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Sample records for abuse patient records

  1. Confidentiality of Alcohol and Drug Abuse Patient Records. Participant Manual.

    ERIC Educational Resources Information Center

    Coggins, Patrick C.; And Others

    This participant manual is designed to provide an overview of federal laws and regulations pertaining to the confidentiality of alcohol and drug abuse patient records. The relationship of federal laws to state laws and regulations is also discussed. The materials, useful for persons involved in the fields of substance abuse treatment or…

  2. 42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... abuse patient records. 2.1 Section 2.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND 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...

  3. 42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... abuse patient records. 2.1 Section 2.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND 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...

  4. 42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... abuse patient records. 2.1 Section 2.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND 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...

  5. 42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... abuse patient records. 2.1 Section 2.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND 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...

  6. 42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... abuse patient records. 2.1 Section 2.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND 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...

  7. 42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... suspected child abuse and neglect to State or local authorities The prohibitions of this section do not... suspected child abuse and neglect to the appropriate State or local authorities. (f) Penalty for first and... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH...

  8. 42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... suspected child abuse and neglect to State or local authorities The prohibitions of this section do not... suspected child abuse and neglect to the appropriate State or local authorities. (f) Penalty for first and... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH...

  9. 42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... suspected child abuse and neglect to State or local authorities The prohibitions of this section do not... suspected child abuse and neglect to the appropriate State or local authorities. (f) Penalty for first and... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH...

  10. 42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... suspected child abuse and neglect to State or local authorities The prohibitions of this section do not... suspected child abuse and neglect to the appropriate State or local authorities. (f) Penalty for first and... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH...

  11. 42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... suspected child abuse and neglect to State or local authorities The prohibitions of this section do not... suspected child abuse and neglect to the appropriate State or local authorities. (f) Penalty for first and... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH...

  12. Drug and alcohol abuse in patients with acute burn injuries.

    PubMed

    Swenson, J R; Dimsdale, J E; Rockwell, E; Carroll, W; Hansbrough, J

    1991-01-01

    We reviewed records of adult patients admitted to our burn unit who were reported to abuse drugs or alcohol from 1985 to 1988. The proportion of patients reported as abusing drugs increased significantly from 1987 to 1988, compared to previous years. However, there was no increase in the proportion of patients reported to abuse alcohol. Patients identified as abusing drugs had longer hospital stays, compared to patients who were not reported to abuse substances. Methamphetamine and cocaine were the drugs most often abused by patients who abused drugs or both drugs and alcohol. Mechanisms of burn injury in these patients included "accidental" burn injury related to acute intoxication, and self-injury due to psychosis or depression. PMID:1882020

  13. Assisting sexually abused adults. Practical guide to interviewing patients.

    PubMed Central

    Leach, M. M.; Bethune, C.

    1996-01-01

    Millions of adults have been sexually abused. Patients often confide in their family physicians concerning their abuse. Physicians must understand their own issues surrounding sexual abuse and its sequelae before they attempt to treat sexually abused patients. The PLISSIT model offers a practical guide for assisting abused adult patients. PMID:8924817

  14. Dental care of patients with substance abuse.

    PubMed

    Bullock, K

    1999-07-01

    Patients who abuse alcohol, crack, heroin or prescription drugs, are likely to interact with the dental professional. The dentist should therefore be able to identify problems of abuse and provide informed care and referral. Substance abuse should be a consideration in all patients who present with dental trauma and those who present with frequent vague complaints, multiple pain medication allergies, and regimens with multiple narcotic medications. Polydrug use, either prescription or illicit, is also a possibility, and effective treatment requires prompt recognition. Dentists should be alert to drug-seeking behavior within the context of pain management, and because pain severity is an objective experience, each patient must be treated carefully and sensitively. Unrelieved or unremitting pain can be a relapse trigger and therefore adequate pain control is a necessity in the recovering chemically dependent patient. New modalities, such as coanalgesia with low-dose ketamine in the opioid addicted have been shown to work effectively. In the post-dental surgical patient with chemical dependency, agents with less psychoactive activity than their drugs of abuse, such as extended-release morphine (MS Contin) have been tried with variable success. An informed treatment plan includes recognition of substance abuse, appropriate intervention, and referral. This plan may include universal screening, followed by brief interventional therapy for positive patients and in some cases, pharmacological pain control. On discharge from the office, instructions concerning referral to a substance abuse program or, in the case of the patient who may require more immediate treatment, to the emergency department are important. PMID:10516924

  15. Pregabalin Abuse amongst Opioid Substitution Treatment Patients.

    PubMed

    McNamara, S; Stokes, S; Kilduff, R; Shine, A

    2015-01-01

    Pregabalin (Lyrica®) is used in treating epilepsy, nerve pain and anxiety. Pregabalin was initially thought to have a low misuse potential however there are emerging reports of Pregabalin being abused. A study was commenced at the National Drug Treatment Centre's (NDTC) Drug Analysis Laboratory to determine the level of usage of Pregabalin within the addiction services population in Ireland. A total of 498 urine samples representing samples from 440 individual opioid substitution patients, initially screened by immunoassay for drugs of abuse, were subjected to further analysis for Pregabalin by Liquid Chromatography/Mass Spectrometry (LC/MS). Of 440 patients tested, 39 tested positive for Pregabalin (9.2%). Only 10 patients from this group were prescribed this drug to our knowledge thus giving an estimated rate of misuse of 7.0%. Other drugs detected in the Pregabalin positive patients were Opiates (31.8%), Cocaine (11.4%), Benzodiazepines (79.5%) and Cannabis (77.8%). Our study confirms that Pregabalin abuse is taking place amongst the addiction services population. We believe that misuse of this prescription drug is a serious emerging issue which should be monitored carefully. PMID:26817289

  16. Among a German Sample of Forensic Patients, Previous Animal Abuse Mediates Between Psychopathy and Sadistic Actions.

    PubMed

    Stupperich, Alexandra; Strack, Micha

    2016-05-01

    In an attempt to explain the relationship between psychopathy and severe violent behavior, this study associates previous animal abuse, psychopathy, and sadistic acting in forensic patients. Two topics are addressed: (i) whether previous animal abuse can be identified by a patient's Psychopathy Checklist profile and (ii) whether animal abuse statistically mediates between psychopathy and sadistic acting. In a German forensic hospital, 60 patients were investigated. Animal abuse was assessed using face-to-face interviews and the Psychopathy Checklist: Screening Version (PCL:SV), and sadistic acting was identified by file records.Discriminant analysis separated previous animal abuse (10/60) by high adolescent antisocial behavior, superficiality, lack of remorse, lack of empathy, and grandiosity. The mediation from psychopathy to sadistic acting (6/60) through animal abuse was found to be complete.The results, although sample size is limited and base rate of animal abuse and sadistic acting are low, fit with a model suggestive of animal abuse as a causal step toward sadistic crimes. Animal abuse correlates with callous, unemotional traits, and a development of sadistic crimes. PMID:27122409

  17. Prescription drug abuse. Patient, physician, and cultural responsibilities.

    PubMed

    Wesson, D R; Smith, D E

    1990-05-01

    The abuse of prescription drugs is one facet of America's drug problem that is particularly complex because access to prescription drugs must be maintained for some purposes and contained for others. The American Medical Association has sponsored two national conferences to grapple with the confluence of the medical access to prescription drugs and a national drug abuse control policy. One result has been a classification of misprescribing physicians that blames physicians for prescription drug abuse. The conceptualization and public policy response to prescription drug abuse have been largely shaped by the emotional response to the epidemic of crack cocaine and other nonprescription drug abuse. A new perspective is needed--one that accommodates the evolving role of physicians in society, the life-style choices that physicians enable in their patients, and the respective responsibilities of both physicians and patients in physician-patient transactions. PMID:2349802

  18. Newborn Patients of Mothers with Substance Abuse

    PubMed Central

    Albersheim, Susan G.

    1991-01-01

    It is important to identify high-risk women abusing drugs in order to provide good care for them and their babies. These infants require close observation after birth for perinatal complications withdrawal, long-term neurobehavioral abnormalities (even with drug use only early in pregnancy), and sudden infant death syndrome. The degree of withdrawal is not an indicator of outcome. Early involvement of Child Protective Services is important for this group, at risk for abuse and neglect. PMID:21228966

  19. Abuse of family physicians by patients seeking controlled substances

    PubMed Central

    Saveland, Christine; Hawker, Leisha; Miedema, Baukje; MacDougall, Peter

    2014-01-01

    Abstract Objective To examine family physicians’ career prevalence and monthly incidence of workplace abuse by controlled substance prescription seekers. Design A 4-page cross-sectional survey. Setting A family medicine continuing medical education event in Halifax, NS. Participants The survey was distributed to 316 family physicians attending the continuing medical education event. Main outcome measures Career prevalence and monthly incidence of workplace abuse related to the act of prescribing controlled substances. Results Fifty-six percent (n = 178) of the 316 surveys were returned completed. Half the study participants were men (49%). Most study participants were in private practice and lived in Nova Scotia, and approximately half (51%) practised in urban settings. On average, the study participants had 20 years of practice experience. The career prevalence of abusive encounters related to controlled substance prescribing was divided into “minor,” “major,” and “severe” incidents. Overall, 95% of study participants reported having experienced at least 1 incident of minor abuse; 48% had experienced at least 1 incident of major abuse; and 17% had experienced at least 1 incident of severe abuse during their careers. Further, 30% reported having been abused in the past month; among those, the average number of abusive encounters was 3. Most (82%) of the abusers were male with a history of addiction (85%) and mental illness (39%). Opioids were the most frequently sought controlled substance. Conclusion Abuse of family physicians by patients seeking controlled substances is substantial. Family physicians who prescribe controlled substances are at risk of being subjected to minor, major, or even severe abuse. Opioids were the most often sought controlled substance. A national discussion to deal with this issue is needed. PMID:24522691

  20. The patient-physician relationship and the sexual abuse of patients.

    PubMed Central

    1994-01-01

    The CMA's policy on the patient-physician relationship and the sexual abuse of patients follows a review of policies and initiatives of its provincial and territorial divisions and other professional associations. The CMA's approach to this policy has been to consider the overall patient-physician relationship in order to understand factors associated with functional and dysfunctional relationships, including those involving sexual abuse. In addition to defining abuse of patients by physicians in general and sexual abuse in particular this document gives guidelines on such issues as sexual or romantic relationships with current or former patients and provides educational and preventive strategies. PMID:8199968

  1. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    ERIC Educational Resources Information Center

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  2. Management of the patient in labor who has abused substances.

    PubMed

    Geary, Franklyn H; Turnquest Wells, Mureena A

    2013-03-01

    The drug abusing patient can provide a management dilemma for health care providers including nurses, obstetrician, anesthesiologist, and pediatrician. Certain illicit drugs may mimic other diseases of pregnancy and result in inappropriate treatment for the mother and child. Pain management may be challenging in such patients because of increasing drug tolerance and increased sensitivity to pain. This article highlights the clinical presentation in a pregnant patient who may have recently used some of the more commonly abused drugs. The ability to identify such a patient is crucial so that the appropriate screening and treatment can occur. PMID:23370170

  3. Abuse

    MedlinePlus

    ... also may fall prey to strangers who take advantage of their cognitive impairment. Types of abuse Signs ... property) to his or her disadvantage or the advantage of someone else Sexual abuse: touching, fondling or ...

  4. Association of abuse history with symptom severity and quality of life in patients with fibromyalgia.

    PubMed

    Jiao, Juan; Vincent, Ann; Cha, Stephen S; Luedtke, Connie A; Oh, Terry H

    2015-03-01

    A high prevalence of abuse has been reported in patients with fibromyalgia. We aimed to examine the association between self-reported abuse history and symptom severity and quality of life (QOL) in 962 patients with fibromyalgia. All patients completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form 36 health survey (SF-36). Multivariate regression analyses were performed. In total, 289 patients (30%) reported a history of abuse. Of those who specified abuse types, 161 patients (59%) reported more than 1 type of abuse (36% emotional, 32% physical, 25% sexual, and 7% verbal). Patients in the abuse group were younger and more likely to be female, unemployed, unmarried, and current smokers compared with patients who reported no abuse. After adjusting for these differences, abuse history was associated with worse symptoms, as indicated by a higher FIQ total score (P < .001) and higher FIQ subscale scores in physical function (P = .001), work missed (P < .001), job ability (P < .001), pain (P = .02), depression (P < .001), and anxiety (P < .001). Similarly, abuse history was associated with worse QOL, with lower SF-36 scores in all domains except the physical component summary. In conclusion, abuse history in patients with fibromyalgia was associated with worse symptoms and QOL compared with those patients without abuse history. Future studies are needed to assess whether additional tailored interventions as part of fibromyalgia treatment are helpful for patients with a history of abuse. PMID:25129032

  5. Benefits of listening to a recording of euphoric joint music making in polydrug abusers

    PubMed Central

    Fritz, Thomas Hans; Vogt, Marius; Lederer, Annette; Schneider, Lydia; Fomicheva, Eira; Schneider, Martha; Villringer, Arno

    2015-01-01

    Background and Aims: Listening to music can have powerful physiological and therapeutic effects. Some essential features of the mental mechanism underlying beneficial effects of music are probably strong physiological and emotional associations with music created during the act of music making. Here we tested this hypothesis in a clinical population of polydrug abusers in rehabilitation listening to a previously performed act of physiologically and emotionally intense music making. Methods: Psychological effects of listening to self-made music that was created in a previous musical feedback intervention were assessed. In this procedure, participants produced music with exercise machines (Jymmin) which modulate musical sounds. Results: The data showed a positive effect of listening to the recording of joint music making on self-efficacy, mood, and a readiness to engage socially. Furthermore, the data showed the powerful influence of context on how the recording evoked psychological benefits. The effects of listening to the self-made music were only observable when participants listened to their own performance first; listening to a control music piece first caused effects to deteriorate. We observed a positive correlation between participants’ mood and their desire to engage in social activities with their former training partners after listening to the self-made music. This shows that the observed effects of listening to the recording of the single musical feedback intervention are influenced by participants recapitulating intense pleasant social interactions during the Jymmin intervention. Conclusions: Listening to music that was the outcome of a previous musical feedback (Jymmin) intervention has beneficial psychological and probably social effects in patients that had suffered from polydrug addiction, increasing self-efficacy, mood, and a readiness to engage socially. These intervention effects, however, depend on the context in which the music recordings are

  6. [Response to treatment of patients abusing the "dappou drug" who participated in a group relapse prevention program: a comparison with patients abusing methamphetamine].

    PubMed

    Hikitsuchi, Emi; Matsumoto, Toshihiko; Wada, Kiyoshi; Tanibuchi, Yuko; Takano, Ayumi; Imamura, Fumi; Kawachi, Hiraku; Wakabayashi, Asako; Kato, Takashi

    2014-12-01

    In this study, we compared the efficacy of a group relapse prevention program using the cognitive behavioral therapy-based workbook, Serigaya Methamphetamine Relapse Prevention Program (SMARPP), between patients abusing the so-called "dappou drugs" (designer drug in Japan, and those abusing methamphetamine (MAP). Both groups participated in the SMARPP at the Center Hospital, National Center of Neurology and Psychiatry. Results showed that, no significant differences were found in the rates of participation in the program or self-reported frequency of drug or alcohol use between the patients abusing "dappou drugs" or MAP. However, patients using "dappou drugs" reported no significant increase in their confidence in their ability to resist the temptation to use drugs on the self- report drug abuse scales after the SMARPP intervention, while patients abusing MAP reported a significant positive difference in their ability to resist temptation. In addition, insight into substance abuse problems and motivation to participate in further treatment slightly declined in those using "dappou drugs," while there was a significant increase reported by the patients using MAP. These results suggested that the SMARPP might not be as effective for patients abusing "dappou drugs" as for those abusing MAP. The development of a relapse prevention program specifically designed for patients abusing "dappou drugs" is required. PMID:25831947

  7. Arab Parents' Reactions to Child Sexual Abuse: A Review of Clinical Records

    ERIC Educational Resources Information Center

    Abu-Baker, Khawla

    2013-01-01

    This paper addresses parents' reactions to sexual abuse cases in their families. The study analyzed the clinical records of individual and family therapy sessions with 35 cases of Arab Palestinian clients, citizens of Israel (27 individuals and 8 families). Families were categorized as either functional or dysfunctional. It was concluded that…

  8. Psychological, physical, and sexual abuse in addicted patients who undergo treatment.

    PubMed

    Fernández-Montalvo, Javier; López-Goñi, José J; Arteaga, Alfonso

    2015-05-01

    This study explored the prevalence of a history as victims of abuse among patients who sought outpatient treatment for drug addiction. A sample of 252 addicted patients was assessed. Information was collected on the patients' lifetime history of abuse (psychological, physical, and/or sexual abuse), sociodemographic factors, consumption factors, psychopathological factors, and personality variables. Drug-addicted patients who present a lifelong history of abuse were compared with patients who were not abused. Of the total sample, 46% of the patients (n = 115) who were addicted to drugs had been victims of abuse. There was a statistically significant difference between the victimization rates of men (37.8%) and women (79.6%). Moreover, for some variables, significant differences were observed between patients who had been abused and those who had not. Compared with patients who had not been abused, the addicted patients with a history of victimization scored significantly higher on several European Addiction Severity Index, Millon Clinical Multiaxial Inventory-II, and maladjustment variables but not on the Symptom Checklist-90-Revised. The current results indicate that patients who present a lifelong history of abuse exhibit both a more severe addiction than patients who were not abused and several comorbidities. The implications of these results for further research and clinical practice are discussed. PMID:24992952

  9. [Analgesic abuse and psychiatric comorbidity in headache patients].

    PubMed

    Radat, F; Irachabal, S; Swendsen, J; Henry, P

    2002-01-01

    Headache patients frequently overuse analgesic medications: 20% of the patients from headache centers is concerned by this problem, which has been estimated to occur in four percent of the community migrainers. Frequent use of various types of headache medication may paradoxically cause an increase in headache attack frequency as well as their chronicisation due to potentially complex mechanisms of sensitization. Patients will enter into a self- perpetuating cycle of daily headaches and use of symptomatic medications which can lead to addiction and to social and occupational impairement. Indeed, many patients will experience pharmacological tolerance and dependence but also by some kind of craving. International Headache Society qualify these patients as abusers referring mostly to the amount of substance ingested. Hence patients are labelled analgesic abusers . However, as many of these analgesic medications contained psychotropic substances (i.e. caffeine, codeine.), these patients may fulfill DSM IV criteria of dependance. Nevertheless, the dependance criteria should be adapted to chronic pain patients. Indeed, if pharmacological dependence and tolerance criteria are easy to apply in such patients, it is not the case for the criteria a great deal of time spent to obtain substances, to use substances or to recover from substances effects . As analgesic medications are legally obtained from medical practitioners, drug seeking behaviours are mostly: obtaining medications from multiple providers, repeating episodes of prescription loss and multiplying requests for early refills. Moreover the detrimental effects of analgesic abuse on psychosocial functioning is likely to be related to pain rather than to medication overuse. Finally the best indicator of addictive behaviors in such patients, is the loss of control over the use of analgesic medication despite the adverse consequences over pain. Comorbidity with addiction to other substances has never been specifically

  10. Did Freud mislead patients to confabulate memories of abuse?

    PubMed

    Powell, R A; Boer, D P

    1994-06-01

    Freud's abandonment of the seduction theory within a year of first proposing it has been the subject of considerable recent debate and speculation. Closer examination of Freud's writings, however, shows that he had often used highly suggestive procedures to elicit the memories of childhood "seductions" from his patients. Moreover, he had not considered alternative explanations for the evidence he presented when first claiming that these recovered memories of sexual abuse were real. Nevertheless, some present-day authors have argued for the validity of recovered memories by presenting much the same type of evidence that Freud once did. Research is needed to assess the extent to which recovered memories can be clearly corroborated and to establish rules for distinguishing between real and false memories of abuse. PMID:8084947

  11. Patients reporting ritual abuse in childhood: a clinical syndrome. Report of 37 cases.

    PubMed

    Young, W C; Sachs, R G; Braun, B G; Watkins, R T

    1991-01-01

    Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. Patients came from a variety of separate clinical settings and geographical locations and reported a number of similar abuses. The most frequently reported types of ritual abuse are outlined, and a clinical syndrome is presented which includes dissociative states with satanic overtones, severe post-traumatic stress disorder, survivor guilt, bizarre self abuse, unusual fears, sexualization of sadistic impulses, indoctrinated beliefs, and substance abuse. Questions relating to issues of reliability, credibility and verifiability are addressed in depth, and the findings and implications are discussed. PMID:2043970

  12. Reduced gray matter volume in psychotic disorder patients with a history of childhood sexual abuse.

    PubMed

    Sheffield, Julia M; Williams, Lisa E; Woodward, Neil D; Heckers, Stephan

    2013-01-01

    Childhood trauma is associated with smaller gray matter volume, similar to the pattern seen in psychotic disorders. We explored the relationship between childhood abuse, psychosis, and brain volume in a group of 60 individuals with a psychotic disorder and 26 healthy control subjects. We used voxel-based morphometry (VBM) to quantify gray and white matter volume and the Childhood Trauma Questionnaire (CTQ) to measure childhood abuse. Within the psychotic disorder group, total gray matter volume was inversely correlated with the severity of childhood sexual abuse (r=-.34, p=.008), but not the other types of abuse. When the 24 patients with sexual abuse were compared with demographically matched samples of 23 patients without sexual abuse and 26 control subjects, only patients with a history of sexual abuse had reduced total gray matter volume (t(48)=2.3, p=.03; Cohen's d=.63). Voxel-based analysis revealed a cluster in the prefrontal cortex where volume was negatively correlated with sexual abuse severity. Voxel based comparison of the three matched groups revealed a similar pattern of results, with widespread reductions in psychosis patients with sexual abuse relative to controls that were not found in psychosis patients without sexual abuse. These findings indicate that some of the variance of gray matter volume in psychotic disorders can be explained by a history of sexual abuse. PMID:23178105

  13. [The patient with an alcohol abuse problem family doctor practice].

    PubMed

    Szponar, Jarosław; Kuźniar-Placek, Justyna; Panasiuk, Lech

    2012-01-01

    Doctors of many specialties, including the family doctors, encounter the problems of alcohol abuse in their patients. Due to the fact that many symptoms of dangerous diseases can be masked by the fact of alcoholism, a brief doctor's visit has to be conducted with watchfulness, caution and care. Family doctors have some brief testes (such as CAGE test, AUDIT test), besides of precise anamnesis and blood chemistry, which make it easier to identify a patient with an alcohol problem. People with disabilities are more exposed to alcohol abuse since they often experience additional factors such as unemployment, social isolation and homelessness. All of the above factors foster the more frequent alcohol usage. In Poland the main treatment method of alcohol addiction is psychotherapy practiced in the rehab centers. The detoxification treatment is voluntary and free of charge even though the patients checking into those facilities are doing it against their will. They are forced to do so by entourage, family, spouse or risk of unemployment. Acamprozate is considered as a drug, run to extend abstaining from alcohol. In the past, therapy with disulfiram substance was common, but now, it is considered as unethical behaviour. In practice of medicine, a patient with alcohol addiction creates not onlya medical but also legal problems. Therefore keeping of detailed medical documentation is very important as it may become significant evidence in the future. PMID:23243928

  14. Substance Abuse and Schizophrenia: A Health Maintenance Perspective.

    ERIC Educational Resources Information Center

    Damron, Susan W.; Simpson, William R.

    Abuse of alcohol or other substances by schizophrenic patients seriously undermines effective treatment. To document the extent of substance abuse among schizophrenic patients hospitalized in one Veterans Administration Hospital, medical records of 100 patients were reviewed. The results revealed that 54 patients had recent substance abuse, with…

  15. Ethics and Undertreatment of Pain in Patients with a History of Drug Abuse.

    PubMed

    da Cunha, Brooke Faria

    2015-01-01

    Patients with substance abuse history make up 14% of inpatient admissions to acute care units, where it has been reported a great deal of patient pain is unrelieved (Substance Abuse and Mental Health Service Administration [SAMHSA], 2009. Definitions of substance abuse terms including tolerance, dependence, addiction, and pseudoaddiction are essential to a nurse's understanding of pain medication administration in patients with substance abuse history. Pain management is one of the nurse's main responsibilities, and using the principles of autonomy, beneficence, nonmaleficence, and justice can guide the nurse to making appropriate pain management decisions for and with these patients. Nursing implications and resources for more information are discussed. PMID:26306351

  16. History of Abuse and Neglect in Patients with Schizophrenia Who Have a History of Violence

    ERIC Educational Resources Information Center

    Bennouna-Greene, Mehdi; Bennouna-Greene, Valerie; Berna, Fabrice; Defranoux, Luc

    2011-01-01

    Objective: To determine the prevalence of five forms of abuse/neglect during childhood and adolescence in a group of schizophrenic patients with a history of violence. Methods: Twenty-eight patients hospitalized in a highly secured psychiatric unit were included. Abuse and neglect during patients' growth were evaluated with the childhood trauma…

  17. Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse.

    ERIC Educational Resources Information Center

    Columbia Univ., New York, NY. National Center on Addiction and Substance Abuse.

    A national representative survey of primary care physicians (N=648) was conducted to determine how they deal with patients who have substance abuse problems. The survey revealed how physicians identify substance abuse in their patients, what efforts they make to help these patients, and what barriers they find to effective diagnosis and treatment.…

  18. Evaluation of ongoing oxycodone abuse among methadone-maintained patients.

    PubMed

    Dunn, Kelly E; Sigmon, Stacey C; McGee, Mark R; Heil, Sarah H; Higgins, Stephen T

    2008-12-01

    Prevalence of prescription opioid abuse has increased dramatically in recent years in the United States generally, and a similar pattern of increasing prescription opioid use has also been noted among patients seeking treatment for opioid dependence. This study presents results from an internal quality assurance project conducted by an outpatient methadone maintenance (MM) treatment clinic which sought to examine the extent of ongoing oxycodone abuse among patients that might be going undetected with current urinalysis-testing methods. One hundred five MM patients provided 437 urine samples over a 6-week period. Samples were analyzed using the clinic's usual enzyme multiplied immunoassay test (EMIT) opiate assay (300 ng/ml opiate cutpoint) and a supplemental oxycodone test strip (100 ng/ml oxycodone cutpoint). The EMIT assay identified only 6% (20/437) of samples as positive for oxycodone, whereas the oxycodone test strip indicated that 19% (83/437) tested positive for recent oxycodone use. Inspection of patient characteristics revealed that oxycodone users were more likely to report a prescription opioid as their primary drug at intake, be in MM treatment for a significantly shorter duration, and provide significantly more opioid- and cocaine-positive urine samples. Overall, these data illustrate the potential importance of monitoring for ongoing oxycodone use in MM clinics. Although future efforts should examine this question using more rigorous experimental methods, findings from this initial project have implications for clinical issues such as evaluating patient stability in treatment, making medication-dosing decisions, and determining patient eligibility for methadone take-home privileges. PMID:18295434

  19. Evaluation of Ongoing Oxycodone Abuse among Methadone-Maintained Patients

    PubMed Central

    Dunn, Kelly E.; Sigmon, Stacey C.; McGee, Mark R.; Heil, Sarah H; Higgins, Stephen T.

    2008-01-01

    Prevalence of prescription opioid abuse has increased dramatically in recent years in the United States generally, and a similar pattern of increasing prescription opioid use has also been noted among patients seeking treatment for opioid dependence. The current study presents results from an internal quality-assurance project conducted by an outpatient methadone-maintenance (MM) treatment clinic which sought to examine the extent of ongoing oxycodone abuse among patients that might be going undetected with current urinalysis testing methods. One-hundred and five MM patients provided 437 urine samples over a 6-week period. Samples were analyzed using the clinic’s usual enzyme multiplied immunoassay test (EMIT) opiate assay (300 ng/ml opiate cutpoint) and a supplemental oxycodone test strip (100 ng/ml oxycodone cutpoint). The EMIT assay identified only 6% (20/437) of samples as positive for oxycodone, while the oxycodone test strip indicated that 19% (83/437) tested positive for recent oxycodone use. Inspection of patient characteristics revealed that oxycodone users were more likely to report a prescription opioid as their primary drug at intake, be in MM treatment for a significantly shorter duration and provide significantly more opioid- and cocaine-positive urine samples. Overall, these data illustrate the potential importance of monitoring for ongoing oxycodone use in MM clinics. While future efforts should examine this question using more rigorous experimental methods, findings from this initial project have implications for clinical issues such as evaluating patient stability in treatment, making medication dosing decisions, and determining patient eligibility for methadone take-home privileges. PMID:18295434

  20. Beyond abuse: the association among parenting style, abdominal pain, and somatization in IBS patients.

    PubMed

    Lackner, Jeffrey M; Gudleski, Gregory D; Blanchard, Edward B

    2004-01-01

    This study assessed the relative strength of the association between abuse, negative parenting style, and somatization in irritable bowel syndrome (IBS) patients. Drawing from preclinical stress physiology and abuse research identifying the family social climate as a frequently stronger and independent determinant of long-term health effects than abuse-specific variables, we predicted that negative parenting behaviors would more strongly correlate with somatization than abuse. Subjects were 81 consecutively evaluated patients, who at baseline underwent psychological testing, measuring perceived parental style, abuse history, somatization, and pain. Although abuse correlated with maternal and paternal rejection, abuse was not associated with somatization. Higher levels of rejection and/or hostility among fathers (not mothers) were more strongly correlated with somatization than was abuse. Further, paternal parenting behaviors were more predictive of somatization than abuse, age, and gender. The lack of an association between abuse and somatization is discussed in light of limitations of biopsychosocial IBS models, whose strong focus on "pathological stressors" (e.g., abuse, trauma) as risk factors may overlook the importance of "less extreme" parenting variables in influencing somatic complaints. The relationship between parenting and somatization is discussed in the context of broader behavioral science research linking disruptions in the quality of parenting to dramatic and long-term changes in patterns of stress reactivity and brain abnormalities seen in IBS patients. PMID:14744522

  1. Prevalence of illicit drug use in patients without controlled substance abuse in interventional pain management.

    PubMed

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Damron, Kim S; Beyer, Carla D; Barnhill, Renee C

    2003-04-01

    Drug abuse with illicit drugs and licit drugs has been increasing steadily over the past decade. A recent National Household Survey on Drug Abuse found statistically significant increases between 2000 and 2001 in the use of multiple drugs, including marijuana, cocaine, and non-medical use of pain relievers and tranquilizers. Prescription controlled substance abuse is a major issue in chronic pain management. Various means suggested to avoid or monitor abuse in patients in treatment include urine/serum drug screening whenever requested, along with other precautions including one prescribing physician and one designated pharmacy, etc. Based on the present evidence, physicians assume that patients adhering to controlled substance agreements and without obvious dependency behavior do not abuse either illicit or licit drugs. Thus, it is accepted that there is no necessity to perform routine urine/drug testing in this specific group of the patient population. One hundred patients undergoing interventional pain management and receiving controlled substances were randomly selected for evaluation of illicit drug abuse by urine drug testing. They were selected from a total of 250 patients who were identified as non-abusers of prescription drugs. Results showed that illicit drug abuse in patients without history of controlled substance abuse was seen in 16 patients. Thirteen of the 16 patients tested positive for marijuana and 3 patients tested positive for cocaine. Only one patient tested positive for a combined use of both marijuana and cocaine. This study showed that, in an interventional pain management setting, there is significant use of illicit drugs (16%) with 13% use of marijuana and 3% use of cocaine in patients who are considered as non-abusers of prescription controlled substances and those who are adherent to controlled substance agreements. However, if cocaine is considered as a hardcore drug in contrast to marijuana, abuse of hardcore illicit drugs is only 3

  2. History of sexual, emotional or physical abuse and psychiatric comorbidity in substance-dependent patients.

    PubMed

    Daigre, Constanza; Rodríguez-Cintas, Laia; Tarifa, Núria; Rodríguez-Martos, Lola; Grau-López, Lara; Berenguer, Marta; Casas, Miguel; Roncero, Carlos

    2015-10-30

    Sexual, emotional or physical abuse history is a risk factor for mental disorders in addicted patients. However, the relationship between addiction and abuse lifespan is not well known. This study aims to compare clinical and psychopathological features of addicted patients according to the experience of abuse and to the number of different types of abuse suffered. Bivariate and multivariate analyses were conducted. 512 addicted patients seeking treatment were included, 45.9% reported abuse throughout life (38.9% emotional, 22.3% physical and 13.5% sexual abuse). It was found that female gender; depressive symptoms and borderline personality disorder were independently associated with history of any abuse throughout life. As well, it was found that 14% have been suffered from all three types of abuse (sexual, emotional and physical), 34.5% from two and 55.5% from one type. Female gender and borderline personality disorder were independently associated independently with a greater number of different types of abuse. Results suggest that history of abuse is frequent among substance-dependent patients and these experiences are more prevalent in women and are associated with more psychiatric comorbidity. PMID:26279128

  3. Increased Childhood Abuse in Patients With Premenstrual Dysphoric Disorder in a Turkish Sample: A Cross-Sectional Study

    PubMed Central

    Albayrak, Yakup; Sahin, Basak

    2014-01-01

    Objective: Abuse is considered to have a place in the etiology of various psychiatric disorders. Premenstrual dysphoric disorder (PMDD) is one of the psychiatric disorders for which abuse could be an etiologic factor; however, few studies have investigated the relationship between abuse and PMDD. In this study, our aim was to investigate childhood abuse in patients with PMDD and compare them with healthy female subjects. Method: This cross-sectional study included 70 women with PMDD (DSM-IV-TR criteria) who were admitted to the outpatient psychiatry clinic of Ankara Yenimahalle State Hospital, Ankara, Turkey, between December 2012 and December 2013. Additionally, 78 healthy controls were included in the study. Sociodemographic, familial, and reproductive period characteristics of the women were recorded. All subjects were administered the Premenstrual Syndrome Scale (PMSS) and the Childhood Trauma Questionnaire (CTQ). Results: Among the sociodemographic characteristics, being a university graduate (76.9%) and being a public servant (70.5%) were significantly higher in the healthy control group (P = .01 and P = .01, respectively). A family history of PMDD (31.4%), a history of postpartum psychiatric disorders (11.4%), and a history of attempted suicide (7.1%) were higher in the PMDD group compared with the healthy control group (P = .001, P = .003, and P = .024, respectively). Significant differences were also found between PMDD and healthy controls in PMSS score (P ≤ .001), CTQ total scores (P = .002), and subscale scores including emotional abuse and emotional neglect (P = .004), physical abuse (P = .009), and sexual abuse (P = .012). Conclusions: To our knowledge, the present study is the first to investigate associations between PMDD and childhood abuse from Turkey. More comprehensive studies on this topic with larger sample sizes are required to enrich the literature and enable practitioners to be more effective in clinical practice. PMID:25664213

  4. [Patients' access to their medical records].

    PubMed

    Laranjo, Liliana; Neves, Ana Luisa; Villanueva, Tiago; Cruz, Jorge; Brito de Sá, Armando; Sakellarides, Constantitno

    2013-01-01

    Until recently, the medical record was seen exclusively as being the property of health institutions and doctors. Its great technical and scientific components, as well as the personal characteristics attributed by each doctor, have been the reasons appointed for that control. However, nowadays throughout the world that paradigm has been changing. In Portugal, since 2007 patients are allowed full and direct access to their medical records. Nevertheless, the Deontological Code of the Portuguese Medical Association (2009) explicitly states that patients' access to their medical records should have a doctor as intermediary and that the records are each physician's intellectual property. Furthermore, several doctors and health institutions, receiving requests from patients to access their medical records, end up requesting the legal opinion of the Commission for access to administrative documents. Each and every time, that opinion goes in line with the notion of full and direct patient access. Sharing medical records with patients seems crucial and inevitable in the current patient-centred care model, having the potential to improve patient empowerment, health literacy, autonomy, self-efficacy and satisfaction with care. With the recent technological developments and the fast dissemination of Personal Health Records, it is foreseeable that a growing number of patients will want to access their medical records. Therefore, promoting awareness on this topic is essential, in order to allow an informed debate between all the stakeholders. PMID:23815842

  5. The effect of pretreatment with clonidine on propofol consumption in opium abuser and non-abuser patients undergoing elective leg surgery

    PubMed Central

    Moghadam, Morteza Jabbari; Ommi, Davood; Mirkheshti, Alireza; Shadnoush, Mehdi; Dabbagh, Ali

    2012-01-01

    Objective: Clonidine, an alpha-2 adrenergic agonist, increases the quality of perioperative sedation and analgesia with a few side effects. This study was designed to assess the effect of clonidine premedication on the anesthesics used for elective below knee surgeries in opium abusers and non-abusers. Materials and Methods: In a randomized clinical trial, 160 patients were selected and assigned into four groups. Eighty patients among the opium abusers were divided randomly into clonidine and no clonidine groups, with 40 patients in each, and 80 among the non-abusers were again divided randomly into clonidine and no clonidine groups, with 40 patients in each group. All were anesthetized for elective orthopedic operation using the same predetermined method. The total administered dose of propofol and other variables were compared. Results: The total propofol dose in a decreasing order was as follows: Abuser patients receiving placebo (862 ± 351 mg), non-abuser patients receiving placebo (806 ± 348 mg), abuser patients receiving clonidine (472 ± 175 mg), and non-abuser patients receiving clonidine (448 ± 160 mg). Hence, a statistically significant difference was observed among the four study groups (P value for ANOVA = 0.0001). Conclusion: Adding clonidine as a preoperative medication decreases the patient's anesthetic needs; this decrease was even more considerable on the anesthetic needs than the effect of opium abuse history on anesthetic dose. PMID:23798938

  6. Psychiatric comorbidity of patients on methadone maintenance treatment with a history of sexual abuse.

    PubMed

    Peles, Einat; Potik, David; Schreiber, Shaul; Bloch, Miki; Adelson, Miriam

    2012-12-01

    The aim of this study was to assess the prevalence of a history of sexual abuse and its relation to psychiatric comorbidity among former opiate addicts currently on methadone maintenance treatment (MMT). We evaluated the history of sexual abuse and current clinical obsessive compulsive disorder (OCD), dissociative identity disorder (DID), and complex posttraumatic distress disorder (cPTSD), and administered the Life Events Inventory Questionnaire among 125 MMT patients (76 females and 49 males). Eighty (64%) patients had experienced sexual abuse, 69 (55.2%) met the criteria for clinical OCD, 20 (16.0%) for cPTSD and 13 (10.4%) for DID. More females had clinical OCD than males (63.2% vs. 42.9%, respectively, p=0.03). Sexually abused patients had higher rates of clinical OCD than their non-abused counterparts (67.5% vs. 33.3%, respectively, p<0.0005) and a higher mean number of negative life events (8.0±2.0 vs. 7.1±1.8, p=0.01). Sexually abused patients showed a trend towards a higher Dissociative Experiences Scale score (17.6±10.1 vs. 14.6±8.1, p=0.08) and rate of DID (13.8% vs. 4.4%, p=0.1), but no significant difference in the rate of cPTSD (17.5% vs. 13.3%, p=0.6) compared to non-abused subjects. The 80 sexually abused patients were mostly female (85%), and 57.5% of them were abused by a family member. In summary, more sexually abused MMT patients were diagnosed with clinical OCD and fewer with cPTSD and DID. Those with cPTSD were characterized by more negative life events, higher dissociation scores, and assaults by a family member. We conclude that sexually abused MMT patients should be screened for clinical OCD. PMID:22564825

  7. Monthly incidence rates of abusive encounters for canadian family physicians by patients and their families.

    PubMed

    Miedema, Baukje Bo; Hamilton, Ryan; Tatemichi, Sue; Lambert-Lanning, Anita; Lemire, Francine; Manca, Donna; Ramsden, Vivian R

    2010-01-01

    Objective. The goal of this study was to examine the monthly incidence rates of abusive encounters for family physicians in Canada. Methods. A 7-page cross-sectional survey. Results. Of the entire study sample (N = 720), 29% of the physicians reported having experienced an abusive event in the last month by a patient or patient family member. Abusive incidents were classified as minor, major, or severe. Of the physician participants who reported having been abused, all reported having experienced a minor event, 26% a major, and 8% a severe event. Of the physicians who experienced an abusive event, 55% were not aware of any policies to protect them, 76% did not seek help, and 64% did not report the abusive event. Conclusion. Family physicians are subjected to significant amounts of abuse in their day-to-day practices. Few physicians are aware of workplace policies that could protect them, and fewer report abusive encounters. Physicians would benefit from increased awareness of institutional policies that can protect them against abusive patients and their families and from the development of a national policy. PMID:22332007

  8. Patient Perceptions of Electronic Health Records

    ERIC Educational Resources Information Center

    Lulejian, Armine

    2011-01-01

    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…

  9. Differences in methylphenidate abuse rates among methadone maintenance treatment patients in two clinics.

    PubMed

    Peles, Einat; Schreiber, Shaul; Linzy, Shirley; Domani, Yoav; Adelson, Miriam

    2015-07-01

    Methylphenidate, an amphetamine-like prescription medication for attention deficit hyperactivity disorder (ADHD) was suspected as being abused among methadone maintenance treatment (MMT) patients. We tested its presence in the routine urine monitoring of all patients in both Tel Aviv and Las Vegas MMT clinics. Data on demographic and addiction history, ADHD (Wender Utah Rating Scale), cognitive impairment (Mini Mental State Exam), and lifetime DSM-IV-TR psychiatric diagnosis from admission were retrieved, and retention following 6 months. None of the 190 patients in Las Vegas tested positive for methylphenidate, while 14.7% (45/306) did in Tel Aviv. Abusers were less educated (p = 0.01), had higher ADHD scores (p = 0.02), lower cognitive scores (p = 0.05), and a higher benzodiazepine (BDZ) abuse rate (p < 0.0005), with no difference in age, gender, duration in MMT, cannabis, opiates, and cocaine abuse and infectious disease. Of the methylphenidate abuse 42.2% have take-home methadone dose privileges. Not like opiate use, being methylphenidate positive did not relate to 6-months retention. Compared to Tel Aviv, Las Vegas patients were more educated, with lower BDZ, and cocaine abuse. The greater abuse of methylphenidate among ADHD subjects might indicate their using it as self-medication, raising a possible indication for its prescription for that subgroup of MMT patients. The high rate of methylphenidate abuse in Israel needs future study. PMID:25605438

  10. Parental substance abuse, reports of chronic pain and coping in adult patients with sickle cell disease.

    PubMed Central

    Edwards, Christopher; Whitfield, Keith; Sudhakar, Shiv; Pearce, Michele; Byrd, Goldie; Wood, Mary; Feliu, Miriam; Leach-Beale, Brittani; DeCastro, Laura; Whitworth, Elaine; Abrams, Mary; Jonassaint, Jude; Harrison, M. Ojinga; Mathis, Markece; Scott, Lydia; Johnson, Stephanie; Durant, Lauren; Holmes, Anita; Presnell, Katherine; Bennett, Gary; Shelby, Rebecca; Robinson, Elwood

    2006-01-01

    There is increasing interest from a social learning perspective in understanding the role of parental factors on adult health behaviors and health outcomes. Our review revealed no studies, to date, that have evaluated the effects of parental substance abuse on reports of chronic pain and coping in adult patients with sickle cell disease (SCD). We explored the effects of parental substance (alcohol or drug) abuse on reports of the sensory, affective and summary indices of pain in 67 adult patients, mean age 38.9 (13.5), with SCD. We also explored the effects of parental substance abuse on psychopathology associated with pain and active coping. Twenty-four percent of patients reported that their parent(s) abused substances. Patients whose parent(s) were characterized as substance abusers reported greater sensory (p=0.02), affective (p=0.01) and summary (VAS; p=0.02) indices of pain as compared to their counterparts, whose parent(s) were not characterized as substance abusers. Patients did not differ in average age, education or the propensity to respond in a socially acceptable manner. There was a significant trend towards patients who characterized their parents as abusers scoring higher than their counterparts on active coping. We propose a Social Learning Theory to explain the current findings and suggest a need for additional prospective research to simultaneously explore biological (genetic) and social factors that influence the interpretation, experience and reporting of chronic pain in adult patients with chronic disease. PMID:16573309

  11. Impact of Patient History on Residents' Evaluation of Child Sexual Abuse.

    ERIC Educational Resources Information Center

    Ashworth, Carolyn S.; And Others

    1995-01-01

    Twenty-three pediatric residents reviewed slides of 15 children's genitalia (normal or abnormal) and were given either a specific or nonspecific history for sexual abuse. Results indicated that incongruency between patient history and physical examination negatively affected residents' ability to discriminate between abuse and nonabuse findings.…

  12. Patients Reporting Ritual Abuse in Childhood: A Clinical Syndrome. Report of 37 Cases.

    ERIC Educational Resources Information Center

    Young, Walter C.; And Others

    1991-01-01

    Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. A clinical syndrome is presented that includes dissociative states with satanic overtones, posttraumatic stress disorder, survivor guilt, unusual fears, and substance abuse. Questions concerning reliability, credibility, and…

  13. Failure to find association between childhood abuse and cognition in first-episode psychosis patients.

    PubMed

    Sideli, L; Fisher, H L; Russo, M; Murray, R M; Stilo, S A; Wiffen, B D R; O'Connor, J A; Aurora Falcone, M; Pintore, S M; Ferraro, L; Mule', A; La Barbera, D; Morgan, C; Di Forti, M

    2014-01-01

    This study investigated the relationship between severe childhood abuse and cognitive functions in first-episode psychosis patients and geographically-matched controls. Reports of any abuse were associated with lower scores in the executive function domain in the control group. However, in contrast with our hypothesis, no relationships were found amongst cases. PMID:23764407

  14. Evaluating and Training Substance Abuse Counselors: A Pilot Study Assessing Standardized Patients as Authentic Clients

    ERIC Educational Resources Information Center

    Fussell, Holly E.; Lewy, Colleen S.; McFarland, Bentson H.

    2009-01-01

    Clinician training and supervision are needed to transfer evidence-based practices to community-based treatment organizations. Standardized patients (SPs) are used for clinician training and evaluating. However, to be effective for substance abuse counselors, SPs must realistically portray substance abuse treatment clients. The current study…

  15. Relationship of Coping Styles with Suicidal Behavior in Hospitalized Asthma and Chronic Obstructive Pulmonary Disease Patients: Substance Abusers versus Non- Substance Abusers

    PubMed Central

    Safa, Mitra; Talischi, Firouzeh; Masjedi, Mohammad Reza

    2014-01-01

    Background Treatment of patients with chronic conditions requiring hospitalization requires patient acceptance and cooperation and adoption of coping strategies. Inappropriate coping strategies such as substance abuse are concerning in the course of treatment. This study sought to explore the association of coping strategies with suicidal behavior in substance abusers and non substance abuser patients with chronic pulmonary diseases namely asthma and chronic obstructive pulmonary disease (COPD). Materials and Methods This comparative study was performed on 100 patients with asthma and COPD selected via convenience sampling. Subjects with and without substance abuse were separated into two groups of 50 patients each. Ways of Coping Questionnaire of Lazarus (WOCQ) and Suicide Behavior Questionnaire-Revised (SBQ-R) were completed by them. Five Persian speaking patients rated this questionnaire to be easily understandable in the pre-test stage. Cronbach's alpha was calculated to measure the internal consistency. Results The mean (±standard deviation) age of participants was 40 (±14) years; 58% of individuals were men; 62% had chosen problem-focused coping. The most abused substances were cigarettes (78%) and opium (42%); 6% of substance abusers had thought about suicide five times or more in the past year; 5% of substance abusers had seriously attempted suicide. Tendency to commit suicide was greater in men, substance abusers and participants who had chosen emotion-focused coping strategies, based on a regression model. Average score of suicide tendency was significantly higher in substance abusers (B=2.196, P =0.007). Conclusion Chronic disease is a crisis and patients need to acquire appropriate coping strategies to deal with it, especially in substance abusers and suicidal patients. Precise recognition of coping strategies in chronic pulmonary patients with substance abuse is necessary via a team cooperation among psychiatrics, psychologists and an internal

  16. Patient information: confidentiality and the electronic record.

    PubMed

    Griffith, Richard

    The rise of the electronic record now allows nurses to access a large archive of patient information that was more difficult to obtain when records consisted of manually held paper files. There have been several instances where curiosity and, occasionally, more malicious motivations have led nurses to access these records and read the notes of a celebrity or a person they know. In this article, Richard Griffith considers whether nurses' accessing and reading of the record of someone who is not in their care is in breach of their duty of confidentiality. PMID:26419719

  17. Association Between Opioid Abuse/Dependence and Outcomes in Hospitalized Heart Failure Patients.

    PubMed

    Gupta, Tanush; Mujib, Marjan; Agarwal, Pallak; Prakash, Priya; Garg, Anjali; Sharma, Nisha; Aronow, Wilbert S; Nabors, Christopher

    2016-01-01

    Opioid use is associated with unintentional and intentional overdose and is one of the leading causes of emergency room visits and accidental deaths. However, the association between opioid abuse/dependence and outcomes in hospitalized patients has not been well studied. Congestive heart failure (HF) is the fourth most common cause of hospitalization in the United States. The purpose of this study was to examine the effect of opioid abuse/dependence on outcomes in patients hospitalized with HF. We queried the 2002-2010 Nationwide Inpatient Sample databases to identify all patients aged 18 years and older admitted with the primary diagnosis of HF. Multivariate logistic regression analysis was used to compare the frequency of hospital-acquired conditions (HACs) and in-hospital mortality between patients with and without a history of opioid abuse/dependence. Of 9,993,240 patients with HF, 29,014 had a history of opioid abuse or dependence. Opioid abusers/dependents were likely to be younger men of poor socioeconomic background with self pay or Medicaid as their primary payer. They had a lower prevalence of dyslipidemia, diabetes mellitus, coronary artery disease, prior myocardial infarction, and peripheral vascular disease (P < 0.001 for all). They were more likely to be smokers and have chronic pulmonary disease, depression, liver disease, and obesity (P < 0.001 for all). Patients with a history of opioid abuse/dependence had lower incidence of HACs (14.8% vs. 16.5%, adjusted odds ratio: 0.71, P < 0.001) and lower in-hospital mortality (1.3% vs. 3.6%, adjusted odds ratio: 0.64, P < 0.001) as compared with patients without prior opioid abuse/dependence. In conclusion, among adult patients aged 18 years and older hospitalized with HF, opioid abuse/dependence was associated with lower frequency of HACs and lower in-hospital mortality. PMID:25611362

  18. Electronic Health Records and Patient Safety

    PubMed Central

    Gans, D.; White, J.; Nath, R.; Pohl, J.

    2015-01-01

    Summary Background The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective 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. Methods 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. Results 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. Conclusions 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. PMID:25848419

  19. Preventing and Recognizing Prescription Drug Abuse

    MedlinePlus

    ... Abuse » Preventing and recognizing prescription drug abuse Prescription Drug Abuse Email Facebook Twitter Preventing and recognizing prescription drug abuse To ensure proper medical care, patients should discuss ...

  20. Lifetime positive symptoms in patients with schizophrenia and cannabis abuse are partially explained by co-morbid addiction.

    PubMed

    Dubertret, Caroline; Bidard, Isabelle; Adès, Jean; Gorwood, Philip

    2006-09-01

    Recent prospective findings have shown that cannabis use by young people could be a risk factor for psychotic symptoms in adulthood, but the long-term impact of cannabis abuse on the clinical features of declared schizophrenia remains to be explored. We assessed the independent influence of cannabis abuse on the clinical symptoms of schizophrenia, after controlling for frequently co-occurring addictive disorders. Patients with schizophrenia, and with (N=66), or without (N=139) cannabis abuse, were compared for lifetime positive and negative symptoms, taking into account presence of any other addictive disorders. The incidence of the abuse of drugs other than cannabis was nearly five times greater amongst patients with both schizophrenia and cannabis abuse. When the analyses were limited to subjects with no other abuse, less avolution and fewer apathy symptoms were still detected in patients with schizophrenia and cannabis abuse than in those with no abuse (p=0.0001). In contrast, between-group differences for positive symptoms were abolished when multiple substance abuses were taken into account. The strong association between cannabis abuse and fewer negative symptoms in schizophrenia was thus replicated in this sample, but once co-morbid addictive disorders had been controlled no influence of cannabis abuse on hallucinations was detected. Distinguishing the effects of co-occurring addictive disorder(s) in patients with schizophrenia and cannabis dependence may thus be important when attempting to analyse the impact of cannabis abuse. PMID:16806837

  1. The Role of Key Informants and Direct Patient Interviews in Epidemiological Studies of Substance Abuse

    PubMed Central

    Cicero, Theodore J.; Ellis, Matthew S.; Paradis, Alethea; Ortbal, Zachary

    2010-01-01

    Purpose The present study was undertaken to assess the degree to which key informants’ perceptions of relative abuse liability of opioids in their communities correspond to actual drug use in their patients. Methods Key Informants (N=49), and their patients (N=738) were asked to complete anonymous, independent paper surveys about perceived or actual abuse of nine targeted opioid drugs: buprenorphine, fentanyl, heroin, hydrocodone, hydromorphone, methadone, morphine, oxycodone and tramadol. Results There was a strong correspondence (R=.98) between KI rankings of relative abuse of opioids in their patient population and the actual rank order calculated from their patient’s selection of a primary euphorigenic opioid. The patient surveys not only validated the KI’s conclusions, but also provided a great deal of important information about the nature of the abuse patterns. Notably, significant co-morbidity was found in the patient population: 55% had a history of psychiatric problems; chronic pain of moderate intensity was common; 67% were nicotine dependent; and 43% were diagnosed alcoholics. Discussion Our results demonstrate that KI’s perceived rank order of drugs of choice correlated almost perfectly with their patients’ choice of a primary drug. These data suggest that key informants, as they have for decades in epidemiological research, provide a reliable, high-level view of substance abuse in their catchment area. As such, KIs provide valid and reliable information on scope and patterns of abuse, but if more detail is required about the characteristics of abuse, such as that required for FDA-mandated Risk Evaluation and Mitigation Strategies (REMS), then direct interviews with the abusers themselves seem more appropriate. PMID:21351313

  2. Alcohol use and abuse among patients with multidrug-resistant tuberculosis in Botswana

    PubMed Central

    Zetola, N. M.; Modongo, C.; Kip, E. C.; Gross, R.; Bisson, G. P.; Collman, R. G.

