Sample records for patient records court

  1. 25 CFR 11.908 - Court records. (United States)


    ... INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Children's Court § 11.908 Court records. (a) A record of all hearings under §§ 11.900-11.1114 of this part shall be made and preserved. (b) All children's court records shall be confidential and shall not be...

  2. Court Upholds Confidentiality of Research Records/Data. (United States)

    Florio, David H.


    Reviews the background of the Forsham v Harris case and discusses the implications of the Supreme Court's ruling that research records and data of federally funded grantees are not considered federal agency records subject to disclosure under the Freedom of Information Act. (Author/GC)

  3. 19 CFR 176.11 - Transmission of records to Court of International Trade. (United States)


    ... SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) PROCEEDINGS IN THE COURT OF INTERNATIONAL TRADE Transmission of Records § 176.11 Transmission of records to Court of International Trade. Upon receipt of service of a summons in an action initiated in the Court of International Trade the following items shall...

  4. Comparison of victims' reports and court records of intimate partner violence perpetrators' criminal case outcomes. (United States)

    Bell, Margret E; Larsen, Sadie E; Goodman, Lisa A; Dutton, Mary Ann


    Intimate partner violence (IPV) victims often report feeling confused and uninformed about court proceedings, including even about the final disposition of the case against their partner. This is problematic because victims' decisions in responding to subsequent abuse may be significantly influenced by their beliefs about the outcomes of prior court experiences. Also, researchers often rely on victim report of court case outcomes; discrepancies between women's reports and official records may account for some of the conflicting findings in the empirical literature. In the current study, we compared the reports of case outcome given by 81 women recruited immediately after the final hearing of an IPV-related criminal case against their perpetrator with court records of case outcome. Findings revealed a fair level of agreement between women's reports and court files that was significantly different from the level of agreement expected by chance, but far from perfect. Level of agreement increased substantially when cases involving suspended sentences were removed. In reviewing these findings, we discuss the extent to which results can or cannot be interpreted as reflecting the accuracy of women's knowledge and review their implications for IPV researchers and court systems.

  5. Visual patient records

    NARCIS (Netherlands)

    Luu, M.D.


    Patient information is often complex and fragmented; visualization can help to obtain and communicate insights. To move from paper medical records to interactive and visual patient records is a big challenge. This project aims to move towards this ultimate goal by providing an interactive prototype

  6. Records of the Chernobyl court. Excerpts from Karpan's book 'Revenge of Peaceful Atom'

    International Nuclear Information System (INIS)

    Hirano, Shin-ichiro


    The trial took place in July 1987, and it was a speedy trial of three weeks until the ruling from indictment reading. The court was virtually 'closed.' The accused were the following 6 persons: Director of Chernobyl NPP, power plant chief engineer, power plant deputy chief engineer, second reactor work center chief, Chernobyl NPP National Nuclear Energy Supervisory Board inspector, and power plant night shift chief. Court records or court documents have not officially published as of March 2013. These court records have been reconstructed from the memos of Nikolay Karpan (Chernobyl NPP nuclear safety ex-deputy chief engineer), who recorded them at a time when he appeared in the court as a witness, and when he attended the court for hearing. The impressions of the translator are as follows. (1) The first purpose of the trial was to promptly punish responsible persons, and to put an end to the accident. (2) Emphasis was not placed on the investigation of the accident cause or accident background. (3) As Mr. Karpan pointed out, this trial gave impression that it was 'farce' according to certain 'scenario' or 'fixed game' that was held in order to conclude that the accident was caused by the sins of accused persons. As for the defects of the nuclear reactor as the defendants pointed out, they were dismissed as 'separate issues to be addressed,' and eliminated from judgment contents. (4) All the accused denied the indictment contents (asserting the inadequacy of the reactor itself, deficiencies of regulations and documentations, and deficit of authority). However, they admitted the moral responsibility for being unable to prevent the accident. All the defendants received actual prison term of 2 to 10 years with correctional labor. (A.O.)

  7. Clinical factors associated with rape victims' ability to testify in court: a records-based study of final psychiatric recommendation to court. (United States)

    Phaswana, T D; Van der Westhuizen, D; Krüger, C


    A rape victim may encounter professionals in both the health and the legal systems. Unanswered questions remain about clinical factors associated with a rape victim's ability to testify in court, and the quality of care offered to rape victims. The objectives of this study were thus to determine the clinical factors that are associated with a rape victim's ability to testify in court, as well as to undertake a preliminary exploration of the referral system between the court and the mental health services. A retrospective study was conducted of rape victims referred by the court (n=70) to be assessed psycho-legally by psychiatrists. Rape victims who were recommended as able and those recommended as unable to testify in court were compared with regard to their clinical characteristics. Thirty-seven (53.6%) victims were recommended as able to testify and 32 (46.4%) victims as unable to testify in court. Victims from rural areas and victims with severe mental retardation were statistically significantly more often found to be unable to testify in court. Almost half (49.2%) of the victims were referred by court for first assessment within six months of being raped. Most (63.5%) victims were assessed for the first time within one month of being referred. The decision about a victim's ability to testify should not be based solely on the two statistically significant variables but, rather, individualised. Optimal mental health and legal services should be offered to rape victims. Further studies are required in assessing the collaboration between the health and legal systems.

  8. Patients' thoughts on patient- retained medical records

    African Journals Online (AJOL)

    was also thought to motivate the patients to act on the advice given, and the records also served as a reminder to take their ... to use it and to standardise the information that is recorded; and health planners should be motivated to implement .... Table I: Combined list of themes identified and quotations supporting them.

  9. "Boarding" Psychiatric Patients in Emergency Rooms: One Court Says "No More". (United States)

    Appelbaum, Paul S


    "Boarding" involuntary psychiatric patients in medical emergency rooms is common in many parts of the United States. The practice, driven by a shortage of alternative resources, including limited inpatient capacity, can result in patients' being held for days without treatment or a hospital room, often in busy corridors or treatment rooms. A recent challenge to this practice led the Washington Supreme Court to declare it illegal and resulted in the appropriation of substantial funding to create new psychiatric beds. Centralized psychiatric crisis services, with appropriate payment models, may offer another approach to reducing the need for holding patients awaiting inpatient admission.

  10. Checking Interceptions and Audio Video Recordings by the Court after Referral

    Directory of Open Access Journals (Sweden)

    Sandra Grădinaru


    Full Text Available In any event, the prosecutor and the judiciary should pay particular attention to the risk of theirfalsification, which can be achieved by taking only parts of conversations or communications that took place in thepast and are declared to be registered recently, or by removing parts of conversations or communications, or evenby the translation or removal of images. This is why the legislature provided an express provision for theirverification. Provisions of art. 916 Paragraph 1 Criminal Procedure Code offers the possibility of a technicalexpertise regarding the originality and continuity of the records, at the prosecutor's request, the parties or exofficio, where there are doubts about the correctness of the registration in whole or in part, especially if notsupported by all the evidence. Therefore, audio or video recordings serve themselves as evidence in criminalproceedings, if not appealed or confirmed by technical expertise, if there were doubts about their conformity withreality. In the event that there is lack of expertise from the authenticity of records, they will not be accepted asevidence in solving a criminal case, thus eliminating any probative value of the intercepted conversations andcommunications in that case, by applying article 64 Par. 2 Criminal Procedure Code.

  11. Patient records and clinical overview

    DEFF Research Database (Denmark)

    Jensen, Lotte Groth

    the possibilities to mark up pages in personal ways and add personal notes to it. On the other hand, the EPR provides quick and easy access to lot of information and once information is entered in the EPR they stay in place. Information in the EPR is often updated due to real time entry, which avoid...... that information has to travel physically between different departments or different hospitals. Another advantage in the creation of clinical overview, when using an EPR, is that the record is never lost. If you have access to a computer, you have access to the record. Besides this, the search function...... at hospitals, these results indicate that you need to think besides the presentation of information. If the physicians are supposed to create an overview, information should be presented in ways that enables them to interpret and make sense of this information. At the same time, to support the creation...

  12. Providing a complete online multimedia patient record. (United States)

    Dayhoff, R. E.; Kuzmak, P. M.; Kirin, G.; Frank, S.


    Seamless integration of all types of patient data is a critical feature for clinical workstation software. The Dept. of Veterans Affairs has developed a multimedia online patient record that includes traditional medical chart information as well as a wide variety of medical images from specialties such as cardiology, pulmonary and gastrointestinal medicine, pathology, radiology, hematology, and nuclear medicine. This online patient record can present data in ways not possible with a paper chart or other physical media. Obtaining a critical mass of information online is essential to achieve the maximum benefits from an integrated patient record system. Images Figure 1 Figure 2 PMID:10566357

  13. A prototype of a computerized patient record. (United States)

    Adelhard, K; Eckel, R; Hölzel, D; Tretter, W


    Computerized medical record systems (CPRS) should present user and problem oriented views of the patient file. Problem lists, clinical course, medication profiles and results of examinations have to be recorded in a computerized patient record. Patient review screens should give a synopsis of the patient data to inform whenever the patient record is opened. Several different types of data have to be stored in a patient record. Qualitative and quantitative measurements, narratives and images are such examples. Therefore, a CPR must also be able to handle these different data types. New methods and concepts appear frequently in medicine. Thus a CPRS must be flexible enough to cope with coming demands. We developed a prototype of a computer based patient record with a graphical user interface on a SUN workstation. The basis of the system are a dynamic data dictionary, an interpreter language and a large set of basic functions. This approach gives optimal flexibility to the system. A lot of different data types are already supported. Extensions are easily possible. There is also almost no limit concerning the number of medical concepts that can be handled by our prototype. Several applications were built on this platform. Some of them are presented to exemplify the patient and problem oriented handling of the CPR.

  14. Patient Perceptions of Electronic Health Records (United States)

    Lulejian, Armine


    Research objective. Electronic Health Records (EHR) are expected to transform the way medicine is delivered with patients/consumers being the intended beneficiaries. However, little is known regarding patient knowledge and attitudes about EHRs. This study examined patient perceptions about EHR. Study design. Surveys were administered following…

  15. Sharing electronic health records: the patient view

    Directory of Open Access Journals (Sweden)

    John Powell


    Full Text Available The introduction of a national electronic health record system to the National Health Service (NHS has raised concerns about issues of data accuracy, security and confidentiality. The primary aim of this project was to identify the extent to which primary care patients will allow their local electronic record data to be shared on a national database. The secondary aim was to identify the extent of inaccuracies in the existing primary care records, which will be used to populate the new national Spine. Fifty consecutive attenders to one general practitioner were given a paper printout of their full primary care electronic health record. Participants were asked to highlight information which they would not want to be shared on the national electronic database of records, and information which they considered to be incorrect. There was a 62% response rate (31/50. Five of the 31 patients (16% identified information that they would not want to be shared on the national record system. The items they identified related almost entirely to matters of pregnancy, contraception, sexual health and mental health. Ten respondents (32% identified incorrect information in their records (some of these turned out to be correct on further investigation. The findings in relation to data sharing fit with the commonly held assumption that matters related to sensitive or embarrassing issues, which may affect how the patient will be treated by other individuals or institutions, are most likely to be censored by patients. Previous work on this has tended to ask hypothetical questions concerning data sharing rather than examine a real situation. A larger study of representative samples of patients in both primary and secondary care settings is needed to further investigate issues of data sharing and consent.

  16. 78 FR 45454 - Patient Access to Records (United States)


    ... regarding current and future health care. Removing barriers to a veteran's access to VA records will support... patient autonomy and shared decision making. Removing this regulation will directly benefit veterans by... property, Infants and children, Inventions and patents, Parking, Penalties, Privacy, Reporting and...

  17. [Nutritional status recording in hospitalized patient notes]. (United States)

    Matos, L; Teixeira, M A; Henriques, A; Tavares, M M; Alvares, L; Antunes, A; Amaral, Teresa F


    The prevalence of disease-related malnutrition (DRM) is described to be of 30-60% on admission to hospital, and of 10% in the community. It has been associated with worse clinical outcomes, namely higher morbidity and mortality as well as higher frequency of health care and its associated costs. The lack of screening and monitoring of nutritional status have been said to be risk factors for the increased prevalence of DRM during hospital stay. The aims of this study were to evaluate the importance given by health care professionals to certain aspects related with nutritional status (weight, food intake) of hospital patients and to see if there were any differences between the under and non undernourished ones. A systematic sample of patients from six hospitals was collected. Pregnancy, paediatric age and critical illness were exclusion criteria as well as incapacity to fulfil nutritional risk screening protocol and length-of-stay less than 24h. Socio-demographic, anthropometric data and clinical notes (e.g. weight, food/nutrient intake) from medical records were collected and Nutritional Risk Screening 2002 protocol was applied. A total of 1152 patients were included in this study. The prevalence of nutritional risk varied between 28.5% and 47.3% while undernutrition classified by anthropometrical parameters was considerably lower (6.3% to 14.9%). Two thirds of the patients had their food intake monitored and registered in medical records but only one third were weighted. Undernourished patients had their food intake more frequently monitored but their weight was less frequently measured, than the well-nourished ones. DRM prevalence amongst hospital patients on admission is significantly high. Clinical notes regarding nutritional status is rather infrequent on medical records. This study showed that urges the need to empower health care providers of the importance of the screening and monitoring of weight and food intake, on admission and during hospital stay.

  18. Patient health record on a smart card. (United States)

    Naszlady, A; Naszlady, J


    A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.

  19. UK: Welsh court reduces sentence, cites HIV status. (United States)

    Marceau, Emmanuelle


    A Welsh appeal court has reduced the sentence handed down to an offender because of his HIV status, despite his lengthy criminal record. The court reduced the sentence from five to three-and-a-half years' imprisonment.

  20. At the Supreme Court. (United States)

    Williams, Charles F.


    States that in the past juvenile courts afforded children with fewer rights than criminal courts accorded to adults accused of the same crimes. Reviews three U.S. Supreme Court cases that affirmed the constitutional rights of juvenile offenders and changed juvenile court proceedings. Discusses whether the juvenile death penalty violates…

  1. 42 CFR 491.10 - Patient health records. (United States)


    ... 42 Public Health 5 2010-10-01 2010-10-01 false Patient health records. 491.10 Section 491.10...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.10 Patient health records. (a) Records... systematically organized. (3) For each patient receiving health care services, the clinic or center maintains a...

  2. [Electronic patient record as the tool for better patient safety]. (United States)

    Schneider, Henning


    Recent studies indicate again that there is a deficit in the use of electronic health records (EHR) in German hospitals. Despite good arguments in favour of their use, such as the rapid availability of data, German hospitals shy away from a wider implementation. The reason is the high cost of installing and maintaining the EHRs, for the benefit is difficult to evaluate in monetary terms for the hospital. Even if a benefit can be shown it is not necessarily evident within the hospital, but manifests itself only in the health system outside. Many hospitals only manage to partly implement EHR resulting in increased documentation requirements which reverse their positive effect.In the United States, electronic medical records are also viewed in light of their positive impact on patient safety. In particular, electronic medication systems prove the benefits they can provide in the context of patient safety. As a result, financing systems have been created to promote the digitalisation of hospitals in the United States. This has led to a large increase in the use of IT systems in the United States in recent years. The Universitätsklinikum Eppendorf (UKE) introduced electronic patient records in 2009. The benefits, in particular as regards patient safety, are numerous and there are many examples to illustrate this position. These positive results are intended to demonstrate the important role EHR play in hospitals. A financing system of the ailing IT landscape based on the American model is urgently needed to benefit-especially in terms of patient safety-from electronic medical records in the hospital.

  3. Display methods of electronic patient record screens: patient privacy concerns. (United States)

    Niimi, Yukari; Ota, Katsumasa


    To provide adequate care, medical professionals have to collect not only medical information but also information that may be related to private aspects of the patient's life. With patients' increasing awareness of information privacy, healthcare providers have to pay attention to the patients' right of privacy. This study aimed to clarify the requirements of the display method of electronic patient record (EPR) screens in consideration of both patients' information privacy concerns and health professionals' information needs. For this purpose, semi-structured group interviews were conducted of 78 medical professionals. They pointed out that partial concealment of information to meet patients' requests for privacy could result in challenges in (1) safety in healthcare, (2) information sharing, (3) collaboration, (4) hospital management, and (5) communication. They believed that EPRs should (1) meet the requirements of the therapeutic process, (2) have restricted access, (3) provide convenient access to necessary information, and (4) facilitate interprofessional collaboration. This study provides direction for the development of display methods that balance the sharing of vital information and protection of patient privacy.

  4. HyPR Device: Mobile Support for Hybrid Patient Records

    DEFF Research Database (Denmark)

    Houben, Steven; Frost, Mads; Bardram, Jakob E


    The patient record is one of the central artifacts in medical work that is used to organize, communicate and coordinate important information related to patient care. In many hospitals a double record consisting of an electronic and paper part is maintained. This practice introduces a number of c......PR device decreases configuration work, supports mobility in clinical work and increases awareness on patient data.......The patient record is one of the central artifacts in medical work that is used to organize, communicate and coordinate important information related to patient care. In many hospitals a double record consisting of an electronic and paper part is maintained. This practice introduces a number...... introduce the HyPR Device, a device that merges the paper and electronic patient record into one system. We provide results from a clinical simulation with eight clinicians and discuss the functional, design and infrastructural requirements of such hybrid patient records. Our study suggests that the Hy...

  5. Electronic patient record: what makes care providers use it?

    NARCIS (Netherlands)

    Michel-Verkerke, M.B.


    Despite the enormous progress that is made, many healthcare professionals still experience problems regarding patient information and patient records. For a long time the expectation is that an electronic patient record (EPR) will solve these problems. In this research the factors determining the

  6. Juvenile Court Statistics - 1972. (United States)

    Office of Youth Development (DHEW), Washington, DC.

    This report is a statistical study of juvenile court cases in 1972. The data demonstrates how the court is frequently utilized in dealing with juvenile delinquency by the police as well as by other community agencies and parents. Excluded from this report are the ordinary traffic cases handled by juvenile court. The data indicate that: (1) in…

  7. Juvenile Court Statistics, 1974. (United States)

    Corbett, Jacqueline; Vereb, Thomas S.

    This report presents information on juvenile court processing of youth in the U.S. during 1974. It is based on data gathered under the National Juvenile Court Statistical Reporting System. Findings can be summarized as follows: (1) 1,252,700 juvenile delinquency cases, excluding traffic offenses, were handled by courts in the U.S. in 1974; (2) the…

  8. Clinical Databases Originating in Electronic Patient Records

    Czech Academy of Sciences Publication Activity Database

    Zvárová, Jana


    Roč. 22, č. 1 (2002), s. 43-60 ISSN 0208-5216 R&D Projects: GA MŠk LN00B107 Keywords : medical informatics * tekemedicine * electronic health record * electronic medical guidelines * decision-support systems * cardiology Subject RIV: BD - Theory of Information

  9. Digital audio recordings improve the outcomes of patient consultations

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René


    OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires...

  10. Can audio recording improve patients' recall of outpatient consultations?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    Introduction In order to give patients possibility to listen to their consultation again, we have designed a system which gives the patients access to digital audio recordings of their consultations. An Interactive Voice Response platform enables the audio recording and gives the patients access...... and those who have not (control).The audio recordings and the interviews are coded according to six themes: Test results, Treatment, Risks, Future tests, Advice and Plan. Afterwards the extent of patients recall is assessed by comparing the accuracy of the patient’s statements (interview...

  11. Collaborative Affordances of Hybrid Patient Record Technologies in Medical Work

    DEFF Research Database (Denmark)

    Houben, Steven; Frost, Mads; Bardram, Jakob E


    explored the integration of paper and digital technology, there are still a wide range of open issues in the design of technologies that integrate digital and paper-based medical records. This paper studies the use of one such novel technology, called the Hybrid Patient Record (HyPR), that is designed......The medical record is a central artifact used to organize, communicate and coordinate information related to patient care. Despite recent deployments of electronic health records (EHR), paper medical records are still widely used because of the affordances of paper. Although a number of approaches...... to digitally augment a paper medical record. We report on two studies: a field study in which we describe the benefits and challenges of using a combination of electronic and paper-based medical records in a large university hospital and a deployment study in which we analyze how 8 clinicians used the Hy...


    Directory of Open Access Journals (Sweden)

    Pedro Luiz Cortês


    Full Text Available The importance of patient records, also known as medical records, is related to different needs and objectives, as they constitute permanent documents on the health of patients. With the advancement of information technologies and systems, patient records can be stored in databases, resulting in a positive impact on patient care. Based on these considerations, a research question that arises is “what are the benefits and problems that can be seen with the use of electronic versions of medical records?” This question leads to the formulation of the following hypothesis: although problems can be identified during the process of using electronic record systems, the benefits outweigh the difficulties, thereby justifying their use. To respond to the question and test the presented hypothesis, a research study was developed with users of the same electronic record system, consisting of doctors, nurses, and administrative personnel in three hospitals located in the city of São Paulo, Brazil. The results show that, despite some problems in their usage, the benefits of electronic patient records outweigh possible disadvantages.

  13. Hybrid Patient Record – Supporting Hybrid Interaction in Clinical Wards

    DEFF Research Database (Denmark)

    Houben, Steven; Schmidt, Mathias; Frost, Mads


    Despite the widespread dissemination of the electronic health record, the paper medical record remains an important central artefact in modern clinical work. A number of new technological solutions have been proposed to mitigate some of the configuration, mobility and awareness problems that emerge...... when using this dual record setup. In this paper, we present one such technology, the HyPR device, in which a paper record is augmented with an electronic sensing platform that is designed to reduce the configuration overhead, provide awareness cues and support mobility across the patient ward. Our...

  14. Genetics in the courts

    Energy Technology Data Exchange (ETDEWEB)

    Coyle, Heather; Drell, Dan


    Various: (1)TriState 2000 Genetics in the Courts (2) Growing impact of the new genetics on the courts (3)Human testing (4) Legal analysis - in re G.C. (5) Legal analysis - GM ''peanots'', and (6) Legal analysis for State vs Miller

  15. The International Criminal Court

    DEFF Research Database (Denmark)

    Damgaard, Ciara Therése

    This article considers whether acts of international terrorism can and should be prosecuted before the International Criminal Court as crimes against humanity.......This article considers whether acts of international terrorism can and should be prosecuted before the International Criminal Court as crimes against humanity....

  16. Supreme Court Update (United States)

    Taylor, Kelley R.


    "Chief Justice Flubs Oath." "Justice Ginsburg Has Cancer Surgery." At the start of this year, those were the news headlines about the U.S. Supreme Court. But January 2009 also brought news about key education cases--one resolved and two others on the docket--of which school administrators should take particular note. The Supreme Court updates on…

  17. How patients can improve the accuracy of their medical records. (United States)

    Dullabh, Prashila M; Sondheimer, Norman K; Katsh, Ethan; Evans, Michael A


    Assess (1) if patients can improve their medical records' accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback's impact on medical record accuracy. Improving medical record' accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records' accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists' accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists' medication reconciliation logs. (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency-or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms, pharmacists responded positively to 68 percent of patient requests for

  18. Keeping record of the postoperative nursing care of patients

    Directory of Open Access Journals (Sweden)

    L. Roets


    Full Text Available The aim of this research project was to evaluate the recordkeeping of postoperative nursing care. A total of 186 randomly selected patient records were evaluated in terms of a checklist that included the most important parameters for postoperative nursing care. All the patients underwent operations under general anaesthetic in one month in a Level 3 hospital and were transferred to general wards after the operations. The data collected was analysed by means of frequencies. One finding was that the neurological status of most patients was assessed but that little attention was paid in the patient records to emotional status and physical comfort. The respiratory and circulatory status of the patients and their fluid balance were inadequately recorded. The patients were well monitored for signs of external haemorrhage, but in most cases haemorrhage was checked only once, on return from the theatre. Although the patients’ pain experience were well-monitored, follow-up actions after the administration of pharmacological agents was poor. The surgical intervention was fully described and, generally speaking, the records were complete and legible, but the signatures and ranks of the nurses were illegible. Allergies were indicated in the most important records. The researchers recommend that a comprehensive and easily usable documentation form be used in postoperative nursing care. Such a form would serve as a checklist and could ensure to a large degree that attention is given to the most important postoperative parameters. Errors and negligence could also be reduced by this means.

  19. A security analysis of the Dutch electronic patient record system

    NARCIS (Netherlands)

    van 't Noordende, G.


    In this article, we analyze the security architecture of the Dutch Electronic Patient Dossier (EPD) system. Intended as a national infrastructure for exchanging medical patient records among authorized parties (particularly, physicians), the EPD has to address a number of requirements, ranging from

  20. Security in the Dutch electronic patient record system

    NARCIS (Netherlands)

    van 't Noordende, G.


    In this article, we analyze the security architecture of the Dutch Electronic Patient Dossier (EPD) system. Intended as a mandatory infrastructure for exchanging medical records of most if not all patients in the Netherlands among authorized parties (particularly, physicians), the EPD has to address

  1. Socio-technical considerations in epilepsy electronic patient record implementation.

    LENUS (Irish Health Repository)

    Mc Quaid, Louise


    Examination of electronic patient record (EPR) implementation at the socio-technical interface. This study was based on the introduction of an anti-epileptic drug (AED) management module of an EPR in an epilepsy out-patient clinic. The objective was to introduce the module to a live clinical setting within strictly controlled conditions to evaluate its usability and usefulness.

  2. Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records. (United States)

    Quantin, Catherine; Jaquet-Chiffelle, David-Olivier; Coatrieux, Gouenou; Benzenine, Eric; Allaert, François-André


    The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  3. [Clinical decision making with regard to the granting of escorted leave for forensic patients detained by court order in a Dutch psychiatric clinic. Role of gender, disorder and the type of offence in the procedure]. (United States)

    Ter Horst, P; Jessen, A; Bogaerts, S; Spreen, M


    An increase in the length of time until the first escorted leave is granted to a patient detained by court order (tbs) results in a longer period of treatment. Physicians involved in the treatment and clinic managers are striving to reduce, in a responsible manner, the length of the period of treatment preceding the patient's first escorted leave. Forensic Psychiatric Clinic (fpk) 'De Woenselse Poort' aims to find out to what extent gender, pathology and the type of offence committed by the detainee influence the length of time that elapses before the patient's first leave is granted. We conducted a retrospective study based on patients' records. Although men use physical aggression more often than women, we found that gender, pathology and the type of offence had no influence on the length of the treatment period that preceded the granting of the patient's first escorted leave. Partly on the basis of risk management scales, clinicians judge whether the patient has adopted a more positive or a more negative attitude to risk factors relating to his or her offence. If the risk factors have become more positive, one would expect the application for leave to be made earlier. Surprisingly, this was not the case. In order to speed up the decision-making process regarding the application for leave, a clinical method for evaluating risk related treatment needs to be developed in which offence related risk factors are identified and the patient's positive or negative attitude to these risks are measured and monitored. At each treatment evaluation practitioners should be required to produce arguments that determine whether or not the patient is to be granted permission to go on leave at a particular moment.

  4. SU-E-T-502: Biometrically Accepted Patient Records

    International Nuclear Information System (INIS)

    Basavatia, A; Kalnicki, S; Garg, M; Lukaj, A; Hong, L; Fret, J; Yaparpalvi, R; Tome, W


    Purpose: To implement a clinically useful palm vein pattern recognition biometric system to treat the correct treatment plan to the correct patient each and every time and to check-in the patient into the department to access the correct medical record. Methods: A commercially available hand vein scanning system was paired to Aria and utilized an ADT interface from the hospital electronic health system. Integration at two points in Aria, version 11 MR2, first at the appointment tracker screen for the front desk medical record access and second at the queue screen on the 4D treatment console took place for patient daily time-out. A test patient was utilized to check accuracy of identification as well as to check that no unintended interactions take place between the 4D treatment console and the hand vein scanning system. This system has been in clinical use since December 2013. Results: Since implementation, 445 patients have been enrolled into our biometric system. 95% of patients learn the correct methodology of hand placement on the scanner in the first try. We have had two instances of patient not found because of a bad initial scan. We simply erased the scanned metric and the patient enrolled again in those cases. The accuracy of the match is 100% for each patient, we have not had one patient misidentified. We can state this because we still use patient photo and date of birth as identifiers. A QA test patient is run monthly to check the integrity of the system. Conclusion: By utilizing palm vein scans along with the date of birth and patient photo, another means of patient identification now exits. This work indicates the successful implementation of technology in the area of patient safety by closing the gap of treating the wrong plan to a patient in radiation oncology. FOJP Service Corporation covered some of the costs of the hardware and software of the palm vein pattern recognition biometric system

  5. SU-E-T-502: Biometrically Accepted Patient Records

    Energy Technology Data Exchange (ETDEWEB)

    Basavatia, A; Kalnicki, S; Garg, M; Lukaj, A; Hong, L [Montefiore Medical Center, Bronx, NY (United States); Fret, J [Montefiore Information Technology, Yonkers, NY (United States); Yaparpalvi, R [Montefiore Medical Center, Bronx, NY (United States); Montefiore Medical Center, Bronx, NY (United States); Tome, W [Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (United States)


    Purpose: To implement a clinically useful palm vein pattern recognition biometric system to treat the correct treatment plan to the correct patient each and every time and to check-in the patient into the department to access the correct medical record. Methods: A commercially available hand vein scanning system was paired to Aria and utilized an ADT interface from the hospital electronic health system. Integration at two points in Aria, version 11 MR2, first at the appointment tracker screen for the front desk medical record access and second at the queue screen on the 4D treatment console took place for patient daily time-out. A test patient was utilized to check accuracy of identification as well as to check that no unintended interactions take place between the 4D treatment console and the hand vein scanning system. This system has been in clinical use since December 2013. Results: Since implementation, 445 patients have been enrolled into our biometric system. 95% of patients learn the correct methodology of hand placement on the scanner in the first try. We have had two instances of patient not found because of a bad initial scan. We simply erased the scanned metric and the patient enrolled again in those cases. The accuracy of the match is 100% for each patient, we have not had one patient misidentified. We can state this because we still use patient photo and date of birth as identifiers. A QA test patient is run monthly to check the integrity of the system. Conclusion: By utilizing palm vein scans along with the date of birth and patient photo, another means of patient identification now exits. This work indicates the successful implementation of technology in the area of patient safety by closing the gap of treating the wrong plan to a patient in radiation oncology. FOJP Service Corporation covered some of the costs of the hardware and software of the palm vein pattern recognition biometric system.

  6. Can audio recording of outpatient consultations improve patient outcome?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    different departments: Orthopedics, Urology, Internal Medicine and Pediatrics. A total of 5,460 patients will be included from the outpatient clinics. All patients randomized to an intervention group are offered audio recording of their consultation. An Interactive Voice Response platform enables an audio....... The intervention will be evaluated using a questionnaire measuring different aspect of patients recall and understanding of the information given, patients need for additional information subsequent to the consultation and their overall satisfaction with the consultation. Results The study will be conducted from...

  7. Prevalence of accurate nursing documentation in patient records

    NARCIS (Netherlands)

    Paans, Wolter; Sermeus, Walter; Nieweg, Roos; van der Schans, Cees


    AIM: This paper is a report of a study conducted to describe the accuracy of nursing documentation in patient records in hospitals. Background.  Accurate nursing documentation enables nurses to systematically review the nursing process and to evaluate the quality of care. Assessing nurses' reports

  8. The computerized patient record: Where do we stand?

    NARCIS (Netherlands)

    Jaspers, M. W. M.; Knaup, P.; Schmidt, D.


    OBJECTIVES: To provide an overview of trends in research, developments and implementations of the computerized patient record (CPR) of the last two years. METHODS: We surveyed the medical informatics literature, spanning the years 2004-2005, focusing on publications on CPRs. RESULTS: The main trends

  9. Patients prefer electronic medical records - fact or fiction? (United States)

    Masiza, Melissa; Mostert-Phipps, Nicky; Pottasa, Dalenca


    Incomplete patient medical history compromises the quality of care provided to a patient while well-kept, adequate patient medical records are central to the provision of good quality of care. According to research, patients have the right to contribute to decision-making affecting their health. Hence, the researchers investigated their views regarding a paper-based system and an electronic medical record (EMR). An explorative approach was used in conducting a survey within selected general practices in the Nelson Mandela Metropole. The majority of participants thought that the use of a paper-based system had no negative impact on their health. Participants expressed concerns relating to the confidentiality of their medical records with both storage mediums. The majority of participants indicated they prefer their GP to computerise their consultation details. The main objective of the research on which this poster is based was to investigate the storage medium of preference for patients and the reasons for their preference. Overall, 48% of the 85 participants selected EMRs as their preferred storage medium and the reasons for their preference were also uncovered.


    Directory of Open Access Journals (Sweden)

    Nikolay Sapundzhiev


    Full Text Available Introduction: Oncology patients need extensive follow-up and meticulous documentation. The aim of this study was to introduce a simple, platform independent file based system for documentation of diagnostic and therapeutic procedures in oncology patients and test its function.Material and methods: A file-name based system of the type M1M2M3.F2 was introduced, where M1 is a unique identifier for the patient, M2 is the date of the clinical intervention/event, M3 is an identifier for the author of the medical record and F2 is the specific software generated file-name extension.Results: This system is in use at 5 institutions, where a total of 11 persons on 14 different workstations inputted 16591 entries (files for 2370. The merge process was tested on 2 operating systems - when copied together all files sort up as expected by patient, and for each patient in a chronological order, providing a digital cumulative patient record, which contains heterogeneous file formats.Conclusion: The file based approach for storing heterogeneous digital patient related information is an reliable system, which can handle open-source, proprietary, general and custom file formats and seems to be easily scalable. Further development of software for automatic checks of the integrity and searching and indexing of the files is expected to produce a more user-friendly environment

  11. Electronic patient record and archive of records in system for telecardiology. (United States)

    Sierdziński, Janusz; Karpiński, Grzegorz


    In modern medicine the well structured patient data set, fast access to it and reporting capability become an important question. With the dynamic development of information technology (IT) such question is solved via building electronic patient record (EPR) archives. We then obtain fast access to patient data, diagnostic and treatment protocols etc. It results in more efficient, better and cheaper treatment. The aim of the work was to design a uniform Electronic Patient Record, implemented in system for telecardiology allowing the co-operation among regional hospitals and reference centers. It includes questionnaires for demographic data and questionnaires supporting doctor's work (initial diagnosis, final diagnosis, history and physical, ECG at the discharge, applied treatment, additional tests, drugs, daily and periodical reports). The browser is implemented in EPR archive to facilitate data retrieval. Several tools for creating EPR and EPR archive were used such as: XML, PHP, Java Script and MySQL. The separate question is the security of data on WWW server. The security is ensured via Security Socket Layer (SSL) protocols and other tools. EPR in system is a module enabling the co-work of many physicians and the communication among different medical centers.

  12. Using Electronic Patient Records to Discover Disease Correlations and Stratify Patient Cohorts

    DEFF Research Database (Denmark)

    Roque, Francisco S.; Jensen, Peter B.; Schmock, Henriette


    Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracting...... phenotype information from the free-text in such records we demonstrate that we can extend the information contained in the structured record data, and use it for producing fine-grained patient stratification and disease co-occurrence statistics. The approach uses a dictionary based on the International...

  13. A Randomized Controlled Trial on the Effectiveness of Court-Type Traditional Thai Massage versus Amitriptyline in Patients with Chronic Tension-Type Headache

    Directory of Open Access Journals (Sweden)

    Peerada Damapong


    Full Text Available This study aimed to evaluate the effectiveness of the court-type traditional Thai massage (CTTM to treat patients with chronic tension-type headaches (CTTHs comparing with amitriptyline taking. A randomized controlled trial was conducted. Sixty patients diagnosed with CTTH were equally divided into a treatment and a control group. The treatment group received a 45-minute course of CTTM twice per week lasting 4 weeks while the control group was prescribed 25 mg of amitriptyline once a day before bedtime lasting 4 weeks. Outcome measures were evaluated in week 2, week 4 and followed up in week 6 consisting of visual analog scale (VAS, tissue hardness, pressure pain threshold (PPT, and heart rate variability (HRV. The results demonstrated a significant decrease in VAS pain intensity for the CTTM group at different assessment time points while a significant difference occurred in within-group and between-group comparison (P < 0.05 for each evaluated measure. Moreover, the tissue hardness of the CTTM group was significantly lower than the control group at week 4 (P < 0.05. The PPT and HRV of the CTTM group were significantly increased (P < 0.05. CTTM could be an alternative therapy for treatment of patients with CTTHs.

  14. The Impact of an Indiana (United States Drug Court on Criminal Recidivism

    Directory of Open Access Journals (Sweden)

    John R. Gallagher


    Full Text Available This study evaluated a drug court located in a metropolitan area of Indiana (United States, focusing specifically on identifying variables that predicted recidivism among drug court participants and comparing criminal recidivism patterns among drug court and probation participants. Drug court participants were most likely to recidivate if they were younger, had a violation within the first 30 days of the program, had a previous criminal record, and were terminated unsuccessfully from the program. Furthermore, drug court participants were less likely to recidivate than probationers who had similar offense and demographic characteristics. Implications for drug court practice, policy advocacy, and future research are discussed.

  15. Unity in Diversity: Electronic Patient Record Use in Multidisciplinary Practice


    Oborn, Eivor; Barrett, Michael; Davidson, Elizabeth


    In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this persp...

  16. Supreme Court Review (United States)

    Williams, Charles F.


    By the end of the 2008-2009 term, Justice David Souter's decision to return to New Hampshire and President Obama's nomination of Sonia Sotomayor to replace him on the bench had taken over the Supreme Court news cycle. In the end, the consensus has been that, with the possible exception of criminal justice issues, swapping out Souter for Sotomayor…

  17. Patient access to complex chronic disease records on the Internet

    Directory of Open Access Journals (Sweden)

    Bartlett Cherry


    Full Text Available Abstract Background Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine available to patients over the Internet in a project involving more than half of renal units in the UK. Methods Content and presentation of the Renal PatientView (RPV system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver. Results By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (90 yrs but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular

  18. Patient access to complex chronic disease records on the Internet. (United States)

    Bartlett, Cherry; Simpson, Keith; Turner, A Neil


    Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrollment and usage were extracted from the webserver. By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enroll each patient. Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no

  19. Attitudes toward inter-hospital electronic patient record exchange: discrepancies among physicians, medical record staff, and patients. (United States)

    Wang, Jong-Yi; Ho, Hsiao-Yun; Chen, Jen-De; Chai, Sinkuo; Tai, Chih-Jaan; Chen, Yung-Fu


    In this era of ubiquitous information, patient record exchange among hospitals still has technological and individual barriers including resistance to information sharing. Most research on user attitudes has been limited to one type of user or aspect. Because few analyses of attitudes toward electronic patient records (EPRs) have been conducted, understanding the attitudes among different users in multiple aspects is crucial to user acceptance. This proof-of-concept study investigated the attitudes of users toward the inter-hospital EPR exchange system implemented nationwide and focused on discrepant behavioral intentions among three user groups. The system was designed by combining a Health Level 7-based protocol, object-relational mapping, and other medical informatics techniques to ensure interoperability in realizing patient-centered practices. After implementation, three user-specific questionnaires for physicians, medical record staff, and patients were administered, with a 70 % response rate. The instrument showed favorable convergent construct validity and internal consistency reliability. Two dependent variables were applied: the attitudes toward privacy and support. Independent variables comprised personal characteristics, work characteristics, human aspects, and technology aspects. Major statistical methods included exploratory factor analysis and general linear model. The results from 379 respondents indicated that the patients highly agreed with privacy protection by their consent and support for EPRs, whereas the physicians remained conservative toward both. Medical record staff was ranked in the middle among the three groups. The three user groups demonstrated discrepant intentions toward privacy protection and support. Experience of computer use, level of concerns, usefulness of functions, and specifically, reason to use electronic medical records and number of outpatient visits were significantly associated with the perceptions. Overall, four

  20. [Problem list in computer-based patient records]. (United States)

    Ludwig, C A


    Computer-based clinical information systems are capable of effectively processing even large amounts of patient-related data. However, physicians depend on rapid access to summarized, clearly laid out data on the computer screen to inform themselves about a patient's current clinical situation. In introducing a clinical workplace system, we therefore transformed the problem list-which for decades has been successfully used in clinical information management-into an electronic equivalent and integrated it into the medical record. The table contains a concise overview of diagnoses and problems as well as related findings. Graphical information can also be integrated into the table, and an additional space is provided for a summary of planned examinations or interventions. The digital form of the problem list makes it possible to use the entire list or selected text elements for generating medical documents. Diagnostic terms for medical reports are transferred automatically to corresponding documents. Computer technology has an immense potential for the further development of problem list concepts. With multimedia applications sound and images will be included in the problem list. For hyperlink purpose the problem list could become a central information board and table of contents of the medical record, thus serving as the starting point for database searches and supporting the user in navigating through the medical record.

  1. Using electronic patient records to discover disease correlations and stratify patient cohorts.

    Directory of Open Access Journals (Sweden)

    Francisco S Roque


    Full Text Available Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracting phenotype information from the free-text in such records we demonstrate that we can extend the information contained in the structured record data, and use it for producing fine-grained patient stratification and disease co-occurrence statistics. The approach uses a dictionary based on the International Classification of Disease ontology and is therefore in principle language independent. As a use case we show how records from a Danish psychiatric hospital lead to the identification of disease correlations, which subsequently can be mapped to systems biology frameworks.

  2. Childrens Hospital Integrated Patient Electronic Record System Continuation (CHIPERS) (United States)


    Pediatric  ICU  with  severe  sepsis/shock...traumatic  brain  injury  and  pulmonary  embolus   and  in  both  adult  and   pediatric  patients.  CDS  can  be  a...record,   pediatric  critical  care,  neonatal  intensive  care,  severe  sepsis,  septic  shock   16. SECURITY CLASSIFICATION

  3. Medical ADP Systems: Automated Medical Records Hold Promise to Improve Patient Care (United States)


    automated medical records. The report discusses the potential benefits that automation could make to the quality of patient care and the factors that impede...information systems, but no organization has fully automated one of the most critical types of information, patient medical records. The patient medical record...its review of automated medical records. GAO’s objectives in this study were to identify the (1) benefits of automating patient records and (2) factors

  4. Consumers' Perceptions of Patient-Accessible Electronic Medical Records (United States)

    Vaughon, Wendy L; Czaja, Sara J; Levy, Joslyn; Rockoff, Maxine L


    Background Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. Objective The objective of the study was to identify vulnerable consumers’ response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. Methods This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. Results Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor’s visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. Conclusions Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually

  5. Impact of patients' access to medical records in occupational medicine. (United States)

    Krakov, A; Kabaha, N; Azuri, J; Moshe, S


    Information technologies offer new ways to engage with patients regarding their health, but no studies have been done in occupational health services (OHS). To examine the advantages and disadvantages of providing written and oral medical information to patients in OHS. In this cross-sectional study, data were retrieved from patients visiting four different OHS during 2014-15 for a fitness for work evaluation. We built a semi-quantitative satisfaction questionnaire, with responses ranging on a Likert scale of 1-5 from very dissatisfied (1) to very satisfied (5). There were 287 questionnaires available for analysis. The number of patients who received detailed oral and written information, which included an explanation of their health condition and of the occupational physician's (OP's) decision, was higher in clinics 1 and 3 compared to clinics 2 and 4 (48 and 38% compared to 21 and 31% respectively, P < 0.05). When patients were provided with detailed oral and written information, they declared having a better understanding (4.3 and 4.4 compared to 3.8 respectively, P < 0.001), a higher level of confidence in their OP (4.4 and 4.3 compared to 3.7 and 4 respectively, P < 0.001), a higher level of satisfaction (4.3 and 4.4 compared to 3.8 respectively, P < 0.001) and a higher sense of control and ability to correct the record (1.8 compared to 1.4 respectively, P < 0.01), compared to patients who received partial information. We recommend sharing detailed oral and written medical information with patients in OHS.

  6. Instant availability of patient records, but diminished availability of patient information: A multi-method study of GP's use of electronic patient records

    Directory of Open Access Journals (Sweden)

    Grimsmo Anders


    Full Text Available Abstract Background In spite of succesful adoption of electronic patient records (EPR by Norwegian GPs, what constitutes the actual benefits and effects of the use of EPRs in the perspective of the GPs and patients has not been fully characterized. We wanted to study primary care physicians' use of electronic patient record (EPR systems in terms of use of different EPR functions and the time spent on using the records, as well as the potential effects of EPR systems on the clinician-patient relationship. Methods A combined qualitative and quantitative study that uses data collected from focus groups, observations of primary care encounters and a questionnaire survey of a random sample of general practitioners to describe their use of EPR in primary care. Results The overall availability of individual patient records had improved, but the availability of the information within each EPR was not satisfactory. GPs' use of EPRs were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians. We found no indications of disturbance of the clinician-patient relationship by use of computers in this study. Conclusion Although GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians.

  7. [Cochlear implants in the social courts]. (United States)

    Lottner, A; Iro, H; Schützenberger, A; Hoppe, U


    Since the indication for receiving a cochlear implant (CI) has widened (single-sided deafness [SSD], electric acoustic stimulation [EAS], bilateral CI, CI for long-term deafness), more and more patients come into consideration for such a treatment. Hence, disputes increasingly arise between patients and their insurance companies concerning the question of whether surgery and follow-up treatment have to be paid for by statutory health insurance. This work provides an overview of judgments rendered by the German social courts. We investigated whether and in which cases it is advisable for a patient to go to court, and how long the proceedings may take. We looked for judgments in the two biggest commercial legal databases and in the database of the German social courts, using combinations of the search parameters "Cochlear," "Cochlea," "Implant," and "Implantat." Three verdicts were attained by directly contacting the court; another one was mentioned in an article. The reviewed judgements were issued between 2003 and 2017. A total of 12 judgments were found. The patients won in all but one of the main proceedings. The case that was lost concerned exceptional circumstances. One patient didn't get the desired interim measure, but won in the main proceedings. The proceedings took between 1 year and 8 months, and 9 years and 5 months. Despite the amount of time the patient has to invest, taking legal action is worthwhile. The proceedings at the social courts are generally exempt from charges. In most cases, the statutory health insurance is ordered to pay for a CI.


    Directory of Open Access Journals (Sweden)

    Ioana Nely Militaru


    Full Text Available Court of Justice of the European Union (CJEU performs according to its competence, the position of International Justice in solving disputes between two or more subjects of international law. International jurisdiction of the Court of Justice of the EU is - mandatory that each Member State has the opportunity to seize this court if it considers that another state violated an obligation incumbent upon it under Union Treaties; - optional in disputes between Member States in connection with the subject Union Treaties.

  9. Patient safety in out-of-hours primary care: a review of patient records

    Directory of Open Access Journals (Sweden)

    Wensing Michel


    Full Text Available Abstract Background Most patients receive healthcare in primary care settings, but relatively little is known about patient safety. Out-of-hours contacts are of particular importance to patient safety. Our aim was to examine the incidence, types, causes, and consequences of patient safety incidents at general practice cooperatives for out-of-hours primary care and to examine which factors were associated with the occurrence of patient safety incidents. Methods A retrospective study of 1,145 medical records concerning patient contacts with four general practice cooperatives. Reviewers identified records with evidence of a potential patient safety incident; a physician panel determined whether a patient safety incident had indeed occurred. In addition, the panel determined the type, causes, and consequences of the incidents. Factors associated with incidents were examined in a random coefficient logistic regression analysis. Results In 1,145 patient records, 27 patient safety incidents were identified, an incident rate of 2.4% (95% CI: 1.5% to 3.2%. The most frequent incident type was treatment (56%. All incidents had at least partly been caused by failures in clinical reasoning. The majority of incidents did not result in patient harm (70%. Eight incidents had consequences for the patient, such as additional interventions or hospitalisation. The panel assessed that most incidents were unlikely to result in patient harm in the long term (89%. Logistic regression analysis showed that age was significantly related to incident occurrence: the likelihood of an incident increased with 1.03 for each year increase in age (95% CI: 1.01 to 1.04. Conclusion Patient safety incidents occur in out-of-hours primary care, but most do not result in harm to patients. As clinical reasoning played an important part in these incidents, a better understanding of clinical reasoning and guideline adherence at GP cooperatives could contribute to patient safety.

  10. Participation, Power, Critique: Constructing a Standard for Electronic Patient Records

    DEFF Research Database (Denmark)

    Bossen, Claus


      The scope of participatory design is discussed through the case of a national standard for electronic patient records (EPR) in Denmark. Currently within participatory design, the relationship between participatory methods and techniques on the one hand and critical and emancipatory aims...... on the other hand is discussed. Some argue that participation in itself entails a strive towards democracy, others argue that the tendency to focus upon tools, techniques and the arena of single projects should be supplemented with emancipatory aims, such as technology assessment and critique of dominance....... These issues are discussed through the controversies around the test in late 2004 of a prototype application based on BEHR, a standard developed from 1999 to 2005 for EPRs. I argue that participation is valuable, but that the scope of participatory design should also include critical conceptualizations...

  11. Patients, privacy and trust: patients' willingness to allow researchers to access their medical records. (United States)

    Damschroder, Laura J; Pritts, Joy L; Neblo, Michael A; Kalarickal, Rosemarie J; Creswell, John W; Hayward, Rodney A


    The federal Privacy Rule, implemented in the United States in 2003, as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), created new restrictions on the release of medical information for research. Many believe that its restrictions have fallen disproportionately on researchers prompting some to call for changes to the Rule. Here we ask what patients think about researchers' access to medical records, and what influences these opinions. A sample of 217 patients from 4 Veteran Affairs (VA) facilities deliberated in small groups at each location with the opportunity to question experts and inform themselves about privacy issues related to medical records research. After extensive deliberation, these patients were united in their inclination to share their medical records for research. Yet they were also united in their recommendations to institute procedures that would give them more control over whether and how their medical records are used for research. We integrated qualitative and quantitative results to derive a better understanding of this apparent paradox. Our findings can best be presented as answers to questions related to five dimensions of trust: Patients' trust in VA researchers was the most powerful determinant of the kind of control they want over their medical records. More specifically, those who had lower trust in VA researchers were more likely to recommend a more stringent process for obtaining individual consent. Insights on the critical role of trust suggest actions that researchers and others can take to more fully engage patients in research.

