Sample records for addressing medical coding

  1. The Full Scope of Family Physicians' Work Is Not Reflected by Current Procedural Terminology Codes.

    PubMed

    Young, Richard A; Burge, Sandy; Kumar, Kaparaboyna Ashok; Wilson, Jocelyn

    2017-01-01

    The purpose of this study was to characterize the content of family physician (FP) clinic encounters, and to count the number of visits in which the FPs addressed issues not explicitly reportable by 99211 to 99215 and 99354 Current Procedural Terminology (CPT) codes with current reimbursement methods and based on examples provided in the CPT manual. The data collection instrument was modeled on the National Ambulatory Medical Care Survey. Trained assistants directly observed every other FP-patient encounter and recorded every patient concern, issue addressed by the physician (including care barriers related to health care systems and social determinants), and treatment ordered in clinics affiliated with 10 residencies of the Residency Research Network of Texas. A visit was deemed to include physician work that was not explicitly reportable if the number or nature of issues addressed exceeded the definitions or examples for 99205/99215 or 99214 + 99354 or a preventive service code, included the physician addressing health care system or social determinant issues, or included the care of a family member. In 982 physician-patient encounters, patients raised 517 different reasons for visit (total, 5278; mean, 5.4 per visit; range, 1 to 16) and the FPs addressed 509 different issues (total issues, 3587; mean, 3.7 per visit; range, 1 to 10). FPs managed 425 different medications, 18 supplements, and 11 devices. A mean of 3.9 chronic medications were continued per visit (range, 0 to 21) and 4.6 total medications were managed (range, 0 to 22). In 592 (60.3%) of the visits the FPs did work that was not explicitly reportable with available CPT codes: 582 (59.3%) addressed more numerous issues than explicitly reportable, 64 (6.5%) addressed system barriers, and 13 (1.3%) addressed concerns for other family members. FPs perform cognitive work in a majority of their patient encounters that are not explicitly reportable, either by being higher than the CPT example number of diagnoses per code or the type of problems addressed, which has implications for the care of complex multi-morbid patients and the growth of the primary care workforce. To address these limitations, either the CPT codes and their associated rules should be updated to reflect the realities of family physicians' practices or new billing and coding approaches should be developed. © Copyright 2017 by the American Board of Family Medicine.

  2. SU-A-210-04: Panel Discussion

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Stanford, J.

    The purpose of this student annual meeting is to address topics that are becoming more relevant to medical physicists, but are not frequently addressed, especially for students and trainees just entering the field. The talk is divided into two parts: medical billing and regulations. Hsinshun Wu – Why should we learn radiation oncology billing? Many medical physicists do not like to be involved with medical billing or coding during their career. They believe billing is not their responsibility and sometimes they even refuse to participate in the billing process if given the chance. This presentation will talk about a physicist’smore » long career and share his own experience that knowing medical billing is not only important and necessary for every young medical physicist, but that good billing knowledge could provide a valuable contribution to his/her medical physics development. Learning Objectives: The audience will learn the basic definition of Current Procedural Terminology (CPT) codes performed in a Radiation Oncology Department. Understand the differences between hospital coding and physician-based or freestanding coding. Apply proper CPT coding for each Radiation Oncology procedure. Each procedure with its specific CPT code will be discussed in detail. The talk will focus on the process of care and use of actual workflow to understand each CPT code. Example coding of a typical Radiation Oncology procedure. Special procedure coding such as brachytherapy, proton therapy, radiosurgery, and SBRT. Maryann Abogunde – Medical physics opportunities at the Nuclear Regulatory Commission (NRC) The NRC’s responsibilities include the regulation of medical uses of byproduct (radioactive) materials and oversight of medical use end-users (licensees) through a combination of regulatory requirements, licensing, safety oversight including inspection and enforcement, operational experience evaluation, and regulatory support activities. This presentation will explore the career options for medical physicists in the NRC, how the NRC interacts with clinical medical physicists, and a physicist’s experience as a regulator. Learning Objectives: Explore non-clinical career pathways for medical physics students and trainees at the Nuclear Regulatory Commission. Overview of NRC medical applications and medical use regulations. Understand the skills needed for physicists as regulators. Abogunde is funded to attend the meeting by her employer, the NRC.« less

  3. SU-A-210-03: Panel Discussion

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rodrigues, A.

    The purpose of this student annual meeting is to address topics that are becoming more relevant to medical physicists, but are not frequently addressed, especially for students and trainees just entering the field. The talk is divided into two parts: medical billing and regulations. Hsinshun Wu – Why should we learn radiation oncology billing? Many medical physicists do not like to be involved with medical billing or coding during their career. They believe billing is not their responsibility and sometimes they even refuse to participate in the billing process if given the chance. This presentation will talk about a physicist’smore » long career and share his own experience that knowing medical billing is not only important and necessary for every young medical physicist, but that good billing knowledge could provide a valuable contribution to his/her medical physics development. Learning Objectives: The audience will learn the basic definition of Current Procedural Terminology (CPT) codes performed in a Radiation Oncology Department. Understand the differences between hospital coding and physician-based or freestanding coding. Apply proper CPT coding for each Radiation Oncology procedure. Each procedure with its specific CPT code will be discussed in detail. The talk will focus on the process of care and use of actual workflow to understand each CPT code. Example coding of a typical Radiation Oncology procedure. Special procedure coding such as brachytherapy, proton therapy, radiosurgery, and SBRT. Maryann Abogunde – Medical physics opportunities at the Nuclear Regulatory Commission (NRC) The NRC’s responsibilities include the regulation of medical uses of byproduct (radioactive) materials and oversight of medical use end-users (licensees) through a combination of regulatory requirements, licensing, safety oversight including inspection and enforcement, operational experience evaluation, and regulatory support activities. This presentation will explore the career options for medical physicists in the NRC, how the NRC interacts with clinical medical physicists, and a physicist’s experience as a regulator. Learning Objectives: Explore non-clinical career pathways for medical physics students and trainees at the Nuclear Regulatory Commission. Overview of NRC medical applications and medical use regulations. Understand the skills needed for physicists as regulators. Abogunde is funded to attend the meeting by her employer, the NRC.« less

  4. SU-A-210-00: AAPM Medical Physics Student Meeting: Medical Billing and Regulations: Everything You Always Wanted To Know, But Were Too Afraid To Ask

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    NONE

    The purpose of this student annual meeting is to address topics that are becoming more relevant to medical physicists, but are not frequently addressed, especially for students and trainees just entering the field. The talk is divided into two parts: medical billing and regulations. Hsinshun Wu – Why should we learn radiation oncology billing? Many medical physicists do not like to be involved with medical billing or coding during their career. They believe billing is not their responsibility and sometimes they even refuse to participate in the billing process if given the chance. This presentation will talk about a physicist’smore » long career and share his own experience that knowing medical billing is not only important and necessary for every young medical physicist, but that good billing knowledge could provide a valuable contribution to his/her medical physics development. Learning Objectives: The audience will learn the basic definition of Current Procedural Terminology (CPT) codes performed in a Radiation Oncology Department. Understand the differences between hospital coding and physician-based or freestanding coding. Apply proper CPT coding for each Radiation Oncology procedure. Each procedure with its specific CPT code will be discussed in detail. The talk will focus on the process of care and use of actual workflow to understand each CPT code. Example coding of a typical Radiation Oncology procedure. Special procedure coding such as brachytherapy, proton therapy, radiosurgery, and SBRT. Maryann Abogunde – Medical physics opportunities at the Nuclear Regulatory Commission (NRC) The NRC’s responsibilities include the regulation of medical uses of byproduct (radioactive) materials and oversight of medical use end-users (licensees) through a combination of regulatory requirements, licensing, safety oversight including inspection and enforcement, operational experience evaluation, and regulatory support activities. This presentation will explore the career options for medical physicists in the NRC, how the NRC interacts with clinical medical physicists, and a physicist’s experience as a regulator. Learning Objectives: Explore non-clinical career pathways for medical physics students and trainees at the Nuclear Regulatory Commission. Overview of NRC medical applications and medical use regulations. Understand the skills needed for physicists as regulators. Abogunde is funded to attend the meeting by her employer, the NRC.« less

  5. SU-A-210-02: Medical Physics Opportunities at the NRC

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Abogunde, M.

    The purpose of this student annual meeting is to address topics that are becoming more relevant to medical physicists, but are not frequently addressed, especially for students and trainees just entering the field. The talk is divided into two parts: medical billing and regulations. Hsinshun Wu – Why should we learn radiation oncology billing? Many medical physicists do not like to be involved with medical billing or coding during their career. They believe billing is not their responsibility and sometimes they even refuse to participate in the billing process if given the chance. This presentation will talk about a physicist’smore » long career and share his own experience that knowing medical billing is not only important and necessary for every young medical physicist, but that good billing knowledge could provide a valuable contribution to his/her medical physics development. Learning Objectives: The audience will learn the basic definition of Current Procedural Terminology (CPT) codes performed in a Radiation Oncology Department. Understand the differences between hospital coding and physician-based or freestanding coding. Apply proper CPT coding for each Radiation Oncology procedure. Each procedure with its specific CPT code will be discussed in detail. The talk will focus on the process of care and use of actual workflow to understand each CPT code. Example coding of a typical Radiation Oncology procedure. Special procedure coding such as brachytherapy, proton therapy, radiosurgery, and SBRT. Maryann Abogunde – Medical physics opportunities at the Nuclear Regulatory Commission (NRC) The NRC’s responsibilities include the regulation of medical uses of byproduct (radioactive) materials and oversight of medical use end-users (licensees) through a combination of regulatory requirements, licensing, safety oversight including inspection and enforcement, operational experience evaluation, and regulatory support activities. This presentation will explore the career options for medical physicists in the NRC, how the NRC interacts with clinical medical physicists, and a physicist’s experience as a regulator. Learning Objectives: Explore non-clinical career pathways for medical physics students and trainees at the Nuclear Regulatory Commission. Overview of NRC medical applications and medical use regulations. Understand the skills needed for physicists as regulators. Abogunde is funded to attend the meeting by her employer, the NRC.« less

  6. Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

    PubMed Central

    Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

    2002-01-01

    Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice. Images p432-a PMID:12078924

  7. SU-A-210-01: Why Should We Learn Radiation Oncology Billing?

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wu, H.

    The purpose of this student annual meeting is to address topics that are becoming more relevant to medical physicists, but are not frequently addressed, especially for students and trainees just entering the field. The talk is divided into two parts: medical billing and regulations. Hsinshun Wu – Why should we learn radiation oncology billing? Many medical physicists do not like to be involved with medical billing or coding during their career. They believe billing is not their responsibility and sometimes they even refuse to participate in the billing process if given the chance. This presentation will talk about a physicist’smore » long career and share his own experience that knowing medical billing is not only important and necessary for every young medical physicist, but that good billing knowledge could provide a valuable contribution to his/her medical physics development. Learning Objectives: The audience will learn the basic definition of Current Procedural Terminology (CPT) codes performed in a Radiation Oncology Department. Understand the differences between hospital coding and physician-based or freestanding coding. Apply proper CPT coding for each Radiation Oncology procedure. Each procedure with its specific CPT code will be discussed in detail. The talk will focus on the process of care and use of actual workflow to understand each CPT code. Example coding of a typical Radiation Oncology procedure. Special procedure coding such as brachytherapy, proton therapy, radiosurgery, and SBRT. Maryann Abogunde – Medical physics opportunities at the Nuclear Regulatory Commission (NRC) The NRC’s responsibilities include the regulation of medical uses of byproduct (radioactive) materials and oversight of medical use end-users (licensees) through a combination of regulatory requirements, licensing, safety oversight including inspection and enforcement, operational experience evaluation, and regulatory support activities. This presentation will explore the career options for medical physicists in the NRC, how the NRC interacts with clinical medical physicists, and a physicist’s experience as a regulator. Learning Objectives: Explore non-clinical career pathways for medical physics students and trainees at the Nuclear Regulatory Commission. Overview of NRC medical applications and medical use regulations. Understand the skills needed for physicists as regulators. Abogunde is funded to attend the meeting by her employer, the NRC.« less

  8. The Nuremberg Code: its history and implications.

    PubMed

    Kious, B M

    2001-01-01

    The Nuremberg Code is a foundational document in the ethics of medical research and human experimentation; the principle its authors espoused in 1946 have provided the framework for modern codes that address the same issues, and have received little challenge and only slight modification in decades since. By analyzing the Code's tragic genesis and its normative implications, it is possible to understand some of the essence of modern experimental ethics, as well as certain outstanding controversies that still plague medical science.

  9. Medical ethics in an era of bioethics: resetting the medical profession's compass.

    PubMed

    Pellegrino, Edmund D

    2012-02-01

    What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This presentation summarizes the history of medical professionalism and refocuses attention on the interpersonal relationship of doctor and patient. This keynote address was delivered at the Founders of Bioethics International Congress (June, 2010).

  10. The Effects of Bar-coding Technology on Medication Errors: A Systematic Literature Review.

    PubMed

    Hutton, Kevin; Ding, Qian; Wellman, Gregory

    2017-02-24

    The bar-coding technology adoptions have risen drastically in U.S. health systems in the past decade. However, few studies have addressed the impact of bar-coding technology with strong prospective methodologies and the research, which has been conducted from both in-pharmacy and bedside implementations. This systematic literature review is to examine the effectiveness of bar-coding technology on preventing medication errors and what types of medication errors may be prevented in the hospital setting. A systematic search of databases was performed from 1998 to December 2016. Studies measuring the effect of bar-coding technology on medication errors were included in a full-text review. Studies with the outcomes other than medication errors such as efficiency or workarounds were excluded. The outcomes were measured and findings were summarized for each retained study. A total of 2603 articles were initially identified and 10 studies, which used prospective before-and-after study design, were fully reviewed in this article. Of the 10 included studies, 9 took place in the United States, whereas the remaining was conducted in the United Kingdom. One research article focused on bar-coding implementation in a pharmacy setting, whereas the other 9 focused on bar coding within patient care areas. All 10 studies showed overall positive effects associated with bar-coding implementation. The results of this review show that bar-coding technology may reduce medication errors in hospital settings, particularly on preventing targeted wrong dose, wrong drug, wrong patient, unauthorized drug, and wrong route errors.

  11. The Nuremberg Code and the Nuremberg Trial. A reappraisal.

    PubMed

    Katz, J

    1996-11-27

    The Nuremberg Code includes 10 principles to guide physician-investigators in experiments involving human subjects. These principles, particularly the first principle on "voluntary consent," primarily were based on legal concepts because medical codes of ethics existent at the time of the Nazi atrocities did not address consent and other safeguards for human subjects. The US judges who presided over the proceedings did not intend the Code to apply only to the case before them, to be a response to the atrocities committed by the Nazi physicians, or to be inapplicable to research as it is customarily carried on in medical institutions. Instead, a careful reading of the judgment suggests that they wrote the Code for the practice of human experimentation whenever it is being conducted.

  12. Creating a culture of mutual respect.

    PubMed

    Kaplan, Kathryn; Mestel, Pamela; Feldman, David L

    2010-04-01

    The Joint Commission mandates that hospitals seeking accreditation have a process to define and address disruptive behavior. Leaders at Maimonides Medical Center, Brooklyn, New York, took the initiative to create a code of mutual respect that not only requires respectful behavior, but also encourages sensitivity and awareness to the causes of frustration that often lead to inappropriate behavior. Steps to implementing the code included selecting code advocates, setting up a system for mediating disputes, tracking and addressing operational system issues, providing training for personnel, developing a formal accountability process, and measuring the results. Copyright 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  13. Role of Cyclin E as an Early Event in Ovarian Carcinogenesis

    DTIC Science & Technology

    2010-04-01

    PERFORMING ORGANIZATION NAME(S) AND ADDRESS( ES ) 8. PERFORMING ORGANIZATION REPORT NUMBER Cedars-Sinai Medical Center Los Angeles, CA...90048-9004 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS( ES ) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research...a. REPORT U b. ABSTRACT U c . THIS PAGE U UU 30 19b. TELEPHONE NUMBER (include area code) Standard Form 298 (Rev. 8-98) Prescribed by

  14. Mechanism of Cytotoxicity of the AIDS Virus, HTLV-III/LAV

    DTIC Science & Technology

    1989-05-21

    distribution unlimited 4. PERFORMING OR3ANIZATION REPORT NUMBER(S) S. MONITORING ORGANIZATION REPORT NUMBER($) 143-065-3611-Al 6s. NAME OF PERFORMING... ORGANIZATION 6b. OFFICE SYMBOL 7a. NAME Of MONITORING ORGANIZATIONj (I aI cb) Washinton University k€. ADORESS (City, State, and ZIP Code) 7b. ADDRESS...IDENTIFICATION NUMBER ORGANIZATiON U.S. Army Medical (if awible) Resch. & Development Command DArJM-17-87-C-7101 Sc. ADDRESS (Oil, State, and ZIP Code

  15. Managing perceived conflicts of interest while ensuring the continued innovation of medical technology.

    PubMed

    Van Haute, Andrew

    2011-09-01

    If it were not for the ongoing collaboration between vascular surgeons and the medical technology industry, many of these advanced treatments used every day in vascular interventional surgery would not exist. The flip side of this coin is that these vital relationships create multiple roles for surgeons and must be appropriately managed. The dynamic process of innovation, along with factors such as product delivery technique refinement, education, testing and clinical trials, and product support, all make it necessary for ongoing and close collaboration between surgeons and the device industry. This unique relationship sometimes leads to the perception of conflicts of interest for physicians, in part because the competing pressures from the multiple, overlapping roles as clinician/caregiver/investigator/innovator/customer are significant. To address this issue, the Advanced Medical Technology Association (AdvaMed), the nation's largest medical technology association representing medical device and diagnostics companies, developed a Code of Ethics to guide medical technology companies in their interactions with health care professionals. First introduced in 1993, the AdvaMed Code strongly encourages both industry and physicians to commit to openness and high ethical standards in the conduct of their business interactions. The AdvaMed Code addresses many of the types of interactions that can occur between companies and health care professionals, including training, consulting agreements, the provision of demonstration and evaluation units, and charitable donations. By following the Code, companies send a strong message that treatment decisions must always be based on the best interest of the patient. Copyright © 2011. Published by Mosby, Inc.

  16. 78 FR 21612 - Medical Device Classification Product Codes; Guidance for Industry and Food and Drug...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-11

    ... (CDRH) and the Center for Biologics Evaluation and Research (CBER). DATES: Submit either electronic or...-addressed adhesive label to assist that office in processing your request, or fax your request to CDRH at... CDRH's Classification Product Code structure and organization. These 16 Panels have largely been the...

  17. Information quality measurement of medical encoding support based on usability.

    PubMed

    Puentes, John; Montagner, Julien; Lecornu, Laurent; Cauvin, Jean-Michel

    2013-12-01

    Medical encoding support systems for diagnoses and medical procedures are an emerging technology that begins to play a key role in billing, reimbursement, and health policies decisions. A significant problem to exploit these systems is how to measure the appropriateness of any automatically generated list of codes, in terms of fitness for use, i.e. their quality. Until now, only information retrieval performance measurements have been applied to estimate the accuracy of codes lists as quality indicator. Such measurements do not give the value of codes lists for practical medical encoding, and cannot be used to globally compare the quality of multiple codes lists. This paper defines and validates a new encoding information quality measure that addresses the problem of measuring medical codes lists quality. It is based on a usability study of how expert coders and physicians apply computer-assisted medical encoding. The proposed measure, named ADN, evaluates codes Accuracy, Dispersion and Noise, and is adapted to the variable length and content of generated codes lists, coping with limitations of previous measures. According to the ADN measure, the information quality of a codes list is fully represented by a single point, within a suitably constrained feature space. Using one scheme, our approach is reliable to measure and compare the information quality of hundreds of codes lists, showing their practical value for medical encoding. Its pertinence is demonstrated by simulation and application to real data corresponding to 502 inpatient stays in four clinic departments. Results are compared to the consensus of three expert coders who also coded this anonymized database of discharge summaries, and to five information retrieval measures. Information quality assessment applying the ADN measure showed the degree of encoding-support system variability from one clinic department to another, providing a global evaluation of quality measurement trends. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  18. Release of Iron from Hemoglobin

    DTIC Science & Technology

    1993-02-17

    Medical Research and Development Division of Blood Research SGRD-ULY-BRP Command 6C. ADDRESS KCay. State, And ZIP Code) 7b. ADDRESS (Cjry. Stitt, and...17]. 28. D. P. Derman, A. Green, T. H. Bothwell, B. Graham, L. McNamara, A. P. MacPhail and R. D. Baynes . Ann. Clin. Biochem. 26, 144; 1989. 29. W. W

  19. Codes of medical ethics: traditional foundations and contemporary practice.

    PubMed

    Sohl, P; Bassford, H A

    1986-01-01

    The Hippocratic Coprus recognized the interaction of 'business' and patient-health moral considerations, and urged that the former be subordinated to the latter. During the 1800s with the growth of complexity in both scientific knowledge and the organization of health services, the medical ethical codes addressed themselves to elaborate rules of conduct to be followed by the members of the newly emerging national medical associations. After World War II the World Medical Association was established as an international forum where national medical associations could debate the ethical problems presented by modern medicine. The International Code of Medical ethics and the Declaration of Geneva were written as 20th century restatements of the medical profession's commitment to the sovereignty of the patient-care norm. Many ethical statements have been issued by the World Medical Association in the past 35 years; they show the variety and difficulties of contemporary medical practice. The newest revisions were approved by the General Assembly of the World Medical Association in Venice, Italy October 1983. Their content is examined and concern is voiced about the danger of falling into cultural relativism when questions about the methods of financing medical services are the subject of an ethical declaration which is arrived at by consensus in the W.M.A.

  20. Living with chronic pain: Evaluating patient experiences with a medical group visit focused on mindfulness and non-pharmacological strategies.

    PubMed

    Lestoquoy, Anna Sophia; Laird, Lance D; Mitchell, Suzanne; Gergen-Barnett, Katherine; Negash, N Lily; McCue, Kelly; Enad, Racquel; Gardiner, Paula

    2017-12-01

    Little is known about the acceptance of non-pharmacological group strategies delivered to low income racially diverse patients with chronic pain and depression. This paper examines how the Integrative Medical Group Visit (IMGV) addresses many of the deficits identified with usual care. Six IMGVs cohorts were held at a safety net hospital and two federally funded community health centres. Data was gathered through focus groups. Transcripts were analysed using both a priori codes and inductive coding. The intervention included ten sessions of Integrative Medical Group Visits with a primary care provider and a meditation instructor. The curriculum uses principles of Mindfulness Based Stress Reduction and evidence based integrative medicine. The visit is structured similarly to other group medical visits. Data was gathered through four focus groups held after the cohorts were completed. Participants (N=20) were largely low income minority adults with chronic pain and comorbid depression. Six themes emerged from the coding including: chronic pain is isolating; group treatment contributes to better coping with pain; loss of control and autonomy because of the unpredictability of pain as well as dependence on medication and frequent medical appointments; groups improve agency and control over one's health condition; navigating the healthcare system and unsatisfactory treatment options; and changes after the IMGV due to non-pharmacological health management. The IMGV is a promising format of delivering integrative care for chronic pain and depression which addresses many of the problems identified by patients in usual care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Frequency of GP communication addressing the patient's resources and coping strategies in medical interviews: a video-based observational study.

    PubMed

    Mjaaland, Trond A; Finset, Arnstein

    2009-07-01

    There is increasing focus on patient-centred communicative approaches in medical consultations, but few studies have shown the extent to which patients' positive coping strategies and psychological assets are addressed by general practitioners (GPs) on a regular day at the office. This study measures the frequency of GPs' use of questions and comments addressing their patients' coping strategies or resources. Twenty-four GPs were video-recorded in 145 consultations. The consultations were coded using a modified version of the Roter Interaction Analysis System. In this study, we also developed four additional coding categories based on cognitive therapy and solution-focused therapy: attribution, resources, coping, and solution-focused techniques.The reliability between coders was established, a factor analysis was applied to test the relationship between the communication categories, and a tentative validating exercise was performed by reversed coding. Cohen's kappa was 0.52 between coders. Only 2% of the utterances could be categorized as resource or coping oriented. Six GPs contributed 59% of these utterances. The factor analysis identified two factors, one task oriented and one patient oriented. The frequency of communication about coping and resources was very low. Communication skills training for GPs in this field is required. Further validating studies of this kind of measurement tool are warranted.

  2. [Status of health psychology teaching in Chilean schools of medicine].

    PubMed

    Santander, Jaime T; Pinedo, José P; Repetto, Paula L

    2012-07-01

    Physicians should be exposed, during their training to basic concepts in psychology. To describe the current status of the formal teaching of health psychology or medical psychology in Chilean medical schools. We reviewed the programs of the courses including topics of Medical Psychology, Health Psychology and Behavioral Medicine at 18 medical schools in Chile, using a focused coding method. The contents and the time spent on these courses were considered and analyzed. Eighty three percent of medical schools have a Medical Psychology or related program, 56.3% are carried out during the first year of medical School teaching and the weekly load has an average of 4 hours. The contents are mixed and predominantly concerning general and developmental psychology, but also address specific issues of Medical Psychology in most cases. There is little clarity about the training issues to be addressed in medical psychology for medical students in Chile. It is necessary to define the minimum content that all medical graduates should learn.

  3. ClinicalCodes: an online clinical codes repository to improve the validity and reproducibility of research using electronic medical records.

    PubMed

    Springate, David A; Kontopantelis, Evangelos; Ashcroft, Darren M; Olier, Ivan; Parisi, Rosa; Chamapiwa, Edmore; Reeves, David

    2014-01-01

    Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR studies, build on previous code lists and compare disease definitions across studies. It will also assist health informaticians in replicating database studies, tracking changes in disease definitions or clinical coding practice through time and sharing clinical code information across platforms and data sources as research objects.

  4. ClinicalCodes: An Online Clinical Codes Repository to Improve the Validity and Reproducibility of Research Using Electronic Medical Records

    PubMed Central

    Springate, David A.; Kontopantelis, Evangelos; Ashcroft, Darren M.; Olier, Ivan; Parisi, Rosa; Chamapiwa, Edmore; Reeves, David

    2014-01-01

    Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR studies, build on previous code lists and compare disease definitions across studies. It will also assist health informaticians in replicating database studies, tracking changes in disease definitions or clinical coding practice through time and sharing clinical code information across platforms and data sources as research objects. PMID:24941260

  5. Air Medical Evacuations of Soldiers for Oral-facial Disease and Injuries, Operations Enduring Freedom/Iraqi Freedom, January-December 2006

    DTIC Science & Technology

    2006-12-01

    COL Timothy A Mitchener, DC USA 5e. TASK NUMBER 6. AUTHOR( S ) 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) 8...SPONSORING/MONITORING AGENCY NAME( S ) AND 10. SPONSOR/MONITOR’S ACRONYM( S ) ADDRESS(ES) 11. SPONSOR/MONITOR’S REPORT NUMBER( S ) 12. DISTRIBUTION/AVAILABILITY...NATO) Standardization Agreement (STANAG), 5th edition, coding scheme. (See P.J. Amoroso, G.S. Smith, and N.S. Bell : Qualitative assessment of cause

  6. Scientific journals and conflict of interest disclosure: what progress has been made?

    PubMed

    Ruff, Kathleen

    2015-05-30

    The article addresses the failure of the scientific community to create an effective mechanism to protect the integrity of the scientific literature from improper influence by vested interests. The seriousness of this threat is increasingly recognized. Scientists willing to distort scientific research to serve vested interests receive millions of dollars for their services. Organizations such as the International Committee of Medical Journal Editors, the World Association of Medical Editors and the Committee on Publication Ethics (COPE) have launched initiatives to establish international standards for Conflict of Interest (COI) disclosure. COPE requires its 7,000 member journals to comply with its Code of Conduct for Journal Editors. While these initiatives are encouraging, they are internal educational endeavours only. Five examples are given showing failure of COPE member journals to comply with COPE's Code of Conduct. While COPE offers a complaint process, it involves only discussion and voluntary compliance. COPE neither polices nor enforces its Code. Instead of the current feeble, un-resourced process, which delivers neither transparency nor accountability, the article proposes the creation of a mechanism that will employ specific, effective measures to address contraventions of COI disclosure requirements.

  7. Evaluating training of screening, brief intervention, and referral to treatment (SBIRT) for substance use: Reliability of the MD3 SBIRT Coding Scale.

    PubMed

    DiClemente, Carlo C; Crouch, Taylor Berens; Norwood, Amber E Q; Delahanty, Janine; Welsh, Christopher

    2015-03-01

    Screening, brief intervention, and referral to treatment (SBIRT) has become an empirically supported and widely implemented approach in primary and specialty care for addressing substance misuse. Accordingly, training of providers in SBIRT has increased exponentially in recent years. However, the quality and fidelity of training programs and subsequent interventions are largely unknown because of the lack of SBIRT-specific evaluation tools. The purpose of this study was to create a coding scale to assess quality and fidelity of SBIRT interactions addressing alcohol, tobacco, illicit drugs, and prescription medication misuse. The scale was developed to evaluate performance in an SBIRT residency training program. Scale development was based on training protocol and competencies with consultation from Motivational Interviewing coding experts. Trained medical residents practiced SBIRT with standardized patients during 10- to 15-min videotaped interactions. This study included 25 tapes from the Family Medicine program coded by 3 unique coder pairs with varying levels of coding experience. Interrater reliability was assessed for overall scale components and individual items via intraclass correlation coefficients. Coder pair-specific reliability was also assessed. Interrater reliability was excellent overall for the scale components (>.85) and nearly all items. Reliability was higher for more experienced coders, though still adequate for the trained coder pair. Descriptive data demonstrated a broad range of adherence and skills. Subscale correlations supported concurrent and discriminant validity. Data provide evidence that the MD3 SBIRT Coding Scale is a psychometrically reliable coding system for evaluating SBIRT interactions and can be used to evaluate implementation skills for fidelity, training, assessment, and research. Recommendations for refinement and further testing of the measure are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  8. American Academy of Neurology policy on pharmaceutical and device industry support.

    PubMed

    Hutchins, J C; Rydell, C M; Griggs, R C; Sagsveen, M; Bernat, J L

    2012-03-06

    To examine the American Academy of Neurology (AAN)'s prevention and limitation of conflicts of interest (COI) related to relationships with pharmaceutical and medical device manufacturers and other medically related commercial product and service companies (industry). We reviewed the AAN's polices governing its interactions with industry, mechanisms for enforcement, and the recent findings of the board-appointed COI task force, in the context of the 2009 David Rothman and colleagues' article in JAMA, the Council of Medical Specialty Societies (CMSS) Code for Interactions with Companies (Code), efforts of the American Medical Association in this area, and increased public and Congressional scrutiny of physician/physician organizations' relationships with industry. The AAN's Policy on Conflicts of Interest provides 4 mechanisms for addressing COI: avoidance, separation, disclosure, and regulation. The AAN's Principles Governing Academy Relationships with External Sources of Support, including recent amendments proposed by the COI task force, regulate industry interaction with AAN programming, products, and leadership. With the Policy, Principles, and other methods of COI prevention, the AAN meets or exceeds all recommendations of the CMSS Code. With its adherence to the Principles since 2004, the AAN has been a leader among professional medical associations in appropriately managing COI related to interactions with industry. Recent amendments to the Principles maintain the AAN's position as a leader in a time of increased public scrutiny of physicians' and professional medical associations' relationships with industry. The AAN is responsive to the recommendations of the COI task force, and has adopted the CMSS Code.

  9. ICD-10 procedure codes produce transition challenges.

    PubMed

    Boyd, Andrew D; Li, Jianrong 'John'; Kenost, Colleen; Zaim, Samir Rachid; Krive, Jacob; Mittal, Manish; Satava, Richard A; Burton, Michael; Smith, Jacob; Lussier, Yves A

    2018-01-01

    The transition of procedure coding from ICD-9-CM-Vol-3 to ICD-10-PCS has generated problems for the medical community at large resulting from the lack of clarity required to integrate two non-congruent coding systems. We hypothesized that quantifying these issues with network topology analyses offers a better understanding of the issues, and therefore we developed solutions (online tools) to empower hospital administrators and researchers to address these challenges. Five topologies were identified: "identity"(I), "class-to-subclass"(C2S), "subclass-toclass"(S2C), "convoluted(C)", and "no mapping"(NM). The procedure codes in the 2010 Illinois Medicaid dataset (3,290 patients, 116 institutions) were categorized as C=55%, C2S=40%, I=3%, NM=2%, and S2C=1%. Majority of the problematic and ambiguous mappings (convoluted) pertained to operations in ophthalmology cardiology, urology, gyneco-obstetrics, and dermatology. Finally, the algorithms were expanded into a user-friendly tool to identify problematic topologies and specify lists of procedural codes utilized by medical professionals and researchers for mitigating error-prone translations, simplifying research, and improving quality.http://www.lussiergroup.org/transition-to-ICD10PCS.

  10. Analysis of readability and quality of web pages addressing both common and uncommon topics in pediatric surgery.

    PubMed

    Adorisio, Ottavio; Silveri, Massimiliano; Rivosecchi, Massimo; Tozzi, Alberto Eugenio; Scottoni, Federico; Buonuomo, Paola Sabrina

    2012-06-01

    The quality medical information on Internet is highly variable. The aim of this study is to determine if Web pages addressing four common pediatric surgical topics (CT) and four uncommon pediatric surgical topics (UT) differ significantly in terms of quality and/or characteristics. We performed an Internet search regarding four CT, addressing more frequent clinical conditions with an incidence≤1:1.500 children (inguinal hernia, varicocele, umbilical hernia, and phimosis) and four UT addressing less frequent clinical conditions with an incidence≥1:1.500 children (anorectal malformation, intestinal atresia, gastroschisis, and omphalocele), using a popular search engine (Google). We evaluated readability with the Flesch reading ease (FRE) and the Flesch-Kincaid grade (FKG) and quality of content using the site checker of the HON Code of Conduct (HON code) for each website. In this study, 30/40 websites addressing CT versus 33/50 addressing UT responded to our criteria. No differences statistically significant in advertisements between the two groups were found (15 vs. 16%) (p>0.05). No differences were found in terms of time from last update, owner/author type, financial disclosure, accreditation, or advertising. CT had higher quality level according to the HON code (6.54±1.38 vs. 5.05±1.82) (p<0.05). Mean FRE was 47.38±14.27 versus 46.24±14.56, respectively, for CT and UT (p>0.05). The mean FKG was 8.1±1.9 for CT versus 8±1.9 for UT (p>0.05). Websites devoted to pediatric surgical topics have higher readability and quality information for disease diagnosis and natural history. Otherwise, the quality of pediatric surgical information on the Internet is high for CT and UT. A high reading level is required to use these resources. Copyright © 2012 by Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  11. Health sciences librarians' awareness and assessment of the Medical Library Association Code of Ethics for Health Sciences Librarianship: the results of a membership survey.

    PubMed

    Byrd, Gary D; Devine, Patricia J; Corcoran, Kate E

    2014-10-01

    The Medical Library Association (MLA) Board of Directors and president charged an Ethical Awareness Task Force and recommended a survey to determine MLA members' awareness of and opinions about the current Code of Ethics for Health Sciences Librarianship. THE TASK FORCE AND MLA STAFF CRAFTED A SURVEY TO DETERMINE: (1) awareness of the MLA code and its provisions, (2) use of the MLA code to resolve professional ethical issues, (3) consultation of other ethical codes or guides, (4) views regarding the relative importance of the eleven MLA code statements, (5) challenges experienced in following any MLA code provisions, and (6) ethical problems not clearly addressed by the code. Over 500 members responded (similar to previous MLA surveys), and while most were aware of the code, over 30% could not remember when they had last read or thought about it, and nearly half had also referred to other codes or guidelines. The large majority thought that: (1) all code statements were equally important, (2) none were particularly difficult or challenging to follow, and (3) the code covered every ethical challenge encountered in their professional work. Comments provided by respondents who disagreed with the majority views suggest that the MLA code could usefully include a supplementary guide with practical advice on how to reason through a number of ethically challenging situations that are typically encountered by health sciences librarians.

  12. Health sciences librarians' awareness and assessment of the Medical Library Association Code of Ethics for Health Sciences Librarianship: the results of a membership survey

    PubMed Central

    Byrd, Gary D.; Devine, Patricia J.; Corcoran, Kate E.

    2014-01-01

    Objective: The Medical Library Association (MLA) Board of Directors and president charged an Ethical Awareness Task Force and recommended a survey to determine MLA members' awareness of and opinions about the current Code of Ethics for Health Sciences Librarianship. Methods: The task force and MLA staff crafted a survey to determine: (1) awareness of the MLA code and its provisions, (2) use of the MLA code to resolve professional ethical issues, (3) consultation of other ethical codes or guides, (4) views regarding the relative importance of the eleven MLA code statements, (5) challenges experienced in following any MLA code provisions, and (6) ethical problems not clearly addressed by the code. Results: Over 500 members responded (similar to previous MLA surveys), and while most were aware of the code, over 30% could not remember when they had last read or thought about it, and nearly half had also referred to other codes or guidelines. The large majority thought that: (1) all code statements were equally important, (2) none were particularly difficult or challenging to follow, and (3) the code covered every ethical challenge encountered in their professional work. Implications: Comments provided by respondents who disagreed with the majority views suggest that the MLA code could usefully include a supplementary guide with practical advice on how to reason through a number of ethically challenging situations that are typically encountered by health sciences librarians. PMID:25349544

  13. New ethical code reflects expectations for industry behavior.

    PubMed

    Bailey, Pamela G

    2005-07-01

    Sporadic misbehavior, suspect sales and marketing practices, and the perceived deep pockets of the health care industry have put corporations and physicians alike at risk for investigation for fraud and abuse misconduct. The Advanced Medical Technology Association's (AdvaMed) Code of Ethics on Interactions with Healthcare Professionals addresses interactions between the technology industry and physicians, recommending appropriate behavior for partners engaged in developing, testing, learning, and applying often complex technical innovations. As this discussion shows, AdvaMed's industry code underscores uniformity between the drug and technology industries where similarities exist yet sets a distinct course where the needs of the two industries diverge. Health care professionals must be keenly aware of the differences and similarities of the overlapping codes of conducts. Provisions for allowable financial support for third-party conferences, sales and promotional meetings, industry-sponsored educational and training meetings, consulting arrangements, gifts to physicians, reimbursement for technical information, and charitable donations are all examined within the AdvaMed code of ethics and compared against codes and compliance guidance adopted by the American Medical Association; the Pharmaceutical Research and Manufacturers of America; and the US Department of Health and Human Services; Office of Inspector General.

  14. Initial development of the Systems Approach to Home Medication Management (SAHMM) model.

    PubMed

    Doucette, William R; Vinel, Shanrae'l; Pennathur, Priyadarshini

    Adverse drug events and medication nonadherence are two problems associated with prescription medication use for chronic conditions. These issues often develop because patients have difficulty managing their medications at home. To guide patients and providers for achieving safe and effective medication use at home, the Systems Approach to Home Medication Management (SAHMM) model was derived from a systems engineering model for health care workplace safety. To explore how well concepts from the SAHMM model can represent home medication management by using patient descriptions of how they take prescription medications at home. Twelve patients were interviewed about home medication management using an interview guide based on the factors of the SAHMM model. Each interview was audio-taped and then transcribed verbatim. Interviews were coded to identify themes for home medication management using MAXQDA for Windows. SAHMM concepts extracted from the coded interview transcripts included work system components of person, tasks, tools & technology, internal environment, external environment, and household. Concepts also addressed work processes and work outcomes for home medication management. Using the SAHMM model for studying patients' home medication management is a promising approach to improving our understanding of the factors that influence patient adherence to medication and the development of adverse drug events. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Emergency department discharge prescription errors in an academic medical center

    PubMed Central

    Belanger, April; Devine, Lauren T.; Lane, Aaron; Condren, Michelle E.

    2017-01-01

    This study described discharge prescription medication errors written for emergency department patients. This study used content analysis in a cross-sectional design to systematically categorize prescription errors found in a report of 1000 discharge prescriptions submitted in the electronic medical record in February 2015. Two pharmacy team members reviewed the discharge prescription list for errors. Open-ended data were coded by an additional rater for agreement on coding categories. Coding was based upon majority rule. Descriptive statistics were used to address the study objective. Categories evaluated were patient age, provider type, drug class, and type and time of error. The discharge prescription error rate out of 1000 prescriptions was 13.4%, with “incomplete or inadequate prescription” being the most commonly detected error (58.2%). The adult and pediatric error rates were 11.7% and 22.7%, respectively. The antibiotics reviewed had the highest number of errors. The highest within-class error rates were with antianginal medications, antiparasitic medications, antacids, appetite stimulants, and probiotics. Emergency medicine residents wrote the highest percentage of prescriptions (46.7%) and had an error rate of 9.2%. Residents of other specialties wrote 340 prescriptions and had an error rate of 20.9%. Errors occurred most often between 10:00 am and 6:00 pm. PMID:28405061

  16. Medical decision making: guide to improved CPT coding.

    PubMed

    Holt, Jim; Warsy, Ambreen; Wright, Paula

    2010-04-01

    The Current Procedural Terminology (CPT) coding system for office visits, which has been in use since 1995, has not been well studied, but it is generally agreed that the system contains much room for error. In fact, the available literature suggests that only slightly more than half of physicians will agree on the same CPT code for a given visit, and only 60% of professional coders will agree on the same code for a particular visit. In addition, the criteria used to assign a code are often related to the amount of written documentation. The goal of this study was to evaluate two novel methods to assess if the most appropriate CPT code is used: the level of medical decision making, or the sum of all problems mentioned by the patient during the visit. The authors-a professional coder, a residency faculty member, and a PGY-3 family medicine resident-reviewed 351 randomly selected visit notes from two residency programs in the Northeast Tennessee region for the level of documentation, the level of medical decision making, and the total number of problems addressed. The authors assigned appropriate CPT codes at each of those three levels. Substantial undercoding occurred at each of the three levels. Approximately 33% of visits were undercoded based on the written documentation. Approximately 50% of the visits were undercoded based on the level of documented medical decision making. Approximately 80% of the visits were undercoded based on the total number of problems which the patient presented during the visit. Interrater agreement was fair, and similar to that noted in other coding studies. Undercoding is not only common in a family medicine residency program but it also occurs at levels that would not be evident from a simple audit of the documentation on the visit note. Undercoding also occurs from not exploring problems mentioned by the patient and not documenting additional work that was performed. Family physicians may benefit from minor alterations in their documentation of office visit notes.

  17. ICD-10 procedure codes produce transition challenges

    PubMed Central

    Boyd, Andrew D.; Li, Jianrong ‘John’; Kenost, Colleen; Zaim, Samir Rachid; Krive, Jacob; Mittal, Manish; Satava, Richard A.; Burton, Michael; Smith, Jacob; Lussier, Yves A.

    2018-01-01

    The transition of procedure coding from ICD-9-CM-Vol-3 to ICD-10-PCS has generated problems for the medical community at large resulting from the lack of clarity required to integrate two non-congruent coding systems. We hypothesized that quantifying these issues with network topology analyses offers a better understanding of the issues, and therefore we developed solutions (online tools) to empower hospital administrators and researchers to address these challenges. Five topologies were identified: “identity”(I), “class-to-subclass”(C2S), “subclass-toclass”(S2C), “convoluted(C)”, and “no mapping”(NM). The procedure codes in the 2010 Illinois Medicaid dataset (3,290 patients, 116 institutions) were categorized as C=55%, C2S=40%, I=3%, NM=2%, and S2C=1%. Majority of the problematic and ambiguous mappings (convoluted) pertained to operations in ophthalmology cardiology, urology, gyneco-obstetrics, and dermatology. Finally, the algorithms were expanded into a user-friendly tool to identify problematic topologies and specify lists of procedural codes utilized by medical professionals and researchers for mitigating error-prone translations, simplifying research, and improving quality.http://www.lussiergroup.org/transition-to-ICD10PCS PMID:29888037

  18. From Interdisciplinary to Integrated Care of the Child with Autism: The Essential Role for a Code of Ethics

    ERIC Educational Resources Information Center

    Cox, David J.

    2012-01-01

    To address the developmental deficits of children with autism, several disciplines have come to the forefront within intervention programs. These are speech-pathologists, psychologists/counselors, occupational-therapists/physical-therapists, special-education consultants, behavior analysts, and physicians/medical personnel. As the field of autism…

  19. Redefining "Medical Care."

    PubMed

    Roth, Lauren R

    President Donald J. Trump has said he will repeal the Affordable Care Act (ACA) and replace it with health savings accounts (HSAs). Conservatives have long preferred individual accounts to meet social welfare needs instead of more traditional entitlement programs. The types of "medical care" that can be reimbursed through an HSA are listed in section 213(d) of the Internal Revenue Code (Code) and include expenses "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." In spite of the broad language, regulations and court interpretations have narrowed this definition substantially. It does not include the many social factors that determine health outcomes. Though the United States spends over seventeen percent of gross domestic product (GDP) on "healthcare", the country's focus on the traditional medicalized model of health results in overall population health that is far beneath the results of other countries that spend significantly less. Precision medicine is one exceptional way in which American healthcare has focused more on individuals instead of providing broad, one-size-fits-all medical care. The precision medicine movement calls for using the genetic code of individuals to both predict future illness and to target treatments for current illnesses. Yet the definition of "medical care" under the Code remains the same for all. My proposal for precision healthcare accounts involves two steps-- the first of which requires permitting physicians to write prescriptions for a broader range of goods and services. The social determinants of health are as important to health outcomes as are surgical procedures and drugs--or perhaps more so according to many population health studies. The second step requires agencies and courts to interpret what constitutes "medical care" under the Code differently depending on the taxpayer's income level. Childhood sports programs and payments for fruits and vegetables may be covered for those in the lower income brackets who could not otherwise afford these items and would not choose to spend scarce resources on them if they could. This all assumes that the government takes funds previously used to subsidize the purchase of health insurance under the ACA (or allocates new funds) and puts the funds in individual accounts so the poor or near poor have money to pay for these expenses. Section I of this Article will explore the current definition of medical care, which excludes the social determinants of health from "healthcare" spending. I then address how precision medicine has changed the types of services and treatments that it makes sense to reimburse for each individual. If efficacy can vary from person to person based on genetic code, then it also can vary depending on environment. There is an opportunity to not only vary the types of "medical care" that can be reimbursed or deducted within the traditional range of services and drugs, but also outside of that range. Section II addresses the historical shift towards health financing through individual accounts, and specifically through HSAs. If this is the only avenue for health reform in the next few years, I advocate using it to engage in the type of experiments that are typically only possible under the cover of tax expenditures. My proposal for precision healthcare accounts moves the government to experiment with individual social spending that can lead to improved overall health outcomes. Finally, in Section III, I address two dichotomies that affect any healthcare proposal: (1) entitlement programs v. grants-in-aid, and (2) pooled insurance v. consumer-driven health plans (CDHPs). In the end, I argue that an entitlement method of funding precision HSAs along with pooled insurance subsidized by the government is the most realistic resolution to these dichotomies. Only a broad-based entitlement to funding for all healthcare expenses (medical and social) allows for significant improvements in overall population health.

  20. Ethical Challenges of Medicine and Health on the Internet: A Review

    PubMed Central

    2001-01-01

    Knowledge and capabilities, particularly of a new technology or in a new area of study, frequently develop faster than the guidelines and principles needed for practitioners to practice ethically in the new arena; this is particularly true in medicine. The blending of medicine and healthcare with e-commerce and the Internet raises many questions involving what sort of ethical conduct should be expected by practitioners and developers of the medical Internet. Some of the early pioneers in medical and healthcare Web sites pushed the ethical boundaries with questionable, even unethical, practices. Many involved with the medical Internet are now working to reestablish patient and consumer trust by establishing guidelines to determine how the fundamentals of the medical code of ethical conduct can best be adapted for the medical/healthcare Internet. Ultimately, all those involved in the creation, maintenance, and marketing of medical and healthcare Web sites should be required to adhere to a strict code of ethical conduct, one that has been fairly determined by an impartial international organization with reasonable power to regulate the code. This code could also serve as a desirable, recognizable label-of-distinction for ethical Web sites within the medical and healthcare Internet community. One challenge for those involved with the medical and healthcare Internet will be to determine what constitutes "Medical Internet Ethics" or "Healthcare Internet Ethics," since the definition of medical ethics can vary from country to country. Therefore, the emerging field of Medical/ Healthcare Internet Ethics will require careful thought and insights from an international collection of ethicists in many contributing areas. This paper is a review of the current status of the evolving field of Medical/Healthcare Internet Ethics, including proposed definitions and identification of many diverse areas that may ultimately contribute to this multidisciplinary field. The current role that medicine and health play in the growing area of Internet communication and commerce and many of the ethical challenges raised by the Internet for the medical community are explored and some possible ways to address these ethical challenges are postulated. PMID:11720965

  1. Ethical challenges of medicine and health on the Internet: a review.

    PubMed

    Dyer, K A

    2001-01-01

    Knowledge and capabilities, particularly of a new technology or in a new area of study, frequently develop faster than the guidelines and principles needed for practitioners to practice ethically in the new arena; this is particularly true in medicine. The blending of medicine and healthcare with e-commerce and the Internet raises many questions involving what sort of ethical conduct should be expected by practitioners and developers of the medical Internet. Some of the early pioneers in medical and healthcare Web sites pushed the ethical boundaries with questionable, even unethical, practices. Many involved with the medical Internet are now working to reestablish patient and consumer trust by establishing guidelines to determine how the fundamentals of the medical code of ethical conduct can best be adapted for the medical/healthcare Internet. Ultimately, all those involved in the creation, maintenance, and marketing of medical and healthcare Web sites should be required to adhere to a strict code of ethical conduct, one that has been fairly determined by an impartial international organization with reasonable power to regulate the code. This code could also serve as a desirable, recognizable label-of-distinction for ethical Web sites within the medical and healthcare Internet community. One challenge for those involved with the medical and healthcare Internet will be to determine what constitutes "Medical Internet Ethics" or "Healthcare Internet Ethics," since the definition of medical ethics can vary from country to country. Therefore, the emerging field of Medical/ Healthcare Internet Ethics will require careful thought and insights from an international collection of ethicists in many contributing areas. This paper is a review of the current status of the evolving field of Medical/Healthcare Internet Ethics, including proposed definitions and identification of many diverse areas that may ultimately contribute to this multidisciplinary field. The current role that medicine and health play in the growing area of Internet communication and commerce and many of the ethical challenges raised by the Internet for the medical community are explored and some possible ways to address these ethical challenges are postulated.

  2. The Italian Code of Medical Deontology. Historical, ethical and legal issues.

    PubMed

    Patuzzo, Sara; De Stefano, Francesco; Ciliberti, Rosagemma

    2018-06-15

    Medical deontology is increasingly important, owing to the interests and rights which the medical profession involves. This paper focuses on the relationships of the Italian Code of Medical Deontology (CMD) with both the ethical and legal dimensions, in order to clarify the role of medical ethics within the medical profession, society and the overall system of the sources of law. The authors analyze the CMD from an ethical perspective and through the new doctrinal guidelines and current trends in the Italian law courts. From an ethical point of view,  moral philosophical analysis scarcely seems to  address professional medical ethics. Nonetheless, the CMD needs to undergo careful ethical analysis. From a legal perspective, the Italian CMD contains provisions which do not have  an official legal nature. However, they are directly binding for medical practitioners, and therefore could be understood as a supplement to the general rules of the legal system. At an ethical level, rigorous debate on the CMD is indispensable, in order to update its specific principles and to make it a real moral normative document. At a legislative level, there is a possible contradiction between a legal system that does not take into account the CMD, but which then attributes significant importance to the violation of its rules.

  3. Education in medical billing benefits both neurology trainees and academic departments.

    PubMed

    Waugh, Jeff L

    2014-11-11

    The objective of residency training is to produce physicians who can function independently within their chosen subspecialty and practice environment. Skills in the business of medicine, such as clinical billing, are widely applicable in academic and private practices but are not commonly addressed during formal medical education. Residency and fellowship training include limited exposure to medical billing, but our academic department's performance of these skills was inadequate: in 56% of trainee-generated outpatient notes, documentation was insufficient to sustain the chosen billing level. We developed a curriculum to improve the accuracy of documentation and coding and introduced practice changes to address our largest sources of error. In parallel, we developed tools that increased the speed and efficiency of documentation. Over 15 months, we progressively eliminated note devaluation, increased the mean level billed by trainees to nearly match that of attending physicians, and increased outpatient revenue by $34,313/trainee/year. Our experience suggests that inclusion of billing education topics into the formal medical curriculum benefits both academic medical centers and trainees. © 2014 American Academy of Neurology.

  4. The lexeme hypotheses: Their use to generate highly grammatical and completely computerized medical records.

    PubMed

    Macfarlane, Donald

    2016-07-01

    Medical records often contain free text created by harried clinicians. Free text often contains errors which make it an unsuitable target for computerized data extraction. The cost of healthcare can be reduced by creating medical records that are fully computerized at their inception. We examine hypotheses that enable us to construct such records. We regard the text of the medical record as being an ordered collection of meaningful fragments. The intellectual content (or "lexeme") of each text fragment in the record is considered separately from the language that used to express it. We further consider that each lexeme exists as a combination of a lexeme query (defining the issue being addressed) and a lexeme response to that query. The medical record can then be perceived as a stream of these responses. The responses can be expressed in any style or language, including computer code. Examining medical records in this light gives rise to a number of observations and hypotheses. The physical location and nature of the medical episode (which we term "context") determines the general layout of the record. The order that lexeme-queries are addressed in within the record is highly consistent ("coherence"). Issues are only addressed if they are logically called-for by the context or by a previously-selected lexeme response ("predicance"), and only to a needed depth of detail ("level"). We hypothesize that all of the lexeme queries required to write any clinical notes can be stored in a large database ("lexicon") in coherence order, wherein each lexeme query is associated with its own collection of lexeme responses. We hypothesize that the issue a note-writer will need to address next is identifiable purely by using the rules of coherence, level and predicance. We have tested these hypotheses with a computer program which repeatedly offers the user a menu of lexeme responses with associated text. On selection, the program issues the text fragment, and its corresponding computer code, to output files. The program then uses coherence, predicance and level to navigate to the next appropriate lexeme query for presentation to the user. The net result is that the user creates a grammatically correct and completely computerized note at the time of its inception. The value of this approach and its practical implementation to create medical records are discussed. In our work so far, the hypotheses appear not to be false, but further testing is needed using a larger lexicon to establish their robustness in actual clinical practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Segmental Neogenesis of the Dog Esophagus Utilizing a Biodegradable Polymer Framework

    DTIC Science & Technology

    1988-12-20

    Dental (If applicable) US Army Medical Research & Development Research I SGRD-UDR-B Command (HQDA-IS) 6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS...Marvin F. Grower, D.D.S., Ph.D. Emery A. Russell, Jr., D.D.S., M.S. Duane E. Cutright, D.D.S., M.S., Ph.D. U. S. Army Institute of Dental Research...the polymer solutions with a #152 dental atomizer (DeVilbiss Corp.) using 20-30 psi of nitrogen as a prdpellant at a distance of 10-18 inches from a

  6. Implementing a rapid response team: factors influencing success.

    PubMed

    Murray, Theresa; Kleinpell, Ruth

    2006-12-01

    Rapid response teams (RRTs), or medical emergency teams, focus on preventing a patient crisis by addressing changes in patient status before a cardiopulmonary arrest occurs. Responding to acute changes, RRTs and medical emergency teams are similar to "code" teams. The exception, however is that they step into action before a patient arrests. Although RRTs are acknowledge as an important initiative, implementation can present many challenges. This article reports on the implementation and ongoing use of a RRT at a community health care setting, highlighting important considerations and strategies for success.

  7. Cross-terminology mapping challenges: a demonstration using medication terminological systems.

    PubMed

    Saitwal, Himali; Qing, David; Jones, Stephen; Bernstam, Elmer V; Chute, Christopher G; Johnson, Todd R

    2012-08-01

    Standardized terminological systems for biomedical information have provided considerable benefits to biomedical applications and research. However, practical use of this information often requires mapping across terminological systems-a complex and time-consuming process. This paper demonstrates the complexity and challenges of mapping across terminological systems in the context of medication information. It provides a review of medication terminological systems and their linkages, then describes a case study in which we mapped proprietary medication codes from an electronic health record to SNOMED CT and the UMLS Metathesaurus. The goal was to create a polyhierarchical classification system for querying an i2b2 clinical data warehouse. We found that three methods were required to accurately map the majority of actively prescribed medications. Only 62.5% of source medication codes could be mapped automatically. The remaining codes were mapped using a combination of semi-automated string comparison with expert selection, and a completely manual approach. Compound drugs were especially difficult to map: only 7.5% could be mapped using the automatic method. General challenges to mapping across terminological systems include (1) the availability of up-to-date information to assess the suitability of a given terminological system for a particular use case, and to assess the quality and completeness of cross-terminology links; (2) the difficulty of correctly using complex, rapidly evolving, modern terminologies; (3) the time and effort required to complete and evaluate the mapping; (4) the need to address differences in granularity between the source and target terminologies; and (5) the need to continuously update the mapping as terminological systems evolve. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Cross-terminology mapping challenges: A demonstration using medication terminological systems

    PubMed Central

    Saitwal, Himali; Qing, David; Jones, Stephen; Bernstam, Elmer; Chute, Christopher G.; Johnson, Todd R.