    2013-01-01

    SUMMARY BACKGROUND Data on alcohol abuse as a risk factor for the development of multidrug-resistant tuberculosis (MDR-TB) are scarce. OBJECTIVE To describe the patterns of alcohol use in MDR-TB patients and to determine whether alcohol use is associated with the development of MDR-TB in Botswana. METHODS We compared the level of alcohol use among MDR-TB patients against three control groups: 1) non-MDR-TB patients, 2) human immunodeficiency virus (HIV) infected patients without a history of TB, and 3) the general population. Alcohol use and abuse was measured with the Alcohol Use Disorders Identification Test 10 (AUDIT) questionnaire. RESULTS Of a total national population of 164 MDR-TB cases, 114 (70%) were interviewed. MDR-TB cases had a lifetime prevalence of alcohol use of 35.1%, which was lower than that of all control groups (P < 0.001). MDR-TB cases had higher 1-month prevalence of alcohol dependence symptoms and a lower 1-year period prevalence of alcohol dependence symptoms (P < 0.01 and P = 0.01 respectively). Among patients with TB, alcohol abuse was found to be a risk factor for the development of MDR-TB. CONCLUSION MDR-TB patients in Botswana have high rates of alcohol use and abuse. Among TB patients, alcohol abuse is associated with the diagnosis of MDR-TB, and could be an important modifiable factor. PMID:22963934

  3. Identifying medical-surgical nursing staff perceptions of the drug-abusing patient.

    PubMed

    Nilsen, Stacy L; Stone, Wendy L; Burleson, Stephanie L

    2013-01-01

    Nurses report a negative, stereotypical, and moralistic view of substance-abusing patients. Unaddressed bias may impede delivery of quality care. There is limited research of the needs specific to medical-surgical nursing staff interacting with substance-abusing patients. Nursing therapeutic commitment refers to the degree the nurse feels prepared with an adequate knowledge base, professional support, and personal ownership of a patient condition. Low therapeutic commitment correlates with job dissatisfaction. The Drug and Drug Problems Perceptions Questionnaire assesses healthcare provider attitude and therapeutic commitment to patients using or abusing medication or illicit substances. This therapeutic commitment survey serves as a staff needs assessment for a targeted educational innovation. The results show that the medical and surgical nursing staff has a constructive attitude and a moderately high degree of therapeutic commitment to the drug-abusing patient population, similar to more specialized multidisciplinary, mental healthcare workers. This study showed that medical-surgical nurses feel professionally responsible and clinically supported with patients with primary or comorbid drug abuse. Consistent with established results, focused and ongoing education on the risk factors, outcomes, and physical and psychological effects of illicit substances is necessary to improve therapeutic commitment to drug-dependent patients. PMID:24621546

  4. Physical and sexual abuse histories in patients with eating disorders: a comparison of Japanese and American patients.

    PubMed

    Nagata, T; Kaye, W H; Kiriike, N; Rao, R; McConaha, C; Plotnicov, K H

    2001-08-01

    Physical and sexual abuse among patients with eating disorders has been a focus of attention in Western countries, however, there is no study comparing the incidence of these factors in Western and Asian countries. Japanese subjects consisted of 38 patients with anorexia nervosa restricting type (AN-R), 46 patients with anorexia nervosa binge eating/purging type (AN-BP), 76 patients with bulimia nervosa purging type (BN) and 99 controls. Subjects from the USA consisted of 29 AN-R, 34 AN-BP and 16 BN. The Physical and Sexual Abuse Questionnaire was administered to all subjects. Minor sexual abuse such as confronting exhibitionism or being fondled by a stranger tended to be more prevalent among Japanese subjects, while victimization by rape or incest was more prevalent among USA subjects. Conversely, physical abuse history was similarly distributed across each diagnostic subgroup in both countries. Events related to physical abuse, such as an abusive family background, may contribute whether eating disorder patients are restricting or bulimic and regardless of culture. PMID:11442883

  5. Protecting Patient Records from Unwarranted Access

    NASA Astrophysics Data System (ADS)

    Gardner, Ryan; Garera, Sujata; Rubin, Aviel D.; Rajan, Anand; Rozas, Carlos V.; Sastry, Manoj

    Securing access to medical information is vital to protecting patient privacy. However, Electronic Patient Record (EPR) systems are vulnerable to a number of inside and outside threats. Adversaries can compromise EPR client machines to obtain a variety of highly sensitive information including valid EPR login credentials, without detection. Furthermore, medical staff can covertly view records of their choosing for personal interest or more malicious purposes. In particular, we observe that the lack of integrity measurement and auditability in these systems creates a potential threat to the privacy of patient information. We explore the use of virtualization and trusted computing hardware to address these problems. We identify open problems and encourage further research in the area.

  6. HARVEST, a longitudinal patient record summarizer

    PubMed Central

    Hirsch, Jamie S; Tanenbaum, Jessica S; Lipsky Gorman, Sharon; Liu, Connie; Schmitz, Eric; Hashorva, Dritan; Ervits, Artem; Vawdrey, David; Sturm, Marc; Elhadad, Noémie

    2015-01-01

    Objective To describe HARVEST, a novel point-of-care patient summarization and visualization tool, and to conduct a formative evaluation study to assess its effectiveness and gather feedback for iterative improvements. Materials and methods HARVEST is a problem-based, interactive, temporal visualization of longitudinal patient records. Using scalable, distributed natural language processing and problem salience computation, the system extracts content from the patient notes and aggregates and presents information from multiple care settings. Clinical usability was assessed with physician participants using a timed, task-based chart review and questionnaire, with performance differences recorded between conditions (standard data review system and HARVEST). Results HARVEST displays patient information longitudinally using a timeline, a problem cloud as extracted from notes, and focused access to clinical documentation. Despite lack of familiarity with HARVEST, when using a task-based evaluation, performance and time-to-task completion was maintained in patient review scenarios using HARVEST alone or the standard clinical information system at our institution. Subjects reported very high satisfaction with HARVEST and interest in using the system in their daily practice. Discussion HARVEST is available for wide deployment at our institution. Evaluation provided informative feedback and directions for future improvements. Conclusions HARVEST was designed to address the unmet need for clinicians at the point of care, facilitating review of essential patient information. The deployment of HARVEST in our institution allows us to study patient record summarization as an informatics intervention in a real-world setting. It also provides an opportunity to learn how clinicians use the summarizer, enabling informed interface and content iteration and optimization to improve patient care. PMID:25352564

  7. Revision of the Word Association Test for assessing associations of patients reporting satanic ritual abuse in childhood.

    PubMed

    Leavitt, F; Labott, S M

    1998-11-01

    A growing number of psychiatric patients report satanic ritual abuse, prompting research into this controversial area. In the current study, the Word Association Test (WAT) was modified to assess experience with satanic abuse. Pilot work resulted in norms for two domains: normative and satanic. Female psychiatric patients were compared on their associations in two studies. Based on a sexual history, they were grouped into those reporting sexual abuse, those reporting satanic ritual abuse (SRA), and those without a history of sexual abuse (controls). In both studies, SRA patients gave significantly more total associations, significantly fewer normative associations, and significantly more satanic associations than did the other two groups. These results suggest that an experience base is shared by individuals reporting SRA that is not found in individuals who do not report satanic abuse (even if they do report sexual abuse). The implications of these findings are discussed from the perspective of arguments advanced by advocates and critics of SRA. PMID:9811130

  8. History of sexual abuse and suicide attempts in alcohol-dependent patients.

    PubMed

    Jakubczyk, A; Klimkiewicz, A; Krasowska, A; Kopera, M; Sławińska-Ceran, A; Brower, K J; Wojnar, M

    2014-09-01

    History of child abuse is considered one of the important risk factors of suicide attempt in general population. At the same time it has been shown that suicide attempts appear significantly more frequently in alcoholics than in healthy individuals. The objective of this study was to investigate associations between history of childhood sexual abuse and suicide attempts in a sample of Polish alcohol dependent patients. A sample of 364 alcohol-dependent subjects was recruited in alcohol treatment centers in Warsaw, Poland. Information was obtained about demographics, family history of psychiatric problems, history of suicide attempts, sexual and physical abuse during childhood and adulthood and severity of alcohol problems. When analyzed by gender, 7.4% of male and 39.2% of female patients had a lifetime history of sexual abuse; 31.9% of the study group reported at least one suicide attempt during their lifetime. Patients who reported suicide attempts were significantly younger (p=0.0008), had greater severity of alcohol dependence (p=0.0002), lower social support (p=0.003), and worse economic status (p=0.002). Moreover, there was a significant association between history of suicide attempts and family history of psychiatric problems (p=0.00025), suicide attempts in the family (p=0.0073), childhood history of sexual abuse (p=0.009) as well as childhood history of physical abuse (p=0.002). When entered into linear regression analysis with other dependent variables history of childhood sexual abuse remained a significant predictor of suicide attempt (OR=2.52; p=0.035). Lifetime experience of sexual abuse is a significant and independent risk factor of suicide attempts in alcohol-dependent individuals. PMID:24997776

  9. Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review

    PubMed Central

    Carmichael, Ashley-Nicole; Morgan, Laura; Del Fabbro, Egidio

    2016-01-01

    Background The misuse and abuse of opioid medications in many developed nations is a health crisis, leading to increased health-system utilization, emergency department visits, and overdose deaths. There are also increasing concerns about opioid abuse and diversion in patients with cancer, even at the end of life. Aims To evaluate the current literature on opioid misuse and abuse, and more specifically the identification and assessment of opioid-abuse risk in patients with cancer. Our secondary aim is to offer the most current evidence of best clinical practice and suggest future directions for research. Materials and methods Our integrative review included a literature search using the key terms “identification and assessment of opioid abuse in cancer”, “advanced cancer and opioid abuse”, “hospice and opioid abuse”, and “palliative care and opioid abuse”. PubMed, PsycInfo, and Embase were supplemented by a manual search. Results We found 691 articles and eliminated 657, because they were predominantly non cancer populations or specifically excluded cancer patients. A total of 34 articles met our criteria, including case studies, case series, retrospective observational studies, and narrative reviews. The studies were categorized into screening questionnaires for opioid abuse or alcohol, urine drug screens to identify opioid misuse or abuse, prescription drug-monitoring programs, and the use of universal precautions. Conclusion Screening questionnaires and urine drug screens indicated at least one in five patients with cancer may be at risk of opioid-use disorder. Several studies demonstrated associations between high-risk patients and clinical outcomes, such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose, greater health care utilization, and symptom burden. PMID:27330340

  10. Recurrent paraparesis and death of a patient with ‘whippet’ abuse

    PubMed Central

    Hirvioja, Jouni; Joutsa, Juho; Wahlsten, Pia; Korpela, Jaana

    2016-01-01

    Nitrous oxide is increasingly used as a recreational drug that is easily and legally available worldwide. Occasional nitrous oxide use has been considered relatively safe without the development of addiction or major adverse effects. However, heavy long-term nitrous oxide abuse can be associated with severe neurological complications, and even deaths have been described. The characteristic presentation is myeloneuropathy with dorsal column degeneration and demyelinating sensory polyneuropathy related to vitamin B12 deficiency. Described is a 23-year-old male who developed recurrent paraparesis related to nitrous oxide abuse. A second, more severe, episode of paraparesis was associated with predominantly lower motor neuron damage. A partial recovery was achieved by discontinuation of nitrous oxide use and initiation of vitamin B12 supplementation. However, the patient relapsed and ultimately died while being intoxicated with several abusive substances. The case adds to the cumulative literature about the clinical phenomenology and dangers of nitrous oxide abuse. PMID:26989492

  11. Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history.

    PubMed

    Michna, Edward; Ross, Edgar L; Hynes, Wilfred L; Nedeljkovic, Srdjan S; Soumekh, Sharonah; Janfaza, David; Palombi, Diane; Jamison, Robert N

    2004-09-01

    Physicians can encounter problems in prescribing opioids for some patients with chronic pain such as multiple unsanctioned dose escalations, episodes of lost or stolen prescriptions, and positive urine drug screenings for illicit substances. This study explored the usefulness of questions on abuse history in predicting problems with prescribing opioids for patients at a hospital-based pain management program. One hundred forty-five (145) patients who were taking long- and short-acting opioids for their pain were classified as high or low risk on the basis of their responses to interview questions about 1) substance abuse history in their family, 2) past problems with drug or alcohol abuse, and 3) history of legal problems. The treating physicians completed a questionnaire about problems that they had encountered with their patients. Problem behaviors were verified through chart review. No differences in demographic characteristics were found between those classified as high and low risk. Patients who admitted to a family history of substance abuse, a history of legal problems, and drug or alcohol abuse were prone to more aberrant drug-related behaviors, including a higher incidence of lost or stolen prescriptions and the presence of illicit substances in their urine (P < 0.05). Patients classified as high risk also had a significantly higher frequency of reported mental health problems and motor vehicle accidents. More of these patients smoked cigarettes, tended to need a cigarette within the first hour of the day, took higher doses of opioids, and reported fewer adverse effects from the medications than did those without such a history (P < 0.05). This study demonstrates that questions about abuse history and legal problems can be useful in predicting aberrant drug-related behavior with opioid use in persons with chronic noncancer pain. PMID:15336337

  12. Prevalent Intravenous Abuse of Methylphenidate Among Treatment-Seeking Patients With Substance Abuse Disorders: A Descriptive Population-Based Study

    PubMed Central

    Haraldsson, Haraldur M.; Rafnar, Bjarni O.; Sigurdsson, Engilbert; Steingrimsson, Steinn; Johannsson, Magnus; Bragadottir, Helena; Magnusson, Andres

    2015-01-01

    Objectives: Prescription rates of methylphenidate (MPH) are sharply rising in most Western countries. Although it has been reported that MPH has abuse potential, little is known about the prevalence of intravenous (IV) abuse of MPH. The aim of the study was to investigate the prevalence of IV MPH abuse among treatment-seeking IV substance abusers in Iceland. Methods: This is a descriptive population-based study using a semistructured interview assessing sociodemographics, substance abuse history, and the method of administration of 108 IV substance abusers. During 1 year, consecutively admitted adult inpatients with substance use disorder at any detoxification center in Iceland that reported any IV substance abuse in the past 30 days were invited to participate. Abuse was defined as nontherapeutic use of a substance to gain psychological or physiological effect. Results: Prevalence of any IV MPH abuse among participants was 88% in the last 30 days (95% confidence interval [CI], 0.82-0.94) and MPH was the most commonly abused substance (65%) and the preferred substance (63%). Around one third (30%) reported MPH as the first IV substance ever abused. However, among those reporting a shorter history than 10 years of IV abuse, 42% reported MPH as the first IV substance ever abused. Conclusions: This first nationwide study on IV abuse of MPH shows that it is common among treatment-seeking IV abusers in Iceland and suggests that MPH has high abuse potential. Therefore, both the use and possible abuse of MPH in those with high abuse potential should be monitored, especially in countries where MPH prescriptions rates are on the rise. PMID:25748561

  13. Protecting the whistleblower: preventing retaliation following a report of patient abuse in health-care institutions.

    PubMed

    Burkin, K; Kleiner, B H

    1998-01-01

    Health-care providers throughout the United States face litigation and the threat of litigation on a daily basis due to claims of patient abuse. Hidden within the costs associated with defending patient abuse claims are the wrongful termination filings made by employees who claim they were retaliated against for their whistleblowing activity. The purpose of this paper is to demonstrate why an employer would resort to retaliatory acts in the shadow of a patient abuse filing and to discuss what steps are currently taken to prove and investigate the validity of a retaliation claim. Included within the body of this paper are court decisions on the topics of whistleblowing protection and violation of public policy. These examples are illustrated so that recommendations can be provided that assist the employer in avoiding a wrongful discharge claim and help to conclude that retaliation against the whistleblower is a costly mistake even with the employment at-will principle as a defense. PMID:10346307

  14. Paperless medical records: reinventing the patient experience.

    PubMed

    Tobey, Mary Ellen

    2004-01-01

    At North Shore Magnetic Imaging Center, the patient paper medical record system was becoming very cumbersome, and it served as a source of frustration for everyone involved: patients, technologists, radiologists, and staff members. The center's mapping of a typical patient experience indicated that, from the initial phone call scheduling an exam to a completed visit (claim processed and payment received), a record could be handled by as many as 20 sets of hands! In June 2002, the center's growth and a concern that patients were losing a one-on-one experience with the medical staff led to an evaluation of workflow processes existing at that time. The evaluation began with a survey of staff members, center management, radiologists, and referring physicians. Their responses indicated 3 common themes: stress, overload, and frustration over systems in place. Comments from the survey were grouped into 3 areas: Continue to Do, Stop Doing, and Start Doing. The Start Doing responses provided solid objectives. The center set out to establish a breakthrough project that included all stakeholders--patients, staff, management, and radiologists. The Reinvention Project had 2 primary goals: move to a paperless environment and increase the level of patient care. The project was divided into internal and external teams. The internal team, called the Reinvention Team, was responsible for the actual hands-on aspects of the process. There were numerous external teams; each had defined roles and specific outcomes for achievement. The external teams' responsibilities included implementing an Internet protocol telephone system; researching voice recognition; restructuring job descriptions, training manuals, and performance evaluations; and conducting a patient-centered focus group. PMID:15259685

  15. Combined Abuse of Clonidine and Amitriptyline in a Patient on Buprenorphine Maintenance Treatment

    PubMed Central

    Dittmer, Trent; Sigman, Erika J.; Clemons, Holly; Johnson, J. Aaron

    2014-01-01

    Buprenorphine/naloxone maintenance therapy is often prescribed in primary care to treat opioid dependence. Previous reports have described concomitant abuse of opioids and clonidine. In this case, a primary care patient on buprenorphine/naloxone maintenance therapy demonstrating altered mental status, hallucinations, falls, and rebound hypertension was found to be concomitantly abusing clonidine and amitryptyline, which share metabolic pathways with buprenorphine. Clinicians should be aware of patients' combining amitryptyline, clonidine, and gabapentin with buprenorphine to achieve a mood altering state, avoid co-prescribing them if possible, and maintain communication with pharmacies and other providers when they are prescribed. PMID:25314340

  16. Comparison of Early Maladaptive Schemas and Parenting Origins in Patients with Opioid Abuse and Non-Abusers

    PubMed Central

    Zargar, Mohammad; Salavati, Mojgan; Kakavand, Ali Reza

    2011-01-01

    Objective The aim of this study was to examine the difference of early maladaptive schemas and parenting origins in opioid abusers and non-opioid abusers. Method The early maladaptive schemas and parenting origins were compared in 56 opioid abusers and 56 non-opioids abusers. Schemas were assessed by the Young Schema Questionnaire 3rd (short form); and parenting origins were assessed by the Young Parenting Inventory. Results Data were analyzed by multivariate analysis of variance (MANOVA). The analysis showed that the means for schemas between opioid abusers and non-opioid abusers were different. Chi square test showed that parenting origins were significantly associated with their related schemas. Conclusion The early maladaptive schemas and parenting origins in opioid abusers were more than non-opioid abusers; and parenting origins were related to their Corresponding schemas. PMID:22952522

  17. [In a medical setting, why and how can the doctor identify the patient as a victim of abuse].

    PubMed

    Gauthier, C

    2011-01-01

    People who were victims of childhood abuse (sexual, emotional or physical), later on will develop psychosomatic illnesses and psychological problems. These health problems, sad consequences of past abuse, will bring them to consult a physician at one point or another. But, because these patients often do not talk about the ancient trauma, the physician is unaware of this past abuse and only treats the illness' symptoms. Abused people will also develop behavioral problems which put them repeatedly back into the position of victim, without realizing why. If this dysfunctional behavior is not identified as the result of trauma, these multi-abused patients will go from bad to worse, repeating in an endless cycle their role as victim. If the physician is able to identify this typical replay of victimization, the patient can be helped to become aware of and to avoid compulsive self-abusive behaviors which are discussed in the following article. PMID:21942076

  18. [Continuous ECG recording for freely moving patients].

    PubMed

    Shi, Bo; Liu, Shengyang; Chen, Jianfang; Zhang, Genxuan; Tsau, Young

    2013-04-01

    As more and more people are becoming aged in China and many of them tend to suffer from chronic cardiac problems, the long-term dynamic cardiac monitoring for freely moving patients becomes essential. A new design for continuous ECG recording on the freely moving patients at home and/or at work is proposed here. It is miniature in size, using digital technologies of the low gain amplifier, the high resolution analog to digital converter and the real-time digital filter that features > 100dB input signal dynamic range (ISDR), > 100dB common-mode rejection ratio (CMRR), and < 5microV (RMS) internal noise. The device works continuously more than 24 hours with a pair of AAA batteries, and is capable of storing the recorded data into a storage card. The preliminary tests showed that the P-QRS-T waveforms were captured and displayed smoothly in resting, walking, and activities, making the device useful in monitoring and analyzing for the patients on the move. PMID:23858751

  19. Understanding forearm fractures in young children: Abuse or not abuse?

    PubMed

    Ryznar, Elizabeth; Rosado, Norell; Flaherty, Emalee G

    2015-09-01

    This retrospective study describes the characteristics and mechanisms of forearm fractures in children <18 months adding to the evidence-base about forearm fractures. It also examines which features of forearm fractures in young children may help discriminate between abusive and noninflicted injuries. Electronic medical records were reviewed for eligible patients evaluated between September 1, 2007 and January 1, 2012 at two children's hospitals in Chicago, IL. The main outcome measures were the type of fracture and the etiology of the fracture (abuse versus not abuse). The 135 included patients sustained 216 forearm fractures. Most were buckle (57%) or transverse (26%). Child protection teams evaluated 47 (35%) of the patients and diagnosed 11 (23%) as having fractures caused by abuse. Children with abusive versus non-inflicted injuries had significant differences in age (median age 7 versus 12 months), race, and presence of additional injuries. Children with abusive forearm fractures often presented without an explanation or a changing history for the injury. Children with non-inflicted forearm fractures often presented after a fall. No particular type of forearm fracture was specific for child abuse. Any forearm fracture in a young child should be evaluated with special attention to the details of the history and the presence of other injuries. Young age, additional injuries, and an absent or inconsistent explanation should increase concern that the fracture was caused by child abuse. PMID:25765815

  20. Computerised patient record with distributed objects.

    PubMed

    Gornik, T; Orel, A; Roblek, D; Verhovsek, R

    1999-01-01

    The vast spectrum of information and functionality requirements imposed on a Computerised Patient Record (CPR), fueled by an ever changing and expanding business model demands information system interoperability. The management of information, created across the continuum of care, and associated information system functionality, can not be provided by data interchange to and from monolithic applications. WebDoctor is a Computerised Patient Record (CPR) which is fully used at the Institute of Oncology in Ljubljana, Slovenia--a hospital with 500 beds and more than 200 users, all of them medical professionals. The data are stored in an underlying Oracle hospital data base. For logging the username and password security is used. WebDoctor uses Internationalization APIs. Currently GUI is currently written in Slovenian language, but can be easily adapted to any other language. It is available in either Metal or Windows look. Search for patients is based on CPR No. or partial data from demographics. All the available patients data can be found on a single screen divided into several tab sections. The tab sections cover general and speciality data. The general data include demographics, admissions and diagnoses, meanwhile the speciality data are divided into Labs where data are represented numerically by date or by type and graphically with the ability of detailed view in separate window, Radiology where results are represented in textual form as well as pictures together with a special viewer to provide detailed analyses and Radioisotopes where results are also being represented in textual form together with a graphical representation. WebDoctor is running on virtually any platform. It achieved the 100% Java Certification which places the application among the firsts if not the first of this kind in the healthcare industry. It excels with a small and light client which doesn't exceed the 150K. PMID:10725016

  1. Survey of abuse and violence by patients and relatives towards intensive care staff.

    PubMed

    Lynch, J; Appelboam, R; McQuillan, P J

    2003-09-01

    A postal survey of senior nurses in intensive care units in England and Wales was conducted. The aim was to ascertain the frequency of abusive and violent behaviour by patients and relatives towards intensive care staff, discover the perceived causes, effects and documentation of such behaviour and define the current and proposed security arrangements for intensive care units. Response rate was 94%. During the study period, verbal abuse of nurses by patients and by relatives occurred in 87% and 74% of intensive care units, respectively. The relevant figures for doctors were 65% and 59%, respectively. Nurses experienced physical abuse by patients and by relatives in at least 77% and 17% of intensive care units, respectively (doctors 38% and 8%). Illness was the main perceived cause of offences by patients whereas 'distress' (45%), alcohol (24%), sociopathic behaviour (27%) were the main putative causes amongst relatives. Whilst 43% of intensive care units have no security system at the door, staff awareness, training and communication skills may be the principle tools in reducing the frequency and consequences of violent and abusive behaviour. This survey probably underestimates the problem. PMID:12911365

  2. Inhalant Use, Abuse, and Dependence among Adolescent Patients: Commonly Comorbid Problems.

    ERIC Educational Resources Information Center

    Sakai, Joseph T.; Hall, Shannon K.; Mikulich-Gilbertson, Susan K.; Crowley, Thomas J.

    2004-01-01

    Objective: Little is known about adolescents with DSM-IV-defined inhalant abuse and dependence. The aim of this study was to compare comorbidity among (1) adolescents with inhalant use disorders, (2) adolescents who reported using inhalants without inhalant use disorder, and (3) other adolescent patients drawn from an adolescent drug and alcohol…

  3. Effect of Intravenous Patient Controlled Ketamine Analgesiaon Postoperative Pain in Opium Abusers

    PubMed Central

    Dahi-Taleghani, Mastane; Fazli, Benjamin; Ghasemi, Mahshid; Vosoughian, Maryam; Dabbagh, Ali

    2014-01-01

    Background: Acutepostoperative pain is among the worst experience that patient scan undergo, and many analgesics have been used to suppress it; especially in chronic opium abusers. Ketamine is an N-methyl-D-aspartate antagonist analgesic, having both anesthetic and analgesic properties, which are not affected to the same extent in chronic opium abusers. Objectives: In this study, we assessed the analgesic effects of ketamine added to morphine as a patient-controlled analgesia method for acute pain management, compared with a placebo, inchronic maleopium abusers. Patients and Methods: After institutional review board approval for ethical considerations, a randomized double-blinded placebo controlled clinical trial was conducted. A total of 140 male patients aged 18-65 years, undergoing orthopedic surgery, were entered into the study after matching inclusion and exclusion criteria. All patients received the same anesthesia method; while the first group received ketamine (1mg/mL) and morphine (0.5 mg/mL) as a patient-controlled analgesia (70 patients), the second group received morphine (0.5 mg/mL) plus normal saline (70 patients). P value less than 0.05 was considered statistically significant. Results: The ketamine and morphine group of patients experienced less postoperative pain and required less postoperative rescue analgesia. However, the unwanted postoperative side effects were nearly the same; although increased levels of postoperative nausea and vomiting were observed in the ketamine and morphine group Conclusions: This study demonstrated improved analgesic effects after using intravenous patient controlled analgesia with ketamine on postoperative pain in opium abusers. PMID:24701419

  4. Review of cases of patient risk associated with ginseng abuse and misuse

    PubMed Central

    Paik, Doo Jin; Lee, Chang Ho

    2014-01-01

    Ginseng has long been used as a functional food or therapeutic supplement and it is empirically known to be safe and nontoxic. During recent decades, a number of in vitro and in vivo experiments, as well as human studies have been conducted to prove the safety of various types of ginseng samples and their components. Clinical trials, case reports, and in vitro and in vivo research articles addressing the safety, toxicity, and other adverse events of ginseng application were selected and reviewed. Patient risks associated with ginseng abuse and misuse such as affective disorder, allergy, cardiovascular and renal toxicity, genital organ bleeding, gynecomastia, hepatotoxicity, hypertension, reproductive toxicity, and anticoagulant-ginseng interaction were reviewed and summarized. There are some cases of patient risk associated with ginseng abuse and misuse depending on patients' conditions although further investigation in more cases is required to clarify these issues. PMID:26045681

  5. Shallow medication extraction from hospital patient records.

    PubMed

    Boytcheva, Svetla

    2011-01-01

    This paper presents methods for shallow Information Extraction (IE) from the free text zones of hospital Patient Records (PRs) in Bulgarian language in the Patient Safety through Intelligent Procedures in medication (PSIP) project. We extract automatically information about drug names, dosage, modes and frequency and assign the corresponding ATC code to each medication event. Using various modules for rule-based text analysis, our IE components in PSIP perform a significant amount of symbolic computations. We try to address negative statements, elliptical constructions, typical conjunctive phrases, and simple inferences concerning temporal constraints and finally aim at the assignment of the drug ACT code to the extracted medication events, which additionally complicates the extraction algorithm. The prototype of the system was used for experiments with a training corpus containing 1,300 PRs and the evaluation results are obtained using a test corpus containing 6,200 PRs. The extraction accuracy (f-score) for drug names is 98.42% and for dose 93.85%. PMID:21685617

  6. Intravenous Drug Abuse by Patients Inside the Hospital: A Cause for Sustained Bacteremia

    PubMed Central

    Thyagarajan, Braghadheeswar

    2016-01-01

    Patients with history of intravenous drug abuse are noted to be at risk of several infections including HIV, endocarditis, and other opportunistic infections. We report the case of a patient with sustained Bacillus cereus bacteremia despite use of multiple antibiotic regimens during his inpatient stay. Our case highlights the importance of high suspicion for active drug use inside the hospital in such patients. This is important in order to minimize unnecessary diagnostic workup and provide adequate treatment and safe hospital stay for these patients. PMID:27433362

  7. Geriatric forensics: A dentist's perspective and contribution to identify existence of elder abuse among his patients

    PubMed Central

    Mattoo, Khurshid A; Shalabh, Kumar; Khan, Aamir

    2010-01-01

    Aims and Objectives: To identify existence of elder abuse among the patients seeking prosthetic rehabilitation of missing teeth. Materials and Methods: This study was conducted on 300 patients aged 65 years and above. It included 238 males and 62 females. A questionnaire prepared by a psychologist was used to evaluate the patient in various aspects of neglect. Results: The results revealed that 40% of the total subjects that were studied were suffering from neglect in one way or the other. Conclusion: The results conclude that elder negligence was highly prevalent in elder patients who report to the dental office seeking oral prosthetic rehabilitation. PMID:21731345

  8. Intravenous Drug Abuse by Patients Inside the Hospital: A Cause for Sustained Bacteremia.

    PubMed

    Goel, Noopur; Munshi, Lubna Bashir; Thyagarajan, Braghadheeswar

    2016-01-01

    Patients with history of intravenous drug abuse are noted to be at risk of several infections including HIV, endocarditis, and other opportunistic infections. We report the case of a patient with sustained Bacillus cereus bacteremia despite use of multiple antibiotic regimens during his inpatient stay. Our case highlights the importance of high suspicion for active drug use inside the hospital in such patients. This is important in order to minimize unnecessary diagnostic workup and provide adequate treatment and safe hospital stay for these patients. PMID:27433362

  9. Profile of female patients seeking in-patient treatment for prescription opioid abuse from a tertiary care drug dependence treatment centre from India

    PubMed Central

    Dayal, Prabhoo; Balhara, Yatan Pal Singh

    2016-01-01

    Background & objectives: There has been a limited focus on prescription drug abuse among women in the country. Choice of psychoactive substance, reasons for initiation and co-occurring disorders have been found to be different among men and women. The current study was aimed at studying the profile of female patients seeking in-patient treatment for prescription drug use over a period of five years at a tertiary care drug dependence treatment centre in India. Methods: Case records of all female patients admitted with substance use disorder at a national level drug dependence treatment centre in north India across five years (between January 2008 and December 2012) were reviewed retrospectively to study their socio-demographic and clinical profile. The information was gathered using a semi-structured proforma and detailed case records. Abstinence, relapse and retention rates were calculated. Results: Over the five years, 31 female patients were admitted with prescription drug abuse. Of them, 12 (39%) used prescription opioids and 11 (36%) used prescription opioid along with benzodiazepines. Commonest prescription opioid was pentazocine used by 87 per cent of the women. Twenty two (71%) women were introduced to opioid by medical practitioners and commonest reason for introduction was pain (among 48%). Common co-occurring psychiatric diagnoses were depressive disorder (26%), cluster B traits/disorder (19%) and somatoform disorder (13%). Eight women did not complete treatment and left against medical advice. Thirteen women were advised maintenance treatment, and 70 per cent of them were retained for at least six months. Interpretation & conclusions: Our findings revealed a link between mental illness, pain and non-medical use of prescription opioids among women. Majority of these women received opioids as a legitimate prescription form physician. Therefore, these legitimate prescribers should be trained for pain management to facilitate proper treatment of pain and to

  10. 78 FR 45454 - Patient Access to Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-29

    ...The Department of Veterans Affairs (VA) amends its regulation governing disclosure of information to veterans and other beneficiaries. The current regulation provides for a special procedure for evaluating sensitive records and determining whether an individual may gain access to his or her own records. The special procedure allows VA to prevent an individual's access to his or her own records......

  11. 42 CFR 2.15 - Incompetent and deceased patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.15 Incompetent and deceased... a deceased patient as an alcohol or drug abuser is subject to these regulations. If a...

  12. Reliability of the Revised Psychopathy Checklist in Substance Abuse Patients.

    ERIC Educational Resources Information Center

    Alterman, Arthur I.; And Others

    1993-01-01

    One month test-retest reliability of the Revised Psychopathy Checklist (PCL-R) was examined in 88 methadone-maintained males, along with effects of increased information about patients on PCL-R scores and diagnostic derivations. Test-retest reliabilities are quite good. Other findings also confirm potential utility of the PCL-R for research. (SLD)

  13. Alcohol abuse as the strongest risk factor for violent offending in patients with paranoid schizophrenia

    PubMed Central

    Kudumija Slijepčević, Marija; Jukić, Vlado; Novalić, Darko; Žarković-Palijan, Tija; Milošević, Milan; Rosenzweig, Ivana

    2014-01-01

    Aim To determine predictive risk factors for violent offending in patients with paranoid schizophrenia in Croatia. Method The cross-sectional study including male in-patients with paranoid schizophrenia with (N = 104) and without (N = 102) history of physical violence and violent offending was conducted simultaneously in several hospitals in Croatia during one-year period (2010-2011). Data on their sociodemographic characteristics, duration of untreated illness phase (DUP), alcohol abuse, suicidal behavior, personality features, and insight into illness were collected and compared between the groups. Binary logistic regression model was used to determine the predictors of violent offending. Results Predictors of violent offending were older age, DUP before first contact with psychiatric services, and alcohol abuse. Regression model showed that the strongest positive predictive factor was harmful alcohol use, as determined by AUDIT test (odds ratio 37.01; 95% confidence interval 5.20-263.24). Psychopathy, emotional stability, and conscientiousness were significant positive predictive factors, while extroversion, pleasantness, and intellect were significant negative predictive factors for violent offending. Conclusion This study found an association between alcohol abuse and the risk for violent offending in paranoid schizophrenia. We hope that this finding will help improve public and mental health prevention strategies in this vulnerable patient group. PMID:24778102

  14. Patient records: from single events to elements for health planning.

    PubMed

    Pisanelli, D M; Ricci, F L

    1994-12-01

    Data collected in patient records are not only the kernel of a ward information system, but also the groundwork for planning and evaluating services in health care. The aim of this study was to analyze the problem of aggregate data generation starting from separate items in patient records. After describing the different uses of patient record data, we outline the process which generates aggregates data starting from individual records. This process leads to the definition of the "view on aggregation" as an intermediate step between patient records and aggregate data. A simplified schema is presented based on the Entity-Relationship model representing a conceptual model of the integration of aggregate data and patient record items. Finally, the role is discussed of automation in this process and the perspectives for its implementation. PMID:7869944

  15. TeleMed: A distributed virtual patient record system

    SciTech Connect

    Forslund, D.W.; Phillips, R.L.; Kilman, D.G.; Cook, J.L.

    1996-06-01

    TeleMed is a distributed diagnosis and analysis system, which permits physicians who are not collocated to consult on the status of a patient. The patient`s record is dynamically constructed from data that may reside at several sites but which can be quickly assembled for viewing by pointing to the patient`s name. Then, a graphical patient record appears, through which consulting physicians can retrieve textual and radiographic data with a single mouse click. TeleMed uses modern distributed object technology and emerging telecollaboration tools. The authors describe in this paper some of the motivation for this change, what they mean by a virtual patient record, and some results of some early implementations of a virtual patient record.

  16. The Formation of Marijuana Risk Perception in a Population of Substance Abusing Patients.

    PubMed

    Wilkinson, Samuel T; van Schalkwyk, Gerrit I; Davidson, Larry; D'Souza, Deepak C

    2016-03-01

    Risk perception has been shown to be protective with regard to marijuana use. Notably, the risk perception of marijuana in individuals with substance abuse problems varies significantly from that of the general public. Understanding how risk perception is formed in substance users could explain these differences and help predict the consequences of policy changes. Using this framework, we explored risk perception and its formation in a sample of substance abusing veterans. Semi-structured interviews were conducted with veterans who were receiving treatment for substance abuse. Interviews were recorded digitally, transcribed verbatim, and analyzed using inductive thematic analysis. A prominent perspective among the 31 participants was that marijuana is significantly different from other drugs because it is safe, not addictive, not associated with physical withdrawal, and has less overt behavioral effects than other substances. Many of these participants drew upon their own innocuous experiences with the drug in developing this perspective, more so than information from any other source. A contrasting narrative emphasized marijuana's capacity to cause negative social consequences, act as a gateway to the use of other, more harmful substances, and cause paranoia or worsen psychosis. In conclusion, individual experience with marijuana featured more prominently in informing risk perception than any other source of information. Our results and previous literature suggest that the significant disconnect between the individual experiences of substance users and the current clinical and legal policy towards marijuana may weaken the legitimacy of public policy or the authority of the medical community. PMID:25982082

  17. Elder abuse.

    PubMed

    Costa, A J

    1993-06-01

    Elder abuse is a tragedy both for the individual and for society because it occupies a pivotal position in the family life cycle of violence. Great variety exists among victims, abusers, and situations; thus, no single model is adequate to explain cause and direct treatment. Primary care physicians must be alert to the possibility of elder abuse in their patients and aware of resources within their community for managing cases once identified. Federal laws and regulations must take a proactive, long-term approach to the solution of this problem and must respect the autonomy of competent elderly patients. PMID:8356158

  18. Criminality in men with major mental disorder with and without comorbid substance abuse.

    PubMed

    Modestin, Jiri; Wuermle, Othmar

    2005-02-01

    Violent and criminal behavior in the mentally ill remains an issue of major importance and in this context the role of comorbid substance abuse must be addressed. Data on criminal behavior in 282 men with schizophrenia and 261 men with affective disorder were studied. Samples of patients with and without additional substance abuse were compared. Also, non-abusing patients from both diagnostic groups were compared with matched controls from the general population. Substance abuse was found in half of all men in both groups of major mental disorders, and substance abusers had twice as high a probability of having a criminal record. However, compared with the matched sample from the general population, violent criminality was increased in schizophrenic patients without comorbid substance abuse, and patients with affective disorders without substance abuse had a higher probability of committing crimes against property. Men with major mental disorder have an increased probability of becoming criminal even when there is no comorbid substance abuse. PMID:15679536

  19. The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients.

    PubMed

    Humphreys, K; Noke, J M

    1997-02-01

    The effect of 12-step mutual help groups (e.g., Narcotics Anonymous) on members' friendship networks has received little attention. This 1-year longitudinal study examined such effects in a sample of 2,337 male substance abuse inpatients, 57.7% of whom became significantly involved in 12-step activities (e.g., reading program literature, attending meetings) after treatment. An a priori model of the interplay of 12-step involvement) and friendship networks was tested using structural equation modeling, and found to have excellent fit to the data. Twelve-step group involvement after treatment predicted better general friendship characteristics (e.g., number of close friends) and substance abuse-specific friendship characteristics (e.g., proportion of friends who abstain from drugs and alcohol) at follow-up. Results are discussed in terms of how mutual help group involvement benefits patients and how the self-help group evaluation paradigm should be broadened. PMID:9231993

  20. 42 CFR 137.178 - May Self-Governance Tribes store patient records at the Federal Records Centers?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false May Self-Governance Tribes store patient records at... SELF-GOVERNANCE Operational Provisions Records § 137.178 May Self-Governance Tribes store patient records at the Federal Records Centers? Yes, at the option of a Self-Governance Tribe, patient records...

  1. 42 CFR 137.178 - May Self-Governance Tribes store patient records at the Federal Records Centers?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false May Self-Governance Tribes store patient records at... SELF-GOVERNANCE Operational Provisions Records § 137.178 May Self-Governance Tribes store patient records at the Federal Records Centers? Yes, at the option of a Self-Governance Tribe, patient records...

  2. 42 CFR 137.178 - May Self-Governance Tribes store patient records at the Federal Records Centers?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false May Self-Governance Tribes store patient records at... SELF-GOVERNANCE Operational Provisions Records § 137.178 May Self-Governance Tribes store patient records at the Federal Records Centers? Yes, at the option of a Self-Governance Tribe, patient records...

  3. 42 CFR 137.178 - May Self-Governance Tribes store patient records at the Federal Records Centers?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false May Self-Governance Tribes store patient records at... SELF-GOVERNANCE Operational Provisions Records § 137.178 May Self-Governance Tribes store patient records at the Federal Records Centers? Yes, at the option of a Self-Governance Tribe, patient records...

  4. 42 CFR 137.178 - May Self-Governance Tribes store patient records at the Federal Records Centers?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false May Self-Governance Tribes store patient records at... SELF-GOVERNANCE Operational Provisions Records § 137.178 May Self-Governance Tribes store patient records at the Federal Records Centers? Yes, at the option of a Self-Governance Tribe, patient records...

  5. Antisocial personality disorder is associated with receipt of physical disability benefits in substance abuse treatment patients

    PubMed Central

    Byrne, Shannon A.; Cherniack, Martin G.; Petry, Nancy M.

    2013-01-01

    Background Opioid dependence is growing at an alarming rate in the United States, and opioid dependent patients have substantial medical, as well as psychiatric, conditions that impact their ability to work. This study evaluated the association between antisocial personality disorder (ASPD) and receipt of physical disability payments in methadone maintenance patients. Methods Using data from 115 drug and alcohol abusing methadone maintained patients participating in two clinical trials, baseline characteristics of individuals receiving (n = 22) and those not receiving (n = 93) physical disability benefits were compared, and a logistic regression evaluated unique predictors of disability status. Results Both an ASPD diagnosis and severity of medical problems were significant predictors of disability receipt, ps < .05. After controlling for other variables that differed between groups, patients with ASPD were more than five times likelier to receive physical disability benefits than patients without ASPD (odds ratio = 5.66; 95% confidence interval = 1.58 – 20.28). Conclusions These results demonstrate a role of ASPD in the receipt of disability benefits in substance abusers and suggest the need for greater understanding of the reasons for high rates of physical disability benefits in this population. PMID:23394688

  6. Abuse liability measures for use in analgesic clinical trials in patients with pain: IMMPACT recommendations.

    PubMed

    O'Connor, Alec B; Turk, Dennis C; Dworkin, Robert H; Katz, Nathaniel P; Colucci, Robert; Haythornthwaite, Jennifer A; Klein, Michael; O'Brien, Charles; Posner, Kelly; Rappaport, Bob A; Reisfield, Gary; Adams, Edgar H; Balster, Robert L; Bigelow, George E; Burke, Laurie B; Comer, Sandra D; Cone, Edward; Cowan, Penney; Denisco, Richard A; Farrar, John T; Foltin, Richard W; Haddox, J David; Hertz, Sharon; Jay, Gary W; Junor, Roderick; Kopecky, Ernest A; Leiderman, Deborah B; McDermott, Michael P; Palmer, Pamela P; Raja, Srinivasa N; Rauschkolb, Christine; Rowbotham, Michael C; Sampaio, Cristina; Setnik, Beatrice; Smith, Shannon M; Sokolowska, Marta; Stauffer, Joseph W; Walsh, Sharon L; Zacny, James P

    2013-11-01

    Assessing and mitigating the abuse liability (AL) of analgesics is an urgent clinical and societal problem. Analgesics have traditionally been assessed in randomized clinical trials (RCTs) designed to demonstrate analgesic efficacy relative to placebo or an active comparator. In these trials, rigorous, prospectively designed assessment for AL is generally not performed. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) convened a consensus meeting to review the available evidence and discuss methods for improving the assessment of the AL of analgesics in clinical trials in patients with pain. Recommendations for improved assessment include: (1) performing trials that include individuals with diverse risks of abuse; (2) improving the assessment of AL in clinical trials (eg, training study personnel in the principles of abuse and addiction behaviors, designing the trial to assess AL outcomes as primary or secondary outcome measures depending on the trial objectives); (3) performing standardized assessment of outcomes, including targeted observations by study personnel and using structured adverse events query forms that ask all subjects specifically for certain symptoms (such as euphoria and craving); and (4) collecting detailed information about events of potential concern (eg, unexpected urine drug testing results, loss of study medication, and dropping out of the trial). The authors also propose a research agenda for improving the assessment of AL in future trials. PMID:24148704

  7. Diversity in relapse prevention needs: gender and race comparisons among substance abuse treatment patients.

    PubMed

    Walton, M A; Blow, F C; Booth, B M

    2001-05-01

    Attempts to address high relapse rates following substance abuse treatment have focused on identifying relapse prevention needs and development of subsequent relapse prevention programs. Few studies have examined whether women and African-Americans have unique relapse prevention needs. Research in this area could provide an initial basis for the development of alternative relapse prevention approaches that could be more appropriate for this pop ulation. This study examined gender and race differences in psychosocial concerns among patients recruited from substance abuse treatment as potential indicators of relapse prevention needs. Participants (N = 331) completed several questionnaires during their first month of substance abuse treatment. Assessment packets included measures of coping, self-efficacy, resource needs, cravings, social influences, exposure, and leisure activities. Analyses focused on gender and race differences in these variables before and after controlling for background characteristics (i.e., age, marital status, income, polysubstance use, treatment type, and problem severity). Gender differences found were that men reported poorer coping skills and more negative social influences and exposure to substances than women; these differences remained significant when controlling for background characteristics. Significant race differences were found on all scales except negative social influences. After controlling for background characteristics, African-Americans reported significantly greater coping skills and self-efficacy than did Caucasians; however, African-Americans also reported greater resource needs in comparison to Caucasians. Results highlight the diversity in psychosocial issues among substance abusers in treatment, particularly between Caucasians and African-Americans. Implications for developing alternative relapse prevention approaches to address this diversity are discussed. PMID:11417937

  8. Patient Records in the Mental Health Disciplines.

    ERIC Educational Resources Information Center

    Reynolds, John Frederick; Mair, David

    1989-01-01

    Examines reports written in mental health hospitals and community mental health centers. Analyzes a total of 150 randomly selected samples of 5 basic mental health records, and evaluates the rhetorical contexts for each with regard to author, purpose, audience and use. (KEH)

  9. Dementia and elder abuse.

    PubMed

    Hansberry, Maria R; Chen, Elaine; Gorbien, Martin J

    2005-05-01

    Dementia and elder abuse are relatively common and under-diagnosed geriatric syndromes. A unique relationship is observed when the two entities coexist. Special issues can confound the care of the dementia patient suspected of being abused. Impaired language or motor abilities to communicate abusive situations to a third party, lack of decisional capacity to address the abusive situation, disinhibited behavior that contributes to a cycle of violence, and coincident depression of the abused elder complicate the diagnosis and management of elder abuse. Education of the caregiver and attention to caregiver stress, including depression, may prevent onset and perpetuation of abuse. PMID:15804553

  10. Patient Access to Their Health Record Using Open Source EHR.

    PubMed

    Chelsom, John; Dogar, Naveed

    2015-01-01

    In both Europe and North America, patients are beginning to gain access to their health records in electronic form. Using the open source cityEHR as an example, we have focussed on the needs of clinical users to gather requirements for patient access and have implemented these requirements in a new application called cityEHR-PA. The development of a separate application for patient access was necessary to address requirements for security and ease of use. The use of open standards throughout the design of the EHR allows the possibility of third parties to develop applications for patient access, consuming the individual patient record extracted from the full EHR. PMID:25676956

  11. 42 CFR 2.65 - Procedures and criteria for orders authorizing disclosure and use of records to criminally...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., rape, kidnapping, armed robbery, assault with a deadly weapon, and child abuse and neglect. (2) There... OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Court Orders Authorizing Disclosure and Use §...

  12. 42 CFR 2.65 - Procedures and criteria for orders authorizing disclosure and use of records to criminally...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., rape, kidnapping, armed robbery, assault with a deadly weapon, and child abuse and neglect. (2) There... OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Court Orders Authorizing Disclosure and Use §...

  13. 42 CFR 2.65 - Procedures and criteria for orders authorizing disclosure and use of records to criminally...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., rape, kidnapping, armed robbery, assault with a deadly weapon, and child abuse and neglect. (2) There... OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Court Orders Authorizing Disclosure and Use §...

  14. 42 CFR 2.65 - Procedures and criteria for orders authorizing disclosure and use of records to criminally...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., rape, kidnapping, armed robbery, assault with a deadly weapon, and child abuse and neglect. (2) There... OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Court Orders Authorizing Disclosure and Use §...

  15. 42 CFR 2.65 - Procedures and criteria for orders authorizing disclosure and use of records to criminally...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., rape, kidnapping, armed robbery, assault with a deadly weapon, and child abuse and neglect. (2) There... OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Court Orders Authorizing Disclosure and Use §...

  16. [Diagnostics and treatment of Wernicke-Korsakoff syndrome patients with an alcohol abuse].

    PubMed

    Nilsson, Maria; Sonne, Charlotte

    2013-04-01

    Wernicke-Korsakoff syndrome is a condition with high morbidity and mortality and occurs as a consequence of thiamine deficiency. Clinical symptoms are often ambiguous and post-mortem examinations show that the syndrome is underdiagnosed and probably undertreated. There is sparse clinical evidence concerning optimal dosage and duration of treatment. This article reviews the current literature and concludes that all patients with a history of alcohol abuse should be treated with high dosage IV thiamine for an extended period of time, albeit further research is needed. PMID:23582065

  17. The Effects of Abuse History on Sexually Intrusive Behavior by Children: An Analysis of Child Justice Records

    ERIC Educational Resources Information Center

    Hershkowitz, Irit

    2011-01-01

    Objectives: A commonly cited risk factor for sexually intrusive behavior (SIB) among children and adolescents is a history of abuse. Based on a large and non-clinical nationwide sample of children who were investigated as abuse victims and suspects of SIBs in Israel over a decade, the present study examines the rate of abuse history among child…

  18. Childhood sexual abuse in advanced cancer patients in the palliative care setting.

    PubMed

    Wygant, Carmella; Hui, David; Bruera, Eduardo

    2011-08-01

    Childhood sexual abuse (CSA) is a common, distressing, yet rarely discussed topic in palliative care. The long-term effects of CSA can have a significant impact on patients' quality of life, particularly at the end of life. In this article, we aim to initiate a discussion regarding the need to address CSA in the palliative care setting, using the example of an advanced cancer patient and her caregiver sister who revealed their common past. Specifically, we will be discussing 1) the comorbidities, psychological distress, and family distress associated with CSA, 2) its impact on health care delivery, 3) an approach to initiating conversations regarding CSA, and 4) various management strategies. Successful management of CSA necessitates an interprofessional team approach and may help to improve the quality of life of patients and their families. PMID:21444190

  19. Patient ECG recording control for an automatic implantable defibrillator

    NASA Technical Reports Server (NTRS)

    Fountain, Glen H. (Inventor); Lee, Jr., David G. (Inventor); Kitchin, David A. (Inventor)

    1986-01-01

    An implantable automatic defibrillator includes sensors which are placed on or near the patient's heart to detect electrical signals indicative of the physiology of the heart. The signals are digitally converted and stored into a FIFO region of a RAM by operation of a direct memory access (DMA) controller. The DMA controller operates transparently with respect to the microprocessor which is part of the defibrillator. The implantable defibrillator includes a telemetry communications circuit for sending data outbound from the defibrillator to an external device (either a patient controller or a physician's console or other) and a receiver for sensing at least an externally generated patient ECG recording command signal. The patient recording command signal is generated by the hand held patient controller. Upon detection of the patient ECG recording command, DMA copies the contents of the FIFO into a specific region of the RAM.

  20. Physical Abuse

    MedlinePlus

    Navigation Physical Abuse Sexual Abuse Domestic Violence Psychological Abuse Financial Abuse Neglect Critical Issues What Communities Can Do The Role of Professionals and Concerned Citizens Help for Victims ...

  1. Sexual Abuse

    MedlinePlus

    Navigation Physical Abuse Sexual Abuse Domestic Violence Psychological Abuse Financial Abuse Neglect Critical Issues What Communities Can Do The Role of Professionals and Concerned Citizens Help for Victims ...