  12. Evaluation of the process of recording patient education, consistency of record-keeping with perception, and patient satisfaction after implementing clinical supervision: An embedded evaluation

    Directory of Open Access Journals (Sweden)

    Khorasani Parvaneh


    Full Text Available Background and Objective: Currently, patient education has been considered in medical centers. Clinical provision, which is one of the legal tools with training-support dimensions, can evaluate the consistency between the implemented procedures and the planned ones. This study aimed to evaluate the process of recording patient education, consistency of record-keeping with perception, and patient satisfaction after implementing clinical supervision. Materials and Methods: This longitudinal, embedded study was conducted during 2013-2015 in three stages of designing, implementation, and evaluation of the supervision program using randomized convenience sampling on 786 monitoring units (medical records of patients being discharged at Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. In the designing stage, the checklists for supervision of recording patient education and consistency of patient perception with the recorded trainings and the patient satisfaction questionnaire were designed and their valididty and reliability were established. In the implementation stage, structure of the monitoring program was designed with the cooperation of eight supervisors. During 12 months, 2333 checklists and questionnaires were completed at the time of hospital discharge in the evaluation stage. Data analysis was performed in SPSS, version 18, using One-way ANOVA. Results: After 12 months of embedded evaluation, the mean score of recording patient education was 88.5±21.75, and the mean scores of patient satisfaction with the training process and consistency between patients’ perception and the recorded trainings were 47.17±21.48 and 73±25.13, respectively. The mean scores of recording patient training and consistency between patients’ perception and the recorded trainings had an increasing trend (P<0.001, while the mean score of patient satisfaction reduced (P<0.001. Conclusion: The results of clinical supervision during

  13. 42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records. (United States)


    ... HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.1 Statutory authority for confidentiality of drug abuse patient records. The restrictions of these regulations upon the disclosure and use of drug abuse patient records were initially authorized by section 408...

  14. Patient-centred care: using online personal medical records in IVF practice.

    NARCIS (Netherlands)

    Tuil, W.S.; Hoopen, A.J. ten; Braat, D.D.M.; Vries Robbé, P.F. de; Kremer, J.A.M.


    BACKGROUND: Generic patient-accessible medical records have shown promise in enhancing patient-centred care for patients with chronic diseases. We sought to design, implement and evaluate a patient-accessible medical record specifically for patients undergoing a course of assisted reproduction (IVF

  15. Medical narratives and patient analogs: the ethical implications of electronic patient records. (United States)

    Kluge, E H


    An electronic patient record consists of electronically stored data about a specific patient. It therefore constitutes a data-space. The data may be combined into a patient profile which is relative to a particular specialty as well as phenomenologically unique to the specific professional who constructs the profile. Further, a diagnosis may be interpreted as a path taken by a health care professional with a certain specialty through the data-space relative to the patient profile constructed by that professional. This way of looking at electronic patient records entails certain ethical implications about privacy and accessibility. However, it also permits the construction of artificial intelligence and competence algorithms for health care professionals relative to their specialties.

  16. Patient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics: A Feasibility Study. (United States)

    Nahm, Eun-Shim; Diblasi, Catherine; Gonzales, Eva; Silver, Kristi; Zhu, Shijun; Sagherian, Knar; Kongs, Katherine


    Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current

  17. Guide to Alabama Court Procedures. (United States)

    Alabama Administrative Office of Courts, Montgomery.

    Designed to assist the public in understanding the judicial system and judicial process in Alabama, this handbook (1) presents an overview of Alabama's courts and their jurisdictions, (2) identifies the officers of the courts and the contributions each makes to the judicial process, and (3) narrates in general terms the procedures most common to…

  18. International Justice through Domestic Courts:

    DEFF Research Database (Denmark)

    Tang, Yi Shin


    In April 2010, the Brazilian Supreme Federal Court (Supremo Tribunal Federal, or STF) controversially decided to uphold the country’s amnesty law, which currently prevents prosecutions for violations of human rights committed during the military dictatorship. However, the Inter-American Court...

  19. Supervisory Control and Court Management

    Directory of Open Access Journals (Sweden)

    Andreas Lienhard


    Full Text Available Court management is an essential precondition for guaranteeing the adjudication of cases. At the same time, court administration is the key focus of supervisory control. Management instruments and structures, caseload management and other elements of quality assurance including the certification of judicial authorities must therefore be accorded considerable constitutional importance.

  20. Economic outcomes of a dental electronic patient record. (United States)

    Langabeer, James R; Walji, Muhammad F; Taylor, David; Valenza, John A


    The implementation of an electronic patient record (EPR) in many sectors of health care has been suggested to have positive relationships with both quality of care and improved pedagogy, although evaluation of actual results has been somewhat disillusioning. Evidence-based dentistry clearly suggests the need for tools and systems to improve care, and an EPR is a critical tool that has been widely proposed in recent years. In dental schools, EPR systems are increasingly being adopted, despite obstacles such as high costs, time constraints necessary for process workflow change, and overall project complexity. The increasing movement towards cost-effectiveness analyses in health and medicine suggests that the EPR should generally cover expenses, or produce total benefits greater than its combined costs, to ensure that resources are being utilized efficiently. To test the underlying economics of an EPR, we utilized a pre-post research design with a probability-based economic simulation model to analyze changes in performance and costs in one dental school. Our findings suggest that the economics are positive, but only when student fees are treated as an incremental revenue source. In addition, other performance indicators appeared to have significant changes, although most were not comprehensively measured pre-implementation, making it difficult to truly understand the performance differential-such pre-measurement of expected benefits is a key lesson learned. This article also provides recommendations for dental clinics and universities that are about to embark on this endeavor.

  1. Association between personal health record enrollment and patient loyalty. (United States)

    Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne


    To examine the association between patient loyalty, as measured by member retention in the health plan, and access to My Health Manager (MHM), Kaiser Permanente's PHR, which is linked to its electronic health record, KP HealthConnect. We conducted a retrospective cohort observational quality improvement project from the third quarter of 2005 to the fourth quarter of 2008 for approximately 394,000 Kaiser Permanente Northwest members. To control for self-selection bias, we used propensity scores to perform exact 1-to-1 matching without replacement between MHM users and nonusers. We estimated retention rates of the matched data and assessed the association between MHM use and retention versus voluntary termination. We also estimated odds ratios of significant variables impacting member retention. The probability of remaining a member or being involuntarily terminated versus voluntary termination was 96.7% for users (95% confidence interval [CI], 96.6%-96.7%) and 92.2% for nonusers (95% CI, 92.1%-92.4%; P loyalty, retention is critical to healthcare organizations.

  2. Patient-Centered e-Health Record over the Cloud. (United States)

    Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilacopoulos, George; Prentza, Andrianna; Kyriazis, Dimosthenis; Malamateniou, Flora; Maglaveras, Nicos; Chouvarda, Ioanna; Mourouzis, Alexandros


    The purpose of this paper is to introduce the Patient-Centered e-Health (PCEH) conceptual aspects alongside a multidisciplinary project that combines state-of-the-art technologies like cloud computing. The project, by combining several aspects of PCEH, such as: (a) electronic Personal Healthcare Record (e-PHR), (b) homecare telemedicine technologies, (c) e-prescribing, e-referral, e-learning, with advanced technologies like cloud computing and Service Oriented Architecture (SOA), will lead to an innovative integrated e-health platform of many benefits to the society, the economy, the industry, and the research community. To achieve this, a consortium of experts, both from industry (two companies, one hospital and one healthcare organization) and academia (three universities), was set to investigate, analyse, design, build and test the new platform. This paper provides insights to the PCEH concept and to the current stage of the project. In doing so, we aim at increasing the awareness of this important endeavor and sharing the lessons learned so far throughout our work.

  3. An Ever More Powerful Court?

    DEFF Research Database (Denmark)

    Martinsen, Dorte Sindbjerg

    on the basis of a careful examination of how judicial–legislative interactions determine the scope and limits of European integration in the daily EU decision-making processes. The legislative impact of Court rulings is traced by the use of original data over time from 1957 to 2014 and through three case......Scholars generally agree that courts are powerful authorities in settling disputes between parties, but the broader political impact of such resolution is disputed. Are courts powerful generators of political change? This book examines the ability of the Court of Justice of the European Union (CJEU......) to foster political change for a European Union (EU) social policy, including healthcare. The conventional assumption is that a strong causal link exists between legal and political integration in the EU, in which Court rulings progress and shape European integration. The book challenges this view...

  4. The use of nationwide on-line prescription records improves the drug history in hospitalized patients

    DEFF Research Database (Denmark)

    Glintborg, Bente; Poulsen, Henrik E; Dalhoff, Kim P


    What is already known about this subject: Structured medication interviews improve the medication history upon hospitalization. Pharmacy records are valid lists of the prescribed medications available to individual patients. In Denmark, treating doctors now have access to their patients' pharmacy...... records through a real-time online electronic database What this study adds: Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits. Pharmacy records may be used to minimize patients' recall bias and improve the medication lists....

  5. Norwegians GPs' use of electronic patient record systems. (United States)

    Christensen, Tom; Faxvaag, Arild; Loerum, Hallvard; Grimsmo, Anders


    To evaluate GPs use of three major electronic patient record systems with emphasis on the ability of the systems to support important clinical tasks and to compare the findings with results from a study of the three major hospital-wide systems. A national, cross-sectional questionnaire survey was conducted in Norwegian primary care. 247 (73%) of 338 GPs responded. Proportions of the respondents who reported to use the EPR system to conduct 23 central clinical tasks, differences in the proportions of users of different EPR systems and user satisfaction and perceived usefulness of the EPR system were measured. The GPs reported extensive use of their EPR systems to support clinical tasks. There were no significant differences in functionality between the systems, but there were differences in reported software and hardware dysfunction and user satisfaction. The respondents reported high scores in computer literacy and there was no correlation between computer usage and respondent age or gender. A comparison with hospital physicians' use of three hospital-wide EPR systems revealed that GPs had higher usage than the hospital-based MDs. Primary care EPR systems support clinical tasks far better than hospital systems with better overall user satisfaction and reported impact on the overall quality of the work. EPR systems in Norwegian primary care that have been developed in accordance with the principles of user-centered design have achieved widespread adoption and highly integrated use. The quality and efficiency of the clinical work has increased in contrast to the situation of their hospital colleagues, who report more modest use and benefits of EPR systems.

  6. Court orders on procreation. (United States)

    Matevosyan, Naira R


    The aim of this study is to empirically evaluate judgments entered from 1913 to 2013 in the matters of compulsory sterilization. Holdings and dispositions at the U.S. Appellate and Supreme courts are randomly located in LexisNexis using Shepard's symbols. Continuous variables are processed with the Mantel-Haenszel method. Court orders are used as units of analysis. The majority of cases (56.4 %) concern minors at a mean age of 11.7 years. Forty-four (80 %) petitions are filed by the parents or guardians; 11 (20 %) are parens patriae. Petitions for female sterilization are denied in 56.4 % cases under the Federal Laws (2 U.S.C. 431; 28 U.S.C; 29 U.S.C; 42 U.S.C; 424 U.S.), Procedural due process clause of the 14th Amendment, statutes, and common law precedents. Petitions for female sterilization are granted in 36.4 % cases under the statutory penal codes, the Law of the land, precedents, and the dicta. No significant associations are found between the parity and degree of mental impairment (r = 0.342). Substantial correlations are met between the gender, degree of impairment (r (2) = 0.724), and dispositions (r (2) = 802). The mean age of women is 20.78 years; the mean age of men is 30.25 years. Correlations fail to establish reasoning between the age of the subjects and the entered judgments (r (2) = 0. 356). (1) The female/male ratio (8:1) and age gap of the respondents indicate on a disproportionate impact of the statutes. (2) The procedure of sterilization in itself is incommensurate with equality, as the volume of surgery is uneven in males and females. (3) The case law is instructive with respect to which arguments have not been advanced. (4) Lastly, due to the etiological intricacy of mental impairment, with genetic transmission strikingly different in men and women, expert-witnesses ought to act in a medical vacuum because there is no mathematical certainty as to the transmission mode of the traits in question (exon and intron mutations, triplet repeat

  7. [Computerized medical record: deontology and legislation]. (United States)

    Allaert, F A; Dusserre, L


    Computerization of medical records is making headway for patients' follow-up, scientific research, and health expenses control, but it must not alter the guarantees provided to the patients by the medical code of ethics and the law of January 6, 1978. This law, modified on July 1, 1994, requires to register all computerized records of personal data and establishes rights to protect privacy against computer misdemeanor. All medical practitioners using computerized medical records must be aware that the infringement of this law may provoke suing in professional, civil or criminal court.

  8. From planning to realisation of an electronic patient record. (United States)

    Krämer, T; Rapp, R; Krämer, K-L


    The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the neccessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occured during this process.

  9. [From planning to realization of an electronic patient record]. (United States)

    Krämer, T; Rapp, R; Krämer, K L


    The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the necessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occurred during this process.

  10. Introduction of a national electronic patient record in The Netherlands: some legal issues

    NARCIS (Netherlands)

    Ploem, Corrette; Gevers, Sjef


    The electronic patient record (EPR) is a major technological development within the healthcare sector. Many hospitals across Europe already use institution-based electronic patient records, which allow not only for electronic exchange of patient data within the hospital, but potentially also for

  11. Record linkage for pharmacoepidemiological studies in cancer patients. (United States)

    Herk-Sukel, Myrthe P P van; Lemmens, Valery E P P; Poll-Franse, Lonneke V van de; Herings, Ron M C; Coebergh, Jan Willem W


    An increasing need has developed for the post-approval surveillance of (new) anti-cancer drugs by means of pharmacoepidemiology and outcomes research in the area of oncology. To create an overview that makes researchers aware of the available database linkages in Northern America and Europe which facilitate pharmacoepidemiology and outcomes research in cancer patients. In addition to our own database, i.e. the Eindhoven Cancer Registry (ECR) linked to the PHARMO Record Linkage System, we considered database linkages between a population-based cancer registry and an administrative healthcare database that at least contains information on drug use and offers a longitudinal perspective on healthcare utilization. Eligible database linkages were limited to those that had been used in multiple published articles in English language included in Pubmed. The HMO Cancer Research Network (CRN) in the US was excluded from this review, as an overview of the linked databases participating in the CRN is already provided elsewhere. Researchers who had worked with the data resources included in our review were contacted for additional information and verification of the data presented in the overview. The following database linkages were included: the Surveillance, Epidemiology, and End-Results-Medicare; cancer registry data linked to Medicaid; Canadian cancer registries linked to population-based drug databases; the Scottish cancer registry linked to the Tayside drug dispensing data; linked databases in the Nordic Countries of Europe: Norway, Sweden, Finland and Denmark; and the ECR-PHARMO linkage in the Netherlands. Descriptives of the included database linkages comprise population size, generalizability of the population, year of first data availability, contents of the cancer registry, contents of the administrative healthcare database, the possibility to select a cancer-free control cohort, and linkage to other healthcare databases. The linked databases offer a longitudinal

  12. The courts in Renaissance Italy

    Directory of Open Access Journals (Sweden)

    Beatrice Del Bo


    Full Text Available This review article offers a brief introduction to the issue of the courts in Renaissance Italy along with a selective description of bibliographic sources and electronic resources.

  13. ECHR and national constitutional courts

    Directory of Open Access Journals (Sweden)

    Nastić Maja


    Full Text Available Comprising fundamental rights and freedoms and establishing the effective control system, the European Convention on Human Rights (ECHR encroaches upon the area that is traditional reserved for constitutional law. Although built on the doctrine reserved for international treaty law, the Convention goes beyond the traditional boundaries that exist between international and constitutional law. It has gradually infiltrated into the national legal systems. Constitutional courts have had the crucial role in this process. This paper will focus on the applicability of the ECHR in proceedings before national constitutional courts. Having in mind the jurisdiction of the national constitutional court, the ECHR may be applied in two ways: first, in the process of constitutional review by national constitutional courts and, second, in the process of deciding on constitutional complaints.

  14. Identifying Patients for Clinical Studies from Electronic Health Records: TREC 2012 Medical Records Track at OHSU (United States)


    report_text:infectious OR report_text:meningitis OR report_text:cefdinir OR report_text:encephalitis OR report_text:"brain abscess " OR...sertraline|zyprexa|olanza pine" 178 Patients with metastatic breast cancer ((report_text:metast* OR discharge_icd_codes_tx:196* OR...report_text:"metastatic breast cancer" 179 Patients taking atypical antipsychotics without a diagnosis schizophrenia or bipolar depression

  15. Court interpreting and pragmatic meaning

    DEFF Research Database (Denmark)

    Jacobsen, Bente

    In Denmark, court interpreters are required to deliver verbatim translations of speakers' originals and to refrain from transferring pragmatic meaning. Yet, as this paper demonstrates, pragmatic meaning is central to courtroom interaction.......In Denmark, court interpreters are required to deliver verbatim translations of speakers' originals and to refrain from transferring pragmatic meaning. Yet, as this paper demonstrates, pragmatic meaning is central to courtroom interaction....

  16. Changes to criminal records checks used to safeguard vulnerable patients. (United States)

    Griffith, Richard; Tengnah, Cassam


    The Protection of Freedoms Act 2012 is introducing changes to the Criminal Records Bureau (CRB) checks carried out on those people who work with vulnerable groups. The new law is the coalition Government's response to the criticism of the Safeguarding Vulnerable Group Act 2006. It will merge the CRB and Independent Safeguarding Authority into a new Disclosure and Barring Service and will enhance the rights of applicants to challenge the CRB's right to disclose non-conviction information as part of an enhanced criminal records check. In the first of two articles on the Protection of Freedoms Act 2012, Richard Griffith and Cassam Tengnah discuss the current framework for disclosing criminal records and the impact of the changes on district nurses applying for new posts.

  17. Improving Patient Safety With the Military Electronic Health Record

    National Research Council Canada - National Science Library

    Charles, Marie-Jocelyne; Harmon, Bart J; Jordan, Pamela S


    The United States Department of Defense (DoD) has transformed health care delivery in its use of information technology to automate patient data documentation, leading to improvements in patient safety...

  18. DANBIO-powerful research database and electronic patient record

    DEFF Research Database (Denmark)

    Hetland, Merete Lund


    an overview of the research outcome and presents the cohorts of RA patients. The registry, which is approved as a national quality registry, includes patients with RA, PsA and AS, who are followed longitudinally. Data are captured electronically from the source (patients and health personnel). The IT platform...... as an electronic patient 'chronicle' in routine care, and at the same time provides a powerful research database....

  19. Tried as an adult, housed as a juvenile: a tale of youth from two courts incarcerated together. (United States)

    Bechtold, Jordan; Cauffman, Elizabeth


    Research has questioned the wisdom of housing juveniles who are convicted in criminal court in facilities with adult offenders. It is argued that minors transferred to criminal court should not be incarcerated with adults, due to a greater likelihood of developing criminal skills, being victimized, and attempting suicide. Alternatively, it has been suggested that the other option, housing these youth with minors who have committed less serious crimes and who are therefore adjudicated in juvenile courts, might have unintended consequences for juvenile court youth. The present study utilizes a sample of youth incarcerated in one secure juvenile facility, with some offenders processed in juvenile court (n = 261) and others processed in adult court (n = 103). We investigate whether youth transferred to adult court engage in more institutional offending (in particular, violence) and experience less victimization than their juvenile court counterparts. Results indicate that although adult court youth had a greater likelihood of being convicted of violent commitment offenses than juvenile court youth, the former engaged in less offending during incarceration than the latter. In addition, no significant differences in victimization were observed. These findings suggest that the concern about the need for separate housing for adult court youth is unfounded; when incarcerated together, those tried in adult court do not engage in more institutional violence than juvenile court youth. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  20. Attorney Argumentation and Supreme Court Opinions. (United States)

    Benoit, William L.


    Investigates the relationship between argumentation advanced by attorneys in four Supreme Court cases and the reasoning proffered by the Court in its decisions in those cases. Finds attorney argumentation sometimes irrelevant to the Court's reasoning and sometimes adopted by the Court. Offers a perspective on argumentation and decision making to…

  1. Maternity patients' access to their electronic medical records: use and perspectives of a patient portal. (United States)

    Megan Forster, Megan; Dennison, Kerrie; Callen, Joanne; Andrew, Andrew; Westbrook, Johanna I

    Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response

  2. Improving stroke patients' care: a patient held record is not enough

    Directory of Open Access Journals (Sweden)

    Lampe Fiona


    Full Text Available Abstract Background Stroke patients' care in hospital tends to be poorly organised, with poor communication and a lack of information being frequent sources of complaint. The purpose of this study was to evaluate whether a patient-held record (PHR would result in greater patient satisfaction and better care planning for stroke patients. Methods A time series control (6 months - intervention (8 months - control (6 months was used among London teaching hospital general medical and geriatric medicine inpatient wards. All stroke patients admitted to the wards during the intervention phase received a PHR and were instructed in its use. Demographic, stroke severity, social factors and outcomes were collected from all stroke patients during all phases of the study. Results Of 252 stroke patients aged 46 to 98 years entered into the study, by six months after admission 118 (46.8% had died. PHR and control group patients were well matched in terms of socio-demographic characteristics and pre-stroke ability. At six months after admission, 119 (97% patients responded to the questionnaire. Just over half (56%, 13 of intervention group patients recalled receiving a PHR. Of those patients, 59% reported reading the PHR, 27% had lost their PHR, and two-thirds said they had difficulties encouraging staff to write in the PHR. Half felt that possession of the PHR was more trouble than it was worth. PHR group patients were more satisfied with the recovery they had made (79% vs. 59%, p=0.04, but felt less able to talk to staff about their problems (61% vs. 82%, p=0.02. PHR group patients reported receiving fewer explanations about their condition (18% vs. 33%, p=0.12 and treatment (26% vs. 45%, p=0.07, and were more afraid of asking doctors questions (21% vs. 4%, p=0.01 than controls. PHR group patients were no better prepared for hospital discharge than control group patients, and both groups were ill-informed about services and benefits that might have helped

  3. DANBIO-powerful research database and electronic patient record

    DEFF Research Database (Denmark)

    Hetland, Merete Lund


    is based on open-source software. Via a unique personal identification code, linkage with various national registers is possible for research purposes. Since the year 2000, more than 10,000 patients have been included. The main focus of research has been on treatment efficacy and drug survival. Compared...... an overview of the research outcome and presents the cohorts of RA patients. The registry, which is approved as a national quality registry, includes patients with RA, PsA and AS, who are followed longitudinally. Data are captured electronically from the source (patients and health personnel). The IT platform...... with RA patients, who were on conventional treatment with DMARDs, the patients who started biological treatment were younger, had longer disease duration, higher disease activity, tried more DMARDs and received more prednisolone. Also, more patients on biological therapy were seropositive and had erosive...

  4. Patients Reading Their Medical Records: Differences in Experiences and Attitudes between Regular and Inexperienced Readers (United States)

    Huvila, Isto; Daniels, Mats; Cajander, Åsa; Åhlfeldt, Rose-Mharie


    Introduction: We report results of a study of how ordering and reading of printouts of medical records by regular and inexperienced readers relate to how the records are used, to the health information practices of patients, and to their expectations of the usefulness of new e-Health services and online access to medical records. Method: The study…


    Directory of Open Access Journals (Sweden)

    Ioana Nely Militaru


    Full Text Available Treaty of Lisbon entered into force on 1 December 2009, improved functioning judicial system European Union ( EU. Court of Justice of the EU has been reformed, said Treaty changing the EU courts so very name : Court of Justice of the EU, the Court referred to above, the Court of First Instance, and specialized courts, known previously, judicial panels. The paper shows the first part of his creation, composition and competence of the specialized courts, and as a manifestation of them in the second part examines the Civil Service Tribunal, the same point of view. EU specialized courts may be set up in specific areas, specializing in some technical disputes. These specialized courts have jurisdiction to hear and decide the cases in the first instance with the possibility that their decision subject to appeal to the General Court . In this context, to resolve disputes between the Union and its officials was established Tribunal.

  6. Development of the electronic patient record system based on problem oriented system. (United States)

    Uto, Yumiko; Iwaanakuchi, Takashi; Muranaga, Fuminori; Kumamoto, Ichiro


    In Japan, POS (problem oriented system) is recommended in the clinical guideline. Therefore, the records are mainly made by SOAP. We developed a system mainly with a function which enabled our staff members of all kinds of professions including doctors to enter the patients' clinical information as an identical record, regardless if they were outpatients or inpatients, and to observe the contents chronologically. This electric patient record system is called "e-kanja recording system". On this system, all staff members in the medical team can now share the same information. Moreover, the contents can be reviewed by colleagues; the quality of records has been improved as it is evaluated by the others.

  7. Barriers to retrieving patient information from electronic health record data: failure analysis from the TREC Medical Records Track. (United States)

    Edinger, Tracy; Cohen, Aaron M; Bedrick, Steven; Ambert, Kyle; Hersh, William


    Secondary use of electronic health record (EHR) data relies on the ability to retrieve accurate and complete information about desired patient populations. The Text Retrieval Conference (TREC) 2011 Medical Records Track was a challenge evaluation allowing comparison of systems and algorithms to retrieve patients eligible for clinical studies from a corpus of de-identified medical records, grouped by patient visit. Participants retrieved cohorts of patients relevant to 35 different clinical topics, and visits were judged for relevance to each topic. This study identified the most common barriers to identifying specific clinic populations in the test collection. Using the runs from track participants and judged visits, we analyzed the five non-relevant visits most often retrieved and the five relevant visits most often overlooked. Categories were developed iteratively to group the reasons for incorrect retrieval for each of the 35 topics. Reasons fell into nine categories for non-relevant visits and five categories for relevant visits. Non-relevant visits were most often retrieved because they contained a non-relevant reference to the topic terms. Relevant visits were most often infrequently retrieved because they used a synonym for a topic term. This failure analysis provides insight into areas for future improvement in EHR-based retrieval with techniques such as more widespread and complete use of standardized terminology in retrieval and data entry systems.

  8. 12 CFR 404.20 - Notice of court-ordered and emergency disclosures. (United States)


    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Notice of court-ordered and emergency disclosures. 404.20 Section 404.20 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES INFORMATION DISCLOSURE Access to Records Under the Privacy Act of 1974 § 404.20 Notice of court-ordered and emergency...

  9. Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records (United States)

    Miotto, Riccardo; Li, Li; Kidd, Brian A.; Dudley, Joel T.


    Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name “deep patient”. We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems.

  10. Incorporating Personal Health Records into the Disease Management of Rural Heart Failure Patients (United States)

    Baron, Karen Parsley


    Personal Health Records (PHRs) allow patients to access and in some cases manage their own health records. Their potential benefits include access to health information, enhanced asynchronous communication between patients and clinicians, and convenience of online appointment scheduling and prescription refills. Potential barriers to PHR use…

  11. Integrating phenotypic data from electronic patient records with molecular level systems biology

    DEFF Research Database (Denmark)

    Brunak, Søren


    Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracti...... Classification of Disease ontology and is therefore in principle language independent. As a use case we show how records from a Danish psychiatric hospital lead to the identification of disease correlations, which subsequently are mapped to systems biology frameworks....

  12. Positive effects of electronic patient records on three clinical activities

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper


    records prior to the trial period. The data comprise measurements from 11 team conferences, 7 ward rounds, and 10 nursing handovers. Results: During team conferences the clinicians experienced a reduction on five of six subscales of mental workload, and the physicians experienced an overall reduction...... in mental workload. The physician in charge also experienced increased clarity about the importance of and responsibilities for work tasks, and reduced mental workload during ward rounds. During nursing handovers the nurses experienced fewer missing pieces of information and fewer messages to pass on after...

  13. Cancer patients' attitudes and experiences of online access to their electronic medical records: A qualitative study. (United States)

    Rexhepi, Hanife; Åhlfeldt, Rose-Mharie; Cajander, Åsa; Huvila, Isto


    Patients' access to their online medical records serves as one of the cornerstones in the efforts to increase patient engagement and improve healthcare outcomes. The aim of this article is to provide in-depth understanding of cancer patients' attitudes and experiences of online medical records, as well as an increased understanding of the complexities of developing and launching e-Health services. The study result confirms that online access can help patients prepare for doctor visits and to understand their medical issues. In contrast to the fears of many physicians, the study shows that online access to medical records did not generate substantial anxiety, concerns or increased phone calls to the hospital.

  14. Informed use of patients' records on trusted health care services. (United States)

    Sahama, Tony; Miller, Evonne


    Health care is an information-intensive business. Sharing information in health care processes is a smart use of data enabling informed decision-making whilst ensuring. the privacy and security of patient information. To achieve this, we propose data encryption techniques embedded Information Accountability Framework (IAF) that establishes transitions of the technological concept, thus enabling understanding of shared responsibility, accessibility, and efficient cost effective informed decisions between health care professionals and patients. The IAF results reveal possibilities of efficient informed medical decision making and minimisation of medical errors. Of achieving this will require significant cultural changes and research synergies to ensure the sustainability, acceptability and durability of the IAF.

  15. [Electronic versus paper-based patient records: a cost-benefit analysis]. (United States)

    Neubauer, A S; Priglinger, S; Ehrt, O


    The aim of this study is to compare the costs and benefits of electronic, paperless patient records with the conventional paper-based charts. Costs and benefits of planned electronic patient records are calculated for a University eye hospital with 140 beds. Benefit is determined by direct costs saved by electronic records. In the example shown, the additional benefits of electronic patient records, as far as they can be quantified total 192,000 DM per year. The costs of the necessary investments are 234,000 DM per year when using a linear depreciation over 4 years. In total, there are additional annual costs for electronic patient records of 42,000 DM. Different scenarios were analyzed. By increasing the time of depreciation to 6 years, the cost deficit reduces to only approximately 9,000 DM. Increased wages reduce the deficit further while the deficit increases with a loss of functions of the electronic patient record. However, several benefits of electronic records regarding research, teaching, quality control and better data access cannot be easily quantified and would greatly increase the benefit to cost ratio. Only part of the advantages of electronic patient records can easily be quantified in terms of directly saved costs. The small cost deficit calculated in this example is overcompensated by several benefits, which can only be enumerated qualitatively due to problems in quantification.

  16. 25 CFR 11.909 - Law enforcement records. (United States)


    ... BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Children's Court § 11.909 Law enforcement records. (a) Law enforcement records and files... minor's parents or guardian, the presenting officer, or others by order of the children's court. ...

  17. National Courts and EU Law

    DEFF Research Database (Denmark)

    approaches and theories originating from law, political science, sociology and economics. The first section addresses issues relating to judicial dialogue and EU legal mandates, the second looks at the topic of EU law in national courts and the third considers national courts’ roles in protecting fundamental......, National Courts and EU Law will hold strong appeal for scholars and students in the fields of EU law, social sciences and humanities. It will also be of use to legal practitioners interested in the issue of judicial application of EU law....

  18. Atypical Rulings of the Indonesian Constitutional Court

    Directory of Open Access Journals (Sweden)



    Full Text Available In deciding judicial review cases, the Court may issue rulings that is not in accordance to what is stipulated in the Constitutional Court Law (Law Number 8 Year 2011. Atypical rulings means that the court may reconstruct a provision, delay the legislation/rulings enactment or give instruction to lawmakers. In addition, the court also introduce the “conditionally (unconstitutional” concept. This essay attempts to identify and classify these atypical rulings, including conditionally (un constitutional rulings, by examined the constitutional court judicial review rulings from 2003 to 2015. This study will provide a ground work for advance research on typical rulings by the Indonesian constitutional court.

  19. Self-reported stressors among patients with Exhaustion Disorder: an exploratory study of patient records (United States)


    Background Several researchers imply that both work-related and non-work-related stress exposure are likely to contribute to stress-related mental illness. Yet empirical studies investigating both domains seem to be limited, particularly in a clinical population. The purpose of this study was to a) explore which stressors (non-work and work-related) are reported as important for the onset of illness by patients seeking medical care for stress-related exhaustion and b) explore the prevalence of each stressor and examine whether the pattern differs between men and women. Methods This is an exploratory mixed method study, comprising patients at a specialist outpatient stress clinic. Information from medical records of 20 patients was initially used in a first qualitative step to construct the instrument, using a combination of a conventional content analysis and a directed content analysis. In the second phase patient records from 50 men and 50 women were selected and coded in accordance with the coding instrument. Frequency statistics were calculated for all stressors. Results A total of 24 categories of stressors (11 related to work and 13 related to private life) were identified in the first qualitative step. A median of four stressors, usually both work and non-work-related was reported by the patients. The most common stressors were 1) quantitative demands at work, 2) private relational conflicts and 3) emotional demands at work. Conclusions Work demands are, by far, the most prevalent stressor, followed by relational problems in private life. The pattern was similar for women and men, with a slight difference in the distribution between work and non-work stressors. Men and women also show similar patterns when comparing the occurrence of each stressor. Slight differences were seen, in particular with regard to managerial responsibility that was reported by 6% of the women compared to 36% of the men. One important practical implication of this study is that

  20. English as a Court Language in Continental Courts

    NARCIS (Netherlands)

    C. Kern (Cristoph)


    markdownabstract__Abstract__ Most recently, several countries on the European continent have admitted, or are discussing to admit, English as an optional court language. This article provides some information about the background of these recent initiatives, projects and reforms, clarifies the

  1. Improving Patient Safety With the Military Electronic Health Record (United States)


    Consolidated Health Informatics (CHI) project, one of the 24 electronic government ( eGov ) Internet- based technology initiatives supporting the president’s...United States Department of Defense (DoD) has transformed health care delivery in its use of information technology to automate patient data...use throughout the Federal Government . The importance of standards in EHR systems was further recognized in an IOM report, which stated, “Electronic

  2. Performance Assessment in Courts - The Swiss Case

    Directory of Open Access Journals (Sweden)

    Andreas Lienhard


    Full Text Available Abstract Performance assessments have become commonplace in management, even in the public sector. With the increasing pressure on courts to perform while making efficient use of resources, performance assessments in the justice system are also gaining in importance. However, the need for judicial independence poses special challenges for performance assessments in courts. Against this background, this article conducts a constitutional appraisal, and contrasts the need for judicial independence with the principles governing effectiveness and efficiency, self-government and supervision, and appointment and re-appointment. A duty to guarantee justice can be derived from this that does not in principle exclude the performance assessment of judges, but even renders it essential, subject to compliance with certain requirements. In these circumstances, it seems hardly surprising that numerous countries conduct performance assessments of judges and also that various international institutions have developed principles for this purpose, a summary of which is presented – in Switzerland’s case based on a recently conducted survey. In the field of conflict between the guaranteeing justice and protecting the judiciary, the following key questions arise in particular: What is the purpose of performance assessments and what are the consequences?What is subjected to a performance assessment and what are the assessment criteria?How is performance recorded as the basis for the performance assessment?Who is subjected to a performance assessment, and must a distinction be made between judges in higher and lower courts?Who carries out the performance assessment and what methods of protecting one’s rights are available?Who should receive the results of the performance assessment?The contribution sketches out possible answers to these key questions and aims to encourage academics and practitioners to give further consideration to this subject.

  3. Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study. (United States)

    Woods, Susan S; Schwartz, Erin; Tuepker, Anais; Press, Nancy A; Nazi, Kim M; Turvey, Carolyn L; Nichol, W Paul


    Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. A qualitative study with purposeful sampling sought to examine patients' views and experiences with reading their health records, including their clinical notes, online. Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared

  4. The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record. (United States)

    Biagioli, Frances E; Elliot, Diane L; Palmer, Ryan T; Graichen, Carla C; Rdesinski, Rebecca E; Ashok Kumar, Kaparaboyna; Galper, Ari B; Tysinger, James W


    Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. The authors collected performance data for students (n = 71) at the first institution during academic years 2011-2013 and for students (n = 211) at the second institution during academic year 2013-2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students' EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Cross-institutional data comparisons will help determine whether differences in curricula affect students' EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.

  5. Using the Electronic Medical Record to Enhance Physician-Nurse Communication Regarding Patients' Discharge Status. (United States)

    Driscoll, Molly; Gurka, David


    The fast-paced environment of hospitals contributes to communication failures between health care providers while impacting patient care and patient flow. An effective mechanism for sharing patients' discharge information with health care team members is required to improve patient throughput. The communication of a patient's discharge plan was identified as crucial in alleviating patient flow delays at a tertiary care, academic medical center. By identifying the patients who were expected to be discharged the following day, the health care team could initiate discharge preparations in advance to improve patient care and patient flow. The patients' electronic medical record served to convey dynamic information regarding the patients' discharge status to the health care team via conditional discharge orders. Two neurosciences units piloted a conditional discharge order initiative. Conditional discharge orders were designed in the electronic medical record so that the conditions for discharge were listed in a dropdown menu. The health care team was trained on the conditional discharge order protocol, including when to write them, how to find them in the patients' electronic medical record, and what actions should be prompted by these orders. On average, 24% of the patients discharged had conditional discharge orders written the day before discharge. The average discharge time for patients with conditional discharge orders decreased by 83 minutes (0.06 day) from baseline. Qualitatively, the health care team reported improved workflows with conditional orders. The conditional discharge orders allowed physicians to communicate pending discharges electronically to the multidisciplinary team. The initiative positively impacted patient discharge times and workflows.

  6. Juvenile Courts. Creation and development

    Directory of Open Access Journals (Sweden)



    Full Text Available This paper studies the creation of Juvenile or Children's Courts in Spain, analysing their reasons and aims, as well as the ethical and political connotations present on their way of acting. Their history and the one of the institutions that complement them is built from the legislation, writings and ideas of their promoters.

  7. The Camera Comes to Court. (United States)

    Floren, Leola

    After the Lindbergh kidnapping trial in 1935, the American Bar Association sought to eliminate electronic equipment from courtroom proceedings. Eventually, all but two states adopted regulations applying that ban to some extent, and a 1965 Supreme Court decision encouraged the banning of television cameras at trials as well. Currently, some states…

  8. Results with Open Court Reading. (United States)

    McGraw-Hill Companies, New York, NY. Educational and Professional Publishing Group.

    This publication tells the stories of eight schools from around the nation that have used the Open Court Reading program, describing the history of the schools, the challenges they faced, and their attempts to meet those challenges. The schools are located in California, Florida, Texas, and New York. Each of the school stories includes a focus on…

  9. Freer markets, more court rulings?

    NARCIS (Netherlands)

    Hildebrand, Y.


    The governance of economic sectors in Europe has over the past decades been characterized by several important shifts. Two of the most notable shifts are those from state to market governance and from state to court governance. The first shift is the result of a coherent set of policies that have

  10. Regional Courts as Judicial Brakes?

    Directory of Open Access Journals (Sweden)

    Metcalf Katrin Nyman


    Full Text Available The article examines how regional integration courts can act as judicial brakes, at a time when “constitutional coups” – leaders staying in power past constitutional time limits or other forms of actions against the spirit if not always the letter of the constitution – are alarmingly common. The article discusses how regional courts can be used to modify or protect national rule of law and the constitutional order from the outside (i.e. from the regional integration aspect and the extent to which this can be valid particularly to promote a uniform interpretation and application of human rights. Although this trend is visible in Europe, it is more striking, because less expected, on other continents, in particular Africa and the Americas, where the developments take place in less than perfect democratic environments. The article contains evidence from cases dealt with in the various regional courts, supporting that a system of political and judicial oversight, especially in regions with weak or fragile democratic systems, can be a useful addition to national judicial or other mechanisms of protection of rule of law and control of the executive. Action by regional courts helps defeat perceptions of majoritarian politics, which in many countries allow for the winner to take all. Under a system of regional oversight, states become aware of the limits they themselves have set and citizens become aware of their possibilities to challenge political power.

  11. Pragmatics in Court Interpreting: Additions

    DEFF Research Database (Denmark)

    Jacobsen, Bente


    Danish court interpreters are expected to follow ethical guidelines, which instruct them to deliver exact verbatim versions of source texts. However, this requirement often clashes with the reality of the interpreting situation in the courtroom. This paper presents and discusses the findings of a...

  12. Intercultural pragmatics and court interpreting

    DEFF Research Database (Denmark)

    Jacobsen, Bente


      This paper reports on an on-going investigation of conversational implicature in triadic speech events: Interpreter-mediated questionings in criminal proceedings in Danish district courts. The languages involved are Danish and English, and the mode of interpreting is the consecutive mode. The c...

  13. Neonatal Nurses Experience Unintended Consequences and Risks to Patient Safety With Electronic Health Records. (United States)

    Dudding, Katherine M; Gephart, Sheila M; Carrington, Jane M


    In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.

  14. Court decisions on medical malpractice. (United States)

    Knaak, Jan-Paul; Parzeller, Markus


    Recent studies on court cases dealing with medical malpractice are few and far between. This retrospective study, therefore, undertakes an analysis of medical malpractice lawsuits brought before regional courts in two judicial districts of the federal state of Hesse. Over a 5-year period (2006-2010), 232 court decisions on medical malpractice taken by the regional courts (Landgericht) of Kassel and Marburg were evaluated according to medical discipline, diagnosis, therapy, relevant level of care, charge of neglect of duty by the claimant party, outcome of the lawsuit, and further criteria. With certain overlaps, the disciplines most frequently confronted with claims of medical malpractice were accident surgery and orthopedics (30.2%; n = 70), dentistry (16.4%; n = 38), surgery (12.1%; n = 28), and gynecology and obstetrics (7.8%; n = 18), followed by the remaining medical disciplines (38.8%; n = 90). Malpractice allegations were brought against the practice-based sector in 35.8 % (n = 83) of cases, the hospital-based sector in 63.3% (n = 147) of cases, and other sectors in 0.9% (n = 2) of cases. The allegation grounds included false administration of treatment (67.2%; n = 156), false indication of treatment (37.1%; n = 86), false diagnosis (31.5%; n = 73), and/or organizational negligence (13.8%; n = 32). A breach of duty to inform was given as grounds for the claim in 38.8% (n = 90) of cases. A significant majority of 65.6% (n = 152) of cases ended in a court settlement. Of the cases, 18.9% (n = 44) were concluded by claim withdrawal, 11.2% (n = 26) by claim dismissal and 2.6% (n = 6) by criminal sentence. Of the cases, 1.7% (n = 4) were for purposes of securing evidence. Although there was no conclusive evidence of malpractice, two thirds of the cases ended in a court settlement. On the one hand, this outcome reduces the burden on the courts, but on the other, it can in the long term give

  15. Opteren voor de Netherlands Commercial Court

    NARCIS (Netherlands)

    Hoeben, J.; Keirse, A.L.M.; Reijneveld, M.D.

    Internationale contracten leiden tot internationale handelsgeschillen. Deze kunnen onder meer worden beslecht bij een commercial court. In Nederland wordt momenteel een Netherlands Commercial Court (NCC) opgericht. Dit introduceert een keuze voor (contracts)partijen voor een nieuw forum voor

  16. Patients want granular privacy control over health information in electronic medical records. (United States)

    Caine, Kelly; Hanania, Rima


    To assess patients' desire for granular level privacy control over which personal health information should be shared, with whom, and for what purpose; and whether these preferences vary based on sensitivity of health information. A card task for matching health information with providers, questionnaire, and interview with 30 patients whose health information is stored in an electronic medical record system. Most patients' records contained sensitive health information. No patients reported that they would prefer to share all information stored in an electronic medical record (EMR) with all potential recipients. Sharing preferences varied by type of information (EMR data element) and recipient (eg, primary care provider), and overall sharing preferences varied by participant. Patients with and without sensitive records preferred less sharing of sensitive versus less-sensitive information. Patients expressed sharing preferences consistent with a desire for granular privacy control over which health information should be shared with whom and expressed differences in sharing preferences for sensitive versus less-sensitive EMR data. The pattern of results may be used by designers to generate privacy-preserving EMR systems including interfaces for patients to express privacy and sharing preferences. To maintain the level of privacy afforded by medical records and to achieve alignment with patients' preferences, patients should have granular privacy control over information contained in their EMR.


    Directory of Open Access Journals (Sweden)



    Full Text Available Patient-controlled personal health record systems can help make health care safer, cheaper, and more convenient by facilitating patients to 1 grant any care provider access to their complete personal health records anytime from anywhere, 2 avoid repeated tests and 3 control their privacy transparently. In this paper, we present the architecture of our Privacy-aware Patient-controlled Personal Health Record (P3HR system through which a patient can view her integrated health history, and share her health information transparently with others (e.g., healthcare providers. Access to the health information of a particular patient is completely controlled by that patient. We also carry out intuitive security and privacy analysis of the P3HR system architecture considering different types of security attacks. Finally, we describe a prototype implementation of the P3HR system that we developed reflecting the special view of Japanese society. The most important advantage of P3HR system over other existing systems is that most likely P3HR system provides complete privacy protection without losing data accuracy. Unlike traditional partially anonymous health records (e.g., using k-anonymity or l-diversity, the health records in P3HR are closer to complete anonymity, and yet preserve data accuracy. Our approach makes it very unlikely that patients could be identified by an attacker from their anonymous health records in the P3HR system.

  18. Negation scope and spelling variation for text-mining of Danish electronic patient records

    DEFF Research Database (Denmark)

    Thomas, Cecilia Engel; Jensen, Peter Bjødstrup; Werge, Thomas


    Electronic patient records are a potentially rich data source for knowledge extraction in biomedical research. Here we present a method based on the ICD10 system for text-mining of Danish health records. We have evaluated how adding functionalities to a baseline text-mining tool affected...

  19. Explaining African Participation in International Courts

    DEFF Research Database (Denmark)

    Gissel, Line Engbo; Brett, Peter


    constructivist and liberal institutionalist International Relations theories. International court creation did not reflect the pursuit of national interests or a response to normative NGO pressures. Making this argument, the article analyses the design and ratification of two new international courts: the SADC...... Tribunal and International Criminal Court. Using the case studies of Zimbabwe and Kenya, it shows how global scripts were repeated by even those states which have, in recent years, most vocally asserted their national interests against these courts....

  20. Trial Courts in the Judicial Process. (United States)

    McKnight, R. Neal


    Describes a college course which examines the organizational and behavioral characteristics of trial courts in the American judicial process. A major course objective is to help students understand the trial court process as a political process by showing how trial court organizations are involved in the allocation of social values. (RM)

  1. The Court in the Homeric Epos (United States)

    Loginov, Alexandr


    The research investigates the court system in Homeric Greece. This period was characterized by a declining culture and scarce works that described those times. Hence, the court procedures of those times remains understudied; therefore, the purpose of this research is to reconstruct theoretically the court procedure in Homeric Greece. Homer's and…

  2. Privacy preservation and information security protection for patients' portable electronic health records. (United States)

    Huang, Lu-Chou; Chu, Huei-Chung; Lien, Chung-Yueh; Hsiao, Chia-Hung; Kao, Tsair


    As patients face the possibility of copying and keeping their electronic health records (EHRs) through portable storage media, they will encounter new risks to the protection of their private information. In this study, we propose a method to preserve the privacy and security of patients' portable medical records in portable storage media to avoid any inappropriate or unintentional disclosure. Following HIPAA guidelines, the method is designed to protect, recover and verify patient's identifiers in portable EHRs. The results of this study show that our methods are effective in ensuring both information security and privacy preservation for patients through portable storage medium.

  3. Patients Know Best: Qualitative Study on How Families Use Patient-Controlled Personal Health Records (United States)

    Schneider, Hanna; Hill, Susan


    Background Self-management technologies, such as patient-controlled electronic health records (PCEHRs), have the potential to help people manage and cope with disease. Objective This study set out to investigate patient families’ lived experiences of working with a PCEHR. Methods We conducted a semistructured qualitative field study with patient families and clinicians at a children’s hospital in the UK that uses a PCEHR (Patients Know Best). All families were managing the health of a child with a serious chronic condition, who was typically under the care of multiple clinicians. As data gathering and analysis progressed, it became clear that while much of the literature assumes that patients are willing and waiting to take more responsibility for and control over their health management (eg, with PCEHRs), only a minority of participants in our study responded in this way. Their experiences with the PCEHR were diverse and strongly shaped by their coping styles. Theory on coping identifies a continuum of coping styles, from approach to avoidance oriented, and proposes that patients’ information needs depend on their style. Results We identified 3 groups of patient families and an outlier, distinguished by their coping style and their PCEHR use. We refer to the outlier as controlling (approach oriented, highly motivated to use PCEHR), and the 3 groups as collaborating (approach oriented, motivated to use PCEHR), cooperating (avoidance oriented, less motivated to use PCEHR), and avoiding (very avoidance oriented, not motivated to use PCEHR). Conclusions The PCEHR met the needs of controller and collaborators better than the needs of cooperators and avoiders. We draw on the Self-Determination Theory to propose ways in which a PCEHR design might better meet the needs of avoidance-oriented users. Further, we highlight the need for families to also relinquish control at times, and propose ways in which PCEHR design might support a better distribution of control

  4. Individualized music played for agitated patients with dementia: analysis of video-recorded sessions. (United States)

    Ragneskog, H; Asplund, K; Kihlgren, M; Norberg, A


    Many nursing home patients with dementia suffer from symptoms of agitation (e.g. anxiety, shouting, irritability). This study investigated whether individualized music could be used as a nursing intervention to reduce such symptoms in four patients with severe dementia. The patients were video-recorded during four sessions in four periods, including a control period without music, two periods where individualized music was played, and one period where classical music was played. The recordings were analysed by systematic observations and the Facial Action Coding System. Two patients became calmer during some of the individualized music sessions; one patient remained sitting in her armchair longer, and the other patient stopped shouting. For the two patients who were most affected by dementia, the noticeable effect of music was minimal. If the nursing staff succeed in discovering the music preferences of an individual, individualized music may be an effective nursing intervention to mitigate anxiety and agitation for some patients.


    Directory of Open Access Journals (Sweden)

    Ovidiu-Horia Maican


    Full Text Available The US Supreme Court and the European Court of Justice are coordinating constitutional review. Although the European Union does not have a constitution, the European Court often engages in what functionally amounts to constitutional review, particularly in relation to the quasi-federal structure of the EU. Both courts have engaged in the constitutionalization of politics and seem in risk of politicizing the constitution. The threats to their respective powers and legitimacy are different. The US Supreme Court is vulnerable to internal forces (the President, Congress, national public opinion whereas the European Court is vulnerable to external forces (the member states and, in particular, theirs constitutional courts.


    Directory of Open Access Journals (Sweden)

    Bosilja Britvić Vetma


    Full Text Available This paper discusses the dialogue judges between administrative court and Court of Justice of the European Union, and determines the most important elements of this cooperation. Special attention was given preliminary ruling procedure and position of Croatian administrative courts in it. In the following paper, the relationship between tha national administrative courts, the Courts of Justice of the European Union and the European Court of Human Rights after the Treaty of Lisbon. This paper also discusses the solutions adopted in other countries, special attention was paid to the influence of French administrative law on cooperation (dialogue between the courts due to a strong influence on the development of that cooperation.

