. In April 2015, relevant medication adherence apps were identified by searching the Apple App Store and the Google Play Store using a combination of relevant search terms. Data extracted included app store source, app price, documentation of health care professional (HCP) involvement during app development, and evidence base for each respective app. Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardized medication regimen of three reminders over a 4-hour period. Nonadherence features designed to enhance user experience were also documented. The app repository search identified a total of 5881 apps. Of these, 805 fulfilled the inclusion criteria initially and were tested. Furthermore, 681 apps were further analyzed for data extraction. Of these, 420 apps were free for testing, 58 were inaccessible and 203 required payment. Of the 420 free apps, 57 apps were developed with HCP involvement and an evidence base was identified in only 4 apps. Of the paid apps, 9 apps had HCP involvement, 1 app had a documented evidence base, and 1 app had both. In addition, 18 inaccessible apps were produced with HCP involvement, whereas 2 apps had a documented evidence base. The 420 free apps were

Usability inspection to improve an electronic provincial medication repository.

Science.gov (United States)

Kitson, Nicole A; Price, Morgan; Bowen, Michael; Lau, Francis

2013-01-01

Medication errors are a significant source of actual and potential harm for patients. Community medication records have the potential to reduce medication errors, but they can also introduce unintended consequences when there is low fit to task (low cognitive fit). PharmaNet is a provincially managed electronic repository that contains the records for community-based pharmacy-dispensed medications in British Columbia. This research explores the usability of PharmaNet, as a representative community-based medication repository. We completed usability inspections of PharmaNet through vendor applications. Vendor participants were asked to complete activity-driven scenarios, which highlighted aspects of medication management workflow. Screen recording was later reviewed. Heuristics were applied to explore usability issues and improvement opportunities. Usability inspection was conducted with four PharmaNet applications. Ninety-six usability issues were identified; half of these had potential implications for patient safety. These were primarily related to login and logout procedures; display of patient name; display of medications; update and display of alert information; and the changing or discontinuation of medications. PharmaNet was designed primarily to support medication dispensing and billing activities by community pharmacies, but is also used to support care providers with monitoring and prescribing activities. As such, some of the features do not have a strong fit for other clinical activities. To improve fit, we recommend: having a Current Medications List and Displaying Medication Utilization Charts.

Simulation in Medical School Education: Review for Emergency Medicine

Directory of Open Access Journals (Sweden)

Shahram Lotfipour

2011-05-01

Full Text Available Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM. The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.

The effectiveness of robust RMCD control chart as outliers’ detector

Science.gov (United States)

Darmanto; Astutik, Suci

2017-12-01

A well-known control chart to monitor a multivariate process is Hotelling’s T 2 which its parameters are estimated classically, very sensitive and also marred by masking and swamping of outliers data effect. To overcome these situation, robust estimators are strongly recommended. One of robust estimators is re-weighted minimum covariance determinant (RMCD) which has robust characteristics as same as MCD. In this paper, the effectiveness term is accuracy of the RMCD control chart in detecting outliers as real outliers. In other word, how effectively this control chart can identify and remove masking and swamping effects of outliers. We assessed the effectiveness the robust control chart based on simulation by considering different scenarios: n sample sizes, proportion of outliers, number of p quality characteristics. We found that in some scenarios, this RMCD robust control chart works effectively.

Medical leaders or masters? - A systematic review of medical leadership in hospital settings

NARCIS (Netherlands)

M. Berghout (Mathilde); I.N. Fabbricotti (Isabelle); M. Buljac-Samardzic (Martina); C.G.J.M. Hilders (Carina)

2017-01-01

textabstractMedical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal

Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center

Science.gov (United States)

Detweiler, Mark B.; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S.; Detweiler, Jonna G.; Lutgens, Brian W.

2016-01-01

The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares. PMID:27999253

The impact of a Critical Care Information System (CCIS) on time spent charting and in direct patient care by staff in the ICU: a review of the literature.