  2. Platelet Activation in Human Immunodeficiency Virus Type-1 Patients Is Not Altered with Cocaine Abuse

    PubMed Central

    Kiebala, Michelle; Singh, Meera V.; Piepenbrink, Michael S.; Qiu, Xing; Kobie, James J.; Maggirwar, Sanjay B.

    2015-01-01

    Recent work has indicated that platelets, which are anucleate blood cells, significantly contribute to inflammatory disorders. Importantly, platelets also likely contribute to various inflammatory secondary disorders that are increasingly associated with Human Immunodeficiency Virus Type-1 (HIV) infection including neurological impairments and cardiovascular complications. Indeed, HIV infection is often associated with increased levels of platelet activators. Additionally, cocaine, a drug commonly abused by HIV-infected individuals, leads to increased platelet activation in humans. Considering that orchestrated signaling mechanisms are essential for platelet activation, and that nuclear factor-kappa B (NF-κB) inhibitors can alter platelet function, the role of NF-κB signaling in platelet activation during HIV infection warrants further investigation. Here we tested the hypothesis that inhibitory kappa B kinase complex (IKK) activation would be central for platelet activation induced by HIV and cocaine. Whole blood from HIV-positive and HIV-negative individuals, with or without cocaine abuse was used to assess platelet activation via flow cytometry whereas IKK activation was analyzed by performing immunoblotting and in vitro kinase assays. We demonstrate that increased platelet activation in HIV patients, as measured by CD62P expression, is not altered with reported cocaine use. Furthermore, cocaine and HIV do not activate platelets in whole blood when treated ex vivo. Finally, HIV-induced platelet activation does not involve the NF-κB signaling intermediate, IKKβ. Platelet activation in HIV patients is not altered with cocaine abuse. These results support the notion that non-IKK targeting approaches will be better suited for the treatment of HIV-associated inflammatory disorders. PMID:26076359

  3. Information integrity and privacy for computerized medical patient records

    SciTech Connect

    Gallegos, J.; Hamilton, V.; Gaylor, T.; McCurley, K.; Meeks, T.

    1996-09-01

    Sandia National Laboratories and Oceania, Inc. entered into a Cooperative Research and Development Agreement (CRADA) in November 1993 to provide ``Information Integrity and Privacy for Computerized Medical Patient Records`` (CRADA No. SC93/01183). The main objective of the project was to develop information protection methods that are appropriate for databases of patient records in health information systems. This document describes the findings and alternative solutions that resulted from this CRADA.

  4. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor... or drug abuse treatment, any written consent for disclosure authorized under subpart C of these... drug abuse treatment, any written consent for disclosure authorized under subpart C of...

  5. A Recommendation for the Management of Illness Anxiety Disorder Patients Abusing the Health Care System

    PubMed Central

    Almalki, Mohammad; Al-Tawayjri, Ibrahim; Al-Anazi, Ahmed; Mahmoud, Sami

    2016-01-01

    Introduction. Illness anxiety disorder (IAD) entails a preoccupation with having a serious, undiagnosed illness in which somatic symptoms are, if present, mild in intensity (American Psychiatric Association, 2013). Case Report. This is a case of seventy-three-year-old Saudi man who started visiting the primary health care center around twenty-five years ago. With concerns of having cancer, the patient continuously visited the hospital, costing over $170,000. Throughout this period, the patient has been exposed to extensive unnecessary imaging studies and laboratory tests that have effects on his life in all aspects with such concerns. Five years ago, a family doctor has put an end to that by directing the patient to the right path. The doctor made several actions; most importantly, he directed the patient to a cognitive behavioral therapy which significantly improved a range of hypochondriacal beliefs and attitudes. This patient's case demonstrates the fundamental importance of a proper health system that limits such patients from abusing the health system and depleting the medical resources. Moreover, this case emphasizes the important role of the family physician who can be the first physician to encounter such patients. Thus, proper understanding of the nature of such disorder is a key element for better diagnosis and management. PMID:27313939

  6. Cognitive analysis of the summarization of longitudinal patient records.

    PubMed

    Reichert, Daniel; Kaufman, David; Bloxham, Benjamin; Chase, Herbert; Elhadad, Noémie

    2010-01-01

    Electronic health records contain an abundance of valuable information that can be used to guide patient care. However, the large volume of information embodied in these records also renders access to relevant information a time-consuming and inefficient process. Our ultimate objective is to develop an automated summarizer that succinctly captures all relevant information in the patient record. In this paper, we present a cognitive study of 8 clinicians who were asked to create summaries based on data contained in the patients' electronic health record. The study characterized the primary sources of information that were prioritized by clinicians, the temporal strategies used to develop a summary and the cognitive operations used to guide the summarization process. Although we would not expect the automated summarizer to emulate human performance, we anticipate that this study will inform its development in instrumental ways. PMID:21347062

  7. The electronic patient record: a strategic planning framework.

    PubMed

    Gordon, D B; Marafioti, S; Carter, M; Kunov, H; Dolan, A

    1995-01-01

    Sunnybrook Health Science Center (Sunnybrook) is a multifacility academic teaching center. In May 1994, Sunnybrook struck an electronic patient record taskforce to develop a strategic plan for the implementation of a comprehensive, facility wide electronic patient record (EPR). The taskforce sought to create a conceptual framework which provides context and integrates decision-making related to the comprehensive electronic patient record. The EPR is very much broader in scope than the traditional paper-based record. It is not restricted to simply reporting individual patient data. By the Institute of Medicine's definition, the electronic patient record resides in a system specifically designed to support users through availability of complete and accurate data, practitioner reminders and alerts, clinical decision support systems, links to bodies of medical knowledge, and other aids [1]. It is a comprehensive resource for patient care. The taskforce proposed a three domain model for determining how the EPR affects Sunnybrook. The EPR enables Sunnybrook to have a high performance team structure (domain 1), to function as an integrated organization (domain 2), and to reach out and develop new relationships with external organizations to become an extended enterprise (domain 3) [2]. Domain 1: Sunnybrook's high performance teams or patient service units' (PSUs) are decentralized, autonomous operating units that provide care to patients grouped by 'like' diagnosis and resource needs. The EPR must provide functions and applications which promote patient focused care, such as cross functional charting and care maps, group scheduling, clinical email, and a range of enabling technologies for multiskilled workers. Domain 2: In the integrated organization domain, the EPR should facilitate closer linkages between the arrangement of PSUs into clinical teams and with other facilities within the center in order to provide a longitudinal record that covers a continuum of care

  8. Extracting Temporal Information from Electronic Patient Records

    PubMed Central

    Li, Min; Patrick, Jon

    2012-01-01

    A method for automatic extraction of clinical temporal information would be of significant practical importance for deep medical language understanding, and a key to creating many successful applications, such as medical decision making, medical question and answering, etc. This paper proposes a rich statistical model for extracting temporal information from an extremely noisy clinical corpus. Besides the common linguistic, contextual and semantic features, the highly restricted training sample expansion and the structure distance between the temporal expression & related event expressions are also integrated into a supervised machine-learning approach. The learning method produces almost 80% F- score in the extraction of five temporal classes, and nearly 75% F-score in identifying temporally related events. This process has been integrated into the document-processing component of an implemented clinical question answering system that focuses on answering patient-specific questions (See demonstration at http://hitrl.cs.usyd.edu.au/ICNS/). PMID:23304326

  9. Development framework for a patient-centered record.

    PubMed

    Puentes, John; Roux, Michèle; Montagner, Julien; Lecornu, Laurent

    2012-12-01

    Patient records have been developed to support the physician-oriented medical activity scheme. One recommended yet rarely studied alternative, expected to improve healthcare, is the patient-centered record. We propose a development framework for such record, which includes domain-specific database models at the conceptual level, analyzing the fundamental role of complementary information destined to ensure proper patient understanding of related clinical situations. A patient-centered awareness field study of user requirements and medical workflow was carried out in three medical services and two technical units to identify the most relevant elements of the framework, and compared to the definitions of a theoretical approach. Three core data models - centered on the patient, medical personnel, and complementary patient information, corresponding to the determined set of entities, information exchanges and actors roles, constitute the technical recommendations of the development framework. An open source proof of concept prototype was developed to show the model feasibility. The resulting patient-centered record development framework implies particular medical personnel contributions to supply complementary information. PMID:22795581

  10. Patient experiences with electronic medical records: Lessons learned

    PubMed Central

    Rose, Dale; Richter, Louiseann T; Kapustin, Jane

    2014-01-01

    Purpose To describe the lived experience of patients communicating with their nurse practitioners and physicians while using paper health records (PHRs) and electronic health records (EHRs) in the examination rooms. The significance of the study lies in the salience of communication between the patient and provider in promoting optimal clinical outcomes and the highest level of patient satisfaction. Data sources The study used a qualitative, phenomenological design. Audio-taped focus group interviews were conducted with 21 patients from a diabetes clinic in Baltimore, Maryland. Patients had visits with the provider before and after implementation of EHRs in the clinic. Conclusions The four themes that emerged from the three focus groups included communication issues, patient preferences for electronic records, safety and security concerns, and transition problems with implementation of EHRs. Implications for practice Potential benefits for nurse practitioners implementing the recommendations in this study include enhanced communication between patients and providers while using EHRs, increased patient satisfaction, higher levels of nurse practitioner and physician satisfaction, and avoidance of communication issues during implementation of EHR systems. PMID:25234112

  11. Redundancy-aware topic modeling for patient record notes.

    PubMed

    Cohen, Raphael; Aviram, Iddo; Elhadad, Michael; Elhadad, Noémie

    2014-01-01

    The clinical notes in a given patient record contain much redundancy, in large part due to clinicians' documentation habit of copying from previous notes in the record and pasting into a new note. Previous work has shown that this redundancy has a negative impact on the quality of text mining and topic modeling in particular. In this paper we describe a novel variant of Latent Dirichlet Allocation (LDA) topic modeling, Red-LDA, which takes into account the inherent redundancy of patient records when modeling content of clinical notes. To assess the value of Red-LDA, we experiment with three baselines and our novel redundancy-aware topic modeling method: given a large collection of patient records, (i) apply vanilla LDA to all documents in all input records; (ii) identify and remove all redundancy by chosing a single representative document for each record as input to LDA; (iii) identify and remove all redundant paragraphs in each record, leaving partial, non-redundant documents as input to LDA; and (iv) apply Red-LDA to all documents in all input records. Both quantitative evaluation carried out through log-likelihood on held-out data and topic coherence of produced topics and qualitative assessment of topics carried out by physicians show that Red-LDA produces superior models to all three baseline strategies. This research contributes to the emerging field of understanding the characteristics of the electronic health record and how to account for them in the framework of data mining. The code for the two redundancy-elimination baselines and Red-LDA is made publicly available to the community. PMID:24551060

  12. How Patients Can Improve the Accuracy of their Medical Records

    PubMed Central

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

    2014-01-01

    Objectives: 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. Background: 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. Methods: 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. Findings/Discussion: (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

  13. Long-Term Effects of Incest: Life Events Triggering Mental Disorders in Female Patients with Sexual Abuse in Childhood.

    ERIC Educational Resources Information Center

    Kinzl, Johannes; Biebl, Wilfried

    1992-01-01

    Psychosocial, psychosomatic, and psychodynamic factors were evaluated in 33 female psychiatric patients who had been victims of incest. Sexual abuse experiences in childhood were related to feelings of anxiety, helplessness, and powerlessness, which, with a lack of support from the mother, led to ego weakness, and an autoplastic model of coping…

  14. Elder Abuse and Substance Abuse

    MedlinePlus

    ... Additional Resources Return to: What is Elder Abuse? Elder Abuse and Substance Abuse Substance abuse has been identified ... the most frequently cited risk factor associated with elder abuse and neglect. It may be the victim and/ ...

  15. Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

    ERIC Educational Resources Information Center

    Stefansson, Ragnar; Hesse, Morten

    2008-01-01

    A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Base-rate scores indicated a prevalence of 95% of…

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

    SciTech Connect

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

    2014-06-01

    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.

  17. Health-based payment and computerized patient record systems.

    PubMed

    Hornbrook, M C; Goodman, M J; Fishman, P A; Meenan, R T

    1998-01-01

    Health care information technology is changing rapidly and dramatically. A small but growing number of clinicians, especially those in staff and group model HMOs and hospital-affiliated practices, are automating their patient medical records in response to pressure to improve quality and reduce costs. Computerized patient record systems in HMOs track risks, diagnoses, patterns of care, and outcomes across large populations. These systems provide access to large amounts of clinical information; as a result, they are very useful for risk-adjusted or health-based payment. The next stage of evolution in health-based payment is to switch from fee-for-service (claims) to HMO technology in calculating risk coefficients. This will occur when HMOs accumulate data sets containing records on provider-defined disease episodes, with every service linked to its appropriate disease episode for millions of patients. Computerized patient record systems support clinically meaningful risk-assessment models and protect patients and medical groups from the effects of adverse selection. They also offer significant potential for improving quality of care. PMID:10187225

  18. Patient clustering with uncoded text in electronic medical records.

    PubMed

    Henao, Ricardo; Murray, Jared; Ginsburg, Geoffrey; Carin, Lawrence; Lucas, Joseph E

    2013-01-01

    We propose a mixture model for text data designed to capture underlying structure in the history of present illness section of electronic medical records data. Additionally, we propose a method to induce bias that leads to more homogeneous sets of diagnoses for patients in each cluster. We apply our model to a collection of electronic records from an emergency department and compare our results to three other relevant models in order to assess performance. Results using standard metrics demonstrate that patient clusters from our model are more homogeneous when compared to others, and qualitative analyses suggest that our approach leads to interpretable patient sub-populations when applied to real data. Finally, we demonstrate an example of our patient clustering model to identify adverse drug events. PMID:24551361

  19. Patient Clustering with Uncoded Text in Electronic Medical Records

    PubMed Central

    Henao, Ricardo; Murray, Jared; Ginsburg, Geoffrey; Carin, Lawrence; Lucas, Joseph E.

    2013-01-01

    We propose a mixture model for text data designed to capture underlying structure in the history of present illness section of electronic medical records data. Additionally, we propose a method to induce bias that leads to more homogeneous sets of diagnoses for patients in each cluster. We apply our model to a collection of electronic records from an emergency department and compare our results to three other relevant models in order to assess performance. Results using standard metrics demonstrate that patient clusters from our model are more homogeneous when compared to others, and qualitative analyses suggest that our approach leads to interpretable patient sub-populations when applied to real data. Finally, we demonstrate an example of our patient clustering model to identify adverse drug events. PMID:24551361

  20. Giving Patients Access to Their Medical Records via the Internet

    PubMed Central

    Masys, Daniel; Baker, Dixie; Butros, Amy; Cowles, Kevin E.

    2002-01-01

    Objective: The Patient-Centered Access to Secure Systems Online (pcasso) project is designed to apply state-of-the-art-security to the communication of clinical information over the Internet. Design: The authors report the legal and regulatory issues associated with deploying the system, and results of its use by providers and patients. Human subject protection concerns raised by the Institutional Review Board focused on three areas—unauthorized access to information by persons other than the patient; the effect of startling or poorly understood information; and the effect of patient access to records on the record-keeping behavior of providers. Measurements: Objective and subjective measures of security and usability were obtained. Results: During its initial deployment phase, the project enrolled 216 physicians and 41 patients; of these, 68 physicians and 26 patients used the system one or more times. The system performed as designed, with no unauthorized information access or intrusions detected. Providers rated the usability of the system low because of the complexity of the secure login and other security features and restrictions limiting their access to those patients with whom they had a professional relationship. In contrast, patients rated the usability and functionality of the system favorably. Conclusion: High-assurance systems that serve both patients and providers will need to address differing expectations regarding security and ease of use. PMID:11861633

  1. Severe lactic acidosis in a diabetic patient after ethanol abuse and floor cleaner intake.

    PubMed

    Hendrikx, Jeroen J M A; Lagas, Jurjen S; Daling, Ratana; Hooijberg, Jan Hendrik; Schellens, Jan H M; Beijnen, Jos H; Brandjes, Desiderius P M; Huitema, Alwin D R

    2014-11-01

    An intoxication with drugs, ethanol or cleaning solvents may cause a complex clinical scenario if multiple agents have been ingested simultaneously. The situation can become even more complex in patients with (multiple) co-morbidities. A 59-year-old man with type 2 diabetes mellitus (without treatment two weeks before the intoxication) intentionally ingested a substantial amount of ethanol along with ~750 mL of laminate floor cleaner containing citric acid. The patient was admitted with severe metabolic acidosis (both ketoacidosis and lactic acidosis, with serum lactate levels of 22 mM). He was treated with sodium bicarbonate, insulin and thiamine after which he recovered within two days. Diabetic ketoacidosis and lactic acidosis aggravated due to ethanol intoxication, thiamine deficiency and citrate. The high lactate levels were explained by excessive lactate formation caused by the combination of untreated diabetes mellitus, thiamine deficiency and ethanol abuse. Metabolic acidosis in diabetes is multi-factorial, and the clinical situation may be further complicated, when ingestion of ethanol and toxic agents are involved. Here, we reported a patient in whom diabetic ketoacidosis was accompanied by severe lactic acidosis as a result of citric acid and mainly ethanol ingestion and a possible thiamine deficiency. In the presence of lactic acidosis in diabetic ketoacidosis, physicians need to consider thiamine deficiency and ingestion of ethanol or other toxins. PMID:24717115

  2. The independent effects of child sexual abuse and impulsivity on lifetime suicide attempts among female patients.

    PubMed

    Daray, Federico M; Rojas, Sasha M; Bridges, Ana J; Badour, Christal L; Grendas, Leandro; Rodante, Demián; Puppo, Soledad; Rebok, Federico

    2016-08-01

    Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (β=.18, p<.05) and impulsivity (β=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (β=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior. PMID:27352091

  3. Prevalence and Record of Alcoholism Among Emergency Department Patients

    PubMed Central

    Boniatti, Márcio Manozzo; Diogo, Luciano Passamani; Almeida, Caroline Lorenzoni; de Oliveira Cardoso, Michelle

    2009-01-01

    OBJECTIVES: The purpose of this study was to investigate the prevalence of alcoholism among inpatients, to identify social and demographic factors associated with this prevalence and to determine its rate of recognition by the medical team. METHODS: The study population consisted of all patients admitted to the emergency room at Hospital São Lucas, Porto Alegre, Brazil, between July and September of 2005. The data were collected in two steps: an interview with the patient and a review of the medical records to investigate the cases of alcoholism recorded by the medical team. The questionnaire consisted of questions concerning social and demographic data, smoking habits and Alcohol Use Disorders Identification Test. RESULTS: We interviewed 248 patients. Twenty-eight (11.3%) were identified as alcoholics. Compared to the patients with a negative Alcohol Use Disorders Identification Test value (less than 8), those with a positive Alcohol Use Disorders Identification Test were more likely to be male, illiterate and smokers. The medical records of 217 (87.5%) patients were reviewed. Only 5 (20.0%) of the 25 patients with a positive Alcohol Use Disorders Identification Test whose medical records were reviewed were identified as alcoholics by the medical team. The diagnosis made by the medical team, compared to Alcohol Use Disorders Identification Test, shows only a 20% sensitivity, 93% specificity and positive and negative predictive values of 29% and 90%, respectively. CONCLUSION: Alcoholism has been underrecognized in patients who are hospitalized, and, as such, this opportunity for possible early intervention is often lost. Key social and demographic factors could provide physicians with risk factors and, when used together with a standardized diagnostic instrument, could significantly improve the rate of identification of alcoholic patients. PMID:19142548

  4. Using a computerized patient record to reengineer an outpatient clinic.

    PubMed Central

    Borowitz, S. M.

    1994-01-01

    By employing process flow analysis and work redesign techniques during the design and implementation of a computerized patient record in the pediatric outpatient clinics at the University of Virginia Health Sciences Center, we have developed a database of clinical observations while simultaneously shortening the time that patients spend waiting in the pediatric clinics and decreasing the number of support staff employed within the clinics. PMID:7949936

  5. Physicians’ Attitudes regarding Patient Access to Electronic Medical Records

    PubMed Central

    Dorr, David A.; Rowan, Belle; Weed, Matt; James, Brent; Clayton, Paul

    2003-01-01

    Prior to the implementation of Electronic Medical Record (EMR) web access for patients at a large integrated delivery systems, we surveyed physicians’ attitudes. Our web based questionnaire revealed largely positive attitudes about access. The exceptions included abnormal reports, progress notes, and e-care. A factor analysis identified the group of physicians who didn’t view patients as partners felt most negative about the process. PMID:14728337

  6. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  7. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  8. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  9. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  10. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  11. Improving diabetes management with electronic health records and patients' health records.

    PubMed

    Benhamou, P-Y

    2011-12-01

    The lack of patient engagement and clinical inertia both contribute to suboptimal diabetes care. However, both obstacles are amenable to informatics- and Internet-based interventions. The use of electronic medical records (EMRs) is now established as being useful for improving diabetes care. Intelligent records that integrate computerized decision-support systems are now able to recommend care protocols tailored to risk levels. Web-based personal health record (PHR) systems, shared with healthcare providers, could also provide added value by promoting self-management of the behaviours related to diabetes. These Web-based programmes include patients' access to EMRs, uploading of glucose monitoring results, a glucose diary, secure e-mail with providers, manual or automated feedback on blood glucose readings and other risk factors, an educational website, and an online diary for entering personal information on exercise, diet and medication. The integration of Web-based patients' systems into the EMR used by physicians is the next frontier. In addition, the input from "smartphones" that are able to provide real-time support to patients could contribute to the reorganization of diabetes care. Convincing data on HbA(1c) improvements with such systems are available for type 2 diabetes, but are still equivocal for type 1 diabetes. Obstacles include patients' compliance with the technology, their ergonomic design and the need to reimburse providers for their care. Designing appropriate electronic tools and tailoring them to the conditions in France merits our attention. PMID:22208711

  12. Integration of electronic patient record context with message context.

    PubMed

    De Clercq, Etienne; Bangels, Marc; France, Francis Roger

    2004-01-01

    A methodology to construct specific messages with clear objectives inside clinical processes, while simultaneously including contextual information, remains a problem today. This paper addresses the issue of combining specific message context (process driven) with the context of a patient record (patient centered). In Belgium, simplified conceptual models for Electronic Patient Record (EPR) architecture and for message architecture, based on previous comprehensive and international work, have been produced, validated and mapped into an integrated message format. The resulting model described in this paper highlights the main conceptual links between both basic models: at the action level and at the Transaction level. Using XML, some parts of the model have already been implemented in various national projects. Key lessons learned may be imported at the international level. PMID:15360968

  13. Meconium Indicators of Maternal Alcohol Abuse during Pregnancy and Association with Patient Characteristics

    PubMed Central

    Goecke, Tamme W.; Burger, Pascal; Fasching, Peter A.; Bakdash, Abdulsallam; Engel, Anne; Häberle, Lothar; Voigt, Franziska; Faschingbauer, Florian; Raabe, Eva; Maass, Nicolai; Rothe, Michael; Beckmann, Matthias W.; Pragst, Fritz

    2014-01-01

    Aim. Identification of women with moderate alcohol abuse during pregnancy is difficult. We correlated self-reported alcohol consumption during pregnancy and patient characteristics with objective alcohol indicators measured in fetal meconium. Methods. A total of 557 women singleton births and available psychological tests, obstetric data and meconium samples were included in statistical analysis. Alcohol metabolites (fatty acid ethyl esters (FAEEs) and ethyl glucuronide (EtG)), were determined from meconium and correlated with patient characteristics. Results. We found that 21.2% of the 557 participants admitted low-to-moderate alcohol consumption during pregnancy. Of the parameters analyzed from meconium, only EtG showed an association with alcohol history (P < 0.01). This association was inverse in cases with EtG value above 120 ng/g. These values indicate women with most severe alcohol consumption, who obviously denied having consumed alcohol during pregnancy. No other associations between socioeconomic or psychological characteristics and the drinking status (via meconium alcohol metabolites) could be found. Conclusion. Women who drink higher doses of ethanol during pregnancy, according to metabolite measures in meconium, might be less likely to admit alcohol consumption. No profile of socioeconomic or psychological characteristics of those women positively tested via meconium could be established. PMID:24800249

  14. Mental Illness, Alcoholism, Substance Abuse, Multiple Disabilities...Whose Patient, Whose Treatment Approach?

    ERIC Educational Resources Information Center

    Sciacca, Kathleen

    This paper reviews issues in the provision of services to individuals who are mentally ill chemical abusers and addicted (MICAA). Introductory material defines this population and notes that these people are frequently ineligible for services aimed at either mental illness or chemical abuse alone. Service provisions within the psychiatric/mental…

  15. Childhood Physical and Sexual Abuse in Depressed Patients with Single and Multiple Suicide Attempts

    ERIC Educational Resources Information Center

    Andover, Margaret S.; Zlotnick, Caron; Miller, Ivan W.

    2007-01-01

    Research has shown both childhood physical and sexual abuse to be associated with later suicide attempts, although some studies have not supported these findings. However, few studies have investigated differences in physical and sexual abuse histories among single and multiple suicide attempters. The goals of the current study were two-fold: (a)…

  16. Silencing the Patient: Freud, Sexual Abuse, and "The Etiology of Hysteria."

    ERIC Educational Resources Information Center

    McOmber, James B.

    1996-01-01

    States that, in "The Etiology of Hysteria," Sigmund Freud's "seduction theory" asserted that child sexual abuse was the single cause of adult hysteria. Argues that Freud's failure to persuade his audience can be attributed not only to their denial of sexual abuse but also to his failure to clarify how pschyoanalysis could comport with traditional…

  17. The Development of a Substance Abuse Treatment Program for Forensic Patients with Cognitive Impairment

    ERIC Educational Resources Information Center

    Glassmire, David M.; Welsh, Robert K.; Clevenger, Jeanne K.

    2007-01-01

    The Substance Abuse and Mental Illness (SAMI) program combines cognitive rehabilitation and dual-diagnosis substance abuse treatment within a stages of change context. This article describes the development, implementation, and preliminary outcome analysis of the SAMI program in a forensic hospital.

  18. A Study of the Relationship between Child Abuse and Drug Addiction in 178 Patients: Preliminary Results.

    ERIC Educational Resources Information Center

    Cohen, Frederick S.; Densen-Gerber, Judianne

    1982-01-01

    A questionnaire on family intactness, parental and sibling relationships, and personal physical/sexual abuse histories was completed by 178 adults in treatment for drug/alcohol addiction. Results revealed that 84 percent of the sample reported a history of child abuse/neglect. (Author/CL)

  19. A computer-based patient record: Emory's approach.

    PubMed

    Bennett, J J; Alligood, R; Beck, K L; Dardeen, K; Payne, L

    1993-05-01

    The replacement of the paper medical record at Emory will be gradual over the next several years. We foresee milestone events after which portions of the patient record are no longer retained in paper form. As these milestones are identified, the HIM professionals at the three institutions will begin the formidable task of managing the transition to a paperless system. Evaluation of business processes and the skill sets needed by staff members can be accomplished and a plan for each phase of transition developed. PMID:10139112

  20. Personal Health Records for Patients with Chronic Disease

    PubMed Central

    Rozenblum, R.; Park, A.; Dunn, M.; Bates, D.W.

    2014-01-01

    Summary Background Personal health records (PHRs) connected to a physician’s electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. Objectives: To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations. Methods A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations. Results Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged. Conclusion This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination. PMID:25024758

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

    PubMed Central

    Schmock, Henriette; Dalgaard, Marlene; Andreatta, Massimo; Hansen, Thomas; Søeby, Karen; Bredkjær, Søren; Juul, Anders; Werge, Thomas; Jensen, Lars J.; Brunak, Søren

    2011-01-01

    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. PMID:21901084

  2. Patient-Reported Use of Personalized Video Recordings to Improve Neurosurgical Patient-Provider Communication

    PubMed Central

    Porter, Randall

    2015-01-01

    Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication. Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes. Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed. Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more “at ease” with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action. Conclusions: Patient responses to the recording system and having a copy of their video

  3. Matching Patient Records to Clinical Trials Using Ontologies

    NASA Astrophysics Data System (ADS)

    Patel, Chintan; Cimino, James; Dolby, Julian; Fokoue, Achille; Kalyanpur, Aditya; Kershenbaum, Aaron; Ma, Li; Schonberg, Edith; Srinivas, Kavitha

    This paper describes a large case study that explores the applicability of ontology reasoning to problems in the medical domain. We investigate whether it is possible to use such reasoning to automate common clinical tasks that are currently labor intensive and error prone, and focus our case study on improving cohort selection for clinical trials. An obstacle to automating such clinical tasks is the need to bridge the semantic gulf between raw patient data, such as laboratory tests or specific medications, and the way a clinician interprets this data. Our key insight is that matching patients to clinical trials can be formulated as a problem of semantic retrieval. We describe the technical challenges to building a realistic case study, which include problems related to scalability, the integration of large ontologies, and dealing with noisy, inconsistent data. Our solution is based on the SNOMED CT® ontology, and scales to one year of patient records (approx. 240,000 patients).

  4. Developing a handheld record for patients with cystic fibrosis

    PubMed Central

    Narayan, Omendra; Davies, Siobhan; Tibbins, Carly; Rees, JH Martyn; Lenney, Warren; Gilchrist, Francis J

    2015-01-01

    Patient handheld records (PHHRs) promote self-management and empower the holder to take a more active role in the management of their disease. They have been used successfully in improving preventative care for children and have contributed to improved adherence in a number of chronic illnesses. Despite the potential advantages, there are no standard PHHRs for patients with cystic fibrosis (CF). We report the consultation process that led to the development of a CF PHHR, describe the final document, and analyze the feedback from their use at our center. We have made the CF PHHR freely available online. PMID:26316833

  5. Substance Abuse, Relapse, and Treatment Program Evaluation in Malaysia: Perspective of Rehab Patients and Staff Using the Mixed Method Approach.

    PubMed

    Chie, Qiu Ting; Tam, Cai Lian; Bonn, Gregory; Dang, Hoang Minh; Khairuddin, Rozainee

    2016-01-01

    This study examined reasons for substance abuse and evaluated the effectiveness of substance treatment programs in Malaysia through interviews with rehab patients and staff. Substance rehab patients (aged 18-69 years; n = 30) and staff (ages 30-72 years; n = 10) participated in semi-structured interviews covering a range of topics, including family and peer relationships, substance use and treatment history, factors for substance use and relapse, motivation for entering treatment, work experience, job satisfaction, treatment evaluation, and patient satisfaction. Most patients did not demonstrate the substance progression trend and had normal family relationships. Most patients reported having peers from normal family backgrounds as well. Various environmental and personal factors was cited as contributing to substance abuse and relapse. There was no significant difference between patient and staff program evaluation scores although the mean score for patients was lower. A holistic treatment approach with a combination of cognitive-behavioral, medical, social, and spiritual components was favored by patients. Suggestions for improving existing programs include better tailoring treatment to individual needs, and providing more post-treatment group support. PMID:27303313

  6. Substance Abuse, Relapse, and Treatment Program Evaluation in Malaysia: Perspective of Rehab Patients and Staff Using the Mixed Method Approach

    PubMed Central

    Chie, Qiu Ting; Tam, Cai Lian; Bonn, Gregory; Dang, Hoang Minh; Khairuddin, Rozainee

    2016-01-01

    This study examined reasons for substance abuse and evaluated the effectiveness of substance treatment programs in Malaysia through interviews with rehab patients and staff. Substance rehab patients (aged 18–69 years; n = 30) and staff (ages 30–72 years; n = 10) participated in semi-structured interviews covering a range of topics, including family and peer relationships, substance use and treatment history, factors for substance use and relapse, motivation for entering treatment, work experience, job satisfaction, treatment evaluation, and patient satisfaction. Most patients did not demonstrate the substance progression trend and had normal family relationships. Most patients reported having peers from normal family backgrounds as well. Various environmental and personal factors was cited as contributing to substance abuse and relapse. There was no significant difference between patient and staff program evaluation scores although the mean score for patients was lower. A holistic treatment approach with a combination of cognitive–behavioral, medical, social, and spiritual components was favored by patients. Suggestions for improving existing programs include better tailoring treatment to individual needs, and providing more post-treatment group support. PMID:27303313

  7. Thinking the unthinkable:the clinician as perpetrator of elder abuse in patients in pain.

    PubMed

    Rich, Ben A

    2004-01-01

    Some advocates for improved pain management have devised and had initial success utilizing a controversial new weapon-the elder abuse claim. In California, two recent cases have been brought under the state's elder abuse statutes against physicians and health care institutions. The first lead to a much publicized jury verdict against a physician, and the second was recently settled as to all defendants, with related disciplinary actions against a treating physician and a skilled nursing facility by their respective regulatory agencies. This commentary reviews the phenomenon of litigating cases of undertreated pain, analyzes the most recent cases, and considers the implications of invoking elder abuse statutes in such cases. PMID:15364633

  8. A clerking tool for the patient record system.

    PubMed

    McDermott, D; Heathfield, H; Kirby, J

    1995-01-01

    1. BACKGROUND. The goal of the PEN&PAD (Elderly Care) project is to develop a patient record system to assist the many different professionals that care for patients in a hospital setting. At the core of the project is the use of structured data which can be reused in a variety of ways--both within the system for further manipulation and display, and externally for auditing and statistical purposes. To accommodate these needs, a compositional method of data entry called Structured Data Entry (SDE) was used in this application. SDE was developed in an earlier project PEN&PAD (GP)(1). Our application utilizes a network representation of the medical semantics that can be queried to obtain what is sensible to "say" about a particular concept. This functionality is contained within a separate application known as the Terminology Server (TeS), which has been developed within the GALEN project (2). The client application (the patient record system) requests information from the TeS which can then be used to produce compositional data entry forms that require the user to choose values for given attributes (e.g., if information pertaining to chest pain were being recorded, the attribute 'location' and a choice of possible values i.e., 'left' 'right' and 'bilateral' might appear on the form). Given the importance of capturing clinical information in a highly structured format, SDE is a valuable tool. However, its long term success depends on a very comprehensive model of the medical terminology corpus. This component is currently being studied by the GALEN team. 2. CURRENT WORK. We are developing a clerking tool to be used to create records for the newly admitted patient. The clinician seeks to identify a patient's problems based on physical examination and information obtained through conversation with the patient. Patients are usually admitted with a presenting complaint and obtaining more information about this complaint is an important part of the clerking process. While

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

    PubMed Central

    2012-01-01

    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 (<10 to >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, providing an increased

  10. Lessons Learned for Follow-up Phone Booster Counseling Calls with Substance Abusing Emergency Department Patients

    PubMed Central

    Donovan, Dennis M.; Hatch-Maillette, Mary A.; Phares, Melissa M.; McGarry, Ernest; Peavy, K. Michelle; Taborsky, Julie

    2014-01-01

    Background Post-visit “booster” sessions have been recommended to augment the impact of brief interventions delivered in the Emergency Department (ED). This paper, which focuses on implementation issues, presents descriptive information and interventionists’ qualitative perspectives on providing brief interventions over the phone, challenges, “lessons learned”, and recommendations for others attempting to implement adjunctive booster calls. Method Attempts were made to complete two 20-minute telephone “booster” calls within a week following a patient’s ED discharge with 425 patients who screened positive for and had recent problematic substance use other than alcohol or nicotine. Results Over half (56.2%) of participants completed the initial call; 66.9% of those who received the initial call also completed the second call. Median number of attempts to successfully contact participants for the first and second calls was 4 and 3, respectively. Each completed call lasted an average of about 22 minutes. Common challenges/barriers identified by booster callers included unstable housing, limited phone access, unavailability due to additional treatment, lack of compensation for booster calls, and booster calls coming from an area code different than the participants’ locale and from someone other than ED staff. Conclusions Specific recommendations are presented with respect to implementing a successful centralized adjunctive booster call system. Future use of booster calls might be informed by research on contingency management (e.g., incentivizing call completions), smoking cessation quitlines, and phone-based continuing care for substance abuse patients. Future research needs to evaluate the incremental benefit of adjunctive booster calls on outcomes over and above that of brief motivational interventions delivered in the ED setting. PMID:25534151

  11. Low plasma antibodies specific for phosphatidylethanol in alcohol abusers and patients with alcoholic pancreatitis.

    PubMed

    Nissinen, Antti E; Laitinen, L Maria; Kakko, Sakari; Helander, Anders; Savolainen, Markku J; Hörkkö, Sohvi

    2012-11-01

    Phosphatidylethanol (PEth) is a group of alcohol-modified phospholipids present in cell membranes after heavy drinking. Our aim was to demonstrate the presence of human plasma antibodies binding to PEth and to address their specificity and value in detecting subjects engaged in heavy alcohol consumption. Antibodies to PEth were analyzed in plasma from heavy drinkers (n=20), patients with alcoholic pancreatitis (n=58) and control subjects (n=24), using chemiluminescent immunoassay. Heavy drinkers and patients with alcoholic pancreatitis demonstrated significantly lower levels of plasma IgG, IgA and IgM titers to PEth compared with controls (P<0.001). The specificity of the antibodies to PEth was demonstrated with competitive liquid phase immunoassays and flow cytometry. The plasma IgG, but not IgA or IgM, titers to PEth in heavy drinkers correlated with the whole blood PEth concentration determined by liquid chromatography-mass spectrometry (r=0.655, P=0.002). Compared with traditional markers for alcohol abuse (aspartate aminotransferase, gamma-glutamyl transpeptidase and mean corpuscular volume), receiver operating characteristic curve analysis showed that a low plasma IgA to PEth had the highest area under the curve (AUC 0.940, P<0.001). In conclusion, plasma IgG, IgA and IgM antibodies binding specifically to PEth were found in subjects of all study groups. Subjects with heavy alcohol consumption showed markedly lower plasma immunoglobulin levels to PEth, potentially making them useful as a biomarker to distinguish heavy from moderate alcohol use. PMID:21309928

  12. The sexual abuse questionnaire: a preliminary examination of a time and cost efficient method in evaluating the presence of childhood sexual abuse in adult patients.

    PubMed

    Lock, Timothy G; Levis, Donald J; Rourke, Patricia A

    2005-01-01

    This paper provides the results of two studies designed to evaluate a newly constructed self-report instrument, the Sexual Abuse Questionnaire (SAQ). The SAQ was designed as a brief screening device to aid in the identification of a childhood sexual abuse history. A "unique" feature of the SAQ is the inclusion of a number of non-face valid questions derived from clinical experience. Both studies used an undergraduate population of self-reported abused and non-abused participants. Based upon the combined results of the two studies, the final version of the SAQ was developed, which is comprised of 45 items that manifest good test-retest reliability, internal consistency, and convergent and discriminative validity. The SAQ can discriminate between abused and non-abused male and female participants. PMID:15914402

  13. Child Abuse and Cot Deaths.

    ERIC Educational Resources Information Center

    Newlands, Mary; Emery, John S.

    1991-01-01

    A search was made of confidential health department records in Great Britain for abused children, or children at risk for abuse, with siblings who had died of Sudden Infant Death Syndrome (SIDS). An association was found between child abuse and about 10 percent of deaths of children diagnosed as SIDS. (BRM)

  14. Sociodemographic profile and pattern of opioid abuse among patients presenting to a de-addiction centre in tertiary care Hospital of Kashmir

    PubMed Central

    Farhat, Samina; Hussain, Syed Sajad; Rather, Yasir Hassan; Hussain, Syed Karrar

    2015-01-01

    Background: The substances abuse has become one of the major public health problems of present society. Recently there has been an increase in the incidence of substance abuse including that of opioids throughout the world. The proper assessment of the current trends and pattern of opioid abuse can be helpful in more effective intervention of this menace. Materials and Methods: To find out various socio-demographic variables and pattern of opioid abuse, a predevised questionnaire was administered to 200 opioid patients who presented to de-addiction center for treatment. Results: Majority of the participants (75%) were of young age group (20–30 years) and the mean age of subjects was 27.6 years. More than half of participants (55%) were abusing the opioid substances for < 3 years followed by 30% of the abusers who were using the opioids for 4–6 years. Oral route was the most common route(35%)of substance administration followed by chasing(13%) and intravenous(11%) routes. Diverted pharmaceuticals emerged as one of the common substances of abuse, and peer pressure was found to be the main reason to start substance abuse. Conclusion: A comprehensive preventive program targeting young adults needs to be formulated and strict laws against sales of diverted pharmaceuticals to be implemented. PMID:26229346

  15. Training Tomorrow's Doctors to Safeguard the Patients of Today: Using Medical Student Simulation Training to Explore Barriers to Recognition of Elder Abuse.

    PubMed

    Fisher, James M; Rudd, Matthew P; Walker, Richard W; Stewart, Jane

    2016-01-01

    In recognition of the fact that elder abuse is a global problem that doctors underrecognize and underreport, a simulation training session for undergraduate medical students was developed. The primary objective of this qualitative study was to examine barriers to and drivers of medical students making a diagnosis of elder abuse in simulated practice, with the goal of refining teaching methods and informing future teaching sessions for other clinical teachers. Third-year medical students (Newcastle University, United Kingdom) undertook a simulation scenario with a high-fidelity mannequin representing an elder abuse victim. After the simulation scenario, students underwent a semistructured debriefing. A tripartite approach to data collection was employed that included audio recordings of the simulation, data sheets capturing students' thoughts during the scenario, and postscenario debriefing. A different researcher analyzed each data set in isolation before discussions were held to triangulate findings from the data sets. Forty-six students undertook the scenario; none declined to participate. A number of barriers to students diagnosing elder abuse were identified. Students held a low index of suspicion for elder abuse and were overly optimistic regarding the etiology of the individual's injuries. Students lacked the confidence to raise concerns about possible elder abuse, believing that certainty was required before doing so. There was widespread confusion about nomenclature. These findings provide clinical teachers with important topic areas to address in future teaching sessions. Simulation, as a method to teach about elder abuse in a reproducible and immersive fashion, is recommended to clinical teachers. PMID:26782868

  16. The challenges in making electronic health records accessible to patients

    PubMed Central

    Beard, Leslie; Schein, Rebecca; Morra, Dante; Wilson, Kumanan

    2011-01-01

    It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians. PMID:22120207

  17. Sexual Abuse of the Mentally Retarded Patient: Medical and Legal Analysis for the Primary Care Physician

    PubMed Central

    Morano, Jamie P.

    2001-01-01

    The primary care physician has a vital role in documenting and preventing sexual abuse among the mentally retarded populations in our community. Since the current national trend is to integrate citizens with mental retardation into the community away from institutionalized care, it is essential that all physicians have a basic understanding of the unique medical and legal ramifications of their clinical diagnoses. As the legal arena is currently revising laws concerning rights of sexual consent among the mentally retarded, it is essential that determinations of mental competency follow national standards in order to delineate clearly any instance of sexual abuse. Clinical documentation of sexual abuse and sexually transmitted disease is an important part of a routine examination since many such individuals are indeed sexually active. Legal codes adjudicating sexual abuse cases of the mentally retarded often offer scant protection and vague terminology. Thus, medical documentation and physician competency rulings form a solid foundation for future work toward legal recourse for the abused. PMID:15014610

  18. Sexual Orientation Disparities in Substance Misuse: The Role of Childhood Abuse and Intimate Partner Violence Among Patients in Care at an Urban Community Health Center

    PubMed Central

    Reisner, Sari L; Falb, Kathryn L; Van Wagenen, Aimee; Grasso, Chris; Bradford, Judith

    2014-01-01

    This study examined disparities in lifetime substance misuse by sexual orientation among 2,653 patients engaged in care at an urban community health center in Boston, MA, as well as the potential mediating roles of childhood abuse abuse by sexual orientation with differences seen by sex. Clinicians should assess history of CA and IPV among sexual minorities presenting with a history of substance abuse disorders. The study's limitations are noted. PMID:23368669

  19. The standard data model approach to patient record transfer.

    PubMed Central

    Canfield, K.; Silva, M.; Petrucci, K.

    1994-01-01

    This paper develops an approach to electronic data exchange of patient records from Ambulatory Encounter Systems (AESs). This approach assumes that the AES is based upon a standard data model. The data modeling standard used here is IDEFIX for Entity/Relationship (E/R) modeling. Each site that uses a relational database implementation of this standard data model (or a subset of it) can exchange very detailed patient data with other such sites using industry standard tools and without excessive programming efforts. This design is detailed below for a demonstration project between the research-oriented geriatric clinic at the Baltimore Veterans Affairs Medical Center (BVAMC) and the Laboratory for Healthcare Informatics (LHI) at the University of Maryland. PMID:7949973

  20. Consumers' Perceptions of Patient-Accessible Electronic Medical Records

    PubMed Central

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

    2013-01-01

    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

  1. Polysubstance abuse: alcohol, opioids and benzodiazepines require coordinated engagement by society, patients, and physicians.

    PubMed

    Ogbu, Uzor C; Lotfipour, Shahram; Chakravarthy, Bharath

    2015-01-01

    The Centers for Disease Control and Prevention (CDC) has published significant data trends related to substance abuse involving opioid pain relievers (OPR), benzodiazepines and alcohol in the United States. The CDC describes opioid misuse and abuse as an epidemic, with the use of OPR surpassing that of illicit drugs. Alcohol has also been a persistent problem and is associated with a number of emergency department visits and deaths independent of other substances. The use of these drugs in combination creates an additive effect with increased central nervous system suppression and a heightened risk of an overdose. We present a summary of the findings from the Morbidity and Mortality Weekly Report (MMWR) with commentary on strategies to combat prescription drug and alcohol abuse. PMID:25671013

  2. Elder Abuse

    MedlinePlus

    ... Physical, sexual, or emotional abuse Neglect or abandonment Financial abuse - stealing of money or belongings Possible signs ... may be a sudden change in the person's financial situation. Elder abuse will not stop on its ...

  3. Elder Abuse

    MedlinePlus

    ... facilities or nursing homes. The mistreatment may be Physical, sexual, or emotional abuse Neglect or abandonment Financial abuse - stealing of money or belongings Possible signs of elder abuse include unexplained bruises, burns, ...

  4. Child Abuse

    MedlinePlus

    ... puts a child at risk of harm. Child abuse can be physical, sexual or emotional. Neglect, or not providing for a child's needs, is also a form of abuse. Most abused children suffer greater emotional than physical ...

  5. Reviewing 741 patients records in two hours with FASTVISU

    PubMed Central

    Escudié, Jean-Baptiste; Jannot, Anne-Sophie; Zapletal, Eric; Cohen, Sarah; Malamut, Georgia; Burgun, Anita; Rance, Bastien

    2015-01-01

    The secondary use of electronic health records opens up new perspectives. They provide researchers with structured data and unstructured data, including free text reports. Many applications been developed to leverage knowledge from free-text reports, but manual review of documents is still a complex process. We developed FASTVISU a web-based application to assist clinicians in reviewing documents. We used FASTVISU to review a set of 6340 documents from 741 patients suffering from the celiac disease. A first automated selection pruned the original set to 847 documents from 276 patients’ records. The records were reviewed by two trained physicians to identify the presence of 15 auto-immune diseases. It took respectively two hours and two hours and a half to evaluate the entire corpus. Inter-annotator agreement was high (Cohen’s kappa at 0.89). FASTVISU is a user-friendly modular solution to validate entities extracted by NLP methods from free-text documents stored in clinical data warehouses. PMID:26958189

  6. Prolonged Exposure for Treating PTSD Among Female Methadone Patients Who Were Survivors of Sexual Abuse in Israel.

    PubMed

    Schiff, Miriam; Nacasch, Nitsa; Levit, Shabtay; Katz, Noam; Foa, Edna B

    2015-01-01

    The aims of this pilot study were: (a) to test the feasibility of prolonged exposure (PE) therapy conducted by a social worker staff on female patients in methadone program clinics who were survivors of child sexual abuse or rape and (b) to examine preliminary outcomes of PE on posttraumatic stress disorder (PTSD), depression, and illicit drug use at pre- and posttreatment, and up to 12-month follow-ups. Twelve female methadone patients who were survivors of child sexual abuse or rape diagnosed with PTSD were enrolled in 13-19 weekly individual PE sessions. Assessments were conducted at pre-, mid-, and posttreatment, as well as at 3, 6, and 12-month follow-ups. The treatment outcomes measures included PTSD symptoms, depressive symptoms, and illicit drug use. Ten of the 12 study patients completed treatment. PTSD and depressive symptoms showed significant reduction. No relapse to illicit drug use was detected. These preliminary results suggest that PE may be delivered by methadone social workers with successful outcomes. Further research should test the efficacy of PE among methadone patients in a randomized control trial with standard care as the control condition. PMID:26399489

  7. Drug abuse

    MedlinePlus

    ... abuse References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 5th ed. Arlington, VA: American Psychiatric Publishing. 2013. Weiss RD. Drugs of abuse. In: Goldman ...

  8. The Moderating Role of Purging Behaviour in the Relationship Between Sexual/Physical Abuse and Nonsuicidal Self-Injury in Eating Disorder Patients.

    PubMed

    Gonçalves, Sónia; Machado, Bárbara; Silva, Cátia; Crosby, Ross D; Lavender, Jason M; Cao, Li; Machado, Paulo P P

    2016-03-01

    This study sought to examine predictors of nonsuicidal self-injury (NSSI) in eating disorder patients and to evaluate the moderating role of purging behaviours in the relationship between a theorised predictor (i.e. sexual/physical abuse) and NSSI. Participants in this study were 177 female patients with eating disorders (age range = 14-38 years) who completed semistructured interviews assessing eating disorder symptoms and eating disorder-related risk factors (e.g. history of sexual and physical abuse, history of NSSI and feelings of fatness). Results revealed that 65 participants (36.7%) reported lifetime engagement in NSSI, and 48 participants (27.1%) reported a history of sexual/physical abuse. Early onset of eating problems, lower BMI, feeling fat, a history of sexual/physical abuse and the presence of purging behaviours were all positively associated with the lifetime occurrence of NSSI. The relationship between sexual/physical abuse before eating disorder onset and lifetime NSSI was moderated by the presence of purging behaviours, such that the relationship was stronger in the absence of purging. These findings are consistent with the notion that purging and NSSI may serve similar functions in eating disorder patients (e.g. emotion regulation), such that the presence of purging may attenuate the strength of the association between sexual/physical abuse history (which is also associated with elevated NSSI risk) and engagement in NSSI behaviours. PMID:26606864

  9. Association between Experience of Child Abuse and Severity of Drug Addiction Measured by the Addiction Severity Index among Japanese Drug-Dependent Patients

    PubMed Central

    Ogai, Yasukazu; Senoo, Eiichi; Gardner, Fumiyuki Chin; Haraguchi, Ayako; Saito, Tamaki; Morita, Nobuaki; Ikeda, Kazutaka

    2015-01-01

    The aim of the present study was to clarify the association between child abuse experiences and drug addiction severity among Japanese drug-dependent patients using the Addiction Severity Index-Japanese version (ASI-J). One hundred and eleven inpatients and outpatients with drug dependence participated in the study. Some of the questions on the ASI-J asked about lifetime experiences of abuse. A higher percentage of female participants experienced child abuse compared with male participants. Male participants who experienced child abuse (MEA) had a significantly higher severity of drug use than men who did not experience it (MNEA). Female participants who experienced child abuse (FEA) had significantly more serious problems in family/social relationships than female participants who did not experience it (FNEA). Patients in the MEA group were arrested less frequently for drug charges, experienced more serious problems with their fathers, and experienced more severe anxiety in their lifetime compared with the MNEA group. The FEA group experienced more serious troubles with their sexual partners, close friends, and families and experienced more severe psychiatric problems in their lifetime compared with the FNEA group. These results suggest gender differences in the problems experienced by drug-dependent patients with child abuse experiences, and gender-specific interventions may be more effective in treating their drug dependence. PMID:25741639

  10. Association between experience of child abuse and severity of drug addiction measured by the Addiction Severity Index among Japanese drug-dependent patients.

    PubMed

    Ogai, Yasukazu; Senoo, Eiichi; Gardner, Fumiyuki Chin; Haraguchi, Ayako; Saito, Tamaki; Morita, Nobuaki; Ikeda, Kazutaka

    2015-03-01

    The aim of the present study was to clarify the association between child abuse experiences and drug addiction severity among Japanese drug-dependent patients using the Addiction Severity Index-Japanese version (ASI-J). One hundred and eleven inpatients and outpatients with drug dependence participated in the study. Some of the questions on the ASI-J asked about lifetime experiences of abuse. A higher percentage of female participants experienced child abuse compared with male participants. Male participants who experienced child abuse (MEA) had a significantly higher severity of drug use than men who did not experience it (MNEA). Female participants who experienced child abuse (FEA) had significantly more serious problems in family/social relationships than female participants who did not experience it (FNEA). Patients in the MEA group were arrested less frequently for drug charges, experienced more serious problems with their fathers, and experienced more severe anxiety in their lifetime compared with the MNEA group. The FEA group experienced more serious troubles with their sexual partners, close friends, and families and experienced more severe psychiatric problems in their lifetime compared with the FNEA group. These results suggest gender differences in the problems experienced by drug-dependent patients with child abuse experiences, and gender-specific interventions may be more effective in treating their drug dependence. PMID:25741639

  11. Increasing the availability of the computerized patient record.

    PubMed Central

    Giuse, D. A.; Mickish, A.