  7. PADS (Patient Archiving and Documentation System): a computerized patient record with educational aspects. (United States)

    Hohnloser, J H; Pürner, F


    Rapid acquisition and analysis of information in an Intensive Care Unit (ICU) setting is essential, even more so the documentation of the decision making process which has vital consequences for the lives of ICU patients. We describe an Ethernet based local area network (LAN) with clinical workstations (Macintosh fx, ci). Our Patient Archiving and Documentation System (PADS) represents a computerized patient record presently used in a university hospitals' ICU. Taking full advantage of the Macintosh based graphical user interface (GUI) our system enables nurses and doctors to perform the following tasks: admission, medical history taking, physical examination, generation of problem lists and follow up notes, access to laboratory data and reports, semiautomatic generation of a discharge summary including full word processor capabilities. Furthermore, the system offers rapid, consistent and complete automatic encoding of diagnoses following the International Classification of Disease (ICD; WHO, [1]). For educational purposes the user can also view disease entities or complications related to the diagnoses she/he encoded. The system has links to other educational programs such as cardiac auscultation. A MEDLINE literature search through a CD-ROM based system can be performed without exiting the system; also, CD-ROM based medical textbooks can be accessed as well. Commercially available Macintosh programs can be integrated in the system without existing the main program thus enabling users to customize their working environment. Additional options include automatic background monitoring of users learning behavior, analyses and graphical display of numerous epidemiological and health care related problems. Furthermore, we are in the process of integrating sound and digital video in our system. This system represents one in a line of modular departmental models which will eventually be integrated to form a decentralized Hospital Information System (HIS).

  8. Embedding online patient record access in UK primary care: a survey of stakeholder experiences. (United States)

    Pagliari, Claudia; Shand, Tim; Fisher, Brian


    To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Primary care centres within NHS England that had offered online record access for the preceding year. Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients' health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.

  9. Does Europe need two Courts of Human Rights? On the Relationship between the Strasbourg and Luxembourg Courts

    DEFF Research Database (Denmark)

    Rytter, Jens Elo


    Den Europæiske Menneskerettighedsdomstol, European Court of Human Rights, EF-Domstolen, European Court of Justice......Den Europæiske Menneskerettighedsdomstol, European Court of Human Rights, EF-Domstolen, European Court of Justice...

  10. The Special Court for Sierra Leone

    DEFF Research Database (Denmark)

    Damgaard, Ciara Therése


    The focus of this article is the Special Court for Sierra Leone and the extent to which it can be said that the Special Court has already challenged, or will, in the future, challenge the tradition of impunity for gender-based crimes. In this regard, an analysis is undertaken of the Special Court......'s Statute, Rules of Procedure and Evidence and practice to date, in order to determine its treatment of gender-based crimes and whether it can be said that the Special Court for Sierra Leone challenges the tradition of impunity for gender-based crimes. Udgivelsesdato: december 2004...

  11. Antoine Thomas, SI as a «Patient» of the Kangxi Emperor (r. 1662-1722: A Case Study on the Appropriation of Theriac at the Imperial Court

    Directory of Open Access Journals (Sweden)

    Puente-Ballesteros, Beatriz


    Full Text Available In this article I shall concentrate on Antoine Thomas’ illness and death (July 28, 1709 in Peking. This will serve as a case study to elucidate certain aspects of the role played by Jesuit medicine, i.e. Jesuit physicians and Jesuit drugs, at the court of the Kangxi emperor (r. 1662-1722, the first of the three great rulers of the Qing dynasty (1644-1911. As a first step the network of power, as reflected in the so-called medical palace memorials, will be presented in order to arrive at a more comprehensive evaluation of the medical involvement of the Jesuits, as practising physicians, suppliers of foreign drugs and as patients. It will be shown that the circumstances of Thomas’ illness and death must be based on a political and social analysis of the role of court medicine as patronised by the Kangxi emperor. Secondly, the case study of Antoine Thomas will also allow us to reflect on the delocalisation and appropriation of theriac at the Chinese court - one of the foreign drugs in the supply of which Jesuits might have been participated. Last but not least, I shall introduce a number of references in archival documents which throw some additional light on Thomas’ illness and death, and how they were perceived and dealt with in the imperial court.

    En el presente artículo me centro en la enfermedad y muerte de Antoine Thomas (28 de Julio, 1709 en Beijing. Lo cual servirá como estudio para aclarar ciertos aspectos del papel jugado por la medicina Jesuita, es decir, médicos Jesuitas y medicinas Jesuitas en la corte del emperador Kangxi (r. 1662-1722, el primero de los tres grandes emperadores de la dinastía Qing (1644-1911. Primero se presentará la red de poder, según se ve reflejada en los llamados memoriales de palacio de medicina, para poder llegar a una evaluación más profunda de la involucración médica de los Jesuitas, como médicos practicantes, proveedores de medicamentos extranjeros y como pacientes. Se demostrar

  12. Court rejects claim of mental illness from needlestick. (United States)


    The Montana Supreme Court rejected the bid of a medical technician to remain on workers' compensation, based on his claims that he suffered from psychosis, depression, and hallucinations after pricking himself with a needle used on an HIV-positive patient. [Name removed], a respiratory therapist at Community Medical Center in Missoula, tested negative for HIV, but claimed that the psychological trauma from the needlestick injury caused him to become disabled. Based on expert testimony, the Workers' Compensation Court determined that [name removed] was faking his symptoms to collect benefits from his employer's insurer, EBI/Orion Group. [Name removed] appealed, and the Supreme Court remanded the case, stating that psychologists are not included among the medical professionals able to conduct medical reviews. The Workers' Compensation Court again found that [name removed] was faking his symptoms, and [name removed] unsuccessfully appealed. The compensation panel cited conflicting evidence from psychological tests, [name removed]'s friends' testimonies, and [name removed]'s personal diary. The Supreme Court upheld the verdict.

  13. In the public interest: intellectual disability, the Supreme Court, and the death penalty. (United States)

    Abeles, Norman


    This article deals with a case that recently came before the U.S. Supreme Court. The issues involved whether attorneys provided effective assistance to a person convicted of murder when no mitigating evidence was presented (either strategically or by neglect) to the jury concerning the intellectual disabilities of their client during the death penalty phase of the trial. The Supreme Court had previously ruled that the death penalty for intellectually disabled individuals (mentally retarded) constituted cruel and unusual punishment. In this case the attorneys made a strategic decision not to present possibly mitigating evidence for the death penalty phase. The Supreme Court considered whether the appeals court abdicated its judicial review responsibilities. The results of psychological evaluations are presented, and the decisions of the Supreme Court are discussed. PsycINFO Database Record (c) 2010 APA, all rights reserved.

  14. “Nothing About Me Without Me”: An Interpretative Review of Patient Accessible Electronic Health Records (United States)

    Callahan, Ryan; Sevdalis, Nick; Mayer, Erik K; Darzi, Ara


    Background Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers. Objective We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome. Methods A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including “review*” with “patient access to records”. These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs. Results Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than

  15. Criminal Courts of Justice, Dublin

    Directory of Open Access Journals (Sweden)

    Jonathan Tooth


    Full Text Available The newly completed Criminal Courts of Justice (CCJ at Parkgate Street in Dublin 8 is the largest courts project undertaken in the history of the Irish State. The design of the heating, ventilation and air conditioning (HVAC systems was based on computer simulated modelling of the build ing to determine the optimum plant selection and operation based on the contract conditions and energy targets. The report will analyse the computer simulated energy targets versus the actual energy consumption and assess the benefit of engineering solutions such as twin-skin facades and heat recovery based on real data. The report will draw conclusions on the real benefit of such systems with in the built environment. In addition to the energy targets, the report will discuss the commission ing processes involved in delivering the energy targets required and the importance of designing metering strategies to enable the data to be collected and analysed.

  16. Nuclear fuel tax in court

    International Nuclear Information System (INIS)

    Leidinger, Tobias


    Besides the 'Nuclear Energy Moratorium' (temporary shutdown of eight nuclear power plants after the Fukushima incident) and the legally decreed 'Nuclear Energy Phase-Out' (by the 13th AtG-amendment), also the legality of the nuclear fuel tax is being challenged in court. After receiving urgent legal proposals from 5 nuclear power plant operators, the Hamburg fiscal court (4V 154/13) temporarily obliged on 14 April 2014 respective main customs offices through 27 decisions to reimburse 2.2 b. Euro nuclear fuel tax to the operating companies. In all respects a remarkable process. It is not in favour of cleverness to impose a political target even accepting immense constitutional and union law risks. Taxation 'at any price' is neither a statement of state sovereignty nor one for a sound fiscal policy. Early and serious warnings of constitutional experts and specialists in the field of tax law with regard to the nuclear fuel tax were not lacking. (orig.)

  17. ECHR and national constitutional courts


    Nastić, Maja


    Comprising fundamental rights and freedoms and establishing the effective control system, the European Convention on Human Rights (ECHR) encroaches upon the area that is traditional reserved for constitutional law. Although built on the doctrine reserved for international treaty law, the Convention goes beyond the traditional boundaries that exist between international and constitutional law. It has gradually infiltrated into the national legal systems. Constitutional courts have had the cruc...

  18. Evaluating the Risk of Re-identification of Patients from Hospital Prescription Records. (United States)

    Emam, Khaled El; Dankar, Fida K; Vaillancourt, Régis; Roffey, Tyson; Lysyk, Mary


    Pharmacies often provide prescription records to private research firms, on the assumption that these records are de-identified (i.e., identifying information has been removed). However, concerns have been expressed about the potential that patients can be re-identified from such records. Recently, a large private research firm requested prescription records from the Children's Hospital of Eastern Ontario (CHEO), as part of a larger effort to develop a database of hospital prescription records across Canada. To evaluate the ability to re-identify patients from CHEO'S prescription records and to determine ways to appropriately de-identify the data if the risk was too high. The risk of re-identification was assessed for 18 months' worth of prescription data. De-identification algorithms were developed to reduce the risk to an acceptable level while maintaining the quality of the data. The probability of patients being re-identified from the original variables and data set requested by the private research firm was deemed quite high. A new de-identified record layout was developed, which had an acceptable level of re-identification risk. The new approach involved replacing the admission and discharge dates with the quarter and year of admission and the length of stay in days, reporting the patient's age in weeks, and including only the first character of the patient's postal code. Additional requirements were included in the data-sharing agreement with the private research firm (e.g., audit requirements and a protocol for notification of a breach of privacy). Without a formal analysis of the risk of re-identification, assurances of data anonymity may not be accurate. A formal risk analysis at one hospital produced a clinically relevant data set that also protects patient privacy and allows the hospital pharmacy to explicitly manage the risks of breach of patient privacy.

  19. Body posture recognition and turning recording system for the care of bed bound patients. (United States)

    Hsiao, Rong-Shue; Mi, Zhenqiang; Yang, Bo-Ru; Kau, Lih-Jen; Bitew, Mekuanint Agegnehu; Li, Tzu-Yu


    This paper proposes body posture recognition and turning recording system for assisting the care of bed bound patients in nursing homes. The system continuously detects the patient's body posture and records the length of time for each body posture. If the patient remains in the same body posture long enough to develop pressure ulcers, the system notifies caregivers to change the patient's body posture. The objective of recording is to provide the log of body turning for querying of patients' family members. In order to accurately detect patient's body posture, we developed a novel pressure sensing pad which contains force sensing resistor sensors. Based on the proposed pressure sensing pad, we developed a bed posture recognition module which includes a bed posture recognition algorithm. The algorithm is based on fuzzy theory. The body posture recognition algorithm can detect the patient's bed posture whether it is right lateral decubitus, left lateral decubitus, or supine. The detected information of patient's body posture can be then transmitted to the server of healthcare center by the communication module to perform the functions of recording and notification. Experimental results showed that the average posture recognition accuracy for our proposed module is 92%.

  20. Dreams and nightmares: practical and ethical issues for patients and physicians using personal health records. (United States)

    Wynia, Matthew; Dunn, Kyle


    Electronic health records for patients, personal health records (PHRs), have become increasingly popular among policy makers and purchasers, but uptake among patients and physicians has been relatively slow. PHRs have varying uses that might make them more or less appealing to different stakeholders. The three core uses for PHRs - promoting communication, data use, and patient responsibility - each raises a set of potential practical and financial dilemmas. But some ethical concerns are also at play, some of which are rarely recognized as values-based barriers to the use of PHRs. Recognizing these ethical issues, and addressing them explicitly in PHR design and policy making, would help PHRs to achieve their promise.

  1. An analysis of electronic health record-related patient safety incidents. (United States)

    Palojoki, Sari; Mäkelä, Matti; Lehtonen, Lasse; Saranto, Kaija


    The aim of this study was to analyse electronic health record-related patient safety incidents in the patient safety incident reporting database in fully digital hospitals in Finland. We compare Finnish data to similar international data and discuss their content with regard to the literature. We analysed the types of electronic health record-related patient safety incidents that occurred at 23 hospitals during a 2-year period. A procedure of taxonomy mapping served to allow comparisons. This study represents a rare examination of patient safety risks in a fully digital environment. The proportion of electronic health record-related incidents was markedly higher in our study than in previous studies with similar data. Human-computer interaction problems were the most frequently reported. The results show the possibility of error arising from the complex interaction between clinicians and computers.

  2. A shared computer-based problem-oriented patient record for the primary care team. (United States)

    Linnarsson, R; Nordgren, K


    1. INTRODUCTION. A computer-based patient record (CPR) system, Swedestar, has been developed for use in primary health care. The principal aim of the system is to support continuous quality improvement through improved information handling, improved decision-making, and improved procedures for quality assurance. The Swedestar system has evolved during a ten-year period beginning in 1984. 2. SYSTEM DESIGN. The design philosophy is based on the following key factors: a shared, problem-oriented patient record; structured data entry based on an extensive controlled vocabulary; advanced search and query functions, where the query language has the most important role; integrated decision support for drug prescribing and care protocols and guidelines; integrated procedures for quality assurance. 3. A SHARED PROBLEM-ORIENTED PATIENT RECORD. The core of the CPR system is the problem-oriented patient record. All problems of one patient, recorded by different members of the care team, are displayed on the problem list. Starting from this list, a problem follow-up can be made, one problem at a time or for several problems simultaneously. Thus, it is possible to get an integrated view, across provider categories, of those problems of one patient that belong together. This shared problem-oriented patient record provides an important basis for the primary care team work. 4. INTEGRATED DECISION SUPPORT. The decision support of the system includes a drug prescribing module and a care protocol module. The drug prescribing module is integrated with the patient records and includes an on-line check of the patient's medication list for potential interactions and data-driven reminders concerning major drug problems. Care protocols have been developed for the most common chronic diseases, such as asthma, diabetes, and hypertension. The patient records can be automatically checked according to the care protocols. 5. PRACTICAL EXPERIENCE. The Swedestar system has been implemented in a

  3. Can audio recording of outpatient consultations improve patients recall and understanding?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken

    of the dialogue between the patient and the clinician via the telephone in the consultation room. By dialing a dedicated number, patients can get access to an audio recording of their consultation by entering their social security number along with a PIN. The primary objective of this study is to determine......Introduction Information provided in an outpatient consultation concerns medication, diagnostic tests, treatment and rehabilitation, all of which are crucial knowledge with regards to patient compliance, decision making and general patient satisfaction. Despite good communication skills among...... clinicians, the communication is challenged by the fact that patients tend to forget or misunderstand parts of the information given. Thus we have designed a study which gives the patients a possibility to hear their consultation again. An Interactive Voice Response platform enables an audio recording...

  4. Lack of recording of systemic lupus erythematosus in the death certificates of lupus patients. (United States)

    Calvo-Alén, J; Alarcón, G S; Campbell, R; Fernández, M; Reveille, J D; Cooper, G S


    To determine to what extent the diagnosis of systemic lupus erythematosus (SLE) in deceased lupus patients is under-reported in death certificates, and the patient characteristics associated with such an occurrence. The death certificates of 76 of the 81 deceased SLE patients from two US lupus cohorts (LUMINA for Lupus in Minorities: Nature vs Nurture and CLU for Carolina Lupus Study), including 570 and 265 patients, respectively, were obtained from the Offices of Vital Statistics of the states where the patients died (Alabama, Georgia, North Carolina, South Carolina, Tennessee and Texas). Both cohorts included patients with SLE as per the American College of Rheumatology criteria, aged > or =16 yr, and disease duration at enrolment of < or =5 yr. The median duration of follow-up in each cohort at the time of these analyses ranged from 38.1 to 53.0 months. Standard univariable analyses were performed comparing patients with SLE recorded anywhere in the death certificate and those without it. A multivariable logistic regression model was performed to identify the variables independently associated with not recording SLE in death certificates. In 30 (40%) death certificates, SLE was not recorded anywhere in the death certificate. In univariable analyses, older age was associated with lack of recording of SLE in death certificates [mean age (standard deviation) 50.9 (15.6) years and 39.1 (18.6) yr among those for whom SLE was omitted and included on the death certificates, respectively, P = 0.005]. Patients without health insurance, those dying of a cardiovascular event and those of Caucasian ethnicity were also more likely to be in the non-recorded group. In the multivariable analysis, variables independently associated with not recording SLE as cause of death were older age [odds ratio = (95% confidence interval) 1.043 (1.005-1.083 per yr increase); P = 0.023] and lack of health insurance [4.649 (1.152-18.768); P = 0.031]. A high proportion of SLE diagnoses are not

  5. Designing a patient-centered personal health record to promote preventive care

    Directory of Open Access Journals (Sweden)

    Krist Alex H


    Full Text Available Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. Results The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices. Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results

  6. Meeting the health information needs of prostate cancer patients using personal health records. (United States)

    Pai, H H; Lau, F; Barnett, J; Jones, S


    There is interest in the use of health information technology in the form of personal health record (phr) systems to support patient needs for health information, care, and decision-making, particularly for patients with distressing, chronic diseases such as prostate cancer (pca). We sought feedback from pca patients who used a phr. For 6 months, 22 pca patients in various phases of care at the BC Cancer Agency (bcca) were given access to a secure Web-based phr called provider, which they could use to view their medical records and use a set of support tools. Feedback was obtained using an end-of-study survey on usability, satisfaction, and concerns with provider. Site activity was recorded to assess usage patterns. Of the 17 patients who completed the study, 29% encountered some minor difficulties using provider. No security breaches were known to have occurred. The two most commonly accessed medical records were laboratory test results and transcribed doctor's notes. Of survey respondents, 94% were satisfied with the access to their medical records, 65% said that provider helped to answer their questions, 77% felt that their privacy and confidentiality were preserved, 65% felt that using provider helped them to communicate better with their physicians, 83% found new and useful information that they would not have received by talking to their health care providers, and 88% said that they would continue to use provider. Our results support the notion that phrs can provide cancer patients with timely access to their medical records and health information, and can assist in communication with health care providers, in knowledge generation, and in patient empowerment.

  7. Insights to Building a Succesful E-filing Case Management Service: U.S. Federal Court Experience

    Directory of Open Access Journals (Sweden)

    J. Michael Greenwood


    Full Text Available The U.S. Federal Courts Case Management/Electronic Case Files (CM/ECF service is a very successful court automation system deployed throughout the country that integrated case management, electronic court case records and documents, and the electronic transmission and service of court records via the Internet. The authors briefly explain the history of automation development and indicators of success in these courts. The primary focus of the article is (a on what capabilities and functions should be integrated into any modern court electronic filing and case management service; and (b on insights as to key technical components, fundamental project guidelines, technical objectives, and non-technical principles and implementation techniques that were critical to achieving success. The ultimate CM/ECF goals that have been achieved are (1 that the entire U.S. federal court community (court, lawyers, government, public are comfortable in totally relying on this service, and (2 that CM/ECF is the official record eliminating the traditional paper record.

  8. Sharing Annotated Audio Recordings of Clinic Visits With Patients-Development of the Open Recording Automated Logging System (ORALS): Study Protocol. (United States)

    Barr, Paul J; Dannenberg, Michelle D; Ganoe, Craig H; Haslett, William; Faill, Rebecca; Hassanpour, Saeed; Das, Amar; Arend, Roger; Masel, Meredith C; Piper, Sheryl; Reicher, Haley; Ryan, James; Elwyn, Glyn


    Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth's Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a

  9. Beyond the computer-based patient record: re-engineering with a vision. (United States)

    Genn, B; Geukers, L


    In order to achieve real benefit from the potential offered by a Computer-Based Patient Record, the capabilities of the technology must be applied along with true re-engineering of healthcare delivery processes. University Hospital recognizes this and is using systems implementation projects, such as the catalyst, for transforming the way we care for our patients. Integration is fundamental to the success of these initiatives and this must be explicitly planned against an organized systems architecture whose standards are market-driven. University Hospital also recognizes that Community Health Information Networks will offer improved quality of patient care at a reduced overall cost to the system. All of these implementation factors are considered up front as the hospital makes its initial decisions on to how to computerize its patient records. This improves our chances for success and will provide a consistent vision to guide the hospital's development of new and better patient care.

  10. The use of electronic patient records for medical research: conflicts and contradictions. (United States)

    Stevenson, Fiona


    The use of electronic patient records for medical research is extremely topical. The Clinical Practice Research Datalink (CRPD), the English NHS observational data and interventional research service, was launched in April 2012. The CPRD has access to, and facilities to link, many healthcare related datasets. The CPRD is partially based on learning from the Health Research Support Service (HRSS), which was used to test the technical and practical aspects of downloading and linking electronic patient records for research. Questions around the feasibility and acceptability of implementing and integrating the processes necessary to enable electronic patient records to be used for the purposes of research remain. Focus groups and interviews were conducted with a total of 50 patients and 7 staff from the two English GP practices involved in piloting the HRSS, supplemented with 11 interviews with key stakeholders. Emergent themes were mapped on to the constructs of normalization process theory (NPT) to consider the ways in which sense was made of the work of implementing and integrating the HRSS. The NPT analysis demonstrated a lack of commitment to, and engagement with, the HRSS on the part of patients, whilst the commitment of doctors and practice staff was to some extent mitigated by concerns about issues of governance and consent, particularly in relation to downloading electronic patient records with associated identifiers. Although the CPRD is presented as a benign, bureaucratic process, perceptions by patients and staff of inherent contradictions with centrally held values of information governance and consent in downloading and linking electronic patient records for research remains a barrier to implementation. It is likely that conclusions reached about the problems of balancing the contradictions inherent in sharing what can be perceived as a private resource for the public good are globally transferrable.

  11. Is patient confidentiality compromised with the electronic health record?: a position paper. (United States)

    Wallace, Ilse M


    In order for electronic health records to fulfill their expected benefits, protection of privacy of patient information is key. Lack of trust in confidentiality can lead to reluctance in disclosing all relevant information, which could have grave consequences. This position paper contemplates whether patient confidentiality is compromised by electronic health records. The position that confidentiality is compromised was supported by the four bioethical principles and argued that despite laws and various safeguards to protect patients' confidentiality, numerous data breaches have occurred. The position that confidentiality is not compromised was supported by virtue ethics and a utilitarian viewpoint and argued that safeguards keep information confidential and the public feels relatively safe with the electronic health record. The article concludes with an ethically superior position that confidentiality is compromised with the electronic health record. Although organizational and governmental ways of enhancing the confidentiality of patient information within the electronic health record facilitate confidentiality, the ultimate responsibility of maintaining confidentiality rests with the individual end-users and their ethical code of conduct. The American Nurses Association Code of Ethics for nurses calls for nurses to be watchful with data security in electronic communications.

  12. The patients' active role in managing a personal electronic health record: a qualitative analysis. (United States)

    Baudendistel, Ines; Winkler, Eva; Kamradt, Martina; Brophy, Sarah; Längst, Gerda; Eckrich, Felicitas; Heinze, Oliver; Bergh, Bjoern; Szecsenyi, Joachim; Ose, Dominik


    The complexity of illness and cross-sectoral health care pose challenges for patients with colorectal cancer and their families. Within a patient-centered care paradigm, it is vital to give patients the opportunity to play an active role. Prospective users' attitudes regarding the patients' role in the context of a patient-controlled electronic health record (PEPA) were explored. A qualitative study across regional health care settings and health professions was conducted. Overall, 10 focus groups were performed collecting views of 3 user groups: patients with colorectal cancer (n = 12) and representatives from patient support groups (n = 2), physicians (n = 17), and other health care professionals (HCPs) (n = 16). Data were audio- and videotaped, transcribed verbatim and thematically analyzed using qualitative content analysis. The patients' responsibility as a gatekeeper and access manager was at the center of the focus group discussions, although HCPs addressed aspects that would limit patients taking an active role (e.g., illness related issues). Despite expressed concerns, PEPAs possibility to enhance personal responsibility was seen in all user groups. Giving patients an active role in managing a personal electronic health record is an innovative patient-centered approach, although existing restraints have to be recognized. To enhance user adoption and advance PEPAs potential, key user needs have to be addressed.

  13. Pragmatic Randomized, Controlled Trial of Patient Navigators and Enhanced Personal Health Records in CKD. (United States)

    Navaneethan, Sankar D; Jolly, Stacey E; Schold, Jesse D; Arrigain, Susana; Nakhoul, Georges; Konig, Victoria; Hyland, Jennifer; Burrucker, Yvette K; Dann, Priscilla Davis; Tucky, Barbara H; Sharp, John; Nally, Joseph V


    Patient navigators and enhanced personal health records improve the quality of health care delivered in other disease states. We aimed to develop a navigator program for patients with CKD and an electronic health record-based enhanced personal health record to disseminate CKD stage-specific goals of care and education. We also conducted a pragmatic randomized clinical trial to compare the effect of a navigator program for patients with CKD with enhanced personal health record and compare their combination compared with usual care among patients with CKD stage 3b/4. Two hundred and nine patients from six outpatient clinics (in both primary care and nephrology settings) were randomized in a 2×2 factorial design into four-study groups: ( 1 ) enhanced personal health record only, ( 2 ) patient navigator only, ( 3 ) both, and ( 4 ) usual care (control) group. Primary outcome measure was the change in eGFR over a 2-year follow-up period. Secondary outcome measures included acquisition of appropriate CKD-related laboratory measures, specialty referrals, and hospitalization rates. Median age of the study population was 68 years old, and 75% were white. At study entry, 54% of patients were followed by nephrologists, and 88% were on renin-angiotensin system blockers. After a 2-year follow-up, rate of decline in eGFR was similar across the four groups ( P =0.19). Measurements of CKD-related laboratory parameters were not significantly different among the groups. Furthermore, referral for dialysis education and vascular access placement, emergency room visits, and hospitalization rates were not statistically significant different between the groups. We successfully developed a patient navigator program and an enhanced personal health record for the CKD population. However, there were no differences in eGFR decline and other outcomes among the study groups. Larger and long-term studies along with cost-effectiveness analyses are needed to evaluate the role of patient navigators

  14. Electronic health record use, intensity of hospital care, and patient outcomes. (United States)

    Blecker, Saul; Goldfeld, Keith; Park, Naeun; Shine, Daniel; Austrian, Jonathan S; Braithwaite, R Scott; Radford, Martha J; Gourevitch, Marc N


    Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "electronic health record interactions." Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates. Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25). Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Improving patient-centered communication while using an electronic health record: Report from a curriculum evaluation. (United States)

    Fogarty, Colleen T; Winters, Paul; Farah, Subrina


    Researchers and clinicians are concerned about the impact of electronic health record use and patient-centered communication. Training about patient-centered clinical communication skills with the electronic health record may help clinicians adapt and remain patient-centered. We developed an interactive workshop eliciting challenges and opportunities of working with the electronic health record in clinical practice, introduction of specific patient-centered behaviors and mindful practice techniques, and video demonstrating contrasts in common behavior and "better practices." One hundred thirty-nine resident physicians and faculty supervisors in five residency training programs at the University of Rochester Medical Center participated in the workshops. Participants were asked to complete an 11-item survey of behaviors related to their use of the electronic health record prior to training and after attending training. We used paired t-tests to assess changes in self-reported behavior from pre-intervention to post-intervention. We trained 139 clinicians in the workshops; 110 participants completed the baseline assessment and 39 completed both the baseline and post-intervention assessment. Data from post-curriculum respondents found a statistically significant increase in "I told the patient when turning my attention from the patient to the computer," from 60% of the time prior to the training to 70% of the time after. Data from our program evaluation demonstrated improvement in one communication behavior. Sample size limited the detection of other changes; further research should investigate effective training techniques for patient-centered communication while using the electronic health record. © The Author(s) 2016.

  16. Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report. (United States)

    Harle, Christopher A; Listhaus, Alyson; Covarrubias, Constanza M; Schmidt, Siegfried Of; Mackey, Sean; Carek, Peter J; Fillingim, Roger B; Hurley, Robert W


    In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  17. Classifying Normal and Abnormal Status Based on Video Recordings of Epileptic Patients

    Directory of Open Access Journals (Sweden)

    Jing Li


    Full Text Available Based on video recordings of the movement of the patients with epilepsy, this paper proposed a human action recognition scheme to detect distinct motion patterns and to distinguish the normal status from the abnormal status of epileptic patients. The scheme first extracts local features and holistic features, which are complementary to each other. Afterwards, a support vector machine is applied to classification. Based on the experimental results, this scheme obtains a satisfactory classification result and provides a fundamental analysis towards the human-robot interaction with socially assistive robots in caring the patients with epilepsy (or other patients with brain disorders in order to protect them from injury.

  18. Administrative court control in taxation matters


    Nataša Zunić Kovačević


    Starting with the current organisation of administrative court control in taxation matters, this paper, after a brief overview of the normative legal framework of control in such matters, provides an analysis of certain indicators of administrative and administrative court control implementation in taxation matters. The experience of the application of administrative control in taxation matters and an analysis of accessible indicators of recent administrative court control in taxation matters...

  19. Overcoming Structural Constraints to Patient Utilization of Electronic Medical Records: A Critical Review and Proposal for an Evaluation Framework


    Winkelman, Warren J.; Leonard, Kevin J.


    There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An ...

  20. Investigating the recording and accuracy of fluid balance monitoring in critically ill patients

    Directory of Open Access Journals (Sweden)

    Annette Diacon


    Full Text Available Background. The accurate assessment of fluid balance data collected during physical assessment as well as during monitoring and record-keeping forms an essential part of the baseline patient information that guides medical and nursing interventions aimed at achieving physiological stability in patients. An informal audit of 24-hour fluid balance records in a local intensive care unit (ICU showed that seven out of ten fluid balance calculations were incorrect.Objective. To identify and describe current clinical nursing practice in fluid balance monitoring and measurement accuracy in ICUs, conducted as part of a broader study in partial fulfilment of a Master of Nursing degree.Methods. A quantitative approach utilising a descriptive, exploratory study design was applied. An audit of 103 ICU records was conducted to establish the current practices and accuracy in recording of fluid balance monitoring. Data were collected using a purpose-designed tool based on relevant literature and practice experience. Results. Of the original recorded fluid balance calculations, 79% deviated by more than 50 mL from the audited calculations. Further­more, a significant relationship was shown between inaccurate fluid balance calculation and administration of diuretics (p=0.01. Conclusion. The majority of fluid balance records were incorrectly calculated.

  1. When and How Should Clinicians Share Details from a Health Record with Patients with Mental Illness? (United States)

    Thom, Robyn P; Farrell, Helen M


    Stigma associated with mental illness-a public health crisis-is perpetuated by the language used to describe and document it. Psychiatric pathology and how it can be perceived among clinicians contribute to the marginalization of patients, which exacerbates their vulnerability. Clinical documentation of mental illness has long been mired in pejorative language that perpetuates negative assumptions about those with mental illness. Although patients have the legal right to view their health record, sharing mental health notes with patients remains a sensitive issue, largely due to clinicians' fears that review of this content might cause harm, specifically psychiatric destabilization. However, the ethical principles of justice, beneficence, and autonomy as well as nonmaleficence must be considered by clinicians in determining when and how to share psychiatric details from a health record with their patients. © 2017 American Medical Association. All Rights Reserved.

  2. Corridor consultations and the medical microbiological record: is patient safety at risk? (United States)

    Heard, S R; Roberts, C; Furrows, S J; Kelsey, M; Southgate, L


    The performance procedures of the General Medical Council are aimed at identifying seriously deficient performance in a doctor. The performance procedures require the medical record to be of a standard that enables the next doctor seeing the patient to give adequate care based on the available information. Setting standards for microbiological record keeping has proved difficult. Over one fifth of practising medical microbiologists (including virologists) in the UK (139 of 676) responded to a survey undertaken by the working group developing the performance procedures for microbiology, to identify current practice and to develop recommendations for agreement within the profession about the standards of the microbiological record. The cumulative frequency for the surveyed recording methods used indicated that at various times 65% (90 of 139) of respondents used a daybook, 62% (86 of 139) used the back of the clinical request card, 57% (79 of 139) used a computer record, and 22% (30 of 139) used an index card system to record microbiological advice, suggesting wide variability in relation to how medical microbiologists maintain clinical records. PMID:12499432

  3. Victimological aspects of court judgments

    Directory of Open Access Journals (Sweden)

    Bačanović Oliver


    Full Text Available The subject of this paper is the review of the results of the research: „Analysis of judgments form the victimological aspect“ of the Basic court Skopje I in Skopje. It is the first research of it’s kind in the Republic of Macedonia, conducted by the project team of the Faculty of Security in Skopje in the period from January to April 2011. By using the content analysis (for this purpose a special instrument was developed 172 irrevocable court judgment brought in the period 2005-2010 were analyzed, for the following criminal offences: murder, crimes against sexual freedom and sexual morality (sexual assault, severe bodily injuries and insult. The aim of the research was to highlight the victimological dimensions of mentioned criminal offences, while special attention was paid to the role of a victim in a crime, victim‘ s interaction with the perpetrator, individual characteristics of the victim, as well as the characteristics of the time when and the space where the crime occurred.

  4. Importance of court practice review in Russian arbitration (commercial) court proceedings


    Solovyev, A.


    The article concerns the matters of court practice review in terms of participation in arbitration (commercial) court proceedings. The author gives general description of the system of the arbitration courts administering business and economic justice in the Russian Federation, covered the key areas and worked out the practical recommendations concerning the focal points of arranging the appropriate work in respect of review of law enforcement practice of such courts.

  5. Attitudes of nursing staff towards electronic patient records: a questionnaire survey.

    NARCIS (Netherlands)

    Veer, A.J.E. de; Francke, A.L.


    BACKGROUND: A growing number of health care organizations are implementing a system of electronic patient records (EPR). This implies a change in work routines for nursing staff, but it could also be regarded as an opportunity to improve the quality of care. OBJECTIVE: The objective of this paper is

  6. The six P’s of the next step in electronic patient records in the Netherlands

    NARCIS (Netherlands)

    Michel-Verkerke, Margreet B.; Stegwee, Robert A.; Spil, Antonius A.M.


    The objective of this study was to evaluate a decade of Electronic Patient Record development. During the study a second question was added: How to take the next step in the Netherlands? This paper describes the developments but the main results create a framework for the future situation. The USE

  7. 42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records. (United States)


    ... HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction.... (B) To qualified personnel for the purpose of conducting scientific research, management audits, financial audits, or program evaluation, but such personnel may not identify, directly or indirectly, any...

  8. How Healthcare Professionals "Make Sense" of an Electronic Patient Record Adoption

    DEFF Research Database (Denmark)

    Jensen, Tina Blegind; Aanestad, Margunn


    This article examines how healthcare professionals experience an Electronic Patient Record (EPR) adoption process. Based on a case study from two surgical wards in Danish hospitals, we analyze the healthcare professionals' conceptions of the technology, how it relates to their professional roles...

  9. Develop security architecture for both in-house healthcare information systems and electronic patient record (United States)

    Zhang, Jianguo; Chen, Xiaomeng; Zhuang, Jun; Jiang, Jianrong; Zhang, Xiaoyan; Wu, Dongqing; Huang, H. K.


    In this paper, we presented a new security approach to provide security measures and features in both healthcare information systems (PACS, RIS/HIS), and electronic patient record (EPR). We introduced two security components, certificate authoring (CA) system and patient record digital signature management (DSPR) system, as well as electronic envelope technology, into the current hospital healthcare information infrastructure to provide security measures and functions such as confidential or privacy, authenticity, integrity, reliability, non-repudiation, and authentication for in-house healthcare information systems daily operating, and EPR exchanging among the hospitals or healthcare administration levels, and the DSPR component manages the all the digital signatures of patient medical records signed through using an-symmetry key encryption technologies. The electronic envelopes used for EPR exchanging are created based on the information of signers, digital signatures, and identifications of patient records stored in CAS and DSMS, as well as the destinations and the remote users. The CAS and DSMS were developed and integrated into a RIS-integrated PACS, and the integration of these new security components is seamless and painless. The electronic envelopes designed for EPR were used successfully in multimedia data transmission.

  10. Continuous event recorders did not affect anxiety or quality of life in patients with palpitations

    NARCIS (Netherlands)

    Hoefman, Emmy; Boer, Kimberly R.; van Weert, Henk C. P. M.; Reitsma, Johannes B.; Koster, Rudolf W.; Bindels, Patrick J. P.


    OBJECTIVES: Palpitations can generate feelings of anxiety and decrease quality of life (QoL) due to fear of a cardiac abnormality. Continuous event recorders (CERs) have proven to be successful in diagnosing causes of palpitations but may affect patient QoL and anxiety. The aim is to determine

  11. Design of a consumer health record for supporting the patient-centered management of chronic diseases.

    NARCIS (Netherlands)

    de Clerq, P.A.; Hasman, A.; Wolffenbuttel, B.H.R.


    : Medinfo 2001;10(Pt 2):1445-9 Related Articles, Books, LinkOut Design of a consumer health record for supporting the patient-centered management of chronic diseases. de Clercq PA, Hasman A, Wolffenbuttel BH. Department of Medical Informatics, University of Maastricht, Maastricht, The Netherlands.

  12. 25 CFR 11.912 - Contempt of court. (United States)


    ... OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Children's Court § 11.912 Contempt of court. Any willful disobedience or interference with any order of the children's court constitutes contempt of court which may be punished in accordance...

  13. Status of Court Management in Switzerland

    Directory of Open Access Journals (Sweden)

    Andreas Lienhard


    Full Text Available At an international level, and in particular in the Anglo-American region, there is a long tradition of scientific study of court management. Thus in Australia there has for quite some time been the Australasian Institution of Judicial Administration (AIJA, which concerns itself with every aspect of court administration. In the USA too, research and education in the field of court management has been institutionalized for a long time, in particular by the National Center for State Courts (NCSC and the related Institute for Court Management (ICM. In Europe, a working group known as the European Commission for the Efficiency of Justice (CEPEJ deals with issues of court management as part of the activities of the Council of Europe. The fact that court management is also increasingly becoming an important topic in the European area was demonstrated by the establishment, in 2008, of a new professional journal that focuses on court management, the International Journal for Court Administration (IJCA. In Switzerland, the issue of court management was discussed for the first time in the course of the New Public Management (NPM projects in the cantons, but was often limited to the question of whether to include the courts in the relevant cantonal NPM model. Generally speaking, court management was a matter that was only sporadically raised, such as at a symposium of the Swiss Society of Administrative Sciences (SSAS in 2003 or more recently in an article in which theses on good court management are formulated. In Switzerland even today there is a general dearth of empirical and other theoretical findings on the mode of operation of the justice system and its interaction with society, or with specific social target groups. For example, it was only in 2009 that the first indications were obtained of how cases in various categories were handled by the highest administrative and social insurance courts in Switzerland. In the fields of criminal and civil

  14. Wireless connection of continuous glucose monitoring system to the electronic patient record (United States)

    Murakami, Alexandre; Gutierrez, Marco A.; Lage, Silvia G.; Rebelo, Marina S.; Granja, Luiz A. R.; Ramires, Jose A. F.


    The control of blood sugar level (BSL) at near-normal levels has been documented to reduce both acute and chronic complications of diabetes mellitus. Recent studies suggested, the reduction of mortality in a surgical intensive care unit (ICU), when the BSL are maintained at normal levels. Despite of the benefits appointed by these and others clinical studies, the strict BSL control in critically ill patients suffers from some difficulties: a) medical staff need to measure and control the patient"s BSL using blood sample at least every hour. This is a complex and time consuming task; b) the inaccuracy of standard capillary glucose monitoring (fingerstick) in hypotensive patients and, if frequently used to sample arterial or venous blood, may lead to excess phlebotomy; c) there is no validated procedure for continuously monitoring of BSL levels. This study used the MiniMed CGMS in ill patients at ICU to send, in real-time, BSL values to a Web-Based Electronic Patient Record. The BSL values are parsed and delivered through a wireless network as an HL7 message. The HL7 messages with BSL values are collected, stored into the Electronic Patient Record and presented into a bed-side monitor at the ICU together with other relevant patient information.

  15. Analysis of free text in electronic health records for identification of cancer patient trajectories

    DEFF Research Database (Denmark)

    Jensen, Kasper; Soguero-Ruiz, Cristina; Mikalsen, Karl Oyvind


    With an aging patient population and increasing complexity in patient disease trajectories, physicians are often met with complex patient histories from which clinical decisions must be made. Due to the increasing rate of adverse events and hospitals facing financial penalties for readmission......, there has never been a greater need to enforce evidence-led medical decision-making using available health care data. In the present work, we studied a cohort of 7,741 patients, of whom 4,080 were diagnosed with cancer, surgically treated at a University Hospital in the years 2004-2012. We have developed...... a methodology that allows disease trajectories of the cancer patients to be estimated from free text in electronic health records (EHRs). By using these disease trajectories, we predict 80% of patient events ahead in time. By control of confounders from 8326 quantified events, we identified 557 events...

  16. 75 FR 57985 - Records Schedules; Availability and Request for Comments (United States)


    ... audiovisual recordings and photographs, and court order and report files including Indian Fiduciary Trust... Advisory Committee on Historical Diplomatic Documentation, reference materials, office Web site content...


    Directory of Open Access Journals (Sweden)

    Andrea Fehér


    Full Text Available The purpose of this presentation is to address the issue of female criminality in early modern Cluj, and to analyze women’s position before the law. Our investigation is based on the records of the secular Court from the town Cluj, where we have identified more than 250 cases of women accused of fornication, adultery, witchcraft, infanticide, theft and drunkenness, poisoning, swearing and slander. There were a significant number of female convictions during the century, from which most ended with light sentences, such as banishment, corporal punishments, stigmatizations with hot iron, mutilations and only occasionally death. We would like to analyze in detail the types of crime and their punishments presenting the legal background, the jurisdiction and the habitual practices of the Court. We would also like to underline the importance of the narrative strategies used in these inquisitorial trials, since our documents reveal female criminality from a male perspective, as in these times men ran the legal system, consequently the Court records, in our reading contain moral, legal and sexual elements of a male discourse on female crime.


    African Journals Online (AJOL)

    management, rational allocation of resources and provision of adequate and effective ... records management environment in which records can be timely accessed to .... most critical in terms of impact and influence in the development of records and ..... and educative role of the Court of Appeal as the highest judicial organ ...

  19. Perampanel: An audit of clinical experience using the epilepsy electronic patient record.

    LENUS (Irish Health Repository)

    Ryan, E


    Perampanel is a non-competitive antagonist of AMPA glutamate receptors on post synaptic neurons. The aim of this study was to conduct an audit of the experience of perampanel treatment in Ireland based on the interrogation of the national epilepsy electronic patient record (EPR). A retrospective audit was compiled which reviewed the progress of patients who had been treated across two regional epilepsy centres. The EPR was used to identify patients and collect information relevant to their perampanel therapy. Collected data was entered into a statistical package for social sciences for analysis using descriptive statistics.\\r\

  20. Atrial fibrillation detected by external loop recording for seven days or two-day simultaneous Holter recording: A comparison in patients with ischemic stroke or transient ischemic attack. (United States)

    Sejr, Michala Herskind; Nielsen, Jens Cosedis; Damgaard, Dorte; Sandal, Birgitte Forsom; May, Ole

    Atrial fibrillation (AF) is the most common cardiac cause of ischemic stroke and transient ischemic attack (IS/TIA). To compare the diagnostic value of seven-day external loop recording (ELR) and two-day Holter recording for detecting AF after IS/TIA. 191 IS/TIA patients without AF history. Endpoint was AF >30s. We started two-day Holter recording and seven-day ELR simultaneously. Seven-day ELR and two-day Holter recording detected the same three AF patients. ELR detected another six patients with AF adjudicated by cardiologists, four detections after Holter (3 vs. 7, p=0.125) and two false-positive detections during Holter. Seven-day ELR automatically classified 50/191 patients (26%) with AF, but only 7/50 (14%) were confirmed as AF by cardiologists. Seven-day ELR did not detect significantly more patients with AF than two-day Holter recording. 86% of patients with ELR-classified AF were false positives, indicating a poor performance of the automatic AF detection algorithm used. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Court Cases Involving Contracts for School Districts (United States)

    Allen, L. Hank


    The purpose of this research was to analyze trends in the United States regarding contract disputes that exist in school districts. Court cases were identified at the state and federal level to determine the outcomes and the fact patterns of contract disputes. To gain the knowledge of how courts handle cases of contractual breach, contracts…

  2. 78 FR 14017 - Courts of Indian Offenses (United States)


    ... process of establishing, tribal courts; and are therefore no longer in need of an extra-tribal judicial... Health Hospital, and the Albuquerque Indian School Property (land held in trust for the 19 Pueblos of New... have courts to administer justice on land under their jurisdiction. Prior notice and comment are...

  3. Editorial Coverage of Reagan Supreme Court Nominees. (United States)

    Hale, F. Dennis

    To measure the editorial advocacy of influential newspapers concerning the membership of the Supreme Court, a study analyzed editorials from such newspapers concerning the last five Supreme Court nominees of President Ronald Reagan (William Rehnquist, Antonin Scalia, Robert Bork, Douglas Ginsburg, and Anthony Kennedy). A telephone survey of 100…

  4. Court supervised institutional transformation in South Africa ...

    African Journals Online (AJOL)

    The traditional adversarial model of litigation in South Africa operates on the basis that two or more parties approach the court, each with its own desired outcome. The court is then obliged to decide in favour of one of the parties. A different model of litigation is emerging in South African law. This model involves actions ...

  5. Educational Malpractice: Why the Courts Say No. (United States)

    Hammes, Richard


    The courts have refused to award damages to litigants claiming educational malpractice. This article discusses recurring themes in the courts' rationale for their decisions. Discussion focuses on elements of negligence: the duty of care, the breach of duty, injury and proximate cause. (IAH)

  6. Sociomateriality at the Royal Court of IS

    DEFF Research Database (Denmark)

    Kautz, Karlheinz; Jensen, Tina Blegind


    understanding of the notion of sociomateriality and its use in the IS discipline. We invite the reader to attend a prolonged monologue – characterized by honesty, frank observations and wit – at the royal court of IS. The monologue is delivered by the court jester and directed to the two sovereigns who, based...

  7. Honoring Dental Patients' Privacy Rule Right of Access in the Context of Electronic Health Records. (United States)

    Ramoni, Rachel B; Asher, Sheetal R; White, Joel M; Vaderhobli, Ram; Ogunbodede, Eyitope O; Walji, Muhammad F; Riedy, Christine; Kalenderian, Elsbeth


    A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

  8. Investigating the Extent to Which Patients Should Control Access to Patient Records for Research: A Deliberative Process Using Citizens’ Juries (United States)

    Bozentko, Kyle; Clement, Sarah; Hunn, Amanda; Hassan, Lamiece; Norris, Ruth; Oswald, Malcolm; Peek, Niels


    Background The secondary use of health data for research raises complex questions of privacy and governance. Such questions are ill-suited to opinion polling where citizens must choose quickly between multiple-choice answers based on little information. Objective The aim of this project was to extend knowledge about what control informed citizens would seek over the use of health records for research after participating in a deliberative process using citizens’ juries. Methods Two 3-day citizens’ juries, of 17 citizens each, were convened to reflect UK national demographics from 355 eligible applicants. Each jury addressed the mission “To what extent should patients control access to patient records for secondary use?” Jurors heard from and questioned 5 expert witnesses (chosen either to inform the jury, or to argue for and against the secondary use of data), interspersed with structured opportunities to deliberate among themselves, including discussion and role-play. Jurors voted on a series of questions associated with the jury mission, giving their rationale. Individual views were polled using questionnaires at the beginning and at end of the process. Results At the end of the process, 33 out of 34 jurors voted in support of the secondary use of data for research, with 24 wanting individuals to be able to opt out, 6 favoring opt in, and 3 voting that all records should be available without any consent process. When considering who should get access to data, both juries had very similar rationales. Both thought that public benefit was a key justification for access. Jury 1 was more strongly supportive of sharing patient records for public benefit, whereas jury 2 was more cautious and sought to give patients more control. Many jurors changed their opinion about who should get access to health records: 17 people became more willing to support wider information sharing of health data for public benefit, whereas 2 moved toward more patient control over

  9. Improving Self-Care of Patients with Chronic Disease using Online Personal Health Record

    Directory of Open Access Journals (Sweden)

    Amol Wagholikar


    Full Text Available Background Effective management of chronic diseases such as prostate cancer is important. Research suggests a tendency to use self-care treatment options such as over-the-counter (OTC complementary medications among prostate cancer patients. The current trend in patient-driven recording of health data in an online Personal Health Record (PHR presents an opportunity to develop new data-driven approaches for improving prostate cancer patient care. However, the ability of current online solutions to share patients’ data for better decision support is limited. An informatics approach may improve online sharing of self-care interventions among these patients. It can also provide better evidence to support decisions made during their self-managed care.Aims To identify requirements for an online system and describe a new case-based reasoning (CBR method for improving self-care of advanced prostate cancer patients in an online PHR environment. Method A non-identifying online survey was conducted to understand self-care patterns among prostate cancer patients and to identify requirements for an online information system. The pilot study was carried out between August 2010 and December 2010. A case-base of 52 patients was developed. Results The data analysis showed self-care patterns among the prostate cancer patients. Selenium (55% was the common complementary supplement used by the patients. Paracetamol (about 45% was the commonly used OTC by the patients. Conclusion The results of this study specified requirements for an online case-based reasoning information system. The outcomes of this study are being incorporated in design of the proposed Artificial Intelligence (AI driven patient journey browser system. A basic version of the proposed system is currently being considered for implementation.