Science.gov (United States)

Mador, Rebecca L; Shaw, Nicola T

2009-07-01

The introduction of a Critical Care Information System (CCIS) into an intensive care unit (ICU) is purported to reduce the time health care providers (HCP) spend on documentation and increase the time available for direct patient care. However, there is a paucity of rigorous empirical research that has investigated these assertions. Moreover, those studies that have sought to elucidate the relationship between the introduction of a CCIS and the time spent by staff on in/direct patient care activities have published contradictory findings. The objective of this literature review is to establish the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU. Five electronic databases were searched including PubMed Central, EMBASE, CINAHL, IEEE Xplore, and the Cochrane Database of Systematic Reviews. Reference lists of all published papers were hand searched, and citations reviewed to identify extra papers. We included studies that were empirical articles, published in English, and provided original data on the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU. In total, 12 articles met the inclusion criteria. Workflow analysis (66%) and time-and-motion analysis (25%) were the most common forms of data collection. Three (25%) studies found an increase in time spent charting, five (42%) found no difference, and four (33%) studies reported a decrease. Results on the impact of a CCIS on direct patient care were similarly inconclusive. Due to the discrepant findings and several key methodological issues, the impact of a CCIS on time spent charting and in direct patient care remains unclear. This review highlights the need for an increase in rigorous empirical research in this area and provides recommendations for the design and implementation of future studies.

Charting Transnational Native American Studies

Directory of Open Access Journals (Sweden)

Hsinya Huang

2012-06-01

Full Text Available Introduction to the Special Forum entitled "Charting Transnational Native American Studies: Aesthetics, Politics, Identity," edited by Hsinya Huang, Philip J. Deloria, Laura M. Furlan, and John Gamber

Quality Control Charts in Large-Scale Assessment Programs

Science.gov (United States)

Schafer, William D.; Coverdale, Bradley J.; Luxenberg, Harlan; Jin, Ying

2011-01-01

There are relatively few examples of quantitative approaches to quality control in educational assessment and accountability contexts. Among the several techniques that are used in other fields, Shewart charts have been found in a few instances to be applicable in educational settings. This paper describes Shewart charts and gives examples of how…

46 CFR 109.565 - Charts and nautical publications.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Charts and nautical publications. 109.565 Section 109... OPERATIONS Miscellaneous § 109.565 Charts and nautical publications. The master or person in charge of a self...) Notices to mariners. (f) Tide Tables. (g) Current Tables. (h) All other nautical publications necessary. 1...

Medications and Impaired Driving: A Review of the Literature

Science.gov (United States)

Hetland, Amanda; Carr, David B

2013-01-01

Objective To describe the association of specific medication classes with driving outcomes and provide clinical recommendations. Data sources The MEDLINE and EMBASE databases were searched for articles published from January 1973 to June 2013 on specific classes of medications known to be associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. Study selection and data extraction Only English-language articles that contained findings from observational or interventional designs were included. Cross-sectional studies, case series, and case reports were excluded. Studies of ≥ 10 subjects were included in this review. Data synthesis Driving is an important task and activity for the majority of adults. Unfortunately, some specific classes of commonly prescribed medications have been associated with driving impairment as measured by road performance, driving simulation, and/or motor vehicle crashes. This review of 30 studies identified findings with barbiturates, benzodiazepines, certain non-benzodiazepine hypnotics, various antidepressants, opioid and non-steroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents. Additional studies identifying medication impacts on sedation, sleep latency, and psychomotor function – as well as the role of alcohol – are also discussed. Conclusions Psychotropic agents and those with CNS side effects were associated with various measures of impaired driving performance. It is difficult to determine if such associations are actually a result of medication use or perhaps the medical diagnosis itself. Regardless, clinicians should be aware of the increased risk of impaired driving with specific populations and classes of medications when prescribing these agents, educate their patients, and/or consider safer alternatives

A new specialized visual acuity chart for amblyopic children aged 3-5 years old:development and its clinical applications

Directory of Open Access Journals (Sweden)

Yang-Qing Huang

2013-12-01

Full Text Available AIM: To introduce a new specialized visual acuity chart for amblyopic children aged 3-5 years old and its clinical applications.METHODS:The new visual acuity chart and notations were designed based on Weber-Fechner law. The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle, square, triangle，and cross. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 14 lines. The progression rate of the optotype size between two lines was 1.2589 and the testing distance was 3m. Visual acuity score could be recorded as logMAR notation or decimal notation. Age-stratified diagnostic criteria for amblyopia established by consensus statement on diagnosis of amblyopia (2011 among members of the Strabismus and Pediatric Ophthalmology Group, Ophthalmology Society, Chinese Medical Association (SPOGOSCMA were illustrated in the new visual acuity chart.RESULTS: When assessing visual acuity in children aged 3-5 years old, this new visual acuity chart that consists of four symmetrical shapes (triangle, square, cross, and circle overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling ‘E’ or Landolt ‘C’, which the subjects were prone to lose interest in. The visual acuity score may be recorded in different notations:decimal acuity and logMAR. These two notations can be easily converted each other in the new eye chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the international standard logarithmic visual acuity chart (r=0.932, P<0.01, but also indicated a high test-retest reliability (89% of retest scores were within 0.1logMAR units of the initial test score.CONCLUSION: The results of this study support the validity and reliability of distance visual acuity measurements using the new eye chart in

Gamification and Multimedia for Medical Education: A Landscape Review.