    1996-01-01

    The MARS clinical repository, originally developed at the University of Pittsburgh, provides electronic access to the patient record at Vanderbilt University Medical Center. The original client interface we developed runs on all standard clinical workstations in the medical center, but is operating-system dependent. Porting and maintaining it on the variety of hardware- and software combinations found on VUMC personal computers would be fairly costly. To broaden the availability of the system to faculty and health care providers in all areas, and to support future access from Vanderbilt-affiliated providers outside the main campus, we are developing a new Web-based client. The new client provides good functionality and performance, and will be a strategic asset in our long-term commitment to making relevant clinical information immediately available to authorized health care providers. PMID:8947743

  12. Accelerometer recorder and display system for ambulatory patients

    NASA Astrophysics Data System (ADS)

    Berka, Martin; Żyliński, Marek; Niewiadomski, Wiktor; Cybulski, Gerard

    2015-09-01

    This paper presents the design of a compact, wearable, rechargeable acceleration recorder to support long-term monitoring of ambulatory patients with motor disorders, and of software to display and analyze its output. The device consists of a microcontroller, operational amplifier, accelerometer, SD card, indicator LED, rechargeable battery, and associated minor components. It can operate for over a day without charging and can continuously collect data for three weeks without downloading to an outside system, as currently configured. With slight modifications, this period could be extended to several months. The accompanying software provides flexible visualization of the acceleration data over long periods, basic file operations and compression for easier archiving, annotation of segments of interest, and functions for calculation of various parameters and detection of immobility and vibration frequencies. Applications in analysis of gait and other movements are discussed.

  13. Cycles of abuse nurtured by concealment: a clinical report.

    PubMed

    Wijma, Barbro; Thapar-Björkert, Suruchi; Hammarström, Nevija Cah; Swahnberg, Katarina

    2007-09-01

    At present, health care staff do not seem to have sufficient knowledge about their patients' abusive experiences. The aim of the present study is to analyze and discuss what the implications might be for the encounter between patients and health care professionals, when experiences of abuse are concealed. The methodology of this article is varied: a personal narrative, medical records, sociological theoretical literature and empirical evidence. From the narrative we learn that concealment of abuse was devastating for the patient. She was "treated" in vain as a correct diagnosis was not made, while abuse by her father continued. Health care staff also violated her, which she told her therapist, but her protests were not acknowledged. Ten years of treatment thus made her even more sick. This case story focuses on the mechanisms which nurture concealment of a patient's history of abuse, such as structural and symbolic violence. We also suggest ways to break "cycles of abuse". Help the patient to stop concealing also means that she/he leaves a victim role, gets in charge of the situation and takes a first step towards empowerment. In this way, health care settings can become enabling and empowering environments. PMID:17577758

  14. Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

    PubMed Central

    Krist, Alex H.; Woolf, Steven H.; Bello, Ghalib A.; Sabo, Roy T.; Longo, Daniel R.; Kashiri, Paulette; Etz, Rebecca S.; Loomis, John; Rothemich, Stephen F.; Peele, J. Eric; Cohn, Jeffrey

    2014-01-01

    PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODS We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. PMID:25354405

  15. A profile of suspected child abuse as a subgroup of major trauma patients

    PubMed Central

    Davies, Ffion C; Coats, Timothy J; Fisher, Ross; Lawrence, Thomas; Lecky, Fiona E

    2015-01-01

    Introduction Non-accidental injury (NAI) in children is an important cause of major injury. The Trauma Audit Research Network (TARN) recently analysed data on the demographics of paediatric trauma and highlighted NAI as a major cause of death and severe injury in children. This paper examined TARN data to characterise accidental versus abusive cases of major injury. Methods The national trauma registry of England and Wales (TARN) database was interrogated for the classification of mechanism of injury in children by intent, from January 2004 to December 2013. Contributing hospitals’ submissions were classified into accidental injury (AI), suspected child abuse (SCA) or alleged assault (AA) to enable demographic and injury comparisons. Results In the study population of 14 845 children, 13 708 (92.3%, CI 91.9% to 92.8%) were classified as accidental injury, 368 as alleged assault (2.5%, CI 2.2% to 2.7%) and 769 as SCA (5.2%, CI 4.8% to 5.5%). Nearly all cases of severely injured children suffering trauma because of SCA occurred in the age group of 0–5 years (751 of 769, 97.7%), with 76.3% occurring in infants under the age of 1 year. Compared with accidental injury, suspected victims of abuse have higher overall injury severity scores, have a higher proportion of head injury and a threefold higher mortality rate of 7.6% (CI 5.51% to 9.68%) vs 2.6% (CI 2.3% to 2.9%). Conclusions This study highlights that major injury occurring as a result of SCA has a typical demographic pattern. These children tend to be under 12 months of age, with more severe injury. Understanding these demographics could help receiving hospitals identify children with major injuries resulting from abuse and ensure swift transfer to specialist care. PMID:26598630

  16. 78 FR 79201 - Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ...In this final rule, the Office of Inspector General (OIG) amends the safe harbor regulation concerning electronic health records items and services, which defines certain conduct that is protected from liability under the Federal anti-kickback statute, section 1128B(b) of the Social Security Act (the Act). Amendments include updating the provision under which electronic health records software......

  17. Child Abuse: One Tree in the Forest

    ERIC Educational Resources Information Center

    Burland, J. Alexis; And Others

    1973-01-01

    The records of 28 abused or severely neglected children, as reviewed and analyzed, show the importance of meeting the child's and parent's dependency needs, rather than focusing exclusively on the abuse itself. (Author/CS)

  18. Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest.

    PubMed

    Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla C; Petersson, Göran I; Bath, Peter A

    2016-03-01

    Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. PMID:24782478

  19. Med Students View Ex-Patients' E-Records to Track Progress

    MedlinePlus

    ... 2016 (HealthDay News) -- Many U.S. medical students use electronic health records to track the progress of their ... also pointed out that the students who used electronic health records to track their patients often did ...

  20. Comparing the security risks of paper-based and computerized patient record systems

    NASA Astrophysics Data System (ADS)

    Collmann, Jeff R.; Meissner, Marion C.; Tohme, Walid G.; Winchester, James F.; Mun, Seong K.

    1997-05-01

    How should hospital administrators compare the security risks of paper-based and computerized patient record systems. There is a general tendency to assume that because computer networks potentially provide broad access to hospital archives, computerized patient records are less secure than paper records and increase the risk of breaches of patient confidentiality. This assumption is ill-founded on two grounds. Reasons exist to say that the computerized patient record provides better access to patient information while enhancing overall information system security. A range of options with different trade-offs between access and security exist in both paper-based and computerized records management systems. The relative accessibility and security of any particular patient record management system depends, therefore, on administrative choice, not simply on the intrinsic features of paper or computerized information management systems.

  1. Identifying patient smoking status from medical discharge records.

    PubMed

    Uzuner, Ozlem; Goldstein, Ira; Luo, Yuan; Kohane, Isaac

    2008-01-01

    The authors organized a Natural Language Processing (NLP) challenge on automatically determining the smoking status of patients from information found in their discharge records. This challenge was issued as a part of the i2b2 (Informatics for Integrating Biology to the Bedside) project, to survey, facilitate, and examine studies in medical language understanding for clinical narratives. This article describes the smoking challenge, details the data and the annotation process, explains the evaluation metrics, discusses the characteristics of the systems developed for the challenge, presents an analysis of the results of received system runs, draws conclusions about the state of the art, and identifies directions for future research. A total of 11 teams participated in the smoking challenge. Each team submitted up to three system runs, providing a total of 23 submissions. The submitted system runs were evaluated with microaveraged and macroaveraged precision, recall, and F-measure. The systems submitted to the smoking challenge represented a variety of machine learning and rule-based algorithms. Despite the differences in their approaches to smoking status identification, many of these systems provided good results. There were 12 system runs with microaveraged F-measures above 0.84. Analysis of the results highlighted the fact that discharge summaries express smoking status using a limited number of textual features (e.g., "smok", "tobac", "cigar", Social History, etc.). Many of the effective smoking status identifiers benefit from these features. PMID:17947624

  2. Economic outcomes of a dental electronic patient record.

    PubMed

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

    2008-10-01

    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. PMID:18923100

  3. Patient-Centered e-Health Record over the Cloud.

    PubMed

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

    2014-01-01

    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. PMID:25000049

  4. Maternity patients' access to their electronic medical records: use and perspectives of a patient portal.

    PubMed

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

    2015-01-01

    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

  5. The prevalence of problem opioid use in patients receiving chronic opioid therapy: computer-assisted review of electronic health record clinical notes.

    PubMed

    Palmer, Roy E; Carrell, David S; Cronkite, David; Saunders, Kathleen; Gross, David E; Masters, Elizabeth; Donevan, Sean; Hylan, Timothy R; Von Kroff, Michael

    2015-07-01

    To estimate the prevalence of problem opioid use, we used natural language processing (NLP) techniques to identify clinical notes containing text indicating problem opioid use from over 8 million electronic health records (EHRs) of 22,142 adult patients receiving chronic opioid therapy (COT) within Group Health clinics from 2006 to 2012. Computer-assisted manual review of NLP-identified clinical notes was then used to identify patients with problem opioid use (overuse, misuse, or abuse) according to the study criteria. These methods identified 9.4% of patients receiving COT as having problem opioid use documented during the study period. An additional 4.1% of COT patients had an International Classification of Disease, version 9 (ICD-9) diagnosis without NLP-identified problem opioid use. Agreement between the NLP methods and ICD-9 coding was moderate (kappa = 0.61). Over one-third of the NLP-positive patients did not have an ICD-9 diagnostic code for opioid abuse or dependence. We used structured EHR data to identify 14 risk indicators for problem opioid use. Forty-seven percent of the COT patients had 3 or more risk indicators. The prevalence of problem opioid use was 9.6% among patients with 3 to 4 risk indicators, 26.6% among those with 5 to 6 risk indicators, and 55.04% among those with 7 or more risk indicators. Higher rates of problem opioid use were observed among young COT patients, patients who sustained opioid use for more than 4 quarters, and patients who received higher opioid doses. Methods used in this study provide a promising approach to efficiently identify clinically recognized problem opioid use documented in EHRs of large patient populations. Computer-assisted manual review of EHR clinical notes found a rate of problem opioid use of 9.4% among 22,142 COT patients over 7 years. PMID:25760471

  6. Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records.

    PubMed

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

    2016-01-01

    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. PMID:27185194

  7. Documenting wife abuse: a guide for physicians

    PubMed Central

    Ferris, L E; McMain-Klein, M; Silver, L

    1997-01-01

    An estimated 12% to 30% of women are assaulted by their male partners at least once during the relationship. Therefore, in their everyday practice, physicians are likely to encounter women who have suffered domestic abuse. The authors define wife abuse, outline epidemiologic aspects and discuss common signs and symptoms. In cases of suspected or confirmed abuse, it is very important for physicians to document the details of the injuries, the patient visit, any treatment and follow-up as well as to screen for associated conditions and ensure that any samples taken are not tampered with. When asked to disclose information by police or courts, physicians need to know when they are obliged to submit copies of their patients' medical records, when patient consent is required, what information should be divulged and how to defend this information in court. The authors present information about the necessary, relevant and appropriate evidence to be collected and documented for both medical and legal purposes. They also discuss the criminal justice system and the role of physicians in legal proceedings concerning wife abuse. PMID:9099172

  8. 78 FR 21314 - Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ... (Aug. 8, 2006); and 72 FR 56632 (Oct. 4, 2007). Health care providers and others may voluntarily seek..., Medicaid, or other Federal health care programs (and otherwise meets the safe harbor conditions).'' 71 FR... Electronic Health Records Safe Harbor In the October 11, 2005 Federal Register (70 FR 59015), we published...

  9. Abusive Relationships

    MedlinePlus

    ... relationships and friendships. Emotional abuse (stuff like teasing, bullying, and humiliating others) can be difficult to recognize ... How to Break Up Respectfully Abuse Dealing With Bullying Date Rape Getting Over a Break-Up Posttraumatic ...

  10. Impact of a Computer-based Patient Record System on Data Collection, Knowledge Organization, and Reasoning

    PubMed Central

    Patel, Vimla L.; Kushniruk, Andre W.; Yang, Seungmi; Yale, Jean-Francois

    2000-01-01

    Objective: To assess the effects of a computer-based patient record system on human cognition. Computer-based patient record systems can be considered "cognitive artifacts," which shape the way in which health care workers obtain, organize, and reason with knowledge. Design: Study 1 compared physicians' organization of clinical information in paper-based and computer-based patient records in a diabetes clinic. Study 2 extended the first study to include analysis of doctor–patient–computer interactions, which were recorded on video in their entirety. In Study 3, physicians' interactions with computer-based records were followed through interviews and automatic logging of cases entered in the computer-based patient record. Results: Results indicate that exposure to the computer-based patient record was associated with changes in physicians' information gathering and reasoning strategies. Differences were found in the content and organization of information, with paper records having a narrative structure, while the computer-based records were organized into discrete items of information. The differences in knowledge organization had an effect on data gathering strategies, where the nature of doctor-patient dialogue was influenced by the structure of the computer-based patient record system. Conclusion: Technology has a profound influence in shaping cognitive behavior, and the potential effects of cognition on technology design needs to be explored. PMID:11062231

  11. The effect of electronic patient records on hepatitis B vaccination completion rates at a genitourinary medicine clinic.

    PubMed

    Kuria, Patrick; Brook, Gary; McSorley, John

    2016-05-01

    The study was conducted to assess whether the introduction of an electronic patient records-based system affected hepatitis B vaccination completion rates and post-vaccination return rates, when compared to a paper-based system. Data were gathered for three groups of patients: those commencing vaccination (a) when paper records were in use (paper records group), (b) after electronic patient records were introduced (basic electronic patient records group) and (c) after electronic patient records were enhanced with recall (enhanced electronic patient records group). Compared to the paper records group, the third dose completion rates for patients managed using electronic patient records did not differ significantly: 74/119 (62.2%) paper vs. 58/98 (59.2%) basic electronic patient records, p = 0.652 and 89/130 (68.5%) enhanced electronic patient records, p = 0.298. On sub-group analysis, completion rates in patients of black ethnicity in the enhanced electronic patient records group were significantly higher than those in the paper records group: 16/19 (84.2%) enhanced electronic patient records vs. 11/23 (47.8%) paper, p = 0.014. Patients in the enhanced electronic patient records group were more likely than those in the paper records group to attend for measurement of hepatitis B surface antibody levels: 61/130 (46.9%) vs. 39/119 (32.8%), p = 0.023. PMID:26085502

  12. On the usage of health records for the design of virtual patients: a systematic review

    PubMed Central

    2013-01-01

    Background The process of creating and designing Virtual Patients for teaching students of medicine is an expensive and time-consuming task. In order to explore potential methods of mitigating these costs, our group began exploring the possibility of creating Virtual Patients based on electronic health records. This review assesses the usage of electronic health records in the creation of interactive Virtual Patients for teaching clinical decision-making. Methods The PubMed database was accessed programmatically to find papers relating to Virtual Patients. The returned citations were classified and the relevant full text articles were reviewed to find Virtual Patient systems that used electronic health records to create learning modalities. Results A total of n = 362 citations were found on PubMed and subsequently classified, of which n = 28 full-text articles were reviewed. Few articles used unformatted electronic health records other than patient CT or MRI scans. The use of patient data, extracted from electronic health records or otherwise, is widespread. The use of unformatted electronic health records in their raw form is less frequent. Patient data use is broad and spans several areas, such as teaching, training, 3D visualisation, and assessment. Conclusions Virtual Patients that are based on real patient data are widespread, yet the use of unformatted electronic health records, abundant in hospital information systems, is reported less often. The majority of teaching systems use reformatted patient data gathered from electronic health records, and do not use these electronic health records directly. Furthermore, many systems were found that used patient data in the form of CT or MRI scans. Much potential research exists regarding the use of unformatted electronic health records for the creation of Virtual Patients. PMID:24011027

  13. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time

    PubMed Central

    Baines, Rebecca; Langelaan, Maaike; de Bruijne, Martine; Spreeuwenberg, Peter; Wagner, Cordula

    2015-01-01

    Objectives To assess whether, compared with previous years, hospital care became safer in 2011/2012, expressing itself in a fall in preventable adverse event (AE) rates alongside patient safety initiatives. Design Retrospective patient record review at three points in time. Setting In three national AE studies, patient records of 2004, 2008 and 2011/2012 were reviewed in, respectively, 21 hospitals in 2004, 20 hospitals in 2008 and 20 hospitals in 2011/2012. In each hospital, 400, 200 and 200 patient records were sampled, respectively. Participants In total, 15 997 patient admissions were included in the study, 7926 patient admissions from 2004, 4023 from 2008 and 4048 from 2011/2012. Interventions The main patient safety initiatives in hospital care at a national level between 2004 and 2012 have been small as well as large-scale multifaceted programmes. Main outcome measures Rates of both AEs and preventable AEs. Results Uncorrected crude overall AE rates showed no change in 2011/2012 in comparison with 2008, whereas preventable AE rates showed a reduction of 45%. After multilevel corrections, the decrease in preventable AE rate in 2011/2012 was still clearly visible with a decrease of 30% in comparison to 2008 (p=0.10). In 2011/2012, fewer preventable AEs were found in older age groups, or related to the surgical process, in comparison with 2008. Conclusions Our study shows some improvements in preventable AEs in the areas that were addressed during the comprehensive national safety programme. There are signs that such a programme has a positive impact on patient safety. PMID:26150548

  14. Elder Abuse.

    PubMed

    Lachs, Mark S; Pillemer, Karl A

    2015-11-12

    Because older victims of abuse tend to be isolated, their interactions with physicians are important opportunities to recognize abuse and intervene. This review explores the manifestations of elder abuse and the role of multidisciplinary teams in its assessment and management. PMID:26559573

  15. Drug Abuse

    MedlinePlus

    ... as drugged driving, violence, stress, and child abuse. Drug abuse can lead to homelessness, crime, and missed work or problems with keeping a job. It harms unborn babies and destroys families. There are different types of treatment for drug abuse. But the best is to prevent drug ...

  16. Child Abuse

    MedlinePlus

    ... or become violent. An older child may use drugs or alcohol, try to run away or abuse others. Child abuse is a serious problem. If you suspect a child is being abused or neglected, call the police or your local child welfare agency.

  17. Substance Abuse

    ERIC Educational Resources Information Center

    Rowe, Cynthia L.; Liddle, Howard A.

    2003-01-01

    Liddle and Dakof's (1995) comprehensive review of the status of family-based treatment for drug abuse concluded that this modality offered a "promising, but not definitive" approach to treating drug abuse among adolescents and adults. Less than a decade later, significant progress can be seen in the treatment of drug abuse problems using…

  18. Digital Audio Recording of Initial Patient Visits to an Ocular Oncology Clinic: A Pilot Study.

    PubMed

    Seider, Michael I; Damato, Bertil E

    2015-05-01

    It is challenging for patients to receive a new diagnosis of a life-threatening ocular tumor when visiting an ocular oncology clinic for the first time. Audio recording of patient-physician interactions has been shown to be an effective memory aid and stress-reducing technique for patients with various types of nonophthalmic cancer. This study evaluated a protocol for digitally recording the initial conversation between the ocular oncologist and the patient. Twenty patients were enrolled in the study, and 13 patients (65%) returned the survey. All of the patients who returned the survey reported being "very satisfied" with the audio recording, indicating that patients with a newly diagnosed ocular tumor were highly satisfied with the audio recording of their conversations with the ocular oncologist. Although larger studies are needed to confirm this conclusion, the initial results are encouraging. PMID:26057768

  19. Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records

    PubMed Central

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

    2016-01-01

    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. PMID:27185194

  20. The use and costs of health and social services in patients with longstanding substance abuse

    PubMed Central

    2013-01-01

    Background Persons with longstanding substance abuse might become increasingly dependent on help by the public, eventually requiring permanent care. In 2006 the municipality of Stavanger established a so-called addiction ward for these clients, comprising 17 beds at the largest municipal nursing home. We assumed that the residents of this ward were high consumers of health care and social services during the last months preceding their admission. The aim of the study was to register the type and extent of services that were claimed by this client group during the last six months prior to admission, and to calculate the costs that were caused. Further, we estimated the incremental costs for nursing home placement. Methods In 15 residents from the addiction ward the use of all welfare services during the six months prior to admission were registered. Costs were calculated by unit costs from a municipal, national and societal perspective. Results Mean total costs during this period were €32 474. Approximately half of these costs were borne by state-funded institutions, and half were borne by the municipality. The clients used a great variety of services aimed at subsistence, health care and support in independent living, while services aimed at drug withdrawal were not claimed. There was no correlation between costs and the level of functioning. The incremental costs for nursing home admission were borne by the municipalities. Conclusion Persons with longstanding substance abuse represent a group with a high use of welfare resources and hence cause high costs. However, our findings do not indicate any correlation between the amount of services rendered and the level of functioning. Further research should focus on the identification of the clients’ need for support in order to facilitate targeted interventions that might prevent further deterioration and, finally, the need for permanent care. PMID:23692822

  1. Mania following ketamine abuse

    PubMed Central

    Lu, Yuan-Yuan; Lin, Chieh-Hsin; Lane, Hsien-Yuan

    2016-01-01

    Ketamine, a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, has multiple clinical uses. On the other hand, ketamine abuse or recreational use has been gaining increasing attention. Induction of mania and psychotic symptoms has been reported in a patient receiving IV ketamine therapy for reflex sympathetic dystrophy. We here report a 26 year-old man who abused ketamine by inhalation for 12 months and developed manic-like symptoms after ketamine use. This case suggests a possible relationship between manic symptoms and ketamine abuse. To the best of our knowledge, this may be the first report regarding mania after recreational use of ketamine. PMID:26869791

  2. The Computer-Based Patient Record and Confidentiality.

    ERIC Educational Resources Information Center

    Woodward, Beverly

    1996-01-01

    Information technology poses a threat to confidentiality of medical records. The number of parties claiming a need to know is increasing, but unrestricted access can lead to improper disclosure. Making health records semipublic may affect when and how people choose to obtain medical services. (SK)

  3. Patients Reading Their Medical Records: Differences in Experiences and Attitudes between Regular and Inexperienced Readers

    ERIC Educational Resources Information Center

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

    2016-01-01

    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…

  4. Incorporating Personal Health Records into the Disease Management of Rural Heart Failure Patients

    ERIC Educational Resources Information Center

    Baron, Karen Parsley

    2012-01-01

    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…

  5. The effectiveness of an abuse assessment protocol in public health prenatal clinics.

    PubMed Central

    Wiist, W H; McFarlane, J

    1999-01-01

    OBJECTIVES: This study evaluated whether incorporation of an abuse assessment protocol into the routine procedures of the prenatal clinics of a large urban public health department led to increased referral for and assessment, identification, and documentation of abuse. METHODS: Evaluation was conducted at 3 matched prenatal clinics serving a total of 12,000 maternity patients per year. Two clinics used the abuse protocol and 1 did not. An audit was performed at the clinics on a randomly selected sample of 540 maternity patient charts for the 15 months before the protocol was initiated and of 540 records for the 15 months after the protocol was introduced. Ninety-six percent of the patients represented in the sample were Latina. RESULTS: At the clinics using the protocol, abuse assessment increased from 0 to 88%. Detection of abuse increased from 0.8% to 7%. There were no changes at the comparison clinic. CONCLUSIONS: Incorporation of an abuse assessment protocol into the routine procedures of public health department prenatal clinics increases the assessment, identification, and documentation of and referral for abuse among pregnant women. An abuse protocol should be a routine part of maternity care. PMID:10432909

  6. Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse.

    PubMed

    Miniati, M; Rucci, P; Benvenuti, A; Frank, E; Buttenfield, J; Giorgi, G; Cassano, G B

    2010-04-01

    Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were initially randomized to IPT or SSRI and then augmented with the second treatment if they did not remit with monotherapy. Assessments included the SCID-I, the SCID-II for DSM-IV diagnoses, the HRSD, the QIDS and the Mood Spectrum Self-Report (MOODS-SR). Seventy-eight (25%) patients reported a history of EPA; 60 (76.9%) were women. Patients with a history of EPA did not differ from those without on HRSD scores at baseline, but showed an earlier age at onset of depression and a longer duration of illness. The two groups differed on several mood spectrum factors, namely: 'depressivemood' (15.6+/-4.9 vs. 13.5+/-5.4; p<0.004), 'psychomotorretardation' (11.7+/-4.5 vs. 9.6+/-4.7; p<0.001), 'drugandillness-relateddepression' (1.3+/-1.3 vs. 0.6+/-1.0; p<0.0001), and 'neurovegetativesymptoms' (8.3+/-2.6 vs. 6.9+/-2.9; p<0.0001). Patients with EPA had also a significantly longer time to remission (89 vs. 67days, log-rank test, p=0.035). The need for augmentation treatment was significantly more frequent among patients with EPA than in those without. The present study suggests that patients with a history of EPA show a subtype of depression characterized by poor treatment response and more severe neurovegetative and psychomotor symptoms. PMID:19800634

  7. Clinical Characteristics and Treatment Outcome of Depression in Patients with and without a History of Emotional and Physical Abuse

    PubMed Central

    Miniati, M.; Rucci, P.; Benvenuti, A.; Frank, E.; Buttenfield, J.; Giorgi, G.; Cassano, G.B.

    2009-01-01

    Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were initially randomized to IPT or SSRI and then augmented with the second treatment if they did not remit with monotherapy. Assessments included the SCID-I, the SCID-II for DSM-IV diagnoses, the HRSD, the QIDS and the Mood Spectrum Self-Report (MOODS-SR). Seventy-eight (25%) patients reported a history of EPA; 60 (76.9%) were women. Patients with a history of EPA did not differ from those without on HRSD scores at baseline, but showed an earlier age at onset of depression and a longer duration of illness. The two groups differed on several mood spectrum factors, namely: ‘depressive mood’ (15.6±4.9 vs. 13.5±5.4; p<0.004), ‘psychomotor retardation’ (11.7±4.5 vs. 9.6±4.7; p<0.001), ‘drug and illness-related depression’ (1.3±1.3 vs. 0.6±1.0; p<0.0001), and ‘neurovegetative symptoms’ (8.3±2.6 vs. 6.9±2.9; p<0.0001). Patients with EPA had also a significantly longer time to remission (89 vs. 67 days, log-rank test, p=0.035). The need for augmentation treatment was significantly more frequent among patients with EPA than in those without. The present study suggests that patients with a history of EPA show a subtype of depression characterized by poor treatment response and more severe neurovegetative and psychomotor symptoms. PMID:19800634

  8. The electronic patient record in primary care—regression or progression? A cross sectional study

    PubMed Central

    Hippisley-Cox, Julia; Pringle, Mike; Cater, Ruth; Wynn, Alison; Hammersley, Vicky; Coupland, Carol; Hapgood, Rhydian; Horsfield, Peter; Teasdale, Sheila; Johnson, Christine

    2003-01-01

    Objectives To determine whether paperless medical records contained less information than paper based medical records and whether that information was harder to retrieve. Design Cross sectional study with review of medical records and interviews with general practitioners. Setting 25 general practices in Trent region. Participants 53 British general practitioners (25 using paperless records and 28 using paper based records) who each provided records of 10 consultations. Main outcome measures Content of a sample of records and doctor recall of consultations for which paperless or paper based records had been made. Results Compared with paper based records, more paperless records were fully understandable (89.2% v 69.9%, P=0.0001) and fully legible (100% v 64.3%, P < 0.0001). Paperless records were significantly more likely to have at least one diagnosis recorded (48.2% v 33.2%, P=0.05), to record that advice had been given (23.7% vs 10.7%, P=0.017), and, when a referral had been made, were more likely to contain details of the specialty (77.4% v 59.5%, P=0.03). When a prescription had been issued, paperless records were more likely to specify the drug dose (86.6% v 66.2%, P=0.005). Paperless records contained significantly more words, abbreviations, and symbols (P < 0.01 for all). At doctor interview, there was no difference between the groups for the proportion of patients or consultations that could be recalled. Doctors using paperless records were able to recall more advice given to patients (38.6% v 26.8%, P=0.03). Conclusion We found no evidence to support our hypotheses that paperless records would be truncated and contain more local abbreviations; and that the absence of writing would decrease subsequent recall. Conversely we found that the paperless records compared favourably with manual records. PMID:12829558

  9. Patient record access: making it work for you and the NHS

    PubMed Central

    2011-01-01

    Background Patient record access is NHS policy. It is now a reality in the UK, although it remains a rarity. Setting This article summarises the current state of patient record access in the UK, focusing on a particular system for which there is most data available. It also explores possibilities for expanded functionality in the near future. This will offer both patients and the NHS a more interactive approach that offers significant benefits to both. Results Patient record access not only appears safe, but also offers benefits to patients. These include improved safety; a more accurate record; better relationships between patients and clinicians; better data sharing and integration across the NHS; improved self-care and shared decision-making; and better compliance. Practices gain by saving time. In addition, they gain by having empowered patients who can do more for themselves. However, clinicians in general, and GPs in particular, are anxious about enabling record access, fearing loss of control, litigation and breaches of the daa protection act. Conclusions Patient record access with added transactional services is likely to benefit patients and practices across the NHS. It supports QIPP. It is likely to become routine, but cannot substitute for good traditional communication with and support for patients. PMID:25949647

  10. Characterizing Patient-Generated Clinical Data and Associated Implications for Electronic Health Records.

    PubMed

    Arsoniadis, Elliot G; Tambyraja, Rabindra; Khairat, Saif; Jahansouz, Cyrus; Scheppmann, Daren; Kwaan, Mary R; Hultman, Gretchen; Melton, Genevieve B

    2015-01-01

    Patient-facing technologies are increasingly utilized for direct patient data entry for potential incorporation into the electronic health record. We analyzed patient-entered data during implementation of a patient-facing data entry technology using an online patient portal and clinic-based tablet computers at a University-based tertiary medical center clinic, including entries for past medical history, past surgical history, and social history. Entries were assessed for granularity, clinical accuracy, and the addition of novel information into the record. We found that over half of patient-generated diagnoses were duplicates of lesser or equal granularity compared to previous provider-entered diagnoses. Approximately one fifth of patient-generated diagnoses were found to meet the criteria for new, meaningful additions to the medical record. Our findings demonstrate that while patient-generated data provides important additional information, it may also present challenges including generating inaccurate or less granular information. PMID:26262030

  11. [Dutch Health Care Inspectorate (IGZ) abuses its inspection authority in patient files].

    PubMed

    van Lessen Kloeke, Koosje

    2014-01-01

    For its investigation regarding the transfer of data after discharge of vulnerable elderly patients from hospital to nursing homes, care homes or home care, the Dutch Health Care Inspectorate (IGZ) demands access to patients' files, without their explicit consent. Doctors who do not cooperate run the risk of penalty payments. Since it concerns a limited number of patients per practice, it would not be unreasonably onerous for the Inspectorate to allow doctors to ask their patients' consent. Other reasons mentioned by the Inspectorate, such as possible "inappropriate correction" of data and the capability of vulnerable elderly patients to give their consent seem improper grounds to breach patients' right to privacy and to demand that doctors breach professional confidentiality. The legality of the Inspectorate's actions could be addressed in a test case and should be discussed more widely in light of the Inspectorate's work plan for 2014. PMID:24893819

  12. A survey of user acceptance of electronic patient anesthesia records

    PubMed Central

    Jin, Hyun Seung; Lee, Suk Young; Jeong, Hui Yeon; Choi, Soo Joo; Lee, Hye Won

    2012-01-01

    Background An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users' attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). Methods A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administered to anesthesiologists, trainees, and nurses during February 2011 and the responses were collected anonymously during March 2011. Results A total of 28 anesthesiologists, 27 trainees, and 47 nurses responded to this survey. Most participants involved in this survey were satisfied with AIMS (96.3%, 82.2%, and 89.3% of trainees, anesthesiologists, and nurses, respectively) and preferred AIMS over handwritten anesthesia records in 96.3%, 71.4%, and 97.9% of trainees, anesthesiologists, and nurses, respectively. However, there were also criticisms of AIMS related to user-discomfort during short, simple or emergency surgeries, doubtful legal status, and inconvenient placement of the system. Conclusions Overall, most of the anesthetic practitioners in this hospital quickly accepted and prefer AIMS over the handwritten anesthetic records in the OR. PMID:22558502

  13. Self-reported stressors among patients with Exhaustion Disorder: an exploratory study of patient records

    PubMed Central

    2014-01-01

    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

  14. COL1A1 and COL1A2 sequencing results in cohort of patients undergoing evaluation for potential child abuse.

    PubMed

    Zarate, Yuri A; Clingenpeel, Rachel; Sellars, Elizabeth A; Tang, Xinyu; Kaylor, Julie A; Bosanko, Katherine; Linam, Leann E; Byers, Peter H

    2016-07-01

    Child abuse is a major public health concern that can explain a proportion of fractures in children. Osteogenesis imperfecta (OI) is the most common inherited syndrome that predisposes to skeletal fractures. We conducted a retrospective analysis of data from clinical, laboratory, and radiographic information from children evaluated for child abuse in which molecular testing for COL1A1 and COL1A2 genes was conducted. A total of 43 patients underwent molecular testing for OI. Pathogenic variants predicted to result in a mild form of OI were found in two patients (5%), both clinically suspected to have this diagnosis. None of the cases in whom OI molecular testing was ordered when maltreatment concerns were thought to be more likely (0/35) were identified to have pathogenic variants. After reviewing each individual case, the final diagnosis was child abuse for 34 cases (77%), and additional radiographic and laboratory studies did not identify any with inherited metabolic predisposition to fracture or rickets. We conclude that routine testing for OI in the setting of child abuse when no other suggestive clinical findings are present has a low yield. A careful review of the medical history and a detailed clinical evaluation help identify those at risk for genetic alterations. © 2016 Wiley Periodicals, Inc. PMID:27090748

  15. Increased density of neurons containing NADPH diaphorase and nitric oxide synthase in the cerebral cortex of patients with HIV-1 infection and drug abuse.

    PubMed

    Kuljis, Rodrigo O; Shapshak, Paul; Alcabes, Philip; Rodríguez de la Vega, Pura; Fujimura, Robert; Petito, Carol K

    2002-01-01

    To determine whether nitrogen monoxide (nitric oxide; NO) synthase (NOS) and NADPH diaphorase (NDP) co-containing cerebrocortical neurons (NOSN) neurons are affected in patients infected with human immunodeficiency virus type 1 (HIV-1) with and without associated intake of drugs of abuse, we examined the temporal neocortex of 24 individuals: 12 HIV-1 positive (including 3 drug users, 9 non-drug users) and 12 HIV-1 negative (including 6 drug users, and 6 non-drug users). Histochemical labeling for NDP-an enzymatic domain co-expressed in the NOS enzyme-was employed to visualize NOSN. Drug abuse and HIV-1 infection cause independently an increase in NOSN density, but combined they result in up to a 38-fold increase in NOSN density, suggesting that the combination of these factors induces NOS expression powerfully in neurons that normally do not synthesize NDP/NOS. This is associated with an increase in the proportion of NOSN displaying dystrophic changes, indicating that NOSN undergo massive degeneration in association with NOS synthesis induction. The increase in density of NOSN in HIV-1 infected drug abusers may be among the important sources of NO mediating cerebrocortical dysfunction, and the degeneration of NOS-containing local circuit neurons in patients with HIV-1 infection or drug abuse may underlie in part their neuropsychiatric manifestations. PMID:16873197

  16. Visualizing collaborative electronic health record usage for hospitalized patients with heart failure

    PubMed Central

    Carson, Matthew B; Lee, Young Ji; Schneider, Daniel H; Skeehan, Connor T; Scholtens, Denise M

    2015-01-01

    Objective To visualize and describe collaborative electronic health record (EHR) usage for hospitalized patients with heart failure. Materials and methods We identified records of patients with heart failure and all associated healthcare provider record usage through queries of the Northwestern Medicine Enterprise Data Warehouse. We constructed a network by equating access and updates of a patient’s EHR to a provider-patient interaction. We then considered shared patient record access as the basis for a second network that we termed the provider collaboration network. We calculated network statistics, the modularity of provider interactions, and provider cliques. Results We identified 548 patient records accessed by 5113 healthcare providers in 2012. The provider collaboration network had 1504 nodes and 83 998 edges. We identified 7 major provider collaboration modules. Average clique size was 87.9 providers. We used a graph database to demonstrate an ad hoc query of our provider-patient network. Discussion Our analysis suggests a large number of healthcare providers across a wide variety of professions access records of patients with heart failure during their hospital stay. This shared record access tends to take place not only in a pairwise manner but also among large groups of providers. Conclusion EHRs encode valuable interactions, implicitly or explicitly, between patients and providers. Network analysis provided strong evidence of multidisciplinary record access of patients with heart failure across teams of 100+ providers. Further investigation may lead to clearer understanding of how record access information can be used to strategically guide care coordination for patients hospitalized for heart failure. PMID:25710558

  17. Point and counterpoint: patient control of access to data in their electronic health records.

    PubMed

    Caine, Kelly; Tierney, William M

    2015-01-01

    Information collection, storage, and management is central to the practice of health care. For centuries, patients' and providers' expectations kept medical records confidential between providers and patients. With the advent of electronic health records, patient health information has become more widely available to providers and health care managers and has broadened its potential use beyond individual patient care. Adhering to the principles of Fair Information Practice, including giving patients control over the availability and use of their individual health records, would improve care by fostering the sharing of sensitive information between patients and providers. However, adherence to such principles could put patients at risk for unsafe care as a result of both missed opportunities for providing needed care as well as provision of contraindicated care, as it would prevent health care providers from having full access to health information. Patients' expectations for the highest possible quality and safety of care, therefore, may be at odds with their desire to limit provider access to their health records. Conversely, provider expectations that patients would willingly seek care for embarrassing conditions and disclose sensitive information may be at odds with patients' information privacy rights. An open dialogue between patients and providers will be necessary to balance respect for patient rights with provider need for patient information. PMID:25480723

  18. Osteogenesis imperfecta misdiagnosed as child abuse.

    PubMed

    Singh Kocher, Mininder; Dichtel, Laura

    2011-11-01

    The differential diagnosis of child abuse includes osteogenesis imperfecta (OI). Mild phenotypes of OI may be misdiagnosed as child abuse. The purpose of this study was to review the experience of families in which OI was misdiagnosed as child abuse. Sixty-one potential cases of misdiagnosis were identified from a lay support organization. Upon review of the medical records, 33 cases were identified with a confirmed diagnosis of OI (skin biopsy or DNA blood test). Questionnaires were given to families to describe their condition and experiences. There were 19 male and 14 female children. Mean age at presentation was 7.1 months (range: 1-23 months). All patients had fractures and the presenting symptoms included pain (n=14), swelling (n=7), decreased limb movement (n=5), or unusual limb position (n=2). Abnormal radiograph findings consistent with OI were found in 19 of 33 patients (58%), clinical findings of OI were present in 23 of 33 patients (70%), and a family history that could be supportive of OI was present in 18 of 33 families (55%). Children were removed from the family in 70% of cases and older siblings were removed from the family in 62% of cases. The mean age at the time of diagnosis of OI was 10.5 months (range: 3-35 months). The consequences of misdiagnosis of OI as child abuse are devastating to the family. OI should be considered in all cases of suspected child abuse. In children with any clinical, radiographic, or family history features of OI, early involvement of a bone specialist and performance of laboratory testing should be considered to establish a timely and accurate diagnosis. PMID:21716141

  19. The Use and Abuse of Tranquillizing Drugs for Chronic Mental Patients

    PubMed Central

    Dewar, Robert; Ross, Hugo

    1962-01-01

    The purpose of this study was to determine the necessity of administering maintenance doses of tranquillizing drugs to chronic mental patients. The behaviour of 16 female psychotic patients in a mental hospital was measured while they received maintenance doses of chlorpromazine (average dose, 50 mg. q.i.d.) and again while receiving identical doses of a placebo. The double-blind technique was employed. Nurses used a behaviour rating scale to measure noisiness, personal cleanliness, interpersonal relations among patients, occupational activities, hostility, activity, co-operation, dress, eating, and sleeping. Patients' behaviour over a six-week period of chlorpromazine administration was compared with behaviour over an equal period of placebo administration. There was no evident difference in behaviour in 90% of the cases. Among the others there was a slight trend towards improved behaviour while the patients received placebo. It was concluded that tranquillizing drugs are often used needlessly for chronic mental patients. Implications of the use of tranquillizing drugs with chronic mental patients are discussed. PMID:14027427

  20. Does meeting the HEDIS substance abuse treatment engagement criterion predict patient outcomes?

    PubMed

    Harris, Alex H S; Humphreys, Keith; Bowe, Thomas; Tiet, Quyen; Finney, John W

    2010-01-01

    This study examines the patient-level associations between the Health Plan Employer Data and Information Set (HEDIS) substance use disorder (SUD) treatment engagement quality indicator and improvements in clinical outcomes. Administrative and survey data from 2,789 US Department of Veterans Affairs SUD patients were used to estimate the effects of meeting the HEDIS engagement criterion on improvements in Addiction Severity Index Alcohol, Drug, and Legal composite scores. Patients meeting the engagement indicator improved significantly more in all domains than patients who did not engage, and the relationship was stronger for alcohol and legal outcomes for patients seen in outpatient settings. The benefit accrued by those who engaged was statistically significant but clinically modest. These results add to the literature documenting the clinical benefits of treatment entry and engagement. Although these findings only indirectly support the use of the HEDIS engagement measure for its intended purpose-discriminating quality at the facility or system level-they confirm that the processes of care captured by the measure are associated with important patient outcomes. PMID:18770044

  1. 42 CFR 2.16 - Security for written records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Security for written records. 2.16 Section 2.16 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.16 Security for written...

  2. Management Systems, Patient Quality Improvement, Resource Availability, and Substance Abuse Treatment Quality

    PubMed Central

    Fields, Dail; Roman, Paul M; Blum, Terry C

    2012-01-01

    Objective To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data Sources/Study Setting Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). Study Design The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Data Collection Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007–2008. Principal Findings Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Conclusions Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. PMID:22098342

  3. Are low income patients receiving the benefits of electronic health records? A statewide survey.

    PubMed

    Butler, Matthew J; Harootunian, Gevork; Johnson, William G

    2013-06-01

    There are concerns that physicians serving low-income, Medicaid patients, in the United States are less likely to adopt electronic health records and, if so, that Medicaid patients will be denied the benefits from electronic health record use. This study seeks to determine whether physicians treating Medicaid patients were less likely to have adopted electronic health records. Physician surveys completed during physicians' license renewal process in Arizona were merged with the physician licensing data and Medicaid administrative claims data. Survey responses were received from 50.7 percent (6,780 out of 13,380) of all physicians practicing in Arizona. Physician survey responses were used to identify whether the physician used electronic health records and the degree to which the physician exchanged electronic health records with other health-care providers. Medicaid claims data were used to identify which physicians provided health care to Medicaid beneficiaries. The primary outcome of interest was whether Medicaid providers were more or less likely to have adopted electronic health records. Logistic regression analysis was used to estimate average marginal effects. In multivariate analysis, physicians with 20 or more Medicaid patients during the survey cycle were 4.1 percent more likely to use an electronic health record and 5.2 percent more likely to be able to transmit electronic health records to at least one health-care provider outside of their practice. These effects increase in magnitude when the analysis is restricted to solo practice physicians This is the first study to find a pro-Medicaid gap in electronic health record adoption suggesting that the low income patients served by Arizona's Health Care Cost Containment System are not at a disadvantage with regard to electronic health record access and that Arizona's model of promoting electronic health record adoption merits further study. PMID:23715209

  4. Screening Spouse Abusers for Child Abuse Potential.

    ERIC Educational Resources Information Center

    Milner, Joel S.; Gold, Ruth G.

    1986-01-01

    Investigated the ability of the Child Abuse Potential Inventory to screen for child abuse in a group of spouse abusers. The completed, valid protocols revealed that 36.5 percent of the spouse abusers had elevated child abuse scores, while only 9.1 percent of the nonabusers had elevated abuse scores. (Author/BL)

  5. Patients Know Best: Qualitative Study on How Families Use Patient-Controlled Personal Health Records

    PubMed Central

    Schneider, Hanna; Hill, Susan

    2016-01-01

    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

  6. Fetal Abuse.

    ERIC Educational Resources Information Center

    Kent, Lindsey; And Others

    1997-01-01

    Five cases of fetal abuse by mothers suffering from depression are discussed. Four of the women had unplanned pregnancies and had considered termination of the pregnancy. Other factors associated with fetal abuse include pregnancy denial, pregnancy ambivalence, previous postpartum depression, and difficulties in relationships. Vigilance for…

  7. Development of a standardized format for archiving and exchange of electronic patient records in Sweden.

    PubMed

    Wigefeldt, T; Larnholt, S; Peterson, H

    1997-01-01

    This paper describes an effort to standardize the long term archiving format of the electronic patient record. A format is given in SGML (Standard Generalized Markup Language) and also tested as a prototype in a production system. PMID:10179549

  8. Graphical electrocardiogram waveforms as part of an integrated hospital system's patient record.

    PubMed Central

    Enison, E. J.; Dayhoff, R.; Fletcher, R. D.

    1993-01-01

    The U.S. Department of Veterans Affairs (VA) has an ongoing project to integrate diagnostic images into its existing text-based hospital information system. High-quality images from cardiology, pulmonary medicine, gastroenterology, endoscopy, pathology, radiology, hematology and nuclear medicine can be displayed for clinicians quickly and conveniently on workstations throughout the hospital. As a part of this endeavor, diagnostic-quality computer generated 12-lead electrocardiograms, including both median and rhythm data, can be viewed as a part of the on-line patient record of an integrated hospital information system. Now computer generated graphics can be included in the longitudinal patient record. Incorporating generated graphics and images into a text based patient record is another step towards the next generation of integrated hospital information system with multimedia patient records. PMID:8130498

  9. Sexual abuses.

    PubMed

    Abel, G G; Rouleau, J L

    1995-03-01

    The sexual abuses described in this article are occurring so frequently that they constitute a public health problem. Superficially they appear to be quite dissimilar because they involve individuals of different ages, different settings, and different power relationships. Basic to each of them, however, is an absence of consent by the victim and the misuse of power by the perpetrator in order to accomplish the abuse. We now have an adequate understanding of each of these abuses and it is now time to make a concerted effort to stop these abuses. This will require the combined efforts of the education of the public, improved identification of the abuses, treatment of the victims, and an appropriate criminal justice response combined with treatment of the perpetrator. PMID:7761302

  10. Research strategies that result in optimal data collection from the patient medical record.

    PubMed

    Gregory, Katherine E; Radovinsky, Lucy

    2012-05-01

    Data obtained from the patient medical record are often a component of clinical research led by nurse investigators. The rigor of the data collection methods correlates to the reliability of the data and, ultimately, the analytical outcome of the study. Research strategies for reliable data collection from the patient medical record include the development of a precise data collection tool, the use of a coding manual, and ongoing communication with research staff. PMID:20974093

  11. Unrecognized "crack" cocaine abuse in pregnancy.

    PubMed

    Campbell, D; Parr, M J; Shutt, L E

    1996-10-01

    We report a case of "crack" cocaine abuse in a pregnant patient associated with haematuria, proteinuria, haemolytic anaemia, renal impairment, thrombocytopenia and pulmonary oedema. The case illustrates the problems for clinicians where unrecognized cocaine abuse interferes with the diagnosis and management of a complicated pregnancy. In addition, we discuss the principles for the safe conduct of anaesthesia in the pregnant cocaine abuser. PMID:8942348

  12. Commentary on the abuse of metal chelation therapy in patients with autism spectrum disorders.

    PubMed

    Brent, Jeffrey

    2013-12-01

    Approximately half a million patients with autism spectrum disorders are subjected to chelation therapy in the US annually. The overwhelming majority of such cases are chelated for non-accepted medical indications. These patients may seek evaluation when a urine sample is assayed after the administration of a chelating agent and the values obtained have been improperly compared to references ranges for non-chelated urines, causing falsely elevated results. Legitimate practitioners confronted with such data must decide, preferably in consultation with the patient or their guardian(s), whether to do further testing using legitimate methodology or to simply dismiss the results of the improper testing. Bayesian principles tell us that further testing is likely to yield results within normal reference ranges. However, under some circumstances, it is useful to do such testing in order to demonstrate that there is no need for chelation therapy. Unnecessary chelation therapy is expensive, can cause significant acute adverse effects, and may be associated with long-term consequences. PMID:24113859

  13. “Nothing About Me Without Me”: An Interpretative Review of Patient Accessible Electronic Health Records

    PubMed Central

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

    2015-01-01

    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

  14. Cocaine modulates HIV-1 integration in primary CD4+ T cells: implications in HIV-1 pathogenesis in drug-abusing patients

    PubMed Central

    Addai, Amma B.; Pandhare, Jui; Paromov, Victor; Mantri, Chinmay K.; Pratap, Siddharth; Dash, Chandravanu

    2015-01-01

    Epidemiologic studies suggest that cocaine abuse worsens HIV-1 disease progression. Increased viral load has been suggested to play a key role for the accelerated HIV disease among cocaine-abusing patients. The goal of this study was to investigate whether cocaine enhances proviral DNA integration as a mechanism to increase viral load. We infected CD4+ T cells that are the primary targets of HIV-1 in vivo and treated the cells with physiologically relevant concentrations of cocaine (1 µM–100 µM). Proviral DNA integration in the host genome was measured by nested qPCR. Our results illustrated that cocaine from 1 µM through 50 µM increased HIV-1 integration in CD4+ T cells in a dose-dependent manner. As integration can be modulated by several early postentry steps of HIV-1 infection, we examined the direct effects of cocaine on viral integration by in vitro integration assays by use of HIV-1 PICs. Our data illustrated that cocaine directly increases viral DNA integration. Furthermore, our MS analysis showed that cocaine is able to enter CD4+ T cells and localize to the nucleus-. In summary, our data provide strong evidence that cocaine can increase HIV-1 integration in CD4+ T cells. Therefore, we hypothesize that increased HIV-1 integration is a novel mechanism by which cocaine enhances viral load and worsens disease progression in drug-abusing HIV-1 patients. PMID:25691383

  15. Patients Covertly Recording Clinical Encounters: Threat or Opportunity? A Qualitative Analysis of Online Texts

    PubMed Central

    Tsulukidze, Maka; Grande, Stuart W.; Thompson, Rachel; Rudd, Kenneth; Elwyn, Glyn

    2015-01-01

    Background The phenomenon of patients covertly recording clinical encounters has generated controversial media reports. This study aims to examine the phenomenon and analyze the underlying issues. Methods and Findings We conducted a qualitative analysis of online posts, articles, blogs, and forums (texts) discussing patients covertly recording clinical encounters. Using Google and Google Blog search engines, we identified and analyzed 62 eligible texts published in multiple countries between 2006 and 2013. Thematic analysis revealed four key themes: 1) a new behavior that elicits strong reactions, both positive and negative, 2) an erosion of trust, 3) shifting patient-clinician roles and relationships, and 4) the existence of confused and conflicting responses. When patients covertly record clinical encounters – a behavior made possible by various digital recording technologies – strong reactions are evoked among a range of stakeholders. The behavior represents one consequence of an erosion of trust between patients and clinicians, and when discovered, leads to further deterioration of trust. Confused and conflicting responses to the phenomenon by patients and clinicians highlight the need for policy guidance. Conclusions This study describes strong reactions, both positive and negative, to the phenomenon of patients covertly recording clinical encounters. The availability of smartphones capable of digital recording, and shifting attitudes to patient-clinician relationships, seems to have led to this behavior, mostly viewed as a threat by clinicians but as a welcome and helpful innovation by some patients, possibly indicating a perception of subordination and a lack of empowerment. Further examination of this tension and its implications is needed. PMID:25933002

  16. Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?

    PubMed Central

    Lester, Melissa; Boateng, Samuel; Studeny, Jana; Coustasse, Alberto

    2016-01-01

    Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been shown to be difficult for patients to use and understand, and providers had concerns about correct information transferring to the portals and patients eliminating information from the record. Concerns regarding patient understanding of medical records, legal liability, and the response time required of providers were also identified. For the PHR to succeed in the US healthcare system, assurance that the information will be protected, useful, and easily accessed is necessary. PMID:27134613

  17. Patients want granular privacy control over health information in electronic medical records

    PubMed Central

    Caine, Kelly; Hanania, Rima

    2013-01-01

    Objective 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. Materials and methods 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. Results 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. Discussion 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. Conclusions 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. PMID:23184192

  18. The many victims of substance abuse.

    PubMed

    Mauro, Tara

    2007-09-01

    Substance abuse is a complicated disorder and has far reaching consequences. The victims of substance abuse extend beyond the unfortunate ones suffering from this disorder and often include family and friends. Treatment options for substance abuse are many; however, positive outcomes are not always guaranteed. Many factors play into the potential for successful treatment. Some of these include the adherence and motivation of the substance abusing patients as well as patients' surrounding environments and support systems. In this article, we present a clinical case of opioid dependence and discuss various treatment options and modalities. We will discuss different variables that may maximize positive treatment outcomes. Also a review of the current literature regarding substance abuse treatment, psychotherapy with the drug abuser, and grief therapy should the substance abusing patient die for the surviving family members will be presented. PMID:20532120

  19. Drugs of abuse and Parkinson's disease.

    PubMed

    Mursaleen, Leah R; Stamford, Jonathan A

    2016-01-01

    The term "drug of abuse" is highly contextual. What constitutes a drug of abuse for one population of patients does not for another. It is therefore important to examine the needs of the patient population to properly assess the status of drugs of abuse. The focus of this article is on the bidirectional relationship between patients and drug abuse. In this paper we will introduce the dopaminergic systems of the brain in Parkinson's and the influence of antiparkinsonian drugs upon them before discussing this synergy of condition and medication as fertile ground for drug abuse. We will then examine the relationship between drugs of abuse and Parkinson's, both beneficial and deleterious. In summary we will draw the different strands together and speculate on the future merit of current drugs of abuse as treatments for Parkinson's disease. PMID:25816790

  20. Elder Abuse

    MedlinePlus

    ... to watch or be part of sexual acts. Money Matters: Financial Abuse and Healthcare Fraud After Victor’s ... the past 6 months, Victor has been taking money from their account for his own use. He ...