  10. The constitutional court review of judicial decisions

    Directory of Open Access Journals (Sweden)

    Stojanović Dragan M.


    Full Text Available In principle, the constitutional precepts envisage that judicial decisions are not subject to extrajudicial control. However, in the course of deciding on constitutional complaints, the Constitutional Court reviews the compliance of individual legal acts and actions of state authorities with the Constitution, including court decisions on cases involving the constitutionally guaranteed rights. Hence, in order to eliminate tension or even contradiction between the constitutional precepts, the constitutional review of judicial decisions should be considered as a special form of judicial control, regardless of the fact that the Constitutional Court is not part of the judicial structure in the strict organizational sense. Thus, unlike the cases where the Court is involved in the normative control of the applicable law, in the process of reviewing judicial decision of lower courts the constitutional judiciary acts in the capacity of a specific judicial authority. According to another possible interpretation of the aforementioned constitutional norms, the direct constitutional protection of the constitutionally guaranteed rights may only be pursued in the process of reviewing individual legal acts and actions of state authorities, but not by pursuing a judicial review of court decisions which the Constitutional Court has no jurisdiction to decide upon. Thus, the dogma of judicial independence would prevail over the dogma of direct protection of fundamental rights. The third interpretation of this relationship maintains that that judicial decisions may be subject to control but, in this specific case, the Constitutional Court may only issue an opinion (a statement rather than a binding decision which would cancel the lower court judgment. Then, it is up to the judicial authorities of the lower instance to adjust their judicial decision, which in the opinion of the Constitutional Court constitutes a violation of the constitutionally guaranteed rights

  11. Pursuing transparency through science courts

    Energy Technology Data Exchange (ETDEWEB)

    Field, Thomas G. Jr. [Franklin Pierce Law Center, Concord, NH (United States)


    Many, disappointed with traditional ways to assess and manage health, safety and environmental risks, have sought alternatives that might better serve democratic values and truth. Arthur Kantrowitz proposed one in 1967. Named the 'Science Court' by the media, it sought to air opposing viewpoints publicly before an independent, neutral and technically competent panel of scientists. The idea has received considerable attention over the years, but some see it as too opaque and elitist. Ironically, others may view it as too transparent. Beyond that, as proposed it might have been too time-consuming and expensive, and few scientists would have welcomed a suggestion for cross-examination. Yet, its key features still offer promise for resolving difficult policy disputes and might be usefully integrated with notions since leading to the creation and endorsement of advisory science boards.

  12. Pursuing transparency through science courts

    International Nuclear Information System (INIS)

    Field, Thomas G. Jr.


    Many, disappointed with traditional ways to assess and manage health, safety and environmental risks, have sought alternatives that might better serve democratic values and truth. Arthur Kantrowitz proposed one in 1967. Named the 'Science Court' by the media, it sought to air opposing viewpoints publicly before an independent, neutral and technically competent panel of scientists. The idea has received considerable attention over the years, but some see it as too opaque and elitist. Ironically, others may view it as too transparent. Beyond that, as proposed it might have been too time-consuming and expensive, and few scientists would have welcomed a suggestion for cross-examination. Yet, its key features still offer promise for resolving difficult policy disputes and might be usefully integrated with notions since leading to the creation and endorsement of advisory science boards

  13. Pursuing transparency through science courts

    Energy Technology Data Exchange (ETDEWEB)

    Field, Jr, Thomas G [Franklin Pierce Law Center, Concord, NH (United States)


    Many, disappointed with traditional ways to assess and manage health, safety and environmental risks, have sought alternatives that might better serve democratic values and truth. Arthur Kantrowitz proposed one in 1967. Named the 'Science Court' by the media, it sought to air opposing viewpoints publicly before an independent, neutral and technically competent panel of scientists. The idea has received considerable attention over the years, but some see it as too opaque and elitist. Ironically, others may view it as too transparent. Beyond that, as proposed it might have been too time-consuming and expensive, and few scientists would have welcomed a suggestion for cross-examination. Yet, its key features still offer promise for resolving difficult policy disputes and might be usefully integrated with notions since leading to the creation and endorsement of advisory science boards.

  14. Identification of Patient Safety Risks Associated with Electronic Health Records: A Software Quality Perspective. (United States)

    Virginio, Luiz A; Ricarte, Ivan Luiz Marques


    Although Electronic Health Records (EHR) can offer benefits to the health care process, there is a growing body of evidence that these systems can also incur risks to patient safety when developed or used improperly. This work is a literature review to identify these risks from a software quality perspective. Therefore, the risks were classified based on the ISO/IEC 25010 software quality model. The risks identified were related mainly to the characteristics of "functional suitability" (i.e., software bugs) and "usability" (i.e., interface prone to user error). This work elucidates the fact that EHR quality problems can adversely affect patient safety, resulting in errors such as incorrect patient identification, incorrect calculation of medication dosages, and lack of access to patient data. Therefore, the risks presented here provide the basis for developers and EHR regulating bodies to pay attention to the quality aspects of these systems that can result in patient harm.

  15. The PHARMS (Patient Held Active Record of Medication Status) feasibility study: a research proposal.

    LENUS (Irish Health Repository)

    Walsh, Elaine


    Medication errors are a major source of preventable morbidity, mortality and cost and many occur at the times of hospital admission and discharge. Novel interventions (such as new methods of recording medication information and conducting medication reconciliation) are required to facilitate accurate transfer of medication information. With existing evidence supporting the use of information technology and the patient representing the one constant in the care process, an electronic patient held medication record may provide a solution. This study will assess the feasibility of introducing a patient held electronic medication record in primary and secondary care using the Consolidated Framework for Implementation Research (CFIR).This feasibility study is a mixed method study of community dwelling older adult patients admitted to an urban secondary care facility comprising a non-randomised intervention and qualitative interviews with key stakeholders. Outcomes of interest include clinical outcomes and process evaluation.This study will yield insights pertaining to feasibility, acceptability and participation for a more definitive evaluation of the intervention. The study also has the potential to contribute to knowledge of implementation of technology in a healthcare context and to the broader area of implementation science.

  16. Self-Reported Interview-Assisted Diet Records Underreport Energy Intake in Maintenance Hemodialysis Patients. (United States)

    Shapiro, Bryan B; Bross, Rachelle; Morrison, Gillian; Kalantar-Zadeh, Kamyar; Kopple, Joel D


    Studies suggest that maintenance hemodialysis (MHD) patients report dietary energy intakes (EIs) that are lower than what is actually ingested. Data supporting this conclusion have several important limitations. The present study introduces a novel approach of assessing underreporting of EI in MHD patients. Comparisons of EI of free-living MHD patients determined from food records to their measured energy needs. Metabolic research ward. Thirteen clinically stable MHD patients with unchanging weights whose EI was assessed by dietitian interview-assisted 3-day food records. EI was compared with (1) patients' resting energy expenditure (REE), measured by indirect calorimetry, and estimated total energy expenditure (TEE) and (2) patients' dietary energy requirements (DER) measured while patients underwent nitrogen balance studies and consumed a constant energy diet in a research ward for a mean duration of 89.5 days. DER was calculated as the actual EI during the research study corrected for changes in body fat and lean body mass measured by Dual X-Ray Absorptiometry. Underreporting of EI was determined by an EI:REE ratio <1.27 and an EI:TEE ratio or EI:DEE ratio <1.0. Seven of the 13 MHD patients studied were male. Patient's ages were 47.7 ± standard deviation 9.7 years; body mass index averaged 25.4 ± 2.8 kg/m2, and dialysis vintage was 53.3 ± 37.1 months. The EI:REE ratio (1.03 ± 0.23) was significantly less than the cutoff value for underreporting of 1.27 (P = .001); 12 of 13 patients had EI:REE ratios <1.27. The mean EI:TEE ratio was significantly less than the cutoff value of 1.0 (0.73 ± 0.17, P < .0001), and 12 MHD patients had EI:TEE ratios <1.0. The EI:DER ratio was also <1.0 (0.83 ± 0.25, P = .012), and 10 MHD had EI:DER ratios <1.0. Dietitian interview-assisted diet records by MHD patients substantially underestimate the patient's dietary EI. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  17. Modified automatic R-peak detection algorithm for patients with epilepsy using a portable electrocardiogram recorder. (United States)

    Jeppesen, J; Beniczky, S; Fuglsang Frederiksen, A; Sidenius, P; Johansen, P


    Earlier studies have shown that short term heart rate variability (HRV) analysis of ECG seems promising for detection of epileptic seizures. A precise and accurate automatic R-peak detection algorithm is a necessity in a real-time, continuous measurement of HRV, in a portable ECG device. We used the portable CE marked ePatch® heart monitor to record the ECG of 14 patients, who were enrolled in the videoEEG long term monitoring unit for clinical workup of epilepsy. Recordings of the first 7 patients were used as training set of data for the R-peak detection algorithm and the recordings of the last 7 patients (467.6 recording hours) were used to test the performance of the algorithm. We aimed to modify an existing QRS-detection algorithm to a more precise R-peak detection algorithm to avoid the possible jitter Qand S-peaks can create in the tachogram, which causes error in short-term HRVanalysis. The proposed R-peak detection algorithm showed a high sensitivity (Se = 99.979%) and positive predictive value (P+ = 99.976%), which was comparable with a previously published QRS-detection algorithm for the ePatch® ECG device, when testing the same dataset. The novel R-peak detection algorithm designed to avoid jitter has very high sensitivity and specificity and thus is a suitable tool for a robust, fast, real-time HRV-analysis in patients with epilepsy, creating the possibility for real-time seizure detection for these patients.

  18. A computerised out-patient medical records programme based on the Summary Time-Oriented Record (STOR) System. (United States)

    Cheong, P Y; Goh, L G; Ong, R; Wong, P K


    Advances in microcomputer hardware and software technology have made computerised outpatient medical records practical. We have developed a programme based on the Summary Time-Oriented Record (STOR) system which complements existing paper-based record keeping. The elements of the Problem Oriented Medical Record (POMR) System are displayed in two windows within one screen, namely, the SOAP (Subjective information, Objective information, Assessments and Plans) elements in the Reason For Encounter (RFE) window and the problem list with outcomes in the Problem List (PL) window. Context sensitive child windows display details of plans of management in the RFE window and clinical notes in the PL window. The benefits of such innovations to clinical decision making and practice based research and its medico-legal implications are discussed.

  19. NHS England Patient Online - Patient Access to their Medical Record in General Practice

    Directory of Open Access Journals (Sweden)

    Jana Dale


    Patient Online can be promoted quickly and successfully when the clear evidence demonstrates it reduces workload. Its implementation will then result in the improved patient care and changes in behaviour necessary for the NHS National Information Board “Personalised Health and Care 2020” Implementation.

  20. Ethical Implications of the Electronic Health Record: In the Service of the Patient. (United States)

    Sulmasy, Lois Snyder; López, Ana María; Horwitch, Carrie A


    Electronic health records (EHRs) provide benefits for patients, physicians, and clinical teams, but also raise ethical questions. Navigating how to provide care in the digital age requires an assessment of the impact of the EHR on patient care and the patient-physician relationship. EHRs should facilitate patient care and, as an essential component of that care, support the patient-physician relationship. Billing, regulatory, research, documentation, and administrative functions determined by the operational requirements of health care systems, payers, and others have resulted in EHRs that are better able to satisfy such external functions than to ensure that patient care needs are met. The profession has a responsibility to identify and address this mismatch. This position paper by the American College of Physicians (ACP) Ethics, Professionalism and Human Rights Committee does not address EHR design, user variability, meaningful use, or coding requirements and other government and payer mandates per se; these issues are discussed in detail in ACP's Clinical Documentation policy. This paper focuses on EHRs and the patient-physician relationship and patient care; patient autonomy, privacy and confidentiality; and professionalism, clinical reasoning and training. It explores emerging ethical challenges and concerns for and raised by physicians across the professional lifespan, whose ongoing input is crucial to the development and use of information technology that truly serves patients.

  1. Patient-centered communication in the era of electronic health records: What does the evidence say? (United States)

    Rathert, Cheryl; Mittler, Jessica N; Banerjee, Sudeep; McDaniel, Jennifer


    Patient-physician communication is essential for patient-centered health care. Physicians are concerned that electronic health records (EHRs) negatively affect communication with patients. This study identified a framework for understanding communication functions that influence patient outcomes. We then conducted a systematic review of the literature and organized it within the framework to better understand what is known. A comprehensive search of three databases (CINAHL, Medline, PsycINFO) yielded 41 articles for analysis. Results indicated that EHR use improves capture and sharing of certain biomedical information. However, it may interfere with collection of psychosocial and emotional information, and therefore may interfere with development of supportive, healing relationships. Patient access to the EHR and messaging functions may improve communication, patient empowerment, engagement, and self-management. More rigorous examination of EHR impacts on communication functions and their influences on patient outcomes is imperative for achieving patient-centered care. By focusing on the role of communication functions on patient outcomes, future EHRs can be developed to facilitate care. Training alone is likely to be insufficient to address disruptions to communication processes. Processes must be improved, and EHRs must be developed to capture useful data without interfering with physicians' and patients' abilities to effectively communicate. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Enabling Patient Control of Personal Electronic Health Records Through Distributed Ledger Technology. (United States)

    Cunningham, James; Ainsworth, John


    The rise of distributed ledger technology, initiated and exemplified by the Bitcoin blockchain, is having an increasing impact on information technology environments in which there is an emphasis on trust and security. Management of electronic health records, where both conformation to legislative regulations and maintenance of public trust are paramount, is an area where the impact of these new technologies may be particularly beneficial. We present a system that enables fine-grained personalized control of third-party access to patients' electronic health records, allowing individuals to specify when and how their records are accessed for research purposes. The use of the smart contract based Ethereum blockchain technology to implement this system allows it to operate in a verifiably secure, trustless, and openly auditable environment, features crucial to health information systems moving forward.

  3. Worldwide telemedicine services based on distributed multimedia electronic patient records by using the second generation Web server hyperwave. (United States)

    Quade, G; Novotny, J; Burde, B; May, F; Beck, L E; Goldschmidt, A


    A distributed multimedia electronic patient record (EPR) is a central component of a medicine-telematics application that supports physicians working in rural areas of South America, and offers medical services to scientists in Antarctica. A Hyperwave server is used to maintain the patient record. As opposed to common web servers--and as a second generation web server--Hyperwave provides the capability of holding documents in a distributed web space without the problem of broken links. This enables physicians to browse through a patient's record by using a standard browser even if the patient's record is distributed over several servers. The patient record is basically implemented on the "Good European Health Record" (GEHR) architecture.

  4. Consumer-directed health care and the courts: let the buyer (and seller) beware. (United States)

    Jacobson, Peter D; Tunick, Michael R


    In consumer-directed health care, patients will be expected to exert greater control over their spending decisions than before. As consumer-directed care gains market acceptance, courts will inevitably be involved in resolving challenges to the new arrangements. We anticipate that courts will be generally favorable toward consumer-directed care, but the new legal doctrine will not uniformly favor medical professionals and insurers. The information demands inherent in consumer-directed care will present particular legal challenges to physicians and insurers. Even as courts provide flexibility to reflect the new market realities, they will closely monitor how consumer-directed care is implemented.

  5. Record High US Measles Cases: Patient Vaccination, Clinical Assessment and Management

    Centers for Disease Control (CDC) Podcasts

    This podcast is an overview of the Clinician Outreach and Communication Activity (COCA) Call: Record High US Measles Cases: Patient Vaccination, Clinical Assessment and Management. In May 2014, the United States recorded the largest number of reported measles cases since 1994 and the number continues to rise. Most cases reported have been acquired in the U.S. and are associated with importations from countries where measles is still common. This highly contagious, acute viral illness spreads quickly in unvaccinated populations once reaching the U.S. The recent measles outbreaks highlight the importance of maintaining high vaccination coverage in the U.S. and ensuring age-appropriate vaccination for international travelers. During this COCA call, clinicians will learn the status of measles in the U.S. and CDC vaccination recommendations and guidelines for patient assessment and management.

  6. Image-based electronic patient records for secured collaborative medical applications. (United States)

    Zhang, Jianguo; Sun, Jianyong; Yang, Yuanyuan; Liang, Chenwen; Yao, Yihong; Cai, Weihua; Jin, Jin; Zhang, Guozhen; Sun, Kun


    We developed a Web-based system to interactively display image-based electronic patient records (EPR) for secured intranet and Internet collaborative medical applications. The system consists of four major components: EPR DICOM gateway (EPR-GW), Image-based EPR repository server (EPR-Server), Web Server and EPR DICOM viewer (EPR-Viewer). In the EPR-GW and EPR-Viewer, the security modules of Digital Signature and Authentication are integrated to perform the security processing on the EPR data with integrity and authenticity. The privacy of EPR in data communication and exchanging is provided by SSL/TLS-based secure communication. This presentation gave a new approach to create and manage image-based EPR from actual patient records, and also presented a way to use Web technology and DICOM standard to build an open architecture for collaborative medical applications.

  7. Using text-mining techniques in electronic patient records to identify ADRs from medicine use

    DEFF Research Database (Denmark)

    Warrer, Pernille; Hansen, Ebba Holme; Jensen, Lars Juhl


    This literature review included studies that use text-mining techniques in narrative documents stored in electronic patient records (EPRs) to investigate ADRs. We searched PubMed, Embase, Web of Science and International Pharmaceutical Abstracts without restrictions from origin until July 2011. We...... included empirically based studies on text mining of electronic patient records (EPRs) that focused on detecting ADRs, excluding those that investigated adverse events not related to medicine use. We extracted information on study populations, EPR data sources, frequencies and types of the identified ADRs......, medicines associated with ADRs, text-mining algorithms used and their performance. Seven studies, all from the United States, were eligible for inclusion in the review. Studies were published from 2001, the majority between 2009 and 2010. Text-mining techniques varied over time from simple free text...

  8. Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation. (United States)

    Gold, Jeffrey Allen; Stephenson, Laurel E; Gorsuch, Adriel; Parthasarathy, Keshav; Mohan, Vishnu


    Numerous reports describe unintended consequences of electronic health record implementation. Having previously described physicians' failures to recognize patient safety issues within our electronic health record simulation environment, we now report on our use of eye and screen-tracking technology to understand factors associated with poor error recognition during an intensive care unit-based electronic health record simulation. We linked performance on the simulation to standard eye and screen-tracking readouts including number of fixations, saccades, mouse clicks and screens visited. In addition, we developed an overall Composite Eye Tracking score which measured when, where and how often each safety item was viewed. For 39 participants, the Composite Eye Tracking score correlated with performance on the simulation (p = 0.004). Overall, the improved performance was associated with a pattern of rapid scanning of data manifested by increased number of screens visited (p = 0.001), mouse clicks (p = 0.03) and saccades (p = 0.004). Eye tracking can be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision making and electronic health record usability. © The Author(s) 2015.

  9. Should the District Courts Have Jurisdiction Over Pre-Award Contract Claims? A Claim for the Claims Court

    National Research Council Canada - National Science Library

    Short, John J


    This thesis briefly examines the jurisdiction of the federal district courts and the United States Court of Claims over pre-award contract claims before the Federal Courts Improvement Act of October 1...

  10. EAP recordings in ineraid patients--correlations with psychophysical measures and possible implications for patient fitting. (United States)

    Zimmerling, Martin J; Hochmair, Erwin S


    Objective measurements can be helpful for cochlear implant fitting of difficult populations, as for example very young children. One method, the recording of the electrically evoked compound action potential (EAP), measures the nerve recruitment in the cochlea in response to stimulation through the implant. For coding strategies implemented at a moderate stimulation rate of 250 pps per channel, useful correlations between EAP data and psychophysical data have been already found. With new systems running at higher rates, it is important to check these correlations again. This study investigates the correlations between psychophysical data and EAP measures calculated from EAP amplitude growth functions. EAP data were recorded in 12 Ineraid subjects. Additionally, behavioral thresholds (THR) and maximum acceptable loudness levels (MAL) were determined for stimulation rates of 80 pps and 2,020 pps for each electrode. Useful correlations between EAP data and psychophysical data were found at the low stimulation rate (80 pps). However, at the higher stimulation rate (2,020 pps) correlations were not significant. They were improved substantially, however, by introducing a factor that corrected for disparities due to temporal integration. Incorporation of this factor, which controls for the influence of the stimulation rate on the threshold, improved the correlations between EAP measures recorded at 80 pps and psychophysical MALs measured at 2,020 pps to better than r = 0.70. EAP data as such can only be used to predict behavioral THRs or MCLs at low stimulation rates. To cope with temporal integration effects at higher stimulation rates, EAP data must be rate corrected. The introduction of a threshold-rate-factor is a promising way to achieve that goal. Further investigations need to be performed.

  11. Unreliable patient identification warrants ABO typing at admission to check existing records before transfusion. (United States)

    Ferrera-Tourenc, V; Lassale, B; Chiaroni, J; Dettori, I


    This study describes patient identification errors leading to transfusional near-misses in blood issued by the Alps Mediterranean French Blood Establishment (EFSAM) to Marseille Public Hospitals (APHM) over an 18-month period. The EFSAM consolidates 14 blood banks in southeast France. It supplies 149 hospitals and maintains a centralized database on ABO types used at all area hospitals. As an added precaution against incompatible transfusion, the APHM requires ABO testing at each admission regardless of whether the patient has an ABO record. The study goal was to determine if admission testing was warranted. Discrepancies between ABO type determined by admission testing and records in the centralized database were investigated. The root cause for each discrepancy was classified as specimen collection or patient admission error. Causes of patient admission events were further subclassified as namesake (name similarity) or impersonation (identity fraud). The incidence of ABO discrepancies was 1:2334 including a 1:3329 incidence of patient admission events. Impersonation was the main cause of identity events accounting for 90.3% of cases. The APHM's ABO control policy prevented 19 incompatible transfusions. In relation to the 48,593 packed red cell units transfused, this would have corresponded to a risk of 1:2526. Collecting and storing ABO typing results in a centralized database is an essential public health tool. It allows crosschecking of current test results with past records and avoids redundant testing. However, as patient identification remains unreliable, ABO typing at each admission is still warranted to prevent transfusion errors. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. Implementation of computer-based patient records in primary care: the societal health economic effects.


    Arias-Vimárlund, V.; Ljunggren, M.; Timpka, T.


    OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland...

  13. Integrating clinical theory and practice in an epilepsy-specific electronic patient record.

    LENUS (Irish Health Repository)

    Breen, Patricia


    This study\\'s objective was to assess the usability of the epilepsy history module of the electronic patient record, developed at Beaumont Hospital, and to identify opportunities for improvement. Observation, interview and document analysis methods were used. Results indicated that the module was useable but the design did not work as well in practice as anticipated by theory. The next iteration of the module included identified enhancements; this iteration is currently in use.

  14. Expectations for the next generation of electronic patient records in primary care: a triangulated study

    Directory of Open Access Journals (Sweden)

    Tom Christensen


    Conclusions Progress toward a problem-oriented EPR system based on episodes of care that includes decision support is necessary to satisfy the needs expressed by GPs. Further research could solve the problem of integration of functionality for consultation with specialists and integration with patient held records. Results from this study could contribute to further development of the next generation of EPRs in primary care, as well as inspire the application of EPRs in other parts of the health sector.

  15. Pediatric patients on ketogenic diet undergoing general anesthesia-a medical record review. (United States)

    Soysal, Elif; Gries, Heike; Wray, Carter


    To identify guidelines for anesthesia management and determine whether general anesthesia is safe for pediatric patients on ketogenic diet (KD). Retrospective medical record review. Postoperative recovery area. All pediatric patients who underwent general anesthesia while on KD between 2009 and 2014 were reviewed. We identified 24 patients who underwent a total of 33 procedures. All children were on KD due to intractable epilepsy. The age of patients ranged from 1 to 15 years. General anesthesia for the scheduled procedures. Patients' demographics, seizure history, type of procedure; perioperative blood chemistry, medications including the anesthesia administered, and postoperative complications. Twenty-four patients underwent a total of 33 procedures. The duration of KD treatment at the time of general anesthesia ranged from 4 days to 8 years. Among the 33 procedures, 3 patients had complications that could be attributable to KD and general anesthesia. A 9-year-old patient experienced increased seizures on postoperative day 0. An 8-year-old patient with hydropcephalus developed metabolic acidosis on postoperative day 1, and a 7-year-old patient's procedure was complicated by respiratory distress and increased seizure activity in the postanesthesia care unit. This study showed that it is relatively safe for children on KD to undergo general anesthesia. The 3 complications attributable to general anesthesia were mild, and the increased seizure frequencies in 2 patients returned back to baseline in 24 hours. Although normal saline is considered more beneficial than lactated Ringer's solution in patients on KD, normal saline should also be administered carefully because of the risk of exacerbating patients' metabolic acidosis. One should be aware of the potential change of the ketogenic status due to drugs given intraoperatively. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Identifying patients with hypertension: a case for auditing electronic health record data. (United States)

    Baus, Adam; Hendryx, Michael; Pollard, Cecil


    Problems in the structure, consistency, and completeness of electronic health record data are barriers to outcomes research, quality improvement, and practice redesign. This nonexperimental retrospective study examines the utility of importing de-identified electronic health record data into an external system to identify patients with and at risk for essential hypertension. We find a statistically significant increase in cases based on combined use of diagnostic and free-text coding (mean = 1,256.1, 95% CI 1,232.3-1,279.7) compared to diagnostic coding alone (mean = 1,174.5, 95% CI 1,150.5-1,198.3). While it is not surprising that significantly more patients are identified when broadening search criteria, the implications are critical for quality of care, the movement toward the National Committee for Quality Assurance's Patient-Centered Medical Home program, and meaningful use of electronic health records. Further, we find a statistically significant increase in potential cases based on the last two or more blood pressure readings greater than or equal to 140/90 mm Hg (mean = 1,353.9, 95% CI 1,329.9-1,377.9).

  17. Realization of a universal patient identifier for electronic medical records through biometric technology. (United States)

    Leonard, D C; Pons, Alexander P; Asfour, Shihab S


    The technology exists for the migration of healthcare data from its archaic paper-based system to an electronic one, and, once in digital form, to be transported anywhere in the world in a matter of seconds. The advent of universally accessible healthcare data has benefited all participants, but one of the outstanding problems that must be addressed is how the creation of a standardized nationwide electronic healthcare record system in the United States would uniquely identify and match a composite of an individual's recorded healthcare information to an identified individual patients out of approximately 300 million people to a 1:1 match. To date, a few solutions to this problem have been proposed that are limited in their effectiveness. We propose the use of biometric technology within our fingerprint, iris, retina scan, and DNA (FIRD) framework, which is a multiphase system whose primary phase is a multilayer consisting of these four types of biometric identifiers: 1) fingerprint; 2) iris; 3) retina scan; and 4) DNA. In addition, it also consists of additional phases of integration, consolidation, and data discrepancy functions to solve the unique association of a patient to their medical data distinctively. This would allow a patient to have real-time access to all of their recorded healthcare information electronically whenever it is necessary, securely with minimal effort, greater effectiveness, and ease.

  18. Protecting the privacy of individual general practice patient electronic records for geospatial epidemiology research. (United States)

    Mazumdar, Soumya; Konings, Paul; Hewett, Michael; Bagheri, Nasser; McRae, Ian; Del Fante, Peter


    General practitioner (GP) practices in Australia are increasingly storing patient information in electronic databases. These practice databases can be accessed by clinical audit software to generate reports that inform clinical or population health decision making and public health surveillance. Many audit software applications also have the capacity to generate de-identified patient unit record data. However, the de-identified nature of the extracted data means that these records often lack geographic information. Without spatial references, it is impossible to build maps reflecting the spatial distribution of patients with particular conditions and needs. Links to socioeconomic, demographic, environmental or other geographically based information are also not possible. In some cases, relatively coarse geographies such as postcode are available, but these are of limited use and researchers cannot undertake precision spatial analyses such as calculating travel times. We describe a method that allows researchers to implement meaningful mapping and spatial epidemiological analyses of practice level patient data while preserving privacy. This solution has been piloted in a diabetes risk research project in the patient population of a practice in Adelaide. The method offers researchers a powerful means of analysing geographic clinic data in a privacy-protected manner. © 2014 Public Health Association of Australia.

  19. [Electronic medical records: Evolution of physician-patient relationship in the Primary Care clinic]. (United States)

    Pérez-Santonja, T; Gómez-Paredes, L; Álvarez-Montero, S; Cabello-Ballesteros, L; Mombiela-Muruzabal, M T


    The introduction of electronic medical records and computer media in clinics, has influenced the physician-patient relationship. These modifications have many advantages, but there is concern that the computer has become too important, going from a working tool to the centre of our attention during the clinical interview, decreasing doctor interaction with the patient. The objective of the study was to estimate the percentage of time that family physicians spend on computer media compared to interpersonal communication with the patient, and whether this time is modified depending on different variables such as, doctor's age or reason for the consultation. An observational and descriptive study was conducted for 10 weeks, with 2 healthcare centres involved. The researchers attended all doctor- patient interviews, recording the patient time in and out of the consultation. Each time the doctor fixed his gaze on computer media the time was clocked. A total of 436 consultations were collected. The doctors looked at the computer support a median 38.33% of the total duration of an interview. Doctors of 45 years and older spent more time fixing their eyes on computer media (P<.05). Family physicians used almost 40% of the consultation time looking at computer media, and depends on age of physician, number of queries, and number of medical appointments. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Electronic medical records and communication with patients and other clinicians: are we talking less? (United States)

    O'Malley, Ann S; Cohen, Genna R; Grossman, Joy M


    Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication--real-time, face-to-face or phone conversations--with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-work flow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.

  1. The Impact of Health Literacy on a Patient's Decision to Adopt a Personal Health Record (United States)

    Noblin, Alice M.; Wan, Thomas T. H.; Fottler, Myron


    Health literacy is a concept that describes a patient's ability to understand materials provided by physicians or other providers. Several factors, including education level, income, and age, can influence health literacy. Research conducted at one medical practice in Florida indicated that in spite of the patients’ relatively low education level, the majority indicated a broad acceptance of personal health record (PHR) technology. The key variable explaining patient willingness to adopt a PHR was the patient's health literacy as measured by the eHealth Literacy Scale (eHEALS). Adoption and use rates may also depend on the availability of office staff for hands-on training as well as assistance with interpretation of medical information. It is hoped that technology barriers will disappear over time, and usefulness of the information will promote increased utilization of PHRs. Patient understanding of the information remains a challenge that must be overcome to realize the full potential of PHRs. PMID:23209454

  2. Hardships of end-of-life care with court-appointed guardians. (United States)

    Hastings, Kylie B


    In the United States, the court-appointed guardians do not have the ability to make decisions regarding end-of-life (EOL) care for their clients. Additionally, the process of initiating EOL care measures can be slow and cumbersome, despite an existing process of getting approval for such care. This process has the potential to prolong suffering and delay imperative decisions. This article reviews the hardships that patients, court-appointed guardians, and health care staff endure while moving through the oppressive process of obtaining EOL care orders through the court. This article also proposes ways of tuning up the laws, regulations, and communications to make it easier and faster to obtain orders regarding EOL care to preserve the dignity of our patients and loved ones. "A guardianship is a legal relationship created when a person or institution named in a will or assigned by the court to take care of minor children or incompetent adults."

  3. Increased patient communication using a process supplementing an electronic medical record. (United States)

    Garvey, Thomas D; Evensen, Ann E


    Importance: Patients with cervical cytology abnormalities may require surveillance for many years, which increases the risk of management error, especially in clinics with multiple managing clinicians. National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) certification requires tracking of abnormal results and communicating effectively with patients. The purpose of this study was to determine whether a computer-based tracking system that is not embedded in the electronic medical record improves (1) accurate and timely communication of results and (2) patient adherence to follow-up recommendations. Design: Pre/post study using data from 2005-2012. Intervention implemented in 2008. Data collected via chart review for at least 18 months after index result. Participants: Pre-intervention: all women (N = 72) with first abnormal cytology result from 2005-2007. Post-intervention: all women (N = 128) with first abnormal cytology result from 2008-2010. Patients were seen at a suburban, university-affiliated, family medicine residency clinic. Intervention: Tracking spreadsheet reviewed monthly with reminders generated for patients not in compliance with recommendations. Main Outcome and Measures: (1) rates of accurate and timely communication of results and (2) rates of patient adherence to follow-up recommendations. Intervention decreased absent or erroneous communication from clinician to patient (6.4% pre- vs 1.6% post-intervention [P = 0.04]), but did not increase patient adherence to follow-up recommendations (76.1% pre- vs 78.0% post-intervention [ P= 0.78]). Use of a spreadsheet tracking system improved communication of abnormal results to patients, but did not significantly improve patient adherence to recommended care. Although the tracking system complies with NCQA PCMH requirements, it was insufficient to make meaningful improvements in patient-oriented outcomes.

  4. reading the Zimbabwean colonial court records, 1935-1980

    African Journals Online (AJOL)


    in terms of storage, retrieval and dissemination. With modernization ... standards of development against the African transpired. ... original paper format and not digitized for ... in most cases they form the greater part of agents of ..... remembered of the two is Nehanda that even saw ... together with her famous 'my bones shall.

  5. Patients' online access to their electronic health records and linked online services: a systematic interpretative review. (United States)

    de Lusignan, Simon; Mold, Freda; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Gronlund, Toto Anne; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Barker, Fiona; Ellis, Beverley; Koczan, Phil; Arvanitis, Theodoros N; McCarthy, Mary; Jones, Simon; Rafi, Imran


    To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. Primary care. A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO

  6. A technique to stabilize record bases for Gothic arch tracings in patients with implant-retained complete dentures. (United States)

    Raigrodski, A J; Sadan, A; Carruth, P L


    Clinicians have long expressed concern about the accuracy of the Gothic arch tracing for recording centric relation in edentulous patients. With the use of dental implants to assist in retaining complete dentures, the problem of inaccurate recordings, made for patients without natural teeth, can be significantly reduced. This article presents a technique that uses healing abutments to stabilize the record bases so that an accurate Gothic arch tracing can be made.

  7. The organization of information in electronic patient record under the perspective of usability recommendations: proposition of organization of information.

    Directory of Open Access Journals (Sweden)

    Tatiana Tissa Kawakami


    Full Text Available Introduction: Among the various areas of studies, health information is highlighted in this study. More specifically, the patient's electronic medical records and issues related to it’s informational organization and usability. Objectives: suggest Usability recommendations applicable to the Electronic Patient Record. More specifically, identify, according to the specialized literature, recommendations of Usability, as well as to develop a checklist with recommendations of Usability for the Electronic Patient Record. Methodology: the study’s basic purpose is the theoretical nature. The deductive method of documental delimitation was chosen. Results: elaboration of checklist with recommendations of Usability for Electronic Patient Records. Conclusion: Usability recommendations can be used to improve electronic patient records. However, it should be noted that knowledge in the scope of Information Science should be considered and summed up, since a great deal of content related to Usability refers to operational and visual aspects of the interface, not clearly or directly contemplating the issues related to information.

  8. Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study. (United States)

    Lee, Wei Wei; Alkureishi, Maria A; Ukabiala, Obioma; Venable, Laura Ruth; Ngooi, Samantha S; Staisiunas, Daina D; Wroblewski, Kristen E; Arora, Vineet M


    While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. This was a prospective mixed-methods study. Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the "Clinical Care" subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the "Communication Functions" theme, and the majority of those related to the "Physical Focus" subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors. Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive

  9. Data mining in bone marrow transplant records to identify patients with high odds of survival. (United States)

    Taati, Babak; Snoek, Jasper; Aleman, Dionne; Ghavamzadeh, Ardeshir


    Patients undergoing a bone marrow stem cell transplant (BMT) face various risk factors. Analyzing data from past transplants could enhance the understanding of the factors influencing success. Records up to 120 measurements per transplant procedure from 1751 patients undergoing BMT were collected (Shariati Hospital). Collaborative filtering techniques allowed the processing of highly sparse records with 22.3% missing values. Ten-fold cross-validation was used to evaluate the performance of various classification algorithms trained on predicting the survival status. Modest accuracy levels were obtained in predicting the survival status (AUC = 0.69). More importantly, however, operations that had the highest chances of success were shown to be identifiable with high accuracy, e.g., 92% or 97% when identifying 74 or 31 recipients, respectively. Identifying the patients with the highest chances of survival has direct application in the prioritization of resources and in donor matching. For patients where high-confidence prediction is not achieved, assigning a probability to their survival odds has potential applications in probabilistic decision support systems and in combination with other sources of information.

  10. Signal averaging technique for noninvasive recording of late potentials in patients with coronary artery disease (United States)

    Abboud, S.; Blatt, C. M.; Lown, B.; Graboys, T. B.; Sadeh, D.; Cohen, R. J.


    An advanced non invasive signal averaging technique was used to detect late potentials in two groups of patients: Group A (24 patients) with coronary artery disease (CAD) and without sustained ventricular tachycardia (VT) and Group B (8 patients) with CAD and sustained VT. Recorded analog data were digitized and aligned using a cross correlation function with fast Fourier transform schema, averaged and band pass filtered between 60 and 200 Hz with a non-recursive digital filter. Averaged filtered waveforms were analyzed by computer program for 3 parameters: (1) filtered QRS (fQRS) duration (2) interval between the peak of the R wave peak and the end of fQRS (R-LP) (3) RMS value of last 40 msec of fQRS (RMS). Significant change was found between Groups A and B in fQRS (101 -/+ 13 msec vs 123 -/+ 15 msec; p < .0005) and in R-LP vs 52 -/+ 11 msec vs 71-/+18 msec, p <.002). We conclude that (1) the use of a cross correlation triggering method and non-recursive digital filter enables a reliable recording of late potentials from the body surface; (2) fQRS and R-LP durations are sensitive indicators of CAD patients susceptible to VT.

  11. Utility of electronic patient records in primary care for stroke secondary prevention trials

    Directory of Open Access Journals (Sweden)

    Ashworth Mark


    Full Text Available Abstract Background This study aimed to inform the design of a pragmatic trial of stroke prevention in primary care by evaluating data recorded in electronic patient records (EPRs as potential outcome measures. The study also evaluated achievement of recommended standards of care; variation between family practices; and changes in risk factor values from before to after stroke. Methods Data from the UK General Practice Research Database (GPRD were analysed for 22,730 participants with an index first stroke between 2003 and 2006 from 414 family practices. For each subject, the EPR was evaluated for the 12 months before and after stroke. Measures relevant to stroke secondary prevention were analysed including blood pressure (BP, cholesterol, smoking, alcohol use, body mass index (BMI, atrial fibrillation, utilisation of antihypertensive, antiplatelet and cholesterol lowering drugs. Intraclass correlation coefficients (ICC were estimated by family practice. Random effects models were fitted to evaluate changes in risk factor values over time. Results In the 12 months following stroke, BP was recorded for 90%, cholesterol for 70% and body mass index (BMI for 47%. ICCs by family practice ranged from 0.02 for BP and BMI to 0.05 for LDL and HDL cholesterol. For subjects with records available both before and after stroke, the mean reductions from before to after stroke were: mean systolic BP, 6.02 mm Hg; diastolic BP, 2.78 mm Hg; total cholesterol, 0.60 mmol/l; BMI, 0.34 Kg/m2. There was an absolute reduction in smokers of 5% and heavy drinkers of 4%. The proportion of stroke patients within the recommended guidelines varied from less than a third (29% for systolic BP, just over half for BMI (54%, and over 90% (92% on alcohol consumption. Conclusions Electronic patient records have potential for evaluation of outcomes in pragmatic trials of stroke secondary prevention. Stroke prevention interventions in primary care remain suboptimal but important

  12. Bridging the digital divide: mobile access to personal health records among patients with diabetes. (United States)

    Graetz, Ilana; Huang, Jie; Brand, Richard J; Hsu, John; Yamin, Cyrus K; Reed, Mary E


    Some patients lack regular computer access and experience a digital divide that causes them to miss internet-based health innovations. The diffusion of smartphones has increased internet access across the socioeconomic spectrum, and increasing the channels through which patients can access their personal health records (PHRs) could help bridge the divide in PHR use. We examined PHR use through a computer-based Web browser or mobile device. Cross-sectional historical cohort analysis. Among adult patients in the diabetes registry of an integrated healthcare delivery system, we studied the devices used to access their PHR during 2016. Among 267,208 patients with diabetes, 68.1% used the PHR in 2016; 60.6% of all log-ins were via computer and 39.4% were via mobile device. Overall, 63.9% used it from both a computer and mobile device, 29.6% used only a computer, and 6.5% used only a mobile device. After adjustment, patients who were black, Hispanic, or Asian; lived in lower socioeconomic status (SES) neighborhoods; or had lower engagement were all significantly more likely to use the PHR only from a mobile device (P digital divide in computer use, disproportionately reaching racial/ethnic minorities and lower SES patients. Nonetheless, even with a mobile-optimized and app-accessible PHR, differences in PHR use by race/ethnicity and SES remain. Continued efforts are needed to increase equitable access to PHRs among patients with chronic conditions.

  13. The role and benefits of accessing primary care patient records during unscheduled care: a systematic review. (United States)

    Bowden, Tom; Coiera, Enrico


    The purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Unscheduled care is typically delivered in hospital Emergency Departments. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved. Twenty-two articles met inclusion criteria from a pool of 192. Many shared electronic health records (SEHRs) were large in scale, servicing many millions of patients. Reported utilization rates by clinicians was variable, with rates >20% amongst health management organizations but much lower in nation-scale systems. No study reported on clinical outcomes or patient safety, and no economic studies of SEHR access during unscheduled care were available. Design factors that may affect utilization included consent and access models, SEHR content, and system usability and reliability. Despite their size and expense, SEHRs designed to support unscheduled care have been poorly evaluated, and it is not possible to draw conclusions about any likely benefits associated with their use. Heterogeneity across the systems and the populations they serve make generalization about system design or performance difficult. None of the reviewed studies used a theoretical model to guide evaluation. Value of Information models may be a useful theoretical approach to design evaluation metrics, facilitating comparison across systems in future studies. Well-designed SEHRs should in principle be capable of improving the efficiency, quality and safety of unscheduled care, but at present the evidence for such benefits is weak, largely because it has not been sought.

  14. Novel screen printed electrode set for routine EEG recordings in patients with altered mental status. (United States)

    Myllymaa, Sami; Lepola, Pasi; Hukkanen, Taina; Oun, Andre; Mervaala, Esa; Toyras, Juha; Lappalainen, Reijo; Myllymaa, Katja


    There is a growing need for an easy to use screening tool for the assessment of brain's electrical function in patients with altered mental status (AMS). The purpose of this study is to give a brief overview of the state-of-the-art in electrode technology, and to present a novel sub-hairline electrode set developed in our research group. Screen-printing technology was utilized to construct the electrode set consisting of ten electroencephalography (EEG) electrodes, two electrooculography (EOG) electrodes, two ground electrodes and two reference electrodes. Electrical characteristics of hydrogel-coated silver ink electrodes were found adequate for clinical EEG recordings as assessed by electrical impedance spectroscopy (EIS). The skin-electrode impedances remain stable and low enough at least two days enabling high-quality long-term recordings. Due to the proper material selection, thin ink layers and detachable zero insertion force (ZIF) - connector, electrode was observed to be CT- and MRI-compatible allowing imaging without removing the electrodes. Pilot EEG recordings gave very promising results and an on-going clinical trial with larger number of patients will show the true feasibility of this approach.

  15. Congressional Authority Over the Federal Courts

    National Research Council Canada - National Science Library

    Bazan, Elizabeth B; Killian, John; Thomas, Kenneth R


    .... While Congress has broad power to regulate the structure, administration and jurisdiction of the courts, its powers are limited by precepts of due process, equal protection and separation of powers...

  16. National New Court Cases Data Collection (United States)

    Social Security Administration — This dataset creates a collection of reports for the national total of new court case (NCC) receipts, dispositions, and pending at the Appeals Council level in the...

  17. National Court Remand Activity Data Collection (United States)

    Social Security Administration — This dataset creates a collection of reports for the national total of court remand receipts, dispositions, and pending cases at the Office of Hearings Operations...

  18. The electronic patient record as a meaningful audit tool - Accountability and autonomy in general practitioner work

    DEFF Research Database (Denmark)

    Winthereik, Brit Ross; van der Ploeg, I.; Berg, Marc


    Health authorities increasingly request that general practitioners (GPs) use information and communication technologies such as electronic patient records (EPR) for accountability purposes. This article deals with the use of EPRs among general practitioners in Britain. It examines two ways in which...... makes them active in finding ways that turn the EPR into a meaningful tool for them, that is, a tool that helps them provide what they see as good care. The article's main contribution is to show how accountability and autonomy are coproduced; less professional autonomy does not follow from more...... GPs use the EPR for accountability purposes. One way is to generate audit reports on the basis of the information that has been entered into the record. The other is to let the computer intervene in the clinical process through prompts. The article argues that GPs' ambivalence toward using the EPR...

  19. Web technology for emergency medicine and secure transmission of electronic patient records. (United States)

    Halamka, J D


    The American Heritage dictionary defines the word "web" as "something intricately contrived, especially something that ensnares or entangles." The wealth of medical resources on the World Wide Web is now so extensive, yet disorganized and unmonitored, that such a definition seems fitting. In emergency medicine, for example, a field in which accurate and complete information, including patients' records, is urgently needed, more than 5000 Web pages are available today, whereas fewer than 50 were available in December 1994. Most sites are static Web pages using the Internet to publish textbook material, but new technology is extending the scope of the Internet to include online medical education and secure exchange of clinical information. This article lists some of the best Web sites for use in emergency medicine and then describes a project in which the Web is used for transmission and protection of electronic medical records.

  20. One positive impact of health care reform to physicians: the computer-based patient record. (United States)

    England, S P


    The health care industry is an information-dependent business that will require a new generation of health information systems if successful health care reform is to occur. We critically need integrated clinical management information systems to support the physician and related clinicians at the direct care level, which in turn will have linkages with secondary users of health information such as health payors, regulators, and researchers. The economic dependence of health care industry on the CPR cannot be underestimated, says Jeffrey Ritter. He sees the U.S. health industry as about to enter a bold new age where our records are electronic, our computers are interconnected, and our money is nothing but pulses running across the telephone lines. Hence the United States is now in an age of electronic commerce. Clinical systems reform must begin with the community-based patient chart, which is located in the physician's office, the hospital, and other related health care provider offices. A community-based CPR and CPR system that integrates all providers within a managed care network is the most logical step since all health information begins with the creation of a patient record. Once a community-based CPR system is in place, the physician and his or her clinical associates will have a common patient record upon which all direct providers have access to input and record patient information. Once a community-level CPR system is in place with a community provider network, each physician will have available health information and data processing capability that will finally provide real savings in professional time and effort. Lost patient charts will no longer be a problem. Data input and storage of health information would occur electronically via transcripted text, voice, and document imaging. All electronic clinical information, voice, and graphics could be recalled at any time and transmitted to any terminal location within the health provider network. Hence

  1. Opteren voor de Netherlands Commercial Court


    Hoeben, J.; Keirse, A.L.M.; Reijneveld, M.D.


    Internationale contracten leiden tot internationale handelsgeschillen. Deze kunnen onder meer worden beslecht bij een commercial court. In Nederland wordt momenteel een Netherlands Commercial Court (NCC) opgericht. Dit introduceert een keuze voor (contracts)partijen voor een nieuw forum voor beslechting van internationale handelsgeschillen in de Engelse taal, waarbij de belangen van snelheid, efficiëntie en goede financierbaarheid centraal staan. Dit artikel verkent de positieve aspecten van ...

  2. Federal Constitutional Court - report on Court decisions 1984 no. 40-56

    International Nuclear Information System (INIS)

    Berkemann, J.


    The decision deals with the question to which extent administrative courts have to examine the case in summary proceedings against licences pursuant to Atomic Energy Law. The Federal Constitutional Court examines the question if the administrative court has, in checking the chances, misjudged the importance of the appellant's fundamental rights and thus infringed his constitutionally protected position. In this case, the Court comes to the result that after having adjusted the determined interests, the confirmation of immediate execution did not infringe the fundamental rights of the appellant. (HP) [de

  3. Expanded HIV Testing Strategy Leveraging the Electronic Medical Record Uncovers Undiagnosed Infection Among Hospitalized Patients. (United States)

    Felsen, Uriel R; Cunningham, Chinazo O; Heo, Moonseong; Futterman, Donna C; Weiss, Jeffrey M; Zingman, Barry S


    Routine HIV testing of hospitalized patients is recommended, but few strategies to expand testing in the hospital setting have been described. We assessed the impact of an electronic medical record (EMR) prompt on HIV testing for hospitalized patients. We performed a pre-post study at 3 hospitals in the Bronx, NY. We compared the proportion of admissions of patients 21-64 years old with an HIV test performed, characteristics of patients tested, and rate of new HIV diagnoses made by screening while an EMR prompt recommending HIV testing was inactive vs. active. The prompt appeared for patients with no previous HIV test or a high-risk diagnosis after their last HIV test. Among 36,610 admissions while the prompt was inactive, 9.5% had an HIV test performed. Among 18,943 admissions while the prompt was active, 21.8% had an HIV test performed. Admission while the prompt was active was associated with increased HIV testing among total admissions [adjusted odds ratio (aOR) 2.78, 95% confidence interval (CI): 2.62 to 2.96], those without a previous HIV test (aOR 4.03, 95% CI: 3.70 to 4.40), and those with a previous negative test (aOR 1.52, 95% CI: 1.37 to 1.68) (P diversification of patients tested, and an increase in diagnoses made by screening.