    2015-01-01

    Standardized terminological systems for biomedical information have provided considerable benefits to biomedical applications and research. However, practical use of this information often requires mapping across terminological systems—a complex and time-consuming process. This paper demonstrates the complexity and challenges of mapping across terminological systems in the context of medication information. It provides a review of medication terminological systems and their linkages, then describes a case study in which we mapped proprietary medication codes from an electronic health record to SNOMED-CT and the UMLS Metathesaurus. The goal was to create a polyhierarchical classification system for querying an i2b2 clinical data warehouse. We found that three methods were required to accurately map the majority of actively prescribed medications. Only 62.5% of source medication codes could be mapped automatically. The remaining codes were mapped using a combination of semi-automated string comparison with expert selection, and a completely manual approach. Compound drugs were especially difficult to map: only 7.5% could be mapped using the automatic method. General challenges to mapping across terminological systems include (1) the availability of up-to-date information to assess the suitability of a given terminological system for a particular use case, and to assess the quality and completeness of cross-terminology links; (2) the difficulty of correctly using complex, rapidly evolving, modern terminologies; (3) the time and effort required to complete and evaluate the mapping; (4) the need to address differences in granularity between the source and target terminologies; and (5) the need to continuously update the mapping as terminological systems evolve. PMID:22750536

  9. Manual versus automated coding of free-text self-reported medication data in the 45 and Up Study: a validation study.

    PubMed

    Gnjidic, Danijela; Pearson, Sallie-Anne; Hilmer, Sarah N; Basilakis, Jim; Schaffer, Andrea L; Blyth, Fiona M; Banks, Emily

    2015-03-30

    Increasingly, automated methods are being used to code free-text medication data, but evidence on the validity of these methods is limited. To examine the accuracy of automated coding of previously keyed in free-text medication data compared with manual coding of original handwritten free-text responses (the 'gold standard'). A random sample of 500 participants (475 with and 25 without medication data in the free-text box) enrolled in the 45 and Up Study was selected. Manual coding involved medication experts keying in free-text responses and coding using Anatomical Therapeutic Chemical (ATC) codes (i.e. chemical substance 7-digit level; chemical subgroup 5-digit; pharmacological subgroup 4-digit; therapeutic subgroup 3-digit). Using keyed-in free-text responses entered by non-experts, the automated approach coded entries using the Australian Medicines Terminology database and assigned corresponding ATC codes. Based on manual coding, 1377 free-text entries were recorded and, of these, 1282 medications were coded to ATCs manually. The sensitivity of automated coding compared with manual coding was 79% (n = 1014) for entries coded at the exact ATC level, and 81.6% (n = 1046), 83.0% (n = 1064) and 83.8% (n = 1074) at the 5, 4 and 3-digit ATC levels, respectively. The sensitivity of automated coding for blank responses was 100% compared with manual coding. Sensitivity of automated coding was highest for prescription medications and lowest for vitamins and supplements, compared with the manual approach. Positive predictive values for automated coding were above 95% for 34 of the 38 individual prescription medications examined. Automated coding for free-text prescription medication data shows very high to excellent sensitivity and positive predictive values, indicating that automated methods can potentially be useful for large-scale, medication-related research.

  10. Fire Technology Abstracts, volume 4, issue 1, August, 1981

    NASA Astrophysics Data System (ADS)

    Holtschlag, L. J.; Kuvshinoff, B. W.; Jernigan, J. B.

    This bibliography contains over 400 citations with abstracts addressing various aspects of fire technology. Subjects cover the dynamics of fire, behavior and properties of materials, fire modeling and test burns, fire protection, fire safety, fire service organization, apparatus and equipment, fire prevention, suppression, planning, human behavior, medical problems, codes and standards, hazard identification, safe handling of materials, insurance, economics of loss and prevention, and more.

  11. USE OF ELECTRONIC HEALTH RECORDS TO CHARACTERIZE A RARE DISEASE IN THE U.S.: TREATMENT, COMORBIDITIES, AND FOLLOW-UP TRENDS AMONG PATIENTS WITH A CONFIRMED DIAGNOSIS OF ACROMEGALY.

    PubMed

    Silverstein, Julie M; Roe, Erin D; Munir, Kashif M; Fox, Janet L; Emir, Birol; Kouznetsova, Maria; Lamerato, Lois E; King, Donna

    2018-06-01

    Understanding of acromegaly disease management is hampered in the U.S. by the lack of a national registry. We describe medical management in a population with confirmed acromegaly. Inpatient and outpatient electronic health records (EHRs) were used to create a database of de-identified patients assigned the Acromegaly and Gigantism International Classification of Diseases, 9 th revision (ICD-9) code and/or an appropriate pituitary procedure code at 1 of 4 regional hospital systems over a 6- to 11-year period. Information regarding demographics, medical history, labs, procedures, and medications was collected and supplemented with a chart review to validate the diagnosis of acromegaly. Of 367 patients with validated acromegaly, available records showed that during the years studied, pituitary surgery was performed on 31%, 4% received radiosurgery, and 22% were prescribed a drug indicated for acromegaly. Insulin-like growth factor-1 (IGF-1) levels were measured in 62% of patients, 83% of whom had at least 1 normal value. Coded comorbidities reflect those reported previously in patients with acromegaly, with the exception of esophageal reflux in 20% of patient records. Fewer data regarding acromegaly-specific medications and testing were available for patients aged 65 and older. AcroMEDIC is a U.S. multisite retrospective study of acromegaly that captured medical management in the majority of patients included in the cohort. Chart review highlighted the importance of verification of coded diagnoses. Most of the acromegaly-related comorbidities identified here are known to increase with age and obesity. Patients ≥65 appeared to have less active management/monitoring of their disease. Medical attention should be directed to this population to address evolving needs over time. AcroMEDIC = Acromegaly Multisite Electronic Data Innovative Consortium; BMI = body mass index; CCI = Charlson Comorbidity Index; EHR = electronic health record; GH = growth hormone; GHRA = growth hormone receptor antagonist; ICD-9 = International Classification of Diseases, 9 th revision; IGF-1 = insulin-like growth factor-1; SSA = somatostatin analogue.

  12. Unconventional Gas and Oil Drilling Is Associated with Increased Hospital Utilization Rates.

    PubMed

    Jemielita, Thomas; Gerton, George L; Neidell, Matthew; Chillrud, Steven; Yan, Beizhan; Stute, Martin; Howarth, Marilyn; Saberi, Pouné; Fausti, Nicholas; Penning, Trevor M; Roy, Jason; Propert, Kathleen J; Panettieri, Reynold A

    2015-01-01

    Over the past ten years, unconventional gas and oil drilling (UGOD) has markedly expanded in the United States. Despite substantial increases in well drilling, the health consequences of UGOD toxicant exposure remain unclear. This study examines an association between wells and healthcare use by zip code from 2007 to 2011 in Pennsylvania. Inpatient discharge databases from the Pennsylvania Healthcare Cost Containment Council were correlated with active wells by zip code in three counties in Pennsylvania. For overall inpatient prevalence rates and 25 specific medical categories, the association of inpatient prevalence rates with number of wells per zip code and, separately, with wells per km2 (separated into quantiles and defined as well density) were estimated using fixed-effects Poisson models. To account for multiple comparisons, a Bonferroni correction with associations of p<0.00096 was considered statistically significant. Cardiology inpatient prevalence rates were significantly associated with number of wells per zip code (p<0.00096) and wells per km2 (p<0.00096) while neurology inpatient prevalence rates were significantly associated with wells per km2 (p<0.00096). Furthermore, evidence also supported an association between well density and inpatient prevalence rates for the medical categories of dermatology, neurology, oncology, and urology. These data suggest that UGOD wells, which dramatically increased in the past decade, were associated with increased inpatient prevalence rates within specific medical categories in Pennsylvania. Further studies are necessary to address healthcare costs of UGOD and determine whether specific toxicants or combinations are associated with organ-specific responses.

  13. Designing an Intervention for Women with Systemic Lupus Erythematosus from Medically Underserved Areas to Improve Care: A Qualitative Study

    PubMed Central

    Feldman, Candace H; Bermas, Bonnie L; Zibit, Melanie; Fraser, Patricia; Todd, Derrick J; Fortin, Paul R; Massarotti, Elena; Costenbader, Karen H

    2013-01-01

    Objective Systemic lupus erythematosus (lupus) disproportionately affects women, racial/ethnic minorities and low-income populations. We held focus groups for women from medically underserved communities to discuss interventions to improve care. Methods From our Lupus Registry, we invited 282 women, > 18 years, residing in urban, medically underserved areas. Hospital-based clinics and support groups also recruited participants. Women were randomly assigned to 3 focus groups. 75-minute sessions were recorded, transcribed and coded thematically using interpretative phenomenologic analysis and single counting methods. We categorized interventions by benefits, limitations, target populations and implementation questions. Results 29 women with lupus participated in 3 focus groups, (n=9, 9, 11). 80% were African American and 83% were from medically underserved zip codes. Themes included the desire for lupus education, isolation at the time of diagnosis, emotional and physical barriers to care, and the need for assistance navigating the healthcare system. 20 of 29 participants (69%) favored a peer support intervention; 17 (59%) also supported a lupus health passport. Newly diagnosed women were optimal intervention targets. Improvements in quality of life and mental health were proposed outcome measures. Conclusion Women with lupus from medically underserved areas have unique needs best addressed with an intervention designed through collaboration between community members and researchers. PMID:23087258

  14. COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES): statistical and economic analysis plan for a randomised controlled trial.

    PubMed

    Robinson, Emily J; Goldstein, Laura H; McCrone, Paul; Perdue, Iain; Chalder, Trudie; Mellers, John D C; Richardson, Mark P; Murray, Joanna; Reuber, Markus; Medford, Nick; Stone, Jon; Carson, Alan; Landau, Sabine

    2017-06-06

    Dissociative seizures (DSs), also called psychogenic non-epileptic seizures, are a distressing and disabling problem for many patients in neurological settings with high and often unnecessary economic costs. The COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES) trial is an evaluation of a specifically tailored psychological intervention with the aims of reducing seizure frequency and severity and improving psychological well-being in adults with DS. The aim of this paper is to report in detail the quantitative and economic analysis plan for the CODES trial, as agreed by the trial steering committee. The CODES trial is a multicentre, pragmatic, parallel group, randomised controlled trial performed to evaluate the clinical effectiveness and cost-effectiveness of 13 sessions of cognitive behavioural therapy (CBT) plus standardised medical care (SMC) compared with SMC alone for adult outpatients with DS. The objectives and design of the trial are summarised, and the aims and procedures of the planned analyses are illustrated. The proposed analysis plan addresses statistical considerations such as maintaining blinding, monitoring adherence with the protocol, describing aspects of treatment and dealing with missing data. The formal analysis approach for the primary and secondary outcomes is described, as are the descriptive statistics that will be reported. This paper provides transparency to the planned inferential analyses for the CODES trial prior to the extraction of outcome data. It also provides an update to the previously published trial protocol and guidance to those conducting similar trials. ISRCTN registry ISRCTN05681227 (registered on 5 March 2014); ClinicalTrials.gov NCT02325544 (registered on 15 December 2014).

  15. The Canadian Medical Association Code of Ethics 1868 to 1996: a primer for medical educators.

    PubMed

    Brownell, A Keith W; Brownell, Elizabeth

    2002-06-01

    The Canadian Medical Association's (CMA) Code of Ethics applies to all physicians, residents, and medical students in Canada. Learning about the code must be a part of every physician's education, and keeping current with it must be a part of every physician's continuing medical education. This article, based on a review of the 19 CMA codes of ethics issued from 1868 to 1996, shows how deeply the Code of Ethics is tied to the past, highlights those topics that have been part of every version, and demonstrates how the code changed over time. This article should assist medical educators as they develop teaching material on codes of medical ethics, and would be of interest to practising physicians.

  16. Family-initiated dialogue about medications during family-centered rounds.

    PubMed

    Benjamin, Jessica M; Cox, Elizabeth D; Trapskin, Philip J; Rajamanickam, Victoria P; Jorgenson, Roderick C; Weber, Holly L; Pearson, Rachel E; Carayon, Pascale; Lubcke, Nikki L

    2015-01-01

    Experts suggest family engagement in care can improve safety for hospitalized children. Family-centered rounds (FCRs) can offer families the opportunity to participate in error recovery related to children's medications. The objective of this study was to describe family-initiated dialogue about medications and health care team responses to this dialogue during FCR to understand the potential for FCR to foster safe medication use. FCR were video-recorded daily for 150 hospitalized children. Coders sorted family-initiated medication dialogue into mutually exclusive categories, reflecting place of administration, therapeutic class, topic, and health care team responses. Health care team responses were coded to reflect intent, actions taken by the team, and appropriateness of any changes. Eighty-three (55%) of the 150 families raised 318 medication topics during 347 FCR. Most family-initiated dialogue focused on inpatient medications (65%), with home medications comprising 35%. Anti-infectives (31%), analgesics (14%), and corticosteroids (11%) were the most commonly discussed medications. The most common medication topics raised by families were scheduling (24%) and adverse drug reactions (11%). Although most health care team responses were provision of information (74%), appropriate changes to the child's medications occurred in response to 8% of family-initiated dialogue, with most changes preventing or addressing adverse drug reactions or scheduling issues. Most families initiated dialogue regarding medications during FCRs, including both inpatient and home medications. They raised topics that altered treatment and were important for medication safety, adherence, and satisfaction. Study findings suggest specific medication topics that health care teams can anticipate addressing during FCR. Copyright © 2015 by the American Academy of Pediatrics.

  17. Billing by residents and attending physicians in family medicine: the effects of the provider, patient, and visit factors.

    PubMed

    Al Achkar, Morhaf; Kengeri-Srikantiah, Seema; Yamane, Biniyam M; Villasmil, Jomil; Busha, Michael E; Gebke, Kevin B

    2018-06-13

    Medical billing and coding are critical components of residency programs since they determine the revenues and vitality of residencies. It has been suggested that residents are less likely to bill higher evaluation and management (E/M) codes compared with attending physicians. The purpose of this study is to assess the variation in billing patterns between residents and attending physicians, considering provider, patient, and visit characteristics. A retrospective cohort study of all established outpatient visits at a family medicine residency clinic over a 5-year period was performed. We employed the logistic regression methodology to identify residents' and attending physicians' variations in coding E/M service levels. We also employed Poisson regression to test the sensitivity of our result. Between January 5, 2009 and September 25, 2015, 98,601 visits to 116 residents and 18 attending physicians were reviewed. After adjusting for provider, patient, and visit characteristics, residents billed higher E/M codes less often compared with attending physicians for comparable visits. In comparison with attending physicians, the odds ratios for billing higher E/M codes were 0.58 (p = 0.01), 0.56 (p = 0.01), and 0.63 (p = 0.01) for the third, second, and first years of postgraduate training, respectively. In addition to the main factors of patient age, medical conditions, and number of addressed problems, the gender of the provider was also implicated in the billing variations. Residents are less likely to bill higher E/M codes than attending physicians are for similar visits. While these variations are known to contribute to lost revenues, further studies are required to explore their effect on patient care in relation to attendings' direct involvement in higher E/M-coded versus their indirect involvement in lower E/M-coded visits.

  18. An Alternative Laboratory Designed to Address Ethical Concerns Associated with Traditional "TAS2R38" Student Genotyping

    ERIC Educational Resources Information Center

    LaBonte, Michelle L.; Beers, Melissa A.

    2015-01-01

    The "TAS2R38" alleles that code for the PAV/AVI T2R38 proteins have long been viewed as benign taste receptor variants. However, recent studies have demonstrated an expanding and medically relevant role for "TAS2R38." The AVI variant of T2R38 is associated with an increased risk of both colorectal cancer and "Pseudomonas…

  19. [The evolution of the Italian Code of Medical Deontology: a historical-epistemological perspective].

    PubMed

    Conti, A A

    The Italian Code of Medical Deontology is a set of self-discipline rules prefixed by the medical profession, that are mandatory for the members of the medical registers, who must conform to these rules. The history of the Italian Code of Medical Deontology dates back to the beginning of the twentieth century. In 1903 it appeared in the form of a "Code of Ethics and Deontology" and was prepared by the Board of the Medical Register of Sassari (Sardinia). This Board inserted the principles inspiring the correct practice of the medical profession in an articulated and self-normative system, also foreseeing disciplinary measures. About ten years later, in 1912, the Medical Register of Turin (Piedmont) elaborated a Code which constituted the basis for a subsequent elaboration leading to a Unified Code of Medical Ethics (1924). After World War II the idea prevailed in Italy that the codes of medical deontology should undergo periodical review, updating and dissemination, and the new 1947 text (Turin) was for the first time amply diffused among Italian physicians. The next national code dates back to 1958, and twenty years later a revision was published. In the 1989 Code new topics appeared, including organ transplantation, artificial in vitro insemination and the role of police doctors; these and other issues were later developed in the 1995, 1998 and 2006 versions of the Code. The last available edition of the Italian Code of Medical Deontology is that of May 2014.

  20. PRISM: An open source framework for the interactive design of GPU volume rendering shaders.

    PubMed

    Drouin, Simon; Collins, D Louis

    2018-01-01

    Direct volume rendering has become an essential tool to explore and analyse 3D medical images. Despite several advances in the field, it remains a challenge to produce an image that highlights the anatomy of interest, avoids occlusion of important structures, provides an intuitive perception of shape and depth while retaining sufficient contextual information. Although the computer graphics community has proposed several solutions to address specific visualization problems, the medical imaging community still lacks a general volume rendering implementation that can address a wide variety of visualization use cases while avoiding complexity. In this paper, we propose a new open source framework called the Programmable Ray Integration Shading Model, or PRISM, that implements a complete GPU ray-casting solution where critical parts of the ray integration algorithm can be replaced to produce new volume rendering effects. A graphical user interface allows clinical users to easily experiment with pre-existing rendering effect building blocks drawn from an open database. For programmers, the interface enables real-time editing of the code inside the blocks. We show that in its default mode, the PRISM framework produces images very similar to those produced by a widely-adopted direct volume rendering implementation in VTK at comparable frame rates. More importantly, we demonstrate the flexibility of the framework by showing how several volume rendering techniques can be implemented in PRISM with no more than a few lines of code. Finally, we demonstrate the simplicity of our system in a usability study with 5 medical imaging expert subjects who have none or little experience with volume rendering. The PRISM framework has the potential to greatly accelerate development of volume rendering for medical applications by promoting sharing and enabling faster development iterations and easier collaboration between engineers and clinical personnel.

  1. PRISM: An open source framework for the interactive design of GPU volume rendering shaders

    PubMed Central

    Collins, D. Louis

    2018-01-01

    Direct volume rendering has become an essential tool to explore and analyse 3D medical images. Despite several advances in the field, it remains a challenge to produce an image that highlights the anatomy of interest, avoids occlusion of important structures, provides an intuitive perception of shape and depth while retaining sufficient contextual information. Although the computer graphics community has proposed several solutions to address specific visualization problems, the medical imaging community still lacks a general volume rendering implementation that can address a wide variety of visualization use cases while avoiding complexity. In this paper, we propose a new open source framework called the Programmable Ray Integration Shading Model, or PRISM, that implements a complete GPU ray-casting solution where critical parts of the ray integration algorithm can be replaced to produce new volume rendering effects. A graphical user interface allows clinical users to easily experiment with pre-existing rendering effect building blocks drawn from an open database. For programmers, the interface enables real-time editing of the code inside the blocks. We show that in its default mode, the PRISM framework produces images very similar to those produced by a widely-adopted direct volume rendering implementation in VTK at comparable frame rates. More importantly, we demonstrate the flexibility of the framework by showing how several volume rendering techniques can be implemented in PRISM with no more than a few lines of code. Finally, we demonstrate the simplicity of our system in a usability study with 5 medical imaging expert subjects who have none or little experience with volume rendering. The PRISM framework has the potential to greatly accelerate development of volume rendering for medical applications by promoting sharing and enabling faster development iterations and easier collaboration between engineers and clinical personnel. PMID:29534069

  2. The application of coded excitation technology in medical ultrasonic Doppler imaging

    NASA Astrophysics Data System (ADS)

    Li, Weifeng; Chen, Xiaodong; Bao, Jing; Yu, Daoyin

    2008-03-01

    Medical ultrasonic Doppler imaging is one of the most important domains of modern medical imaging technology. The application of coded excitation technology in medical ultrasonic Doppler imaging system has the potential of higher SNR and deeper penetration depth than conventional pulse-echo imaging system, it also improves the image quality, and enhances the sensitivity of feeble signal, furthermore, proper coded excitation is beneficial to received spectrum of Doppler signal. Firstly, this paper analyzes the application of coded excitation technology in medical ultrasonic Doppler imaging system abstractly, showing the advantage and bright future of coded excitation technology, then introduces the principle and the theory of coded excitation. Secondly, we compare some coded serials (including Chirp and fake Chirp signal, Barker codes, Golay's complementary serial, M-sequence, etc). Considering Mainlobe Width, Range Sidelobe Level, Signal-to-Noise Ratio and sensitivity of Doppler signal, we choose Barker codes as coded serial. At last, we design the coded excitation circuit. The result in B-mode imaging and Doppler flow measurement coincided with our expectation, which incarnated the advantage of application of coded excitation technology in Digital Medical Ultrasonic Doppler Endoscope Imaging System.

  3. Comparison of blogged and written reflections in two medicine clerkships.

    PubMed

    Fischer, Melissa A; Haley, Heather-Lyn; Saarinen, Carrie L; Chretien, Katherine C

    2011-02-01

    academic medical centres may adopt new learning technologies with little data on their effectiveness or on how they compare with traditional methodologies. We conducted a comparative study of student reflective writings produced using either an electronic (blog) format or a traditional written (essay) format to assess differences in content, depth of reflection and student preference. students in internal medicine clerkships at two US medical schools during the 2008-2009 academic year were quasi-randomly assigned to one of two study arms according to which they were asked to either write a traditional reflective essay and subsequently join in faculty-moderated, small-group discussion (n = 45), or post two writings to a faculty-moderated group blog and provide at least one comment on a peer's posts (n = 50). Examples from a pilot block were used to refine coding methods and determine inter-rater reliability. Writings were coded for theme and level of reflection by two blinded authors; these coding processes reached inter-rater reliabilities of 91% and 80%, respectively. Anonymous pre- and post-clerkship surveys assessed student perceptions and preferences. student writing addressed seven main themes: (i) being humanistic; (ii) professional behaviour; (iii) understanding caregiving relationships; (iv) being a student; (v) clinical learning; (vi) dealing with death and dying, and (vii) the health care system, quality, safety and public health. The distribution of themes was similar across institutions and study arms. The level of reflection did not differ between study arms. Post-clerkship surveys showed that student preferences for blogging or essay writing were predicted by experience, with the majority favouring the method they had used. our study suggests there is no significant difference in themes addressed or levels of reflection achieved when students complete a similar assignment via online blogging or traditional essay writing. Given this, faculty staff should feel comfortable in utilising the blog format for reflective exercises. Faculty members could consider the option of using either format to address different learning styles of students.

  4. The human genome: Some assembly required. Final report

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    NONE

    1994-12-31

    The Human Genome Project promises to be one of the most rewarding endeavors in modern biology. The cost and the ethical and social implications, however, have made this project the source of considerable debate both in the scientific community and in the public at large. The 1994 Graduate Student Symposium addresses the scientific merits of the project, the technical issues involved in accomplishing the task, as well as the medical and social issues which stem from the wealth of knowledge which the Human Genome Project will help create. To this end, speakers were brought together who represent the diverse areasmore » of expertise characteristic of this multidisciplinary project. The keynote speaker addresses the project`s motivations and goals in the larger context of biological and medical sciences. The first two sessions address relevant technical issues, data collection with a focus on high-throughput sequencing methods and data analysis with an emphasis on identification of coding sequences. The third session explores recent advances in the understanding of genetic diseases and possible routes to treatment. Finally, the last session addresses some of the ethical, social and legal issues which will undoubtedly arise from having a detailed knowledge of the human genome.« less

  5. The feasibility of paper-based Tracking Codes and electronic medical record systems to monitor tobacco-use assessment and intervention in an Individual Practice Association (IPA) Model health maintenance organization (HMO).

    PubMed

    Bentz, Charles J; Davis, Nancy; Bayley, Bruce

    2002-01-01

    Despite evidence of its effectiveness, tobacco cessation is not systematically addressed in routine healthcare settings. Its measurement is part of the problem. A pilot study was designed to develop and implement two different tobacco tracking systems in two independent primary care offices that participated in an IPA Model health maintenance organization in Portland, Oregon. The first clinic, which utilized a paper-based charting system, implemented CPT-like tracking codes to measure and report tobacco-cessation activities, which were eventually included in the managed-care organization's (MCO) claims database. The second clinic implemented an electronic tracking system based on its computerized electronic medical record (EMR) charting system. This paper describes the pilot study, including the processes involved in building provider acceptance for the new tracking systems in these two clinics, the barriers and successes encountered during implementation, and the resources expended by the clinics and by the MCO during the pilot. The findings from the 3-month implementation period were that documentation of tobacco-use status remained stable at 42-45% in the paper-based clinic and increased from 79% to 88% in the EMR clinic. This pilot study demonstrated that Tracking Codes are a feasible preventive-care tracking system in paper-based medical offices. However, high levels of effort and support are needed, and a critical mass of insurers and health plans would need to adopt Tracking Codes before widespread use could be expected. Results of the EMR-based tracking system are also reviewed and discussed.

  6. Unconventional Gas and Oil Drilling Is Associated with Increased Hospital Utilization Rates

    PubMed Central

    Neidell, Matthew; Chillrud, Steven; Yan, Beizhan; Stute, Martin; Howarth, Marilyn; Saberi, Pouné; Fausti, Nicholas; Penning, Trevor M.; Roy, Jason; Propert, Kathleen J.; Panettieri, Reynold A.

    2015-01-01

    Over the past ten years, unconventional gas and oil drilling (UGOD) has markedly expanded in the United States. Despite substantial increases in well drilling, the health consequences of UGOD toxicant exposure remain unclear. This study examines an association between wells and healthcare use by zip code from 2007 to 2011 in Pennsylvania. Inpatient discharge databases from the Pennsylvania Healthcare Cost Containment Council were correlated with active wells by zip code in three counties in Pennsylvania. For overall inpatient prevalence rates and 25 specific medical categories, the association of inpatient prevalence rates with number of wells per zip code and, separately, with wells per km2 (separated into quantiles and defined as well density) were estimated using fixed-effects Poisson models. To account for multiple comparisons, a Bonferroni correction with associations of p<0.00096 was considered statistically significant. Cardiology inpatient prevalence rates were significantly associated with number of wells per zip code (p<0.00096) and wells per km2 (p<0.00096) while neurology inpatient prevalence rates were significantly associated with wells per km2 (p<0.00096). Furthermore, evidence also supported an association between well density and inpatient prevalence rates for the medical categories of dermatology, neurology, oncology, and urology. These data suggest that UGOD wells, which dramatically increased in the past decade, were associated with increased inpatient prevalence rates within specific medical categories in Pennsylvania. Further studies are necessary to address healthcare costs of UGOD and determine whether specific toxicants or combinations are associated with organ-specific responses. PMID:26176544

  7. A systematic review of service-learning in medical education: 1998-2012.

    PubMed

    Stewart, Trae; Wubbena, Zane C

    2015-01-01

    PHENOMENON: In the United States, the Affordable Care Act has increased the need for community-centered pedagogy for medical education such as service-learning, wherein students connect academic curriculum and reflections to address a community need. Yet heterogeneity among service-learning programs suggests the need for a framework to understand variations among service-learning programs in medical education. A qualitative systematic review of literature on service-learning and medical education was conducted for the period between 1998 and 2012. A two-stage inclusion criteria process resulted in articles (n = 32) on service-learning and Doctor of Medicine or Doctor of Osteopathic Medicine being included for both coding and analysis. Focused and selective coding were employed to identify recurring themes and subthemes from the literature. The findings of the qualitative thematic analysis of service-learning variation in medical education identified a total of seven themes with subthemes. The themes identified from the analysis were (a) geographic location and setting, (b) program design, (c) funding, (d) participation, (e) program implementation, (f) assessment, and (g) student outcomes. Insights: This systematic review of literature confirmed the existence of program heterogeneity among service-learning program in medical education. However, the findings of this study provide key insights into the nature of service-learning in medical education building a framework for which to organize differences among service-learning programs. A list of recommendations for future areas of inquiry is provided to guide future research.

  8. Practical guide to bar coding for patient medication safety.

    PubMed

    Neuenschwander, Mark; Cohen, Michael R; Vaida, Allen J; Patchett, Jeffrey A; Kelly, Jamie; Trohimovich, Barbara

    2003-04-15

    Bar coding for the medication administration step of the drug-use process is discussed. FDA will propose a rule in 2003 that would require bar-code labels on all human drugs and biologicals. Even with an FDA mandate, manufacturer procrastination and possible shifts in product availability are likely to slow progress. Such delays should not preclude health systems from adopting bar-code-enabled point-of-care (BPOC) systems to achieve gains in patient safety. Bar-code technology is a replacement for traditional keyboard data entry. The elements of bar coding are content, which determines the meaning; data format, which refers to the embedded data and symbology, which describes the "font" in which the machine-readable code is written. For a BPOC system to deliver an acceptable level of patient protection, the hospital must first establish reliable processes for a patient identification band, caregiver badge, and medication bar coding. Medications can have either drug-specific or patient-specific bar codes. Both varieties result in the desired code that supports patient's five rights of drug administration. When medications are not available from the manufacturer in immediate-container bar-coded packaging, other means of applying the bar code must be devised, including the use of repackaging equipment, overwrapping, manual bar coding, and outsourcing. Virtually all medications should be bar coded, the bar code on the label should be easily readable, and appropriate policies, procedures, and checks should be in place. Bar coding has the potential to be not only cost-effective but to produce a return on investment. By bar coding patient identification tags, caregiver badges, and immediate-container medications, health systems can substantially increase patient safety during medication administration.

  9. 45 CFR 162.1002 - Medical data code sets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Terminology, Fourth Edition (CPT-4), as maintained and distributed by the American Medical Association, for... 45 Public Welfare 1 2012-10-01 2012-10-01 false Medical data code sets. 162.1002 Section 162.1002... REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Code Sets § 162.1002 Medical data code sets. The Secretary adopts the...

  10. 45 CFR 162.1002 - Medical data code sets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Terminology, Fourth Edition (CPT-4), as maintained and distributed by the American Medical Association, for... 45 Public Welfare 1 2014-10-01 2014-10-01 false Medical data code sets. 162.1002 Section 162.1002... REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Code Sets § 162.1002 Medical data code sets. The Secretary adopts the...

  11. 45 CFR 162.1002 - Medical data code sets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Terminology, Fourth Edition (CPT-4), as maintained and distributed by the American Medical Association, for... 45 Public Welfare 1 2013-10-01 2013-10-01 false Medical data code sets. 162.1002 Section 162.1002... REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Code Sets § 162.1002 Medical data code sets. The Secretary adopts the...

  12. 45 CFR 162.1002 - Medical data code sets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Terminology, Fourth Edition (CPT-4), as maintained and distributed by the American Medical Association, for... 45 Public Welfare 1 2011-10-01 2011-10-01 false Medical data code sets. 162.1002 Section 162.1002... REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Code Sets § 162.1002 Medical data code sets. The Secretary adopts the...

  13. 45 CFR 162.1002 - Medical data code sets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Terminology, Fourth Edition (CPT-4), as maintained and distributed by the American Medical Association, for... 45 Public Welfare 1 2010-10-01 2010-10-01 false Medical data code sets. 162.1002 Section 162.1002... REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Code Sets § 162.1002 Medical data code sets. The Secretary adopts the...

  14. Informed consent in human subject research: a comparison of current international and Nigerian guidelines.

    PubMed

    Fadare, Joseph O; Porteri, Corinna

    2010-03-01

    Informed consent is a basic requirement for the conduct of ethical research involving human subjects. Currently, the Helsinki Declaration of the World Medical Association and the International Ethical Guidelines for Biomedical Research of the Council for International Organizations of Medical Sciences (CIOMS) are widely accepted as international codes regulating human subject research and the informed consent sections of these documents are quite important. Debates on the applicability of these guidelines in different socio-cultural settings are ongoing and many workers have advocated the need for national or regional guidelines. Nigeria, a developing country, has recently adopted its national guideline regulating human subject research: the National Health Research Ethics Committee (NHREC) code. A content analysis of the three guidelines was done to see if the Nigerian guidelines confer any additional protection for research subjects. The concept of a Community Advisory Committee in the Nigerian guideline is a novel one that emphasizes research as a community burden and should promote a form of "research friendship" to foster the welfare of research participants. There is also the need for a regular update of the NHREC code so as to address some issues that were not considered in its current version.

  15. Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence.

    PubMed

    Bosworth, Hayden B; Zullig, Leah L; Mendys, Phil; Ho, Michael; Trygstad, Troy; Granger, Christopher; Oakes, Megan M; Granger, Bradi B

    2016-03-15

    The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain. The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT. We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence. The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed. To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues.

  16. Malnutrition coding 101: financial impact and more.

    PubMed

    Giannopoulos, Georgia A; Merriman, Louise R; Rumsey, Alissa; Zwiebel, Douglas S

    2013-12-01

    Recent articles have addressed the characteristics associated with adult malnutrition as published by the Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). This article describes a successful interdisciplinary program developed by the Department of Food and Nutrition at New York-Presbyterian Hospital to maintain and monitor clinical documentation, ensure accurate International Classification of Diseases 9th Edition (ICD-9) coding, and identify subsequent incremental revenue resulting from the early identification, documentation, and treatment of malnutrition in an adult inpatient population. The first step in the process requires registered dietitians to identify patients with malnutrition; then clear and specifically worded diagnostic statements that include the type and severity of malnutrition are documented in the medical record by the physician, nurse practitioner, or physician's assistant. This protocol allows the Heath Information Management/Coding department to accurately assign ICD-9 codes associated with protein-energy malnutrition. Once clinical coding is complete, a final diagnosis related group (DRG) is generated to ensure appropriate hospital reimbursement. Successful interdisciplinary programs such as this can drive optimal care and ensure appropriate reimbursement.

  17. Residential Segregation and the Availability of Primary Care Physicians

    PubMed Central

    Gaskin, Darrell J; Dinwiddie, Gniesha Y; Chan, Kitty S; McCleary, Rachael R

    2012-01-01

    Objective To examine the association between residential segregation and geographic access to primary care physicians (PCPs) in metropolitan statistical areas (MSAs). Data Sources We combined zip code level data on primary care physicians from the 2006 American Medical Association master file with demographic, socioeconomic, and segregation measures from the 2000 U.S. Census. Our sample consisted of 15,465 zip codes located completely or partially in an MSA. Methods We defined PCP shortage areas as those zip codes with no PCP or a population to PCP ratio of >3,500. Using logistic regressions, we estimated the association between a zip code's odds of being a PCP shortage area and its minority composition and degree of segregation in its MSA. Principal Findings We found that odds of being a PCP shortage area were 67 percent higher for majority African American zip codes but 27 percent lower for majority Hispanic zip codes. The association varied with the degree of segregation. As the degree of segregation increased, the odds of being a PCP shortage area increased for majority African American zip codes; however, the converse was true for majority Hispanic and Asian zip codes. Conclusions Efforts to address PCP shortages should target African American communities especially in segregated MSAs. PMID:22524264

  18. [Hippocratic Oath: professional or ethic code?].

    PubMed

    Popović, Milos

    2011-01-01

    In order to study the historical relationship of early medical professional codex and contemporary demands and challenges, which are currently being placed before physicians, the first such text, known as Hippocratic Oath has been re-translated. According to the source, it is clear that this is a Code of professional conduct, primarily for the welfare of patients, and in order to maintain and preserve medical authority. All parts of the Oath have been discussed and presented, as well as the historical data from which one can see how the system in ancient Greece and Rome worked. The study includes historical data from that time on two controversial issues: the liability of medical awards, and addressing medical services. These are mistakenly considered to belong to the text of the Oath. Examples of the amount of medical awards are stated, as well as the examples of selflessness and dedication of the physicians in that time. A physician was obliged to help by law, only in the case of accidents and injuries. It is obvious that "medical doctrine" existed also in this time. Requirements set to a doctor were realistic, modest and appropriate to the call, with the main purpose of protecting the reputation and dignity of the profession. Despite the historical distance, classical text of the Oath is still up to date. In this context, ambiguities and errors result from not being familiar with the both, the basic text, and the circumstances prevailing at the time and society, in which the Oath was made.

  19. [Comparative review of the Senegalese and French deontology codes].

    PubMed

    Soumah, M; Mbaye, I; Bah, H; Gaye Fall, M C; Sow, M L

    2005-01-01

    The medical deontology regroups duties of the physicians and regulate the exercise of medicine. The code of medical deontology of Senegal inspired of the French medical deontology code, has not been revised since its institution whereas the French deontology code knew three revisions. Comparing the two codes of deontology titles by title and article by article, this work beyond a parallel between the two codes puts in inscription the progress in bioethics that are to the basis of the revisions of the French medical deontology code. This article will permit an advocacy of the health professionals, in favor of a setting to level of the of Senegalese medical deontology code. Because legal litigation, that is important in the developed countries, intensify in our developing countries. It is inherent to the technological progress and to the awareness of the patients of their rights.

  20. Scanning for safety: an integrated approach to improved bar-code medication administration.

    PubMed

    Early, Cynde; Riha, Chris; Martin, Jennifer; Lowdon, Karen W; Harvey, Ellen M

    2011-03-01

    This is a review of lessons learned in the postimplementation evaluation of a bar-code medication administration technology implemented at a major tertiary-care hospital in 2001. In 2006, with a bar-code medication administration scan compliance rate of 82%, a near-miss sentinel event prompted review of this technology as part of an institutional recommitment to a "culture of safety." Multifaceted problems with bar-code medication administration created an environment of circumventing safeguards as demonstrated by an increase in manual overrides to ensure timely medication administration. A multiprofessional team composed of nursing, pharmacy, human resources, quality, and technical services formalized. Each step in the bar-code medication administration process was reviewed. Technology, process, and educational solutions were identified and implemented systematically. Overall compliance with bar-code medication administration rose from 82% to 97%, which resulted in a calculated cost avoidance of more than $2.8 million during this time frame of the project.

  1. QR code for medical information uses.

    PubMed

    Fontelo, Paul; Liu, Fang; Ducut, Erick G

    2008-11-06

    We developed QR code online tools, simulated and tested QR code applications for medical information uses including scanning QR code labels, URLs and authentication. Our results show possible applications for QR code in medicine.

  2. The speakers' bureau system: a form of peer selling.

    PubMed

    Reid, Lynette; Herder, Matthew

    2013-01-01

    In the speakers' bureau system, physicians are recruited and trained by pharmaceutical, biotechnology, and medical device companies to deliver information about products to other physicians, in exchange for a fee. Using publicly available disclosures, we assessed the thesis that speakers' bureau involvement is not a feature of academic medicine in Canada, by estimating the prevalence of participation in speakers' bureaus among Canadian faculty in one medical specialty, cardiology. We analyzed the relevant features of an actual contract made public by the physician addressee and applied the Canadian Medical Association (CMA) guidelines on physician-industry relations to participation in a speakers' bureau. We argue that speakers' bureau participation constitutes a form of peer selling that should be understood to contravene the prohibition on product endorsement in the CMA Code of Ethics. Academic medical institutions, in conjunction with regulatory colleges, should continue and strengthen their policies to address participation in speakers' bureaus.

  3. “Do your homework…and then hope for the best”: the challenges that medical tourism poses to Canadian family physicians’ support of patients’ informed decision-making

    PubMed Central

    2013-01-01

    Background Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism. Methods Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants’ perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians’ abilities to support medical tourists’ informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Results Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician’s role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician’s reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians’ concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Conclusions Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad. PMID:24053385

  4. "Do your homework…and then hope for the best": the challenges that medical tourism poses to Canadian family physicians' support of patients' informed decision-making.

    PubMed

    Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Dharamsi, Shafik

    2013-09-22

    Medical tourism-the practice where patients travel internationally to privately access medical care-may limit patients' regular physicians' abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors' typical involvement in patients' informed decision-making is challenged when their patients engage in medical tourism. Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants' perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians' abilities to support medical tourists' informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician's role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician's reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians' concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad.

  5. Medication Errors: New EU Good Practice Guide on Risk Minimisation and Error Prevention.

    PubMed

    Goedecke, Thomas; Ord, Kathryn; Newbould, Victoria; Brosch, Sabine; Arlett, Peter

    2016-06-01

    A medication error is an unintended failure in the drug treatment process that leads to, or has the potential to lead to, harm to the patient. Reducing the risk of medication errors is a shared responsibility between patients, healthcare professionals, regulators and the pharmaceutical industry at all levels of healthcare delivery. In 2015, the EU regulatory network released a two-part good practice guide on medication errors to support both the pharmaceutical industry and regulators in the implementation of the changes introduced with the EU pharmacovigilance legislation. These changes included a modification of the 'adverse reaction' definition to include events associated with medication errors, and the requirement for national competent authorities responsible for pharmacovigilance in EU Member States to collaborate and exchange information on medication errors resulting in harm with national patient safety organisations. To facilitate reporting and learning from medication errors, a clear distinction has been made in the guidance between medication errors resulting in adverse reactions, medication errors without harm, intercepted medication errors and potential errors. This distinction is supported by an enhanced MedDRA(®) terminology that allows for coding all stages of the medication use process where the error occurred in addition to any clinical consequences. To better understand the causes and contributing factors, individual case safety reports involving an error should be followed-up with the primary reporter to gather information relevant for the conduct of root cause analysis where this may be appropriate. Such reports should also be summarised in periodic safety update reports and addressed in risk management plans. Any risk minimisation and prevention strategy for medication errors should consider all stages of a medicinal product's life-cycle, particularly the main sources and types of medication errors during product development. This article describes the key concepts of the EU good practice guidance for defining, classifying, coding, reporting, evaluating and preventing medication errors. This guidance should contribute to the safe and effective use of medicines for the benefit of patients and public health.

  6. Infant food marketing strategies undermine effective regulation of breast-milk substitutes: trends in print advertising in Australia, 1950-2010.

    PubMed

    Smith, Julie; Blake, Miranda

    2013-08-01

    This study addresses the issue of whether voluntary industry regulation has altered companies' marketing of breast-milk substitutes in Australia since the adoption of the World Health Organization (WHO) International Code on the Marketing of Breast-milk Substitutes 1981. Print advertisements marketing breast-milk substitutes were systematically sampled from the Australian Women's Weekly (AWW) magazine and the Medical Journal of Australia (MJA) for the 61 years from 1950 to 2010. Breast-milk substitute advertising in both the MJA and the AWW peaked and began declining before the introduction of the WHO Code in 1981. Although there was almost no infant formula advertising in AWW after 1975-79, other breast-milk substitute advertising has been increasing since 1992, in particular for baby food, toddler formula and food and brand promotion. Companies have adopted strategies to minimise the effects of the Code on sales and profit in Australia, including increasing toddler formula and food advertisements, increasing brand promotion to the public, and complying with more limited voluntary regulatory arrangements. Comprehensive regulation is urgently required to address changed marketing practices if it is to protect breastfeeding in Australia. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

  7. Effect of bar-code technology on the safety of medication administration.

    PubMed

    Poon, Eric G; Keohane, Carol A; Yoon, Catherine S; Ditmore, Matthew; Bane, Anne; Levtzion-Korach, Osnat; Moniz, Thomas; Rothschild, Jeffrey M; Kachalia, Allen B; Hayes, Judy; Churchill, William W; Lipsitz, Stuart; Whittemore, Anthony D; Bates, David W; Gandhi, Tejal K

    2010-05-06

    Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR). We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it. Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.) 2010 Massachusetts Medical Society

  8. Evaluation and implementation of QR Code Identity Tag system for Healthcare in Turkey.

    PubMed

    Uzun, Vassilya; Bilgin, Sami

    2016-01-01

    For this study, we designed a QR Code Identity Tag system to integrate into the Turkish healthcare system. This system provides QR code-based medical identification alerts and an in-hospital patient identification system. Every member of the medical system is assigned a unique QR Code Tag; to facilitate medical identification alerts, the QR Code Identity Tag can be worn as a bracelet or necklace or carried as an ID card. Patients must always possess the QR Code Identity bracelets within hospital grounds. These QR code bracelets link to the QR Code Identity website, where detailed information is stored; a smartphone or standalone QR code scanner can be used to scan the code. The design of this system allows authorized personnel (e.g., paramedics, firefighters, or police) to access more detailed patient information than the average smartphone user: emergency service professionals are authorized to access patient medical histories to improve the accuracy of medical treatment. In Istanbul, we tested the self-designed system with 174 participants. To analyze the QR Code Identity Tag system's usability, the participants completed the System Usability Scale questionnaire after using the system.

  9. Using QR Codes to Differentiate Learning for Gifted and Talented Students

    ERIC Educational Resources Information Center

    Siegle, Del

    2015-01-01

    QR codes are two-dimensional square patterns that are capable of coding information that ranges from web addresses to links to YouTube video. The codes save time typing and eliminate errors in entering addresses incorrectly. These codes make learning with technology easier for students and motivationally engage them in news ways.

  10. Ethical considerations in industry-sponsored multiregional clinical trials.

    PubMed

    Ibia, Ekopimo; Binkowitz, Bruce; Saillot, Jean-Louis; Talerico, Steven; Koerner, Chin; Ferreira, Irene; Agarwal, Anupam; Metz, Craig; Maman, Marianne

    2010-01-01

    During the last several decades, the scientific and ethics communities have addressed important ethical issues in medical research, resulting in the elaboration and adoption of concepts, guidelines, and codes. Ethical issues in the conduct of Multiregional Clinical Trials have attracted significant attention mainly in the last two decades. With the globalization of clinical research and the rapid expansion to countries with a limited tradition of biomedical research, sponsors must proactively address local ethical issues, the adequacy of oversight as well as the applicability and validity of data, and scientific conclusions drawn from diverse patient populations. This paper highlights some core ethical principles and milestones in medical research, and, from an industry perspective, it discusses ethical issues that the clinical trial team may face when conducting Multiregional Clinical Trials (MRCT, clinical trials conducted at sites located across multiple geographic regions of the world). This paper further highlights the areas of consensus and controversies and proposes points to consider. Copyright © 2010 John Wiley & Sons, Ltd.

  11. Management of Stress and Anxiety Among PhD Students During Thesis Writing: A Qualitative Study.

    PubMed

    Bazrafkan, Leila; Shokrpour, Nasrin; Yousefi, Alireza; Yamani, Nikoo

    2016-01-01

    Today, postgraduate students experience a variety of stresses and anxiety in different situations of academic cycle. Stress and anxiety have been defined as a syndrome shown by emotional exhaustion and reduced personal goal achievement. This article addresses the causes and different strategies of coping with this phenomena by PhD students at Iranian Universities of Medical Sciences. The study was conducted by a qualitative method using conventional content analysis approach. Through purposive sampling, 16 postgraduate medical sciences PhD students were selected on the basis of theoretical sampling. Data were gathered through semistructured interviews and field observations. Six hundred fifty-four initial codes were summarized and classified into 4 main categories and 11 subcategories on the thematic coding stage dependent on conceptual similarities and differences. The obtained codes were categorized under 4 themes including "thesis as a major source of stress," "supervisor relationship," "socioeconomic problem," and "coping with stress and anxiety." It was concluded that PhD students experience stress and anxiety from a variety of sources and apply different methods of coping in effective and ineffective ways. Purposeful supervision and guidance can reduce the cause of stress and anxiety; in addition, coping strategy must be in a thoughtful approach, as recommended in this study.

  12. A Model for the Management of Supplemental Care Expenditures for Computed Tomography (CT) Scans at Irwin Army Community Hospital, Fort Riley, Kansas

    DTIC Science & Technology

    1989-07-24

    NUMBER ORGANIZATION (If applicable) Bc. ADDRESS (City, State, and ZIP Code) 10 SOURCE OF FUNDING NUMBERS PROGRAM IPROJECT ITASK IWORK UNIT ELEMENT NO NO...A mobile CT scanner with transporter vehicle has been purchased for IACH by Defense Personnel Support Center as part of a multiple unit purchase...lag time inherent in the procurement of high-cost, high technology medical equipment. Current indications are that the unit will be 1 installed some

  13. Disaster Relief and Emergency Medical Services Project (DREAMS TM): Digital EMS

    DTIC Science & Technology

    2000-10-01

    exchanges between the hospital and the EMS vehicle. By creating the virtual presence of a physician at or near the emergency scene, more lives will be saved ...address, cross street, zip code etc. The map can be saved to the clipboard or to an EMF graphics file for use by other applications in the system. 29...section can be found in Appendix B. The EMS personnel on board the ambulance can benefit greatly from technology integration. Several time- saving

  14. Characterization of Explosives Processing Waste Decomposition Due to Composting. Phase 1

    DTIC Science & Technology

    1990-01-31

    Caidwell, G. S . Fleming, R. M. Edwards, and E. T. Maestas of the Analytical Chemistry Division, L A. Kszos. L. F. Wicker, P. W. Braden, R. D. Bailey...DISTRIBUTION UNLIMITED. V =-PE.ORMING ORGANIZATION REPORT NUMBER( S ) 5. MONITORING ORGANIZATION REPORT NUMBER( S ) ORNL/TM-11573 6a. NAME OF PERFORMING...ORGANIZATIONAN (If apolicable)U.S. ARMY MEDICAL RESEARCHANES.T.PMFNT EDIA SGRD-RMI- S PROJECT ORDER NO. 89PP9921 Sc. ADDRESS (City, State, and ZIP Code) 10

  15. Hemoglobin Function and Red Cell Metabolism in Stored Blood

    DTIC Science & Technology

    1988-04-01

    but still worsen ATP maintenance relative to the CPD-A control. Ascorbate (or vitamin C ), at a 10 mM concentration, maintains near normal 2,3-DPG...ORGANIZATION U.S. Army Medical (if applicable) Research & Development Command Contract No. DADAI7-72- C -2005 8c. ADDRESS(City, State, and ZIP Code) 10- SOURCE OF...ATTENTION OF SGRD-RMI-S SUBJECT: Review of Draft Final Report, April 1, 1988, for Contract No. DADAI7-72- C -2005 Ben R. Dawson, M.D. University of

  16. Standardization and Implementation of a Standard Emergency Code Call System within Estern Region Medical Command

    DTIC Science & Technology

    2009-03-01

    currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 21-04-2009 2. REPORT TYPE...morph with the advent of the personal computer. Instead, they went out of business . A similar situation exists with the Ford, Chrysler and GM, where...This dissent needs a constructive forum or outlet so outside-the-box solutions and better business practices have a nurturing environment for

  17. An address geocoding method for improving rural spatial information infrastructure

    NASA Astrophysics Data System (ADS)

    Pan, Yuchun; Chen, Baisong; Lu, Zhou; Li, Shuhua; Zhang, Jingbo; Zhou, YanBing

    2010-11-01

    The transition of rural and agricultural management from divisional to integrated mode has highlighted the importance of data integration and sharing. Current data are mostly collected by specific department to satisfy their own needs and lake of considering on wider potential uses. This led to great difference in data format, semantic, and precision even in same area, which is a significant barrier for constructing an integrated rural spatial information system to support integrated management and decision-making. Considering the rural cadastral management system and postal zones, the paper designs a rural address geocoding method based on rural cadastral parcel. It puts forward a geocoding standard which consists of absolute position code, relative position code and extended code. It designs a rural geocoding database model, and addresses collection and update model. Then, based on the rural address geocoding model, it proposed a data model for rural agricultural resources management. The results show that the address coding based on postal code is stable and easy to memorize, two-dimensional coding based on the direction and distance is easy to be located and memorized, while extended code can enhance the extensibility and flexibility of address geocoding.

  18. An Analysis of the Changes in Communication Techniques in the Italian Codes of Medical Deontology.

    PubMed

    Conti, Andrea Alberto

    2017-04-28

    The code of deontology of the Italian National Federation of the Colleges of Physicians, Surgeons and Dentists (FNOMCeO) contains the principles and rules to which the professional medical practitioner must adhere. This work identifies and analyzes the medical-linguistic choices and the expressive techniques present in the different editions of the code, and evaluates their purpose and function, focusing on the first appearance and the subsequent frequency of key terms. Various aspects of the formal and expressive revisions of the eight editions of the Codes of Medical Deontology published after the Second World War (from 1947/48 to 2014) are here presented, starting from a brief comparison with the first edition of 1903. Formal characteristics, choices of medical terminology and the introduction of new concepts and communicative attitudes are here identified and evaluated. This paper, in presenting a quantitative and epistemological analysis of variations, modifications and confirmations in the different editions of the Italian code of medical deontology over the last century, enucleates and demonstrates the dynamic paradigm of changing attitudes in the medical profession. This analysis shows the evolution in medical-scientific communication as embodied in the Italian code of medical deontology. This code, in its adoption, changes and adaptations, as evidenced in its successive editions, bears witness to the expressions and attitudes pertinent to and characteristic of the deontological stance of the medical profession during the twentieth century.

  19. When a physician and a clinical ethicist collaborate for better patient care.

    PubMed

    Arawi, Thalia; Charafeddine, Lama

    2018-06-01

    Bioethics is a relatively new addition to bedside medical care in Arab world which is characterized by a special culture that often makes blind adaptation of western ethics codes and principles; a challenge that has to be faced. To date, the American University of Beirut Medical Center is the only hospital that offers bedside ethics consultations in the Arab Region aiming towards better patient-centered care. This article tackles the role of the bedside clinical ethics consultant as an active member of the medical team and the impact of such consultations on decision-making and patient-centered care. Using the case of a child with multiple medical problems and a futile medical condition, we describe how the collaboration of the medical team and the clinical ethics consultant took a comprehensive approach to accompany and lead the parents and the medical team in their decision-making process and how the consultations allowed several salient issues to be addressed. This approach proved to be effective in the Arab cultural setting and indeed did lead to better patientcentered care. © 2018 John Wiley & Sons Ltd.

  20. Medical waste management in Jordan: A study at the King Hussein Medical Center

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Oweis, Rami; Al-Widyan, Mohamad; Al-Limoon, Ohood

    2005-07-01

    As in many other developing countries, the generation of regulated medical waste (RMW) in Jordan has increased significantly over the last few decades. Despite the serious impacts of RMW on humans and the environment, only minor attention has been directed to its proper handling and disposal. This study was conducted in the form of a case study at one of Jordan's leading medical centers, namely, the King Hussein Medical Center (KHMC). Its purpose was to report on the current status of medical waste management at KHMC and propose possible measures to improve it. In general, it was found that themore » center's administration was reasonably aware of the importance of medical waste management and practiced some of the measures to adequately handle waste generated at the center. However, it was also found that significant voids were present that need to be addressed in the future including efficient segregation, the use of coded and colored bags, better handling and transfer means, and better monitoring and tracking techniques, as well as the need for training and awareness programs for the personnel.« less

  1. Radiology and Ethics Education.

    PubMed

    Camargo, Aline; Liu, Li; Yousem, David M

    2017-09-01

    The purpose of this study is to assess medical ethics knowledge among trainees and practicing radiologists through an online survey that included questions about the American College of Radiology Code of Ethics and the American Medical Association Code of Medical Ethics. Most survey respondents reported that they had never read the American Medical Association Code of Medical Ethics or the American College of Radiology Code of Ethics (77.2% and 67.4% of respondents, respectively). With regard to ethics education during medical school and residency, 57.3% and 70.0% of respondents, respectively, found such education to be insufficient. Medical ethics training should be highlighted during residency, at specialty society meetings, and in journals and online resources for radiologists.