  1. Ongoing incestuous abuse during adulthood.

    PubMed

    Middleton, Warwick

    2013-01-01

    Individual cases of adult incestuous abuse have surfaced repeatedly in the lay and professional literature of the past 1.5 centuries without it occasioning systematic investigation, such as the reporting of a case series of individuals subjected to such extreme abuse. Yet substantial numbers of patients with dissociative identity disorder at the time of presentation report incestuous abuse continuing into the adult years, and for many the abuse is ongoing. Data relating to a series of 10 such incestuously abused women are presented. These patients were sexually abused from a very early age (typically from before age 3), with the manipulation of their sexual response a key component in conditioning an enduring sexualized attachment. Shame and fear were also used to ensure compliance and silence. The women, when able to speak of it, describe the induction by their paternal abuser of orgasm at an early age, typically around the age of 6. The women have high indices of self-harm and suicidality and are prone to placing themselves in dangerous reenactment scenarios. The average duration of incestuous abuse for this group of women was 31 years, and the average estimate of total episodes of sexual abuse was 3,320. Most women do not feel that they own their body and experience being "fused" to their father. Their mother was reported as an active participant in the sexual abuse or as having done nothing to protect their daughter despite seeing obvious evidence of incest. The fathers, despite a propensity to use or threaten violence, were generally outwardly productively employed, financially comfortable, and stably married and half had close church involvement. However, suicide and murder occurred within the 1st- or 2nd-degree relatives of these women at a high frequency. All 10 had been sexually abused by various groupings of individuals connected to their fathers. PMID:23627476

  2. Brief Family Treatment Intervention to Promote Aftercare among Substance Abusing Patients in Inpatient Detoxification: Transferring A Research Intervention to Clinical Practice

    PubMed Central

    O’Farrell, Timothy J.; Murphy, Marie; Alter, Jane; Fals-Stewart, William

    2008-01-01

    Two earlier studies showed that a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification increased aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member with whom the patient lived to review aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Based on the earlier research results, we trained a newly hired staff person to continue providing BFT. We monitored key process benchmarks derived from the earlier research studies to ensure ongoing fidelity in delivering BFT. This method proved successful in transferring BFT from delivery in a research study to ongoing delivery in routine clinical practice after the research ended. It also ensured that a high proportion of patients had their families contacted and included in planning the patients’ aftercare. PMID:18063317

  3. Patient Accessible Electronic Health Records: Exploring Recommendations for Successful Implementation Strategies

    PubMed Central

    Urowitz, Sara; Apatu, Emma; DeLenardo, Claudette; Eysenbach, Gunther; Harth, Tamara; Pai, Howard; Leonard, Kevin J

    2008-01-01

    Background Providing patients with access to their electronic health records offers great promise to improve patient health and satisfaction with their care, as well to improve professional and organizational approaches to health care. Although many benefits have been identified, there are many questions about best practices for the implementation of patient accessible Electronic Health Records (EHRs). Objectives To develop recommendations to assist health care organizations in providing patients with access to EHRs in a meaningful, responsible, and responsive manner. Methods A Patient Accessible Electronic Health Record (PAEHR) Workshop was held with nationally and internationally renowned experts to explore issues related to providing patient access to the EHR and managing institutional change. Results The PAEHR Workshop was attended by 45 participants who discussed recommendations for the implementation of patient accessible EHRs. Recommendations were discussed under four subject domains: (1) providing patient access to the EHR, (2) maintaining privacy and confidentiality related to the PAEHR, (3) patient education and navigation of the PAEHR, and (4) strategies for managing institutional change. The discussion focused on the need for national infrastructure, clear definitions for privacy, security and confidentiality, flexible, interoperable solutions, and patient and professional education. In addition, there was a strong call for research into all domains of patient accessible EHRs to ensure the adoption of evidence-based practices. Conclusions Patient access to personal health information is a fundamental issue for patient engagement and empowerment. Health care professionals and organizations should consider the potential benefits and risks of patient access when developing EHR strategies. Flexible, standardized, and interoperable solutions must be integrated with outcomes-based research to activate effectively patients as partners in their health care

  4. Childhood abuse, adult interpersonal abuse, and depression in individuals with extreme obesity.

    PubMed

    Salwen, Jessica K; Hymowitz, Genna F; Vivian, Dina; O'Leary, K Daniel

    2014-03-01

    This study sought to examine (a) a mediational model of childhood abuse, adult interpersonal abuse, and depressive symptoms and (b) the impact of weight-related teasing on rates and correlates of childhood abuse. Charts of 187 extremely obese individuals seeking psychological clearance for bariatric (weight-loss) surgery were retrospectively examined. Among the participants, 61% reported a history of childhood abuse, 30.5% reported adult interpersonal abuse, and 15% reported clinically significant depressive symptoms. Initially, the relationship between childhood abuse and current depressive symptoms was significant (p<.001). However, the introduction of adult interpersonal abuse as a mediator in the model reduced the magnitude of its significance (Sobel's test p=.01). The associations between childhood abuse and adult interpersonal abuse and between adult interpersonal abuse and depressive symptoms were significant (p<.001 and p=.002, respectively), and the model showed a good fit across multiple indices. Finally, weight-related teasing was a significant moderator in the relationship between childhood and adult interpersonal abuse. Bariatric surgery patients report elevated rates of childhood abuse that are comparable to rates in psychiatric populations (e.g., eating disorders, depression), and higher than those in community samples and other medical populations. The relationship between child abuse and depressive symptomatology may be partially explained by the presence of adult interpersonal abuse; additionally, the relationship between childhood and adult interpersonal abuse was stronger for those who did not endure weight-related teasing than for those who did. PMID:24412223

  5. Treatment of anxiety disorders and comorbid alcohol abuse with buspirone in a patient with antidepressant-induced platelet dysfunction: a case report.

    PubMed

    Mazhar, Mir; Hassan, Tariq; Munshi, Tariq

    2013-01-01

    The risk of abnormal bleeding with serotonin reuptake inhibitors has been known, but there is insufficient evidence base to guide pharmacological treatment of anxiety in patients with underlying haematological conditions. The following case report is about a 50-year-old female with generalized anxiety disorder, social phobia, obsessive compulsive disorder, and alcohol abuse where pharmacological treatment of anxiety symptoms has been difficult as it would lead to bruising due to the patient's underlying qualitative platelet dysfunction. Treatment with venlafaxine, citalopram, escitalopram, and clomipramine resulted in improvement and anxiety symptoms, as well as reduction in alcohol use, but pharmacological treatment has to be discontinued because of bruising and hematomas. In view of an active substance use disorder, benzodiazepines were avoided as a treatment option. The patient's anxiety symptoms and comorbid alcohol abuse responded well to pharmacological treatment with buspirone which gradually titrated up to a dose of 30 mg BID. Patient was followed for around a six-month period while she was on buspirone before being discharged to family doctor's care. Buspirone is unlikely to have a significant effect on platelet serotonin transponder and could be an effective alternative for pharmacological treatment of anxiety in patients with a bleeding diathesis. PMID:24416612

  6. Treatment of Anxiety Disorders and Comorbid Alcohol Abuse with Buspirone in a Patient with Antidepressant-Induced Platelet Dysfunction: A Case Report

    PubMed Central

    Mazhar, Mir; Hassan, Tariq; Munshi, Tariq

    2013-01-01

    The risk of abnormal bleeding with serotonin reuptake inhibitors has been known, but there is insufficient evidence base to guide pharmacological treatment of anxiety in patients with underlying haematological conditions. The following case report is about a 50-year-old female with generalized anxiety disorder, social phobia, obsessive compulsive disorder, and alcohol abuse where pharmacological treatment of anxiety symptoms has been difficult as it would lead to bruising due to the patient's underlying qualitative platelet dysfunction. Treatment with venlafaxine, citalopram, escitalopram, and clomipramine resulted in improvement and anxiety symptoms, as well as reduction in alcohol use, but pharmacological treatment has to be discontinued because of bruising and hematomas. In view of an active substance use disorder, benzodiazepines were avoided as a treatment option. The patient's anxiety symptoms and comorbid alcohol abuse responded well to pharmacological treatment with buspirone which gradually titrated up to a dose of 30 mg BID. Patient was followed for around a six-month period while she was on buspirone before being discharged to family doctor's care. Buspirone is unlikely to have a significant effect on platelet serotonin transponder and could be an effective alternative for pharmacological treatment of anxiety in patients with a bleeding diathesis. PMID:24416612

  7. Assessment of Factors Resulting in Abuse Evaluations in Young Children with Minor Head Trauma

    ERIC Educational Resources Information Center

    Anderst, James D.

    2008-01-01

    Objective: The primary objective was to determine which of the examined factors prompted physicians to initiate a further abuse evaluation in young children with minor head injury. The recording of important historical elements in the charts of these patients was also evaluated. Methods: Charts of 349 children less than 3 years of age with minor…

  8. Meeting the health information needs of prostate cancer patients using personal health records

    PubMed Central

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

    2013-01-01

    Background 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. Methods 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. Results 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. Conclusions 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. PMID:24311957

  9. Assessment of family history of substance abuse for preventive interventions with patients experiencing chronic pain: A quality improvement project.

    PubMed

    Pestka, Elizabeth; Nash, Virginia; Evans, Michele; Cronin, Joan; Bee, Susan; King, Susan; Osborn, Kristine; Gehin, Jessica; Weis, Karen; Loukianova, Larissa

    2016-04-01

    This quality improvement project demonstrates that RN Care Managers, in a chronic pain programme, can assess for a family history of substance abuse in 5-10 min. Information informs treatment based on specific high risk criteria. Benefits include heightened awareness of the genetic and environmental risks associated with a family history of substance abuse, an opportunity to participate in motivational interventions to prevent or minimize consequences of substance use disorders, and likely substantial overall health-care cost savings. PMID:25963926

  10. Cocaine enhances HIV-1-induced CD4(+) T-cell apoptosis: implications in disease progression in cocaine-abusing HIV-1 patients.

    PubMed

    Pandhare, Jui; Addai, Amma B; Mantri, Chinmay K; Hager, Cynthia; Smith, Rita M; Barnett, Louis; Villalta, Fernando; Kalams, Spyros A; Dash, Chandravanu

    2014-04-01

    Substance abuse is a major barrier in eradication of the HIV epidemic because it serves as a powerful cofactor for viral transmission, disease progression, and AIDS-related mortality. Cocaine, one of the commonly abused drugs among HIV-1 patients, has been suggested to accelerate HIV disease progression. However, the underlying mechanism remains largely unknown. Therefore, we tested whether cocaine augments HIV-1-associated CD4(+) T-cell decline, a predictor of HIV disease progression. We examined apoptosis of resting CD4(+) T cells from HIV-1-negative and HIV-1-positive donors in our study, because decline of uninfected cells plays a major role in HIV-1 disease progression. Treatment of resting CD4(+) T cells with cocaine (up to 100 μmol/L concentrations) did not induce apoptosis, but 200 to 1000 μmol/L cocaine induced apoptosis in a dose-dependent manner. Notably, treatment of CD4(+) T cells isolated from healthy donors with both HIV-1 virions and cocaine significantly increased apoptosis compared with the apoptosis induced by cocaine or virions alone. Most important, our biochemical data suggest that cocaine induces CD4(+) T-cell apoptosis by increasing intracellular reactive oxygen species levels and inducing mitochondrial depolarization. Collectively, our results provide evidence of a synergy between cocaine and HIV-1 on CD4(+) T-cell apoptosis that may, in part, explain the accelerated disease observed in HIV-1-infected drug abusers. PMID:24486327

  11. Evaluating the Risk of Re-identification of Patients from Hospital Prescription Records

    PubMed Central

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

    2009-01-01

    Background: 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. Objective: 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. Methods: 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. Results: 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). Conclusions: 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. PMID:22478909

  12. Meg recordings of patients with CNS disorders before and after external magnetic stimulation.

    PubMed

    Anninos, P; Kotini, A; Anninou, N; Adamopoulos, A; Papastergiou, A; Tsagas, N

    2008-03-01

    Magnetoencephalographic (MEG) recordings of patients with CNS disorders were obtained using a whole-head 122-channel magnetometer SQUID and analyzed using Fourier statistical analysis. External transcranial magnetic stimulation in the order of pico Tesla (pTMS) was applied to the above patients with proper characteristics (magnetic intensity 1-7.5 pT; frequency: 8-13 Hz) which were obtained with MEG recordings prior to pTMS. The MEG recordings after the application of pTMS showed a rapid attenuation of the high abnormal activity followed by an increase in the number of the low frequency components toward the patients alpha-rhythm. The possible mechanisms of the effects of external magnetic stimulation on the pineal gland in the brain are presented. PMID:18431816

  13. SOEMPI: A Secure Open Enterprise Master Patient Index Software Toolkit for Private Record Linkage

    PubMed Central

    Toth, Csaba; Durham, Elizabeth; Kantarcioglu, Murat; Xue, Yuan; Malin, Bradley

    2014-01-01

    To mitigate bias in multi-institutional research studies, healthcare organizations need to integrate patient records. However, this process must be accomplished without disclosing the identities of the corresponding patients. Various private record linkage (PRL) techniques have been proposed, but there is a lack of translation into practice because no software suite supports the entire PRL lifecycle. This paper addresses this issue with the introduction of the Secure Open Enterprise Master Patient Index (SOEMPI). We show how SOEMPI covers the PRL lifecycle, illustrate the implementation of several PRL protocols, and provide a runtime analysis for the integration of two datasets consisting of 10,000 records. While the PRL process is slower than a non-secure setting, our analysis shows the majority of processes in a PRL protocol require several seconds or less and that SOEMPI completes the process in approximately two minutes, which is a practical amount of time for integration. PMID:25954421

  14. Is patient confidentiality compromised with the electronic health record?: a position paper.

    PubMed

    Wallace, Ilse M

    2015-02-01

    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. PMID:25532832

  15. Development and initial validation of a content taxonomy for patient records in general dentistry

    PubMed Central

    Acharya, Amit; Hernandez, Pedro; Thyvalikakath, Thankam; Ye, Harold; Song, Mei; Schleyer, Titus

    2013-01-01

    Objective Develop and validate an initial content taxonomy for patient records in general dentistry. Methods Phase 1–Obtain 95 de-identified patient records from 11 general dentists in the United States. Phase 2–Extract individual data fields (information items), both explicit (labeled) and implicit (unlabeled), from records, and organize into categories mirroring original field context. Phase 3–Refine raw list of information items by eliminating duplicates/redundancies and focusing on general dentistry. Phase 4–Validate all items regarding inclusion and importance using a two-round Delphi study with a panel of 22 general dentists active in clinical practice, education, and research. Results Analysis of 76 patient records from 9 dentists, combined with previous work, yielded a raw list of 1,509 information items. Refinement reduced this list to 1,107 items, subsequently rated by the Delphi panel. The final model contained 870 items, with 761 (88%) rated as mandatory. In Round 1, 95% (825) of the final items were accepted, in Round 2 the remaining 5% (45). Only 45 items on the initial list were rejected and 192 (or 17%) remained equivocal. Conclusion Grounded in the reality of clinical practice, our proposed content taxonomy represents a significant advance over existing guidelines and standards by providing a granular and comprehensive information representation for general dental patient records. It offers a significant foundational asset for implementing an interoperable health information technology infrastructure for general dentistry. PMID:23838618

  16. LifeLines: using visualization to enhance navigation and analysis of patient records.

    PubMed Central

    Plaisant, C.; Mushlin, R.; Snyder, A.; Li, J.; Heller, D.; Shneiderman, B.

    1998-01-01

    LifeLines provide a general visualization environment for personal histories. We explore its use for clinical patient records. A Java user interface is described, which presents a one-screen overview of a computerized patient record using timelines. Problems, diagnoses, test results or medications can be represented as dots or horizontal lines. Zooming provides more details; line color and thickness illustrate relationships or significance. The visual display acts as a giant menu, giving direct access to the data. Images Figure 2 Figure 3 PMID:9929185

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

    PubMed Central

    Li, Jing; Zhen, Xiantong; Liu, Xianzeng

    2014-01-01

    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. PMID:24977196

  18. Patients' consent preferences for research uses of information in electronic medical records: interview and survey data

    PubMed Central

    Willison, Donald J; Keshavjee, Karim; Nair, Kalpana; Goldsmith, Charlie; Holbrook, Anne M

    2003-01-01

    Objectives To assess patients' preferred method of consent for the use of information from electronic medical records for research. Design Interviews and a structured survey of patients in practices with electronic medical records. Setting Family practices in southern Ontario, Canada. Participants 123 patients: 17 were interviewed and 106 completed a survey. Main outcome measures Patients' opinions and concerns on use of information from their medical records for research and their preferences for method of consent. Results Most interviewees were willing to allow the use of their information for research purposes, although the majority preferred that consent was sought first. The seeking of consent was considered an important element of respect for the individual. Most interviewees made little distinction between identifiable and anonymised data. Research sponsored by private insurance firms generated the greatest concern, and research sponsored by foundation the least. Sponsorship by drug companies evoked negative responses during interview and positive responses in the survey. Conclusions Patients are willing to allow information from their medical records to be used for research, but most prefer to be asked for consent either verbally or in writing. What is already known on this topicLegislation is being introduced worldwide to restrict the circumstances under which personal information may be used for secondary purposes without consentLittle empirical information exists about patients' concerns over privacy and preferences for consent for use of such information for researchWhat this study addsPatients are willing to allow personal information to be used for research purposes but want to be actively consulted firstPatients make little distinction between identifiable and non-identifiable informationMost patients prefer a time limit for their consent PMID:12586673

  19. Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report.

    PubMed

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

    2016-01-01

    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. PMID:26159464

  20. Mental Health and Substance Use Characteristics of Flight Attendants Enrolled in an In-Patient Substance Abuse Treatment Program

    ERIC Educational Resources Information Center

    Horton, Gail; Diaz, Naelys; McIlveen, John; Weiner, Michael; Mullaney, Donald

    2011-01-01

    The purpose of this study was to explore the prevalence rates of co-occurring mental health problems among 70 flight attendants in substance abuse treatment. Results indicated that flight attendants in treatment were more likely to experience alcohol dependency than drug dependency. A high proportion of participants reported clinical levels of…

  1. Semantic extraction and processing of medical records for patient-oriented visual index

    NASA Astrophysics Data System (ADS)

    Zheng, Weilin; Dong, Wenjie; Chen, Xiangjiao; Zhang, Jianguo

    2012-02-01

    To have comprehensive and completed understanding healthcare status of a patient, doctors need to search patient medical records from different healthcare information systems, such as PACS, RIS, HIS, USIS, as a reference of diagnosis and treatment decisions for the patient. However, it is time-consuming and tedious to do these procedures. In order to solve this kind of problems, we developed a patient-oriented visual index system (VIS) to use the visual technology to show health status and to retrieve the patients' examination information stored in each system with a 3D human model. In this presentation, we present a new approach about how to extract the semantic and characteristic information from the medical record systems such as RIS/USIS to create the 3D Visual Index. This approach includes following steps: (1) Building a medical characteristic semantic knowledge base; (2) Developing natural language processing (NLP) engine to perform semantic analysis and logical judgment on text-based medical records; (3) Applying the knowledge base and NLP engine on medical records to extract medical characteristics (e.g., the positive focus information), and then mapping extracted information to related organ/parts of 3D human model to create the visual index. We performed the testing procedures on 559 samples of radiological reports which include 853 focuses, and achieved 828 focuses' information. The successful rate of focus extraction is about 97.1%.

  2. Immunizations: the first step in a personal health record to empower patients.

    PubMed

    Popovich, Michael L; Aramini, Jeffery J; Garcia, Michael

    2008-01-01

    Despite the promise of better health care through information-centric patient empowerment, little progress has been made. The issue is not that the data do not exist in a useable form, nor that technologies are lacking that would enable access to this information. There are two primary challenges standing in the way of patient empowerment: (1) in the private sector there is no proven revenue model for providing this access and (2) in the public sector the standard argument is confidentiality of information. The lack of a priority by either private or public health providers to empower individuals will lead to these initiatives being consumer driven. Access to immunization records through health informatics and supporting compunetics presents an easy-win opportunity to significantly empower individuals with their own health information. Scientific Technologies Corporation (STC) has been implementing and supporting immunization registries in North America for over fifteen years. As the leading expert in this area, STC has developed a process for achieving successful large-scale access to personal immunization records with minimal investment. As a first step to empower individuals with on-line access to their immunization records, the STC approach leverages the technical frameworks established for health insurance and 3rd party payer environments linking to statewide immunization information systems. The individual is provided access to their records through their insurer's health portal. This is populated through electronic exports of member immunization records as retrieved from state or provincial registries that contain provider-supplied patient records, allowing individuals to utilize these hosted services or download their provider administered records into their personal health record. Individuals have the ability to review their immunization and their family immunization histories. They have the ability to know when an immunization is due, where vaccines are

  3. Automated identification of patients with a diagnosis of binge eating disorder from narrative electronic health records

    PubMed Central

    Bellows, Brandon K; LaFleur, Joanne; Kamauu, Aaron W C; Ginter, Thomas; Forbush, Tyler B; Agbor, Stephen; Supina, Dylan; Hodgkins, Paul; DuVall, Scott L

    2014-01-01

    Binge eating disorder (BED) does not have an International Classification of Diseases, 9th or 10th edition code, but is included under ‘eating disorder not otherwise specified’ (EDNOS). This historical cohort study identified patients with clinician-diagnosed BED from electronic health records (EHR) in the Department of Veterans Affairs between 2000 and 2011 using natural language processing (NLP) and compared their characteristics to patients identified by EDNOS diagnosis codes. NLP identified 1487 BED patients with classification accuracy of 91.8% and sensitivity of 96.2% compared to human review. After applying study inclusion criteria, 525 patients had NLP-identified BED only, 1354 had EDNOS only, and 68 had both BED and EDNOS. Patient characteristics were similar between the groups. This is the first study to use NLP as a method to identify BED patients from EHR data and will allow further epidemiological study of patients with BED in systems with adequate clinical notes. PMID:24201026

  4. Forensic revolution need maintenance of dental records of patients by the dentists: A descriptive study

    PubMed Central

    Gupta, Anamika; Mishra, Gaurav; Bhutani, Hemant; Hoshing, Chetan; Bhalla, Ashish

    2016-01-01

    Objectives: With the growth of forensic odontology, dental records have become an essential source of information, especially for medicolegal cases in general practice. It is mandated by the law that every dentist must keep some kind of records for every patient they treat. After the death of an individual, remnants of teeth are usually damaged at the last among all body parts. Dental records assist in personal identification in cases of mass disasters, criminal investigations, and medicolegal issues. However, in India, rules for maintaining dental records are not very strictly followed. Thus, the aim of this study was to evaluate the knowledge regarding the maintenance of dental records among dentists in Punjab and Uttar Pradesh. Materials and Methods: Data collection was performed via a questionnaire. The study population responded to the questions pertaining to knowledge regarding forensic odontology methods and the mode of maintaining dental records in their regular practice through a personal interview. A descriptive analysis was carried out for the data. The data were summarized and analyzed using the statistical software Statistical Package for the Social Sciences (SPSS) version 18.0. Results: A very low percentage (22%) of the dentists were seen to be maintaining records on a regular basis. Seventy-eight percent of the dentists were not maintaining any records. Conclusion: This study clearly indicates that the dentists in Punjab and Uttar Pradesh need to be properly trained for any kind of forensic and medicolegal needs. PMID:27583219

  5. Characterization of patients who suffer asthma exacerbations using data extracted from electronic medical records.

    PubMed

    Himes, Blanca E; Kohane, Isaac S; Ramoni, Marco F; Weiss, Scott T

    2008-01-01

    The increasing availability of electronic medical records offers opportunities to better characterize patient populations and create predictive tools to individualize health care. We determined which asthma patients suffer exacerbations using data extracted from electronic medical records of the Partners Healthcare System using Natural Language Processing tools from the "Informatics for Integrating Biology to the Bedside" center (i2b2). Univariable and multivariable analysis of data for 11,356 patients (1,394 cases, 9,962 controls) found that race, BMI, smoking history, and age at initial observation are predictors of asthma exacerbations. The area under the receiver operating characteristic curve (AUROC) corresponding to prediction of exacerbations in an independent group of 1,436 asthma patients (106 cases, 1,330 controls) is 0.67. Our findings are consistent with previous characterizations of asthma patients in epidemiological studies, and demonstrate that data extracted by natural language processing from electronic medical records is suitable for the characterization of patient populations. PMID:18999057

  6. Issues in identification and linkage of patient records across an integrated delivery system.

    PubMed

    Arellano, M G; Weber, G I

    1998-01-01

    Historically, the health information systems community has viewed linking personal records as a mundane task. The oversimplified view that routine database manipulation can accurately identify multiple records for a single individual is erroneous, an assumption based on a misperception of the quality of the underlying data. Such data have been adversely affected by the evolution of individual facility patient indexes from multiple systems and the results of backload procedures, and the lack of focus on the need for data integrity by users of the automated systems. Much of the random, invalid data we identify on a daily basis is directly associated with the need for system users to place data in the patient record while they face the situation of having no obvious data field in which to place them. Combined with an underlying lack of standards for the collection of personal identification information, this results in pure chaos when reviewing an MPI file containing a million records at the start of a linkage evaluation project. We have documented the considerable effort that must therefore be made in standardizing the MPI files using stringent analytical procedures and applying common edit routines before commencing record linkage. This preprocessing effort must then be supplemented with sophisticated matching procedures that can handle the dual challenge of minimizing false negatives (the failure to identify true linkages) and false positives (the incorrect linking of records that do not represent the same person). The identification of pairs of linked records does not, however, complete an EPI loading. Because it is fairly common for a multiple facility linkage evaluation to identify more than two medical record numbers for the same patient, and the primary goal of an EPI is to assign a unique identifier for the patient which will link that patient's multiple files, it becomes necessary to develop a means of readily associating three or more records for the same

  7. Disrespect, harassment, and abuse

    PubMed Central

    Miedema, Baukje; Easley, Julie; Fortin, Pierrette; Hamilton, Ryan; Tatemichi, Sue

    2009-01-01

    ABSTRACT OBJECTIVE To examine harassment and abusive encounters between family physicians and their patients or colleagues in the workplace. DESIGN Qualitative case study using semistructured interviews. SETTING Province of New Brunswick. PARTICIPANTS Forty-eight family physicians from across the province. METHODS A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation (< 10 years, 10 to 20 years, or > 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick’s physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. MAIN FINDINGS Although the original intent of this study was to examine the work environment of family physicians in light of the increasing number of women entering the profession, harassment and abusive encounters in the workplace emerged as a main theme. These encounters ranged from minor to severe. Minor abusive encounters included disrespectful behaviour and verbal threats by patients, their families, and occasionally colleagues. More severe forms of harassment involved physical threats, physical encounters, and stalking. Demanding patients, such as heavy drug users, were often seen as threatening. Location of practice, years in practice, and sex of the physician seemed to affect abusive encounters—young, female, rural physicians appeared to experience such encounters most often. CONCLUSION Abusive encounters in the workplace are concerning. It is essential to

  8. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor. As used in these regulations the term “minor” means a person who has not attained the age of majority... 42 Public Health 1 2014-10-01 2014-10-01 false Minor patients. 2.14 Section 2.14 Public...

  9. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Minor patients. 2.14 Section 2.14 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor. As used in these regulations the term...

  10. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor. As used in these regulations the term “minor” means a person who has not attained the age of majority... 42 Public Health 1 2013-10-01 2013-10-01 false Minor patients. 2.14 Section 2.14 Public...

  11. 42 CFR 2.14 - Minor patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.14 Minor patients. (a) Definition of minor. As used in these regulations the term “minor” means a person who has not attained the age of majority... 42 Public Health 1 2012-10-01 2012-10-01 false Minor patients. 2.14 Section 2.14 Public...

  12. [Electronic patient records and teleophthalmology : part 1: introduction to the various systems and standards].

    PubMed

    Schargus, M; Michelson, G; Grehn, F

    2011-05-01

    Electronic storage of patient-related data will replace paper-based patient records in the near future. Some steps in medical practice can even now not be achieved without electronic data processing. Both systems, conventional paper-based and electronic-based records, have advantages and disadvantages which have to be taken into consideration. The advantages of electronic-based records are e.g. good availability of data, structured storage of data, scientific analysis of long-term data and possible data exchange with colleagues in the context of teleconsultation systems. Problems have to be solved in the field of data security, initial high investment costs and time consumption in learning to use the system as well as in incompatibility of existing IT systems. PMID:21590353

  13. Pulmonary Complications of Drug Abuse

    PubMed Central

    Gottlieb, Leon S.; Boylen, Thomas C.

    1974-01-01

    Complications resulting from drug abuse more frequently affect the lung than any other organ. The spectrum of pulmonary complications associated with drug abuse is wide. The current practice of using mixtures of drugs is mainly responsible for the increase in pulmonary complications. The chief complications observed in a series of 241 drug abuse patients were aspiration pneumonitis (12.9 percent), pulmonary edema (10.0 percent), and pneumonia (7.5 percent). ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10. PMID:4812215

  14. Structured data entry in a workflow-enabled electronic patient record.

    PubMed

    Webster, C; Copenhaver, J

    2001-01-01

    Touch-screen technology is used with a structured data entry system for electronic patient records. This article describes a program that coordinates pre-set screens for detailed history, physical examination, treatment and prescription modules. It also presents "pick lists" that allow further customization and individualization of data inputs. PMID:11771069

  15. A Quantitative Exploration of the Relationship between Patient Health and Electronic Personal Health Records

    ERIC Educational Resources Information Center

    Hines, Denise Williams

    2009-01-01

    The use of electronic personal health records is becoming increasingly more popular as healthcare providers, healthcare and government leaders, and patients are seeking ways to improve healthcare quality and to decrease costs (Abrahamsen, 2007). This quantitative, descriptive correlational study examined the relationship between the degree of…

  16. Develop security architecture for both in-house healthcare information systems and electronic patient record

    NASA Astrophysics Data System (ADS)

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

    2003-05-01

    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.

  17. Cognitive analyses of a paper medical record and electronic medical record on the documentation of two nursing tasks: patient education and adherence assessment of insulin administration.

    PubMed Central

    Rinkus, Susan M.; Chitwood, Ainsley

    2002-01-01

    The incorporation of electronic medical records into busy physician clinics has been a major development in the healthcare industry over the past decade. Documentation of key nursing activities, especially when interacting with patients who have chronic diseases, is often lacking or missing from the paper medical record. A case study of a patient with diabetes mellitus was created. Well established methods for the assessment of usability in the areas of human-computer interaction and computer supported cooperative work were employed to compare the nursing documentation of two tasks in a commercially available electronic medical record (eRecord) and in a paper medical record. Overall, the eRecord was found to improve the timeliness and quality of nursing documentation. With certain tasks, the number of steps to accomplish the same task was higher, which may result in the perception by the end user that the tool is more complex and therefore difficult to use. Recommendations for the eRecord were made to expand the documentation of patient teaching and adherence assessment and to incorporate web technology for patient access to medical records and healthcare information. PMID:12463905

  18. Wireless connection of continuous glucose monitoring system to the electronic patient record

    NASA Astrophysics Data System (ADS)

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

    2005-04-01

    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.

  19. Youth Alcohol Use and Dating Abuse Victimization and Perpetration: A Test of the Relationships at the Daily Level in a Sample of Pediatric Emergency Department Patients Who Use Alcohol

    ERIC Educational Resources Information Center

    Rothman, Emily F.; Stuart, Gregory L.; Winter, Michael; Wang, Na; Bowen, Deborah J.; Bernstein, Judith; Vinci, Robert

    2012-01-01

    Objective: This study retrospectively examined the daily-level associations between youth alcohol use and dating abuse (DA) victimization and perpetration for a 6-month period. Method: Timeline Followback (TLFB) interview data were collected from 397 urban emergency department patients, ages 17 to 21 years. Patients were eligible if they reported…

  20. Longitudinal histories as predictors of future diagnoses of domestic abuse: modelling study

    PubMed Central

    Kohane, Isaac S; Mandl, Kenneth D

    2009-01-01

    Objective To determine whether longitudinal data in patients’ historical records, commonly available in electronic health record systems, can be used to predict a patient’s future risk of receiving a diagnosis of domestic abuse. Design Bayesian models, known as intelligent histories, used to predict a patient’s risk of receiving a future diagnosis of abuse, based on the patient’s diagnostic history. Retrospective evaluation of the model’s predictions using an independent testing set. Setting A state-wide claims database covering six years of inpatient admissions to hospital, admissions for observation, and encounters in emergency departments. Population All patients aged over 18 who had at least four years between their earliest and latest visits recorded in the database (561 216 patients). Main outcome measures Timeliness of detection, sensitivity, specificity, positive predictive values, and area under the ROC curve. Results 1.04% (5829) of the patients met the narrow case definition for abuse, while 3.44% (19 303) met the broader case definition for abuse. The model achieved sensitive, specific (area under the ROC curve of 0.88), and early (10-30 months in advance, on average) prediction of patients’ future risk of receiving a diagnosis of abuse. Analysis of model parameters showed important differences between sexes in the risks associated with certain diagnoses. Conclusions Commonly available longitudinal diagnostic data can be useful for predicting a patient’s future risk of receiving a diagnosis of abuse. This modelling approach could serve as the basis for an early warning system to help doctors identify high risk patients for further screening. PMID:19789406

  1. 42 CFR 2.19 - Disposition of records by discontinued programs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Disposition of records by discontinued programs. 2.19 Section 2.19 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.19 Disposition...

  2. A detailed description and assessment of outcomes of patients with hospital recorded QTc prolongation.

    PubMed

    Laksman, Zachary; Momciu, Bogdan; Seong, You Won; Burrows, Patricia; Conacher, Susan; Manlucu, Jaimie; Leong-Sit, Peter; Gula, Lorne J; Skanes, Allan C; Yee, Raymond; Klein, George J; Krahn, Andrew D

    2015-04-01

    Corrected QT (QTc) interval prolongation has been shown to be an independent predictor of mortality in many clinical settings and is a common finding in hospitalized patients. The causes and outcomes of patients with extreme QTc interval prolongation during a hospital admission are poorly described. The aim of this study was to prospectively identify patients with automated readings of QTc intervals >550 ms at 1 academic tertiary hospital. One hundred seventy-two patients with dramatic QTc interval prolongation (574 ± 53 ms) were identified (mean age 67.6 ± 15.1 years, 48% women). Most patients had underlying heart disease (60%), predominantly ischemic cardiomyopathy (43%). At lease 1 credible and presumed reversible cause associated with QTc interval prolongation was identified in 98% of patients. The most common culprits were QTc interval-prolonging medications, which were deemed most responsible in 48% of patients, with 25% of these patients taking ≥2 offending drugs. Two patients were diagnosed with congenital long-QT syndrome. Patients with electrocardiograms available before and after hospital admission demonstrated significantly lower preadmission and postdischarge QTc intervals compared with the QTc intervals recorded in the hospital. In conclusion, in-hospital mortality was high in the study population (29%), with only 4% of patients experiencing arrhythmic deaths, all of which were attributed to secondary causes. PMID:25665761

  3. Promoting Effective Interviewing of Sexually Abused Children: A Pilot Study

    ERIC Educational Resources Information Center

    Cheung, Monit

    2008-01-01

    Objective: This study is centered on interviewing techniques with alleged child sexual abuse victims who do and do not disclose sexual abuse. Method: Ninety randomly selected videotapes are reviewed, and the interviewing techniques are recorded on a 69-item Child Sexual Abuse Interviewing Skills Instrument. Results: The nondisclosure children are…

  4. A Neuro-Oncology Workstation for Structuring, Modeling, and Visualizing Patient Records

    PubMed Central

    Hsu, William; Arnold, Corey W.; Taira, Ricky K.

    2016-01-01

    The patient medical record contains a wealth of information consisting of prior observations, interpretations, and interventions that need to be interpreted and applied towards decisions regarding current patient care. Given the time constraints and the large—often extraneous—amount of data available, clinicians are tasked with the challenge of performing a comprehensive review of how a disease progresses in individual patients. To facilitate this process, we demonstrate a neuro-oncology workstation that assists in structuring and visualizing medical data to promote an evidence-based approach for understanding a patient’s record. The workstation consists of three components: 1) a structuring tool that incorporates natural language processing to assist with the extraction of problems, findings, and attributes for structuring observations, events, and inferences stated within medical reports; 2) a data modeling tool that provides a comprehensive and consistent representation of concepts for the disease-specific domain; and 3) a visual workbench for visualizing, navigating, and querying the structured data to enable retrieval of relevant portions of the patient record. We discuss this workstation in the context of reviewing cases of glioblastoma multiforme patients.

  5. Worldwide telemedicine services based on distributed multimedia electronic patient records by using the second generation Web server hyperwave.

    PubMed Central

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

    1999-01-01

    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. Images Figure 1 PMID:10566494

  6. Developing image-based electronic patient records for collaborative medical applications

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Sun, Jianyong; Yong, Yuanyuan; Chen, Xiaomeng; Yu, Fenghai; Zhang, Xiaoyan; Lian, Ping; Sun, Kun; Huang, H. K.

    2004-04-01

    We developed a Web-based system to interactively display image-based electronic patient records (EPR) for 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). We have successfully used this system two times for the teleconsultation on Severe acute respiratory syndrome (SARS) in Shanghai Xinhua Hospital and Shanghai Infection Hospital. During the consultation, both the physicians in infection control area and the experts outside the control area could interactively study, manipulate and navigate the EPR of the SARS patients to make more precise diagnosis on images with this system assisting. 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. Should medical students track former patients in the electronic health record? An emerging ethical conflict.

    PubMed

    Brisson, Gregory E; Neely, Kathy Johnson; Tyler, Patrick D; Barnard, Cynthia

    2015-08-01

    Medical students are increasingly using electronic health records (EHRs) in clerkships, and medical educators should seek opportunities to use this new technology to improve training. One such opportunity is the ability to "track" former patients in the EHR, defined as following up on patients in the EHR for educational purposes for a defined period of time after they have left one's direct care. This activity offers great promise in clinical training by enabling students to audit their diagnostic impressions and follow the clinical history of illness in a manner not possible in the era of paper charting. However, tracking raises important questions about the ethical use of protected health information, including concerns about compromising patient autonomy, resulting in a conflict between medical education and patient privacy. The authors offer critical analysis of arguments on both sides and discuss strategies to balance the ethical conflict by optimizing outcomes and mitigating harms. They observe that tracking improves training, thus offering long-lasting benefits to society, and is supported by the principle of distributive justice. They conclude that students should be permitted to track for educational purposes, but only with defined limits to safeguard patient autonomy, including obtaining permission from patients, having legitimate educational intent, and self-restricting review of records to those essential for training. Lastly, the authors observe that this conflict will become increasingly important with completion of the planned Nationwide Health Information Network and emphasize the need for national guidelines on tracking patients in an ethically appropriate manner. PMID:25565261

  8. New drugs of abuse.

    PubMed

    Rech, Megan A; Donahey, Elisabeth; Cappiello Dziedzic, Jacqueline M; Oh, Laura; Greenhalgh, Elizabeth

    2015-02-01

    Drug abuse is a common problem and growing concern in the United States, and over the past decade, novel or atypical drugs have emerged and have become increasingly popular. Recognition and treatment of new drugs of abuse pose many challenges for health care providers due to lack of quantitative reporting and routine surveillance, and the difficulty of detection in routine blood and urine analyses. Furthermore, street manufacturers are able to rapidly adapt and develop new synthetic isolates of older drugs as soon as law enforcement agencies render them illegal. In this article, we describe the clinical and adverse effects and purported pharmacology of several new classes of drugs of abuse including synthetic cannabinoids, synthetic cathinones, salvia, desomorphine, and kratom. Because many of these substances can have severe or life-threatening adverse effects, knowledge of general toxicology is key in recognizing acute intoxication and overdose; however, typical toxidromes (e.g., cholinergic, sympathomimetic, opioid, etc.) are not precipitated by many of these agents. Medical management of patients who abuse or overdose on these drugs largely consists of supportive care, although naloxone may be used as an antidote for desomorphine overdose. Symptoms of aggression and psychosis may be treated with sedation (benzodiazepines, propofol) and antipsychotics (haloperidol or atypical agents such as quetiapine or ziprasidone). Other facets of management to consider include treatment for withdrawal or addiction, nutrition support, and potential for transmission of infectious diseases. PMID:25471045

  9. A multicenter, primary care-based, open-label study to identify behaviors related to prescription opioid misuse, abuse, and diversion in opioid-experienced patients with chronic moderate-to-severe pain

    PubMed Central

    Setnik, Beatrice; Roland, Carl L; Sommerville, Kenneth W; Pixton, Glenn C; Berke, Robert; Calkins, Anne; Goli, Veeraindar

    2015-01-01

    Objective To compare the investigator assessment of patient risk for prescription opioid misuse, abuse, and diversion with patient self-reports of these activities in a population with chronic pain. Methods As a secondary objective of an open-label, multicenter, primary care-based clinical study to evaluate the success of converting opioid-experienced patients with chronic pain to morphine sulfate with sequestered naltrexone hydrochloride, risk for misuse, abuse, and diversion was assessed using two nonvalidated questionnaires: one was completed by the investigator and another by the patient (Self-Reported Misuse, Abuse, and Diversion [SR-MAD]). In addition, the validated Current Opioid Misuse Measure (COMM) test and urine drug test were used. Results Of the 684 patients assessed by the investigators, 537 returned the self-assessment, SR-MAD. Most patients were assigned by the investigator as low risk for misuse (84.2%), abuse (89.3%), and diversion (94.3%). Of the patients who returned SR-MAD, 60% indicated having taken more opioids than prescribed and 10.9% reported chewing or crushing their opioids in the past. Of the patients who completed COMM, 40.6% were deemed as having aberrant behaviors. COMM results correlated with the risk levels from the investigator assessment. One-third of patients (33.8%) had at least one abnormal urine drug test result. Conclusion More research is needed to better understand the gap between the investigator assessment of potential risk for misuse, abuse, and diversion and the actual extent of these behaviors among patients with chronic pain. PMID:26185467

  10. Comorbidity of Schizophrenia and Substance Abuse: Implications for Treatment.

    ERIC Educational Resources Information Center

    Mueser, Kim T.; And Others

    1992-01-01

    Reviews substance abuse disorders in schizophrenia patients, including prevalence of comorbid disorders, assessment, hypothesized mechanisms underlying abuse, and clinical effects of abuse on course of illness and cognitive functioning. Outlines principles of treatment for dual-diagnosis schizophrenia patients, noting limitations of existing…

  11. A Guide for Pain Management in Low and Middle Income Communities. Managing the Risk of Opioid Abuse in Patients with Cancer Pain

    PubMed Central

    Pergolizzi, Joseph V.; Zampogna, Gianpietro; Taylor, Robert; Gonima, Edmundo; Posada, Jose; Raffa, Robert B.

    2016-01-01

    Most patients who present with cancer have advanced disease and often suffer moderate to severe pain. Opioid therapy can be safe and effective for use in cancer patients with pain, but there are rightful concerns about inappropriate opioid use even in the cancer population. Since cancer patients live longer than ever before in history (and survivors may have long exposure times to opioid therapy), opioid misuse among cancer patients is an important topic worthy of deeper investigation. Cancer patients with pain must be evaluated for risk factors for potential opioid misuse and aberrant drug-taking behaviors assessed. A variety of validated screening tools should be used. Of particular importance is the fact that pain in cancer patients changes frequently, whether it is related to their underlying disease (progression or remission), pain related to treatment (such as painful chemotherapy-induced peripheral neuropathy), and concomitant pain unrelated to cancer (such as osteoarthritis, headache, or back pain). Fortunately, clinicians can use universal precautions to help reduce the risk of opioid misuse while still assuring that cancer patients get the pain therapy they need. Another important new “tool” in this regard is the emergence of abuse-deterrent opioid formulations. PMID:26973529

  12. Patient Core Data Set. Standard for a longitudinal health/medical record.

    PubMed

    Renner, A L; Swart, J C

    1997-01-01

    Blue Chip Computers Company, in collaboration with Wright State University-Miami Valley College of Nursing and Health, with support from the Agency for Health Care Policy and Research, Public Health Service, completed Small Business innovative Research research to design a comprehensive integrated Patient information System. The Wright State University consultants undertook the development of a Patient Core Data Set (PCDS) in response to the lack of uniform standards of minimum data sets, and lack of standards in data transfer for continuity of care. The purpose of the Patient Core Data Set is to develop a longitudinal patient health record and medical history using a common set of standard data elements with uniform definitions and coding consistent with Health Level 7 (HL7) protocol and the American Society for Testing and Materials (ASTM) standards. The PCDS, intended for transfer across all patient-care settings, is essential information for clinicians, administrators, researchers, and health policy makers. PMID:9099030

  13. Honoring Dental Patients' Privacy Rule Right of Access in the Context of Electronic Health Records.

    PubMed

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

    2016-06-01

    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. PMID:27251351

  14. Personal health records, symptoms, uncertainty, and mood in brain tumor patients

    PubMed Central

    Cahill, Jennifer E.; Lin, Lin; LoBiondo-Wood, Geri; Armstrong, Terri S.; Acquaye, Alvina A.; Vera-Bolanos, Elizabeth; Gilbert, Mark R.; Padhye, Nikhil S.

    2014-01-01

    Background The advantages of patient access to the electronic medical record (EMR) through integrated personal health records (PHR) may be substantial, and foremost is the enhanced information flow between patient and practitioner. Because this is an emerging technology, the actualized benefits to complex patient groups remain largely unknown. MD Anderson Cancer Center provides web-based PHR portal access to the EMR including clinic notes, MRI results, and pathology reports. This study sought to evaluate PHR use by glioma patients. Methods Cross-sectional survey and PHR-derived user data from 186 patients were analyzed using descriptive and inferential statistics. Logistic regression assessed disparities between users and nonusers. Dependence of PHR access on treatment stage was tested through linear regression. Path analysis evaluated PHR access, disease-related uncertainty, symptom experience, and mood. Results Patients averaged 44.2 years (range 19y–80y), 77% had a high-grade tumor, and 60% had accessed PHR at least one time (range 0–126). Strongest predictors of access included education level (college level or higher), low performance status, middle income, and in-state residency. Patients undergoing treatment were more active users. PHR access was associated with lower disease-related uncertainty and lower symptom severity. Mood was not directly related to PHR use but mediated an association between symptom severity and uncertainty. Conclusions While many reports presume better disease and symptom understanding for patients with EMR access, this study is the first to correlate PHR use to lower patient uncertainty levels. Early examination of PHR provides an important basis for critical evaluation and optimization to better structure this benefit for brain tumor patients. PMID:26034618

  15. Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (EMSANT-W) Algorithm.

    PubMed

    Derrington, Taletha Mae; Bernstein, Judith; Belanoff, Candice; Cabral, Howard J; Babakhanlou-Chase, Hermik; Diop, Hafsatou; Evans, Stephen R; Kotelchuck, Milton

    2015-10-01

    Substance use disorder (SUD) in women of reproductive age is associated with adverse health consequences for both women and their offspring. US states need a feasible population-based, case-identification tool to generate better approximations of SUD prevalence, treatment use, and treatment outcomes among women. This article presents the development of the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), a gender-tailored tool based upon existing International Classification of Diseases, 9th Edition, Clinical Modification diagnostic code-based groupers that can be applied to hospital administrative data. Gender-tailoring entailed the addition of codes related to infants, pregnancy, and prescription drug abuse, as well as the creation of inclusion/exclusion rules based on other conditions present in the diagnostic record. Among 1,728,027 women and associated infants who accessed hospital care from January 1, 2002 to December 31, 2008 in Massachusetts, EMSANT-W identified 103,059 women with probable SUD. EMSANT-W identified 4,116 women who were not identified by the widely used Clinical Classifications Software for Mental Health and Substance Abuse (CCS-MHSA) and did not capture 853 women identified by CCS-MHSA. Content and approach innovations in EMSANT-W address potential limitations of the Clinical Classifications Software, and create a methodologically sound, gender-tailored and feasible population-based tool for identifying women of reproductive age in need of further evaluation for SUD treatment. Rapid changes in health care service infrastructure, delivery systems and policies require tools such as the EMSANT-W that provide more precise identification methods for sub-populations and can serve as the foundation for analyses of treatment use and outcomes. PMID:25680703

  16. Implications of Swedish National Regulatory Framework of the Patient Accessible Electronic Health Record.

    PubMed

    Scandurra, Isabella; Lyttkens, Leif; Eklund, Benny

    2016-01-01

    Online access to your own electronic health record is a controversial issue. In a Swedish county such eHealth service has been in operation since 2012 and it is now being widely deployed in the other counties. This first review presents work regarding current National Regulatory Framework (NRF) related to the public eHealth service Patient Accessible Electronic Health Record (PAEHR) and points out how electable paragraphs have been applied in different counties. Potential implications due to the different decisions made are discussed in terms of patient centricity and health information outcome. In current PAEHR, care providers have assessed differently how to apply the NRF. For the patients, this means that information gathered from the health record may be displayed differently, depending on where, when and why they seek treatment. When a patient visits different care providers such solution may cause confusion and its purpose may go lost. Consequently a revised NRF with less electable paragraphs is recommended, as well as adherence to the next NRF by all county councils. PMID:27577474

  17. Elevated homocysteine level in first-episode schizophrenia patients--the relevance of family history of schizophrenia and lifetime diagnosis of cannabis abuse.

    PubMed

    Misiak, Blazej; Frydecka, Dorota; Slezak, Ryszard; Piotrowski, Patryk; Kiejna, Andrzej

    2014-09-01

    Accumulating evidence indicates that elevated homocysteine (Hcy) level occurs in first-episode schizophrenia (FES) patients. We included 56 FES patients and 53 healthy controls (HC). Plasma level of Hcy was significantly higher in FES patients than HC (p = 0.044). In addition, plasma levels of high-density lipoproteins (HDL) and folate were significantly lower in FES than in HC (p < 0.001). Positive family history of schizophrenia was associated with lower plasma HDL (p = 0.041) and vitamin B12 (p = 0.017), as well as higher level of Hcy (p = 0.017). Patients with FES, who abused cannabis, had higher levels of Hcy (p = 0.017), as well as lower levels of vitamin B12 (p = 0.017) and HDL (p = 0.041). Plasma Hcy negatively correlated with duration of untreated psychosis (r = -0.272, p = 0.042). There was a positive correlation between Hcy level and the severity of negative symptoms (r = 0.363, p = 0.006) and general psychopathology (r = 0.349, p = 0.008) assessed using Positive and Negative Syndrome Scale (PANSS). Vitamin B12 level was negatively associated with the severity of negative symptoms (r = -0.406, p = 0.002), while folate level negatively correlated with general psychopathology score (r = -0.365, p = 0.006) in PANSS. These results indicate that the severity of one-carbon metabolism alterations and HDL deficiency might be associated with family history of schizophrenia and cannabis abuse. Lower vitamin B12 and folate along with elevated Hcy may influence the severity of FES psychopathology. PMID:24682777

  18. Cocaine abuse among heroin addicts in Spain.

    PubMed

    Torrens, M; San, L; Peri, J M; Olle, J M

    1991-01-01

    Abuse of cocaine is becoming a major problem among heroin addicts in Spain. Between 1987 and 1988, 75% of patients admitted as inpatients for detoxification from opiate dependence had consumed cocaine during the 6 months prior to admission and 25% had abused cocaine daily or several times/week. These cocaine abusers showed more toxicologic and psychopathologic problems than opiate addicts who did not abuse cocaine. The opiate addicts who also abused cocaine had begun using illicit drugs earlier and showed a higher frequency of anti-HIV antibodies. They also had more antisocial personality disorders and persistence of depressive symptoms during opiate detoxification than heroin addicts who did not abuse cocaine. Based on these findings, we insist on the need to develop different treatments for detoxifying patients with this dual addiction. PMID:2029857

  19. Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records.

    PubMed

    Ryan, James; Hendler, James; Bennett, Kristin P

    2015-12-01

    Electronic Healthcare Records (EHRs) have the potential to improve healthcare quality and to decrease costs by providing quality metrics, discovering actionable insights, and supporting decision-making to improve future outcomes. Within the United States Medicaid Program, rates of recidivism among emergency department (ED) patients serve as metrics of hospital performance that help ensure efficient and effective treatment within the ED. We analyze ED Medicaid patient data from 1,149,738 EHRs provided by a hospital over a 2-year period to understand the characteristics of the ED return visits within a 72-hour time frame. Frequent flyer patients with multiple revisits account for 47% of Medicaid patient revisits over this period. ED encounters by frequent flyer patients with prior 72-hour revisits in the last 6 months are thrice more likely to result in a readmit than those of infrequent patients. Statistical L1-logistic regression and random forest analyses reveal distinct patterns of ED usage and patient diagnoses between frequent and infrequent patient encounters, suggesting distinct opportunities for interventions to improve efficacy of care and streamline ED workflow. This work forms a foundation for future development of predictive models, which could flag patients at high risk of revisiting. PMID:27441405

  20. Child Abuse: Definition.

    ERIC Educational Resources Information Center

    Wilson, Timothy L.-Y.

    The purpose of this paper was to elaborate on the definitions of child abuse in order to improve the understanding of child abuse. The definitions given by the U.S. House Joint Committee on Child Abuse in the Child Abuse Prevention and Treatment Act, and in research by Holden (1984), are cited. These definitions refer to the nature of abusive acts…

  1. Spousal Abuse

    PubMed Central

    Gullattee, Alyce C.