  4. Comparison of electronic health record system functionalities to support the patient recruitment process in clinical trials. (United States)

    Schreiweis, Björn; Trinczek, Benjamin; Köpcke, Felix; Leusch, Thomas; Majeed, Raphael W; Wenk, Joachim; Bergh, Björn; Ohmann, Christian; Röhrig, Rainer; Dugas, Martin; Prokosch, Hans-Ulrich


    Reusing data from electronic health records for clinical and translational research and especially for patient recruitment has been tackled in a broader manner since about a decade. Most projects found in the literature however focus on standalone systems and proprietary implementations at one particular institution often for only one singular trial and no generic evaluation of EHR systems for their applicability to support the patient recruitment process does yet exist. Thus we sought to assess whether the current generation of EHR systems in Germany provides modules/tools, which can readily be applied for IT-supported patient recruitment scenarios. We first analysed the EHR portfolio implemented at German University Hospitals and then selected 5 sites with five different EHR implementations covering all major commercial systems applied in German University Hospitals. Further, major functionalities required for patient recruitment support have been defined and the five sample EHRs and their standard tools have been compared to the major functionalities. In our analysis of the site's hospital information system environments (with four commercial EHR systems and one self-developed system) we found that - even though no dedicated module for patient recruitment has been provided - most EHR products comprise generic tools such as workflow engines, querying capabilities, report generators and direct SQL-based database access which can be applied as query modules, screening lists and notification components for patient recruitment support. A major limitation of all current EHR products however is that they provide no dedicated data structures and functionalities for implementing and maintaining a local trial registry. At the five sites with standard EHR tools the typical functionalities of the patient recruitment process could be mostly implemented. However, no EHR component is yet directly dedicated to support research requirements such as patient recruitment. We

  5. How do the Constitutional Courts decide?

    Directory of Open Access Journals (Sweden)

    Pasquale Pasquino


    Full Text Available The purpose of this article is to explore the mode of production of judicial sentences drafted by constitutional courts in Europe. The natural object of study of the constitutional theory is the analysis of this final product of judicial creation of Law by Constitutional Courts. However, the doctrine has not given sufficient attention –from a comparative law perspective– to the mechanisms and procedures that lead to the decisions of these institutions. Thus, this document will classify the different types of decision-making processes in the courts, analyzing the stages that make up the «mode of production», from the study of the decisions of the Supreme Court of the United States, the Constitutional Council of the French Republic, The Constitutional Court of Italy and the Federal Constitutional Court of Germany. At the end of the paper, some conclusions are made about the period of the magistrates, their party affiliation, the temporary restrictions of deliberation and institutional factors such as the number of attendees or the personalization of its members.

  6. Past and Future for Management of Courts

    Directory of Open Access Journals (Sweden)

    Bert Maan


    Full Text Available This article is written from the perspective of a court president in The Netherlands, a so called civil law country. In theory, in a civil law country, judges and lawyers in civil and commercial cases base their actions on the application of the law and its interpretation. Moreover, in criminal matters, the courts use inquisitorial procedures which differ from the adversarial procedures used in common law countries. The field of court management is not highly developed because of the tension between the need for judicial independence and judicial organization. There are many examples of this tension, including the fact that courts may be subject to budgetary limits which themselves may intrude upon judicial independence. For instance, suppose that a judge believes it necessary to appoint an expert to answer a certain scientific question, but the expert is expensive and budgetary considerations preclude the appointment. When I was involved in the process of the budgets of prosecutors’ offices and courts, this question frequently arose. In an effort to deal with this problem, part of the courts’ budgets were treated as open-ended even though courts rarely spent these open-ended budgets lavishly.

  7. Enemy Combatant Detainees: Habeas Corpus Challenges in Federal Court (United States)


    Separation of Powers Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Eliminating Federal Court Jurisdiction Where There Is No State Court Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 1 542 U.S. 466 (2004). Enemy Combatant Detainees: Habeas Corpus Challenges in Federal Court In Rasul v. Bush,1 a divided Supreme Court declared that “a state

  8. 25 CFR 11.901 - The children's court established. (United States)


    ... 25 Indians 1 2010-04-01 2010-04-01 false The children's court established. 11.901 Section 11.901 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Children's Court § 11.901 The children's court established. When conducting...

  9. Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients (United States)

    Sanz-García, Ancor; Vega-Zelaya, Lorena; Pastor, Jesús; Torres, Cristina V.; Sola, Rafael G.; Ortega, Guillermo J.


    Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area. PMID:28060326

  10. Electronic Health Records: An Enhanced Security Paradigm to Preserve Patient's Privacy (United States)

    Slamanig, Daniel; Stingl, Christian

    In recent years, demographic change and increasing treatment costs demand the adoption of more cost efficient, highly qualitative and integrated health care processes. The rapid growth and availability of the Internet facilitate the development of eHealth services and especially of electronic health records (EHRs) which are promising solutions to meet the aforementioned requirements. Considering actual web-based EHR systems, patient-centric and patient moderated approaches are widely deployed. Besides, there is an emerging market of so called personal health record platforms, e.g. Google Health. Both concepts provide a central and web-based access to highly sensitive medical data. Additionally, the fact that these systems may be hosted by not fully trustworthy providers necessitates to thoroughly consider privacy issues. In this paper we define security and privacy objectives that play an important role in context of web-based EHRs. Furthermore, we discuss deployed solutions as well as concepts proposed in the literature with respect to this objectives and point out several weaknesses. Finally, we introduce a system which overcomes the drawbacks of existing solutions by considering an holistic approach to preserve patient's privacy and discuss the applied methods.

  11. From Task Descriptions via Coloured Petri Nets Towards an Implementation of a New Electronic Patient Record

    DEFF Research Database (Denmark)

    Jørgensen, Jens Bæk; Lassen, Kristian Bisgaard; van der Aalst, Willibrordus Martinus Pancratius


    help to validate and elicit requirements. The second CPN model is a Colored Workflow Net (CWN). The CWN is derived from the EUC. Together, the EUC and the CWN are used to close the gap between the given requirements specification and the realization of these requirements with the help of an IT system......We consider a given specification of functional requirements for a new electronic patient record system for Fyn County, Denmark. The requirements are expressed as task descriptions, which are informal descriptions of work processes to be supported. We describe how these task descriptions are used...

  12. Can the use of Electronic Health Records in General Practice reduce hospitalizations for diabetes patients?

    DEFF Research Database (Denmark)

    Kongstad, Line Planck; Mellace, Giovanni; Rose Olsen, Kim

    on Electronic Health Records (EHR) on diabetes patients total hospitalizations, diabetes related hospitalizations and hospitalizations with diabetes and cardiovascular related Ambulatory Care Sentive Conditions (ACSC). We use a rich nationwide panel dataset (2004-2013) with information of stepwise enrolment...... of GPs in the EHR program. As a control group we use GPs who never enrolled. Following the recent literature on causal inference with panel data, we use a standard propensity score matching estimator where we also match on pre-treatment outcomes. This allows controlling for all the unobservable...

  13. System requirements for a computerised patient record information system at a busy primary health care clinic

    Directory of Open Access Journals (Sweden)

    PJ Blignaut


    Full Text Available A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

  14. Identification and Fibrosis Staging of Hepatitis C Patients Using the Electronic Medical Record System. (United States)

    Anand, Vijay; Hyun, Christian; Khan, Qasim M; Hall, Curtis; Hessefort, Norbert; Sonnenberg, Amnon; Fimmel, Claus J


    The aim of this study was to noninvasively assess the severity of chronic hepatitis C virus (HCV) in large patient populations. It would be helpful if fibrosis scores could be calculated solely on the basis of data contained in the patients' electronic medical records (EMR). We performed a pilot study to identify all HCV-infected patients in a large health care system, and predict their fibrosis stage on the basis of demographic and laboratory data using common data from their EMR. HCV-infected patients were identified using the EMR. The liver biopsies of 191 HCV patients were graded using the Ishak and Metavir scoring systems. Demographic and laboratory data were extracted from the EMR and used to calculate the aminotransferase to platelet ratio index, Fib-4, Fibrosis Index, Forns, Göteborg University Cirrhosis Index, Lok Index, and Vira-HepC. In total, 869 HCV-infected patients were identified from a population of over 1 million. In the subgroup of patients with liver biopsies, all 7 algorithms were significantly correlated with the fibrosis stage. The degree of correlation was moderate, with correlation coefficients ranging from 0.22 to 0.60. For the detection of advanced fibrosis (Metavir 3 or 4), the areas under the receiver operating characteristic curve ranged from 0.71 to 0.84, with no significant differences between the individual scores. Sensitivities, specificities, and positive and negative predictive values were within the previously reported range. All scores tended to perform better for higher fibrosis stages. Our study demonstrates that HCV-infected patients can be identified and their fibrosis staged using commonly available EMR-based algorithms.

  15. Using electronic patient records to inform strategic decision making in primary care. (United States)

    Mitchell, Elizabeth; Sullivan, Frank; Watt, Graham; Grimshaw, Jeremy M; Donnan, Peter T


    Although absolute risk of death associated with raised blood pressure increases with age, the benefits of treatment are greater in elderly patients. Despite this, the 'rule of halves' particularly applies to this group. We conducted a randomised controlled trial to evaluate different levels of feedback designed to improve identification, treatment and control of elderly hypertensives. Fifty-two general practices were randomly allocated to either: Control (n=19), Audit only feedback (n=16) or Audit plus Strategic feedback, prioritising patients by absolute risk (n=17). Feedback was based on electronic data, annually extracted from practice computer systems. Data were collected for 265,572 patients, 30,345 aged 65-79. The proportion of known hypertensives in each group with BP recorded increased over the study period and the numbers of untreated and uncontrolled patients reduced. There was a significant difference in mean systolic pressure between the Audit plus Strategic and Audit only groups and significantly greater control in the Audit plus Strategic group. Providing patient-specific practice feedback can impact on identification and management of hypertension in the elderly and produce a significant increase in control.

  16. Will electronic personal health records benefit providers and patients in rural America? (United States)

    Hargreaves, John S


    The objective of this study was to educate stakeholders (e.g., providers, patients, insurers, government) in the healthcare industry about electronic personal health records (PHRs) and their potential application in rural America. Extensive research was performed on PHRs through standard literature search, product demonstrations, educational webinars, and fact finding via news releases. Various stakeholders are eager to transform the healthcare industry into the digital age like other industries (i.e., banking, retail). Despite low adoption of PHRs in 2008 (2.7% of U.S. adults), patients are interested in secure messaging and eVisits with their physicians, online appointment scheduling and reminders, and online access to their laboratory and radiology results. Federal agencies (e.g., Health and Human Services, Department of Defense, Veterans Affairs [VA]), popular information technology (IT) vendors (e.g., Google, Microsoft), and large insurers (e.g., Aetna) have energized the industry through pilot programs and new product announcements. It remains to be seen if barriers to adoption, including privacy concerns, lack of interoperability standards and funding, and provider resistance, can be overcome to enable PHRs to become a critical tool in the creation of a more efficient and less costly U.S. healthcare industry. Electronic PHRs hold great promise to enhance access and improve the quality of care provided to patients in rural America. Government, vendors, and insurers should create incentives for providers and patients to implement PHRs. Likewise, patients need to become more aware of PHRs and their ability to improve health outcomes.

  17. Digital imaging and electronic patient records in pathology using an integrated department information system with PACS. (United States)

    Kalinski, Thomas; Hofmann, Harald; Franke, Dagmar-Sybilla; Roessner, Albert


    Picture archiving and communication systems have been widely used in radiology thus far. Owing to the progress made in digital photo technology, their use in medicine opens up further opportunities. In the field of pathology, digital imaging offers new possiblities for the documentation of macroscopic and microscopic findings. Digital imaging has the advantage that the data is permanently and readily available, independent of conventional archives. In the past, PACS was a separate entity. Meanwhile, however, PACS has been integrated in DIS, the department information system, which was also run separately in former times. The combination of these two systems makes the administration of patient data, findings and images easier. Moreover, thanks to the introduction of special communication standards, a data exchange between different department information systems and hospital information systems (HIS) is possible. This provides the basis for a communication platform in medicine, constituting an electronic patient record (EPR) that permits an interdisciplinary treatment of patients by providing data of findings and images from clinics treating the same patient. As the pathologic diagnosis represents a central and often therapy-determining component, it is of utmost importance to add pathologic diagnoses to the EPR. Furthermore, the pathologist's work is considerably facilitated when he is able to retrieve additional data from the patient file. In this article, we describe our experience gained with the combined PACS and DIS systems recently installed at the Department of Pathology, University of Magdeburg. Moreover, we evaluate the current situation and future prospects for PACS in pathology.

  18. Overcoming structural constraints to patient utilization of electronic medical records: a critical review and proposal for an evaluation framework. (United States)

    Winkelman, Warren J; Leonard, Kevin J


    There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes.

  19. Development and daily use of an electronic oncological patient record for the total management of cancer patients: 7 years' experience. (United States)

    Galligioni, E; Berloffa, F; Caffo, O; Tonazzolli, G; Ambrosini, G; Valduga, F; Eccher, C; Ferro, A; Forti, S


    We describe our experience with an electronic oncological patient record (EOPR) for the total management of cancer patients. The web-based EOPR was developed on the basis of a user-centred design including user education and training, followed by continuous assistance; user acceptance was monitored by means of three questionnaires administered after 2 weeks, 6 months and 6 years. The EOPR has been used daily for all in-ward, day hospital and ambulatory clinical activities since July 2000. The most widely appreciated functions are its rapid multipoint access, the self-updated summary of the patients' clinical course, the management of the entire therapeutic programme synchronised with working agendas and oncological teleconsultation. Security and privacy are assured by means of the separate storage of clinical and demographic data, with access protected by login and a password. The questionnaires highlighted appreciation of rapid data retrieval and exchange and the perception of improved quality of care, but also revealed a sense of additional work and a negative impact on doctor-patient relationships. Our EOPR has proved to be effective in the total management of cancer patients. Its user-centred design and flexible web technology have been key factors in its successful implementation and daily use.

  20. Toward best practice: leveraging the electronic patient record as a clinical data warehouse. (United States)

    Ledbetter, C S; Morgan, M W


    Automating clinical and administrative processes via an electronic patient record (EPR) gives clinicians the point-of-care tools they need to deliver better patient care. However, to improve clinical practice as a whole and then evaluate it, healthcare must go beyond basic automation and convert EPR data into aggregated, multidimensional information. Unfortunately, few EPR systems have the established, powerful analytical clinical data warehouses (CDWs) required for this conversion. This article describes how an organization can support best practice by leveraging a CDW that is fully integrated into its EPR and clinical decision support (CDS) system. The article (1) discusses the requirements for comprehensive CDS, including on-line analytical processing (OLAP) of data at both transactional and aggregate levels, (2) suggests that the transactional data acquired by an OLTP EPR system must be remodeled to support retrospective, population-based, aggregate analysis of those data, and (3) concludes that this aggregate analysis is best provided by a separate CDW system.

  1. The place of SGML and HTML in building electronic patient records. (United States)

    Pitty, D; Gordon, C; Reeves, P; Capey, A; Vieyra, P; Rickards, T


    The authors are concerned that, although popular, SGML (Standard Generalized Markup Language) is only one approach to capturing, storing, viewing and exchanging healthcare information and does not provide a suitable paradigm for solving most of the problems associated with paper based patient record systems. Although a discussion of the relative merits of SGML, HTML (HyperText Markup Language) may be interesting, we feel such a discussion is avoiding the real issues associated with the most appropriate way to model, represent, and store electronic patient information in order to solve healthcare problems, and therefore the medical informatics community should firstly concern itself with these issues. The paper substantiates this viewpoint and concludes with some suggestions of how progress can be made.

  2. A Socio-Technical Analysis of Patient Accessible Electronic Health Records. (United States)

    Hägglund, Maria; Scandurra, Isabella


    In Sweden, and internationally, there is a movement towards increased transparency in healthcare including giving patients online access to their electronic health records (EHR). The purpose of this paper is to analyze the Swedish patient accessible EHR (PAEHR) service using a socio-technical framework, to increase the understanding of factors that influence the design, implementation, adoption and use of the service. Using the Sitting and Singh socio-technical framework as a basis for analyzing the Swedish PAEHR system and its context indicated that there are many stakeholders engaged in these types of services, with different driving forces and incentives that may influence the adoption and usefulness of PAEHR services. The analysis was useful in highlighting important areas that need to be further explored in evaluations of PAEHR services, and can act as a guide when planning evaluations of any PAEHR service.

  3. Electromagnetic Interference in Patients with Implanted Cardioverter-Defibrillators and Implantable Loop Recorders

    Directory of Open Access Journals (Sweden)

    Marcos de Sousa


    Full Text Available Modern life exposes us all to an ever-increasing number of potential sources of electromagnetic interference (EMI and patients with Implantable rhythm devices (IRD like pacemakers, implantable cardioverter defibrillators or implantable loop recorders often ask about the use of microwave ovens, walking through airport metal detectors and the use of cellular phones. Electromagnetic interference occurs when electromagnetic waves emitted by one device impede the normal function of another electronic device. The potential for interaction between implanted pacing systems and cardioverter-defibrillators (electromagnetic interference, EMI has been recognized for years.1,2,3,4. It has been shown that EMI can produce clinically significant effects on patients with implanted pacemakers and ICDs. For these reasons the following text discusses the influence of several EMI generating devices on IRD .

  4. Sustains--direct access for the patient to the medical record over the Internet. (United States)

    Eklund, Benny; Joustra-Enquist, Ingrid


    The basic idea of Sustains III is to emulate the Internet banking for Health Care. Instead of an "Internet Bank Account" the user has a "Health Care Account". The user logs in using a One Time Password which is sent to the user's mobile phone as an SMS, three seconds after the PIN code is entered. Thus personal information can be transferred both ways in a secure way, with acceptable privacy. The user can then explore the medical record in detail. Also get full and complete list of prescriptions, lab-result etc. It's also an easy way of exchange written information between the doctor and the patient. So far Sustains has showed that patients are very satisfied and is also beneficial for the physicians.

  5. All together now: findings from a PCORI workshop to align patient-reported outcomes in the electronic health record. (United States)

    Jensen, Roxanne E; Snyder, Claire F; Basch, Ethan; Frank, Lori; Wu, Albert W


    In recent years, patient-reported outcomes have become increasingly collected and integrated into electronic health records. However, there are few cross-cutting recommendations and limited guidance available in this rapidly developing research area. Our goal is to report key findings from a 2013 Patient-Centered Outcomes Research Institute workshop on this topic and a summary of actions that followed from the workshop, and present resulting recommendations that address patient, clinical and research/quality improvement barriers to regular use. These findings provide actionable guidance across research and practice settings to promote and sustain widespread adoption of patient-reported outcomes across patient populations, healthcare settings and electronic health record systems.

  6. Patient preferences toward an interactive e-consent application for research using electronic health records. (United States)

    Harle, Christopher A; Golembiewski, Elizabeth H; Rahmanian, Kiarash P; Krieger, Janice L; Hagmajer, Dorothy; Mainous, Arch G; Moseley, Ray E


    The purpose of this study was to assess patient perceptions of using an interactive electronic consent (e-consent) application when deciding whether or not to grant broad consent for research use of their identifiable electronic health record (EHR) information. For this qualitative study, we conducted a series of 42 think-aloud interviews with 32 adults. Interview transcripts were coded and analyzed using a modified grounded theory approach. We identified themes related to patient preferences, reservations, and mixed attitudes toward consenting electronically; low- and high-information-seeking behavior; and an emphasis on reassuring information, such as data protections and prohibitions against sharing data with pharmaceutical companies. Participants expressed interest in the types of information contained in their EHRs, safeguards protecting EHR data, and specifics on studies that might use their EHR data. This study supports the potential value of interactive e-consent applications that allow patients to customize their consent experience. This study also highlights that some people have concerns about e-consent platforms and desire more detailed information about administrative processes and safeguards that protect EHR data used in research. This study contributes new insights on how e-consent applications could be designed to ensure that patients' information needs are met when seeking consent for research use of health record information. Also, this study offers a potential electronic approach to meeting the new Common Rule requirement that consent documents contain a "concise and focused" presentation of key information followed by more details. © The Author(s) 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  7. Data mining of audiology patient records: factors influencing the choice of hearing aid type (United States)


    Background This paper describes the analysis of a database of over 180,000 patient records, collected from over 23,000 patients, by the hearing aid clinic at James Cook University Hospital in Middlesbrough, UK. These records consist of audiograms (graphs of the faintest sounds audible to the patient at six different pitches), categorical data (such as age, gender, diagnosis and hearing aid type) and brief free text notes made by the technicians. This data is mined to determine which factors contribute to the decision to fit a BTE (worn behind the ear) hearing aid as opposed to an ITE (worn in the ear) hearing aid. Methods From PCA (principal component analysis) four main audiogram types are determined, and are related to the type of hearing aid chosen. The effects of age, gender, diagnosis, masker, mould and individual audiogram frequencies are combined into a single model by means of logistic regression. Some significant keywords are also discovered in the free text fields by using the chi-squared (χ2) test, which can also be used in the model. The final model can act a decision support tool to help decide whether an individual patient should be offered a BTE or an ITE hearing aid. Results The final model was tested using 5-fold cross validation, and was able to replicate the decisions of audiologists whether to fit an ITE or a BTE hearing aid with precision in the range 0.79 to 0.87. Conclusions A decision support system was produced to predict the type of hearing aid which should be prescribed, with an explanation facility explaining how that decision was arrived at. This system should prove useful in providing a "second opinion" for audiologists. PMID:22595091

  8. Circuit courts clash over HIV in the workplace. (United States)


    Some of the major differences of opinions between the circuit courts on issues affecting HIV and employment are examined. In the seven years since the passing of the Americans with Disabilities Act (ADA), there has been disagreement among the circuits relative to the interpretation of the law. At the heart of the debate is whether or not HIV infection, without symptoms of AIDS, actually qualifies for a disability under the meaning and intent of the ADA. Another fundamental issue is whether or not reproduction is considered a major life activity under the ADA. Federal circuit courts have also considered what happens to patients in the latter stages of HIV diseases, when symptoms are so pronounced that he or she qualifies for disability benefits including Social Security or private disability plans. There is disagreement among the circuits as to whether insurance products, including those provided through an employee benefit program, are covered under the ADA. As of this date, the U.S. Supreme Court has not intervened on any of the HIV/ADA-related cases.

  9. The double-edged sword of electronic health records: implications for patient disclosure. (United States)

    Campos-Castillo, Celeste; Anthony, Denise L


    Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients' global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure. A nationally representative sample from the 2012 Health Information National Trends Survey was analyzed using bivariate and multivariable logit regressions to examine whether global ratings of care suppress the relationship between EHR provider-use and patient non-disclosure. 13% of respondents reported having ever withheld information from a provider because of privacy/security concerns. Bivariate analysis showed that withholding information was unrelated to whether respondents' providers used an EHR. Multivariable analysis showed that accounting for respondents' global ratings of care revealed a positive relationship between having a provider who uses an EHR and withholding information. After accounting for global ratings of care, findings suggest that patients may non-disclose to providers to protect against the perceived EHR privacy and security risks. Despite evidence that EHRs inhibit patient disclosure, their advantages for promoting quality of care may outweigh the drawbacks. Clinicians should leverage the EHR's value in quality of care and discuss patients' privacy concerns during clinic visits, while policy makers should consider how to address the real and perceived privacy and security risks of EHRs. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  10. Chronic pain among patients with opioid use disorder: Results from electronic health records data. (United States)

    Hser, Yih-Ing; Mooney, Larissa J; Saxon, Andrew J; Miotto, Karen; Bell, Douglas S; Huang, David


    To examine the prevalence of comorbid chronic pain among patients with opioid use disorder (OUD) and to compare other comorbidities (substance use disorder (SUD), mental health disorders, health/disease conditions) among patients in four categories: no chronic pain (No Pain), OUD prior to pain (OUD First), OUD and pain at the same time (Same Time), or pain condition prior to OUD (Pain First). Using an electronic health record (EHR) database from 2006-2015, the study assessed 5307 adult patients with OUD in a large healthcare system; 35.6% were No Pain, 9.7% were OUD First, 14.9% were Same Time, and 39.8% were Pain First. Most OUD patients (64.4%) had chronic pain conditions, and among them 61.8% had chronic pain before their first OUD diagnosis. Other SUDs occurred more frequently among OUD First patients than among other groups in terms of alcohol (33.4% vs. 25.4% for No Pain, 20.7% for Same Time, and 20.3% for Pain First), cocaine (19.0%, vs. 13.8%, 9.4%, 7.1%), and alcohol or drug-induced disorders. OUD First patients also had the highest rates of HIV (4.7%) and hepatitis C virus (HCV; 28.2%) among the four groups. Pain First patients had the highest rates of mental disorder (81.7%), heart disease (72.0%), respiratory disease (68.4%), sleep disorder (41.8%), cancer (23.4%), and diabetes (19.3%). The alarming high rates of chronic pain conditions occurring before OUD and the associated severe mental health and physical health conditions require better models of assessment and coordinated care plans to address these complex medical conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Identifying primary care patients at risk for future diabetes and cardiovascular disease using electronic health records

    Directory of Open Access Journals (Sweden)

    Shrader Peter


    Full Text Available Abstract Background Prevention of diabetes and coronary heart disease (CHD is possible but identification of at-risk patients for targeting interventions is a challenge in primary care. Methods We analyzed electronic health record (EHR data for 122,715 patients from 12 primary care practices. We defined patients with risk factor clustering using metabolic syndrome (MetS characteristics defined by NCEP-ATPIII criteria; if missing, we used surrogate characteristics, and validated this approach by directly measuring risk factors in a subset of 154 patients. For subjects with at least 3 of 5 MetS criteria measured at baseline (2003-2004, we defined 3 categories: No MetS (0 criteria; At-risk-for MetS (1-2 criteria; and MetS (≥ 3 criteria. We examined new diabetes and CHD incidence, and resource utilization over the subsequent 3-year period (2005-2007 using age-sex-adjusted regression models to compare outcomes by MetS category. Results After excluding patients with diabetes/CHD at baseline, 78,293 patients were eligible for analysis. EHR-defined MetS had 73% sensitivity and 91% specificity for directly measured MetS. Diabetes incidence was 1.4% in No MetS; 4.0% in At-risk-for MetS; and 11.0% in MetS (p MetS vs No MetS = 6.86 [6.06-7.76]; CHD incidence was 3.2%, 5.3%, and 6.4% respectively (p Conclusion Risk factor clustering in EHR data identifies primary care patients at increased risk for new diabetes, CHD and higher resource utilization.

  12. Record High US Measles Cases: Patient Vaccination, Clinical Assessment and Management

    Centers for Disease Control (CDC) Podcasts


    This podcast is an overview of the Clinician Outreach and Communication Activity (COCA) Call: Record High US Measles Cases: Patient Vaccination, Clinical Assessment and Management. In May 2014, the United States recorded the largest number of reported measles cases since 1994 and the number continues to rise. Most cases reported have been acquired in the U.S. and are associated with importations from countries where measles is still common. This highly contagious, acute viral illness spreads quickly in unvaccinated populations once reaching the U.S. The recent measles outbreaks highlight the importance of maintaining high vaccination coverage in the U.S. and ensuring age-appropriate vaccination for international travelers. During this COCA call, clinicians will learn the status of measles in the U.S. and CDC vaccination recommendations and guidelines for patient assessment and management.  Created: 6/30/2014 by : National Center for Immunization and Respiratory Diseases; Division of Viral Diseases; Healthcare Preparedness Activity (HPA); Office of Public Health Preparedness and Response (OPHPR).   Date Released: 6/30/2014.

  13. Using text-mining techniques in electronic patient records to identify ADRs from medicine use. (United States)

    Warrer, Pernille; Hansen, Ebba Holme; Juhl-Jensen, Lars; Aagaard, Lise


    This literature review included studies that use text-mining techniques in narrative documents stored in electronic patient records (EPRs) to investigate ADRs. We searched PubMed, Embase, Web of Science and International Pharmaceutical Abstracts without restrictions from origin until July 2011. We included empirically based studies on text mining of electronic patient records (EPRs) that focused on detecting ADRs, excluding those that investigated adverse events not related to medicine use. We extracted information on study populations, EPR data sources, frequencies and types of the identified ADRs, medicines associated with ADRs, text-mining algorithms used and their performance. Seven studies, all from the United States, were eligible for inclusion in the review. Studies were published from 2001, the majority between 2009 and 2010. Text-mining techniques varied over time from simple free text searching of outpatient visit notes and inpatient discharge summaries to more advanced techniques involving natural language processing (NLP) of inpatient discharge summaries. Performance appeared to increase with the use of NLP, although many ADRs were still missed. Due to differences in study design and populations, various types of ADRs were identified and thus we could not make comparisons across studies. The review underscores the feasibility and potential of text mining to investigate narrative documents in EPRs for ADRs. However, more empirical studies are needed to evaluate whether text mining of EPRs can be used systematically to collect new information about ADRs. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

  14. Towards iconic language for patient records, drug monographs, guidelines and medical search engines. (United States)

    Lamy, Jean-Baptiste; Duclos, Catherine; Hamek, Saliha; Beuscart-Zéphir, Marie-Catherine; Kerdelhué, Gaetan; Darmoni, Stefan; Favre, Madeleine; Falcoff, Hector; Simon, Christian; Pereira, Suzanne; Serrot, Elisabeth; Mitouard, Thierry; Hardouin, Etienne; Kergosien, Yannick; Venot, Alain


    Practicing physicians have limited time for consulting medical knowledge and records. We have previously shown that using icons instead of text to present drug monographs may allow contraindications and adverse effects to be identified more rapidly and more accurately. These findings were based on the use of an iconic language designed for drug knowledge, providing icons for many medical concepts, including diseases, antecedents, drug classes and tests. In this paper, we describe a new project aimed at extending this iconic language, and exploring the possible applications of these icons in medicine. Based on evaluators' comments, focus groups of physicians and opinions of academic, industrial and associative partners, we propose iconic applications related to patient records, for example summarizing patient conditions, searching for specific clinical documents and helping to code structured data. Other applications involve the presentation of clinical practice guidelines and improving the interface of medical search engines. These new applications could use the same iconic language that was designed for drug knowledge, with a few additional items that respect the logic of the language.

  15. Mental health court outcomes: a comparison of re-arrest and re-arrest severity between mental health court and traditional court participants. (United States)

    Moore, Marlee E; Hiday, Virginia Aldigé


    Mental health courts have been proliferating across the country since their establishment in the late 1990's. Although numerous advocates have proclaimed their merit, only few empirical studies have evaluated their outcomes. This paper evaluates the effect of one mental health court on criminal justice outcomes by examining arrests and offense severity from one year before to one year after entry into the court, and by comparing mental health court participants to comparable traditional criminal court defendants on these measures. Multivariate models support the prediction that mental health courts reduce the number of new arrests and the severity of such re-arrests among mentally ill offenders. Similar analysis of mental health court completers and non-completers supports the prediction that a "full dose" of mental health treatment and court monitoring produce even fewer re-arrests.

  16. "Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health. (United States)

    Bazemore, Andrew W; Cottrell, Erika K; Gold, Rachel; Hughes, Lauren S; Phillips, Robert L; Angier, Heather; Burdick, Timothy E; Carrozza, Mark A; DeVoe, Jennifer E


    Social determinants of health significantly impact morbidity and mortality; however, physicians lack ready access to this information in patient care and population management. Just as traditional vital signs give providers a biometric assessment of any patient, "community vital signs" (Community VS) can provide an aggregated overview of the social and environmental factors impacting patient health. Knowing Community VS could inform clinical recommendations for individual patients, facilitate referrals to community services, and expand understanding of factors impacting treatment adherence and health outcomes. This information could also help care teams target disease prevention initiatives and other health improvement efforts for clinic panels and populations. Given the proliferation of big data, geospatial technologies, and democratization of data, the time has come to integrate Community VS into the electronic health record (EHR). Here, the authors describe (i) historical precedent for this concept, (ii) opportunities to expand upon these historical foundations, and (iii) a novel approach to EHR integration. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  17. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting (United States)

    Wiggley, Shirley L.


    Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…

  18. Modeling Patient Treatment With Medical Records: An Abstraction Hierarchy to Understand User Competencies and Needs. (United States)

    St-Maurice, Justin D; Burns, Catherine M


    Health care is a complex sociotechnical system. Patient treatment is evolving and needs to incorporate the use of technology and new patient-centered treatment paradigms. Cognitive work analysis (CWA) is an effective framework for understanding complex systems, and work domain analysis (WDA) is useful for understanding complex ecologies. Although previous applications of CWA have described patient treatment, due to their scope of work patients were previously characterized as biomedical machines, rather than patient actors involved in their own care. An abstraction hierarchy that characterizes patients as beings with complex social values and priorities is needed. This can help better understand treatment in a modern approach to care. The purpose of this study was to perform a WDA to represent the treatment of patients with medical records. The methods to develop this model included the analysis of written texts and collaboration with subject matter experts. Our WDA represents the ecology through its functional purposes, abstract functions, generalized functions, physical functions, and physical forms. Compared with other work domain models, this model is able to articulate the nuanced balance between medical treatment, patient education, and limited health care resources. Concepts in the analysis were similar to the modeling choices of other WDAs but combined them in as a comprehensive, systematic, and contextual overview. The model is helpful to understand user competencies and needs. Future models could be developed to model the patient's domain and enable the exploration of the shared decision-making (SDM) paradigm. Our work domain model links treatment goals, decision-making constraints, and task workflows. This model can be used by system developers who would like to use ecological interface design (EID) to improve systems. Our hierarchy is the first in a future set that could explore new treatment paradigms. Future hierarchies could model the patient as a

  19. Unsupervised ensemble ranking of terms in electronic health record notes based on their importance to patients. (United States)

    Chen, Jinying; Yu, Hong


    Allowing patients to access their own electronic health record (EHR) notes through online patient portals has the potential to improve patient-centered care. However, EHR notes contain abundant medical jargon that can be difficult for patients to comprehend. One way to help patients is to reduce information overload and help them focus on medical terms that matter most to them. Targeted education can then be developed to improve patient EHR comprehension and the quality of care. The aim of this work was to develop FIT (Finding Important Terms for patients), an unsupervised natural language processing (NLP) system that ranks medical terms in EHR notes based on their importance to patients. We built FIT on a new unsupervised ensemble ranking model derived from the biased random walk algorithm to combine heterogeneous information resources for ranking candidate terms from each EHR note. Specifically, FIT integrates four single views (rankers) for term importance: patient use of medical concepts, document-level term salience, word co-occurrence based term relatedness, and topic coherence. It also incorporates partial information of term importance as conveyed by terms' unfamiliarity levels and semantic types. We evaluated FIT on 90 expert-annotated EHR notes and used the four single-view rankers as baselines. In addition, we implemented three benchmark unsupervised ensemble ranking methods as strong baselines. FIT achieved 0.885 AUC-ROC for ranking candidate terms from EHR notes to identify important terms. When including term identification, the performance of FIT for identifying important terms from EHR notes was 0.813 AUC-ROC. Both performance scores significantly exceeded the corresponding scores from the four single rankers (P<0.001). FIT also outperformed the three ensemble rankers for most metrics. Its performance is relatively insensitive to its parameter. FIT can automatically identify EHR terms important to patients. It may help develop future interventions

  20. Court Compliance as a Predictor of Postadjudication Recidivism for Domestic Violence Offenders (United States)

    Kindness, Alana; Kim, Han; Alder, Stephen; Edwards, Alison; Parekh, Asha; rOlson, Lenora M.


    This study evaluated pre- and postadjudication behavior of 220 male defendants convicted of a domestic violence-related offense using court records and police department data. Our goal was the identification of possible predictors for continued criminal behavior that could pose a risk of further harm to victims. Factors identified as significant…

  1. Care team identification in the electronic health record: A critical first step for patient-centered communication. (United States)

    Dalal, Anuj K; Schnipper, Jeffrey L


    Patient-centered communication is essential to coordinate care and safely progress patients from admission through discharge. Hospitals struggle with improving the complex and increasingly electronic conversation patterns among care team members, patients, and caregivers to achieve effective patient-centered communication across settings. Accurate and reliable identification of all care team members is a precursor to effective patient-centered communication and ideally should be facilitated by the electronic health record. However, the process of identifying care team members is challenging, and team lists in the electronic health record are typically neither accurate nor reliable. Based on the literature and on experience from 2 initiatives at our institution, we outline strategies to improve care team identification in the electronic health record and discuss potential implications for patient-centered communication. Journal of Hospital Medicine 2016;11:381-385. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  2. Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts. (United States)

    Fernández-Breis, Jesualdo Tomás; Maldonado, José Alberto; Marcos, Mar; Legaz-García, María del Carmen; Moner, David; Torres-Sospedra, Joaquín; Esteban-Gil, Angel; Martínez-Salvador, Begoña; Robles, Montserrat


    The secondary use of electronic healthcare records (EHRs) often requires the identification of patient cohorts. In this context, an important problem is the heterogeneity of clinical data sources, which can be overcome with the combined use of standardized information models, virtual health records, and semantic technologies, since each of them contributes to solving aspects related to the semantic interoperability of EHR data. To develop methods allowing for a direct use of EHR data for the identification of patient cohorts leveraging current EHR standards and semantic web technologies. We propose to take advantage of the best features of working with EHR standards and ontologies. Our proposal is based on our previous results and experience working with both technological infrastructures. Our main principle is to perform each activity at the abstraction level with the most appropriate technology available. This means that part of the processing will be performed using archetypes (ie, data level) and the rest using ontologies (ie, knowledge level). Our approach will start working with EHR data in proprietary format, which will be first normalized and elaborated using EHR standards and then transformed into a semantic representation, which will be exploited by automated reasoning. We have applied our approach to protocols for colorectal cancer screening. The results comprise the archetypes, ontologies, and datasets developed for the standardization and semantic analysis of EHR data. Anonymized real data have been used and the patients have been successfully classified by the risk of developing colorectal cancer. This work provides new insights in how archetypes and ontologies can be effectively combined for EHR-driven phenotyping. The methodological approach can be applied to other problems provided that suitable archetypes, ontologies, and classification rules can be designed.

  3. Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts (United States)

    Fernández-Breis, Jesualdo Tomás; Maldonado, José Alberto; Marcos, Mar; Legaz-García, María del Carmen; Moner, David; Torres-Sospedra, Joaquín; Esteban-Gil, Angel; Martínez-Salvador, Begoña; Robles, Montserrat


    Background The secondary use of electronic healthcare records (EHRs) often requires the identification of patient cohorts. In this context, an important problem is the heterogeneity of clinical data sources, which can be overcome with the combined use of standardized information models, virtual health records, and semantic technologies, since each of them contributes to solving aspects related to the semantic interoperability of EHR data. Objective To develop methods allowing for a direct use of EHR data for the identification of patient cohorts leveraging current EHR standards and semantic web technologies. Materials and methods We propose to take advantage of the best features of working with EHR standards and ontologies. Our proposal is based on our previous results and experience working with both technological infrastructures. Our main principle is to perform each activity at the abstraction level with the most appropriate technology available. This means that part of the processing will be performed using archetypes (ie, data level) and the rest using ontologies (ie, knowledge level). Our approach will start working with EHR data in proprietary format, which will be first normalized and elaborated using EHR standards and then transformed into a semantic representation, which will be exploited by automated reasoning. Results We have applied our approach to protocols for colorectal cancer screening. The results comprise the archetypes, ontologies, and datasets developed for the standardization and semantic analysis of EHR data. Anonymized real data have been used and the patients have been successfully classified by the risk of developing colorectal cancer. Conclusions This work provides new insights in how archetypes and ontologies can be effectively combined for EHR-driven phenotyping. The methodological approach can be applied to other problems provided that suitable archetypes, ontologies, and classification rules can be designed. PMID:23934950

  4. Jurisdiction of courts with a focus on the Special Chamber of the Supreme Court of Kosovo

    Directory of Open Access Journals (Sweden)

    Mr.Sc. Sabri Halili


    Full Text Available The legal solution offered by the Law establishing the Special Chamber of the Supreme Court of Kosovo is rather challenging for practical implementation. Due to this fact, the decisions of the Special Chamber contain various dilemmas of judges on the jurisdiction of the Chamber on the matters related to natural persons sued by the PAK, which are related to various liabilities of these persons to socially-owned enterprises, namely to the PAK. Since the PAK administers and represents socially owned property in general, it is naturally bound to seek for legal resolutions for all legal contests before a competent court. Naturally, the PAK would seek for such a solution before the Special Chamber of the Supreme Court of Kosovo on PAK-related matters, which is already bound by the title itself, “on PAK-related matters”. Comparisons of remedies by various laws related to subject competence are based on legal literature used in higher education in Kosovo. Analysis of subject competences of regular and special courts is two-fold: the Commercial Court and the Military Court, while the competence of the Special Chamber is only analysed in relation with the Law on Courts, and the Law on the Special Chamber of the Supreme Court, comparing it with the Law on Contested Procedure and the Law on the PAK. The Special Chamber has before and still continues to avoid jurisdiction of this Court, which is sanctioned by Articles 4 and 5 of the Law on the Special Chamber, due to the fact that in cases in which the PAK has sued a natural or legal person, due to debts, occupation of socially owned property, or any other disputed matter, which is directly related to socially owned properties, the Special Chamber proclaims itself incompetent, and transfers the case to regular courts, although the Special Chamber adjudicates “on PAK-related matters”, but in this case only when the PAK is respondent, not when it is claimant.

  5. Using Electronic Health Records to Build an Ophthalmologic Data Warehouse and Visualize Patients' Data. (United States)

    Kortüm, Karsten U; Müller, Michael; Kern, Christoph; Babenko, Alexander; Mayer, Wolfgang J; Kampik, Anselm; Kreutzer, Thomas C; Priglinger, Siegfried; Hirneiss, Christoph


    To develop a near-real-time data warehouse (DW) in an academic ophthalmologic center to gain scientific use of increasing digital data from electronic medical records (EMR) and diagnostic devices. Database development. Specific macular clinic user interfaces within the institutional hospital information system were created. Orders for imaging modalities were sent by an EMR-linked picture-archiving and communications system to the respective devices. All data of 325 767 patients since 2002 were gathered in a DW running on an SQL database. A data discovery tool was developed. An exemplary search for patients with age-related macular degeneration, performed cataract surgery, and at least 10 intravitreal (excluding bevacizumab) injections was conducted. Data related to those patients (3 142 204 diagnoses [including diagnoses from other fields of medicine], 720 721 procedures [eg, surgery], and 45 416 intravitreal injections) were stored, including 81 274 optical coherence tomography measurements. A web-based browsing tool was successfully developed for data visualization and filtering data by several linked criteria, for example, minimum number of intravitreal injections of a specific drug and visual acuity interval. The exemplary search identified 450 patients with 516 eyes meeting all criteria. A DW was successfully implemented in an ophthalmologic academic environment to support and facilitate research by using increasing EMR and measurement data. The identification of eligible patients for studies was simplified. In future, software for decision support can be developed based on the DW and its structured data. The improved classification of diseases and semiautomatic validation of data via machine learning are warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Characterizing workflow for pediatric asthma patients in emergency departments using electronic health records. (United States)

    Ozkaynak, Mustafa; Dziadkowiec, Oliwier; Mistry, Rakesh; Callahan, Tiffany; He, Ze; Deakyne, Sara; Tham, Eric


    The purpose of this study was to describe a workflow analysis approach and apply it in emergency departments (EDs) using data extracted from the electronic health record (EHR) system. We used data that were obtained during 2013 from the ED of a children's hospital and its four satellite EDs. Workflow-related data were extracted for all patient visits with either a primary or secondary diagnosis on discharge of asthma (ICD-9 code=493). For each patient visit, eight different a priori time-stamped events were identified. Data were also collected on mode of arrival, patient demographics, triage score (i.e. acuity level), and primary/secondary diagnosis. Comparison groups were by acuity levels 2 and 3 with 2 being more acute than 3, arrival mode (ambulance versus walk-in), and site. Data were analyzed using a visualization method and Markov Chains. To demonstrate the viability and benefit of the approach, patient care workflows were visually and quantitatively compared. The analysis of the EHR data allowed for exploration of workflow patterns and variation across groups. Results suggest that workflow was different for different arrival modes, settings and acuity levels. EHRs can be used to explore workflow with statistical and visual analytics techniques novel to the health care setting. The results generated by the proposed approach could be utilized to help institutions identify workflow issues, plan for varied workflows and ultimately improve efficiency in caring for diverse patient groups. EHR data and novel analytic techniques in health care can expand our understanding of workflow in both large and small ED units. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Organizational strategies for promoting patient and provider uptake of personal health records. (United States)

    Wells, Susan; Rozenblum, Ronen; Park, Andrea; Dunn, Marie; Bates, David W


    To investigate organizational strategies to promote personal health records (PHRs) adoption with a focus on patients with chronic disease. Using semi-structured interviews and a web-based survey, we sampled US health delivery organizations which had implemented PHRs for at least 12 months, were recognized as PHR innovators, and had scored highly in national patient satisfaction surveys. Respondents had lead positions for clinical information systems or high-risk population management. Using grounded theory approach, thematic categories were derived from interviews and coupled with data from the survey. Interviews were conducted with 30 informants from 16 identified organizations. Organizational strategies were directed towards raising patient awareness via multimedia communications, and provider acceptance and uptake. Strategies for providers were grouped into six main themes: organizational vision, governance and policies, work process redesign, staff training, information technology (IT) support, and monitoring and incentives. Successful organizations actively communicated their vision, engaged leaders at all levels, had clear governance, planning, and protocols, set targets, and celebrated achievement. The most effective strategy for patient uptake was through health professional encouragement. No specific outreach efforts targeted patients with chronic disease. Registration and PHR activity was routinely measured but without reference to a denominator population or high risk subpopulations. Successful PHR implementation represents a social change and operational project catalyzed by a technical solution. The key to clinician acceptance is making their work easier. However, organizations will likely not achieve the value they want from PHRs unless they target specific populations and monitor their uptake. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions

  8. What Defines an International Criminal Court?

    DEFF Research Database (Denmark)

    Kjeldgaard-Pedersen, Astrid


    that only criminal tribunals deriving their authority from international law should be labelled ‘international’, while the term ‘national criminal court’ should apply to tribunals set up under national law. This terminology would underline that issues concerning jurisdiction and applicable law must......Since the post-World War II tribunals, only few scholars have attempted to draw a definitional distinction between international and national criminal courts. Remarkable exceptions include Robert Woetzel, who in 1962 categorized criminal courts according to ‘the involvement of the international...... that ‘the involvement of the international community’ is at best an unhelpful criterion when it comes to resolving questions, e.g. regarding the immunity of state officials and the relevance of domestic law, that require a determination of the legal system in which the court operates. Instead, it is argued...

  9. Unwrapping Court-Connected Mediation Agreements

    DEFF Research Database (Denmark)

    Adrian, Lin; Mykland, Solfrid


    Court-connected mediated agreements seem to both fulfil and fail the ideal of self-determination in mediation theory. In a study of 134 agreements from court-connected mediation, we found that the majority of agreements contain creative elements and display great variation in the provisions...... and understand them. The judicial language is well known for the drafters of the agreement but not the parties. Thus, court-connected mediation seems to fail aspects of self-determination when it comes to drafting agreements. We draw on new-institutional theory when we explore and explain this apparent...... they contain. These results indicate that the parties play an important role in crafting the substance of their agreements. However, we also found that the wording of the agreements is characterised by legal and bureaucratic language to the extent that people without legal training find it difficult to read...

  10. Employers liability to the international criminal court

    Directory of Open Access Journals (Sweden)

    Yenifer Yiseth Suárez Díaz


    Full Text Available The constant changes in the social dynamics due to economic and technological development has brought along the need to dispose of a High Court, with competence over International Crimes. The above was the reason to establish the International Criminal Court, destined to prosecute and punish the maximum responsible for crimes of its jurisdiction. Nonetheless, despite the existence of individual criminal responsibility as an accomplice in the case of entrepreneurs who contribute to the crime, there is not an actual investigation or conviction as such in the Court fase for those individuals. Through a criminological study, the actions in the frame of the criminal policy in international law, in order to hold individual criminal responsibility towards entrepreneurs for international crimes, will be evaluated, from the dogmatic categories established in the international guidelines as well as from international doctrine.

  11. How bioethics principles can aid design of electronic health records to accommodate patient granular control. (United States)

    Meslin, Eric M; Schwartz, Peter H


    Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was recently adopted by a team of informaticists who are designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and nonmaleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper, we show how using ethical principles can help in the design of EHRs by first explaining how ethical principles can and should be used generally, and then by discussing how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest.

  12. Acoustic analysis of snoring sounds recorded with a smartphone according to obstruction site in OSAS patients. (United States)

    Koo, Soo Kweon; Kwon, Soon Bok; Kim, Yang Jae; Moon, J I Seung; Kim, Young Jun; Jung, Sung Hoon


    Snoring is a sign of increased upper airway resistance and is the most common symptom suggestive of obstructive sleep apnea. Acoustic analysis of snoring sounds is a non-invasive diagnostic technique and may provide a screening test that can determine the location of obstruction sites. We recorded snoring sounds according to obstruction level, measured by DISE, using a smartphone and focused on the analysis of formant frequencies. The study group comprised 32 male patients (mean age 42.9 years). The spectrogram pattern, intensity (dB), fundamental frequencies (F 0 ), and formant frequencies (F 1 , F 2 , and F 3 ) of the snoring sounds were analyzed for each subject. On spectrographic analysis, retropalatal level obstruction tended to produce sharp and regular peaks, while retrolingual level obstruction tended to show peaks with a gradual onset and decay. On formant frequency analysis, F 1 (retropalatal level vs. retrolingual level: 488.1 ± 125.8 vs. 634.7 ± 196.6 Hz) and F 2 (retropalatal level vs. retrolingual level: 1267.3 ± 306.6 vs. 1723.7 ± 550.0 Hz) of retrolingual level obstructions showed significantly higher values than retropalatal level obstruction (p smartphone can be effective for recording snoring sounds.

  13. Рarticular criminalistic methods of court hearing in criminal proceedings: essence and goals

    Directory of Open Access Journals (Sweden)

    В. І. Алєксєйчук


    . І. Kogutych, І. І. Kotyuk, V. Т. Nor, B. V. Shchur. At the same time the scientists have not paid enough attention to the research of essence of particular criminalistic methods of court hearing of criminal cases and to the definition of its goals. Paper objective is an emphasizing and grounding of specific nature of goals of particular criminalistic methods of court hearing in criminal proceeding, definition of its essence. Paper main body. An essence of particular criminalistic methods of crimes investigation are scientific and practical guidelines which concern specific actions sequence, specific methods, techniques, ways and means of their implementation during investigation of a certain type (category of a crime, intended for use in specific typical situations. The court hearing of criminal proceedings is actually a continuation of a process of learning an event which took place, it is of crucial importance, therefore it requires scientific and practical guidelines concerning its providing. The differences in the content of such guidelines are connected with diversity in some tasks of pre-court and court proceeding and goals of corresponding particular criminalistic methods concerning their providing. In this regard, definition of goals of particular criminalistic methods of court hearing in criminal proceeding should be based on an analysis of tasks of criminalistic methods in general as a section of criminalistics, goals of criminal proceedings and essence of proof. At the same time, goals of particular criminalistic methods (of investigation as well as of court hearing of criminal cases have to disclose practical destination of the last one - as a system of guidelines developed for direct use in specific typical situations. The structure of such system of guidelines is determined by components of proof process which cover the following: collecting, recording, research, estimation аnd using of evidences. It should be taken into consideration that the

  14. Usefulness of implantable loop recorder in a patient with syncope during bathing

    Directory of Open Access Journals (Sweden)

    Motohiro Nakao, MD


    Full Text Available A 27-year-old man presented to our hospital with a 1-year-hisory of repeated syncope, which particularly occurred while bathing or on a hot day. The head-up tilt test did not induce arrhythmia; however, blood pressure decreased by 39 mm Hg without any symptoms. Given that no bradycardia/tachycardia was induced on electrophysiological study and carotid sinus massage, an implantable loop recorder (ILR was implanted. After 2 months, syncope again occurred during bathing at midnight. Sinus arrest and a maximum ventricular pause of 10.2 s were documented using the ILR. After pacemaker implantation, the patient had not experienced syncope for 14 months.

