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Sample records for patient chart reviews

  1. Using patients' charts to assess medical trainees in the workplace: a systematic review.

    Science.gov (United States)

    Al-Wassia, Heidi; Al-Wassia, Rolina; Shihata, Shadi; Park, Yoon Soo; Tekian, Ara

    2015-04-01

    The objective of this review is to summarize and critically appraise existing evidence on the use of chart stimulated recall (CSR) and case-based discussion (CBD) as an assessment tool for medical trainees. Medline, Embase, CINAHL, PsycINFO, Educational Resources Information Centre (ERIC), Web of Science, and the Cochrane Central Register of Controlled Trials were searched for original articles on the use of CSR or CBD as an assessment method for trainees in all medical specialties. Four qualitative and three observational non-comparative studies were eligible for this review. The number of patient-chart encounters needed to achieve sufficient reliability varied across studies. None of the included studies evaluated the content validity of the tool. Both trainees and assessors expressed high level of satisfaction with the tool; however, inadequate training, different interpretation of the scoring scales and skills needed to give feedback were addressed as limitations for conducting the assessment. There is still no compelling evidence for the use of patient's chart to evaluate medical trainees in the workplace. A body of evidence that is valid, reliable, and documents the educational effect in support of the use of patients' charts to assess medical trainees is needed.

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

    Directory of Open Access Journals (Sweden)

    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

  3. 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...

  4. 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

  5. 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

  6. 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.

  7. Control chart applications in healthcare: a literature review

    Science.gov (United States)

    Suman, Gaurav; Prajapati, DeoRaj

    2018-05-01

    The concept of Statistical process control (SPC) was given by the physicist Walter Shewhart in order to improve the industrial manufacturing. The SPC was firstly applied in laboratory and after then shifted to patient level in hospitals. As there is more involvement of human in healthcare, the chances of errors are also more. SPC i.e., control chart can help in determining the source of errors by identifying the special and common causes of variations. This paper presents the review of literature on the application of SPC and control chart in healthcare sector. Forty articles are selected out of 142 potentially relevant searched studies. Selected studies are categorised into eight departments. Literature survey shows that most of work on control chart applications in healthcare is carried out in Surgery, Emergency and Epidemiology departments. US, UK and Australia are the main customers where maximum amount of work was done. The US is the country where control chart in healthcare sector have been used at regular interval. This shows the gap of deploying control chart in different departments and different countries as well. The CUSUM and EWMA chart came into picture in healthcare sector after 2008 and are used at regular interval.

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

    Directory of Open Access Journals (Sweden)

    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

  9. Medication documentation in a primary care network serving North Carolina medicaid patients: results of a cross-sectional chart review

    Directory of Open Access Journals (Sweden)

    Olson Matthew D

    2012-08-01

    Full Text Available Abstract Background Medical records that do not accurately reflect the patient’s current medication list are an open invitation to errors and may compromise patient safety. Methods This cross-sectional study compares primary care provider (PCP medication lists and pharmacy claims for 100 patients seen in 8 primary care practices and examines the association of congruence with demographic, clinical, and practice characteristics. Medication list congruence was measured as agreement of pharmacy claims with the entire PCP chart, including current medication list, visit notes, and correspondence sections. Results Congruence between pharmacy claims and the PCP chart was 65%. Congruence was associated with large chronic disease burden, frequent PCP visits, group practice, and patient age ≥45 years. Conclusion Agreement of medication lists between the PCP chart and pharmacy records is low. Medication documentation was more accurate among patients who have more chronic conditions, those who have frequent PCP visits, those whose practice has multiple providers, and those at least 45 years of age. Improved congruence among patients with multiple chronic conditions and in group practices may reflect more frequent visits and reviews by providers.

  10. 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.

  11. "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.

  12. Measuring severe adverse events and medication selection using a “PEER Report” for nonpsychotic patients: a retrospective chart review

    Directory of Open Access Journals (Sweden)

    Hoffman DA

    2012-06-01

    Full Text Available Daniel A Hoffman,1 Charles DeBattista,2 Rob J Valuck,3 Dan V Iosifescu41Neuro-Therapy Clinic, Inc, Denver, CO, USA; 2Stanford University School of Medicine, Palo Alto, CA, USA; 3University of Colorado, SKAGES School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA; 4Mood and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY, USAAbstract: We previously reported on an objective new tool that uses quantitative electroencephalography (QEEG normative- and referenced-electroencephalography sampling databases (currently called Psychiatric EEG Evaluation Registry [PEER], which may assist physicians in determining medication selection for optimal efficacy to overcome trial-and-error prescribing. The PEER test compares drug-free QEEG features for individual patients to a database of patients with similar EEG patterns and known outcomes after pharmacological interventions. Based on specific EEG data elements and historical outcomes, the PEER Report may also serve as a marker of future severe adverse events (eg, agitation, hostility, aggressiveness, suicidality, homicidality, mania, hypomania with specific medications. We used a retrospective chart review to investigate the clinical utility of such a registry in a naturalistic environment.Results: This chart review demonstrated significant improvement on the global assessment scales Clinical Global Impression – Improvement and Quality of Life Enjoyment and Satisfaction – Short Form as well as time to maximum medical improvement and decreased suicidality occurrences. The review also showed that 54.5% of previous medications causing a severe adverse event would have been raised as a caution had the PEER Report been available at the time the drug was prescribed. Finally, due to the significant amount of off-label prescribing of psychotropic medications, additional, objective, evidence-based data aided the prescriber toward better choices.Conclusion: The PEER Report may be

  13. 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.

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

    Science.gov (United States)

    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.

  15. “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

  16. 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

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Retrospective chart review of a referenced EEG database in assisting medication selection for treatment of depression in patients with eating disorders

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    Greenblatt JM

    2011-09-01

    Full Text Available James M Greenblatt1, Craig Sussman1, Mariko Jameson1, Lee Yuan1, Daniel A Hoffman2, Dan V Iosifescu31Comprehensive Psychiatric Resources, Waltham, MA, USA; 2Neuro-Therapy Clinic Inc, Denver, CO, USA; 3Mood and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY, USABackground: A retrospective chart review was undertaken in a private clinic to examine the clinical outcomes for patients with an eating disorder comorbid with depression or bipolar illness who underwent a referenced electroencephalographic (EEG database analysis to help guide medication selection.Method: We examined 33 charts for patients with the primary psychiatric diagnosis of an eating disorder and comorbid major depressive disorder or bipolar disorder who underwent a quantitative EEG database assessment to provide additional information for choices of medication. The current analysis includes data from 22 subjects who accepted treatments based on information from the referenced-EEG medication database. Hamilton Depression Rating Scale, Clinical Global Impression-Severity, Clinical Global Impression-Improvement, and hospitalization data were examined for these patients.Results: Patients whose EEG data was used for clinical treatment reported significant decreases in associated depressive symptoms (HDRS scores, overall severity of illness (Clinical Global Impression-Severity, and overall clinical global improvement (Clinical Global Impression-Improvement. This cohort also reported fewer inpatient, residential, and partial hospitalization program days following referenced-EEG compared with the two-year period prior to treatment.Conclusion: These findings are consistent with previously reported data for patients with eating disorders and suggest the need for future studies using EEG data correlated with those from other patients with similar quantitative EEG features.Keywords: eating disorders, anorexia, bulimia, depression, referenced-EEG, chart review

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

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    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.

  1. 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.

  2. 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...

  3. Development and validation of a medical chart review checklist for symptom management performance of oncologists in the routine care of patients with advanced cancer.

    Science.gov (United States)

    Blum, David; Rosa, Daniel; deWolf-Linder, Susanne; Hayoz, Stefanie; Ribi, Karin; Koeberle, Dieter; Strasser, Florian

    2014-12-01

    Oncologists perform a range of pharmacological and nonpharmacological interventions to manage the symptoms of outpatients with advanced cancer. The aim of this study was to develop and test a symptom management performance checklist (SyMPeC) to review medical charts. First, the content of the checklist was determined by consensus of an interprofessional team. The SyMPeC was tested using the data set of the SAKK 96/06 E-MOSAIC (Electronical Monitoring of Symptoms and Syndromes Associated with Cancer) trial, which included six consecutive visits from 247 patients. In a test data set (half of the data) of medical charts, two people extracted and quantified the definitions of the parameters (content validity). To assess the inter-rater reliability, three independent researchers used the SyMPeC on a random sample (10% of the test data set), and Fleiss's kappa was calculated. To test external validity, the interventions retrieved by the SyMPeC chart review were compared with nurse-led assessment of patient-perceived oncologists' palliative interventions. Five categories of symptoms were included: pain, fatigue, anorexia/nausea, dyspnea, and depression/anxiety. Interventions were categorized as symptom specific or symptom unspecific. In the test data set of 123 patients, 402 unspecific and 299 symptom-specific pharmacological interventions were detected. Nonpharmacological interventions (n = 242) were mostly symptom unspecific. Fleiss's kappa for symptom and intervention detections was K = 0.7 and K = 0.86, respectively. In 1003 of 1167 visits (86%), there was a match between SyMPeC and nurse-led assessment. Seventy-nine percent (195 of 247) of patients had no or one mismatch. Chart review by SyMPeC seems reliable to detect symptom management interventions by oncologists in outpatient clinics. Nonpharmacological interventions were less symptom specific. A template for documentation is needed for standardization. Copyright © 2014 American Academy of Hospice and

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting.

    Science.gov (United States)

    Finnell, John S; Saul, Bradley C; Goldhamer, Alan C; Myers, Toshia R

    2018-02-20

    Evidence suggests that fasting, during which only water is consumed, results in potentially health promoting physiological effects. However, peer-reviewed research assessing the safety of water-only fasting is lacking. To address this, we conducted a chart review to describe adverse events (AEs) that occurred during medically supervised, water-only fasting. Electronic charts from patient visits to a residential medical facility from 2006 to 2011 were reviewed. Patients who were at least 21 years of age and water-only fasted for ≥2 consecutive days with a refeeding period equal to half of the fast length were included. Out of 2539 charts, 768 visits met our inclusion and exclusion criteria. AEs were abstracted from chart notes and classified according to CTCAE (v4.03) and MedDRA (v12.1) terminology. Descriptive analysis of AEs is reported. During the protocol period, the highest grade AE (HGAE) in 555 visits was a grade 2 event or lower, in 212 visits it was a grade 3 event, in 1 visit it was a grade 4 event, and there were no grade 5 events. There were 2 (0.002%) visits with a serious adverse event (SAE). The majority of AEs identified were mild (n = 4490, 75%) in nature and known reactions to fasting. To our knowledge, this is the most comprehensive analysis of AEs experienced during medically supervised, water-only fasting conducted to date. Overall, our data indicate that the majority of AEs experienced were mild to moderate and known reactions to fasting. This suggests that the protocol used in this study can be safely implemented in a medical setting with minimal risk of a SAE.

  6. Comparison of Onsite Versus Online Chart Reviews as Part of the American College of Radiation Oncology Accreditation Program.

    Science.gov (United States)

    Hepel, Jaroslaw T; Heron, Dwight E; Mundt, Arno J; Yashar, Catheryn; Feigenberg, Steven; Koltis, Gordon; Regine, William F; Prasad, Dheerendra; Patel, Shilpen; Sharma, Navesh; Hebert, Mary; Wallis, Norman; Kuettel, Michael

    2017-05-01

    Accreditation based on peer review of professional standards of care is essential in ensuring quality and safety in administration of radiation therapy. Traditionally, medical chart reviews have been performed by a physical onsite visit. The American College of Radiation Oncology Accreditation Program has remodeled its process whereby electronic charts are reviewed remotely. Twenty-eight radiation oncology practices undergoing accreditation had three charts per practice undergo both onsite and online review. Onsite review was performed by a single reviewer for each practice. Online review consisted of one or more disease site-specific reviewers for each practice. Onsite and online reviews were blinded and scored on a 100-point scale on the basis of 20 categories. A score of less than 75 was failing, and a score of 75 to 79 was marginal. Any failed charts underwent rereview by a disease site team leader. Eighty-four charts underwent both onsite and online review. The mean scores were 86.0 and 86.9 points for charts reviewed onsite and online, respectively. Comparison of onsite and online reviews revealed no statistical difference in chart scores ( P = .43). Of charts reviewed, 21% had a marginal (n = 8) or failing (n = 10) score. There was no difference in failing charts ( P = .48) or combined marginal and failing charts ( P = .13) comparing onsite and online reviews. The American College of Radiation Oncology accreditation process of online chart review results in comparable review scores and rate of failing scores compared with traditional on-site review. However, the modern online process holds less potential for bias by using multiple reviewers per practice and allows for greater oversight via disease site team leader rereview.

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

    Science.gov (United States)

    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.

  8. 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

  9. 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.

  10. 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

  11. 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...

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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...

  20. 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

  1. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review.

    Science.gov (United States)

    Artico, Marco; Dante, Angelo; D'Angelo, Daniela; Lamarca, Luciano; Mastroianni, Chiara; Petitti, Tommasangelo; Piredda, Michela; De Marinis, Maria Grazia

    2018-01-01

    Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers' prevalence, incidence and associated factors are largely insufficient. To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients' and caregivers' characteristics associated with their occurrence. Retrospective chart review. Patients ( n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index ( p 70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. The notable pressure ulcers' incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses' clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers' characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient's needs.

  2. 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.

    Science.gov (United States)

    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

  3. 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

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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

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

    Science.gov (United States)

    Redelmeier, Donald A; Kraus, Nicole C

    2018-02-06

    Electronic patient portals provide a new method for sharing personal medical information with individual patients. Our aim was to review utilization patterns of the largest online patient portal in Canada's largest city. 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. 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 (Psecurity breach, malware attack, or software failure occurred during the study. Online patient portals can provide a popular and reliable system for distributing personal medical information to active patients and may merit consideration for hospitals. ©Donald A Redelmeier, Nicole C Kraus. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.02.2018.

  10. Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

    Science.gov (United States)

    Chantelau, Ernst-A.; Zweck, Brigitte; Haage, Patrick

    2018-01-01

    ABSTRACT Background: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. Study design: Retrospective observational study, chart review Material and methods: Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment. Only cases without concomitant infection or skin ulcer were chosen, in whom both was documented, onset of symptomatic foot swelling and patient compliance with cast treatment. Results: From 1994 to 2017, 45 consecutive cases in 37 patients were retrieved, with 95 MRI follow-up studies (1–6 per case, average interval between studies 13 weeks). Decreasing EESC was documented in 66/95 (69%) follow-up studies. However, 29/95 (31%) studies revealed temporarily increasing, migrating or stagnating EESC. Conclusion: EESC on MRI disappear in response to prolonged offloading and immobilizing treatment; however, physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images. Conventional MRI is useful for surveillance of active-stage Charcot foot recovery. PMID:29713425

  11. 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.

  12. [A blood glucose slide chart for improving diabetes patient education].

    Science.gov (United States)

    Potteau, Marie-Hélène

    2015-03-01

    A blood glucose slide chart has been developed in order to help patients with type 2 diabetes who do not speak French or who have comprehension difficulties. Combined with pictograms to help patients visualise the action they need to take depending on the recorded glucose level, it constitutes a therapeutic education tool which can be useful on a day-to-day basis both for patients as well as caregivers.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. 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.

  15. 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.

  16. Correlations between M-CHARTS and PHP findings and subjective perception of metamorphopsia in patients with macular diseases.

    Science.gov (United States)

    Arimura, Eiko; Matsumoto, Chota; Nomoto, Hiroki; Hashimoto, Shigeki; Takada, Sonoko; Okuyama, Sachiko; Shimomura, Yoshikazu

    2011-01-05

    To assess the correlations between a patient's subjective perception of metamorphopsia and the clinical measurements of metamorphopsia by M-CHARTS and PreView PHP (PHP). The authors designed a 10-item questionnaire focusing on the symptoms of metamorphopsia and verified its validity with a Rasch analysis. M-CHARTS measured the minimum visual angle of a dotted line needed to detect metamorphopsia, and PHP used the hyperacuity function for detection. Subjects were 39 patients with idiopathic epiretinal membrane (ERM), 22 patients with idiopathic macular hole (M-hole), 19 patients with age-related macular degeneration (AMD), and 51 healthy controls. Rasch analysis suggested the elimination of one question. The nine-item questionnaire score significantly correlated to the M-CHARTS score in ERM (r = 0.59; P = 0.0004) but not in M-hole and to the PHP result in AMD (r = -0.29; P = 0.04) but not in ERM. Eighty percent of ERM patients with greater horizontal M-CHARTS score subjectively perceived horizontal metamorphopsia more often. M-CHARTS showed better sensitivities than PHP in both ERM (89% vs. 42%) and AMD (74% vs. 68%) and better specificity (100% vs. 71%) in healthy controls. Rasch analysis indicated that the present form of the questionnaire is better suited for moderate to severe cases of metamorphopsia than for mild cases. The questionnaire appears to be a valid assessment of patient subjective perception of metamorphopsia and can be used to supplement the clinical measurements of metamorphopsia by M-CHARTS and PHP in patients with macular diseases.

  17. 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.

  18. 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

  19. 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

  20. 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

  1. Medication Review and Patient Outcomes in an Orthopedic Department

    DEFF Research Database (Denmark)

    Lisby, Marianne; Bonnerup, Dorthe Krogsgaard; Brock, Birgitte

    2015-01-01

    OBJECTIVE: We investigated the health-related effect of systematic medication review performed by a clinical pharmacist and a clinical pharmacologist on nonelective elderly orthopedic patients. METHODS: This is a nonblinded randomized controlled study of 108 patients 65 years or older treated...... with at least 4 drugs. For the intervention, the clinical pharmacist reviewed the participants' medication after completion of the usual medication routine. Information was collected from medical charts, interviews with participants, and database registrations of drug purchase. Results were conferred...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. 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

  5. TU-D-201-02: Medical Physics Practices for Plan and Chart Review: Results of AAPM Task Group 275 Survey

    Energy Technology Data Exchange (ETDEWEB)

    Fong de los Santos, L [Mayo Clinic, Rochester, MN (United States); Dong, L [Scripps Proton Therapy Center, San Diego, CA (United States); Greener, A [VA Medical Center, East Orange, NJ (United States); Johnson, J [UT MD Anderson Cancer Center, Houston, TX (United States); Johnson, P [University of Miami, Miami, FL (United States); Kim, G [University of California, San Diego, La Jolla, CA (United States); Mechalakos, J; Yorke, E [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Napolitano, B [Massachusetts General Hospital, Boston, MA (United States); Parker, S [Novant Health, Winston Salem, NC (United States); Schofield, D [Saint Vincent Hospital, Acton, MA (United States); Wells, M [Piedmont Hospital, Atlanta, GA (United States); Ford, E [Mayo Clinic, Rochester, MN (United States); Scripps Proton Therapy Center, San Diego, CA (United States)

    2016-06-15

    Purpose: AAPM Task Group (TG) 275 is charged with developing riskbased guidelines for plan and chart review clinical processes. As part of this work an AAPM-wide survey was conducted to gauge current practices. Methods: The survey consisted of 103 multiple-choice questions covering the following review processes for external beam including protons: 1) Initial Plan Check, 2) On-Treatment and 3) End-of-Treatment Chart Check. The survey was designed and validated by TG members with the goal of providing an efficient and easy response process. The survey, developed and deployed with the support of AAPM headquarters, was released to all AAPM members who have self-reported as working in the radiation oncology field and it was kept open for 7 weeks. Results: There are an estimated 4700 eligible participants. At the time of writing, 962 completed surveys have been collected with an average completion time of 24 minutes. Participants are mainly from community hospitals (40%), academicaffiliated hospitals (31%) and free-standing clinics (18%). Among many other metrics covered on the survey, results so far indicate that manual review is an important component on the plan and chart review process (>90%) and that written procedures and checklists are widely used (>60%). However, the details of what is reviewed or checked are fairly heterogeneous among the sampled medical physics community. Conclusion: The data gathered from the survey gauging current practices will be used by TG 275 to develop benchmarks and recommendations for the type and extent of checks to perform effective physics plan and chart review processes.

  6. Birth-weight charts and immigrant populations: A critical review.

    Science.gov (United States)

    Urquia, Marcelo L; Sørbye, Ingvil K; Wanigaratne, Susitha

    2016-04-01

    There is an increasing body of literature focusing on differences in newborn size between different population subgroups defined by racial, ethnic, and immigration status. The interpretation of these differences as pathological or as merely reflecting normal variability is not straightforward and may have consequences for the provision of obstetric and neonatal care to minority populations. In this review, we critically assess some methodological issues affecting the assessment of newborn size and their potential implications for minority populations. In particular, we discuss the pros and cons of different types of newborn birth-weight (BW) charts (i.e., single local population-based references, minority-specific references, and a single international standard) to determine abnormal newborn size, with emphasis on immigrant populations. We conclude that size alone is not enough to inform clinical decisions and that all newborn size charts should be used as screening tools, not as diagnostic tools. Parental minority status may be regarded as a marker and used to further inquire about individual risk factors, particularly among immigrants who may not have a complete medical history in the new country. Finally, we outline areas for further research and recommendations for clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Comparison of disease-severity measures within severe and very severe COPD patients: results from a nationally representative chart review and patient survey

    Directory of Open Access Journals (Sweden)

    Solem CT

    2014-09-01

    Full Text Available Caitlyn T Solem,1 Shawn X Sun,2 Sizhu Liu,1 Cynthia Macahilig,3 Monica Katyal,3 Xin Gao,1 Andrew F Shorr4 1Pharmerit International, Bethesda, MD, 2Forest Research Institute, Jersey City, NJ, 3Medical Data Analytics, Parsippany, NJ, 4Pulmonary Critical Care, Washington Hospital Center and Georgetown University, Washington, DC, USA Objective: This study aimed to compare spirometry- and risk + symptom-based classification systems to physician-based severity assessment and find which system is most predictive of patient-reported health status, as measured by the St George's Respiratory Questionnaire for COPD (chronic obstructive pulmonary disease; SGRQ-C.Materials and methods: In this chart review/patient survey, 99 physicians recruited patients with physician-assessed severe or very severe COPD who had recently experienced a moderate or severe exacerbation. A cross-tabulation was undertaken comparing physician report, spirometry (mild/moderate, forced expiratory volume in 1 second [FEV1] ≥50%; severe, 30% ≤ FEV1 <50%; very severe, FEV1 <30% predicted, and risk + symptom-based (A, low risk/fewer symptoms; B, low risk/more symptoms; C, high risk/fewer symptoms; D, high risk/more symptoms severity systems. Analysis of covariance models were run for SGRQ-C, varying COPD-severity systems.Results: Of 244 patients, 58.6% were severe and 34.8% very severe by physician report, 70% had FEV1 ≤50% at their most recent visit, and 86% fell into quadrant D. Spirometry and physician report had 57.4% agreement, with physicians often indicating higher severity. Physician report and risk + symptom agreement was high (81.2% severe/very severe and D. Physician-reported severity, risk + symptoms, exacerbations in the previous year, and symptoms were significant SGRQ-C predictors, while spirometry was not.Conclusion: For recently exacerbating severe or very severe COPD patients, risk + symptoms more closely aligned with physician-reported severity and SGRQ-C versus

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. 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.

  11. Medical chart validation of an algorithm for identifying multiple sclerosis relapse in healthcare claims.

    Science.gov (United States)

    Chastek, Benjamin J; Oleen-Burkey, Merrikay; Lopez-Bresnahan, Maria V

    2010-01-01

    Relapse is a common measure of disease activity in relapsing-remitting multiple sclerosis (MS). The objective of this study was to test the content validity of an operational algorithm for detecting relapse in claims data. A claims-based relapse detection algorithm was tested by comparing its detection rate over a 1-year period with relapses identified based on medical chart review. According to the algorithm, MS patients in a US healthcare claims database who had either (1) a primary claim for MS during hospitalization or (2) a corticosteroid claim following a MS-related outpatient visit were designated as having a relapse. Patient charts were examined for explicit indication of relapse or care suggestive of relapse. Positive and negative predictive values were calculated. Medical charts were reviewed for 300 MS patients, half of whom had a relapse according to the algorithm. The claims-based criteria correctly classified 67.3% of patients with relapses (positive predictive value) and 70.0% of patients without relapses (negative predictive value; kappa 0.373: p value of the operational algorithm. Limitations of the algorithm include lack of differentiation between relapsing-remitting MS and other types, and that it does not incorporate measures of function and disability. The claims-based algorithm appeared to successfully detect moderate-to-severe MS relapse. This validated definition can be applied to future claims-based MS studies.

  12. Induction Chemotherapy and Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Patients With Locally Advanced Inoperable Non-Small-Cell Lung Cancer: The MRC INCH Randomized Trial

    International Nuclear Information System (INIS)

    Hatton, Matthew; Nankivell, Matthew; Lyn, Ethan; Falk, Stephen; Pugh, Cheryl; Navani, Neal; Stephens, Richard; Parmar, Mahesh

    2011-01-01

    Purpose: Recent clinical trials and meta-analyses have shown that both CHART (continuous hyperfractionated accelerated radiation therapy) and induction chemotherapy offer a survival advantage over conventional radical radiotherapy for patients with inoperable non-small cell-lung cancer (NSCLC). This multicenter randomized controlled trial (INCH) was set up to assess the value of giving induction chemotherapy before CHART. Methods and Materials: Patients with histologically confirmed, inoperable, Stage I-III NSCLC were randomized to induction chemotherapy (ICT) (three cycles of cisplatin-based chemotherapy followed by CHART) or CHART alone. Results: Forty-six patients were randomized (23 in each treatment arm) from 9 UK centers. As a result of poor accrual, the trial was closed in December 2007. Twenty-eight patients were male, 28 had squamous cell histology, 34 were Stage IIIA or IIIB, and all baseline characteristics were well balanced between the two treatment arms. Seventeen (74%) of the 23 ICT patients completed the three cycles of chemotherapy. All 42 (22 CHART + 20 ICT) patients who received CHART completed the prescribed treatment. Median survival was 17 months in the CHART arm and 25 months in the ICT arm (hazard ratio of 0.60 [95% CI 0.31-1.16], p = 0.127). Grade 3 or 4 adverse events (mainly fatigue, dysphagia, breathlessness, and anorexia) were reported for 13 (57%) CHART and 13 (65%) ICT patients. Conclusions: This small randomized trial indicates that ICT followed by CHART is feasible and well tolerated. Despite closing early because of poor accrual, and so failing to show clear evidence of a survival benefit for the additional chemotherapy, the results suggest that CHART, and ICT before CHART, remain important options for the treatment of inoperable NSCLC and deserve further study.

  13. 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.

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

    Science.gov (United States)

    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.

  15. 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.

  16. 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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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)

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  8. Clinical characteristics of keratoconus patients in Malaysia: a review from a cornea specialist centre

    OpenAIRE

    Mohd-Ali, Bariah; Abdu, Mustafa; Yaw, Choong Yean; Mohidin, Norhani

    2012-01-01

    Purpose: To evaluate the demographic profile, refraction, visual acuity (VA), corneal curvature (K) and severity of keratoconus (KC) patients from a cornea specialist centre in Malaysia. This may improve the management of KC patients in this country. Methods: Records of 13,000 patients were reviewed. The patients were categorized into 4 age groups: (Gp 1: 42 years). Refraction and VA were determined using subjective refraction and Snellen chart. Corneal curvature was measured using Orbscan...

  9. Narrative medicine to improve the management and quality of life of patients with COPD: the first experience applying parallel chart in Italy

    Science.gov (United States)

    Banfi, Paolo; Cappuccio, Antonietta; Latella, Maura E; Reale, Luigi; Muscianisi, Elisa; Marini, Maria Giulia

    2018-01-01

    Purpose Poor adherence to therapy and the failure of current smoking cessation programs demonstrate that the current management of COPD can be improved, and it is necessary to educate physicians about new approaches for taking care of patients. Parallel chart is a narrative medicine tool that improves the doctor–patient relationship by asking physicians to write about their patients’ lives, thereby encouraging reflective thoughts on care. Patients and methods Between October 2015 and March 2016, 50 Italian pulmonologists were involved in the collection of parallel charts of anonymous patients with COPD. The narratives were analyzed according to the Grounded Theory methodology. Results In the 243 parallel charts collected, the patients (mean age 69 years, 68% men) are described as still active and as a resource for their families (71%). The doctor–patient relationship started as difficult in 50% of cases, and younger age and smoking were the main risk factors. The conversations turned positive in 78% of narratives, displaying deeper mutual knowledge, trust for the clinicians’ ability to establish effective therapy (92%), support efforts to quit smoking (63%), or restore patients’ activities (78%). Conclusion All the physicians concurred that the adoption of innovative parallel charts was useful for improving clinical care and worthy of official inclusion in protocols for the management of COPD. PMID:29391786

  10. Continuous hyperfractionated accelerated radiotherapy (chart) in localized cancer of the esophagus

    International Nuclear Information System (INIS)

    Powell, Melanie E.B.; Hoskin, Peter J.; Saunders, Michele I.; Foy, Christopher J.W.; Dische, Stanley

    1997-01-01

    Purpose: To assess the efficacy and toxicity of continuous hyperfractionated accelerated radiotherapy (CHART) in locoregional control compared with a historical group of patients treated with conventionally fractionated radical radiotherapy. Methods and Materials: Between 1985 and 1994, 54 patients with localized esophageal cancer were treated with CHART. Twenty-eight patients received CHART alone (54 Gy in 36 fractions over 12 consecutive days) and 15 were given intravenous mitomycin C and cisplatin on days 10 and 13, respectively. Eleven patients received 40.5 Gy in 27 fractions over 9 days, followed by a single high-dose-rate intraluminal brachytherapy insertion of 15 Gy at 1 cm. Results: Acute toxicity was well tolerated and dysphagia was improved in 35 patients (65%), with 28 (52%) eating a normal diet by week 12. This compares with an improvement in dysphagia score in 72% of the conventionally treated group. The median duration of relief of dysphagia was 7.8 months (range 0-41.4) in the CHART group compared with 5.5 months (range 0-48) in the controls. Strictures developed in 29 patients (61%) and 18 were confirmed on biopsy to be due to recurrent disease. Median survival was 12 months (range 0.5-112) in the CHART group and 15 months (range 3.6-56) in the control patients. Conclusion: CHART is well tolerated and achieves a high rate of local control. Palliation in the short overall treatment time of esophageal cancer is an advantage in these patients whose median survival is only 12 months

  11. Dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses.

    Science.gov (United States)

    Zhang, Xiang; Loda, Justin B; Woodall, William H

    2017-07-20

    For a patient who has survived a surgery, there could be several levels of recovery. Thus, it is reasonable to consider more than two outcomes when monitoring surgical outcome quality. The risk-adjusted cumulative sum (CUSUM) chart based on multiresponses has been developed for monitoring a surgical process with three or more outcomes. However, there is a significant effect of varying risk distributions on the in-control performance of the chart when constant control limits are applied. To overcome this disadvantage, we apply the dynamic probability control limits to the risk-adjusted CUSUM charts for multiresponses. The simulation results demonstrate that the in-control performance of the charts with dynamic probability control limits can be controlled for different patient populations because these limits are determined for each specific sequence of patients. Thus, the use of dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses allows each chart to be designed for the corresponding patient sequence of a surgeon or a hospital and therefore does not require estimating or monitoring the patients' risk distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  12. Development of electronic medical record charting for hospital-based transfusion and apheresis medicine services: Early adoption perspectives

    Directory of Open Access Journals (Sweden)

    Rebecca Levy

    2010-01-01

    Full Text Available Background: Electronic medical records (EMRs provide universal access to health care information across multidisciplinary lines. In pathology departments, transfusion and apheresis medicine services (TAMS involved in direct patient care activities produce data and documentation that typically do not enter the EMR. Taking advantage of our institution′s initiative for implementation of a paperless medical record, our TAMS division set out to develop an electronic charting (e-charting strategy within the EMR. Methods: A focus group of our hospital′s transfusion committee consisting of transfusion medicine specialists, pathologists, residents, nurses, hemapheresis specialists, and information technologists was constituted and charged with the project. The group met periodically to implement e-charting TAMS workflow and produced electronic documents within the EMR (Cerner Millenium for various service line functions. Results: The interdisciplinary working group developed and implemented electronic versions of various paper-based clinical documentation used by these services. All electronic notes collectively gather and reside within a unique Transfusion Medicine Folder tab in the EMR, available to staff with access to patient charts. E-charting eliminated illegible handwritten notes, resulted in more consistent clinical documentation among staff, and provided greater real-time review/access of hemotherapy practices. No major impediments to workflow or inefficiencies have been encountered. However, minor updates and corrections to documents as well as select work re-designs were required for optimal use of e-charting by these services. Conclusion: Documentation of pathology subspecialty activities such as TAMS can be successfully incorporated into the EMR. E-charting by staff enhances communication and helps promote standardized documentation of patient care within and across service lines. Well-constructed electronic documents in the EMR may also

  13. Comparative effectiveness of everolimus-based therapy versus endocrine monotherapy among postmenopausal women with HR+/HER2- metastatic breast cancer: a retrospective chart review in community oncology practices in the US.

    Science.gov (United States)

    Xie, Jipan; Hao, Yanni; Li, Nanxin; Lin, Peggy L; Ohashi, Erika; Koo, Valerie; Signorovitch, James E; Wu, Eric Q; Yardley, Denise A

    2015-06-01

    Everolimus-based therapy and endocrine monotherapy are used among postmenopausal women with hormone receptor-positive human epidermal growth factor receptor-2 negative (HR+/HER2-) metastatic breast cancer (mBC) whose disease progressed or recurred on a non-steroidal aromatase inhibitor (NSAI). However, limited evidence exists regarding the real-world comparative effectiveness of these agents. This retrospective chart review examined postmenopausal HR+/HER2- mBC patients in community-based oncology practices who received everolimus-based therapy or endocrine monotherapy (index therapy) as any line of therapy for mBC between 1 July 2012 and 15 April 2013 after NSAI failure. Time on treatment (TOT), progression-free survival (PFS), and time to chemotherapy (TTC) from index therapy initiation were compared using Kaplan-Meier analyses and Cox proportional hazards models adjusting for baseline characteristics. A total of 243 and 270 patients received everolimus-based therapy or endocrine monotherapy in a quota-based sample. Patients treated with everolimus-based therapy had a higher proportion of visceral metastases, high tumor burden, and use of prior chemotherapies for mBC. After adjusting for baseline characteristics, everolimus-based therapy was associated with significantly longer TOT (HR = 0.67, 95% CI: 0.51-0.87) and PFS (HR = 0.75, 95% CI: 0.57-0.98) than endocrine monotherapy. No significant difference was found between everolimus-based therapy and endocrine monotherapy in TTC (HR = 0.81, 95% CI: 0.52-1.27). Results stratified by line of therapy were generally consistent with the overall results. Limitations include recall and information bias with potentially absent or erroneous chart data, unobserved factors due to non-randomization, inability to measure outcome assessments paired with measuring outcomes prior to exposures, and potential patient selection bias associated with chart review. Among a nationwide sample of postmenopausal HR+/HER2- m

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

    Science.gov (United States)

    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

  15. 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)

  16. Adherence to the Australian National Inpatient Medication Chart: the efficacy of a uniform national drug chart on improving prescription error.