  2. Light Infantry in the Defense of Urban Europe.

    DTIC Science & Technology

    1986-12-14

    if applicable) 6c. ADDRESS (City, State, and ZIP Code ) 7b. ADDRESS (City, State, and ZIP Code ) Fort Leavenworth, Kansas 66027-6900 Ba. NAME OF FUNDING...SPONSORING 8b. OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION (If applicable) Sc. ADDRESS (City, State, and ZIP Code ) 10...PAGE COUNT wo - EFROM TO144 16. SUPPLEMENTARY NOTATION 17. COSATI CODES A*SUBJECT TERMS (Continue on reverse if necessary and identify by block

  3. Nurses' attitudes toward the use of the bar-coding medication administration system.

    PubMed

    Marini, Sana Daya; Hasman, Arie; Huijer, Huda Abu-Saad; Dimassi, Hani

    2010-01-01

    This study determines nurses' attitudes toward bar-coding medication administration system use. Some of the factors underlying the successful use of bar-coding medication administration systems that are viewed as a connotative indicator of users' attitudes were used to gather data that describe the attitudinal basis for system adoption and use decisions in terms of subjective satisfaction. Only 67 nurses in the United States had the chance to respond to the e-questionnaire posted on the CARING list server for the months of June and July 2007. Participants rated their satisfaction with bar-coding medication administration system use based on system functionality, usability, and its positive/negative impact on the nursing practice. Results showed, to some extent, positive attitude, but the image profile draws attention to nurses' concerns for improving certain system characteristics. The high bar-coding medication administration system skills revealed a more negative perception of the system by the nursing staff. The reasons underlying dissatisfaction with bar-coding medication administration use by skillful users are an important source of knowledge that can be helpful for system development as well as system deployment. As a result, strengthening bar-coding medication administration system usability by magnifying its ability to eliminate medication errors and the contributing factors, maximizing system functionality by ascertaining its power as an extra eye in the medication administration process, and impacting the clinical nursing practice positively by being helpful to nurses, speeding up the medication administration process, and being user-friendly can offer a congenial settings for establishing positive attitude toward system use, which in turn leads to successful bar-coding medication administration system use.

  4. Analysis of the technology acceptance model in examining hospital nurses' behavioral intentions toward the use of bar code medication administration.

    PubMed

    Song, Lunar; Park, Byeonghwa; Oh, Kyeung Mi

    2015-04-01

    Serious medication errors continue to exist in hospitals, even though there is technology that could potentially eliminate them such as bar code medication administration. Little is known about the degree to which the culture of patient safety is associated with behavioral intention to use bar code medication administration. Based on the Technology Acceptance Model, this study evaluated the relationships among patient safety culture and perceived usefulness and perceived ease of use, and behavioral intention to use bar code medication administration technology among nurses in hospitals. Cross-sectional surveys with a convenience sample of 163 nurses using bar code medication administration were conducted. Feedback and communication about errors had a positive impact in predicting perceived usefulness (β=.26, P<.01) and perceived ease of use (β=.22, P<.05). In a multiple regression model predicting for behavioral intention, age had a negative impact (β=-.17, P<.05); however, teamwork within hospital units (β=.20, P<.05) and perceived usefulness (β=.35, P<.01) both had a positive impact on behavioral intention. The overall bar code medication administration behavioral intention model explained 24% (P<.001) of the variance. Identified factors influencing bar code medication administration behavioral intention can help inform hospitals to develop tailored interventions for RNs to reduce medication administration errors and increase patient safety by using this technology.

  5. An Internet-Based Method for Extracting Nursing Home Resident Sedative Medication Data From Pharmacy Packing Systems: Descriptive Evaluation

    PubMed Central

    Gee, Peter; Westbury, Juanita; Bindoff, Ivan; Peterson, Gregory

    2017-01-01

    Background Inappropriate use of sedating medication has been reported in nursing homes for several decades. The Reducing Use of Sedatives (RedUSe) project was designed to address this issue through a combination of audit, feedback, staff education, and medication review. The project significantly reduced sedative use in a controlled trial of 25 Tasmanian nursing homes. To expand the project to 150 nursing homes across Australia, an improved and scalable method of data collection was required. This paper describes and evaluates a method for remotely extracting, transforming, and validating electronic resident and medication data from community pharmacies supplying medications to nursing homes. Objective The aim of this study was to develop and evaluate an electronic method for extracting and enriching data on psychotropic medication use in nursing homes, on a national scale. Methods An application uploaded resident details and medication data from computerized medication packing systems in the pharmacies supplying participating nursing homes. The server converted medication codes used by the packing systems to Australian Medicines Terminology coding and subsequently to Anatomical Therapeutic Chemical (ATC) codes for grouping. Medications of interest, in this case antipsychotics and benzodiazepines, were automatically identified and quantified during the upload. This data was then validated on the Web by project staff and a “champion nurse” at the participating home. Results Of participating nursing homes, 94.6% (142/150) had resident and medication records uploaded. Facilitating an upload for one pharmacy took an average of 15 min. A total of 17,722 resident profiles were extracted, representing 95.6% (17,722/18,537) of the homes’ residents. For these, 546,535 medication records were extracted, of which, 28,053 were identified as antipsychotics or benzodiazepines. Of these, 8.17% (2291/28,053) were modified during validation and verification stages, and 4.75% (1398/29,451) were added. The champion nurse required a mean of 33 min website interaction to verify data, compared with 60 min for manual data entry. Conclusions The results show that the electronic data collection process is accurate: 95.25% (28,053/29,451) of sedative medications being taken by residents were identified and, of those, 91.83% (25,762/28,053) were correct without any manual intervention. The process worked effectively for nearly all homes. Although the pharmacy packing systems contain some invalid patient records, and data is sometimes incorrectly recorded, validation steps can overcome these problems and provide sufficiently accurate data for the purposes of reporting medication use in individual nursing homes. PMID:28778844

  6. Wartime Tracking of Class I Surface Shipments from Production or Procurement to Destination

    DTIC Science & Technology

    1992-04-01

    Armed Forces I ICAF-FAP National Defense University 6c. ADDRESS (City, State, ard ZIP Code ) 7b. ADDRESS (City, State, and ZIP Code ) Fort Lesley J...INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION (If applicable) 9c. ADDRESS (City, State, and ZIP Code ) 10. SOURCE OF FUNDING NUMBERS PROGRAM PROJECT TASK...COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP 19. ABSTRACT (Continue on reverse

  7. Force Identification from Structural Response

    DTIC Science & Technology

    1999-12-01

    STUDENT AT (If applicable) AFIT/CIA Univ of New Mexico A 6c. ADDRESS (City, State, and ZIP Code ) 7b. ADDRESS (City, State, and ZIP Code ) Wright...ADDRESS (City, State, and ZIP Code ) 10. SOURCE OF FUNDING NUMBERS PROGRAM PROJECT TASK WORK UNIT ELEMENT NO. NO. NO. ACCESSION NO. 11. TITLE (h,,clude...FOR PUBLIC RELEASE IAW AFR 190-1 ERNEST A. HAYGOOD, 1st Lt, USAF Executive Officer, Civilian Institution Programs 17. COSATI CODES 18. SUBJECT TERMS

  8. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts.

    PubMed

    Cahill, Sean; Taylor, S Wade; Elsesser, Steven A; Mena, Leandro; Hickson, DeMarc; Mayer, Kenneth H

    2017-11-01

    Gay and bisexual men and other men who have sex with men (MSM) account for more than two thirds of new HIV infections in the U.S., with Black MSM experiencing the greatest burden. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce MSM's vulnerability to HIV infection. Uptake of PrEP has been limited, particularly among racial and ethnic minority MSM. Four semi-structured focus groups with gay and bisexual men and other MSM at risk for HIV infection were convened in Boston and Jackson in late 2013. The analysis plan utilized a within-case, across-case approach to code and analyze emerging themes, and to compare results across the two cities. Participants recruited in Jackson were primarily Black gay men, while Boston participants were mostly non-Hispanic White gay men. Participants in both sites shared concerns about medication side effects and culturally insensitive health care for gay men. Jackson participants described stronger medical mistrust, and more frequently described experiences of anti-gay and HIV related stigma. Multiple addressable barriers to PrEP uptake were described. Information about side effects should be explicitly addressed in PrEP education campaigns. Providers and health departments should address medical mistrust, especially among Black gay and bisexual men and other MSM, in part by training providers in how to provide affirming, culturally competent care. Medicaid should be expanded in Mississippi to cover low-income young Black gay and bisexual men and other MSM.

  9. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts

    PubMed Central

    Cahill, Sean; Taylor, S. Wade; Elsesser, Steven A.; Mena, Leandro; Hickson, DeMarc; Mayer, Kenneth H.

    2017-01-01

    Gay and bisexual men and other men who have sex with men (MSM) account for more than two thirds of new HIV infections in the U.S., with Black MSM experiencing the greatest burden. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce MSM's vulnerability to HIV infection. Uptake of PrEP has been limited, particularly among racial and ethnic minority MSM. Four semi-structured focus groups with gay and bisexual men and other MSM at risk for HIV infection were convened in Boston and Jackson in late 2013. The analysis plan utilized a within-case, across-case approach to code and analyze emerging themes, and to compare results across the two cities. Participants recruited in Jackson were primarily Black gay men, while Boston participants were mostly non-Hispanic White gay men. Participants in both sites shared concerns about medication side effects and culturally insensitive health care for gay men. Jackson participants described stronger medical mistrust, and more frequently described experiences of anti-gay and HIV related stigma. Multiple addressable barriers to PrEP uptake were described. Information about side effects should be explicitly addressed in PrEP education campaigns. Providers and health departments should address medical mistrust, especially among Black gay and bisexual men and other MSM, in part by training providers in how to provide affirming, culturally competent care. Medicaid should be expanded in Mississippi to cover low-income young Black gay and bisexual men and other MSM. PMID:28286983

  10. Time trend of injection drug errors before and after implementation of bar-code verification system.

    PubMed

    Sakushima, Ken; Umeki, Reona; Endoh, Akira; Ito, Yoichi M; Nasuhara, Yasuyuki

    2015-01-01

    Bar-code technology, used for verification of patients and their medication, could prevent medication errors in clinical practice. Retrospective analysis of electronically stored medical error reports was conducted in a university hospital. The number of reported medication errors of injected drugs, including wrong drug administration and administration to the wrong patient, was compared before and after implementation of the bar-code verification system for inpatient care. A total of 2867 error reports associated with injection drugs were extracted. Wrong patient errors decreased significantly after implementation of the bar-code verification system (17.4/year vs. 4.5/year, p< 0.05), although wrong drug errors did not decrease sufficiently (24.2/year vs. 20.3/year). The source of medication errors due to wrong drugs was drug preparation in hospital wards. Bar-code medication administration is effective for prevention of wrong patient errors. However, ordinary bar-code verification systems are limited in their ability to prevent incorrect drug preparation in hospital wards.

  11. The impact of medical tourism and the code of medical ethics on advertisement in Nigeria

    PubMed Central

    Makinde, Olusesan Ayodeji; Brown, Brandon; Olaleye, Olalekan

    2014-01-01

    Advances in management of clinical conditions are being made in several resource poor countries including Nigeria. Yet, the code of medical ethics which bars physician and health practices from advertising the kind of services they render deters these practices. This is worsened by the incursion of medical tourism facilitators (MTF) who continue to market healthcare services across countries over the internet and social media thereby raising ethical questions. A significant review of the advertisement ban in the code of ethics is long overdue. Limited knowledge about advances in medical practice among physicians and the populace, the growing medical tourism industry and its attendant effects, and the possibility of driving brain gain provide evidence to repeal the code. Ethical issues, resistance to change and elitist ideas are mitigating factors working in the opposite direction. The repeal of the code of medical ethics against advertising will undoubtedly favor health facilities in the country that currently cannot advertise the kind of services they render. A repeal or review of this code of medical ethics is necessary with properly laid down guidelines on how advertisements can be and cannot be done. PMID:25722776

  12. The impact of medical tourism and the code of medical ethics on advertisement in Nigeria.

    PubMed

    Makinde, Olusesan Ayodeji; Brown, Brandon; Olaleye, Olalekan

    2014-01-01

    Advances in management of clinical conditions are being made in several resource poor countries including Nigeria. Yet, the code of medical ethics which bars physician and health practices from advertising the kind of services they render deters these practices. This is worsened by the incursion of medical tourism facilitators (MTF) who continue to market healthcare services across countries over the internet and social media thereby raising ethical questions. A significant review of the advertisement ban in the code of ethics is long overdue. Limited knowledge about advances in medical practice among physicians and the populace, the growing medical tourism industry and its attendant effects, and the possibility of driving brain gain provide evidence to repeal the code. Ethical issues, resistance to change and elitist ideas are mitigating factors working in the opposite direction. The repeal of the code of medical ethics against advertising will undoubtedly favor health facilities in the country that currently cannot advertise the kind of services they render. A repeal or review of this code of medical ethics is necessary with properly laid down guidelines on how advertisements can be and cannot be done.

  13. Using RxNorm and NDF-RT to classify medication data extracted from electronic health records: experiences from the Rochester Epidemiology Project.

    PubMed

    Pathak, Jyotishman; Murphy, Sean P; Willaert, Brian N; Kremers, Hilal M; Yawn, Barbara P; Rocca, Walter A; Chute, Christopher G

    2011-01-01

    RxNorm and NDF-RT published by the National Library of Medicine (NLM) and Veterans Affairs (VA), respectively, are two publicly available federal medication terminologies. In this study, we evaluate the applicability of RxNorm and National Drug File-Reference Terminology (NDF-RT) for extraction and classification of medication data retrieved using structured querying and natural language processing techniques from electronic health records at two different medical centers within the Rochester Epidemiology Project (REP). Specifically, we explore how mappings between RxNorm concept codes and NDF-RT drug classes can be leveraged for hierarchical organization and grouping of REP medication data, identify gaps and coverage issues, and analyze the recently released NLM's NDF-RT Web service API. Our study concludes that RxNorm and NDF-RT can be applied together for classification of medication extracted from multiple EHR systems, although several issues and challenges remain to be addressed. We further conclude that the Web service APIs developed by the NLM provide useful functionalities for such activities.

  14. From primary care to public health: using Problem-based Learning and the ecological model to teach public health to first year medical students.

    PubMed

    Hoover, Cora R; Wong, Candice C; Azzam, Amin

    2012-06-01

    We investigated whether a public health-oriented Problem-Based Learning case presented to first-year medical students conveyed 12 "Population Health Competencies for Medical Students," as recommended by the Association of American Medical Colleges and the Regional Medicine-Public Health Education Centers. A public health-oriented Problem-Based Learning case guided by the ecological model paradigm was developed and implemented among two groups of 8 students at the University of California, Berkeley-UCSF Joint Medical Program, in the Fall of 2010. Using directed content analysis, student-generated written reports were coded for the presence of the 12 population health content areas. Students generated a total of 29 reports, of which 20 (69%) contained information relevant to at least one of the 12 population health competencies. Each of the 12 content areas was addressed by at least one report. As physicians-in-training prepare to confront the challenges of integrating prevention and population health with clinical practice, Problem-Based Learning is a promising tool to enhance medical students' engagement with public health.

  15. [Towards a new Tunisian Medical Code of Deontology].

    PubMed

    Aissaoui, Abir; Haj Salem, Nidhal; Chadly, Ali

    2010-06-01

    The Medical Code of Deontology is a legal text including the physician's duties towards his patients, colleagues, auxiliaries and the community. Considering the scientific, legal and social changes, the deontology code should be revised periodically. The first Tunisian Medical Code of Deontology (TMCD) was promulgated in 1973 and abrogated in 1993 by the new Code. This version has never been reviewed and does not seem to fit the current conditions of medical practice. The TMCD does not contain texts referring to information given to the patient, pain control, palliative care and management of the end of life as well as protection of medical data. Furthermore, the TMCD does not include rules related to tissues and organs transplantation and medical assisted human reproduction in accordance with Tunisian legal texts. We aim in this paper at analyzing the insufficiencies of the TMCD and suggesting modifications in order to update it.

  16. Reinventing radiology reimbursement.

    PubMed

    Marshall, John; Adema, Denise

    2005-01-01

    Lee Memorial Health System (LMHS), located in southwest Florida, consists of 5 hospitals, a home health agency, a skilled nursing facility, multiple outpatient centers, walk-in medical centers, and primary care physician offices. LMHS annually performs more than 300,000 imaging procedures with gross imaging revenues exceeding dollar 350 million. In fall 2002, LMHS received the results of an independent audit of its IR coding. The overall IR coding error rate was determined to be 84.5%. The projected net financial impact of these errors was an annual reimbursement loss of dollar 182,000. To address the issues of coding errors and reimbursement loss, LMHS implemented its clinical reimbursementspecialist (CRS) system in October 2003, as an extension of financial services' reimbursement division. LMHS began with CRSs in 3 service lines: emergency department, cardiac catheterization, and radiology. These 3 CRSs coordinate all facets of their respective areas' chargemaster, patient charges, coding, and reimbursement functions while serving as a resident coding expert within their clinical areas. The radiology reimbursement specialist (RRS) combines an experienced radiologic technologist, interventional technologist, medical records coder, financial auditor, reimbursement specialist, and biller into a single position. The RRS's radiology experience and technologist knowledge are key assets to resolving coding conflicts and handling complex interventional coding. In addition, performing a daily charge audit and an active code review are essential if an organization is to eliminate coding errors. One of the inherent effects of eliminating coding errors is the capturing of additional RVUs and units of service. During its first year, based on account level detail, the RRS system increased radiology productivity through the additional capture of just more than 3,000 RVUs and 1,000 additional units of service. In addition, the physicians appreciate having someone who "keeps up with all the coding changes" and looks out for the charges. By assisting a few physicians' staff with coding questions, providing coding updates, and allowing them to sit in on educational sessions, at least 2 physicians have transferred some their volume to LMHS from a competitor. The provision of a "clean account," without coding errors, allows the biller to avoid the rework and billing delays caused by coding issues. During the first quarter of the RRS system, the billers referred an average of 9 accounts per day for coding resolution. During the fourth quarter of the system, these referrals were reduced to less than one per day. Prior to the RRS system, resolving these issues took an average of 4 business days. Now the conflicts are resolved within 24 hours.

  17. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior

    PubMed Central

    Linn, Annemiek J; van Weert, Julia CM; Schouten, Barbara C; Smit, Edith G; van Bodegraven, Ad A; van Dijk, Liset

    2012-01-01

    Purpose The barriers to patients’ successful medication intake behavior could be reduced through tailored communication about these barriers. The aim of this study is therefore (1) to develop a new communication typology to address these barriers to successful medication intake behavior, and (2) to examine the relationship between the use of the typology and the reduction of the barriers to successful medication intake behavior. Patients and methods Based on a literature review, the practical and perceptual barriers to successful medication intake behavior typology (PPB-typology) was developed. The PPB-typology addresses four potential types of barriers that can be either practical (memory and daily routine barriers) or perceptual (concern and necessity barriers). The typology describes tailored communication strategies that are organized according to barriers and communication strategies that are organized according to provider and patient roles. Eighty consultations concerning first-time medication use between nurses and inflammatory bowel disease patients were videotaped. The verbal content of the consultations was analyzed using a coding system based on the PPB-typology. The Medication Understanding and Use Self-efficacy Scale and the Beliefs about Medicine Questionnaire Scale were used as indicators of patients’ barriers and correlated with PPB-related scores. Results The results showed that nurses generally did not communicate with patients according to the typology. However, when they did, fewer barriers to successful medication intake behavior were identified. A significant association was found between nurses who encouraged question-asking behavior and memory barriers (r = −0.228, P = 0.042) and between nurses who summarized information (r = −0.254, P = 0.023) or used cartoons or pictures (r = −0.249, P = 0.026) and concern barriers. Moreover, a significant relationship between patients’ emotional cues about side effects and perceived concern barriers (r = 0.244, P = 0.029) was found as well. Conclusion The PPB-typology provides communication recommendations that are designed to meet patients’ needs and assist providers in the promotion of successful medication intake behavior, and it can be a useful tool for developing effective communication skills training programs. PMID:23271896

  18. Quality improvement of International Classification of Diseases, 9th revision, diagnosis coding in radiation oncology: single-institution prospective study at University of California, San Francisco.

    PubMed

    Chen, Chien P; Braunstein, Steve; Mourad, Michelle; Hsu, I-Chow J; Haas-Kogan, Daphne; Roach, Mack; Fogh, Shannon E

    2015-01-01

    Accurate International Classification of Diseases (ICD) diagnosis coding is critical for patient care, billing purposes, and research endeavors. In this single-institution study, we evaluated our baseline ICD-9 (9th revision) diagnosis coding accuracy, identified the most common errors contributing to inaccurate coding, and implemented a multimodality strategy to improve radiation oncology coding. We prospectively studied ICD-9 coding accuracy in our radiation therapy--specific electronic medical record system. Baseline ICD-9 coding accuracy was obtained from chart review targeting ICD-9 coding accuracy of all patients treated at our institution between March and June of 2010. To improve performance an educational session highlighted common coding errors, and a user-friendly software tool, RadOnc ICD Search, version 1.0, for coding radiation oncology specific diagnoses was implemented. We then prospectively analyzed ICD-9 coding accuracy for all patients treated from July 2010 to June 2011, with the goal of maintaining 80% or higher coding accuracy. Data on coding accuracy were analyzed and fed back monthly to individual providers. Baseline coding accuracy for physicians was 463 of 661 (70%) cases. Only 46% of physicians had coding accuracy above 80%. The most common errors involved metastatic cases, whereby primary or secondary site ICD-9 codes were either incorrect or missing, and special procedures such as stereotactic radiosurgery cases. After implementing our project, overall coding accuracy rose to 92% (range, 86%-96%). The median accuracy for all physicians was 93% (range, 77%-100%) with only 1 attending having accuracy below 80%. Incorrect primary and secondary ICD-9 codes in metastatic cases showed the most significant improvement (10% vs 2% after intervention). Identifying common coding errors and implementing both education and systems changes led to significantly improved coding accuracy. This quality assurance project highlights the potential problem of ICD-9 coding accuracy by physicians and offers an approach to effectively address this shortcoming. Copyright © 2015. Published by Elsevier Inc.

  19. Characteristics of New-Onset and Chronic Sleep Medication Users Among Older Adults: A Retrospective Study of a US Medigap Plan Population using Propensity Score Matching.

    PubMed

    Musich, Shirley; Wang, Shaohung S; Slindee, Luke B; Saphire, Lynn; Wicker, Ellen

    2018-05-01

    Prescription sleep medications are often utilized to manage sleep problems among older adults even though these drugs are associated with multiple risks. The aim was to determine the prevalence and characteristics of new-onset compared to chronic sleep medication users and to examine factors associated with the conversion from new to chronic use. A secondary objective was to investigate the impact of sleep medications on health outcomes of injurious falls and patterns of healthcare utilization and expenditures. A 25% random sample of adults ≥ 65 years with 3-year continuous AARP ® Medicare Supplement medical and AARP ® MedicareRx drug plan enrollment was utilized to identify new-onset and chronic sleep medication users. Prescription sleep medication drugs were defined using National Drug Codes (NDCs); falls or hip fractures were identified from diagnosis codes. New users had no sleep medication use in 2014, but initiated medication use in 2015; chronic users had at least one sleep medication prescription in 2014 and in 2015; both groups had follow-up through 2016. Characteristics associated with new users, new users who converted to chronic use, and chronic users were determined using multivariate logistic regression. Prevalence of falls, healthcare utilization and expenditures were regression adjusted. Among eligible insureds, 3 and 9% were identified as new-onset and chronic sleep medication users, respectively. New-onset sleep medication prescriptions were often associated with an inpatient hospitalization. The strongest characteristics associated with new users, those who converted to chronic use, and chronic users were sleep disorders, depression and opioid use. About 50% of new users had > 30 days' supply; 25% converted to chronic use with ≥ 90 days' supply. The prevalence of falls for new-onset users increased by 70% compared to a 22% increase among chronic users. New-onset and chronic sleep medication users were characterized by sleep disorders, depression and pain. Addressing the underlying problems associated with sleep problems among older adults may decrease the need for sleep medications and thus reduce the risk of sleep medication-related adverse events.

  20. Integrating Bar-Code Medication Administration Competencies in the Curriculum: Implications for Nursing Education and Interprofessional Collaboration.

    PubMed

    Angel, Vini M; Friedman, Marvin H; Friedman, Andrea L

    This article describes an innovative project involving the integration of bar-code medication administration technology competencies in the nursing curriculum through interprofessional collaboration among nursing, pharmacy, and computer science disciplines. A description of the bar-code medication administration technology project and lessons learned are presented.

  1. The challenge of mapping between two medical coding systems.

    PubMed

    Wojcik, Barbara E; Stein, Catherine R; Devore, Raymond B; Hassell, L Harrison

    2006-11-01

    Deployable medical systems patient conditions (PCs) designate groups of patients with similar medical conditions and, therefore, similar treatment requirements. PCs are used by the U.S. military to estimate field medical resources needed in combat operations. Information associated with each of the 389 PCs is based on subject matter expert opinion, instead of direct derivation from standard medical codes. Currently, no mechanisms exist to tie current or historical medical data to PCs. Our study objective was to determine whether reliable conversion between PC codes and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes is possible. Data were analyzed for three professional coders assigning all applicable ICD-9-CM diagnosis codes to each PC code. Inter-rater reliability was measured by using Cohen's K statistic and percent agreement. Methods were developed to calculate kappa statistics when multiple responses could be selected from many possible categories. Overall, we found moderate support for the possibility of reliable conversion between PCs and ICD-9-CM diagnoses (mean kappa = 0.61). Current PCs should be modified into a system that is verifiable with real data.

  2. Medical Ultrasound Video Coding with H.265/HEVC Based on ROI Extraction

    PubMed Central

    Wu, Yueying; Liu, Pengyu; Gao, Yuan; Jia, Kebin

    2016-01-01

    High-efficiency video compression technology is of primary importance to the storage and transmission of digital medical video in modern medical communication systems. To further improve the compression performance of medical ultrasound video, two innovative technologies based on diagnostic region-of-interest (ROI) extraction using the high efficiency video coding (H.265/HEVC) standard are presented in this paper. First, an effective ROI extraction algorithm based on image textural features is proposed to strengthen the applicability of ROI detection results in the H.265/HEVC quad-tree coding structure. Second, a hierarchical coding method based on transform coefficient adjustment and a quantization parameter (QP) selection process is designed to implement the otherness encoding for ROIs and non-ROIs. Experimental results demonstrate that the proposed optimization strategy significantly improves the coding performance by achieving a BD-BR reduction of 13.52% and a BD-PSNR gain of 1.16 dB on average compared to H.265/HEVC (HM15.0). The proposed medical video coding algorithm is expected to satisfy low bit-rate compression requirements for modern medical communication systems. PMID:27814367

  3. Medical Ultrasound Video Coding with H.265/HEVC Based on ROI Extraction.

    PubMed

    Wu, Yueying; Liu, Pengyu; Gao, Yuan; Jia, Kebin

    2016-01-01

    High-efficiency video compression technology is of primary importance to the storage and transmission of digital medical video in modern medical communication systems. To further improve the compression performance of medical ultrasound video, two innovative technologies based on diagnostic region-of-interest (ROI) extraction using the high efficiency video coding (H.265/HEVC) standard are presented in this paper. First, an effective ROI extraction algorithm based on image textural features is proposed to strengthen the applicability of ROI detection results in the H.265/HEVC quad-tree coding structure. Second, a hierarchical coding method based on transform coefficient adjustment and a quantization parameter (QP) selection process is designed to implement the otherness encoding for ROIs and non-ROIs. Experimental results demonstrate that the proposed optimization strategy significantly improves the coding performance by achieving a BD-BR reduction of 13.52% and a BD-PSNR gain of 1.16 dB on average compared to H.265/HEVC (HM15.0). The proposed medical video coding algorithm is expected to satisfy low bit-rate compression requirements for modern medical communication systems.

  4. The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care.

    PubMed

    Tsopra, Rosy; Peckham, Daniel; Beirne, Paul; Rodger, Kirsty; Callister, Matthew; White, Helen; Jais, Jean-Philippe; Ghosh, Dipansu; Whitaker, Paul; Clifton, Ian J; Wyatt, Jeremy C

    2018-07-01

    Coding of diagnoses is important for patient care, hospital management and research. However coding accuracy is often poor and may reflect methods of coding. This study investigates the impact of three alternative coding methods on the inaccuracy of diagnosis codes and hospital reimbursement. Comparisons of coding inaccuracy were made between a list of coded diagnoses obtained by a coder using (i)the discharge summary alone, (ii)case notes and discharge summary, and (iii)discharge summary with the addition of medical input. For each method, inaccuracy was determined for the primary, secondary diagnoses, Healthcare Resource Group (HRG) and estimated hospital reimbursement. These data were then compared with a gold standard derived by a consultant and coder. 107 consecutive patient discharges were analysed. Inaccuracy of diagnosis codes was highest when a coder used the discharge summary alone, and decreased significantly when the coder used the case notes (70% vs 58% respectively, p < 0.0001) or coded from the discharge summary with medical support (70% vs 60% respectively, p < 0.0001). When compared with the gold standard, the percentage of incorrect HRGs was 42% for discharge summary alone, 31% for coding with case notes, and 35% for coding with medical support. The three coding methods resulted in an annual estimated loss of hospital remuneration of between £1.8 M and £16.5 M. The accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary. Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Future Research Needs for Dredgeability of Rock: Rock Dredging Workshop Held in Jacksonville, Florida on 25-26 July 1985.

    DTIC Science & Technology

    1986-09-01

    ORGANIZATION Gjeoteehnical Laborator WESGR-M 6c ADDRESS (City, Slate, and ZIP Code ) 7b ADDRESS(City, State. and ZIP Code ) PO Box 631 Vicksburg, MS 39180...of Engineers 8< ADDRESS(City, State, and ZIP Code ) 10 SOURCE OF FUNDING NUMBERS PROGRAM PROJECT TASK WORK UNIT.. ", 1 :, • ; I, - u It ., " ’ ~f...Springfield, VA 22161 17 COSATI CODES 18 SUBJECT TERMS (Continue-On revprse of necessary and identify by block number) " FIELD GROUP SUB GROUP

  6. Harm reduction interventions in HIV care: a qualitative exploration of patient and provider perspectives

    PubMed Central

    2016-01-01

    Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction—which removes judgment and operates at the patient’s stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38). A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen’s Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision) from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm reduction interventions from their HIV care providers, while provider receptiveness is mixed. The findings reveal critical implications for diffusion of harm reduction into HIV care, including the need to address cited barriers for both patients and providers to ensure feasibility of implementation. Strategies to address these barriers are discussed, and recommendations for further research are also shared. PMID:27114879

  7. Proceedings of the Brain Mapping Machine Design Workshop Held in College Station, TX on 10-16 August, 1985. Volume 3. Background Papers Submitted by Participants.

    DTIC Science & Technology

    1985-08-01

    interactively. First, with the "tissue highlight" function, the user must define the range of intensity values (in Hounsfield units ) corresponding to the...Cosponsored by the United States Army Medical Research and Development Command, Scripps Clinic and Research Foundation, Texas A&M University, University of...Research & Development Command DAMDI7-85-G-5042 Sc. ADDRESS (City, State, and ZIP Code) 10. SOURCE OF FUNDING NUMBERS e PROGRAM PROJECT TASK IWORK UNIT

  8. Proposed regs address new hospital tax-exemption requirements.

    PubMed

    Speizman, Richard A; Moore, V A; Mitchell, Alexandra O

    2013-03-01

    Proposed regulations set forth detailed rules for implementing the new tax-exemption requirements of Section 501(r) of the Internal Revenue Code for not-for-profit organizations operating hospital facilities. The proposed regulations provide guidance on the written financial assistance policies (FAPs) that hospital facilities are required to establish. The regulations propose methodologies for determining the amounts that a hospital facility can charge FAP-eligible individuals for emergency and other medically necessary care. They prescribe procedures that hospital facilities would be required to follow before engaging in extraordinary collection actions against an individual.

  9. Spontaneous mental associations with the words "side effect": Implications for informed and shared decision making.

    PubMed

    Izadi, Sonya; Pachur, Thorsten; Wheeler, Courtney; McGuire, Jaclyn; Waters, Erika A

    2017-10-01

    To gain insight into patients' medical decisions by exploring the content of laypeople's spontaneous mental associations with the term "side effect." An online cross-sectional survey asked 144 women aged 40-74, "What are the first three things you think of when you hear the words 'side effect?"' Data were analyzed using content analysis, chi-square, and Fisher's exact tests. 17 codes emerged and were grouped into 4 themes and a Miscellaneous category: Health Problems (70.8% of participants), Decision-Relevant Evaluations (52.8%), Negative Affect (30.6%), Practical Considerations (18.1%) and Miscellaneous (9.7%). The 4 most frequently identified codes were: Risk (36.1%), Health Problems-Specific Symptoms (35.4%), Health Problems-General Terms (32.6%), and Negative Affect-Strong (19.4%). Code and theme frequencies were generally similar across demographic groups (ps>0.05). The term "side effect" spontaneously elicited comments related to identifying health problems and expressing negative emotions. This might explain why the mere possibility of side effects triggers negative affect for people making medical decisions. Some respondents also mentioned decision-relevant evaluations and practical considerations in response to side effects. Addressing commonly-held associations and acknowledging negative affects provoked by side effects are first steps healthcare providers can take towards improving informed and shared patient decision making. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Lexical analysis of the Code of Medical Ethics of the Federal Council of Medicine.

    PubMed

    Andrade, Edson de Oliveira; Andrade, Edson de Oliveira

    2016-04-01

    The Code of Medical Ethics (CME) of the Federal Council of Medicine is the legal document that exposes the moral discourse of Brazilian physicians to society and the profession. It is a set of propositions based on which doctors say they are committed to values of conduct aimed at fair and proper professional practice. To verify through lexical analysis of the CME corpus if the goals presented in the arguments of the resolution that established the code are properly addressed in these regulations. This is a quantitative and qualitative study of descriptive nature, aiming at a lexical analysis of the CME. The lexical analysis was performed using a method of Top-Down Hierarchical Classification of vocabulary, as described by Reinert in 1987, assuming that words used in similar contexts are associated with a single lexical world. In addition to the analysis of results, an improved representation of the charts related with Factorial and Similitude Analyses was made. Six clusters were extracted, leading to the identification of three major branches: health care, professional practice and research. These branches revolve around the figures of physician and patient. The similitude analysis revealed a complementarity status between these two figures. The lexical analysis showed that the purposes contained in the resolution that established the CME were adequately represented in the document body.

  11. Doping in sport: a review of medical practitioners' knowledge, attitudes and beliefs.

    PubMed

    Backhouse, Susan H; McKenna, Jim

    2011-05-01

    Central to the work of many medical practitioners is the provision of pharmaceutical support for patients. Patients can include athletes who are subject to anti-doping rules and regulations which prohibit the use of certain substances in and out of competition. This paper examines the evidence on medical practitioners' knowledge, attitudes and beliefs towards doping in sport. A systematic search strategy was followed. Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches limited to English language articles published between 1990 and 2010. Articles were assessed for relevance by two independent assessors and the results of selected studies were abstracted and synthesised. Outcomes of interest were knowledge, attitudes and beliefs in relation to doping in sport. Six studies met the inclusion criteria and were examined in detail. Samples reflected a range of medical practitioners drawn from the UK, France (2), Greece, Italy and Ireland. The investigations varied with respect to outcome focus and quality of evidence presented. Whilst the extant empirical research posits a negative attitude towards illegal performance enhancement combined with a positive inclination towards doping prevention, it also exposes a limited knowledge of anti-doping rules and regulations. Insufficient education, leading to a lack of awareness and understanding, could render this professional group at risk of doping offences considering Article 2.8 of the World Anti-Doping Agency Code (WADC). Moreover, in light of the incongruence between professional medical codes and WADC Article 2.8, medical professionals may face doping dilemmas and therefore further discourse is required. At present, the current evidence-base makes it difficult to plan developmentally appropriate education to span the exposure spectrum. Addressing this situation appears warranted. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Automated UMLS-Based Comparison of Medical Forms

    PubMed Central

    Dugas, Martin; Fritz, Fleur; Krumm, Rainer; Breil, Bernhard

    2013-01-01

    Medical forms are very heterogeneous: on a European scale there are thousands of data items in several hundred different systems. To enable data exchange for clinical care and research purposes there is a need to develop interoperable documentation systems with harmonized forms for data capture. A prerequisite in this harmonization process is comparison of forms. So far – to our knowledge – an automated method for comparison of medical forms is not available. A form contains a list of data items with corresponding medical concepts. An automatic comparison needs data types, item names and especially item with these unique concept codes from medical terminologies. The scope of the proposed method is a comparison of these items by comparing their concept codes (coded in UMLS). Each data item is represented by item name, concept code and value domain. Two items are called identical, if item name, concept code and value domain are the same. Two items are called matching, if only concept code and value domain are the same. Two items are called similar, if their concept codes are the same, but the value domains are different. Based on these definitions an open-source implementation for automated comparison of medical forms in ODM format with UMLS-based semantic annotations was developed. It is available as package compareODM from http://cran.r-project.org. To evaluate this method, it was applied to a set of 7 real medical forms with 285 data items from a large public ODM repository with forms for different medical purposes (research, quality management, routine care). Comparison results were visualized with grid images and dendrograms. Automated comparison of semantically annotated medical forms is feasible. Dendrograms allow a view on clustered similar forms. The approach is scalable for a large set of real medical forms. PMID:23861827

  13. Medical students' medication communication skills regarding drug prescription-a qualitative analysis of simulated physician-patient consultations.

    PubMed

    Hauser, Katarina; Matthes, Jan

    2017-04-01

    Poor medication communication of physicians to patients is detrimental, e.g. for medication adherence. Reasons for physicians' deficits in medication communication may be unfavourable conditions in daily practice or already insufficient training during their (undergraduate) medical studies. We explored medical students' communication on new medications in simulated physician-patient conversations to identify actual deficits indicating apparent educational needs. Fifth year medical students attending a mandatory course at the University of Cologne had simulated physician-patient consultations aiming at drug prescription. In 2015, 21 consultations were recorded, transcribed and subjected to qualitative content analysis based on the method of inductive coding. Even essential information on drug therapy was often lacking (e.g. adverse effects, drug administration). Some aspects were addressed more frequently than others. This seemed to differ depending on the diagnosis underlying the particular treatment (acute event vs. chronic disease). The extent of information on drug treatments given in simulated physician-patient consultations varied significantly between students. Fifth year medical students showed appreciable deficits in communicating drug prescriptions to patients though there were remarkable inter-individual differences. Our findings suggest that communication on drug therapy to patients is no self-evolving skill. Thus, there is obviously a need for emphasizing medication communication in the training of medical students. Communication aids specifically aiming at medication communication might facilitate learning of adequate medication communication skills.

  14. The new Italian code of medical ethics.

    PubMed Central

    Fineschi, V; Turillazzi, E; Cateni, C

    1997-01-01

    In June 1995, the Italian code of medical ethics was revised in order that its principles should reflect the ever-changing relationship between the medical profession and society and between physicians and patients. The updated code is also a response to new ethical problems created by scientific progress; the discussion of such problems often shows up a need for better understanding on the part of the medical profession itself. Medical deontology is defined as the discipline for the study of norms of conduct for the health care professions, including moral and legal norms as well as those pertaining more strictly to professional performance. The aim of deontology is therefore, the in-depth investigation and revision of the code of medical ethics. It is in the light of this conceptual definition that one should interpret a review of the different codes which have attempted, throughout the various periods of Italy's recent history, to adapt ethical norms to particular social and health care climates. PMID:9279746

  15. 75 FR 73169 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It finalizes the calendar year (CY) 2010 interim relative value units (RVUs) and issues interim RVUs for new and revised procedure codes for CY 2011. It also addresses, implements, or discusses certain provisions of both the Affordable Care Act (ACA) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In addition, this final rule with comment period discusses payments under the Ambulance Fee Schedule (AFS), the Ambulatory Surgical Center (ASC) payment system, and the Clinical Laboratory Fee Schedule (CLFS), payments to end-stage renal disease (ESRD) facilities, and payments for Part B drugs. Finally, this final rule with comment period also includes a discussion regarding the Chiropractic Services Demonstration program, the Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (CBP DMEPOS), and provider and supplier enrollment issues associated with air ambulances.

  16. Processes of code status transitions in hospitalized patients with advanced cancer.

    PubMed

    El-Jawahri, Areej; Lau-Min, Kelsey; Nipp, Ryan D; Greer, Joseph A; Traeger, Lara N; Moran, Samantha M; D'Arpino, Sara M; Hochberg, Ephraim P; Jackson, Vicki A; Cashavelly, Barbara J; Martinson, Holly S; Ryan, David P; Temel, Jennifer S

    2017-12-15

    Although hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown. We conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR. In total, 1047 hospitalizations were reviewed among 728 patients. Admitting clinicians did not address code status in 53% of hospitalizations, resulting in code status orders of "presumed full." In total, 275 patients (26.3%) transitioned from full code to DNR, and 48.7% (134 of 275 patients) of those had an order of "presumed full" at admission; however, upon further clarification, the patients expressed that they had wished to be DNR before the hospitalization. We identified 3 additional processes leading to order transition from full code to DNR acute clinical deterioration (15.3%), discontinuation of cancer-directed therapy (17.1%), and education about the potential harms/futility of CPR (15.3%). Compared with discontinuing therapy and education, transitions because of acute clinical deterioration were associated with less patient involvement (P = .002), a shorter time to death (P < .001), and a greater likelihood of inpatient death (P = .005). One-half of code status order changes among hospitalized patients with advanced cancer were because of full code orders in patients who had a preference for DNR before hospitalization. Transitions due of acute clinical deterioration were associated with less patient engagement and a higher likelihood of inpatient death. Cancer 2017;123:4895-902. © 2017 American Cancer Society. © 2017 American Cancer Society.

  17. [The DRG responsible physician in trauma and orthopedic surgery. Surgeon, encoder, and link to medical controlling].

    PubMed

    Ruffing, T; Huchzermeier, P; Muhm, M; Winkler, H

    2014-05-01

    Precise coding is an essential requirement in order to generate a valid DRG. The aim of our study was to evaluate the quality of the initial coding of surgical procedures, as well as to introduce our "hybrid model" of a surgical specialist supervising medical coding and a nonphysician for case auditing. The department's DRG responsible physician as a surgical specialist has profound knowledge both in surgery and in DRG coding. At a Level 1 hospital, 1000 coded cases of surgical procedures were checked. In our department, the DRG responsible physician who is both a surgeon and encoder has proven itself for many years. The initial surgical DRG coding had to be corrected by the DRG responsible physician in 42.2% of cases. On average, one hour per working day was necessary. The implementation of a DRG responsible physician is a simple, effective way to connect medical and business expertise without interface problems. Permanent feedback promotes both medical and economic sensitivity for the improvement of coding quality.

  18. Ethics in sports medicine.

    PubMed

    Dunn, Warren R; George, Michael S; Churchill, Larry; Spindler, Kurt P

    2007-05-01

    Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.

  19. Medical image classification based on multi-scale non-negative sparse coding.

    PubMed

    Zhang, Ruijie; Shen, Jian; Wei, Fushan; Li, Xiong; Sangaiah, Arun Kumar

    2017-11-01

    With the rapid development of modern medical imaging technology, medical image classification has become more and more important in medical diagnosis and clinical practice. Conventional medical image classification algorithms usually neglect the semantic gap problem between low-level features and high-level image semantic, which will largely degrade the classification performance. To solve this problem, we propose a multi-scale non-negative sparse coding based medical image classification algorithm. Firstly, Medical images are decomposed into multiple scale layers, thus diverse visual details can be extracted from different scale layers. Secondly, for each scale layer, the non-negative sparse coding model with fisher discriminative analysis is constructed to obtain the discriminative sparse representation of medical images. Then, the obtained multi-scale non-negative sparse coding features are combined to form a multi-scale feature histogram as the final representation for a medical image. Finally, SVM classifier is combined to conduct medical image classification. The experimental results demonstrate that our proposed algorithm can effectively utilize multi-scale and contextual spatial information of medical images, reduce the semantic gap in a large degree and improve medical image classification performance. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Breaking the sound barrier: exploring parents' decision-making process of cochlear implants for their children.

    PubMed

    Chang, Pamara F

    2017-08-01

    To understand the dynamic experiences of parents undergoing the decision-making process regarding cochlear implants for their child(ren). Thirty-three parents of d/Deaf children participated in semi-structured interviews. Interviews were digitally recorded, transcribed, and coded using iterative and thematic coding. The results from this study reveal four salient topics related to parents' decision-making process regarding cochlear implantation: 1) factors parents considered when making the decision to get the cochlear implant for their child (e.g., desire to acculturate child into one community), 2) the extent to which parents' communities influence their decision-making (e.g., norms), 3) information sources parents seek and value when decision-making (e.g., parents value other parent's experiences the most compared to medical or online sources), and 4) personal experiences with stigma affecting their decision to not get the cochlear implant for their child. This study provides insights into values and perspectives that can be utilized to improve informed decision-making, when making risky medical decisions with long-term implications. With thorough information provisions, delineation of addressing parents' concerns and encompassing all aspects of the decision (i.e., medical, social and cultural), health professional teams could reduce the uncertainty and anxiety for parents in this decision-making process for cochlear implantation. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. DoD Electronic Data Interchange (EDI) Convention: ASC X12 Transaction Set 836 Contract Award (Version 003010)

    DTIC Science & Technology

    1993-01-01

    upon designation of DoD Activity Address Code (DoDAAC) or other code coordinated with the value-added network (VAN). Mandatory ISA06 106 Interc.ange...coordinated with the value-added network (VAN). Non-DoD activities use identification code qualified by ISA05 and coordinated with the VAN. Mandatory...designation of DoD Activity Address Code (DoDAAC) or other code coordinated with the value-added network (VAN). Mandatory ISA08 107 Interchange Receiver

  2. European Science Notes. Volume 40, Number 4.

    DTIC Science & Technology

    1986-04-01

    OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION (if applicable) 8c. ADDRESS (City, State, and ZIP Code ) 10. SOURCE OF...Office, London ONRL 6c. ADDRESS (City, State, and ZIP Code ) 7b. ADDRESS (City, State, and ZIPCode) Box 39 FPO, NY 09510 Ba. NAME OF FUNDING/SPONSORING 8b...13..TYPj9 REPORT13bTIECVRD1.DTOFRPT(YaMnhDy)1.AGCUNMonthly FROM TO _ April 1986 32 16. SUPPLEMENTARY NOTATION 17. COSATI CODES 18. SUBJECT TERMS

  3. The theory of planned behaviour explains intentions to use antiresorptive medication after a fragility fracture.

    PubMed

    Sale, Joanna E M; Cameron, Cathy; Thielke, Stephen; Meadows, Lynn; Senior, Kevin

    2017-06-01

    Our objective was to ascertain whether the Theory of Planned Behaviour (TPB) explains patient intentions to use antiresorptive medication after a fracture. A qualitative study was conducted with English-speaking members of the Canadian Osteoporosis Patient Network (COPN) who had sustained a fragility fracture at 50+ years of age and were not taking antiresorptive medication at the time of that fracture. Questions during a 1-h telephone interview were guided by the domains of the TPB: they addressed the antecedent constructs regarding antiresorptive medication (attitudes, subjective norms, and perceived behavioural control) as well as intentions regarding antiresorptive medication use. We created a coding template a priori based on the TPB domains and applied this template to the interview data. Twenty-six eligible participants (24 females, 2 males) aged 51-89 completed an interview. The TPB appeared to be predictive of intentions in 19 (73%) participants. In the majority of participants where the TPB did not appear to be predictive (57%), a positive attitude toward antiresorptive medication was the most important antecedent variable in determining intentions. The TPB appeared to be predictive of intentions to use antiresorptive medication among individuals who had experienced a fragility fracture. Attitudes towards medication were especially important.

  4. 48 CFR 246.710-70 - Warranty attachment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Enterprise Identifier Code Type 0-9—GS1 Company Prefix. D—CAGE. LB—ATIS-0322000. LH—EHIBCC. RH—HIBCC. UN—DUNS... Guarantor Enterprise Identifier Code Type 0-9—GS1 Company Prefix. D—CAGE. LB—ATIS-0322000. LH—EHIBCC. RH... returns Name ** Address line 1 ** Address line 2 ** City/county ** State/province ** Postal code...

  5. The old faith and the new science: the Nuremberg Code and human experimentation ethics in Britain, 1946-73.

    PubMed

    Hazelgrove, Jenny

    2002-04-01

    This article explores the impact of the Nuremberg Code on post-Second World War research ethics in Britain. Against the background of the Nuremberg Medical Trial, the Code received international endorsement, but how much did its ethical percepts influence actual research? This paper shows that, despite British involvement in the formulation of the Code, the experience of war-time and changing career structures were more influential in shaping the approach of investigators to their subjects. Where medical debates ensued, primarily over controversial research practices at the British Postgraduate Medical School, Hammersmith Hospital, they were set in the context of a much older division between 'bedside' and 'scientific' medicine. But whatever differences there may have been between those physicians who advocated research and those who questioned its use and ethical basis, most clung to the paternalist assumption that it was the doctor's place to decide what was best for his patients. Faced with rising public and medical criticism of contemporary research practices, the medical élite of the 1960s and 1970s safeguarded the reputation of the profession and medical control of research by negotiating new voluntary codes. In a similar move, their predecessors had helped to negotiate the Nuremberg Code in anticipation of public criticism of experimentation arising from the Nuremberg Medical Trial.

  6. Coding of adverse events of suicidality in clinical study reports of duloxetine for the treatment of major depressive disorder: descriptive study.

    PubMed

    Maund, Emma; Tendal, Britta; Hróbjartsson, Asbjørn; Lundh, Andreas; Gøtzsche, Peter C

    2014-06-04

    To assess the effects of coding and coding conventions on summaries and tabulations of adverse events data on suicidality within clinical study reports. Systematic electronic search for adverse events of suicidality in tables, narratives, and listings of adverse events in individual patients within clinical study reports. Where possible, for each event we extracted the original term reported by the investigator, the term as coded by the medical coding dictionary, medical coding dictionary used, and the patient's trial identification number. Using the patient's trial identification number, we attempted to reconcile data on the same event between the different formats for presenting data on adverse events within the clinical study report. 9 randomised placebo controlled trials of duloxetine for major depressive disorder submitted to the European Medicines Agency for marketing approval. Clinical study reports obtained from the EMA in 2011. Six trials used the medical coding dictionary COSTART (Coding Symbols for a Thesaurus of Adverse Reaction Terms) and three used MedDRA (Medical Dictionary for Regulatory Activities). Suicides were clearly identifiable in all formats of adverse event data in clinical study reports. Suicide attempts presented in tables included both definitive and provisional diagnoses. Suicidal ideation and preparatory behaviour were obscured in some tables owing to the lack of specificity of the medical coding dictionary, especially COSTART. Furthermore, we found one event of suicidal ideation described in narrative text that was absent from tables and adverse event listings of individual patients. The reason for this is unclear, but may be due to the coding conventions used. Data on adverse events in tables in clinical study reports may not accurately represent the underlying patient data because of the medical dictionaries and coding conventions used. In clinical study reports, the listings of adverse events for individual patients and narratives of adverse events can provide additional information, including original investigator reported adverse event terms, which can enable a more accurate estimate of harms. © Maund et al 2014.

  7. Practice management education during surgical residency.

    PubMed

    Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest

    2008-12-01

    Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. When residents finish their surgical training they need to be ready to enter the world of business. These needs will be present whether pursuing a career in academic medicine or the private sector. A program that focuses on the business aspect of surgery enables the residents to better navigate the future while helping to fulfill the systems-based practice competency.

  8. Monitoring Sub-Saharan African Physician Migration and Recruitment Post-Adoption of the WHO Code of Practice: Temporal and Geographic Patterns in the United States

    PubMed Central

    Tankwanchi, Akhenaten Benjamin Siankam; Vermund, Sten H.; Perkins, Douglas D.

    2015-01-01

    Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians’ locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician “brain drain”, it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians. PMID:25875010

  9. Processor-in-memory-and-storage architecture

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    DeBenedictis, Erik

    A method and apparatus for performing reliable general-purpose computing. Each sub-core of a plurality of sub-cores of a processor core processes a same instruction at a same time. A code analyzer receives a plurality of residues that represents a code word corresponding to the same instruction and an indication of whether the code word is a memory address code or a data code from the plurality of sub-cores. The code analyzer determines whether the plurality of residues are consistent or inconsistent. The code analyzer and the plurality of sub-cores perform a set of operations based on whether the code wordmore » is a memory address code or a data code and a determination of whether the plurality of residues are consistent or inconsistent.« less

  10. Unsupervised Extraction of Diagnosis Codes from EMRs Using Knowledge-Based and Extractive Text Summarization Techniques

    PubMed Central

    Kavuluru, Ramakanth; Han, Sifei; Harris, Daniel

    2017-01-01

    Diagnosis codes are extracted from medical records for billing and reimbursement and for secondary uses such as quality control and cohort identification. In the US, these codes come from the standard terminology ICD-9-CM derived from the international classification of diseases (ICD). ICD-9 codes are generally extracted by trained human coders by reading all artifacts available in a patient’s medical record following specific coding guidelines. To assist coders in this manual process, this paper proposes an unsupervised ensemble approach to automatically extract ICD-9 diagnosis codes from textual narratives included in electronic medical records (EMRs). Earlier attempts on automatic extraction focused on individual documents such as radiology reports and discharge summaries. Here we use a more realistic dataset and extract ICD-9 codes from EMRs of 1000 inpatient visits at the University of Kentucky Medical Center. Using named entity recognition (NER), graph-based concept-mapping of medical concepts, and extractive text summarization techniques, we achieve an example based average recall of 0.42 with average precision 0.47; compared with a baseline of using only NER, we notice a 12% improvement in recall with the graph-based approach and a 7% improvement in precision using the extractive text summarization approach. Although diagnosis codes are complex concepts often expressed in text with significant long range non-local dependencies, our present work shows the potential of unsupervised methods in extracting a portion of codes. As such, our findings are especially relevant for code extraction tasks where obtaining large amounts of training data is difficult. PMID:28748227

  11. Using databases in medical education research: AMEE Guide No. 77.

    PubMed

    Cleland, Jennifer; Scott, Neil; Harrild, Kirsten; Moffat, Mandy

    2013-05-01

    This AMEE Guide offers an introduction to the use of databases in medical education research. It is intended for those who are contemplating conducting research in medical education but are new to the field. The Guide is structured around the process of planning your research so that data collection, management and analysis are appropriate for the research question. Throughout we consider contextual possibilities and constraints to educational research using databases, such as the resources available, and provide concrete examples of medical education research to illustrate many points. The first section of the Guide explains the difference between different types of data and classifying data, and addresses the rationale for research using databases in medical education. We explain the difference between qualitative research and qualitative data, the difference between categorical and quantitative data, and the difference types of data which fall into these categories. The Guide reviews the strengths and weaknesses of qualitative and quantitative research. The next section is structured around how to work with quantitative and qualitative databases and provides guidance on the many practicalities of setting up a database. This includes how to organise your database, including anonymising data and coding, as well as preparing and describing your data so it is ready for analysis. The critical matter of the ethics of using databases in medical educational research, including using routinely collected data versus data collected for research purposes, and issues of confidentiality, is discussed. Core to the Guide is drawing out the similarities and differences in working with different types of data and different types of databases. Future AMEE Guides in the research series will address statistical analysis of data in more detail.

  12. Prediction task guided representation learning of medical codes in EHR.

    PubMed

    Cui, Liwen; Xie, Xiaolei; Shen, Zuojun

    2018-06-18

    There have been rapidly growing applications using machine learning models for predictive analytics in Electronic Health Records (EHR) to improve the quality of hospital services and the efficiency of healthcare resource utilization. A fundamental and crucial step in developing such models is to convert medical codes in EHR to feature vectors. These medical codes are used to represent diagnoses or procedures. Their vector representations have a tremendous impact on the performance of machine learning models. Recently, some researchers have utilized representation learning methods from Natural Language Processing (NLP) to learn vector representations of medical codes. However, most previous approaches are unsupervised, i.e. the generation of medical code vectors is independent from prediction tasks. Thus, the obtained feature vectors may be inappropriate for a specific prediction task. Moreover, unsupervised methods often require a lot of samples to obtain reliable results, but most practical problems have very limited patient samples. In this paper, we develop a new method called Prediction Task Guided Health Record Aggregation (PTGHRA), which aggregates health records guided by prediction tasks, to construct training corpus for various representation learning models. Compared with unsupervised approaches, representation learning models integrated with PTGHRA yield a significant improvement in predictive capability of generated medical code vectors, especially for limited training samples. Copyright © 2018. Published by Elsevier Inc.

  13. X-ray backscatter radiography with lower open fraction coded masks

    NASA Astrophysics Data System (ADS)

    Muñoz, André A. M.; Vella, Anna; Healy, Matthew J. F.; Lane, David W.; Jupp, Ian; Lockley, David

    2017-09-01

    Single sided radiographic imaging would find great utility for medical, aerospace and security applications. While coded apertures can be used to form such an image from backscattered X-rays they suffer from near field limitations that introduce noise. Several theoretical studies have indicated that for an extended source the images signal to noise ratio may be optimised by using a low open fraction (<0.5) mask. However, few experimental results have been published for such low open fraction patterns and details of their formulation are often unavailable or are ambiguous. In this paper we address this process for two types of low open fraction mask, the dilute URA and the Singer set array. For the dilute URA the procedure for producing multiple 2D array patterns from given 1D binary sequences (Barker codes) is explained. Their point spread functions are calculated and their imaging properties are critically reviewed. These results are then compared to those from the Singer set and experimental exposures are presented for both type of pattern; their prospects for near field imaging are discussed.