    1979-01-01

    Spouse abuse is being discussed and agonized over more frequently than in past years. Although interpousal and intrafamilial violence have been behaviors of note and considerable consequence, they have been attributable, almost exclusively, to the lower socioeconomic classes. Many hypotheses have been proposed concerning the etiology of violence. The author discusses some of the more general sociopolitical theories of violence and proposes three areas of significant moment to behaviorists. PMID:439165

  2. Predictors and Intensity of Online Access to Electronic Medical Records Among Patients With Cancer

    PubMed Central

    Gerber, David E.; Laccetti, Andrew L.; Chen, Beibei; Yan, Jingsheng; Cai, Jennifer; Gates, Samantha; Xie, Yang; Lee, Simon J. Craddock

    2014-01-01

    Introduction: Electronic portals are secure Web-based servers that provide patients with real-time access to their personal health record (PHR). These applications are now widely used at cancer centers nationwide, but their impact has not been well studied. This study set out to determine predictors and patterns of use of a Web-based portal for accessing PHRs and communicating with health providers among patients with cancer. Methods: Retrospective analysis of enrollment in and use of MyChart, a PHR portal for the Epic electronic medical record system, among patients seen at a National Cancer Institute–designated cancer center. Predictors of MyChart use were analyzed through univariable and multivariable regression models. Results: A total of 6,495 patients enrolled in MyChart from 2007 to 2012. The median number of log-ins over this period was 57 (interquartile range 17-137). The most common portal actions were viewing test results (37%), viewing and responding to clinic messages (29%), and sending medical advice requests (6.4%). Increased portal use was significantly associated with younger age, white race, and an upper aerodigestive malignancy diagnosis. Thirty-seven percent of all log-ins and 31% of all medical advice requests occurred outside clinic hours. Over the study period, the average number of patient log-ins per year more than doubled. Conclusions: Among patients with cancer, PHR portal use is frequent and increasing. Younger patients, white patients, and patients with upper aerodigestive malignancies exhibit the heaviest portal use. Understanding the implications of this new technology will be central to the delivery of safe and effective care. PMID:25006222

  3. Drug abuse in slum population

    PubMed Central

    Ghulam, Ram; Verma, Kamal; Sharma, Pankaj; Razdan, Monica; Razdan, Rahul Anand

    2016-01-01

    Substance abuse is an important health problem throughout the world including India, but prevalence and pattern of abuse varies from country to country and in different types of population. Slums have their own social and economic problems so that substance abuse may be different in this population and might be related with these problems. The aim of the present study was to study the prevalence and pattern substances in slum population. Prakash Chandra Sethi Nagar slum area of Indore district was selected for the purpose of this study. In first phase of the study, first a camp was organized to sensitize local leaders, key persons, and local inhabitants about drug abuse at Chandra Prakash Sethi Nagar. After that basic information was gathered with the key persons in Chandra Prakash Sethi Nagar. In second phase by house-to-house survey, all members of the family were interviewed in detail and information was recorded on semi-structured proforma. We observed prevalence rate of 560/1000 populations, 78.2% were males, 28.2% were females, and two-third abusers were laborers (72%). In order of frequency, tobacco was the most common substance abused in 53.9% population followed by gutka (nontobacco pan masala). Other drugs in order of frequency were alcohol 46.5%, cannabis 8.9%, opiates 4.9%, sedative and hypnotic 2.0%, solvents 1.0%, and cocaine in 0.1%. Slum population has higher prevalence rates than general population. PMID:26985110

  4. Drug abuse in slum population.

    PubMed

    Ghulam, Ram; Verma, Kamal; Sharma, Pankaj; Razdan, Monica; Razdan, Rahul Anand

    2016-01-01

    Substance abuse is an important health problem throughout the world including India, but prevalence and pattern of abuse varies from country to country and in different types of population. Slums have their own social and economic problems so that substance abuse may be different in this population and might be related with these problems. The aim of the present study was to study the prevalence and pattern substances in slum population. Prakash Chandra Sethi Nagar slum area of Indore district was selected for the purpose of this study. In first phase of the study, first a camp was organized to sensitize local leaders, key persons, and local inhabitants about drug abuse at Chandra Prakash Sethi Nagar. After that basic information was gathered with the key persons in Chandra Prakash Sethi Nagar. In second phase by house-to-house survey, all members of the family were interviewed in detail and information was recorded on semi-structured proforma. We observed prevalence rate of 560/1000 populations, 78.2% were males, 28.2% were females, and two-third abusers were laborers (72%). In order of frequency, tobacco was the most common substance abused in 53.9% population followed by gutka (nontobacco pan masala). Other drugs in order of frequency were alcohol 46.5%, cannabis 8.9%, opiates 4.9%, sedative and hypnotic 2.0%, solvents 1.0%, and cocaine in 0.1%. Slum population has higher prevalence rates than general population. PMID:26985110

  5. The computer-based patient record challenges towards timeless and spaceless medical practice.

    PubMed

    Sicotte, C; Denis, J L; Lehoux, P; Champagne, F

    1998-08-01

    Although computerization is increasingly advocated as a means for hospitals to enhance quality of care and control costs, few studies have evaluated its impact on the day-to-day organization of medical work. This study investigated a large Computerized Patient Record (CPR) project ($50 million U.S.) aimed at allowing physicians to work in a completely electronic record environment. The present multiple-case study analyzed the implementation of this project conducted in four hospitals. Our results show the intricate complexity of introducing the CPR in medical work. Profound obstructions to the achievement of a tighter synchronization between the care and information processes were the main problems. The presence of multiple information systems in one (Communication, Decision Support, and Archival record keeping) was overlooked. It introduced several misconceptions in the meaning and codification of clinical information that were then torn apart between information richness to sustain clinical decisions and concision to sustain care coordination. PMID:9690181

  6. Abuse and neglect in schools.

    PubMed

    Sugar, M

    1990-10-01

    Maltreatment in the classroom by students of teachers, and teachers of students, is widespread with emotional, physical, sexual, and neglect aspects. Its frequency and long-term developmental effects are undocumented. We know of the consequences in some who become our patients; but for the others we can only speculate based on reports about parental abuse and neglect. This paper presents these issues about the four types of abuse with representative cases. Idealization and transference feelings seem to contribute to the lack of reporting of abuse by teachers. Perhaps teachers do not report being abused by students for fear of retaliation. Some approaches to management are considered. The seriousness of this problem is underlined even more by the paucity of research and reports despite the obvious need. Hopefully, documentation of incidence and developmental effects will be forthcoming. PMID:2285074

  7. Predicting length of stay from an electronic patient record system: a primary total knee replacement example

    PubMed Central

    2014-01-01

    Background To investigate whether factors can be identified that significantly affect hospital length of stay from those available in an electronic patient record system, using primary total knee replacements as an example. To investigate whether a model can be produced to predict the length of stay based on these factors to help resource planning and patient expectations on their length of stay. Methods Data were extracted from the electronic patient record system for discharges from primary total knee operations from January 2007 to December 2011 (n = 2,130) at one UK hospital and analysed for their effect on length of stay using Mann-Whitney and Kruskal-Wallis tests for discrete data and Spearman’s correlation coefficient for continuous data. Models for predicting length of stay for primary total knee replacements were tested using the Poisson regression and the negative binomial modelling techniques. Results Factors found to have a significant effect on length of stay were age, gender, consultant, discharge destination, deprivation and ethnicity. Applying a negative binomial model to these variables was successful. The model predicted the length of stay of those patients who stayed 4–6 days (~50% of admissions) with 75% accuracy within 2 days (model data). Overall, the model predicted the total days stayed over 5 years to be only 88 days more than actual, a 6.9% uplift (test data). Conclusions Valuable information can be found about length of stay from the analysis of variables easily extracted from an electronic patient record system. Models can be successfully created to help improve resource planning and from which a simple decision support system can be produced to help patient expectation on their length of stay. PMID:24708853

  8. Image-based electronic patient records for secured collaborative medical applications.

    PubMed

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

    2005-01-01

    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. PMID:17282930

  9. "Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health.

    PubMed

    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

    2016-03-01

    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. PMID:26174867

  10. A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

    PubMed Central

    Satoh-Asahara, Noriko; Ito, Hiroto; Akashi, Tomoyuki; Yamakage, Hajime; Kotani, Kazuhiko; Nagata, Daisuke; Nakagome, Kazuyuki; Noda, Mitsuhiko

    2016-01-01

    PURPOSE Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. METHOD We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. RESULTS Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. CONCLUSION A new PHR may be suitable for comorbid patients with diabetes and depression. PMID:27478395

  11. Factors Associated with Sexual Behavior Problems in Young Sexually Abused Children.

    ERIC Educational Resources Information Center

    Hall, Darlene Kordich; Mathews, Fred; Pearce, John

    1998-01-01

    Analysis of data from the clinical records of 100 sexually abused boys and girls, ages 3-7 years, identified five variables predictive of sexual behavior problems, including sexual arousal of the child during the abuse, perpetrator's use of sadism, a history of physical and emotional abuse, and who the child blames for the abuse. (DB)

  12. Multimorbidity and weight loss in obese primary care patients: longitudinal study based on electronic healthcare records

    PubMed Central

    Calderón-Larrañaga, Amaia; Hernández-Olivan, Paola; González-Rubio, Francisca; Gimeno-Feliu, Luis A; Poblador-Plou, Beatriz; Prados-Torres, Alexandra

    2015-01-01

    Objective To analyse the association between cardiovascular and mental comorbidities of obesity and weight loss registered in the electronic primary healthcare records. Design and setting Longitudinal study of a cohort of adult patients assigned to any of the public primary care centres in Aragon, Spain, during 2010 and 2011. Participants Adult obese patients for whom data on their weight were available for 2010 (n=62 901), and for both 2010 and 2011 (n=42 428). Outcomes Weight loss (yes/no) was calculated based on the weight difference between the first value registered in 2010 and the last value registered in 2011. Multivariate logistic regression models were adjusted for individuals’ age, sex, total number of chronic comorbidities, type of obesity and length of time between both weight measurements. Results According to the recorded clinical information, 9 of 10 obese patients showed at least one chronic comorbidity. After adjusting for covariates, weight loss seemed to be more likely among obese patients with a diagnosis of diabetes and/or dementia and less likely among those with hypertension, anxiety and/or substance use problems (p<0.05). The probability of weight loss was also significantly higher in male patients with more severe obesity and older age. Conclusions An increased probability of weight loss over 1 year was observed in older obese male patients, especially among those already manifesting high levels of obesity and severe comorbidities such as diabetes and/or dementia. Yet patients with certain psychological problems showed lower rates of weight reduction. Future research should clarify if these differences persist beyond potential selective weight documentation in primary care, to better understand the trends in weight reduction among obese patients and the underlying role of general practitioners regarding such trends. PMID:25783419

  13. Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.

    PubMed

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

    2016-09-01

    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. PMID:26142432

  14. Identifying patients with hypertension: a case for auditing electronic health record data.

    PubMed

    Baus, Adam; Hendryx, Michael; Pollard, Cecil

    2012-01-01

    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). PMID:22737097

  15. Identifying Patients with Hypertension: A Case for Auditing Electronic Health Record Data

    PubMed Central

    Baus, Adam; Hendryx, Michael; Pollard, Cecil

    2012-01-01

    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). PMID:22737097

  16. Characteristics and trends of hospitalized pediatric abuse head trauma in Wuhan, China: 2002–2011.

    PubMed

    Xia, Xin; Xiang, Joe; Shao, Jianbo; Smith, Gary A; Yu, Chuanhua; Zhu, Huiping; Xiang, Huiyun

    2012-11-01

    This study investigated characteristics and trends of hospitalized abuse-related traumatic brain injuries (TBI) treated at a large pediatric medical center in Wuhan, China during the past 10 years. De-identified hospital discharge data for patients 0–4 years old hospitalized at the Wuhan Medical Care Center for Women and Children were analyzed, and ICD-10 codes were used to identify cases of TBI. Medical notes provided by doctors in the medical record were used to identify TBI cases in which suspected child abuse was the cause. From 2002 to 2011, 3,061 pediatric TBI patients were hospitalized and 4.6% (140) of these cases were suspected child abuse-related. The majority of suspected child abuse cases involved children younger than 1 year of age (68.6%) and usually affected males (63.6%). Children with non-Abusive Head Trauma (AHT) were more likely to have full recovery outcome (68.4%, 95% CI: 66.6%--70%) than children with suspected AHT (44.3%, 95% CI: 36.1%--52/5%). The proportion of all childhood TBI attributable to abuse did not appear to have increased in the 10-year period at this medical center. This is the first comprehensive study highlighting the important role of suspected child abuse in causing TBIs among Chinese children. Child abuse as a major cause of TBIs among infants in China should be studied further, and there should be greater awareness of this important social and medical problem in China. PMID:23202840

  17. Child Sexual Abuse

    MedlinePlus

    ... victim of prolonged sexual abuse usually develops low self-esteem, a feeling of worthlessness and an abnormal or ... can help abused children regain a sense of self-esteem, cope with feelings of guilt about the abuse, ...

  18. Drug abuse first aid

    MedlinePlus

    Drug abuse is the misuse or overuse of any medication or drug, including alcohol. This article discusses first ... use of these drugs is a form of drug abuse. Legitimate medications can be abused by people who ...

  19. Child Sexual Abuse

    MedlinePlus

    Sexual abuse is one form of child abuse. It includes a wide range of actions between a child ... to children or pressuring them for sex is sexual abuse. Using a child for pornography is also sexual ...

  20. How to Handle Abuse

    MedlinePlus

    ... them. Another word for hurting someone is "abuse." Child abuse (say: ah-BYOOS) can affect all kinds of ... a babysitter, teacher, coach, or a bigger kid. Child abuse can happen anywhere — at home, school, childcare, or ...

  1. The Role of Anxiety Sensitivity and Difficulties in Emotion Regulation in Posttraumatic Stress Disorder among Crack/Cocaine Dependent Patients in Residential Substance Abuse Treatment

    PubMed Central

    McDermott, Michael J.; Tull, Matthew T.; Gratz, Kim L.; Daughters, Stacey B.; Lejuez, C. W.

    2009-01-01

    Current research suggests the importance of anxiety sensitivity (AS) in the risk for PTSD, and a growing body of research has demonstrated that difficulties in emotion regulation may also play a role. This study examined the unique relationships between AS dimensions, difficulties in emotion regulation, and a probable PTSD diagnosis among a sample of inner-city crack/cocaine dependent patients in residential substance abuse treatment. Probable PTSD participants exhibited higher levels of the AS dimension of social concerns and emotion regulation difficulties. Emotion regulation difficulties reliably distinguished probable PTSD participants from non-PTSD participants above and beyond both anxiety symptom severity and the AS dimension of social concerns. Further, social concerns did not account for unique variance when difficulties in emotion regulation was entered into the model. Results provide support for the central role of difficulties in emotion regulation relative to AS dimensions in the prediction of PTSD within a crack/cocaine dependent population. PMID:19233609

  2. [Hebephrenic symptoms as an expression of an XYY chromosome abnormality? Case report of a patient with suspected sexual abuse of his own 2 minor children].

    PubMed

    Dirksen, T; Mönikes, E

    1995-06-01

    A 48 year old patient was hospitalised because of parasuicidal behaviour and suicidal ideation. He was under suspicion of having sexually abused his 4-year old daughter and his 4-year old son. At the age of 17, he was hospitalised in a psychiatric ward under the diagnosis of hebephrenic schizophrenia. He successfully received an insulin coma therapy. Because of his increased height (1.89 m), mental retardation and other psychical disorders in his youth, we now suspected him of having an extra Y chromosome which was confirmed by chromosome analysis. The non-uniform symptomatology of XYY-individuals includes a hebephrenic aspect. Concerning the different therapeutical and juridical consequences, we considered a critical investigation of the former diagnosis "Hebephrenic Schizophrenia". PMID:7635385

  3. Signal averaging technique for noninvasive recording of late potentials in patients with coronary artery disease

    NASA Technical Reports Server (NTRS)

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

    1987-01-01

    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.

  4. A review of approaches to identifying patient phenotype cohorts using electronic health records

    PubMed Central

    Shivade, Chaitanya; Raghavan, Preethi; Fosler-Lussier, Eric; Embi, Peter J; Elhadad, Noemie; Johnson, Stephen B; Lai, Albert M

    2014-01-01

    Objective To summarize literature describing approaches aimed at automatically identifying patients with a common phenotype. Materials and methods We performed a review of studies describing systems or reporting techniques developed for identifying cohorts of patients with specific phenotypes. Every full text article published in (1) Journal of American Medical Informatics Association, (2) Journal of Biomedical Informatics, (3) Proceedings of the Annual American Medical Informatics Association Symposium, and (4) Proceedings of Clinical Research Informatics Conference within the past 3 years was assessed for inclusion in the review. Only articles using automated techniques were included. Results Ninety-seven articles met our inclusion criteria. Forty-six used natural language processing (NLP)-based techniques, 24 described rule-based systems, 41 used statistical analyses, data mining, or machine learning techniques, while 22 described hybrid systems. Nine articles described the architecture of large-scale systems developed for determining cohort eligibility of patients. Discussion We observe that there is a rise in the number of studies associated with cohort identification using electronic medical records. Statistical analyses or machine learning, followed by NLP techniques, are gaining popularity over the years in comparison with rule-based systems. Conclusions There are a variety of approaches for classifying patients into a particular phenotype. Different techniques and data sources are used, and good performance is reported on datasets at respective institutions. However, no system makes comprehensive use of electronic medical records addressing all of their known weaknesses. PMID:24201027

  5. Overlooked Issues Relevant in Sexual Abuse.

    ERIC Educational Resources Information Center

    Barham, Martha; Clark, Mary McGinn

    This paper presents clinical observations, experiences, and interventions from group psychotherapy when the main theme was molestation/sexual abuse. The findings presented are a synthesis of experiences in three areas: (1) the difficulty patients encounter when trying to disconnect with the negative effects of sexual abuse; (2) assessment and…

  6. Towards the Prevention of Alcohol Abuse

    ERIC Educational Resources Information Center

    Facy, FranCoise; Rabaud, Myriam

    2006-01-01

    Mortality resulting from alcohol abuse in young French people is too high in spite of prevention campaigns for road safety in particular. There are problems in identifying alcohol abuse in young people in preventive medicine or alcohol care services. This study was carried out in alcohol centres; data from patients under 25 are analysed and…

  7. Systematically Improving Tobacco Cessation Patient Services Through Electronic Medical Record Integration.

    PubMed

    Karn, Shelley; Fernandez, Alejandra; Grossberg, Lou Ann; Robertson, Trina; Sharp, Barry; Huang, Philip; Loukas, Alexandra

    2016-07-01

    The Health Information Act of 2010 has presented an opportunity to discuss, establish, and promote innovative ways to incorporate tobacco cessation assistance to patients in the health care setting. This article provides an overview of the development and implementation of an electronic tobacco cessation protocol (the eTobacco protocol), into an electronic medical record (EMR) system, while evaluating the barriers and benefits encountered. The protocol was developed to facilitate the process of electronically referring patients to a state-funded quitline service by establishing a one-click connect for providers to use within the EMR system. While evaluating the implementation of the protocol, findings indicate that several barriers were encountered including disruption of clinic workflow, EMR limitations, and training complications. In spite of the barriers, the protocol shows promising results by increasing referrals to the quitline from 7 patients the year prior to implementation to 1,254 patients after the implementation of the electronic solution. Health care systems that have the ability to modify their EMR system can help lower tobacco use rates among their patients while meeting Meaningful Use requirements. Future research should examine if referrals through the eTobacco protocol are directly associated with patients' tobacco cessation rates. PMID:27199147

  8. Pharmacologic Prophylaxis for Venous Thromboembolism Among Patients With Total Joint Replacement: An Electronic Medical Records Study.

    PubMed

    Rosenman, Marc; Liu, Xianchen; Phatak, Hemant; Qi, Rong; Teal, Evgenia; Nisi, Daniel; Liu, Larry Z; Parr, J Andrew

    2016-01-01

    Patients who have total hip (THR) or knee (TKR) replacement have an elevated risk of venous thromboembolism (VTE). The American College of Chest Physicians guidelines recommend prophylactic anticoagulation. The aim of the study was to examine pharmacologic prophylaxis against VTE among patients with THR or TKR and to assess demographic and clinical correlates related to VTE prophylaxis. Using 15 years of data (1995-2009) from an electronic medical record system for an inner-city public hospital in the United States, we examined pharmacologic prophylaxis against VTE and associated factors in patients after THR (n = 242) and TKR (n = 317). Before the early 2000s, aspirin was the most common prophylaxis agent (THR, 61% and TKR, 65%), and 26% of patients with THR and 19% of patients with TKR did not receive prophylaxis. Enoxaparin use has increased since 2000, and warfarin is now the most common prophylaxis agent (THR, 70% and TKR, 61%). After controlling for time period, factors associated with prophylaxis pattern included obesity, hip fracture, and the surgeon's number of years in practice. VTE prophylaxis medications in patients with total joint replacement have changed over 15 years, in trends generally consistent with the evolution of guidelines. Obesity, history of hip fracture, and physician's experience are associated with the prescription of VTE prophylaxis medications. PMID:26736015

  9. Abuse and misuse of antidepressants

    PubMed Central

    Evans, Elizabeth A; Sullivan, Maria A

    2014-01-01

    Background Rates of prescription drug abuse have reached epidemic proportions. Large-scale epidemiologic surveys of this under-recognized clinical problem have not included antidepressants despite their contribution to morbidity and mortality. The purpose of this review is to look specifically at the misuse of antidepressants and how this behavior may fit into the growing crisis of nonmedical use of prescription drugs. Methods We conducted a comprehensive search on PubMed, Medline, and PsycINFO using the search terms “antidepressant”, “abuse”, “misuse”, “nonmedical use”, “dependence”, and “addiction”, as well as individual antidepressant classes (eg, “SSRI”) and individual antidepressants (eg, “fluoxetine”) in various combinations, to identify articles of antidepressant misuse and abuse. Results A small but growing literature on the misuse and abuse of antidepressants consists largely of case reports. Most cases of antidepressant abuse have occurred in individuals with comorbid substance use and mood disorders. The most commonly reported motivation for abuse is to achieve a psychostimulant-like effect. Antidepressants are abused at high doses and via a variety of routes of administration (eg, intranasal, intravenous). Negative consequences vary based upon antidepressant class and pharmacology, but these have included seizures, confusion, and psychotic-like symptoms. Conclusion The majority of individuals prescribed antidepressants do not misuse the medication. However, certain classes of antidepressants do carry abuse potential. Vulnerable patient populations include those with a history of substance abuse and those in controlled environments. Warning signs include the presence of aberrant behaviors. Physicians should include antidepressants when screening for risky prescription medication use. When antidepressant misuse is detected, a thoughtful treatment plan, including referral to an addiction specialist, should be developed and

  10. Development and validation of a continuous measure of patient condition using the Electronic Medical Record.

    PubMed

    Rothman, Michael J; Rothman, Steven I; Beals, Joseph

    2013-10-01

    Patient condition is a key element in communication between clinicians. However, there is no generally accepted definition of patient condition that is independent of diagnosis and that spans acuity levels. We report the development and validation of a continuous measure of general patient condition that is independent of diagnosis, and that can be used for medical-surgical as well as critical care patients. A survey of Electronic Medical Record data identified common, frequently collected non-static candidate variables as the basis for a general, continuously updated patient condition score. We used a new methodology to estimate in-hospital risk associated with each of these variables. A risk function for each candidate input was computed by comparing the final pre-discharge measurements with 1-year post-discharge mortality. Step-wise logistic regression of the variables against 1-year mortality was used to determine the importance of each variable. The final set of selected variables consisted of 26 clinical measurements from four categories: nursing assessments, vital signs, laboratory results and cardiac rhythms. We then constructed a heuristic model quantifying patient condition (overall risk) by summing the single-variable risks. The model's validity was assessed against outcomes from 170,000 medical-surgical and critical care patients, using data from three US hospitals. Outcome validation across hospitals yields an area under the receiver operating characteristic curve(AUC) of ≥0.92 when separating hospice/deceased from all other discharge categories, an AUC of ≥0.93 when predicting 24-h mortality and an AUC of 0.62 when predicting 30-day readmissions. Correspondence with outcomes reflective of patient condition across the acuity spectrum indicates utility in both medical-surgical units and critical care units. The model output, which we call the Rothman Index, may provide clinicians with a longitudinal view of patient condition to help address known

  11. Case-based reasoning using electronic health records efficiently identifies eligible patients for clinical trials

    PubMed Central

    Miotto, Riccardo

    2015-01-01

    Objective To develop a cost-effective, case-based reasoning framework for clinical research eligibility screening by only reusing the electronic health records (EHRs) of minimal enrolled participants to represent the target patient for each trial under consideration. Materials and Methods The EHR data—specifically diagnosis, medications, laboratory results, and clinical notes—of known clinical trial participants were aggregated to profile the “target patient” for a trial, which was used to discover new eligible patients for that trial. The EHR data of unseen patients were matched to this “target patient” to determine their relevance to the trial; the higher the relevance, the more likely the patient was eligible. Relevance scores were a weighted linear combination of cosine similarities computed over individual EHR data types. For evaluation, we identified 262 participants of 13 diversified clinical trials conducted at Columbia University as our gold standard. We ran a 2-fold cross validation with half of the participants used for training and the other half used for testing along with other 30 000 patients selected at random from our clinical database. We performed binary classification and ranking experiments. Results The overall area under the ROC curve for classification was 0.95, enabling the highlight of eligible patients with good precision. Ranking showed satisfactory results especially at the top of the recommended list, with each trial having at least one eligible patient in the top five positions. Conclusions This relevance-based method can potentially be used to identify eligible patients for clinical trials by processing patient EHR data alone without parsing free-text eligibility criteria, and shows promise of efficient “case-based reasoning” modeled only on minimal trial participants. PMID:25769682

  12. The Patient Portal of the Personal Cross-Enterprise Electronic Health Record (PEHR) in the Rhine-Neckar-Region.

    PubMed

    Brandner, Antje; Schreiweis, Björn; Aguduri, Lakshmi S; Bronsch, Tobias; Kunz, Aline; Pensold, Peter; Stein, Katharina E; Weiss, Nicolas; Yüksekogul, Nilay; Bergh, Björn; Heinze, Oliver

    2016-01-01

    Over the last years we stepwise implemented our vision of a personal cross-enterprise electronic health record (PEHR) in the Rhine-Neckar-Region in Germany. The patient portal is one part of the PEHR architecture with IHE connectivity. The patient is enabled to access and manage his medical record by use of the patient portal. Moreover, he can give his consent regarding which healthcare providers are allowed to send data into or read data from his medical record. Forthcoming studies will give evidence for improvements and further requirements to develop. PMID:27577362

  13. Sexual, Physical, Verbal/Emotional Abuse and Unexplained Chest Pain

    ERIC Educational Resources Information Center

    Eslick, Guy D.; Koloski, Natasha A.; Talley, Nicholas J.

    2011-01-01

    Objectives: Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained…

  14. Web technology for emergency medicine and secure transmission of electronic patient records.

    PubMed

    Halamka, J D

    1998-01-01

    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. PMID:9673087

  15. Hardware issues in the movement to computer-based patient records.

    PubMed

    Bunschoten, B; Deming, B

    1995-02-01

    The health care field is making significant progress in shifting to computer-based patient records. Providers are faced with some difficult decisions about what hardware options are most appropriate. Key issues include the choice of clinical workstations vs. portable computers, the use of new client-server architecture or traditional mainframe-based systems and the role of personal computers. This special report offers an indepth assessment of important hardware trends in the records automation movement. The first story offers an analysis of the hardware implications of client-server architecture and an assessment of the long-term role of mainframe computers. The second story sizes up the potential role for mobile computing, including hand-held devices and wireless technology. PMID:10143840

  16. Integration of healthcare information: from enterprise PACS to patient centered multimedia health record.

    PubMed

    Soriano, Enrique; Plazzotta, Fernando; Campos, Fernando; Kaminker, Diego; Cancio, Alfredo; Aguilera Díaz, Jerónimo; Luna, Daniel; Seehaus, Alberto; Carcía Mónaco, Ricardo; de Quirós, Fernán González Bernaldo

    2010-01-01

    Every single piece of healthcare information should be fully integrated and transparent within the electronic health record. The Italian Hospital of Buenos Aires initiated the project Multimedia Health Record with the goal to achieve this integration while maintaining a holistic view of current structure of the systems of the Hospital, where the axis remains are the patient and longitudinal history, commencing with section Computed Tomography. Was implemented DICOM standard for communication and image storage and bought a PACS. It was necessary adapt our generic reporting system for live up to the commercial RIS. The Computerized Tomography (CT) Scanners of our hospital were easily integrated into the DICOM network and all the CT Scans generated by our radiology service were stored in the PACS, reported using the Structured Reporting System (we installed diagnostic terminals equipped with 3 monitors) and displayed in the EHR at any point of HIBA's healthcare network. PMID:20841663

  17. An approach to assessing elder abuse and neglect in the dental office.

    PubMed

    Osei, Anthony D

    2009-07-01

    Elder abuse and neglect is a complex phenomenon with no clear markers identified as both reliable and valid in the dental operatory. Applying the concepts and definition of abuse and attention to risk factors for abuse could lead the clinician, as the head of the care team to situations where abuse of an elder could be suspected. Once abuse is suspected, direct questioning and comprehensive assessment of an elders' physical, emotional, and emotional state could be recorded as part of social history in their dental records. A multidisciplinary team approach is encouraged to combat elder abuse. In Texas, state statutes on suspected abuse mandate reporting to appropriate Adult Protective Services within your region with stipulated penalties for failure to report suspected abuse or neglect. Elder abuse hotlines are (800) 252-5400 or (512) 834-3784 (elder abuse domestic or community). PMID:19753814

  18. Electronic Health Records: An Enhanced Security Paradigm to Preserve Patient's Privacy

    NASA Astrophysics Data System (ADS)

    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.

  19. Advanced patient records: some ethical and legal considerations touching medical information space.

    PubMed

    Kluge, E H

    1993-04-01

    The application of advanced computer-based information technology to patient records presents an opportunity for expanding the informational resource base that is available to health-care providers at all levels. Consequently, it has the potential for fundamentally restructuring the ethics of the physician/patient relationship and the ethos of contemporary health-care delivery. At the same time, the technology raises several important ethical problems. This paper explores some of these implications. It suggests that the fundamental ethical issue at stake in these developments is the status of the electronic record which functions as the analog of the health-care consumer in health-care decision making. Matters such as control and patient dignity are implicated. Other important ethical issues requiring solution include data ownership, data liability, informed consent to use and retrieval, security and access. The paper suggests that the ethical problems that arise cannot be solved in piecemeal fashion and on a purely national basis. They should be addressed in a coordinated international fashion and receive appropriate legal expression in the relevant countries and be incorporated into appropriate codes of ethics. PMID:8321138

  20. Use of electronic health records for early detection of high-cost, low back pain patients

    PubMed Central

    Maeng, Daniel D; Stewart, Walter F; Yan, Xiaowei; Boscarino, Joseph A; Mardekian, Jack; Harnett, James; Von Korff, Michael R

    2015-01-01

    BACKGROUND: Low back pain (LBP) is a debilitating condition that is complex to manage. One reason is that clinicians lack means to identify early on patients who are likely to become high care utilizers. OBJECTIVE: To explore the feasibility of developing a ‘dynamic’ predictive model using electronic health record data to identify costly LBP patients within the first year after their initial LBP encounter with a primary care provider. Dynamic, in this context, indicates a process in which the decision on how to manage patients is dependent on whether they are at their first, second or third LBP visit with the provider. METHODS: A series of logistic regression models was developed to predict who will be a high-cost patient (defined as top 30% of the cost distribution) at each of the first three LBP visits. RESULTS: The c-statistics of the three logistic regression models corresponding to each of the first three visits were 0.683, 0.795 and 0.741, respectively. The overall sensitivity of the model was 42%, the specificity was 86% and the positive predictive value was 48%. Men were more likely to become expensive than women, while patients who had workers’ compensation as their primary payer type had higher use of prescription opioid drugs or were smokers before the first LBP visit were also more likely to become expensive. CONCLUSION: The results suggest that it is feasible to develop a dynamic, primary care provider visit-based predictive model for LBP care based on longitudinal data obtained via electronic health records. PMID:26291127

  1. Mono- versus polydrug abuse patterns among publicly funded clients.

    PubMed

    Kedia, Satish; Sell, Marie A; Relyea, George

    2007-01-01

    To examine patterns of mono- versus polydrug abuse, data were obtained from intake records of 69,891 admissions to publicly funded treatment programs in Tennessee between 1998 and 2004. While descriptive statistics were employed to report frequency and patterns of mono- and polydrug abuse by demographic variables and by study years, bivariate logistic regression was applied to assess the probability of being a mono- or polydrug abuser for a number of demographic variables. The researchers found that during the study period 51.3% of admissions reported monodrug abuse and 48.7% reported polydrug abuse. Alcohol, cocaine, and marijuana were the most commonly abused substances, both alone and in combination. Odds ratio favored polydrug abuse for all but one drug category-other drugs. Gender did not affect drug abuse patterns; however, admissions for African Americans and those living in urban areas exhibited higher probabilities of polydrug abuse. Age group also appeared to affect drug abuse patterns, with higher odds of monodrug abuse among minors and adults over 45 years old. The discernable prevalence of polydrug abuse suggests a need for developing effective prevention strategies and treatment plans specific to polydrug abuse. PMID:17996066

  2. Psychophysiological Reactivity in Child Sexual Abuse.

    PubMed

    Ben-Amitay, Galit; Kimchi, Nir; Wolmer, Leo; Toren, Paz

    2016-01-01

    Sexual abuse has physiological and emotional implications. The purpose of this study is to evaluate the neurobiological sequels of childhood sexual trauma by monitoring physiological variables among sexually abused girls and women compared to controls. We assessed posttrauma and traumatic life events of 35 females sexually abused in their childhood (age range 7-51 years) and 25 control females (age range 7-54 years). Electroencephalography, frontalis electromyography, electrodermal activity, and heart rate parameters were recorded while watching sets of pictures representing neutral and trauma-suggestive stimuli. A minority of participants met the Diagnostic and Statistical Manual of Mental Disorders criteria for post-traumatic stress disorder. Abused females displayed significant elevations in heart rate, electromyography, and electroencephalography while viewing allusive stimuli and elevated heart rate while viewing neutral stimuli. The dysfunctional regulation of the physiological stress system associated with child sexual abuse may endanger the victims with various stress and anxiety disorders. PMID:26934544

  3. Child abuse: concerns for oral health practitioners.

    PubMed

    Rayman, Salim; Dincer, Elvir; Almas, Khalid

    2013-01-01

    Child abuse and neglect are prevalent issues that permeate all ethnic, cultural and socioeconomic segments of society. Parents of abused children frequently change physicians in order to prevent detection, but they are more likely to continue to visit the child's dentist. Most states recognize four major types of maltreatment: neglect; physical abuse; psychological maltreatment; and sexual abuse. The American Academy of Pediatric Dentistry defines dental neglect as "the willful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection." The oral health practitioner must uphold his or her legal and ethical responsibility if there is suspicion, record and report the incidence. It may help save a child from further abuse. PMID:24027895

  4. Time accuracy of a radio frequency identification patient tracking system for recording operating room timestamps.

    PubMed

    Marjamaa, Riitta A; Torkki, Paulus M; Torkki, Markus I; Kirvelä, Olli A

    2006-04-01

    A patient tracking system is a promising tool for managing patient flow and improving efficiency in the operating room. Wireless location systems, using infrared or radio frequency transmitters, can automatically timestamp key events, thereby decreasing the need for manual data input. In this study, we measured the accuracy and precision of automatically documented timestamps compared with manual recording. Each patient scheduled for urgent surgery was given an active radio frequency/infrared transmitter. The prototype software tracked the patient throughout the perioperative process, automatically documenting the timestamps. Both automatic and traditional data entry were compared with the reference data. The absolute value of median error was 64% smaller (P < 0.01), and the average quartile deviation of error was 69% smaller in automatic documentation. The average delay between an activity and the documentation was 80 seconds in automatic documentation and 735 seconds in manual documentation. Both the accuracy and the precision were better in automatic documentation and the data were immediately available. Automatic documentation with the Indoor Positioning System can help in managing patient flow and in increasing transparency with faster availability and better accuracy of data. PMID:16551921

  5. Use of an Electronic Patient Record system to evaluate restorative treatment following root canal therapy.

    PubMed

    Shelley, Peter Q; Johnson, Bradford R; BeGole, Ellen A

    2007-10-01

    Electronic Patient Record (EPR) systems are rapidly gaining acceptance as an important tool for managing patient information. The purpose of this project was to evaluate the use of an EPR system for assessment of quality of care in an academic dental institution. The primary outcome of interest was the timeliness and completeness of restorative care following completion of nonsurgical root canal therapy. An initial query of the EPR database was performed using the following inclusion criteria: root canal treatment performed in the postgraduate endodontics clinic between September 2002 and June 2004, patient age > or =18 years old, and posterior tooth (premolars and molars). A total of 925 patients with 1,014 endodontically treated teeth met the inclusion criteria. A random sample of 30 percent of the treated teeth (302 teeth on 281 patients) was selected for detailed review. This sample of 302 teeth was then screened to determine if any restorative treatment had been performed between September 2002 and November 2005. Forty-eight percent (n=146) of the 302 teeth did not receive any form of permanent restoration over the time period studied. Twenty-five percent (n=75) of the teeth received a buildup only, and 27 percent (n=82) received the recommended treatment, a full occlusal coverage restoration. This study documents the use of an EPR system to objectively and efficiently assess one aspect of quality of care in a dental school environment. PMID:17923711

  6. Parent Abuse: A Review

    ERIC Educational Resources Information Center

    Kennair, Nicola; Mellor, David

    2007-01-01

    A recent focus of research and clinical practice has been on the issue of abuse of parents by their children (parent abuse). This paper reviews the literature on this phenomenon. While parent abuse falls under the umbrella of family violence, it appears to be qualitatively different from other forms of intra-family abuse. Research has primarily…

  7. HL7 document patient record architecture: an XML document architecture based on a shared information model.

    PubMed

    Dolin, R H; Alschuler, L; Behlen, F; Biron, P V; Boyer, S; Essin, D; Harding, L; Lincoln, T; Mattison, J E; Rishel, W; Sokolowski, R; Spinosa, J; Williams, J P

    1999-01-01

    The HL7 SGML/XML Special Interest Group is developing the HL7 Document Patient Record Architecture. This draft proposal strives to create a common data architecture for the interoperability of healthcare documents. Key components are that it is under the umbrella of HL7 standards, it is specified in Extensible Markup Language, the semantics are drawn from the HL7 Reference Information Model, and the document specifications form an architecture that, in aggregate, define the semantics and structural constraints necessary for the exchange of clinical documents. The proposal is a work in progress and has not yet been submitted to HL7's formal balloting process. PMID:10566319

  8. A Preliminary Evaluation of the UMLS Metathesaurus for Patient Record Classification

    PubMed Central

    Chute, C. G.; Tuttle, M. S.; Yang, Yiming; Sherertz, D. D.; Olson, N. E.; Erlbaum, M. S.

    1990-01-01

    The UMLS project seeks to provide a unified interface to biomedical knowledge resources. Patient medical records are an enormous repository of clinical intervention and outcome, and are drawing increasing attention in the pursuit of quality assurance, outcomes research, and epidemiologic analysis. We sought to evaluate an unedited version of the preliminary UMLS Metathesaurus, Meta-1, for the automated coding of medical diagnosis and surgical procedures. Identical evaluations were undertaken using SNOMED and the Mayo Clinic indexing lexicon. Meta-1 performed comparably to the comparison clinical indexing systems, although all systems exhibited problems associated with clinical attribute levels and modifier combinations.

  9. Maintaining the continuity of HIV-care records for patients transferring care between centers: challenges, workloads, needs and risks.

    PubMed

    Gill, M John; Ody, Meagan; Lynch, Tarah; Jessiman-Perreault, Lynn; Krentz, Hartmut B

    2016-08-01

    With improved life expectancy, the medical records of HIV-infected patients are likely to be transferred repeatedly between HIV caregivers. The challenges, and risk for introducing medical error from incomplete record transfers are poorly understood. We measured number of requests for record transfer, the workload incurred, and explore, using genotypic antiretroviral resistance testing results (GART), the potential risk of incomplete records. Using retrospective database and chart review, we examined all patients followed at the Southern Alberta Clinic between 1 January 2004 and 1 January 2015, and determined how many patients transferred care into and out our program, the associated requests and the workload for record transfer. Using a complete record of all GART tests, the potential importance of absent historic records in current treatment decisions was analyzed. The annual churn rate was 22 ± 3.4%. We received requests for only 70% of patient records who had left our care. Median time for receipt of incoming medical records was 28 days; average clerical time for processing data was 2 hours/record. Of all GART results, 25% exhibited resistance. Of 111 patients with potentially misleading GART results (i.e., documented historical resistance not visible on more recent GART), 34 (30.6%) had moved in from elsewhere. Rigorous maintenance of the continuity of the HIV record is not universally practiced. Resources, costs and logistic challenges as well as a lack of appreciation of risks clearly shown by GART testing, may be relevant barriers. Addressing such issues is pressing as aging and transfers of care are increasingly common. PMID:26829326

  10. Maxillary sinus manifestations of methamphetamine abuse.

    PubMed

    Faucett, Erynne A; Marsh, Katherine M; Farshad, Kayven; Erman, Audrey B; Chiu, Alexander G

    2015-01-01

    Methamphetamines are the second most commonly used illicit drug worldwide and cost the United States health-care system ∼$23.4 billion annually. Use of this drug affects multiple organ systems and causes a variety of clinical manifestations. Although there are commonly known sequelae of methamphetamine abuse such as "meth mouth," there is limited evidence regarding maxillary sinus manifestations. The following cases highlight the initial evaluation and management of two methamphetamine abusers with loculated purulent collections within the maxillary sinus as a result of methamphetamine abuse. Our aim was to delineate the otolaryngologic symptoms associated with the patients' methamphetamine abuse. Computed tomography and magnetic resonance imaging studies revealed loculated purulent collections within the maxillary sinus of probable odontogenic origin in both patients. Methamphetamine abuse leading to rampant caries and poor oral hygiene may predispose individuals for craniofacial infections and fluid collections. These cases illustrate the development of maxillary sinusitis and maxilla mucoceles that have been associated with methamphetamine use. PMID:25675268

  11. Abuse potential of propofol used for sedation in gastric endoscopy and its correlation with subject characteristics

    PubMed Central

    Kim, Ja Hyun; Byun, Heewon

    2013-01-01

    Background Propofol has been widely used for an induction and/or maintenance of general anesthesia, or for sedation for various procedures. Although it has many ideal aspects, there have been several cases of drug abuse and addiction. The authors investigated whether there are abuse liable groups among the general population. Methods We surveyed 169 patients after gastric endoscopic examination, which used propofol as a sedative, with the Addiction Research Center Inventory (ARCI) questionnaire. Other characteristics of the patients, such as past history, smoking habits, depression, anxiety, alcohol abuse liability and sleep disturbance, were recorded by history taking and several questionnaires before the exam. Results Propofol had a high Morphine-Benzedrine Group (MBG) score (representative value for euphoria) of 6.3, which is higher than marijuana, and a Pentobarbital-Chlorpromazine-Alcohol Group (PCAG) score (representative value of sedation) of 8.1, which is lower than most opioids. The MBG score showed no statistically significant correlation between any of the characteristics of the groups. In females, the PCAG score showed a correlation with age, and in males, it showed a correlation with a sleeping problem. Conclusions Propofol had relatively high euphoria and low residual sedative effects. It had a more potent sedative effect in the female group who were young, and in the male group who had a low sleep quality index. There were differences in the abuse liability from a single exposure to propofol in the general population. Further study is needed to evaluate the abuse liability of repeated exposure. PMID:24363842

  12. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting

    ERIC Educational Resources Information Center

    Wiggley, Shirley L.

    2011-01-01

    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…

  13. Patient Electronic Health Records as a Means to Approach Genetic Research in Gastroenterology.

    PubMed

    Ananthakrishnan, Ashwin N; Lieberman, David

    2015-10-01

    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. PMID:26073373

  14. Moving towards an electronic patient record: a survey to assess the needs of community family physicians.

    PubMed Central

    Strasberg, H. R.; Tudiver, F.; Holbrook, A. M.; Geiger, G.; Keshavjee, K. K.; Troyan, S.

    1998-01-01

    OBJECTIVE: To determine the needs of community family physicians regarding electronic patient records (EPRs). DESIGN: A comprehensive survey was sent to 101 community family physicians in Hamilton, Ontario, who had expressed an interest in EPRs. RESULTS: 46 physicians responded (46%). 87% felt that an EPR would result in their providing better patient care. A wide variety of items were deemed to be important to be included on the EPR "front page". Desired functionality emphasized labs, medications, consultation, hospital follow-up and health maintenance. Family physicians tended to prefer templates to other data entry methods such as typing and dictating. Respondents were more willing to view information from the hospital than to let the hospital view information from their own offices. CONCLUSION: This survey provided useful information on the perceived EPR needs of community-based family physicians. It will be repeated post-computerization. PMID:9929216

  15. Dynamic Estimation of the Probability of Patient Readmission to the ICU using Electronic Medical Records

    PubMed Central

    Caballero, Karla; Akella, Ram

    2015-01-01

    In this paper, we propose a framework to dynamically estimate the probability that a patient is readmitted after he is discharged from the ICU and transferred to a lower level care. We model this probability as a latent state which evolves over time using Dynamical Linear Models (DLM). We use as an input a combination of numerical and text features obtained from the patient Electronic Medical Records (EMRs). We process the text from the EMRs to capture different diseases, symptoms and treatments by means of noun phrases and ontologies. We also capture the global context of each text entry using Statistical Topic Models. We fill out the missing values using a Expectation Maximization based method (EM). Experimental results show that our method outperforms other methods in the literature terms of AUC, sensitivity and specificity. In addition, we show that the combination of different features (numerical and text) increases the prediction performance of the proposed approach. PMID:26958282

  16. Patient isolation in multichannel bioelectric recordings by digital transmission through a single optical fiber.

    PubMed

    MettingVanRijn, A C; Kuiper, A P; Linnenbank, A C; Grimbergen, C A

    1993-03-01

    A design for patient isolation in 64-channel ECG recordings is presented. Small dimensions of the isolated section and the use of an optical fiber as the only connection between the isolated section and the grounded section of the measurement system ensured a minimal capacitance between the patient and the environment. The consistent low-power design of the isolated section resulted in a power consumption of 210 mW, which enabled a 10 h continuous operating time of the battery powered isolated section. The system handles 64 signals with a dynamic range of 75 dB. Analog to digital conversion is performed in the isolated section with a sample rate of 1 kHz per channel. The receiver interfaces to a commercially available DMA board for a standard personal computer. PMID:8335335

  17. Exploring the sociotechnical intersection of patient safety and electronic health record implementation

    PubMed Central

    Meeks, Derek W; Takian, Amirhossein; Sittig, Dean F; Singh, Hardeep; Barber, Nick

    2014-01-01

    Objective The intersection of electronic health records (EHR) and patient safety is complex. To examine the applicability of two previously developed conceptual models comprehensively to understand safety implications of EHR implementation in the English National Health Service (NHS). Methods We conducted a secondary analysis of interview data from a 30-month longitudinal, prospective, case study-based evaluation of EHR implementation in 12 NHS hospitals. We used a framework analysis approach to apply conceptual models developed by Sittig and Singh to understand better EHR implementation and use: an eight-dimension sociotechnical model and a three-phase patient safety model (safe technology, safe use of technology, and use of technology to improve safety). Results The intersection of patient safety and EHR implementation and use was characterized by risks involving technology (hardware and software, clinical content, and human–computer interfaces), the interaction of technology with non-technological factors, and improper or unsafe use of technology. Our data support that patient safety improvement activities as well as patient safety hazards change as an organization evolves from concerns about safe EHR functionality, ensuring safe and appropriate EHR use, to using the EHR itself to provide ongoing surveillance and monitoring of patient safety. Discussion We demonstrate the face validity of two models for understanding the sociotechnical aspects of safe EHR implementation and the complex interactions of technology within a healthcare system evolving from paper to integrated EHR. Conclusions Using sociotechnical models, including those presented in this paper, may be beneficial to help stakeholders understand, synthesize, and anticipate risks at the intersection of patient safety and health information technology. PMID:24052536

  18. Working effectively with patients with comorbid mental illness and substance abuse: a case study using a structured motivational behavioural approach

    PubMed Central

    Lawn, Sharon; Pols, Rene G; Battersby, Malcolm W

    2009-01-01

    This case describes the use of innovative person-centred motivational behaviour change tools to enhance chronic condition self-management with a person with chronic paranoid schizophrenia, significant drug abuse and multiple psychosocial issues. In standard care, the complexity of this patient’s presentation, their cognitive impairment level and history of violence would likely exclude them from many therapies and treatment programs as unsuitable or in the “too hard” basket. In fact, using a motivational and highly person-centred approach proved to be extremely necessary and rewarding for the person and their mental health worker. This approach provided a clear structure, actual tools and a clear rationale for what many would argue, yet is often ill-defined, was “just good clinical practice”. However, it also facilitated the development of “something special” in the relationship between the person and their worker that is central to person-centred care. Through a semistructured, motivational, sequential process that encouraged gradual disclosure and greater self-awareness by the client and active listening by the worker, greater collaboration and shared responsibility was enhanced. PMID:21686687

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

    PubMed Central

    2011-01-01

    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 reported relatively more

  20. Electrodermal Recording and fMRI to Inform Sensorimotor Recovery in Stroke Patients

    PubMed Central

    MacIntosh, Bradley J.; McIlroy, William E.; Mraz, Richard; Staines, W. Richard; Black, Sandra E.; Graham, Simon J.

    2016-01-01

    Background Functional magnetic resonance imaging (fMRI) appears to be useful for investigating motor recovery after stroke. Some of the potential confounders of brain activation studies, however, could be mitigated through complementary physiological monitoring. Objective To investigate a sensorimotor fMRI battery that included simultaneous measurement of electrodermal activity in subjects with hemiparetic stroke to provide a measure related to the sense of effort during motor performance. Methods Bilateral hand and ankle tasks were performed by 6 patients with stroke (2 subacute, 4 chronic) during imaging with blood oxygen level-dependent (BOLD) fMRI using an event-related design. BOLD percent changes, peak activation, and laterality index values were calculated in the sensorimotor cortex. Electrodermal recordings were made concurrently and used as a regressor. Results Sensorimotor BOLD time series and percent change values provided evidence of an intact motor network in each of these well-recovered patients. During tasks involving the hemiparetic limb, electrodermal activity changes were variable in amplitude, and electrodermal activity time-series data showed significant correlations with fMRI in 3 of 6 patients. No such correlations were observed for control tasks involving the unaffected lower limb. Conclusions Electrodermal activity activation maps implicated the contralesional over the ipsilesional hemisphere, supporting the notion that stroke patients may require higher order motor processing to perform simple tasks. Electrodermal activity recordings may be useful as a physiological marker of differences in effort required during movements of a subject’s hemiparetic compared with the unaffected limb during fMRI studies. PMID:18784267

  1. Patient-Perceived Usefulness of Online Electronic Medical Records: Employing Grounded Theory in the Development of Information and Communication Technologies for Use by Patients Living with Chronic Illness

    PubMed Central

    Winkelman, Warren J.; Leonard, Kevin J.; Rossos, Peter G.