    Science.gov (United States)

    Atik, Alp

    2013-10-01

    In 2006, the National Inpatient Medication Chart (NIMC) was introduced as a uniform medication chart in Australian public hospitals with the aim of reducing prescription error. The rate of regular medication prescription error in the NIMC was assessed. Data was collected using the NIMC Audit Tool and analyzed with respect to causes of error per medication prescription and per medication chart. The following prescription requirements were assessed: date, generic drug name, route of administration, dose, frequency, administration time, indication, signature, name and contact details. A total of 1877 medication prescriptions were reviewed. 1653 prescriptions (88.07%) had no contact number, 1630 (86.84%) did not have an indication, 1230 and 675 (35.96%) used a drug's trade name. Within 261 medication charts, all had at least one entry, which did not include an indication, 258 (98.85%) had at least one entry, which did not have a contact number and 200 (76.63%) had at least one entry, which used a trade name. The introduction of a uniform national medication chart is a positive step, but more needs to be done to address the root causes of prescription error. © 2012 John Wiley & Sons Ltd.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. Narrative medicine to improve the management and quality of life of patients with COPD: the first experience applying parallel chart in Italy

    Directory of Open Access Journals (Sweden)

    Banfi P

    2018-01-01

    Full Text Available Paolo Banfi,1 Antonietta Cappuccio,2 Maura E Latella,3 Luigi Reale,2 Elisa Muscianisi,3 Maria Giulia Marini2 1Pneumological Rehabilitation, IRCCS Fondazione Don Gnocchi Onlus, Milan, Italy; 2Healthcare Area, Fondazione ISTUD, Milan, Italy; 3Medical Department, Novartis Farma Spa, Origgio, Italy Purpose: Poor adherence to therapy and the failure of current smoking cessation programs demonstrate that the current management of COPD can be improved, and it is necessary to educate physicians about new approaches for taking care of patients. Parallel chart is a narrative medicine tool that improves the doctor–patient relationship by asking physicians to write about their patients’ lives, thereby encouraging reflective thoughts on care. Patients and methods: Between October 2015 and March 2016, 50 Italian pulmonologists were involved in the collection of parallel charts of anonymous patients with COPD. The narratives were analyzed according to the Grounded Theory methodology. Results: In the 243 parallel charts collected, the patients (mean age 69 years, 68% men are described as still active and as a resource for their families (71%. The doctor–patient relationship started as difficult in 50% of cases, and younger age and smoking were the main risk factors. The conversations turned positive in 78% of narratives, displaying deeper mutual knowledge, trust for the clinicians’ ability to establish effective therapy (92%, support efforts to quit smoking (63%, or restore patients’ activities (78%.Conclusion: All the physicians concurred that the adoption of innovative parallel charts was useful for improving clinical care and worthy of official inclusion in protocols for the management of COPD. Keywords: narrative medicine, COPD, doctor–patient relationship, quality of life

  2. 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.

  3. Pediatric morphea (localized scleroderma): review of 136 patients.

    Science.gov (United States)

    Christen-Zaech, Stéphanie; Hakim, Miriam D; Afsar, F Sule; Paller, Amy S

    2008-09-01

    Morphea is an autoimmune inflammatory sclerosing disorder that may cause permanent functional disability and disfigurement. We sought to determine the clinical features of morphea in a large pediatric cohort. We conducted a retrospective chart review of 136 pediatric patients with morphea from one center, 1989 to 2006. Most children showed linear morphea, with a disproportionately high number of Caucasian and female patients. Two patients with rapidly progressing generalized or extensive linear morphea and arthralgias developed restrictive pulmonary disease. Initial oral corticosteroid treatment and long-term methotrexate administration stabilized and/or led to disease improvement in most patients with aggressive disease. Retrospective analysis, relatively small sample size, and risk of a selected referral population to the single site are limitations. These data suggest an increased prevalence of morphea in Caucasian girls, and support methotrexate as treatment for problematic forms. Visceral manifestations rarely occur; the presence of progressive problematic cutaneous disease and arthralgias should trigger closer patient monitoring.

  4. 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

  5. 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.

  6. CHART in lung cancer: Economic evaluation and incentives for implementation

    International Nuclear Information System (INIS)

    Lievens, Yolande; Kesteloot, Katrien; Bogaert, Walter van den

    2005-01-01

    Background and purpose: To investigate the financial consequences and the impact on daily implementation of CHART in lung cancer. Patients and methods: A cost-effectiveness and cost-utility analysis were performed using Markov models, comparing the early and delayed costs and effects of CHART for NSCLC over a 4-year time span from a societal viewpoint. The outcome estimates were based on the CHART literature, the cost estimates on the standard practice of the Leuven University Hospitals, the radiotherapy costs being derived from an activity-based costing (ABC) programme developed in the department. Results: The additional societal cost per life-year gained was EURO 9164, the incremental cost per quality-adjusted life-year EURO 11,576. Sensitivity analyses confirmed the robustness of these results, the incremental cost-utility ratio remaining well under 20,000 EURO /QALY in all tested circumstances. The threshold analyses found the results of the study to be sensitive to the cost of CHART and to the quality of life after treatment. More specifically, standard treatment would become the optimal treatment if CHART would have a higher cost or would result in more long-term side effects. Conclusion: CHART should not be denied to patients with NSCLC on the basis of clinical or economic arguments. Other factors such as socio-economical, institutional, practical departmental and physician-bound barriers most probably explain the lack of implementation into daily practice

  7. Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study.

    Science.gov (United States)

    Artico, Marco; D'Angelo, Daniela; Piredda, Michela; Petitti, Tommasangelo; Lamarca, Luciano; De Marinis, Maria Grazia; Dante, Angelo; Lusignani, Maura; Matarese, Maria

    2018-07-01

    Patients with advanced illnesses show the highest prevalence for pressure injuries. In the palliative care setting, the ultimate goal is injury healing, but equally important is wound maintenance, wound palliation (wound-related pain and symptom management), and primary and secondary wound prevention. To describe the course of healing for pressure injuries in a home palliative care setting according to different end-points, and to explore patient and caregiver characteristics and specific care activities associated with their achievement. Four-year retrospective chart review of 669 patients cared for in a home palliative care service, of those 124 patients (18.5%) had at least one pressure injury with a survival rate less than or equal to six months. The proportion of healed pressure injuries was 24.4%. Of the injuries not healed, 34.0% were in a maintenance phase, whereas 63.6% were in a process of deterioration. Body mass index (P = 0.0014), artificial nutrition (P = 0.002), and age pay attention to artificial nutrition, continuous deep sedation, and the caregiver's role and gender. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  8. 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

  9. Development of Markup Language for Medical Record Charting: A Charting Language.

    Science.gov (United States)

    Jung, Won-Mo; Chae, Younbyoung; Jang, Bo-Hyoung

    2015-01-01

    Nowadays a lot of trials for collecting electronic medical records (EMRs) exist. However, structuring data format for EMR is an especially labour-intensive task for practitioners. Here we propose a new mark-up language for medical record charting (called Charting Language), which borrows useful properties from programming languages. Thus, with Charting Language, the text data described in dynamic situation can be easily used to extract information.

  10. 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.

  11. 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' ...

  12. 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.

  13. Rapid infusion of esketamine for unipolar and bipolar depression: a retrospective chart review

    Directory of Open Access Journals (Sweden)

    Correia-Melo FS

    2017-06-01

    Full Text Available Fernanda S Correia-Melo,1 Felipe C Argolo,1 Lucas Araújo-de-Freitas,1,2 Gustavo Carneiro Leal,1 Flávio Kapczinski,3 Acioly Luiz Lacerda,4 Lucas C Quarantini1,2 1Psychiatry Service, University Hospital, Federal University of Bahia, Salvador, Brazil; 2Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil; 3Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; 4Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil Background: This study evaluated efficacy and safety of intravenous subanesthetic doses of esketamine using an administration time of 10 minutes in patients with treatment-resistant depression and bipolar depression.Methods: A retrospective chart review was conducted to identify patients who met the inclusion criteria for treatment-resistant depression and bipolar depression according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and these patients received rapid infusion of esketamine between June 2012 and December 2015. The Montgomery–Åsberg Depression Rating Scale (MADRS was administered to measure and score depressive symptom severity before infusion and at 24 hours, 72 hours, and 7 days after infusion. In addition, Clinical Global Impression scale was administered before and 7 days after esketamine infusion.Results: Esketamine was administered to 30 patients. A total of 27 patients met the inclusion criteria and had MADRS evaluation data, which showed that 23 had unipolar and 4 had bipolar depression. Thirteen patients (48.1% showed therapeutic response (MADRS reduction ≥50% within 1 week (7 days of intervention. Remission (MADRS <7 was observed in 10 patients (37.0% in the same period. Therapeutic response and remission frequencies were seen in 16 (59.3% and 11 (40.7% patients, respectively, within 24 hours following drug infusion. The most relevant side effect observed during

  14. Surface Prognostic Charts

    Data.gov (United States)

    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...

  15. 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

  16. Crude versus case-mix-adjusted control charts for safety monitoring in thyroid surgery.

    Science.gov (United States)

    Duclos, Antoine; Voirin, Nicolas; Touzet, Sandrine; Soardo, Pietro; Schott, Anne-Marie; Colin, Cyrille; Peix, Jean-Louis; Lifante, Jean-Christophe

    2010-12-01

    Patient-safety monitoring based on health-outcome indicators can lead to misinterpretation of changes in case mix. This study aimed to compare the detection of indicator variations between crude and case-mix-adjusted control charts using data from thyroid surgeries. The study population included each patient who underwent thyroid surgery in a teaching hospital from January 2006 to May 2008. Patient safety was monitored according to two indicators, which are immediately recognisable postoperative complications: recurrent laryngeal nerve palsy and hypocalcaemia. Each indicator was plotted monthly on a p-control chart using exact limits. The weighted κ statistic was calculated to measure the agreement between crude and case-mix-adjusted control charts. We evaluated the outcomes of 1405 thyroidectomies. The overall proportions of immediate recurrent laryngeal nerve palsy and hypocalcaemia were 7.4% and 20.5%, respectively. The proportion of agreement in the detection of indicator variations between the crude and case-mix-adjusted p-charts was 95% (95% CI 85% to 99%). The strength of the agreement was κ = 0.76 (95% CI 0.54 to 0.98). The single special cause of variation that occurred was only detected by the case-mix-adjusted p-chart. There was good agreement in the detection of indicator variations between crude and case-mix-adjusted p-charts. The joint use of crude and adjusted charts seems to be a reasonable approach to increase the accuracy of interpretation of variations in outcome indicators.

  17. Weight control in schizophrenic patients through Sakata's Charting of Daily Weight Pattern and its associations with temperament and character.

    Science.gov (United States)

    Miyoshi, Ryoei; Matsuo, Hisae; Naono-Nagatomo, Keiko; Ozono, Kazuhiko; Araki, Ryuji; Ishikawa, Michiko; Abe, Hiroshi; Taniguchi, Hiroshi; Ishida, Yasushi

    2014-02-01

    This study examined whether daily self-monitoring of weight and monthly interviews with a doctor improved eating habits and led to weight loss, and whether temperament and character traits affect weight change in persons with schizophrenia. Participants used Sakata's Charting of Daily Weight Pattern to monitor their weight daily. In addition, Sakata's Eating Behavior Questionnaire was administered to evaluate eating-behavior awareness. The Temperament and Character Inventory (TCI) was used to assess participants' temperament and character. Fifty patients were divided into two groups: the intervention group (n = 25) filled in Sakata's Charting of Daily Weight Pattern every day; was interviewed monthly by a doctor about weight management; was weighed monthly. The non-intervention group (n = 25) was only weighed monthly. The body mass index (mean ± standard error: 0.59 ± 0.10 kg/m(2), p Weight change and TCI scores were not correlated for the intervention group, but scores for "self-directedness" and weight gain in the non-intervention group had a marginally significant negative correlation (r = -0.33, p weight daily on Sakata's Charting of Daily Weight Pattern led to improvements in eating behavior and a decrease in BMI of patients with schizophrenia. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. Accuracy of nurse documentation of delirium symptoms in medical charts.

    Science.gov (United States)

    Voyer, Philippe; Cole, Martin G; McCusker, Jane; St-Jacques, Sylvie; Laplante, Johanne

    2008-04-01

    The purpose of this study undertaken in an acute care hospital was to evaluate sensitivity and specificity of the documentation of nurse-reported delirium symptoms in medical charts. This is a descriptive study based on the clinical assessments of a study nurse and nursing notes in the medical charts of 226 delirious older patients newly admitted to an acute care hospital. The results of this prospective validation study indicated that documentation of delirium symptoms is poor. Disorientation, agitation and altered level of consciousness were the three symptoms yielding a higher level of sensitivity, but even so said symptoms were reported in less than a third of the medical charts. Univariate analysis suggested that higher comorbidity level, more severe symptoms of delirium and the use of physical restraints were associated with more valid documentation of delirium symptoms in medical charts. Lastly, this study corroborates results of previous studies, indicating that documentation of delirium symptoms in medical charts can be improved. Future study should target improving nurse documentation of delirium symptoms in medical charts.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. [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.

  1. 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.

  2. Quality improvement program reduces perioperative dental injuries – A review of 64,718 anesthetic patients

    OpenAIRE

    Kuo, Yi-Wei; Lu, I-Cheng; Yang, Hui-Ying; Chiu, Shun-Li; Hsu, Hung-Te; Cheng, Kuang-I

    2016-01-01

    Background: Perioperative dental injury (PDI) is a common adverse event associated with anesthesia that can easily lead to medicolegal litigation. A quality improvement program was conducted with the electronic, standardized dental chart to document dentition before anesthesia and dentist consultation when necessary. This study aimed to reduce PDIs through execution of a quality improvement program. Methods: We reviewed the 42-month interval anesthetic records of 64,718 patients who underw...

  3. 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.

  4. 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.

  5. Image registration assessment in radiotherapy image guidance based on control chart monitoring.

    Science.gov (United States)

    Xia, Wenyao; Breen, Stephen L

    2018-04-01

    Image guidance with cone beam computed tomography in radiotherapy can guarantee the precision and accuracy of patient positioning prior to treatment delivery. During the image guidance process, operators need to take great effort to evaluate the image guidance quality before correcting a patient's position. This work proposes an image registration assessment method based on control chart monitoring to reduce the effort taken by the operator. According to the control chart plotted by daily registration scores of each patient, the proposed method can quickly detect both alignment errors and image quality inconsistency. Therefore, the proposed method can provide a clear guideline for the operators to identify unacceptable image quality and unacceptable image registration with minimal effort. Experimental results demonstrate that by using control charts from a clinical database of 10 patients undergoing prostate radiotherapy, the proposed method can quickly identify out-of-control signals and find special cause of out-of-control registration events.

  6. Are primary care practitioners in Barbados following hypertension guidelines? - a chart audit

    Directory of Open Access Journals (Sweden)

    Carter Anne O

    2010-11-01

    Full Text Available Abstract Background About 55% of the population 40 to 80 years of age in Barbados is hypertensive. The quality of hypertension primary care compared to available practice guidelines is uncertain. Findings Charts of hypertensive and diabetic patients were randomly sampled at all public and 20 private sector primary care clinics. Charts of all hypertensive patients ≥ 40 years of age were then selected and processes of care and blood pressure (BP maintenance 343 charts of hypertensive patients (170 public, and 173 private were audited. Patients had the following characteristics: mean age 64 years, female gender 63%, mean duration of diagnosis 9.1 years, and diabetes diagnosed 58%. Patients had an average of 4.7 clinic visits per year, 70% were prescribed a thiazide diuretic, 42% a calcium channel blocker, 40% an angiotensin receptor blocker, and 19% a beta blocker. Public patients compared to private patients were more likely to be female (73% vs. 52%, p Conclusions Improvements are needed in following guidelines for basic interventions such as body mass assessment, accurate BP measurement, use of thiazide diuretics and lifestyle advice. BP control is inadequate.

  7. 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.

  8. 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

  9. 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

  10. 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

  11. 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.

  12. Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial design.

    Science.gov (United States)

    Bartunek, Jozef; Davison, Beth; Sherman, Warren; Povsic, Thomas; Henry, Timothy D; Gersh, Bernard; Metra, Marco; Filippatos, Gerasimos; Hajjar, Roger; Behfar, Atta; Homsy, Christian; Cotter, Gad; Wijns, William; Tendera, Michal; Terzic, Andre

    2016-02-01

    Cardiopoiesis is a conditioning programme that aims to upgrade the cardioregenerative aptitude of patient-derived stem cells through lineage specification. Cardiopoietic stem cells tested initially for feasibility and safety exhibited signs of clinical benefit in patients with ischaemic heart failure (HF) warranting definitive evaluation. Accordingly, CHART-1 is designed as a large randomized, sham-controlled multicentre study aimed to validate cardiopoietic stem cell therapy. Patients (n = 240) with chronic HF secondary to ischaemic heart disease, reduced LVEF (Heart Failure Questionnaire score, 6 min walk test, LV end-systolic volume, and LVEF at 9 months. The secondary efficacy endpoint is the time to cardiovascular death or worsening HF at 12 months. Safety endpoints include mortality, readmissions, aborted sudden deaths, and serious adverse events at 12 and 24 months. The CHART-1 clinical trial is powered to examine the therapeutic impact of lineage-directed stem cells as a strategy to achieve cardiac regeneration in HF populations. On completion, CHART-1 will offer a definitive evaluation of the efficacy and safety of cardiopoietic stem cells in the treatment of chronic ischaemic HF. NCT01768702. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

  13. 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

  14. A Retrospective Chart Review of Two Different Insulin Administration Systems on Glycemic Control in Older Adults in Long-Term Care.

    Science.gov (United States)

    Boonin, Alan; Balinski, Brenda; Sauter, Jerry; Martinez, Joe; Abbott, Scott

    2017-01-01

    The current retrospective chart review compared glycemic control and cost impact of two insulin administration systems, V-Go ® versus usual care with standard of care (SOC) insulin injections, in eight patients residing in a nursing home (NH). A total of 1,937 blood glucose (BG) values were collected over 61 days. Significant improvements were observed for the V-Go versus SOC group in time in range 100 mg/dL to 200 mg/dL (V-Go 59.09% vs. SOC 34.02%; p < 0.001), reduced BG fluctuations as measured by standard deviation (V-Go 61.2 vs. SOC 92.1; p < 0.001), and improved mean daily BG (V-Go 159.38 mg/dL vs. SOC 223.86 mg/dL; p < 0.001). The estimated A1c change, calculated from BG values, decreased from 8.9% to 7.2% in the V-Go group and increased from 9.0% to 9.4% in the SOC group. Compared to SOC, use of V-Go decreased the mean time for insulin administration by nursing staff by 26.3 minutes per patient per day and associated labor costs by $328.75 per patient per month. Insulin administration with V-Go may improve glycemic control and reduce administration costs compared to existing care in the NH setting. [Journal of Gerontological Nursing, 43(1), 10-16.]. Copyright 2017, SLACK Incorporated.

  15. Therapeutic implications of selecting the SCORE (European versus the D'AGOSTINO (American risk charts for cardiovascular risk assessment in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Giné-Garriga Maria

    2009-05-01

    Full Text Available Abstract Background No comparisons have been made of scales estimating cardiovascular mortality and overall cardiovascular morbidity and mortality. The study objectives were to assess the agreement between the Framingham-D'Agostino cardiovascular risk (CVR scale and the chart currently recommended in Europe (SCORE with regard to identification of patients with high CVR, and to describe the discrepancies between them and the attendant implications for the treatment of hypertension and hyperlipidaemia. Methods A total of 474 hypertensive patients aged 40–65 years monitored in primary care were enrolled into the study. CVR was assessed using the Framingham-D'Agostino scale, which estimates the overall cardiovascular morbidity and mortality risk, and the SCORE chart, which estimates the cardiovascular mortality risk. Cardiovascular risk was considered to be high for values ≥ 20% and ≥ 5% according to the Framingham-D'Agostino and SCORE charts respectively. Kappa statistics was estimated for agreement in classification of patients with high CVR. The therapeutic recommendations in the 2007 European Guidelines on Cardiovascular Disease Prevention were followed. Results Mean patient age was 54.1 (SD 7.3, and 58.4% were males. A high CVR was found in 17.5% using the SCORE chart (25.3% males, 6.6% females and in 32.7% using the D'Agostino method (56.9% males, 12,7% females. Kappa coefficient was 0.52, and increased to 0.68 when the high CVR threshold was established at 29% according to D'Agostino. Hypertensive patients with high SCORE and non-high D'Agostino (1.7% were characterized by an older age, diabetes, and a lower atherogenic index, while the opposite situation (16.9% was associated to males, hyperlipidaemia, and a higher atherogenic index. Variables with a greater weight in discrepancies were sex and smoking. A 32.0% according to SCORE and 33.5% according to D'Agostino would be candidates to receive antihypertensive treatment, and 15.8% and

  16. A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer

    International Nuclear Information System (INIS)

    Dische, Stanley; Saunders, Michele; Barrett, Ann; Harvey, Angela; Gibson, Della; Parmar, Mahesh

    1997-01-01

    Background and purpose: Continuous, hyperfractionated, accelerated radiotherapy (CHART) has shown promise of improved tumour control and reduced late morbidity in pilot studies and has now been tested in a multicentre randomised controlled clinical trial. Material and methods: Patients with squamous cell cancer in the main sites within the head and neck region with the general exception of early T1 N0 tumours were entered into the study by 11 centres. There was a 3:2 randomisation to either CHART, where a dose of 54 Gy was given in 36 fractions over 12 days, or to conventional therapy where 66 Gy was given in 33 fractions over 6.5 weeks. A total of 918 patients were included over a 5 year period from March 1990. Results: Acute Morbidity: Acute radiation mucositis was more severe with CHART, occurred earlier but settled sooner and was in nearly all cases healed by 8 weeks in both arms. Skin reactions were less severe and settled more quickly in the CHART treated patients. Tumour control and survival: Life table analyses of loco-regional control, primary tumour control, nodal control, disease-free interval, freedom from metastasis and survival showed no evidence of differences between the two arms. In exploratory subgroup analyses there was evidence of a greater response to CHART in younger patients (P = 0.041) and poorly differentiated tumours appeared to fare better with conventional radiotherapy (P = 0.030). In the larynx there was evidence of a trend towards increasing benefit with more advanced T stage (P = 0.002). Late treatment related morbidity: Osteoradionecrosis occurred in 0.4% of patients after CHART and 1.4% of patients after conventional radiotherapy. The incidence of chondritis or cartilage necrosis was similar in both arms. Life table analysis showed evidence of reduced severity in a number of late morbidities in favour of CHART. These were most striking for skin telangiectasia, superficial and deep ulceration of the mucosa and laryngeal oedema

  17. 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…

  18. 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.

  19. Statistical evaluation of the dose-distribution charts of the National Computerized Irradiation Planning Network

    International Nuclear Information System (INIS)

    Varjas, Geza; Jozsef, Gabor; Gyenes, Gyoergy; Petranyi, Julia; Bozoky, Laszlo; Pataki, Gezane

    1985-01-01

    The establishment of the National Computerized Irradiation Planning Network allowed to perform the statistical evaluation presented in this report. During the first 5 years 13389 dose-distribution charts were calculated for the treatment of 5320 patients, i.e. in average, 2,5 dose-distribution chart-variants per patient. This number practically did not change in the last 4 years. The irradiation plan of certain tumour localizations was performed on the basis of the calculation of, in average, 1.6-3.0 dose-distribution charts. Recently, radiation procedures assuring optimal dose-distribution, such as the use of moving fields, and two- or three-irradiation fields, are gaining grounds. (author)

  20. 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.

  1. 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

  2. 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.

  3. Dental x-ray validation study: comparison of information from patient interviews and dental charts

    International Nuclear Information System (INIS)

    Preston-Martin, S.; Bernstein, L.; Maldonado, A.A.; Henderson, B.E.; White, S.C.

    1985-01-01

    Information was collected from dentists of a subset of participants in a case-control interview study conducted in Los Angeles County, California, in August 1980-August 1981 to evaluate the relationship of dental x-rays to tumors of the parotid gland. Complete dental charts were available from 142 dentists of 84 cases and from 130 dentists of 79 control. Analysis of data from these interview chart comparisons indicates that recall appears to be unbiased since the measures of agreement between interview and dental chart data are similar for cases and controls. The authors further conclude that interview data alone may be used for case-control comparisons of dental x-ray exposure and would, because of unbiased misclassification, tend to underestimate the relative risks. 12 references, 3 tables

  4. 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.

  5. Functional impairment in patients with sporadic Inclusion Body Myositis.

    Science.gov (United States)

    Dunlap, Heather V; Macneil, Lauren G; Tarnopolsky, Mark A

    2014-03-01

    We conducted a retrospective chart review of 53 patients diagnosed with sporadic Inclusion Body Myositis (sIBM) who have been followed at the McMaster Neuromuscular Clinic since 1996. We reviewed patient medical histories in order to compare our findings with similar cohorts, and analyzed quantitative strength data to determine functionality in guiding decisions related to gait assistive devices. Patient information was acquired through retrospective clinic chart review. Our study found knee extension strength decreased significantly as patients transitioned to using more supportive gait assistive devices (P cane)(P Falls and fear of falling poses a significant threat to patient physical well-being. The prevalence of dysphagia increased as patients required more supportive gait devices, and finally a significant negative correlation was found between time after onset and creatine kinase (CK) levels (P falling would be beneficial in preventing future falls and improving long-term patient outcomes.

  6. Diagnosing delirium in very elderly intensive care patients.

    Science.gov (United States)

    Heriot, Natalie R; Levinson, Michele R; Mills, Amber C; Khine, Thinn Thinn; Gellie, Anthea L; Sritharan, Gaya

    2017-02-01

    To determine the incidence of delirium in elderly intensive care patients and to compare incidence using two retrospective chart-based diagnostic methods and a hospital reporting measure (ICD-10). Retrospective study. An ICU in a large metropolitan private hospital in Melbourne, Australia. English-speaking participants (n=348) 80+ years, admitted to ICU for >24 hours. Medical files of ICU patients admitted October 2009-October 2012 were retrospectively assessed for delirium using the Inouye chart review method, DSM-IV diagnostic criteria and ICD-10 coding data. General patient characteristics, first onset of delirium symptoms, source of delirium information, administration of delirium medication, hospital and ICU length of stay, 90 day mortality were documented. Delirium was found in 11-29% of patients, the highest incidence identified by chart review. Patients diagnosed with delirium had higher 90 day mortality, and those meeting criteria for all three methods had longer hospital and ICU length of stay. ICU delirium in the elderly is often under-reported and strategies are needed to improve staff education and diagnosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Postoperative Survival for Patients with Thymoma Complicating Myasthenia Gravis
- Preliminary Retrospective Results of the ChART Database

    Directory of Open Access Journals (Sweden)

    Fangrui WANG

    2016-07-01

    Full Text Available Background and objective It is so far not clear that how myasthenia gravis (MG affected the prognosis of thymoma patients. The aim of this assay is to compare the postoperative survival between patients with thymoma only and those with both thymoma and MG. Methods The Chinese Alliance for Research in Thymomas (ChART registry recruited patients with thymoma from 18 centers over the country on an intention to treat basis from 1992 to 2012. Two groups were formed according to whether the patient complicated MG. Demographic and clinical data were reviewed, Patients were followed and their survival status were analyzed. Results There were 1,850 patients included in this study, including 421 with and 1,429 without MG. Complete thymectomy were done in 91.2% patients in MG group and 71.0% in non-MG group (P<0.05. There were more percentage of patients with the histology of thymoma AB, B1, or B2 (P<0.05 in MG group, and more percentage of patients with MG were in Masaoka stage I and II. The 5 year and 10 year OS rates were both higher in MG group (93% vs 88%; 83% vs 81%, P=0.034 respectively. The survival rate was significantly higher in patients with MG when the Masaoka staging was III/IV (P=0.003. Among patients with advanced stage thymoma (stage III, IVa, IVb, the constituent ratios of III, IVa, IVb were similar between MG and Non-MG group. Histologically, however, there were significantly more proportion of AB/B1/B2/B3 in the MG group while there were more C in the non-MG group (P=0.000. Univariate analyses for all patients showed that MG, WHO classification, Masaoka stage, surgical approach, chemotherapy and radiotherapy and resectability were significant factors, and multivariate analysis showed WHO Classification, Masaoka stage, and resectability were strong independent prognostic indicators. Conclusion Although MG is not an independent prognostic factor, the survival of patients with thymoma was superior when MG was present, especially in late

  8. 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

  9. 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.

  10. 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)

  11. 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

  12. 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)

  13. 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.

  14. 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.

  15. 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.)

  16. 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...

  17. 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.

  18. 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...

  19. 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

  20. 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.

  1. Development of a Personal Digital Assistant (PDA) based client/server NICU patient data and charting system.

    Science.gov (United States)

    Carroll, A E; Saluja, S; Tarczy-Hornoch, P

    2001-01-01

    Personal Digital Assistants (PDAs) offer clinicians the ability to enter and manage critical information at the point of care. Although PDAs have always been designed to be intuitive and easy to use, recent advances in technology have made them even more accessible. The ability to link data on a PDA (client) to a central database (server) allows for near-unlimited potential in developing point of care applications and systems for patient data management. Although many stand-alone systems exist for PDAs, none are designed to work in an integrated client/server environment. This paper describes the design, software and hardware selection, and preliminary testing of a PDA based patient data and charting system for use in the University of Washington Neonatal Intensive Care Unit (NICU). This system will be the subject of a subsequent study to determine its impact on patient outcomes and clinician efficiency.

  2. 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...

  3. Airway management for occipital encephalocele in neonatal patients: A review of 17 cases

    Directory of Open Access Journals (Sweden)

    Zeynep Baysal Yildirim

    2011-01-01

    Full Text Available Introduction: Encephalocele, midline defect of cranial bone fusion, occurs most frequently in the occipital region. Airway management in pediatric patients with craniofacial disorders poses many challenges to the anesthesiologist. The purpose of this study is to describe the airway problems encountered for such cases, and describe how these problems were managed. Materials and Methods: We reviewed the charts of occipital encephalocele newborn that were treated by surgical correction in Harran University Hospital during 2006-2008. The collected data were categorized into preoperative, intraoperative, and postoperative data. Results: The mean age of the patients was 5.17 days. Of these 17 patients, eight patients (47.1% had hydrocephaly, one patient (5.8% with Dandy Walker syndrome. Micrognathia, macroglossia, restriction in neck movements were recorded as the reasons in six cases each. No major anesthetic complication was found. Conclusions: We reported perioperative management in 17 occipital encephalocele infant. Comprehensive care during peroperative period is essential for successful outcome.

  4. 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

  5. Peripheral nerve block in patients with Ehlers-Danlos syndrome, hypermobility type: a case series.

    Science.gov (United States)

    Neice, Andrew E; Stubblefield, Eryn E; Woodworth, Glenn E; Aziz, Michael F

    2016-09-01

    Ehlers-Danlos syndrome (EDS) is an inherited disease characterized by defects in various collagens or their post translational modification, with an incidence estimated at 1 in 5000. Performance of peripheral nerve block in patients with EDS is controversial, due to easy bruising and hematoma formation after injections as well as reports of reduced block efficacy. The objective of this study was to review the charts of EDS patients who had received peripheral nerve block for any evidence of complications or reduced efficacy. Case series, chart review. Academic medical center. Patients with a confirmed or probable diagnosis of EDS who had received a peripheral nerve block in the last 3 years were identified by searching our institutions electronic medical record system. The patients were classified by their subtype of EDS. Patients with no diagnosed subtype were given a probable subtype based on a chart review of the patient's symptoms. Patient charts were reviewed for any evidence of complications or reduced block efficacy. A total of 21 regional anesthetics, on 16 unique patients were identified, 10 of which had a EDS subtype diagnosis. The majority of these patients had a diagnosis of hypermobility-type EDS. No block complications were noted in any patients. Two block failures requiring repeat block were noted, and four patients reported uncontrolled pain on postoperative day one despite successful placement of a peripheral nerve catheter. Additionally, blocks were performed without incident in patients with classical-type and vascular-type EDS although the number was so small that no conclusions can be drawn about relative safety of regional anesthesia in these groups. This series fails to show an increased risk of complications of peripheral nerve blockade in patients with hypermobility-type EDS. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. 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...

  7. THE EFFECTS OF AMOXICILLIN WITH OR WITHOUT CLAVULANIC ACID ON THE POSTOPERATIVE COMPLAINTS AFTER THIRD MOLAR SURGERY: A RETROSPECTIVE CHART ANALYSIS

    Directory of Open Access Journals (Sweden)

    Alparslan ESEN

    2017-04-01

    Full Text Available Purpose: The aim of this chart-based retrospective study was to evaluate the effects of orally administered amoxicillin alone or amoxicillin combined with clavulanic acid on the frequency of post-operative complications and patients’ comfort after mandibular third molar surgery. Materials and Methods: The records of patients who had undergone lower third molar surgery between October 2014 and December 2015 were examined. A total of 62 patients who had fully impacted teeth in mesioangular position and who had been prescribed same type and dose of anti-inflammatory drug were included in this study. Among them, 32 subjects were found to have been prescribed 500 mg amoxicillin trihydrate orally every 8 h for 5 days (Group A and 30 patients 500 mg amoxicillin trihydrate plus 125 mg potassium clavulanate orally every 8 h for 5 days postoperatively (Group AC. Post-operative pain levels, swelling, presence of trismus, frequency of alveolar osteitis and quality of life (QoL scores were gathered from patients’ charts and were statistically compared. Results: Analysis of the variables showed that there were no significant differences between the Groups A and AC regarding pain levels, swelling, trismus and QoL scores. The frequency of alveolar osteitis was found to be 1.6% in the Group A, however, no significant difference was observed among study groups. Conclusion: Within the limitations of this retrospective chart review, it can be stated that amoxicillin and amoxicillin with clavulanic acid might provide similar outcome in terms of patient comfort following third molar surgery.

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

    Directory of Open Access Journals (Sweden)

    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

  9. 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.

  10. DOES PRESENTING PATIENT'S BMI INCREASE DOCUMENTATION OF OBESITY?

    Directory of Open Access Journals (Sweden)

    Norm Clothier, MD, M. Kim Marvel, PhD, Courtney S. Cruickshank, MS

    2002-09-01

    Full Text Available Purpose: Despite the associated health consequences, obesity is infrequently documented as a problem in medical charts. The purpose of this study is to determine whether a simple intervention (routine listing of the BMI on the medical chart will increase physician documentation of obesity in the medical record. Methods: Participants were resident physicians in a family medicine residency program. Participants were randomly assigned to either an experimental group or a control group. For experimental group physicians, the Body Mass Index was listed alongside other vital signs of patients seen in an ambulatory setting. Physician documentation of patient obesity was assessed by chart review after patient visits. Documentation was defined as inclusion of obesity on the problem list or in the progress note. Results: The intervention did not significantly increase the rate of documentation of obesity in the medical chart. Several reasons for the lack of change are explored, including the difficulty of treating obesity successfully.

  11. SU-F-T-96: A New Paradigm of Weekly Chart Checking for Radiation Therapy Clinics

    International Nuclear Information System (INIS)

    Tan, J; Pompos, A; Jiang, S; Yan, Y

    2016-01-01

    Purpose: To put forth an innovative clinical paradigm for weekly chart checking so that treatment status is periodically checked accurately and efficiently. This study also aims to help optimize the chart checking clinical workflow in a busy radiation therapy clinic. Methods: It is mandated by the Texas Administrative code to check patient charts of radiation therapy once a week or every five fractions, however it varies drastically among institutions in terms of when and how it is done. Some do it every day, but a lot of efforts are wasted on opening ineligible charts; some do it on a fixed day but the distribution of intervals between subsequent checks is not optimal. To establish an optimal chart checking procedure, a new paradigm was developed to achieve 1) charts are checked more accurately and more efficiently; 2) charts are checked on optimal days without any miss; 3) workload is evened out throughout a week when multiple physicists are involved. All active charts will be accessed by querying the R&V system. Priority is assigned to each chart based on the number of days before the next due date followed by sorting and workload distribution steps. New charts are also taken into account when distributing the workload so it is reasonably even throughout the week. Results: Our clinical workflow became more streamlined and smooth. In addition, charts get checked in a more timely fashion so that errors would get caught earlier should they occur. Conclusion: We developed a new weekly chart checking diagram. It helps physicists check charts in a timely manner, saves their time in busy clinics, and consequently reduces possible errors.

  12. SU-F-T-96: A New Paradigm of Weekly Chart Checking for Radiation Therapy Clinics

    Energy Technology Data Exchange (ETDEWEB)

    Tan, J; Pompos, A; Jiang, S; Yan, Y [UT Southwestern Medical Center, Dallas, TX (United States)

    2016-06-15

    Purpose: To put forth an innovative clinical paradigm for weekly chart checking so that treatment status is periodically checked accurately and efficiently. This study also aims to help optimize the chart checking clinical workflow in a busy radiation therapy clinic. Methods: It is mandated by the Texas Administrative code to check patient charts of radiation therapy once a week or every five fractions, however it varies drastically among institutions in terms of when and how it is done. Some do it every day, but a lot of efforts are wasted on opening ineligible charts; some do it on a fixed day but the distribution of intervals between subsequent checks is not optimal. To establish an optimal chart checking procedure, a new paradigm was developed to achieve 1) charts are checked more accurately and more efficiently; 2) charts are checked on optimal days without any miss; 3) workload is evened out throughout a week when multiple physicists are involved. All active charts will be accessed by querying the R&V system. Priority is assigned to each chart based on the number of days before the next due date followed by sorting and workload distribution steps. New charts are also taken into account when distributing the workload so it is reasonably even throughout the week. Results: Our clinical workflow became more streamlined and smooth. In addition, charts get checked in a more timely fashion so that errors would get caught earlier should they occur. Conclusion: We developed a new weekly chart checking diagram. It helps physicists check charts in a timely manner, saves their time in busy clinics, and consequently reduces possible errors.