Science.gov (United States)

McCoy, Lise; Lewis, Joy H; Dalton, David

2016-01-01

Medical education is rapidly evolving. Students enter medical school with a high level of technological literacy and an expectation for instructional variety in the curriculum. In response, many medical schools now incorporate technology-enhanced active learning and multimedia education applications. Education games, medical mobile applications, and virtual patient simulations are together termed gamified training platforms. To review available literature for the benefits of using gamified training platforms for medical education (both preclinical and clinical) and training. Also, to identify platforms suitable for these purposes with links to multimedia content. Peer-reviewed literature, commercially published media, and grey literature were searched to compile an archive of recently published scientific evaluations of gamified training platforms for medical education. Specific educational games, mobile applications, and virtual simulations useful for preclinical and clinical training were identified and categorized. Available evidence was summarized as it related to potential educational advantages of the identified platforms for medical education. Overall, improved learning outcomes have been demonstrated with virtual patient simulations. Games have the potential to promote learning, increase engagement, allow for real-word application, and enhance collaboration. They can also provide opportunities for risk-free clinical decision making, distance training, learning analytics, and swift feedback. A total of 5 electronic games and 4 mobile applications were identified for preclinical training, and 5 electronic games, 10 mobile applications, and 12 virtual patient simulation tools were identified for clinical training. Nine additional gamified, virtual environment training tools not commercially available were also identified. Many published studies suggest possible benefits from using gamified media in medical curriculum. This is a rapidly growing field. More

Medication effects on the rate of orthodontic tooth movement: a systematic literature review.

NARCIS (Netherlands)

Bartzela, T.N.; Turp, J.C.; Motschall, E.; Maltha, J.C.

2009-01-01

INTRODUCTION: Recently, several reviews have been published on the effects of medications on bone physiology and the clinical side effects in orthodontics. However, the effects of medications on the rate of orthodontic tooth movement have not been evaluated. METHODS: A systematic literature review

An Assessment of Statistical Process Control-Based Approaches for Charting Student Evaluation Scores

Science.gov (United States)

Ding, Xin; Wardell, Don; Verma, Rohit

2006-01-01

We compare three control charts for monitoring data from student evaluations of teaching (SET) with the goal of improving student satisfaction with teaching performance. The two charts that we propose are a modified "p" chart and a z-score chart. We show that these charts overcome some of the shortcomings of the more traditional charts…

Monitoring a PVC batch process with multivariate statistical process control charts

NARCIS (Netherlands)

Tates, A. A.; Louwerse, D. J.; Smilde, A. K.; Koot, G. L. M.; Berndt, H.

1999-01-01

Multivariate statistical process control charts (MSPC charts) are developed for the industrial batch production process of poly(vinyl chloride) (PVC). With these MSPC charts different types of abnormal batch behavior were detected on-line. With batch contribution plots, the probable causes of these

The use of Facebook in medical education – A literature review

Directory of Open Access Journals (Sweden)

Pander, Tanja

2014-08-01

Full Text Available [english] Background: The vogue of social media has changed interpersonal communication as well as learning and teaching opportunities in medical education. The most popular social media tool is Facebook. Its features provide potentially useful support for the education of medical students but it also means that some new challenges will have to be faced. Aims: This review aimed to find out how Facebook has been integrated into medical education. A systematical review of the current literature and grade of evidence is provided, research gaps are identified, links to prior reviews are drawn and implications for the future are discussed.Method: The authors searched six databases. Inclusion criteria were defined and the authors independently reviewed the search results. The key information of the articles included was methodically abstracted and coded, synthesized and discussed in the categories study design, study participants’phase of medical education and study content.Results: 16 articles met all inclusion criteria. 45-96% of health care professionals in all phases of their medical education have a Facebook profile. Most studies focused on Facebook and digital professionalism. Unprofessional behavior and privacy violations occurred in 0.02% to 16%. In terms of learning and teaching environment, Facebook is well accepted by medical students. It is used to prepare for exams, share online material, discuss clinical cases, organize face-to-face sessions and exchange information on clerkships. A few educational materials to teach Facebook professionalism were positively evaluated. There seems to be no conclusive evidence as to whether medical students benefit from Facebook as a learning environment on higher competence levels.Discussion: Facebook influences a myriad of aspects of health care professionals, particularly at undergraduate and graduate level in medical education. Despite an increasing number of interventions, there is a lack of