    2005-01-01

    Objective: Patient use of online electronic medical records (EMR) holds the potential to improve health outcomes. The purpose of this study is to discover how patients living with chronic inflammatory bowel disease (IBD) value Internet-based patient access to electronic patient records. Design: This was a qualitative, exploratory, descriptive study using in-depth interviews and focus groups of a total of 12 patients with IBD of at least one-year duration at University Health Network, a tertiary care center in Toronto, Ontario. Results: Four themes have been elucidated that comprise a theoretical framework of patient-perceived information and communication technology usefulness: promotion of a sense of illness ownership, of patient-driven communication, of personalized support, and of mutual trust. Conclusions: For patients with chronic IBD, simply providing access to electronic medical records has little usefulness on its own. Useful technology for patients with IBD is multifaceted, self-care promoting, and integrated into the patient's already existing health and psychosocial support infrastructure. The four identified themes can serve as focal points for the evaluation of information technology designed for patient use, thus providing a patient-centered framework for developers seeking to adapt existing EMR systems to patient access and use for the purposes of improving health care quality and health outcomes. Further studies in other populations are needed to enhance generalizability of the emergent theory. PMID:15684128

  2. Abusive head trauma: past, present, and future.

    PubMed

    Narang, Sandeep; Clarke, Jennifer

    2014-12-01

    Abusive head trauma has a robust and interesting scientific history. Recently, the American Academy of Pediatrics has endorsed a change in terminology to a term that is more general in describing the vast array of abusive mechanisms that can result in pediatric head injury. Simply defined, abusive head trauma is "child physical abuse that results in injury to the head or brain." Abusive head trauma is a relatively common cause of childhood neurotrauma, with an estimated incidence of 16 to 33 cases per 100,000 children per year in the first 2 years of life. Clinical findings are variable; AHT should be considered in all children with neurologic signs and symptoms, especially if no or only mild trauma is described. Subdural and retinal hemorrhages are the most common findings. The current best evidence-based literature has identified some features--apnea and severe retinal hemorrhages--that reliably discriminate abusive from accidental injury. Longitudinal studies of outcomes in abusive head trauma patients demonstrate that approximately one-third of the children are severely disabled, one third of them are moderately disabled, and one third have no or only mild symptoms. Abusive head trauma cases are complex cases that require a rigorous, multidisciplinary team approach. The clinician can establish this diagnosis with confidence if he/she maintains a high index of suspicion for the diagnosis, has knowledge of the signs, symptoms, and risk factors of abusive head trauma, and reasonably excludes other etiologies on the differential diagnosis. PMID:25316728

  3. Terms used by nurses to describe patient problems: can SNOMED III represent nursing concepts in the patient record?

    PubMed Central

    Henry, S B; Holzemer, W L; Reilly, C A; Campbell, K E

    1994-01-01

    OBJECTIVE: To analyze the terms used by nurses in a variety of data sources and to test the feasibility of using SNOMED III to represent nursing terms. DESIGN: Prospective research design with manual matching of terms to the SNOMED III vocabulary. MEASUREMENTS: The terms used by nurses to describe patient problems during 485 episodes of care for 201 patients hospitalized for Pneumocystis carinii pneumonia were identified. Problems from four data sources (nurse interview, intershift report, nursing care plan, and nurse progress note/flowsheet) were classified based on the substantive area of the problem and on the terminology used to describe the problem. A test subset of the 25 most frequently used terms from the two written data sources (nursing care plan and nurse progress note/flowsheet) were manually matched to SNOMED III terms to test the feasibility of using that existing vocabulary to represent nursing terms. RESULTS: Nurses most frequently described patient problems as signs/symptoms in the verbal nurse interview and intershift report. In the written data sources, problems were recorded as North American Nursing Diagnosis Association (NANDA) terms and signs/symptoms with similar frequencies. Of the nursing terms in the test subset, 69% were represented using one or more SNOMED III terms. PMID:7719788

  4. Child abuse and mental disorders in Canada

    PubMed Central

    Afifi, Tracie O.; MacMillan, Harriet L.; Boyle, Michael; Taillieu, Tamara; Cheung, Kristene; Sareen, Jitender

    2014-01-01

    Background: Nationally representative Canadian data on the prevalence of child abuse and its relation with mental disorders are lacking. We used contemporary, nationally representative data to examine the prevalence of 3 types of child abuse (physical abuse, sexual abuse and exposure to intimate partner violence) and their association with 14 mental conditions, including suicidal ideation and suicide attempts. Methods: We obtained data from the 2012 Canadian Community Health Survey: Mental Health, collected from the 10 provinces. Respondents aged 18 years and older were asked about child abuse and were selected for the study sample (n = 23 395). The survey had a multistage stratified cluster design (household response rate 79.8%). Results: The prevalence of any child abuse was 32% (individual types ranged from 8% to 26%). All types of child abuse were associated with all mental conditions, including suicidal ideation and suicide attempts, after adjustment for sociodemographic variables (adjusted odds ratios ranged from 1.4 to 7.9). We found a dose–response relation, with increasing number of abuse types experienced corresponding with greater odds of mental conditions. Associations between child abuse and attention deficit disorder, suicidal ideation and suicide attempts showed stronger effects for women than men. Interpretation: We found robust associations between child abuse and mental conditions. Health care providers, especially those assessing patients with mental health problems, need to be aware of the relation between specific types of child abuse and certain mental conditions. Success in preventing child abuse could lead to reductions in the prevalence of mental disorders, suicidal ideation and suicide attempts. PMID:24756625

  5. Towards iconic language for patient records, drug monographs, guidelines and medical search engines.

    PubMed

    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

    2010-01-01

    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. PMID:20841669

  6. Identifying patients with asthma in primary care electronic medical record systems

    PubMed Central

    Xi, Nancy; Wallace, Rebecca; Agarwal, Gina; Chan, David; Gershon, Andrea; Gupta, Samir

    2015-01-01

    Objective To develop and test a variety of electronic medical record (EMR) search algorithms to allow clinicians to accurately identify their patients with asthma in order to enable improved care. Design A retrospective chart analysis identified 5 relevant unique EMR information fields (electronic disease registry, cumulative patient profile, billing diagnostic code, medications, and chart notes); asthma-related search terms were designated for each field. The accuracy of each term was tested for its ability to identify the asthma patients among all patients whose charts were reviewed. Increasingly sophisticated search algorithms were then designed and evaluated by serially combining individual searches with Boolean operators. Setting Two large academic primary care clinics in Hamilton, Ont. Participants Charts for 600 randomly selected patients aged 16 years and older identified in an initial EMR search as likely having asthma (n = 150), chronic obstructive pulmonary disease (n = 150), other respiratory conditions (n = 150), or nonrespiratory conditions (n = 150) were reviewed until 100 patients per category were identified (or until all available names were exhausted). A total of 398 charts were reviewed in full and included. Main outcome measures Sensitivity and specificity of each search for asthma diagnosis (against the reference standard of a physician chart review–based diagnosis). Results Two physicians reviewed the charts identified in the initial EMR search using a standardized data collection form and ascribed the following diagnoses in 398 patients: 112 (28.1%) had asthma, 81 (20.4%) had chronic obstructive pulmonary disease, 104 (26.1%) had other respiratory conditions, and 101 (25.4%) had nonrespiratory conditions. Concordance between reviewers in chart abstraction diagnosis was high (κ = 0.89, 95% CI 0.80 to 0.97). Overall, the algorithm searching for patients who had asthma in their cumulative patient profiles or for whom an asthma billing code

  7. Mining Symptom-Herb Patterns from Patient Records Using Tripartite Graph

    PubMed Central

    Chen, Jinpeng; Poon, Josiah; Poon, Simon K.; Xu, Ling; Sze, Daniel M. Y.

    2015-01-01

    Unlike the western medical approach where a drug is prescribed against specific symptoms of patients, traditional Chinese medicine (TCM) treatment has a unique step, which is called syndrome differentiation (SD). It is argued that SD is considered as patient classification because prior to the selection of the most appropriate formula from a set of relevant formulae for personalization, a practitioner has to label a patient belonging to a particular class (syndrome) first. Hence, to detect the patterns between herbs and symptoms via syndrome is a challenging problem; finding these patterns can help prepare a prescription that contributes to the efficacy of a treatment. In order to highlight this unique triangular relationship of symptom, syndrome, and herb, we propose a novel three-step mining approach. It first starts with the construction of a heterogeneous tripartite information network, which carries richer information. The second step is to systematically extract path-based topological features from this tripartite network. Finally, an unsupervised method is used to learn the best parameters associated with different features in deciding the symptom-herb relationships. Experiments have been carried out on four real-world patient records (Insomnia, Diabetes, Infertility, and Tourette syndrome) with comprehensive measurements. Interesting and insightful experimental results are noted and discussed. PMID:26167191

  8. Decoding of motor intentions from epidural ECoG recordings in severely paralyzed chronic stroke patients

    NASA Astrophysics Data System (ADS)

    Spüler, M.; Walter, A.; Ramos-Murguialday, A.; Naros, G.; Birbaumer, N.; Gharabaghi, A.; Rosenstiel, W.; Bogdan, M.

    2014-12-01

    Objective. Recently, there have been several approaches to utilize a brain-computer interface (BCI) for rehabilitation with stroke patients or as an assistive device for the paralyzed. In this study we investigated whether up to seven different hand movement intentions can be decoded from epidural electrocorticography (ECoG) in chronic stroke patients. Approach. In a screening session we recorded epidural ECoG data over the ipsilesional motor cortex from four chronic stroke patients who had no residual hand movement. Data was analyzed offline using a support vector machine (SVM) to decode different movement intentions. Main results. We showed that up to seven hand movement intentions can be decoded with an average accuracy of 61% (chance level 15.6%). When reducing the number of classes, average accuracies up to 88% can be achieved for decoding three different movement intentions. Significance. The findings suggest that ipsilesional epidural ECoG can be used as a viable control signal for BCI-driven neuroprosthesis. Although patients showed no sign of residual hand movement, brain activity at the ipsilesional motor cortex still shows enough intention-related activity to decode different movement intentions with sufficient accuracy.

  9. Characterizing the sexual abuse experiences of young adolescents

    PubMed Central

    Negriff, Sonya; Schneiderman, Janet U.; Smith, Caitlin; Schreyer, Justine K.; Trickett, Penelope K.

    2013-01-01

    The purpose of this descriptive study was to: (a) compare the demographics of maltreated youth initially labeled as sexually abused by the Department of Child and Family Services (DCFS) to maltreated youth classified as sexually abused using current and past case records, (b) identify differences in sexual abuse experiences and types of perpetrators between boys and girls, and (c) provide a detailed description of the sexual abuse experiences for boys and girls. Participants were youth ages 9–12 years old with a recent maltreatment allegation. The Maltreatment Case Record Abstraction Instrument (MCRAI) was used to code child welfare records of 303 maltreated youth of whom 60 experienced sexual abuse. Perpetrators were classified by gender into four categories (biological parent, parental figure, relative, and unrelated) and type of abuse was classified into three categories (penetrative, contact without penetration, and non-contact). Using Chi-Square tests, perpetrator categories and sexual abuse types were compared by child gender for significant differences. Only 23 (38.3%) of the 60 sexually abused youth were labeled as sexually abused in the most recent DCFS report when they entered the study. About three-quarters of the sexually abused youth experienced non-penetrative physical contact, 40% experienced penetration, and 15% experienced sexual abuse without physical contact. Most youth (91.7%) were victimized by a male, and 21.7% were abused by a female. Youth experienced a large range of sexual abuse experiences, the details of which may be important for exploration of consequences of childhood sexual abuse. PMID:24095179

  10. Security of the distributed electronic patient record: a case-based approach to identifying policy issues.

    PubMed

    Anderson, J G

    2000-11-01

    The growth of managed care and integrated delivery systems has created a new commodity, health information and the technology that it requires. Surveys by Deloitte and Touche indicate that over half of the hospitals in the US are in the process of implementing electronic patient record (EPR) systems. The National Research Council has established that industry spends as much as $15 billion on information technology (IT), an amount that is expanding by 20% per year. The importance of collecting, electronically storing, and using the information is undisputed. This information is needed by consumers to make informed choices; by physicians to provide appropriate quality clinical care: and by health plans to assess outcomes, control costs and monitor quality. The collection, storage and communication of a large variety of personal patient data, however, present a major dilemma. How can we provide the data required by the new forms of health care delivery and at the same time protect the personal privacy of patients? Recent debates concerning medical privacy legislation, software regulation, and telemedicine suggest that this dilemma will not be easily resolved. The problem is systemic and arises out of the routine use and flow of information throughout the health industry. Health care information is primarily transferred among authorized users. Not only is the information used for patient care and financial reimbursement, secondary users of the information include medical, nursing, and allied health education, research, social services, public health, regulation, litigation, and commercial purposes such as the development of new medical technology and marketing. The main threats to privacy and confidentiality arise from within the institutions that provide patient care as well as institutions that have access to patient data for secondary purposes. PMID:11154961

  11. Pilot study on identification of incidents in healthcare transitions and concordance between medical records and patient interview data

    PubMed Central

    van Melle, Marije A; Erkelens, Daphne C A; van Stel, Henk F; de Wit, Niek J; Zwart, Dorien L M

    2016-01-01

    Objective To investigate whether transitional incidents can be identified from the medical records of the general practitioners and the hospital and to assess the concordance of transitional incidents between medical records and patient interviews. Design A pilot study. Setting The study was conducted in 2 regions in the Netherlands: a rural and an urban region. Participants A purposeful sample of patients who experienced a transitional incident or are at high risk of experiencing transitional incidents. Main outcome measures Transitional incidents were identified from both the interviews with patients and medical records and concordance was assessed. We also classified the transitional incidents according to type, severity, estimated cause and preventability. Results We identified 28 transitional incidents within 78 transitions of which 3 could not be found in the medical records and another 5 could have been missed without the patient as information source. To summarise, 8 (29%) incidents could have been missed using solely medical records, and 7 (25%) using the patients’ information exclusively. Concordance in transitional incidents between patient interviews and medical records was 64% (18/28). The majority of the transitional incidents were unsafe situations; however, 43% (12/28) of the incidents reached the patient and 18% (5/28) caused temporary patient harm. Over half of the incidents were potentially preventable. Conclusions This pilot study suggests that the majority of transitional incidents can be identified from medical records of the general practitioner and hospital. With this information, we aim to develop a measurement tool for transitional incidents in the medical record of general practitioner and hospital. PMID:27543588

  12. Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts

    PubMed Central

    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

    2013-01-01

    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

  13. A Qualitative Study of How Patients with Type 2 Diabetes Use an Electronic Stand-Alone Personal Health Record

    PubMed Central

    Abbott, Amy A.; Galt, Kimberly A.

    2015-01-01

    Abstract Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. PMID:25614996

  14. Organizational strategies for promoting patient and provider uptake of personal health records

    PubMed Central

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

    2015-01-01

    Objective To investigate organizational strategies to promote personal health records (PHRs) adoption with a focus on patients with chronic disease. Methods 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. Results 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. Discussion and conclusion 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. PMID:25326601

  15. Caveats of bisphosphonate abuse

    PubMed Central

    Agarwala, Sanjay; Agashe, Vikas M; Shetty, Vivek; Mohrir, Ganesh; Moonot, Pradeep

    2016-01-01

    Background: Bisphosphonates (BPs) are the common drugs used for the treatment of postmenopausal osteoporosis. Short term benefits of the BPs are well known. However, there are concerns regarding their long term use. The aim of the study was to analyze the association between atypical femoral fractures and BP misuse/abuse as well as study the outcome of management of these fractures. Materials and Methods: A retrospective study of a prospectively studied patients who presented with atypical femoral fractures between January 2010 and August 2012 and were followed up upto June 2014. The cohort consisted of nine female patients (12 fractures) with an average age of 71 years (range 58-85 years). Analysis was done for the indications, duration of BP use, configuration of associated fractures and method of treatment. Results: The mean duration of BP use was 6.6 years (range 4-10 years). BP treatment was initiated without sufficient indication and continued without proper review and followup in most cases. Most patients did not followup and continued to consume BPs without any review by the doctors. All patients had prodromal thigh pain of various duration, which was inadequately investigated and managed before the presentation. Two cases with an incomplete fracture and no thigh pain were managed successfully with conservative treatment. The rest were treated by surgery with intramedullary nailing. The average union time was longer and two fractures went into nonunion which required further surgical intervention. Conclusion: Atypical femoral fractures appear to be strongly related to abuse of BPs. Great care is to be exercised at initiation as well as the continuation of BP therapy, and regular review is required. There is a need for improved awareness among physicians about the possibility of such fractures, and interpretation of thigh pain and radiological findings, especially if the patient has been on BPs therapy. Internal fixation for complete fractures and for

  16. Enhancing Practice Efficiency and Patient Care by Sharing Electronic Health Records.

    PubMed

    Keller, Megan E; Kelling, Sarah E; Cornelius, Douglas C; Oni, Hafusat A; Bright, David R

    2015-01-01

    One primary function of community pharmacies is to dispense medications to patients. In doing so, pharmacists frequently communicate with physicians' offices to clarify prescription orders and obtain additional information to ensure the safe and accurate dispensing of medications. Such communication is often done by telephone or fax, which is inefficient for both the pharmacy and the physician's office. This problem was highlighted in a recent American Medical Association resolution defining certain pharmacy inquiries as "interference with the practice of medicine and unwarranted." As a result, many are seeking to understand how to balance the needs of the patient care process with the need for operational efficiency in the physician's office and pharmacy. This study presents one example of a health information technology-based solution involving shared access to an electronic health record (EHR), and describes a case in which a physician's office and a community pharmacy experimented with this model to promote practice efficiency while also providing enhanced access to clinical information in both directions. The rationale behind the process change, a brief description of how the new process came into existence, and a description of how information sharing can be helpful in related clinical situations are provided. Similar models that involve sharing of EHRs may create valuable opportunities for collaboration between physicians and pharmacists to enhance patient care and improve workflow efficiency. PMID:26604871

  17. PTSD substance abuse comorbidity and treatment utilization.

    PubMed

    Brown, P J; Recupero, P R; Stout, R

    1995-01-01

    The present study investigates the prevalence of posttraumatic stress disorder (PTSD) among a sample of treatment-seeking substance abusers and examines the relationship between PTSD comorbidity and rates of inpatient substance abuse treatment. Eighty-four patients (48 male and 36 female) admitted for detoxification at a private hospital were administered self-report measures of lifetime stressor events, PTSD symptomatology, and prior treatment history. Approximately one quarter of the sample was found to present with significant PTSD symptomatology. Women were more likely than men to have been physically and sexually abused, and women reported experiencing a greater number of traumatic events. Consequently, more women than men were classified as having possible PTSD. With respect to inpatient substance abuse treatment admission rates, the PTSD group reported a greater number of hospitalizations than their non-PTSD counterparts. Implications of these findings for routine trauma screening and more effective treatment for substance abusers with concomitant PTSD are highlighted. PMID:7484319

  18. Patients' satisfaction with primary heath care in kuwait after electronic medical record implementation.

    PubMed

    Al-Azmi, Saadoun F; Mohammed, Aida M; Hanafi, Manal I

    2006-01-01

    This study aimed at assessing the level of patients' satisfaction with primary heath care services after implementation of the electronic medical record system (EMR). Also, to explore the relationship of some participants' characteristics with satisfaction which are of importance in planning, managing and evaluation. A descriptive cross-sectional approach was adopted. Ten primary health care centers (out of total 78) related to the five health regions in Kuwait were randomly selected. A random sample of 200 people (at age of 18 years and above) attending the two-shift periods of the chosen centers were included. Through an exit interview, a well trained investigator interviewed them about their satisfaction with the primary heath care services provided after implementation of electronic medical record system. A structured questionnaire for measuring satisfaction was used. The response rate was 93.02% of whom 47.5% were males and 52.5% were females. The mean overall satisfaction percent score as reported by subjects was 85.6% (SD 4.9). There were statistically significant associations between mean percent satisfaction score of the participants and their age, level of education visiting the center at morning shift, and waiting less than 10 minutes before the examination. The vast majority of participants indicated that overall service at the center had greatly improved after EMR implementation. The system also helped in improvement of the physician performance, arrangement of patient's turn, dispense medication from pharmacy, written guidance of medication, accuracy and easiness of follow up for health status, time spent to retrieve medical record and that for receiving medication. However, it didn't achieve much improvement in physician selection or waiting time. The majority of interviewees (96.5%) were totally satisfied with the overall quality of service at the center, location of the center (96.5%), hours when the center is open (96.5%), thoroughness of

  19. Cough and Cold Medicine Abuse

    MedlinePlus

    ... and Cold Medicine Abuse DrugFacts: Cough and Cold Medicine Abuse Email Facebook Twitter Revised May 2014 Some ... diverted for abuse. How Are Cough and Cold Medicines Abused? Cough and cold medicines are usually consumed ...

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

    PubMed Central

    2014-01-01

    Background 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. Results 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. Conclusions 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

  1. The VA's use of DICOM to integrate image data seamlessly into the online patient record.

    PubMed Central

    Kuzmak, P. M.; Dayhoff, R. E.

    1999-01-01

    The US Department of Veterans Affairs (VA) is using the Digital Imaging and Communications in Medicine (DICOM) standard to integrate image data objects from multiple systems for use across the healthcare enterprise. DICOM uses a structured representation of image data and a communication mechanism that allows the VA to easily acquire radiology images and store them directly into the online patient record. Images can then be displayed on low-cost clinician's workstations throughout the medical center. High-resolution diagnostic quality multi-monitor VistA workstations with specialized viewing software can be used for reading radiology images. Various image and study specific items from the DICOM data object are essential for the correct display of images. The VA's DICOM capabilities are now used to interface seven different commercial Picture Archiving and Communication Systems (PACS) and over twenty different radiology image acquisition modalities. PMID:10566327

  2. Transforming XML-based electronic patient records for use in medical case based reasoning systems.

    PubMed

    Abidi, S S; Manickam, S

    2000-01-01

    Electronic patient records (EPR) can be regarded as an implicit source of clinical behaviour and problem-solving knowledge, systematically compiled by clinicians. We present an approach, together with its computational implementation, to pro-actively transform XML-based EPR into specialised Clinical Cases (CC) in the realm of Medical Case Base Systems. The 'correct' transformation of EPR to CC involves structural, terminological and conceptual standardisation, which is achieved by a confluence of techniques and resources, such as XML, UMLS (meta-thesaurus) and medical knowledge ontologies. We present below the functional architecture of a Medical Case-Base Reasoning Info-Structure (MCRIS) that features two distinct, yet related, functionalities: (1) a generic medical case-based reasoning system for decision-support activities; and (2) an EPR-CC transformation system to transform typical EPR's to CC. PMID:11187645

  3. Traceability of patient records usage: barriers and opportunities for improving user interface design and data management.

    PubMed

    Cruz-Correia, Ricardo; Lapão, Luís; Rodrigues, Pedro Pereira

    2011-01-01

    Although IT governance practices (like ITIL, which recommends on the use of audit logs for proper service level management) are being introduced in many Hospitals to cope with increasing levels of information quality and safety requirements, the standard maturity levels of hospital IT departments is still not enough to reach the level of frequent use of audit logs. This paper aims to address the issues related to the existence of AT in patient records, describe the Hospitals scenario and to produce recommendations. Representatives from four hospitals were interviewed regarding the use of AT in their Hospital IS. Very few AT are known to exist in these hospitals (average of 1 per hospital in an estimate of 21 existing IS). CIOs should to be much more concerned with the existence and maintenance of AT. Recommendations include server clock synchronization and using advanced log visualization tools. PMID:21893756

  4. The development and design of an electronic patient record using open source web-based technology.

    PubMed

    Syed-Mohamad, Sharifa Mastura; Ali, Siti Hawa; Mat-Husin, Mohd Nazri

    2010-01-01

    This paper describes the method used to develop the One Stop Crisis Centre (OSCC) Portal, an open source web-based electronic patient record system (EPR) for the One Stop Crisis Center, Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia. Features and functionalities of the system are presented to demonstrate the workflow. Use of the OSCC Portal improved data integration and data communication and contributed to improvements in care management. With implementation of the OSCC portal, improved coordination between disciplines and standardisation of data in HUSM were noticed. It is expected that this will in turn result in improved data confidentiality and data integrity. The collected data will also be useful for quality assessment and research. Other low-resource centers with limited computer hardware and access to open-source software could benefit from this endeavour. PMID:20335647

  5. Power of expression in the electronic patient record: structured data or narrative text?

    PubMed

    Lovis, C; Baud, R H; Planche, P

    2000-09-01

    This paper presents the authors' experience with the development and use of a document-centered electronic patient record (EPR) in a large teaching hospital. The development of the document-centered EPR began with the formulation of a set of critical hypotheses to facilitate both the continuation of the best medical practice and the implementation and use of the EPR. An alternate and more conventional approach - the data-centered EPR - is compared with the document-centered EPR. Various benefits and pitfalls are discussed. Finally, the choice was to offer both solutions in a tightly linked system. The need for an EPR which combines the document and data centered approaches is a reflection of the more general discussion of what the medical record will be in the future. All too often, the need for structured data conflicts with the need for free texts and the power of expression. It is not easy to evaluate the consequences of this initial decision. However, changing the foundations of the EPR after its implementation is difficult and expensive. Therefore, the selection of the correct orientation in a given hospital requires a broad-based discussion. PMID:10978913

  6. Cortical gamma-oscillations modulated by visuomotor tasks -Intracranial recording in patients with epilepsy-

    PubMed Central

    Nagasawa, Tetsuro; Rothermel, Robert; Juhász, Csaba; Nishida, Masaaki; Sood, Sandeep; Asano, Eishi

    2010-01-01

    SUMMARY We determined how visuomotor tasks modulated gamma-oscillations on electrocorticography in epileptic patients who underwent epilepsy surgery. Each visual-cue consisted of either a sentence or hand gesture instructing the subject to press or not to press the button. Regardless of the recorded hemisphere, viewing sentence and gesture cues elicited gamma-augmentation sequentially in the lateral-polar occipital and inferior occipital-temporal areas; subsequently, button-press movement elicited gamma-augmentation in the Rolandic area. The magnitudes of gamma-augmentation in the Rolandic and inferior occipital-temporal areas were larger when the hand contralateral to the recorded hemisphere was used for motor responses. A double dissociation was found in the left inferior occipital-temporal cortex in one subject; the lateral portion had greater gamma-augmentation elicited by a sentence-cue, whereas the medial portion had greater gamma-augmentation elicited by a gesture-cue. The present study has increased our understanding of the physiology of the human visuomotor system. PMID:20580900

  7. Displays of authority in the clinical consultation: a linguistic ethnographic study of the electronic patient record.

    PubMed

    Swinglehurst, Deborah

    2014-10-01

    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. PMID:25086422

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

    PubMed Central

    Chen, Pei; Bochenek, Joseph; Doshi-Velez, Finale; Manning-Courtney, Patty; Bickel, Julie; Wildenger Welchons, Leah; Reinhold, Judy; Bing, Nicole; Ni, Yizhao; Barbaresi, William; Mentch, Frank; Basford, Melissa; Denny, Joshua; Vazquez, Lyam; Perry, Cassandra; Namjou, Bahram; Qiu, Haijun; Connolly, John; Abrams, Debra; Holm, Ingrid A.; Cobb, Beth A.; Lingren, Nataline; Solti, Imre; Hakonarson, Hakon; Kohane, Isaac S.; Harley, John; Savova, Guergana

    2016-01-01

    Objective 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. Methods 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. Results 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. Conclusions 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. PMID:27472449

  9. Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data

    PubMed Central

    Foster, Wendy; Gilder, Jason; Love, Thomas E; Jain, Anil K

    2012-01-01

    Objective To demonstrate the potential of de-identified clinical data from multiple healthcare systems using different electronic health records (EHR) to be efficiently used for very large retrospective cohort studies. Materials and methods Data of 959 030 patients, pooled from multiple different healthcare systems with distinct EHR, were obtained. Data were standardized and normalized using common ontologies, searchable through a HIPAA-compliant, patient de-identified web application (Explore; Explorys Inc). Patients were 26 years or older seen in multiple healthcare systems from 1999 to 2011 with data from EHR. Results Comparing obese, tall subjects with normal body mass index, short subjects, the venous thromboembolic events (VTE) OR was 1.83 (95% CI 1.76 to 1.91) for women and 1.21 (1.10 to 1.32) for men. Weight had more effect then height on VTE. Compared with Caucasian, Hispanic/Latino subjects had a much lower risk of VTE (female OR 0.47, 0.41 to 0.55; male OR 0.24, 0.20 to 0.28) and African-Americans a substantially higher risk (female OR 1.83, 1.76 to 1.91; male OR 1.58, 1.50 to 1.66). This 13-year retrospective study of almost one million patients was performed over approximately 125 h in 11 weeks, part time by the five authors. Discussion As research informatics tools develop and more clinical data become available in EHR, it is important to study and understand unique opportunities for clinical research informatics to transform the scale and resources needed to perform certain types of clinical research. Conclusions With the right clinical research informatics tools and EHR data, some types of very large cohort studies can be completed with minimal resources. PMID:22759621

  10. Stratifying Risk for Renal Insufficiency Among Lithium-Treated Patients: An Electronic Health Record Study.

    PubMed

    Castro, Victor M; Roberson, Ashlee M; McCoy, Thomas H; Wiste, Anna; Cagan, Andrew; Smoller, Jordan W; Rosenbaum, Jerrold F; Ostacher, Michael; Perlis, Roy H

    2016-03-01

    Although lithium preparations remain first-line treatment for bipolar disorder, risk for development of renal insufficiency may discourage their use. Estimating such risk could allow more informed decisions and facilitate development of prevention strategies. We utilized electronic health records from a large New England health-care system between 2006 and 2013 to identify patients aged 18 years or older with a lithium prescription. Renal insufficiency was identified using the presence of renal failure by ICD9 code or laboratory-confirmed glomerular filtration rate below 60 ml/min. Logistic regression was used to build a predictive model in a random two-thirds of the cohort, which was tested in the remaining one-third. Risks associated with aspects of pharmacotherapy were also examined in the full cohort. We identified 1445 adult lithium-treated patients with renal insufficiency, matched by risk set sampling 1 : 3 with 4306 lithium-exposed patients without renal insufficiency. In regression models, features associated with risk included older age, female sex, history of smoking, history of hypertension, overall burden of medical comorbidity, and diagnosis of schizophrenia or schizoaffective disorder (p<0.01 for all contrasts). The model yielded an area under the ROC curve exceeding 0.81 in an independent testing set, with 74% of renal insufficiency cases among the top two risk quintiles. Use of lithium more than once daily, lithium levels greater than 0.6 mEq/l, and use of first-generation antipsychotics were independently associated with risk. These results suggest the possibility of stratifying risk for renal failure among lithium-treated patients. Once-daily lithium dosing and maintaining lower lithium levels where possible may represent strategies for reducing risk. PMID:26294109

  11. Technology versus humanism: how patients perceive the use of electronic health records in physicians' offices--a qualitative study.

    PubMed

    Mwachofi, Ari K; Khaliq, Amir A; Carrillo, Estevan R; Winfree, William

    2016-01-01

    Electronic Health Records (EHRs) have the potential to improve the quality of care. In view of the accelerated adoption of EHRs, there is a need to understand conditions necessary for their effective use. Patients are the focus of healthcare and their perceptions and expectations need to be included in developing and implementing EHRs. The purpose of this study was to gather exploratory qualitative information from patients about their experiences and perceptions regarding the effects of EHRs on healthcare quality in physicians' offices. We conducted five focus groups with patients representing a random mix of diverse socio-demographic backgrounds in Oklahoma. Related to EHRs, patients reported improvements on the technical side of care but no change on the human side. They expressed concerns about the potential for breach of confidentiality and security of medical records. They were also concerned about the possibility of governmental agencies or insurance companies having unauthorized access to patient records. Patients differentiated between the human and technical sides of care and reported no change or improvement in the doctor-patient interaction. Patients have an important perspective on the use of EHRs and their perceptions and experiences should be considered in the development, adoption and implementation of EHRs. Otherwise, the use of EHRs may not be fully effective. There is also a need to educate patients about the potential benefits and risks of EHRs and the steps being taken to mitigate such risks. PMID:26305852

  12. Lichen sclerosus et atrophicus and sexual abuse.

    PubMed Central

    Warrington, S A; de San Lazaro, C

    1996-01-01

    AIMS: The aetiology of lichen sclerosus et atrophicus (LSA) is unknown. A series of 42 cases of this uncommon condition is reported. The aim of this study was to identify associations of LSA and document the association with sexual abuse. METHODS: Information about the patients was obtained by retrospective case note review and some patients were contacted by telephone for further information. RESULTS: In 12 cases there was evidence of sexual abuse. The abused group were slightly older than the non-abused group but were similar in all other respects. All three patients who presented over the age of 12 years had evidence of sexual abuse. Genital trauma was recalled by the patient or found at examination in 17 cases. Evidence of autoimmunity was present in five cases. Positive microbiological isolates were obtained in 18 cases. In only 11 cases were there no associated factors. The symptoms of LSA started between the ages of 3 and 7 years in most patients. The usual symptoms were related to genital skin involvement, and symptoms related to bladder and bowel function were common (50%). CONCLUSION: In this large series of paediatric LSA, associations with trauma, autoimmunity, and infection were noted. There was a high rate of coexisting sexual abuse with LSA, possibly due to genital trauma. Images Figure 2 PMID:9014605

  13. Patients' Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice.

    PubMed

    Mold, Freda; de Lusignan, Simon

    2015-01-01

    Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems. PMID:26690225

  14. 42 CFR 2.23 - Patient access and restrictions on use.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Patient access and restrictions on use. 2.23 Section 2.23 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS General Provisions § 2.23 Patient...

  15. Cough & Cold Medicine Abuse

    MedlinePlus

    ... I Help a Friend Who Cuts? Cough & Cold Medicine Abuse KidsHealth > For Teens > Cough & Cold Medicine Abuse ... DXM Why Do People Use Cough and Cold Medicines to Get High? There's an ingredient in many ...

  16. Prescription Drug Abuse

    MedlinePlus

    ... what the doctor prescribed, it is called prescription drug abuse. It could be Taking a medicine that ... purpose, such as getting high Abusing some prescription drugs can lead to addiction. These include narcotic painkillers, ...

  17. Students and Drug Abuse

    ERIC Educational Resources Information Center

    Todays Educ, 1969

    1969-01-01

    Introduction to "Students and Drug Abuse, prepared by the Public Information Branch and Center for Studies of Narcotic and Drug Abuse, National Institute of Mental Health, in cooperation with the staff of Today's Education.

  18. Abuse during Pregnancy

    MedlinePlus

    ... depressed, eat unhealthy foods, or pick up bad habits such as smoking or drinking . An abusive partner may try to ... depressed, eat unhealthy foods, or pick up bad habits such as smoking or drinking . An abusive partner may try to ...

  19. Mental health problems and medically unexplained physical symptoms in adult survivors of childhood sexual abuse: an integrative literature review.

    PubMed

    Nelson, S; Baldwin, N; Taylor, J

    2012-04-01

    People sexually abused in childhood are at higher risk than non-abused people of medically unexplained symptoms such as irritable bowel syndrome or chronic pain, with mental ill health and high healthcare use. Friction and frustration, with high, unproductive healthcare costs, can often develop between these patients and health-care professionals such as general practitioners and nursing staff. The aim of this integrative literature review was to seek a sound evidence base from which to develop helpful interventions, improve relationships and identify gaps in knowledge. It found some theories about interconnections among childhood sexual abuse mental health and medically unexplained symptoms, such as 'somatization' or 'secondary gain', were used prejudicially, stigmatizing survivors. Conflicting theories make more difficult the search for effective interventions. Researchers rarely collaborated with sexual abuse specialists. Emphasis on identifying key risk factors, rather than providing support or alleviating distress, and lack of studies where survivors voiced their own experiences, meant very few targeted interventions for this group were proposed. Recommendations to enable effective interventions include making abuse survivors the prime study focus; qualitative research with survivors, to assist doctors and nursing staff with sensitive care; case histories using medical records; prospective studies with sexually abused children; support for the growing field of neurobiological research. PMID:22070785

  20. Measuring abusive behaviors: is economic abuse a unique form of abuse?

    PubMed

    Stylianou, Amanda Mathisen; Postmus, Judy L; McMahon, Sarah

    2013-11-01

    Recent attention has been given by researchers to exploring economic abuse strategies used by abusers. However, little research has been conducted to understanding how to conceptualize economic abuse in relation to other forms of abuse. This article examines the factor structure of abusive items from the Scale of Economic Abuse--12 and the Abusive Behavior Inventory through confirmatory factor analyses using data collected with 457 female survivors of abuse. The findings provide evidence for conceptualizing economic abuse as a unique form of abuse moderately correlated with psychological, physical, and sexual forms of abuse. PMID:23946140

  1. Family history of mental illness or alcohol abuse and the irritable bowel syndrome

    PubMed Central

    Knight, James R.; Locke, G. Richard; Zinsmeister, Alan R.; Schleck, Cathy D.; Talley, Nicholas J.

    2015-01-01

    Objective We have observed that many patients with IBS drink very little alcohol, and postulated this may reflect membership in families affected by alcoholism and mental illness. We aimed to evaluate whether a family history of substance or alcohol abuse, or psychiatric illness, is associated with IBS. Methods A valid GI questionnaire was mailed to a randomly selected population-based cohort to identify IBS and healthy controls. The electronic medical record was reviewed to record the subjects’ self-reported personal and family health histories. Results 2300 subjects responded (response rate 55%; IBS 13% n=287). 230 subjects with IBS and 318 controls were eligible. Family history of alcohol/substance abuse was reported by 33% of cases and 25% of controls (OR 1.4, 95% CI 1.0–2.1, p=0.06). Family history of psychiatric illness was reported by 37% of cases and 22% of controls (OR 2.0, 95% CI 1.3–2.9, p<0.001). In the absence of a personal history of alcohol use, a family history of alcohol/substance abuse was predictive of IBS status (OR adjusted for age and gender 1.5, 95% CI 1.0–2.3, p=0.05). In the absence of a personal history of alcohol use, reporting both a family history of alcohol/substance abuse and anxiety/depression/mental illness was clearly predictive of IBS status (OR 2.5, 95% CI 1.4–4.5; p<0.005). Substance abuse as a child was associated with an increased risk of IBS (OR 2.3, 95% CI 1.1–4.8; p<0.03). Conclusion IBS is independently associated with a family history of psychiatric illness and may be linked to a family history of alcohol/substance abuse. PMID:25582802

  2. The computer based patient record: a strategic issue in process innovation.

    PubMed

    Sicotte, C; Denis, J L; Lehoux, P

    1998-12-01

    Reengineering of the workplace through Information Technology is an important strategic issue for today's hospitals. The computer-based patient record (CPR) is one technology that has the potential to profoundly modify the work routines of the care unit. This study investigates a CPR project aimed at allowing physicians and nurses to work in a completely electronic environment. The focus of our analysis was the patient nursing care process. The rationale behind the introduction of this technology was based on its alleged capability to both enhance quality of care and control costs. This is done by better managing the flow of information within the organization and by introducing mechanisms such as the timeless and spaceless organization of the work place, de-localization, and automation of work processes. The present case study analyzed the implementation of a large CPR project ($45 million U.S.) conducted in four hospitals in joint venture with two computer firms. The computerized system had to be withdrawn because of boycotts from both the medical and nursing personnel. User-resistance was not the problem. Despite its failure, this project was a good opportunity to understand better the intricate complexity of introducing technology in professional work where the usefulness of information is short lived and where it is difficult to predetermine the relevancy of information. Profound misconceptions in achieving a tighter fit (synchronization) between care processes and information processes were the main problems. PMID:9871877

  3. [Changes in multi-locally recorded muscle responses following cortex stimulation in patients with multiple sclerosis].

    PubMed

    Meyer, B U; Zipper, S; Conrad, B; Benecke, R

    1988-12-01

    The application of transcranial brain stimulation widens the range of neurophysiological tools available for the diagnostic evaluation of impaired function in central conduction pathways. A standardized examination of 25 patients with multiple sclerosis (diagnoses of different certainties using the classification by Bauer) was performed with electrical brain stimulation and EMG recordings from 3 muscles in each of the upper and lower extremities (Fig. 2). The occurrence and the change (amplitude, latency) of abnormal cortically evoked muscle responses correlated with the distribution and the severity of the clinical motor deficits respectively (Fig. 1 to 4 and Tab. 1). Furthermore, in some cases, abnormal responses were found in clinically unaffected limbs. Non-invasive stimulation of the motor cortex may reveal lesions affecting the function of the fast conducting component of the corticospinal tract even when there is no pathological clinical finding. In patients suspected of having multiple sclerosis the use of this technique may allow greater diagnostic certainty or even an early diagnosis. PMID:2850152

  4. Lightening the burden of the heavy regulatory hand an incentive for outpatient computer patient record.

    PubMed

    Walker, K; Flanagan, J R; Lane, T

    2001-01-01

    However many benefits may be achieved for the organization, it is difficult to introduce a computer patient record (CPR) into an outpatient setting until the clinical practitioners themselves see direct benefit from the time invested. The ever increasing burden of regulation on health care in the outpatient setting includes (but is not limited to) guidelines for evaluation and management (E&M) coding, Local Medical Review Policy (LMRP) rules for diagnostic justification of tests and procedures and associated requirements for Advance Beneficiary Notification (ABN), and the rules for teaching physicians in academic settings. Achieving compliance with just the LMRP rules requires immediate access to an eight-inch-thick stack of manuals (ICD9, CPT, HCPCS, and LMRP), 4 inches of which is subject to update on a monthly basis. Accurate E&M coding is about as complicated as using the long form to do one s tax return. Without tools that can be provided by the CPR, these requirements add significant time to the patient encounter and significant risk of non-compliance and fines. We report our strategy for deploying the CPR as a strategy to keep clinicians from being overwhelmed by the rules, thereby allowing them to focus on healthcare. In the context of the CPR, and against all odds otherwise, the impact of the regulations can sometimes have beneficial and educational impacts on clinical care. PMID:11825283

  5. Vital signs in intensive care: automatic acquisition and consolidation into electronic patient records.

    PubMed

    Fonseca, Telmo; Ribeiro, Cristina; Granja, Cristina

    2009-02-01

    The integration of computer systems into clinical practice is a consequence of the growing sophistication of medical machinery. The fact that patient management in large institutions is handled by complex information systems brings about the need for integration between applications on both sides. The paper describes a prototype for automatic data collection from intensive care devices developed at Pedro Hispano Hospital in Portugal. The system acts as an application gateway between the network of patient monitoring devices and the general-purpose hospital network. The conformance to medical standards is one of the main concerns. The international standard Health Level 7 (HL7) has been adopted to import vital signs, as well as to prepare data for visualization in departmental applications and to organize archives. The design has followed the administrative and clinical processes in the hospital closely, leading to a successful interaction with the health professionals. Automatic acquisition eliminates transcription errors, improves the quality of records and allows the assembly of large electronic archives of vital sign data. The concern with data archiving in standard formats opens many possibilities for further analysis of the collected data sets. The possibility of communicating via the HL7 standard makes the whole system easily interoperable with applications in related domains. PMID:19238896

  6. Child sexual abuse: seven years in practice.

    PubMed

    Bahali, Kayhan; Akçan, Ramazan; Tahiroglu, Aysegul Y; Avci, Ayse

    2010-05-01

    The purpose of this study was to determine the socio-demographic characteristics of sexually abused children. The records of 101 cases of child sexual abuse (CSA) were retrospectively evaluated. Socio-demographic characteristics of the victims, type of sexual abuse, and psychiatric diagnosis were studied. Of the victims, 56.4% (n = 57) were female and 43.6% (n = 44) were male. The mean age was 9.57 +/- 3.5, with a range of 4-17 years. Ninety-three (92.1%) of the victims had been admitted as part of the legal process. The majority (66.3%) of the victims had been abused by an acquaintance, while 33.7% had been abused by a stranger. Anal or vaginal penetration was reported in 48.5% of the cases. Post-traumatic stress disorder was the most common (54.5%) psychiatric diagnosis established after sexual abuse. Descriptive data related to the abused children and an understanding of the consequences of CSA will help authorities in planning prevention. PMID:20345776

  7. Confidentiality of the medical records of HIV-positive patients in the United Kingdom – a medicolegal and ethical perspective

    PubMed Central

    Williams, Mike

    2011-01-01

    This article examines the legal and ethical issues that surround the confidentiality of medical records, particularly in relation to patients who are HIV positive. It records some historical background of the HIV epidemic, and considers the relative risks of transmission of HIV from individual to individual. It explains the law as it pertains to confidentiality, and reports the professional guidance in these matters. It then considers how these relate to HIV-positive individuals in particular. PMID:22312224

  8. The contribution of emotion regulation difficulties to risky sexual behavior within a sample of patients in residential substance abuse treatment.

    PubMed

    Tull, Matthew T; Weiss, Nicole H; Adams, Claire E; Gratz, Kim L

    2012-10-01

    The present study examined the unique contribution of emotion regulation difficulties to past-year risky sexual behavior (RSB) among substance use disorder (SUD) patients (above and beyond other known RSB risk factors). A sample of 177 SUD patients completed a series of questionnaires. At the zero-order level, emotion regulation difficulties, were significantly positively associated with the number of commercial sexual (i.e., the exchange of sex for drugs or money) partners with which penetrative sex occurred and significantly negatively associated with the likelihood of using a condom when having sex with a commercial partner under the influence of drugs. Emotion regulation difficulties also significantly predicted these RSB indices above and beyond other RSB risk factors, including demographics, depression, sensation seeking, traumatic exposure, and substance use severity. The specific emotion regulation difficulty of lack of emotional clarity emerged as a unique predictor of RSB. The implications of these findings for understanding motivations for RSB and developing targeted interventions for RSB among SUD patients are discussed. PMID:22658304

  9. Preventing Child Abuse

    ERIC Educational Resources Information Center

    Alvy, Kerby T.

    1975-01-01

    Focuses on two major and general approaches to analyzing the problems of child abuse; briefly discusses the prevention implications; deals with the individual physical abuse of children, with particular emphasis on the relationship between theoretical formulations of the causes of individual physical abuse and preventative programs; and, finally,…

  10. Substance Abuse. Policy Statement.

    ERIC Educational Resources Information Center

    National Collaboration for Youth, Washington, DC.

    This paper presents the policy statement on substance abuse from the National Collaboration for Youth (NCY). The policy statement section lists programs and activities supported by the NCY. A section on background includes a statement of the issue of substance abuse. Areas examined in this section include alcohol abuse and drunk driving among…

  11. Elder Abuse in Japan

    ERIC Educational Resources Information Center

    Arai, Mizuho

    2006-01-01

    Perceptions of elder abuse were examined in Japanese women (n =100) and men (n =46). Japanese women and men both emphasized physical aggression, followed by neglect and blaming, when giving examples of extremely abusive behavior. Physical aggression was also the most frequently mentioned type of moderate elder abuse, followed by neglect, economic…

  12. Elder Abuse Awareness Project.

    ERIC Educational Resources Information Center

    Morrow, Marilyn J.; Doyle, Kathleen

    The Elder Abuse Awareness Project was developed to determine the incidence of abuse and neglect of elderly people in several rural counties in central Illinois. A primary purpose of the study was to survey service providers as to their actual encounters with elder abuse and neglect. Each provider was asked about warning signs or cues that were…

  13. CIS3/398: Implementation of a Web-Based Electronic Patient Record for Transplant Recipients

    PubMed Central

    Fritsche, L; Lindemann, G; Schroeter, K; Schlaefer, A; Neumayer, H-H

    1999-01-01

    Introduction While the "Electronic patient record" (EPR) is a frequently quoted term in many areas of healthcare, only few working EPR-systems are available so far. To justify their use, EPRs must be able to store and display all kinds of medical information in a reliable, secure, time-saving, user-friendly way at an affordable price. Fields with patients who are attended to by a large number of medical specialists over a prolonged period of time are best suited to demonstrate the potential benefits of an EPR. The aim of our project was to investigate the feasibility of an EPR based solely on "of-the-shelf"-software and Internet-technology in the field of organ transplantation. Methods The EPR-system consists of three main elements: Data-storage facilities, a Web-server and a user-interface. Data are stored either in a relational database (Sybase Adaptive 11.5, Sybase Inc., CA) or in case of pictures (JPEG) and files in application formats (e. g. Word-Documents) on a Windows NT 4.0 Server (Microsoft Corp., WA). The entire communication of all data is handled by a Web-server (IIS 4.0, Microsoft) with an Active Server Pages extension. The database is accessed by ActiveX Data Objects via the ODBC-interface. The only software required on the user's computer is the Internet Explorer 4.01 (Microsoft), during the first use of the EPR, the ActiveX HTML Layout Control is automatically added. The user can access the EPR via Local or Wide Area Network or by dial-up connection. If the EPR is accessed from outside the firewall, all communication is encrypted (SSL 3.0, Netscape Comm. Corp., CA).The speed of the EPR-system was tested with 50 repeated measurements of the duration of two key-functions: 1) Display of all lab results for a given day and patient and 2) automatic composition of a letter containing diagnoses, medication, notes and lab results. For the test a 233 MHz Pentium II Processor with 10 Mbit/s Ethernet connection (ping-time below 10 ms) over 2 hubs to the server

  14. Patient-Held Maternal and/or Child Health Records: Meeting the Information Needs of Patients and Healthcare Providers in Developing Countries?

    PubMed Central

    Turner, Kathleen E.; Fuller, Sherrilynne

    2011-01-01

    Though improvements in infant and maternal mortality rates have occurred over time, women and children still die every hour from preventable causes. Various regional, social and economic factors are involved in the ability of women and children to receive adequate care and prevention services. Patient-held maternal and/or child health records have been used for a number of years in many countries to help track health risks, vaccinations and other preventative health measures performed. Though these records are primarily designed to record patient histories and healthcare information and guide healthcare workers providing care, because the records are patient-held, they also allow families a greater ability to track their own health and prevention strategies. A literature search was performed to answer these questions: (1) What are maternal information needs regarding pregnancy, post-natal and infant healthcare, especially in developing countries? (2) What is known about maternal information seeking behavior in developing countries? (3) What is the history and current state of maternal and/or child patient-held healthcare records, do they provide for the information needs of the healthcare provider and what are the effects and outcomes of patient-held records in general and for maternal and/or child health in particular? Specific information needs of pregnant women and mothers are rarely studied. The small numbers of maternal information behavior results available indicate that mothers, in general, prefer to receive health information directly from their healthcare provider as opposed to from other sources (written, etc.) Overall, in developing countries, patient-held maternal and/or child healthcare records have a mostly positive effect for both patient and care provider. Mothers and children with records tend to have better outcomes in healthcare and preventative measures. Further research into the information behaviors of pregnant women and mothers to determine

  15. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group

    PubMed Central

    Deutsch, Madeline B; Green, Jamison; Keatley, JoAnne; Mayer, Gal; Hastings, Jennifer; Hall, Alexandra M

    2013-01-01

    Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender variant persons. In September 2011, the WPATH Executive Committee convened an Electronic Medical Records Working Group comprised of both expert clinicians and medical information technology specialists, to make recommendations for developers, vendors, and users of EHR systems with respect to transgender patients. These recommendations and supporting rationale are presented here. PMID:23631835

  16. An electronic medical record system with treatment recommendations based on patient similarity.

    PubMed

    Wang, Yu; Tian, Yu; Tian, Li-Li; Qian, Yang-Ming; Li, Jing-Song

    2015-05-01

    As the core of health information technology (HIT), electronic medical record (EMR) systems have been changing to meet health care demands. To construct a new-generation EMR system framework with the capability of self-learning and real-time feedback, thus adding intelligence to the EMR system itself, this paper proposed a novel EMR system framework by constructing a direct pathway between the EMR workflow and EMR data. A prototype of this framework was implemented based on patient similarity learning. Patient diagnoses, demographic data, vital signs and structured lab test results were considered for similarity calculations. Real hospitalization data from 12,818 patients were substituted, and Precision @ Position measurements were used to validate self-learning performance. Our EMR system changed the way in which orders are placed by establishing recommendation order menu and shortcut applications. Two learning modes (EASY MODE and COMPLEX MODE) were provided, and the precision values @ position 5 of both modes were 0.7458 and 0.8792, respectively. The precision performance of COMPLEX MODE was better than that of EASY MODE (tested using a paired Wilcoxon-Mann-Whitney test, p < 0.001). Applying the proposed framework, the EMR data value was directly demonstrated in the clinical workflow, and intelligence was added to the EMR system, which could improve system usability, reliability and the physician's work efficiency. This self-learning mechanism is based on dynamic learning models and is not limited to a specific disease or clinical scenario, thus decreasing maintenance costs in real world applications and increasing its adaptability. PMID:25762458

  17. Electronic Health Record Patient Portal Adoption by Health Care Consumers: An Acceptance Model and Survey

    PubMed Central

    2016-01-01

    Background The future of health care delivery is becoming more citizen centered, as today’s user is more active, better informed, and more demanding. Worldwide governments are promoting online health services, such as electronic health record (EHR) patient portals and, as a result, the deployment and use of these services. Overall, this makes the adoption of patient-accessible EHR portals an important field to study and understand. Objective The aim of this study is to understand the factors that drive individuals to adopt EHR portals. Methods We applied a new adoption model using, as a starting point, Ventkatesh's Unified Theory of Acceptance and Use of Technology in a consumer context (UTAUT2) by integrating a new construct specific to health care, a new moderator, and new relationships. To test the research model, we used the partial least squares (PLS) causal modelling approach. An online questionnaire was administrated. We collected 360 valid responses. Results The statistically significant drivers of behavioral intention are performance expectancy (beta=.200; t=3.619), effort expectancy (beta=.185; t=2.907), habit (beta=.388; t=7.320), and self-perception (beta=.098; t=2.285). The predictors of use behavior are habit (beta=0.206; t=2.752) and behavioral intention (beta=0.258; t=4.036). The model explained 49.7% of the variance in behavioral intention and 26.8% of the variance in use behavior. Conclusions Our research helps to understand the desired technology characteristics of EHR portals. By testing an information technology acceptance model, we are able to determine what is more valued by patients when it comes to deciding whether to adopt EHR portals or not. The inclusion of specific constructs and relationships related to the health care consumer area also had a significant impact on understanding the adoption of EHR portals. PMID:26935646

  18. 49 CFR 219.903 - Retention of drug testing records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... by part 40 of this title, each railroad must maintain drug abuse prevention program records in a.... (4) Records related to employee training: (i) Materials on drug abuse awareness, including a copy of the railroad's policy on drug abuse. (ii) Documentation of compliance with the requirements of §...

  19. Recurrent concerns for child abuse: repeated consultations by a subspecialty child abuse team.

    PubMed

    Martindale, Jennifer; Swenson, Alice; Coffman, Jamye; Newton, Alice W; Lindberg, Daniel M

    2014-07-01

    Physically abused children may be repeatedly reported to child protection services and undergo multiple medical evaluations. Less is known about recurrent evaluations by hospital-based child abuse teams for possible abuse. The objectives of this study were to determine the frequency of repeated consultations by child abuse teams and to describe this cohort in terms of injury pattern, perceived likelihood of abuse, disposition plan, and factors related to repeat consultation. This was a prospectively planned, secondary analysis of data from the Examining Siblings to Recognize Abuse (ExSTRA) research network. Subjects included children younger than 10 years of age who were referred to child abuse subspecialty teams at one of 20 U.S. academic centers. Repeat consultations occurred in 101 (3.5%; 95% CI 2.9-4.2%) of 2890 subjects. The incidence of death was 4% (95% CI 1-9%) in subjects with repeated consults and 3% (95% CI 2-3%) in subjects with single consults. Perceived likelihood of abuse from initial to repeat visit remained low in 33% of subjects, remained high in 24.2% of subjects, went from low to high in 16.5%, and high to low in 26.4% of subjects. Themes identified among the subset of patients suspected of repeated abuse include return to the same environment, failure to comply with a safety plan, and abuse in foster care. Repeated consultation by child abuse specialists occurs for a minority of children. This group of children may be at higher risk of subsequent abuse and may represent an opportunity for quality improvement. PMID:24726050

  20. Prevalence of abusive encounters in the workplace of family physicians

    PubMed Central

    Miedema, Baukje; Hamilton, Ryan; Lambert-Lanning, Anita; Tatemichi, Sue R.; Lemire, Francine; Manca, Donna; Ramsden, Vivian R.