  13. 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)

  14. Colorectal cancer screening in patients with spinal cord injury yields similar results to the general population with an effective bowel preparation: a retrospective chart audit.

    Science.gov (United States)

    Teng, Brandon J; Song, Shawn H; Svircev, Jelena N; Dominitz, Jason A; Burns, Stephen P

    2018-03-01

    Retrospective chart audit. To compare adequacy of colonoscopy bowel preparation and diagnostic findings between persons with SCI receiving an extended inpatient bowel preparation and the general population. Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA. We reviewed an electronic database of all colonoscopies performed at a tertiary Veterans Affairs medical center between 7/12/13 and 15/10/15. Patients with SCI received a multi-day bowel preparation with magnesium citrate, and 8-10 liters of polyethylene glycol-3350 and electrolyte colonic lavage solution (PEG-ELS) over two and one half days. The control population received a standard bowel preparation consisting of magnesium citrate and 4 liters of PEG-ELS over 1 day. Two hundred and fifty-five patients were included in the study, including 85 patients with SCI. Average risk screening was a more common colonoscopy indication in patients with SCI vs. the control population (24 vs. 13% p = 0.03). There was no difference in adequacy of bowel preparation (87 vs. 85%, p = 0.73) or adenoma detection rate (55 vs. 51%, p = 0.59) when comparing patients with SCI with the control population. No difference in polyp histopathology was detected (p = 0.748). Our study demonstrated that an extended bowel preparation for patients with SCI produces similar bowel preparation results and diagnostic yield when compared to patients without SCI undergoing colonoscopy.

  15. 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.

  16. Participation restriction in childhood phenotype of myotonic dystrophy type 1: a systematic retrospective chart review.

    Science.gov (United States)

    Gagnon, Cynthia; Kierkegaard, Marie; Blackburn, Catherine; Chrestian, Nicolas; Lavoie, Mélissa; Bouchard, Marie-Frédéric; Mathieu, Jean

    2017-03-01

    Myotonic dystrophy type 1 (DM1), a neuromuscular disorder, is divided into four clinical phenotypes: congenital; childhood; adult-onset, and late-onset. Publications about the childhood phenotype, especially the long-term outcome, are scarce. The aims of this study were to assess and describe participation outcomes in adults with the childhood phenotype. A retrospective chart methodology. Data were extracted from health records for 63 adults with childhood DM1 (32 males, 31 females; mean age 34y, standard deviation [SD] 11y 6mo; range 18-54y) who had attended the Saguenay Neuromuscular Clinic, Canada. Thirty-four adults (54%) lived with their parents or in foster homes, and most patients needed services or help to live independently. A significant proportion (22%) were isolated in regard to friendship. Very few adults had children, although 33% lived with a spouse. The majority of patients (86%) relied on social security and only one person was currently working. Financial responsibilities were often an issue and 13 (21%) were under legal guardianship. This study showed that patients with the childhood phenotype present a guarded prognosis regarding long-term social participation. These participation restrictions could be related to behavioural, cognitive, and social stigma problems in childhood. This study illustrates the absolute necessity to pursue an interdisciplinary follow-up of these patients when they are reaching adulthood. © 2016 Mac Keith Press.

  17. Ethical and legal questions as regards filling out dental clinical charts

    Directory of Open Access Journals (Sweden)

    Mauro Henrique Nogueira Guimarãe de Abreu

    Full Text Available Objective: Evaluate imperfections in filling out dental clinical history charts of patients attended at the “Universidade Estadual de Montes Claros – Unimontes”, in 2005, from the ethical and legal aspects. Method: Descriptive statistical analysis, Pearson’s correlation, Chi-Square test (p<0.05 with Bonferroni correction in a contingency table (p<0.003 tests were performed, and Anova – Tukey (p<0.05 were calculate using SPSS software. This study was conducted using 881 clinical history charts of 19 subjects. Results: The highest percentage of charts concerned Stomatology (12% and 8 th period of the course (25%. The majority (63.3% of chartshad fields left blank and in 68% the handwriting was illegible. Unjustifiable erasures were found in 74.7% of charts. The majority of charts (98% were filled out in ink. The treatment plan was signed by course tutor in 83% of the cases. The term of consent was signed in the 94.9 % of the charts. As regards mistakes, 5.1% of documents had one error; 42% two errors; 23.5% three or more errors (average 1.89(± 0.9; percentile 25%=1; 50%=2 and 75%=2. The difference in the proportion of errors as regards filling out all fields differed statistically among the periods (p<0.05. Conclusion: It was concluded that an alarming number of documents were filled out incorrectly. The worst filling out performance was shown in the 5th, 6th and 7th periods (p<0.05.

  18. Growth charts for children with Ellis-van Creveld syndrome

    NARCIS (Netherlands)

    S. Verbeek (Sabine); P.H.C. Eilers (Paul); K.A. Lawrence (Karen); R.C.M. Hennekam (Raoul); F.G. Versteegh (Florens)

    2011-01-01

    textabstractEllis-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

  19. Growth charts for children with Ellis-van Creveld syndrome

    NARCIS (Netherlands)

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

    2011-01-01

    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

  20. Hypercalcaemia in patients with breast cancer: Patterns and ...

    African Journals Online (AJOL)

    Purpose: To assess the patterns of use of bisphosphonate therapies for hypercalcaemia in breast cancer patients, and their outcomes. Methods: A retrospective chart review study of breast cancer patients hospitalised between 2009 and 2014 at Penang Hospital, a public tertiary hospital in Malaysia was conducted. Patients ...

  1. 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)...

  2. Volatile anesthetics for status asthmaticus in pediatric patients: a comprehensive review and case series.

    Science.gov (United States)

    Carrié, Sabrina; Anderson, Thomas Anthony

    2015-05-01

    Status asthmaticus is an acute, intractable asthma attack refractory to standard interventions that can lead to progressive respiratory failure. Successful management requires a fundamental understanding of the disease process, its clinical presentation, and proper evaluation. Treatment must be instituted early and is aimed at reversing the airway inflammation, bronchoconstriction, and hyper-reactivity that often lead to lower airway obstruction, impaired ventilation, and oxygenation. Most patients are effectively treated with standard therapy including beta2-adrenergic agonists and corticosteroids. Others necessitate adjunctive therapies and escalation to noninvasive ventilation or intubation. We will review the pathophysiology, evaluation, and treatment options for pediatric patients presenting with status asthmaticus with a particular focus on refractory status asthmaticus treated with volatile anesthetics. In addition, we include a proven approach to the management of these patients in the critical care setting, which requires close coordination between critical care and anesthesia providers. We present a case series of three patients, two of which have the longest reported cases of continuous isoflurane use in status asthmaticus. This series was obtained from a retrospective chart review and highlights the efficacy of the volatile anesthetic, isoflurane, in three pediatric patients with refractory life-threatening status asthmaticus. © 2015 John Wiley & Sons Ltd.

  3. 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

  4. 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

  5. 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 ...

  6. 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...

  7. 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.

  8. Quality improvement program reduces perioperative dental injuries - A review of 64,718 anesthetic patients.

    Science.gov (United States)

    Kuo, Yi-Wei; Lu, I-Cheng; Yang, Hui-Ying; Chiu, Shun-Li; Hsu, Hung-Te; Cheng, Kuang-I

    2016-12-01

    Perioperative dental injury (PDI) is a common adverse event associated with anesthesia that can easily lead to medicolegal litigation. A quality improvement program was conducted with the electronic, standardized dental chart to document dentition before anesthesia and dentist consultation when necessary. This study aimed to reduce PDIs through execution of a quality improvement program. We reviewed the 42-month interval anesthetic records of 64,718 patients who underwent anesthesia. A standardized electronic dental chart was designed to identify any dental prosthetics, fixed and removable dentures, and degree of loose teeth. The incidence of dental injuries associated with anesthesia was separated into three time periods: baseline, initiative (Phase I), and execution (Phase II). Primary outcome measurement was the incidence of PDIs related to anesthesia. The overall incidence of dental injury related to anesthesia was 0.059% (38/64,718 patients). During the baseline period, the dental injury rate was 0.108% (26/24,137 patients), and it decreased from 0.051% in the initiative period (10/19,711 patients) to 0.009% in the execution period (2/20,870 patients) during implementation of the quality improvement program. Most dental injuries were associated with laryngeal mask airway (42.1%) and laryngoscopy (28.9%). The most commonly involved teeth were the upper incisors. Dental injury incidence was significantly reduced and remained at low levels after implementation of the quality improvement program. We suggest the implementation of a standardized dental examination into the preoperative evaluation system adding pathologic teeth fixed or protected devices to minimize dental injury associated with anesthesia. Copyright © 2016. Published by Elsevier Taiwan LLC.

  9. Patient Outcomes After Palliative Care Consultation Among Patients Undergoing Therapeutic Hypothermia.

    Science.gov (United States)

    Pinto, Priya; Brown, Tartania; Khilkin, Michael; Chuang, Elizabeth

    2018-04-01

    To compare the clinical outcomes of patients who did and did not receive palliative care consultation among those who experienced out-of-hospital cardiac arrest and underwent therapeutic hypothermia. We identified patients at a single academic medical center who had undergone therapeutic hypothermia after out-of-hospital cardiac arrest between 2009 and 2013. We performed a retrospective chart review for demographic data, hospital and critical care length of stay, and clinical outcomes of care. We reviewed the charts of 62 patients, of which 35 (56%) received a palliative care consultation and 27 (44%) did not. Palliative care consultation occurred an average of 8.3 days after admission. Patients receiving palliative care consultation were more likely to have a do-not-resuscitate (DNR) order placed (odds ratio: 2.3, P care or not (16.7 vs 17.1 days, P = .90). Intensive care length of stay was also similar (11.3 vs 12.6 days, P = .55). Palliative care consultation was underutilized and utilized late in this cohort. Palliative consultation was associated with DNR orders but did not affect measures of utilization such as hospital and intensive care length of stay.

  10. 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.

  11. 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.

  12. Improved implementation of the risk-adjusted Bernoulli CUSUM chart to monitor surgical outcome quality.

    Science.gov (United States)

    Keefe, Matthew J; Loda, Justin B; Elhabashy, Ahmad E; Woodall, William H

    2017-06-01

    The traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information. We propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery. A simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration. Deterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  13. 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)

  14. Review of dextromethorphan administration in 18 patients with subacute methotrexate central nervous system toxicity.

    Science.gov (United States)

    Afshar, Maryam; Birnbaum, Daniel; Golden, Carla

    2014-06-01

    The pathogenesis of methotrexate central nervous system toxicity is multifactorial, but it is likely related to central nervous system folate homeostasis. The use of folinate rescue has been described to decrease toxicity in patients who had received intrathecal methotrexate. It has also been described in previous studies that there is an elevated level of homocysteine in plasma and cerebrospinal fluid of patients who had received intrathecal methotrexate. Homocysteine is an N-methyl-D-aspartate receptor agonist. The use of dextromethorphan, noncompetitive N-methyl-D-aspartate receptor receptor antagonist, has been used in the treatment of sudden onset of neurological dysfunction associated with methotrexate toxicity. It remains unclear whether the dextromethorphan impacted the speed of recovery, and its use remains controversial. This study reviews the use of dextromethorphan in the setting of subacute methotrexate central nervous system toxicity. Charts of 18 patients who had sudden onset of neurological impairments after receiving methotrexate and were treated with dextromethorphan were reviewed. The use of dextromethorphan in most of our patients resulted in symptomatic improvement. In this patient population, earlier administration of dextromethorphan resulted in faster improvement of impairments and led to prevention of recurrence of seizure activity induced by methotrexate central nervous system toxicity. Our study provides support for the use of dextromethorphan in patients with subacute methotrexate central nervous system toxicity. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. 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.

  16. Automatic exposure control systems designed to maintain constant image noise: effects on computed tomography dose and noise relative to clinically accepted technique charts.

    Science.gov (United States)

    Favazza, Christopher P; Yu, Lifeng; Leng, Shuai; Kofler, James M; McCollough, Cynthia H

    2015-01-01

    To compare computed tomography dose and noise arising from use of an automatic exposure control (AEC) system designed to maintain constant image noise as patient size varies with clinically accepted technique charts and AEC systems designed to vary image noise. A model was developed to describe tube current modulation as a function of patient thickness. Relative dose and noise values were calculated as patient width varied for AEC settings designed to yield constant or variable noise levels and were compared to empirically derived values used by our clinical practice. Phantom experiments were performed in which tube current was measured as a function of thickness using a constant-noise-based AEC system and the results were compared with clinical technique charts. For 12-, 20-, 28-, 44-, and 50-cm patient widths, the requirement of constant noise across patient size yielded relative doses of 5%, 14%, 38%, 260%, and 549% and relative noises of 435%, 267%, 163%, 61%, and 42%, respectively, as compared with our clinically used technique chart settings at each respective width. Experimental measurements showed that a constant noise-based AEC system yielded 175% relative noise for a 30-cm phantom and 206% relative dose for a 40-cm phantom compared with our clinical technique chart. Automatic exposure control systems that prescribe constant noise as patient size varies can yield excessive noise in small patients and excessive dose in obese patients compared with clinically accepted technique charts. Use of noise-level technique charts and tube current limits can mitigate these effects.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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...

  2. 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...

  3. The immediate placement of dental implants into extraction sites with periapical lesions: a retrospective chart review.

    Science.gov (United States)

    Bell, Christopher Lincoln; Diehl, David; Bell, Brian Michael; Bell, Robert E

    2011-06-01

    The purpose of this study was to evaluate the success of dental implants placed immediately into extraction sites in the presence of chronic periapical pathology. The charts of 655 patients who had implants immediately placed into fresh extraction sites were reviewed for the presence or absence of periapical radiolucencies. A total of 922 implants were included. Of the 922 implants, 285 were immediately placed into sockets that had chronic periapical infections. The remaining 637 implants, without signs of periapical pathology, were used as the control group. Success of the implants was defined as successful osseointegration, successful restoration, and absence of evidence of bone loss or peri-implantitis. Other variables such as age, gender, smoking, diabetes, bisphosphonate use, lucencies of adjacent teeth, and implant stability at the time of placement were also evaluated. Of the 922 implants, 285 were placed into sockets with periapical radiolucencies. The success rate of implants placed in the study group was 97.5%, whereas the success rate of the control group was 98.7%. The difference was not found to be statistically significant. The mean follow-up was 19.75 months, with a maximum of 93 months and a minimum of 3 months. A statistically higher failure rate was found for implants placed adjacent to retained teeth with periapical pathology. The placement of implants in sockets affected by chronic periapical pathology can be considered a safe and viable treatment option. There is a risk of implant failure when placing implants adjacent to teeth with periapical radiolucencies. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. 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

  5. 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).

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

    Science.gov (United States)

    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

  7. 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.)

  8. 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

  9. 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...

  10. 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.

  11. 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

  12. 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...

  13. 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

  14. 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...

  15. 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

  16. Treatment changes in patients with psoriasis on etanercept or adalimumab

    DEFF Research Database (Denmark)

    Lee, Erica B; Amin, Mina; Egeberg, Alexander

    2018-01-01

    PURPOSE: To determine the frequency of and reasons for treatment changes in patients with psoriasis. MATERIALS AND METHODS: A retrospective chart review of 140 patients with psoriasis treated with adalimumab or etanercept seen at Kaiser Permanente Los Angeles Medical Center between September 20, ...

  17. 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

  18. The need for standardisation of peak flow charts

    OpenAIRE

    Reddel, H; Vincent, S; Civitico, J

    2005-01-01

    Peak expiratory flow (PEF) monitoring is recommended in asthma guidelines as a tool for assessing severity, monitoring response to treatment, detecting exacerbations, identifying triggers, and providing objective justification for treatment to the patient, but some clinicians have expressed concerns about its relevance in the management of asthma. We have identified a sevenfold variation in the scale of existing PEF charts, with resulting wide variation in the appearance of the same PEF date ...

  19. A feasibility study of continuous hyperfractionated accelerated radiotherapy (CHART) and brachytherapy in patients with early oral or oropharyngeal carcinomas

    International Nuclear Information System (INIS)

    Goodchild, K.; Hoskin, P.; Dische, S.; Pigott, K.; Powell, M.; Saunders, M.

    1999-01-01

    Overall time is important in the curative treatment of head and neck cancer (Dische, S., Saunders, M.I., Barrett, A., Harvey, A., Gibson, D., Parmar, M., 1997, Radiother. Oncol., 44:123-136). Results are presented on outcome and morbidity in ten patients with head and neck cancer treated with external beam irradiation (CHART protocol) and interstitial implantation, completing treatment in 12 days. Local control and overall survival at 5 years was 67%. Acute and late morbidity was acceptable giving scope for dose escalation. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

  20. 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...

  1. Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis.

    Science.gov (United States)

    Iwashyna, Theodore J; Odden, Andrew; Rohde, Jeffrey; Bonham, Catherine; Kuhn, Latoya; Malani, Preeti; Chen, Lena; Flanders, Scott

    2014-06-01

    Severe sepsis is a common and costly problem. Although consistently defined clinically by consensus conference since 1991, there have been several different implementations of the severe sepsis definition using ICD-9-CM codes for research. We conducted a single center, patient-level validation of 1 common implementation of the severe sepsis definition, the so-called "Angus" implementation. Administrative claims for all hospitalizations for patients initially admitted to general medical services from an academic medical center in 2009-2010 were reviewed. On the basis of ICD-9-CM codes, hospitalizations were sampled for review by 3 internal medicine-trained hospitalists. Chart reviews were conducted with a structured instrument, and the gold standard was the hospitalists' summary clinical judgment on whether the patient had severe sepsis. Three thousand one hundred forty-six (13.5%) hospitalizations met ICD-9-CM criteria for severe sepsis by the Angus implementation (Angus-positive) and 20,142 (86.5%) were Angus-negative. Chart reviews were performed for 92 randomly selected Angus-positive and 19 randomly-selected Angus-negative hospitalizations. Reviewers had a κ of 0.70. The Angus implementation's positive predictive value was 70.7% [95% confidence interval (CI): 51.2%, 90.5%]. The negative predictive value was 91.5% (95% CI: 79.0%, 100%). The sensitivity was 50.4% (95% CI: 14.8%, 85.7%). Specificity was 96.3% (95% CI: 92.4%, 100%). Two alternative ICD-9-CM implementations had high positive predictive values but sensitivities of Angus implementation of the international consensus conference definition of severe sepsis offers a reasonable but imperfect approach to identifying patients with severe sepsis when compared with a gold standard of structured review of the medical chart by trained hospitalists.

  2. 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)

  3. 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,...

  4. 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

  5. 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…

  6. Depreciation Accounting in the Uniform Chart of Accounts.

    Science.gov (United States)

    1982-12-01

    footage of building occupied. Reason( s ) for Compute full cost of Rate setting, cash accounting for patient care flow generation and fund- depreciation ing... Horngren , Charles T., Cost Accounting ; A Managerial Emphasis, Prentice-Hall Inc., 1972. 32. Sawyer, Lawrence B., The Practice of Modern Internal Auditing...Awd ubtlft) S . TYPE or RE PORT a PE*IoO CovIERWO Master’s Thesis; Depreciation Accounting in the Uniform Dembr18 Chart of Accounts .PSOiwON.EORlumm

  7. 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)

  8. 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)

  9. SU-D-BRD-02: Auto Weekly - An Automated Online Weekly Chart Check System for Medical Physics

    Energy Technology Data Exchange (ETDEWEB)

    Tan, J; Yan, Y; Hager, F; Gu, X; Jia, X; Pompos, A; Foster, R; Stojadinovic, S; Yang, M; Hrycushko, B; Folkerts, M; Zhao, B; Medin, P; Ding, C; Jiang, S [UT Southwestern Medical Center, Dallas, TX (United States)

    2015-06-15

    Purpose: Radiation therapy has evolved to become not only more precise and potent, but also more complicated to monitor and deliver. More rigorous and comprehensive quality assurance is needed to safeguard ever advancing radiation therapy. ICRU standards dictate that an ever growing set of treatment parameters are manually checked weekly by medical physicists. This “weekly chart check” procedure is laborious and subject to human errors or other factors. A computer-assisted chart checking process will enable more complete and accurate human review of critical parameters, reduce the risk of medical errors, and improve the efficiency. Methods: We developed a web-based software system that enables a thorough weekly quality assurance checks. In the backend, the software retrieves all machine parameters from a Treatment Management System (TMS) and compares them against the corresponding ones from the treatment planning system. They are also checked for validity against preset rules. The results are displayed as a web page in the front-end for physicists to review. Then a summary report is generated and uploaded automatically to the TMS as a record for weekly chart checking. Results: The software system has been deployed on a web server in our department’s intranet, and has been tested thoroughly by our clinical physicists. A plan parameter would be highlighted when it is off the preset limit. The developed system has changed the way of checking charts with significantly improved accuracy, efficiency, and completeness. It has been shown to be robust, fast, and easy to use. Conclusion: A computer-assisted system has been developed for efficient, accurate, and comprehensive weekly chart checking. The system has been extensively validated and is being implemented for routine clinical use.

  10. SU-D-BRD-02: Auto Weekly - An Automated Online Weekly Chart Check System for Medical Physics

    International Nuclear Information System (INIS)

    Tan, J; Yan, Y; Hager, F; Gu, X; Jia, X; Pompos, A; Foster, R; Stojadinovic, S; Yang, M; Hrycushko, B; Folkerts, M; Zhao, B; Medin, P; Ding, C; Jiang, S

    2015-01-01

    Purpose: Radiation therapy has evolved to become not only more precise and potent, but also more complicated to monitor and deliver. More rigorous and comprehensive quality assurance is needed to safeguard ever advancing radiation therapy. ICRU standards dictate that an ever growing set of treatment parameters are manually checked weekly by medical physicists. This “weekly chart check” procedure is laborious and subject to human errors or other factors. A computer-assisted chart checking process will enable more complete and accurate human review of critical parameters, reduce the risk of medical errors, and improve the efficiency. Methods: We developed a web-based software system that enables a thorough weekly quality assurance checks. In the backend, the software retrieves all machine parameters from a Treatment Management System (TMS) and compares them against the corresponding ones from the treatment planning system. They are also checked for validity against preset rules. The results are displayed as a web page in the front-end for physicists to review. Then a summary report is generated and uploaded automatically to the TMS as a record for weekly chart checking. Results: The software system has been deployed on a web server in our department’s intranet, and has been tested thoroughly by our clinical physicists. A plan parameter would be highlighted when it is off the preset limit. The developed system has changed the way of checking charts with significantly improved accuracy, efficiency, and completeness. It has been shown to be robust, fast, and easy to use. Conclusion: A computer-assisted system has been developed for efficient, accurate, and comprehensive weekly chart checking. The system has been extensively validated and is being implemented for routine clinical use

  11. Evaluation of the Reliability of Electronic Medical Record Data in Identifying Comorbid Conditions among Patients with Advanced Non-Small Cell Lung Cancer

    International Nuclear Information System (INIS)

    Muehlenbein, C. E.; Lawson, A.; Pohl, G.; Hoverman, R.; Gruschkus, S. K.; Forsyth, M.; Chen, C.; Lopez, W.; Hartnett, H. J.

    2011-01-01

    Traditional methods for identifying co morbidity data in EMRs have relied primarily on costly and time-consuming manual chart review. The purpose of this study was to validate a strategy of electronically searching EMR data to identify co morbidities among cancer patients. Methods. Advanced stage NSCLC patients ( N = 2,513) who received chemotherapy from 7/1/2006 to 6/30/2008 were identified using iKnowMed, US Oncology's proprietary oncology-specific EMR system. EMR data were searched for documentation of co morbidities common to advanced stage cancer patients. The search was conducted by a series of programmatic queries on standardized information including concomitant illnesses, patient history, review of systems, and diagnoses other than cancer. The validity of the co morbidity information that we derived from the EMR search was compared to the chart review gold standard in a random sample of 450 patients for whom the EMR search yielded no indication of co morbidities. Negative predictive values were calculated. Results. The overall prevalence of co morbidities of 22%. Overall negative predictive value was 0.92 in the 450 patients randomly sampled patients (36 of 450 were found to have evidence of co morbidities on chart review). Conclusion. Results of this study suggest that efficient queries/text searches of EMR data may provide reliable data on co morbid conditions among cancer patients.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. A qualitative study exploring nurses’ attitudes, confidence, and perceived barriers to implementing a traumatic brain injury nursing chart in Uganda

    Directory of Open Access Journals (Sweden)

    Leslie Wynveen

    2018-06-01

    Full Text Available Introduction: In Africa, traumatic brain injuries frequently result from road traffic injuries and assaults. Despite limited resources and the high costs of life-saving neurosurgical interventions, secondary brain injury prevention has the potential for improving outcomes. However, nurses and other medical personnel infrequently monitor vital signs, blood sugar, and pulse oximetry and only sporadically re-assess neurological status. Methods: In one-on-one, semi-structured interviews, 27 nurses from Mulago Hospital’s emergency centre, a tertiary care trauma hospital in Kampala, Uganda, provided feedback regarding a traumatic brain injury-focused education session and use of a nursing chart for detecting secondary brain injury. The interviews explored the nurses’ confidence and perceived barriers to long-term chart implementation and traumatic brain injury care, as well as their ideas for improving this intervention. Interviews were audio recorded, transcribed, and coded using ATLAS.ti: Qualitative Data Analysis and Research Software (Cleverbridge, Inc., Chicago, USA and Microsoft Word and Excel (Microsoft Office, Redmond, USA for thematic content analysis. Results: Key findings identified in the interviews included the nurses’ attitudes toward the chart and their feelings of increased confidence in assessing and caring for these patients. The main barriers to continuous implementation included inadequate staffing and resources. Conclusion: Nurses were receptive to the education session and nursing chart, and felt that it increased their confidence and improved their ability to care for traumatic brain injured patients. However, lack of supplies, overwhelming numbers of patients, and inadequate staffing interfered with consistent monitoring of patients. The nurses offered various suggestions for improving traumatic brain injury care that should be further investigated. More research is needed to assess the applicability of a standardised

  2. 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...

  3. 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...

  4. 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.

  5. 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)

  6. 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.)

  7. 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

  8. 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.

  9. 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.

  10. UPPER GASTROINTESTINAL ENDOSCOPY FINDINGS IN PATIENTS REFERRED WITH UPPER GASTROINTESTINAL SYMPTOMS IN ELDORET, KENYA: A RETROSPECTIVE REVIEW.

    Science.gov (United States)

    Ayuo, P O; Some, F F; Kiplagat, J

    2014-08-01

    Dyspepsia is one of the major indications for upper gastrointestinal endoscopy. Other indications include dysphagia, odynophagia and gastrointestinal bleeding. Endoscopy is an expensive procedure that is out of reach of many patients in resource constrained region such as western Kenya. We reviewed endoscopy records from both public and private health institutions spanning ten years. To determine the pattern of referral and endoscopy diagnoses in patients referred for upper gastrointestinal endoscopy in Eldoret, Kenya. Retrospective chart review. Moi Teaching and Referral Hospital, private hospitals and private clinics in Eldoret, Kenya. One thousand six hundred and ninety (1690) Patients who underwent upper GI endoscopy from 1993 to 2003 were reviewed after obtaining clearances from the respective institutions. Information on age, sex, symptoms, and endoscopy diagnosis were extracted and subjected to statistical analysis. The most common symptom was dyspepsia in 1059 (62.7%) followed by dysphagia in 224 (13.3%). Others were referred with diagnosis of cancer of the stomach or oesophagus. Common endoscopy diagnoses were cancer of the oesophagus in 199 (11.8%) and duodenal ulcer in 186 (11.0%). The majority of the patients (30.4%) had normal endoscopy findings. Of the 1059 patients with dyspepsia, only 154 (14.5%) had duodenal ulcer and 34 (3.2%) had gastric ulcers, the majority, 37.2% had normal endoscopy findings. Dyspepsia was main reason for referral, but the majority of such patients had normal findings. Cancer of the oesophagus was the main diagnosis in patients with dysphagia. In view of the cost of endoscopy, only those with dyspepsia and alarm symptoms be referred for the procedure.

  11. 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.

  12. 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...

  13. 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...

  14. 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...

  15. 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

  16. Are primary care practitioners in Barbados following diabetes guidelines? - a chart audit with comparison between public and private care sectors

    Directory of Open Access Journals (Sweden)

    Carter Anne O

    2011-06-01

    Full Text Available Abstract Background Over 19% of the population ≥ 40 years of age in Barbados are diabetic. The quality of diabetes primary care is uncertain. Findings Charts of diabetic and hypertensive patients were randomly sampled at all public and 20 private sector primary care clinics. Charts of all diabetic patients ≥ 40 years of age were then selected. Processes of care, and quality targets for blood pressure (BP, fasting blood glucose (FBG and glycosylated haemoglobin (HbA1c were documented. 252 charts of diabetic patients (125 public and 127 private were audited. Patients had the following characteristics: mean age 64 years, female gender 61%, mean duration of diagnosis 9 years, and hypertension diagnosed 78%. Patients had an average of 4.7 clinic visits per year, 66% were prescribed metformin, 68% a sulphonylurea, 25% a statin, 21% insulin, 15% aspirin and 12% a glucosidase inhibitor. Public patients compared to private patients were more likely to be female (77% vs. 46%, p Conclusions Interventions such as body mass assessment, lifestyle advice, screening for retinopathy, monitoring blood glucose control, and achieving BP and glycaemic targets need improvement.

  17. 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.

  18. [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.

  19. Identification and Referral of Patients at Risk for Post-traumatic Stress Disorder: A Literature Review and Retrospective Analysis.

    Science.gov (United States)

    Bolduc, Aaron; Hwang, Brice; Hogan, Christopher; Bhalla, Varun K; Nesmith, Elizabeth; Medeiros, Regina; Alexander, Cassie; Holsten, Steven B

    2015-09-01

    Post-traumatic stress disorder (PTSD) is a well-established psychological disorder after severe traumatic injury but remains poorly recognized. Recent changes in the "Resources for Optimal Care of the Injured Trauma Patient 2014" stress the need for comprehensive screening and referral for PTSD and depression after injury. Our purpose was to review the current PTSD literature and perform a retrospective chart review to evaluate screening at our institution. We hypothesized a lack of documentation and thus referral of these patients to mental health professionals. We performed a literature review of 43 publications of risk factors for PTSD in the civilian adult population followed by a retrospective review. Records were analyzed for basic demographics, risk factors found in the literature, and referrals to mental health providers. Risk factors included amputation, dissociative symptoms, female gender, history of mental health disorder, and peri-traumatic emotionality. Traumatic amputation status and gender were recorded in all patients. History of mental health disorder was present in 11.5 per cent patients, absent in 80.75 per cent, and not recorded in 7.75 per cent with an overall documentation of 91.75 per cent. Dissociative symptoms and peri-traumatic emotionality were recorded in 0.5 per cent and 1.0 per cent of patients, respectively. Only 13 patients of 400 (3.25%) were referred to mental health professionals. Despite extensive evidence and literature supporting risk factors for the development of PTSD, identification and treatment at our level 1 trauma center is lacking. There is a need for consistent screening among trauma centers to identify PTSD risk factors and protocols for risk reduction and referrals for patients at risk.

  20. 32 CFR 728.93 - Chart of adjuncts.

    Science.gov (United States)

    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...

  1. 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

  2. Emergency thoracic surgery in elderly patients

    OpenAIRE

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants ...

  3. 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)

  4. Non-invasive ventilation in HIV positive patients with sepsis and ...

    African Journals Online (AJOL)

    Method: We conducted an observational prospective cohort study for the NIV arm (in the first half of 2016) with a retrospective chart review for the controls that focused on HIV positive patients with sepsis and hypoxaemic respiratory failure. 77 consecutive HIV positive patients with sepsis and respiratory distress meeting the ...

  5. 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…

  6. 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.

  7. 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...

  8. Routine airway surveillance in pediatric tracheostomy patients.

    Science.gov (United States)

    Gergin, Ozgul; Adil, Eelam; Kawai, Kosuke; Watters, Karen; Moritz, Ethan; Rahbar, Reza

    2017-06-01

    The aim of this study is to review airway findings in children with tracheostomies who underwent surveillance direct laryngoscopy and bronchoscopy (DLB) to determine the yield of routine airway evaluation in these patients. Retrospective chart review at tertiary referral children's hospital. A retrospective chart review was conducted of all of the children with tracheostomies who underwent DLB after tracheostomy between 1984 and 2015. A total of 303 patients met inclusion criteria. The median time interval between tracheostomy and first follow-up DLB was 12.0 months (IQR 4.8-28.9 months). There was no significant difference in the incidence of airway lesions between patients who underwent endoscopy tracheostomy versus those who had a longer time interval between tracheostomy and DLB (p = 0.16). One hundred sixty seven patients (55.1%) were diagnosed with lesions, with suprastomal granulation (39.9%) being the most common. Symptomatic patients were significantly more likely to have an airway lesion identified (69.9% versus 42.0%; p tracheostomy were significantly more likely to have an airway lesion (p = 0.01). The high incidence of airway lesions noted during surveillance DLB support the utility of routine airway endoscopy in pediatric tracheostomy patients. Symptomatic patients, those with ventilator dependence, or cardiopulmonary or trauma indications for tracheostomy are more likely to have airway lesions and should be monitored closely. The ideal time interval between surveillance endoscopies needs to be examined further. Copyright © 2017. Published by Elsevier B.V.

  9. 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.

  10. 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)

  11. 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

  12. 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.

  13. Recognition versus Resolution: a Comparison of Visual Acuity Results Using Two Alternative Test Chart Optotype

    Science.gov (United States)

    Pointer, Jonathan S.

    2010-01-01

    Purpose To quantify the difference between recognition (letter) and resolution (Landolt) visual acuity (VA) in a group of normally sighted subjects. Is it reasonable to assume that the two acuity measures are clinically equivalent? Methods A pair of 6 m acuity test charts was produced: one comprised letters and the other Landolt broken rings. Construction of both charts conformed to the logMAR design format. Monocular VA was determined for the dominant eye of 300 screened and normally sighted optometric patients aged 16 to 40, each wearing an optical refractive (spectacle) correction. Results Letter acuity was superior to Landolt acuity (P≤0.0001). The mean paired acuity difference was -0.041 logMAR (standard deviation 0.034): the 95% limits of agreement were ±0.067 logMAR units or ±3.3 chart optotype. Repeatability was high and similar for each chart type (±2.1 and ±2.4 optotype for letter and Landolt, respectively). Gender, test sequence, and laterality of the dominant eye (left or right) were each non-statistically significant variables. Conclusions For normally sighted subjects wearing an optimal refractive correction, a bias was recorded in favour of recognition over resolution acuity: the clinical difference amounted to approximately 40% of one logMAR chart line, with similar high repeatability for either chart optotype. We conclude that the assumption of clinical equivalence between letter and Landolt acuity is reasonable under optimum test conditions.

  14. Translation, cross-cultural adaptation and validation of the Persian version of COOP/WONCA charts in Persian-speaking Iranians with multiple sclerosis.