  14. Knowledge and Processes in Design

    DTIC Science & Technology

    1992-09-03

    Orqanization Name(s) and Address(es). Self-explanatory. Block 16. Price Code. Enter approoriate price Block 8. Performing Organization Report code...NTIS on/y). Number. Enter the unique alphanumerc report number(s) assigned by the organization periorming the report. Blocks 17.-19...statement codings were then organized into larger control-flow structures centered around design components called modules. The general assumption was

  15. CodeSlinger: a case study in domain-driven interactive tool design for biomedical coding scheme exploration and use.

    PubMed

    Flowers, Natalie L

    2010-01-01

    CodeSlinger is a desktop application that was developed to aid medical professionals in the intertranslation, exploration, and use of biomedical coding schemes. The application was designed to provide a highly intuitive, easy-to-use interface that simplifies a complex business problem: a set of time-consuming, laborious tasks that were regularly performed by a group of medical professionals involving manually searching coding books, searching the Internet, and checking documentation references. A workplace observation session with a target user revealed the details of the current process and a clear understanding of the business goals of the target user group. These goals drove the design of the application's interface, which centers on searches for medical conditions and displays the codes found in the application's database that represent those conditions. The interface also allows the exploration of complex conceptual relationships across multiple coding schemes.

  16. Cracking the code: the accuracy of coding shoulder procedures and the repercussions.

    PubMed

    Clement, N D; Murray, I R; Nie, Y X; McBirnie, J M

    2013-05-01

    Coding of patients' diagnosis and surgical procedures is subject to error levels of up to 40% with consequences on distribution of resources and financial recompense. Our aim was to explore and address reasons behind coding errors of shoulder diagnosis and surgical procedures and to evaluate a potential solution. A retrospective review of 100 patients who had undergone surgery was carried out. Coding errors were identified and the reasons explored. A coding proforma was designed to address these errors and was prospectively evaluated for 100 patients. The financial implications were also considered. Retrospective analysis revealed the correct primary diagnosis was assigned in 54 patients (54%) had an entirely correct diagnosis, and only 7 (7%) patients had a correct procedure code assigned. Coders identified indistinct clinical notes and poor clarity of procedure codes as reasons for errors. The proforma was significantly more likely to assign the correct diagnosis (odds ratio 18.2, p < 0.0001) and the correct procedure code (odds ratio 310.0, p < 0.0001). Using the proforma resulted in a £28,562 increase in revenue for the 100 patients evaluated relative to the income generated from the coding department. High error levels for coding are due to misinterpretation of notes and ambiguity of procedure codes. This can be addressed by allowing surgeons to assign the diagnosis and procedure using a simplified list that is passed directly to coding.

  17. The Council for International Organizations and Medical Sciences (CIOMS) guidelines on ethics of clinical trials.

    PubMed

    Macrae, Duncan J

    2007-05-01

    Numerous bodies from many countries, including governments, government regulatory departments, research organizations, medical professional bodies, and health care providers, have issued guidance or legislation on the ethical conduct of clinical trials. It is possible to trace the development of current guidelines back to the post-World War II Nuremburg war crimes trials, more specifically the "Doctors' Trial." From that trial emerged the Nuremburg Code, which set out basic principles to be observed when conducting research involving human subjects and which subsequently formed the basis for comprehensive international guidelines on medical research, such as the Declaration of Helsinki. Most recently, the Council for International Organizations and Medical Sciences (CIOMS) produced detailed guidelines (originally published in 1993 and updated in 2002) on the implementation of the principles outlined in the Declaration of Helsinki. The CIOMS guidelines set in an appropriate context the challenges of present-day clinical research, by addressing complex issues including HIV/AIDS research, availability of study treatments after a study ends, women as research subjects, safeguarding confidentiality, compensation for adverse events, as well guidelines on consent.

  18. Using Modified-ISS Model to Evaluate Medication Administration Safety During Bar Code Medication Administration Implementation in Taiwan Regional Teaching Hospital.

    PubMed

    Ma, Pei-Luen; Jheng, Yan-Wun; Jheng, Bi-Wei; Hou, I-Ching

    2017-01-01

    Bar code medication administration (BCMA) could reduce medical errors and promote patient safety. This research uses modified information systems success model (M-ISS model) to evaluate nurses' acceptance to BCMA. The result showed moderate correlation between medication administration safety (MAS) to system quality, information quality, service quality, user satisfaction, and limited satisfaction.

  19. Projection of Patient Condition Code Distributions Based on Mechanism of Injury

    DTIC Science & Technology

    2003-01-01

    The Medical Readiness and Strategic Plan (MRSP)1998-20041 requires that the military services develop a method for linking real world patient load...data with modern Patient Condition (PC) codes to enable planners to forecast medical workload and resource requirements. Determination of the likely...various levels of medical care. Medical planners and logisticians plan for medical contingencies based on anticipated patient streams, distributions of

  20. Report of the AMA Council on Ethical and Judicial Affairs: professionalism in the use of social media.

    PubMed

    Shore, Rebecca; Halsey, Julia; Shah, Kavita; Crigger, Bette-Jane; Douglas, Sharon P

    2011-01-01

    Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians' nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA's Code of Medical Ethics).

  1. Medical and Transmission Vector Vocabulary Alignment with Schema.org

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Smith, William P.; Chappell, Alan R.; Corley, Courtney D.

    Available biomedical ontologies and knowledge bases currently lack formal and standards-based interconnections between disease, disease vector, and drug treatment vocabularies. The PNNL Medical Linked Dataset (PNNL-MLD) addresses this gap. This paper describes the PNNL-MLD, which provides a unified vocabulary and dataset of drug, disease, side effect, and vector transmission background information. Currently, the PNNL-MLD combines and curates data from the following research projects: DrugBank, DailyMed, Diseasome, DisGeNet, Wikipedia Infobox, Sider, and PharmGKB. The main outcomes of this effort are a dataset aligned to Schema.org, including a parsing framework, and extensible hooks ready for integration with selected medical ontologies. The PNNL-MLDmore » enables researchers more quickly and easily to query distinct datasets. Future extensions to the PNNL-MLD will include Traditional Chinese Medicine, broader interlinks across genetic structures, a larger thesaurus of synonyms and hypernyms, explicit coding of diseases and drugs across research systems, and incorporating vector-borne transmission vocabularies.« less

  2. A resident's primer of Medicare reimbursement in radiology.

    PubMed

    Lee, Ryan K

    2006-01-01

    After having completed medical school, residency, and in many cases specialized fellowships, radiologists are well equipped to practice clinical radiology. However, they receive little if any exposure to the business of radiology, such as coding, billing, and other administrative duties that maintain the financial well-being of any medical practice. Medicare insolvency, managed care, self-referral, and increasing imaging by nonradiology specialists are all issues creating a competitive and ever changing medical environment, and understanding the economic and business aspects of health care is becoming increasingly important for both academic and private practice radiologists. The intent of this paper is to provide new radiologists as well as radiologists in training an introduction to the reimbursement system, as well as to provide a generalized review of the process for practicing radiologists. In particular, this article addresses the fundamentals of the Medicare fee-for-service reimbursement process as well as the factors considered in arriving at the valuation of radiologic services by Medicare.

  3. Gist and verbatim communication concerning medication risks/benefits.

    PubMed

    Blalock, Susan J; DeVellis, Robert F; Chewning, Betty; Sleath, Betsy L; Reyna, Valerie F

    2016-06-01

    To describe the information about medication risks/benefits that rheumatologists provide during patient office visits, the gist that patients with rheumatoid arthritis (RA) extract from the information provided, and the relationship between communication and medication satisfaction. Data from 169 RA patients were analyzed. Each participant had up to three visits audiotaped. Four RA patients coded the audiotapes using a Gist Coding Scheme and research assistants coded the audiotapes using a Verbatim Coding Scheme. When extracting gist from the information discussed during visits, patient coders distinguished between discussion concerning the possibility of medication side effects versus expression of significant safety concerns. Among patients in the best health, nearly 80% reported being totally satisfied with their medications when the physician communicated the gist that the medication was effective, compared to approximately 50% when this gist was not communicated. Study findings underscore the multidimensional nature of medication risk communication and the importance of communication concerning medication effectiveness/need. Health care providers should ensure that patients understand that medication self-management practices can minimize potential risks. Communicating simple gist messages may increase patient satisfaction, especially messages about benefits for well-managed patients. Optimal communication also requires shared understanding of desired therapeutic outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Bilayer Protograph Codes for Half-Duplex Relay Channels

    NASA Technical Reports Server (NTRS)

    Divsalar, Dariush; VanNguyen, Thuy; Nosratinia, Aria

    2013-01-01

    Direct to Earth return links are limited by the size and power of lander devices. A standard alternative is provided by a two-hops return link: a proximity link (from lander to orbiter relay) and a deep-space link (from orbiter relay to Earth). Although direct to Earth return links are limited by the size and power of lander devices, using an additional link and a proposed coding for relay channels, one can obtain a more reliable signal. Although significant progress has been made in the relay coding problem, existing codes must be painstakingly optimized to match to a single set of channel conditions, many of them do not offer easy encoding, and most of them do not have structured design. A high-performing LDPC (low-density parity-check) code for the relay channel addresses simultaneously two important issues: a code structure that allows low encoding complexity, and a flexible rate-compatible code that allows matching to various channel conditions. Most of the previous high-performance LDPC codes for the relay channel are tightly optimized for a given channel quality, and are not easily adapted without extensive re-optimization for various channel conditions. This code for the relay channel combines structured design and easy encoding with rate compatibility to allow adaptation to the three links involved in the relay channel, and furthermore offers very good performance. The proposed code is constructed by synthesizing a bilayer structure with a pro to graph. In addition to the contribution to relay encoding, an improved family of protograph codes was produced for the point-to-point AWGN (additive white Gaussian noise) channel whose high-rate members enjoy thresholds that are within 0.07 dB of capacity. These LDPC relay codes address three important issues in an integrative manner: low encoding complexity, modular structure allowing for easy design, and rate compatibility so that the code can be easily matched to a variety of channel conditions without extensive re-optimization. The main problem of half-duplex relay coding can be reduced to the simultaneous design of two codes at two rates and two SNRs (signal-to-noise ratios), such that one is a subset of the other. This problem can be addressed by forceful optimization, but a clever method of addressing this problem is via the bilayer lengthened (BL) LDPC structure. This method uses a bilayer Tanner graph to make the two codes while using a concept of "parity forwarding" with subsequent successive decoding that removes the need to directly address the issue of uneven SNRs among the symbols of a given codeword. This method is attractive in that it addresses some of the main issues in the design of relay codes, but it does not by itself give rise to highly structured codes with simple encoding, nor does it give rate-compatible codes. The main contribution of this work is to construct a class of codes that simultaneously possess a bilayer parity- forwarding mechanism, while also benefiting from the properties of protograph codes having an easy encoding, a modular design, and being a rate-compatible code.

  5. 75 FR 78707 - Medicare Program; First Semi-Annual Meeting of the Advisory Panel on Ambulatory Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-16

    ... hospital payment systems; hospital medical care delivery systems; provider billing and accounting systems; APC groups; Current Procedural Terminology codes; Health Care Common Procedure Coding System (HCPCS) codes; the use of, and payment for, drugs, medical devices, and other services in the outpatient setting...

  6. Feasibility of a computer-assisted feedback system between dispatch centre and ambulances.

    PubMed

    Lindström, Veronica; Karlsten, Rolf; Falk, Ann-Charlotte; Castrèn, Maaret

    2011-06-01

    The aim of the study was to evaluate the feasibility of a newly developed computer-assisted feedback system between dispatch centre and ambulances in Stockholm, Sweden. A computer-assisted feedback system based on a Finnish model was designed to fit the Swedish emergency medical system. Feedback codes were identified and divided into three categories; assessment of patients' primary condition when ambulance arrives at scene, no transport by the ambulance and level of priority. Two ambulances and one emergency medical communication centre (EMCC) in Stockholm participated in the study. A sample of 530 feedback codes sent through the computer-assisted feedback system was reviewed. The information on the ambulance medical records was compared with the feedback codes used and 240 assignments were further analyzed. The used feedback codes sent from ambulance to EMCC were correct in 92% of the assignments. The most commonly used feedback code sent to the emergency medical dispatchers was 'agree with the dispatchers' assessment'. In addition, in 160 assignments there was a mismatch between emergency medical dispatchers and ambulance nurse assessments. Our results have shown a high agreement between medical dispatchers and ambulance nurse assessment. The feasibility of the feedback codes seems to be acceptable based on the small margin of error. The computer-assisted feedback system may, when used on a daily basis, make it possible for the medical dispatchers to receive feedback in a structural way. The EMCC organization can directly evaluate any changes in the assessment protocol by structured feedback sent from the ambulance.

  7. Ethics in human experimentation: the two military physicians who helped develop the Nuremberg Code.

    PubMed

    Temme, Leonard A

    2003-12-01

    The Nuremberg Code is generally considered the beginning of modern ethics in human experimentation. The Code is a list of 10 principles that Judge Walter Beals included in the judgment he delivered at the close of the Nuremberg Medical Trial on 19 August 1947. Recently, scholars have studied the origin of the Code, who wrote it, and why. This is important to military medicine and the Aerospace Medical Association in particular because many of the defendants claimed their crimes were experiments in aviation and environmental physiology conducted under wartime conditions. The chief prosecutor of the Nuremberg Medical Trial, General Telford Taylor, relied on the guidance of an advisor provided by the American Medical Association, Andrew C. Ivy, one of the foremost physiologists of his time. The neurologist, Leo Alexander, then a colonel in the U.S. Army Reserves, was another medical advisor. Both men were crucial to the development of Taylor's courtroom strategy. The material Alexander and Ivy provided was incorporated verbatim in the section of the judgment that became the Code. Although both men contributed to the Code, Ivy provided what seems to be the first formulation of many of these principles during a meeting of Allied medical investigators at the Pasteur Institute in July 1946. Naval researchers should note that Ivy had been the Director of the Research Division of the Naval Medical Research Institute when it was commissioned on October 27, 1942.

  8. 21 CFR 803.42 - If I am an importer, what information must I submit in my individual adverse event reports?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE REPORTING... preexisting medical conditions. (c) Device information (Form 3500A, Block D). You must submit the following... device code (refer to FDA MEDWATCH Medical Device Reporting Code Instructions); (11) Whether a report was...

  9. 21 CFR 803.42 - If I am an importer, what information must I submit in my individual adverse event reports?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE REPORTING... preexisting medical conditions. (c) Device information (Form 3500A, Block D). You must submit the following... device code (refer to FDA MEDWATCH Medical Device Reporting Code Instructions); (11) Whether a report was...

  10. The Impact of Bar Code Medication Administration Technology on Reported Medication Errors

    ERIC Educational Resources Information Center

    Holecek, Andrea

    2011-01-01

    The use of bar-code medication administration technology is on the rise in acute care facilities in the United States. The technology is purported to decrease medication errors that occur at the point of administration. How significantly this technology affects actual rate and severity of error is unknown. This descriptive, longitudinal research…

  11. Analysis of Champus Per Capita Mental Health Expenditures and Utilization for Beneficiaries Less Than Eighteen Years

    DTIC Science & Technology

    1991-04-01

    and (If applicable) Clinical Investigation Icty HSAD -A HQ HSC/HSCL-M 6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code...NAME OF RESPONSIBLE INDIVIDUAL 22b. TELEPHONE (Include Area Code) 22c. OFFICE SYMBOL Dr. Scott A. Optenberg, GM-14 (512) 221-5880 HSAD -A DD Form

  12. Tradeoffs of Using Administrative Claims and Medical Records to Identify the Use of Personalized Medicine for Patients with Breast Cancer

    PubMed Central

    Liang, Su-Ying; Phillips, Kathryn A.; Wang, Grace; Keohane, Carol; Armstrong, Joanne; Morris, William M.; Haas, Jennifer S.

    2012-01-01

    Background Administrative claims and medical records are important data sources to examine healthcare utilization and outcomes. Little is known about identifying personalized medicine technologies in these sources. Objectives To describe agreement, sensitivity, and specificity of administrative claims compared to medical records for two pairs of targeted tests and treatments for breast cancer. Research Design Retrospective analysis of medical records linked to administrative claims from a large health plan. We examined whether agreement varied by factors that facilitate tracking in claims (coding and cost) and that enhance medical record completeness (records from multiple providers). Subjects Women (35 – 65 years) with incident breast cancer diagnosed in 2006–2007 (n=775). Measures Use of human epidermal growth factor receptor 2 (HER2) and gene expression profiling (GEP) testing, trastuzumab and adjuvant chemotherapy in claims and medical records. Results Agreement between claims and records was substantial for GEP, trastuzumab, and chemotherapy, and lowest for HER2 tests. GEP, an expensive test with unique billing codes, had higher agreement (91.6% vs. 75.2%), sensitivity (94.9% vs. 76.7%), and specificity (90.1% vs. 29.2%) than HER2, a test without unique billing codes. Trastuzumab, a treatment with unique billing codes, had slightly higher agreement (95.1% vs. 90%) and sensitivity (98.1% vs. 87.9%) than adjuvant chemotherapy. Conclusions Higher agreement and specificity were associated with services that had unique billing codes and high cost. Administrative claims may be sufficient for examining services with unique billing codes. Medical records provide better data for identifying tests lacking specific codes and for research requiring detailed clinical information. PMID:21422962

  13. Problem-Solving Under Time Constraints: Alternatives for the Commander’s Estimate

    DTIC Science & Technology

    1990-03-26

    CHOOL OF ADVANCED MILITAR (If applicable) STUDIES, USAC&GSC IATZL-SWV 6. ADDRESS (City, State, and ZIP Code ) 7b. ADDRESS (City, State, and ZIP Code ...NOTATION 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELD GROUP SUB-GROUP DECISIONJ*MAKING...OF RESPONSIBLE INDIVIDUAL 22b. TELEPHONE (Include Area Code ) 122c. OFFICE SYMBOL MAJ TIMOTHY D. LYNCH 9 684-3437 1 AT71-.qWV DO Form 1473, JUN 86

  14. Accuracy and time requirements of a bar-code inventory system for medical supplies.

    PubMed

    Hanson, L B; Weinswig, M H; De Muth, J E

    1988-02-01

    The effects of implementing a bar-code system for issuing medical supplies to nursing units at a university teaching hospital were evaluated. Data on the time required to issue medical supplies to three nursing units at a 480-bed, tertiary-care teaching hospital were collected (1) before the bar-code system was implemented (i.e., when the manual system was in use), (2) one month after implementation, and (3) four months after implementation. At the same times, the accuracy of the central supply perpetual inventory was monitored using 15 selected items. One-way analysis of variance tests were done to determine any significant differences between the bar-code and manual systems. Using the bar-code system took longer than using the manual system because of a significant difference in the time required for order entry into the computer. Multiple-use requirements of the central supply computer system made entering bar-code data a much slower process. There was, however, a significant improvement in the accuracy of the perpetual inventory. Using the bar-code system for issuing medical supplies to the nursing units takes longer than using the manual system. However, the accuracy of the perpetual inventory was significantly improved with the implementation of the bar-code system.

  15. Towards a European code of medical ethics. Ethical and legal issues.

    PubMed

    Patuzzo, Sara; Pulice, Elisabetta

    2017-01-01

    The feasibility of a common European code of medical ethics is discussed, with consideration and evaluation of the difficulties such a project is going to face, from both the legal and ethical points of view. On the one hand, the analysis will underline the limits of a common European code of medical ethics as an instrument for harmonising national professional rules in the European context; on the other hand, we will highlight some of the potentials of this project, which could be increased and strengthened through a proper rulemaking process and through adequate and careful choice of content. We will also stress specific elements and devices that should be taken into consideration during the establishment of the code, from both procedural and content perspectives. Regarding methodological issues, the limits and potentialities of a common European code of medical ethics will be analysed from an ethical point of view and then from a legal perspective. The aim of this paper is to clarify the framework for the potential but controversial role of the code in the European context, showing the difficulties in enforcing and harmonising national ethical rules into a European code of medical ethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. GRABGAM Analysis of Ultra-Low-Level HPGe Gamma Spectra

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Winn, W.G.

    The GRABGAM code has been used successfully for ultra-low level HPGe gamma spectrometry analysis since its development in 1985 at Savannah River Technology Center (SRTC). Although numerous gamma analysis codes existed at that time, reviews of institutional and commercial codes indicated that none addressed all features that were desired by SRTC. Furthermore, it was recognized that development of an in-house code would better facilitate future evolution of the code to address SRTC needs based on experience with low-level spectra. GRABGAM derives its name from Gamma Ray Analysis BASIC Generated At MCA/PC.

  17. Addressing Low Colorectal Cancer Screening in African Americans: Using Focus Groups to Inform the Development of Effective Interventions.

    PubMed

    May, Folasade P; Whitman, Cynthia B; Varlyguina, Ksenia; Bromley, Erica G; Spiegel, Brennan M R

    2016-09-01

    African Americans have the highest burden of colorectal cancer (CRC) in the United States of America (USA) yet lower CRC screening rates than whites. Although poor screening has prompted efforts to increase screening uptake, there is a persistent need to develop public health interventions in partnership with the African American community. The aim of this study was to conduct focus groups with African Americans to determine preferences for the content and mode of dissemination of culturally tailored CRC screening interventions. In June 2013, 45-75-year-old African Americans were recruited through online advertisements and from an urban Veterans Affairs system to create four focus groups. A semi-structured interview script employing open-ended elicitation was used, and transcripts were analyzed using ATLAS.ti software to code and group data into a concept network. A total of 38 participants (mean age = 54) were enrolled, and 59 ATLAS.ti codes were generated. Commonly reported barriers to screening included perceived invasiveness of colonoscopy, fear of pain, and financial concerns. Facilitators included poor diet/health and desire to prevent CRC. Common sources of health information included media and medical providers. CRC screening information was commonly obtained from medical personnel or media. Participants suggested dissemination of CRC screening education through commercials, billboards, influential African American public figures, Internet, and radio. Participants suggested future interventions include culturally specific information, including details about increased risk, accessing care, and dispelling of myths. Public health interventions to improve CRC screening among African Americans should employ media outlets, emphasize increased risk among African Americans, and address race-specific barriers. Specific recommendations are presented for developing future interventions.

  18. Coding of adverse events of suicidality in clinical study reports of duloxetine for the treatment of major depressive disorder: descriptive study

    PubMed Central

    Tendal, Britta; Hróbjartsson, Asbjørn; Lundh, Andreas; Gøtzsche, Peter C

    2014-01-01

    Objective To assess the effects of coding and coding conventions on summaries and tabulations of adverse events data on suicidality within clinical study reports. Design Systematic electronic search for adverse events of suicidality in tables, narratives, and listings of adverse events in individual patients within clinical study reports. Where possible, for each event we extracted the original term reported by the investigator, the term as coded by the medical coding dictionary, medical coding dictionary used, and the patient’s trial identification number. Using the patient’s trial identification number, we attempted to reconcile data on the same event between the different formats for presenting data on adverse events within the clinical study report. Setting 9 randomised placebo controlled trials of duloxetine for major depressive disorder submitted to the European Medicines Agency for marketing approval. Data sources Clinical study reports obtained from the EMA in 2011. Results Six trials used the medical coding dictionary COSTART (Coding Symbols for a Thesaurus of Adverse Reaction Terms) and three used MedDRA (Medical Dictionary for Regulatory Activities). Suicides were clearly identifiable in all formats of adverse event data in clinical study reports. Suicide attempts presented in tables included both definitive and provisional diagnoses. Suicidal ideation and preparatory behaviour were obscured in some tables owing to the lack of specificity of the medical coding dictionary, especially COSTART. Furthermore, we found one event of suicidal ideation described in narrative text that was absent from tables and adverse event listings of individual patients. The reason for this is unclear, but may be due to the coding conventions used. Conclusion Data on adverse events in tables in clinical study reports may not accurately represent the underlying patient data because of the medical dictionaries and coding conventions used. In clinical study reports, the listings of adverse events for individual patients and narratives of adverse events can provide additional information, including original investigator reported adverse event terms, which can enable a more accurate estimate of harms. PMID:24899651

  19. 75 FR 51465 - Medicare Program; Announcement of Five New Members to the Advisory Panel on Ambulatory Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... Panel. This expertise encompasses hospital payment systems; hospital medical-care delivery systems; provider billing systems; APC groups, Current Procedural Terminology codes, and alpha-numeric Healthcare Common Procedure Coding System codes; and the use of, and payment for, drugs and medical devices in the...

  20. Unique identification code for medical fundus images using blood vessel pattern for tele-ophthalmology applications.

    PubMed

    Singh, Anushikha; Dutta, Malay Kishore; Sharma, Dilip Kumar

    2016-10-01

    Identification of fundus images during transmission and storage in database for tele-ophthalmology applications is an important issue in modern era. The proposed work presents a novel accurate method for generation of unique identification code for identification of fundus images for tele-ophthalmology applications and storage in databases. Unlike existing methods of steganography and watermarking, this method does not tamper the medical image as nothing is embedded in this approach and there is no loss of medical information. Strategic combination of unique blood vessel pattern and patient ID is considered for generation of unique identification code for the digital fundus images. Segmented blood vessel pattern near the optic disc is strategically combined with patient ID for generation of a unique identification code for the image. The proposed method of medical image identification is tested on the publically available DRIVE and MESSIDOR database of fundus image and results are encouraging. Experimental results indicate the uniqueness of identification code and lossless recovery of patient identity from unique identification code for integrity verification of fundus images. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations.

    PubMed

    Moreira, Maria E; Hernandez, Caleb; Stevens, Allen D; Jones, Seth; Sande, Margaret; Blumen, Jason R; Hopkins, Emily; Bakes, Katherine; Haukoos, Jason S

    2015-08-01

    The Institute of Medicine has called on the US health care system to identify and reduce medical errors. Unfortunately, medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients when dosing requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national health care priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared with conventional medication administration, in simulated pediatric emergency department (ED) resuscitation scenarios. We performed a prospective, block-randomized, crossover study in which 10 emergency physician and nurse teams managed 2 simulated pediatric arrest scenarios in situ, using either prefilled, color-coded syringes (intervention) or conventional drug administration methods (control). The ED resuscitation room and the intravenous medication port were video recorded during the simulations. Data were extracted from video review by blinded, independent reviewers. Median time to delivery of all doses for the conventional and color-coded delivery groups was 47 seconds (95% confidence interval [CI] 40 to 53 seconds) and 19 seconds (95% CI 18 to 20 seconds), respectively (difference=27 seconds; 95% CI 21 to 33 seconds). With the conventional method, 118 doses were administered, with 20 critical dosing errors (17%); with the color-coded method, 123 doses were administered, with 0 critical dosing errors (difference=17%; 95% CI 4% to 30%). A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by emergency physician and nurse teams during simulated pediatric ED resuscitations. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  2. Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care.

    PubMed

    Miller, Robin Lin; Reed, Sarah J; Chiaramonte, Danielle; Strzyzykowski, Trevor; Spring, Hannah; Acevedo-Polakovich, Ignacio D; Chutuape, Kate; Cooper-Walker, Bendu; Boyer, Cherrie B; Ellen, Jonathan M

    2017-09-01

    Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community. © Society for Community Research and Action 2017.

  3. TRIAD IV: Nationwide Survey of Medical Students' Understanding of Living Wills and DNR Orders.

    PubMed

    Mirarchi, Ferdinando L; Ray, Matthew; Cooney, Timothy

    2016-12-01

    Living wills are a form of advance directives that help to protect patient autonomy. They are frequently encountered in the conduct of medicine. Because of their impact on care, it is important to understand the adequacy of current medical school training in the preparation of physicians to interpret these directives. Between April and August 2011 of third and fourth year medical students participated in an internet survey involving the interpretation of living wills. The survey presented a standard living will as a "stand-alone," a standard living will with the addition an emergent clinical scenario and then variations of the standard living will that included a code status designation ("DNR," "Full Code," or "Comfort Care"). For each version/ scenario, respondents were asked to assign a code status and choose interventions based on the cases presented. Four hundred twenty-five students from medical schools throughout the country responded. The majority indicated they had received some form of advance directive training and understood the concept of code status and the term "DNR." Based on a stand-alone document, 15% of respondents correctly denoted "full code" as the appropriate code status; adding a clinical scenario yielded negligible improvement. When a code designation was added to the living will, correct code status responses ranged from 68% to 93%, whereas correct treatment decisions ranged from 18% to 78%. Previous training in advance directives had no impact on these results. Our data indicate that the majority of students failed to understand the key elements of a living will; adding a code status designations improved correct responses with the exception of the term DNR. Misunderstanding of advance directives is a nationwide problem and jeopardizes patient safety. Medical School ethics curricula need to be improved to ensure competency with respect to understanding advance directives.

  4. A qualitative study of doctors' and nurses' barriers to communicating with seriously ill patients about their dependent children.

    PubMed

    Dencker, Annemarie; Rix, Bo Andreassen; Bøge, Per; Tjørnhøj-Thomsen, Tine

    2017-12-01

    Research indicates that health personnel caring for seriously ill patients with dependent children aged 0 to 18 years often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients risk serious trauma and emotional difficulty later in life and depend on adult support to minimize these consequences. Patients suffer anxiety about supporting their children during their illness. Because of their potentially pivotal role in supporting patients in enabling parent-child communication, we examined HP's structural and emotional barriers to communicating with patients about their children. The study was based on 49 semi-structured, in-depth interviews with doctors and nurses working with haematology, gynaecological cancer, and neurointensive care. Both interviews and analysis addressed emotional and structural barriers, drawing on the theoretical framework of Maturana's domains. The study found structural barriers (eg, lack of space in the medical recording system, professional code, time pressure, and lack of training) and emotional barriers (eg, the painful nature of the situation and the perceived need of keeping professional distance). We found that emotional barriers tended to grow when structural barriers were not addressed. Our study indicates (1) the need to use templates and manual procedures to gather and process information about children in medical records; (2) the need for managerial backing for addressing children of seriously ill patients and time spent on it; and (3) the need for future HP training programmes to include how to implement procedures and how to address all barriers. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Finding Meaning in Medication Reconciliation Using Electronic Health Records: Qualitative Analysis in Safety Net Primary and Specialty Care

    PubMed Central

    Matta, George Yaccoub; Khoong, Elaine C; Lyles, Courtney R; Schillinger, Dean

    2018-01-01

    Background Safety net health systems face barriers to effective ambulatory medication reconciliation for vulnerable populations. Although some electronic health record (EHR) systems offer safety advantages, EHR use may affect the quality of patient-provider communication. Objective This mixed-methods observational study aimed to develop a conceptual framework of how clinicians balance the demands and risks of EHR and communication tasks during medication reconciliation discussions in a safety net system. Methods This study occurred 3 to 16 (median 9) months after new EHR implementation in five academic public hospital clinics. We video recorded visits between English-/Spanish-speaking patients and their primary/specialty care clinicians. We analyzed the proportion of medications addressed and coded time spent on nonverbal tasks during medication reconciliation as “multitasking EHR use,” “silent EHR use,” “non-EHR multitasking,” and “focused patient-clinician talk.” Finally, we analyzed communication patterns to develop a conceptual framework. Results We examined 35 visits (17%, 6/35 Spanish) between 25 patients (mean age 57, SD 11 years; 44%, 11/25 women; 48%, 12/25 Hispanic; and 20%, 5/25 with limited health literacy) and 25 clinicians (48%, 12/25 primary care). Patients had listed a median of 7 (IQR 5-12) relevant medications, and clinicians addressed a median of 3 (interquartile range [IQR] 1-5) medications. The median duration of medication reconciliation was 2.1 (IQR 1.0-4.2) minutes, comprising a median of 10% (IQR 3%-17%) of visit time. Multitasking EHR use occurred in 47% (IQR 26%-70%) of the medication reconciliation time. Silent EHR use and non-EHR multitasking occurred a smaller proportion of medication reconciliation time, with a median of 0% for both. Focused clinician-patient talk occurred a median of 24% (IQR 0-39%) of medication reconciliation time. Five communication patterns with EHR medication reconciliation were observed: (1) typical EHR multitasking for medication reconciliation, (2) dynamic EHR use to negotiate medication discrepancies, (3) focused patient-clinician talk for medication counseling and addressing patient concerns, (4) responding to patient concerns while maintaining EHR use, and (5) using EHRs to engage patients during medication reconciliation. We developed a conceptual diagram representing the dilemma of the multitasking clinician during medication reconciliation. Conclusions Safety net visits involve multitasking EHR use during almost half of medication reconciliation time. The multitasking clinician balances the cognitive and emotional demands posed by incoming information from multiple sources, attempts to synthesize and act on this information through EHR and communication tasks, and adopts strategies of silent EHR use and focused patient-clinician talk that may help mitigate the risks of multitasking. Future studies should explore diverse patient perspectives about clinician EHR multitasking, clinical outcomes related to EHR multitasking, and human factors and systems engineering interventions to improve the safety of EHR use during the complex process of medication reconciliation. PMID:29735477

  6. Integrating advanced practice providers into medical critical care teams.

    PubMed

    McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark

    2013-03-01

    Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

  7. Investigating the Use of Quick Response Codes in the Gross Anatomy Laboratory

    ERIC Educational Resources Information Center

    Traser, Courtney J.; Hoffman, Leslie A.; Seifert, Mark F.; Wilson, Adam B.

    2015-01-01

    The use of quick response (QR) codes within undergraduate university courses is on the rise, yet literature concerning their use in medical education is scant. This study examined student perceptions on the usefulness of QR codes as learning aids in a medical gross anatomy course, statistically analyzed whether this learning aid impacted student…

  8. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial☆, ☆

    PubMed Central

    Stevens, Allen D.; Hernandez, Caleb; Jones, Seth; Moreira, Maria E.; Blumen, Jason R.; Hopkins, Emily; Sande, Margaret; Bakes, Katherine; Haukoos, Jason S.

    2016-01-01

    Background Medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients where dosing often requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national healthcare priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared to conventional medication administration, in simulated prehospital pediatric resuscitation scenarios. Methods We performed a prospective, block-randomized, cross-over study, where 10 full-time paramedics each managed two simulated pediatric arrests in situ using either prefilled, color-coded-syringes (intervention) or their own medication kits stocked with conventional ampoules (control). Each paramedic was paired with two emergency medical technicians to provide ventilations and compressions as directed. The ambulance patient compartment and the intravenous medication port were video recorded. Data were extracted from video review by blinded, independent reviewers. Results Median time to delivery of all doses for the intervention and control groups was 34 (95% CI: 28–39) seconds and 42 (95% CI: 36–51) seconds, respectively (difference = 9 [95% CI: 4–14] seconds). Using the conventional method, 62 doses were administered with 24 (39%) critical dosing errors; using the prefilled, color-coded syringe method, 59 doses were administered with 0 (0%) critical dosing errors (difference = 39%, 95% CI: 13–61%). Conclusions A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by paramedics during simulated prehospital pediatric resuscitations. PMID:26247145

  9. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial.

    PubMed

    Stevens, Allen D; Hernandez, Caleb; Jones, Seth; Moreira, Maria E; Blumen, Jason R; Hopkins, Emily; Sande, Margaret; Bakes, Katherine; Haukoos, Jason S

    2015-11-01

    Medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients where dosing often requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national healthcare priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared to conventional medication administration, in simulated prehospital pediatric resuscitation scenarios. We performed a prospective, block-randomized, cross-over study, where 10 full-time paramedics each managed two simulated pediatric arrests in situ using either prefilled, color-coded syringes (intervention) or their own medication kits stocked with conventional ampoules (control). Each paramedic was paired with two emergency medical technicians to provide ventilations and compressions as directed. The ambulance patient compartment and the intravenous medication port were video recorded. Data were extracted from video review by blinded, independent reviewers. Median time to delivery of all doses for the intervention and control groups was 34 (95% CI: 28-39) seconds and 42 (95% CI: 36-51) seconds, respectively (difference=9 [95% CI: 4-14] seconds). Using the conventional method, 62 doses were administered with 24 (39%) critical dosing errors; using the prefilled, color-coded syringe method, 59 doses were administered with 0 (0%) critical dosing errors (difference=39%, 95% CI: 13-61%). A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by paramedics during simulated prehospital pediatric resuscitations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Use of Economic Compensation to Increase Demand for Voluntary Medical Male Circumcision in Kenya: Qualitative Interviews With Male Participants in a Randomized Controlled Trial and Their Partners.

    PubMed

    Evens, Emily; Lanham, Michele; Murray, Kate; Rao, Samwel; Agot, Kawango; Omanga, Eunice; Thirumurthy, Harsha

    2016-08-15

    Interventions to increase demand for medical male circumcision are urgently needed in eastern and southern Africa. Following promising evidence that providing economic compensation can increase male circumcision uptake in Kenya, there is a need to understand the role of this intervention in individuals' decision-making regarding circumcision and explore perceptions of the intervention and concerns such as coercion. As part of a randomized controlled trial in Kenya that found compensation in the form of food vouchers worth US $8.75-US $15.00 to be effective in increasing male circumcision uptake, we conducted qualitative in-depth interviews with 45 circumcised and uncircumcised male participants and 19 female partners to explore how compensation provision influenced the decision to get circumcised. Interview transcripts were coded and an inductive thematic analysis was conducted to identify patterns in decision-making. Interviews revealed that compensation promoted circumcision uptake by addressing a major barrier to male circumcision uptake: lost wages during and after the circumcision procedure. Participants who did not get circumcised perceived the compensation amounts to be insufficient for offsetting their costs associated with getting circumcised or reported having nonfinancial barriers that were not addressed by the intervention, such as fear of pain. Participants also reported that they did not feel compelled to get circumcised for financial gain. Female partners of circumcised participants felt that the intervention helped to motivate their partners to get circumcised. The results suggest that the provision of economic compensation is an acceptable intervention that can address an important barrier to male circumcision uptake. Providing compensation to circumcision clients in the form of food vouchers warrants further consideration in voluntary medical male circumcision demand creation efforts.

  11. (Re)disclosing physician financial interests: rebuilding trust or making unreasonable burdens on physicians?

    PubMed

    Sperling, Daniel

    2017-06-01

    Recent professional guidelines published by the General Medical Council instruct physicians in the UK to be honest and open in any financial agreements they have with their patients and third parties. These guidelines are in addition to a European policy addressing disclosure of physician financial interests in the industry. Similarly, In the US, a national open payments program as well as Federal regulations under the Affordable Care Act re-address the issue of disclosure of physician financial interests in America. These new professional and legal changes make us rethink the fiduciary duties of providers working under new organizational and financial schemes, specifically their clinical fidelity and their moral and professional obligations to act in the best interests of patients. The article describes the legal changes providing the background for such proposals and offers a prima facie ethical analysis of these evolving issues. It is argued that although disclosure of conflicting interest may increase trust it may not necessarily be beneficial to patients nor accord with their expectations and needs. Due to the extra burden associated with disclosure as well as its implications on the medical profession and the therapeutic relationship, it should be held that transparency of physician financial interest should not result in mandatory disclosure of such interest by physicians. It could lead, as some initiatives in Europe and the US already demonstrate, to voluntary or mandatory disclosure schemes carried out by the industry itself. Such schemes should be in addition to medical education and the address of the more general phenomenon of physician conflict of interest in ethical codes and ethical training of the parties involved.

  12. The origins of informed consent: the International Scientific Commission on Medical War Crimes, and the Nuremburg code.

    PubMed

    Weindling, P

    2001-01-01

    The Nuremberg Code has generally been seen as arising from the Nuremberg Medical Trial. This paper examines developments prior to the Trial, involving the physiologist Andrew Conway Ivy and an inter-Allied Scientific Commission on Medical War Crimes. The paper traces the formulation of the concept of a medical war crime by the physiologist John West Thompson, as part of the background to Ivy's code on human experiments of 1 August 1946. It evaluates subsequent responses by the American Medical Association, and by other war crimes experts, notably Leo Alexander, who developed Ivy's conceptual framework. Ivy's interaction with the judges at Nuremberg alerted them to the importance of formulating ethical guidelines for clinical research.

  13. SiNC: Saliency-injected neural codes for representation and efficient retrieval of medical radiographs

    PubMed Central

    Sajjad, Muhammad; Mehmood, Irfan; Baik, Sung Wook

    2017-01-01

    Medical image collections contain a wealth of information which can assist radiologists and medical experts in diagnosis and disease detection for making well-informed decisions. However, this objective can only be realized if efficient access is provided to semantically relevant cases from the ever-growing medical image repositories. In this paper, we present an efficient method for representing medical images by incorporating visual saliency and deep features obtained from a fine-tuned convolutional neural network (CNN) pre-trained on natural images. Saliency detector is employed to automatically identify regions of interest like tumors, fractures, and calcified spots in images prior to feature extraction. Neuronal activation features termed as neural codes from different CNN layers are comprehensively studied to identify most appropriate features for representing radiographs. This study revealed that neural codes from the last fully connected layer of the fine-tuned CNN are found to be the most suitable for representing medical images. The neural codes extracted from the entire image and salient part of the image are fused to obtain the saliency-injected neural codes (SiNC) descriptor which is used for indexing and retrieval. Finally, locality sensitive hashing techniques are applied on the SiNC descriptor to acquire short binary codes for allowing efficient retrieval in large scale image collections. Comprehensive experimental evaluations on the radiology images dataset reveal that the proposed framework achieves high retrieval accuracy and efficiency for scalable image retrieval applications and compares favorably with existing approaches. PMID:28771497

  14. Extracellular Matrix Induced Integrin Signal Transduction and Breast Cancer Invasion.

    DTIC Science & Technology

    1995-10-01

    Metalloproteinase, breast, mammary, integrin, collagen, RGDS, matrilysin 49 breast cancer 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY...Organization Name(s) and Address(es). Self-explanatory. Block 16. Price Code. Enter appropriate price Block 8. Performinc!_rcanization Report code...areas of necrosis in the center of the tumor; a portion of the mammary gland can be seen in the lower right . The matrilysin in situ showed

  15. Are Military and Medical Ethics Necessarily Incompatible? A Canadian Case Study.

    PubMed

    Rochon, Christiane; Williams-Jones, Bryn

    2016-12-01

    Military physicians are often perceived to be in a position of 'dual loyalty' because they have responsibilities towards their patients but also towards their employer, the military institution. Further, they have to ascribe to and are bound by two distinct codes of ethics (i.e., medical and military), each with its own set of values and duties, that could at first glance be considered to be very different or even incompatible. How, then, can military physicians reconcile these two codes of ethics and their distinct professional/institutional values, and assume their responsibilities towards both their patients and the military institution? To clarify this situation, and to show how such a reconciliation might be possible, we compared the history and content of two national professional codes of ethics: the Defence Ethics of the Canadian Armed Forces and the Code of Ethics of the Canadian Medical Association. Interestingly, even if the medical code is more focused on duties and responsibility while the military code is more focused on core values and is supported by a comprehensive ethical training program, they also have many elements in common. Further, both are based on the same core values of loyalty and integrity, and they are broad in scope but are relatively flexible in application. While there are still important sources of tension between and limits within these two codes of ethics, there are fewer differences than may appear at first glance because the core values and principles of military and medical ethics are not so different.

  16. 21 CFR 803.52 - If I am a manufacturer, what information must I submit in my individual adverse event reports?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE REPORTING..., result, and conclusion codes) (refer to FDA MEDWATCH Medical Device Reporting Code Instructions); (7... the device was involved, nature of the problem, patient followup or required treatment, and any...

  17. 21 CFR 803.52 - If I am a manufacturer, what information must I submit in my individual adverse event reports?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE REPORTING..., result, and conclusion codes) (refer to FDA MEDWATCH Medical Device Reporting Code Instructions); (7... the device was involved, nature of the problem, patient followup or required treatment, and any...

  18. Can community health workers play a greater role in increasing access to medical abortion services? A qualitative study.

    PubMed

    Gupta, Pallavi; Iyengar, Sharad D; Ganatra, Bela; Johnston, Heidi Bart; Iyengar, Kirti

    2017-05-25

    Despite being legally available in India since 1971, barriers to safe and legal abortion remain, and unsafe and/or illegal abortion continues to be a problem. Community health workers have been involved in improving access to health information and care for maternal and child health in resource poor settings, but their role in facilitating accurate information about and access to safe abortion has been relatively unexplored. A qualitative study was conducted in Rajasthan, India to study acceptability, perspectives and preferences of women and community health workers, regarding the involvement of community health workers in medical abortion referrals. In-depth interviews were conducted with 24 women seeking early medical abortion at legal abortion facilities or presenting at these facilities for a follow-up assessment after medical abortion. Ten community health workers who were trained to assess eligibility for early medical abortion and/or to assess whether women needed a follow-up visit after early medical abortion were also interviewed. The transcripts were coded using ATLAS-ti 7 (version 7.1.4) in the local language and reports were generated for all the codes, emerging themes were identified and the findings were analysed. Community health workers (CHWs) were willing to play a role in assessing eligibility for medical abortion and in identifying women who are in need of follow-up care after early medical abortion, when provided with appropriate training, regular supplies and job aids. Women however had apprehensions about contacting CHWs in relation to abortions. Important barriers that prevented women from seeking information and assistance from community health workers were fear of breach of confidentiality and a perception that they would be pressurised to undergo sterilisation. Our findings support a potential for greater role of CHWs in making safe abortion information and services accessible to women, while highlighting the need to address women's concerns about approaching CHWs in case of unwanted pregnancy. Further intervention research would be needed to shed light on the effectiveness of role of CHWs in facilitating access to safe abortion and to outline specific components in a programme setting. Not applicable.

  19. Empirical analysis of knowledge bases to support structured output in the Arden syntax.

    PubMed

    Jenders, Robert A

    2013-01-01

    Structured output has been suggested for the Arden Syntax to facilitate interoperability. Tabulate the components of WRITE statements in a corpus of medical logic modules (MLMs)in order to validate requiring structured output. WRITE statements were tabulated in 258 MLMs from 2 organizations. In a total of 351 WRITE statements, email destinations (226) predominated, and 39 orders and 40 coded output elements also were tabulated. Free-text strings predominated as the message data. Arden WRITE statements contain considerable potentially structured data now included as free text. A future, normative structured WRITE statement must address a variety of data types and destinations.

  20. Can we prevent doctors being complicit in torture? Breaking the serpent's egg.

    PubMed

    O'Connor, Mike

    2009-12-01

    A significant minority of the tortured prisoners who survive report that a doctor was present during their torture. Yet few medical practitioners are ever criminally prosecuted or even disciplined by their regulatory bodies. Can such gross violations of the Hippocratic Code be so easily ignored or are these doctors carefully shielded from detection and prosecution by a grateful state? Mostly doctors act to vet prisoners for their capacity to withstand the torture or resuscitate them to allow torture and interrogation to continue. However, on occasion, the "healers" may be the actual torturers as happened in Russian psychoprisons in the latter part of the 20th century. This article argues that the de facto immunity which complicit doctors currently appear to enjoy must be stripped away and replaced by effective processes to detect and then prosecute criminal behaviour. This will require widespread reporting of cases and action by international bodies, including non-government organisations. Prevention is clearly preferable and this will require improvements in undergraduate and graduate medical education about international humanitarian and human rights law. There is evidence that many medical faculties pay scant attention to this education and their students graduate with serious flaws in their understanding and attitudes towards human rights. Education should target "doctors at risk" in prisons, armed forces and the police. It should address professional behaviour which tolerates or even protects cultures of abuse. A code of professional conduct would assist "doctors at risk" to resist overtures for them to become complicit in torture, Medical Practice Acts should include statements on respecting human rights when defining good professional conduct. Doctors who become complicit in torture betray their profession. Swift action should be taken to stop such abuses and perpetrators should receive strong disciplinary action from regulatory bodies.

  1. Importance of external cause coding for injury surveillance: lessons from assessment of overexertion injuries among U.S. Army soldiers in 2014.

    PubMed

    Canham-Chervak, Michelle; Steelman, Ryan A; Schuh, Anna; Jones, Bruce H

    2016-11-01

    Injuries are a barrier to military medical readiness, and overexertion has historically been a leading mechanism of injury among active duty U.S. Army soldiers. Details are needed to inform prevention planning. The Defense Medical Surveillance System (DMSS) was queried for unique medical encounters among active duty Army soldiers consistent with the military injury definition and assigned an overexertion external cause code (ICD-9: E927.0-E927.9) in 2014 (n=21,891). Most (99.7%) were outpatient visits and 60% were attributed specifically to sudden strenuous movement. Among the 41% (n=9,061) of visits with an activity code (ICD-9: E001-E030), running was the most common activity (n=2,891, 32%); among the 19% (n=4,190) with a place of occurrence code (ICD-9: E849.0-E849.9), the leading location was recreation/sports facilities (n=1,332, 32%). External cause codes provide essential details, but the data represented less than 4% of all injury-related medical encounters among U.S. Army soldiers in 2014. Efforts to improve external cause coding are needed, and could be aligned with training on and enforcement of ICD-10 coding guidelines throughout the Military Health System.

  2. Psychiatric and medical comorbidities, associated pain, and health care utilization of patients prescribed buprenorphine.

    PubMed

    Mark, Tami L; Dilonardo, Joan; Vandivort, Rita; Miller, Kay

    2013-01-01

    This study describes the comorbidities and health care utilization of individuals treated with buprenorphine using the 2007-2009 MarketScan Research Databases. Buprenorphine recipients had a high prevalence of comorbidities associated with chronic pain, including back problems (42%), connective tissue disease (24-27%), and nontraumatic joint disorders (20-23%). Approximately 69% of recipients filled prescriptions for opioid agonist medications in the 6 months before buprenorphine initiation. Buprenorphine recipients were frequently diagnosed with anxiety (23-42%) and mood disorders (39-51%) and filled prescriptions for antidepressants (47-56%) and benzodiazepines (47-56%) at high rates. Surprisingly, only 53-54% of patients filling a prescription for buprenorphine had a coded opioid abuse/dependence diagnosis. Research is needed to better understand buprenorphine's effectiveness in the context of prescription drug abuse and the best way to coordinate services to address the patient's comorbid addiction, pain, and psychiatric illnesses. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Student decisions about lecture attendance: do electronic course materials matter?

    PubMed

    Billings-Gagliardi, Susan; Mazor, Kathleen M

    2007-10-01

    This study explored whether first-year medical students make deliberate decisions about attending nonrequired lectures. If so, it sought to identify factors that influence these decisions, specifically addressing the potential impact of electronic materials. Medical students who completed first-year studies between 2004 and 2006 responded to an open-ended survey question about their own lecture-attendance decisions. Responses were coded to capture major themes. Students' ratings of the electronic materials were also examined. Most respondents made deliberate attendance decisions. Decisions were influenced by previous experiences with the lecturer, predictions of what would occur during the session itself, personal learning preferences, and learning needs at that particular time, with the overriding goal of maximizing learning. Access to electronic materials did not influence students' choices. Fears that the increasing availability of technology-enhanced educational materials has a negative impact on lecture attendance seem unfounded.

  4. Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers?

    PubMed

    Lowe, Jeanne R; Raugi, Gregory J; Reiber, Gayle E; Whitney, Joanne D

    2013-01-01

    The purpose of this cohort study was to evaluate the effect of a 1-year intervention of an electronic medical record wound care template on the completeness of wound care documentation and medical coding compared to a similar time interval for the fiscal year preceding the intervention. From October 1, 2006, to September 30, 2007, a "good wound care" intervention was implemented at a rural Veterans Affairs facility to prevent amputations in veterans with diabetes and foot ulcers. The study protocol included a template with foot ulcer variables embedded in the electronic medical record to facilitate data collection, support clinical decision making, and improve ordering and medical coding. The intervention group showed significant differences in complete documentation of good wound care compared to the historic control group (χ = 15.99, P < .001), complete documentation of coding for diagnoses and procedures (χ = 30.23, P < .001), and complete documentation of both good wound care and coding for diagnoses and procedures (χ = 14.96, P < .001). An electronic wound care template improved documentation of evidence-based interventions and facilitated coding for wound complexity and procedures.

  5. [Poor promotional practices in pharmaceutical communication: the anti- medical visit, International experience].

    PubMed

    Castillo Pérez, P

    1993-05-01

    We start with a short introduction about the concept of "bad promotional practices" within the Pharmaceutical Industry's (PHI) communication, giving rise to the birth of so-called "un-representatives" (un'rep). Taking the self-control model from the "Association of the British Pharmaceutical Industry" (ABPI), based upon the "code of practice" as a paradigma, we comment about those who notify presumed code's breaches besides the assessment process and penalties that are usually imposed. We also considered the possibility that sometimes the physician instead of being a prosecutor is accused, by the PHI, of supposed "Medical Deonthological Code's" Infringement. The several modalities of malpraxis during the un-rep visit are classified into four categories: product un-information; unloyal competition; echonomical temptations addressed toward physicians; and disregarding stablished visit planning. We devote most of the text to exemplarize five common and very well documented situations; promotion of non-registered indications; influence of prescriptions through prebends to doctors; doubtful payments to compensate clinical trials and drug surveillance studies; the use of exagerated claims; and the abuse of the qualification "drug of choice". We end with a self-critism, from the phi's outlook on the prudence that a "good pharmaceutical communicator" must respect. As an excellent model of wisdom, we propose doctors, Because they follow the classical good-sense picture that illustrates the process of adoption of a new drug. We emphasize the fact that product over-estimation, creating false expectatives, is--together with the lak of informative liability--one of major reasons for a drug innovation to fail.

  6. 41 CFR 109-26.203 - Activity address codes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Activity address codes. 109-26.203 Section 109-26.203 Public Contracts and Property Management Federal Property Management Regulations System (Continued) DEPARTMENT OF ENERGY PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26...

  7. Ethical guidance in the era of managed care: an analysis of the American College of Healthcare Executives' Code of Ethics.

    PubMed

    Higgins, W

    2000-01-01

    Market competition and the rise of managed care are transforming the healthcare system from a physician-dominated cottage industry into a manager-dominated corporate enterprise. The managed care revolution is also undermining the safe-guards offered by medical ethics and raising serious public concerns. These trends highlight the growing importance of ethical standards for managers. The most comprehensive ethical guidance for health service managers is contained in the American College of Healthcare Executives' (ACHE) Code of Ethics. An analysis of the ACHE Code suggests that it does not adequately address several ethical concerns associated with managed care. The ACHE may wish to develop a supplemental statement regarding ethical issues in managed care. A supplemental statement that provides more specific guidance in the areas of financial incentives to reduce utilization, social mission, consumer/patient information, and the health service manager's responsibility to patients could be extremely valuable in today's complex and rapidly changing environment. More specific ethical guidelines would not ensure individual or organizational compliance. However, they would provide professional standards that could guide decision making and help managers evaluate performance in managed care settings.

  8. Image Coding Based on Address Vector Quantization.

    NASA Astrophysics Data System (ADS)

    Feng, Yushu

    Image coding is finding increased application in teleconferencing, archiving, and remote sensing. This thesis investigates the potential of Vector Quantization (VQ), a relatively new source coding technique, for compression of monochromatic and color images. Extensions of the Vector Quantization technique to the Address Vector Quantization method have been investigated. In Vector Quantization, the image data to be encoded are first processed to yield a set of vectors. A codeword from the codebook which best matches the input image vector is then selected. Compression is achieved by replacing the image vector with the index of the code-word which produced the best match, the index is sent to the channel. Reconstruction of the image is done by using a table lookup technique, where the label is simply used as an address for a table containing the representative vectors. A code-book of representative vectors (codewords) is generated using an iterative clustering algorithm such as K-means, or the generalized Lloyd algorithm. A review of different Vector Quantization techniques are given in chapter 1. Chapter 2 gives an overview of codebook design methods including the Kohonen neural network to design codebook. During the encoding process, the correlation of the address is considered and Address Vector Quantization is developed for color image and monochrome image coding. Address VQ which includes static and dynamic processes is introduced in chapter 3. In order to overcome the problems in Hierarchical VQ, Multi-layer Address Vector Quantization is proposed in chapter 4. This approach gives the same performance as that of the normal VQ scheme but the bit rate is about 1/2 to 1/3 as that of the normal VQ method. In chapter 5, a Dynamic Finite State VQ based on a probability transition matrix to select the best subcodebook to encode the image is developed. In chapter 6, a new adaptive vector quantization scheme, suitable for color video coding, called "A Self -Organizing Adaptive VQ Technique" is presented. In addition to chapters 2 through 6 which report on new work, this dissertation includes one chapter (chapter 1) and part of chapter 2 which review previous work on VQ and image coding, respectively. Finally, a short discussion of directions for further research is presented in conclusion.