    2010-01-01

    ABSTRACT OBJECTIVE To examine the career prevalence of abusive encounters for family physicians in Canada. DESIGN A 7-page cross-sectional mailed survey in English and French. SETTING Canada. PARTICIPANTS A total of 3802 randomly selected practising family physicians who were members of the College of Family Physicians of Canada. MAIN OUTCOME MEASURES Demographic characteristics of survey participants, career prevalence of abusive encounters, and perpetrators of abuse. MAIN FINDINGS Twenty percent (20.4%) of the surveys (n = 774) were returned. Of the respondents, 44% were men and 56% were women. Most were in private practice in urban settings. The average number of years in practice was 15. The career prevalence of abusive encounters was divided into “minor,” “major,” and “severe” incidents. Of all the respondents, 98% had experienced at least 1 incident of minor abuse, 75% had experienced at least 1 incident of major abuse, and 39% had experienced at least 1 incident of severe abuse. Using χ2 analysis, a number of demographic variables were found to be significantly associated with abuse including the physician’s race and sex. Patients were the most common perpetrators of abuse. Ninety percent of family physicians surveyed reported that they had been abused by patients, while 70% reported that they had been abused by family members of patients. CONCLUSION Approximately 2 in 5 family physicians surveyed were subjected to a considerable amount of severe abuse during practice. Abuse in the office setting might have grave consequences for the health and well-being of the victimized physicians and might hinder service retention where the risk of abuse is greatest. PMID:20228289

  1. Dilated cardiomyopathy associated with toluene abuse.

    PubMed

    Vural, Mutlu; Ogel, Kultegin

    2006-01-01

    The use of paint thinner and glue to achieve an euphoric state has been associated with serious social and health problems in children and young adults. We present the case of a 21-year-old man with dilated cardiomyopathy occurring following abuse of paint thinner and glue containing toluene as main compound. After cessation of toluene abuse, the patient recovered rapidly and completely. Because of the increasing prevalence of toluene abuse, harmful effects of this volatile agent on the heart are also discussed. PMID:16479101

  2. Expanding psychiatry's role in child abuse treatment.

    PubMed

    Green, A H

    1979-10-01

    Child abuse, a problem that has plagued societies for centuries, has been largely ignored by psychiatrists, the author asserts. He traces the relatively recent interest in the problem of other medical specialists such as pediatricians and radiologists and maintains that it is time for psychiatrists to become more involved. He explains how problems of confidentiality, the patient's lack of motivation for treatment, and other factors have discouraged many psychiatrists from treating child abusers. He demonstrates ways psychiatrists can treat both the abused child and his family if they are willing to use non-traditional services such as home intervention. PMID:90001

  3. Alcohol abuse-related severe acute pancreatitis with rhabdomyolysis complications

    PubMed Central

    SU, MAO-SHENG; JIANG, YING; YAN, XIAO-YUAN HU; ZHAO, QING-HUA; LIU, ZHI-WEI; ZHANG, WEN-ZHI; HE, LEI

    2013-01-01

    Non-traumatic rhabdomyolysis is a rare complication of acute pancreatitis. One of the major risk factors of both acute pancreatitis and rhabdomyolysis is alcohol abuse. However, only a few studies have reported the prognosis and association of severe acute pancreatitis (SAP) and rhabdomyolysis in alcohol abuse patients. In the present study, we report two cases presenting with SAP complicated by rhabdomyolysis following high-dose alcohol intake. The disease onset, clinical manifestations, laboratory data, diagnosis and treatment procedure of each patient were recorded, and the association with rhabdomyolysis was analyzed. Alcohol consumption was the most predominant cause of SAP and rhabdomyolysis in these patients. SAP-related rhabdomyolysis was primarily induced by the toxicity associated with pancreatic necrosis. The laboratory tests revealed that the concentration of serum creatine kinase (CK) and myoglobin increased and acute renal failure symptoms were present, which provided an exact diagnosis for SAP-induced rhabdomyolysis. Rhabdomyolysis and subsequent hypermyoglobinuria severely impaired kidney function and aggravated hypocalcemia. The therapy of early stage SAP complicated by rhabdomyolysis involved liquid resuscitation support. When first stage treatment fails, blood purification should be performed immediately. Both patients developed multiple organ failure (MOF) and succumbed to the disease. Considering the two cases presented, we conclude that alcohol-related SAP complicated by rhabdomyolysis may have a poor clinical prognosis. PMID:23251265

  4. Advisory Committee Report on Drug Abuse: Summations and Recommendations.

    ERIC Educational Resources Information Center

    Governor's Citizen Advisory Committee on Drugs, Salt Lake City, UT.

    A citizen's Drug Abuse Evaluation Committee was formed in Utah to evaluate past research and gather new data on basic questions concerning the drug problem. This booklet provides information based on the Committee's research, hearings, and an investigation of the current drug abuse problem in Utah. Data was also obtained from recorded testimony of…

  5. Developmental Experiences of Child Sexual Abusers and Rapists

    ERIC Educational Resources Information Center

    Simons, Dominique A.; Wurtele, Sandy K.; Durham, Robert L.

    2008-01-01

    Objective: The aim of this study is to identify the distinct developmental experiences associated with child sexual abuse and rape. Method: For 269 sexual offenders (137 rapists and 132 child sexual abusers), developmental experiences were recorded from a behavioral checklist, a parental-bonding survey, and a sexual history questionnaire. Offender…

  6. A Multidisciplinary Approach to Assessing the Abused Youngster.

    ERIC Educational Resources Information Center

    Rotatori, Anthony F.; And Others

    1984-01-01

    Discusses ways of gathering social, medical, educational, intellectual, and personality data, and points out research needs. Two tables provide, respectively, an abuse data recording form and names and sources of training materials for the identification, assessment, and prevention of abuse of young children. (RH)

  7. Qualities and Characteristics of the Child Abusing Population.

    ERIC Educational Resources Information Center

    Breiner, Sander J.

    Most child abuse has a violent quality. A review of the research on child abusers reveals some interesting psychosocial and historical characteristics. Research has shown violence to be more likely in less stable populations, in persons with poor driving records and histories of severe accidents, and in those who are undereducated and unsuccessful…

  8. The Developmentally Disabled Child as a Victim of Child Abuse.

    ERIC Educational Resources Information Center

    Lewark, Carol A.

    Records (1972-1982) showing documentation of abuse or neglect in 95 developmentally disabled children were examined. Information was gathered on the children's functioning level, family income, involvement of communiy services, sibling abuse, and family's general lifestyle. Results indicated that in almost every case, the families experienced…

  9. A portable, GUI-based, object-oriented client-server architecture for computer-based patient record (CPR) systems.

    PubMed

    Schleyer, T K

    1995-01-01

    Software applications for computer-based patient records require substantial development investments. Portable, open software architectures are one way to delay or avoid software application obsolescence. The Clinical Management System at Temple University School of Dentistry uses a portable, GUI-based, object-oriented client-server architecture. Two main criteria determined this approach: preservation of investment in software development and a smooth migration path to a Computer-based Patient Record. The application is separated into three layers: graphical user interface, database interface, and application functionality Implementation with generic cross-platform development tools ensures maximum portability. PMID:7662879

  10. Extracting medical information from narrative patient records: the case of medication-related information

    PubMed Central

    Grouin, Cyril; Zweigenbaum, Pierre

    2010-01-01

    Objective While essential for patient care, information related to medication is often written as free text in clinical records and, therefore, difficult to use in computerized systems. This paper describes an approach to automatically extract medication information from clinical records, which was developed to participate in the i2b2 2009 challenge, as well as different strategies to improve the extraction. Design Our approach relies on a semantic lexicon and extraction rules as a two-phase strategy: first, drug names are recognized and, then, the context of these names is explored to extract drug-related information (mode, dosage, etc) according to rules capturing the document structure and the syntax of each kind of information. Different configurations are tested to improve this baseline system along several dimensions, particularly drug name recognition—this step being a determining factor to extract drug-related information. Changes were tested at the level of the lexicons and of the extraction rules. Results The initial system participating in i2b2 achieved good results (global F-measure of 77%). Further testing of different configurations substantially improved the system (global F-measure of 81%), performing well for all types of information (eg, 84% for drug names and 88% for modes), except for durations and reasons, which remain problematic. Conclusion This study demonstrates that a simple rule-based system can achieve good performance on the medication extraction task. We also showed that controlled modifications (lexicon filtering and rule refinement) were the improvements that best raised the performance. PMID:20819863

  11. Task and error analysis balancing benefits over business of electronic medical records.

    PubMed

    Carstens, Deborah Sater; Rodriguez, Walter; Wood, Michael B

    2014-01-01

    Task and error analysis research was performed to identify: a) the process for healthcare organisations in managing healthcare for patients with mental illness or substance abuse; b) how the process can be enhanced and; c) if electronic medical records (EMRs) have a role in this process from a business and safety perspective. The research question is if EMRs have a role in enhancing the healthcare for patients with mental illness or substance abuse. A discussion on the business of EMRs is addressed to understand the balancing act between the safety and business aspects of an EMR. PMID:25161108

  12. Inhalant Abuse and Dextromethorphan.

    PubMed

    Storck, Michael; Black, Laura; Liddell, Morgan

    2016-07-01

    Inhalant abuse is the intentional inhalation of a volatile substance for the purpose of achieving an altered mental state. As an important, yet underrecognized form of substance abuse, inhalant abuse crosses all demographic, ethnic, and socioeconomic boundaries, causing significant morbidity and mortality in school-aged and older children. This review presents current perspectives on epidemiology, detection, and clinical challenges of inhalant abuse and offers advice regarding the medical and mental health providers' roles in the prevention and management of this substance abuse problem. Also discussed is the misuse of a specific "over-the-counter" dissociative, dextromethorphan. PMID:27338970

  13. Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities.

    PubMed

    Miyamoto, Sheridan; Dharmar, Madan; Boyle, Cathy; Yang, Nikki H; MacLeod, Kristen; Rogers, Kristen; Nesbitt, Thomas; Marcin, James P

    2014-09-01

    To assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support. Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine. Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms, photo/video documentation, and medical records using two structured implicit review instruments. Among the 183 patients included in the study, 101 (55.2%) children were evaluated at telemedicine hospitals and 82 (44.8%) were evaluated at comparison hospitals. Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam, the genital exam, documentation of examination findings, the overall assessment, and the summed total quality score (p<0.05 for each). Evaluation of the photos/videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo/video quality, completeness of the examination, and the summed total completeness and accuracy score (p<0.05 for each). Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations, more complete examinations, and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support. PMID:24841062

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

    PubMed Central

    Aksoy, Nilgün; Arli, Senay; Yigit, Ozlem

    2014-01-01

    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 other

  15. The Relationship of Animal Abuse to Violence and Other Forms of Antisocial Behavior.

    ERIC Educational Resources Information Center

    Arluke, Arnold; Levin, Jack; Luke, Carter; Ascione, Frank

    1999-01-01

    Criminal records of 153 animal abusers and 153 control participants were tracked and compared. Animal abusers were more likely to commit property offenses, drug offenses, and public disorder offenses. Thus, results show an association between animal abuse and a variety of antisocial behavior, but not violence alone. Implications of these findings…

  16. Anabolic steroid abuse and dependence.

    PubMed

    Brower, Kirk J

    2002-10-01

    Anabolic-androgenic steroids (AAS) are mainly used to treat androgen deficiency syndromes and, more recently, catabolic states such as AIDS-associated wasting. There is no evidence in the reviewed literature that AAS abuse or dependence develops from the therapeutic use of AAS. Conversely, 165 instances of AAS dependence have been reported among weightlifters and bodybuilders who, as part of their weight training regimens, chronically administered supraphysiologic doses, often including combinations of injected and oral AAS as well as other drugs of abuse. A new model is proposed in which both the "myoactive" and psychoactive effects of AAS contribute to the development of AAS dependence. The adverse consequences of AAS are reviewed, as well as their assessment by means of a history and physical, mental status examination, and laboratory testing. When patients with AAS use disorders are compared with patients with other substance use disorders, both similarities and differences become apparent and have implications for treatment. PMID:12230967

  17. Usefulness of an Implantable Loop Recorder to Detect Clinically Relevant Arrhythmias in Patients With Advanced Fabry Cardiomyopathy.

    PubMed

    Weidemann, Frank; Maier, Sebastian K G; Störk, Stefan; Brunner, Thomas; Liu, Dan; Hu, Kai; Seydelmann, Nora; Schneider, Andreas; Becher, Jan; Canan-Kühl, Sima; Blaschke, Daniela; Bijnens, Bart; Ertl, Georg; Wanner, Christoph; Nordbeck, Peter

    2016-07-15

    Patients with genetic cardiomyopathy that involves myocardial hypertrophy often develop clinically relevant arrhythmias that increase the risk of sudden death. Consequently, guidelines for medical device therapy were established for hypertrophic cardiomyopathy, but not for conditions with only anecdotal evidence of arrhythmias, like Fabry cardiomyopathy. Patients with Fabry cardiomyopathy progressively develop myocardial fibrosis, and sudden cardiac death occurs regularly. Because 24-hour Holter electrocardiograms (ECGs) might not detect clinically important arrhythmias, we tested an implanted loop recorder for continuous heart rhythm surveillance and determined its impact on therapy. This prospective study included 16 patients (12 men) with advanced Fabry cardiomyopathy, relevant hypertrophy, and replacement fibrosis in "loco typico." No patients previously exhibited clinically relevant arrhythmias on Holter ECGs. Patients received an implantable loop recorder and were prospectively followed with telemedicine for a median of 1.2 years (range 0.3 to 2.0 years). The primary end point was a clinically meaningful event, which required a therapy change, captured with the loop recorder. Patients submitted data regularly (14 ± 11 times per month). During follow-up, 21 events were detected (including 4 asystole, i.e., ECG pauses ≥3 seconds) and 7 bradycardia events; 5 episodes of intermittent atrial fibrillation (>3 minutes) and 5 episodes of ventricular tachycardia (3 sustained and 2 nonsustained). Subsequently, as defined in the primary end point, 15 events leaded to a change of therapy. These patients required therapy with a pacemaker or cardioverter-defibrillator implantation and/or anticoagulation therapy for atrial fibrillation. In conclusion, clinically relevant arrhythmias that require further device and/or medical therapy are often missed with Holter ECGs in patients with advanced stage Fabry cardiomyopathy, but they can be detected by telemonitoring with

  18. Compliance with adjuvant capecitabine in patients with stage II and III colon cancer: comparison of administrative versus medical record data.

    PubMed

    Amlani, Adam; Kumar, Aalok; Ruan, Jenny Y; Cheung, Winson Y

    2016-08-01

    We aimed to examine the frequency of treatment delays as well as the reasons and appropriateness of such delays in early stage colon cancer patients receiving adjuvant capecitabine by comparing data from pharmacy dispensing versus medical records. Patients diagnosed with stage II or III colon cancer from 2008 to 2012 and who received at least two cycle of adjuvant capecitabine were reviewed for treatment delays. Data from pharmacy dispensing and patient medical records were compared. Multivariate regression models were constructed to identify predictors of treatment delays. A total of 697 patients were analyzed: median age was 70 years (IQR 30-89), 394 (57%) were men, 598 (86%) reported Eastern Cooperative Oncology Group 0/1, and 191 (27%) had stage II disease. In this study cohort, 396 (57%) patients experienced at least 1 treatment delay during their adjuvant treatment. Upon medical record review, half of treatment delays identified using pharmacy administrative data were actually attributable to side effects, of which over 90% were considered clinically appropriate for patients to withhold rather than to continue the drug. The most prevalent side effects were hand-foot syndrome and diarrhea which occurred in 176 (44%) and 67 (17%) patients, respectively. Multivariate analysis revealed a statistically significant association between stage and inappropriate treatment delays whereby patients with stage II disease were more likely to experience drug noncompliance (OR 1.79, 95% CI: 1.27-2.53, P < 0.001) than those with stage III disease. Compliance with adjuvant capecitabine was reasonable. Adherence ascertained from pharmacy administrative data differs significantly from that obtained from medical records. PMID:27228415

  19. Pattern-visual evoked potentials in thinner abusers.

    PubMed

    Poblano, A; Lope Huerta, M; Martínez, J M; Falcón, H D

    1996-01-01

    Organic solvents cause injury to lipids of neuronal and glial membranes. A well known characteristic of workers exposed to thinner is optic neuropathy. We decided to look for neurophysiologic signs of visual damage in patients identified as thinner abusers. Pattern reversal visual evoked potentials was performed on 34 thinner abuser patients and 30 controls. P-100 wave latency was found to be longer on abuser than control subjects. Results show the possibility of central alterations on thinner abusers despite absence of clinical symptoms. PMID:8987190

  20. Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review

    PubMed Central

    Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Vincent, Charles; van Gurp, Petra J; de Vet, Henrica C W; Wollersheim, Hub

    2016-01-01

    Objectives Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. Design A systematic review of the literature. Methods We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled κ values (κ) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events. Results In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-rater reliability of the GTT and HMPS showed a pooled κ of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS. Conclusions The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are potential reference methods that can be used to test concurrent validity. PMID:27550650

  1. Factors affecting the diffusion of the Computer-Based Patient Record.

    PubMed Central

    Ash, J. S.

    1997-01-01

    A survey of the perceptions of 629 informatics experts representing 67 institutions with accredited schools of medicine was used to identify factors most important in implementing the Computer-Based Patient Record. A model outlined three theoretical factors: Innovation Attributes (attributes inherent in the CPR itself); Organizational Attributes; and Boundary-Spanning Attributes (related to marketing efforts). The model was explored using multiple regression techniques to delineate the relative importance of 15 variables within the three sets of factors and their effect on two measures of diffusion. The two dependent variables were internal diffusion, or spread of usage of the CPR, and infusion, or depth of usage. Data from the 144 respondents indicate that for diffusion, the organizational variables of "decision making" and "planning" had a significant impact, although the relation between "planning" and diffusion was negative. For infusion, the Innovation Attributes variable "visibility" was significant. The major implication is that successfully encouraging usage of the CPR entails attention and resources devoted to managing the organizational aspects of implementation. PMID:9357712

  2. Implications of the Java language on computer-based patient records.

    PubMed

    Pollard, D; Kucharz, E; Hammond, W E

    1996-01-01

    The growth of the utilization of the World Wide Web (WWW) as a medium for the delivery of computer-based patient records (CBPR) has created a new paradigm in which clinical information may be delivered. Until recently the authoring tools and environment for application development on the WWW have been limited to Hyper Text Markup Language (HTML) utilizing common gateway interface scripts. While, at times, this provides an effective medium for the delivery of CBPR, it is a less than optimal solution. The server-centric dynamics and low levels of interactivity do not provide for a robust application which is required in a clinical environment. The emergence of Sun Microsystems' Java language is a solution to the problem. In this paper we examine the Java language and its implications to the CBPR. A quantitative and qualitative assessment was performed. The Java environment is compared to HTML and Telnet CBPR environments. Qualitative comparisons include level of interactivity, server load, client load, ease of use, and application capabilities. Quantitative comparisons include data transfer time delays. The Java language has demonstrated promise for delivering CBPRs. PMID:8947762

  3. A Role for Semantic Web Technologies in Patient Record Data Collection

    NASA Astrophysics Data System (ADS)

    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.

  4. Towards shared patient records: an architecture for using routine data for nationwide research.

    PubMed

    Knaup, Petra; Garde, Sebastian; Merzweiler, Angela; Graf, Norbert; Schilling, Freimut; Weber, Ralf; Haux, Reinhold

    2006-01-01

    Ubiquitous information is currently one of the most challenging slogans in medical informatics research. An adequate architecture for shared electronic patient records is needed which can use data for multiple purposes and which is extensible for new research questions. We introduce eardap as architecture for using routine data for nationwide clinical research in a multihospital environment. eardap can be characterized as terminology-based. Main advantage of our approach is the extensibility by new items and new research questions. Once the definition of items for a research question is finished, a consistent, corresponding database can be created without any informatics skills. Our experiences in pediatric oncology in Germany have shown the applicability of eardap. The functions of our core system were in routine clinical use in several hospitals. We validated the terminology management system (TMS) and the module generation tool with the basic data set of pediatric oncology. The multiple usability depends mainly on the quality of item planning in the TMS. High quality harmonization will lead to a higher amount of multiply used data. When using eardap, special emphasis is to be placed on interfaces to local hospital information systems and data security issues. PMID:16115794

  5. A data-hiding technique with authentication, integration, and confidentiality for electronic patient records.

    PubMed

    Chao, Hui-Mei; Hsu, Chin-Ming; Miaou, Shaou-Gang

    2002-03-01

    A data-hiding technique called the "bipolar multiple-number base" was developed to provide capabilities of authentication, integration, and confidentiality for an electronic patient record (EPR) transmitted among hospitals through the Internet. The proposed technique is capable of hiding those EPR related data such as diagnostic reports, electrocardiogram, and digital signatures from doctors or a hospital into a mark image. The mark image could be the mark of a hospital used to identify the origin of an EPR. Those digital signatures from doctors and a hospital could be applied for the EPR authentication. Thus, different types of medical data can be integrated into the same mark image. The confidentiality is ultimately achieved by decrypting the EPR related data and digital signatures with an exact copy of the original mark image. The experimental results validate the integrity and the invisibility of the hidden EPR related data. This newly developed technique allows all of the hidden data to be separated and restored perfectly by authorized users. PMID:11936596

  6. 49 CFR 199.227 - Retention of records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... defined in 49 CFR part 40) shall be maintained for a minimum of one year. (c) Types of records. The... pertaining to a determination by a substance abuse professional concerning a covered employee's need for... abuse professional. (5) Record(s) related to the operator's MIS annual testing data. (6) Records...

  7. Embracing the Sparse, Noisy, and Interrelated Aspects of Patient Demographics for use in Clinical Medical Record Linkage

    PubMed Central

    Ash, Stephen M.; Ip-Lin, King

    2015-01-01

    Duplicate patient records in health information systems have received increased attention in recent time due to regulatory incentives to integrate the healthcare enterprise. Historically, most patient record matching systems have been limited to simple applications of the Fellegi-Sunter theory of record linkage with edit distance based string similarity measurements. String similarity approaches ignore the rich semantic information present by reducing it to a simple syntactic comparison of characters. This work describes an updated approach to building clinical medical record linkage systems, which embraces the unavoidable problems present in real-world patient matching. Using a ground truth dataset of a real patient population, we demonstrate that systems built in this fashion improve recall by 76% with little reduction in precision. This result empirically demonstrates the size of the gap between sophisticated systems and naïve approaches. Additionally, it accentuates the difficulty in estimating the false negative error in this setting as previous research has reported much higher levels of recall, due, in part, to measuring from biased samples. PMID:26306279

  8. Embracing the Sparse, Noisy, and Interrelated Aspects of Patient Demographics for use in Clinical Medical Record Linkage.

    PubMed

    Ash, Stephen M; Ip-Lin, King

    2015-01-01

    Duplicate patient records in health information systems have received increased attention in recent time due to regulatory incentives to integrate the healthcare enterprise. Historically, most patient record matching systems have been limited to simple applications of the Fellegi-Sunter theory of record linkage with edit distance based string similarity measurements. String similarity approaches ignore the rich semantic information present by reducing it to a simple syntactic comparison of characters. This work describes an updated approach to building clinical medical record linkage systems, which embraces the unavoidable problems present in real-world patient matching. Using a ground truth dataset of a real patient population, we demonstrate that systems built in this fashion improve recall by 76% with little reduction in precision. This result empirically demonstrates the size of the gap between sophisticated systems and naïve approaches. Additionally, it accentuates the difficulty in estimating the false negative error in this setting as previous research has reported much higher levels of recall, due, in part, to measuring from biased samples. PMID:26306279

  9. Administrative Codes Combined with Medical Records-based Criteria Accurately Identified Bacterial Infections among Rheumatoid Arthritis Patients

    PubMed Central

    Patkar, Nivedita M.; Curtis, Jeffrey R.; Teng, Gim Gee; Allison, Jeroan J.; Saag, Michael; Martin, Carolyn; Saag, Kenneth G.

    2009-01-01

    Objective To evaluate diagnostic properties of International Classification of Diseases, Version 9 (ICD-9) diagnosis codes and infection criteria to identify bacterial infections among rheumatoid arthritis (RA) patients. Study Design and Setting We performed a cross- sectional study of RA patients with and without ICD-9 codes for bacterial infections. Sixteen bacterial infection criteria were developed. Diagnostic properties of comprehensive and restrictive sets of ICD-9 codes and the infection criteria were tested against an adjudicated review of medical records. Results Records on 162 RA patients with and 50 without purported bacterial infections were reviewed. Positive (PPV) and negative predictive values (NPVs) of ICD-9 codes ranged from 54% – 85% and 84% – 100%, respectively. PPVs of the medical records-based criteria were: 84% and 89% for “definite” and “definite or empirically treated” infections, respectively. PPV of infection criteria increased by 50% as disease prevalence increased using ICD-9 codes to enhance infection likelihood. Conclusion ICD-9 codes alone may misclassify bacterial infections in hospitalized RA patients. Misclassification varies with the specificity of the codes used and strength of evidence required to confirm infections. Combining ICD-9 codes with infection criteria identified infections with greatest accuracy. Novel infection criteria may limit the requirement to review medical records. PMID:18834713

  10. Reported child sexual abuse in Bahrain: 2000-2009

    PubMed Central

    Al-Mahroos, Fadheela; Al-Amer, Eshraq

    2011-01-01

    BACKGROUND AND OBJECTIVE: Child sexual abuse (CSA) is a common problem with severe short and long-term consequences to the abused child, the family and to society. The aim of this study was to evaluate the extent of CSA, and demographic and other characteristics of the abused and their families. DESIGN AND SETTING: Retrospective and descriptive study based on a review of medical records of CSA cases from 2000-2009 at Sulmaniya Medical Complex, the main secondary and tertiary medical care facility in Bahrain. PATIENTS AND METHODS: The review included demographic data, child and family characteristics, manifestations and interventions. RESULTS: The 440 children diagnosed with CSA had a mean age of 8 years (range, 9 months to 17 years); 222 were males (50.5%) and 218 were females (49.5%). There was a steady increase in cases from 31 per year in 2000 to 77 cases in 2009. Children disclosed abuse in 26% of cases, while health sector professionals recognized 53% of the cases. Genital touching and fondling (62.5%) were the most common form of CSA, followed by sodomy in 39%. Gonorrhea was documented in 2% of the cases and pregnancy in 4% of the females. The illiteracy rate among the fathers and mothers was 9% and 12%, respectively, which is higher than the rate among the adult general population. Children came from all socio-economic classes. There was referral to police in 56%, public prosecution in 31% of the cases, but only 8% reached the court. CONCLUSION: During ten years there has been a 2.5% increase in reported cases of CSA. Improving the skill of professionals in identifying CSA indicators and a mandatory reporting law might be needed to improve the rate of recognition and referral of CSA cases. Further general population-based surveys are needed to determine more accurately the scope of CSA and the risk and protective factors in the family and community. PMID:21808114

  11. Condyloma lata in a preschooler: The dilemma of sexual abuse versus non-abuse.

    PubMed

    Narang, Tarun; Kanwar, Amrinder Jit; Kumaran, M Sendhil

    2013-07-01

    It is well-known that syphilis is a sexually-transmitted or an inherited infection. Syphilis in preschoolers is rarely described in modern medical literature. Our case represents the difficulty or dilemma faced by dermatologists after diagnosing syphilis in a girl child due to inability of the young children to provide a history of sexual abuse and more over the parents/guardians also try to hide the history of sexual-abuse. Although rare, we can consider non-sexual transmission after we have thoroughly investigated and ruled out even the remote possibility of sexual abuse, because misdiagnosis of both abuse and non-abuse can be devastating to the patient and family. PMID:24339468

  12. Criminal Prosecution of Child Sexual Abuse Cases.

    ERIC Educational Resources Information Center

    Martone, Mary; And Others

    1996-01-01

    This study of police and hospital records for 451 intrafamilial/caretaker child sexual abuse allegations in Chicago, Illinois, found that few children had to appear as witnesses, as 95% of cases were resolved through plea bargaining. Trial resolution took 12 to 16 months. Of 77 felony complaints initiated, 48 ended in convictions, with 43 convicts…

  13. Selected Materials on Drug Abuse and Misuse.

    ERIC Educational Resources Information Center

    Vigo County Public Library, Terre Haute, IN.

    The Vigo County Public Library has a Center for Drug Information which contains pamphlets, leaflets, newsletters, realia kits, films, records, cassettes, slides, educational aids and other materials on drug use, abuse and education. The materials in this list were selected for their relevance to the needs of local groups and organizations in…

  14. Contingency management: utility in the treatment of drug abuse disorders.

    PubMed

    Stitzer, M L; Vandrey, R

    2008-04-01

    Contingency management (CM) is a strategy that uses positive reinforcement to improve the clinical outcomes of substance abusers in treatment, especially sustained abstinence from drugs of abuse. Further, CM has been adopted to improve methodology and interpretation of outcomes in clinical trials testing new pharmacotherapies and to improve adherence to efficacious medications in substance abuse patients. Thus, CM has proven to be widely useful as a direct therapeutic intervention and as a tool in treatment development. PMID:18305456

  15. Imaging of Abusive Trauma.

    PubMed

    Shekdar, Karuna

    2016-06-01

    "Shaken baby syndrome" is a term often used by the physicians and public to describe abusive trauma inflicted on infants and young children. Advances in the understanding of the mechanisms and the associated clinical spectrum of injury has lead us to modify our terminology and address it as "abusive trauma" (AT). Pediatric abusive head trauma is defined as an injury to the skull or intracranial contents of an infant or a young child (< 5 y age) due to inflicted blunt impact and/or violent shaking. This chapter focuses on the imaging aspects of childhood abusive trauma along with a brief description of the mechanism and pathophysiology of abusive injury. The diagnosis of AT is not always obvious, and abusive injuries in many infants may remain unrecognized. Pediatricians should be cognizant of AT since pediatricians play a crucial role in the diagnosis, management and prevention of AT. PMID:26882906

  16. Abuse and HIV-related risk.

    PubMed

    Benson, J D

    1995-04-01

    Research has been conducted on the effects of childhood abuse that may lead to HIV risk-taking behaviors in adolescence and adulthood. There is evidence of a higher incidence of childhood abuse among HIV-infected individuals and those at highest risk, but not enough evidence to confirm childhood abuse as a root cause of risk-taking. Research is beginning to show important connections between psychological trauma and risk, and to suggest therapeutic approaches. The trauma of childhood sexual abuse is retained by the victims, which can cause dissociative defenses and damaging feelings of self-efficacy which may affect safer sex practices. To identify sexual abuse as an issue in therapy, it is advised that counselors develop client histories regarding relationships, sexual expression and identity, substance use, suicidality, and other recurring self-destructive patterns of thought and behavior. The treatment goal is to assist the patient in understanding how abuse has affected feelings, thoughts, and relationship styles, and to recognize patterns that lead directly to HIV-related risk or that set the stage for risky activities. The critical aspect of treatment is to accurately assess the patient's coping skills when determining the course of treatment. ¿¿¿¿¿¿¿ PMID:11362459

  17. [Differential diagnosis of child sexual abuse].

    PubMed

    Csorba, Roland; Lampé, Rudolf; Póka, Róbert

    2009-12-01

    The evaluation of a child presenting with an anogenital complaint or lesion can be challenging for both the clinician and the patient. The doctor met the real possibility that a diagnosis of a condition caused by sexual abuse will affect significantly the child and the family. A misdiagnosis of abuse or failure to recognize a treatable condition can also have detrimental consequences. Most primary care physicians are not trained to recognize the variety of systemic and dermatologic problems that affect the anogenital area. Dermatologists and other specialists often do not appreciate the possibility of sexual abuse. In this article we present a systematic approach to the child with anogenital complaints which may mimic sexual abuse. PMID:19939783

  18. Neurologic manifestations of chronic methamphetamine abuse

    PubMed Central

    Rusyniak, Daniel E.

    2011-01-01

    Summary Chronic methamphetamine abuse has devastating effects on the central nervous system. The degree to which addicts will tolerate the dysfunction in the way they think, feel, move, and even look, is a powerful testimony to the addictive properties of this drug. While the mechanisms behind these disorders are complex, at their heart they involve the recurring increase in the concentrations of central monoamines with subsequent dysfunction in dopaminergic neurotransmission. The mainstay of treatment for the problems associated with chronic methamphetamine abuse is abstinence. However, by recognizing the manifestations of chronic abuse, clinicians will be better able to help their patients get treatment for their addiction and to deal with the neurologic complications related to chronic abuse. PMID:21803215

  19. [Web-based for preanesthesia evaluation record: a structured, evidence-based patient interview to assess the anesthesiological risk profile].

    PubMed

    Kramer, Sylvia; Lau, Alexandra; Krämer, Michael; Wendler, Olafur Gunnarsson; Müller-Lobeck, Lutz; Scheding, Christoph; Klarhöfer, Manja; Schaffartzik, Walter; Neumann, Tim; Krampe, Henning; Spies, Claudia

    2011-10-01

    At present, providers at an Anesthesia Preoperative Evaluation Clinic (APEC) may have difficulties in gaining access to relevant clinical information, including external medical records, surgical dictations etc. This common occurence makes obtaining an informed consent by the patient after a complete pre-anesthetic assessment difficult. This form of patient information is subject to wide interindividual variations and, thus, represents a challenge for quality assurance. Insufficient or not completed pre-anesthetic assessments can lead to an untimely termination of an elective procedure.A web-based pre-anesthetic evaluation record moves the time point of the first contact to well before the day of admission. The current pre-anesthesia evaluation record is replaced by a structured interview in the form of a complex of questions in a specific hierarchy taking guidelines, standard operating procedures (SOP) and evidence-based medicine (EBM) into consideration. The answers to the complex of questions are then classified according to agreed criteria and possible scoring systems of relevant classifications. The endpoints result in procedural recommendations not only for the informing anesthesiologist but also for the patient. The standardized risk criteria can be used as core process indicators to check the process quality of the anesthesiological risk evaluation. Short-notice cancellations of elective operations due to incomplete premedication procedures will then be avoided with the help of such structured and evidence-based patient interviews with detailed assessment of the anesthesiological risk profile.The web-based anesthesia evaluation record (WAR) corresponds with the recommendations of the DGAI to carry out the staged information in analogy to the staged information of Weissauer. The basic practice is not changed by WACH. By means of WACH, the time point of the first contact with anesthesia is moved forward and occurs within a different framework. WACH has

  20. Creating an Oversight Infrastructure for Electronic Health Record-Related Patient Safety Hazards

    PubMed Central

    Singh, Hardeep; Classen, David C.; Sittig, Dean F.

    2013-01-01

    Electronic health records (EHRs) have potential quality and safety benefits. However, reports of EHR-related safety hazards are now emerging. The Office of the National Coordinator (ONC) for Health Information Technology (HIT) recently sponsored an Institute of Medicine committee to evaluate how HIT use affects patient safety. In this paper, we propose the creation of a national EHR oversight program to provide dedicated surveillance of EHR-related safety hazards and to promote learning from identified errors, close calls, and adverse events. The program calls for data gathering, investigation/analysis and regulatory components. The first two functions will depend on institution-level EHR safety committees that will investigate all known EHR-related adverse events and near-misses and report them nationally using standardized methods. These committees should also perform routine safety self-assessments to proactively identify new risks. Nationally, we propose the long-term creation of a centralized, non-partisan board with an appropriate legal and regulatory infrastructure to ensure the safety of EHRs. We discuss the rationale of the proposed oversight program and its potential organizational components and functions. These include mechanisms for robust data collection and analyses of all safety concerns using multiple methods that extend beyond reporting; multidisciplinary investigation of selected high-risk safety events; and enhanced coordination with other national agencies in order to facilitate broad dissemination of hazards information. Implementation of this proposed infrastructure can facilitate identification of EHR-related adverse events and errors and potentially create a safer and more effective EHR-based health care delivery system. PMID:22080284

  1. [Challenges in the implementation of electronic health care records and patient cards in Austria].

    PubMed

    Pfeiffer, K P; Auer, C M

    2009-03-01

    Patient-centered, interinstitutional digital documentation and communication in the Austrian health care system is a primary goal of Austria health politics. The implementation of the eCard in the year 2005 was a very important step towards digitalization of the Austria health system. The main responsibility of the Ministry of Health (MoH) is coordinating the implementation of the eHealth infrastructure based on international standards. The Austrian electronic health care record (ELGA) should include all relevant multimedia medical and health-related data of a uniquely identified person. A selection of "relevant" documents must be made. The implementation of ELGA will take place in modules. Because of the importance of the federal states and their role in health care, a special commission was set up to represent the most important stakeholders. Thereby they are included in the decision-making process. This is important with regard to the future use of many already existing information systems and for further investments. The most important steps until now were the implementation of a working group for ELGA as an association of the national health commission in the year 2006 and the implementation of a feasibility study as well as a cost-benefit analysis. Data protection and security are considered very important factors and, with respect to these, the roles for health care providers will be defined. To achieve high acceptance from the public and especially from health care providers, it is important to inform them about the benefits of eHealth. PMID:19259636

  2. Women's Dependency on Prescription Drugs; Hearing Before the Select Committee on Narcotics Abuse and Control, House of Representatives, Ninety-Sixth Congress, First Session.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House.

    This record of the Select Committee on Narcotics Abuse and Control contains testimonies addressing the problems facing drug abusing women. The extensive prescribing of legal drugs such as tranquilizers, sedatives, pain killers, and stimulants is examined. The problems of polydrug abuse and alcohol abuse in combination with other drugs are also…

  3. New Paradigms for Patient-Centered Outcomes Research in Electronic Medical Records: An Example of Detecting Urinary Incontinence Following Prostatectomy

    PubMed Central

    Hernandez-Boussard, Tina; Tamang, Suzanne; Blayney, Douglas; Brooks, Jim; Shah, Nigam

    2016-01-01

    Introduction: National initiatives to develop quality metrics emphasize the need to include patient-centered outcomes. Patient-centered outcomes are complex, require documentation of patient communications, and have not been routinely collected by healthcare providers. The widespread implementation of electronic medical records (EHR) offers opportunities to assess patient-centered outcomes within the routine healthcare delivery system. The objective of this study was to test the feasibility and accuracy of identifying patient centered outcomes within the EHR. Methods: Data from patients with localized prostate cancer undergoing prostatectomy were used to develop and test algorithms to accurately identify patient-centered outcomes in post-operative EHRs – we used urinary incontinence as the use case. Standard data mining techniques were used to extract and annotate free text and structured data to assess urinary incontinence recorded within the EHRs. Results A total 5,349 prostate cancer patients were identified in our EHR-system between 1998–2013. Among these EHRs, 30.3% had a text mention of urinary incontinence within 90 days post-operative compared to less than 1.0% with a structured data field for urinary incontinence (i.e. ICD-9 code). Our workflow had good precision and recall for urinary incontinence (positive predictive value: 0.73 and sensitivity: 0.84). Discussion. Our data indicate that important patient-centered outcomes, such as urinary incontinence, are being captured in EHRs as free text and highlight the long-standing importance of accurate clinician documentation. Standard data mining algorithms can accurately and efficiently identify these outcomes in existing EHRs; the complete assessment of these outcomes is essential to move practice into the patient-centered realm of healthcare. PMID:27347492

  4. Social consequences of substance abuse: the impact of comorbid psychiatric disorders. A prospective study of a nation-wide sample of treatment-seeking patients.

    PubMed

    Tómasson, K; Vaglum, P

    1998-03-01

    This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrest, and reduced employment) related to alcohol in a nation-wide sample (n = 351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR = 2.9) and fights (OR = 3.9) among men, while among pure alcoholics of both sexes phobia (OR = 4.3) and antisocial personality disorder (OR = 3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence. PMID:9526766

  5. Patient Perceptions of a Personal Health Record: A Test of the Diffusion of Innovation Model

    PubMed Central

    2012-01-01

    Background Personal health records (PHRs) have emerged as an important tool with which patients can electronically communicate with their doctors and doctor’s offices. However, there is a lack of theoretical and empirical research on how patients perceive the PHR and the differences in perceptions between users and non-users of the PHR. Objective To apply a theoretical model, the diffusion of innovation model, to the study of PHRs and conduct an exploratory empirical study on the applicability of the model to the study of perceptions of PHRs. A secondary objective was to assess whether perceptions of PHRs predict the perceived value of the PHR for communicating with the doctor’s office. Methods We first developed a survey capturing perceptions of PHR use and other factors such as sociodemographic characteristics, access and use of technology, perceived innovativeness in the domain of information technology, and perceptions of privacy and security. We then conducted a cross-sectional survey (N = 1500). Patients were grouped into five groups of 300: PHR users (innovators, other users, and laggards), rejecters, and non-adopters. We applied univariate statistical analysis (Pearson chi-square and one-way ANOVA) to assess differences among groups and used multivariate statistical techniques (factor analysis and multiple regression analysis) to assess the presence of factors identified by the diffusion of innovation model and the predictors of our dependent variable (value of PHR for communicating with the doctor’s office). Results Of the 1500 surveys, 760 surveys were returned for an overall response rate of 51%. Computer use among non-adopters (75%) was lower than that among PHR users (99%) and rejecters (92%) (P < .001). Non-adopters also reported a lower score on personal innovativeness in information technology (mean = 2.8) compared to 3.6 and 3.1, respectively, for users and rejecters (P < .001). Four factors identified by the diffusion of innovation model

  6. Identifying patients with medically unexplained physical symptoms in electronic medical records in primary care: a validation study

    PubMed Central

    2014-01-01

    Background When medically unexplained physical symptoms (MUPS) become persistent, it may have major implications for the patient, the general practitioner (GP) and for society. Early identification of patients with MUPS in electronic medical records (EMRs) might contribute to prevention of persistent MUPS by creating awareness among GPs and providing an opportunity to start stepped care management. However, procedures for identification of patients with MUPS in EMRs are not well established yet. In this validation study we explore the test characteristics of an EMR screening method to identify patients with MUPS. Methods The EMR screening method consists of three steps. First, all patients ≥18 years were included when they had five or more contacts in the last 12 months. Second, patients with known chronic conditions were excluded. Finally, patients were included with a MUPS syndrome or when they had three or more complaints suggestive for MUPS. We compared the results of the EMR screening method with scores on the Patient Health Questionnaire-15 (PHQ-15), which we used as reference test. We calculated test characteristics for various cut-off points. Results From the 1223 patients in our dataset who completed the PHQ-15, 609 (49/8%) scored ≥5 on the PHQ-15. The EMR screening method detected 131/1223 (10.7%) as patients with MUPS. Of those, 102 (77.9%) scored ≥5 on the PHQ-15 and 53 (40.5%) scored ≥10. When compared with the PHQ-15 cut-off point ≥10, sensitivity and specificity were 0.30 and 0.93 and positive and negative predictive values were 0.40 and 0.89, respectively. Conclusions The EMR screening method to identify patients with MUPS has a high specificity. However, many potential MUPS patients will be missed. Before using this method as a screening instrument for selecting patients who might benefit from structured care, its sensitivity needs to be improved while maintaining its specificity. PMID:24903850

  7. Sexual abuse in children - what to know

    MedlinePlus

    Sexual abuse - children ... abused before they turn 18. Sexual abuse of children is any activity that the abuser does to get sexually aroused, including: Touching a child's genitals Rubbing the abuser's genitals against a child's ...

  8. Beyond attachment: psychotherapy with a sexually abused teenager.

    PubMed

    Adams, Christine B L

    2012-01-01

    When children are abused they utilize strategies already in place to cope with stress. These strategies develop during early life within the family and may be part of the unconscious framework formed within attachments and relationships. The case presented illustrates a teen-aged girl who was the victim of sexual abuse and experienced depression, PTSD and substance abuse. This paper describes the psychodynamic psychotherapy used to examine the patient's coping skills, which predated the abuse, and how these coping mechanisms were used to ameliorate her symptoms. PMID:23393991

  9. Childhood Sexual Abuse Patterns, Psychosocial Correlates, and Treatment Outcomes among Adults in Drug Abuse Treatment

    ERIC Educational Resources Information Center

    Boles, Sharon M.; Joshi, Vandana; Grella, Christine; Wellisch, Jean

    2005-01-01

    This study reports on the effects of having a history of childhood sexual abuse (CSA) on treatment outcomes among substance abusing men and women (N = 2,434) in a national, multisite study of drug treatment outcomes. A history of CSA was reported by 27.2% of the women and 9.2% of the men. Controlling for gender, compared to patients without CSA,…

  10. Dynamics of intracranial electroencephalographic recordings from epilepsy patients using univariate and bivariate recurrence networks

    NASA Astrophysics Data System (ADS)

    Subramaniyam, Narayan Puthanmadam; Hyttinen, Jari

    2015-02-01

    Recently Andrezejak et al. combined the randomness and nonlinear independence test with iterative amplitude adjusted Fourier transform (iAAFT) surrogates to distinguish between the dynamics of seizure-free intracranial electroencephalographic (EEG) signals recorded from epileptogenic (focal) and nonepileptogenic (nonfocal) brain areas of epileptic patients. However, stationarity is a part of the null hypothesis for iAAFT surrogates and thus nonstationarity can violate the null hypothesis. In this work we first propose the application of the randomness and nonlinear independence test based on recurrence network measures to distinguish between the dynamics of focal and nonfocal EEG signals. Furthermore, we combine these tests with both iAAFT and truncated Fourier transform (TFT) surrogate methods, which also preserves the nonstationarity of the original data in the surrogates along with its linear structure. Our results indicate that focal EEG signals exhibit an increased degree of structural complexity and interdependency compared to nonfocal EEG signals. In general, we find higher rejections for randomness and nonlinear independence tests for focal EEG signals compared to nonfocal EEG signals. In particular, the univariate recurrence network measures, the average clustering coefficient C and assortativity R , and the bivariate recurrence network measure, the average cross-clustering coefficient Ccross, can successfully distinguish between the focal and nonfocal EEG signals, even when the analysis is restricted to nonstationary signals, irrespective of the type of surrogates used. On the other hand, we find that the univariate recurrence network measures, the average path length L , and the average betweenness centrality BC fail to distinguish between the focal and nonfocal EEG signals when iAAFT surrogates are used. However, these two measures can distinguish between focal and nonfocal EEG signals when TFT surrogates are used for nonstationary signals. We also

  11. [Twenty-four hour automatic recording of blood pressure and cardiac rhythm in patients with borderline hypertension].

    PubMed

    Cybulska, I; Popławska, W; Niegowska, J; Makowiecka-Cieśla, M; Kabat, M; Borowiecka, E; Sznajderman, M

    1989-01-01

    The aim of the study was to evaluate the usefulness of 24-hour automatic recording of blood pressure and cardiac rhythm in patients with borderline hypertension. The study was performed in 50 patients aged 38.8 +/- 13.1 using the Del Mar Avionics device. Mean time of recordings was 21.3 hours, and the mean number of blood pressure measurements per one patient was 52.4. Great fluctuations of systolic blood pressure (from 92.1 +/- 12.6 to 191 +/- 37.0 mm Hg) and diastolic one (from 57.3 +/- 11.4 to 118.9 +/- 13.8 mm Hg) were observed. Mean systolic blood pressure (125.6 +/- 10.6 mm Hg) was significantly lower than the mean value of last three ambulatory measurements (141.9 +/- 9.8; p less than 0.001). Also mean diastolic pressure was lower than that obtained in the out patient clinic (84.7 +/- 9.7 vs 91.9 +/- 3.2 mm Hg; p less than 0.001). Mean heart rate during the day was 86.2 +/- 10.7 and at night 69.7 +/- 10.5 beats per minute. Ventricular and/or supraventricular cardiac arrhythmias were observed in 14 (28%) of examined patients. Results of the study indicate, that 24-hour automatic blood pressure recording is the valuable method, affording possibilities for more precise estimation of blood pressure and its 24-hour fluctuations in patients with borderline hypertension. PMID:2639977

  12. Special Issue: Substance Abuse.

    ERIC Educational Resources Information Center

    Fuhrmann, Barbara S., Ed.; Washington, Craig S., Ed.

    1984-01-01

    Presents ten articles about substance abuse: its effects, consequences, and strategies for intervention. Describes specific group therapy techniques and presents both a court service designed for assisting juveniles with drug/alcohol offenses, and a school-based substance abuse prevention program. Looks at strategies for counseling special…

  13. Battling Sexual Abuse

    ERIC Educational Resources Information Center

    Dessoff, Alan

    2010-01-01

    From costly lawsuits on behalf of victims to negative media coverage, districts can face potentially devastating consequences as a result of sexual abuse of their students by district employees. This article offers a few tips on how to battle sexual abuse particularly in school districts. The author stresses that by adopting strong policies that…

  14. Adolescent Substance Abuse.

    ERIC Educational Resources Information Center

    Thorne, Craig R.; DeBlassie, Richard R.

    1985-01-01

    Cummings (1979), citing evidence from the National Institute of Drug Abuse, reports that one of every eleven adult Americans suffers from a severe addictive problem. Drug addiction is epidemic among teenagers; one of every six teenagers suffers from a severe addictive problem. This paper focuses on adolescent drug/substance abuse. (Author)

  15. Antitussives and substance abuse

    PubMed Central

    Burns, Jarrett M; Boyer, Edward W

    2013-01-01

    Abuse of antitussive preparations is a continuing problem in the United States and throughout the world. Illicit, exploratory, or recreational use of dextromethorphan and codeine/promethazine cough syrups is widely described. This review describes the pharmacology, clinical effects, and management of toxicity from commonly abused antitussive formulations. PMID:24648790

  16. Antitussives and substance abuse.

    PubMed

    Burns, Jarrett M; Boyer, Edward W

    2013-01-01

    Abuse of antitussive preparations is a continuing problem in the United States and throughout the world. Illicit, exploratory, or recreational use of dextromethorphan and codeine/promethazine cough syrups is widely described. This review describes the pharmacology, clinical effects, and management of toxicity from commonly abused antitussive formulations. PMID:24648790

  17. Substance Abuse and Disability.

    ERIC Educational Resources Information Center

    Sales, Amos

    A review of the literature provides the conclusion that individuals with a disability versus those without a disability are more likely to have a substance abuse problem and less likely to get effective treatment. Data suggest 10-40% of all individuals in treatment for substance abuse have a coexisting physical or mental disability. Alcohol rates…

  18. Patient empowerment by the means of citizen-managed Electronic Health Records: web 2.0 health digital identity scenarios.

    PubMed

    Falcão-Reis, Filipa; Correia, Manuel E

    2010-01-01

    With the advent of more sophisticated and comprehensive healthcare information systems, system builders are becoming more interested in patient interaction and what he can do to help to improve his own health care. Information systems play nowadays a crucial and fundamental role in hospital work-flows, thus providing great opportunities to introduce and improve upon "patient empowerment" processes for the personalization and management of Electronic Health Records (EHRs). In this paper, we present a patient's privacy generic control mechanisms scenarios based on the Extended OpenID (eOID), a user centric digital identity provider previously developed by our group, which leverages a secured OpenID 2.0 infrastructure with the recently released Portuguese Citizen Card (CC) for secure authentication in a distributed health information environment. eOID also takes advantage of Oauth assertion based mechanisms to implement patient controlled secure qualified role based access to his EHR, by third parties. PMID:20543356

  19. Development of a clinical event monitor for use with the Veterans Affairs Computerized Patient Record System and other data sources.

    PubMed Central

    Payne, T. H.; Savarino, J.

    1998-01-01

    We are developing an event monitor to operate with the Veterans Affairs Computerized Patient Record System (CPRS). The event monitor is designed to receive messages when important patient events such as posting of new results, patient movement, and orders occur. Our design separates the event monitor from CPRS itself, using communication via a network connection to receive HL7 messages, to access other data needed to run rules, and to communicate with providers by message display, electronic mail and other mechanisms. Results from operation of the event monitor using patient data in our test account show that a wide variety of data can be accessed by the event monitor with acceptable response times. Images Figure 1 PMID:9929199

  20. The International Classification of Primary Care (ICPC): new applications in research and computer-based patient records in family practice.

    PubMed

    Hofmans-Okkes, I M; Lamberts, H

    1996-06-01

    The international Classification of Primary Care (ICPC) has now been available to the family medicine community for a decade as the main ordering principle of its domain. Research data and practical experiences with ICPC, as well as the development of new concepts in family medicine, have resulted in new applications. The structure of episodes of care to be included in a computer-based patient record has been further developed and refined. ICPC as the ordering principle of patient data is now available in 19 languages. Its conversion structure with the International Classification of Diseases (ICD-10) allows the highest possible level of specificity in a patient's problem list necessary in patient care, while the compatibility of the ICPC drug codes with the Anatomic Therapeutic Chemical Classification Index allows the systematic inclusion of data on prescription. PMID:8671139