    Science.gov (United States)

    Taghipour, Morteza; Salavati, Mahyar; Nabavi, Seyed Massood; Akhbari, Behnam; Ebrahimi Takamjani, Ismail; Negahban, Hossein; Rajabzadeh, Fatemeh

    2018-03-01

    Translation, cross-culturally adaptation and validation of a Persian version of COOP/WONCA charts in Persian-speaking Iranians with multiple sclerosis (MS). The Persian version of COOP/WONCA charts was developed after a standard forward translation, synthesis and backward translation. A total of 197 subjects with MS participated in this study. They were asked to complete the COOP/WONCA charts and Short-Form 36 Health Survey (SF-36). The COOP/WONCA charts were re-administered to 50 patients, 4 weeks after the first session. Expanded Disability Status Scale (EDSS) was also scored for each subject by the referring physician. Construct validity was assessed by testing linear relationship between corresponding domains of the COOP/WONCA charts, the SF-36 and the EDSS. Test-retest reliability was examined using interclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) values. Related domains of COOP/WONCA charts and SF-36 demonstrated strong linear relationships with Spearman's coefficients ranging from -0.51 to -0.75 (p0.70) except for feelings and quality-of-life domains that were 0.50 and 0.51, respectively. The Persian version of the COOP/WONCA charts was shown to be psychometrically appropriate to evaluate the functional level and quality of life in Persian-speaking Iranians with MS. Implications for rehabilitation COOP/WONCA charts are now available in Persian and demonstrate good psychometric properties. COOP/WONCA charts demonstrate excellent reliability and construct validity in a Persian-speaking Iranian population with MS. Minimal detectable change in COOP/WONCA is now available in MS to guide within and between group analyses. Knowledge on a wide variety of physical, mental and emotional parameters as well as the status of patients' symptoms, daily activities and quality of life helps rehabilitation clinicians and service providers plan preventive and remedial interventions more effectively.

  15. 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.

  16. Patient-based radiographic exposure factor selection: a systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Ching, William; Robinson, John; McEntee, Mark, E-mail: mark.mcentee@sydney.edu.au [Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, New South Wales (Australia)

    2014-09-15

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system.

  17. Patient-based radiographic exposure factor selection: a systematic review

    International Nuclear Information System (INIS)

    Ching, William; Robinson, John; McEntee, Mark

    2014-01-01

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system

  18. 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)

  19. 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

  20. 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/.

  1. 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...

  2. 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...

  3. 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...

  4. 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

  5. A patient self-assessment tool for cardiac rehabilitation.

    Science.gov (United States)

    Phelan, C; Finnell, M D; Mottla, K A

    1989-01-01

    A patient self-assessment tool was designed, tested, and implemented to promote cardiac-specific data collection, based on Gordon's Functional Health Patterns, to maximize patient/family involvement in determining a plan of care, and to streamline primary nurses' documentation requirements. Retrospective and concurrent chart reviews provided data for quality assurance monitoring. The results of the monitoring demonstrated that the self-assessment tool markedly improved the patient-specific data base.

  6. SU-D-BRD-01: An Automated Physics Weekly Chart Checking System Supporting ARIA

    Energy Technology Data Exchange (ETDEWEB)

    Chang, X; Yang, D [Washington University in St Louis, St Louis, MO (United States)

    2015-06-15

    Purpose: A software tool was developed in this study to perform automatic weekly physics chart check on the patient data in ARIA. The tool accesses the electronic patient data directly from ARIA server and checks the accuracy of treatment deliveries, and generates reports which summarize the delivery history and highlight the errors. Methods: The tool has four modules. 1) The database interface is designed to directly access treatment delivery data from the ARIA database before reorganizing the data into the patient chart tree (PCT). 2) PCT is a core data structure designed to store and organize the data in logical hierarchies, and to be passed among functions. 3) The treatment data check module analyzes the organized data in PCT and stores the checking results into PCT. 4) Report generation module generates reports containing the treatment delivery summary, chart checking results and plots of daily treatment setup parameters (couch table positions, shifts of image guidance). The errors that are found by the tool are highlighted with colors. Results: The weekly check tool has been implemented in MATLAB and clinically tested at two major cancer centers. Javascript, cascading style sheets (CSS) and dynamic HTML were employed to create the user-interactive reports. It takes 0.06 second to search the delivery records of one beam with PCT and compare the delivery records with beam plan. The reports, saved in the HTML files on shared network folder, can be accessed by web browser on computers and mobile devices. Conclusion: The presented weekly check tool is useful to check the electronic patient treatment data in Varian ARIA system. It could be more efficient and reliable than the manually check by physicists. The work was partially supported by a research grant from Varian Medical System.

  7. SU-D-BRD-01: An Automated Physics Weekly Chart Checking System Supporting ARIA

    International Nuclear Information System (INIS)

    Chang, X; Yang, D

    2015-01-01

    Purpose: A software tool was developed in this study to perform automatic weekly physics chart check on the patient data in ARIA. The tool accesses the electronic patient data directly from ARIA server and checks the accuracy of treatment deliveries, and generates reports which summarize the delivery history and highlight the errors. Methods: The tool has four modules. 1) The database interface is designed to directly access treatment delivery data from the ARIA database before reorganizing the data into the patient chart tree (PCT). 2) PCT is a core data structure designed to store and organize the data in logical hierarchies, and to be passed among functions. 3) The treatment data check module analyzes the organized data in PCT and stores the checking results into PCT. 4) Report generation module generates reports containing the treatment delivery summary, chart checking results and plots of daily treatment setup parameters (couch table positions, shifts of image guidance). The errors that are found by the tool are highlighted with colors. Results: The weekly check tool has been implemented in MATLAB and clinically tested at two major cancer centers. Javascript, cascading style sheets (CSS) and dynamic HTML were employed to create the user-interactive reports. It takes 0.06 second to search the delivery records of one beam with PCT and compare the delivery records with beam plan. The reports, saved in the HTML files on shared network folder, can be accessed by web browser on computers and mobile devices. Conclusion: The presented weekly check tool is useful to check the electronic patient treatment data in Varian ARIA system. It could be more efficient and reliable than the manually check by physicists. The work was partially supported by a research grant from Varian Medical System

  8. Building information for systematic improvement of the prevention of hospital-acquired pressure ulcers with statistical process control charts and regression.

    Science.gov (United States)

    Padula, William V; Mishra, Manish K; Weaver, Christopher D; Yilmaz, Taygan; Splaine, Mark E

    2012-06-01

    To demonstrate complementary results of regression and statistical process control (SPC) chart analyses for hospital-acquired pressure ulcers (HAPUs), and identify possible links between changes and opportunities for improvement between hospital microsystems and macrosystems. Ordinary least squares and panel data regression of retrospective hospital billing data, and SPC charts of prospective patient records for a US tertiary-care facility (2004-2007). A prospective cohort of hospital inpatients at risk for HAPUs was the study population. There were 337 HAPU incidences hospital wide among 43 844 inpatients. A probit regression model predicted the correlation of age, gender and length of stay on HAPU incidence (pseudo R(2)=0.096). Panel data analysis determined that for each additional day in the hospital, there was a 0.28% increase in the likelihood of HAPU incidence. A p-chart of HAPU incidence showed a mean incidence rate of 1.17% remaining in statistical control. A t-chart showed the average time between events for the last 25 HAPUs was 13.25 days. There was one 57-day period between two incidences during the observation period. A p-chart addressing Braden scale assessments showed that 40.5% of all patients were risk stratified for HAPUs upon admission. SPC charts complement standard regression analysis. SPC amplifies patient outcomes at the microsystem level and is useful for guiding quality improvement. Macrosystems should monitor effective quality improvement initiatives in microsystems and aid the spread of successful initiatives to other microsystems, followed by system-wide analysis with regression. Although HAPU incidence in this study is below the national mean, there is still room to improve HAPU incidence in this hospital setting since 0% incidence is theoretically achievable. Further assessment of pressure ulcer incidence could illustrate improvement in the quality of care and prevent HAPUs.

  9. 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

  10. 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

  11. 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...

  12. 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.

  13. A Systematic Review of Psychological Interventions for Adult and Pediatric Patients with Vocal Cord Dysfunction

    Directory of Open Access Journals (Sweden)

    Loveleen eGuglani

    2014-08-01

    Full Text Available Background: Vocal Cord Dysfunction (VCD or Paradoxical Vocal Fold Motion (PVFM is a functional disorder of the vocal cords that requires multidisciplinary treatment. Besides relaxation techniques, the use of psychological interventions can help treat the underlying psychological co-morbidities. There is currently no literature that examines the effectiveness of psychological interventions for VCD/PVFM. Objectives: To review the evidence for psychological interventions used for the treatment of patients with VCD/PVFM. Data Sources: We searched electronic databases for English medical literature using Pubmed (Medline, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Registry of Controlled Trials and Clinicaltrials.gov. The date range for our search is from July 1963 to July 2013. Study Eligibility Criteria, Participants and Interventions: We included studies that reported the use of psychological interventions in both adults and children diagnosed with VCD/PVFM. We included randomized controlled trials, case-control studies, retrospective chart reviews, prospective case series, and individual case reports. Results: Most reported studies are small case series or individual case reports that have described the use of interventions such as psychotherapy, behavioral therapy, use of anti-anxiety and anti-depressant medications, and hypnotherapy in conjunction with breathing exercises taught by speech therapists for symptomatic relief. Among the various psychological interventions that have been reported, there is no data regarding effectiveness and/or superiority of one approach over another in either adult or pediatric patients. Conclusions: Psychological interventions have a role to play in the management of adult and pediatric patients with VCD/PVFM. Future prospective studies using uniform approaches for treatment of associated psychopathology may help address this question. Systematic Review Registration Number: CRD42013004873

  14. Single center review of clinicopathological characterization in 77 patients with positive lupus anticoagulant antibodies.

    Science.gov (United States)

    Owaidah, Tarek M; Qurashi, Fat-Hiya M; Al Nounou, Randa M; Al Zahrani, Hazza; Al Mussa, Abdulrahman; Tbakhi, Abdelghani I; Al Daama, Saad; Elkum, Nasser; Roberts, George T

    2003-08-01

    The antiphospholipid syndrome (APS) is a thrombophillic disorder characterized by the presence of antiphospholipid antibodies (APA). It often occurs in patients with systemic lupus erythematosus (SLE) and may be associated with recurrent abortions and thrombocytopenia and, occasionally, catastrophic thrombotic events. To examine, retrospectively, the clinico-pathological features of patients with APS detected by the presence of the lupus anticoagulant (LAC). Patients were selected for study on the basis of a positive LAC test on review of the laboratory computer records of the King Faisal Specialist Hospital and Research Center. Following this, a clinical chart review was conducted in order to determine the clinical presentations, treatment and the course of patients identified. The information obtained was entered into an electronic database and subsequently analyzed. Seventy-seven patients were identified and reviewed. Fifty-six (73%) were female and 16 (21%) were children less than 15-years-old. Thirty-two patients (42%) had no clinical events (incidental APS). The syndrome was classified as primary in 40 (52%) patients and secondary in 37 (48%). Out of the 45 (58%) patients who presented with symptoms related to APA 22 (49%) had thrombosis, 24 (53%) had pregnancy failure, and 4 (9%) presented with catastrophic APS. The activated partial thromboplastin time (aPTT) was elevated and not corrected by mixing with normal plasma in 47 (61%). On the other hand, the prothrombin time (PT) was normal in 66 (90%). There is a significant difference between aPTT and PT as a screening test with P value of presented with thrombosis were treated with warfarin but only 5 (23%) had received aspirin. Out of the 22 patients presenting with thrombosis, 12 (55%) had one or more recurrent thrombotic events while only 6 (25%) out of the 24 patients who presented with pregnancy failure had events other than pregnancy failure. Fifty-two patients were followed up regularly and were alive

  15. 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...

  16. Clinical significance of coryneform Gram-positive rods from blood identified by MALDI-TOF mass spectrometry and their susceptibility profiles - a retrospective chart review.

    Science.gov (United States)

    Mushtaq, Ammara; Chen, Derrick J; Strand, Gregory J; Dylla, Brenda L; Cole, Nicolynn C; Mandrekar, Jayawant; Patel, Robin

    2016-07-01

    With the advent of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), most Gram-positive rods (GPRs) are readily identified; however, their clinical relevance in blood cultures remains unclear. Herein, we assessed the clinical significance of GPRs isolated from blood and identified in the era of MALDI-TOF MS. A retrospective chart review of patients presenting to the Mayo Clinic, Rochester, MN, from January 1, 2013, to October 13, 2015, was performed. Any episode of a positive blood culture for a GPR was included. We assessed the number of bottles positive for a given isolate, time to positivity of blood cultures, patient age, medical history, interpretation of culture results by the healthcare team and whether infectious diseases consultation was obtained. We also evaluated the susceptibility profiles of a larger collection of GPRs tested in the clinical microbiology laboratory of the Mayo Clinic, Rochester, MN from January 1, 2013, to October 31, 2015. There were a total of 246 GPRs isolated from the blood of 181 patients during the study period. 56% (n = 101) were deemed contaminants by the healthcare team and were not treated; 33% (n = 59) were clinically determined to represent true bacteremia and were treated; and 8% (n = 14) were considered of uncertain significance, with patients prescribed treatment regardless. Patient characteristics associated with an isolate being treated on univariate analysis included younger age (P = 0.02), identification to the species level (P = 0.02), higher number of positive blood culture sets (P < 0.0001), lower time to positivity (P < 0.0001), immunosuppression (P = 0.03), and recommendation made by an infectious disease consultant (P = 0.0005). On multivariable analysis, infectious diseases consultation (P = 0.03), higher number of positive blood culture sets (P = 0.0005) and lower time to positivity (P = 0.03) were associated with an isolate being treated. 100, 83, 48 and 34% of GPRs

  17. Review of thromboembolic prophylaxis in patients attending Cork University Hospital.

    Science.gov (United States)

    Byrne, Stephen; Weaver, Daniel Timothy

    2013-06-01

    Although preventable, venous thromboembolism remains a common cause of hospital acquired morbidity and mortality. Guidelines, such as the one produced by the American College of Chest Physicians (ACCP), are aimed at reducing hospital associated venous thromboemboli. Unfortunately the majority of studies have revealed inadequate adherence to these guidelines. The objective of this study was to evaluate the use of venous thromboembolism prophylaxis at Cork University Hospital. Cork University Hospital, Wilton, Cork, Ireland. Data from the patient's chart, drug kardex and laboratory results were recorded during April 2010. A Caprini score, a venous thromboembolism risk factor assessment tool, was subsequently calculated for each patient based on data collected. Appropriate prophylaxis was determined after examining data collected, Caprini score and prophylactic regime according to the ACCP 8th edition guidelines. Primary outcome was to analyse adherence to VTE prophylaxis guidelines. A total of 394 patients met the inclusion criteria and were reviewed, of which, 60% (n = 236) were medical and 37% (n = 146) were surgical patients. In total 63% of patients received some form of venous thromboembolism prophylaxis. Furthermore, 54% of medical and 76% of surgical patients received prophylaxis. However only 37% of the patients studied received appropriate thromboprophylaxis according to the ACCP 8th edition guidelines (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). Additionally 51% of surgical and 27% of medical patients received appropriate prophylaxis. Data collected from Cork University Hospital revealed poor adherence to international venous thromboembolism prophylaxis guidelines. As stated in the ACCP 8th edition guidelines, every hospital should develop a formal strategy for venous thromboembolism prevention (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). In order to improve adherence to guidelines, Cork University Hospital should develop, implement and

  18. Dispatch and prehospital transport for acute septic patients

    DEFF Research Database (Denmark)

    Pedersen, Peter Bank; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren

    2017-01-01

    ambulance transport were identified by structured manual chart review. In all cases it was registered, whether the ordinary ambulance was assisted by the mobile emergency care unit (MECU), manned by anesthesiologists. RESULTS: We included 1,713 patients median age 72 years (IQR 57-81), 793 (46.3%) male, 621...

  19. 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

  20. Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: Retrospective physician surveys including chart reviews at numerous centers

    Energy Technology Data Exchange (ETDEWEB)

    Gossman, Michael S., E-mail: MGossman@TSRCC.com [Regulation Directive Medical Physics, Russell, KY (United States); Wilkinson, Jeffrey D. [Medtronic, Inc., Mounds View, MN (United States); Mallick, Avishek [Department of Mathematics, Marshall University, Huntington, WV (United States)

    2014-01-01

    In a 2-part study, we first examined the results of 71 surveyed physicians who provided responses on how they address the management of patients who maintained either a pacemaker or a defibrillator during radiation treatment. Second, a case review study is presented involving 112 medical records reviewed at 18 institutions to determine whether there was a change in the radiation prescription for the treatment of the target cancer, the method of radiation delivery, or the method of radiation image acquisition. Statistics are provided to illustrate the level of administrative policy; the level of communication between radiation oncologists and heart specialists; American Joint Committee on Cancer (AJCC) staging and classification; National Comprehensive Cancer Network (NCCN) guidelines; tumor site; patient's sex; patient's age; device type; manufacturer; live monitoring; and the reported decisions for planning, delivery, and imaging. This survey revealed that 37% of patient treatments were considered for some sort of change in this regard, whereas 59% of patients were treated without regard to these alternatives when available. Only 3% of all patients were identified with an observable change in the functionality of the device or patient status in comparison with 96% of patients with normal behavior and operating devices. Documented changes in the patient's medical record included 1 device exhibiting failure at 0.3-Gy dose, 1 device exhibiting increased sensor rate during dose delivery, 1 patient having an irregular heartbeat leading to device reprogramming, and 1 patient complained of twinging in the chest wall that resulted in a respiratory arrest. Although policies and procedures should directly involve the qualified medical physicist for technical supervision, their sufficient involvement was typically not requested by most respondents. No treatment options were denied to any patient based on AJCC staging, classification, or NCCN practice standards.

  1. A systematic review of psychological interventions for adult and pediatric patients with vocal cord dysfunction.

    Science.gov (United States)

    Guglani, Loveleen; Atkinson, Sarah; Hosanagar, Avinash; Guglani, Lokesh

    2014-01-01

    Vocal cord dysfunction (VCD) or paradoxical vocal-fold motion (PVFM) is a functional disorder of the vocal cords that requires multidisciplinary treatment. Besides relaxation techniques, the use of psychological interventions can help treat the underlying psychological co-morbidities. There is currently no literature that examines the effectiveness of psychological interventions for VCD/PVFM. To review the evidence for psychological interventions used for the treatment of patients with VCD/PVFM. We searched electronic databases for English medical literature using Pubmed (Medline), PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Registry of Controlled Trials, and Clinicaltrials.gov. The date range for our search is from June 1964 to June 2014. We included studies that reported the use of psychological interventions in both adults and children diagnosed with VCD/PVFM. We included randomized controlled trials, case-control studies, retrospective chart reviews, prospective case series, and individual case reports. Most reported studies are small case series or individual case reports that have described the use of interventions such as psychotherapy, behavioral therapy, use of anti-anxiety and anti-depressant medications, and hypnotherapy in conjunction with breathing exercises taught by speech therapists for symptomatic relief. Among the various psychological interventions that have been reported, there is no data regarding effectiveness and/or superiority of one approach over another in either adult or pediatric patients. Psychological interventions have a role to play in the management of adult and pediatric patients with VCD/PVFM. Future prospective studies using uniform approaches for treatment of associated psychopathology may help address this question.

  2. 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.

  3. 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...

  4. 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

  5. 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.

  6. Changes in pediatric tracheostomy 1982-2011: a Canadian tertiary children's hospital review.

    Science.gov (United States)

    Ogilvie, Lauren N; Kozak, Jessica K; Chiu, Simon; Adderley, Robert J; Kozak, Frederick K

    2014-11-01

    Pediatric tracheostomy has undergone notable changes in frequency and indication over the past 30 years. This study investigates pediatric tracheostomy at British Columbia Children's Hospital (BCCH) over a 30-year period. A retrospective chart review of tracheostomy cases at BCCH from 1982 to 2011 was conducted. Charts were reviewed for demographics, date of tracheostomy, indication, complications, mortality and date of decannulation. Data from three 10-year time periods were compared using Fisher's Exact test to examine changes over time. 251 procedures (154 males) performed on 231 patients were reviewed. Mean age at tracheostomy was 3.74 years with 48% of procedures undertaken before the age of one year. Frequency of procedure by year has generally declined into the early 2000's. Upper airway obstruction was the most common indication accounting for 33% of procedures. The rate of complication across the entire cohort was 22% with 63% of patients being decannulated. Tracheostomy related mortality occurred in 2.0% of cases reviewed. Changes occurred in primary indications with infections indicating less procedures and neurological impairments indicating more procedures over time. Complications increased and the decannulation rate decreased over this 30-year review. Pediatric tracheostomy is considered a safe and effective procedure at BCCH. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. 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

  8. 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…

  9. 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...

  10. 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…

  11. 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

  12. 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.

  13. 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)

  14. 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

  15. Examining patient comprehension of emergency department discharge instructions: Who says they understand when they do not?

    Science.gov (United States)

    Lin, Margaret Jane; Tirosh, Adva Gutman; Landry, Alden

    2015-12-01

    Patient comprehension of emergency department (ED) discharge instructions is important for ensuring that patients understand their diagnosis, recommendations for treatment, appropriate follow-up, and reasons to return. However, many patients may not fully understand their instructions. Furthermore, some patients may state they understand their instructions even when they do not. We surveyed 75 patients on their perception of their understanding of their ED discharge instructions, and asked them specific questions about the instructions. We also performed a chart review, and examined patients' answers for correlation with the written instructions and medical chart. We then performed a statistical analysis evaluating which patients claimed understanding but who were found to have poor understanding on chart review. Overall, there was no significant correlation between patient self-reported understanding and physician evaluation of their understanding (ρ = 0.221, p = 0.08). However, among female patients and patients with less than 4 years of college, there was significant positive correlation between self-report and physician evaluation of comprehension (ρ = 0.326, p = 0.04 and ρ = 0.344, p = 0.04, respectively), whereas there was no correlation for male patients and those with more than 16 years of education (ρ = 0.008, p = 0.9, ρ = -0.041, p = 0.84, respectively). Patients' perception of their understanding may not be accurate, especially among men, and those with greater than college education. Identifying which patients say they understand their discharge instructions, but may actually have poor comprehension could help focus future interventions on improving comprehension.

  16. 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...

  17. 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.

  18. Automated Analysis of Vital Signs Identified Patients with Substantial Bleeding Prior to Hospital Arrival

    Science.gov (United States)

    2015-10-01

    2.1.3 Clinical Outcomes For the BMF dataset, a research nurse collected patient attributes and outcome data via retrospective chart review of...comparison, we also computed the proportion of patients with other hemodynamic abnormalities: initial SBP < 110 mmHg, any prehospital SBP < 90 mmHg, or any

  19. Comparison of EHR-based diagnosis documentation locations to a gold standard for risk stratification in patients with multiple chronic conditions.

    Science.gov (United States)

    Martin, Shelby; Wagner, Jesse; Lupulescu-Mann, Nicoleta; Ramsey, Katrina; Cohen, Aaron; Graven, Peter; Weiskopf, Nicole G; Dorr, David A

    2017-08-02

    To measure variation among four different Electronic Health Record (EHR) system documentation locations versus 'gold standard' manual chart review for risk stratification in patients with multiple chronic illnesses. Adults seen in primary care with EHR evidence of at least one of 13 conditions were included. EHRs were manually reviewed to determine presence of active diagnoses, and risk scores were calculated using three different methodologies and five EHR documentation locations. Claims data were used to assess cost and utilization for the following year. Descriptive and diagnostic statistics were calculated for each EHR location. Criterion validity testing compared the gold standard verified diagnoses versus other EHR locations and risk scores in predicting future cost and utilization. Nine hundred patients had 2,179 probable diagnoses. About 70% of the diagnoses from the EHR were verified by gold standard. For a subset of patients having baseline and prediction year data (n=750), modeling showed that the gold standard was the best predictor of outcomes on average for a subset of patients that had these data. However, combining all data sources together had nearly equivalent performance for prediction as the gold standard. EHR data locations were inaccurate 30% of the time, leading to improvement in overall modeling from a gold standard from chart review for individual diagnoses. However, the impact on identification of the highest risk patients was minor, and combining data from different EHR locations was equivalent to gold standard performance. The reviewer's ability to identify a diagnosis as correct was influenced by a variety of factors, including completeness, temporality, and perceived accuracy of chart data.

  20. Blinded with Science or Informed by Charts? A Replication Study

    OpenAIRE

    Dragicevic , Pierre; Jansen , Yvonne

    2018-01-01

    International audience; We provide a reappraisal of Tal and Wansink's study "Blinded with Science" , where seemingly trivial charts were shown to increase belief in drug efficacy, presumably because charts are associated with science. Through a series of four replications conducted on two crowdsourcing platforms, we investigate an alternative explanation, namely, that the charts allowed participants to better assess the drug's efficacy. Considered together, our experiments suggest that the ch...

  1. Decompressive craniectomy and hydrocephalus: proposal of a therapeutic flow chart.

    Science.gov (United States)

    Peraio, Simone; Calcagni, Maria Lucia; Mattoli, Maria Vittoria; Marziali, Giammaria; DE Bonis, Pasquale; Pompucci, Angelo; Anile, Carmelo; Mangiola, Annunziato

    2017-12-01

    Decompressive craniectomy (DC) may be necessary to save the lives of patients suffering from intracranial hypertension. However, this procedure is not complication-free. Its two main complications are hydrocephalus and the sinking skin-flap syndrome (SSFS). The radiological findings and the clinical evaluation may be not enough to decide when and/or how to treat hydrocephalus in a decompressed patient. SSFS and hydrocephalus may be not unrelated. In fact, a patient affected by hydrocephalus, after the ventriculo-peritoneal shunt, can develop SSFS; on the other hand, SSFS per se can cause hydrocephalus. Treating hydrocephalus in decompressed patients can be challenging. Radiological findings and clinical evaluation may not be enough to define the most appropriate therapeutic strategy. Cerebrospinal fluid (CSF) dynamics and metabolic evaluations can represent important diagnostic tools for assessing the need of a CSF shunt in patients with a poor baseline neurologic status. Based on our experience, we propose a flow chart for treating decompressed patients affected by ventriculomegaly.

  2. Inland Electronic Navigational Charts (IENC)

    Data.gov (United States)

    Army Corps of Engineers, Department of the Army, Department of Defense — These Inland Electronic Navigational Charts (IENCs) were developed from available data used in maintenance of Navigation channels. Users of these IENCs should be...

  3. NOAA Electronic Navigational Charts (ENC)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Office of Coast Survey (OCS) has been involved in the development of a NOAA Electronic Navigational Chart (NOAA ENC) suite to support the marine transportation...

  4. Dose escalation of chart in non-small cell lung cancer: is three-dimensional conformal radiation therapy really necessary?

    International Nuclear Information System (INIS)

    McGibney, Carol; Holmberg, Ola; McClean, Brendan; Williams, Charles; McCrea, Pamela; Sutton, Phil; Armstrong, John

    1999-01-01

    Purpose: To evaluate, pre clinically, the potential for dose escalation of continuous, hyperfractionated, accelerated radiation therapy (CHART) for non small-cell lung cancer (NSCLC), we examined the strategy of omission of elective nodal irradiation with and without the application of three-dimensional conformal radiation technology (3DCRT). Methods and Materials: 2D, conventional therapy plans were designed according to the specifications of CHART for 18 patients with NSCLC (Stages Ib, IIb, IIIa, and IIIb). Further plans were generated with the omission of elective nodal irradiation (ENI) from the treatment portals (2D minus ENI plans [2D-ENI plans]). Both sets were inserted in the patient's planning computed tomographies (CTs). These reconstructed plans were then compared to alternative, three-dimensional treatment plans which had been generated de novo, with the omission of ENI: 3D minus elective nodal irradiation (3D-ENI plans). Dose delivery to the planning target volumes (PTVs) and to the organs at risk were compared between the 3 sets of corresponding plans. The potential for dose escalation of each patient's 2D-ENI and 3D-ENI plan beyond 54 Gy, standard to CHART, was also determined. Results: PTV coverage was suboptimal in the 2D CHART and the 2D-ENI plans. Only in the 3D-ENI plans did 100% of the PTV get ≥95% of the dose prescribed (i.e., 51.5 Gy [51.3-52.2]). Using 3D-ENI plans significantly reduced the dose received by the spinal cord, the mean and median doses to the esophagus and the heart. It did not significantly reduce the lung dose when compared to 2D-ENI plans. Escalation of the dose (minimum ≥1 Gy) with optimal PTV coverage was possible in 55.5% of patients using 3D-ENI, but was possible only in 16.6% when using the 2D-ENI planning strategy. Conclusions: 3DCRT is fundamental to achieving optimal PTV coverage in NSCLC. A policy of omission of elective nodal irradiation alone (and using 2D technology) will not achieve optimal PTV coverage or

  5. US Nuclear Regulatory Commission organization charts and functional statements

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-07-01

    This document is the US NRC organizational structure and chart as of July 1, 1996. It contains the org charts for the Commission, ACRS, ASLAB, Commission staff offices, Executive Director for Operations, Office of the Inspector General, Program offices, and regional offices.

  6. US Nuclear Regulatory Commission organization charts and functional statements

    International Nuclear Information System (INIS)

    1996-01-01

    This document is the US NRC organizational structure and chart as of July 1, 1996. It contains the org charts for the Commission, ACRS, ASLAB, Commission staff offices, Executive Director for Operations, Office of the Inspector General, Program offices, and regional offices

  7. System Behaviour Charts Inform an Understanding of Biodiversity Recovery

    Directory of Open Access Journals (Sweden)

    Simon A. Black

    2015-01-01

    Full Text Available Practitioners working with species and ecosystem recovery typically deal with the complexity of, on one hand, lack of data or data uncertainties and, on the other hand, demand for critical decision-making and intervention. The control chart methods of commercial and industrial and environmental monitoring can complement an ecological understanding of wildlife systems including those situations which incorporate human activities and land use. Systems Behaviour Charts are based upon well-established control chart methods to provide conservation managers with an approach to using existing data and enable insight to aid timely planning of conservation interventions and also complement and stimulate research into wider scientific and ecological questions. When the approach is applied to existing data sets in well-known wildlife conservation cases, the subsequent Systems Behaviour Charts and associated analytical criteria demonstrate insights which would be helpful in averting problems associated with each case example.

  8. Detecting SYN flood attacks via statistical monitoring charts: A comparative study

    KAUST Repository

    Bouyeddou, Benamar

    2017-12-14

    Accurate detection of cyber-attacks plays a central role in safeguarding computer networks and information systems. This paper addresses the problem of detecting SYN flood attacks, which are the most popular Denial of Service (DoS) attacks. Here, we compare the detection capacity of three commonly monitoring charts namely, a Shewhart chart, a Cumulative Sum (CUSUM) control chart and exponentially weighted moving average (EWMA) chart, in detecting SYN flood attacks. The comparison study is conducted using the publicly available benchmark datasets: the 1999 DARPA Intrusion Detection Evaluation Datasets.

  9. The use of principal components and univariate charts to control multivariate processes

    Directory of Open Access Journals (Sweden)

    Marcela A. G. Machado

    2008-04-01

    Full Text Available In this article, we evaluate the performance of the T² chart based on the principal components (PC X chart and the simultaneous univariate control charts based on the original variables (SU charts or based on the principal components (SUPC charts. The main reason to consider the PC chart lies on the dimensionality reduction. However, depending on the disturbance and on the way the original variables are related, the chart is very slow in signaling, except when all variables are negatively correlated and the principal component is wisely selected. Comparing the SU , the SUPC and the T² charts we conclude that the SU X charts (SUPC charts have a better overall performance when the variables are positively (negatively correlated. We also develop the expression to obtain the power of two S² charts designed for monitoring the covariance matrix. These joint S² charts are, in the majority of the cases, more efficient than the generalized variance chart.Neste artigo, avaliamos o desempenho do gráfico de T² baseado em componentes principais (gráfico PC e dos gráficos de controle simultâneos univariados baseados nas variáveis originais (gráfico SU X ou baseados em componentes principais (gráfico SUPC. A principal razão para o uso do gráfico PC é a redução de dimensionalidade. Entretanto, dependendo da perturbação e da correlação entre as variáveis originais, o gráfico é lento em sinalizar, exceto quando todas as variáveis são negativamente correlacionadas e a componente principal é adequadamente escolhida. Comparando os gráficos SU X, SUPC e T² concluímos que o gráfico SU X (gráfico SUPC tem um melhor desempenho global quando as variáveis são positivamente (negativamente correlacionadas. Desenvolvemos também uma expressão para obter o poder de detecção de dois gráficos de S² projetados para controlar a matriz de covariâncias. Os gráficos conjuntos de S² são, na maioria dos casos, mais eficientes que o gr

  10. 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

  11. Gulf of Mexico IFR Aeronautical Chart Index - Aeronautical Information Services Digital Products

    Data.gov (United States)

    Department of Transportation — The IFR Enroute Aeronautical Chart series is designed to meet the needs of users who require a digital version chart. This is the visual index to the charts for the...

  12. Effectiveness of a fluid chart in outpatient management of suspected dengue fever: A pilot study.

    Science.gov (United States)

    Nasir, Nazrila Hairin; Mohamad, Mohazmi; Lum, Lucy Chai See; Ng, Chirk Jenn

    2017-01-01

    Dengue infection is the fastest spreading mosquito-borne viral disease in the world. One of the complications of dengue is dehydration which, if not carefully monitored and treated, may lead to shock, particularly in those with dengue haemorrhagic fever. WHO has recommended oral fluid intake of five glasses or more for adults who are suspected to have dengue fever. However, there have been no published studies looking at self-care intervention measures to improve oral fluid intake among patients suspected of dengue fever. To assess the feasibility and effectiveness of using a fluid chart to improve oral fluid intake in patients with suspected dengue fever in a primary care setting. This feasibility study used a randomized controlled study design. The data was collected over two months at a primary care clinic in a teaching hospital. The inclusion criteria were: age > 12 years, patients who were suspected to have dengue fever based on the assessment by the primary healthcare clinician, fever for > three days, and thrombocytopenia (platelets dengue home care card. The intervention group received the fluid chart and a cup (200ml). Baseline clinical and laboratory data, 24-hour fluid recall (control group), and fluid chart were collected. The main outcomes were: hospitalization rates, intravenous fluid requirement and total oral fluid intake. Among the 138 participants who were included in the final analysis, there were fewer hospital admissions in the intervention group (n = 7, 10.0%) than the control group (n = 12, 17.6%) (p = 0.192). Similarly, fewer patients (n = 9, 12.9%) in the intervention group required intravenous fluid compared to the control group (n = 15, 22.1%), (p = 0.154). There was an increase in the amount of daily oral fluid intake in the intervention group (about 3,000 ml) compared to the control group (about 2,500 ml, p = 0.521). However, these differences did not reach statistical significance. This is a feasible and acceptable study to perform in

  13. Proposed colour banded early warning observation charts for South ...

    African Journals Online (AJOL)

    Introduction of a colour banded observation chart should be combined with a clear communication strategy. The process should be used to change the organisational culture to be more proactive in initiating early intervention to reduce the burden of unintended complications. Keywords: Observation chart; Physiology; ...

  14. SpeckTackle: JavaScript charts for spectroscopy.

    Science.gov (United States)

    Beisken, Stephan; Conesa, Pablo; Haug, Kenneth; Salek, Reza M; Steinbeck, Christoph

    2015-01-01

    Spectra visualisation from methods such as mass spectroscopy, infrared spectroscopy or nuclear magnetic resonance is an essential part of every web-facing spectral resource. The development of an intuitive and versatile visualisation tool is a time- and resource-intensive task, however, most databases use their own embedded viewers and new databases continue to develop their own viewers. We present SpeckTackle, a custom-tailored JavaScript charting library for spectroscopy in life sciences. SpeckTackle is cross-browser compatible and easy to integrate into existing resources, as we demonstrate for the MetaboLights database. Its default chart types cover common visualisation tasks following the de facto 'look and feel' standards for spectra visualisation. SpeckTackle is released under GNU LGPL to encourage uptake and reuse within the community. The latest version of the library including examples and documentation on how to use and extend the library with additional chart types is available online in its public repository.

  15. Computer programs to make a Chart of the nuclides for WWW

    International Nuclear Information System (INIS)

    Nakagawa, Tsuneo; Katakura, Jun-ichi; Horiguchi, Takayoshi

    1999-06-01

    Computer programs to make a chart of the nuclides for World Wide Web (WWW) have been developed. The programs make a data file for WWW chart of the nuclides from a data file containing nuclide information in the format similar to ENSDF, by filling unknown half-lives with calculated ones. Then, the WWW chart of the nuclides in the gif format is created from the data file. The programs to make html files and image map files, to select a chart of selected nuclides, and to show various information of nuclides are included in the system. All the programs are written in C language. This report describes the formats of files, the programs and 1998 issue of Chart of the Nuclides made by means of the present programs. (author)

  16. Constructing an exposure chart: step by step (based on standard procedures)

    International Nuclear Information System (INIS)

    David, Jocelyn L; Cansino, Percedita T.; Taguibao, Angileo P.