The use of Facebook in medical education – A literature review

Science.gov (United States)

Pander, Tanja; Pinilla, Severin; Dimitriadis, Konstantinos; Fischer, Martin R.

2014-01-01

Background: The vogue of social media has changed interpersonal communication as well as learning and teaching opportunities in medical education. The most popular social media tool is Facebook. Its features provide potentially useful support for the education of medical students but it also means that some new challenges will have to be faced. Aims: This review aimed to find out how Facebook has been integrated into medical education. A systematical review of the current literature and grade of evidence is provided, research gaps are identified, links to prior reviews are drawn and implications for the future are discussed. Method: The authors searched six databases. Inclusion criteria were defined and the authors independently reviewed the search results. The key information of the articles included was methodically abstracted and coded, synthesized and discussed in the categories study design, study participants’phase of medical education and study content. Results: 16 articles met all inclusion criteria. 45-96% of health care professionals in all phases of their medical education have a Facebook profile. Most studies focused on Facebook and digital professionalism. Unprofessional behavior and privacy violations occurred in 0.02% to 16%. In terms of learning and teaching environment, Facebook is well accepted by medical students. It is used to prepare for exams, share online material, discuss clinical cases, organize face-to-face sessions and exchange information on clerkships. A few educational materials to teach Facebook professionalism were positively evaluated. There seems to be no conclusive evidence as to whether medical students benefit from Facebook as a learning environment on higher competence levels. Discussion: Facebook influences a myriad of aspects of health care professionals, particularly at undergraduate and graduate level in medical education. Despite an increasing number of interventions, there is a lack of conclusive evidence in terms of

The Determination of National Growth Charts to Prevent and Manage Malnutrition in Iranian Children: Necessity and Importance

International Nuclear Information System (INIS)

Abtahi, Mitra; Doustmohammadian, Aazam; Pouraram, Hamed

2014-01-01

Full text: Objectives: Standard height and weight charts are the most important evaluation tools for the assessment of growth and development of children which could be further used to develop preventive interventions both in individual and epidemiologic assessments in the community. Children of different populations differ a lot in size and shape, resulting from differences in their genetic pattern, their needs and interaction of these two. Regarding the existence of different standards, it seems that a national standard can provide a more accurate functional individual and social evaluation tool and many problems will be solved in case of availability of an Iranian standard for comparison of children’s height, weight, and their growth follow-ups. One of these problems is the abnormal results regarding mal nourishment, overweight, or obesity in Iranian children. Considerable rate of childhood malnutrition in Iran and other countries necessitates the implementation of interventional programs including development of local growth charts to prevent and manage malnutrition in the community. This study was undertaken with the aim of reviewing different current growth curves, their advantages and disadvantages, and performing a review of the studies conducted in Iran and other countries on determination of weight and height standards. Methods: In order to collect materials for this review, a detailed search of Scientific Information Database (SID), Iran Medex, MEDLINE, Pub Med, and Web of Science was carried out for the time period 2005-2011 using the keywords: national standard, height, weight, children, and growth chart. Initially, we reviewed international standards of weight and height. Results: The results of performed studies in European and Asian countries showed that the height and weight curves of these children were different from WHO and NCHS growth standards. The finding of growth trend study of Iranian children showed that the mean height and weight of

Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development.