  9. Brain-CODE: A Secure Neuroinformatics Platform for Management, Federation, Sharing and Analysis of Multi-Dimensional Neuroscience Data.

    PubMed

    Vaccarino, Anthony L; Dharsee, Moyez; Strother, Stephen; Aldridge, Don; Arnott, Stephen R; Behan, Brendan; Dafnas, Costas; Dong, Fan; Edgecombe, Kenneth; El-Badrawi, Rachad; El-Emam, Khaled; Gee, Tom; Evans, Susan G; Javadi, Mojib; Jeanson, Francis; Lefaivre, Shannon; Lutz, Kristen; MacPhee, F Chris; Mikkelsen, Jordan; Mikkelsen, Tom; Mirotchnick, Nicholas; Schmah, Tanya; Studzinski, Christa M; Stuss, Donald T; Theriault, Elizabeth; Evans, Kenneth R

    2018-01-01

    Historically, research databases have existed in isolation with no practical avenue for sharing or pooling medical data into high dimensional datasets that can be efficiently compared across databases. To address this challenge, the Ontario Brain Institute's "Brain-CODE" is a large-scale neuroinformatics platform designed to support the collection, storage, federation, sharing and analysis of different data types across several brain disorders, as a means to understand common underlying causes of brain dysfunction and develop novel approaches to treatment. By providing researchers access to aggregated datasets that they otherwise could not obtain independently, Brain-CODE incentivizes data sharing and collaboration and facilitates analyses both within and across disorders and across a wide array of data types, including clinical, neuroimaging and molecular. The Brain-CODE system architecture provides the technical capabilities to support (1) consolidated data management to securely capture, monitor and curate data, (2) privacy and security best-practices, and (3) interoperable and extensible systems that support harmonization, integration, and query across diverse data modalities and linkages to external data sources. Brain-CODE currently supports collaborative research networks focused on various brain conditions, including neurodevelopmental disorders, cerebral palsy, neurodegenerative diseases, epilepsy and mood disorders. These programs are generating large volumes of data that are integrated within Brain-CODE to support scientific inquiry and analytics across multiple brain disorders and modalities. By providing access to very large datasets on patients with different brain disorders and enabling linkages to provincial, national and international databases, Brain-CODE will help to generate new hypotheses about the biological bases of brain disorders, and ultimately promote new discoveries to improve patient care.

  10. 21 CFR 803.32 - If I am a user facility, what information must I submit in my individual adverse event reports?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE REPORTING User... device; (10) Event problem codes—patient code and device code (refer to the “MEDWATCH Medical Device... device was involved, nature of the problem, patient followup or required treatment, and any environmental...

  11. 21 CFR 803.32 - If I am a user facility, what information must I submit in my individual adverse event reports?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE REPORTING User... device; (10) Event problem codes—patient code and device code (refer to the “MEDWATCH Medical Device... device was involved, nature of the problem, patient followup or required treatment, and any environmental...

  12. A Measurement and Simulation Based Methodology for Cache Performance Modeling and Tuning

    NASA Technical Reports Server (NTRS)

    Waheed, Abdul; Yan, Jerry; Saini, Subhash (Technical Monitor)

    1998-01-01

    We present a cache performance modeling methodology that facilitates the tuning of uniprocessor cache performance for applications executing on shared memory multiprocessors by accurately predicting the effects of source code level modifications. Measurements on a single processor are initially used for identifying parts of code where cache utilization improvements may significantly impact the overall performance. Cache simulation based on trace-driven techniques can be carried out without gathering detailed address traces. Minimal runtime information for modeling cache performance of a selected code block includes: base virtual addresses of arrays, virtual addresses of variables, and loop bounds for that code block. Rest of the information is obtained from the source code. We show that the cache performance predictions are as reliable as those obtained through trace-driven simulations. This technique is particularly helpful to the exploration of various "what-if' scenarios regarding the cache performance impact for alternative code structures. We explain and validate this methodology using a simple matrix-matrix multiplication program. We then apply this methodology to predict and tune the cache performance of two realistic scientific applications taken from the Computational Fluid Dynamics (CFD) domain.

  13. Validation of current procedural terminology codes for rotavirus vaccination among infants in two commercially insured US populations.

    PubMed

    Hoffman, Veena; Everage, Nicholas J; Quinlan, Scott C; Skerry, Kathleen; Esposito, Daina; Praet, Nicolas; Rosillon, Dominique; Holick, Crystal N; Dore, David D

    2016-12-01

    We validated procedure codes used in health insurance claims for reimbursement of rotavirus vaccination by comparing claims for monovalent live-attenuated human rotavirus vaccine (RV1) and live, oral pentavalent rotavirus vaccine (RV5) to medical records. Using administrative data from two commercially insured United States populations, we randomly sampled vaccination claims for RV1 and RV5 from a cohort of infants aged less than 1 year from an ongoing post-licensure safety study of rotavirus vaccines. The codes for RV1 and RV5 found in claims were confirmed through medical record review. The positive predictive value (PPV) of the Current Procedural Terminology codes for RV1 and RV5 was calculated as the number of medical record-confirmed vaccinations divided by the number of medical records obtained. Medical record review confirmed 92 of 104 RV1 vaccination claims (PPV: 88.5%; 95% CI: 80.7-93.9%) and 98 of 113 RV5 vaccination claims (PPV: 86.7%; 95% CI: 79.1-92.4%). Among the 217 medical records abstracted, only three (1.4%) of vaccinations were misclassified in claims-all were RV5 misclassified as RV1. The medical records corresponding to 9 RV1 and 15 RV5 claims contained insufficient information to classify the type of rotavirus vaccine. Misclassification of rotavirus vaccines is infrequent within claims. The PPVs reported here are conservative estimates as those with insufficient information in the medical records were assumed to be incorrectly coded in the claims. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  14. Macrocognition in Complex Team Problem Solving

    DTIC Science & Technology

    2007-06-01

    Organization: Office of Naval Research Complete Address: Dr Michael Letsky Office of Naval Research Life Sciences Department Code 341 Rm 1051 875...S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Office of Naval Research ,Code 341 Rm...distribution unlimited 13. SUPPLEMENTARY NOTES Twelfth International Command and Control Research and Technology Symposium (12th ICCRTS), 19-21 June

  15. 19 CFR 142.42 - Application for Line Release processing.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Company Information: name, address, city, state, contact person, phone number of contact person, and... identification number of the shipper or manufacturer. (f) Importer information (if importer is different than filer): Name, address, city, state and country, zip code, importer number, bond number, and surety code...

  16. 19 CFR 142.42 - Application for Line Release processing.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Company Information: name, address, city, state, contact person, phone number of contact person, and... identification number of the shipper or manufacturer. (f) Importer information (if importer is different than filer): Name, address, city, state and country, zip code, importer number, bond number, and surety code...

  17. 19 CFR 142.42 - Application for Line Release processing.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Company Information: name, address, city, state, contact person, phone number of contact person, and... identification number of the shipper or manufacturer. (f) Importer information (if importer is different than filer): Name, address, city, state and country, zip code, importer number, bond number, and surety code...

  18. 19 CFR 142.42 - Application for Line Release processing.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Company Information: name, address, city, state, contact person, phone number of contact person, and... identification number of the shipper or manufacturer. (f) Importer information (if importer is different than filer): Name, address, city, state and country, zip code, importer number, bond number, and surety code...

  19. Where's the LGBT in integrated care research? A systematic review.

    PubMed

    Hughes, Rachel L; Damin, Catherine; Heiden-Rootes, Katie

    2017-09-01

    Lesbian, gay, bisexual, and transgender (LGBT) individuals experience more negative health outcomes compared with their heterosexual peers. The health disparities are often related to family and social rejection of the LGBT individuals. Integrated care, and Medical Family Therapy in particular, may aid in addressing the systemic nature of the negative health outcomes. To better understand the current state of the integrated care literature on addressing the health needs of LGBT individuals, a systematic review of the research literature was conducted from January 2000 to January 2016 for articles including integrated health care interventions for LGBT populations. Independent reviewers coded identified articles. Only 8 research articles met criteria for inclusion out of the 2,553 initially identified articles in the search. Results indicated a lack of integrated care research on health care and health needs of LGBT individuals, and none of the articles addressed the use of family or systemic-level interventions. Implications for future research and the need for better education training are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Shining the light on the dark side of medical leadership - a qualitative study in Australia.

    PubMed

    Loh, Erwin; Morris, Jennifer; Thomas, Laura; Bismark, Marie Magdaleen; Phelps, Grant; Dickinson, Helen

    2016-07-04

    Purpose The paper aims to explore the beliefs of doctors in leadership roles of the concept of "the dark side", using data collected from interviews carried out with 45 doctors in medical leadership roles across Australia. The paper looks at the beliefs from the perspectives of doctors who are already in leadership roles themselves; to identify potential barriers they might have encountered and to arrive at better-informed strategies to engage more doctors in the leadership of the Australian health system. The research question is: "What are the beliefs of medical leaders that form the key themes or dimensions of the negative perception of the 'dark side'?". Design/methodology/approach The paper analysed data from two similar qualitative studies examining medical leadership and engagement in Australia by the same author, in collaboration with other researchers, which used in-depth semi-structured interviews with 45 purposively sampled senior medical leaders in leadership roles across Australia in health services, private and public hospitals, professional associations and health departments. The data were analysed using deductive and inductive approaches through a coding framework based on the interview data and literature review, with all sections of coded data grouped into themes. Findings Medical leaders had four key beliefs about the "dark side" as perceived through the eyes of their own past clinical experience and/or their clinical colleagues. These four beliefs or dimensions of the negative perception colloquially known as "the dark side" are the belief that they lack both managerial and clinical credibility, they have confused identities, they may be in conflict with clinicians, their clinical colleagues lack insight into the complexities of medical leadership and, as a result, doctors are actively discouraged from making the transition from clinical practice to medical leadership roles in the first place. Research limitations/implications This research was conducted within the Western developed-nation setting of Australia and only involved interviews with doctors in medical leadership roles. The findings are therefore limited to the doctors' own perceptions of themselves based on their past experiences and beliefs. Future research involving doctors who have not chosen to transition to leadership roles, or other health practitioners in other settings, may provide a broader perspective. Also, this research was exploratory and descriptive in nature using qualitative methods, and quantitative research can be carried out in the future to extend this research for statistical generalisation. Practical implications The paper includes implications for health organisations, training providers, medical employers and health departments and describes a multi-prong strategy to address this important issue. Originality/value This paper fulfils an identified need to study the concept of "moving to the dark side" as a negative perception of medical leadership and contributes to the evidence in this under-researched area. This paper has used data from two similar studies, combined together for the first time, with new analysis and coding, looking at the concept of the "dark side" to discover new emergent findings.

  1. Community health center provider ability to identify, treat and account for the social determinants of health: a card study.

    PubMed

    Lewis, Joy H; Whelihan, Kate; Navarro, Isaac; Boyle, Kimberly R

    2016-08-27

    The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America's highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH. Investigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers' perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors. The results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code. An obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations.

  2. Terminology tools: state of the art and practical lessons.

    PubMed

    Cimino, J J

    2001-01-01

    As controlled medical terminologies evolve from simple code-name-hierarchy arrangements, into rich, knowledge-based ontologies of medical concepts, increased demands are placed on both the developers and users of the terminologies. In response, researchers have begun developing tools to address their needs. The aims of this article are to review previous work done to develop these tools and then to describe work done at Columbia University and New York Presbyterian Hospital (NYPH). Researchers working with the Systematized Nomenclature of Medicine (SNOMED), the Unified Medical Language System (UMLS), and NYPH's Medical Entities Dictionary (MED) have created a wide variety of terminology browsers, editors and servers to facilitate creation, maintenance and use of these terminologies. Although much work has been done, no generally available tools have yet emerged. Consensus on requirement for tool functions, especially terminology servers is emerging. Tools at NYPH have been used successfully to support the integration of clinical applications and the merger of health care institutions. Significant advancement has occurred over the past fifteen years in the development of sophisticated controlled terminologies and the tools to support them. The tool set at NYPH provides a case study to demonstrate one feasible architecture.

  3. From data to knowledge through concept-oriented terminologies: experience with the Medical Entities Dictionary.

    PubMed

    Cimino, J J

    2000-01-01

    Knowledge representation involves enumeration of conceptual symbols and arrangement of these symbols into some meaningful structure. Medical knowledge representation has traditionally focused more on the structure than the symbols. Several significant efforts are under way, at local, national, and international levels, to address the representation of the symbols though the creation of high-quality terminologies that are themselves knowledge based. This paper reviews these efforts, including the Medical Entities Dictionary (MED) in use at Columbia University and the New York Presbyterian Hospital. A decade's experience with the MED is summarized to serve as a proof-of-concept that knowledge-based terminologies can support the use of coded patient data for a variety of knowledge-based activities, including the improved understanding of patient data, the access of information sources relevant to specific patient care problems, the application of expert systems directly to the care of patients, and the discovery of new medical knowledge. The terminological knowledge in the MED has also been used successfully to support clinical application development and maintenance, including that of the MED itself. On the basis of this experience, current efforts to create standard knowledge-based terminologies appear to be justified.

  4. Doctors on Values and Advocacy: A Qualitative and Evaluative Study.

    PubMed

    Gallagher, Siun; Little, Miles

    2017-12-01

    Doctors are increasingly enjoined by their professional organisations to involve themselves in supraclinical advocacy, which embraces activities focused on changing practice and the system in order to address the social determinants of health. The moral basis for doctors' decisions on whether or not to do so has been the subject of little empirical research. This opportunistic qualitative study of the values of medical graduates associated with the Sydney Medical School explores the processes that contribute to doctors' decisions about taking up the advocate role. Our findings show that personal ideals were more important than professional commitments in shaping doctors' decisions on engagement in advocacy. Experiences in early life and during training, including exposure to power and powerlessness, significantly influenced their role choices. Doctors included supraclinical advocacy in their mature practices if it satisfied their desire to achieve excellence. These findings suggest that common approaches to promoting and facilitating advocacy as an individual professional obligation are not fully congruent with the experiences and values of doctors that are significant in creating the advocate. It would seem important to understand better the moral commitments inherent in advocacy to inform future developments in codes of medical ethics and medical education programs.

  5. Myotonic Dystrophy and Huntington's Disease Care: "We Like to Think We're Making a Difference".

    PubMed

    LaDonna, Kori A; Watling, Christopher J; Ray, Susan L; Piechowicz, Christine; Venance, Shannon L

    2016-09-01

    Patient-centered care for individuals with myotonic dystrophy (DM1) and Huntington's disease (HD)-chronic, progressive, and life-limiting neurological conditions-may be challenged by patients' cognitive and behavioral impairments. However, no research has explored health care providers' (HCPs') perspectives about patient-centered care provision for these patients along their disease trajectory. Constructivist grounded theory informed the iterative data collection and analysis process. Eleven DM1 or HD HCPs participated in semistructured interviews, and three stages of coding were used to analyze their interview transcripts. Codes were collapsed into themes and categories. Three categories including an evolving care approach, fluid roles, and making a difference were identified. Participants described that their clinical care approach evolved depending on the patient's disease stage and caregivers' degree of involvement. HCPs described that their main goal was to provide hope to patients and caregivers through medical management, crisis prevention, support, and advocacy. Despite the lack of curative treatments, HCPs perceived that patients benefited from ongoing clinical care provided by proactive clinicians. Providing care for individuals with DM1 and HD is a balancing act. HCPs must strike a balance between (1) the frustrations and rewards of patient-centered care provision, (2) addressing symptoms and preventing and managing crises while focusing on patients' and caregivers' quality of life concerns, and (3) advocating for patients while addressing caregivers' needs. This raises important questions: Is patient-centered care possible for patients with cognitive decline? Does chronic neurological care need to evolve to better address patients' and caregivers' complex needs?

  6. Transmission and storage of medical images with patient information.

    PubMed

    Acharya U, Rajendra; Subbanna Bhat, P; Kumar, Sathish; Min, Lim Choo

    2003-07-01

    Digital watermarking is a technique of hiding specific identification data for copyright authentication. This technique is adapted here for interleaving patient information with medical images, to reduce storage and transmission overheads. The text data is encrypted before interleaving with images to ensure greater security. The graphical signals are interleaved with the image. Two types of error control-coding techniques are proposed to enhance reliability of transmission and storage of medical images interleaved with patient information. Transmission and storage scenarios are simulated with and without error control coding and a qualitative as well as quantitative interpretation of the reliability enhancement resulting from the use of various commonly used error control codes such as repetitive, and (7,4) Hamming code is provided.

  7. The static evolution of the new Italian code of medical ethics.

    PubMed

    Montanari Vergallo, G; Busardò, F P; Zaami, S; Marinelli, E

    2016-01-01

    Eight years since the last revision, in May 2014 the Italian code of medical ethics has been updated. Here, the Authors examine the reform in the light of the increasing difficulties of the medical profession arising from the severity of the Italian law Courts. The most significant aspects of this new code are firstly, the patient's freedom of self-determination and secondly, risk prevention through the disclosure of errors and adverse events. However, in both areas the reform seems to be less effective if we compare the ethical codes of France, the United Kingdom and the United States. In particular, the non-taking into consideration of the said code quality standards and scientific evidence which should guide doctors in their clinical practice is to say the least questionable. Since these are the most significant changes in the new code, it seems inevitable to conclude that the 2014 edition is essentially in line with previous versions. Now more than ever it is necessary that medical ethics acknowledges that medicine, society and medical jurisprudence have changed and doctors must be given new rules in order to protect both patients' rights and dignity of the profession. The physician's right to refuse to perform treatment at odds with his own clinical beliefs cannot be the only mean to safeguard the dignity of the profession. A clear boundary must also be established between medicine and professionalism as well as the criteria in determining the scientific evidences that physicians must follow. This has not been done in the Italian code of ethics, despite all the controversy caused by the Stamina case.

  8. Transverse Phase Space Reconstruction and Emittance Measurement of Intense Electron Beams using a Tomography Technique

    NASA Astrophysics Data System (ADS)

    Stratakis, D.; Kishek, R. A.; Li, H.; Bernal, S.; Walter, M.; Tobin, J.; Quinn, B.; Reiser, M.; O'Shea, P. G.

    2006-11-01

    Tomography is the technique of reconstructing an image from its projections. It is widely used in the medical community to observe the interior of the human body by processing multiple x-ray images taken at different angles, A few pioneering researchers have adapted tomography to reconstruct detailed phase space maps of charged particle beams. Some questions arise regarding the limitations of tomography technique for space charge dominated beams. For instance is the linear space charge force a valid approximation? Does tomography equally reproduce phase space for complex, experimentally observed, initial particle distributions? Does tomography make any assumptions about the initial distribution? This study explores the use of accurate modeling with the particle-in-cell code WARP to address these questions, using a wide range of different initial distributions in the code. The study also includes a number of experimental results on tomographic phase space mapping performed on the University of Maryland Electron Ring (UMER).

  9. ADESSA: A Real-Time Decision Support Service for Delivery of Semantically Coded Adverse Drug Event Data

    PubMed Central

    Duke, Jon D.; Friedlin, Jeff

    2010-01-01

    Evaluating medications for potential adverse events is a time-consuming process, typically involving manual lookup of information by physicians. This process can be expedited by CDS systems that support dynamic retrieval and filtering of adverse drug events (ADE’s), but such systems require a source of semantically-coded ADE data. We created a two-component system that addresses this need. First we created a natural language processing application which extracts adverse events from Structured Product Labels and generates a standardized ADE knowledge base. We then built a decision support service that consumes a Continuity of Care Document and returns a list of patient-specific ADE’s. Our database currently contains 534,125 ADE’s from 5602 product labels. An NLP evaluation of 9529 ADE’s showed recall of 93% and precision of 95%. On a trial set of 30 CCD’s, the system provided adverse event data for 88% of drugs and returned these results in an average of 620ms. PMID:21346964

  10. FDA adverse Event Problem Codes: standardizing the classification of device and patient problems associated with medical device use.

    PubMed

    Reed, Terrie L; Kaufman-Rivi, Diana

    2010-01-01

    The broad array of medical devices and the potential for device failures, malfunctions, and other adverse events associated with each device creates a challenge for public health device surveillance programs. Coding reported events by type of device problem provides one method for identifying a potential signal of a larger device issue. The Food and Drug Administration's (FDA) Center for Devices and Radiological Health (CDRH) Event Problem Codes that are used to report adverse events previously lacked a structured set of controls for code development and maintenance. Over time this led to inconsistent, ambiguous, and duplicative concepts being added to the code set on an ad-hoc basis. Recognizing the limitation of its coding system the FDA set out to update the system to improve its usefulness within FDA and as a basis of a global standard to identify important patient and device outcomes throughout the medical community. In 2004, FDA and the National Cancer Institute (NCI) signed a Memorandum of Understanding (MOU) whereby NCI agreed to provide terminology development and maintenance services to all FDA Centers. Under this MOU, CDRH's Office of Surveillance and Biometrics (OSB) convened a cross-Center workgroup and collaborated with staff at NCI Enterprise Vocabulary Service (EVS) to streamline the Patient and Device Problem Codes and integrate them into the NCI Thesaurus and Meta-Thesaurus. This initiative included many enhancements to the Event Problem Codes aimed at improving code selection as well as improving adverse event report analysis. LIMITATIONS & RECOMMENDATIONS: Staff resources, database concerns, and limited collaboration with external groups in the initial phases of the project are discussed. Adverse events associated with medical device use can be better understood when they are reported using a consistent and well-defined code set. This FDA initiative was an attempt to improve the structure and add control mechanisms to an existing code set, improve analysis tools that will better identify device safety trends, and improve the ability to prevent or mitigate effects of adverse events associated with medical device use.

  11. Validity of registration of ICD codes and prescriptions in a research database in Swedish primary care: a cross-sectional study in Skaraborg primary care database

    PubMed Central

    2010-01-01

    Background In recent years, several primary care databases recording information from computerized medical records have been established and used for quality assessment of medical care and research. However, to be useful for research purposes, the data generated routinely from every day practice require registration of high quality. In this study we aimed to investigate (i) the frequency and validity of ICD code and drug prescription registration in the new Skaraborg primary care database (SPCD) and (ii) to investigate the sources of variation in this registration. Methods SPCD contains anonymous electronic medical records (ProfDoc III) automatically retrieved from all 24 public health care centres (HCC) in Skaraborg, Sweden. The frequencies of ICD code registration for the selected diagnoses diabetes mellitus, hypertension and chronic cardiovascular disease and the relevant drug prescriptions in the time period between May 2002 and October 2003 were analysed. The validity of data registration in the SPCD was assessed in a random sample of 50 medical records from each HCC (n = 1200 records) using the medical record text as gold standard. The variance of ICD code registration was studied with multi-level logistic regression analysis and expressed as median odds ratio (MOR). Results For diabetes mellitus and hypertension ICD codes were registered in 80-90% of cases, while for congestive heart failure and ischemic heart disease ICD codes were registered more seldom (60-70%). Drug prescription registration was overall high (88%). A correlation between the frequency of ICD coded visits and the sensitivity of the ICD code registration was found for hypertension and congestive heart failure but not for diabetes or ischemic heart disease. The frequency of ICD code registration varied from 42 to 90% between HCCs, and the greatest variation was found at the physician level (MORPHYSICIAN = 4.2 and MORHCC = 2.3). Conclusions Since the frequency of ICD code registration varies between different diagnoses, each diagnosis must be separately validated. Improved frequency and quality of ICD code registration might be achieved by interventions directed towards the physicians where the greatest amount of variation was found. PMID:20416069

  12. Validity of registration of ICD codes and prescriptions in a research database in Swedish primary care: a cross-sectional study in Skaraborg primary care database.

    PubMed

    Hjerpe, Per; Merlo, Juan; Ohlsson, Henrik; Bengtsson Boström, Kristina; Lindblad, Ulf

    2010-04-23

    In recent years, several primary care databases recording information from computerized medical records have been established and used for quality assessment of medical care and research. However, to be useful for research purposes, the data generated routinely from every day practice require registration of high quality. In this study we aimed to investigate (i) the frequency and validity of ICD code and drug prescription registration in the new Skaraborg primary care database (SPCD) and (ii) to investigate the sources of variation in this registration. SPCD contains anonymous electronic medical records (ProfDoc III) automatically retrieved from all 24 public health care centres (HCC) in Skaraborg, Sweden. The frequencies of ICD code registration for the selected diagnoses diabetes mellitus, hypertension and chronic cardiovascular disease and the relevant drug prescriptions in the time period between May 2002 and October 2003 were analysed. The validity of data registration in the SPCD was assessed in a random sample of 50 medical records from each HCC (n = 1200 records) using the medical record text as gold standard. The variance of ICD code registration was studied with multi-level logistic regression analysis and expressed as median odds ratio (MOR). For diabetes mellitus and hypertension ICD codes were registered in 80-90% of cases, while for congestive heart failure and ischemic heart disease ICD codes were registered more seldom (60-70%). Drug prescription registration was overall high (88%). A correlation between the frequency of ICD coded visits and the sensitivity of the ICD code registration was found for hypertension and congestive heart failure but not for diabetes or ischemic heart disease.The frequency of ICD code registration varied from 42 to 90% between HCCs, and the greatest variation was found at the physician level (MORPHYSICIAN = 4.2 and MORHCC = 2.3). Since the frequency of ICD code registration varies between different diagnoses, each diagnosis must be separately validated. Improved frequency and quality of ICD code registration might be achieved by interventions directed towards the physicians where the greatest amount of variation was found.

  13. Code Mixing and Modernization across Cultures.

    ERIC Educational Resources Information Center

    Kamwangamalu, Nkonko M.

    A review of recent studies addressed the functional uses of code mixing across cultures. Expressions of code mixing (CM) are not random; in fact, a number of functions of code mixing can easily be delineated, for example, the concept of "modernization.""Modernization" is viewed with respect to how bilingual code mixers perceive…

  14. Ethical Challenges in the Teaching of Multicultural Course Work

    ERIC Educational Resources Information Center

    Fier, Elizabeth Boyer; Ramsey, MaryLou

    2005-01-01

    The authors explore the ethical issues and challenges frequently encountered by counselor educators of multicultural course work. Existing ethics codes are examined, and the need for greater specificity with regard to teaching courses of multicultural content is addressed. Options for revising existing codes to better address the challenges of…

  15. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR CODING: FIELD FORMS (UA-D-37.0)

    EPA Science Inventory

    The purpose of this SOP is to define the coding strategy for selected field forms. Forms addressed here will be scanned into databases; databases are created because the forms contain critical values needed to calculate pollutant concentrations. Other forms not addressed by thi...

  16. Verifying the Chemical Weapons Convention: The Case for a United Nations Verification Agency

    DTIC Science & Technology

    1991-12-01

    ORGANIZATION REPORT NUMBER(S) 6&. NAME OF PERFORMING ORGANIZATION j6b. OFFICE SYMBOL 7&. NAME OF MONITORING ORGANIZATION Naval Postgraduate School J(if applicaip...Naval Postgraduate School 6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code) Monterey. CA 93943-5000 Monterey, CA 93943...Governinent. 17. COSATI CODES 18. SUBJECT TERMS (continue on reverse if necessaty and identify by black number) -FIELD GROUP SUBGROUP Chemical

  17. Disaster preparation in kidney transplant recipients: a questionnaire-based cohort study from a large United States transplant center
.

    PubMed

    Sharief, Shimi; Freitas, Daniel; Adey, Deborah; Wiley, James

    2018-04-01

    Few quantitative assessments have assessed disaster preparation in kidney transplant patients. This is a survey-based assessment of disaster preparedness of 200 patients at the University of California San Francisco, USA. Patients answered questionnaires assessing their level of preparedness as well as barriers to preparation. Preparedness was scored based on response to 7 questions. Univariate analyses compared participant characteristics extracted from the medical chart against three tertiles of preparedness: low (scores 0 - 2), medium (scores 3 - 4), and high (scores 5 - 7). California counties were coded and mapped by average preparedness scores. Only 30% of patients were highly prepared for disasters. Participants were prepared with available medication for 2 weeks (78.5%) and least prepared in having a medical ID bracelet (13%). Significant minorities of patients (40% of patients or more) were unprepared with lists of medications, important phone numbers and disaster kits. Preparedness was not associated with demographic and clinical characteristics. Monterey County was the most prepared of the 31 California counties sampled (score of 4.25 out of 7). All patients should be educated regarding disaster preparation. County and medical services should collaborate to address specialized populations in general preparedness planning.
.

  18. Continuous Codes and Standards Improvement (CCSI)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rivkin, Carl H; Burgess, Robert M; Buttner, William J

    2015-10-21

    As of 2014, the majority of the codes and standards required to initially deploy hydrogen technologies infrastructure in the United States have been promulgated. These codes and standards will be field tested through their application to actual hydrogen technologies projects. Continuous codes and standards improvement (CCSI) is a process of identifying code issues that arise during project deployment and then developing codes solutions to these issues. These solutions would typically be proposed amendments to codes and standards. The process is continuous because as technology and the state of safety knowledge develops there will be a need to monitor the applicationmore » of codes and standards and improve them based on information gathered during their application. This paper will discuss code issues that have surfaced through hydrogen technologies infrastructure project deployment and potential code changes that would address these issues. The issues that this paper will address include (1) setback distances for bulk hydrogen storage, (2) code mandated hazard analyses, (3) sensor placement and communication, (4) the use of approved equipment, and (5) system monitoring and maintenance requirements.« less

  19. A method for modeling co-occurrence propensity of clinical codes with application to ICD-10-PCS auto-coding.

    PubMed

    Subotin, Michael; Davis, Anthony R

    2016-09-01

    Natural language processing methods for medical auto-coding, or automatic generation of medical billing codes from electronic health records, generally assign each code independently of the others. They may thus assign codes for closely related procedures or diagnoses to the same document, even when they do not tend to occur together in practice, simply because the right choice can be difficult to infer from the clinical narrative. We propose a method that injects awareness of the propensities for code co-occurrence into this process. First, a model is trained to estimate the conditional probability that one code is assigned by a human coder, given than another code is known to have been assigned to the same document. Then, at runtime, an iterative algorithm is used to apply this model to the output of an existing statistical auto-coder to modify the confidence scores of the codes. We tested this method in combination with a primary auto-coder for International Statistical Classification of Diseases-10 procedure codes, achieving a 12% relative improvement in F-score over the primary auto-coder baseline. The proposed method can be used, with appropriate features, in combination with any auto-coder that generates codes with different levels of confidence. The promising results obtained for International Statistical Classification of Diseases-10 procedure codes suggest that the proposed method may have wider applications in auto-coding. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Physician shadowing: a review of the literature and proposal for guidelines.

    PubMed

    Kitsis, Elizabeth A; Goldsammler, Michelle

    2013-01-01

    Premedical students commonly shadow physicians to gain an understanding of what careers in medicine entail. The authors reviewed the literature to explore (1) whether shadowing achieves this goal consistently and effectively, (2) the ethical issues involved, and (3) other reasons that individuals shadow physicians. The authors searched the MEDLINE database via Ovid for English-language articles published from 1948 to March 2011. Eligible articles described physician shadowing programs and/or assessed the value of physician shadowing independently or in comparison with other educational methods. Of 770 articles identified, 13 articles about physician shadowing programs met inclusion criteria. Two of the 13 programs involved shadowing only, whereas 11 included other educational initiatives. Participants varied; shadowers included students (high school, college, medical school), recent medical school graduates, or international medical graduates. Few studies addressed shadowing by premedical students. Most studies involved programs outside the United States. Shadowing program objectives and characteristics differed. Data reported from focus groups, interviews, and surveys suggest that shadowing experiences generally increased participants' interest in medicine (or a specialty) or improved participants' confidence in transitioning to a new position. Some articles raised ethical and practical concerns related to shadowing. The few shadowing programs described in the literature were heterogeneous and often involved other activities. Further research is warranted; objective outcomes measures would be useful. The authors propose developing guidelines and introducing a code of conduct for premedical students, to enhance the consistency of shadowing experiences and address ethical and practical considerations.

  1. Portal of medical data models: information infrastructure for medical research and healthcare.

    PubMed

    Dugas, Martin; Neuhaus, Philipp; Meidt, Alexandra; Doods, Justin; Storck, Michael; Bruland, Philipp; Varghese, Julian

    2016-01-01

    Information systems are a key success factor for medical research and healthcare. Currently, most of these systems apply heterogeneous and proprietary data models, which impede data exchange and integrated data analysis for scientific purposes. Due to the complexity of medical terminology, the overall number of medical data models is very high. At present, the vast majority of these models are not available to the scientific community. The objective of the Portal of Medical Data Models (MDM, https://medical-data-models.org) is to foster sharing of medical data models. MDM is a registered European information infrastructure. It provides a multilingual platform for exchange and discussion of data models in medicine, both for medical research and healthcare. The system is developed in collaboration with the University Library of Münster to ensure sustainability. A web front-end enables users to search, view, download and discuss data models. Eleven different export formats are available (ODM, PDF, CDA, CSV, MACRO-XML, REDCap, SQL, SPSS, ADL, R, XLSX). MDM contents were analysed with descriptive statistics. MDM contains 4387 current versions of data models (in total 10,963 versions). 2475 of these models belong to oncology trials. The most common keyword (n = 3826) is 'Clinical Trial'; most frequent diseases are breast cancer, leukemia, lung and colorectal neoplasms. Most common languages of data elements are English (n = 328,557) and German (n = 68,738). Semantic annotations (UMLS codes) are available for 108,412 data items, 2453 item groups and 35,361 code list items. Overall 335,087 UMLS codes are assigned with 21,847 unique codes. Few UMLS codes are used several thousand times, but there is a long tail of rarely used codes in the frequency distribution. Expected benefits of the MDM portal are improved and accelerated design of medical data models by sharing best practice, more standardised data models with semantic annotation and better information exchange between information systems, in particular Electronic Data Capture (EDC) and Electronic Health Records (EHR) systems. Contents of the MDM portal need to be further expanded to reach broad coverage of all relevant medical domains. Database URL: https://medical-data-models.org. © The Author(s) 2016. Published by Oxford University Press.

  2. Evaluation on Compressive Characteristics of Medical Stents Applied by Mesh Structures

    NASA Astrophysics Data System (ADS)

    Hirayama, Kazuki; He, Jianmei

    2017-11-01

    There are concerns about strength reduction and fatigue fracture due to stress concentration in currently used medical stents. To address these problems, meshed stents applied by mesh structures were interested for achieving long life and high strength perfromance of medical stents. The purpose of this study is to design basic mesh shapes to obatin three dimensional (3D) meshed stent models for mechanical property evaluation. The influence of introduced design variables on compressive characteristics of meshed stent models are evaluated through finite element analysis using ANSYS Workbench code. From the analytical results, the compressive stiffness are changed periodically with compressive directions, average results need to be introduced as the mean value of compressive stiffness of meshed stents. Secondly, compressive flexibility of meshed stents can be improved by increasing the angle proportional to the arm length of the mesh basic shape. By increasing the number of basic mesh shapes arranged in stent’s circumferential direction, compressive rigidity of meshed stent tends to be increased. Finaly reducing the mesh line width is found effective to improve compressive flexibility of meshed stents.

  3. Evolution of health web certification through the HONcode experience.

    PubMed

    Boyer, Célia; Baujard, Vincent; Geissbuhler, Antoine

    2011-01-01

    Today, the Web is a media with increasing pervasiveness around the world. Its use is constantly growing and the medical field is no exception. With this large amount of information, the problem is no longer about finding information but assessing the credibility of the publishers as well as the relevance and accuracy of the documents retrieved from the web. This problem is particularly relevant in the medical area which has a direct impact on the well-being of citizens and in the Web 2.0 context where information publishing is easier than ever. To address the quality of the medical Internet, the HONcode certification proposed by the Health On the Net Foundation (HON) is certainly the most successful initiative. The aims of this paper are to present certification activity through the HONcode experience and to show that certification is more complex than a simple code of conduct. Therefore, we first present the HONcode, its application and its current evolutions. Following that, we give some quantitative results and describe how the final user can access the certified information.

  4. The Analysis Performance Method Naive Bayes Andssvm Determine Pattern Groups of Disease

    NASA Astrophysics Data System (ADS)

    Sitanggang, Rianto; Tulus; Situmorang, Zakarias

    2017-12-01

    Information is a very important element and into the daily needs of the moment, to get a precise and accurate information is not easy, this research can help decision makers and make a comparison. Researchers perform data mining techniques to analyze the performance of methods and algorithms naïve Bayes methods Smooth Support Vector Machine (ssvm) in the grouping of the disease.The pattern of disease that is often suffered by people in the group can be in the detection area of the collection of information contained in the medical record. Medical records have infromasi disease by patients in coded according to standard WHO. Processing of medical record data to find patterns of this group of diseases that often occur in this community take the attribute address, sex, type of disease, and age. Determining the next analysis is grouping of four ersebut attribute. From the results of research conducted on the dataset fever diabete mellitus, naïve Bayes method produces an average value of 99% and an accuracy and SSVM method produces an average value of 93% accuracy

  5. [How do first codes of medical ethics inspire contemporary physicians?].

    PubMed

    Paprocka-Lipińska, Anna; Basińska, Krystyna

    2014-02-01

    First codes of medical ethics appeared between 18th and 19th century. Their formation was inspired by changes that happened in medicine, positive in general but with some negative setbacks. Those negative consequences revealed the need to codify all those ethical duties, which were formerly passed from generation to generation by the word of mouth and individual example by master physicians. 210 years has passed since the publication of "Medical Ethics" by Thomas Percival, yet essential ethical guidelines remain the same. Similarly, ethical codes published in Poland in 19 century can still be an inspiration to modem physicians.

  6. Co-occurrence of medical conditions: Exposing patterns through probabilistic topic modeling of snomed codes.

    PubMed

    Bhattacharya, Moumita; Jurkovitz, Claudine; Shatkay, Hagit

    2018-04-12

    Patients associated with multiple co-occurring health conditions often face aggravated complications and less favorable outcomes. Co-occurring conditions are especially prevalent among individuals suffering from kidney disease, an increasingly widespread condition affecting 13% of the general population in the US. This study aims to identify and characterize patterns of co-occurring medical conditions in patients employing a probabilistic framework. Specifically, we apply topic modeling in a non-traditional way to find associations across SNOMED-CT codes assigned and recorded in the EHRs of >13,000 patients diagnosed with kidney disease. Unlike most prior work on topic modeling, we apply the method to codes rather than to natural language. Moreover, we quantitatively evaluate the topics, assessing their tightness and distinctiveness, and also assess the medical validity of our results. Our experiments show that each topic is succinctly characterized by a few highly probable and unique disease codes, indicating that the topics are tight. Furthermore, inter-topic distance between each pair of topics is typically high, illustrating distinctiveness. Last, most coded conditions grouped together within a topic, are indeed reported to co-occur in the medical literature. Notably, our results uncover a few indirect associations among conditions that have hitherto not been reported as correlated in the medical literature. Copyright © 2018. Published by Elsevier Inc.

  7. An empirical evaluation of supervised learning approaches in assigning diagnosis codes to electronic medical records

    PubMed Central

    Kavuluru, Ramakanth; Rios, Anthony; Lu, Yuan

    2015-01-01

    Background Diagnosis codes are assigned to medical records in healthcare facilities by trained coders by reviewing all physician authored documents associated with a patient's visit. This is a necessary and complex task involving coders adhering to coding guidelines and coding all assignable codes. With the popularity of electronic medical records (EMRs), computational approaches to code assignment have been proposed in the recent years. However, most efforts have focused on single and often short clinical narratives, while realistic scenarios warrant full EMR level analysis for code assignment. Objective We evaluate supervised learning approaches to automatically assign international classification of diseases (ninth revision) - clinical modification (ICD-9-CM) codes to EMRs by experimenting with a large realistic EMR dataset. The overall goal is to identify methods that offer superior performance in this task when considering such datasets. Methods We use a dataset of 71,463 EMRs corresponding to in-patient visits with discharge date falling in a two year period (2011–2012) from the University of Kentucky (UKY) Medical Center. We curate a smaller subset of this dataset and also use a third gold standard dataset of radiology reports. We conduct experiments using different problem transformation approaches with feature and data selection components and employing suitable label calibration and ranking methods with novel features involving code co-occurrence frequencies and latent code associations. Results Over all codes with at least 50 training examples we obtain a micro F-score of 0.48. On the set of codes that occur at least in 1% of the two year dataset, we achieve a micro F-score of 0.54. For the smaller radiology report dataset, the classifier chaining approach yields best results. For the smaller subset of the UKY dataset, feature selection, data selection, and label calibration offer best performance. Conclusions We show that datasets at different scale (size of the EMRs, number of distinct codes) and with different characteristics warrant different learning approaches. For shorter narratives pertaining to a particular medical subdomain (e.g., radiology, pathology), classifier chaining is ideal given the codes are highly related with each other. For realistic in-patient full EMRs, feature and data selection methods offer high performance for smaller datasets. However, for large EMR datasets, we observe that the binary relevance approach with learning-to-rank based code reranking offers the best performance. Regardless of the training dataset size, for general EMRs, label calibration to select the optimal number of labels is an indispensable final step. PMID:26054428

  8. An empirical evaluation of supervised learning approaches in assigning diagnosis codes to electronic medical records.

    PubMed

    Kavuluru, Ramakanth; Rios, Anthony; Lu, Yuan

    2015-10-01

    Diagnosis codes are assigned to medical records in healthcare facilities by trained coders by reviewing all physician authored documents associated with a patient's visit. This is a necessary and complex task involving coders adhering to coding guidelines and coding all assignable codes. With the popularity of electronic medical records (EMRs), computational approaches to code assignment have been proposed in the recent years. However, most efforts have focused on single and often short clinical narratives, while realistic scenarios warrant full EMR level analysis for code assignment. We evaluate supervised learning approaches to automatically assign international classification of diseases (ninth revision) - clinical modification (ICD-9-CM) codes to EMRs by experimenting with a large realistic EMR dataset. The overall goal is to identify methods that offer superior performance in this task when considering such datasets. We use a dataset of 71,463 EMRs corresponding to in-patient visits with discharge date falling in a two year period (2011-2012) from the University of Kentucky (UKY) Medical Center. We curate a smaller subset of this dataset and also use a third gold standard dataset of radiology reports. We conduct experiments using different problem transformation approaches with feature and data selection components and employing suitable label calibration and ranking methods with novel features involving code co-occurrence frequencies and latent code associations. Over all codes with at least 50 training examples we obtain a micro F-score of 0.48. On the set of codes that occur at least in 1% of the two year dataset, we achieve a micro F-score of 0.54. For the smaller radiology report dataset, the classifier chaining approach yields best results. For the smaller subset of the UKY dataset, feature selection, data selection, and label calibration offer best performance. We show that datasets at different scale (size of the EMRs, number of distinct codes) and with different characteristics warrant different learning approaches. For shorter narratives pertaining to a particular medical subdomain (e.g., radiology, pathology), classifier chaining is ideal given the codes are highly related with each other. For realistic in-patient full EMRs, feature and data selection methods offer high performance for smaller datasets. However, for large EMR datasets, we observe that the binary relevance approach with learning-to-rank based code reranking offers the best performance. Regardless of the training dataset size, for general EMRs, label calibration to select the optimal number of labels is an indispensable final step. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Connection anonymity analysis in coded-WDM PONs

    NASA Astrophysics Data System (ADS)

    Sue, Chuan-Ching

    2008-04-01

    A coded wavelength division multiplexing passive optical network (WDM PON) is presented for fiber to the home (FTTH) systems to protect against eavesdropping. The proposed scheme applies spectral amplitude coding (SAC) with a unipolar maximal-length sequence (M-sequence) code matrix to generate a specific signature address (coding) and to retrieve its matching address codeword (decoding) by exploiting the cyclic properties inherent in array waveguide grating (AWG) routers. In addition to ensuring the confidentiality of user data, the proposed coded-WDM scheme is also a suitable candidate for the physical layer with connection anonymity. Under the assumption that the eavesdropper applies a photo-detection strategy, it is shown that the coded WDM PON outperforms the conventional TDM PON and WDM PON schemes in terms of a higher degree of connection anonymity. Additionally, the proposed scheme allows the system operator to partition the optical network units (ONUs) into appropriate groups so as to achieve a better degree of anonymity.

  10. DebuggingDemo v. 1.0

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gaines, Sherry

    Intentionally simple buggy code created for use in a debugging demonstration as part of recruiting tech talks. Code exemplifies a buffer overflow, leading to return address corruption. Code also demonstrates unused return value.

  11. Social media and medical professionalism: rethinking the debate and the way forward.

    PubMed

    Fenwick, Tara

    2014-10-01

    This Perspective addresses the growing literature about online medical professionalism. Whereas some studies point to the positive potential of social media to enhance and extend medical practice, the dominant emphasis is on the risks and abuses of social media. Overall evidence regarding online medical professionalism is (as with any new area of practice) limited; however, simply accumulating more evidence, without critically checking the assumptions that frame the debate, risks reinforcing negativity toward social media. In this Perspective, the author argues that the medical community should step back and reconsider its assumptions regarding both professionalism and the digital world of social media. Toward this aim, she outlines three areas for critical rethinking by educators and students, administrators, professional associations, and researchers. First she raises some cautions regarding the current literature on using social media in medical practice, which sometimes leaps too quickly from description to prescription. Second, she discusses professionalism. Current debates about the changing nature and contexts of professionalism generally might be helpful in reconsidering notions of online medical professionalism specifically. Third, the author argues that the virtual world itself and its built-in codes deserve more critical scrutiny. She briefly summarizes new research from digital studies both to situate the wider trends more critically and to appreciate the evolving implications for medical practice. Next, the author revisits the potential benefits of social media, including their possibilities to signal new forms of professionalism. Finally, the Perspective ends with specific suggestions for further research that may help move the debate forward.

  12. Medical data protection: a proposal for a deontology code.

    PubMed

    Gritzalis, D; Tomaras, A; Katsikas, S; Keklikoglou, J

    1990-12-01

    In this paper, a proposal for a Medical Data Protection Deontology Code in Greece is presented. Undoubtedly, this code should also be of interest to other countries. The whole effort for the composition of this code is based on what holds internationally, particularly in the EC countries, on recent data acquired from Greek sources and on the experience resulting from what is acceptable in Greece. Accordingly, policies and their influence on the protection of health data, as well as main problems related to that protection, have been considered.

  13. Medical reliable network using concatenated channel codes through GSM network.

    PubMed

    Ahmed, Emtithal; Kohno, Ryuji

    2013-01-01

    Although the 4(th) generation (4G) of global mobile communication network, i.e. Long Term Evolution (LTE) coexisting with the 3(rd) generation (3G) has successfully started; the 2(nd) generation (2G), i.e. Global System for Mobile communication (GSM) still playing an important role in many developing countries. Without any other reliable network infrastructure, GSM can be applied for tele-monitoring applications, where high mobility and low cost are necessary. A core objective of this paper is to introduce the design of a more reliable and dependable Medical Network Channel Code system (MNCC) through GSM Network. MNCC design based on simple concatenated channel code, which is cascade of an inner code (GSM) and an extra outer code (Convolution Code) in order to protect medical data more robust against channel errors than other data using the existing GSM network. In this paper, the MNCC system will provide Bit Error Rate (BER) equivalent to the BER for medical tele monitoring of physiological signals, which is 10(-5) or less. The performance of the MNCC has been proven and investigated using computer simulations under different channels condition such as, Additive White Gaussian Noise (AWGN), Rayleigh noise and burst noise. Generally the MNCC system has been providing better performance as compared to GSM.

  14. Billing and coding knowledge: a comparative survey of professional coders, practicing orthopedic surgeons, and orthopedic residents.

    PubMed

    Wiley, Kevin F; Yousuf, Tariq; Pasque, Charles B; Yousuf, Khalid

    2014-06-01

    Medical knowledge and surgical skills are necessary to become an effective orthopedic surgeon. To run an efficient practice, the surgeon must also possess a basic understanding of medical business practices, including billing and coding. In this study, we surveyed and compared the level of billing and coding knowledge among current orthopedic residents PGY3 and higher, academic and private practice attending orthopedic surgeons, and orthopedic coding professionals. According to the survey results, residents and fellows have a similar knowledge of coding and billing, regardless of their level of training or type of business education received in residency. Most residents would like formal training in coding, billing, and practice management didactics; this is consistent with data from previous studies.

  15. The new CMSS code for interactions with companies managing relationships to minimize conflicts.

    PubMed

    Kahn, Norman B; Lichter, Allen S

    2011-09-01

    Conflicts of interest in medicine have received significant attention in recent years, through the public and professional media, federal and state governments, and through a 2009 report of the Institute of Medicine on Conflict of Interest in Medical Research, Education and Practice. The Council of Medical Specialty Societies (CMSS) Code for Interactions with Companies was adopted by the CMSS in April 2010. The Code guides specialty societies in the profession of medicine in ethical relationships between societies and the pharmaceutical and medical device industries. The Code serves to protect and promote the independence of specialty societies and their leaders in corporate sponsorships, licensing, advertising, society meetings, exhibits, educational programs, journals, clinical practice guidelines, and research. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  16. Mentor Texts and the Coding of Academic Writing Structures: A Functional Approach

    ERIC Educational Resources Information Center

    Escobar Alméciga, Wilder Yesid; Evans, Reid

    2014-01-01

    The purpose of the present pedagogical experience was to address the English language writing needs of university-level students pursuing a degree in bilingual education with an emphasis in the teaching of English. Using mentor texts and coding academic writing structures, an instructional design was developed to directly address the shortcomings…

  17. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR CODING: FIELD FORMS (UA-D-37.0)

    EPA Science Inventory

    The purpose of this SOP is to define the coding strategy for selected field forms. Forms addressed here will be scanned into databases. Databases are created because the forms contain critical values needed to calculate pollutant concentrations. Other forms not addressed by th...

  18. 30 CFR 1204.205 - How do I obtain accounting and auditing relief?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... code, address, phone number, and contact name; and (ii) The specific ONRR lease number and agreement number, if applicable. (2) You may file a single notification for multiple marginal properties. (b) To... request must contain: (i) Your company name, ONRR-assigned payor code, address, phone number, and contact...

  19. 30 CFR 1204.205 - How do I obtain accounting and auditing relief?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... code, address, phone number, and contact name; and (ii) The specific ONRR lease number and agreement number, if applicable. (2) You may file a single notification for multiple marginal properties. (b) To... request must contain: (i) Your company name, ONRR-assigned payor code, address, phone number, and contact...

  20. 30 CFR 1204.205 - How do I obtain accounting and auditing relief?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., ONRR-assigned payor code, address, phone number, and contact name; and (ii) The specific ONRR lease number and agreement number, if applicable. (2) You may file a single notification for multiple marginal.... (1) Your request must contain: (i) Your company name, ONRR-assigned payor code, address, phone number...

  1. 30 CFR 1204.205 - How do I obtain accounting and auditing relief?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... code, address, phone number, and contact name; and (ii) The specific ONRR lease number and agreement number, if applicable. (2) You may file a single notification for multiple marginal properties. (b) To... request must contain: (i) Your company name, ONRR-assigned payor code, address, phone number, and contact...

  2. Normative lessons: codes of conduct, self-regulation and the law.

    PubMed

    Parker, Malcolm H

    2010-06-07

    Good medical practice: a code of conduct for doctors in Australia provides uniform standards to be applied in relation to complaints about doctors to the new Medical Board of Australia. The draft Code was criticised for being prescriptive. The final Code employs apparently less authoritative wording than the draft Code, but the implicit obligations it contains are no less prescriptive. Although the draft Code was thought to potentially undermine trust in doctors, and stifle professional judgement in relation to individual patients, its general obligations always allowed for flexibility of application, depending on the circumstances of individual patients. Professional codes may contain some aspirational statements, but they always contain authoritative ones, and they share this feature with legal codes. In successfully diluting the apparent prescriptivity of the draft Code, the profession has lost an opportunity to demonstrate its commitment to the raison d'etre of self-regulation - the protection of patients. Professional codes are not opportunities for reflection, consideration and debate, but are outcomes of these activities.

  3. Professional Ethics in Teaching: Towards the Development of a Code of Practice.

    ERIC Educational Resources Information Center

    Campbell, Elizabeth

    2000-01-01

    Provides a theoretical discussion about the process of creating a professional code of ethics for educators. Discusses six key issues and questions, introducing the development of a code of professional ethics and the complexities the code should address. Includes references. (CMK)

  4. Building a Better Campus: An Update on Building Codes.

    ERIC Educational Resources Information Center

    Madden, Michael J.

    2002-01-01

    Discusses the implications for higher education institutions in terms of facility planning, design, construction, and renovation of the move from regionally-developed model-building codes to two international sets of codes. Also addresses the new performance-based design option within the codes. (EV)

  5. Coded excitation ultrasonic needle tracking: An in vivo study.

    PubMed

    Xia, Wenfeng; Ginsberg, Yuval; West, Simeon J; Nikitichev, Daniil I; Ourselin, Sebastien; David, Anna L; Desjardins, Adrien E

    2016-07-01

    Accurate and efficient guidance of medical devices to procedural targets lies at the heart of interventional procedures. Ultrasound imaging is commonly used for device guidance, but determining the location of the device tip can be challenging. Various methods have been proposed to track medical devices during ultrasound-guided procedures, but widespread clinical adoption has remained elusive. With ultrasonic tracking, the location of a medical device is determined by ultrasonic communication between the ultrasound imaging probe and a transducer integrated into the medical device. The signal-to-noise ratio (SNR) of the transducer data is an important determinant of the depth in tissue at which tracking can be performed. In this paper, the authors present a new generation of ultrasonic tracking in which coded excitation is used to improve the SNR without spatial averaging. A fiber optic hydrophone was integrated into the cannula of a 20 gauge insertion needle. This transducer received transmissions from the ultrasound imaging probe, and the data were processed to obtain a tracking image of the needle tip. Excitation using Barker or Golay codes was performed to improve the SNR, and conventional bipolar excitation was performed for comparison. The performance of the coded excitation ultrasonic tracking system was evaluated in an in vivo ovine model with insertions to the brachial plexus and the uterine cavity. Coded excitation significantly increased the SNRs of the tracking images, as compared with bipolar excitation. During an insertion to the brachial plexus, the SNR was increased by factors of 3.5 for Barker coding and 7.1 for Golay coding. During insertions into the uterine cavity, these factors ranged from 2.9 to 4.2 for Barker coding and 5.4 to 8.5 for Golay coding. The maximum SNR was 670, which was obtained with Golay coding during needle withdrawal from the brachial plexus. Range sidelobe artifacts were observed in tracking images obtained with Barker coded excitation, and they were visually absent with Golay coded excitation. The spatial tracking accuracy was unaffected by coded excitation. Coded excitation is a viable method for improving the SNR in ultrasonic tracking without compromising spatial accuracy. This method provided SNR increases that are consistent with theoretical expectations, even in the presence of physiological motion. With the ultrasonic tracking system in this study, the SNR increases will have direct clinical implications in a broad range of interventional procedures by improving visibility of medical devices at large depths.

  6. Recruitment, Promotion and Retention of Women in Academic Medicine: How Institutions Are Addressing Gender Disparities

    PubMed Central

    Carr, Phyllis L.; Gunn, Christine; Raj, Anita; Kaplan, Samantha; Freund, Karen M.

    2017-01-01

    Objective Greater numbers of women in medicine have not resulted in more women achieving senior positions. Programs supporting recruitment, promotion and retention of women in academic medicine could help to achieve greater advancement of more women to leadership positions. Qualitative research was conducted to understand such programs at 23 institutions and, using the social ecological model, examine how they operate at the individual, interpersonal, institutional, academic community and policy levels. Methods Telephone interviews were conducted with faculty representatives (N=44) of the Group on Women in Medicine and Science (GWIMS), Diversity and Inclusion (GDI) or senior leaders with knowledge on gender climate in 24 medical schools. Four trained interviewers conducted semi-structured interviews that addressed faculty perceptions of gender equity and advancement, which were audio-taped and transcribed. The data were categorized into three content areas: recruitment, promotion and retention, and coded a priori for each area based on their social ecological level of operation. Findings Participants from nearly 40% of the institutions reported no special programs for recruiting, promoting or retaining women, largely describing such programming as unnecessary. Existing programs primarily targeted the individual and interpersonal levels simultaneously, via training, mentoring, and networking, or the institutional level, via search committee trainings, child and elder care, and spousal hiring programs. Lesser effort at the academic community and policy levels were described. Conclusions Our findings demonstrate that many US medical schools have no programs supporting gender equity among medical faculty. Existing programs primarily target the individual or interpersonal level of the social ecological interaction. The academic community and broader policy environment require greater focus as levels with little attention to advancing women’s careers. Universal multi-level efforts are needed to more effectively advance the careers of medical women faculty and support gender equity. PMID:28063849

  7. The View Behind and Ahead: Implications of Certification *

    PubMed Central

    Darling, Louise

    1973-01-01

    The Medical Library Association's certification plan, never of real significance in employment and promotion practices in health sciences librarianship, does not reflect the many changes which have occurred in swift progression since adoption of the code in 1949. Solutions to the problems which have accumulated since then are sought in a brief examination of trends in credentialing and certification in the health professions and in the library field, both general and special. Emphasis is given to the historical development of provisions in the MLA Code for the Training and Certification of Medical Librarians, the limited opportunity for practical implementation of most of the provisions, the importance of the code in stimulating the Association's educational programs, the impact of the Medical Library Assistance Act, Regional Medical Programs, and increases in demand for health information on manpower requirements for health science libraries, the specific dissatisfactions MLA members have expressed over certification, and the role of the Ad Hoc Committee to Develop a New Certification Code. PMID:4744343

  8. The Italian Code of Medical Deontology: characterizing features of its 2014 edition.

    PubMed

    Conti, Andrea Alberto

    2015-09-14

    The latest edition of the Italian Code of Medical Deontology has been released by the Italian Federation of the Registers of Physicians and Dentists in May 2014 (1). The previous edition of the Italian Code dated back to 2006 (2), and it has been integrated and updated by a multi-professional and inter-disciplinary panel involving, besides physicians, representatives of scientific societies and trade unions, jurisconsults and experts in bioethics....