    2000-01-01

    An exposure chart is very important in conducting radiographic inspection of materials. By using an accurate exposure chart, an inspector is able to avoid a trial and error way of determining correct time to expose a specimen, thereby producing a radiograph that has an acceptable density based on a standard. The chart gives the following information: x-ray machine model and brand, distance of the x-ray tube from the film, type and thickness of intensifying screens, film type, radiograph density, and film processing conditions. The methods of preparing an exposure chart are available in existing radiographic testing manuals. These described methods are presented in step by step procedures, covering the actual laboratory set-up, data gathering, computations, and transformation of derived data into Characteristic Curve and Exposure Chart

  17. Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

    Science.gov (United States)

    Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

    2006-02-01

    A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of

  18. Comparison between Human Immunodeficiency Virus Positive and Negative Patients with Tuberculosis in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Lucélia Henn

    1999-05-01

    Full Text Available The objective of this study is to determine the different characteristics of human immunodeficiency virus (HIV positive and negative patients treated for tuberculosis (TBC in a tertiary hospital in Southern Brazil. We conducted a retrospective cohort study over a 5-year period, from January 1992 through December 1996. We reviewed medical charts of patients from our institution who received TBC treatment. We reviewed 167 medical charts of patients with confirmed TBC. HIV positivity was detected in 74 patients. There were statistically significant difference between HIV positive and negative patients in sex and age. HIV-infected patients showed significantly more signs of bacteremia than HIV-negative patients. Extra-pulmonary TBC was present respectively in 13 (17.6% and 21 (22.6% HIV positive and negative patients. There was a significant difference between chest radiograph presentation in HIV positive and negative patients. There were significantly lower hematocrit, hemoglobin, leukocyte and lymphocyte levels in HIV-positive compared to HIV-negative patients. Outcome was significantly different in the two groups with a death rate of 36.5% and 10.8% in HIV-positive and in HIV-negative patients. The difference between HIV positive and negative patients may have importance in the diagnosis, management and prognosis of patients with TBC.

  19. Control charts for location based on different sampling schemes

    NARCIS (Netherlands)

    Mehmood, R.; Riaz, M.; Does, R.J.M.M.

    2013-01-01

    Control charts are the most important statistical process control tool for monitoring variations in a process. A number of articles are available in the literature for the X̄ control chart based on simple random sampling, ranked set sampling, median-ranked set sampling (MRSS), extreme-ranked set

  20. Three-Dimensional Nuclear Chart--Understanding Nuclear Physics and Nucleosynthesis in Stars

    Science.gov (United States)

    Koura, Hiroyuki

    2014-01-01

    Three-dimensional (3D) nuclear charts were created using toy blocks, which represent the atomic masses per nucleon number and the total half-lives for each nucleus in the entire region of the nuclear mass. The bulk properties of the nuclei can be easily understood by using these charts. Subsequently, these charts were used in outreach activities…

  1. Moral Matters: De-Romanticising Worker Agency and Charting Future Directions for Labour Geography

    OpenAIRE

    Hastings, T.

    2016-01-01

    The rise of labour geography over the last 20 years has ensured that labour politics, worker rights and employment-related struggles have remained strong themes in economic geography. This article provides an updated review of labour geography's development, charting its expansion from an early focus on organised spatial ‘resistance’ at a range of scales, to a more varied project incorporating a wider range of analytical and empirical inquiries. Despite this progression the paper suggests tha...

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

    Science.gov (United States)

    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.

  3. 14 CFR Section 3 - Chart of Balance Sheet Accounts

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Chart of Balance Sheet Accounts Section 3 Section 3 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION... Balance Sheet Classifications Section 3 Chart of Balance Sheet Accounts [See footnotes at end of table...

  4. Toward developing a standardized Arabic continuous text reading chart.

    Science.gov (United States)

    Alabdulkader, Balsam; Leat, Susan Jennifer

    Near visual acuity is an essential measurement during an oculo-visual assessment. Short duration continuous text reading charts measure reading acuity and other aspects of reading performance. There is no standardized version of such chart in Arabic. The aim of this study is to create sentences of equal readability to use in the development of a standardized Arabic continuous text reading chart. Initially, 109 Arabic pairs of sentences were created for use in constructing a chart with similar layout to the Colenbrander chart. They were created to have the same grade level of difficulty and physical length. Fifty-three adults and sixteen children were recruited to validate the sentences. Reading speed in correct words per minute (CWPM) and standard length words per minute (SLWPM) was measured and errors were counted. Criteria based on reading speed and errors made in each sentence pair were used to exclude sentence pairs with more outlying characteristics, and to select the final group of sentence pairs. Forty-five sentence pairs were selected according to the elimination criteria. For adults, the average reading speed for the final sentences was 166 CWPM and 187 SLWPM and the average number of errors per sentence pair was 0.21. Childrens' average reading speed for the final group of sentences was 61 CWPM and 72 SLWPM. Their average error rate was 1.71. The reliability analysis showed that the final 45 sentence pairs are highly comparable. They will be used in constructing an Arabic short duration continuous text reading chart. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  5. Borehole DC-12 hydrostratigraphic chart

    International Nuclear Information System (INIS)

    Gephart, R.E.

    1981-09-01

    This hydrostratigraphic chart identifies the basic stratigraphy and preliminary hydrologic testing results for Borehole DC-12. This borehole was cored through the Saddle Mountains and Wanapum basalt formations and into the Grande Ronde. Selected zones were hydrologically tested during coring

  6. Borehole DC-14 hydrostratigraphic chart

    International Nuclear Information System (INIS)

    Gephart, R.E.

    1981-09-01

    This hydrostratigraphic chart identifies the basic stratigraphy and preliminary hydrologic testing results for Borehole DC-14. This borehole was cored through the Saddle Mountains and Wanapum basalt formations and into the Grande Ronde. Selected zones were hydrologically tested during coring

  7. Borehole DC-15 hydrostratigraphic chart

    International Nuclear Information System (INIS)

    Gephart, R.E.

    1981-09-01

    This hydrostratigraphic chart identifies the basic stratigraphy and preliminary hydrologic testing results for Borehole DC-15. This borehole was cored through the Saddle Mountains and Wanapum basalt formations and into the Grande Ronde. Selected zones were hydrologically tested during coring

  8. Frequency and Type of Prosthetic Complications Associated with Interim, Immediately Loaded Full-Arch Prostheses: A 2-Year Retrospective Chart Review.

    Science.gov (United States)

    Drago, Carl

    2016-08-01

    The purpose of this report was to retrospectively evaluate implant and immediate full-arch prosthesis survival rates over a 24-month period; patients were consecutively treated with immediate occlusal loading. Dental arch, gender, and implant orientation (vertical vs. tilted) were also noted. All Brånemark System implants (Nobel Active) and interim, all-acrylic resin prostheses placed in patients following an All-on-Four™ protocol, in a single private practice were assessed by retrospective patient chart review. The amount of space provided surgically for implant restorative components and prostheses was determined from measurements of the vertical heights of the interim prostheses in the right/left anterior and posterior segments. These measurements were made in the laboratory. Interim prosthetic repairs (type, frequency, length of time from insertion) were analyzed by type, arch, gender, and implant orientation. Implant survival and insertion torque values were also measured. Inclusion criteria consisted of all Brånemark System implants placed with the All-on-Four protocol from September 1, 2011, until August 31, 2013. Specific dietary instructions were given for the first 7 days immediately postoperatively and for the weeks prior to insertion of the definitive prostheses. One hundred twenty-nine patients, comprising 191 arches (766 implants) from September 1, 2011, until August 31, 2013, were included in the study. One patient experienced implant failure yielding an overall implant survival rate (SR) of 99.5% (762 of 766). Four hundred twenty-six of 430 maxillary implants and 336 of 336 mandibular implants survived for SRs of 99.1% and 100%, respectively. Regarding implant orientation, 415 of 417 tilted implants (SR 99.5%) and 343 of 345 (CSR 95.6%) vertical implants were noted to be clinically stable. Interim, all-acrylic resin prostheses were in place for a mean of 199.2 days; mandibular prostheses were in place for an average of 195.4 days; maxillary

  9. Subtle Nonlinearity in Popular Album Charts

    Science.gov (United States)

    Bentley, R. Alexander; Maschner, Herbert D. G.

    Large-scale patterns of culture change may be explained by models of self organized criticality, or alternatively, by multiplicative processes. We speculate that popular album activity may be similar to critical models of extinction in that interconnected agents compete to survive within a limited space. Here we investigate whether popular music albums as listed on popular album charts display evidence of self-organized criticality, including a self-affine time series of activity and power-law distributions of lifetimes and exit activity in the chart. We find it difficult to distinguish between multiplicative growth and critical model hypotheses for these data. However, aspects of criticality may be masked by the selective sampling that a "Top 200" listing necessarily implies.

  10. Monitoring Poisson observations using combined applications of Shewhart and EWMA charts

    Science.gov (United States)

    Abujiya, Mu'azu Ramat

    2017-11-01

    The Shewhart and exponentially weighted moving average (EWMA) charts for nonconformities are the most widely used procedures of choice for monitoring Poisson observations in modern industries. Individually, the Shewhart EWMA charts are only sensitive to large and small shifts, respectively. To enhance the detection abilities of the two schemes in monitoring all kinds of shifts in Poisson count data, this study examines the performance of combined applications of the Shewhart, and EWMA Poisson control charts. Furthermore, the study proposes modifications based on well-structured statistical data collection technique, ranked set sampling (RSS), to detect shifts in the mean of a Poisson process more quickly. The relative performance of the proposed Shewhart-EWMA Poisson location charts is evaluated in terms of the average run length (ARL), standard deviation of the run length (SDRL), median run length (MRL), average ratio ARL (ARARL), average extra quadratic loss (AEQL) and performance comparison index (PCI). Consequently, all the new Poisson control charts based on RSS method are generally more superior than most of the existing schemes for monitoring Poisson processes. The use of these combined Shewhart-EWMA Poisson charts is illustrated with an example to demonstrate the practical implementation of the design procedure.

  11. Overview of the consortium of hospitals advancing research on tobacco (chart

    Directory of Open Access Journals (Sweden)

    Riley William T

    2012-08-01

    Full Text Available Abstract Background The Consortium of Hospitals Advancing Research on Tobacco (CHART is a network of six projects and a research coordinating unit funded by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health (NIH Office of Behavioral and Social Science Research. The CHART projects will assess the effectiveness and cost-effectiveness of smoking cessation interventions initiated during hospitalization and continued post-discharge. Methods/design Along with a seventh project funded previously under the NIH Challenge grants, the CHART projects will assess smoking cessation strategies delivered to approximately 10,000 hospitalized smokers across a geographically diverse group of nearly 20 private, public, academic, and community hospitals. The CHART research coordinating unit at Kaiser Permanente Center for Health Research provides organizational and data coordination support, facilitating the development of common measures for combining data from multiple CHART projects. Discussion The targeted enrollment in CHART, if achieved, will represent the largest, most diverse pooled dataset of hospitalized smokers receiving smoking cessation assistance, and is designed to contribute to the dissemination and implementation of smoking cessation interventions provided by hospital systems.

  12. Arctic Sea Ice Charts from Danish Meteorological Institute, 1893 - 1956

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — From 1893 to 1956, the Danish Meteorological Institute (DMI) created charts of observed and inferred sea ice extent for each summer month. These charts are based on...

  13. 46 CFR 97.05-5 - 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. 97.05-5 Section 97.05... OPERATIONS Notice to Mariners and Aids to Navigation § 97.05-5 Charts and nautical publications. As... tables; (g) Current tables; and (h) All other nautical publications necessary. 1 1 For United States...

  14. MINIMIZING GLOVEBOX GLOVE BREACHES, PART IV: CONTROL CHARTS

    International Nuclear Information System (INIS)

    Cournoyer, Michael E.; Lee, Michelle B.; Schreiber, Stephen B.

    2007-01-01

    At the Los Alamos National Laboratory (LANL) Plutonium Facility, plutonium. isotopes and other actinides are handled in a glovebox environment. The spread of radiological contamination, and excursions of contaminants into the worker's breathing zone, are minimized and/or prevented through the use of glovebox technology. Evaluating the glovebox configuration, the glovebo gloves are the most vulnerable part of this engineering control. Recognizing this vulnerability, the Glovebox Glove Integrity Program (GGIP) was developed to minimize and/or prevent unplanned openings in the glovebox environment, i.e., glove failures and breaches. In addition, LANL implement the 'Lean Six Sigma (LSS)' program that incorporates the practices of Lean Manufacturing and Six Sigma technologies and tools to effectively improve administrative and engineering controls and work processes. One tool used in LSS is the use of control charts, which is an effective way to characterize data collected from unplanned openings in the glovebox environment. The benefit management receives from using this tool is two-fold. First, control charts signal the absence or presence of systematic variations that result in process instability, in relation to glovebox glove breaches and failures. Second, these graphical representations of process variation detennine whether an improved process is under control. Further, control charts are used to identify statistically significant variations (trends) that can be used in decision making to improve processes. This paper discusses performance indicators assessed by the use control charts, provides examples of control charts, and shows how managers use the results to make decisions. This effort contributes to LANL Continuous Improvement Program by improving the efficiency, cost effectiveness, and formality of glovebox operations.

  15. The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital

    National Research Council Canada - National Science Library

    Borgman, Matthew A; Spinella, Philip C; Perkins, Jeremy G; Grathwohl, Kurt W; Repine, Thomas; Beekley, Alec C; Sebesta, James; Jenkins, Donald; Wade, Charles E; Holcomb, John B

    2007-01-01

    ...:1 ratio of plasma to red blood cell (RBC) units. Methods: We performed a retrospective chart review of 246 patients at a US Army combat support hospital, each of who received a massive transfusion...

  16. Long-term doctor-patient relationships: patient perspective from online reviews.

    Science.gov (United States)

    Detz, Alissa; López, Andrea; Sarkar, Urmimala

    2013-07-02

    Continuity of patient care is one of the cornerstones of primary care. To examine publicly available, Internet-based reviews of adult primary care physicians, specifically written by patients who report long-term relationships with their physicians. This substudy was nested within a larger qualitative content analysis of online physician ratings. We focused on reviews reflecting an established patient-physician relationship, that is, those seeing their physicians for at least 1 year. Of the 712 Internet reviews of primary care physicians, 93 reviews (13.1%) were from patients that self-identified as having a long-term relationship with their physician, 11 reviews (1.5%) commented on a first-time visit to a physician, and the remainder of reviews (85.4%) did not specify the amount of time with their physician. Analysis revealed six overarching domains: (1) personality traits or descriptors of the physician, (2) technical competence, (3) communication, (4) access to physician, (5) office staff/environment, and (6) coordination of care. Our analysis shows that patients who have been with their physician for at least 1 year write positive reviews on public websites and focus on physician attributes.

  17. 46 CFR 26.03-4 - Charts and nautical publications.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Charts and nautical publications. 26.03-4 Section 26.03... Operating Requirements § 26.03-4 Charts and nautical publications. (a) As appropriate for the intended... navigation possible; (2) “U.S. Coast Pilot” or similar publication; (3) Coast Guard light list; (4) Tide...

  18. Safe Minimum Internal Temperature Chart

    Science.gov (United States)

    ... Internal Temperature Chart Safe steps in food handling, cooking, and storage are essential in preventing foodborne illness. You can't see, smell, or taste harmful bacteria that may cause illness. In every step of food preparation, follow the four guidelines to keep food safe: ...

  19. Review of management and morbidity of pediatric craniopharyngioma patients in a low-middle-income country: a 12-year experience.

    Science.gov (United States)

    Amayiri, Nisreen; Swaidan, Maisa; Yousef, Yocoub; Halalsheh, Hadeel; Abu-Hijlih, Ramiz; Kalaldeh, Sima; Barbar, Maha; Elayyan, Maher; Faqih, Nesreen; Al-Hussaini, Maysa; Mehyar, Mustafa; Bartels, Ute; Drake, James; Musharbash, Awni; Bouffet, Eric

    2017-06-01

    Management of craniopharyngioma in children is challenging, and their quality of life can be significantly affected. Series describing this from low-middle income countries (LMIC) are few. The study provides a retrospective chart review of pediatric patients craniopharyngioma between 2003 and 2014, and treated at King Hussein Cancer Center, Jordan. Twenty-four patients (12 males) were identified. Median age at diagnosis was 7.4 years (0.9-16.4 years). Commonest symptoms were visual impairment and headache (71%). Review of seventeen preoperative MRIs showed hypothalamic involvement in 88% and hydrocephalus in 76%. Thirteen patients (54%) had multiple surgical interventions. Five patients (21%) had initial gross total resection. Eleven patients (46%) received radiotherapy and six (25%) intra-cystic interferon. Five years' survival was 87 ± 7% with a median follow-up of 4.5 years (0.3-12.3 years). Four patients (17%) died; one after post-operative cerebral infarction and three secondary to hypothalamic damage. At their last evaluation, all but one patient required multiple hormonal supplements. Ten patients (42%) had best eye visual acuity (VA) >20/40, and four (16%) were legally blind. Eleven patients (46%) were overweight/obese; one had gastric bypass surgery. Seven patients had hyperlipidemia, and eight developed fatty liver infiltration. Eleven patients (65%) were attending schools and one at college. Nine of the living patients (53%) expressed difficulty to engage in the community. Management of pediatric craniopharyngioma is particularly complex and demanding in LMIC. Multidisciplinary care is integral to optimize the care and minimize the morbidities. A management outline for LMIC is proposed.

  20. Geo structural chart of Uruguay. Scale 1/2.000.000

    International Nuclear Information System (INIS)

    Preciozzi, F.; Spoturno, F.; Heinzen, W.

    1979-01-01

    This work is about the Geo-Structural Chart of Uruguay , Esca le 1 / 2,000,000. The geological information synthesis in the country, obtained from: published geological work or whose information is registered by laboratory work and geophysical surveys. This Chart will allow an overview of the degree of geological knowledge of Uruguay, restricted to the limits imposed by the scale of this work. The realization of this Chart included a thorough and careful compilation, critical analysis, standardization and interpretation of all geological and geophysical maps available in the country

  1. HOTELLING'S T2 CONTROL CHARTS BASED ON ROBUST ESTIMATORS

    Directory of Open Access Journals (Sweden)

    SERGIO YÁÑEZ

    2010-01-01

    Full Text Available Under the presence of multivariate outliers, in a Phase I analysis of historical set of data, the T 2 control chart based on the usual sample mean vector and sample variance covariance matrix performs poorly. Several alternative estimators have been proposed. Among them, estimators based on the minimum volume ellipsoid (MVE and the minimum covariance determinant (MCD are powerful in detecting a reasonable number of outliers. In this paper we propose a T 2 control chart using the biweight S estimators for the location and dispersion parameters when monitoring multivariate individual observations. Simulation studies show that this method outperforms the T 2 control chart based on MVE estimators for a small number of observations.

  2. The risk of midgut volvulus in patients with abdominal wall defects: A multi-institutional study.

    Science.gov (United States)

    Fawley, Jason A; Abdelhafeez, Abdelhafeez H; Schultz, Jessica A; Ertl, Allison; Cassidy, Laura D; Peter, Shawn St; Wagner, Amy J

    2017-01-01

    The management of malrotation in patients with congenital abdominal wall defects has varied among surgeons. We were interested in investigating the risk of midgut volvulus in patients with gastroschisis and omphalocele to help determine if these patients may benefit from undergoing a Ladd procedure. A retrospective chart review was performed for all patients managed at three institutions born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy. Of the 414 patients identified with abdominal wall defects, 299 patients (72%) had gastroschisis, and 115 patients (28%) had omphalocele. The mean gestational age at birth was 36.1±2.3weeks, and the mean birth weight was 2.57±0.7kg. There were a total of 8 (1.9%) cases of midgut volvulus: 3 (1.0%) patients with gastroschisis compared to 5 patients (4.4%) with omphalocele (p=0.04). Patients with omphalocele have a greater risk of developing midgut volvulus, and a Ladd procedure should be considered during definitive repair to mitigate these risks. III; retrospective comparative study. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Magnetic resonance imaging in evaluating workers' compensation patients.

    Science.gov (United States)

    Babbel, Daniel; Rayan, Ghazi

    2012-04-01

    We studied the utility of magnetic resonance imaging (MRI) studies for workers' compensation patients with hand conditions in which the referring doctor obtained the images. We compared the MRI findings with the eventual clinical findings. We also investigated the approximate cost of these MRI studies. We retrospectively reviewed the charts of all workers' compensation patients seen in a hand and upper extremity practice over the course of 3 years. We selected patients who had MRI studies of the affected upper extremities before referral to the senior author (G.R.). We reviewed the charts for information regarding demographics, referral diagnoses, MRI diagnoses made by the radiologist, the area of the upper extremity studied, and eventual clinical diagnoses by the senior author. We made a determination as to whether a hand surgeon could have adequately diagnosed and treated the patients' conditions without the imaging studies. We also investigated the cost associated with these MRIs. We included 62 patients with a total of 67 MRI scans in this study. The MRI studies did not contribute to clinically diagnosing the patients' conditions in any of the cases we reviewed. The hand surgeon's clinical diagnosis disagreed with the radiologist's MRI diagnosis in 63% of patients. The MRI was unnecessary to arrive at the clinical diagnosis and did not influence the treatment offered for any of the 62 patients. The total cost for the 67 non-contrast MRI studies was approximately $53,000. Costly imaging studies are frequently done to determine the validity of a patient's reported problems; unfortunately, these tests are frequently unnecessary and waste resources. Magnetic resonance imaging scans may not be the standard for accurate diagnosis and can misdirect care. Therapeutic III. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. A design chart for long vacuum pipes and shells

    International Nuclear Information System (INIS)

    Krempetz, K.; Grimson, J.; Kelly, P.

    1986-01-01

    This paper presents a design chart to aid designers in the selection of a wall thickness for long cylindrical shells having atmospheric pressure outside the shell and a pressure less than atmospheric inside the shell. The chart indicates a conservative value for the minimum wall thickness for a given shell diameter and material when the shell is completely evacuated

  5. 46 CFR 78.05-5 - Charts and nautical publications.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 3 2010-10-01 2010-10-01 false Charts and nautical publications. 78.05-5 Section 78.05... Notice to Mariners and Aids to Navigation § 78.05-5 Charts and nautical publications. As appropriate for... publications necessary. 1 1 For United States vessels in or on the navigable waters of the United States, see...

  6. Borehole DC-6 hydrostratigraphic chart

    International Nuclear Information System (INIS)

    Gephart, R.E.

    1981-09-01

    This hydrostratigraphic chart for Borehole DC-6 identifies the basic stratigraphy and preliminary hydrologic test results. This borehole was cored for obtaining stratigraphic data and only that portion within the Grande Ronde formation remains open for hydrologic testing. The upper two formations were cased and cemented off

  7. About the National Forecast Chart

    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. The National Forecast Charts

  8. Data analytics and parallel-coordinate materials property charts

    Science.gov (United States)

    Rickman, Jeffrey M.

    2018-01-01

    It is often advantageous to display material properties relationships in the form of charts that highlight important correlations and thereby enhance our understanding of materials behavior and facilitate materials selection. Unfortunately, in many cases, these correlations are highly multidimensional in nature, and one typically employs low-dimensional cross-sections of the property space to convey some aspects of these relationships. To overcome some of these difficulties, in this work we employ methods of data analytics in conjunction with a visualization strategy, known as parallel coordinates, to represent better multidimensional materials data and to extract useful relationships among properties. We illustrate the utility of this approach by the construction and systematic analysis of multidimensional materials properties charts for metallic and ceramic systems. These charts simplify the description of high-dimensional geometry, enable dimensional reduction and the identification of significant property correlations and underline distinctions among different materials classes.

  9. Development of a fetal weight chart using serial trans-abdominal ultrasound in an East African population

    DEFF Research Database (Denmark)

    Schmiegelow, Christentze; Scheike, Thomas; Oesterholt, Mayke

    2012-01-01

    OBJECTIVE: To produce a fetal weight chart representative of a Tanzanian population, and compare it to weight charts from Sub-Saharan Africa and the developed world. METHODS: A longitudinal observational study in Northeastern Tanzania. Pregnant women were followed throughout pregnancy with serial...... trans-abdominal ultrasound. All pregnancies with pathology were excluded and a chart representing the optimal growth potential was developed using fetal weights and birth weights. The weight chart was compared to a chart from Congo, a chart representing a white population, and a chart representing...... a white population but adapted to the study population. The prevalence of SGA was assessed using all four charts. RESULTS: A total of 2193 weight measurements from 583 fetuses/newborns were included in the fetal weight chart. Our chart had lower percentiles than all the other charts. Most importantly...

  10. Interactive Financial Charts- Agency Financial Reports

    Data.gov (United States)

    General Services Administration — For a visual depiction of GSA's Balance Sheet and Statement of Net Cost, please use the interactive charts to view the financial results for fiscal years 2007-2013.

  11. Development of mild steel exposure chart for neutron radiography application

    International Nuclear Information System (INIS)

    Hafizal Yazid; Rafhayudi Jamro; Hishamuddin Husain; Muhammad Rawi Mohd Zin; Razali Kassim; Abd Aziz Mohamed; Azali Muhammad

    2004-01-01

    A neutron radiography exposure chart for mild steel was developed to facilitate the determination of exposure time when producing neutron radiographs for any given mild steel thickness. A mild steel sample in the form of step wedge (1-10 mm thick) was exposed to thermal neutron using Direct technique. This technique involves exposing x-ray film-Gadolinium converter housed in one film cassette simultaneously to thermal neutron beam. Gadolinium converters with thickness of 0.025 mm and 0.5 mm were used to observe the effect of converter thickness on radiographic density and exposure time. Collected radiographic density data is then calculated based on manufacturer's film characteristic chart and finally exposure chart for mild steel was plotted. This chart could later be used as a guide for estimating exposure time for any given sample thickness providing other conditions are similar (material, film processing, neutron flux, film density and converter thickness). (Author)

  12. Continuous subcutaneous use of levetiracetam: a retrospective review of tolerability and clinical effects.

    Science.gov (United States)

    Rémi, Constanze; Lorenzl, Stefan; Vyhnalek, Birgit; Rastorfer, Karin; Feddersen, Berend

    2014-12-01

    To evaluate the tolerability and clinical effects of subcutaneous (SC) levetiracetam for the treatment of epileptic seizures in a palliative care setting, we conducted a retrospective chart review of patients treated with subcutaneous levetiracetam in the Department of Palliative Medicine at the University Munich, between September 2006 and March 2013. The following parameters were extracted from the charts: reason for antiepileptic drug treatment, daily dose, concentration, infusion rate, co-administration of other drugs, and clinical effects. Furthermore, the charts were screened for signs of adverse drug reactions, e.g., irritation or pain at the infusion site. We identified 20 patients that were treated with levetiracetam SC in the inpatient (n = 7) and outpatient (n = 13) settings. Most patients (n = 17) tolerated the subcutaneous infusion well. Nineteen patients (95%) received levetiracetam in combination with other drugs. These were mainly metamizol (80%), midazolam (75%), and morphine (45%). The median dose of levetiracetam was 95.8 mg/h (SD 37 mg/h), median osmolarity of the infusion solution 2203 mOsmol/L (SD 717 mOsmol/L), and infusion rate 2 mL/h (SD 2.4 ml/h). In 16 patients (80%), seizures were controlled and status epilepticus were interrupted, respectively. We conclude that SC levetiracetam is an effective treatment and well tolerated in the palliative care setting.

  13. Treatment patterns and real world clinical outcomes in ER+/HER2- post-menopausal metastatic breast cancer patients in the United States.

    Science.gov (United States)

    Zanotti, Giovanni; Hunger, Matthias; Perkins, Julia J; Horblyuk, Ruslan; Martin, Monique

    2017-06-02

    With several new therapies becoming available, treatment of metastatic breast cancer (mBC) is evolving. The objective of this study is to describe patient characteristics, treatment patterns and real-world clinical outcomes in post-menopausal women with ER+, HER2- mBC and to obtain insight into patient outcomes and potential unmet needs with current therapies. The current study is a physician survey followed by a retrospective chart review of patient medical records by physicians in the US between March and April 2015. One hundred three physicians were asked to complete an online survey aiming to understand their satisfaction and expectations with current available treatments and potential areas of unmet need for mBC patients. Medical records from 178 females were extracted for the chart review. Using these data from medical records, patient characteristics and treatment patterns were analyzed descriptively. Time to progression (TTP) on first line, and progression-free survival (PFS) on second and third line of therapy were analyzed using the Kaplan-Meier method. Sixty-seven percent (n = 119) of patients had metastatic disease at initial diagnosis of breast cancer. Mean age at chart data extraction was 65.8 (SD: 9.4) years. Aromatase inhibitors (AIs) were prescribed for 58% and around 13% of patients in first line and second line, respectively. Chemotherapy was prescribed to 14% in first line and 31% in second line. Median TTP on first line therapy was 12 months for patients receiving AIs as compared to 7.9 months for patients receiving chemotherapy. Across all treatment lines, bone pain and fatigue were reported as the main symptoms associated with disease progression which had an impact on patient quality of life. Physicians expressed that prolonging life was deemed the most important treatment goal, followed by preservation or improvement of quality of life. In this study the majority of patients received endocrine therapy as first line treatment and current

  14. Create dynamic charts in Microsoft Office Excel 2007 and beyond

    CERN Document Server

    Scheck, Reinhold

    2009-01-01

    Extend your Excel 2007 skills-and create more-powerful and compelling charts in less time. Guided by an Excel expert, you'll learn how to turn flat, static charts into dynamic solutions-where you can visualize and manipulate data countless ways with a simple mouse click. Get the hands-on practice and examples you need to produce your own, professional-quality results. No programming required! Maximize the impact of your ideas and data! Learn how your design decisions affect perception and comprehensionMatch the right chart type to your communication objectiveVisualize-then build-your solut

  15. Cartographic Rules and Differences in Nautical Data Visualization on Paper and Electronic Nautical Charts

    Directory of Open Access Journals (Sweden)

    Tea Duplančić Leder

    2013-04-01

    Full Text Available This paper aims to present cartographic rules for the production of paper and electronic navigational charts and main differences in compilation, visualisation and representation of nautical information. Major differences between paper nautical charts and ENC are visualisation of nautical data: colour mixing, resolution of represented nautical objects, human control of display representation and fonts and signatures and chart content are described. It is concluded that electronic navigational charts have many advantages and few shortcomings to paper navigational charts.

  16. Statistical Control Charts: Performances of Short Term Stock Trading in Croatia

    Directory of Open Access Journals (Sweden)

    Dumičić Ksenija

    2015-03-01

    Full Text Available Background: The stock exchange, as a regulated financial market, in modern economies reflects their economic development level. The stock market indicates the mood of investors in the development of a country and is an important ingredient for growth. Objectives: This paper aims to introduce an additional statistical tool used to support the decision-making process in stock trading, and it investigate the usage of statistical process control (SPC methods into the stock trading process. Methods/Approach: The individual (I, exponentially weighted moving average (EWMA and cumulative sum (CUSUM control charts were used for gaining trade signals. The open and the average prices of CROBEX10 index stocks on the Zagreb Stock Exchange were used in the analysis. The statistical control charts capabilities for stock trading in the short-run were analysed. Results: The statistical control chart analysis pointed out too many signals to buy or sell stocks. Most of them are considered as false alarms. So, the statistical control charts showed to be not so much useful in stock trading or in a portfolio analysis. Conclusions: The presence of non-normality and autocorellation has great impact on statistical control charts performances. It is assumed that if these two problems are solved, the use of statistical control charts in a portfolio analysis could be greatly improved.

  17. Diagnosing diabetic foot infection: the role of imaging and a proposed flow chart for assessment

    International Nuclear Information System (INIS)

    Israel, O.; Sconfienza, L. M.; Lipsky, B. A.

    2014-01-01

    Diabetes mellitus, a major current epidemic, is frequently complicated by foot infections that are associated with high morbidity. Diagnosing these infections, especially whether or not underlying bone is involved, poses clinical challenges, but is crucial to making proper decisions regarding therapeutic strategies. The most effective means of managing patients with a diabetic foot infection is within the framework of a multidisciplinary team. Present diagnostic efforts are aimed at developing better methods to differentiate uninfected from infected soft tissue wounds, to determine when bone infection is present, and to more clearly define when infection has resolved with treatment. Imaging studies play a major role in diagnosis. This usually begins with plain radiographs, but when advanced imaging is needed, magnetic resonance imaging (MRI) is considered the modality of choice. Newer techniques, such as molecular hybrid imaging, positron emission tomography (PET)/computed tomography (CT) and single photon emission (SPECT)/CT using various radiotracers, play an increasing role. These tests may redefine the non-invasive diagnostic work-up of diabetic foot wounds, potentially leading to substantial improvements in patient management. As experts in infectious diseases, radiology and nuclear medicine, we reviewed the available literature on diagnosing diabetic foot infections, especially the currently available imaging techniques, and developed a proposed diagnostic flow chart, for evaluating patients with a diabetic foot wound

  18. Robust control charts in industrial production of olive oil

    Science.gov (United States)

    Grilo, Luís M.; Mateus, Dina M. R.; Alves, Ana C.; Grilo, Helena L.

    2014-10-01

    Acidity is one of the most important variables in the quality analysis and characterization of olive oil. During the industrial production we use individuals and moving range charts to monitor this variable, which is not always normal distributed. After a brief exploratory data analysis, where we use the bootstrap method, we construct control charts, before and after a Box-Cox transformation, and compare their robustness and performance.

  19. Retrospective chart review for obesity and associated interventions among rural Mexican-American adolescents accessing healthcare services.

    Science.gov (United States)

    Champion, Jane Dimmitt; Collins, Jennifer L

    2013-11-01

    To report a retrospective analysis of data routinely collected in the course of healthcare services at a rural health clinic and to assess obesity incidence and associated interventions among rural Mexican-American adolescents. Two hundred and twelve charts reviewed; 98 (46.2%) males and 114 (53.8%) females. Data extracted included Medicaid exams conducted at the clinic within 5 years. Equal overweight or obese (n = 105, 49.5%), versus normal BMI categorizations (n = 107, 50.5%) documented overall and by gender. Female obesity higher (25.4%) than national norms (17.4%); male rates (25.5%) were within national norm. Interventions provided by nurse practitioners (94%) for 34.8%-80% of overweight/obese had limited follow-up (4%). Obesity incidence markedly increased between 13 and 18 years of age without associated interventions; 51.4%-75.6% without interventions. Obesity is a healthcare problem among rural Mexican-American adolescents accessing care at the rural health clinic. Obesity intervention and follow-up was suboptimal within this setting. Rural and ethnic minority adolescents experience health disparities concerning obesity prevalence and remote healthcare access. Obesity prevention and treatment during adolescence is a national health priority given physiologic and psychological tolls on health and potential for obesity into adulthood. Obesity assessment and translation of evidence-based interventions for rural Mexican-American adolescents at rural health clinics is implicated. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  20. Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Philip Vutien

    Full Text Available Treatment rates with interferon-based therapies for chronic hepatitis C have been low. Our aim was to perform a systematic review of available data to estimate the rates and barriers for antiviral therapy for chronic hepatitis C.We conducted a systematic review and meta-analysis searching MEDLINE, SCOPUS through March 2016 and abstracts from recent major liver meetings for primary literature with available hepatitis C treatment rates. Random-effects models were used to estimate effect sizes and meta-regression to test for potential sources of heterogeneity.We included 39 studies with 476,443 chronic hepatitis C patients. The overall treatment rate was 25.5% (CI: 21.1-30.5% and by region 34% for Europe, 28.3% for Asia/Pacific, and 18.7% for North America (p = 0.008. On multivariable meta-regression, practice setting (tertiary vs. population-based, p = 0.04, region (Europe vs. North America p = 0.004, and data source (clinical chart review vs. administrative database, p = 0.025 remained significant predictors of heterogeneity. The overall treatment eligibility rate was 52.5%, and 60% of these received therapy. Of the patients who refused treatment, 16.2% cited side effects, 13.8% cited cost as reasons for treatment refusal, and 30% lacked access to specialist care.Only one-quarter of chronic hepatitis C patients received antiviral therapy in the pre-direct acting antiviral era. Treatment rates should improve in the new interferon-free era but, cost, co-morbidities, and lack of specialist care will likely remain and need to be addressed. Linkage to care should even be of higher priority now that well-tolerated cure is available.