  15. A critical assessment of early warning score records in 168,000 patients

    DEFF Research Database (Denmark)

    Pedersen, Niels Egholm; Rasmussen, Lars Simon; Petersen, John Asger


    critically assessed NEWS data recorded over 12 months. This observational study included NEWS records from adult inpatients hospitalized in the Capital Region of Denmark during 2014. Physiological variables and the use of supplementary oxygen (NEWS variables) were recorded. We identified implausible records...

  16. Displays of authority in the clinical consultation: a linguistic ethnographic study of the electronic patient record. (United States)

    Swinglehurst, Deborah


    The introduction of computers into general practice settings has profoundly changed the dynamics of the clinical consultation. Previous research exploring the impact of the computer (in what has been termed the 'triadic' consultation) has shown that computer use and communication between doctor and patient are intricately coordinated and inseparable. Swinglehurst et al. have recently been critical of the ongoing tendency within health communication research to focus on 'the computer' as a relatively simple 'black box', or as a material presence in the consultation. By re-focussing on the electronic patient record (EPR) and conceptualising this as a complex collection of silent but consequential voices, they have opened up new and more nuanced possibilities for analysis. This orientation makes visible a tension between the immediate contingencies of the interaction as it unfolds moment-by-moment and the more standardised, institutional demands which are embedded in the EPR ('dilemma of attention'). In this paper I extend this work, presenting an in-depth examination of how participants in the consultation manage this tension. I used linguistic ethnographic methods to study 54 video recorded consultations from a dataset collected between 2007 and 2008 in two UK general practices, combining microanalysis of the consultation with ethnographic attention to the wider organisational and institutional context. My analysis draws on the theoretical work of Erving Goffman and Mikhail Bakhtin, incorporating attention to the 'here and now' of the interaction as well as an appreciation of the 'distributed' nature of the EPR, its role in hosting and circulating new voices, and in mediating participants' talk and social practices. It reveals - in apparently fleeting moments of negotiation and contestation - the extent to which the EPR shapes the dynamic construction, display and circulation of authority in the contemporary consultation. Copyright © 2014 The Author. Published by

  17. A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record. (United States)

    Fuji, Kevin T; Abbott, Amy A; Galt, Kimberly A


    Patient use of personal health records (PHRs) to manage their health information has been proposed to enhance patient knowledge and empower patients to make changes in their self-care behaviors. However, there remains a gap in understanding about patients' actual PHR use behaviors. The purpose of this qualitative study was to explore how patients with type 2 diabetes used a PHR to manage their diabetes-related health information for self-care. Fifty-nine patients with type 2 diabetes were interviewed 3-6 months after receiving initial training on a free-of-charge, Web-based PHR. Interviews were audio-recorded, transcribed, and analyzed using an iterative process of in vivo coding, categorization, and theme development. Nine themes emerged, three of which expressed positive experiences: complete and accessible record; increased awareness; and behavioral changes. The remaining six themes expressed negative experiences: out of sight, out of mind; I would have used it if I were sicker; economic, infrastructure, and computer literacy barriers; lack of patient-provider engagement; double tracking; and privacy and security concerns. Despite some potential positive benefits resulting from PHR use, several barriers inhibited sustained and effective use over time. Provider and patient education about the benefits of PHR use and about the potential for filling in information gaps in the provider-based record is key to engage patients and stimulate PHR adoption and use.

  18. How is adult patient adherence recorded in orthodontists’ clinical notes? A mixed-method case-note study

    Directory of Open Access Journals (Sweden)

    Al Shammary N


    Full Text Available Nawaf Al Shammary,1 Koula Asimakopoulou,1 Fraser McDonald,2 Jonathon T Newton,1 Sasha Scambler1 1Division of Population and Patient Health, 2Craniofacial Development and Stem Cell Biology Department, King’s College London Dental Institute, London, UKBackground: Patient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients’ medical records by orthodontists working in a large National Health Service (NHS London hospital.Materials and methods: A mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87 provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature.Results: The term “adherence” did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were “oral hygiene,” “appointment attendance” and “breakages of appliances.” Qualitative analysis not only confirmed these factors but also showed that 1 the clinical aspects of treatment, 2 clinician–patient interaction factors and 3 patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded.Conclusion: Adherence as a term does not feature in the clinical case notes of clinician-identified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency. Keywords: adherence, adults, orthodontic treatment

  19. Electronic Health Record Based Algorithm to Identify Patients with Autism Spectrum Disorder.

    Directory of Open Access Journals (Sweden)

    Todd Lingren

    Full Text Available Cohort selection is challenging for large-scale electronic health record (EHR analyses, as International Classification of Diseases 9th edition (ICD-9 diagnostic codes are notoriously unreliable disease predictors. Our objective was to develop, evaluate, and validate an automated algorithm for determining an Autism Spectrum Disorder (ASD patient cohort from EHR. We demonstrate its utility via the largest investigation to date of the co-occurrence patterns of medical comorbidities in ASD.We extracted ICD-9 codes and concepts derived from the clinical notes. A gold standard patient set was labeled by clinicians at Boston Children's Hospital (BCH (N = 150 and Cincinnati Children's Hospital and Medical Center (CCHMC (N = 152. Two algorithms were created: (1 rule-based implementing the ASD criteria from Diagnostic and Statistical Manual of Mental Diseases 4th edition, (2 predictive classifier. The positive predictive values (PPV achieved by these algorithms were compared to an ICD-9 code baseline. We clustered the patients based on grouped ICD-9 codes and evaluated subgroups.The rule-based algorithm produced the best PPV: (a BCH: 0.885 vs. 0.273 (baseline; (b CCHMC: 0.840 vs. 0.645 (baseline; (c combined: 0.864 vs. 0.460 (baseline. A validation at Children's Hospital of Philadelphia yielded 0.848 (PPV. Clustering analyses of comorbidities on the three-site large cohort (N = 20,658 ASD patients identified psychiatric, developmental, and seizure disorder clusters.In a large cross-institutional cohort, co-occurrence patterns of comorbidities in ASDs provide further hypothetical evidence for distinct courses in ASD. The proposed automated algorithms for cohort selection open avenues for other large-scale EHR studies and individualized treatment of ASD.

  20. Open source electronic health record and patient data management system for intensive care. (United States)

    Massaut, Jacques; Reper, Pascal


    In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed a PDMS and EHR based on open source software and components. The software was designed as a client-server architecture running on the Linux operating system and powered by the PostgreSQL data base system. The client software was developed in C using GTK interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in February 2004, the PDMS was used to care more than three thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of the Mirth HL7 communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on open source software components was able to respond to the medical needs of the local ICU environment. The use of OSS for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

  1. Mental health courts: serving justice and promoting recovery. (United States)

    Wren, Ginger Lerner


    This article begins and ends with a call for more empirical research to understand the connection between societal views of mental illness and the legal system. The author asserts that changing social perceptions of mental illness certainly affect legal outcomes and commitment levels, but the degree remains unknown. This article explores the above two topics through the framework of the Circuit Court 'split' regarding the Constitutional rights of persons committed to state mental health institutions. A main facet of the 'split' is centered on the Circuits' disagreement about whether or not all mentally ill patients committed to institutions deserve the same Constitutional protections.

  2. Clerics and courtly love in Andreas Capellanus' The Art of Courtly Love and Chaucer's Canterbury Tales


    Williams, Andrew


    In both The Canterbury Tales and The Art of Courtly Love Geoffrey Chaucer and Andreas Capellanus deal with various aspects of courtly love. In particular, both of them focus to some degree on the question of clerical celibacy. The use of tale telling and imaginary dialogues result in a contemporary overview of the role of the cleric in courtly love, the church rules on the subject, and the opinions of the people on a subject that is ripe for exploration. My aim is to point out some of the ...

  3. To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports?

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit


    Full Text Available Abstract Background Patient record review is believed to be the most useful method for estimating the rate of adverse events among hospitalised patients. However, the method has some practical and financial disadvantages. Some of these disadvantages might be overcome by using existing reporting systems in which patient safety issues are already reported, such as incidents reported by healthcare professionals and complaints and medico-legal claims filled by patients or their relatives. The aim of the study is to examine to what extent the hospital reporting systems cover the adverse events identified by patient record review. Methods We conducted a retrospective study using a database from a record review study of 5375 patient records in 14 hospitals in the Netherlands. Trained nurses and physicians using a method based on the protocol of The Harvard Medical Practice Study previously reviewed the records. Four reporting systems were linked with the database of reviewed records: 1 informal and 2 formal complaints by patients/relatives, 3 medico-legal claims by patients/relatives and 4 incident reports by healthcare professionals. For each adverse event identified in patient records the equivalent was sought in these reporting systems by comparing dates and descriptions of the events. The study focussed on the number of adverse event matches, overlap of adverse events detected by different sources, preventability and severity of consequences of reported and non-reported events and sensitivity and specificity of reports. Results In the sample of 5375 patient records, 498 adverse events were identified. Only 18 of the 498 (3.6% adverse events identified by record review were found in one or more of the four reporting systems. There was some overlap: one adverse event had an equivalent in both a complaint and incident report and in three cases a patient/relative used two or three systems to complain about an adverse event. Healthcare professionals

  4. Diagnosed Intellectual and Emotional Impairment among Parents Who Seriously Mistreat Their Children: Prevalence, Type, and Outcome in a Court Sample. (United States)

    Taylor, Carol G.; And Others


    This study examined the court records of 206 seriously abused or neglected children and their families in a large urban area and found that in over half the records a parent had been diagnosed as having an emotional disorder and/or low intelligence, with a majority of these diagnoses indicating significant impairment. (Author/DB)

  5. Giving rheumatology patients online home access to their electronic medical record (EMR): advantages, drawbacks and preconditions according to care providers

    NARCIS (Netherlands)

    van der Vaart, R.; Drossaert, Constance H.C.; Taal, Erik; van de Laar, Mart A F J


    Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted.

  6. Clinical coding of prospectively identified paediatric adverse drug reactions--a retrospective review of patient records. (United States)

    Bellis, Jennifer R; Kirkham, Jamie J; Nunn, Anthony J; Pirmohamed, Munir


    National Health Service (NHS) hospitals in the UK use a system of coding for patient episodes. The coding system used is the International Classification of Disease (ICD-10). There are ICD-10 codes which may be associated with adverse drug reactions (ADRs) and there is a possibility of using these codes for ADR surveillance. This study aimed to determine whether ADRs prospectively identified in children admitted to a paediatric hospital were coded appropriately using ICD-10. The electronic admission abstract for each patient with at least one ADR was reviewed. A record was made of whether the ADR(s) had been coded using ICD-10. Of 241 ADRs, 76 (31.5%) were coded using at least one ICD-10 ADR code. Of the oncology ADRs, 70/115 (61%) were coded using an ICD-10 ADR code compared with 6/126 (4.8%) non-oncology ADRs (difference in proportions 56%, 95% CI 46.2% to 65.8%; p codes as a single means of detection. Data derived from administrative healthcare databases are not reliable for identifying ADRs by themselves, but may complement other methods of detection.

  7. Patient Electronic Health Records as a Means to Approach Genetic Research in Gastroenterology. (United States)

    Ananthakrishnan, Ashwin N; Lieberman, David


    Electronic health records (EHRs) are being increasingly utilized and form a unique source of extensive data gathered during routine clinical care. Through use of codified and free text concepts identified using clinical informatics tools, disease labels can be assigned with a high degree of accuracy. Analysis linking such EHR-assigned disease labels to a biospecimen repository has demonstrated that genetic associations identified in prospective cohorts can be replicated with adequate statistical power and novel phenotypic associations identified. In addition, genetic discovery research can be performed utilizing clinical, laboratory, and procedure data obtained during care. Challenges with such research include the need to tackle variability in quality and quantity of EHR data and importance of maintaining patient privacy and data security. With appropriate safeguards, this novel and emerging field of research offers considerable promise and potential to further scientific research in gastroenterology efficiently, cost-effectively, and with engagement of patients and communities. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  8. The Unified Patent Court (UPC) in Action

    DEFF Research Database (Denmark)

    Petersen, Clement Salung; Schovsbo, Jens Hemmingsen; Riis, Thomas


    The new common judiciary for European patents (UPC) will play a crucial role in the future European patent system. The UPC will be a very specialised court that i.a. recruits judges from specialists’ circles and has as part of its mission to develop a coherent and autonomous body of case law...

  9. Challenging international criminal tribunals before domestic courts

    NARCIS (Netherlands)

    d' Aspremont, J.; Brölmann, C.; Reinisch, A.


    International courts, despite the wide-ranging means that have been put at their disposal, need the cooperation of various domestic actors. The cooperation of States with international criminal tribunals has not always been without difficulty, as these tribunals have been the object of various

  10. Push Characteristics in Wheelchair Court Sport Sprinting

    NARCIS (Netherlands)

    van der Slikke, Rienk M A; Berger, Monique; Bregman, Daan; Veeger, Dirkjan


    Short sprints are important components of most wheelchair court sports, since being faster than the opponent often determines keeping ball possession or not. Sprinting capacity is best measured during a field test, allowing the athlete to freely choose push strategies adapted to their own wheelchair

  11. Push characteristics in wheelchair court sport sprinting

    NARCIS (Netherlands)

    van der Slikke, R.M.A.; Berger, Monique; Bregman, D.J.J.; Veeger, H.E.J.; van der Helm, FCT; Jansen, AJ


    Short sprints are important components of most wheelchair court sports, since being faster than the opponent often determines keeping ball possession or not. Sprinting capacity is best measured during a field test, allowing the athlete to freely choose push strategies adapted to their own

  12. Nuclear weapons and the World Court ruling

    International Nuclear Information System (INIS)

    Singh, J.


    based on the initiatives by non-governmental organizations, the World Health Organisation (WHO) Assembly asked the International Court of Justice for an advisory opinion in 1993 whether, considering the environmental and health consequences, the use of nuclear weapons by a state in war or other armed conflict would be a breach of its obligations under international law. The World Court decided that it was not able to give an advisory opinion as requested, because of the fact that questions of use of force and such like were beyond the scope of specialized agencies like the WHO. The Court has ruled that the international community, especially the five nuclear weapon states have not only an obligation to negotiate a treaty for total nuclear disarmament, but also have an obligation to conclude such treaty. We may expect that the nuclear weapon states will cynically disregard the ruling of the World Court as they have been doing to the basic obligation itself in pursuit of nuclear hegemony. But the remaining 150 countries or so also bear a responsibility to keep nudging the recalcitrant states into implementing their commitments to disarm

  13. Swan Song for the Burger Court. (United States)

    Hayman, Robert L., Jr.; Ramarui, Cornelis O.


    Reviews a collection of decisions rendered by the Burger Court during its waning months. The decisions involve (1) criminal procedures, (2) racial bias in jury selection, (3) search and seizure, and (4) the exclusion of jurors who have reservations about the death penalty. (JDH)

  14. Supreme Court Deals Blow to Student Journalists. (United States)

    Gynn, Ann


    Covers the U.S. Supreme Court decision in Hazelwood School District v. Kuhlmeier, which gave principals the right to censor school publications. In "One Student's Pursuit of Journalism," Alexandra Salas relates one student journalist's experience, including internships, from high school through the end of college. (LS)

  15. The Courts, Social Science, and School Desegregation. (United States)

    Levin, Betsy, Ed.; Hawley, Willis D., Ed.

    A conference on the courts, social science, and school desegregation attempted to clarify how social science research has been used and possibly misused in school desegregation litigation. The symposium issue addressed in this book is a product of that conference. First, the judicial evolution of the law of school desegregation from Brown V. the…

  16. The Courts and Student Rights -- Procedural Matters. (United States)

    Phay, Robert E.

    This paper traces the evolution of student rights and the judicial protection of these rights through numerous court cases. The author outlines the minimum standards of due process required in disciplinary proceedings and discusses cases that point up (1) the required specificity of rules on student conduct, (2) the requirements of notice to…

  17. Jurisdiction of the international Criminal Court: Analysis, loopholes ...

    African Journals Online (AJOL)

    Jurisdiction of the international Criminal Court: Analysis, loopholes and challenges. ... Journal Home > Vol 3 (2012) > ... One of the most fundamental questions of law is whether a given court has jurisdiction to preside over a given case.

  18. Matching Judicial Supervision to Clients’ Risk Status in Drug Court (United States)

    Marlowe, Douglas B.; Festinger, David S.; Lee, Patricia A.; Dugosh, Karen L.; Benasutti, Kathleen M.


    This article reports outcomes from a program of experimental research evaluating the risk principle in drug courts. Prior studies revealed that participants who were high risk and had (a) antisocial personality disorder or (b) a prior history of drug abuse treatment performed better in drug court when scheduled to attend biweekly judicial status hearings in court. In contrast, participants who were low risk performed equivalently regardless of the court hearings schedule. This study prospectively matches drug court clients to the optimal schedule of court hearings based on an assessment of their risk status and compares outcomes to clients randomly assigned to the standard hearings schedule. Results confirmed that participants who were high risk and matched to biweekly hearings had better during-treatment outcomes than participants assigned to status hearings as usual. These findings provide confirmation of the risk principle in drug courts and yield practical information for enhancing the efficacy and cost-efficiency of drug courts. PMID:18174915

  19. Parent Group Training Programs in Juvenile Courts: A National Survey (United States)

    Windell, James O.; Windell, Ellen A.


    This survey of juvenile courts across the country indicates that only one of five courts have a parent group program and few use procedures reported in the growing literature relating to changing the behavior of agressive children. (Author)

  20. Casebook: a virtual patient iPad application for teaching decision-making through the use of electronic health records. (United States)

    Bloice, Marcus D; Simonic, Klaus-Martin; Holzinger, Andreas


    Virtual Patients are a well-known and widely used form of interactive software used to simulate aspects of patient care that students are increasingly less likely to encounter during their studies. However, to take full advantage of the benefits of using Virtual Patients, students should have access to multitudes of cases. In order to promote the creation of collections of cases, a tablet application was developed which makes use of electronic health records as material for Virtual Patient cases. Because electronic health records are abundantly available on hospital information systems, this results in much material for the basis of case creation. An iPad-based Virtual Patient interactive software system was developed entitled Casebook. The application has been designed to read specially formatted patient cases that have been created using electronic health records, in the form of X-ray images, electrocardiograms, lab reports, and physician notes, and present these to the medical student. These health records are organised into a timeline, and the student navigates the case while answering questions regarding the patient along the way. Each health record can also be annotated with meta-information by the case designer, such as insight into the thought processes and the decision-making rationale of the physician who originally worked with the patient. Students learn decision-making skills by observing and interacting with real patient cases in this simulated environment. This paper discusses our approach in detail. Our group is of the opinion that Virtual Patient cases, targeted at undergraduate students, should concern patients who exhibit prototypical symptoms of the kind students may encounter when beginning their first medical jobs. Learning theory research has shown that students learn decision-making skills best when they have access to multitudes of patient cases and it is this plurality that allows students to develop their illness scripts effectively

  1. Patient Health Record Systems Scope and Functionalities: Literature Review and Future Directions. (United States)

    Bouayad, Lina; Ialynytchev, Anna; Padmanabhan, Balaji


    A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels. The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice. We conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content. We present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation. Efforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate clinical outcomes associated with automated PHR

  2. Psychology and psychiatry in Singapore courts: A baseline survey of the mental health landscape in the legal arena. (United States)

    Gwee, Kenji

    Despite the increasing prevalence and involvement of mental health professionals in local courts, there has been no systematic study of the role played by these expert witnesses in Singapore courtrooms. An empirical study of all existing recorded cases on Lawnet (Singapore's legal database of all court trial cases) from 1975-2014 involving psychologists and psychiatrists was conducted. Results revealed that, not only were these mental health experts increasingly dotting the landscape of the legal arena, the variety of their contributions has also been gradually growing. Furthermore, there were marked differences across criminal, civil and custody cases with regards to the issues of how these experts were consulted and how their inputs utilized and appreciated by judges. Differences between psychology and psychiatry were also apparent. A future with more assistance rendered by these professions to courts, as well as greater synergy between law and mental health, was predicted for Singapore courts. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. The Supreme Court's Role in Defining the Jurisdiction of Military Courts: A Study and Proposal

    National Research Council Canada - National Science Library

    Baldrate, Brian C


    .... Rather than creating a consistent precedent, the Court's decisions have led to arbitrary results and an increased uncertainty about whether the military commissions at Guantanamo Bay, Cuba, are constitutional...

  4. The International Criminal Court at the crossroads

    Directory of Open Access Journals (Sweden)

    Abdelwahab Biad


    Full Text Available Since the adoption of the Statute of Rome in July 1998, the ICC has been confronted by a number of problems. One such problem is the disagreement which persists among the members of the Assembly of Member States as to whether the crime of Aggression is one over which the Court has competence pursuant to Article 5 of the Statute. Another diffi culty is the opposition of the United States of America which, since the Bush Administration, has deployed a juridical arsenal with the aim of impeding any type of collaboration with the ICC; the tools in the arsenal include the American Service Members’ Protection Act and bilateral immunity agreements which prevent the transfer of American citizens to the Court by State members of the Rome Statute. The entry into force of the of the Statute on 1 July 2002 allowed the Court Prosecutor to initiate the fi rst investigations and processes for war crimes and crimes against humanity committed in the confl icts which have devastated certain African States (D.R.C., The Central African Republic and Uganda. The arrest warrant against the Sudanese President Omar Al Bashir for atrocities committed in Darfur demonstrates the limitations of action on the Court which cannot carry out its mandate without the cooperation of the States. Above all, the Court must confront the criticism of “double standards” and that it is an instrument of “justice for the poor”, while the “powerful” escape. The answers to these problems can be contributed to, in part, through the revision process foreseen by the Statute nine years after its entry into force.

  5. Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention. (United States)

    Montague, Enid; Asan, Onur


    The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care. Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information. A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients' and physicians' gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods. Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor-technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts. This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology. Published by Elsevier Ireland Ltd.

  6. Hospital cannot be held liable for breach of patient's privacy. (United States)


    The Minnesota Court of Appeals ruled that a law guaranteeing the confidentiality of a patient's medical records did not create a private cause of actions for damages when the patient's HIV was revealed. The plaintiff, known as [name removed], requested that his stepbrother not be told his HIV status. A relative gained access to his medical file while working at a medical center and disclosed [name removed]'s HIV status to his stepbrother. [name removed] sued the relative and the hospital. The district court ruled that he did not have a cause of action against the hospital and the Court of Appeals agreed. The State does not recognize claims for an invasion of privacy under the Minnesota Patients Bill of Rights.

  7. Criminal adjudication by state courts under the FDRE constitution ...

    African Journals Online (AJOL)

    ... delegation power or as an original power. This article explores how the state courts are adjudicating federal criminal matters, and how the criminal adjudicative jurisdiction of the federal courts and state courts is compartmentalized. Keywords: jurisdiction, criminal adjudication, compartmentalization, constitution, federalism ...

  8. High School Food Courts: A New Evolution in Student Dining. (United States)

    Beach, George


    Discusses how traditional high school cafeterias have changed in recent years into food courts and dining areas usually found in shopping malls. Areas examined include food court design, traffic patterns, safety and after-hours usage, and kitchens and serving areas. How one school district turned its food court system into a successful…

  9. Legal Bibliography for Juvenile and Family Courts. Supplement 2. (United States)

    Sheridan, William H.; Freer, Alice B.

    This bibliography provides a listing of journal articles on such topics as: the abused child, adoptions, case decisions, confessions, constitutional law, counsel, court administration and organization, courts, criminal law and procedure, custody, delinquency, domestic relations, due process for juveniles, evidence, family court and family law,…

  10. Effect of Court Dimensions on Players’ External and Internal Load during Small-Sided Handball Games

    Directory of Open Access Journals (Sweden)

    Matteo Corvino


    Full Text Available The aim of this study was to investigate the effect of three different court dimensions on the internal and external load during small-sided handball games. Six male amateur handball players took part in this study and participated in three different 8-min 3vs3 (plus goalkeepers small-sided handball games (each repeated twice. The three court dimensions were 12×24m, 30×15m and 32×16m. Through Global Positioning System devices (SPI pro elite 15Hz, GPSports and video analysis, the following parameters were recorded: cyclic and acyclic movements (distance covered and number of technical actions executed, heart rate, and rating of perceived exertion (RPE. Total distance travelled increased with court dimensions (885.2m ± 66.6m in 24×12m; 980.0m ± 73.4m in 30×15m; 1095.0m ± 112.9m in 32×16m, p 5.2 m·s-1 highlighted substantial differences: playing with the 30×15m court in comparison to the 24×12m, the players covered less distance in the first speed zone (p = 0.012; ES = 0.70 and more distance in the second (p = 0.049; ES = 0.73 and third (p = 0.012; ES = 0.51 speed zones. Statistical differences were also found between the 24×12m and 32×16m courts: the players covered more distance in the second and third speed zones (p = 0.013, ES = 0.76; p = 0.023 ES = 0.69 with the 32×16m court in comparison to the 24×12m. There was no significant effect of court dimensions on the technical parameters (number of team actions, passes, piston movements toward goal and defensive activities, the number of specific handball jumps and changes of direction, and the time spent in the different heart rate zones. Considering the average data of all the experimental conditions together (24×12m, 30×15m, 32×16m, a pronounced statistical difference was highlighted between the values in first two HR zones and the last two (p < 0.05; large ES. The rating of perceived exertion was significantly higher during the drill with the 32×16m court compared with the 24

  11. Analysis of clinical records of dental patients attending Jordan University Hospital: Documentation of drug prescriptions and local anesthetic injections

    Directory of Open Access Journals (Sweden)

    Najla Dar-Odeh


    Full Text Available Najla Dar-Odeh1, Soukaina Ryalat1, Mohammad Shayyab1, Osama Abu-Hammad21Department of Oral and Maxillofacial Surgery Oral Medicine and Periodontics, Faculty of Dentistry, University of Jordan, Jordan; 2Department of Prosthetic Dentistry, Faculty of Dentistry, University of Jordan, JordanObjectives: The aim of this study was to analyze clinical records of dental patients attending the Dental Department at the University of Jordan Hospital: a teaching hospital in Jordan. Analysis aimed at determining whether dental specialists properly documented the drug prescriptions and local anesthetic injections given to their patients.Methods: Dental records of the Dental Department at the Jordan University Hospital were reviewed during the period from April 3rd until April 26th 2007 along with the issued prescriptions during that period.Results: A total of 1000 records were reviewed with a total of 53 prescriptions issued during that period. Thirty records documented the prescription by stating the category of the prescribed drug. Only 13 records stated the generic or the trade names of the prescribed drugs. Of these, 5 records contained the full elements of a prescription. As for local anesthetic injections, the term “LA used” was found in 22 records while the names and quantities of the local anesthetics used were documented in only 13 records. Only 5 records documented the full elements of a local anesthetic injection.Conclusion: The essential data of drug prescriptions and local anesthetic injections were poorly documented by the investigated group of dental specialists. It is recommended that the administration of the hospital and the dental department implement clear and firm guidelines for dental practitioners in particular to do the required documentation procedure.Keywords: dental records, documentation, prescriptions, local anesthesia

  12. A Retrospective Analysis of the Burn Injury Patients Records in the Emergency Department, an Epidemiologic Study

    Directory of Open Access Journals (Sweden)

    Nilgün Aksoy


    Full Text Available Introduction: Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim’s families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. Methods: This is a cross-sectional study was conducted by evaluation of patients’ files and forensic reports of burned patients’ referred to the emergency department (ED of Akdeniz hospital, Turkey, 2008. Demographic data, the season, place, reason, anatomical sites, total body surface area, degrees, proceeding treatment, and admission time were recorded. Multinomial logistic regression was used to compare frequencies’ differences among single categorized variables. Stepwise logistic regression was applied to develop a predictive model for hospitalization. P<0.05 was defined as a significant level. Results: Two hundred thirty patients were enrolled (53.9% female. The mean of patients' ages was 25.3 ± 22.3 years. The most prevalence of burn were in the 0-6 age group and most of which was hot liquid scalding (71.3%. The most affected parts of the body were the left and right upper extremities. With increasing the severity of triage level (OR=2.2; 95% CI: 1.02-4.66; p=0.046, intentional burn (OR=4.7; 95% CI: 1.03-21.8; p=0.047, referring from other hospitals or clinics (OR=3.4; 95% CI: 1.7-6.6; p=0.001, and percentage of burn (OR=18.1; 95% CI: 5.42-62.6; p<0.001 were independent predictive factor for hospitalization. In addition, odds of hospitalization was lower in patients older than 15 years (OR=0.7; 95% CI: 0.5-0.91; p=0.035. Conclusion: This study revealed the most frequent burns are encountered in the age group of 0-6 years, percentage of <10%, second degree, upper extremities, indoor, and scalding from hot liquids. Increasing ESI severity, intentional burn, referring from

  13. γ-oscillations modulated by picture naming and word reading: intracranial recording in epileptic patients. (United States)

    Wu, Helen C; Nagasawa, Tetsuro; Brown, Erik C; Juhasz, Csaba; Rothermel, Robert; Hoechstetter, Karsten; Shah, Aashit; Mittal, Sandeep; Fuerst, Darren; Sood, Sandeep; Asano, Eishi


    We measured cortical gamma-oscillations in response to visual-language tasks consisting of picture naming and word reading in an effort to better understand human visual-language pathways. We studied six patients with focal epilepsy who underwent extraoperative electrocorticography (ECoG) recording. Patients were asked to overtly name images presented sequentially in the picture naming task and to overtly read written words in the reading task. Both tasks commonly elicited gamma-augmentation (maximally at 80-100 Hz) on ECoG in the occipital, inferior-occipital-temporal and inferior-Rolandic areas, bilaterally. Picture naming, compared to reading task, elicited greater gamma-augmentation in portions of pre-motor areas as well as occipital and inferior-occipital-temporal areas, bilaterally. In contrast, word reading elicited greater gamma-augmentation in portions of bilateral occipital, left occipital-temporal and left superior-posterior-parietal areas. Gamma-attenuation was elicited by both tasks in portions of posterior cingulate and ventral premotor-prefrontal areas bilaterally. The number of letters in a presented word was positively correlated to the degree of gamma-augmentation in the medial occipital areas. Gamma-augmentation measured on ECoG identified cortical areas commonly and differentially involved in picture naming and reading tasks. Longer words may activate the primary visual cortex for the more peripheral field. The present study increases our understanding of the visual-language pathways. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  14. An analysis of electronic health record-related patient safety concerns (United States)

    Meeks, Derek W; Smith, Michael W; Taylor, Lesley; Sittig, Dean F; Scott, Jean M; Singh, Hardeep


    Objective A recent Institute of Medicine report called for attention to safety issues related to electronic health records (EHRs). We analyzed EHR-related safety concerns reported within a large, integrated healthcare system. Methods The Informatics Patient Safety Office of the Veterans Health Administration (VA) maintains a non-punitive, voluntary reporting system to collect and investigate EHR-related safety concerns (ie, adverse events, potential events, and near misses). We analyzed completed investigations using an eight-dimension sociotechnical conceptual model that accounted for both technical and non-technical dimensions of safety. Using the framework analysis approach to qualitative data, we identified emergent and recurring safety concerns common to multiple reports. Results We extracted 100 consecutive, unique, closed investigations between August 2009 and May 2013 from 344 reported incidents. Seventy-four involved unsafe technology and 25 involved unsafe use of technology. A majority (70%) involved two or more model dimensions. Most often, non-technical dimensions such as workflow, policies, and personnel interacted in a complex fashion with technical dimensions such as software/hardware, content, and user interface to produce safety concerns. Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or ‘hidden dependencies’ within the EHR. Discussion EHR-related safety concerns involving both unsafe technology and unsafe use of technology persist long after ‘go-live’ and despite the sophisticated EHR infrastructure represented in our data source. Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA. Conclusions Because EHR-related safety concerns have complex

  15. 77 FR 56822 - Privacy Act of 1974; System of Records (United States)


    ...; Manual for Courts-Martial (MCM), Part II of the MCM, Rule for Courts-Martial, Part II Rule 109 of the MCM... notarized signature as a means of proving the identity of the individual requesting access to records... will require a notarized signature as a means of proving the identity of the individual requesting...

  16. A Role for Semantic Web Technologies in Patient Record Data Collection (United States)

    Ogbuji, Chimezie

    Business Process Management Systems (BPMS) are a component of the stack of Web standards that comprise Service Oriented Architecture (SOA). Such systems are representative of the architectural framework of modern information systems built in an enterprise intranet and are in contrast to systems built for deployment on the larger World Wide Web. The REST architectural style is an emerging style for building loosely coupled systems based purely on the native HTTP protocol. It is a coordinated set of architectural constraints with a goal to minimize latency, maximize the independence and scalability of distributed components, and facilitate the use of intermediary processors.Within the development community for distributed, Web-based systems, there has been a debate regarding themerits of both approaches. In some cases, there are legitimate concerns about the differences in both architectural styles. In other cases, the contention seems to be based on concerns that are marginal at best. In this chapter, we will attempt to contribute to this debate by focusing on a specific, deployed use case that emphasizes the role of the Semantic Web, a simple Web application architecture that leverages the use of declarative XML processing, and the needs of a workflow system. The use case involves orchestrating a work process associated with the data entry of structured patient record content into a research registry at the Cleveland Clinic's Clinical Investigation department in the Heart and Vascular Institute.

  17. Disease management programs for patients with COPD in Germany: a longitudinal evaluation of routinely collected patient records. (United States)

    Mehring, Michael; Donnachie, Ewan; Fexer, Johannes; Hofmann, Frank; Schneider, Antonius


    The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records. A longitudinal population-based study, comparing the total DMP population of up to 86,560 patients with a stable cohort of 17,549 subjects over a period of 5 years. The effect of subject dropout in the cohort is further estimated by means of inverse probability weighting. The proportion of subjects in the total population who were prescribed and received treatment with oral corticosteroids declined at a constant rate of 1.0% per year (P management education. While the proportion of smokers in the total population remained constant because of the effect of newly enrolled subjects, the proportion of smokers decreased significantly even after dropout adjustment, from 29% to 21%. The occurrence of exacerbations decreased steadily at a rate of 0.9% (total population) or 0.7% (cohort) per year. While the occurrence of emergency hospital admissions decreased in the total population, an increase was observed within the cohort. Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort. Copyright © 2014 by Daedalus Enterprises.

  18. Electronic health records to support obesity-related patient care: Results from a survey of United States physicians. (United States)

    Bronder, Kayla L; Dooyema, Carrie A; Onufrak, Stephen J; Foltz, Jennifer L


    Obesity-related electronic health record functions increase the rates of measuring Body Mass Index, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related electronic health record functions in clinical practice and analyzes characteristics associated with increased obesity-related electronic health record sophistication. Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their electronic health record has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related electronic health record sophistication. Of the 88% of providers with an electronic health record, 83% of electronic health records calculate Body Mass Index, 52% calculate pediatric Body Mass Index percentile, and 32% flag patients with abnormal Body Mass Index values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated electronic health record include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. Few electronic health records optimally supported physician's obesity-related clinical care. The low rates of obesity-related electronic health record functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. More work can be done to develop, implement, and promote the effective utilization of obesity-related electronic health record functions to improve obesity treatment and prevention efforts. Published by Elsevier Inc.

  19. Illinois court seeks new course in AIDS phobia cases. (United States)


    The Illinois Court of Appeals ruled that plaintiffs cannot be compensated for negligent infliction of emotional distress unless there is a substantial, medically-verifiable possibility of contracting HIV. The new standard will impact a growing body of case law requiring plaintiffs to show that the fear of AIDS was predicated on actual exposure to the virus. Under the actual exposure rule, a plaintiff who injures himself with a hypodermic needle that had been used on an HIV-positive hospital patient could recover damages; another plaintiff whose needle puncture cannot be traced to HIV contamination could not be compensated. In Doe v. Northwestern University, six plaintiffs who received dental care from a university dental student who tested positive for HIV antibodies sued the university, alleging negligence. Although the plaintiff's fears of HIV infection were reasonable, the court found that they were not severe enough to warrant tort compensation since the plaintiffs had nothing to support their claims. In the case of [name removed] v. [Name removed], a medical clinic office manager, cut herself on a bloodstained scalpel left in a trash can by Dr. [name removed]. Eight months following the incident, [name removed] died of AIDS-related causes. Mrs. [Name removed] would have been entitled to recover damages under the actual exposure test; however, the case would not have prevailed under the Northwestern standard because it was known that Mrs. [Name removed] tested negative twice prior to learning of [name removed]'s AIDS diagnosis. Controversy within the Illinois courts about the actual exposure rule continues.

  20. Patients' online access to their electronic health records and linked online services: a systematic review in primary care. (United States)

    Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley


    Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups

  1. Patient perceptions of electronic medical records use and ratings of care quality

    Directory of Open Access Journals (Sweden)

    Finney Rutten LJ


    Full Text Available Lila J Finney Rutten,1 Sana N Vieux,2 Jennifer L St Sauver,1 Neeraj K Arora,2 Richard P Moser,2 Ellen Burke Beckjord,3 Bradford W Hesse2 1Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; 2Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA; 3Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA Purpose: Despite considerable potential for improving health care quality, adoption of new technologies, such as electronic medical records (EMRs, requires prudence, to ensure that such tools are designed, implemented, and used meaningfully to facilitate patient-centered communication and care processes, and better health outcomes. The association between patients’ perceptions of health care provider use of EMRs and health care quality ratings was assessed. Method: Data from two iterations of the Health Information National Trends Survey, fielded in 2011 and 2012, were pooled for these analyses. The data were collected via mailed questionnaire, using a nationally representative listing of home addresses as the sampling frame (n=7,390. All data were weighted to provide representative estimates of quality of care ratings and physician use of EMR, in the adult US population. Descriptive statistics, t-tests, and multivariable linear regression analyses were conducted. Results: EMR use was reported significantly more frequently by females, younger age groups, non-Hispanic whites, and those with higher education, higher incomes, health insurance, and a usual source of health care. Respondents who reported physician use of EMRs had significantly higher ratings of care quality (Beta=4.83, standard error [SE]=1.7, P<0.01, controlling for sociodemographic characteristics, usual source of health care, and health insurance status. Conclusion: Nationally representative

  2. Current patient and healthcare worker attitudes to eHealth and the personally controlled electronic health record in major hospitals. (United States)

    Armani, R; Mitchell, L E; Allen-Graham, J; Heriot, N R; Kotsimbos, T; Wilson, J W


    The current health system in Australia is comprised of both electronic- and paper-based medical records. The Federal Government has approved funding for the development of an individual health identifier and a universally adopted online health repository. To determine attitudes and beliefs of patients and healthcare workers regarding the use of stored medical information and the personally controlled electronic health record (PCEHR) in selected major hospitals in Victoria. Qualitative survey of patients and healthcare workers (n = 600 each group) conducted during 2014 across five major hospitals in Melbourne to measure the awareness, attitudes and barriers to electronic health and the PCEHR. Of the patients, 93.3% support the concept of a shared electronic healthcare record, 33.7% were aware of the PCEHR and only 11% had registered. The majority of healthcare workers believed that the presence of a shared health record would result in an increased appropriateness of care and patient safety by reducing adverse drug events and improving the timeliness of care provided. However, only 46% of healthcare workers were aware of the PCEHR. This study provides a baseline evaluation of perceptions surrounding eHealth and PCHER in acute health services in five metropolitan centres. While there appears to be a readiness for adoption of these strategies for healthcare documentation, patients require motivation to register for the PCEHR, and healthcare workers require more information on the potential benefits to them to achieve more timely and efficient care. © 2016 Royal Australasian College of Physicians.

  3. Do electronic health records affect the patient-psychiatrist relationship? A before & after study of psychiatric outpatients

    Directory of Open Access Journals (Sweden)

    Schuyler Mark


    Full Text Available Abstract Background A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients. Method We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness. Results Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category. Conclusions While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.

  4. How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care. (United States)

    Asan, Onur; Young, Henry N; Chewning, Betty; Montague, Enid


    Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal. Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups. Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group. Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement. Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Understanding the failure of health-care exceptionalism in the Supreme Court's Obamacare decision. (United States)

    Moncrieff, Abigail R


    On June 28, 2012, a mere century after the first presidential proposal for national health insurance, the Supreme Court issued a resounding victory for President Obama and for health-care reform generally, upholding the Patient Protection and Affordable Care Act against a serious constitutional challenge. Nevertheless, the Court also struck a potential blow to future health-care reform efforts in refusing to accept the solicitor general's argument that health care is a unique market with unique regulatory needs that justify special constitutional treatment. The failure of health-care exceptionalism in the Court's opinion might render future reform efforts more difficult than they would have been if the solicitor general's argument had carried the day. This commentary seeks to shed light on the Court's hesitation to recognize the uniqueness of health insurance and health care, noting that market-based exceptionalism in constitutional law has a long, dark history that the Court was understandably loath to repeat. Although the result of Chief Justice John Roberts' one-size-fits-all approach to constitutional analysis in this case is an odd holding that elides some genuine uniqueness of American health care, the alternative of health-care exceptionalism might have been much worse for our overall constitutional system.

  6. Trial by Jury in Russian Military Courts

    Directory of Open Access Journals (Sweden)

    Nikolai P. Kovalev


    Full Text Available One of peculiar features of the military criminal justice system in Russia is that in some cases military defendants may apply for trial by jury. Unlike the existing U.S. court-martial jury and the Russian military jury of the early 1900s (World War I period which were comprised of the members of the armed forces, in modern Russia jurors trying military defendants are civilians. This article aims to provide a brief history of military jury in Russia and identify issues of independence and impartiality in Russian military courts with participation of lay decision-makers. In particular, the article will analyze two high-profile cases which resulted in acquittals of Russian officers accused of killing several Chechen civilians during counter-terrorist operations in Chechnya.

  7. Investigating deviations from norms in court interpreting

    DEFF Research Database (Denmark)

    Dubslaff, Friedel; Martinsen, Bodil

    Since Shlesinger (1989) discussed the applicability of translational norms to the field of interpreting, a number of scholars have advocated the use of this concept as a frame of reference in interpreting research (e.g. Harris 1990, Schjoldager 1994, 1995, Jansen 1995, Gile 1999, Garzone 2002). Due...... for the study, we intend to conduct interviews instead. The purpose of the study is to investigate deviations from translational norms in court interpreting. More specifically, we aim to identify and describe instances of deviant behaviour on the part of the interpreters, discuss signs of possible deviant...... speaking these languages. This example does not immediately indicate that Translation Studies might be able to contribute to, for example, an improvement of the training situation for the group of court interpreters mentioned above. However, in our opinion, there is reason to believe that TS can make...

  8. Courts, Scheduled Damages, and Medical Malpractice Insurance

    DEFF Research Database (Denmark)

    Bertoli, Paola; Grembi, Veronica

    We assess the impact of the introduction of schedules of non-economic damages (i.e. tiered caps systems) on the behavior of insurers operating in the medical liability market for hospitals while controlling the performance of the judicial system, measured as court backlog. Using a difference......-in-differences strategy on Italian data, we find that the introduction of schedules increases the presence of insurers (i.e. medical liability market attractiveness) only in inefficient judicial districts. In the same way, court inefficiency is attractive to insurers for average values of schedules penetration...... of the market, with an increasing positive impact of inefficiency as the territorial coverage of schedules increases. Finally, no significant impact is registered on paid premiums. Our analysis sheds light on a complex set of elements affecting the decisions of insurers in malpractice markets. The analysis...

  9. Barriers to addressing substance abuse in domestic violence court. (United States)

    Riger, Stephanie; Bennett, Larry W; Sigurvinsdottir, Rannveig


    Substance abuse commonly co-occurs with intimate partner violence among both perpetrators and survivors. Specialized courts that focus on intimate partner violence provide a unique opportunity to address both problems simultaneously, but research has yet to identify whether this happens. In this qualitative study of a domestic violence court in a large midwestern metropolitan area, key informants were interviewed to understand how the Court treats substance abuse. Results indicate that substance abuse typically is not identified among perpetrators or survivors going through the Court unless it is mentioned in a police report. Barriers to such identification are the organization of the Court, bounded definition of actors' roles in the Court, limited resources, and negative attitudes towards survivors. These results suggest that specialized courts that attend to only one problem may overlook the possibility of addressing issues that commonly co-occur.

  10. Internal and External Dialogue: A Method for Quality Court Management

    Directory of Open Access Journals (Sweden)

    Marie Hagsgård


    Full Text Available The aim of quality court work is to maintain or improve public trust in the court as a vital part of a democratic society. Public confidence in the judicial system is affected by a number of factors, including speedy and judicially correct decisions which are generally understandable and a good treatment of parties and witnesses before and during court proceedings. In order to uphold and enhance public trust, courts need to work systematically to improve the quality of court functioning. But questions remain regarding how to institute quality court management, and how to achieve positive results. Although court managers in Sweden have shown an interest in starting systematic quality work, they have found it difficult to find a method for such work and systematically achieving results.


    Directory of Open Access Journals (Sweden)

    Arie Siswanto


    Since the end of World War II, the international community witnessed the increasingly serious efforts to deal with the international crimes. Besides the domestic criminal courts and purely international tribunals, the forum that is also recently used to handle international crimes is the hybrid courts that have been established in several places such as in Cambodia, Sierra Leone and Timor-Leste. Hybrid courts are established from different political backgrounds, but as a legal institution, its establishment was necessarily based on legal instruments. This paper identifies that there are three patterns in the formation of hybrid court, which are: the establishment of a hybrid court based on an agreement between the UN and the relevant state, the establishment of a hybrid court by the UN or international administration and the establishment of a hybrid court by a country which later gains greater international support.

  12. The use of mental health court appearances in supervision. (United States)

    Redlich, Allison D; Steadman, Henry J; Callahan, Lisa; Robbins, Pamela Clark; Vessilinov, Roumen; Ozdoğru, Asil Ali


    A defining feature of mental health courts (MHCs) is the requirement that enrollees appear periodically for status review hearings before the MHC judge. Although the research base on these specialty courts is growing, MHC appearances have yet to be examined. In the present study, the authors followed more than 400 MHC clients from four courts. We examined the number of court appearances that were mandated versus attended, the number of bench warrants issued, and the proportion of court appearances that were made in-custody versus out-of-custody. Finally, we describe and report on the proportion of clients at each court who had graduated, had been terminated, or who were still in the court one year following enrollment. Copyright 2010 Elsevier Ltd. All rights reserved.

  13. Text Mining of Supreme Administrative Court Jurisdictions


    Feinerer, Ingo; Hornik, Kurt


    Within the last decade text mining, i.e., extracting sensitive information from text corpora, has become a major factor in business intelligence. The automated textual analysis of law corpora is highly valuable because of its impact on a company's legal options and the raw amount of available jurisdiction. The study of supreme court jurisdiction and international law corpora is equally important due to its effects on business sectors. In this paper we use text mining methods to investigate Au...

  14. Social Norms in the Ancient Athenian Courts


    Lanni, Adriaan M.


    Ancient Athens was a remarkably peaceful and well-ordered society by both ancient and contemporary standards. Scholars typically attribute Athens’ success to internalized norms and purely informal enforcement mechanisms. This article argues that the formal Athenian court system played a vital role in maintaining order by enforcing informal norms. This peculiar approach to norm enforcement compensated for apparent weaknesses in the state system of coercion. It mitigated the effects of under-e...

  15. The judgment on the phosphoethanolamine case and the jurisprudence of the Brazilian Federal Supreme Court

    Directory of Open Access Journals (Sweden)

    Zebulum J. C.


    Full Text Available Widespread use of the synthetic substance phosphoethanolamine, known as the cancer pill, was recently reported among patients with malignant neoplasm. However, the substance was not registered in the Brazilian National Health Surveillance Agency and the clinical studies necessary to guarantee its effectiveness and safety had not even been completed. Neverthe-less, the federal government enacted Law number 13.269/2016, authorizing provision by the Brazilian National Public Health System under certain conditions, and various injunctions were granted that forced the state to provide it. The question was considered by the Supreme Court in two important judgments in which the Court suspended all injunctions granted and suspended the effectiveness of the law based on evidence of unconstitutionality. In this article, we analyze the legal grounds of the decisions in the context of previous positions of the Court and the guidelines established in judgment of STA 175-AgR/CE.

  16. Congress, courts, and commerce: upholding the individual mandate to protect the public's health. (United States)

    Hodge, James G; Brown, Erin C Fuse; Orenstein, Daniel G; O'Keefe, Sarah


    Among multiple legal challenges to the Patient Protection and Affordable Care Act (PPACA) is the premise that PPACA's "individual mandate" (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is inviolate of Congress' interstate commerce powers because Congress lacks the power to regulate commercial "inactivity." Several courts initially considering this argument have rejected it, but federal district courts in Virginia and Florida have concurred, leading to numerous appeals and prospective review of the United States Supreme Court. Despite creative arguments, the dispositive constitutional question is not whether Congress' interstate commerce power extends to commercial inactivity. Rather, it is whether Congress may regulate individual decisions with significant economic ramifications in the interests of protecting and promoting the public's health. This article offers a counter-interpretation of the scope of Congress' interstate commerce power to regulate in furtherance of the public's health. © 2011 American Society of Law, Medicine & Ethics, Inc.