  9. Musculoskeletal disorder costs and medical claim filing in the US retail trade sector.

    PubMed

    Bhattacharya, Anasua; Leigh, J Paul

    2011-01-01

    The average costs of Musculoskeletal Disorder (MSD) and odds ratios for filing medical claims related to MSD were examined. The medical claims were identified by ICD 9 codes for four US Census regions within retail trade. Large private firms' medical claims data from Thomson Reuters Inc. MarketScan databases for the years 2003 through 2006 were used. Average costs were highest for claims related to lumbar region (ICD 9 Code: 724.02) and number of claims were largest for low back syndrome (ICD 9 Code: 724.2). Whereas the odds of filing an MSD claim did not vary greatly over time, average costs declined over time. The odds of filing claims rose with age and were higher for females and southerners than men and non-southerners. Total estimated national medical costs for MSDs within retail trade were $389 million (2007 USD).

  10. Views of Health Information Management Staff on the Medical Coding Software in Mashhad, Iran.

    PubMed

    Kimiafar, Khalil; Hemmati, Fatemeh; Banaye Yazdipour, Alireza; Sarbaz, Masoumeh

    2018-01-01

    Systematic evaluation of Health Information Technology (HIT) and users' views leads to the modification and development of these technologies in accordance with their needs. The purpose of this study was to investigate the views of Health Information Management (HIM) staff on the quality of medical coding software. A descriptive cross-sectional study was conducted between May to July 2016 in 26 hospitals (academic and non-academic) in Mashhad, north-eastern Iran. The study population consisted of the chairs of HIM departments and medical coders (58 staff). Data were collected through a valid and reliable questionnaire. The data were analyzed using the SPSS version 16.0. From the views of staff, the advantages of coding software such as reducing coding time had the highest average (Mean=3.82) while cost reduction had the lowest average (Mean =3.20), respectively. Meanwhile, concern about losing job opportunities was the least important disadvantage (15.5%) to the use of coding software. In general, the results of this study showed that coding software in some cases have deficiencies. Designers and developers of health information coding software should pay more attention to technical aspects, in-work reminders, help in deciding on proper codes selection by access coding rules, maintenance services, link to other relevant databases and the possibility of providing brief and detailed reports in different formats.

  11. An exploratory study of factors influencing resuscitation skills retention and performance among health providers.

    PubMed

    Curran, Vernon; Fleet, Lisa; Greene, Melanie

    2012-01-01

    Resuscitation and life support skills training comprises a significant proportion of continuing education programming for health professionals. The purpose of this study was to explore the perceptions and attitudes of certified resuscitation providers toward the retention of resuscitation skills, regular skills updating, and methods for enhancing retention. A mixed-methods, explanatory study design was undertaken utilizing focus groups and an online survey-questionnaire of rural and urban health care providers. Rural providers reported less experience with real codes and lower abilities across a variety of resuscitation areas. Mock codes, practice with an instructor and a team, self-practice with a mannequin, and e-learning were popular methods for skills updating. Aspects of team performance that were felt to influence resuscitation performance included: discrepancies in skill levels, lack of communication, and team leaders not up to date on their skills. Confidence in resuscitation abilities was greatest after one had recently practiced or participated in an update or an effective debriefing session. Lowest confidence was reported when team members did not work well together, there was no clear leader of the resuscitation code, or if team members did not communicate. The study findings highlight the importance of access to update methods for improving providers' confidence and abilities, and the need for emphasis on teamwork training in resuscitation. An eclectic approach combining methods may be the best strategy for addressing the needs of health professionals across various clinical departments and geographic locales. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  12. Continuing medical education revisited: theoretical assumptions and practical implications: a qualitative study.

    PubMed

    Dionyssopoulos, Alexander; Karalis, Thanassis; Panitsides, Eugenia A

    2014-12-31

    Recent research has evidenced that although investment in Continuing Medical Education (CME), both in terms of participation as well as financial resources allocated to it, has been steadily increasing to catch up with accelerating advances in health information and technology, effectiveness of CME is reported to be rather limited. Poor and disproportional returns can be attributed to failure of CME courses to address and stimulate an adult audience. The present study initially drew on research findings and adult learning theories, providing the basis for comprehending adult learning, while entailing practical implications on fostering effectiveness in the design and delivery of CME. On a second level, a qualitative study was conducted with the aim to elucidate parameters accounting for effectiveness in educational interventions. Qualitative data was retrieved through 12 in-depth interviews, conducted with a random sample of participants in the 26th European Workshop of Advanced Plastic Surgery (EWAPS). The data underwent a three level qualitative analysis, following the "grounded theory" methodology, comprising 'open coding', 'axial coding' and 'selective coding'. Findings from the EWAPS study come in line with relevant literature, entailing significant implications for the necessity to apply a more effective and efficient paradigm in the design and delivery of educational interventions, advocating for implementing learner-centered schemata in CME and benefiting from a model that draws on the learning environment and social aspects of learning. What emerged as a pivotal parameter in designing educational interventions is to focus on small group educational events which could provide a supportive friendly context, enhance motivation through learner-centered approaches and allow interaction, experimentation and critical reflection. It should be outlined however that further research is required as the present study is limited in scope, having dealt with a limited sample.

  13. Automatic multi-banking of memory for microprocessors

    NASA Technical Reports Server (NTRS)

    Wiker, G. A. (Inventor)

    1984-01-01

    A microprocessor system is provided with added memories to expand its address spaces beyond its address word length capacity by using indirect addressing instructions of a type having a detectable operations code and dedicating designated address spaces of memory to each of the added memories, one space to a memory. By decoding each operations code of instructions read from main memory into a decoder to identify indirect addressing instructions of the specified type, and then decoding the address that follows in a decoder to determine which added memory is associated therewith, the associated added memory is selectively enabled through a unit while the main memory is disabled to permit the instruction to be executed on the location to which the effective address of the indirect address instruction points, either before the indirect address is read from main memory or afterwards, depending on how the system is arranged by a switch.

  14. Brain-CODE: A Secure Neuroinformatics Platform for Management, Federation, Sharing and Analysis of Multi-Dimensional Neuroscience Data

    PubMed Central

    Vaccarino, Anthony L.; Dharsee, Moyez; Strother, Stephen; Aldridge, Don; Arnott, Stephen R.; Behan, Brendan; Dafnas, Costas; Dong, Fan; Edgecombe, Kenneth; El-Badrawi, Rachad; El-Emam, Khaled; Gee, Tom; Evans, Susan G.; Javadi, Mojib; Jeanson, Francis; Lefaivre, Shannon; Lutz, Kristen; MacPhee, F. Chris; Mikkelsen, Jordan; Mikkelsen, Tom; Mirotchnick, Nicholas; Schmah, Tanya; Studzinski, Christa M.; Stuss, Donald T.; Theriault, Elizabeth; Evans, Kenneth R.

    2018-01-01

    Historically, research databases have existed in isolation with no practical avenue for sharing or pooling medical data into high dimensional datasets that can be efficiently compared across databases. To address this challenge, the Ontario Brain Institute’s “Brain-CODE” is a large-scale neuroinformatics platform designed to support the collection, storage, federation, sharing and analysis of different data types across several brain disorders, as a means to understand common underlying causes of brain dysfunction and develop novel approaches to treatment. By providing researchers access to aggregated datasets that they otherwise could not obtain independently, Brain-CODE incentivizes data sharing and collaboration and facilitates analyses both within and across disorders and across a wide array of data types, including clinical, neuroimaging and molecular. The Brain-CODE system architecture provides the technical capabilities to support (1) consolidated data management to securely capture, monitor and curate data, (2) privacy and security best-practices, and (3) interoperable and extensible systems that support harmonization, integration, and query across diverse data modalities and linkages to external data sources. Brain-CODE currently supports collaborative research networks focused on various brain conditions, including neurodevelopmental disorders, cerebral palsy, neurodegenerative diseases, epilepsy and mood disorders. These programs are generating large volumes of data that are integrated within Brain-CODE to support scientific inquiry and analytics across multiple brain disorders and modalities. By providing access to very large datasets on patients with different brain disorders and enabling linkages to provincial, national and international databases, Brain-CODE will help to generate new hypotheses about the biological bases of brain disorders, and ultimately promote new discoveries to improve patient care. PMID:29875648

  15. MEDICAL OPERATIONS IN DENIED ENVIRONMENTS (MODE): ARE OUR AF MEDICS READY

    DTIC Science & Technology

    2016-02-28

    modernization spending, more than the sum of the previous three administrations combined.16 Regional actors believe China’s increased A2/AD capabilities...requirements makes achieving the right personnel with sufficient medical readiness especially challenging.37 20 AF planners use unit type codes ... Codes (AFSCs) as a manpower-classification system to group together personnel that have similar duties, skills, and required training. The Air Force

  16. Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department.

    PubMed

    Rowe, Christopher; Vittinghoff, Eric; Santos, Glenn-Milo; Behar, Emily; Turner, Caitlin; Coffin, Phillip O

    2017-04-01

    Opioid overdose mortality has tripled in the United States since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events. The present study aimed to validate the use of ICD, 9th revision, Clinical Modification (ICD-9-CM) codes in identifying opioid overdose events in the emergency department (ED) by examining multiple performance measures, including sensitivity and specificity. Data on ED visits from January 1, 2012, to December 31, 2014, including clinical determination of whether the visit constituted an opioid overdose event, were abstracted from electronic medical records for patients prescribed long-term opioids for pain from any of six safety net primary care clinics in San Francisco, California. Combinations of ICD-9-CM codes were validated in the detection of overdose events as determined by medical chart review. Both sensitivity and specificity of different combinations of ICD-9-CM codes were calculated. Unadjusted logistic regression models with robust standard errors and accounting for clustering by patient were used to explore whether overdose ED visits with certain characteristics were more or less likely to be assigned an opioid poisoning ICD-9-CM code by the documenting physician. Forty-four (1.4%) of 3,203 ED visits among 804 patients were determined to be opioid overdose events. Opioid-poisoning ICD-9-CM codes (E850.2-E850.2, 965.00-965.09) identified overdose ED visits with a sensitivity of 25.0% (95% confidence interval [CI] = 13.6% to 37.8%) and specificity of 99.9% (95% CI = 99.8% to 100.0%). Expanding the ICD-9-CM codes to include both nonspecified and general (i.e., without a decimal modifier) drug poisoning and drug abuse codes identified overdose ED visits with a sensitivity of 56.8% (95% CI = 43.6%-72.7%) and specificity of 96.2% (95% CI = 94.8%-97.2%). Additional ICD-9-CM codes not explicitly relevant to opioid overdose were necessary to further enhance sensitivity. Among the 44 overdose ED visits, neither naloxone administration during the visit, whether the patient responded to the naloxone, nor the specific opioids involved were associated with the assignment of an opioid poisoning ICD-9-CM code (p ≥ 0.05). Tracking opioid overdose ED visits by diagnostic coding is fairly specific but insensitive, and coding was not influenced by administration of naloxone or the specific opioids involved. The reason for the high rate of missed cases is uncertain, although these results suggest that a more clearly defined case definition for overdose may be necessary to ensure effective opioid overdose surveillance. Changes in coding practices under ICD-10 might help to address these deficiencies. © 2016 by the Society for Academic Emergency Medicine.

  17. A Lossless Multichannel Bio-Signal Compression Based on Low-Complexity Joint Coding Scheme for Portable Medical Devices

    PubMed Central

    Kim, Dong-Sun; Kwon, Jin-San

    2014-01-01

    Research on real-time health systems have received great attention during recent years and the needs of high-quality personal multichannel medical signal compression for personal medical product applications are increasing. The international MPEG-4 audio lossless coding (ALS) standard supports a joint channel-coding scheme for improving compression performance of multichannel signals and it is very efficient compression method for multi-channel biosignals. However, the computational complexity of such a multichannel coding scheme is significantly greater than that of other lossless audio encoders. In this paper, we present a multichannel hardware encoder based on a low-complexity joint-coding technique and shared multiplier scheme for portable devices. A joint-coding decision method and a reference channel selection scheme are modified for a low-complexity joint coder. The proposed joint coding decision method determines the optimized joint-coding operation based on the relationship between the cross correlation of residual signals and the compression ratio. The reference channel selection is designed to select a channel for the entropy coding of the joint coding. The hardware encoder operates at a 40 MHz clock frequency and supports two-channel parallel encoding for the multichannel monitoring system. Experimental results show that the compression ratio increases by 0.06%, whereas the computational complexity decreases by 20.72% compared to the MPEG-4 ALS reference software encoder. In addition, the compression ratio increases by about 11.92%, compared to the single channel based bio-signal lossless data compressor. PMID:25237900

  18. Application of Microgravity to the Assessment of Existing Structures and Structural Foundations.

    DTIC Science & Technology

    1988-04-29

    UADGU Geophysique Francafse IUSRSU 6c. ADDRESS (City, State. and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code) 20, Rue des Pavilions Box 65 92800...r (2.8 - 2.4) 286 AM~TCT f eldo f6 YOUOUVT 4. EXISTING STRUCTURES AND (U) CONPAGNIE DE PROSPECTION GEOPHYSIQUE FRANCAISE RUEIL-MALNAISO J LAKSHNRNRN

  19. Harbors.

    DTIC Science & Technology

    1981-07-01

    CONTRACT OR GRANT NUMBER(e) Naval Facilities Engineering Command 200 Stovall Street r Alexandria, VA 22332 (Code 0453) s. PERFORMING ORGANIZATION NAME...AND ADDRESS 10. PROGRAM ELEMENT. PROJECT. TASK • Naval Facilities Engineering Command AREA & WORK UNIT NUMBERS < 200 Stovall Street Engineering and...Design Alexandria, VA 22332 It. CONTROLLING OFFICE NAME AND ADDRESS 12. REPORT DATE ~ Naval Facilities Engineering Command (Code10432) July 1981 200

  20. Certification of medical librarians, 1949--1977 statistical analysis.

    PubMed

    Schmidt, D

    1979-01-01

    The Medical Library Association's Code for Training and Certification of Medical Librarians was in effect from 1949 to August 1977, a period during which 3,216 individuals were certified. Statistics on each type of certificate granted each year are provided. Because 54.5% of those granted certification were awarded it in the last three-year, two-month period of the code's existence, these applications are reviewed in greater detail. Statistics on each type of certificate granted each year are provided. Because 54.5% of those granted certification were awarded it in the last three-year, two-month period of the code's existence, these applications are reviewed in greater detail. Statistics on MLA membership, sex, residence, library school, and method of meeting requirements are detailed. Questions relating to certification under the code now in existence are raised.

  1. Certification of medical librarians, 1949--1977 statistical analysis.

    PubMed Central

    Schmidt, D

    1979-01-01

    The Medical Library Association's Code for Training and Certification of Medical Librarians was in effect from 1949 to August 1977, a period during which 3,216 individuals were certified. Statistics on each type of certificate granted each year are provided. Because 54.5% of those granted certification were awarded it in the last three-year, two-month period of the code's existence, these applications are reviewed in greater detail. Statistics on each type of certificate granted each year are provided. Because 54.5% of those granted certification were awarded it in the last three-year, two-month period of the code's existence, these applications are reviewed in greater detail. Statistics on MLA membership, sex, residence, library school, and method of meeting requirements are detailed. Questions relating to certification under the code now in existence are raised. PMID:427287

  2. Investigating the use of quick response codes in the gross anatomy laboratory.

    PubMed

    Traser, Courtney J; Hoffman, Leslie A; Seifert, Mark F; Wilson, Adam B

    2015-01-01

    The use of quick response (QR) codes within undergraduate university courses is on the rise, yet literature concerning their use in medical education is scant. This study examined student perceptions on the usefulness of QR codes as learning aids in a medical gross anatomy course, statistically analyzed whether this learning aid impacted student performance, and evaluated whether performance could be explained by the frequency of QR code usage. Question prompts and QR codes tagged on cadaveric specimens and models were available for four weeks as learning aids to medical (n = 155) and doctor of physical therapy (n = 39) students. Each QR code provided answers to posed questions in the form of embedded text or hyperlinked web pages. Students' perceptions were gathered using a formative questionnaire and practical examination scores were used to assess potential gains in student achievement. Overall, students responded positively to the use of QR codes in the gross anatomy laboratory as 89% (57/64) agreed the codes augmented their learning of anatomy. The users' most noticeable objection to using QR codes was the reluctance to bring their smartphones into the gross anatomy laboratory. A comparison between the performance of QR code users and non-users was found to be nonsignificant (P = 0.113), and no significant gains in performance (P = 0.302) were observed after the intervention. Learners welcomed the implementation of QR code technology in the gross anatomy laboratory, yet this intervention had no apparent effect on practical examination performance. © 2014 American Association of Anatomists.

  3. Services provided by community pharmacies in Wayne County, Michigan: a comparison by ZIP code characteristics.

    PubMed

    Erickson, Steven R; Workman, Paul

    2014-01-01

    To document the availability of selected pharmacy services and out-of-pocket cost of medication throughout a diverse county in Michigan and to assess possible associations between availability of services and price of medication and characteristics of residents of the ZIP codes in which the pharmacies were located. Cross-sectional telephone survey of pharmacies coupled with ZIP code-level census data. 503 pharmacies throughout the 63 ZIP codes of Wayne County, MI. The out-of-pocket cost for a 30 days' supply of levothyroxine 50 mcg and brand-name atorvastatin (Lipitor-Pfizer) 20 mg, availability of discount generic drug programs, home delivery of medications, hours of pharmacy operation, and availability of pharmacy-based immunization services. Census data aggregated at the ZIP code level included race, annual household income, age, and number of residents per pharmacy. The overall results per ZIP code showed that the average cost for levothyroxine was $10.01 ± $2.29 and $140.45 + $14.70 for Lipitor. Per ZIP code, the mean (± SD) percentages of pharmacies offering discount generic drug programs was 66.9% ± 15.0%; home delivery of medications was 44.5% ± 22.7%; and immunization for influenza was 46.7% ± 24.3% of pharmacies. The mean (± SD) hours of operation per pharmacy per ZIP code was 67.0 ± 25.2. ZIP codes with higher household income as well as higher percentage of residents being white had lower levothyroxine price, greater percentage of pharmacies offering discount generic drug programs, more hours of operation per week, and more pharmacy-based immunization services. The cost of Lipitor was not associated with any ZIP code characteristic. Disparities in the cost of generic levothyroxine, the availability of services such as discount generic drug programs, hours of operation, and pharmacy-based immunization services are evident based on race and household income within this diverse metropolitan county.

  4. Development of the Pipe Loop System for Determining Effectiveness of Corrosion Control Chemicals in Potable Water Systems

    DTIC Science & Technology

    1988-08-01

    OFFICE SYMBOL 7a NAME OF MONITORING ORGANIZATION U.S. Army Construction (if applicable) Engr Research Laboratory CECER-EN 6c. ADDRESS (City, State...and ZIP Code) 7b ADDRESS (City, State, and ZIP Code) P.O. Box 4005 Champaign, IL 61821 8a. NAME OF FUNDING/SPONSORING 8b OFFICE SYMBOL 9 PROCUREMENT...NAME OF RESPONSIBLE INDIVIDUAL 22b TELEPHONE (Include Area Code) 22c OFFICE SYMBOL Jane Andrew 1(217) 352-6511, x388 CECER-IMT DD FORM 1473. 84 MAR 83

  5. A survey to identify the clinical coding and classification systems currently in use across Europe.

    PubMed

    de Lusignan, S; Minmagh, C; Kennedy, J; Zeimet, M; Bommezijn, H; Bryant, J

    2001-01-01

    This is a survey to identify what clinical coding systems are currently in use across the European Union, and the states seeking membership to it. We sought to identify what systems are currently used and to what extent they were subject to local adaptation. Clinical coding should facilitate identifying key medical events in a computerised medical record, and aggregating information across groups of records. The emerging new driver is as the enabler of the life-long computerised medical record. A prerequisite for this level of functionality is the transfer of information between different computer systems. This transfer can be facilitated either by working on the interoperability problems between disparate systems or by harmonising the underlying data. This paper examines the extent to which the latter has occurred across Europe. Literature and Internet search. Requests for information via electronic mail to pan-European mailing lists of health informatics professionals. Coding systems are now a de facto part of health information systems across Europe. There are relatively few coding systems in existence across Europe. ICD9 and ICD 10, ICPC and Read were the most established. However the local adaptation of these classification systems either on a by country or by computer software manufacturer basis; significantly reduces the ability for the meaning coded with patients computer records to be easily transferred from one medical record system to another. There is no longer any debate as to whether a coding or classification system should be used. Convergence of different classifications systems should be encouraged. Countries and computer manufacturers within the EU should be encouraged to stop making local modifications to coding and classification systems, as this practice risks significantly slowing progress towards easy transfer of records between computer systems.

  6. Medical ethics and education for social responsibility.

    PubMed

    Roemer, M I

    1980-01-01

    The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization.

  7. Medical ethics and education for social responsibility.

    PubMed Central

    Roemer, M. I.

    1980-01-01

    The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization. PMID:7405276

  8. Environmental Ethics and Civil Engineering.

    ERIC Educational Resources Information Center

    Vesilind, P. Aarne

    1987-01-01

    Traces the development of the civil engineering code of ethics. Points out that the code does have an enforceable provision that addresses the engineer's responsibility toward the environment. Suggests revisions to the code to accommodate the environmental impacts of civil engineering. (TW)

  9. Cracking the Code: Assessing Institutional Compliance with the Australian Code for the Responsible Conduct of Research

    ERIC Educational Resources Information Center

    Morris, Suzanne E.

    2010-01-01

    This paper provides a review of institutional authorship policies as required by the "Australian Code for the Responsible Conduct of Research" (the "Code") (National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC) & Universities Australia (UA) 2007), and assesses them for Code compliance.…

  10. Development of a Run Time Math Library for the 1750A Airborne Microcomputer.

    DTIC Science & Technology

    1985-12-01

    premiue CWUTLDK Is R: Integer :a 0; 0: Integer :ul; LNMM: UEM; -Compute the Lado (alpii) for J In 0..Ol.K-1) loop Itf 0(14 1)/ 0. 0...ORGANIZATION (If appiicable) * School of Engineering AFIT/ ENC 6c. ADDRESS (City, State and ZIP Code) 7b. ADDRESS (City. State and ZIP Code) Air Force

  11. Spare a Little Change? Towards a 5-Nines Internet in 250 Lines of Code

    DTIC Science & Technology

    2011-05-01

    NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Carnegie Mellon University,School of Computer Science,Pittsburgh,PA,15213 8. PERFORMING ...Std Z39-18 Keywords: Internet reliability, BGP performance , Quagga This document includes excerpts of the source code for the Linux operating system...Behavior and Performance . . . . . . . . . . . . . . . . . . . . . . . . . . .  .. Other Related Work

  12. A New Approach: Making Ethical Decisions regarding Adult Learner Issues.

    ERIC Educational Resources Information Center

    Missey, Jeanne T.

    Many new student affairs professionals have had little or no experience in applying such codes to different learners. How to address issues where codes are insufficient and how to make student affairs professionals sensitive to the moral and ethical issues of adult learners are addressed in this paper. It is not meant as a guide, but as a tool for…

  13. Development of Novel p16INK4a Mimetics as Anticancer Therapy

    DTIC Science & Technology

    2014-10-01

    Anticancer Therapy PRINCIPAL INVESTIGATOR: Mark Klein, M.D. CONTRACTING ORGANIZATION: Minnesota Veterans Medical Research and Education...Foundation Minneapolis, MN 55417 REPORT DATE: October 2014 TYPE OF REPORT: Annual Report PREPARED FOR: U.S. Army Medical ...NAME(S) AND ADDRESS(ES) Minnesota Veterans Medical Research and Education Foundation M AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT

  14. Racial differences in sexual dysfunction among postdeployed Iraq and Afghanistan veterans

    PubMed Central

    Monawar Hosain, G. M.; Latini, David M.; Kauth, Micahel R.; Goltz, Heather Honoré; Helmer, Drew A.

    2015-01-01

    This study examined the racial/ethnic differences in prevalence and risk factors of sexual dysfunction among postdeployed Iraqi/Afghanistan veterans. A total of 3,962 recently deployed veterans were recruited from Houston Veterans Affairs medical center. The authors examined sociodemographic, medical, mental-health, and lifestyle-related variables. Sexual dysfunction was diagnosed by ICD9-CM code and/or medicines prescribed for sexual dysfunction. Analyses included chi-square, analysis of variance, and multivariate logistic regression. Sexual dysfunction was observed 4.7% in Whites, 7.9% in African Americans, and 6.3% in Hispanics. Age, marital status, smoking, and hypertension were risk factors for Whites, whereas age, marital status, posttraumatic stress disorder and hypertension were significant for African Americans. For Hispanics, only age and posttraumatic stress disorder were significant. This study identified that risk factors of sexual dysfunction varied by race/ethnicity. All postdeployed veterans should be screened; and psychosocial support and educational materials should address race/ethnicity-specific risk factors. PMID:23300201

  15. US medical researchers, the Nuremberg Doctors Trial, and the Nuremberg Code. A review of findings of the Advisory Committee on Human Radiation Experiments.

    PubMed

    Faden, R R; Lederer, S E; Moreno, J D

    1996-11-27

    The Advisory Committee on Human Radiation Experiments (ACHRE), established to review allegations of abuses of human subjects in federally sponsored radiation research, was charged with identifying appropriate standards to evaluate the ethics of cold war radiation experiments. One central question for ACHRE was to determine what role, if any, the Nuremberg Code played in the norms and practices of US medical researchers. Based on the evidence from ACHRE's Ethics Oral History Project and extensive archival research, we conclude that the Code, at the time it was promulgated, had little effect on mainstream medical researchers engaged in human subjects research. Although some clinical investigators raised questions about the conduct of research involving human beings, the medical profession did not pursue this issue until the 1960s.

  16. A Peer Helpers Code of Behavior.

    ERIC Educational Resources Information Center

    de Rosenroll, David A.

    This document presents a guide for developing a peer helpers code of behavior. The first section discusses issues relevant to the trainers. These issues include whether to give a model directly to the group or whether to engender "ownership" of the code by the group; timing of introduction of the code; and addressing the issue of…

  17. [Medical Applications of the PHITS Code I: Recent Improvements and Biological Dose Estimation Model].

    PubMed

    Sato, Tatsuhiko; Furuta, Takuya; Hashimoto, Shintaro; Kuga, Naoya

    2015-01-01

    PHITS is a general purpose Monte Carlo particle transport simulation code developed through the collaboration of several institutes mainly in Japan. It can analyze the motion of nearly all radiations over wide energy ranges in 3-dimensional matters. It has been used for various applications including medical physics. This paper reviews the recent improvements of the code, together with the biological dose estimation method developed on the basis of the microdosimetric function implemented in PHITS.

  18. Identifying Patients for Clinical Studies from Electronic Health Records: TREC 2012 Medical Records Track at OHSU

    DTIC Science & Technology

    2012-11-01

    causes of hypertension ") AND NOT(report_text:"pulmonary| portal hypertension " OR report_text:"secondary to hypertension ") 182 Patients with Ischemic... hypertension , and tachycardia (discharge_icd_codes_txt:293.0 OR report_text:delirium) AND (discharge_icd_codes_txt:401.* OR discharge_icd_codes_txt:405...report_text:"**AGE[in teens") 162 Patients with hypertension on anti- hypertensive medication (report_text:" hypertension " OR report_text:"high blood

  19. Do plant cell walls have a code?

    PubMed

    Tavares, Eveline Q P; Buckeridge, Marcos S

    2015-12-01

    A code is a set of rules that establish correspondence between two worlds, signs (consisting of encrypted information) and meaning (of the decrypted message). A third element, the adaptor, connects both worlds, assigning meaning to a code. We propose that a Glycomic Code exists in plant cell walls where signs are represented by monosaccharides and phenylpropanoids and meaning is cell wall architecture with its highly complex association of polymers. Cell wall biosynthetic mechanisms, structure, architecture and properties are addressed according to Code Biology perspective, focusing on how they oppose to cell wall deconstruction. Cell wall hydrolysis is mainly focused as a mechanism of decryption of the Glycomic Code. Evidence for encoded information in cell wall polymers fine structure is highlighted and the implications of the existence of the Glycomic Code are discussed. Aspects related to fine structure are responsible for polysaccharide packing and polymer-polymer interactions, affecting the final cell wall architecture. The question whether polymers assembly within a wall display similar properties as other biological macromolecules (i.e. proteins, DNA, histones) is addressed, i.e. do they display a code? Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. The power of the patient question: A secret shopper study.

    PubMed

    Peters, Joanne; Desai, Karishma; Ricci, Daniel; Chen, Dan; Singh, Monny; Chewning, Betty

    2016-09-01

    To examine the effect of one standardized patient question on the length, number and type of new topics pharmacists addressed. To explore how community pharmacists counsel secret shoppers on two types of over-the-counter (OTC) medications-ibuprofen (IB) and emergency contraceptives (EC). 25 pharmacists from 7 independent, midwestern community pharmacies consented to have secret shoppers purchase an OTC medication and to have their consultations audio-recorded. Following standardized scenarios, 5 secret shoppers audio-recorded 73 encounters. At the end of 36 encounters secret shoppers asked one standard question, "What else should I know before taking this product?" Role Theory informed the study design with apriori hypotheses that topics assessed, topics discussed, and consultation length would vary by the OTC medication (IB or EC) and whether secret shoppers asked a question. Audio-recording coding had high inter-rater reliability (kappa=0.94). Length of encounter was significantly associated with patients asking the question (p<0.05), but not type of OTC medication. On average 1.22 new topics were discussed with a patient question. New topics included information about safe and efficacious use of the OTC's. Results highlight the importance of encouraging patients to ask pharmacists their questions about OTC products for safe use and thorough consultations. Copyright © 2016. Published by Elsevier Ireland Ltd.

  1. Medical students' attitudes to gender issues in the role and career of physicians: a qualitative study conducted in Sweden.

    PubMed

    Hamberg, Katarina; Johansson, Eva E

    2006-11-01

    There is an increasing awareness of the importance to address gender issues during medical studies. This qualitative study is aimed at exploring students' attitudes to gender issues in the career of physicians, and identifying questions important to consider in medical education about gender. At Umeå University in Sweden, third-term medical students write an essay about 'being a doctor' and they also reflect on gender issues their future career. In 2002, the essays of 41 men and 63 women (75%) were analysed using open coding and repeated comparisons to elaborate categories. Four main attitudes towards gender were identified. Important and interesting (men 22%, women 63%), meaning gender was regarded as a crucial consideration in a physician's working life. Interested women expressed personal worries about their future, while interested men's reflections were more intellectually focused. Relevant with doubts (54%, 27%) represented a positive stand while simultaneously reducing the significance of gender. In Irrelevant and irritating (20%, 8%), gender was seen as over-talked and politics. Irritated students challenged the teachers and questioned gender as a field of scientific knowledge. Neglecting denoted avoidance of gender (5%, 3%). To avoid reinforcing stereotypical ideas about men and women, teachers and physicians need more knowledge about gender.

  2. Current issues in billing and coding in interventional pain medicine.

    PubMed

    Manchikanti, L

    2000-10-01

    Interventional pain management is a dynamic field with changes occurring on a daily basis, not only with technology but also with regulations that have a substantial financial impact on practices. Regulations are imposed not only by the federal government and other regulatory agencies, and also by a multitude of other payors, state governments and medical boards. Documentation of medical necessity with coding that correlates with multiple components of the patient's medical record, operative report, and billing statement is extremely important. Numerous changes which have occurred in the practice of interventional pain management in the new millennium continue to impact the financial viability of interventional pain practices along with patient access to these services. Thus, while complying with regulations of billing, coding and proper, effective, and ethical practice of pain management, it is also essential for physicians to understand financial aspects and the impact of various practice patterns. This article provides guidelines which are meant to provide practical considerations for billing and coding of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management. Hence, these guidelines do not constitute inflexible treatment, coding, billing or documentation recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis taking into account an individual patient's medical condition, personal needs, and preferences, along with physician's experience and in a similar manner, billing and coding practices will be developed. Based on an individual patient's needs, treatment, billing and coding, different from what is outlined here is not only warranted but essential.

  3. Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens.

    PubMed

    Shaw, Yomei; Metes, Ilinca D; Michaud, Kaleb; Donohue, Julie M; Roberts, Mark S; Levesque, Marc C; Chang, Judy C

    2018-04-01

    Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients' feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. In addition to feelings about the necessity and dangers of medications, patients' feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients' motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients' feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients' feelings throughout the treatment decision-making process. © 2017, American College of Rheumatology.

  4. "Anything above marijuana takes priority": Obstetric providers' attitudes and counseling strategies regarding perinatal marijuana use.

    PubMed

    Holland, Cynthia L; Nkumsah, Michelle Abena; Morrison, Penelope; Tarr, Jill A; Rubio, Doris; Rodriguez, Keri L; Kraemer, Kevin L; Day, Nancy; Arnold, Robert M; Chang, Judy C

    2016-09-01

    To describe obstetric provider attitudes, beliefs, approaches, concerns, and needs about addressing perinatal marijuana use with their pregnant patients. We conducted individual semi-structured interviews with obstetric providers and asked them to describe their thoughts and experiences about addressing perinatal marijuana use. Interviews were transcribed verbatim, coded and reviewed to identify themes. Fifty-one providers participated in semi-structured interviews. Providers admitted they were not familiar with identified risks of marijuana use during pregnancy, they perceived marijuana was not as dangerous as other illicit drugs, and they believed patients did not view marijuana as a drug. Most provider counseling strategies focused on marijuana's status as an illegal drug and the risk of child protective services being contacted if patients tested positive at time of delivery. When counseling about perinatal marijuana use, obstetric providers focus more on legal issues than on health risks. They describe needing more information regarding medical consequences of marijuana use during pregnancy. Provider training should include information about potential consequences of perinatal marijuana use and address ways to improve obstetric providers' counseling. Future studies should assess changes in providers' attitudes as more states consider the legalization of marijuana. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. 78 FR 72576 - Criteria for a Catastrophically Disabled Determination for Purposes of Enrollment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-03

    ... Procedural Terminology (CPT[supreg]) codes. The revisions ensure that the regulation is not out of date when... trademark of the American Medical Association. CPT codes and descriptions are copyrighted by the American Medical Association. All rights reserved.) This approach will soon be outdated; the ICD-9-CM and CPT...

  6. 75 FR 78246 - Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-15

    ... Administrator among the fields of hospital payment systems; hospital medical care delivery systems; provider billing and accounting systems; APC groups; Current Procedural Terminology codes; HCPCS codes; the use of, and payment for, drugs, medical devices, and other services in the outpatient setting; and other forms...

  7. Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2015.

    PubMed

    2014-08-06

    This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2015 as required by the statute. This final rule finalizes a policy to collect data on the amount and mode (that is, Individual, Concurrent, Group, and Co-Treatment) of therapy provided in the IRF setting according to therapy discipline, revises the list of diagnosis and impairment group codes that presumptively meet the "60 percent rule'' compliance criteria, provides a way for IRFs to indicate on the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) form whether the prior treatment and severity requirements have been met for arthritis cases to presumptively meet the "60 percent rule'' compliance criteria, and revises and updates quality measures and reporting requirements under the IRF quality reporting program (QRP). This rule also delays the effective date for the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that were finalized in FY 2014 IRF PPS final rule and adopts the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that are finalized in this rule. This final rule also addresses the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), for the IRF prospective payment system (PPS), which will be effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions.

  8. Joint sparse coding based spatial pyramid matching for classification of color medical image.

    PubMed

    Shi, Jun; Li, Yi; Zhu, Jie; Sun, Haojie; Cai, Yin

    2015-04-01

    Although color medical images are important in clinical practice, they are usually converted to grayscale for further processing in pattern recognition, resulting in loss of rich color information. The sparse coding based linear spatial pyramid matching (ScSPM) and its variants are popular for grayscale image classification, but cannot extract color information. In this paper, we propose a joint sparse coding based SPM (JScSPM) method for the classification of color medical images. A joint dictionary can represent both the color information in each color channel and the correlation between channels. Consequently, the joint sparse codes calculated from a joint dictionary can carry color information, and therefore this method can easily transform a feature descriptor originally designed for grayscale images to a color descriptor. A color hepatocellular carcinoma histological image dataset was used to evaluate the performance of the proposed JScSPM algorithm. Experimental results show that JScSPM provides significant improvements as compared with the majority voting based ScSPM and the original ScSPM for color medical image classification. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Comparative analysis of design codes for timber bridges in Canada, the United States, and Europe

    Treesearch

    James Wacker; James (Scott) Groenier

    2010-01-01

    The United States recently completed its transition from the allowable stress design code to the load and resistance factor design (LRFD) reliability-based code for the design of most highway bridges. For an international perspective on the LRFD-based bridge codes, a comparative analysis is presented: a study addressed national codes of the United States, Canada, and...

  10. Development of the First Guideline for Professional Conduct in Medical Practice in Iran.

    PubMed

    Saeedi Tehrani, Saeedeh; Nayeri, Fatemeh; Parsapoor, Alireza; Jafarian, Ali; Labaf, Ali; Mirzazadeh, Azim; Emadi Kouchak, Hamid; Shahi, Farhad; Ghasemzadeh, Nazafarin; Asghari, Fariba

    2017-01-01

    Professional behavior is first learned at the university. One of the necessary considerations in maintaining the professional environment of the university is establishing a set of codes for the behavior of physicians and medical students. This paper describes the process of developing the professional code of conduct in Tehran University of Medical Sciences, Tehran, Iran. A review of Iranian and international literature was performed to develop the first draft of the guideline. In sessions of group discussion by the authors, the articles of the draft were evaluated for relevancy, clarity, and lack of repetition. The draft was sent for evaluation to all participants, including the medical faculty members, residents, and medical students, four times and necessary corrections were made according to the comments received. The final guideline included 76 behavior codes in 6 categories, including altruism, honor and integrity, responsibility, respect, justice, and excellence. The codes of the guideline cover the physicians' commitments in the physician-patient, physician-colleague, and instructor-student relationships in order to improve the quality of the services. The Islamic and Iranian culture were taken into consideration in developing the guideline. Accordance with the administrative and educational conditions of the universities was ensured in developing the guideline and its acceptance was ensured through extensive surveys. Thus, it is expected that this guideline will be very effective in enhancing professional commitment in medical universities.

  11. Identifying Psoriasis and Psoriatic Arthritis Patients in Retrospective Databases When Diagnosis Codes Are Not Available: A Validation Study Comparing Medication/Prescriber Visit-Based Algorithms with Diagnosis Codes.

    PubMed

    Dobson-Belaire, Wendy; Goodfield, Jason; Borrelli, Richard; Liu, Fei Fei; Khan, Zeba M

    2018-01-01

    Using diagnosis code-based algorithms is the primary method of identifying patient cohorts for retrospective studies; nevertheless, many databases lack reliable diagnosis code information. To develop precise algorithms based on medication claims/prescriber visits (MCs/PVs) to identify psoriasis (PsO) patients and psoriatic patients with arthritic conditions (PsO-AC), a proxy for psoriatic arthritis, in Canadian databases lacking diagnosis codes. Algorithms were developed using medications with narrow indication profiles in combination with prescriber specialty to define PsO and PsO-AC. For a 3-year study period from July 1, 2009, algorithms were validated using the PharMetrics Plus database, which contains both adjudicated medication claims and diagnosis codes. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of the developed algorithms were assessed using diagnosis code as the reference standard. Chosen algorithms were then applied to Canadian drug databases to profile the algorithm-identified PsO and PsO-AC cohorts. In the selected database, 183,328 patients were identified for validation. The highest PPVs for PsO (85%) and PsO-AC (65%) occurred when a predictive algorithm of two or more MCs/PVs was compared with the reference standard of one or more diagnosis codes. NPV and specificity were high (99%-100%), whereas sensitivity was low (≤30%). Reducing the number of MCs/PVs or increasing diagnosis claims decreased the algorithms' PPVs. We have developed an MC/PV-based algorithm to identify PsO patients with a high degree of accuracy, but accuracy for PsO-AC requires further investigation. Such methods allow researchers to conduct retrospective studies in databases in which diagnosis codes are absent. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Applying the Verona coding definitions of emotional sequences (VR-CoDES) to code medical students' written responses to written case scenarios: Some methodological and practical considerations.

    PubMed

    Ortwein, Heiderose; Benz, Alexander; Carl, Petra; Huwendiek, Sören; Pander, Tanja; Kiessling, Claudia

    2017-02-01

    To investigate whether the Verona Coding Definitions of Emotional Sequences to code health providers' responses (VR-CoDES-P) can be used for assessment of medical students' responses to patients' cues and concerns provided in written case vignettes. Student responses in direct speech to patient cues and concerns were analysed in 21 different case scenarios using VR-CoDES-P. A total of 977 student responses were available for coding, and 857 responses were codable with the VR-CoDES-P. In 74.6% of responses, the students used either a "reducing space" statement only or a "providing space" statement immediately followed by a "reducing space" statement. Overall, the most frequent response was explicit information advice (ERIa) followed by content exploring (EPCEx) and content acknowledgement (EPCAc). VR-CoDES-P were applicable to written responses of medical students when they were phrased in direct speech. The application of VR-CoDES-P is reliable and feasible when using the differentiation of "providing" and "reducing space" responses. Communication strategies described by students in non-direct speech were difficult to code and produced many missings. VR-CoDES-P are useful for analysis of medical students' written responses when focusing on emotional issues. Students need precise instructions for their response in the given test format. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. 7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 12 2013-01-01 2013-01-01 false Voluntary National Model Building Codes E Exhibit E... National Model Building Codes The following documents address the health and safety aspects of buildings and related structures and are voluntary national model building codes as defined in § 1924.4(h)(2) of...

  14. 7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Voluntary National Model Building Codes E Exhibit E to... Model Building Codes The following documents address the health and safety aspects of buildings and related structures and are voluntary national model building codes as defined in § 1924.4(h)(2) of this...

  15. 7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 12 2012-01-01 2012-01-01 false Voluntary National Model Building Codes E Exhibit E... National Model Building Codes The following documents address the health and safety aspects of buildings and related structures and are voluntary national model building codes as defined in § 1924.4(h)(2) of...

  16. Coding for Language Complexity: The Interplay among Methodological Commitments, Tools, and Workflow in Writing Research

    ERIC Educational Resources Information Center

    Geisler, Cheryl

    2018-01-01

    Coding, the analytic task of assigning codes to nonnumeric data, is foundational to writing research. A rich discussion of methodological pluralism has established the foundational importance of systematicity in the task of coding, but less attention has been paid to the equally important commitment to language complexity. Addressing the interplay…

  17. The Impact of Living with Klinefelter Syndrome: A Qualitative Exploration of Adolescents and Adults.

    PubMed

    Turriff, Amy; Macnamara, Ellen; Levy, Howard P; Biesecker, Barbara

    2017-08-01

    Klinefelter syndrome (XXY) is a common yet significantly underdiagnosed condition with considerable medical, psychological and social implications. Many health care providers lack familiarity with XXY, resulting in medical management challenges and a limited understanding of the personal impact of the condition. Genetic counselors benefit from understanding the challenges adolescents and men with XXY face to effectively address their medical and psychosocial needs. The purpose of this study was to understand the impact of living with XXY as an adolescent or an adult. Individuals aged 14 to 75 years with self-reported XXY were recruited from online support networks to complete a web-based survey that included open-ended questions. Open-ended responses were coded and analyzed thematically (n = 169 to 210 for each open-ended question). Over half of respondents to the open-ended questions reported challenges in finding health care providers who are knowledgeable about XXY, with many describing an extensive diagnostic odyssey and relief when receiving a diagnosis. Individuals sought support coping with the challenges they face and acknowledgement of the positive aspects of XXY. Recommendations are made for how genetic counseling can enhance quality of life for individuals living with XXY.

  18. Automatic de-identification of French clinical records: comparison of rule-based and machine-learning approaches.

    PubMed

    Grouin, Cyril; Zweigenbaum, Pierre

    2013-01-01

    In this paper, we present a comparison of two approaches to automatically de-identify medical records written in French: a rule-based system and a machine-learning based system using a conditional random fields (CRF) formalism. Both systems have been designed to process nine identifiers in a corpus of medical records in cardiology. We performed two evaluations: first, on 62 documents in cardiology, and on 10 documents in foetopathology - produced by optical character recognition (OCR) - to evaluate the robustness of our systems. We achieved a 0.843 (rule-based) and 0.883 (machine-learning) exact match overall F-measure in cardiology. While the rule-based system allowed us to achieve good results on nominative (first and last names) and numerical data (dates, phone numbers, and zip codes), the machine-learning approach performed best on more complex categories (postal addresses, hospital names, medical devices, and towns). On the foetopathology corpus, although our systems have not been designed for this corpus and despite OCR character recognition errors, we obtained promising results: a 0.681 (rule-based) and 0.638 (machine-learning) exact-match overall F-measure. This demonstrates that existing tools can be applied to process new documents of lower quality.

  19. From Data to Knowledge through Concept-oriented Terminologies

    PubMed Central

    Cimino, James J.

    2000-01-01

    Knowledge representation involves enumeration of conceptual symbols and arrangement of these symbols into some meaningful structure. Medical knowledge representation has traditionally focused more on the structure than the symbols. Several significant efforts are under way, at local, national, and international levels, to address the representation of the symbols though the creation of high-quality terminologies that are themselves knowledge based. This paper reviews these efforts, including the Medical Entities Dictionary (MED) in use at Columbia University and the New York Presbyterian Hospital. A decade's experience with the MED is summarized to serve as a proof-of-concept that knowledge-based terminologies can support the use of coded patient data for a variety of knowledge-based activities, including the improved understanding of patient data, the access of information sources relevant to specific patient care problems, the application of expert systems directly to the care of patients, and the discovery of new medical knowledge. The terminological knowledge in the MED has also been used successfully to support clinical application development and maintenance, including that of the MED itself. On the basis of this experience, current efforts to create standard knowledge-based terminologies appear to be justified. PMID:10833166

  20. Ascertainment of Outpatient Visits by Patients with Diabetes: The National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS)

    PubMed Central

    Asao, Keiko; McEwen, Laura N.; Lee, Joyce M.; Herman, William H.

    2015-01-01

    Aims To estimate and evaluate the sensitivity and specificity of providers’ diagnosis codes and medication lists to identify outpatient visits by patients with diabetes. Methods We used data from the 2006 to 2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We assessed the sensitivity and specificity of providers’ diagnoses and medication lists to identify patients with diabetes, using the checkbox for diabetes as the gold standard. We then examined differences in sensitivity by patients’ characteristics using multivariate logistic regression models. Results The checkbox identified 12,647 outpatient visits by adults with diabetes among the 70,352 visits used for this analysis. The sensitivity and specificity of providers’ diagnoses or listed diabetes medications were 72.3% (95% CI: 70.8% to 73.8%) and 99.2% (99.1% to 99.4%), respectively. Diabetic patients ≥75 years pf age, women, non-Hispanics, and those with private insurance or Medicare were more likely to be missed by providers’ diagnoses and medication lists. Diabetic patients who had more diagnosis codes and medications recorded, had glucose or hemoglobin A1c measured, or made office- rather than hospital-outpatient visits were less likely to be missed. Conclusions Providers’ diagnosis codes and medication lists fail to identify approximately one quarter of outpatient visits by patients with diabetes. PMID:25891975

  1. The NCS code of practice for the quality assurance and control for volumetric modulated arc therapy

    NASA Astrophysics Data System (ADS)

    Mans, Anton; Schuring, Danny; Arends, Mark P.; Vugts, Cornelia A. J. M.; Wolthaus, Jochem W. H.; Lotz, Heidi T.; Admiraal, Marjan; Louwe, Rob J. W.; Öllers, Michel C.; van de Kamer, Jeroen B.

    2016-10-01

    In 2010, the NCS (Netherlands Commission on Radiation Dosimetry) installed a subcommittee to develop guidelines for quality assurance and control for volumetric modulated arc therapy (VMAT) treatments. The report (published in 2015) has been written by Dutch medical physicists and has therefore, inevitably, a Dutch focus. This paper is a condensed version of these guidelines, the full report in English is freely available from the NCS website www.radiationdosimetry.org. After describing the transition from IMRT to VMAT, the paper addresses machine quality assurance (QA) and treatment planning system (TPS) commissioning for VMAT. The final section discusses patient specific QA issues such as the use of class solutions, measurement devices and dose evaluation methods.

  2. Periodontal status and its association with self-reported hypertension in non-medical staff in a university teaching hospital in Nigeria.

    PubMed

    Umeizudike, K A; Ayanbadejo, P O; Onajole, A T; Umeizudike, T I; Alade, G O

    2016-03-01

    A growing body of evidence suggests a relationship between periodontal disease and non-communicable systemic diseases with rising prevalence in developing countries, Nigeria inclusive. To determine the periodontal status and its association with self-reported hypertension among non-medical staff in a university teaching hospital in Nigeria. A cross-sectional study was conducted among non-medical staff using self-administered questionnaires and periodontal clinical examination between July and August 2013. Multivariate analysis was explored to determine the independent variables associated with self-reported hypertension. P values < 0.05 were considered statistically significant. A total of 276 subjects were enrolled into the study. Shallow pockets (CPI code 3) constituted the predominant periodontal disease (46.7%), calculus (CPI code 2) 46%, bleeding gingiva (CPI code 1) in 3.3% and deep pockets ≥ 6mm (CPI code 4) in 2.2%. Self-reported hypertension was the most prevalent self-reported medical condition (18.1%) and found to be associated with periodontitis, increasing age, lower education, and a positive family history of hypertension. Periodontal disease was highly prevalent in this study. Self-reported hypertension was associated with periodontitis, older age, lower education and a positive family history. Periodic periodontal examination and regular blood pressure assessment for non-medical staff is recommended.

  3. The business of ethics: gender, medicine, and the professional codification of the American Physiotherapy Association, 1918-1935.

    PubMed

    Linker, Beth

    2005-07-01

    The history of codes of ethics in health care has almost exclusively been told as a story of how medical doctors developed their own professional principles of conduct. Yet telling the history of medical ethics solely from the physicians' perspective neglects not only the numerous allied health care workers who developed their own codes of ethics in tandem with the medical profession, but also the role that gender played in the writing of such professional creeds. By focusing on the predominantly female organization of the American Physiotherapy Association (APA) and its 1935 "Code of Ethics and Discipline," I demonstrate how these women used their creed to at once curry favor from and challenge the authority of the medical profession. Through their Code, APA therapists engaged in a dynamic dialogue with the male physicians of the American Medical Association (AMA) in the name of professional survival. I conclude that, contrary to historians and philosophers who contend that professional women have historically operated under a gender-specific ethic of care, the physiotherapists avoided rhetoric construed as feminine and instead created a "business-like" creed in which they spoke solely about their relationship with physicians and remained silent on the matter of patient care.

  4. [Orthopedic and trauma surgery in the German DRG system. Recent developments].

    PubMed

    Franz, D; Schemmann, F; Selter, D D; Wirtz, D C; Roeder, N; Siebert, H; Mahlke, L

    2012-07-01

    Orthopedics and trauma surgery are subject to continuous medical advancement. The correct and performance-based case allocation by German diagnosis-related groups (G-DRG) is a major challenge. This article analyzes and assesses current developments in orthopedics and trauma surgery in the areas of coding of diagnoses and medical procedures and the development of the 2012 G-DRG system. The relevant diagnoses, medical procedures and G-DRGs in the versions 2011 and 2012 were analyzed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes were made for the International Classification of Diseases (ICD) coding of complex cases with medical complications, the procedure coding for spinal surgery and for hand and foot surgery. The G-DRG structures were modified for endoprosthetic surgery on ankle, shoulder and elbow joints. The definition of modular structured endoprostheses was clarified. The G-DRG system for orthopedic and trauma surgery appears to be largely consolidated. The current phase of the evolution of the G-DRG system is primarily aimed at developing most exact descriptions and definitions of the content and mutual delimitation of operation and procedures coding (OPS). This is an essential prerequisite for a correct and performance-based case allocation in the G-DRG system.

  5. Use of QR and EAN-13 codes by older patients taking multiple medications for a safer use of medication.

    PubMed

    Mira, José Joaquín; Guilabert, Mercedes; Carrillo, Irene; Fernández, César; Vicente, Ma Asunción; Orozco-Beltrán, Domingo; Gil-Guillen, Vicente F

    2015-06-01

    Older persons following a prolonged complex drug regimen often make mistakes when taking their medication. Currently, the widespread use of tablets and smartphones has encouraged the development of applications to support self-management of medication. The aim of this study was to design, develop and assess an app that transforms medication-associated ean-13 (barcodes) and Quick Response codes (QR) into verbal instructions, to enable safer use of medication by the elderly patients taking multiple medications. Meetings were held in which participated a total of 61 patients. The results showed that patients appreciated the application and found it useful for safer use of medicines. The study results support the use of such technology to increase patient safety taking multiple medications safety. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. A qualitative study on physicians' perceptions of specialty characteristics.

    PubMed

    Park, Kwi Hwa; Jun, Soo-Koung; Park, Ie Byung

    2016-09-01

    There has been limited research on physicians' perceptions of the specialty characteristics that are needed to sustain a successful career in medical specialties in Korea. Medical Specialty Preference Inventory in the United States or SCI59 (specialty choice inventory) in the United Kingdom are implemented to help medical students plan their careers. The purpose of this study was to explore the characteristics of the major specialties in Korea. Twelve physicians from different specialties participated in an exploratory study consisting of qualitative interviews about the personal ability and emotional characteristics and job attributes of each specialty. The collected data were analysed with content analysis methods. Twelve codes were extracted for ability & skill attributes, 23 codes for emotion & attitude attributes, and 12 codes for job attributes. Each specialty shows a different profile in terms of its characteristic attributes. The findings have implications for the design of career planning programs for medical students.

  7. [Orthopedic and trauma surgery in the German-DRG-System 2009].

    PubMed

    Franz, D; Windolf, J; Siebert, C H; Roeder, N

    2009-01-01

    The German DRG-System was advanced into version 2009. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2008 and 2009 based on the publications of the German DRG-institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2009 focussed on the development of DRG-structure, DRG-validation and codes for medical procedures to be used for very complex cases. The outcome of these changes for German hospitals may vary depending in the range of activities. G-DRG-System gained complexity again. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case-allocation within the G-DRG-System was improved. Nevertheless, further adjustments of the G-DRG-System especially for cases with severe injuries are necessary.

  8. Indianapolis emergency medical service and the Indiana Network for Patient Care: evaluating the patient match algorithm.

    PubMed

    Park, Seong C; Finnell, John T

    2012-01-01

    In 2009, Indianapolis launched an electronic medical record system within their ambulances1 and started to exchange patient data with the Indiana Network for Patient Care (INPC) This unique system allows EMS personnel to get important information prior to the patient's arrival to the hospital. In this descriptive study, we found EMS personnel requested patient data on 14% of all transports, with a "success" match rate of 46%, and a match "failure" rate of 17%. The three major factors for causing match "failure" were ZIP code 55%, Patient Name 22%, and Birth date 12%. We conclude that the ZIP code matching process needs to be improved by applying a limitation of 5 digits in ZIP code instead of using ZIP+4 code. Non-ZIP code identifiers may be a better choice due to inaccuracies and changes of the ZIP code in a patient's record.