  1. Nuclear industry chart no. 21 - France

    International Nuclear Information System (INIS)

    Anon.

    1976-01-01

    A fold-out chart shows the relationship between the government bodies and industrial concerns. Nuclear power plant orders under the 1970-84 programme are tabulated. A directory is included of national bodies, firms and establishments. (U.K.)

  2. An Application of Geospatial Information Systems (GIS) Technology to Anatomic Dental Charting

    OpenAIRE

    Bartling, William C.; Schleyer, Titus K.L.

    2003-01-01

    Historically, an anatomic dental chart is a compilation of color-coded symbols and numbers used within a template, either paper or computerized, to create a graphic record of a patient’s oral health status. This poster depicts how Geospatial Information System (GIS) technology can be used to create an accurate, current anatomic dental chart that contains detailed information not present in current charting systems.

  3. A COMPARISON OF SOME ROBUST BIVARIATE CONTROL CHARTS FOR INDIVIDUAL OBSERVATIONS

    Directory of Open Access Journals (Sweden)

    Moustafa Omar Ahmed Abu - Shawiesh

    2014-06-01

    Full Text Available This paper proposed and considered some bivariate control charts to monitor individual observations from a statistical process control. Usual control charts which use mean and variance-covariance estimators are sensitive to outliers. We consider the following robust alternatives to the classical Hoteling's T2: T2MedMAD, T2MCD, T2MVE a simulation study has been conducted to compare the performance of these control charts. Two real life data are analyzed to illustrate the application of these robust alternatives.

  4. News from the Library: The 8th edition Karlsruhe nuclide chart has been released

    CERN Multimedia

    CERN Library

    2012-01-01

    The 8th edition of the Karlsruhe Nuclide Chart contains new data not found in the 7th edition.   Since 1958, the well-known Karlsruhe Nuclide Chart has provided scientists with structured, valuable information on the half-lives, decay modes and energies of radioactive nuclides. The chart is used in many disciplines in physics (health physics, radiation protection, nuclear and radiochemistry, astrophysics, etc.) but also in the life and earth sciences (biology, medicine, agriculture, geology, etc.). The 8th edition of the Karlsruhe Nuclide Chart contains new data on 737 nuclides not found in the 7th edition. In total, nuclear data on 3847 experimentally observed ground states and isomers are presented. A new web-based version of this chart is in the final stages of development for use within the Nucleonica Nuclear Science Portal - a portal for which CERN has an institutional license. The chart is also available in paper format.   If you want to buy a paper version of the chart, ple...

  5. Handbook of thermodynamic tables and charts

    International Nuclear Information System (INIS)

    Raznjevic, K.

    1976-01-01

    A compilation of thermodynamic and thermophysical tables and charts is presented. Numerical values are cited in both technical and SI units. Solid, liquid, vapor, and gaseous forms of organic and inorganic materials are included. 12 figures, 137 tables

  6. Candlestick Charting and Trading Volume: Evidence from Bursa Malaysia

    OpenAIRE

    Chin, Chee-Ling; Jais, Mohamad; Balia, Sophee Sulong; Ahmad, Ayoib Che; Abidin, Azlan Zainol

    2016-01-01

    Technical analysis is deemed to be a futile practice among academicians who propose efficient market hypothesis, typically the weak form market efficiency which strongly protests the application of past prices and trading volume data for prediction of future market movement. As candlestick charting is one of the oldest technical indicators for short term investment, therefore this study examines the predictability of candlestick charting with combination to trading volume for Malaysian stock ...

  7. Reliability of FAMACHA© chart for the evaluation of anaemia in ...

    African Journals Online (AJOL)

    The reliability of FAMACHA© chart for identifying anaemic goats was compared with Packed Cell Volume (PCV). The colour of the lower eyelids was graded with FAMACHA© chart based on FAMACHA© scores (FS) of 1-5. The animals were scored from severely anaemic (white or FS 5) through moderately anaemic (pink or ...

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

    Science.gov (United States)

    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.

  9. Toward a New Brewing Control Chart for the 21st Century.

    Science.gov (United States)

    Melrose, John; Roman-Corrochano, Borja; Montoya-Guerra, Marcela; Bakalis, Serafim

    2018-04-23

    This paper describes new results from a base model of brewing from a bed of packed coffee grains. The model solves for the diffusion of soluble species out of a distribution of particles into the flow through the bed pore space. It requires a limited set of input parameters. It gives a simple picture of the basic physics of coffee brewing and sets out a set of reduced variables for this process. The importance of bed extraction efficiency is elucidated. A coffee brewing control chart has been widely used to describe the region of ideal coffee brewing for some 50 years. A new chart is needed, however, one that connects actual brewing conditions (weight, flow rate, brew time, grind, etc.) to the yield and strength of brews. The paper shows a new approach to brewing control charts, including brew time and bed extraction efficiency as control parameters. Using the base model, an example chart will be given for a particular grind ratio of coarse to fine particles, and an "espresso regime" will be picked out. From such a chart yield, volume and strength of a brew can be read off at will.

  10. Application of machine learning and expert systems to Statistical Process Control (SPC) chart interpretation

    Science.gov (United States)

    Shewhart, Mark

    1991-01-01

    Statistical Process Control (SPC) charts are one of several tools used in quality control. Other tools include flow charts, histograms, cause and effect diagrams, check sheets, Pareto diagrams, graphs, and scatter diagrams. A control chart is simply a graph which indicates process variation over time. The purpose of drawing a control chart is to detect any changes in the process signalled by abnormal points or patterns on the graph. The Artificial Intelligence Support Center (AISC) of the Acquisition Logistics Division has developed a hybrid machine learning expert system prototype which automates the process of constructing and interpreting control charts.

  11. Validation of Computed Radiography (CR) Exposure Chart for Stainless Steel and Aluminium

    International Nuclear Information System (INIS)

    Nassir, M.A.; Khairul Anuar Mohd Salleh; Arshad Yassin

    2015-01-01

    Computed radiography (CR) is a technique that is currently used to complement the conventional radiography in Non Destructive Testing (NDT). With CR, phosphorous base imaging plate (IP) is used to acquire digital radiographic images. The degree of absorption by the IP is proportional to the intensity of the dose received. The IP stores latent image which subsequently digitized by the CR reader. Prior to radiography exposure, the radiation dosage is determined by referring to the exposure chart. Exposure chart is one of the most important tools for achieving acceptable quality radiographs. Therefore, it is important to have a reliable and accurate exposure chart. The aim of this study is to test and validate exposure charts that were developed based on the statistical analysis of the digital radiographic grey values. The charts produced were for stainless steel and aluminum. According to EN 14784-2:2005, acceptable normalized signal-to-noise ratio (SNR N ) for testing class A and class B shall have minimum 70 and 120 respectively. (author)

  12. 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

    defects in the future. Finally, the Gamma test has become a popular metric for reporting TPS Commissioning and QA results. It simplifies complex testing into a numerical index, but noisy data and casual application can make it misleading. A brief review of the issues around the use of the Gamma test will be presented. TPS commissioning and QA: A process orientation and application of control charts (Michael Sharpe) A framework for commissioning a treatment planning system will be presented, focusing on preparations, practical aspects of configuration, priorities, specifications, and establishing performance. The complexity of the modern TPS make modular testing of features inadequate, and modern QA tools can provide “too much information” about the performance of techniques like IMRT and VMAT. We have adopted a process orientation and quality tools, like control charts, for ongoing TPS QA and assessment of patient-specific tests. The trending nature of these tools reveals the overall performance of the TPS system, and quantifies the variations that arise from individual plans, discrete calculations, and experimentation based on discrete measurements. Examples demonstrating application of these tools to TPS QA will be presented. TPS commissioning and QA: Incorporating the entire planning process (Sasa Mutic) The TPS and its features do not perform in isolation. Instead, the features and modules are key components in a complex process that begins with CT Simulation and extends to treatment delivery, along with image guidance and verification. Most importantly, the TPS is used by people working in a multi-disciplinary environment. It is very difficult to predict the outcomes of human interactions with software. Therefore, an interdisciplinary approach to training, commissioning and QA will be presented, along with an approach to the physics chart check and end-to-end testing as a tool for TPS QA. The role of standardization and automation in QA will also be discussed

  13. 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

    defects in the future. Finally, the Gamma test has become a popular metric for reporting TPS Commissioning and QA results. It simplifies complex testing into a numerical index, but noisy data and casual application can make it misleading. A brief review of the issues around the use of the Gamma test will be presented. TPS commissioning and QA: A process orientation and application of control charts (Michael Sharpe) A framework for commissioning a treatment planning system will be presented, focusing on preparations, practical aspects of configuration, priorities, specifications, and establishing performance. The complexity of the modern TPS make modular testing of features inadequate, and modern QA tools can provide “too much information” about the performance of techniques like IMRT and VMAT. We have adopted a process orientation and quality tools, like control charts, for ongoing TPS QA and assessment of patient-specific tests. The trending nature of these tools reveals the overall performance of the TPS system, and quantifies the variations that arise from individual plans, discrete calculations, and experimentation based on discrete measurements. Examples demonstrating application of these tools to TPS QA will be presented. TPS commissioning and QA: Incorporating the entire planning process (Sasa Mutic) The TPS and its features do not perform in isolation. Instead, the features and modules are key components in a complex process that begins with CT Simulation and extends to treatment delivery, along with image guidance and verification. Most importantly, the TPS is used by people working in a multi-disciplinary environment. It is very difficult to predict the outcomes of human interactions with software. Therefore, an interdisciplinary approach to training, commissioning and QA will be presented, along with an approach to the physics chart check and end-to-end testing as a tool for TPS QA. The role of standardization and automation in QA will also be discussed

  14. Application of Special Cause Control Charts to Green Sand Process

    Directory of Open Access Journals (Sweden)

    Perzyk M.

    2015-12-01

    Full Text Available Statistical Process Control (SPC based on the well known Shewhart control charts, is widely used in contemporary manufacturing industry, including many foundries. However, the classic SPC methods require that the measured quantities, e.g. process or product parameters, are not auto-correlated, i.e. their current values do not depend on the preceding ones. For the processes which do not obey this assumption the Special Cause Control (SCC charts were proposed, utilizing the residual data obtained from the time-series analysis. In the present paper the results of application of SCC charts to a green sand processing system are presented. The tests, made on real industrial data collected in a big iron foundry, were aimed at the comparison of occurrences of out-of-control signals detected in the original data with those appeared in the residual data. It was found that application of the SCC charts reduces numbers of the signals in almost all cases It is concluded that it can be helpful in avoiding false signals, i.e. resulting from predictable factors.

  15. The use of cimetidine in hospitalized patients.

    Science.gov (United States)

    Kopala, L

    1984-01-01

    Cimetidine is the most commonly prescribed drug in North America. A clinical review was conducted to identify physicians' prescribing habits. From September 1, 1981 to March 31, 1982, the charts were reviewed of 50 patients receiving cimetidine in an isolated coastal community hospital in British Columbia. It was discovered that physicians prescribed the drug for reasons approved by the Food and Drug Administration (FDA) only 14% of the time. The FDA guidelines approve cimetidine for duodenal ulcer, Zollinger-Ellison syndrome, and other hypersecretory states. A literature review was conducted, and guidelines on prescribing cimetidine were given to all members of the hospital's medical staff.

  16. Historical Map & Chart Collection of NOAA's Nautical Charts, Hydrographic Surveys, Topographic Surveys, Geodetic Surveys, City Plans, and Civil War Battle Maps Starting from the mid 1700's

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Historical Map and Chart Collection of the Office of Coast Survey contains over 20000 historical maps and charts from the mid 1700s through the late 1900s. These...

  17. Patient perceptions of factors leading to spasmodic dysphonia: a combined clinical experience of 350 patients.

    Science.gov (United States)

    Childs, Lesley; Rickert, Scott; Murry, Thomas; Blitzer, Andrew; Sulica, Lucian

    2011-10-01

    Spasmodic dysphonia (SD) is an idiopathic voice disorder that is characterized by either a strained, strangled voice quality or a breathy voice with aphonic segments of connected speech. It has been suggested that environmental factors play a role in triggering the onset. Clinical observation suggests that some patients associate onset with specific events or factors while others do not. The purpose of this study was to examine a large database of SD patients to determine if specific triggers are associated with the onset of SD. Retrospective chart review. A total of 350 charts of patients with SD were identified and were categorized as either "sudden onset" or "gradual onset." One hundred sixty-nine recalled their circumstances surrounding onset. Forty-five percent of these patients described the onset as sudden. Patient perceptions of inciting events in the sudden onset group were identified 77% of the time and 2% of the time in the gradual onset group. The most common factors identified were stress (42%), upper respiratory infection (33%), and pregnancy and parturition (10%). Thirty-five percent of SD patients perceive their disorder to have a sudden onset with identified inciting events. This prevalence raises questions regarding possible behavioral and environmental factors surrounding the onset of this disorder. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  18. The Energy Chart'93

    International Nuclear Information System (INIS)

    Shervashidze, N.

    1993-01-01

    The Energy Chart'93 is developed with respect to forthcoming restructuring of energy sector in Bulgaria and contains its main directions for both short- and long-term periods. The priorities are given to: energy supply, stabilization of the existing units, ecological development, domestic energy sources, atomic energy, gas energy, utilization of the available hydrological potential. The leading role of legislation in this area is also pointed out, as well as the regulating function of the Committee of Energy. (author)

  19. Understanding Charts and Graphs.

    Science.gov (United States)

    1987-07-28

    Farenheit degrees, which have no Onaturalo zero ); finally, ratio scales have numbers that are ordered so that the magnitudes of differences are important and...system. They have to do with the very nature of how marks serve as meaningful symbols. In the ideal case, a chart or graph will be absolutely unambiguous...and these laws comprise this principle (see Stevens, 1974). Absolute discriminability: A minimal magnitude of a mark is necessary for it to be detected

  20. Complementary and Alternative Medicine: A Clinical Study in 1,016 Hematology/Oncology Patients.

    Science.gov (United States)

    Hierl, Marina; Pfirstinger, Jochen; Andreesen, Reinhard; Holler, Ernst; Mayer, Stephanie; Wolff, Daniel; Vogelhuber, Martin

    2017-01-01

    Surveys state a widespread use of complementary and alternative medicine (CAM) in patients with malignant diseases. CAM methods might potentially interfere with the metabolization of tumor-specific therapy. However, there is little communication about CAM use in hematology/oncology patients between patients, CAM providers, and oncologists. A self-administered questionnaire was handed out to all patients attending to the hematology/oncology outpatient clinic of Regensburg University Hospital. Subsequently, a chart review of all CAM users was performed. Questionnaires of 1,016 patients were analyzed. Of these patients, 30% used CAM, preferably vitamins and micronutrients. Main information sources for CAM methods were physicians/nonmedical practitioners and friends/relatives. CAM therapies were provided mainly by licensed physicians (29%), followed by nonmedical practitioners (14%) and the patients themselves (13%). Although 62% of the CAM users agreed that the oncologist may know about their CAM therapy, a chart entry about CAM use was found only in 41%. CAM is frequently used by hematology/oncology patients. Systematic communication about CAM is essential to avoid possible drug interactions. © 2017 S. Karger AG, Basel.

  1. Customized vs population-based growth charts to identify neonates at risk of adverse outcome: systematic review and Bayesian meta-analysis of observational studies.

    Science.gov (United States)

    Chiossi, G; Pedroza, C; Costantine, M M; Truong, V T T; Gargano, G; Saade, G R

    2017-08-01

    To compare the effectiveness of customized vs population-based growth charts for the prediction of adverse pregnancy outcomes. MEDLINE, ClinicalTrials.gov and The Cochrane Library were searched up to 31 May 2016 to identify interventional and observational studies comparing adverse outcomes among large- (LGA) and small- (SGA) for-gestational-age neonates, when classified according to customized vs population-based growth charts. Perinatal mortality and admission to the neonatal intensive care unit (NICU) of both SGA and LGA neonates, intrauterine fetal demise (IUFD) and neonatal mortality of SGA neonates, and neonatal shoulder dystocia and hypoglycemia as well as maternal third- and fourth-degree perineal lacerations in LGA pregnancies were evaluated. The electronic search identified 237 records that were examined based on title and abstract, of which 27 full-text articles were examined for eligibility. After excluding seven articles, 20 observational studies were included in a Bayesian meta-analysis. Neonates classified as SGA according to customized growth charts had higher risks of IUFD (odds ratio (OR), 7.8 (95% CI, 4.2-12.3)), neonatal death (OR, 3.5 (95% CI, 1.1-8.0)), perinatal death (OR, 5.8 (95% CI, 3.8-7.8)) and NICU admission (OR, 3.6 (95% CI, 2.0-5.5)) than did non-SGA cases. Neonates classified as SGA according to population-based growth charts also had increased risk for adverse outcomes, albeit the point estimates of the pooled ORs were smaller: IUFD (OR, 3.3 (95% CI, 1.9-5.0)), neonatal death (OR, 2.9 (95% CI, 1.2-4.5)), perinatal death (OR, 4.0 (95% CI, 2.8-5.1)) and NICU admission (OR, 2.4 (95% CI, 1.7-3.2)). For LGA vs non-LGA, there were no differences in pooled ORs for perinatal death, NICU admission, hypoglycemia and maternal third- and fourth-degree perineal lacerations when classified according to either the customized or the population-based approach. In contrast, both approaches indicated that LGA neonates are at increased risk for

  2. The WIPP decision plan: Charting the course for openness in the decision making process

    International Nuclear Information System (INIS)

    Hagers, J.

    1992-01-01

    In June of 1989, the Secretary of Energy requested that a plan be developed that would clearly outline the prerequisites to opening the Waste Isolation Pilot Plant (WIPP). It was to provide the basis for a decision making process that was not only visible to the public, but one which included public participation. It must also be dynamic enough to effectively deal with the changing legislative, regulatory, and technical environments. Based on a recognized need for openness, the Secretary's Draft Decision Plan was developed. The plan charted the course for ultimately making the decision to declare WIPP ready to receive waste for the start of test phase operations. It outlined to critics and supporters alike the rigorous and thorough process by which the internal decisions were made. The plan identified all internal prerequisites to the decision; charted the review cycles, and targeted the completion dates. It also outlined the processes outside the control of the Department, institutional issues, such as legislative land withdrawal, issuance of permits, and designation of transportation routes

  3. Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients.

    Science.gov (United States)

    Zhan, Rucai; Li, Xueen; Li, Xingang

    2016-02-01

    Objective To assess the safety and effectiveness of the endoscopic endonasal transsphenoidal approach (EETA) for apoplectic pituitary adenoma. Design A retrospective study. Setting Qilu Hospital of Shandong University; Brain Science Research Institute, Shandong University. Participants Patients admitted to Qilu Hospital of Shandong University who were diagnosed with an apoplectic pituitary tumor and underwent EETA for resection of the tumor. Main Outcome Measures In total 45 patients were included in a retrospective chart review. Data regarding patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications were obtained from the chart review. Results In total, 38 (92.7%) of 41 patients with loss of vision obtained visual remission postoperatively. In addition, 16 patients reported a secreting adenoma, and postsurgical hormonal levels were normal or decreased in 14 patients. All other symptoms, such as headache and alteration of mental status, recovered rapidly after surgery. Two patients (4.4%) incurred cerebrospinal fluid leakage. Six patients (13.3%) experienced transient diabetes insipidus (DI) postoperatively, but none of these patients developed permanent DI. Five patients (11.1%) developed hypopituitarism and were treated with replacement of hormonal medicine. No cases of meningitis, carotid artery injury, or death related to surgery were reported. Conclusion EETA offers a safe and effective surgical option for apoplectic pituitary tumors and is associated with low morbidity and mortality.

  4. Chart Supplements - Aeronautical Information Services Digital Products

    Data.gov (United States)

    Department of Transportation — The Chart Supplements are searchable by individual airport in PDF format. They contain data on public and joint use airports, seaplane bases, heliports, VFR airport...

  5. Design chart of optimum current leads

    International Nuclear Information System (INIS)

    Ishibashi, K.; Katase, A.; Maechata, K.

    1986-01-01

    The heat flow through current leads is one of major heat losses in a superconducting magnet system. To reduce the heat flow, current leads have been optimized in a complex way by varying such quantities as conductor length, cross-sectional area, heat transfer coefficient and cooling perimeter. Therefore, this study is made to simplify the design procedure, and to explain the general characteristics of the current leads. A new combined parameter which takes turbulent flow into account is introduced in the present work to enable us to draw a useful design chart. This chart gives, to a wide variety of current leads, detailed information about the optimum design-viz. geometric dimensions, heat flow into liquid helium, and pressure drop of the cooling gas. Change of the cross-sectional area along the conductor may improve the current lead performance. The effects of this area change are examined in detail

  6. Planar Poincare chart - A planar graphic representation of the state of light polarization

    Science.gov (United States)

    Tedjojuwono, Ken K.; Hunter, William W., Jr.; Ocheltree, Stewart L.

    1989-01-01

    The planar Poincare chart, which represents the complete planar equivalence of the Poincare sphere, is proposed. The four sets of basic lines are drawn on two separate charts for the generalization and convenience of reading the scale. The chart indicates the rotation of the principal axes of linear birefringent material. The relationships between parameters of the two charts are given as 2xi-2phi (orientation angle of the major axis-ellipticity angle) pair and 2alpha-delta (angle of amplitude ratio-phase difference angle) pair. The results are useful for designing and analyzing polarization properties of optical components with birefringent properties.

  7. Designing business charts with Excel based on the standards of HICHERT SUCCESS

    CERN Document Server

    Gerths, Holger

    2014-01-01

    This e-book offers a comprehensive range of knowledge for creating professional business charts based on the concept of HICHERT®SUCCESS. Given this knowledge, the SUCCESS rules of designing good business charts can be followed easily. This training is based on one complex example. The tips and trick learned can be transferred to other Excel chart types easily. Contents: Introduction to the HICHERT®SUCCESS design rules.Tips and tricks for Excel 2003 and 2007/2010.Comprehensive trai

  8. Development, implementation and evaluation of a patient handoff tool to improve safety in orthopaedic surgery.

    Science.gov (United States)

    Gagnier, Joel J; Derosier, Joseph M; Maratt, Joseph D; Hake, Mark E; Bagian, James P

    2016-06-01

    To develop, implement and test the effect of a handoff tool for orthopaedic trauma residents that reduces adverse events associated with the omission of critical information and the transfer of erroneous information. Components of this project included a literature review, resident surveys and observations, checklist development and refinement, implementation and evaluation of impact on adverse events through a chart review of a prospective cohort compared with a historical control group. Large teaching hospital. Findings of a literature review were presented to orthopaedic residents, epidemiologists, orthopaedic surgeons and patient safety experts in face-to-face meetings, during which we developed and refined the contents of a resident handoff tool. The tool was tested in an orthopaedic trauma service and its impact on adverse events was evaluated through a chart review. The handoff tool was developed and refined during the face-to-face meetings and a pilot implementation. Adverse event data were collected on 127 patients (n = 67 baseline period; n = 60 test period). A handoff tool for use by orthopaedic residents. Adverse events in patients handed off by orthopaedic trauma residents. After controlling for age, gender and comorbidities, testing resulted in fewer events per person (25-27% reduction; P < 0.10). Preliminary evidence suggests that our resident handoff tool may contribute to a decrease in adverse events in orthopaedic patients. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  9. Protection from retinopathy and other complications in patients with type 1 diabetes of extreme duration

    Science.gov (United States)

    We performed a cross-sectional, observational study of 351 U.S. residents with at least 50 years of insulin-dependent diabetes. Longitudinal data on retinopathy progression was obtained via chart review in patients followed at the Joslin Diabetes Center eye clinic (Boston, MA). HbA1c was determined ...

  10. A robust standard deviation control chart

    NARCIS (Netherlands)

    Schoonhoven, M.; Does, R.J.M.M.

    2012-01-01

    This article studies the robustness of Phase I estimators for the standard deviation control chart. A Phase I estimator should be efficient in the absence of contaminations and resistant to disturbances. Most of the robust estimators proposed in the literature are robust against either diffuse

  11. Nuclear industry chart no. 20 - Sweden

    International Nuclear Information System (INIS)

    Anon.

    1976-01-01

    A folding chart is presented of the Swedish nuclear industry, which shows the government bodies, companies, utilities and other groups who participate in the nuclear field. Their special interests and activities and affiliations with each other and with international organisations are indicated. (U.K.)

  12. ICS International Chronostratigraphic Chart 2016/04

    NARCIS (Netherlands)

    Cohen, K.M.|info:eu-repo/dai/nl/185633374; Finney, S.C.; Gibbard, P.L.

    Units of all ranks are in the process of being defined by Global Boundary Stratotype Section and Points (GSSP) for their lowerboundaries, including those of the Archean and Proterozoic, long defined by Global Standard Stratigraphic Ages (GSSA). Charts and detailed information on ratified GSSPs are

  13. ICS International Chronostratigraphic Chart 2017/02

    NARCIS (Netherlands)

    Cohen, K.M.|info:eu-repo/dai/nl/185633374; Harper, D.A.T.; Gibbard, P.L.

    Units of all ranks are in the process of being defined by Global Boundary Stratotype Section and Points (GSSP) for their lowerboundaries, including those of the Archean and Proterozoic, long defined by Global Standard Stratigraphic Ages (GSSA). Charts and detailed information on ratified GSSPs are

  14. Flaw evaluation charts

    International Nuclear Information System (INIS)

    Korosec, D.; Vojvodic Tuma, J.

    1999-01-01

    The structural integrity of the primary components in pressurized water reactor nuclear power plant is very important in the respect of safe and efficient operation. These components have to be subjected to periodic controls. In the light of fracture mechanics concept, the acceptance criteria for defects (flaws) are developed. Flaw evaluation procedure is necessary, to evaluate the defects regarding their acceptability for further operation. The objective of the flaw evaluation charts is to provide a series of simple graphs as decision maps. that immediate decision may be taken regarding the acceptability of a detected defects, on the basis of ASME Code XI criteria.(author)

  15. Determinants of patient satisfaction: a systematic review.

    Science.gov (United States)

    Batbaatar, Enkhjargal; Dorjdagva, Javkhlanbayar; Luvsannyam, Ariunbat; Savino, Matteo Mario; Amenta, Pietro

    2017-03-01

    A large number of studies have addressed the detection of patient satisfaction determinants, and the results are still inconclusive. Furthermore, it is known that contradicting evidence exists across patient satisfaction studies. This article is the second part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction for further operationalisation procedures. The aim of this work was to systematically identify and review evidence regarding determinants of patient satisfaction between 1980 and 2014, and to seek the reasons for contradicting results in relationships between determinants and patient satisfaction in the literature to design a further robust measurement system for patient satisfaction. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search was conducted in PubMed, CINAHL, and Scopus in October 2014. Studies published in full in peer reviewed journals between January 1980 and August 2014 and in the English language were included. We included 109 articles for the synthesis. We found several number of determinants of patient satisfaction investigated in a wide diversity of studies. However, study results were varied due to no globally accepted formulation of patient satisfaction and measurement system. Health care service quality indicators were the most influential determinants of patient satisfaction across the studies. Among them, health providers' interpersonal care quality was the essential determinant of patient satisfaction. Sociodemographic characteristics were the most varied in the review. The strength and directions of associations with patient satisfaction were found inconsistent. Therefore, person-related characteristics should be considered to be the potential determinants and confounders simultaneously. The selected studies were not able to show all potential characteristics which may have had

  16. Percutaneous biliary drainage in patients with cholangiocarcinoma

    International Nuclear Information System (INIS)

    Mehta, A.C.; Gobel, R.J.; Rose, S.C.; Hayes, J.K.; Miller, F.J.

    1990-01-01

    This paper determines whether radiation therapy (RT) is a risk factor for infectious complications (particularly hepatic abscess formation) related to percutaneous biliary drainage (PBD). The authors retrospectively reviewed the charts of 98 consecutive patients who had undergone PBD for obstruction. In 34 patients with benign obstruction, three infectious complications occurred, none of which were hepatic abscess or fatal sepsis. In 39 patients who had malignant obstruction but did not have cholangiocarcinoma, 13 infectious complications occurred, including two hepatic abscesses and three cases of fatal sepsis. Of the 25 patients with cholangiocarcinoma, 15 underwent RT; in these 15 patients, 14 infectious complications occurred, including six hepatic abscesses and two cases of fatal sepsis

  17. [Performance and optimisation of a trigger tool for the detection of adverse events in hospitalised adult patients].

    Science.gov (United States)

    Guzmán Ruiz, Óscar; Pérez Lázaro, Juan José; Ruiz López, Pedro

    To characterise the performance of the triggers used in the detection of adverse events (AE) of hospitalised adult patients and to define a simplified panel of triggers to facilitate the detection of AE. Cross-sectional study of charts of patients from a service of internal medicine to detect EA through systematic review of the charts and identification of triggers (clinical event often related to AE), determining if there was AE as the context in which it appeared the trigger. Once the EA was detected, we proceeded to the characterization of the triggers that detected it. Logistic regression was applied to select the triggers with greater AE detection capability. A total of 291 charts were reviewed, with a total of 562 triggers in 103 patients, of which 163 were involved in detecting an AE. The triggers that detected the most AE were "A.1. Pressure ulcer" (9.82%), "B.5. Laxative or enema" (8.59%), "A.8. Agitation" (8.59%), "A.9. Over-sedation" (7.98%), "A.7. Haemorrhage" (6.75%) and "B.4. Antipsychotic" (6.75%). A simplified model was obtained using logistic regression, and included the variable "Number of drugs" and the triggers "Over-sedation", "Urinary catheterisation", "Readmission in 30 days", "Laxative or enema" and "Abrupt medication stop". This model showed a probability of 81% to correctly classify charts with EA or without EA (p <0.001; 95% confidence interval: 0.763-0.871). A high number of triggers were associated with AE. The summary model is capable of detecting a large amount of AE, with a minimum of elements. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. On the Use of Ashenhurst Decomposition Chart as an Alternative to ...

    African Journals Online (AJOL)

    ... the Ashenhurst decomposition chart is shown to be a mapping technique which solves this selection problem and enables the design of logic circuits with desirable attributes using multiplexers. The Ashenhurst decomposition chart also serves as a bridging technique between the map based and algorithmic based digital ...

  19. 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.

  20. Pathologic response after neoadjuvant chemotherapy predicts locoregional control in patients with triple negative breast cancer

    OpenAIRE

    Chen, Victor E.; Gillespie, Erin F.; Zakeri, Kaveh; Murphy, James D.; Yashar, Catheryn M.; Lu, Sharon; Einck, John P.

    2017-01-01

    Purpose: Our goal was to determine the impact of pathologic response after neoadjuvant chemotherapy in triple negative breast cancer (TNBC) on the subsequent risk of locoregional recurrence (LRR) and disease-free survival (DFS) in the setting of adjuvant radiation therapy. Methods and materials: This was an institutional review board–approved retrospective chart review of patients with clinical stage I-III breast cancer treated with neoadjuvant chemotherapy, local surgery (breast conservat...

  1. 7 CFR 51.2276 - Color chart.

    Science.gov (United States)

    2010-01-01

    ... Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE REGULATIONS AND STANDARDS UNDER THE AGRICULTURAL MARKETING ACT OF 1946... Walnut Color Chart) to which reference is made in §§ 51.2281 and 51.2282 illustrates the four shades of...

  2. ICS International Chronostratigraphic Chart 2015/01

    NARCIS (Netherlands)

    Cohen, K.M.|info:eu-repo/dai/nl/185633374; Finney, S.C.; Gibbard, P.L.

    Units of all ranks are in the process of being defined by Global Boundary Stratotype Section and Points (GSSP) for their lower boundaries, including those of the Archean and Proterozoic, long defined by Global Standard Stratigraphic Ages (GSSA). Charts and detailed information on ratified GSSPs are

  3. Proposal for internet-based Digital Dental Chart for personal dental identification in forensics.

    Science.gov (United States)

    Hanaoka, Yoichi; Ueno, Asao; Tsuzuki, Tamiyuki; Kajiwara, Masahiro; Minaguchi, Kiyoshi; Sato, Yoshinobu

    2007-05-03

    A dental chart is very useful as a standard source of evidence in the personal identification of bodies. However, the kind of dental chart available will often vary as a number of types of odontogram have been developed where the visual representation of dental conditions has relied on hand-drawn representation. We propose the Digital Dental Chart (DDC) as a new style of dental chart, especially for open investigations aimed at establishing the identity of unknown bodies. Each DDC is constructed using actual oral digital images and dental data, and is easy to upload onto an Internet website. The DDC is a more useful forensic resource than the standard types of dental chart in current use as it has several advantages, among which are its ability to carry a large volume of information and reproduce dental conditions clearly and in detail on a cost-effective basis.

  4. Application of a binomial cusum control chart to monitor one drinking water indicator

    Directory of Open Access Journals (Sweden)

    Elisa Henning

    2014-02-01

    Full Text Available The aim of this study is to analyze the use of a binomial cumulative sum chart (CUSUM to monitor the presence of total coliforms, biological indicators of quality of water supplies in water treatment processes. The sample series were monthly taken from a water treatment plant and were analyzed from 2007 to 2009. The statistical treatment of the data was performed using GNU R, and routines were created for the approximation of the upper limit of the binomial CUSUM chart. Furthermore, a comparative study was conducted to investigate whether there is a significant difference in sensitivity between the use of CUSUM and the traditional Shewhart chart, the most commonly used chart in process monitoring. The results obtained demonstrate that this study was essential for making the right choice in selecting a chart for the statistical analysis of this process.

  5. JDATAVIEWER – JAVA-Based Charting Library

    CERN Document Server

    Kruk, G

    2009-01-01

    The JDataViewer is a Java-based charting library developed at CERN, with powerful, extensible and easy to use function editing capabilities. Function edition is heavily used in Control System applications, but poorly supported in products available on the market. The JDataViewer enables adding, removing and modifying function points graphically (using a mouse) or by editing a table of values. Custom edition strategies are supported: developer can specify an algorithm that reacts to the modification of a given point in the function by automatically adapting all other points. The library provides all typical 2D plotting types (scatter, polyline, area, bar, HiLo, contour), as well as data point annotations and data indicators. It also supports common interactors to zoom and move the visible view, or to select and highlight function segments. A clear API is provided to configure and customize all chart elements (colors, fonts, data ranges ...) programmatically, and to integrate non-standard rendering types, inter...

  6. Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile

    DEFF Research Database (Denmark)

    Søholm, Helle; Bro-Jeppesen, John; Lippert, Freddy K

    2014-01-01

    and prognosis after OHCA in NH. METHODS: Consecutive Emergency Medical Service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected. RESULTS: A total...... survival rates as non-NH-patients when adjusting for known prognostic factors and pre-existing co-morbidity. A policy of not attempting resuscitation in nursing homes at all may therefore not be justified....

  7. The use of control charts by laypeople and hospital decision-makers for guiding decision making.

    Science.gov (United States)

    Schmidtke, K A; Watson, D G; Vlaev, I

    2017-07-01

    Graphs presenting healthcare data are increasingly available to support laypeople and hospital staff's decision making. When making these decisions, hospital staff should consider the role of chance-that is, random variation. Given random variation, decision-makers must distinguish signals (sometimes called special-cause data) from noise (common-cause data). Unfortunately, many graphs do not facilitate the statistical reasoning necessary to make such distinctions. Control charts are a less commonly used type of graph that support statistical thinking by including reference lines that separate data more likely to be signals from those more likely to be noise. The current work demonstrates for whom (laypeople and hospital staff) and when (treatment and investigative decisions) control charts strengthen data-driven decision making. We present two experiments that compare people's use of control and non-control charts to make decisions between hospitals (funnel charts vs. league tables) and to monitor changes across time (run charts with control lines vs. run charts without control lines). As expected, participants more accurately identified the outlying data using a control chart than using a non-control chart, but their ability to then apply that information to more complicated questions (e.g., where should I go for treatment?, and should I investigate?) was limited. The discussion highlights some common concerns about using control charts in hospital settings.