Science.gov (United States)

Abbas, Mark R; Quince, Thelma A; Wood, Diana F; Benson, John A

2011-11-14

There is a growing acknowledgement that doctors need to develop leadership and management competences to become more actively involved in the planning, delivery and transformation of patient services. We undertook a systematic review of what is known concerning the knowledge, skills and attitudes of medical students regarding leadership and management. Here we report the results pertaining to the attitudes of students to provide evidence to inform curriculum development in this developing field of medical education. We searched major electronic databases and citation indexes within the disciplines of medicine, education, social science and management. We undertook hand searching of major journals, and reference and citation tracking. We accessed websites of UK medical institutions and contacted individuals working within the field. 26 studies were included. Most were conducted in the USA, using mainly quantitative methods. We used inductive analysis of the topics addressed by each study to identity five main content areas: Quality Improvement; Managed Care, Use of Resources and Costs; General Leadership and Management; Role of the Doctor, and Patient Safety. Students have positive attitudes to clinical practice guidelines, quality improvement techniques and multidisciplinary teamwork, but mixed attitudes to managed care, cost containment and medical error. Education interventions had variable effects on students' attitudes. Medical students perceive a need for leadership and management education but identified lack of curriculum time and disinterest in some activities as potential barriers to implementation. The findings from our review may reflect the relatively little emphasis given to leadership and management in medical curricula. However, students recognise a need to develop leadership and management competences. Although further work needs to be undertaken, using rigorous methods, to identify the most effective and cost-effective curriculum innovations, this

Development of gamma exposure chart (Selenium-75) for Industrial Radiography Application

International Nuclear Information System (INIS)

Sapizah Rahim; Shaharudin Sayuti; Noorhazleena Azaman

2011-01-01

Radiographic exposure can be determined by either trial exposure, reference to previous data or using exposure chart. Without previous data, exposure chart is the easiest and economic way to achieve correct exposure. It will minimize re-shoot and time. This paper presents the development of gamma exposure chart for Selenium-75 source. Film radiography method has been chosen for this development using steel step wedge blocks. Agfa Structurix D7 films have been used during the exposure and the optical density of the films was measured by using X-Rite densitometer. Method of development of the chart is explained. The chart is tested on pipe and welded plate test sample and the results are discussed. (author)

Charts for Guiding Adjustments of Irrigation Interval to Actual Weather Conditions

International Nuclear Information System (INIS)

Kipkorir, E.C.

2002-01-01

Major problems in irrigation management at short time-step during the season are unreliability of rainfall and absence of guidance. By considering the climate of region, crop and soil characteristics, the irrigation method and local irrigation practices, this paper presents the concept of irrigation charts. The charts are based on soil water technique. As an example irrigation chart for a typical irrigation system located in the semi-arid area in Naivasha, Kenya is presented. The chart guides the user in adjustment of irrigation interval to the actual weather conditions throughout the growing season. It is believed that the simplicity of the chart makes it a useful tool for a better utilisation of the limited irrigation water

Improving Pharmacists’ Targeting of Patients for Medication Review and Deprescription

Directory of Open Access Journals (Sweden)

Vanessa Marvin

2018-04-01

Full Text Available Background: In an acute hospital setting, a multi-disciplinary approach to medication review can improve prescribing and medicine selection in patients with frailty. There is a need for a clear understanding of the roles and responsibilities of pharmacists to ensure that interventions have the greatest impact on patient care. Aim: To use a consensus building process to produce guidance for pharmacists to support the identification of patients at risk from their medicines, and to articulate expected actions and escalation processes. Methods: A literature search was conducted and evidence used to establish a set of ten scenarios often encountered in hospitalised patients, with six or more possible actions. Four consultant physicians and four senior pharmacists ranked their levels of agreement with the listed actions. The process was redrafted and repeated until consensus was reached and interventions were defined. Outcome: Generalised guidance for reviewing older adults’ medicines was developed, alongside escalation processes that should be followed in a specific set of clinical situations. The panel agreed that both pharmacists and physicians have an active role to play in medication review, and face-to-face communication is always preferable to facilitate informed decision making. Only prescribers should deprescribe, however pharmacists who are not also trained as prescribers may temporarily “hold” medications in the best interests of the patient with appropriate documentation and a follow up discussion with the prescribing team. The consensus was that a combination of age, problematic polypharmacy, and the presence of medication-related problems, were the most important factors in the identification of patients who would benefit most from a comprehensive medication review. Conclusions: Guidance on the identification of patients on inappropriate medicines, and subsequent pharmacist-led intervention to prompt and promote deprescribing, has

A computer-controlled conformal radiotherapy system. IV: Electronic chart

International Nuclear Information System (INIS)

Fraass, Benedick A.; McShan, Daniel L.; Matrone, Gwynne M.; Weaver, Tamar A.; Lewis, James D.; Kessler, Marc L.