  17. [The role of the Constitutional Court on the analysis of contracts of prepaid medicine programs]. (United States)

    Quintana-Cepeda, Anamaría


    Since 1991, when the current Colombian Constitution came into force and the Constitutional Court was appointed as its guardian and protector, constitutional values have permeated all subjects and areas of law, even those that were previously considered as private matters. Prepaid medicine contracts are a good example of this phenomenon, since the Colombian Constitutional Court has limited individual freedom of contract to private parties -prepaid medical companies- for the benefit of final users of this service through "acción de tutela", in order to protect the right to healthcare and to prevent some behaviors that violate the principle of good faith. The Court has demanded private companies to assess the health condition of patients and has prohibited pre-existent and exclusion clauses that diminish the responsibilities of said companies. Nevertheless, there is a gap in the law regarding the duties of good faith that concern the user, which will be addressed in this paper.

  18. Behavioral Genetics in Criminal and Civil Courts. (United States)

    Sabatello, Maya; Appelbaum, Paul S

    Although emerging findings in psychiatric and behavioral genetics create hope for improved prevention, diagnosis, and treatment of disorders, the introduction of such data as evidence in criminal and civil proceedings raises a host of ethical, legal, and social issues. Should behavioral and psychiatric genetic data be admissible in judicial proceedings? If so, what are the various means for obtaining such evidence, and for what purposes should its admission be sought and permitted? How could-and should-such evidence affect judicial outcomes in criminal and civil proceedings? And what are the potential implications of using behavioral and psychiatric genetic evidence for individuals and communities, and for societal values of equality and justice? This article provides an overview of the historical and current developments in behavioral genetics. We then explore the extent to which behavioral genetic evidence has-and should-affect determinations of criminal responsibility and sentencing, as well as the possible ramifications of introducing such evidence in civil courts, with a focus on tort litigation and child custody disputes. We also consider two ways in which behavioral genetic evidence may come to court in the future-through genetic theft or the subpoena of a litigant's biospecimen data that was previously obtained for clinical or research purposes-and the concerns that these possibilities raise. Finally, we highlight the need for caution and for approaches to prevent the misuse of behavioral genetic evidence in courts.

  19. Procedural Justice in Dutch Administrative Court Proceedings

    Directory of Open Access Journals (Sweden)

    André Verburg


    Full Text Available In this paper we discuss recent developments in administrative court proceedings in the Netherlands, called the New Approach. Along with developments leading to the New Approach, it became clear that the insights from research on procedural justice deserve particular attention. The goals of the judge's actions in this respect are both that the proceedings are fair and just and that parties perceive the way they are being treated during proceedings as fair and just.Within the New Approach we discern five procedural justice elements: (1 respect, (2 voice and due consideration, (3 some influence on how proceedings will continue, (4 an explanation of how the proceedings will continue and (5 direct interpersonal contact.The introduction of the New Approach shows two important bottlenecks in Dutch administrative court proceedings, which are (i the possible or supposed collision between legally right outcomes and  procedural justice and (ii the lack of uniformity and predictability.Although what we describe and discuss in this paper focuses on the Dutch situation, many of these considerations apply to administrative court proceedings in other countries. The themes and difficulties that face the administrative law judge seem to be common to many countries.

  20. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    de Clercq, Paul A.; Hasman, Arie; Wolffenbuttel, Bruce H. R.


    OBJECTIVES: To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. METHODS: A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  1. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    Clercq, de P.A.; Hasman, A.; Wolffenbuttel, B.H.R.


    Objectives : To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. Methods : A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  2. Influence of Erroneous Patient Records on Population Pharmacokinetic Modeling and Individual Bayesian Estimation

    NARCIS (Netherlands)

    van der Meer, Aize Franciscus; Touw, Daniel J.; Marcus, Marco A. E.; Neef, Cornelis; Proost, Johannes H.


    Background: Observational data sets can be used for population pharmacokinetic (PK) modeling. However, these data sets are generally less precisely recorded than experimental data sets. This article aims to investigate the influence of erroneous records on population PK modeling and individual

  3. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    De Clercq, Paul A; Hasman, Arie; Wolffenbuttel, Bruce H R

    Objectives : To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. Methods : A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  4. Using Simulations to Improve Electronic Health Record Use, Clinician Training and Patient Safety: Recommendations From A Consensus Conference


    Mohan, Vishnu; Woodcock, Deborah; McGrath, Karess; Scholl, Gretchen; Pranaat, Robert; Doberne, Julie W.; Chase, Dian A.; Gold, Jeffrey A.; Ash, Joan S.


    A group of informatics experts in simulation, biomedical informatics, patient safety, medical education, and human factors gathered at Corbett, Oregon on April 30 and May 1, 2015. Their objective: to create a consensus statement on best practices for the use of electronic health record (EHR) simulations in education and training, to improve patient safety, and to outline a strategy for future EHR simulation work. A qualitative approach was utilized to analyze data from the conference and gene...

  5. Chronic multisite brain recordings from a totally implantable bidirectional neural interface: experience in 5 patients with Parkinson's disease. (United States)

    Swann, Nicole C; de Hemptinne, Coralie; Miocinovic, Svjetlana; Qasim, Salman; Ostrem, Jill L; Galifianakis, Nicholas B; Luciano, Marta San; Wang, Sarah S; Ziman, Nathan; Taylor, Robin; Starr, Philip A


    OBJECTIVE Dysfunction of distributed neural networks underlies many brain disorders. The development of neuromodulation therapies depends on a better understanding of these networks. Invasive human brain recordings have a favorable temporal and spatial resolution for the analysis of network phenomena but have generally been limited to acute intraoperative recording or short-term recording through temporarily externalized leads. Here, the authors describe their initial experience with an investigational, first-generation, totally implantable, bidirectional neural interface that allows both continuous therapeutic stimulation and recording of field potentials at multiple sites in a neural network. METHODS Under a physician-sponsored US Food and Drug Administration investigational device exemption, 5 patients with Parkinson's disease were implanted with the Activa PC+S system (Medtronic Inc.). The device was attached to a quadripolar lead placed in the subdural space over motor cortex, for electrocorticography potential recordings, and to a quadripolar lead in the subthalamic nucleus (STN), for both therapeutic stimulation and recording of local field potentials. Recordings from the brain of each patient were performed at multiple time points over a 1-year period. RESULTS There were no serious surgical complications or interruptions in deep brain stimulation therapy. Signals in both the cortex and the STN were relatively stable over time, despite a gradual increase in electrode impedance. Canonical movement-related changes in specific frequency bands in the motor cortex were identified in most but not all recordings. CONCLUSIONS The acquisition of chronic multisite field potentials in humans is feasible. The device performance characteristics described here may inform the design of the next generation of totally implantable neural interfaces. This research tool provides a platform for translating discoveries in brain network dynamics to improved neurostimulation

  6. The RecordAF study: design, baseline data, and profile of patients according to chosen treatment strategy for atrial fibrillation

    DEFF Research Database (Denmark)

    Le Heuzey, Jean-Yves; Breithardt, Günter; Camm, John


    The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation (RecordAF) is the first worldwide, 1-year observational, longitudinal study of the management of paroxysmal/persistent atrial fibrillation (AF) in recently diagnosed patients. The study was conducted at 532 sites...

  7. Computerized extraction of information on the quality of diabetes care from free text in electronic patient records of general practitioners

    NARCIS (Netherlands)

    Voorham, Jaco; Denig, Petra


    Objective: This study evaluated a computerized method for extracting numeric clinical measurements related to diabetes care from free text in electronic patient records (EPR) of general practitioners. Design and Measurements: Accuracy of this number-oriented approach was compared to manual chart

  8. Understanding health care providers' reluctance to adopt a national electronic patient record: an empirical and legal analysis

    NARCIS (Netherlands)

    Zwaanswijk, M.; Ploem, M. C.; Wiesman, F. J.; Verheij, R. A.; Friele, R. D.; Gevers, J. K. M.


    Several countries are implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs on the efficiency, continuity, safety and quality of care, their overall adoption remains low and meets resistance from involved parties. The implementation of the Dutch

  9. Understanding health care providers' reluctance to adopt a national electronic patient record : An empirical and legal analysis

    NARCIS (Netherlands)

    Zwaanswijk, M.; Ploem, M.C.; Wiesman, F.J.; Verheij, R.A.; Friele, R.D.; Gevers, J.K.M.


    Background: Several countries are implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs on the efficiency, continuity, safety and quality of care, their overall adoption remains low and meets resistance from involved parties. The implementation of


    Directory of Open Access Journals (Sweden)

    Bernice Sam, National Programme Coordinator of Wildaf in Ghana, Africa


    Full Text Available Abstract: The Supreme Court of the Republic of Ghana has given value to gender roles of women (and men in the home. For too long many courts had relied on the need to establish substantial contribution by spouses to joint property which many women could not prove, thereby being entitled to less than half of joint property. In matrimonial matters however, case law developed around the Matrimonial Causes Act 1971, (Act 367 acknowledge the weak financial contribution of a spouse to property acquisition.  The courts in their application of equitable principles require a spouse claiming a share in joint property to provide proof of substantial contribution. This principle of proving substantial contribution has for decades being to the disadvantage of many women who, in performing their gender roles as wives, do not keep records of contribution made to joint property. However, in the last decade, some courts began recognising the value of a wife’s contribution to matrimonial property even if the contribution was non-monetary. The Supreme Court case of Gladys Mensah v. Stephen Mensah now firmly establishes the principle of equality in property distribution. Keywords: Equality. Women matrimonial rights. Supreme Court of Ghana.

  11. Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings. (United States)

    Tanner, C; Gans, D; White, J; Nath, R; Pohl, J


    The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.

  12. Court Supervised Institutional Transformation in South Africa

    Directory of Open Access Journals (Sweden)

    Deon Erasmus


    Full Text Available The traditional adversarial model of litigation in South Africa operates on the basis that two or more parties approach the court, each with its own desired outcome. The court is then obliged to decide in favour of one of the parties. A different model of litigation is emerging in South African law. This model involves actions against public institutions that are failing to comply with their constitutional mandate. In this type of litigation there is seldom a dispute regarding the eventual outcome that is desired. Both the applicant and the state, in its capacity of the respondent, have a broad consensus about the manner in which the institution should operate or be transformed. There is accordingly agreement regarding the eventual outcome and the shortcomings that should be addressed. The primary issue relates to the details of the implementation of the transformation of the institution in question, in order that the constitutional mandate of the institution in question will be met. An example of this form of litigation can be seen in litigation concerning the conditions in which prisoners are detained in South African prisons. The constitutional mandate for the imprisonment of offenders is contained in the Correctional Services Act. Ongoing human rights violations often take place in prisons. These include staff shortages, shortages of medical staff and facilities, prison overcrowding, inadequate staff development, the prevalence of HIV/AIDS, infrastructure defects and maintenance problems, gangsterism, requests for prisoner transfers and problems associated therewith, the ineffectiveness of parole boards, staff development needs that are not addressed, an excessive focus on security, lack of rehabilitation and vocational training programmes and assaults of prisoners. The courts have on occasion issued a structured interdict as an appropriate remedy. However, problems arise when violations are widespread and no single order can cause the

  13. Impact of an Electronic Health Record-Integrated Personal Health Record on Patient Participation in Health Care: Development and Randomized Controlled Trial of MyHealthKeeper. (United States)

    Ryu, Borim; Kim, Nari; Heo, Eunyoung; Yoo, Sooyoung; Lee, Keehyuck; Hwang, Hee; Kim, Jeong-Whun; Kim, Yoojung; Lee, Joongseek; Jung, Se Young


    Personal health record (PHR)-based health care management systems can improve patient engagement and data-driven medical diagnosis in a clinical setting. The purpose of this study was (1) to demonstrate the development of an electronic health record (EHR)-tethered PHR app named MyHealthKeeper, which can retrieve data from a wearable device and deliver these data to a hospital EHR system, and (2) to study the effectiveness of a PHR data-driven clinical intervention with clinical trial results. To improve the conventional EHR-tethered PHR, we ascertained clinicians' unmet needs regarding PHR functionality and the data frequently used in the field through a cocreation workshop. We incorporated the requirements into the system design and architecture of the MyHealthKeeper PHR module. We constructed the app and validated the effectiveness of the PHR module by conducting a 4-week clinical trial. We used a commercially available activity tracker (Misfit) to collect individual physical activity data, and developed the MyHealthKeeper mobile phone app to record participants' patterns of daily food intake and activity logs. We randomly assigned 80 participants to either the PHR-based intervention group (n=51) or the control group (n=29). All of the study participants completed a paper-based survey, a laboratory test, a physical examination, and an opinion interview. During the 4-week study period, we collected health-related mobile data, and study participants visited the outpatient clinic twice and received PHR-based clinical diagnosis and recommendations. A total of 68 participants (44 in the intervention group and 24 in the control group) completed the study. The PHR intervention group showed significantly higher weight loss than the control group (mean 1.4 kg, 95% CI 0.9-1.9; Phealth tracker system and its potential to improve patient clinical profiles. NCT03200119; (Archived by WebCite at http

  14. Time Standards as a Court Management Tool: The Experience in American State and Local Trial Courts

    Directory of Open Access Journals (Sweden)

    David Steelman


    Full Text Available As a public institution, the courts must be accountable for their use of a nation’s resources. The institutional independence of the judiciary from political influences and the decisional independence of individual judges in specific cases are intended not for the personal benefit of judges, but for the benefit of the society as a whole and of all those who come before the courts. Indeed, the very legitimacy of government as a whole can be powerfully reinforced by the effective operation of an independent judiciary.

  15. Time Standards as a Court Management Tool: The Experience in American State and Local Trial Courts


    David Steelman


    As a public institution, the courts must be accountable for their use of a nation’s resources. The institutional independence of the judiciary from political influences and the decisional independence of individual judges in specific cases are intended not for the personal benefit of judges, but for the benefit of the society as a whole and of all those who come before the courts. Indeed, the very legitimacy of government as a whole can be powerfully reinforced by the effective operation of a...

  16. Child and youth sexual violence: What do the documents from the court say?


    José Wilson de Lima; Maria de Fátima Pereira Alberto; Viviane Martinho dos Santos; Kahyna Leite Brito; Suzany Ludimila Gadelha e Silva


    This article has as objectives to characterize the cases of sexual violence against children and adolescents found in the records of complaints, notices and prosecutions at the Child and Youth Court in the county of João Pessoa and to analyze the risks to the victims of such violence regarding the decisions, procedures and prosecutions that do not guarantee the protection and enforcement of fundamental rights. The instrument used to collect data was a research protocol analyzed by frequency a...

  17. Examining the links between therapeutic jurisprudence and mental health court completion. (United States)

    Redlich, Allison D; Han, Woojae


    Research demonstrates that mental health courts (MHCs) lead to improved outcomes compared to traditional criminal court processes. An underlying premise of MHCs is therapeutic jurisprudence (TJ). However, no research, to our knowledge, has examined whether MHC outcomes are predicted by TJ principles as theorized. In the present study, we examined whether principles measured at the onset of MHC enrollment (knowledge, perceived voluntariness, and procedural justice) predicted MHC completion (graduation). Using structural equation modeling with MHC participants from four courts, a significant, direct relationship between TJ and MHC completion was found, such that higher levels of TJ were associated with higher rates of success. Although this direct effect became nonsignificant when mediator variables were included, a significant indirect path remained, such that increased levels of initial perceived voluntariness and procedural justice, and MHC knowledge, led to decreased rates of new arrests, prison, MHC bench warrants, and increased court compliance, which, in turn, led to a higher likelihood of MHC graduation. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  18. Safety and reliability of the insertable Reveal XT recorder in patients undergoing 3 Tesla brain magnetic resonance imaging. (United States)

    Haeusler, Karl Georg; Koch, Lydia; Ueberreiter, Juliane; Coban, Nalan; Safak, Erdal; Kunze, Claudia; Villringer, Kersten; Endres, Matthias; Schultheiss, Heinz-Peter; Fiebach, Jochen B; Schirdewan, Alexander


    Up to now there is little evidence about the safety and reliability of insertable cardiac monitors (ICMs) in patients undergoing magnetic resonance imaging (MRI). The purpose of this prospective single-center study (MACPAF; clinicaltrials.govNCT01061931), which we are currently performing, was to evaluate these issues for the ICM Reveal XT at a 3 Tesla MRI scanner in patients undergoing serial brain MRI. We present an interim analysis including 62 brain MRI examinations in 24 patients with paroxysmal atrial fibrillation bearing the Reveal XT. All patients were interviewed for potential ICM-associated clinical symptoms during and after MRI examination. According to the study protocol, data from the Reveal XT were transmitted before and after the MRI examination. All patients were clinically asymptomatic during the MRI procedure. Moreover, the reliability (ability to detect signals, battery status) of the Reveal XT was unaffected, except for one MRI-induced artifact that was recorded by the ICM, mimicking a narrow complex tachycardia, as similarly recorded in a further study patient bearing the forerunner ICM Reveal DX. No loss of ICM data was observed after the MRI examination. The 3 Tesla brain MRI scanning is safe for patients bearing the ICM Reveal XT and does not alloy reliability of the Reveal XT itself. MRI-induced artifacts occur rarely but have to be taken into account. Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  19. Real-time data helps in court

    International Nuclear Information System (INIS)

    Houlahan, T.


    An operating facility with approval to undertake aluminium reprocessing activities at a site in NSW had commenced reprocessing scrap lead into lead debris for re-use. The local council had not been notified of the change in activity from aluminium to lead and the operators had not sought development approval. Council subsequently served a notice of closure on the facility, based on the potential health risks associated with migration of lead dust from the facility. The operators objected to the notice and the matter was brought before the NSW Land and Environment Court for judgement. Twenty-four hours before the court proceedings, lawyers representing the council concluded that for their case to succeed, scientific data vas required to provide evidence that the facility was contributing to elevated lead concentrations in soil off-site. Consequently a consultant was commissioned by council to undertake a preliminary lead contaminated soil screening survey around the perimeter of the subject property. The survey was required to be completed within 24 hours, with the results to be presented before the court at 9am the following day. The samples were placed in plastic bags and screened for total lead, using Niton field portable x-ray fluorescence (XRF) spectrum analyser- model 703A, in accordance with the manufacturer's guidelines and USEPA method 6200. Test time ranged from 20-120 seconds. Several areas were found to contain surface soil lead levels above the proposed site criteria (1500 mg/kg). The XFR data presented in this case demonstrated excellent correlation with NATA-accredited laboratory results

  20. First experience of programming a court decision

    Directory of Open Access Journals (Sweden)

    Sergey B. Polyakov


    Full Text Available Objective Consideration of the computer program model for making a lawful and wellgrounded judicial act in order to reduce the times for making the court decision. Methods universal dialecticmaterialistic method which removes the contradictions of the professional training of judges and procedural controls the formal legal method for transferring the requirements of the law and jurisprudence for the lawenforcement activity into programs for judges and case participants the objectoriented modeling objectoriented programming methodology. Results a computer program was created that allows to adjudicate in a civil case if the claim is recognized by the defendant. The program does not resolve the judge from the decisionmaking process but creates conditions to move along the stages of lawenforcement procedure and legal reasoning in accordance with the requirements of the law and of legal science. Therefore filling forms manually in the trial should be simultaneous with writing the decision judgment sentence assessment. The program includes the following sections preparation of forms common to certain types of proceedings certain categories of cases courts in the above forms determination of the order to establish the actual circumstances the burden of proof distribution types of evidence methods of law interpretation characteristics of collisions and gaps in legislation and ways to overcome them the standard wording in the judicial act templates and in the forms mandatory and optional information in the form. Based on the above the article concludes that by analogy with the presented program it is possible to create software for making a lawful wellgrounded and fair judicial act for other categories of cases and as a consequence to reduce the period of making judicial decisions. Scientific novelty the first computer program is created for rendering and production of judicial decisions. Practical significance the model is made to create a mass tool of

  1. Designing a system for patients controlling providers' access to their electronic health records: organizational and technical challenges. (United States)

    Leventhal, Jeremy C; Cummins, Jonathan A; Schwartz, Peter H; Martin, Douglas K; Tierney, William M


    Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient


    Directory of Open Access Journals (Sweden)



    Full Text Available The independence of the court is essential of state of rule, to maintain the stability in juridical intercourse, for the existence of a constitutional democracy achieved through a warranty of the necessary objectivity for the steady and legal settlement of the causes deducted to the trial and the achievement of a fair trial. The article emphasizes the main international juridical tools in which independence of justice is reflected, achieving an examination of judicial practice of European instance as well as an analysis of this principle as it is regulated by Romanian justice.

  3. The CISG in Denmark and Danish Courts

    DEFF Research Database (Denmark)

    Lookofsky, Joseph


    In this article the author explores key aspects of Denmark’s reception and implementation of the 1980 United Nations Convention on Contracts for the International Sales of Goods (CISG). Placing the treaty within its larger private law context, the author explains the complexity and confusion...... the problematical relationship between these international obligations and the Danish judicial tradition of formulating premises so brief that they shed little light on the decision’s underlying rationale ( ratio decidendi ). Following analysis and critique of three Danish CISG court judgments which help illustrate...... these propositions, the author proposes corrective steps designed to further a more international (and less parochial) approach to the CISG....

  4. Symptom burden and splenomegaly in patients with myelofibrosis in the United States: a retrospective medical record review

    International Nuclear Information System (INIS)

    Mitra, Debanjali; Kaye, James A; Piecoro, Lance T; Brown, Jennifer; Reith, Kelly; Mughal, Tariq I; Sarlis, Nicholas J


    Myelofibrosis (MF) is a clonal hematopoietic malignancy characterized by constitutional and localized symptoms, progressive splenomegaly, bone marrow fibrosis, and cytopenias. Although MF is well studied, few studies exist regarding its symptomatic burden in routine clinical practice. This study aimed to characterize symptoms and other clinical features of MF among patients in the United States. We conducted a retrospective medical record review of adult patients with an MF diagnosis between 1 January 2005 and 31 March 2010, stratified by the presence of palpable splenomegaly. Eligible patients had 12 months or more of follow-up after diagnosis (or after detection of splenomegaly, if present) unless death occurred. Demographic and clinical characteristics, MF-related symptoms, and treatments were reported by treating physicians. We report on 180 MF patients: 102 with splenomegaly, 78 without. Median age was 66 years, 63% were male, and 82% had intermediate-2 or high-risk MF (International Prognostic Scoring System). Fatigue was reported by ∼85% of patients; weight loss, night sweats, and fever (any grade) were each reported by 50% or more of patients. Generalized abdominal pain, left subcostal pain, and early satiety occurred more frequently among patients with splenomegaly. Multiple symptoms were reported by 95% of patients. Common comorbidities were hypertension, diabetes, and chronic pulmonary disease. Symptoms are common in MF patients, regardless of the presence of palpable splenomegaly. Careful assessment of symptom burden is an important aspect of the clinical evaluation of patients with MF

  5. Early clinical experience with CardioCard - a credit card-sized electronic patient record. (United States)

    Bernheim, Alain M; Schaer, Beat A; Kaufmann, Christoph; Brunner-La Rocca, Hanspeter; Moulay-Lakhdar, Nadir; Buser, Peter T; Pfisterer, Matthias E; Osswald, Stefan


    CardioCard is a CDROM of credit card size containing medical information on cardiac patients. Patient data acquired during hospital stay are stored in PDF format and secured by a password known to patients only. In a consecutive series of patients, we assessed acceptance and utility of this new information medium. A questionnaire was sent to all patients who had received CardioCard over a one-year period. The questionnaire was returned by 392 patients (73%). 44% of patients had the card with them all the time. The majority of patients (73%) considered the CardioCard useful (8% not useful, 19% no statement) and most (78%) would even agree to bear additional costs. Only 5% worried about data security. In contrast, 44% would be concerned of data transmission via internet. During an observation period of 6 (SD 3) months, data were accessed by 27% of patients and 12% of their physicians. The proportion of card users was lower among older patients: 70 y, 16% and particularly among older women: 61.70 y, 9%; >70 y, 5%. Technical problems during data access occurred in 34%, mostly due to incorrect handling. A majority of patients considered CardioCard as useful and safe. Lack of hardware equipment or insufficient computer knowledge, but not safety issues were the most important limitations. As patients expressed concerns regarding protection of privacy if data were accessible via internet, this would remain a strong limiting factor for online use.

  6. Medical devices, electronic health records and assuring patient safety : Future challenges?

    NARCIS (Netherlands)

    Kalkman, Cor J.


    The patient safety movement was triggered by publications showing that modern health care is more unsafe than road travel and that more patients are killed annually by avoidable adverse events than by breast cancer [1]. As a result, an urgent need to improve patient safety has dominated

  7. The relationship between administrative court control and legislative control

    International Nuclear Information System (INIS)

    Beckmann, M.


    The legislator can determine the extent of control of administrative courts by reduction of substantive conditions. The author has the opinion that the judicial control cannot be stricter than the legislative control. For the range of the control of administrative courts is decisive, to what extent the legislator is forced to proper legislative settlements. In this context the author discusses the Kalkar-decision of the Federal Constitutional Court of 1978. (CW) [de

  8. Constitutional Court's Crisis Management of Akil Mochtar's Case


    Uli Mediana, Cipta; Naryoso, S.Sos, M.Si, Agus


    The Constitutional Court is one of the state institutions that conduct independent judicial power to hold a court in order to enforce law and justice in Indonesia that became a proof of state agencies was also not spared from the crisis. The Chairman of the Constitutional Court in 2013, Akil Mochtar caught red-handed by the Corruption Eradication Commission (KPK) for allegedly receiving bribe money for handling election disputes Gunung Mas, Central Kalimantan and elections Lebak, Banten. Sinc...

  9. First instance competence of the Higher Administrative Court

    International Nuclear Information System (INIS)



    (1) An interlocutory judgement can determine the admissibility of a legal action, also with regard to single procedural prerequisites (following BVerwG decision 14, 273). (2) The first instance competence for disputes about the dismantling of a decommissioned nuclear installation lies with the administrative courts and not with the higher administrative courts. Federal Administrative Court, decision of May 19, 1988 - 7 C 43.88 - (VGH Munich). (orig.) [de

  10. Court Interpreting in Denmark - the role of court interpreters in Danish courtrooms

    DEFF Research Database (Denmark)

    Jacobsen, Bente


    Court interpreters in Denmark are expected to follow the guidelines laid down in the document Instructions for Interpreters, which was published in 1994, and which deals with four principal areas: accuracy and completeness, impartiality, confidentiality and conflict of interest. This paper contends...

  11. The reasonable woman standard: effects on sexual harassment court decisions. (United States)

    Perry, Elissa L; Kulik, Carol T; Bourhis, Anne C


    Some federal courts have used a reasonable woman standard rather than the traditional reasonable man or reasonable person standard to determine whether hostile environment sexual harassment has occurred. The current research examined the impact of the reasonable woman standard on federal district court decisions, controlling for other factors found to affect sexual harassment court decisions. Results indicated that there was a weak relationship between whether a case followed a reasonable woman precedent-setting case and the likelihood that the court decision favored the plaintiff. The implications of our findings for individuals and organizations involved in sexual harassment claims are discussed.

  12. A retrospective cohort study on lifestyle habits of cardiovascular patients: how informative are medical records?

    NARCIS (Netherlands)

    Fouwels, Annemarie J.; Bredie, Sebastiaan J. H.; Wollersheim, Hub; Schippers, Gerard M.


    ABSTRACT: BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of

  13. A retrospective cohort study on lifestyle habits of cardiovascular patients: how informative are medical records?

    NARCIS (Netherlands)

    Fouwels, A.J.; Bredie, S.J.H.; Wollersheim, H.C.H.; Schippers, G.M.


    BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of the

  14. Automated Methods to Extract Patient New Information from Clinical Notes in Electronic Health Record Systems (United States)

    Zhang, Rui


    The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…

  15. Antidepressant medication use for primary care patients with and without medical comorbidities: a national electronic health record (EHR) network study. (United States)

    Gill, James M; Klinkman, Michael S; Chen, Ying Xia


    Because comorbid depression can complicate medical conditions (eg, diabetes), physicians may treat depression more aggressively in patients who have these conditions. This study examined whether primary care physicians prescribe antidepressant medications more often and in higher doses for persons with medical comorbidities. This secondary data analysis of electronic health record data was conducted in the Centricity Health Care User Research Network (CHURN), a national network of ambulatory practices that use a common outpatient electronic health record. Participants included 209 family medicine and general internal medicine providers in 40 primary care CHURN offices in 17 US states. Patients included adults with a new episode of depression that had been diagnosed during the period October 2006 through July 2007 (n = 1513). Prescription of antidepressant medication and doses of antidepressant medication were compared for patients with and without 6 comorbid conditions: diabetes, coronary heart disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, and cancer. 20.7% of patients had at least one medical comorbidity whereas 5.8% had multiple comorbidities. Overall, 77% of depressed patients were prescribed antidepressant medication. After controlling for age and sex, patients with multiple comorbidities were less likely to be prescribed medication (adjusted odds ratio, 0.58; 95% CI, 0.35-0.96), but there was no significant difference by individual comorbidities. Patients with cerebrovascular disease were less likely to be prescribed a full dose of medication (adjusted odds ratio, 0.26; 95% CI, 0.08-0.88), but there were no differences for other comorbidities or for multiple comorbidities, and there was no difference for any comorbidities in the prescription of minimally effective doses. Patients with new episodes of depression who present to a primary care practice are not treated more aggressively if they have medical

  16. Tolerability of central nervous system symptoms among HIV-1 infected efavirenz users: analysis of patient electronic medical record data. (United States)

    Rosenblatt, Lisa; Broder, Michael S; Bentley, Tanya G K; Chang, Eunice; Reddy, Sheila R; Papoyan, Elya; Myers, Joel


    Efavirenz (EFV) is a non-nucleoside reverse transcriptase inhibitor indicated for treatment of HIV-1 infection. Despite concern over EFV tolerability in clinical trials and practice, particularly related to central nervous system (CNS) adverse events, some observational studies have shown high rates of EFV continuation at one year and low rates of CNS-related EFV substitution. The objective of this study was to further examine the real-world rate of CNS-related EFV discontinuation in antiretroviral therapy naïve HIV-1 patients. This retrospective cohort study used a nationally representative electronic medical records database to identify HIV-1 patients ≥12 years old, treated with a 1st-line EFV-based regimen (single or combination antiretroviral tablet) from 1 January 2009 to 30 June 2013. Patients without prior record of EFV use during 6-month baseline (i.e., antiretroviral therapy naïve) were followed 12 months post-medication initiation. CNS-related EFV discontinuation was defined as evidence of a switch to a replacement antiretroviral coupled with record of a CNS symptom within 30 days prior, absent lab evidence of virologic failure. We identified 1742 1st-line EFV patients. Mean age was 48 years, 22.7% were female, and 8.1% had a prior report of CNS symptoms. The first year, overall discontinuation rate among new users of EFV was 16.2%. Ten percent of patients (n = 174) reported a CNS symptom and 1.1% (n = 19) discontinued EFV due to CNS symptoms: insomnia (n = 12), headache (n = 5), impaired concentration (n = 1), and somnolence (n = 1). The frequency of CNS symptoms was similar for patients who discontinued EFV compared to those who did not (10.3 vs. 9.9%; P = .86). Our study found that EFV discontinuation due to CNS symptoms was low, consistent with prior reports.

  17. [The benefits prevail – why electronic immunization records are advantageous to the general practitioner and his patients]. (United States)

    Burkhardt, Tobias


    Immunization coverage throughout the Swiss population is still not optimal and therefore preventable diseases such as measles have not been eliminated in Switzerland yet. In addition, new vaccination protocols are available and official recommendations are becoming increasingly complex. The website has been in use since 2011 with the primary goal to increase immunization coverage. This service was established by Vaccinologist Professor Claire-Anne Siegrist from the University of Geneva and is free of charge for all Swiss doctors and pharmacists. It enables general practitioners and pediatricians to document the vaccination history of their patients in a new electronic immunization record. After a simple and quick process, the web-based software proposes up-to-date recommendations of new or follow-up vaccinations following the current Swiss Immunization Plan by the Federal Department of Health. Within this single practice, 1446 files have been recorded within the past three years. As a consequence, a total of 4378 immunizations have been administered, leading to a mean of 3.03 immunizations per patient. After introducing the electronic immunization record, the rates of immunizations have increased dramatically for all antigens (factor 2.1 to 41.5). Overall, patient acceptance was high – the doctor’s investment was positively recognized and his approach to patient care was perceived as modern. As a result, the practice has become competent in immunization. In summary, the positive outcome of using the electronic record highly supports the free program to all general practitioners and pediatricians in Switzerland.

  18. Historical context of the Albanian Constitutional Court

    Directory of Open Access Journals (Sweden)

    Ravesa Nano


    Full Text Available The Albanian legal tradition is based mostly on the traditional and customary laws. The Ottoman Empire ruled Albania for nearly five centuries and applied some of its translation of Sharia law together with its own rules and procedures. However, the Albanian population, especially in the north was governed by its own customary laws that were included in the Kanun of Lek Dukagjini. For a long period of time, these customary laws were unwritten and were learned generation aft er generation. The Kanun of Lek Dukagjini had very few rules and procedures regarding penal law. They were not arranged properly and there were some repetition for different cases. The National Court was implemented by a popular gathering of the oldest man of the village called Pleqnia. It used to decide on issues immediately, and there was no review of their issues. The rules were clear, simple and strict. There are some ideas from different Albanian researchers that the communist system although exported as an idea from abroad, based its laws and rules very much on the Albanian tradition as for example the creation also People’s Court. There was no institution of judicial review. These researchers point out that it was for this reason that the communist system in Albania lasted for nearly fifty years.

  19. Appeals court reverses verdict favoring drug companies. (United States)


    An appeals court reversed a verdict favoring drug companies after the widow of a hemophiliac, whose death was linked to HIV-tainted blood products, sued four pharmaceutical companies to pay damages. The four companies, Alpha Therapeutic Corp., Miles Laboratories Inc., Armour Pharmaceutical Co., and Baxter Travenol Laboratories Inc., provided Factor VIII, a clotting concentrate, to [name removed] [name removed], the plaintiff's husband, from 1972 until his death in 1987. [Name removed]'s wife sued the companies, alleging that the defendants negligently solicited blood plasma from paid donors who had a high risk of having HIV, failed to determine whether any lots of Factor VIII contained plasma from an at-risk donor, failed to warn consumers of possible risks, and failed to heat-treat HIV and other viruses in Factor VIII, despite industry-wide knowledge of the risk of infection. The three-judge panel said the trial judge's decision to avoid ruling on the antigenic stimulation theory, based on insufficient evidence, was improper. In addition, the appeals court said a retrial is necessary because of improper remarks made by Alpha's attorney.

  20. [Web-based electronic patient record as an instrument for quality assurance within an integrated care concept]. (United States)

    Händel, A; Jünemann, A G M; Prokosch, H-U; Beyer, A; Ganslandt, T; Grolik, R; Klein, A; Mrosek, A; Michelson, G; Kruse, F E


    A prerequisite for integrated care programmes is the implementation of a communication network meeting quality assurance standards. Against this background the main objective of the integrated care project between the University Eye Hospital Erlangen and the health insurance company AOK Bayern was to evaluate the potential and the acceptance of a web-based electronic patient record in the context of cataract and retinal surgery. Standardised modules for capturing pre-, intra- and post-operative data on the basis of clinical pathway guidelines for cataract- and retinal surgery have been developed. There are 6 data sets recorded per patient (1 pre-operative, 1 operative, 4-6 post-operative). For data collection, a web-based communication system (Soarian Integrated Care) has been chosen which meets the high requirements in data security, as well as being easy to handle. This teleconsultation system and the embedded electronic patient record are independent of the software used by respective offices and hospitals. Data transmission and storage were carried out in real-time. At present, 101 private ophthalmologists are taking part in the IGV contract with the University Eye Hospital Erlangen. This corresponds to 52% of all private ophthalmologists in the region. During the period from January 1st 2006 to December 31st 2006, 1844 patients were entered. Complete documentation was achieved in 1390 (75%) of all surgical procedures. For evaluation of this data, a multidimensional report and analysis tool (Cognos) was used. The deviation from target refraction as one quality indicator was in the mean 0.09 diopter. The web-based patient record used in this project was highly accepted by the private ophthalmologists. However there are still general concerns against the exchange of medical data via the internet. Nevertheless, the web-based patient record is an essential tool for a functional integration between the ambulatory and stationary health-care units. In addition to the

  1. Using Simulations to Improve Electronic Health Record Use, Clinician Training and Patient Safety: Recommendations From A Consensus Conference. (United States)

    Mohan, Vishnu; Woodcock, Deborah; McGrath, Karess; Scholl, Gretchen; Pranaat, Robert; Doberne, Julie W; Chase, Dian A; Gold, Jeffrey A; Ash, Joan S


    A group of informatics experts in simulation, biomedical informatics, patient safety, medical education, and human factors gathered at Corbett, Oregon on April 30 and May 1, 2015. Their objective: to create a consensus statement on best practices for the use of electronic health record (EHR) simulations in education and training, to improve patient safety, and to outline a strategy for future EHR simulation work. A qualitative approach was utilized to analyze data from the conference and generate recommendations in five major categories: (1) Safety, (2) Education and Training, (3) People and Organizations, (4) Usability and Design, and (5) Sociotechnical Aspects.

  2. Benefit-risk of Patients' Online Access to their Medical Records: Consensus Exercise of an International Expert Group. (United States)

    Liyanage, Harshana; Liaw, Siaw-Teng; Konstantara, Emmanouela; Mold, Freda; Schreiber, Richard; Kuziemsky, Craig; Terry, Amanda L; de Lusignan, Simon


    Patients' access to their computerised medical records (CMRs) is a legal right in many countries. However, little is reported about the benefit-risk associated with patients' online access to their CMRs.  To conduct a consensus exercise to assess the impact of patients' online access to their CMRs on the quality of care as defined in six domains by the Institute of Medicine (IoM), now the National Academy of Medicine (NAM).  A five-round Delphi study was conducted. Round One explored experts' (n = 37) viewpoints on providing patients with access to their CMRs. Round Two rated the appropriateness of statements arising from Round One (n = 16). The third round was an online panel discussion of findings (n = 13) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Two additional rounds, a survey of the revised consensus statements and an online workshop, were carried out to further refine consensus statements.  Thirty-seven responses from Round One were used as a basis to initially develop 15 statements which were categorised using IoM's domains of care quality. The experts agreed that providing patients online access to their CMRs for bookings, results, and prescriptions increased efficiency and improved the quality of medical records. Experts also anticipated that patients would proactively use their online access to share data with different health care providers, including emergencies. However, experts differed on whether access to limited or summary data was more useful to patients than accessing their complete records. They thought online access would change recording practice, but they were unclear about the benefit-risk of high and onerous levels of security. The 5-round process, finally, produced 16 consensus statements.  Patients' online access to their CMRs should be part of all CMR systems. It improves the process

  3. Prevalence and usage of printed and electronic drug references and patient medication records in community pharmacies in Malaysia. (United States)

    Usir, Ezlina; Lua, Pei Lin; Majeed, Abu Bakar Abdul


    This study aimed to determine the availability and usage of printed and electronic references and Patient Medication Record in community pharmacy. It was conducted for over 3 months from 15 January to 30 April 2007. Ninety-three pharmacies participated. Structured questionnaires were mailed to community pharmacies. Six weeks later a reminder was sent to all non responders, who were given another six weeks to return the completed questionnaire. Outcomes were analyzed using descriptive statistics and chi-square test of independence. Almost all the pharmacies (96.8%) have at least Monthly Index of Medical Specialties (MIMS) while 78.5% have at least MIMS ANNUAL in their stores. Only about a third (31.2%) of the pharmacies were equipped with online facilities of which the majority referred to medical websites (88.9%) with only a minority (11.1%) referring to electronic journals. More than half (59.1%) of the pharmacists kept Patient Medication Record profiles with 49.1% storing it in paper, 41.8% electronically and 9.1% in both printed and electronic versions. In general, prevalence and usage of electronic references in community pharmacies were rather low. Efforts should be increased to encourage wider usage of electronic references and Patient Medication Records in community pharmacies to facilitate pharmaceutical care.

  4. with a comparative view at the jurisdiction of the U.S.- Supreme Court and the German Federal Constitutional Court


    Hiller, Kinga


    This thesis is about the connection between the constitutional ownership guarantee and the political-philosophical conception of property. I portray and analyze the jurisdiction of the Hungarian Constitutional Court since the fall of Communism in 1989 in light of these two aspects and venture a comparison with the jurisdiction of the U.S.- Supreme Court and the German Federal Constitutional Court. In political and philosophical terms, there are - roughly speaking - two opposing conceptio...

  5. Patient-Controlled Attribute-Based Encryption for Secure Electronic Health Records System. (United States)

    Eom, Jieun; Lee, Dong Hoon; Lee, Kwangsu


    In recent years, many countries have been trying to integrate electronic health data managed by each hospital to offer more efficient healthcare services. Since health data contain sensitive information of patients, there have been much research that present privacy preserving mechanisms. However, existing studies either require a patient to perform various steps to secure the data or restrict the patient to exerting control over the data. In this paper, we propose patient-controlled attribute-based encryption, which enables a patient (a data owner) to control access to the health data and reduces the operational burden for the patient, simultaneously. With our method, the patient has powerful control capability of his/her own health data in that he/she has the final say on the access with time limitation. In addition, our scheme provides emergency medical services which allow the emergency staffs to access the health data without the patient's permission only in the case of emergencies. We prove that our scheme is secure under cryptographic assumptions and analyze its efficiency from the patient's perspective.

  6. Patient and public attitudes towards informed consent models and levels of awareness of Electronic Health Records in the UK (United States)

    Riordan, Fiona; Papoutsi, Chrysanthi; Reed, Julie E.; Marston, Cicely; Bell, Derek; Majeed, Azeem


    Background The development of Electronic Health Records (EHRs) forms an integral part of the information strategy for the National Health Service (NHS) in the UK, with the aim of facilitating health information exchange for patient care and secondary use, including research and healthcare planning. Implementing EHR systems requires an understanding of patient expectations for consent mechanisms and consideration of public awareness towards information sharing as might be made possible through integrated EHRs across primary and secondary health providers. Objectives To explore levels of public awareness about EHRs and to examine attitudes towards different consent models with respect to sharing identifiable and de-identified records for healthcare provision, research and planning. Methods A cross-sectional questionnaire survey was administered to adult patients and members of the public in primary and secondary care clinics in West London, UK in 2011. In total, 5331 individuals participated in the survey, and 3157 were included in the final analysis. Results The majority (91%) of respondents expected to be explicitly asked for consent for their identifiable records to be accessed for health provision, research or planning. Half the respondents (49%) did not expect to be asked for consent before their de-identified records were accessed. Compared with White British respondents, those from all other ethnic groups were more likely to anticipate their permission would be obtained before their de-identified records were used. Of the study population, 59% reported already being aware of EHRs before the survey. Older respondents and individuals with complex patterns of interaction with healthcare services were more likely to report prior awareness of EHRs. Individuals self-identifying as belonging to ethnic groups other than White British, and those with lower educational qualifications were less likely to report being aware of EHRs than White British respondents and

  7. “The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden (United States)


    Background Uppsala County in Sweden launched an eHealth patient portal in 2012, which allows patients to access their medical records over the Internet. However, the launch of the portal was critically debated in the media. The professionals were strongly skeptical, and one reason was possible negative effects on their work environment. This study hence investigates the assumptions and perspectives of physicians to understand their framing of the patient portal in relation to their work environment. Objective The study uses the concept of technological frames to examine how physicians in different specialties make sense of the patient portal in relation to their work environment. Methods A total of 12 semistructured interviews were conducted with physicians from different specialties. Interviews were transcribed and translated. A theoretically informed thematic analysis was performed. Results The thematic analysis revealed 4 main themes: work tool, process, workload, and control. Physicians perceive medical records as their work tool, written for communication within health care only. Considering effects on work environment, the physicians held a negative attitude and expected changes, which would affect their work processes in a negative way. Especially the fact that patients might read their test results before the physician was seen as possibly harmful for patients and as an interference with their established work practices. They expected the occurrence of misunderstandings and needs for additional explanations, which would consequently increase their workload. Other perceptions were that the portal would increase controlling and monitoring of physicians and increase or create a feeling of mistrust from patients. Regarding benefits for the patients, most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided. Conclusions Supported by the study, we conclude

  8. Money Matters: Cost-Effectiveness of Juvenile Drug Court with and without Evidence-Based Treatments (United States)

    Sheidow, Ashli J.; Jayawardhana, Jayani; Bradford, W. David; Henggeler, Scott W.; Shapiro, Steven B.


    The 12-month cost-effectiveness of juvenile drug court and evidence-based treatments within court were compared with traditional Family Court for 128 substance-abusing/dependent juvenile offenders participating in a 4-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community…

  9. Identification and Progression of Heart Disease Risk Factors in Diabetic Patients from Longitudinal Electronic Health Records

    Directory of Open Access Journals (Sweden)

    Jitendra Jonnagaddala


    Full Text Available Heart disease is the leading cause of death worldwide. Therefore, assessing the risk of its occurrence is a crucial step in predicting serious cardiac events. Identifying heart disease risk factors and tracking their progression is a preliminary step in heart disease risk assessment. A large number of studies have reported the use of risk factor data collected prospectively. Electronic health record systems are a great resource of the required risk factor data. Unfortunately, most of the valuable information on risk factor data is buried in the form of unstructured clinical notes in electronic health records. In this study, we present an information extraction system to extract related information on heart disease risk factors from unstructured clinical notes using a hybrid approach. The hybrid approach employs both machine learning and rule-based clinical text mining techniques. The developed system achieved an overall microaveraged F-score of 0.8302.

  10. Supplementing electronic health records through sample collection and patient diaries: A study set within a primary care research database. (United States)

    Joseph, Rebecca M; Soames, Jamie; Wright, Mark; Sultana, Kirin; van Staa, Tjeerd P; Dixon, William G


    To describe a novel observational study that supplemented primary care electronic health record (EHR) data with sample collection and patient diaries. The study was set in primary care in England. A list of 3974 potentially eligible patients was compiled using data from the Clinical Practice Research Datalink. Interested general practices opted into the study then confirmed patient suitability and sent out postal invitations. Participants completed a drug-use diary and provided saliva samples to the research team to combine with EHR data. Of 252 practices contacted to participate, 66 (26%) mailed invitations to patients. Of the 3974 potentially eligible patients, 859 (22%) were at participating practices, and 526 (13%) were sent invitations. Of those invited, 117 (22%) consented to participate of whom 86 (74%) completed the study. We have confirmed the feasibility of supplementing EHR with data collected directly from patients. Although the present study successfully collected essential data from patients, it also underlined the requirement for improved engagement with both patients and general practitioners to support similar studies. © 2017 The Authors. Pharmacoepidemiology & Drug Safety published by John Wiley & Sons Ltd.

  11. Impact of Electronic Medical Record Use on the Patient-Doctor Relationship and Communication: A Systematic Review. (United States)

    Alkureishi, Maria Alcocer; Lee, Wei Wei; Lyons, Maureen; Press, Valerie G; Imam, Sara; Nkansah-Amankra, Akua; Werner, Deb; Arora, Vineet M


    While Electronic Medical Record (EMR) use has increased dramatically, the EMR's impact on the patient-doctor relationship remains unclear. This systematic literature review sought to understand the impact of EMR use on patient-doctor relationships and communication. Parallel searches in Ovid MEDLINE, PubMed, Scopus, PsycINFO, Cochrane Library, reference review of prior systematic reviews, meeting abstract reviews, and expert reviews from August 2013 to March 2015 were conducted. Medical Subject Heading terms related to EMR use were combined with keyword terms identifying face-to-face patient-doctor communication. English language observational or interventional studies (1995-2015) were included. Studies examining physician attitudes only were excluded. Structured data extraction compared study population, design, data collection method, and outcomes. Fifty-three of 7445 studies reviewed met inclusion criteria. Included studies used behavioral analysis (28) to objectively measure communication behaviors using video or direct observation and pre-post or cross-sectional surveys to examine patient perceptions (25). Objective studies reported EMR communication behaviors that were both potentially negative (i.e., interrupted speech, low rates of screen sharing) and positive (i.e., facilitating questions). Studies examining overall patient perceptions of satisfaction, communication or the patient-doctor relationship (n = 22) reported no change with EMR use (16); a positive impact (5) or showed mixed results (1). Study quality was not assessable. Small sample sizes limited generalizability. Publication bias may limit findings. Despite objective evidence that EMR use may negatively impact patient-doctor communication, studies examining patient perceptions found no change in patient satisfaction or patient-doctor communication. Therefore, our findings should encourage providers to adopt the EMR as a communication tool. Future research is needed to better understand how

  12. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. (United States)

    Street, Richard L; Liu, Lin; Farber, Neil J; Chen, Yunan; Calvitti, Alan; Zuest, Danielle; Gabuzda, Mark T; Bell, Kristin; Gray, Barbara; Rick, Steven; Ashfaq, Shazia; Agha, Zia


    The computer with the electronic health record (EHR) is an additional 'interactant' in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower in patient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously

  13. The Relevance of Criminal Courts in the Global South

    Directory of Open Access Journals (Sweden)

    Pablo Leandro Ciocchini


    Full Text Available The literature on comparative law has a long and robust tradition, but studies comparing courts and judicial systems are scarce. Comparative studies in the Global South, following Shapiro’s institutional approach, have aimed to measure the involvement of courts in politics by assessing the power of the judiciary in society, the level of judicial independence, and their role in the context of the judicialization of politics. The focus was on the high courts, including either Constitutional or Supreme Courts. Criminal courts have not received similar attention despite the influence of their everyday decisions on people’s lives and their perception of the judicial system. This article argues that developing a comparative approach for criminal courts in the Global South is needed to help understand the role they play in the development of the rule of law and democratic life. This comparative study helps understand the impact of judicial reform programmes in the Global South. These reforms, inspired by a neoliberal paradigm, have focused on improving the efficiency of the courts. The reforms have promoted managerial techniques detrimental to the standards of due process. Any assessment of the impact of the reforms on the courts in the Global South should start by recognising the widely differing settings under which they operate. This context is characterised by serious economic constraints, such as a lack of material and human resources, and a democratic deficit legacy from the past authoritarian regimes, including widespread police abuse and corruption. Given this context, the role of the courts in ensuring due process and the legality of police procedures is crucial. The impact of the judicial reforms promoting managerial rationality in recent decades must be analysed. To examine the role courts are playing in criminal matters, two cases were explored where courts have undergone extensive judicial reforms, Argentina and the Philippines.