  8. Examining Teachers' Behavioral Management Charts: A Comparison of Class Dojo and Paper-Pencil Methods

    Science.gov (United States)

    Krach, S. Kathleen; McCreery, Michael P.; Rimel, Hillary

    2017-01-01

    Many teachers report using behavioral management charts in their classrooms as a means of managing student behaviors, but little is known about exactly what behaviors teachers are charting, or specifically how. Misunderstanding over how real-world teachers maintain behavioral charts may cause miscommunication between the teacher and the school…

  9. Genotype, Phenotype and Outcomes of Nine Patients with T-B+NK+ SCID

    OpenAIRE

    Yu, Grace P; Nadeau, Kari C; Berk, David R; de Saint Basile, Geneviève; Lambert, Nathalie; Knapnougel, Perrine; Roberts, Joseph; Kavanau, Kristina; Dunn, Elizabeth; Stiehm, E. Richard; Lewis, David B; Umetsu, Dale T; Puck, Jennifer M; Cowan, Morton J

    2011-01-01

    There are few reports of clinical presentation, genotype, and hematopoietic cell transplant (HCT) outcomes for T-B+NK+ SCID patients. Between 1981 and 2007, 8 of 84 SCID patients who received and/or were followed after HCT at UCSF had the T-B+NK+ phenotype. One additional T-B+NK+ SCID patient was identified as the sibling of a patient treated at UCSF. Chart reviews were performed. Molecular analyses of IL7R, IL2RG, JAK3 and the genes encoding the CD3 T-cell receptor components δ (CD3D), ε (CD...

  10. An ex ante control chart for project monitoring using earned duration management observations

    Science.gov (United States)

    Mortaji, Seyed Taha Hossein; Noori, Siamak; Noorossana, Rassoul; Bagherpour, Morteza

    2017-12-01

    In the past few years, there has been an increasing interest in developing project control systems. The primary purpose of such systems is to indicate whether the actual performance is consistent with the baseline and to produce a signal in the case of non-compliance. Recently, researchers have shown an increased interest in monitoring project's performance indicators, by plotting them on the Shewhart-type control charts over time. However, these control charts are fundamentally designed for processes and ignore project-specific dynamics, which can lead to weak results and misleading interpretations. By paying close attention to the project baseline schedule and using statistical foundations, this paper proposes a new ex ante control chart which discriminates between acceptable (as-planned) and non-acceptable (not-as-planned) variations of the project's schedule performance. Such control chart enables project managers to set more realistic thresholds leading to a better decision making for taking corrective and/or preventive actions. For the sake of clarity, an illustrative example has been presented to show how the ex ante control chart is constructed in practice. Furthermore, an experimental investigation has been set up to analyze the performance of the proposed control chart. As expected, the results confirm that, when a project starts to deflect significantly from the project's baseline schedule, the ex ante control chart shows a respectable ability to detect and report right signals while avoiding false alarms.

  11. Control Charts for Processes with an Inherent Between-Sample Variation

    Directory of Open Access Journals (Sweden)

    Eva Jarošová

    2018-06-01

    Full Text Available A number of processes to which statistical control is applied are subject to various effects that cause random changes in the mean value. The removal of these fluctuations is either technologically impossible or economically disadvantageous under current conditions. The frequent occurrence of signals in the Shewhart chart due to these fluctuations is then undesirable and therefore the conventional control limits need to be extended. Several approaches to the design of the control charts with extended limits are presented in the paper and applied on the data from a real production process. The methods assume samples of size greater than 1. The performance of the charts is examined using the operating characteristic and average run length. The study reveals that in many cases, reducing the risk of false alarms is insufficient.

  12. NUCLIDES 2000: an electronic chart of the nuclides

    International Nuclear Information System (INIS)

    Galy, J.; Magill, J.

    2000-01-01

    Radionuclides have many applications in agriculture, medicine, industry and research. For basic information on such radioactive materials, the Chart of the Nuclides has proved to be an indispensable tool for obtaining data on radionuclides and working out qualitatively decay schemes and reaction paths. These Charts are, however, of limited use when one requires quantitative information on the decaying nuclide and its daughters. This was the motivation for the development of the NUCLIDES 2000 software package. The radioactive decay data used in NUCLIDES 2000 is based on the Joint Evaluated File (Jeff) version 2.2. The present version of the program contains decay data on approximately 2700 radionuclides. (authors)

  13. jsGraph and jsNMR—Advanced Scientific Charting

    Directory of Open Access Journals (Sweden)

    Norman Pellet

    2014-09-01

    Full Text Available The jsGraph library is a versatile javascript library that allows advanced charting to be rendered interactively in web browsers without relying on server-side image processing. jsGraph is released under the MIT license and is free of charge. While being highly customizable through an intuitive javascript API, jsGraph is optimized to render a large quantity of data in a short amount of time. jsGraphs can display line, scatter, contour or zone series. Examples can be consulted on the project home page [1]. Customization of the chart, its axis and its series is achieved through simple but comprehensive JSON configurations.

  14. (W)righting women: constructions of gender, sexuality and race in the psychiatric chart.

    Science.gov (United States)

    Daley, Andrea; Costa, Lucy; Ross, Lori

    2012-01-01

    This paper examines the interpretative nature of psychiatry in relation to gender, sexuality and race within the particular time and place of one urban, Canadian, clinical psychiatric setting. We bring women's psychiatric inpatient charts and a critical feminist perspective into dialogue in an effort to focus on gender, sexuality and race in psychiatric narratives on women's madness. The research used a qualitative, retrospective research design to examine the psychiatric narrative as a technique of power as it operates on women. This paper focuses on the overarching theme of 'medicalisation', identified from the analysis of women's psychiatric inpatient charts, including two subthemes: (1) language and composition and (2) decontextualisation. Our analysis suggests that psychiatric chart documentation practices that reproduce gendered, sexualised, and racialised biases and assumptions and decontextualise the social and structural context of women's experiences of madness serve to create the paradox of women's visibility/erasure in psychiatric charts. The paper concludes with an exploration of the significance of women's authorship legitimacy in psychiatric chart documentation.

  15. 49 CFR 236.338 - Mechanical locking required in accordance with locking sheet and dog chart.

    Science.gov (United States)

    2010-10-01

    ... locking sheet and dog chart. 236.338 Section 236.338 Transportation Other Regulations Relating to... in accordance with locking sheet and dog chart. Mechanical locking shall be in accordance with locking sheet and dog chart currently in effect. ...

  16. 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.

  17. Modified Exponential Weighted Moving Average (EWMA) Control Chart on Autocorrelation Data

    Science.gov (United States)

    Herdiani, Erna Tri; Fandrilla, Geysa; Sunusi, Nurtiti

    2018-03-01

    In general, observations of the statistical process control are assumed to be mutually independence. However, this assumption is often violated in practice. Consequently, statistical process controls were developed for interrelated processes, including Shewhart, Cumulative Sum (CUSUM), and exponentially weighted moving average (EWMA) control charts in the data that were autocorrelation. One researcher stated that this chart is not suitable if the same control limits are used in the case of independent variables. For this reason, it is necessary to apply the time series model in building the control chart. A classical control chart for independent variables is usually applied to residual processes. This procedure is permitted provided that residuals are independent. In 1978, Shewhart modification for the autoregressive process was introduced by using the distance between the sample mean and the target value compared to the standard deviation of the autocorrelation process. In this paper we will examine the mean of EWMA for autocorrelation process derived from Montgomery and Patel. Performance to be investigated was investigated by examining Average Run Length (ARL) based on the Markov Chain Method.

  18. North Atlantic IFR Route Planning Chart GEO-TIFF - Aeronautical Information Services Digital Products

    Data.gov (United States)

    Department of Transportation — North Atlantic Route Chart is designed for FAA Controllers to monitor transatlantic flights, this 5-color chart shows oceanic control areas, coastal navigation aids,...

  19. North Atlantic IFR Route Planning Chart PDF File - Aeronautical Information Services Digital Products

    Data.gov (United States)

    Department of Transportation — North Atlantic Route Chart is designed for FAA Controllers to monitor transatlantic flights, this 5-color chart shows oceanic control areas, coastal navigation aids,...

  20. Assessment of the global trigger tool to measure, monitor and evaluate pateint safety in cancer patients

    DEFF Research Database (Denmark)

    Otto Mattsson, Thea; Lehmann-Knudsen, Janne; Lauritsen, Jens M

    2013-01-01

    BACKGROUND: Countries around the world are currently aiming to improve patient safety by means of the Institute for Healthcare Improvement global trigger tool (GTT), which is considered a valid tool for evaluating and measuring patient safety within organisations. So far, only few data....... RESULTS: Only 31% of adverse events (AE) were identified by both teams, and further differences in categorisation of identical events was found. Moderate interrater agreement (κ=0.45) between teams gave rise to different conclusions on the patient safety process when monitoring using SPC charts. The Bland......-Altman plot suggests little systematic error but large random error. CONCLUSIONS: Review teams may identify different AE and reach different conclusions on the safety process when using the GTT on identical charts. Tracking true change in the safety level is difficult due to measurement error of the GTT...

  1. Characteristics and outcome of patients with heart failure due to anabolic-androgenic steroids

    DEFF Research Database (Denmark)

    Søndergaard, Eva Bjerre; Thune, Jens Jakob; Gustafsson, Finn

    2014-01-01

    OBJECTIVES: The objective of the study was to analyse the outcome of patients with advanced heart failure due to abuse of anabolic-androgenic steroids. DESIGN: A retrospective chart review of patients admitted or referred for advanced heart failure, due to anabolic-androgenic steroid abuse...... with angiotensin-converting enzyme inhibitors and beta-blockers. The remaining 3 patients required implantation of a LV assist device (LVAD) and were listed for heart transplantation. No recovery of LV function in the patients treated with assist device was seen. CONCLUSION: Anabolic-androgenic steroid...

  2. Applying Nightingale charts to evaluate the heterogeneity of biomedical waste in a Hospital

    Directory of Open Access Journals (Sweden)

    Janini Cristina Paiz

    2014-12-01

    Full Text Available OBJECTIVES: to evaluate the heterogeneity of biomedical waste (BW using Nightingale charts.METHOD: cross-sectional study consisting of data collection on wastes (direct observation of receptacles, physical characterisation, and gravimetric composition, development of a Management Information System, and creation of statistical charts.RESULTS: the wastes with the greatest degree of heterogeneity are, in order, recyclable, infectious, and organic wastes; chemical waste had the most efficient segregation; Nightingale charts are useful for quick visualisation and systematisation of information on heterogeneity.CONCLUSION: the development of a management information system and the use of Nightingale charts allows for the identification and correction of errors in waste segregation, which increase health risks and contamination by infectious and chemical wastes and reduce the sale and profit from recyclables.

  3. Group consensus peer review in radiation oncology: commitment to quality.

    Science.gov (United States)

    Duggar, W Neil; Bhandari, Rahul; Yang, Chunli Claus; Vijayakumar, Srinivasan

    2018-03-27

    Peer review, especially prospective peer review, has been supported by professional organizations as an important element in optimal Radiation Oncology practice based on its demonstration of efficacy at detecting and preventing errors prior to patient treatment. Implementation of peer review is not without barriers, but solutions do exist to mitigate or eliminate some of those barriers. Peer review practice at our institution involves three key elements: new patient conference, treatment planning conference, and chart rounds. The treatment planning conference is an adaptation of the group consensus peer review model from radiology which utilizes a group of peers reviewing each treatment plan prior to implementation. The peer group in radiation oncology includes Radiation Oncologists, Physician Residents, Medical Physicists, Dosimetrists, and Therapists. Thus, technical and clinical aspects of each plan are evaluated simultaneously. Though peer review is held in high regard in Radiation Oncology, many barriers commonly exist preventing optimal implementation such as time intensiveness, repetition, and distraction from clinic time with patients. Through the use of automated review tools and commitment by individuals and administration in regards to staffing, scheduling, and responsibilities, these barriers have been mitigated to implement this Group Consensus Peer Review model into a Radiation Oncology Clinic. A Group Consensus Peer Review model has been implemented with strategies to address common barriers to effective and efficient peer review.

  4. Evaluation of clinical coding data to determine causes of critical bleeding in patients receiving massive transfusion: a bi-national, multicentre, cross-sectional study.

    Science.gov (United States)

    McQuilten, Z K; Zatta, A J; Andrianopoulos, N; Aoki, N; Stevenson, L; Badami, K G; Bird, R; Cole-Sinclair, M F; Hurn, C; Cameron, P A; Isbister, J P; Phillips, L E; Wood, E M

    2017-04-01

    To evaluate the use of routinely collected data to determine the cause(s) of critical bleeding in patients who receive massive transfusion (MT). Routinely collected data are increasingly being used to describe and evaluate transfusion practice. Chart reviews were undertaken on 10 randomly selected MT patients at 48 hospitals across Australia and New Zealand to determine the cause(s) of critical bleeding. Diagnosis-related group (DRG) and International Classification of Diseases (ICD) codes were extracted separately and used to assign each patient a cause of critical bleeding. These were compared against chart review using percentage agreement and kappa statistics. A total of 427 MT patients were included with complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good overall agreement was found between chart review and ICD codes (78·3%; κ = 0·74, 95% CI 0·70-0·79) and only fair overall agreement with DRG (51%; κ = 0·45, 95% CI 0·40-0·50). Both ICD and DRG were sensitive and accurate for classifying obstetric haemorrhage patients (98% sensitivity and κ > 0·94). However, compared with the ICD algorithm, DRGs were less sensitive and accurate in classifying bleeding as a result of gastrointestinal haemorrhage (74% vs 8%; κ = 0·75 vs 0·1), trauma (92% vs 62%; κ = 0·78 vs 0·67), cardiac (80% vs 57%; κ = 0·79 vs 0·60) and vascular surgery (64% vs 56%; κ = 0·69 vs 0·65). Algorithms using ICD codes can determine the cause of critical bleeding in patients requiring MT with good to excellent agreement with clinical history. DRG are less suitable to determine critical bleeding causes. © 2016 British Blood Transfusion Society.

  5. Cardiovascular risk assessment in type 2 diabetes mellitus: comparison of the World Health Organization/International Society of Hypertension risk prediction charts versus UK Prospective Diabetes Study risk engine.

    Science.gov (United States)

    Herath, Herath M Meththananda; Weerarathna, Thilak Priyantha; Umesha, Dilini

    2015-01-01

    Patients with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular diseases, and assessment of their cardiac risk is important for preventive strategies. The Ministry of Health of Sri Lanka has recommended World Health Organization/International Society of Hypertension (WHO/ISH) charts for cardiac risk assessment in individuals with T2DM. However, the most suitable cardiac risk assessment tool for Sri Lankans with T2DM has not been studied. This study was designed to evaluate the performance of two cardiac risk assessments tools; WHO/ISH charts and UK Prospective Diabetes Study (UKPDS) risk engine. Cardiac risk assessments were done in 2,432 patients with T2DM attending a diabetes clinic in Southern Sri Lanka using the two risk assessment tools. Validity of two assessment tools was further assessed by their ability to recognize individuals with raised low-density lipoprotein (LDL) and raised diastolic blood pressure in a cohort of newly diagnosed T2DM patients (n=332). WHO/ISH charts identified 78.4% of subjects as low cardiac risk whereas the UKPDS risk engine categorized 52.3% as low cardiac risk (Pengine identified higher proportions of patients (28%) compared to WHO/ISH charts (7%). Approximately 6% of subjects were classified as low cardiac risk (20%. Agreement between the two tools was poor (κ value =0.144, Pengine. Risk assessment by both assessment tools demonstrated poor sensitivity in identifying those with treatable levels of LDL cholesterol and diastolic blood pressure.

  6. Rural residents' perspectives on the rural 'good death': a scoping review.

    Science.gov (United States)

    Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J; Wilson, Donna M; Phillips, Christine B; Wiles, Robert B

    2018-05-01

    The 'good death' is one objective of palliative care, with many 'good death' viewpoints and research findings reflecting the urban voice. Rural areas are distinct and need special consideration. This scoping review identified and charted current research knowledge on the 'good' rural death through the perspectives of rural residents, including rural patients with a life-limiting illness, to identify evidence and gaps in the literature for future studies. A comprehensive literature search of English language articles (no date filter applied) was conducted in 2016 (2 January to 14 February) using five library databases. Reference lists of included articles, recent issues of eight relevant journals and three grey literature databases were also hand-searched. Twenty articles (for 17 studies and one systematic review) were identified after a two-phase screening process by two reviewers, using pre-determined inclusion criteria. Data from each study were extracted and charted, analysed using a thematic analysis of the included articles' content, and with a quantitative analysis of the scoping review. These papers revealed data collected from rural patients with a life-limiting illness and family caregivers, rural healthcare providers, the wider rural community, rural community leaders and rural health administrators and policy makers. Rural locations were heterogeneous. Residents from developed and developing countries believe a 'good death' is one that is peaceful, free of pain and without suffering; however, this is subjective and priorities are based on personal, cultural, social and religious perspectives. Currently, there is insufficient data to generalise rural residents' perspectives and what it means for them to die well. Given the extreme importance of a 'good death', there is a need for further studies to elicit rural patient and family caregiver perspectives. © 2016 John Wiley & Sons Ltd.

  7. In vitro fertilisation with recombinant follicle stimulating hormone requires less IU usage compared with highly purified human menopausal gonadotrophin: results from a European retrospective observational chart review

    Directory of Open Access Journals (Sweden)

    Blackmore Stuart

    2010-11-01

    Full Text Available Abstract Background Previous studies have reported conflicting results for the comparative doses of recombinant follicle stimulating hormone (rFSH and highly purified human menopausal gonadotrophin (hMG-HP required per cycle of in vitro fertilisation (IVF; the aim of this study was to determine the average total usage of rFSH versus hMG-HP in a 'real-world' setting using routine clinical practice. Methods This retrospective chart review of databases from four European countries investigated gonadotrophin usage, oocyte and embryo yield, and pregnancy outcomes in IVF cycles (± intra-cytoplasmic sperm injection using rFSH or hMG-HP alone. Included patients met the National Institute for Health and Clinical Excellence (NICE guideline criteria for IVF and received either rFSH or hMG-HP. Statistical tests were conducted at 5% significance using Chi-square or t-tests. Results Of 30,630 IVF cycles included in this review, 74% used rFSH and 26% used hMG-HP. A significantly lower drug usage per cycle for rFSH than hMG-HP (2072.53 +/- 76.73 IU vs. 2540.14 +/- 883.08 IU, 22.6% higher for hMG-HP; p Conclusions Based on these results, IVF treatment cycles with rFSH yield statistically more oocytes (and more mature oocytes, using significantly less IU per cycle, versus hMG-HP. The incidence of all OHSS and hospitalisations due to OHSS was significantly higher in the rFSH cycles compared to the hMG-HP cycles. However, the absolute incidence of hospitalisations due to OHSS was similar to that reported previously. These results suggest that the perceived required dosage with rFSH is currently over-estimated, and the higher unit cost of rFSH may be offset by a lower required dosage compared with hMG-HP.

  8. Progress in the technology of nautical charting

    Digital Repository Service at National Institute of Oceanography (India)

    Joseph, A.

    ". The article skims through the various aspects of safety of navigation such as nautical charts created by the Arabs in the medieval days of stellar navigation in the Indian Ocean; the contributions by the Chinese, the British, and the Portuguese; hydrographic...

  9. Pattern and Distribution of Colorectal Cancer in Tanzania: A Retrospective Chart Audit at Two National Hospitals

    Directory of Open Access Journals (Sweden)

    Leonard K. Katalambula

    2016-01-01

    Full Text Available Background. Colorectal cancer (CRC is a growing public health concern with increasing rates in countries with previously known low incidence. This study determined pattern and distribution of CRC in Tanzania and identified hot spots in case distribution. Methods. A retrospective chart audit reviewed hospital registers and patient files from two national institutions. Descriptive statistics, Chi square (χ2 tests, and regression analyses were employed and augmented by data visualization to display risk variable differences. Results. CRC cases increased sixfold in the last decade in Tanzania. There was a 1.5% decrease in incidences levels of rectal cancer and 2% increase for colon cancer every year from 2005 to 2015. Nearly half of patients listed Dar es Salaam as their primary residence. CRC was equally distributed between males (50.06% and females (49.94%, although gender likelihood of diagnosis type (i.e., rectal or colon was significantly different (P=0.027. More than 60% of patients were between 40 and 69 years. Conclusions. Age (P=0.0183 and time (P=0.004 but not gender (P=0.0864 were significantly associated with rectal cancer in a retrospective study in Tanzania. Gender (P=0.0405, age (P=0.0015, and time (P=0.0075 were all significantly associated with colon cancer in this study. This retrospective study found that colon cancer is more prevalent among males at a relatively younger age than rectal cancer. Further, our study showed that although more patients were diagnosed with rectal cancer, the trend has shown that colon cancer is increasing at a faster rate.

  10. Pattern and Distribution of Colorectal Cancer in Tanzania: A Retrospective Chart Audit at Two National Hospitals

    International Nuclear Information System (INIS)

    Katalambula, L. K.; Buza, J.; Mpolya, E.

    2016-01-01

    Colorectal cancer (CRC) is a growing public health concern with increasing rates in countries with previously known low incidence. This study determined pattern and distribution of CRC in Tanzania and identified hot spots in case distribution. Methods. A retrospective chart audit reviewed hospital registers and patient files from two national institutions. Descriptive statistics, Chi square (x 2 ) tests, and regression analyses were employed and augmented by data visualization to display risk variable differences. Results. CRC cases increased sixfold in the last decade in Tanzania. There was a 1.5% decrease in incidences levels of rectal cancer and 2% increase for colon cancer every year from 2005 to 2015. Nearly half of patients listed Dar es Salaam as their primary residence. CRC was equally distributed between males (50.06%) and females (49.94%), although gender likelihood of diagnosis type (i.e., rectal or colon) was significantly different ( P= 0.027). More than 60% of patients were between 40 and 69 years. Conclusions. Age ( P= 0.0183) and time () but not gender ( P = 0.0864) were significantly associated with rectal cancer in a retrospective study in Tanzania. Gender ( P = 0.0405), age ( P = 0.0015), and time ( P = 0.0075) were all significantly associated with colon cancer in this study. This retrospective study found that colon cancer is more prevalent among males at a relatively younger age than rectal cancer. Further, our study showed that although more patients were diagnosed with rectal cancer, the trend has shown that colon cancer is increasing at a faster rate.

  11. Notre Dame Nuclear Database: A New Chart of Nuclides

    Science.gov (United States)

    Lee, Kevin; Khouw, Timothy; Fasano, Patrick; Mumpower, Matthew; Aprahamian, Ani

    2014-09-01

    Nuclear data is critical to research fields from medicine to astrophysics. We are creating a database, the Notre Dame Nuclear Database, which can store theoretical and experimental datasets. We place emphasis on storing metadata and user interaction with the database. Users are able to search in addition to the specific nuclear datum, the author(s), the facility where the measurements were made, the institution of the facility, and device or method/technique used. We also allow users to interact with the database by providing online search, an interactive nuclide chart, and a command line interface. The nuclide chart is a more descriptive version of the periodic table that can be used to visualize nuclear properties such as half-lives and mass. We achieve this by using D3 (Data Driven Documents), HTML, and CSS3 to plot the nuclides and color them accordingly. Search capabilities can be applied dynamically to the chart by using Python to communicate with MySQL, allowing for customization. Users can save the customized chart they create to any image format. These features provide a unique approach for researchers to interface with nuclear data. We report on the current progress of this project and will present a working demo that highlights each aspect of the aforementioned features. This is the first time that all available technologies are put to use to make nuclear data more accessible than ever before in a manner that is much easier and fully detailed. This is a first and we will make it available as open source ware.

  12. Appreciating the broad clinical features of SMAD4 mutation carriers: a multicenter chart review.

    Science.gov (United States)

    Wain, Karen E; Ellingson, Marissa S; McDonald, Jamie; Gammon, Amanda; Roberts, Maegan; Pichurin, Pavel; Winship, Ingrid; Riegert-Johnson, Douglas L; Weitzel, Jeffrey N; Lindor, Noralane M

    2014-08-01

    Heterozygous loss-of-function SMAD4 mutations are associated with juvenile polyposis syndrome and hereditary hemorrhagic telangiectasia. Some carriers exhibit symptoms of both conditions, leading to juvenile polyposis-hereditary hemorrhagic telangiectasia syndrome. Three families have been reported with connective tissue abnormalities. 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. Twenty-one percent of the patients (7/34) had features suggesting a connective tissue defect: enlarged aortic root (n = 3), aortic and mitral insufficiency (n = 2), aortic dissection (n = 1), retinal detachment (n = 1), brain aneurysms (n = 1), and lax skin and joints (n = 1). Juvenile polyposis-specific findings were almost uniformly present but variable. Ninety-seven percent of the patients had colon polyps that were generally pan-colonic and of variable histology and number. Forty-eight percent of the patients (15/31) had extensive gastric polyposis. Hereditary hemorrhagic telangiectasia features, including epistaxis (19/31, 61%), mucocutaneous telangiectases (15/31, 48%), liver arteriovenous malformation (6/16, 38%), brain arteriovenous malformation (1/26, 4%), pulmonary arteriovenous malformation (9/17, 53%), and intrapulmonary shunting (14/23, 61%), were documented in 76% of the patients. SMAD4 carriers should be managed for juvenile polyposis and hereditary hemorrhagic telangiectasia because symptoms of both conditions are likely yet unpredictable. Connective tissue abnormalities are an emerging component of juvenile polyposis-hereditary hemorrhagic telangiectasia syndrome, and larger studies are needed to understand these manifestations.

  13. Desktop publishing and validation of custom near visual acuity charts.

    Science.gov (United States)

    Marran, Lynn; Liu, Lei; Lau, George

    2008-11-01

    Customized visual acuity (VA) assessment is an important part of basic and clinical vision research. Desktop computer based distance VA measurements have been utilized, and shown to be accurate and reliable, but computer based near VA measurements have not been attempted, mainly due to the limited spatial resolution of computer monitors. In this paper, we demonstrate how to use desktop publishing to create printed custom near VA charts. We created a set of six near VA charts in a logarithmic progression, 20/20 through 20/63, with multiple lines of the same acuity level, different letter arrangements in each line and a random noise background. This design allowed repeated measures of subjective accommodative amplitude without the potential artifact of familiarity of the optotypes. The background maintained a constant and spatial frequency rich peripheral stimulus for accommodation across the six different acuity levels. The paper describes in detail how pixel-wise accurate black and white bitmaps of Sloan optotypes were used to create the printed custom VA charts. At all acuity levels, the physical sizes of the printed custom optotypes deviated no more than 0.034 log units from that of the standard, satisfying the 0.05 log unit ISO criterion we used to demonstrate physical equivalence. Also, at all acuity levels, log unit differences in the mean target distance for which reliable recognition of letters first occurred for the printed custom optotypes compared to the standard were found to be below 0.05, satisfying the 0.05 log unit ISO criterion we used to demonstrate functional equivalence. It is possible to use desktop publishing to create custom near VA charts that are physically and functionally equivalent to standard VA charts produced by a commercial printing process.

  14. Design and analysis of control charts for standard deviation with estimated parameters

    NARCIS (Netherlands)

    Schoonhoven, M.; Riaz, M.; Does, R.J.M.M.

    2011-01-01

    This paper concerns the design and analysis of the standard deviation control chart with estimated limits. We consider an extensive range of statistics to estimate the in-control standard deviation (Phase I) and design the control chart for real-time process monitoring (Phase II) by determining the

  15. Curvas de crescimento pôndero-estatural em crianças com síndrome de Down: uma revisão sistemática Growth charts in children with Down syndrome: a systematic review

    Directory of Open Access Journals (Sweden)

    Nathalie Jeanne M. Bravo-Valenzuela

    2011-06-01

    different countries were analyzed. Studies related only to head circumference charts and Down syndrome growth studies without curves were excluded. In order to describe the variables of weight and length, kilograms, centimeters and Z scores were used. DATA SYNTHESIS: Lower birth length and weight, final short stature, higher prevalence of overweight/obesity in late childhood/adolescence (about 30% and a reduced growth velocity are cardinal features of growth in Down syndrome. Congenital heart defects and other major dis-eases frequently occur and are possible causes of growth delay. Individual mean final height varied between 141.9 to 155cm for girls and 150 to165cm for boys (-2.0 to -4.0 standard deviations. CONCLUSIONS: A delay in growth velocity, a shorter fi-nal stature and a shorter and earlier pubertal growth were observed in this review. There was a higher prevalence of overweight/obesity after late childhood. The use of specific growth charts can help the early recognition of additional diseases and/or incipient obesity/overweight in patients with Down syndrome.

  16. 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. ...

  17. Multivariate control charts based on net analyte signal (NAS) and Raman spectroscopy for quality control of carbamazepine

    Energy Technology Data Exchange (ETDEWEB)

    Rocha, Werickson Fortunato de Carvalho [Institute of Chemistry, University of Campinas - UNICAMP, P.O. Box 6154, 13083-970 Campinas, SP (Brazil); National Institute of Metrology, Standardization and Industrial Quality, Inmetro, Dimci/Dquim - Directorate of Metrology, Science and Industry/Division of Chemical Metrology, Av. Nossa Senhora das Gracas 50, Building 6, 25250-020, Xerem, Duque de Caxias, RJ (Brazil); Poppi, Ronei Jesus, E-mail: ronei@iqm.unicamp.br [Institute of Chemistry, University of Campinas - UNICAMP, P.O. Box 6154, 13083-970 Campinas, SP (Brazil); National Institute of Science and Technology (INCT) for Bioanalytics, 13083-970 Campinas, SP (Brazil)

    2011-10-31

    Raman spectroscopy and control charts based on the net analyte signal (NAS) were applied to polymorphic characterization of carbamazepine. Carbamazepine presents four polymorphic forms: I-IV (dihydrate). X-ray powder diffraction was used as a reference technique. The control charts were built generating three charts: the NAS chart that corresponds to the analyte of interest (form III in this case), the interference chart that corresponds to the contribution of other compounds in the sample and the residual chart that corresponds to nonsystematic variations. For each chart, statistical limits were developed using samples within the quality specifications. It was possible to identify the different polymorphic forms of carbamazepine present in pharmaceutical formulations. Thus, an alternative method for the quality monitoring of the carbamazepine polymorphic forms after the crystallization process is presented.

  18. Multivariate control charts based on net analyte signal (NAS) and Raman spectroscopy for quality control of carbamazepine

    International Nuclear Information System (INIS)

    Rocha, Werickson Fortunato de Carvalho; Poppi, Ronei Jesus

    2011-01-01

    Raman spectroscopy and control charts based on the net analyte signal (NAS) were applied to polymorphic characterization of carbamazepine. Carbamazepine presents four polymorphic forms: I-IV (dihydrate). X-ray powder diffraction was used as a reference technique. The control charts were built generating three charts: the NAS chart that corresponds to the analyte of interest (form III in this case), the interference chart that corresponds to the contribution of other compounds in the sample and the residual chart that corresponds to nonsystematic variations. For each chart, statistical limits were developed using samples within the quality specifications. It was possible to identify the different polymorphic forms of carbamazepine present in pharmaceutical formulations. Thus, an alternative method for the quality monitoring of the carbamazepine polymorphic forms after the crystallization process is presented.

  19. SU-G-IeP3-14: Updating Tools for Radiographic Technique Charts

    Energy Technology Data Exchange (ETDEWEB)

    Walz-Flannigan, A; Lucas, J; Buchanan, K; Schueler, B [Mayo Clinic, Rochester, MN (United States)

    2016-06-15

    Purpose: Manual technique selection in radiography is needed for imaging situations where there is difficulty in proper positioning for AEC, prosthesis, for non-bucky imaging, or for guiding image repeats. Basic information about how to provide consistent image signal and contrast for various kV and tissue thickness is needed to create manual technique charts, and relevant for physicists involved in technique chart optimization. Guidance on technique combinations and rules-of-thumb to provide consistent image signal still in use today are based on measurements with optical density of screen-film combinations and older generation x-ray systems. Tools such as a kV-scale chart can be useful to know how to modify mAs when kV is changed in order to maintain consistent image receptor signal level. We evaluate these tools for modern equipment for use in optimizing proper size scaled techniques. Methods: We used a water phantom to measure calibrated signal change for CR and DR (with grid) for various beam energies. Tube current values were calculated that would yield a consistent image signal response. Data was fit to provide sufficient granularity of detail to compose technique-scale chart. Tissue thickness approximated equivalence to 80% of water depth. Results: We created updated technique-scale charts, providing mAs and kV combinations to achieve consistent signal for CR and DR for various tissue equivalent thicknesses. We show how this information can be used to create properly scaled size-based manual technique charts. Conclusion: Relative scaling of mAs and kV for constant signal (i.e. the shape of the curve) appears substantially similar between film-screen and CR/DR. This supports the notion that image receptor related differences are minor factors for relative (not absolute) changes in mAs with varying kV. However, as demonstrated creation of these difficult to find detailed technique-scales are useful tools for manual chart optimization.

  20. Possible misdiagnosis of HIV associated lymphoma as tuberculosis among patients attending Uganda Cancer Institute.

    Science.gov (United States)

    Buyego, Paul; Nakiyingi, Lydia; Ddungu, Henry; Walimbwa, Stephen; Nalwanga, Damalie; Reynolds, Steven J; Parkes-Ratanshi, Rosalind

    2017-03-14

    Early diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure of biopsy, requires skills and equipment that are not readily available. As a consequence, diagnosis may be delayed increasing the risk of mortality. We set out to determine the frequency and risk factors associated with the misdiagnosis of HIV associated lymphoma as tuberculosis (TB) among patients attending the Uganda Cancer Institute (UCI). A retrospective cohort study design was used among HIV patients with associated lymphoma patients attending the UCI, Kampala, Uganda between February and March 2015. Eligible patient charts were reviewed for information on TB treatment, socio-demographics, laboratory parameters (Hemoglobin, CD4cells count and lactate dehydrogenase) and clinical presentation using a semi structured data extraction form. A total of 183 charts were reviewed; 106/183 were males (57.9%), the median age was 35 (IQR, 28-45). Fifty six (30.6%) patients had a possible misdiagnosis as TB and their median time on TB treatment was 3.5 (1-5.3) months. In multivariate analysis the presence of chest pain had an odd ratio (OR) of 4.4 (95% CI 1.89-10.58, p HIV associated lymphoma attending UCI are misdiagnosed and treated as TB. Chest pain and stage III and IV of lymphoma were associated with an increased risk of a possible misdiagnosis of lymphoma as TB.

  1. Engaging patients and stakeholders in research proposal review: the patient-centered outcomes research institute.

    Science.gov (United States)

    Fleurence, Rachael L; Forsythe, Laura P; Lauer, Michael; Rotter, Jason; Ioannidis, John P A; Beal, Anne; Frank, Lori; Selby, Joseph V

    2014-07-15

    The inaugural round of merit review for the Patient-Centered Outcomes Research Institute (PCORI) in November 2012 included patients and other stakeholders, as well as scientists. This article examines relationships among scores of the 3 reviewer types, changes in scoring after in-person discussion, and the effect of inclusion of patient and stakeholder reviewers on the review process. In the first phase, 363 scientists scored 480 applications. In the second phase, 59 scientists, 21 patients, and 31 stakeholders provided a "prediscussion" score and a final "postdiscussion" score after an in-person meeting for applications. Bland-Altman plots were used to characterize levels of agreement among and within reviewer types before and after discussion. Before discussion, there was little agreement among average scores given by the 4 lead scientific reviewers and patient and stakeholder reviewers. After discussion, the 4 primary reviewers showed mild convergence in their scores, and the 21-member panel came to a much stronger agreement. Of the 25 awards with the best (and lowest) scores after phase 2, only 13 had ranked in the top 25 after the phase 1 review by scientists. Five percent of the 480 proposals submitted were funded. The authors conclude that patient and stakeholder reviewers brought different perspectives to the review process but that in-person discussion led to closer agreement among reviewer types. It is not yet known whether these conclusions are generalizable to future rounds of peer review. Future work would benefit from additional data collection for evaluation purposes and from long-term evaluation of the effect on the funded research.