1995-01-01

Purpose: The design and implementation of a system for electronically tracking relevant plan, prescription, and treatment data for computer-controlled conformal radiation therapy is described. Methods and Materials: The electronic charting system is implemented on a computer cluster coupled by high-speed networks to computer-controlled therapy machines. A methodical approach to the specification and design of an integrated solution has been used in developing the system. The electronic chart system is designed to allow identification and access of patient-specific data including treatment-planning data, treatment prescription information, and charting of doses. An in-house developed database system is used to provide an integrated approach to the database requirements of the design. A hierarchy of databases is used for both centralization and distribution of the treatment data for specific treatment machines. Results: The basic electronic database system has been implemented and has been in use since July 1993. The system has been used to download and manage treatment data on all patients treated on our first fully computer-controlled treatment machine. To date, electronic dose charting functions have not been fully implemented clinically, requiring the continued use of paper charting for dose tracking. Conclusions: The routine clinical application of complex computer-controlled conformal treatment procedures requires the management of large quantities of information for describing and tracking treatments. An integrated and comprehensive approach to this problem has led to a full electronic chart for conformal radiation therapy treatments

No Difference in Psychotropic Medication Use in Cosmetic and General Dermatology Patients.

Science.gov (United States)

Hamilton, Heather K; Lilly, Evelyn; Arndt, Kenneth A; Dover, Jeffrey S

2016-07-01

Patients presenting for appearance-related concerns are often perceived as being more difficult (ie, more needy, more difficult to satisfy) than patients presenting for medical dermatologic problems. While the reasons for this perception are many, some hypothesize that this may be related to a higher rate of anxiety, depression, or body image issues among these patients. To determine the prevalence of psychotropic medication use in cosmetic dermatology patients compared to the prevalence of such medication use in general dermatology patients. METHODS & The study was a retrospective chart review of female patients, 18 or older, new to a private practice. Exclusion criteria included dermatologic disorders with known psychosocial comorbidity. Psychotropic medication use was recorded. The percentage of subjects in the medical group (n=156) who reported using psychotropic medications was 22.2% compared to 26.8% in the cosmetic group (n=154; P=0.09). The prevalence of psychotropic medication use among all dermatology patients in our practice was relatively high, but there was no statistically significant difference in the rate of psychotropic medication use in cosmetic dermatology patients compared to general dermatology patients. J Drugs Dermatol. 2016;15(7):858-861.

Application of CUSUM charts to detect lameness in a milking robot

DEFF Research Database (Denmark)

Pastell, Matti; Madsen, Henrik

2008-01-01

shown that the weight distribution between limbs changes when cow get lame. In this paper we suggest CUSUM charts to automatically detect lameness based on the measurements. CUSUM charts are statistical based control charts and are well suited for checking a measuring system in operation for any...

A systematic review of publications studies on medical tourism

OpenAIRE

Masoud, Ferdosi; Alireza, Jabbari; Mahmoud, Keyvanara; Zahra, Agharahimi

2013-01-01

Introduction: Medical tourism for any study area is complex. Materials and Methods: Using full articles from other databases, Institute for Scientific Information (ISI), Science Direct, Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained using descriptive statistics and content analysis categories were analyzed. Results: Among the 28 articles reviewed, 11 ...

The Usage of Time Series Control Charts for Financial Process Analysis

Directory of Open Access Journals (Sweden)

Kovářík Martin

2012-09-01

Full Text Available We will deal with financial proceedings of the company using methods of SPC (Statistical Process Control, specifically through time series control charts. The paper will outline the intersection of two disciplines which are econometrics and statistical process control. The theoretical part will discuss the methodology of time series control charts and in the research part there will be this methodology demonstrated in three case studies. The first study will focus on the regulation of simulated financial flows for a company by CUSUM control chart. The second study will involve the regulation of financial flows for a heteroskedastic financial process by EWMA control chart. The last case study of our paper will be devoted to applications of ARIMA, EWMA and CUSUM control charts in the financial data that are sensitive to the mean shifting while calculating the autocorrelation in the data. In this paper, we highlight the versatility of control charts not only in manufacturing but also in managing the financial stability of cash flows.

Evaluation of STAT medication ordering process in a community hospital

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Abdelaziz H

2016-06-01

Full Text Available Background: In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. Objective: The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. Methods: All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE orders vs. non-physician entered (NPE orders. Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. Results: A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16–63; p<0.0001. . The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026. In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001]. Conclusion: We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process.

The use of medication in selective mutism: a systematic review.

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Manassis, Katharina; Oerbeck, Beate; Overgaard, Kristin Romvig

2016-06-01

Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.