  14. Understanding the patient perspective on research access to national health records databases for conduct of randomized registry trials. (United States)

    Avram, Robert; Marquis-Gravel, Guillaume; Simard, François; Pacheco, Christine; Couture, Étienne; Tremblay-Gravel, Maxime; Desplantie, Olivier; Malhamé, Isabelle; Bibas, Lior; Mansour, Samer; Parent, Marie-Claude; Farand, Paul; Harvey, Luc; Lessard, Marie-Gabrielle; Ly, Hung; Liu, Geoffrey; Hay, Annette E; Marc Jolicoeur, E


    Use of health administrative databases is proposed for screening and monitoring of participants in randomized registry trials. However, access to these databases raises privacy concerns. We assessed patient's preferences regarding use of personal information to link their research records with national health databases, as part of a hypothetical randomized registry trial. Cardiology patients were invited to complete an anonymous self-reported survey that ascertained preferences related to the concept of accessing government health databases for research, the type of personal identifiers to be shared and the type of follow-up preferred as participants in a hypothetical trial. A total of 590 responders completed the survey (90% response rate), the majority of which were Caucasians (90.4%), male (70.0%) with a median age of 65years (interquartile range, 8). The majority responders (80.3%) would grant researchers access to health administrative databases for screening and follow-up. To this end, responders endorsed the recording of their personal identifiers by researchers for future record linkage, including their name (90%), and health insurance number (83.9%), but fewer responders agreed with the recording of their social security number (61.4%, pgranting researchers access to the administrative databases (OR: 1.69, 95% confidence interval: 1.03-2.90; p=0.04). The majority of Cardiology patients surveyed were supportive of use of their personal identifiers to access administrative health databases and conduct long-term monitoring in the context of a randomized registry trial. Copyright © 2018 Elsevier Ireland Ltd. All rights reserved.

  15. Patterns in Patient Access and Utilization of Online Medical Records: Analysis of MyChart (United States)


    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

  16. Patterns in Patient Access and Utilization of Online Medical Records: Analysis of MyChart. (United States)

    Redelmeier, Donald A; Kraus, Nicole C


    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 (, 06.02.2018.

  17. Implementation of a patient-facing genomic test report in the electronic health record using a web-application interface. (United States)

    Williams, Marc S; Kern, Melissa S; Lerch, Virginia R; Billet, Jonathan; Williams, Janet L; Moore, Gregory J


    Genomic medicine is emerging into clinical care. Communication of genetic laboratory results to patients and providers is hampered by the complex technical nature of the laboratory reports. This can lead to confusion and misinterpretation of the results resulting in inappropriate care. Patients usually do not receive a copy of the report leading to further opportunities for miscommunication. To address these problems, interpretive reports were created using input from the intended end users, patients and providers. This paper describes the technical development and deployment of the first patient-facing genomic test report (PGR) within an electronic health record (EHR) ecosystem using a locally developed standards-based web-application interface. A patient-facing genomic test report with a companion provider report was configured for implementation within the EHR using a locally developed software platform, COMPASS™. COMPASS™ is designed to manage secure data exchange, as well as patient and provider access to patient reported data capture and clinical display tools. COMPASS™ is built using a Software as a Service (SaaS) approach which exposes an API that apps can interact with. An authoring tool was developed that allowed creation of patient-specific PGRs and the accompanying provider reports. These were converted to a format that allowed them to be presented in the patient portal and EHR respectively using the existing COMPASS™ interface thus allowing patients, caregivers and providers access to individual reports designed for the intended end user. The PGR as developed was shown to enhance patient and provider communication around genomic results. It is built on current standards but is designed to support integration with other tools and be compatible with emerging opportunities such as SMART on FHIR. This approach could be used to support genomic return of results as the tool is scalable and generalizable.

  18. Electronic medical records in humanitarian emergencies - the development of an Ebola clinical information and patient management system. (United States)

    Jobanputra, Kiran; Greig, Jane; Shankar, Ganesh; Perakslis, Eric; Kremer, Ronald; Achar, Jay; Gayton, Ivan


    By November 2015, the West Africa Ebola epidemic had caused 28598 infections and 11299 deaths in the three countries most affected. The outbreak required rapid innovation and adaptation. Médecins sans Frontières (MSF) scaled up its usual 20-30 bed Ebola management centres (EMCs) to 100-300 beds with over 300 workers in some settings. This brought challenges in patient and clinical data management resulting from the difficulties of working safely with high numbers of Ebola patients. We describe a project MSF established with software developers and the Google Social Impact Team to develop context-adapted tools to address the challenges of recording Ebola clinical information. We share the outcomes and key lessons learned in innovating rapidly under pressure in difficult environmental conditions. Information on adoption, maintenance, and data quality was gathered through review of project documentation, discussions with field staff and key project stakeholders, and analysis of tablet data. In March 2015, a full prototype was deployed in Magburaka EMC, Sierra Leone. Inpatient data were captured on 204 clinical interactions with 34 patients from 5 March until 10 April 2015. Data continued to also be recorded on paper charts, creating theoretically identical record "pairs" on paper and tablet. 83 record pairs for 33 patients with 22 data items (temperature and symptoms) per pair were analysed. The overall Kappa coefficient for agreement between sources was 0.62, but reduced to 0.59 when rare bleeding symptoms were excluded, indicating moderate to good agreement. The time taken to deliver the product was more than that anticipated by MSF (7 months versus 6 weeks). Deployment of the tablet coincided with a dramatic drop in patient numbers and thus had little impact on patient care. We have identified lessons specific to humanitarian-technology collaborative projects and propose a framework for emergency humanitarian innovation. Time and effort is required to bridge

  19. The readmission risk flag: using the electronic health record to automatically identify patients at risk for 30-day readmission. (United States)

    Baillie, Charles A; VanZandbergen, Christine; Tait, Gordon; Hanish, Asaf; Leas, Brian; French, Benjamin; Hanson, C William; Behta, Maryam; Umscheid, Craig A


    Identification of patients at high risk for readmission is a crucial step toward improving care and reducing readmissions. The adoption of electronic health records (EHR) may prove important to strategies designed to risk stratify patients and introduce targeted interventions. To develop and implement an automated prediction model integrated into our health system's EHR that identifies on admission patients at high risk for readmission within 30 days of discharge. Retrospective and prospective cohort. Healthcare system consisting of 3 hospitals. All adult patients admitted from August 2009 to September 2012. An automated readmission risk flag integrated into the EHR. Thirty-day all-cause and 7-day unplanned healthcare system readmissions. Using retrospective data, a single risk factor, ≥ 2 inpatient admissions in the past 12 months, was found to have the best balance of sensitivity (40%), positive predictive value (31%), and proportion of patients flagged (18%), with a C statistic of 0.62. Sensitivity (39%), positive predictive value (30%), proportion of patients flagged (18%), and C statistic (0.61) during the 12-month period after implementation of the risk flag were similar. There was no evidence for an effect of the intervention on 30-day all-cause and 7-day unplanned readmission rates in the 12-month period after implementation. An automated prediction model was effectively integrated into an existing EHR and identified patients on admission who were at risk for readmission within 30 days of discharge. © 2013 Society of Hospital Medicine.

  20. Credibility of the emotional witness: a study of ratings by court judges. (United States)

    Wessel, Ellen; Drevland, Guri C B; Eilertsen, Dag Erik; Magnussen, Svein


    Previous studies have shown that the emotional behavior displayed during testimony may affect the perceived credibility of the witness. The present study compares credibility ratings by Norwegian court judges with those made by lay people. The participants viewed one of three video-recorded versions of a rape victim's statement, role played by a professional actress. The statement was given in a free-recall manner with one of three kinds of emotions displayed, termed congruent, neutral, and incongruent emotional expression. The results show that, in contrast to lay people, the credibility ratings of court judges and their votes for a guilty verdict were not influenced by the emotions displayed by the witness. Results are discussed in terms of professional expertise.

  1. Health Technology Integration for Clinical, Patient Records and Financial Management Related to the Military (United States)


    as intended.  Apprehension about EHR systems: Some nurses expressed apprehension about and resistance to the new system because they felt it services, he/she is admitted to the hospital. (Note: Your patient is not pregnant ) Update to Patient Information 1) Create a manual...Diabetes, requesting physician number = 712345 7) Humulin N Units= 10; route = SubCutaneous, frequency= morning and evening; begin insulin

  2. Involving patients in checking the validity of the NHS shared record: a single practice pilot

    Directory of Open Access Journals (Sweden)

    Sally Al-Agilly


    Conclusion Only a minority of patients chose to view and offer comment on their core clinical summaries. The majority of summaries were deemed to be accurate but there was a worrying level of omission and inaccuracy, including medication. It might be a better use of time to support doctors and patients working together to construct and check summaries rather than on information technology (IT and the complex ethical debate surrounding the core clinical Spine.

  3. 22 CFR 19.6 - Court orders and divorce decrees. (United States)


    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Court orders and divorce decrees. 19.6 Section 19.6 Foreign Relations DEPARTMENT OF STATE PERSONNEL BENEFITS FOR SPOUSES AND FORMER SPOUSES OF PARTICIPANTS IN THE FOREIGN SERVICE RETIREMENT AND DISABILITY SYSTEM § 19.6 Court orders and divorce decrees. ...

  4. Assisted Reproduction and the Courts: The Case of California (United States)

    Maule, Linda S.; Schmid, Karen


    In this article, the authors analyze appellate court cases heard in California between 1960 and 2000 that focus on the status of children conceived through reproductive technology in an effort to examine the role of the courts in defining parentage and family in the late 20th and early 21st centuries. In the absence of legislation, the primary…

  5. K-12 Implications Seen in Some Cases before High Court (United States)

    Walsh, Mark


    Arizona's variation on government vouchers for religious schools and California's prohibition on the sale of violent video games to minors present the top two cases with implications for education in the U.S. Supreme Court term that formally begins Oct. 4. New Justice Elena Kagan brings to the court extensive education policy experience as a…

  6. Perceived Masculinity Predicts U.S. Supreme Court Outcomes (United States)


    Previous studies suggest a significant role of language in the court room, yet none has identified a definitive correlation between vocal characteristics and court outcomes. This paper demonstrates that voice-based snap judgments based solely on the introductory sentence of lawyers arguing in front of the Supreme Court of the United States predict outcomes in the Court. In this study, participants rated the opening statement of male advocates arguing before the Supreme Court between 1998 and 2012 in terms of masculinity, attractiveness, confidence, intelligence, trustworthiness, and aggressiveness. We found significant correlation between vocal characteristics and court outcomes and the correlation is specific to perceived masculinity even when judgment of masculinity is based only on less than three seconds of exposure to a lawyer’s speech sample. Specifically, male advocates are more likely to win when they are perceived as less masculine. No other personality dimension predicts court outcomes. While this study does not aim to establish any causal connections, our findings suggest that vocal characteristics may be relevant in even as solemn a setting as the Supreme Court of the United States. PMID:27737008

  7. Psychotic Symptomatology in a Juvenile Court Clinic Population (United States)

    Lewis, Dorothy Otnow; And Others


    This report indicating an unexpectedly high incidence of psychotic symptomatology in a population of cases referred to the Juvenile Court Psychiatric Clinic of the Second District of Connecticut, manifests the necessity for juvenile court systems to be made aware of the possibility of psychosis in our delinquent populations. (CS)

  8. HIV/STI Risk Behavior of Drug Court Participants (United States)

    Robertson, Angela A.; St. Lawrence, Janet S.; McCluskey, D. Lee


    Drug abusing offenders have high rates of HIV and other sexually transmitted infections (STI). To date, the HIV/STI prevention needs of offenders in drug court programs have been ignored. This multi-method study employed interviews to assess drug court professionals' perceptions of the need for an HIV risk reduction intervention to be integrated…

  9. Establishing an effective dialog between courts and agencies

    NARCIS (Netherlands)

    Humphery-Jenner, Mark L.


    This thesis examines the relationship between courts, administrators, and legislators. The goal is to improve the operation of judicial review in the United States and provide suggestions on how to enhance emerging doctrines of judicial review in the EU. The thesis focuses on how courts, agencies,

  10. 20 CFR 405.515 - Application of circuit court law. (United States)


    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Application of circuit court law. 405.515 Section 405.515 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Judicial Review § 405.515 Application of circuit court law. We will...

  11. Court Culture during the Reign of Christian IV

    DEFF Research Database (Denmark)

    Olden-Jørgensen, Sebastian


    Court culture can be defined as a range of cultural forms (festival culture, painting, literature, music, architecture) employed for the enhancement of princely status and the communication of political messages. Christian IV evidently set great store on court culture beginning with his magnificent...

  12. The Equal Pay Act: Higher Education and the Court's View. (United States)

    Greenlaw, Paul S.; Swanson, Austin D.


    Effects of the Equal Pay Act of 1963 for college and university employees are reviewed through an examination of trends in court decisions and legal treatment of the issues. It is concluded that case law has been evolutionary, with concepts of "equal,""work," and others not altered drastically by the courts in recent years.…

  13. USTC & TBA Guidelines for Tennis Court & Running Track Construction. (United States)

    United States Tennis Court & Track Builders Association.

    Guidelines are presented on tennis court and track and field construction that reflect the latest developments in construction technology, methodology, and practice. Based on contributions from experienced certified tennis court and track builders, material suppliers and design professionals, this manual examines each of the critical areas of…

  14. Abused and Neglected Children in Court: Knowledge and Attitudes (United States)

    Block, Stephanie D.; Oran, Howard; Oran, Diane; Baumrind, Nikki; Goodman, Gail S.


    Objective: After maltreated children are taken into protective custody, dependency courts determine the children's placements. Many, if not most, maltreated children never attend their dependency court hearings. We had the rare opportunity to interview children in a jurisdiction where children regularly attend their detention hearings in…

  15. Finding Vredo: the Dutch Supreme Court decision on escitalopram

    NARCIS (Netherlands)

    Tsoutsanis, A.


    This article is about the pharma patent litigation sparked by Lundbeck's blockbuster drug for escitalopram. The article focuses on the trials and tribulations before the Dutch Patent Court of Appeal and the Supreme Court, while also briefly contrasting and comparing this with the decisions in

  16. Delinquency Cases in Juvenile Court, 2002. OJJDP Fact Sheet #02 (United States)

    Stahl, Anne L.


    This fact sheet presents statistics on delinquency cases processed by juvenile courts in 2002. The number of delinquency cases handled by juvenile courts decreased 11 percent between 1997 and 2002. During this time, the number of person offense cases decreased 2 percent, property offense cases decreased 27 percent, drug law violation cases…

  17. Questions of legal responsibility for Srebrenica before the Dutch courts

    NARCIS (Netherlands)

    Spijkers, Otto

    This contribution provides an overview of the litigation in the Dutch civil and criminal courts concerning the Srebrenica massacre. The author maps out the Dutch courts' divergent approaches to immunity of United Nations peacekeepers, state responsibility and individual criminal responsibility for

  18. Licensing procedure by steps, indemnity precaution, control by administrative courts

    International Nuclear Information System (INIS)

    Sellner, D.


    The author describes three problems of the Wyhl-judgement of the Federal Administrative Court. The terms 'licensing procedure by steps', 'indemnity precaution pursuant to sec. 7, para. 2, No. 3 Atomic Energy Act', and 'control density of administrative courts' are concretized. The author chooses these terms because they have important impulses even for other fields than Atomic Energy Law. (CW) [de

  19. 16 CFR 1.62 - Ancillary court orders pending review. (United States)


    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Ancillary court orders pending review. 1.62 Section 1.62 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE GENERAL PROCEDURES Injunctive and Condemnation Proceedings § 1.62 Ancillary court orders pending review...

  20. 22 CFR 19.6-2 - Qualifying court order. (United States)


    ... principal's Foreign Service retirement benefit or survivor benefit. If a court directs or implies that a... Foreign Relations DEPARTMENT OF STATE PERSONNEL BENEFITS FOR SPOUSES AND FORMER SPOUSES OF PARTICIPANTS IN... the Secretary of State. A qualifying court order must— (1) Be consistent with the terms of the Act and...

  1. legal pluralism, sharia courts, and constitutional issues in ethiopia

    African Journals Online (AJOL)


    of sharia courts. These laws include the Proclamation to Consolidate Federal. Courts of ... This is found in the statement of the Prophet: 'leave the ...... some support (which may be financial or enforcement).81 To this end, the state may, as in ...

  2. Environment Protection (Northern Territory Supreme Court) Act 1978, No.30

    International Nuclear Information System (INIS)


    This Act relates to the enforcement by the Supreme Court of the Northern Territory of certain provisions for protecting the environment in the Alligator Rivers Region; it provides that the Supreme Court has jurisdiction to make orders concerning enforcement of provisions relating to the environmental effects in the Region of uranium mining operations. (NEA) [fr

  3. Matching Judicial Supervision to Clients' Risk Status in Drug Court (United States)

    Marlowe, Douglas B.; Festinger, David S.; Lee, Patricia A.; Dugosh, Karen L.; Benasutti, Kathleen M.


    This article reports outcomes from a program of experimental research evaluating the risk principle in drug courts. Prior studies revealed that participants who were high risk and had (a) antisocial personality disorder or (b) a prior history of drug abuse treatment performed better in drug court when scheduled to attend biweekly judicial status…


    African Journals Online (AJOL)

    Fr. Ikenga

    Both the 1958 Ordinance and the 1990 Act stipulate the time period within which a foreign judgment may be registered in Nigeria. Section 3(1) of the 1958 Ordinance provides that where a judgment has been obtained in the High Court in England or Ireland, or in the Court of Session in Scotland, the judgment creditor may ...

  5. Introduction. National Courts vis-à-vis EU Law

    DEFF Research Database (Denmark)

    Mayoral, Juan A.; Wind, Marlene


    National Courts and EU Law examines both how and why national courts and judges are involved in the process of legal integration within the European Union. As well as reviewing conventional thinking, the book presents new legal and empirical insights into the issue of judicial behaviour...

  6. 16 CFR 1502.44 - Review by the courts. (United States)


    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Review by the courts. 1502.44 Section 1502.44 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION FEDERAL HAZARDOUS SUBSTANCES ACT REGULATIONS PROCEDURES FOR FORMAL EVIDENTIARY PUBLIC HEARING Judicial Review § 1502.44 Review by the courts...

  7. Perceived Masculinity Predicts U.S. Supreme Court Outcomes.

    Directory of Open Access Journals (Sweden)

    Daniel Chen

    Full Text Available Previous studies suggest a significant role of language in the court room, yet none has identified a definitive correlation between vocal characteristics and court outcomes. This paper demonstrates that voice-based snap judgments based solely on the introductory sentence of lawyers arguing in front of the Supreme Court of the United States predict outcomes in the Court. In this study, participants rated the opening statement of male advocates arguing before the Supreme Court between 1998 and 2012 in terms of masculinity, attractiveness, confidence, intelligence, trustworthiness, and aggressiveness. We found significant correlation between vocal characteristics and court outcomes and the correlation is specific to perceived masculinity even when judgment of masculinity is based only on less than three seconds of exposure to a lawyer's speech sample. Specifically, male advocates are more likely to win when they are perceived as less masculine. No other personality dimension predicts court outcomes. While this study does not aim to establish any causal connections, our findings suggest that vocal characteristics may be relevant in even as solemn a setting as the Supreme Court of the United States.

  8. 8 CFR 337.8 - Oath administered by the courts. (United States)


    ... Form N-646, that the applicant has been determined by the Attorney General to be eligible for admission... ALLEGIANCE § 337.8 Oath administered by the courts. (a) Notification of election. An applicant for... election to have the oath of allegiance administered in an appropriate court having jurisdiction over the...

  9. Improving Labour Courts in Mexico: The Case of Cuautitlan | IDRC ...

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

    In a case study of a large court in Cuautitlan in the State of Mexico, ... Research results are also expected to inform the operations of other Mexican courts, as well as ... in the fields of science, technology, engineering, and mathematics (STEM).

  10. Smells Like Teen Spirit: Evaluating a Midwestern Teen Court (United States)

    Norris, Michael; Twill, Sarah; Kim, Chigon


    Teen courts have grown rapidly in the United States despite little evidence of their effectiveness. A survival analysis of 635 teen court and 186 regular diversion participants showed no significant differences in recidivism, although program completers were half as likely to reoffend as noncompleters. Older offenders survived significantly better…

  11. Cramers Court Nursing Home, Belgooly, Cork.

    LENUS (Irish Health Repository)

    Marathe, N


    The study illustrates advantages of Fiberoptic Bronchoscopy, a new service started at St. Luke’s General Hospital in patient care since April 2014. Retrospective review of Bronchoscopies and referrals to Tertiary care unit for Bronchoscopy, prior and after initiation of service at St. Luke’s Hospital were studied. In total, 106 procedures were performed out of which 103(98%) were for diagnostic purpose. Common indications for bronchoscopy were functional airway assessment in 38 cases (35%) of chronic cough, 26 cases (24.8%) of suspected malignancy. The average time taken for procedure was 15 + 1 minute with overall rate of complication recorded in 1 case (0.95%). 32(30%) inpatients were referred before bronchoscopy services were started locally. Fifteen (14%) patients were referred for Endobronchial Ultrasound (EBUS) after diagnostic procedure performed at St. Luke’s Hospital. To conclude, Bronchoscopy is a safe procedure used for diagnosis of various Lung conditions. The services offered locally reduced the time and cost involved in referrals. The diagnostic bronchoscopies performed for malignancy at St. Luke’s Hospital have rightly increased references for EBUS at Tertiary care Unit

  12. Quantification of clinical scores through physiological recordings in low-responsive patients: a feasibility study

    Directory of Open Access Journals (Sweden)

    Wieser Martin


    Full Text Available Abstract Clinical scores represent the gold standard in characterizing the clinical condition of patients in vegetative or minimally conscious state. However, they suffer from problems of sensitivity, specificity, subjectivity and inter-rater reliability. In this feasibility study, objective measures including physiological and neurophysiological signals are used to quantify the clinical state of 13 low-responsive patients. A linear regression method was applied in nine patients to obtain fixed regression coefficients for the description of the clinical state. The statistical model was extended and evaluated with four patients of another hospital. A linear mixed models approach was introduced to handle the challenges of data sets obtained from different locations. Using linear backward regression 12 variables were sufficient to explain 74.4% of the variability in the change of the clinical scores. Variables based on event-related potentials and electrocardiogram account for most of the variability. These preliminary results are promising considering that this is the first attempt to describe the clinical state of low-responsive patients in such a global and quantitative way. This new model could complement the clinical scores based on objective measurements in order to increase diagnostic reliability. Nevertheless, more patients are necessary to prove the conclusions of a statistical model with 12 variables.

  13. Medical students volunteering in hospital: a novel method of exploring and recording the patient experience

    Directory of Open Access Journals (Sweden)

    Monica Lorraina Hytiris


    Full Text Available Background: Patient experience is increasingly recognised as an important feature of healthcare quality improvement. However, many of the methods implemented for its collection have significant limitations and reliability issues. This article describes how a UK healthcare organisation worked with medical student volunteers to build capacity for the collection of patient feedback in evidence-informed ways, and summarises student reflections on this process. Aims: To improve the quantity and quality of inpatient feedback, and in doing so provide new learning opportunities for medical students. Conclusions: Patient feedback gathered by volunteers is beneficial to the service and to medical student volunteers. As the feedback gathered is ward-specific, opportunities are created for practice improvements to be identified and acted on. It is feasible for medical students to be trained effectively as volunteers in gathering patient care experiences with adequate support mechanisms in place. Implications for practice: •\tHealthcare services should consider the use of personnel independent of the care team for the collection of patient feedback •\tPatient feedback needs to be shared with practitioners in a timely manner •\tMedical schools should consider this type of volunteering as a unique opportunity for medical students to improve understanding of patients’ experiences of healthcare, and of how care can be person-centred

  14. High-Frequency Oscillations Recorded on the Scalp of Patients With Epilepsy Using Tripolar Concentric Ring Electrodes. (United States)

    Besio, Walter G; Martínez-Juárez, Iris E; Makeyev, Oleksandr; Gaitanis, John N; Blum, Andrew S; Fisher, Robert S; Medvedev, Andrei V


    Epilepsy is the second most prevalent neurological disorder ([Formula: see text]% prevalence) affecting [Formula: see text] million people worldwide with up to 75% from developing countries. The conventional electroencephalogram is plagued with artifacts from movements, muscles, and other sources. Tripolar concentric ring electrodes automatically attenuate muscle artifacts and provide improved signal quality. We performed basic experiments in healthy humans to show that tripolar concentric ring electrodes can indeed record the physiological alpha waves while eyes are closed. We then conducted concurrent recordings with conventional disc electrodes and tripolar concentric ring electrodes from patients with epilepsy. We found that we could detect high frequency oscillations, a marker for early seizure development and epileptogenic zone, on the scalp surface that appeared to become more narrow-band just prior to seizures. High frequency oscillations preceding seizures were present in an average of 35.5% of tripolar concentric ring electrode data channels for all the patients with epilepsy whose seizures were recorded and absent in the corresponding conventional disc electrode data. An average of 78.2% of channels that contained high frequency oscillations were within the seizure onset or irritative zones determined independently by three epileptologists based on conventional disc electrode data and videos.

  15. The Impact of Two Los Angeles County Teen Courts on Youth Recidivism: Comparing Two Informal Probation Programs (United States)

    Gase, Lauren N; Kuo, Tony; Lai, Elaine; Stoll, Michael A; Ponce, Ninez


    Objective This study sought to examine the impact of two Teen Courts operating in Los Angeles County, a juvenile justice system diversion program in which youth are judged by their peers and given restorative sentences to complete during a period of supervision. Methods A quasi-experimental design was used to compare youth who participated in Teen Court (n=112) to youth who participated in another diversion program administered by the Probation Department (the 654 Contract program) (n=194). Administrative data were abstracted from Probation records for all youth who participated in these programs between January 1, 2012 and June 20, 2014. Logistic and survival models were used to examine differences in recidivism - measured as whether the minor had any subsequent arrest or arrests for which the charge was filed. Results Comparison group participants had higher rates of recidivism than Teen Court participants, after controlling for age, gender, race/ethnicity, and risk level. While the magnitude of the program effects were fairly consistent across model specifications (odd ratios comparing Teen Court [referent] to school-based 654 Contract ranging from 1.95 to 3.07, hazard ratios ranging from 1.62 to 2.27), differences were not statistically significant in all scenarios. Conclusions While this study provides modest support for the positive impact of Teen Court, additional research is needed to better understand how juvenile diversion programs can improve youth outcomes. PMID:27547171

  16. Rifkin and NIH win in court ruling. (United States)

    Sun, M


    On 27 February 1985 Judge J. Skelly Wright of the U.S. Court of Appeals for the District of Columbia ruled that experiments involving the release of genetically altered organisms into the environment can proceed, provided that their potential ecological effects have been properly evaluated. The ruling has been hailed as a victory by both the National Institutes of Health (NIH) and Jeremy Rifkin. Rifkin brought suit against NIH in 1983, charging that the agency had failed to evaluate adequately the environmental impact of some deliberate release experiments. Sun discusses the implications of the judge's ruling. She also describes a move by private companies to submit their recombinant DNA experiment proposals to the Environmental Protection Agency rather than to NIH, which has regulatory authority only over academic researchers.

  17. Who can monitor the court interpreter's performance?

    DEFF Research Database (Denmark)

    Martinsen, Bodil


    and the conflict about her competence was negotiated. Because of this unusual constellation, combined with a multi-method approach, this single case study can shed some light on the question of the participants' ability to monitor the interpreter's performance. Legal professional users of interpreters tend......  Who can monitor the court interpreter's performance? Results of a case study This paper presents the results of a case study of an unusual interpreting event in a Danish courtroom setting. During the trial, the interpreter's non-normative performance was explicitly criticised by the audience...... are far less transparent for the legal participants than they normally assume. This problem, in turn, stresses the importance of a) the interpreter's competence and self-awareness and b) the use of check interpreters.  ...

  18. Regulatory behaviour under threat of court reversal

    DEFF Research Database (Denmark)

    Söderberg, Magnus; Menezes, Flavio; Santolino, Miguel


    , (ii) inexperienced regulators care more about not having their decisions overturned than experienced regulators, and (iii) experienced regulators also care about consumer surplus. The theoretical implications are tested using a database of Swedish regulatory decisions from the electricity distribution...... sector. We provide empirical evidence that inexperienced regulators are more likely to set higher regulated prices than experienced regulators, and as the complexity of the case increases, there are on averagemore overturned decisions and higher prices for inexperienced regulators. The links between...... experience, complexity and regulatory outcomes are both statistically and economically significant. Simulations show that if those decisions that were not appealed had been appealed, then the court would have lowered the prices by 10% on average....

  19. Dose-specific adverse drug reaction identification in electronic patient records: temporal data mining in an inpatient psychiatric population. (United States)

    Eriksson, Robert; Werge, Thomas; Jensen, Lars Juhl; Brunak, Søren


    Data collected for medical, filing and administrative purposes in electronic patient records (EPRs) represent a rich source of individualised clinical data, which has great potential for improved detection of patients experiencing adverse drug reactions (ADRs), across all approved drugs and across all indication areas. The aim of this study was to take advantage of techniques for temporal data mining of EPRs in order to detect ADRs in a patient- and dose-specific manner. We used a psychiatric hospital's EPR system to investigate undesired drug effects. Within one workflow the method identified patient-specific adverse events (AEs) and links these to specific drugs and dosages in a temporal manner, based on integration of text mining results and structured data. The structured data contained precise information on drug identity, dosage and strength. When applying the method to the 3,394 patients in the cohort, we identified AEs linked with a drug in 2,402 patients (70.8 %). Of the 43,528 patient-specific drug substances prescribed, 14,736 (33.9 %) were linked with AEs. From these links we identified multiple ADRs (p patient population, larger doses were prescribed to sedated patients than non-sedated patients; five antipsychotics [corrected] exhibited a significant difference (p<0.05). Finally, we present two cases (p < 0.05) identified by the workflow. The method identified the potentially fatal AE QT prolongation caused by methadone, and a non-described likely ADR between levomepromazine and nightmares found among the hundreds of identified novel links between drugs and AEs (p < 0.05). The developed method can be used to extract dose-dependent ADR information from already collected EPR data. Large-scale AE extraction from EPRs may complement or even replace current drug safety monitoring methods in the future, reducing or eliminating manual reporting and enabling much faster ADR detection.

  20. Activist Infighting among Courts and Breakdown of Mutual Trust?

    DEFF Research Database (Denmark)

    Neergaard, Ulla; Sørensen, Karsten Engsig


    had itself created it out of nowhere. In turn this appeared to be an implicit reference to the widely criticized interpretative approach of the CJEU, resulting in a far-reaching willingness to espouse judicial activism. But in acting as it did, it seems ironic that the Danish Supreme Court itself......, in this article the judgments are analysed in depth and placed into their wider context. Among other matters, we have considered how the courts should strike a sensitive balance, which has to exist in the relationship between the national courts and the CJEU, requiring mutual trust or, at the least, judicial......In its combative Ajos judgment recently rendered by the Danish Supreme Court, the court openly and controversially challenged the authority of the CJEU. By the same token, in the preliminary ruling by the CJEU preceding it, the CJEU had continued to develop the controversial general principle...

  1. Enrollment in mental health courts: voluntariness, knowingness, and adjudicative competence. (United States)

    Redlich, Allison D; Hoover, Steven; Summers, Alicia; Steadman, Henry J


    Mental health courts (MHCs) are rapidly expanding as a form of diversion from jails and prisons for persons with mental illness charged with crimes. Although intended to be voluntary, little is known about this aspect of the courts. We examined perceptions of voluntariness, and levels of knowingness and legal competence among 200 newly enrolled clients of MHCs at two courts. Although most clients claimed to have chosen to enroll, at the same time, most claimed not to have been told the court was voluntary or told of the requirements prior to entering. The majority knew the "basics" of the courts, but fewer knew more nuanced information. A minority also were found to have impairments in legal competence. Implications are discussed.

  2. The Constitutional Court and the Imperative of its Reform

    Directory of Open Access Journals (Sweden)

    Claudia Gilia


    Full Text Available Recent debates on the upcoming review of the Constitution have determined us to pay close attention to the basic institution in a democratic state, that is the Constitutional Court. Being caught in the crossfire between power and opposition, the Constitutional Court had a hard time lately, facing severe attacks. The aim of our study is to analyze the evolution of the Constitutional Court within the inland constitutional system, particularly bringing up the flaws describing the Court’s activity. We have also analyzed the proposals put forth by several bodies or experts regarding the constitutional contentious court. At the end of our study, following an analysis of different constitutional types of constitutional review, used by a number of states in Europe, we introduced several resolutions that may improve the role, the course and, last but not least, the activity of the Romanian Constitutional Court.

  3. Limits of verification by the Federal Constitutional Court

    International Nuclear Information System (INIS)



    The court of administration of Baden-Wuerttemberg passed a resolution on October 27,1983 - 10 S 1102/83 - dismissing the application to revoke the immediate implementation of the first partial construction permit for the joint nuclear power plant Neckar II. As the plaintiff thereupon lodged a complaint with the Federal Constitutional Court the resolution did not become effective immediately. However, the Federal Constitutional Court on October 1, 1984 decreed unanimously in accordance with the section 93a subsection 3 of the law on the Federal Constitutional Court - 1 BvR 231/84 -: ''The constitutional complaint lodged is not taken up for decision because its chances of success are nil.'' Thus the original decision of the court of administration of Baden-Wuerttemberg passed on October 27, 1983 was confirmed by the endorsement of its immediate implementation. (orig./HSCH) [de

  4. High court asked to review differing definitions of 'disability'. (United States)


    [Name removed] applied for and received Social Security benefits after losing his job at The Disney Stores, Inc. [Name removed], who has AIDS, alleges he was fired in violation of the Americans with Disabilities Act (ADA). The 3rd U.S. Circuit Court of Appeals said [name removed] could not sue [name removed] because of a discrepancy between his statements on the disability application and in the lawsuit. The Court said he had to choose between suing and accepting disability benefits. The court would not accept [name removed]'s argument that the definitions of disability under the Social Security Act and the ADA differed significantly. The U.S. Supreme Court has been asked to overturn this ruling. In a related case, the Michigan Court of Appeals invoked judicial estoppel to bar a worker from suing his employer under the State Handicappers' Civil Rights Act.

  5. Survey of patient and public perceptions of electronic health records for healthcare, policy and research: Study protocol

    Directory of Open Access Journals (Sweden)

    Luchenski Serena


    Full Text Available Abstract Background Immediate access to patients’ complete health records via electronic databases could improve healthcare and facilitate health research. However, the possible benefits of a national electronic health records (EHR system must be balanced against public concerns about data security and personal privacy. Successful development of EHR requires better understanding of the views of the public and those most affected by EHR: users of the National Health Service. This study aims to explore the correlation between personal healthcare experience (including number of healthcare contacts and number and type of longer term conditions and views relating to development of EHR for healthcare, health services planning and policy and health research. Methods/design A multi-site cross-sectional self-complete questionnaire designed and piloted for use in waiting rooms was administered to patients from randomly selected outpatients’ clinics at a university teaching hospital (431 beds and general practice surgeries from the four primary care trusts within the catchment area of the hospital. All patients entering the selected outpatients clinics and general practice surgeries were invited to take part in the survey during August-September 2011. Statistical analyses will be conducted using descriptive techniques to present respondents’ overall views about electronic health records and logistic regression to explore associations between these views and participants’ personal circumstances, experiences, sociodemographics and more specific views about electronic health records. Discussion The study design and implementation were successful, resulting in unusually high response rates and overall recruitment (85.5%, 5336 responses. Rates for face-to-face recruitment in previous work are variable, but typically lower (mean 76.7%, SD 20. We discuss details of how we collected the data to provide insight into how we obtained this unusually high

  6. Implementation of Indigenous Electronic Medical Record System to Facilitate Care of Sickle Cell Disease Patients in Chhattisgarh. (United States)

    Choubey, Mona; Mishra, Hrishikesh; Soni, Khushboo; Patra, Pradeep Kumar


    Sickle cell disease (SCD) is prevalent in central India including Chhattisgarh. Screening for SCD is being carried out by Government of Chhattisgarh. Electronic Medical Record (EMR) system was developed and implemented in two phases. Aim was to use informatics techniques and indigenously develop EMR system to improve the care of SCD patients in Chhattisgarh. EMR systems had to be developed to store and manage: i) huge data generated through state wide screening for SCD; ii) clinical data for SCD patients attending the outpatient department (OPD) of institute. 'State Wide Screening Data Interface' (SWSDI) was designed and implemented for storing and managing data generated through screening program. Further, 'Sickle Cell Patients Temporal Data Management System' (SCPTDMS) was developed and implemented for storing, managing and analysing sickle cell disease patients' data at OPD. Both systems were developed using VB.Net and MS SQL Server 2012. Till April 2015, SWSDI has data of 1294558 persons, out of which 121819 and 4087 persons are carriers and patients of sickle cell disease respectively. Similarly till June 2015, SCPTDMS has data of 3760 persons, of which 923 are sickle cell disease patients (SS) and 1355 are sickle cell carriers (AS). Both systems are proving to be useful in efficient storage, management and analysis of data for clinical and research purposes. The systems are an example of beneficial usage of medical informatics solutions for managing large data at community level.

  7. The Modernization of the Audit Courts of Brazil: PROMOEX deployment assessment in Audit Courts subnational

    Directory of Open Access Journals (Sweden)

    Diones Gomes da Rocha


    Full Text Available Mainly since the Brazilian Federal Constitution of 1988, the Brazilian Courts of Accounts (TC had expanded its expertise to carry out the control of management of public entities on different perspectives, such as operational, accounting, budgetary and financial. The differences between these institutions in terms of economic, technological and human resources were factors that made it difficult to adapt these institutions to the new acquired competences. The Promoex then emerged as a solution for modernization of Brazilian subnational Courts of Accounts. Such solution had funds of US $ 64.4 million dollars. The purpose of this research, therefore, is to assess the implementation of this program by 33 TCs. The evaluation was conducted from documents collected from web pages of MPOG, ATRICON, IRB and the Portal of Brazil Courts of Accounts. The Loan Agreement 1628-OC / BR, Object Compliance Report, Progress Reports of the 1st and 2nd semesters of 2013 (final report, and surveys conducted by the FIA and FGV also were scrutinized. The results indicate that the Promoex was less than expected; the modernization proposals were more focused on solving administrative problems, as well as by the low impact of Promoex over the actions developed by the TCs.

  8. A People’s Court? A Bottom-up approach to litigation before the Euopean Court of Justice

    NARCIS (Netherlands)

    Hoevenaars, J.


    Each year the European Court of Justice delivers over a thousand decisions on the basis of EU law that affect the Members States as well as the lives of their citizens. Most of these decisions are the result of requests for a preliminary ruling sent by national courts and tribunals seeking an

  9. The Hellenistic Royal Court. Court Culture, Ceremonial and Ideology in Greece, Egypt and the Near East, 336-30 BCE

    NARCIS (Netherlands)

    Strootman, R.


    In the Hellenistic empires of Alexander the Great and his successors in Greece, Egypt and the Near East, new forms of court culture and political ideology developed during the last three centuries BCE. Appropriated by Parthian kings and Roman emperors alike, the culture of these Macedonian courts

  10. A Standing Investment Court under TTIP from the Perspective of the Court of Justice of the European Union

    NARCIS (Netherlands)

    Gáspár-Szilágyi, S.


    This article critically assesses the feasibility of the recently proposed Investment Court System (ICS) under the envisaged Transatlantic Trade and Investment Partnership (TTIP), from the perspective of the Court of Justice of the European Union (CJEU). It is argued that an ex ante assessment of the

  11. The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records. (United States)

    Bruns, F J; Seddon, P; Saul, M; Zeidel, M L


    The costs of care for end-stage renal disease patients continue to rise because of increased numbers of patients. Efforts to contain these costs have focused on the development of capitated payment schemes, in which all costs for the care of these patients are covered in a single payment. To determine the effect of a capitated reimbursement scheme on care of dialysis patients (both hemodialysis [HD] and peritoneal dialysis [PD]), complete financial records (all reimbursements for inpatient and outpatient care, as well as physician collections) of dialysis patients at a single medical center over 1 year were analyzed. For the period from July 1994 to July 1995, annualized cost per dialysis patient-year averaged $63,340, or 9.8% higher than the corrected estimate from the U.S. Renal Data Service (USRDS; $57,660). The "most expensive" 25% of patients engendered 44 to 48% of the total costs, and inpatient costs accounted for 37 to 40% of total costs. Nearly half of the inpatient costs resulted from only two categories (room charges and inpatient dialysis), whereas other categories each made up a small fraction of the inpatient costs. PD patients were far less expensive to care for than HD patients, due to reduced hospital days and lower cost of outpatient dialysis. Care for a university-based dialysis population was only slightly more expensive than estimates predicted from the USRDS. These results validate the USRDS spending data and suggest that they can be used effectively for setting capitated rates. Efforts to control costs without sacrificing quality of care must center on reducing inpatient costs, particularly room charges and the cost of inpatient dialysis.

  12. [Introduction of computerized anesthesia-recording systems and construction of comprehensive medical information network for patients undergoing surgery in the University of Tokyo Hospital]. (United States)

    Kitamura, Takayuki; Hoshimoto, Hiroyuki; Yamada, Yoshitsugu


    The computerized anesthesia-recording systems are expensive and the introduction of the systems takes time and requires huge effort. Generally speaking, the efficacy of the computerized anesthesia-recording systems on the anesthetic managements is focused on the ability to automatically input data from the monitors to the anesthetic records, and tends to be underestimated. However, once the computerized anesthesia-recording systems are integrated into the medical information network, several features, which definitely contribute to improve the quality of the anesthetic management, can be developed; for example, to prevent misidentification of patients, to prevent mistakes related to blood transfusion, and to protect patients' personal information. Here we describe our experiences of the introduction of the computerized anesthesia-recording systems and the construction of the comprehensive medical information network for patients undergoing surgery in The University of Tokyo Hospital. We also discuss possible efficacy of the comprehensive medical information network for patients during surgery under anesthetic managements.

  13. Electronic patient records in action: Transforming information into professionally relevant knowledge. (United States)

    Winman, Thomas; Rystedt, Hans


    The implementation of generic models for organizing information in complex institutions like those in healthcare creates a gap between standardization and the need for locally relevant knowledge. The present study addresses how this gap can be bridged by focusing on the practical work of healthcare staff in transforming information in EPRs into knowledge that is useful for everyday work. Video recording of shift handovers on a rehabilitation ward serves as the empirical case. The results show how extensive selections and reorganizations of information in EPRs are carried out in order to transform information into professionally relevant accounts. We argue that knowledge about the institutional obligations and professional ways of construing information are fundamental for these transitions. The findings point to the need to consider the role of professional knowledge inherent in unpacking information in efforts to develop information systems intended to bridge between institutional and professional boundaries in healthcare. © The Author(s) 2011.

  14. Towards Standardized Patient Data Exchange: Integrating a FHIR Based API for the Open Medical Record System. (United States)

    Kasthurirathne, Suranga N; Mamlin, Burke; Grieve, Grahame; Biondich, Paul


    Interoperability is essential to address limitations caused by the ad hoc implementation of clinical information systems and the distributed nature of modern medical care. The HL7 V2 and V3 standards have played a significant role in ensuring interoperability for healthcare. FHIR is a next generation standard created to address fundamental limitations in HL7 V2 and V3. FHIR is particularly relevant to OpenMRS, an Open Source Medical Record System widely used across emerging economies. FHIR has the potential to allow OpenMRS to move away from a bespoke, application specific API to a standards based API. We describe efforts to design and implement a FHIR based API for the OpenMRS platform. Lessons learned from this effort were used to define long term plans to transition from the legacy OpenMRS API to a FHIR based API that greatly reduces the learning curve for developers and helps enhance adhernce to standards.

  15. Bootstrapping a de-identification system for narrative patient records: cost-performance tradeoffs. (United States)

    Hanauer, David; Aberdeen, John; Bayer, Samuel; Wellner, Benjamin; Clark, Cheryl; Zheng, Kai; Hirschman, Lynette


    We describe an experiment to build a de-identification system for clinical records using the open source MITRE Identification Scrubber Toolkit (MIST). We quantify the human annotation effort needed to produce a system that de-identifies at high accuracy. Using two types of clinical records (history and physical notes, and social work notes), we iteratively built statistical de-identification models by annotating 10 notes, training a model, applying the model to another 10 notes, correcting the model's output, and training from the resulting larger set of annotated notes. This was repeated for 20 rounds of 10 notes each, and then an additional 6 rounds of 20 notes each, and a final round of 40 notes. At each stage, we measured precision, recall, and F-score, and compared these to the amount of annotation time needed to complete the round. After the initial 10-note round (33min of annotation time) we achieved an F-score of 0.89. After just over 8h of annotation time (round 21) we achieved an F-score of 0.95. Number of annotation actions needed, as well as time needed, decreased in later rounds as model performance improved. Accuracy on history and physical notes exceeded that of social work notes, suggesting that the wider variety and contexts for protected health information (PHI) in social work notes is more difficult to model. It is possible, with modest effort, to build a functioning de-identification system de novo using the MIST framework. The resulting system achieved performance comparable to other high-performing de-identification systems. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Evaluating Student Self-Assessment through Video-Recorded Patient Simulations. (United States)

    Sanderson, Tammy R; Kearney, Rachel C; Kissell, Denise; Salisbury, Jessica


    The purpose of this pilot study was to determine if the use of a video-recorded clinical session affects the accuracy of dental hygiene student self-assessment and dental hygiene instructor feedback. A repeated measures experiment was conducted. The use of the ODU 11/12 explorer was taught to students and participating faculty through video and demonstration. Students then demonstrated activation of the explorer on a student partner using the same technique. While faculty completed the student assessment in real time, the sessions were video recorded. After completing the activation of the explorer, students and faculty completed an assessment of the student's performance using a rubric. A week later, both students and faculty viewed the video of the clinical skill performance and reassessed the student's performance using the same rubric. The student videos were randomly assigned a number, so faculty reassessed the performance without access to the student's identity or the score that was initially given. Twenty-eight students and 4 pre-clinical faculty completed the study. Students' average score was 4.68±1.16 on the first assessment and slightly higher 4.89±1.45 when reviewed by video. Faculty average scores were 5.07±2.13 at the first assessment and 4.79±2.54 on the second assessment with the video. No significant differences were found between the differences in overall scores, there was a significant difference in the scores of the grading criteria compared to the expert assessment scores (p=0.0001). This pilot study shows that calibration and assessment without bias in education is a challenge. Analyzing and incorporating new techniques can result in more exact assessment of student performance and self-assessment. Copyright © 2016 The American Dental Hygienists’ Association.

  17. A clinical study of short-term sternal photoplethysmography: recordings from patients with obstructive airways diseases

    DEFF Research Database (Denmark)

    Chreiteh, Shadi; Saadi, Dorthe Bodholt; Belhage, Bo


    and commercially accepted range. We then compared the SpO2 levels simultaneously obtained from the sternal PPGs and a commercially available finger pulse oximeter on 28 admitted patients with either asthma or Chronic Obstructive Pulmonary Disease (COPD). The Pearson correlation between the SpO2 levels estimated...

  18. Video-recorded simulated patient interactions: can they help develop clinical and communication skills in today's learning environment? (United States)

    Seif, Gretchen A; Brown, Debora


    It is difficult to provide real-world learning experiences for students to master clinical and communication skills. The purpose of this paper is to describe a novel instructional method using self- and peer-assessment, reflection, and technology to help students develop effective interpersonal and clinical skills. The teaching method is described by the constructivist learning theory and incorporates the use of educational technology. The learning activities were incorporated into the pre-clinical didactic curriculum. The students participated in two video-recording assignments and performed self-assessments on each and had a peer-assessment on the second video-recording. The learning activity was evaluated through the self- and peer-assessments and an instructor-designed survey. This evaluation identified several themes related to the assignment, student performance, clinical behaviors and establishing rapport. Overall the students perceived that the learning activities assisted in the development of clinical and communication skills prior to direct patient care. The use of video recordings of a simulated history and examination is a unique learning activity for preclinical PT students in the development of clinical and communication skills.

  19. Federal Constitutional Court, decision of October 5, 1982 (''Stade'')

    International Nuclear Information System (INIS)



    With the decision of October 5, 1982, the preliminary appraisal committee of the Federal Constitutional Court did not accept for trial the appeal on constitutional grounds against the judgment of December 22, 1980 of the Federal Administrative Court (BVerwGE 61, 256), which dismissed the action for anulment of the 7th part-construction permit for Stade nuclear power plant launched by the apellant domiciled at a distance of about 25 km from said power plant. The committee states that there are doubts even as to the admissibility of the appeal. There is no infringement of Art. 19, Para. 4 of the Basic Law, the court says, and explains the requirements to be met by the statement proving one's case. The apellant did not explain why Art. 3, Para. 1, 2 Para. 1, or 103, Para. 1 Basic Law present a reason to commence legal proceedings, and the court comes to the conclusion that even assuming admissibility on other grounds, the action would most likely be unsuccessful. The court does not accept the opinion stated by the apellant, that the Fed. Adm. Court demanded too stringent requirements for proving one's case, in this particular case the right of third parties affected to call for legal protection. The court furthermore states that there is not sufficient reason to appeal against the preclusion of the apellant's complaints in accordance with section 7 b of the Atomic Energy Act, or section 3(1) of the Nuclear Installations Ordinance. (HP) [de

  20. Informative value of radiological findings recorded from cervical spine with reference to clinical symptoms in patients with cervical syndrome

    International Nuclear Information System (INIS)

    Loreck, D.; Kuehn, A.; Conradi, E.


    Static X-rays recorded at two planes from the cervical spine of 286 patients were evaluated and were compared to findings obtained from 50 probands without complaints. The patients complained about problems relating to vertebrogenic pain syndrome of the cervical spine, including vertigo of cervical origin. They were grouped by four sets of clinical symptoms (cephalgia, vertigo, locally delimited complaints and cervicobrachial syndrome). No statistically significant differences were found to exist among the groups of probands with regard to radiographic morphology, static condition nor impairment of relations. Particular reference is made in this paper to reversible function disorders and their major role among the multifactorial causes of the cervical syndrome. Indications are derived from these observations for primary X-ray examination of the cervical spine. (orig.) [de