  2. Clinical Variables Associated with Hydration Status in Acute Ischemic Stroke Patients with Dysphagia.

    Science.gov (United States)

    Crary, Michael A; Carnaby, Giselle D; Shabbir, Yasmeen; Miller, Leslie; Silliman, Scott

    2016-02-01

    Acute stroke patients with dysphagia are at increased risk for poor hydration. Dysphagia management practices may directly impact hydration status. This study examined clinical factors that might impact hydration status in acute ischemic stroke patients with dysphagia. A retrospective chart review was completed on 67 ischemic stroke patients who participated in a prior study of nutrition and hydration status during acute care. Prior results indicated that patients with dysphagia demonstrated elevated BUN/Cr compared to non-dysphagia cases during acute care and that BUN/Cr increased selectively in dysphagic patients. This chart review evaluated clinical variables potentially impacting hydration status: diuretics, parenteral fluids, tube feeding, oral diet, and nonoral (NPO) status. Exposure to any variable and number of days of exposure to each variable were examined. Dysphagia cases demonstrated significantly more NPO days, tube fed days, and parenteral fluid days, but not oral fed days, or days on diuretics. BUN/Cr values at discharge were not associated with NPO days, parenteral fluid days, oral fed days, or days on diuretics. Patients on modified solid diets had significantly higher mean BUN/Cr values at discharge (27.12 vs. 17.23) as did tube fed patients (28.94 vs. 18.66). No difference was noted between these subgroups at baseline (regular diet vs. modified solids diets). Any modification of solid diets (31.11 vs. 17.23) or thickened liquids (28.50 vs. 17.81) resulted in significantly elevated BUN/Cr values at discharge. Liquid or diet modifications prescribed for acute stroke patients with dysphagia may impair hydration status in these patients.

  3. Clinical experience with adalimumab in a multicenter Swiss cohort of patients with Crohn's disease.

    Science.gov (United States)

    Nichita, Cristina; Stelle, Marc; Vavricka, Stephan; El-Wafa Ali, Abdou; Ballabeni, Pierluigi; de Saussure, Philippe; Straumann, Alex; Rogler, Gerhard; Michetti, Pierre

    2010-01-01

    Controlled clinical trials have demonstrated the efficacy and safety of adalimumab in patients with moderate-to-severe Crohn's disease (CD), but there is, however, only limited long-term experience with adalimumab in daily practice. To assess the long-term effectiveness and safety of adalimumab in a multicenter cohort of practice-based patients with moderate-to-severe CD. We retrospectively reviewed the charts of CD patients who received adalimumab over a 3-year period. Disease severity was scored using the Harvey-Bradshaw index (HBI). Remission was defined as an HBI of 3 points at evaluation compared to the baseline. Univariate logistic regression analysis was used to identify the predictive variables associated with response. The charts of 55 patients were reviewed; remission and response rates observed at weeks 4-6 were 52.7 and 83.6%, respectively. Remission was maintained at weeks 12, 24 and 52 in 89.6, 72.4 and 44.7% of patients, respectively. Remission and response rates were not influenced by smoking status, disease location or duration, the first month total dose, or previous infliximab therapy. The remission rate at weeks 4-6 was significantly higher in patients intolerant of infliximab as compared to those who lost response to this drug. Adalimumab was well tolerated overall. Adalimumab can be considered a suitable option in patients with moderate-to-severe CD, demonstrating sustained long-term effectiveness. Copyright (c) 2010 S. Karger AG, Basel.

  4. Bivariate copulas on the exponentially weighted moving average control chart

    Directory of Open Access Journals (Sweden)

    Sasigarn Kuvattana

    2016-10-01

    Full Text Available This paper proposes four types of copulas on the Exponentially Weighted Moving Average (EWMA control chart when observations are from an exponential distribution using a Monte Carlo simulation approach. The performance of the control chart is based on the Average Run Length (ARL which is compared for each copula. Copula functions for specifying dependence between random variables are used and measured by Kendall’s tau. The results show that the Normal copula can be used for almost all shifts.

  5. Protection of patients in dentistry

    International Nuclear Information System (INIS)

    Selato Selato, P.

    2013-04-01

    Current literature on dental radiology was reviewed in order to seek justification for radiological protection of patients in dental radiography, to explore the different factors affecting patient dose and to derive practical guidance on how to achieve radiological protection of patients in dentistry. Individual doses incurred in dental radiology are in general relatively low, however it is generally accepted that there is no safe level of radiation dose and that no matter how low the doses received are, there is a mathematical probability of an effect. Hence appropriate patient protection measures must be instituted to keep the exposures as low as reasonably achievable (ALARA). The literature review demonstrated that there is considerable scope for significant dose reductions in dental radiology using the techniques of optimisation of protection. The techniques of optimization of protection that can be used to ensure patient dose is as low as reasonably achievable whilst achieving clinically adequate image quality include the following: image receptor selection, image receptor holders, collimation, beam filtration, operating potential and exposure time, patient protective equipment, film exposure and processing, film storage, image viewing, quality assurance, diagnostic reference levels, technique charts and training and education.(au)

  6. Flexible Design and Operation of a Smart Charging Microgrid (Briefing Charts)

    Science.gov (United States)

    2014-04-08

    release; distribution unlimited 13. SUPPLEMENTARY NOTES Briefing Charts for SAE World Congress 2014 14. ABSTRACT A microgrid is a controllable ...UNCLASSIFIED Distribution Statement A: Approved for Public Release Flexible Design and Operation of a Smart Charging Microgrid Annette G... control number. 1. REPORT DATE 08 APR 2014 2. REPORT TYPE Briefing Charts 3. DATES COVERED 08-01-2014 to 09-03-2014 4. TITLE AND SUBTITLE

  7. Performance of risk-adjusted control charts to monitor in-hospital mortality of intensive care unit patients: A simulation study

    NARCIS (Netherlands)

    Koetsier, Antonie; de Keizer, Nicolette F.; de Jonge, Evert; Cook, David A.; Peek, Niels

    2012-01-01

    Objectives: Increases in case-mix adjusted mortality may be indications of decreasing quality of care. Risk-adjusted control charts can be used for in-hospital mortality monitoring in intensive care units by issuing a warning signal when there are more deaths than expected. The aim of this study was

  8. Patient, Provider, and System Factors Associated With Failure to Follow-Up Elevated Glucose Results in Patients Without Diagnosed Diabetes

    Directory of Open Access Journals (Sweden)

    Michael E. Bowen

    2017-08-01

    Full Text Available Background: Although elevated glucose values are strongly associated with undiagnosed diabetes, they are frequently overlooked. Patient, provider, and system factors associated with failure to follow-up elevated glucose values in electronic medical records (EMRs are not well described. Methods: We conducted a chart review in a comprehensive EMR with a patient portal and results management features. Established primary care patients with no known diagnosis of diabetes and ≥ 1 glucose value >125 mg/dL were included. Follow-up failure was defined as (1 no documented comment on the glucose value or result communication to the patient within 30 days or (2 no hemoglobin A 1c (HbA 1c ordered within 30 days or resulted within 12 months. Associations were examined using Wilcoxon and χ 2 tests. Results: Of 150 charts reviewed, 97 met inclusion criteria. The median glucose was 133 mg/dL, and 20% of patients had multiple values >125 mg/dL. Only 36% of elevated glucose values were followed up. No associations were observed between patient characteristics, diabetes risk factors, or provider characteristics and follow-up failures. Automated flagging of glucose values ≥140 mg/dL by highlighting them red in the EMR was not associated with improved follow-up (46% vs 32%; P = .19. Even when follow-up occurred (n = 35, only 31% completed gold standard diabetes testing (HbA 1c within 12 months. Of the resulted HbA 1c tests (n = 11, 55% were in the prediabetes range (5.7%-6.4%. Conclusions: Two-thirds of elevated glucose values were not followed up, despite EMR features facilitating results management. Greater understanding of the results management process and improved EMR functionalities to support results management are needed.

  9. Results of a multicentre randomised controlled trial of statistical process control charts and structured diagnostic tools to reduce ward-acquired meticillin-resistant Staphylococcus aureus: the CHART Project.

    Science.gov (United States)

    Curran, E; Harper, P; Loveday, H; Gilmour, H; Jones, S; Benneyan, J; Hood, J; Pratt, R

    2008-10-01

    Statistical process control (SPC) charts have previously been advocated for infection control quality improvement. To determine their effectiveness, a multicentre randomised controlled trial was undertaken to explore whether monthly SPC feedback from infection control nurses (ICNs) to healthcare workers of ward-acquired meticillin-resistant Staphylococcus aureus (WA-MRSA) colonisation or infection rates would produce any reductions in incidence. Seventy-five wards in 24 hospitals in the UK were randomised into three arms: (1) wards receiving SPC chart feedback; (2) wards receiving SPC chart feedback in conjunction with structured diagnostic tools; and (3) control wards receiving neither type of feedback. Twenty-five months of pre-intervention WA-MRSA data were compared with 24 months of post-intervention data. Statistically significant and sustained decreases in WA-MRSA rates were identified in all three arms (Pcontrol wards, but with no significant difference between the control and intervention arms (P=0.23). There were significantly more post-intervention 'out-of-control' episodes (P=0.021) in the control arm (averages of 0.60, 0.28, and 0.28 for Control, SPC and SPC+Tools wards, respectively). Participants identified SPC charts as an effective communication tool and valuable for disseminating WA-MRSA data.

  10. Control charts for health care monitoring under intermittent out-of-control behavior

    NARCIS (Netherlands)

    Albers, Willem/Wim

    Health care monitoring typically concerns attribute data with very low failure rates. Efficient control charts then signal if the waiting time till r (e.g. r≤5) failures is too small. An interesting alternative is the MAX-chart, which signals if all the associated r waiting times for a single

  11. Control charts for health care monitoring under intermittent out-of-control behavior

    NARCIS (Netherlands)

    Albers, Willem/Wim

    2011-01-01

    Health care monitoring typically concerns attribute data with very low failure rates. Efficient control charts then signal if the waiting time till r (e.g. r≤5) failures is too small. An interesting alternative is the MAX-chart, which signals if all the associated r waiting times for a single

  12. Neonatal Diagnostics: Towards Dynamic Growth Charts of Neuro-motor control

    Directory of Open Access Journals (Sweden)

    Elizabeth B Torres

    2016-11-01

    Full Text Available Current rise of neurodevelopmental disorders, poses a critical need to detect risk early in order to rapidly intervene. One of the tools Pediatricians use to track development is the standard Growth Chart. The Growth Charts are somewhat limited in predicting possible neurodevelopmental issues. They rely on linear models and assumptions of normality for physical growth data —obscuring key statistical information about possible neurodevelopmental risk in growth data that actually has accelerated, non-linear rates-of-change and variability encompassing skewed distributions. Here we use new analytics to profile growth data from 36 newborn babies that were tracked longitudinally for 5 months. By switching to incremental (velocity-based growth charts and combining these dynamic changes with underlying fluctuations in motor performance—as they transition from spontaneous random noise to a systematic signal— we demonstrate a method to detect very early stunting in the development of voluntary neuro-motor control and to flag risk of neurodevelopmental derail.

  13. The construction of control chart for PM10 functional data

    Science.gov (United States)

    Shaadan, Norshahida; Jemain, Abdul Aziz; Deni, Sayang Mohd

    2014-06-01

    In this paper, a statistical procedure to construct a control chart for monitoring air quality (PM10) using functional data is proposed. A set of daily indices that represent the daily PM10 curves were obtained using Functional Principal Component Analysis (FPCA). By means of an iterative charting procedure, a reference data set that represented a stable PM10 process was obtained. The data were then used as a reference for monitoring future data. The application of the procedure was conducted using seven-year (2004-2010) period of recorded data from the Klang air quality monitoring station located in the Klang Valley region of Peninsular Malaysia. The study showed that the control chart provided a useful visualization tool for monitoring air quality and was capable in detecting abnormality in the process system. As in the case of Klang station, the results showed that with reference to 2004-2008, the air quality (PM10) in 2010 was better than that in 2009.

  14. A circular organization chart promotes a hospital-wide focus on teams.

    Science.gov (United States)

    Fanning, M M

    1997-01-01

    Our Lady of the Way Hospital, like most hospitals in the late 1980s and early 1990s, exemplified the bureaucratic organization represented by the traditional "line and box organization chart." Additionally, as in most small hospitals, the CEO of Our Lady of the Way Hospital--a 39-bed, JCAHO accredited, general, acute care hospital in Martin, Kentucky--had direct management responsibility for several functional departments. In 1992, administration replaced the traditional, hierarchical organization chart with a circular structure that reflected its increased reliance on team processes throughout the organization. The new structure also significantly reduced the number of reporting assignments to the CEO. This article describes the hospital's transition to a team-based organization, illustrates the application of a circular organization chart, and assesses its value and limitations.

  15. Positive Predictive Values of International Classification of Diseases, 10th Revision Coding Algorithms to Identify Patients With Autosomal Dominant Polycystic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Vinusha Kalatharan

    2016-12-01

    Full Text Available Background: International Classification of Diseases, 10th Revision codes (ICD-10 for autosomal dominant polycystic kidney disease (ADPKD is used within several administrative health care databases. It is unknown whether these codes identify patients who meet strict clinical criteria for ADPKD. Objective: The objective of this study is (1 to determine whether different ICD-10 coding algorithms identify adult patients who meet strict clinical criteria for ADPKD as assessed through medical chart review and (2 to assess the number of patients identified with different ADPKD coding algorithms in Ontario. Design: Validation study of health care database codes, and prevalence. Setting: Ontario, Canada. Patients: For the chart review, 201 adult patients with hospital encounters between April 1, 2002, and March 31, 2014, assigned either ICD-10 codes Q61.2 or Q61.3. Measurements: This study measured positive predictive value of the ICD-10 coding algorithms and the number of Ontarians identified with different coding algorithms. Methods: We manually reviewed a random sample of medical charts in London, Ontario, Canada, and determined whether or not ADPKD was present according to strict clinical criteria. Results: The presence of either ICD-10 code Q61.2 or Q61.3 in a hospital encounter had a positive predictive value of 85% (95% confidence interval [CI], 79%-89% and identified 2981 Ontarians (0.02% of the Ontario adult population. The presence of ICD-10 code Q61.2 in a hospital encounter had a positive predictive value of 97% (95% CI, 86%-100% and identified 394 adults in Ontario (0.003% of the Ontario adult population. Limitations: (1 We could not calculate other measures of validity; (2 the coding algorithms do not identify patients without hospital encounters; and (3 coding practices may differ between hospitals. Conclusions: Most patients with ICD-10 code Q61.2 or Q61.3 assigned during their hospital encounters have ADPKD according to the clinical

  16. Did Not Wait Patient Management Strategy (DNW PMS) Study.

    LENUS (Irish Health Repository)

    O'Keeffe, Fran

    2011-06-14

    Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists\\' review of all \\'did not wait\\' (DNW) patients\\' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution. Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients\\' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol\\/drug overdose (p=0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients\\' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.

  17. Did Not Wait Patient Management Strategy (DNW PMS) Study.

    LENUS (Irish Health Repository)

    2012-02-01

    Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists\\' review of all \\'did not wait\\' (DNW) patients\\' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution. Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients\\' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol\\/drug overdose (p=0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients\\' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.

  18. Photometric Compliance of Tablet Screens and Retro-Illuminated Acuity Charts As Visual Acuity Measurement Devices.

    Science.gov (United States)

    Livingstone, I A T; Tarbert, C M; Giardini, M E; Bastawrous, A; Middleton, D; Hamilton, R

    2016-01-01

    Mobile technology is increasingly used to measure visual acuity. Standards for chart-based acuity tests specify photometric requirements for luminance, optotype contrast and luminance uniformity. Manufacturers provide some photometric data but little is known about tablet performance for visual acuity testing. This study photometrically characterised seven tablet computers (iPad, Apple inc.) and three ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity charts with room lights on and off, and compared findings with visual acuity measurement standards. Tablet screen luminance and contrast were measured using nine points across a black and white checkerboard test screen at five arbitrary brightness levels. ETDRS optotypes and adjacent white background luminance and contrast were measured. All seven tablets (room lights off) exceeded the most stringent requirement for mean luminance (≥ 120 cd/m2) providing the nominal brightness setting was above 50%. All exceeded contrast requirement (Weber ≥ 90%) regardless of brightness setting, and five were marginally below the required luminance uniformity threshold (Lmin/Lmax ≥ 80%). Re-assessing three tablets with room lights on made little difference to mean luminance or contrast, and improved luminance uniformity to exceed the threshold. The three EDTRS charts (room lights off) had adequate mean luminance (≥ 120 cd/m2) and Weber contrast (≥ 90%), but all three charts failed to meet the luminance uniformity standard (Lmin/Lmax ≥ 80%). Two charts were operating beyond manufacturer's recommended lamp replacement schedule. With room lights on, chart mean luminance and Weber contrast increased, but two charts still had inadequate luminance uniformity. Tablet computers showed less inter-device variability, higher contrast, and better luminance uniformity than charts in both lights-on and lights-off environments, providing brightness setting was >50%. Overall, iPad tablets matched or marginally out

  19. Photometric Compliance of Tablet Screens and Retro-Illuminated Acuity Charts As Visual Acuity Measurement Devices.

    Directory of Open Access Journals (Sweden)

    I A T Livingstone

    Full Text Available Mobile technology is increasingly used to measure visual acuity. Standards for chart-based acuity tests specify photometric requirements for luminance, optotype contrast and luminance uniformity. Manufacturers provide some photometric data but little is known about tablet performance for visual acuity testing. This study photometrically characterised seven tablet computers (iPad, Apple inc. and three ETDRS (Early Treatment Diabetic Retinopathy Study visual acuity charts with room lights on and off, and compared findings with visual acuity measurement standards. Tablet screen luminance and contrast were measured using nine points across a black and white checkerboard test screen at five arbitrary brightness levels. ETDRS optotypes and adjacent white background luminance and contrast were measured. All seven tablets (room lights off exceeded the most stringent requirement for mean luminance (≥ 120 cd/m2 providing the nominal brightness setting was above 50%. All exceeded contrast requirement (Weber ≥ 90% regardless of brightness setting, and five were marginally below the required luminance uniformity threshold (Lmin/Lmax ≥ 80%. Re-assessing three tablets with room lights on made little difference to mean luminance or contrast, and improved luminance uniformity to exceed the threshold. The three EDTRS charts (room lights off had adequate mean luminance (≥ 120 cd/m2 and Weber contrast (≥ 90%, but all three charts failed to meet the luminance uniformity standard (Lmin/Lmax ≥ 80%. Two charts were operating beyond manufacturer's recommended lamp replacement schedule. With room lights on, chart mean luminance and Weber contrast increased, but two charts still had inadequate luminance uniformity. Tablet computers showed less inter-device variability, higher contrast, and better luminance uniformity than charts in both lights-on and lights-off environments, providing brightness setting was >50%. Overall, iPad tablets matched or marginally out

  20. Orthognathic Surgery in Patients With Congenital Myopathies and Congenital Muscular Dystrophies: Case Series and Review of the Literature.

    Science.gov (United States)

    Bezak, Brett J; Arce, Kevin A; Jacob, Adam; Van Ess, James

    2016-03-01

    This case series examined preoperative findings and the surgical, anesthetic, and postoperative management of 6 patients with congenital myopathies (CMs) and congenital muscular dystrophies (CMDs) treated at a tertiary medical institution with orthognathic surgery over 15 years to describe pertinent considerations for performing orthognathic surgery in these complex patients. According to the institutional review board-approved protocol, chart records were reviewed for all orthognathic surgical patients with a clinical, genetic, or muscle biopsy-proved diagnosis of CM or CMD. Six patients (5 male, 1 female) qualified, and they were treated by 4 surgeons in the division of oral and maxillofacial surgery from 1992 through 2007. Average age was 19.5 years at the time of orthognathic surgery. Five patients had Class III malocclusions and 1 patient had Class II malocclusion. All 6 patients had apertognathia with lip incompetence. Nasoendotracheal intubation with a difficulty of 0/3 (0=easiest, 3=most difficult) was performed in all cases. Routine induction and maintenance anesthetics, including halogenated agents and nondepolarizing muscle relaxants, were administered without malignant hyperthermia. All 6 patients underwent Le Fort level osteotomies; 4 also had mandibular setback surgery with or without balancing mandibular inferior border osteotomies. Five patients required planned intensive care unit care postoperatively (average, 18.4 days; range, 4 to 65 days). Postoperative respiratory complications resulting in major blood oxygen desaturations occurred in 5 patients; 4 of these patients required reintubation during emergency code response. Five patients required extended postoperative intubation (average, 4.2 days; range, 3 to 6 days) and ventilatory support. Average hospital length of stay was 21.8 days (range, 6 to 75 days). Average postoperative follow-up interval was 29.8 weeks (range, 6 to 128 weeks). Patients with CMs or CMDs often have characteristic

  1. Charting environmental pollution. [by noise measurements

    Science.gov (United States)

    Halpert, E.; Bizo, F.; Karacsonyi, Z.

    1974-01-01

    It is found that areas affected by different noxious agents are within the limits traced for high noise level areas; consequently, it is suggested that high noise pressure levels should be used as the primary indication of environmental pollution. A complex methodology is reported for charting environmental pollution due to physical, chemical and biological noxious agents on the scale of an industrial district.

  2. Risk stratification and stroke prevention therapy care gaps in Canadian atrial fibrillation patients (from the Co-ordinated National Network to Engage Physicians in the Care and Treatment of Patients With Atrial Fibrillation chart audit).

    Science.gov (United States)

    Patel, Ashish D; Tan, Mary K; Angaran, Paul; Bell, Alan D; Berall, Murray; Bucci, Claudia; Demchuk, Andrew M; Essebag, Vidal; Goldin, Lianne; Green, Martin S; Gregoire, Jean C; Gross, Peter L; Heilbron, Brett; Lin, Peter J; Ramanathan, Krishnan; Skanes, Allan; Wheeler, Bruce H; Goodman, Shaun G

    2015-03-01

    The objectives of this national chart audit (January to June 2013) of 6,346 patients with atrial fibrillation (AF; ≥18 years without a significant heart valve disorder) from 647 primary care physicians were to (1) describe the frequency of stroke and bleed risk assessments in patients with nonvalvular AF by primary care physicians, including the accuracy of these assessments relative to established predictive indexes; (2) outline contemporary methods of anticoagulation used; and (3) report the time in the therapeutic range among patients prescribed warfarin. An annual stroke risk assessment was not undertaken in 15% and estimated without a formal risk tool in 33%; agreement with CHADS2 score estimation was seen in 87% of patients. Major bleeding risk assessment was not undertaken in 25% and estimated without a formal risk tool in 47%; agreement with HAS-BLED score estimation was observed in 64% with physician overestimation in 26% of patients. Antithrombotic therapy included warfarin (58%), dabigatran (22%), rivaroxaban (14%), and apixaban (risk for stroke. There is apparent overestimation of bleeding risk in many patients. Warfarin was the dominant stroke prevention treatment; however, the suggested TTR target was achieved in only 55% of these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. SIZE CHART FOR SOCKS FOR SCHOOL BOYS IN SRI LANKA

    OpenAIRE

    Lanarolle W.D.G*, Jeewandara V.K., Amadoru R.S., Wijayarathna E.K.B. and Randike H.M.

    2017-01-01

    The structure of the body of human depends on many factors. Hence the sizes and size charts for garments need to be developed for a specific nation/human group. This paper presents a size chart developed for socks for school boys in Sri Lanka. The foot and leg measurements of 2650 school boys in six different provinces of the country is used in the analysis in order to get a reasonable sample size as the foot and leg measurements may have many influences. Correlation between different f...

  4. Forecasting of mechanical - and structural behavior of 316 austenitic stainless steels by deformation charts

    International Nuclear Information System (INIS)

    Monteiro, S.N.

    1980-01-01

    The utilization of deformation charts applied to AISI 316 austenitic stainless steel with the purpose of foreseeing its behavior associated with structural and mechanical phenomena, is evaluated. The ocurrence of phenomena such as dynamic aging, martensite transformation, static aging, failure at creep curve, cells, subgrains and boundary slips is discussed in the different regions of the chart. A practical example of the charts' utilization for components of fast reactors is finally presented. (Author) [pt

  5. Body Mass Index (BMI) Charts (For Parents)

    Science.gov (United States)

    ... Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for ... charts for boys and girls to account for differences in growth rates and amounts of body fat as the two genders mature. That information is recorded in your child's ...

  6. Patient participation in patient safety and nursing input - a systematic review.

    Science.gov (United States)

    Vaismoradi, Mojtaba; Jordan, Sue; Kangasniemi, Mari

    2015-03-01

    This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Systematic review using integrative methods. Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: "patient", "healthcare provider", "task", "work environment", "organisation & management". We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Patients have a significant role to play in enhancing their own safety while receiving hospital care. This

  7. Jean Rotz and the Marine Chart, 1542

    Science.gov (United States)

    Taylor, E. G. R.

    This paper was first published in the Journal in 1954 (Vol. 7, p. 138). It is followed by comments from Michael Richey.At the time (1542) when Jean Rotz presented Henry VIII with a variation compass, and an accompanying treatise on its making and use, the question of magnetic variation was an acute one. It formed part of a wider controversy concerning the general validity of the sea-chart which had been raised among seamen. As to this, Dr Pedro Nunez, writing a treatise in 1537 addressed to his friend and pupil the Infante Dom Luys of Portugal, said that there were skilled pilots who derided the chart and declared it to be - the falsest thing in the world. Hastening to its defence, Nunez dealt at length with the navigating errors introduced by ignoring the convergence of the meridians, and showed besides that a rhumb, or line of constant bearing was a spiral curve on the globe.

  8. Orientations of BCFW charts on the Grassmannian

    International Nuclear Information System (INIS)

    Olson, Timothy M.

    2015-01-01

    The Grassmannian formulation of N=4 super Yang-Mills theory expresses tree-level scattering amplitudes as linear combinations of residues from certain contour integrals. BCFW bridge decompositions using adjacent transpositions simplify the evaluation of individual residues, but orientation information is lost in the process. We present a straightforward algorithm to compute relative orientations between the resulting coordinate charts, and we show how to generalize the technique for charts corresponding to sequences of any not-necessarily-adjacent transpositions. As applications of these results, we demonstrate the existence of a signed boundary operator that manifestly squares to zero and prove via our algorithm that any residues appearing in the tree amplitude sum are decorated with appropriate signs so all poles that appear twice cancel exactly, not just mod 2 as in previous works. We also identify other non-physical poles in the boundary of Grassmannian representations of the amplitude and justify their removal so that the final result contains only physical local poles.

  9. APLIKASI GANTT CHART PADA ALGORITMA PENJADUALAN PROSES

    Directory of Open Access Journals (Sweden)

    Sri Handayani

    2014-01-01

    Full Text Available Operating system is a compulsory subject taken in the Information Technology Student FTIK - USM . In the discussion of the material management process of the operating systems course , there are some scheduling algorithm which processes need to be understood and any existing process scheduling algorithm presented in the form of Grantt Charts . Because of the difficulties experienced by students in understanding the process of scheduling algorithms by an Operating System become researchers inspiration to conduct this study to make an application Grantt Chart.. This study uses a waterfall system development , where the flow will follow the research the phase in waterfall . This application will be built using Visual Basic 6 .  The purpose of this research is to produce an application of learning are presented in graphical form to facilitate students in understanding the material scheduling process performed by an operating system so that students can also understand how a computer can do multiple processes simultaneously.

  10. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature

    OpenAIRE

    Hershman, Stuart H.; Kunkle, William A.; Kelly, Michael P.; Buchowski, Jacob M.; Ray, Wilson Z.; Bumpass, David B.; Gum, Jeffrey L.; Peters, Colleen M.; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A.; Hsu, Wellington K.; Nassr, Ahmad; Currier, Bradford L.; Rahman, Ra?Kerry K.

    2017-01-01

    Study Design: Multicenter retrospective case series and review of the literature. Objective: To determine the rate of esophageal perforations following anterior cervical spine surgery. Methods: As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients? charts and created case report forms fo...

  11. Fire characteristics charts for fire behavior and U.S. fire danger rating

    Science.gov (United States)

    Faith Ann Heinsch; Pat Andrews

    2010-01-01

    The fire characteristics chart is a graphical method of presenting U.S. National Fire Danger Rating indices or primary surface or crown fire behavior characteristics. A desktop computer application has been developed to produce fire characteristics charts in a format suitable for inclusion in reports and presentations. Many options include change of scales, colors,...

  12. The Mythical Retention Chart and the Corruption of Dale's Cone of Experience

    Science.gov (United States)

    Subramony, Deepak Prem; Molenda, Michael; Betrus, Anthony K.; Thalheimer, Will

    2014-01-01

    In response to the wide-scale proliferation of "the cone of learning"--a fanciful retention chart confounded with Dale's Cone of Experience--the authors make four major claims debunking this fantasy and provide documentary evidence to support these claims. The first claim is that the data in the mythical retention chart do not make…

  13. Previous Attempts to Debunk the Mythical Retention Chart and Corrupted Dale's Cone

    Science.gov (United States)

    Subramony, Deepak Prem; Molenda, Michael; Betrus, Anthony K.; Thalheimer, Will

    2014-01-01

    Critics have been attempting to debunk the mythical retention chart at least since 1971. The earliest critics, David Curl and Frank Dwyer, were addressing just the retention data. Beginning around 2002, a new generation of critics has taken on the illegitimate combination of the retention chart and Edgar Dale's Cone of Experience--the corrupted…

  14. Chart Smart: A Need for Documentation and Billing Education Among Emergency Medicine Residents?

    Directory of Open Access Journals (Sweden)

    Brian Dawson, MD

    2010-05-01

    Full Text Available Objective: The healthcare chart is becoming ever more complex, serving clinicians, patients, third party payers, regulators, and even medicolegal parties. The purpose of this study was to identify our emergency medicine (EM resident and attending physicians’ current knowledge and attitudes about billing and documentation practices. We hypothesized that resident and attending physicians would identify billing and documentation as an area in which residents need further education.Methods: We gave a 15-question Likert survey to resident and attending physicians regarding charting practices, knowledge of billing and documentation, and opinions regarding need for further education.Results: We achieved a 100% response rate, with 47% (16/34 of resident physicians disagreeing or strongly disagreeing that they have adequate training in billing and documentation, while 91% (31/34 of residents and 95% (21/22 of attending physicians identified this skill as important to a resident’s future practice. Eighty-two percent (28/34 of resident physicians and 100% of attending physicians recommended further education for residents.Conclusion: Residents in this academic EM department identified a need for further education in billing and documentation practices. [West J Emerg Med. 2010;11(2: 116-119.

  15. Statistical Design of an Adaptive Synthetic X- Control Chart with Run Rule on Service and Management Operation

    Directory of Open Access Journals (Sweden)

    Shucheng Yu

    2016-01-01

    Full Text Available An improved synthetic X- control chart based on hybrid adaptive scheme and run rule scheme is introduced to enhance the statistical performance of traditional synthetic X- control chart on service and management operation. The proposed scientific hybrid adaptive schemes consider both variable sampling interval and variable sample size scheme. The properties of the proposed chart are obtained using Markov chain approach. An extensive set of numerical results is presented to test the effectiveness of the proposed model in detecting small and moderate shifts in the process mean. The results show that the proposed chart is quicker than the standard synthetic X- chart and CUSUM chart in detecting small and moderate shifts in the process of service and management operation.

  16. Charting Ingredients for Life

    Science.gov (United States)

    2005-01-01

    [figure removed for brevity, see original site] Figure 1: Spectrum Charts Light from a Faraway Galaxy This graph, or spectrum, charts light from a faraway galaxy located 10 billion light years from Earth. It tracks mid-infrared light from an extremely luminous galaxy when the universe was only 1/4 of its current age. Spectra are created when an instrument called a spectrograph spreads light out into its basic parts, like a prism turning sunlight into a rainbow. They reveal the signatures, or 'fingerprints,' of molecules that make up a galaxy and contribute to its light. Spitzer's infrared spectrometer identified characteristic fingerprints of complex organic molecules called polycyclic aromatic hydrocarbons, illustrated in the artist's concept in the inset. These large molecules comprised of carbon and hydrogen, are considered among the building blocks of life. Scientists determined it took 10 billion years for photons from this galaxy to reach Spitzer's infrared eyes. These complex carbon and hydrogen molecules are from a young galaxy which is undergoing intense star formation, at the time the universe was only 3.5 billion years old. These distant galaxies with enormous amounts of gas being converted into young stars are some of the most luminous objects in the sky. Enshrouded by dust, they are only faint, inconspicuous little dots in optical images. They are as bright as 10 trillion suns put together and 10 times brighter than starburst galaxies seen in our local universe. This prompts a fascinating question as to what physical process is driving such enormous energy production in these galaxies when the universe is so young. These data were taken by Spitzer's infrared spectrograph in August and September 2004.

  17. Socio-economic status of AIDS patients

    DEFF Research Database (Denmark)

    Laursen, E; Larsen, L

    1995-01-01

    The charts of 187 patients diagnosed at Hvidovre University Hospital, Copenhagen from 1981 through 1989 as having AIDS were reviewed retrospectively in order to examine the extent of their employment and alternative sources of income during the first 2 years after diagnosis. At the time...... of diagnosis. After 2 years, only 6% still worked, while 22% had a pension. Sixty-seven percent had died. The major source of income during these first 2 years after diagnosis was a pension, most often a disability pension. During this period the total average disbursement of public allowances per patient...... amounted to US$16,150. As shown here, the work capacity of AIDS patients is quite low, and alternative sources of income must be provided....

  18. [Characteristics of systematic reviews about the impact of pharmacists].

    Science.gov (United States)

    Tanguay, C; Guérin, A; Bussières, J-F

    2014-11-01

    The pharmacists' role is varied and numerous articles evaluate the outcomes of pharmaceutical interventions. The main objectives of this study were to establish the characteristics of systematic reviews about pharmacists' interventions that were published in the last five years. A literature search was performed on Pubmed for French and English articles published between 01-01-2008 and 31-05-2013. Systematic reviews that presented the role, the interventions and the impact of pharmacists were selected by two research assistants. A total of 46 systematic reviews was identified, amongst which one third (n=15/46, 33 %) were meta-analyses. A quarter of systematic reviews did not evaluate the quality of included articles (n=13/46, 28 %). Twelve themes were identified. A median [min-max] of 16 [2-298] articles was included per systematic review. The most frequent pharmaceutical activities were patient counseling (n=41 systematic reviews), patient chart review (n=29), pharmacotherapy evaluation (n=27) and recommendations (n=26). The least frequent activities were teaching others than patients (n=12) and medical rounds participation (n=7). Many elements can influence the completion of pharmacy practice research projects; however, there exists no link between the presence of systematic reviews and the importance of pharmacists in a given healthcare program. This study presents the characteristics of 46 systematic reviews about pharmacists interventions published since 2008. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. A Watercolor NPR System with Web-Mining 3D Color Charts

    Science.gov (United States)

    Chen, Lieu-Hen; Ho, Yi-Hsin; Liu, Ting-Yu; Hsieh, Wen-Chieh

    In this paper, we propose a watercolor image synthesizing system which integrates the user-personalized color charts based on web-mining technologies with the 3D Watercolor NPR system. Through our system, users can personalize their own color palette by using keywords such as the name of the artist or by choosing color sets on an emotional map. The related images are searched from web by adopting web mining technology, and the appropriate colors are extracted to construct the color chart by analyzing these images. Then, the color chart is rendered in a 3D visualization system which allows users to view and manage the distribution of colors interactively. Then, users can use these colors on our watercolor NPR system with a sketch-based GUI which allows users to manipulate watercolor attributes of object intuitively and directly.

  20. The Effect of Autocorrelation on the Hotelling T-2 Control Chart

    DEFF Research Database (Denmark)

    Vanhatalo, Erik; Kulahci, Murat

    2015-01-01

    One of the basic assumptions for traditional univariate and multivariate control charts is that the data are independent in time. For the latter, in many cases, the data are serially dependent (autocorrelated) and cross-correlated because of, for example, frequent sampling and process dynamics......- correlation structures for different magnitudes of shifts in the process mean is not fully explored in the literature. In this article, the performance of the Hotelling T-2 control chart for different shift sizes and various autocorrelation and cross- correlation structures are compared based on the average...... and using the raw data with adjusted control limits calculated through Monte Carlo simulations; and (iii) constructing the control chart for the residuals from a multivariate time series model fitted to the raw data. To limit the complexity, we use a first-order vector autoregressive process and focus...