  9. Semantic enrichment of medical forms - semi-automated coding of ODM-elements via web services.

    PubMed

    Breil, Bernhard; Watermann, Andreas; Haas, Peter; Dziuballe, Philipp; Dugas, Martin

    2012-01-01

    Semantic interoperability is an unsolved problem which occurs while working with medical forms from different information systems or institutions. Standards like ODM or CDA assure structural homogenization but in order to compare elements from different data models it is necessary to use semantic concepts and codes on an item level of those structures. We developed and implemented a web-based tool which enables a domain expert to perform semi-automated coding of ODM-files. For each item it is possible to inquire web services which result in unique concept codes without leaving the context of the document. Although it was not feasible to perform a totally automated coding we have implemented a dialog based method to perform an efficient coding of all data elements in the context of the whole document. The proportion of codable items was comparable to results from previous studies.

  10. Phase II evaluation of clinical coding schemes: completeness, taxonomy, mapping, definitions, and clarity. CPRI Work Group on Codes and Structures.

    PubMed

    Campbell, J R; Carpenter, P; Sneiderman, C; Cohn, S; Chute, C G; Warren, J

    1997-01-01

    To compare three potential sources of controlled clinical terminology (READ codes version 3.1, SNOMED International, and Unified Medical Language System (UMLS) version 1.6) relative to attributes of completeness, clinical taxonomy, administrative mapping, term definitions and clarity (duplicate coding rate). The authors assembled 1929 source concept records from a variety of clinical information taken from four medical centers across the United States. The source data included medical as well as ample nursing terminology. The source records were coded in each scheme by an investigator and checked by the coding scheme owner. The codings were then scored by an independent panel of clinicians for acceptability. Codes were checked for definitions provided with the scheme. Codes for a random sample of source records were analyzed by an investigator for "parent" and "child" codes within the scheme. Parent and child pairs were scored by an independent panel of medical informatics specialists for clinical acceptability. Administrative and billing code mapping from the published scheme were reviewed for all coded records and analyzed by independent reviewers for accuracy. The investigator for each scheme exhaustively searched a sample of coded records for duplications. SNOMED was judged to be significantly more complete in coding the source material than the other schemes (SNOMED* 70%; READ 57%; UMLS 50%; *p < .00001). SNOMED also had a richer clinical taxonomy judged by the number of acceptable first-degree relatives per coded concept (SNOMED* 4.56, UMLS 3.17; READ 2.14, *p < .005). Only the UMLS provided any definitions; these were found for 49% of records which had a coding assignment. READ and UMLS had better administrative mappings (composite score: READ* 40.6%; UMLS* 36.1%; SNOMED 20.7%, *p < .00001), and SNOMED had substantially more duplications of coding assignments (duplication rate: READ 0%; UMLS 4.2%; SNOMED* 13.9%, *p < .004) associated with a loss of clarity. No major terminology source can lay claim to being the ideal resource for a computer-based patient record. However, based upon this analysis of releases for April 1995, SNOMED International is considerably more complete, has a compositional nature and a richer taxonomy. Is suffers from less clarity, resulting from a lack of syntax and evolutionary changes in its coding scheme. READ has greater clarity and better mapping to administrative schemes (ICD-10 and OPCS-4), is rapidly changing and is less complete. UMLS is a rich lexical resource, with mappings to many source vocabularies. It provides definitions for many of its terms. However, due to the varying granularities and purposes of its source schemes, it has limitations for representation of clinical concepts within a computer-based patient record.

  11. Barriers in detecting elder abuse among emergency medical technicians.

    PubMed

    Reingle Gonzalez, Jennifer M; Cannell, M Brad; Jetelina, Katelyn K; Radpour, Sepeadeh

    2016-09-02

    Elder abuse and neglect are highly under-reported in the United States. This may be partially attributed to low incidence of reporting among emergency medical technicians' (EMTs), despite state-mandated reporting of suspected elder abuse. Innovative solutions are needed to address under-reporting. The objective was to describe EMTs' experience detecting and reporting elder abuse. Qualitative data were collected from 11 EMTs and 12 Adult Protective Services (APS) caseworkers that participated in one of five semi-structured focus groups. Focus group data were iteratively coded by two coders. Findings suggest a number of barriers prevent EMTs from reporting elder abuse to APS. Participants suggested that limited training on elder abuse detection or reporting has been provided to them. EMTs suggested that training, creation of an automated reporting system or brief screening tool could be used to enhance EMT's ability to detect and communicate suspected cases of elder abuse to APS. Results from the present study suggest that EMTs may be uniquely situated to serve as elder abuse and neglect surveillance personnel. EMTs are eager to work with APS to address the under-reporting of elder abuse and neglect, but training is minimal and current reporting procedures are time-prohibitive given their primary role as emergency healthcare providers. Future studies should seek to translate these findings into practice by identifying specific indicators predictive of elder abuse and neglect for inclusion on an automated reporting instrument for EMTs.

  12. Socioeconomic issues affecting the treatment of obesity in the new millennium.

    PubMed

    Martin, L F; Robinson, A; Moore, B J

    2000-10-01

    The prevalence of obesity among the populations of most developed countries has increased to such an extent that the healthcare and social security/disability system will accumulate direct and indirect costs related to obesity that will be more substantial than those for any other primary disease within this generation. For the past decade, the Healthcare Financing Agency, which oversees the Medicare and Medicaid programmes, has required all physicians and healthcare agencies serving beneficiaries of these programmes to include diagnoses using codes established by the ninth revision of the World Health Organization's International Classification of Diseases. This coding system actually distorts data collection and undermines appropriate medical insurance reimbursement for the treatment of obesity. Societal prejudices, inability of governmental agencies to address future concerns and the business community's attempts to control healthcare costs without addressing the underlying issues contributing to these costs have led to confusion on how to confront this emerging epidemic. How will we develop the scientific knowledge and the political willpower to confront this epidemic? First, we need more accurate methods for classifying obesity and for measuring the cost of treatment. We can then determine if it is more cost effective to prevent or treat obesity early in its evolution or pay for its consequences in the form of treatment costs associated with its multiple comorbid diseases, such as hypertension, other cardiovascular disorders, diabetes mellitus, osteoarthritis and cancers, plus the lost productivity from absenteeism, premature retirement and death.

  13. Medical Data Architecture Project Status

    NASA Technical Reports Server (NTRS)

    Krihak, M.; Middour, C.; Lindsey, A.; Marker, N.; Wolfe, S.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.

    2017-01-01

    The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current International Space Station (ISS) medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable an increasingly autonomous crew than the current ISS paradigm. The MDA will develop capabilities that support automated data collection, and the necessary functionality and challenges in executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. To attain this goal, the first year of the MDA project focused on reducing technical risk, developing documentation and instituting iterative development processes that established the basis for the first version of MDA software (or Test Bed 1). Test Bed 1 is based on a nominal operations scenario authored by the ExMC Element Scientist. This narrative was decomposed into a Concept of Operations that formed the basis for Test Bed 1 requirements. These requirements were successfully vetted through the MDA Test Bed 1 System Requirements Review, which permitted the MDA project to begin software code development and component integration. This paper highlights the MDA objectives, development processes, and accomplishments, and identifies the fiscal year 2017 milestones and deliverables in the upcoming year.

  14. A Three-Phase Decision Model of Computer-Aided Coding for the Iranian Classification of Health Interventions (IRCHI).

    PubMed

    Azadmanjir, Zahra; Safdari, Reza; Ghazisaeedi, Marjan; Mokhtaran, Mehrshad; Kameli, Mohammad Esmail

    2017-06-01

    Accurate coded data in the healthcare are critical. Computer-Assisted Coding (CAC) is an effective tool to improve clinical coding in particular when a new classification will be developed and implemented. But determine the appropriate method for development need to consider the specifications of existing CAC systems, requirements for each type, our infrastructure and also, the classification scheme. The aim of the study was the development of a decision model for determining accurate code of each medical intervention in Iranian Classification of Health Interventions (IRCHI) that can be implemented as a suitable CAC system. first, a sample of existing CAC systems was reviewed. Then feasibility of each one of CAC types was examined with regard to their prerequisites for their implementation. The next step, proper model was proposed according to the structure of the classification scheme and was implemented as an interactive system. There is a significant relationship between the level of assistance of a CAC system and integration of it with electronic medical documents. Implementation of fully automated CAC systems is impossible due to immature development of electronic medical record and problems in using language for medical documenting. So, a model was proposed to develop semi-automated CAC system based on hierarchical relationships between entities in the classification scheme and also the logic of decision making to specify the characters of code step by step through a web-based interactive user interface for CAC. It was composed of three phases to select Target, Action and Means respectively for an intervention. The proposed model was suitable the current status of clinical documentation and coding in Iran and also, the structure of new classification scheme. Our results show it was practical. However, the model needs to be evaluated in the next stage of the research.

  15. ICD-10 codes used to identify adverse drug events in administrative data: a systematic review.

    PubMed

    Hohl, Corinne M; Karpov, Andrei; Reddekopp, Lisa; Doyle-Waters, Mimi; Stausberg, Jürgen

    2014-01-01

    Adverse drug events, the unintended and harmful effects of medications, are important outcome measures in health services research. Yet no universally accepted set of International Classification of Diseases (ICD) revision 10 codes or coding algorithms exists to ensure their consistent identification in administrative data. Our objective was to synthesize a comprehensive set of ICD-10 codes used to identify adverse drug events. We developed a systematic search strategy and applied it to five electronic reference databases. We searched relevant medical journals, conference proceedings, electronic grey literature and bibliographies of relevant studies, and contacted content experts for unpublished studies. One author reviewed the titles and abstracts for inclusion and exclusion criteria. Two authors reviewed eligible full-text articles and abstracted data in duplicate. Data were synthesized in a qualitative manner. Of 4241 titles identified, 41 were included. We found a total of 827 ICD-10 codes that have been used in the medical literature to identify adverse drug events. The median number of codes used to search for adverse drug events was 190 (IQR 156-289) with a large degree of variability between studies in the numbers and types of codes used. Authors commonly used external injury (Y40.0-59.9) and disease manifestation codes. Only two papers reported on the sensitivity of their code set. Substantial variability exists in the methods used to identify adverse drug events in administrative data. Our work may serve as a point of reference for future research and consensus building in this area.

  16. ICD-10 codes used to identify adverse drug events in administrative data: a systematic review

    PubMed Central

    Hohl, Corinne M; Karpov, Andrei; Reddekopp, Lisa; Stausberg, Jürgen

    2014-01-01

    Background Adverse drug events, the unintended and harmful effects of medications, are important outcome measures in health services research. Yet no universally accepted set of International Classification of Diseases (ICD) revision 10 codes or coding algorithms exists to ensure their consistent identification in administrative data. Our objective was to synthesize a comprehensive set of ICD-10 codes used to identify adverse drug events. Methods We developed a systematic search strategy and applied it to five electronic reference databases. We searched relevant medical journals, conference proceedings, electronic grey literature and bibliographies of relevant studies, and contacted content experts for unpublished studies. One author reviewed the titles and abstracts for inclusion and exclusion criteria. Two authors reviewed eligible full-text articles and abstracted data in duplicate. Data were synthesized in a qualitative manner. Results Of 4241 titles identified, 41 were included. We found a total of 827 ICD-10 codes that have been used in the medical literature to identify adverse drug events. The median number of codes used to search for adverse drug events was 190 (IQR 156–289) with a large degree of variability between studies in the numbers and types of codes used. Authors commonly used external injury (Y40.0–59.9) and disease manifestation codes. Only two papers reported on the sensitivity of their code set. Conclusions Substantial variability exists in the methods used to identify adverse drug events in administrative data. Our work may serve as a point of reference for future research and consensus building in this area. PMID:24222671

  17. Third Party Interaction in the Medical Context: Code-switching and Control

    PubMed Central

    Vickers, Caroline H.; Goble, Ryan; Deckert, Sharon K.

    2015-01-01

    The purpose of this paper is to examine the micro-interactional co-construction of power within Spanish language concordant medical consultations in California involving a third party family member. Findings indicate the third party instigates code-switching to English on the part of medical providers, a language that the patient does not understand, rendering the patient a non-participant in the medical consultation. In these consultations involving a third party family member, monolingual Spanish-speaking patients are stripped of control in ways that are similar to other powerless groups in medical consultations. Implications include the need to further examine how micro-level interactions reproduce societal ideologies and shape policy on the ground. PMID:27667896

  18. Preliminary results of 3D dose calculations with MCNP-4B code from a SPECT image.

    PubMed

    Rodríguez Gual, M; Lima, F F; Sospedra Alfonso, R; González González, J; Calderón Marín, C

    2004-01-01

    Interface software was developed to generate the input file to run Monte Carlo MCNP-4B code from medical image in Interfile format version 3.3. The software was tested using a spherical phantom of tomography slides with known cumulated activity distribution in Interfile format generated with IMAGAMMA medical image processing system. The 3D dose calculation obtained with Monte Carlo MCNP-4B code was compared with the voxel S factor method. The results show a relative error between both methods less than 1 %.

  19. Coding in Stroke and Other Cerebrovascular Diseases.

    PubMed

    Korb, Pearce J; Jones, William

    2017-02-01

    Accurate coding is critical for clinical practice and research. Ongoing changes to diagnostic and billing codes require the clinician to stay abreast of coding updates. Payment for health care services, data sets for health services research, and reporting for medical quality improvement all require accurate administrative coding. This article provides an overview of coding principles for patients with strokes and other cerebrovascular diseases and includes an illustrative case as a review of coding principles in a patient with acute stroke.

  20. Phase II Evaluation of Clinical Coding Schemes

    PubMed Central

    Campbell, James R.; Carpenter, Paul; Sneiderman, Charles; Cohn, Simon; Chute, Christopher G.; Warren, Judith

    1997-01-01

    Abstract Objective: To compare three potential sources of controlled clinical terminology (READ codes version 3.1, SNOMED International, and Unified Medical Language System (UMLS) version 1.6) relative to attributes of completeness, clinical taxonomy, administrative mapping, term definitions and clarity (duplicate coding rate). Methods: The authors assembled 1929 source concept records from a variety of clinical information taken from four medical centers across the United States. The source data included medical as well as ample nursing terminology. The source records were coded in each scheme by an investigator and checked by the coding scheme owner. The codings were then scored by an independent panel of clinicians for acceptability. Codes were checked for definitions provided with the scheme. Codes for a random sample of source records were analyzed by an investigator for “parent” and “child” codes within the scheme. Parent and child pairs were scored by an independent panel of medical informatics specialists for clinical acceptability. Administrative and billing code mapping from the published scheme were reviewed for all coded records and analyzed by independent reviewers for accuracy. The investigator for each scheme exhaustively searched a sample of coded records for duplications. Results: SNOMED was judged to be significantly more complete in coding the source material than the other schemes (SNOMED* 70%; READ 57%; UMLS 50%; *p <.00001). SNOMED also had a richer clinical taxonomy judged by the number of acceptable first-degree relatives per coded concept (SNOMED* 4.56; UMLS 3.17; READ 2.14, *p <.005). Only the UMLS provided any definitions; these were found for 49% of records which had a coding assignment. READ and UMLS had better administrative mappings (composite score: READ* 40.6%; UMLS* 36.1%; SNOMED 20.7%, *p <. 00001), and SNOMED had substantially more duplications of coding assignments (duplication rate: READ 0%; UMLS 4.2%; SNOMED* 13.9%, *p <. 004) associated with a loss of clarity. Conclusion: No major terminology source can lay claim to being the ideal resource for a computer-based patient record. However, based upon this analysis of releases for April 1995, SNOMED International is considerably more complete, has a compositional nature and a richer taxonomy. It suffers from less clarity, resulting from a lack of syntax and evolutionary changes in its coding scheme. READ has greater clarity and better mapping to administrative schemes (ICD-10 and OPCS-4), is rapidly changing and is less complete. UMLS is a rich lexical resource, with mappings to many source vocabularies. It provides definitions for many of its terms. However, due to the varying granularities and purposes of its source schemes, it has limitations for representation of clinical concepts within a computer-based patient record. PMID:9147343

  1. Planned Monolayer Assemblies by Adsorption

    DTIC Science & Technology

    1988-09-01

    RESEARCH OFFICE OF TBE U.S. ARMY Xcndn, Engan aONRAcM NUMBE DAJA45-84-C-0055 acntractor: The Weizmn InstituteAttn: Ms. N. Guter Office of Research ...ORGANIZATION The Weizmann Inst’,a#. of (if appficable) European Research office ScienceUSARDSG-UK) Sk. ADDRESS (Wiy State, and ZIP Code) 7b. ADDRESS (City...State. and ZIP Code) Department of Isotope Research Box 65 76100 Rehoyot FPO NY 09510-1500 IsraelJ

  2. Practical Problems with Medication Use that Older People Experience: A Qualitative Study

    PubMed Central

    Notenboom, Kim; Beers, Erna; van Riet-Nales, Diana A; Egberts, Toine C G; Leufkens, Hubert G M; Jansen, Paul A F; Bouvy, Marcel L

    2014-01-01

    Objectives To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof. Design Qualitative study with semistructured face-to-face interviews. Setting A community pharmacy and a geriatric outpatient ward. Participants Community-dwelling people aged 70 and older (N = 59). Measurements Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale. Results Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration. Conclusion Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems. PMID:25516030

  3. How Attending Physician Preceptors Negotiate Their Complex Work Environment: A Collective Ethnography.

    PubMed

    Lemaire, Jane B; Wallace, Jean E; Sargious, Peter M; Bacchus, Maria; Zarnke, Kelly; Ward, David R; Ghali, William A

    2017-12-01

    To generate an empiric, detailed, and updated view of the attending physician preceptor role and its interface with the complex work environment. In 2013, the authors conducted a modified collective ethnography with observations of internal medicine medical teaching unit preceptors from two university hospitals in Canada. Eleven observers conducted 32 observations (99.5 hours) of 26 preceptors (30 observations [93.5 hours] of 24 preceptors were included in the analysis). An inductive thematic approach was used to analyze the data with further axial coding to identify connections between themes. Four individuals coded the main data set; differences were addressed through discussion to achieve consensus. Three elements or major themes of the preceptor role were identified: (1) competence or the execution of traditional physician competencies, (2) context or the extended medical teaching unit environment, and (3) conduct or the manner of acting or behaviors and attitudes in the role. Multiple connections between the elements emerged. The preceptor role appeared to depend on the execution of professional skills (competence) but also was vulnerable to contextual factors (context) independent of these skills, many of which were unpredictable. This vulnerability appeared to be tempered by preceptors' use of adaptive behaviors and attitudes (conduct), such as creativity, interpersonal skills, and wellness behaviors. Preceptors not only possess traditional competencies but also enlist additional behaviors and attitudes to deal with context-driven tensions and to negotiate their complex work environment. These skills could be incorporated into role training, orientation, and mentorship.

  4. Topological quantum distillation.

    PubMed

    Bombin, H; Martin-Delgado, M A

    2006-11-03

    We construct a class of topological quantum codes to perform quantum entanglement distillation. These codes implement the whole Clifford group of unitary operations in a fully topological manner and without selective addressing of qubits. This allows us to extend their application also to quantum teleportation, dense coding, and computation with magic states.

  5. An Interdisciplinary Code of Ethics for Adult Education.

    ERIC Educational Resources Information Center

    Connelly, Robert J.; Light, Kathleen M.

    1991-01-01

    Proposes five basic principles of a code of ethics for adult educators: social responsibility, an inclusive philosophy of education, pluralism as a strength but consensus as a goal, respect for learners, and respect for fellow educators. The wisdom of developing such a code is addressed. (SK)

  6. 7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... National Model Building Codes The following documents address the health and safety aspects of buildings... International, Inc., 4051 West Flossmoor Road, Country Club Hills, Illinois 60477. 2 Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206. 3 International...

  7. A Computer Oriented Scheme for Coding Chemicals in the Field of Biomedicine.

    ERIC Educational Resources Information Center

    Bobka, Marilyn E.; Subramaniam, J.B.

    The chemical coding scheme of the Medical Coding Scheme (MCS), developed for use in the Comparative Systems Laboratory (CSL), is outlined and evaluated in this report. The chemical coding scheme provides a classification scheme and encoding method for drugs and chemical terms. Using the scheme complicated chemical structures may be expressed…

  8. Surgical treatment of chronic exertional compartment syndrome of the leg: failure rates and postoperative disability in an active patient population.

    PubMed

    Waterman, Brian R; Laughlin, Matthew; Kilcoyne, Kelly; Cameron, Kenneth L; Owens, Brett D

    2013-04-03

    Chronic exertional compartment syndrome of the leg is a frequent source of lower-extremity pain in military personnel, competitive athletes, and runners. We are not aware of any previous study in which the authors rigorously evaluated the rates of return to full activity, persistent disability, and surgical revision after operative management of chronic exertional compartment syndrome of the leg in a large, physically active population. Individuals who had undergone surgical fasciotomy of the anterior, lateral, and/or posterior compartments (current procedural terminology [CPT] codes 27600, 27601, and 27602) for nontraumatic compartment syndrome of the lower extremity (International Classification of Diseases, Ninth Revision [ICD-9] code 729.72) between 2003 and 2010 were identified from the Military Health System Management Analysis and Reporting Tool (M2). Demographic variables including age, sex, and rank were extracted, and rates of postoperative complications, activity limitations, and revision surgery or medical discharge were obtained from the electronic medical record and U.S. Army Physical Disability Agency database. A total of 611 patients underwent 754 surgical procedures. The average patient age was 28.0 years, and 91.8% of the patients were male. Of the surgical procedures, 77.4% involved only anterior and lateral compartment releases; 19.4% addressed the anterior, lateral, and posterior compartments; and 2.2% addressed the posterior compartments alone. Symptom recurrence was reported by 44.7% of the patients, and 27.7% were unable to return to full activity. Surgical complications were documented for 15.7% of the patients, 5.9% underwent surgical revision, and 17.3% were referred for medical discharge because of chronic exertional compartment syndrome. Univariate analysis of prognostic factors revealed that surgical failure was associated with bilateral involvement (odds ratio [OR], 1.64), perioperative complications (OR, 2.12), activity limitations (OR, 4.41), and persistence of preoperative symptoms (OR, 8.46). Multivariable analysis confirmed significant associations between surgical failure and perioperative complications (OR, 1.72), activity limitations (OR, 2.23), and persistence of preoperative symptoms (OR, 5.47), whereas other factors were not significantly associated with surgical failure. Chronic exertional compartment syndrome is a substantial contributor to lower-extremity disability in the military population. Nearly half of all service members undergoing fasciotomy reported persistent symptoms, and one in five individuals had unsuccessful surgical treatment.

  9. Energy Codes at a Glance

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Cole, Pamala C.; Richman, Eric E.

    2008-09-01

    Feeling dim from energy code confusion? Read on to give your inspections a charge. The U.S. Department of Energy’s Building Energy Codes Program addresses hundreds of inquiries from the energy codes community every year. This article offers clarification for topics of confusion submitted to BECP Technical Support of interest to electrical inspectors, focusing on the residential and commercial energy code requirements based on the most recently published 2006 International Energy Conservation Code® and ANSI/ASHRAE/IESNA1 Standard 90.1-2004.

  10. Preliminary Assessment of Turbomachinery Codes

    NASA Technical Reports Server (NTRS)

    Mazumder, Quamrul H.

    2007-01-01

    This report assesses different CFD codes developed and currently being used at Glenn Research Center to predict turbomachinery fluid flow and heat transfer behavior. This report will consider the following codes: APNASA, TURBO, GlennHT, H3D, and SWIFT. Each code will be described separately in the following section with their current modeling capabilities, level of validation, pre/post processing, and future development and validation requirements. This report addresses only previously published and validations of the codes. However, the codes have been further developed to extend the capabilities of the codes.

  11. A research coding method to evaluate medical clinicians conduct of behavioral health care in patients with unexplained symptoms.

    PubMed

    Grayson-Sneed, Katelyn A; Smith, Robert C

    2018-04-01

    Develop a reliable coding method of a Behavioral Health Treatment Model for patients with Medically Unexplained Symptoms (BHTM-MUS). Two undergraduates trained for 30h coded videotaped interviews from 161 resident-simulated patient (SP) interactions. Trained on 45 videotapes, coders coded 33 (20%) of 161 study set tapes for the BHTM-MUS. Guetzkow's U, Cohen's Kappa, and percent of agreement were used to measure coders' reliability in unitizing and coding residents' skills for eliciting: education and informing (4 yes/no items), motivating (2), treatment statements (5), commitment and goals (2), negotiates plan (8), non-emotion patient-centered skills (4), and patient-centered emotional skills (8). 60 items were dichotomized a priori from analysis of the BHTM-MUS and were reduced to 33 during training. Guetzkow's U ranged from .00 to .082. Kappa ranged from 0.76 to 0.97 for the 7 variables and 33 individual items. The overall kappa was 0.87, and percent of agreement was 95.7%. Percent of agreement by item ranged from 85 to 100%. A highly reliable coding method is recommended to evaluate medical clinicians' behavioral care skills in patients with unexplained symptoms. A way to rate behavioral care in patients with unexplained symptoms. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Development of a Shared Decision Making coding system for analysis of patient-healthcare provider encounters

    PubMed Central

    Clayman, Marla L.; Makoul, Gregory; Harper, Maya M.; Koby, Danielle G.; Williams, Adam R.

    2012-01-01

    Objectives Describe the development and refinement of a scheme, Detail of Essential Elements and Participants in Shared Decision Making (DEEP-SDM), for coding Shared Decision Making (SDM) while reporting on the characteristics of decisions in a sample of patients with metastatic breast cancer. Methods The Evidence-Based Patient Choice instrument was modified to reflect Makoul and Clayman’s Integrative Model of SDM. Coding was conducted on video recordings of 20 women at the first visit with their medical oncologists after suspicion of disease progression. Noldus Observer XT v.8, a video coding software platform, was used for coding. Results The sample contained 80 decisions (range: 1-11), divided into 150 decision making segments. Most decisions were physician-led, although patients and physicians initiated similar numbers of decision-making conversations. Conclusion DEEP-SDM facilitates content analysis of encounters between women with metastatic breast cancer and their medical oncologists. Despite the fractured nature of decision making, it is possible to identify decision points and to code each of the Essential Elements of Shared Decision Making. Further work should include application of DEEP-SDM to non-cancer encounters. Practice Implications: A better understanding of how decisions unfold in the medical encounter can help inform the relationship of SDM to patient-reported outcomes. PMID:22784391

  13. The development and evaluation of a new coding system for medical records.

    PubMed

    Papazissis, Elias

    2014-01-01

    The present study aims to develop a simple, reliable and easy tool enabling clinicians to codify the major part of individualized medical details (patient history and findings of physical examination) quickly and easily in routine medical practice, by entering data to a purpose-built software application, using structure data elements and detailed medical illustrations. We studied medical records of 9,320 patients and we extracted individualized medical details. We recorded the majority of symptoms and the majority of findings of physical examination into the system, which was named IMPACT® (Intelligent Medical Patient Record and Coding Tool). Subsequently the system was evaluated by clinicians, based on the examination of 1206 patients. The evaluation results showed that IMPACT® is an efficient tool, easy to use even under time-pressing conditions. IMPACT® seems to be a promising tool for illustration-guided, structured data entry of medical narrative, in electronic patient records.

  14. Implementing the Code of Practice on International Recruitment in Romania - exploring the current state of implementation and what Romania is doing to retain its domestic health workforce.

    PubMed

    Paina, Ligia; Ungureanu, Marius; Olsavszky, Victor

    2016-06-30

    The Romanian health system is struggling to retain its health workers, who are currently facing strong incentives for migration to Western European health systems. Retention issues, coupled with high levels of migration, complicate Romania's efforts in providing basic health services for rural, underserved, and marginalized populations, as well as in achieving equitable health access for all. The WHO Global Code of Practice on International Recruitment of Health Personnel (the Code) aims to promote ethical international recruitment and health systems strengthening. We explore Romania's implementation of the Code's principles and recommendations. We analysed peer-reviewed and grey literature, in English and Romanian, and sought secondary data from the websites of Romania's largest medical universities. The analysis was guided by the following themes and recommendations in the Code: health personnel development and health systems sustainability, international cooperation, data gathering, information exchange, and implementation and monitoring of the Code. Romania's implementation of the Code was observed to be limited. Gaps were identified with regards to several aspects of the Romanian health system, including the lack of support to health personnel training, recruitment, and retention in order to increase the appeal for health providers to practice in Romania and in underserved areas. In terms of international cooperation, the Code recommends various policy instruments to guide recruitment, including bilateral agreements. However, we could not determine which of these instruments were used as a result of the Code and whether or not they were effective. We identified little evidence of initiatives for health workers' professional and personal support. Insufficient data and few information exchange platforms exist on health workforce issues, hindering active sharing of data on migration with European Union and WHO audiences. We could not identify any evidence of monitoring of the Code's implementation to date. In the absence of major system reforms, health workers will continue to migrate to urban areas and abroad. Romanian policymakers should address more of the Code's recommendations by developing a national policy for human resources for health, a central database to aid health workforce planning and management, stronger platforms for information exchange and civil society engagement, and updated and transparent bilateral agreements.

  15. A comparative analysis of moral principles and behavioral norms in eight ethical codes relevant to health sciences librarianship, medical informatics, and the health professions.

    PubMed

    Byrd, Gary D; Winkelstein, Peter

    2014-10-01

    Based on the authors' shared interest in the interprofessional challenges surrounding health information management, this study explores the degree to which librarians, informatics professionals, and core health professionals in medicine, nursing, and public health share common ethical behavior norms grounded in moral principles. Using the "Principlism" framework from a widely cited textbook of biomedical ethics, the authors analyze the statements in the ethical codes for associations of librarians (Medical Library Association [MLA], American Library Association, and Special Libraries Association), informatics professionals (American Medical Informatics Association [AMIA] and American Health Information Management Association), and core health professionals (American Medical Association, American Nurses Association, and American Public Health Association). This analysis focuses on whether and how the statements in these eight codes specify core moral norms (Autonomy, Beneficence, Non-Maleficence, and Justice), core behavioral norms (Veracity, Privacy, Confidentiality, and Fidelity), and other norms that are empirically derived from the code statements. These eight ethical codes share a large number of common behavioral norms based most frequently on the principle of Beneficence, then on Autonomy and Justice, but rarely on Non-Maleficence. The MLA and AMIA codes share the largest number of common behavioral norms, and these two associations also share many norms with the other six associations. The shared core of behavioral norms among these professions, all grounded in core moral principles, point to many opportunities for building effective interprofessional communication and collaboration regarding the development, management, and use of health information resources and technologies.

  16. Rapid 3D bioprinting from medical images: an application to bone scaffolding

    NASA Astrophysics Data System (ADS)

    Lee, Daniel Z.; Peng, Matthew W.; Shinde, Rohit; Khalid, Arbab; Hong, Abigail; Pennacchi, Sara; Dawit, Abel; Sipzner, Daniel; Udupa, Jayaram K.; Rajapakse, Chamith S.

    2018-03-01

    Bioprinting of tissue has its applications throughout medicine. Recent advances in medical imaging allows the generation of 3-dimensional models that can then be 3D printed. However, the conventional method of converting medical images to 3D printable G-Code instructions has several limitations, namely significant processing time for large, high resolution images, and the loss of microstructural surface information from surface resolution and subsequent reslicing. We have overcome these issues by creating a JAVA program that skips the intermediate triangularization and reslicing steps and directly converts binary dicom images into G-Code. In this study, we tested the two methods of G-Code generation on the application of synthetic bone graft scaffold generation. We imaged human cadaveric proximal femurs at an isotropic resolution of 0.03mm using a high resolution peripheral quantitative computed tomography (HR-pQCT) scanner. These images, of the Digital Imaging and Communications in Medicine (DICOM) format, were then processed through two methods. In each method, slices and regions of print were selected, filtered to generate a smoothed image, and thresholded. In the conventional method, these processed images are converted to the STereoLithography (STL) format and then resliced to generate G-Code. In the new, direct method, these processed images are run through our JAVA program and directly converted to G-Code. File size, processing time, and print time were measured for each. We found that this new method produced a significant reduction in G-Code file size as well as processing time (92.23% reduction). This allows for more rapid 3D printing from medical images.

  17. A comparative analysis of moral principles and behavioral norms in eight ethical codes relevant to health sciences librarianship, medical informatics, and the health professions

    PubMed Central

    Byrd, Gary D.; Winkelstein, Peter

    2014-01-01

    Objective: Based on the authors' shared interest in the interprofessional challenges surrounding health information management, this study explores the degree to which librarians, informatics professionals, and core health professionals in medicine, nursing, and public health share common ethical behavior norms grounded in moral principles. Methods: Using the “Principlism” framework from a widely cited textbook of biomedical ethics, the authors analyze the statements in the ethical codes for associations of librarians (Medical Library Association [MLA], American Library Association, and Special Libraries Association), informatics professionals (American Medical Informatics Association [AMIA] and American Health Information Management Association), and core health professionals (American Medical Association, American Nurses Association, and American Public Health Association). This analysis focuses on whether and how the statements in these eight codes specify core moral norms (Autonomy, Beneficence, Non-Maleficence, and Justice), core behavioral norms (Veracity, Privacy, Confidentiality, and Fidelity), and other norms that are empirically derived from the code statements. Results: These eight ethical codes share a large number of common behavioral norms based most frequently on the principle of Beneficence, then on Autonomy and Justice, but rarely on Non-Maleficence. The MLA and AMIA codes share the largest number of common behavioral norms, and these two associations also share many norms with the other six associations. Implications: The shared core of behavioral norms among these professions, all grounded in core moral principles, point to many opportunities for building effective interprofessional communication and collaboration regarding the development, management, and use of health information resources and technologies. PMID:25349543

  18. 48 CFR 52.204-7 - System for Award Management.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... for Award Manangement (JUL 2013) (a) Definitions. As used in this provision— Data Universal Numbering... information, including the DUNS number or the DUNS+4 number, the Contractor and Government Entity (CAGE) code... Zip Code. (iv) Company Mailing Address, City, State and Zip Code (if separate from physical). (v...

  19. 48 CFR 52.204-7 - System for Award Management.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... for Award Manangement (JUL 2013) (a) Definitions. As used in this provision— Data Universal Numbering... information, including the DUNS number or the DUNS+4 number, the Contractor and Government Entity (CAGE) code... Zip Code. (iv) Company Mailing Address, City, State and Zip Code (if separate from physical). (v...

  20. 7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Voluntary National Model Building Codes E Exhibit E... HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY... National Model Building Codes The following documents address the health and safety aspects of buildings...

  1. 77 FR 17460 - Multistakeholder Process To Develop Consumer Data Privacy Codes of Conduct

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-26

    .... 120214135-2203-02] RIN 0660-XA27 Multistakeholder Process To Develop Consumer Data Privacy Codes of Conduct... request for public comments on the multistakeholder process to develop consumer data privacy codes of...-multistakeholder-process without change. All personal identifying information (for example, name, address...

  2. Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy

    PubMed Central

    Moura, Lidia M V R; Carneiro, Thiago S; Cole, Andrew J; Hsu, John; Vickrey, Barbara G; Hoch, Daniel B

    2016-01-01

    Background and aim Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence. Patients and methods This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering “no” to all questions. Results Sixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence (P=0.22 and 0.20). Discussion and conclusion Among patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence. PMID:27826186

  3. High acuity GIS comparison of dentist and doctor surgery locations in Auckland, New Zealand.

    PubMed

    Kruger, E; Whyman, R; Tennant, M

    2013-06-01

    New Zealanders are one of the healthiest populations in the world, but significant inequalities in health and oral health remain. New Zealand suffers a possible shortage of medical and dental practitioners and an agreed mal-distribution of both. This study examines the distribution of dental and medical practices in New Zealand's largest city Auckland, using modem Geographic Information System tools. The aim of the study is to determine if medical and dental practices are similarly distributed across the city. The address for each dental and medical practice in Auckland was obtained and mapped over the census population data. A total of 442 medical and 256 dental practices were geo-coded in the study area. These practices overlaid the Auckland region, with a total population of 0.8 million, and an adult population (>9 years old) of 0.69 million. Auckland city was deemed, for this study, to be a region included in a 15km radius circle from a central reference point that was the General Post Office (GPO). The medical practice to total population ratio ranged from 1:1,500 for people 121/2-15km from the GPO, to 1:1,200 for those within 21/2km. Dental practice to population ratio ranged from 1:2,700 for people living 121/2-15km from the GPO to 1:1,300 for those within 21/2km. Medical practices were relatively evenly distributed, regardless of distance from the GPO, but the fairly dense distribution of dental practices in the city's inner 21/2km circle rapidly decreased in density as distance from the GPO increased. These results refute the hypothesis of this study in that there is a similar distribution of primary health practices (medical and dental) across the Auckland region.

  4. Threats to bioethical principles in medical practice in Brazil: new medical ethics code period.

    PubMed

    Gracindo, G C L; da Silva Gallo, J H; Nunes, R

    2018-03-15

    We aimed to outline the profile of medical professionals in Brazil who have violated the deontological norms set forth in the ethics code of the profession, and whose cases were judged by the higher tribunal for medical ethics between 2010 and 2016. This survey was conducted using a database formed from professional ethics cases extracted from the plenary of the medical ethics tribunal of the Federal Council of Medicine. These were disciplinary ethics cases that were judged at appeal level between 2010 and 2016. Most of these professionals were male (88.5%) and their mean age was 59.9 years (SD=11.62) on the date of judgment of their appeals, ranging from 28 to 95 years. Most of them were based in the southeastern region of Brazil (50.89%). Articles 1 and 18 of the medical ethics code were the rules most frequently violated. The sentence given most often was the cancellation of their professional license (37.6%) and the acts most often sentenced involved malpractice, imprudence, and negligence (18.49%). It is acknowledged that concern for the principles of bioethics was present in the appeal decisions made by the plenary of the medical ethics tribunal of the Federal Council of Medicine.

  5. What happens during early outpatient palliative care consultations for persons with newly diagnosed advanced cancer? A qualitative analysis of provider documentation.

    PubMed

    Bagcivan, Gulcan; Dionne-Odom, J Nicholas; Frost, Jennifer; Plunkett, Margaret; Stephens, Lisa A; Bishop, Peggy; Taylor, Richard A; Li, Zhongze; Tucker, Rodney; Bakitas, Marie

    2018-01-01

    Early outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters. Describe the evaluation and treatment recommendations made in early outpatient palliative care consultations. Outpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated. Outpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US. In all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations-marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms-mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations-counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations-pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants. Outpatient palliative care consultations for newly diagnosed advanced cancer patients can address patients' needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom indicators versus reliance on oncologist referral.

  6. Coding in Muscle Disease.

    PubMed

    Jones, Lyell K; Ney, John P

    2016-12-01

    Accurate coding is critically important for clinical practice and research. Ongoing changes to diagnostic and billing codes require the clinician to stay abreast of coding updates. Payment for health care services, data sets for health services research, and reporting for medical quality improvement all require accurate administrative coding. This article provides an overview of administrative coding for patients with muscle disease and includes a case-based review of diagnostic and Evaluation and Management (E/M) coding principles in patients with myopathy. Procedural coding for electrodiagnostic studies and neuromuscular ultrasound is also reviewed.

  7. 45 CFR 162.1000 - General requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... sets. Use the applicable medical data code sets described in § 162.1002 as specified in the...) Nonmedical data code sets. Use the nonmedical data code sets as described in the implementation... Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED...

  8. 45 CFR 162.1000 - General requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... sets. Use the applicable medical data code sets described in § 162.1002 as specified in the...) Nonmedical data code sets. Use the nonmedical data code sets as described in the implementation... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED...

  9. 45 CFR 162.1000 - General requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... sets. Use the applicable medical data code sets described in § 162.1002 as specified in the...) Nonmedical data code sets. Use the nonmedical data code sets as described in the implementation... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED...

  10. 45 CFR 162.1000 - General requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... sets. Use the applicable medical data code sets described in § 162.1002 as specified in the...) Nonmedical data code sets. Use the nonmedical data code sets as described in the implementation... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED...

  11. 45 CFR 162.1000 - General requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... sets. Use the applicable medical data code sets described in § 162.1002 as specified in the...) Nonmedical data code sets. Use the nonmedical data code sets as described in the implementation... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED...

  12. Exploratory Experimental Investigation of a Wave Propeller

    DTIC Science & Technology

    1992-03-01

    ORGANIZATION 6b. OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION Naval Postgraduate School (if appl able) Naval Postgraduate School 6c. ADDRESS (City... SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION (ff applicable) Bc ADDRESS (City, State, and ZIP Code) 10- SOURCE OF FUNDING...UNCLASSIFIED 22a. NAME OF RESPONSIBLE INDIVIDUAL 22b. TELEPHONE (Include Area code) 22c. OFFICE SYMBOL Max F. Platter (408) 646-2058 AA/PL DD FORM 1473,84

  13. Return with Honor: Code of Conduct Training in the National Military Strategy Security Environment

    DTIC Science & Technology

    2004-09-01

    maximize the number of deaths and injuries among the most vulnerable civilians, such as children, women and the elderly… The terrorist leaders - who do...Return with Honor: Code of Conduct Training in the National Military Strategy Security Environment 6. AUTHOR(S) Major Laura M. Ryan 5. FUNDING NUMBERS ...7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943-5000 8. PERFORMING ORGANIZATION REPORT NUMBER

  14. Applications of the JPEG standard in a medical environment

    NASA Astrophysics Data System (ADS)

    Wittenberg, Ulrich

    1993-10-01

    JPEG is a very versatile image coding and compression standard for single images. Medical images make a higher demand on image quality and precision than the usual 'pretty pictures'. In this paper the potential applications of the various JPEG coding modes in a medical environment are evaluated. Due to legal reasons the lossless modes are especially interesting. The spatial modes are equally important because medical data may well exceed the maximum of 12 bit precision allowed for the DCT modes. The performance of the spatial predictors is investigated. From the users point of view the progressive modes, which provide a fast but coarse approximation of the final image, reduce the subjective time one has to wait for it, so they also reduce the user's frustration. Even the lossy modes will find some applications, but they have to be handled with care, because repeated lossy coding and decoding leads to a degradation of the image quality. The amount of this degradation is investigated. The JPEG standard alone is not sufficient for a PACS because it does not store enough additional data such as creation data or details of the imaging modality. Therefore it will be an imbedded coding format in standards like TIFF or ACR/NEMA. It is concluded that the JPEG standard is versatile enough to match the requirements of the medical community.

  15. Object-oriented controlled-vocabulary translator using TRANSOFT + HyperPAD.

    PubMed

    Moore, G W; Berman, J J

    1991-01-01

    Automated coding of surgical pathology reports is demonstrated. This public-domain translation software operates on surgical pathology files, extracting diagnoses and assigning codes in a controlled medical vocabulary, such as SNOMED. Context-sensitive translation algorithms are employed, and syntactically correct diagnostic items are produced that are matched with controlled vocabulary. English-language surgical pathology reports, accessioned over one year at the Baltimore Veterans Affairs Medical Center, were translated. With an interface to a larger hospital information system, all natural language pathology reports are automatically rendered as topography and morphology codes. This translator frees the pathologist from the time-intensive task of personally coding each report, and may be used to flag certain diagnostic categories that require specific quality assurance actions.

  16. Object-oriented controlled-vocabulary translator using TRANSOFT + HyperPAD.

    PubMed Central

    Moore, G. W.; Berman, J. J.

    1991-01-01

    Automated coding of surgical pathology reports is demonstrated. This public-domain translation software operates on surgical pathology files, extracting diagnoses and assigning codes in a controlled medical vocabulary, such as SNOMED. Context-sensitive translation algorithms are employed, and syntactically correct diagnostic items are produced that are matched with controlled vocabulary. English-language surgical pathology reports, accessioned over one year at the Baltimore Veterans Affairs Medical Center, were translated. With an interface to a larger hospital information system, all natural language pathology reports are automatically rendered as topography and morphology codes. This translator frees the pathologist from the time-intensive task of personally coding each report, and may be used to flag certain diagnostic categories that require specific quality assurance actions. PMID:1807773

  17. Potential application of item-response theory to interpretation of medical codes in electronic patient records

    PubMed Central

    2011-01-01

    Background Electronic patient records are generally coded using extensive sets of codes but the significance of the utilisation of individual codes may be unclear. Item response theory (IRT) models are used to characterise the psychometric properties of items included in tests and questionnaires. This study asked whether the properties of medical codes in electronic patient records may be characterised through the application of item response theory models. Methods Data were provided by a cohort of 47,845 participants from 414 family practices in the UK General Practice Research Database (GPRD) with a first stroke between 1997 and 2006. Each eligible stroke code, out of a set of 202 OXMIS and Read codes, was coded as either recorded or not recorded for each participant. A two parameter IRT model was fitted using marginal maximum likelihood estimation. Estimated parameters from the model were considered to characterise each code with respect to the latent trait of stroke diagnosis. The location parameter is referred to as a calibration parameter, while the slope parameter is referred to as a discrimination parameter. Results There were 79,874 stroke code occurrences available for analysis. Utilisation of codes varied between family practices with intraclass correlation coefficients of up to 0.25 for the most frequently used codes. IRT analyses were restricted to 110 Read codes. Calibration and discrimination parameters were estimated for 77 (70%) codes that were endorsed for 1,942 stroke patients. Parameters were not estimated for the remaining more frequently used codes. Discrimination parameter values ranged from 0.67 to 2.78, while calibration parameters values ranged from 4.47 to 11.58. The two parameter model gave a better fit to the data than either the one- or three-parameter models. However, high chi-square values for about a fifth of the stroke codes were suggestive of poor item fit. Conclusion The application of item response theory models to coded electronic patient records might potentially contribute to identifying medical codes that offer poor discrimination or low calibration. This might indicate the need for improved coding sets or a requirement for improved clinical coding practice. However, in this study estimates were only obtained for a small proportion of participants and there was some evidence of poor model fit. There was also evidence of variation in the utilisation of codes between family practices raising the possibility that, in practice, properties of codes may vary for different coders. PMID:22176509

  18. Towards a Framework for Developing Semantic Relatedness Reference Standards

    PubMed Central

    Pakhomov, Serguei V.S.; Pedersen, Ted; McInnes, Bridget; Melton, Genevieve B.; Ruggieri, Alexander; Chute, Christopher G.

    2010-01-01

    Our objective is to develop a framework for creating reference standards for functional testing of computerized measures of semantic relatedness. Currently, research on computerized approaches to semantic relatedness between biomedical concepts relies on reference standards created for specific purposes using a variety of methods for their analysis. In most cases, these reference standards are not publicly available and the published information provided in manuscripts that evaluate computerized semantic relatedness measurement approaches is not sufficient to reproduce the results. Our proposed framework is based on the experiences of medical informatics and computational linguistics communities and addresses practical and theoretical issues with creating reference standards for semantic relatedness. We demonstrate the use of the framework on a pilot set of 101 medical term pairs rated for semantic relatedness by 13 medical coding experts. While the reliability of this particular reference standard is in the “moderate” range; we show that using clustering and factor analyses offers a data-driven approach to finding systematic differences among raters and identifying groups of potential outliers. We test two ontology-based measures of relatedness and provide both the reference standard containing individual ratings and the R program used to analyze the ratings as open-source. Currently, these resources are intended to be used to reproduce and compare results of studies involving computerized measures of semantic relatedness. Our framework may be extended to the development of reference standards in other research areas in medical informatics including automatic classification, information retrieval from medical records and vocabulary/ontology development. PMID:21044697

  19. [Quality management and strategic consequences of assessing documentation and coding under the German Diagnostic Related Groups system].

    PubMed

    Schnabel, M; Mann, D; Efe, T; Schrappe, M; V Garrel, T; Gotzen, L; Schaeg, M

    2004-10-01

    The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.

  20. [Analysis of actions taken by medical rescue teams in the Polish Emergency Medical Servies system. Is the model of division into specialistad basic teams reasonable?].

    PubMed

    Guła, Przemysław; Wejnarski, Arkadiusz; Moryto, Remigiusz; Gałazkowski, Robert; Swiezewski, Stanisław

    2014-01-01

    The Polish Emergency Medical Services (EMS) system is based on two types of medical rescue teams (MRT): specialist (S)--with system doctors and basic (B)--only paramedics. The aim of this study is to assess the reasonability of dividing medical rescue teams into specialist and basic. The retrospective analysis of medical cards of rescue activities performed during 21,896 interventions by medical rescue teams, 15,877 of which--by basic medical rescue teams (B MRT) and 6,019--by specialist medical rescue teams (S MRT). The procedures executed by both types of teams were compared. In the analysed group of dispatches, 56.4% were unrelated to medical emergencies. Simultaneously, 52.7% of code 1 interventions and 59.2% of code 2 interventions did not result in transporting the patient to the hospital. The qualification of S teams' dispatches is characterised by a higher number of assigned codes 1 (53.2% vs. 15.9%). It is worth emphasising that the procedures that can be applied exclusively by system doctors do not exceed 1% of interventions. Moreover, the number of the actions performed in medical emergencies in the secured region by the S team that is dispatched as the first one is comparable to that performed by B teams. The low need for usinq S teams'aid by B teams (0.92% of the interventions) was also indicated. This study points to the necessity to discuss the implementation of straightforward principles of call qualification and the optimisation of the system doctors' role in prehospital activities.

  1. Examining hospital pharmacists' goals for medication counseling within the communication accommodation theoretical framework.

    PubMed

    Chevalier, Bernadette A M; Watson, Bernadette M; Barras, Michael A; Cottrell, William Neil

    2016-01-01

    Medication counseling opportunities are key times for pharmacists to speak to patients about their medications and any changes made during their hospital stay. Communication Accommodation Theory (CAT) posits that an individual's goals drive their communication behavior. The way in which pharmacists communicate with patients may be determined by the goals they set for these medication counseling sessions. To examine hospital pharmacists' goals in patient medication counseling within the CAT framework. Hospital pharmacist focus groups were held in two teaching hospitals. Interested pharmacists attended a focus group designed to elicit their goals in patient medication counseling. Focus groups were audio recorded and transcribed verbatim. NVivo(®) software was used to assist in coding and organization. The codes were reviewed for reliability by pharmacists independent of the focus groups. An inductive thematic analysis was applied to the data. Six 1 h focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was achieved after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. Patient-centered themes constructed from these codes were to build rapport, to empower patients and to improve patients' experience, health and safety. Exemplars provided by pharmacists for the goals of building rapport and empowering patients were aligned with five CAT communication behaviors (approximation, interpretability, discourse management, emotional expression and interpersonal control). Patient-centered goals described by hospital pharmacists for medication counseling aligned well with CAT behaviors necessary for effective communication. Further research using the CAT framework to examine the effectiveness of hospital pharmacist-patient exchanges that include both participants' perspectives is required to better understand how well pharmacists communicate with patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. A low noise stenography method for medical images with QR encoding of patient information

    NASA Astrophysics Data System (ADS)

    Patiño-Vanegas, Alberto; Contreras-Ortiz, Sonia H.; Martinez-Santos, Juan C.

    2017-03-01

    This paper proposes an approach to facilitate the process of individualization of patients from their medical images, without compromising the inherent confidentiality of medical data. The identification of a patient from a medical image is not often the goal of security methods applied to image records. Usually, any identification data is removed from shared records, and security features are applied to determine ownership. We propose a method for embedding a QR-code containing information that can be used to individualize a patient. This is done so that the image to be shared does not differ significantly from the original image. The QR-code is distributed in the image by changing several pixels according to a threshold value based on the average value of adjacent pixels surrounding the point of interest. The results show that the code can be embedded and later fully recovered with minimal changes in the UIQI index - less than 0.1% of different.

  3. Recruitment, Promotion, and Retention of Women in Academic Medicine: How Institutions Are Addressing Gender Disparities.

    PubMed

    Carr, Phyllis L; Gunn, Christine; Raj, Anita; Kaplan, Samantha; Freund, Karen M

    Greater numbers of women in medicine have not resulted in more women achieving senior positions. Programs supporting the recruitment, promotion, and retention of women in academic medicine could help to achieve greater advancement of more women to leadership positions. Qualitative research was conducted to understand such programs at 23 institutions and, using the social ecological model, examine how they operate at the individual, interpersonal, institutional, academic community, and policy levels. Telephone interviews were conducted with faculty representatives (n = 44) of the Group on Women in Medicine and Science, Diversity and Inclusion, or senior leaders with knowledge on gender climate in 24 medical schools. Four trained interviewers conducted semistructured interviews that addressed faculty perceptions of gender equity and advancement, which were audiotaped and transcribed. The data were categorized into three content areas-recruitment, promotion, and retention-and coded a priori for each area based on their social ecological level of operation. Participants from nearly 40% of the institutions reported no special programs for recruiting, promoting, or retaining women, largely describing such programming as unnecessary. Existing programs primarily targeted the individual and interpersonal levels simultaneously, via training, mentoring, and networking, or the institutional level, via search committee trainings, child and elder care, and spousal hiring programs. Lesser effort at the academic community and policy levels were described. Our findings demonstrate that many U.S. medical schools have no programs supporting gender equity among medical faculty. Existing programs primarily target the individual or interpersonal level of the social ecological interaction. The academic community and broader policy environment require greater focus as levels with little attention to advancing women's careers. Universal multilevel efforts are needed to more effectively advance the careers of medical women faculty and support gender equity. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  4. Ethical conduct for research : a code of scientific ethics

    Treesearch

    Marcia Patton-Mallory; Kathleen Franzreb; Charles Carll; Richard Cline

    2000-01-01

    The USDA Forest Service recently developed and adopted a code of ethical conduct for scientific research and development. The code addresses issues related to research misconduct, such as fabrication, falsification, or plagiarism in proposing, performing, or reviewing research or in reporting research results, as well as issues related to professional misconduct, such...

  5. Poetry in Programs: A Brief Examination of Software Aesthetics, Including Observations on the History of Programming Styles and Speculations on Post-object Programming

    NASA Technical Reports Server (NTRS)

    Filman, Robert E.

    2004-01-01

    This viewgraph presentation provides samples of computer code which have characteristics of poetic verse, and addresses the theoretical underpinnings of artistic coding, as well as how computer language influences software style, and the possible style of future coding.

  6. Verification and benchmark testing of the NUFT computer code

    NASA Astrophysics Data System (ADS)

    Lee, K. H.; Nitao, J. J.; Kulshrestha, A.

    1993-10-01

    This interim report presents results of work completed in the ongoing verification and benchmark testing of the NUFT (Nonisothermal Unsaturated-saturated Flow and Transport) computer code. NUFT is a suite of multiphase, multicomponent models for numerical solution of thermal and isothermal flow and transport in porous media, with application to subsurface contaminant transport problems. The code simulates the coupled transport of heat, fluids, and chemical components, including volatile organic compounds. Grid systems may be cartesian or cylindrical, with one-, two-, or fully three-dimensional configurations possible. In this initial phase of testing, the NUFT code was used to solve seven one-dimensional unsaturated flow and heat transfer problems. Three verification and four benchmarking problems were solved. In the verification testing, excellent agreement was observed between NUFT results and the analytical or quasianalytical solutions. In the benchmark testing, results of code intercomparison were very satisfactory. From these testing results, it is concluded that the NUFT code is ready for application to field and laboratory problems similar to those addressed here. Multidimensional problems, including those dealing with chemical transport, will be addressed in a subsequent report.

  7. Solving free-plasma-boundary problems with the SIESTA MHD code

    NASA Astrophysics Data System (ADS)

    Sanchez, R.; Peraza-Rodriguez, H.; Reynolds-Barredo, J. M.; Tribaldos, V.; Geiger, J.; Hirshman, S. P.; Cianciosa, M.

    2017-10-01

    SIESTA is a recently developed MHD equilibrium code designed to perform fast and accurate calculations of ideal MHD equilibria for 3D magnetic configurations. It is an iterative code that uses the solution obtained by the VMEC code to provide a background coordinate system and an initial guess of the solution. The final solution that SIESTA finds can exhibit magnetic islands and stochastic regions. In its original implementation, SIESTA addressed only fixed-boundary problems. This fixed boundary condition somewhat restricts its possible applications. In this contribution we describe a recent extension of SIESTA that enables it to address free-plasma-boundary situations, opening up the possibility of investigating problems with SIESTA in which the plasma boundary is perturbed either externally or internally. As an illustration, the extended version of SIESTA is applied to a configuration of the W7-X stellarator.

  8. Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.

    PubMed

    Long, Theodore; Chaiyachati, Krisda; Bosu, Olatunde; Sircar, Sohini; Richards, Bradley; Garg, Megha; McGarry, Kelly; Solomon, Sonja; Berman, Rebecca; Curry, Leslie; Moriarty, John; Huot, Stephen

    2016-12-01

    Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. This was a qualitative study based on semi-structured, in-person interviews. Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue a career in primary care.

  9. A comparison of two surveillance systems for deaths related to violent injury

    PubMed Central

    Comstock, R; Mallonee, S; Jordan, F

    2005-01-01

    Objective: To compare violent injury death reporting by the statewide Medical Examiner and Vital Statistics Office surveillance systems in Oklahoma. Methods: Using a standard study definition for violent injury death, the sensitivity and predictive value positive (PVP) of the Medical Examiner and Vital Statistics violent injury death reporting systems in Oklahoma in 2001 were evaluated. Results: Altogether 776 violent injury deaths were identified (violent injury death rate: 22.4 per 100 000 population) including 519 (66.9%) suicides, 248 (32.0%) homicides, and nine (1.2%) unintentional firearm deaths. The Medical Examiner system over-reported homicides and the Vital Statistics system under-reported homicides and suicides and over-reported unintentional firearm injury deaths. When compared with the standard, the Medical Examiner and Vital Statistics systems had sensitivities of 99.2% and 90.7% (respectively) and PVPs of 95.0% and 99.1% for homicide, sensitivities of 99.2% and 93.1% and PVPs of 100% and 99.0% for suicide, and sensitivities of 100% and 100% and PVPs of 100% and 31.0% for unintentional firearm deaths. Conclusions: Both the Vital Statistics and Medical Examiner systems contain valuable data and when combined can work synergistically to provide violent injury death information while also serving as quality control checks for each other. Preventable errors within both systems can be reduced by increasing training, addressing sources of human error, and expanding computer quality assurance programming. A standardized nationwide Medical Examiners' coding system and a national violent death reporting system that merges multiple public health and criminal justice datasets would enhance violent injury surveillance and prevention efforts. PMID:15691992

  10. Critical study of pathology theses supported at the medical university of Tunis (2000-2010).

    PubMed

    Mrabet, Ali; Chadli Debbiche, Aschraf; Abidi, Emna; Borsali Falfoul, Nabiha; Dziri, Chadli

    2016-02-01

    Medical writing is a coded language; its purpose is to convey a scientific message. In pathology, specialty involving the study of cell and tissue, quantitative and qualitative production of medical doctoral theses and their thematic focus has not been studied. The aim of this study was to analyze the pathology theses on the level of form, the background and methodology. Descriptive retrospective study of medical doctoral theses in the specialty "Pathology", listed in the catalog of theses of the library of the Faculty of Medicine of Tunis and supported between 2000 and 2010. Each thesis has been subject of a direct reading, systematic and thorough. The study involved 189 pathology theses. The average overall productivity per academic pathologist was 5.5 theses. Gastrointestinal pathology was the most studied theme (24.9%). Tumor pathology was addressed in 74.1% of the theses. The IMRAD structure was respected in 57.7% of theses; by assistant professor than by associate professor and professor (p = 0.005). The summary was structured in 88.3% of theses, comparably with the grade of the thesis director (p = 0.5) and with the grade of PhD student (p = 0.08). The transcript of references did not meet the recommendations of Vancouver in 87.8% of theses and irrespective of the rank of director of thesis (p = 0.2). The pathology theses presented some shortcomings, particularly in the quality of medical writing. To remedy this problem, our faculty should increase efforts to improve the quality of scientific work, in order to have a better view of medical research in Tunisia.

  11. In-school asthma management and physical activity: children’s perspectives

    PubMed Central

    Walker, Timothy J.; Reznik, Marina

    2014-01-01

    OBJECTIVE Regular physical activity (PA) is an important component of pediatric asthma management. No studies have examined how in-school asthma management influences PA from children’s perspectives. The aim of this study was to explore children’s perceptions of the impact of in-school asthma management on PA. METHODS Qualitative interviews with 23 inner-city minority children with asthma (ages 8–10 yrs; 12 girls, 11 boys) were conducted in 10 Bronx, New York elementary schools. Sampling continued until saturation was reached. Interviews were recorded, transcribed and independently coded for common themes. RESULTS Interviews produced five themes representing students’ perceptions about 1) asthma symptoms during in-school PA; 2) methods to control asthma episodes during school PA; 3) methods to prevent asthma episodes during school; 4) limited accessibility of asthma medications; and 5) negative feelings about asthma and medication use. The majority of students experienced asthma symptoms while performing PA during school. Primary methods of managing asthma symptoms were sitting out during activity, drinking water, and visiting the nurse. Students lacked awareness or adherence to action plans to prevent or control asthma. Students reported limited access to medication during school and feelings of embarrassment and/or concerns of teasing when medicating in front of others. CONCLUSIONS Our results indicate inappropriate in-school management of asthma symptoms, poor asthma control, lack of accessible medication, and stigma around publicly using asthma medication. Thus, students often missed or were withheld from PA. Interventions to improve in-school asthma care must consider ways to address these issues. PMID:24796650

  12. Locking it down: The privacy and security of mobile medication apps.

    PubMed

    Grindrod, Kelly; Boersema, Jonathan; Waked, Khrystine; Smith, Vivian; Yang, Jilan; Gebotys, Catherine

    2017-01-01

    To explore the privacy and security of free medication applications (apps) available to Canadian consumers. The authors searched the Canadian iTunes store for iOS apps and the Canadian Google Play store for Android apps related to medication use and management. Using an Apple iPad Air 2 and a Google Nexus 7 tablet, 2 reviewers generated a list of apps that met the following inclusion criteria: free, available in English, intended for consumer use and related to medication management. Using a standard data collection form, 2 reviewers independently coded each app for the presence/absence of passwords, the storage of personal health information, a privacy statement, encryption, remote wipe and third-party sharing. A Cohen's Kappa statistic was used to measure interrater agreement. Of the 184 apps evaluated, 70.1% had no password protection or sign-in system. Personal information, including name, date of birth and gender, was requested by 41.8% (77/184) of apps. Contact information, such as address, phone number and email, was requested by 25% (46/184) of apps. Finally, personal health information, other than medication name, was requested by 89.1% (164/184) of apps. Only 34.2% (63/184) of apps had a privacy policy in place. Most free medication apps offer very limited authentication and privacy protocols. As a result, the onus currently falls on patients to input information in these apps selectively and to be aware of the potential privacy issues. Until more secure systems are built, health care practitioners cannot fully support patients wanting to use such apps.

  13. [Retrospective census of cancers between 1994 and 2002 around the municipal solid waste incinerator of Gilly-sur-Isère].

    PubMed

    Thabuis, A; Schmitt, M; Megas, F; Fabres, B

    2007-12-01

    The retrospective cancer incidence study carried out around the municipal solid waste incinerator of Gilly-sur-Isère (Savoie, France) was ordered in a context of crisis during its closing in the late 2001. Its purpose was to determine whether or not there was an excessive number of cancers around the incinerator. In the absence of cancer registry in Savoie, this study consisted in counting as exhaustively as possible the cancers that occurred between 1994 and 2002 in the study area, which was exposed to the atmospheric fallouts from the incinerator. Thus, it was planned to compare the observed cancer incidence to the French cancer registries'. This work describes the main difficulties encountered as well as the solutions found during the census of cancer cases; the results of the incidence study are not included. The collection of medical data was carried out thanks to multiple sources of information: pathology and hematology laboratories, hospitals' and clinics' departments of medical information, health insurance funds, liberal practitioners or specialised cancer registries. The collected medical data files were dealt with: looking for the missing addresses, selecting patients from the study area, homogenizing cancers coding, merging files into a single database, analysing available information on each cancer and de-duplicating the database. Most cancers were validated by consulting medical folders so as to exclude the false cases like metastasises of a known primary cancer or recurrences. Two thousand eight hundred and forty-five cancers were initially collected, and 28% of them were excluded because they did not correspond to the case definition (no proof of cancer, diagnosis date before the study period...); the final database was made of 2055 cancer cases. Quality indicators showed that the database could be considered as exhaustive and valid as a registry's. Three types of sources allowed to identify 94% of cases: laboratories, hospitals' departments of medical information and health insurance funds. Using administrative data and consulting medical folders turned out to be necessary considering uncertainties about: the patients' residence at the time of the diagnosis, errors in coding cancers in some databases that were collected and difficulties to identify false cases. This census required very important means.

  14. E-medicine and health care consumers: recognizing current problems and possible resolutions for a safer environment.

    PubMed

    Brann, Maria; Anderson, James G

    2002-01-01

    Millions of Americans access the Internet for health information, which is changing the way patients seek information about, and often treat, certain medical conditions. It is estimated that there may be as many as 100,000 health-related Web sites. The availability of so much health information permits consumers to assume more responsibility for their own health care. At the same time, it raises a number of issues that need to be addressed. The health information available to Internet users may be inaccurate or out-of-date. Potential conflicts of interest result from the blurring of the distinction between advertising and professional health information. Also, potential threats to privacy may result from data mining. Health care consumers need to be able to evaluate the quality of the information provided on the Internet. Various evaluative mechanisms such as codes of ethics, rating systems, and seals of approval have been developed to aid in this process. The effectiveness of these solutions is evaluated in this paper. Finally, the paper addresses the importance of including patients in developing standardized quality assurance systems for online health information.

  15. Identifying and addressing potential conflict of interest: a professional medical organization's code of ethics.

    PubMed

    Heim, Lori

    2010-01-01

    The new Consumer Alliance agreement between the American Academy of Family Physicians (AAFP) and The Coca-Cola Company provides a valuable opportunity to illustrate AAFP's adherence to its ethical foundation, demonstrate the AAFP's commitment to serving physicians and the public, and maintain the trust Americans put in their family physicians and the organization that represents them. Throughout the development of this program, as well as in all business interactions, the AAFP consistently addresses possible conflict of interest openly and directly, sharing with our members and the public exactly what measures we take to ensure that, in fact, no unethical conduct or breach of trust would--or will in the future--occur. In this case, the AAFP saw a public health and education need that was both unmet and undermined by the barrage of marketing messages and confusing information, and acted to fill that need. In so doing, the AAFP hewed to its high ethical standards, its core values, and its mission in the decisions made and the actions that followed.

  16. Designing Flight Deck Procedures

    NASA Technical Reports Server (NTRS)

    Degani, Asaf; Wiener, Earl

    2005-01-01

    Three reports address the design of flight-deck procedures and various aspects of human interaction with cockpit systems that have direct impact on flight safety. One report, On the Typography of Flight- Deck Documentation, discusses basic research about typography and the kind of information needed by designers of flight deck documentation. Flight crews reading poorly designed documentation may easily overlook a crucial item on the checklist. The report surveys and summarizes the available literature regarding the design and typographical aspects of printed material. It focuses on typographical factors such as proper typefaces, character height, use of lower- and upper-case characters, line length, and spacing. Graphical aspects such as layout, color coding, fonts, and character contrast are discussed; and several cockpit conditions such as lighting levels and glare are addressed, as well as usage factors such as angular alignment, paper quality, and colors. Most of the insights and recommendations discussed in this report are transferable to paperless cockpit systems of the future and computer-based procedure displays (e.g., "electronic flight bag") in aerospace systems and similar systems that are used in other industries such as medical, nuclear systems, maritime operations, and military systems.

  17. Identifying and Addressing Potential Conflict of Interest: A Professional Medical Organization’s Code of Ethics

    PubMed Central

    Heim, Lori

    2010-01-01

    The new Consumer Alliance agreement between the American Academy of Family Physicians (AAFP) and The Coca-Cola Company provides a valuable opportunity to illustrate AAFP’s adherence to its ethical foundation, demonstrate the AAFP’s commitment to serving physicians and the public, and maintain the trust Americans put in their family physicians and the organization that represents them. Throughout the development of this program, as well as in all business interactions, the AAFP consistently addresses possible conflict of interest openly and directly, sharing with our members and the public exactly what measures we take to ensure that, in fact, no unethical conduct or breach of trust would—or will in the future—occur. In this case, the AAFP saw a public health and education need that was both unmet and undermined by the barrage of marketing messages and confusing information, and acted to fill that need. In so doing, the AAFP hewed to its high ethical standards, its core values, and its mission in the decisions made and the actions that followed. PMID:20644192

  18. Using framework-based synthesis for conducting reviews of qualitative studies.

    PubMed

    Dixon-Woods, Mary

    2011-04-14

    Framework analysis is a technique used for data analysis in primary qualitative research. Recent years have seen its being adapted to conduct syntheses of qualitative studies. Framework-based synthesis shows considerable promise in addressing applied policy questions. An innovation in the approach, known as 'best fit' framework synthesis, has been published in BMC Medical Research Methodology this month. It involves reviewers in choosing a conceptual model likely to be suitable for the question of the review, and using it as the basis of their initial coding framework. This framework is then modified in response to the evidence reported in the studies in the reviews, so that the final product is a revised framework that may include both modified factors and new factors that were not anticipated in the original model. 'Best fit' framework-based synthesis may be especially suitable in addressing urgent policy questions where the need for a more fully developed synthesis is balanced by the need for a quick answer. Please see related article: http://www.biomedcentral.com/1471-2288/11/29.

  19. Ethics and biobanks

    PubMed Central

    Hansson, M G

    2008-01-01

    Biobank research has been the focus of great interest of scholars and regulatory bodies who have addressed different ethical issues. On the basis of a review of the literature it may be concluded that, regarding some major themes in this discussion, a consensus seems to emerge on the international scene after the regular exchange of arguments in scientific journals. Broad or general consent is emerging as the generally preferred solution for biobank studies and straightforward instructions for coding will optimise privacy while facilitating research that may result in new methods for the prevention of disease and for medical treatment. The difficult question regarding the return of information to research subjects is the focus of the current research, but a helpful analysis of some of the issues at stake and concrete recommendations have recently been suggested. PMID:19034276

  20. Determination of SPEAR-1 Rocket Body Potential during High-Voltage Experiments

    DTIC Science & Technology

    1990-06-01

    California at San Diego La Jolla, CA 92093 10 . Dr. C. E. McIlwain Center for Astrophysics and Space Science University of California at San Diego La Jolla...Postgraduate School 39 Naval Postgraduate School 6c. ADDRESS (City, S:are, and ZIP Code) 7b. ADDRESS (Ciy, State, and ZIP Code) Monterey. CA 93943-5000...Monterey. CA 93943-5000 8a. NAME OF FUNDING.SPONSORING 80. OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION (If applicable

  1. Pullout of a Rigid Insert Adhesively Bonded to an Elastic Half Plane.

    DTIC Science & Technology

    1983-12-01

    COMMAND UNITED STATES AIR FORCE C-= °84 02 13 071. C,, W % d 6 This document was prepared by the Department of Engineering Mechanics, USAF Academy Faculty...THOMAS E. KULLGREN, Lt Col, USAF Project Engineer /Scientist Professor and Acting Head, Department of Engineering Mechanics KENNETH E. SIEGETH Lt Col...Department of Engineering (Ifapphicable) Mechanics USAFA/DFEM 6c. ADDRESS (City. State and ZIP Code) 7b. ADDRESS (City, Slate and ZIP Code) USAF Academy

  2. USAF Presence in Latin America in the 21st Century.

    DTIC Science & Technology

    1988-04-01

    faculty in partial fulfillment of requirements for graduation. AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY MAXWELL AFB, AL 36112 UNCLASSIFIED SECURITY...ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code) Maxwell AFB AL 36112-5542 Ba. NAME OF FUNDING /SPONSORING 8 b. OFFICE SYMBOL... Servicio Multimodal Transistmico across the Isthmus of Tehuantepec (11:28). It does, however. *%4 row:n militaiy importance. The U.S. Atlantic Command’s

  3. IGG Subclass and Isotype Specific Immunoglobulin Responses to Lassa Fever and Venezuelan Equine Encephalomyelitis: Natural Infection and Immunization

    DTIC Science & Technology

    1990-09-30

    EQUINE N ENCEPHALOMYELITIS: NATURAL INFECTION AND IMMUNIZATION , I PRINCIPAL INVESTIGATOR: Renata J. Engler, LTC, MC CONTRACTING ORGANIZATION: Uniformed...Services University of the Health Sciences Department of Medicine Bethesda, MD 20814-4799 REPORT DATE: September 30, 1990 ELECTEO 0CT 3 11990 TYPE OF...Uniformed Services University (If applicable) of Health Sciences I 6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code

  4. Quality of coding diagnoses in emergency departments: effects on mapping the public's health.

    PubMed

    Aharonson-Daniel, Limor; Schwartz, Dagan; Hornik-Lurie, Tzipi; Halpern, Pinchas

    2014-01-01

    Emergency department (ED) attendees reflect the health of the population served by that hospital and the availability of health care services in the community. To examine the quality and accuracy of diagnoses recorded in the ED to appraise its potential utility as a guage of the population's medical needs. Using the Delphi process, a preliminary list of health indicators generated by an expert focus group was converted to a query to the Ministry of Health's database. In parallel, medical charts were reviewed in four hospitals to compare the handwritten diagnosis in the medical record with that recorded on the standard diagnosis "pick list" coding sheet. Quantity and quality of coding were assessed using explicit criteria. During 2010 a total of 17,761 charts were reviewed; diagnoses were not coded in 42%. The accuracy of existing coding was excellent (mismatch 1%-5%). Database query (2,670,300 visits to 28 hospitals in 2009) demonstrated potential benefits of these data as indicators of regional health needs. The findings suggest that an increase in the provision of community care may reduce ED attendance. Information on ED visits can be used to support health care planning. A "pick list" form with common diagnoses can facilitate quality recording of diagnoses in a busy ED, profiling the population's health needs in order to optimize care. Better compliance with the directive to code diagnosis is desired.

  5. Automation of PCXMC and ImPACT for NASA Astronaut Medical Imaging Dose and Risk Tracking

    NASA Technical Reports Server (NTRS)

    Bahadori, Amir; Picco, Charles; Flores-McLaughlin, John; Shavers, Mark; Semones, Edward

    2011-01-01

    To automate astronaut organ and effective dose calculations from occupational X-ray and computed tomography (CT) examinations incorporating PCXMC and ImPACT tools and to estimate the associated lifetime cancer risk per the National Council on Radiation Protection & Measurements (NCRP) using MATLAB(R). Methods: NASA follows guidance from the NCRP on its operational radiation safety program for astronauts. NCRP Report 142 recommends that astronauts be informed of the cancer risks from reported exposures to ionizing radiation from medical imaging. MATLAB(R) code was written to retrieve exam parameters for medical imaging procedures from a NASA database, calculate associated dose and risk, and return results to the database, using the Microsoft .NET Framework. This code interfaces with the PCXMC executable and emulates the ImPACT Excel spreadsheet to calculate organ doses from X-rays and CTs, respectively, eliminating the need to utilize the PCXMC graphical user interface (except for a few special cases) and the ImPACT spreadsheet. Results: Using MATLAB(R) code to interface with PCXMC and replicate ImPACT dose calculation allowed for rapid evaluation of multiple medical imaging exams. The user inputs the exam parameter data into the database and runs the code. Based on the imaging modality and input parameters, the organ doses are calculated. Output files are created for record, and organ doses, effective dose, and cancer risks associated with each exam are written to the database. Annual and post-flight exposure reports, which are used by the flight surgeon to brief the astronaut, are generated from the database. Conclusions: Automating PCXMC and ImPACT for evaluation of NASA astronaut medical imaging radiation procedures allowed for a traceable and rapid method for tracking projected cancer risks associated with over 12,000 exposures. This code will be used to evaluate future medical radiation exposures, and can easily be modified to accommodate changes to the risk calculation procedure.

  6. Scalable and expressive medical terminologies.

    PubMed

    Mays, E; Weida, R; Dionne, R; Laker, M; White, B; Liang, C; Oles, F J

    1996-01-01

    The K-Rep system, based on description logic, is used to represent and reason with large and expressive controlled medical terminologies. Expressive concept descriptions incorporate semantically precise definitions composed using logical operators, together with important non-semantic information such as synonyms and codes. Examples are drawn from our experience with K-Rep in modeling the InterMed laboratory terminology and also developing a large clinical terminology now in production use at Kaiser-Permanente. System-level scalability of performance is achieved through an object-oriented database system which efficiently maps persistent memory to virtual memory. Equally important is conceptual scalability-the ability to support collaborative development, organization, and visualization of a substantial terminology as it evolves over time. K-Rep addresses this need by logically completing concept definitions and automatically classifying concepts in a taxonomy via subsumption inferences. The K-Rep system includes a general-purpose GUI environment for terminology development and browsing, a custom interface for formulary term maintenance, a C+2 application program interface, and a distributed client-server mode which provides lightweight clients with efficient run-time access to K-Rep by means of a scripting language.

  7. Methodological, technical, and ethical issues of a computerized data system.

    PubMed

    Rice, C A; Godkin, M A; Catlin, R J

    1980-06-01

    This report examines some methodological, technical, and ethical issues which need to be addressed in designing and implementing a valid and reliable computerized clinical data base. The report focuses on the data collection system used by four residency based family health centers, affiliated with the University of Massachusetts Medical Center. It is suggested that data reliability and validity can be maximized by: (1) standardizing encounter forms at affiliated health centers to eliminate recording biases and ensure data comparability; (2) using forms with a diagnosis checklist to reduce coding errors and increase the number of diagnoses recorded per encounter; (3) developing uniform diagnostic criteria; (4) identifying sources of error, including discrepancies of clinical data as recorded in medical records, encounter forms, and the computer; and (5) improving provider cooperation in recording data by distributing data summaries which reinforce the data's applicability to service provision. Potential applications of the data for research purposes are restricted by personnel and computer costs, confidentiality considerations, programming related issues, and, most importantly, health center priorities, largely focused on patient care, not research.

  8. Medical Surveillance Monthly Report (MSMR). Volume 17, Number 08, August 2010

    DTIC Science & Technology

    2010-08-01

    notifi able medical event reports that included diagnostic codes (ICD-9-CM) indicative of chlamydia, gonorrhea, syphilis, herpes simplex virus (HSV...infections of interest for this report Results: Condition Diagnostic codes Chlamydia 099.41, 099.5 Gonorrhea 098 Herpes simplex (HSV) 054 Human...housing arrangements may also play roles and off er opportunities for targeted prevention.6 Human papillomavirus (HPV), the cause of genital warts

  9. Hypochondria as withdrawal and comedy as cure in Dr. Willibald's Der Hypochondrist (1824).

    PubMed

    Potter, Edward T

    2012-01-01

    Balthasar von Ammann's comedy Der Hypochondrist, published in 1824 under the pseudonym Dr. Willibald, foregrounds the social, sexual, and political implications of hypochondria. The play engages with early nineteenth-century medical and popular conceptions of hypochondria to co-opt potentially subversive elements and to promote a specific social, sexual, and political agenda. The text promotes literature — specifically comedic drama — as a cure for hypochondria. Hypochondria functions as a code for withdrawal. The hypochondriac withdraws medically from healthy society, gaining exceptional status. He withdraws sexually from society by remaining a bachelor, possibly engaged in non-normative sexual behaviour. Furthermore, the politically disenfranchised protagonist voices his political frustrations via a coded medical metaphor. The hypochondriac poses a threefold challenge to the social, sexual, and political order, and the play engages with contemporary conceptions of the disease to provide the solution: comedy. The text, presented as a cure for hypochondria, replaces the coded questioning of the social order via hypochondria with the less threatening code of heraldry. A comedy-within-the-comedy uses the hypochondriac's love of heraldry to cure him, resulting in the elimination of his medical problems and exceptional status, in the purification of his bachelorhood from non-normative elements, and in the pre-emption of political frustrations.

  10. Medical residents reflect on their prejudices toward poverty: a photovoice training project.

    PubMed

    Loignon, Christine; Boudreault-Fournier, Alexandrine; Truchon, Karoline; Labrousse, Yanouchka; Fortin, Bruno

    2014-12-31

    Clinicians face challenges in delivering care to socioeconomically disadvantaged patients. While both the public and academic sectors recognize the importance of addressing social inequities in healthcare, there is room for improvement in the training of family physicians, who report being ill-equipped to provide care that is responsive to the living conditions of these patients. This study explored: (i) residents' perceptions and experience in relation to providing care for socioeconomically disadvantaged patients, and (ii) how participating in a photovoice study helped them uncover and examine some of their prejudices and assumptions about poverty. We conducted a participatory photovoice study. Participants were four family medicine residents, two medical supervisors, and two researchers. Residents attended six photovoice meetings at which they discussed photos they had taken. In collaboration with the researchers, the participants defined the research questions, took photos, and participated in data analysis and results dissemination. Meetings were recorded and transcribed for analysis, which consisted of coding, peer debriefing, thematic analysis, and interpretation. The medical residents uncovered and examined their own prejudices and misconceptions about poverty. They reported feeling unprepared to provide care to socioeconomically disadvantaged patients. Supported by medical supervisors and researchers, the residents underwent a three-phase reflexive process of: (1) engaging reflexively, (2) break(ing) through, and (3) taking action. The results indicated that medical residents subsequently felt encouraged to adopt a care approach that helped them overcome the social distance between themselves and their socioeconomically disadvantaged patients. This study highlights the importance of providing medical training on issues related to poverty and increasing awareness about social inequalities in medical education to counteract prejudices toward socioeconomically disadvantaged patients. Future studies should examine which elective courses and training could provide suitable tools to clinicians to improve their competence in delivering care to socioeconomically disadvantaged patients.

  11. Stakeholder analysis for adopting a personal health record standard in Korea.

    PubMed

    Kang, Min-Jeoung; Jung, Chai Young; Kim, Soyoun; Boo, Yookyung; Lee, Yuri; Kim, Sundo

    Interest in health information exchanges (HIEs) is increasing. Several countries have adopted core health data standards with appropriate strategies. This study was conducted to determine the feasibility of a continuity of care record (CCR) as the standard for an electronic version of the official transfer note and the HIE in Korean healthcare. A technical review of the CCR standard and analysis of stakeholders' views were undertaken. Transfer notes were reviewed and matched with CCR standard categories. The standard for the Korean coding system was selected. Stakeholder analysis included an online survey of members of the Korean Society of Medical Informatics, a public hearing to derive opinions of consumers, doctors, vendors, academic societies and policy makers about the policy process, and a focus group meeting with EMR vendors to determine which HIE objects were technically applicable. Data objects in the official transfer note form matched CCR standards. Korean Classification of Diseases, Korean Standard Terminology of Medicine, Electronic Data Interchange code (EDI code), Logical Observation Identifiers Names and Codes, and Korean drug codes (KD code) were recommended as the Korean coding standard.'Social history', 'payers', and 'encounters' were mostly marked as optional or unnecessary sections, and 'allergies', 'alerts', 'medication list', 'problems/diagnoses', 'results',and 'procedures' as mandatory. Unlike the US, 'social history' was considered optional and 'advance directives' mandatory.At the public hearing there was some objection from the Korean Medical Association to the HIE on legal grounds in termsof intellectual property and patients' personal information. Other groups showed positive or neutral responses. Focus group members divided CCR data objects into three phases based onpredicted adoption time in CCR: (i) immediate adoption; (ii) short-term adoption ('alerts', 'family history'); and (iii) long-term adoption ('results', 'advanced directives', 'functional status', 'medical equipment', 'vital signs', 'plan of care', 'social history'). There were no technical problems in generating the CCR standard document from EMRs. Matters of concern that arose from study results should be resolved with time and consultation.

  12. A Three-Phase Decision Model of Computer-Aided Coding for the Iranian Classification of Health Interventions (IRCHI)

    PubMed Central

    Azadmanjir, Zahra; Safdari, Reza; Ghazisaeedi, Marjan; Mokhtaran, Mehrshad; Kameli, Mohammad Esmail

    2017-01-01

    Introduction: Accurate coded data in the healthcare are critical. Computer-Assisted Coding (CAC) is an effective tool to improve clinical coding in particular when a new classification will be developed and implemented. But determine the appropriate method for development need to consider the specifications of existing CAC systems, requirements for each type, our infrastructure and also, the classification scheme. Aim: The aim of the study was the development of a decision model for determining accurate code of each medical intervention in Iranian Classification of Health Interventions (IRCHI) that can be implemented as a suitable CAC system. Methods: first, a sample of existing CAC systems was reviewed. Then feasibility of each one of CAC types was examined with regard to their prerequisites for their implementation. The next step, proper model was proposed according to the structure of the classification scheme and was implemented as an interactive system. Results: There is a significant relationship between the level of assistance of a CAC system and integration of it with electronic medical documents. Implementation of fully automated CAC systems is impossible due to immature development of electronic medical record and problems in using language for medical documenting. So, a model was proposed to develop semi-automated CAC system based on hierarchical relationships between entities in the classification scheme and also the logic of decision making to specify the characters of code step by step through a web-based interactive user interface for CAC. It was composed of three phases to select Target, Action and Means respectively for an intervention. Conclusion: The proposed model was suitable the current status of clinical documentation and coding in Iran and also, the structure of new classification scheme. Our results show it was practical. However, the model needs to be evaluated in the next stage of the research. PMID:28883671

  13. 25 CFR 11.1014 - Medical examination.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false Medical examination. 11.1014 Section 11.1014 Indians... ORDER CODE Juvenile Offender Procedure § 11.1014 Medical examination. The children's court may order a medical examination for a minor who is alleged to be a juvenile offender. ...

  14. 25 CFR 11.1014 - Medical examination.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true Medical examination. 11.1014 Section 11.1014 Indians... ORDER CODE Juvenile Offender Procedure § 11.1014 Medical examination. The children's court may order a medical examination for a minor who is alleged to be a juvenile offender. ...

  15. 25 CFR 11.1014 - Medical examination.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Medical examination. 11.1014 Section 11.1014 Indians... ORDER CODE Juvenile Offender Procedure § 11.1014 Medical examination. The children's court may order a medical examination for a minor who is alleged to be a juvenile offender. ...

  16. 25 CFR 11.1014 - Medical examination.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Medical examination. 11.1014 Section 11.1014 Indians... ORDER CODE Juvenile Offender Procedure § 11.1014 Medical examination. The children's court may order a medical examination for a minor who is alleged to be a juvenile offender. ...

  17. 25 CFR 11.1014 - Medical examination.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Medical examination. 11.1014 Section 11.1014 Indians... ORDER CODE Juvenile Offender Procedure § 11.1014 Medical examination. The children's court may order a medical examination for a minor who is alleged to be a juvenile offender. ...

  18. Biomedicalization and the public sphere: newspaper coverage of health and medicine, 1960s-2000s.

    PubMed

    Hallin, Daniel C; Brandt, Marisa; Briggs, Charles L

    2013-11-01

    This article examines historical trends in the reporting of health and medicine in The New York Times and Chicago Tribune from the 1960s to the 2000s. It focuses on the extent to which health reporting can be said to have become increasingly politicized, or to have shifted from treating the production of medical knowledge as something belonging to a restricted, specialized sphere, to treating it as a part of the general arena of public debate. We coded a sample of 400 stories from the two newspapers for four different Implied Audiences which health stories can address: Scientific/Professional, Patient/Consumer, Investor and Citizen/Policymaker. Stories were also coded for the origin of the story, the sources cited, the presence of controversy, and the positive or negative representation of biomedical institutions and actors. The data show that through all five decades, news reporting on health and medicine addressed readers as Citizen/Policymakers most often, though Patient/Consumer and Investor-oriented stories increased over time. Biomedical researchers eclipsed individual physicians and public health officials as sources of news, and the sources diversified to include more business sources, civil society organizations and patients and other lay people. The reporting of controversy increased, and portrayals of biomedicine shifted from lopsidedly positive to more mixed. We use these data in pinpointing how media play a constitutive role in the process of "biomedicalization," through which biomedicine has both extended its reach into and become entangled with other spheres of society and of knowledge production. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Ethics Standards Impacting Test Development and Use: A Review of 31 Ethics Codes Impacting Practices in 35 Countries

    ERIC Educational Resources Information Center

    Leach, Mark M.; Oakland, Thomas

    2007-01-01

    Ethics codes are designed to protect the public by prescribing behaviors professionals are expected to exhibit. Although test use is universal, albeit reflecting strong Western influences, previous studies that examine the degree issues pertaining to test development and use and that are addressed in ethics codes of national psychological…

  20. Review and verification of CARE 3 mathematical model and code

    NASA Technical Reports Server (NTRS)

    Rose, D. M.; Altschul, R. E.; Manke, J. W.; Nelson, D. L.

    1983-01-01

    The CARE-III mathematical model and code verification performed by Boeing Computer Services were documented. The mathematical model was verified for permanent and intermittent faults. The transient fault model was not addressed. The code verification was performed on CARE-III, Version 3. A CARE III Version 4, which corrects deficiencies identified in Version 3, is being developed.

  1. Telemetry advances in data compression and channel coding

    NASA Technical Reports Server (NTRS)

    Miller, Warner H.; Morakis, James C.; Yeh, Pen-Shu

    1990-01-01

    Addressed in this paper is the dependence of telecommunication channel, forward error correcting coding and source data compression coding on integrated circuit technology. Emphasis is placed on real time high speed Reed Solomon (RS) decoding using full custom VLSI technology. Performance curves of NASA's standard channel coder and a proposed standard lossless data compression coder are presented.

  2. Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery: a Canadian database study.

    PubMed

    Guy, Pierre; Sheehan, Katie J; Morin, Suzanne N; Waddell, James; Dunbar, Michael; Harvey, Edward; Sirett, Susan; Sobolev, Boris; Kuramoto, Lisa; Tang, Michael

    2017-10-05

    Failure to account for medically necessary delays may lead to an underestimation of early surgery benefits. This study investigated the feasibility of using administrative data to identify the National Institute for Health and Care Excellence (NICE) 124 guideline list of conditions that appropriately delay hip fracture surgery. We assembled a list of diagnosis and procedure codes to reflect the NICE 124 conditions. The list was reviewed and updated by an advanced clinical coder. The list was refined by five clinical experts. We then screened Canadian Institute for Health Information discharge abstracts for 153 918 patients surgically treated for a non-pathological first hip fracture between 1 January 2004 and 31 December 2012 for diagnosis codes present on admission and procedure codes that antedated hip fracture surgery. We classified abstracts as having medical reasons for delaying surgery based on the presence of these codes. In total, 10 237 (6.7%; 95% CI 6.5% to 6.8%) patients had diagnostic and procedure codes indicating medical reasons for delay. The most common reasons for medical delay were exacerbation of a chronic chest condition (35.9%) and acute chest infection (23.2%). The proportion of patients with reasons for medical delays increased with time from admission to surgery: 3.9% (95% CI 3.6% to 4.1%) for same day surgery; 4.7% (95% CI 4.5% to 4.8%) for surgery 1 day after admission; 7.1% (95% CI 6.9% to 7.4%) for surgery 2 days after admission; and 15.5% (95% CI 15.1% to 16.0%) for surgery more than 2 days after admission. The trend was seen for admissions on weekday working hours, weekday after hours and on weekends. Administrative data can be considered to identify conditions that appropriately delay hip fracture surgery. Accounting for medically necessary delays can improve estimates of the effectiveness of early surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes.

    PubMed

    Balamuth, Fran; Weiss, Scott L; Hall, Matt; Neuman, Mark I; Scott, Halden; Brady, Patrick W; Paul, Raina; Farris, Reid W D; McClead, Richard; Centkowski, Sierra; Baumer-Mouradian, Shannon; Weiser, Jason; Hayes, Katie; Shah, Samir S; Alpern, Elizabeth R

    2015-12-01

    To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard. Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classification of Diseases, Ninth Revision, Clinical Modification codes: (1) severe sepsis/septic shock (sepsis codes); (2) infection plus organ dysfunction (combination codes); (3) subjects without codes for infection, organ dysfunction, or severe sepsis; and (4) infection but not severe sepsis or organ dysfunction. Combination codes were allowed, but not required within the sepsis codes group. We determined the presence of reference standard severe sepsis according to consensus criteria. Logistic regression was performed to determine whether addition of codes for sepsis therapies improved case identification. A total of 130 out of 432 subjects met reference SD of severe sepsis. Sepsis codes had sensitivity 73% (95% CI 70-86), specificity 92% (95% CI 87-95), and positive predictive value 79% (95% CI 70-86). Combination codes had sensitivity 15% (95% CI 9-22), specificity 71% (95% CI 65-76), and positive predictive value 18% (95% CI 11-27). Slight improvements in model characteristics were observed when codes for vasoactive medications and endotracheal intubation were added to sepsis codes (c-statistic 0.83 vs 0.87, P = .008). Sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. [Everything is valid in chronic pain: Interventions by older adults for pain relief].

    PubMed

    Alvarado-García, Alejandra María; Salazar-Maya, Ángela María

    To describe interventions used by older adults with benign chronic pain. Qualitative study with 25 older adults with benign chronic pain, inhabitants of the cities of Medellín and Bogotá. The technique used to collect information was in-depth interview. The analysis was made using the tools of the theory based on the guidelines of Strauss and Corbin. Using open, axial and selective coding, the constant comparison method allowed the identification of categories and subcategories and simultaneously memos and diagrams were made to reach theoretical saturation. A number of categories were found in this study, suggesting interventions used by the elderly to address chronic pain. They started looking at a number of options such as: taking medication, self-prescribing, feeling fear of taking pills, identifying the damage caused by drugs, using hot water, staying still, taking right postures, walking and exercising, using attachments that help them and making home remedies; all of them become alternatives that can cause pain relief. The study allowed describing interventions that older adults use to mitigate their pain. This ranged from pharmacological to non-pharmacological interventions, as simple as posture, cold, heat, massage or distractions among others, which play an important role in pain relief. Knowing these interventions helps healthcare professionals consider care options different to medication intake, proposing strategies that are easily accessible and can operate at the time to address a patient with chronic pain. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  5. A qualitative study of physician perspectives of cost-related communication and patients' financial burden with managing chronic disease.

    PubMed

    Patel, Minal R; Shah, Khooshbu S; Shallcross, Meagan L

    2015-11-25

    Patient financial burden with chronic disease poses significant health risks, yet it remains outside the scope of clinical visits. Little is known about how physicians perceive their patients' health-related financial burden in the context of primary care. The purpose of this study was to describe physician experiences with patients' financial burden while managing chronic disease and the communication of these issues. In November 2013, four focus groups were conducted in an academic medical center. A convenience sample of 29 internal and family medicine resident physicians was used in this study. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding physicians' experiences with identifying, managing, and communicating financial burden with their patients in the context of primary care. Major themes identified were 1) patient financial burden with chronic care is visible to physicians, 2) patient's financial burden with chronic care and discussing these issues is important to physicians, 3) ability to identify patients who perceive financial burden is imperfect, 4) communication of financial burden with patients is complex and difficult to navigate, 5) strategies utilized to address concerns are not always generalizable, and 6) physicians have ideas for widespread change to make these conversations easier for them. Awareness of physician perspectives in identifying and addressing their patients' disease-related financial burden may better equip researchers and medical educators to develop interventions that aid care teams in better understanding these patient concerns to promote compliance with treatment recommendations.

  6. Gaps, conflicts, and consensus in the ethics statements of professional associations, medical groups, and health plans.

    PubMed

    Berkman, N D; Wynia, M K; Churchill, L R

    2004-08-01

    Patients today interact with physicians, physician groups, and health plans, each of which may follow distinct ethical guidelines. We systematically compared physician codes of ethics with ethics policies at physician group practices and health plans, using the 1998-99 policies of 38 organisations-18 medical associations (associations), nine physician group practices (groups), and 12 health plans (plans)-selected using random and stratified purposive sampling. A clinician and a social scientist independently abstracted each document, using a 397-item health care ethics taxonomy; a reconciled abstraction form was used for analysis. This study focuses on ethics policies regarding professional obligation towards patients, resource allocation, and care for the vulnerable in society. A majority in all three groups mention "fiduciary obligations" of one sort or another, but associations generally address physician/patient relations but not health plan obligations, while plans rarely endorse physicians' obligations of advocacy, beneficence, and non-maleficence. Except for occasional mentions of cost effectiveness or efficiency, ethical considerations in resource allocation rarely arise in the ethics policies of all three organisational types. Very few associations, groups, or plans specifically endorse obligations to vulnerable populations. With some important exceptions, we found that the ethics policies of associations, groups, and plans are narrowly focused and often ignore important ethical concerns for society, such as resource allocation and care for vulnerable populations. More collaborative work is needed to build integrated sets of ethical standards that address the aims and responsibilities of the major stakeholders in health care delivery.

  7. Formalizing the Austrian Procedure Catalogue: A 4-step methodological analysis approach.

    PubMed

    Neururer, Sabrina Barbara; Lasierra, Nelia; Peiffer, Karl Peter; Fensel, Dieter

    2016-04-01

    Due to the lack of an internationally accepted and adopted standard for coding health interventions, Austria has established its own country-specific procedure classification system - the Austrian Procedure Catalogue (APC). Even though the APC is an elaborate coding standard for medical procedures, it has shortcomings that limit its usability. In order to enhance usability and usefulness, especially for research purposes and e-health applications, we developed an ontologized version of the APC. In this paper we present a novel four-step approach for the ontology engineering process, which enables accurate extraction of relevant concepts for medical ontologies from written text. The proposed approach for formalizing the APC consists of the following four steps: (1) comparative pre-analysis, (2) definition analysis, (3) typological analysis, and (4) ontology implementation. The first step contained a comparison of the APC to other well-established or elaborate health intervention coding systems in order to identify strengths and weaknesses of the APC. In the second step, a list of definitions of medical terminology used in the APC was obtained. This list of definitions was used as input for Step 3, in which we identified the most important concepts to describe medical procedures using the qualitative typological analysis approach. The definition analysis as well as the typological analysis are well-known and effective methods used in social sciences, but not commonly employed in the computer science or ontology engineering domain. Finally, this list of concepts was used in Step 4 to formalize the APC. The pre-analysis highlighted the major shortcomings of the APC, such as the lack of formal definition, leading to implicitly available, but not directly accessible information (hidden data), or the poor procedural type classification. After performing the definition and subsequent typological analyses, we were able to identify the following main characteristics of health interventions: (1) Procedural type, (2) Anatomical site, (3) Medical device, (4) Pathology, (5) Access, (6) Body system, (7) Population, (8) Aim, (9) Discipline, (10) Technique, and (11) Body Function. These main characteristics were taken as input of classes for the formalization of the APC. We were also able to identify relevant relations between classes. The proposed four-step approach for formalizing the APC provides a novel, systematically developed, strong framework to semantically enrich procedure classifications. Although this methodology was designed to address the particularities of the APC, the included methods are based on generic analysis tasks, and therefore can be re-used to provide a systematic representation of other procedure catalogs or classification systems and hence contribute towards a universal alignment of such representations, if desired. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Behavior Change Techniques in Apps for Medication Adherence: A Content Analysis.

    PubMed

    Morrissey, Eimear C; Corbett, Teresa K; Walsh, Jane C; Molloy, Gerard J

    2016-05-01

    There are a vast number of smartphone applications (apps) aimed at promoting medication adherence on the market; however, the theory and evidence base in terms of applying established health behavior change techniques underpinning these apps remains unclear. This study aimed to code these apps using the Behavior Change Technique Taxonomy (v1) for the presence or absence of established behavior change techniques. The sample of apps was identified through systematic searches in both the Google Play Store and Apple App Store in February 2015. All apps that fell into the search categories were downloaded for analysis. The downloaded apps were screened with exclusion criteria, and suitable apps were reviewed and coded for behavior change techniques in March 2015. Two researchers performed coding independently. In total, 166 medication adherence apps were identified and coded. The number of behavior change techniques contained in an app ranged from zero to seven (mean=2.77). A total of 12 of a possible 96 behavior change techniques were found to be present across apps. The most commonly included behavior change techniques were "action planning" and "prompt/cues," which were included in 96% of apps, followed by "self-monitoring" (37%) and "feedback on behavior" (36%). The current extent to which established behavior change techniques are used in medication adherence apps is limited. The development of medication adherence apps may not have benefited from advances in the theory and practice of health behavior change. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  9. Supervised Extraction of Diagnosis Codes from EMRs: Role of Feature Selection, Data Selection, and Probabilistic Thresholding.

    PubMed

    Rios, Anthony; Kavuluru, Ramakanth

    2013-09-01

    Extracting diagnosis codes from medical records is a complex task carried out by trained coders by reading all the documents associated with a patient's visit. With the popularity of electronic medical records (EMRs), computational approaches to code extraction have been proposed in the recent years. Machine learning approaches to multi-label text classification provide an important methodology in this task given each EMR can be associated with multiple codes. In this paper, we study the the role of feature selection, training data selection, and probabilistic threshold optimization in improving different multi-label classification approaches. We conduct experiments based on two different datasets: a recent gold standard dataset used for this task and a second larger and more complex EMR dataset we curated from the University of Kentucky Medical Center. While conventional approaches achieve results comparable to the state-of-the-art on the gold standard dataset, on our complex in-house dataset, we show that feature selection, training data selection, and probabilistic thresholding provide significant gains in performance.

  10. Medical Students' Perceptions and Preferences for Sexual Health Education

    ERIC Educational Resources Information Center

    Zamboni, Brian; Bezek, Katelyn

    2017-01-01

    Sexual health topics are not well-covered in US medical schools. Research has not typically asked medical students what sexual health topics they would like addressed and their preferred methods of sexual health education. This study attempted to address this deficit via an online survey of medical students at an institution where little sexual…

  11. Mediating the gap between the white coat ceremony and the ethics and professionalism curriculum.

    PubMed

    Cohn, Felicia; Lie, Désirée

    2002-11-01

    Like many other medical schools, the University of California, Irvine annually conducts a White Coat ceremony in which incoming students take a professional oath of ethical conduct.(1) We report a new educational activity to connect the values expressed in the oath taken to the Ethics and Professionalism (EP) curriculum for first-year medical students(2) and its potential impact on physician training. Following the White Coat ceremony, students participated in the Patient Doctor Society course that integrates diverse curricular topics centered on physician-patient communication. During this course, the students were introduced to EP content through a collaborative peer exercise. With the assistance of background readings on professional values and ethics concepts, small groups of students were asked to construct their own codes of ethics. The process of working in a group became part of the learning. After developing a code of ethics, each group was asked to identify primary values embodied in its code; primary obligations to patients and their families, other members of the health care team, and the community; key factors influencing code development; and likely effects of the code on the conduct of medical students and physicians. The goals of the session were to recognize formally both individual values and the values to which students commit themselves during the White Coat ceremony, to facilitate understanding of those values, and to begin to reconcile differences between personal and professional values. The small groups convened to report their findings in a three-hour session. Common values expressed by the students included patient autonomy, respect, beneficence, and professionalism. The delivery of quality health care, communication, education, and the equitable distribution of health care were among the most often listed obligations. The students reported that culture, societal values, family, experience, religion, education, and assigned readings were the key sources of the values in their codes. Most of the students enjoyed and learned from the exercise, believing that a code of ethics will serve as a helpful educational guide while they are students and as an action guide in their future practices. Student evaluations, narrative feedback, and faculty observation indicated that the students appreciated the opportunity to work in teams and to explore professional values. The students' most common suggestion for improvement involved incorporating analysis of clinical cases in which questions about professional values arise. Medical educators suggest that students' values and professional behaviors change throughout medical school, but such change is difficult to assess. The code-development exercise established a baseline of values at entry to medical school. We plan to track this cohort of students by reintroducing this exercise in their fourth year and will compare the codes developed in their first and fourth years to identify changes in values and to suggest what the students have learned about values during medical school. The comparison will be used to inform further development of the EP curriculum toward the goal of shaping and supporting the positive professional growth of our student-physicians.

  12. Model of Dredging Impact on Dungeness Crab in Grays Harbor, Washington

    DTIC Science & Technology

    1987-06-01

    Washington. 43 pp. Barry, Steve. 1986. Personal communication . Washington Dept. of Fisheries , Montesano, Washington. Bella, D.A. and K.J. Williamson. 1980... FISHERIES 18SHERIES RESEARCH INSTITUTE *~~ ~~~~~~~ Z *;r. .’."*,* U.-~0 SECURITY CLASSIFICATION OF THIS PAGE REPORT DOCUMENTATION PAGE Form Approved...School of Fisheries U.S.Ary Corps of Engineers, Seattle District 6c. ADDRESS (Cty, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code

  13. Social responsibility of nursing: a global perspective.

    PubMed

    Tyer-Viola, Lynda; Nicholas, Patrice K; Corless, Inge B; Barry, Donna M; Hoyt, Pamela; Fitzpatrick, Joyce J; Davis, Sheila M

    2009-05-01

    This study addresses social responsibility in the discipline of nursing and implications for global health. The concept of social responsibility is explicated and its relevance for nursing is examined, grounded in the American Nurses Association Code of Ethics and the International Council of Nurses Code of Ethics. Social justice, human rights, nurse migration, and approaches to nursing education are discussed within the framework of nursing's social responsibility. Strategies for addressing nursing workforce issues and education within a framework of social responsibility are explored.

  14. Applications of Functional Analytic and Martingale Methods to Problems in Queueing Network Theory.

    DTIC Science & Technology

    1983-05-14

    8217’") Air Force Office of Scientific Research Sf. ADDRESS (Cllty. State and ZIP Code) 7b. ADDRESS (City. State and ZIP Code) Directorate of Mathematical... Scientific Report on Air Force Grant #82-0167 Principal Investigator: Professor Walter A. Rosenkrantz I. Publications (1) Calculation of the LaPlace transform...whether or not a protocol for accessing a comunications channel is stable. In AFOSR 82-0167, Report No. 3 we showed that the SLOTTED ALOHA Multi access

  15. Thermospray Liquid Chromatography/Mass Spectrometry of Mustard and Its Metabolites

    DTIC Science & Technology

    1989-05-01

    MONITORING ORGANIZATION REPORT NUMBER(S) CRDEC-TR-066 6a. NAME OF PERFORMING ORGANIZATION 6b OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION (If applicable...see reverse 6c- ADDRESS (Cty, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code) Ba. NAME OF FUNDING/SPONSORING 8b OFFICE SYMBOL 9...Ather und Thioather in Dioxan- Wasser -Gemischen," Chem, Ber. Vol. 81, p 123 (1948). 2. Capon, B., and McManus, S. P., Neighboring Group Participation

  16. The Telecommunications Emergency Decision Support System as a Crisis Management Decision Support System

    DTIC Science & Technology

    1991-09-01

    NAVAL POSTGRADUATE SCHOOL Monterey, California AD-A246 188 7 R DTIC fl ELECTE FEB2 1992 U THESIS THE TELECOMMUNICATIONS EMERGENCY DECISION SUPPORT...ORGANIZATION REPORT NUMBER(S) a. NAME OF PERFORMING ORGANIZATION 6b. OFFICE SYMBOl 7a. NAME OF MONITORING ORGANIZATION Naval Postgraduate School J ""X...s Naval Postgraduate School c. ADDRESS (City, State and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code) Monterey, CA 93943-5000 Monterey, CA 93943

  17. Bibliography on Metrication, January 1977 to August 1989

    DTIC Science & Technology

    1990-08-01

    X.L. 109 Guist, Althea R . 460 Gutmann, Fredrick T. 14,291 Hager. Mary 306 Halstead, Bruce B. 188 Hamilton, A.B. 21,303 Hanley, Charles J. 417 Hart, K.C...Scientific Info. Cent IAMSMI-RD-cs- R 6c. ADDRESS (CIty, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code) Commander, U.S. Army Missile Command...Redstone Scientific Information Center AMSMI-RD-CS- R Redstone Arsenal, AL 35898-5241 8a. NAME OF FUNDING/SPONSORING 18b. OFFICE SYMBOL 9. PROCUREMENT

  18. Proceedings of Workshop 15 of the COSPAR Meetings Held in Toulouse, France on 30 June-12 July 1986. Chapter 2. Reference Atmospheres and Thermospheric Mapping,

    DTIC Science & Technology

    1988-01-21

    DISTRIBUTION/AVAILABILITY OF REPORT Approved for public release; 2b. DECLASSIFICATION /’DOWNGRADING SCHEDULE Distribution unlimited 4. PERFORMING ORGANIZATION ...REPORT NUMBER(S) 5. MONITORING ORGANIZATION REPORT NUMBER(S) AFGL-TR-88-0016 6a, NAME OF PERFORMING ORGANIZATION 6b. OFFICE SYMBOL 7a. NAME OF...MONITORING ORGANIZATION Air Force Geophysics (If applicable) Laboratory I oc. ADDRESS (City, State, and ZIP Code) 7b ADDRESS (City, Stare, and ZIP Code

  19. IGG Subclass and Isotype Specific Immunoglobulin Responses to LASSA fever and Venezuelan Equine Encephalomyelitis: Natural Infection and Immunication

    DTIC Science & Technology

    1989-03-01

    VENEZUELAN EQUINE ENCEPHALOMYELITIS: NATURAL INFECTION AND IMMUNIZATION PRINCIPAL INVESTIGATOR: Renata J. Engler CONTRACTING ORGANIZATION: Uniformed Services...University of Health Sciences 4301 Jones Bridges Road Bethesda, MD 20814-4799 DTIC REPORT DATE: March 1, 1989 E T E MAR0 6 1990 TYPE OF REPORT...University (if applicable) of Health Sciences I 6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code) 4301 Jones Bridges Road

  20. Miller Cave (23PU2), Fort Leonard Wood, Pulaski County, Missouri: Report of Archaeological Testing and Assessment of Damage

    DTIC Science & Technology

    1993-01-01

    SECURITY CLASSIFICATION AUTHORITY 3. DISTRIBUTION JAVAILABIUITY OF REPORT 2b. DECLASSIFICATION I OWNGRAD)ING SCHEDULE I4. PERFORMING ORGANIZATION ...REPORT NUMBER(S) 5. MONITORING ORGANIZATION REPORT NUMBER(S) RESEARCH REPORT NO. 9 6a. NAME OF PERFORMING ORGANIZATION 6b. OFFICE SYMBOL 7a. NAME OF...MONITORING ORGANIZATION Markman & Associates, Inc.(I plcbe 6c. ADDRESS (City. State. and ZIP Code) 7b. ADDRESS (City. State. and ZIP Code) 824 N. Bl

  1. Automation of a high risk medication regime algorithm in a home health care population.

    PubMed

    Olson, Catherine H; Dierich, Mary; Westra, Bonnie L

    2014-10-01

    Create an automated algorithm for predicting elderly patients' medication-related risks for readmission and validate it by comparing results with a manual analysis of the same patient population. Outcome and Assessment Information Set (OASIS) and medication data were reused from a previous, manual study of 911 patients from 15 Medicare-certified home health care agencies. The medication data was converted into standardized drug codes using APIs managed by the National Library of Medicine (NLM), and then integrated in an automated algorithm that calculates patients' high risk medication regime scores (HRMRs). A comparison of the results between algorithm and manual process was conducted to determine how frequently the HRMR scores were derived which are predictive of readmission. HRMR scores are composed of polypharmacy (number of drugs), Potentially Inappropriate Medications (PIM) (drugs risky to the elderly), and Medication Regimen Complexity Index (MRCI) (complex dose forms, instructions or administration). The algorithm produced polypharmacy, PIM, and MRCI scores that matched with 99%, 87% and 99% of the scores, respectively, from the manual analysis. Imperfect match rates resulted from discrepancies in how drugs were classified and coded by the manual analysis vs. the automated algorithm. HRMR rules lack clarity, resulting in clinical judgments for manual coding that were difficult to replicate in the automated analysis. The high comparison rates for the three measures suggest that an automated clinical tool could use patients' medication records to predict their risks of avoidable readmissions. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. 21 CFR 314.440 - Addresses for applications and abbreviated applications.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... mail code for the Office of Generic Drugs is HFD-600, the mail codes for the Divisions of Chemistry I... leukapheresis; (3) Blood component processing solutions and shelf life extenders; and (4) Oxygen carriers. [50...

  3. 21 CFR 314.440 - Addresses for applications and abbreviated applications.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... mail code for the Office of Generic Drugs is HFD-600, the mail codes for the Divisions of Chemistry I... leukapheresis; (3) Blood component processing solutions and shelf life extenders; and (4) Oxygen carriers. [50...

  4. 21 CFR 314.440 - Addresses for applications and abbreviated applications.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... mail code for the Office of Generic Drugs is HFD-600, the mail codes for the Divisions of Chemistry I... leukapheresis; (3) Blood component processing solutions and shelf life extenders; and (4) Oxygen carriers. [50...

  5. 21 CFR 314.440 - Addresses for applications and abbreviated applications.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... mail code for the Office of Generic Drugs is HFD-600, the mail codes for the Divisions of Chemistry I... leukapheresis; (3) Blood component processing solutions and shelf life extenders; and (4) Oxygen carriers. [50...

  6. FAQ Question Submission

    Science.gov Websites

    , fax, or phone. Use this area to send us your question. Your name: Your E-Mail address: Your Phone Number (voice): Please include area code. Your Fax Number: Please include area code. Send Your Question

  7. Modeling of rolling element bearing mechanics. Computer program user's manual

    NASA Technical Reports Server (NTRS)

    Greenhill, Lyn M.; Merchant, David H.

    1994-01-01

    This report provides the user's manual for the Rolling Element Bearing Analysis System (REBANS) analysis code which determines the quasistatic response to external loads or displacement of three types of high-speed rolling element bearings: angular contact ball bearings, duplex angular contact ball bearings, and cylindrical roller bearings. The model includes the defects of bearing ring and support structure flexibility. It is comprised of two main programs: the Preprocessor for Bearing Analysis (PREBAN) which creates the input files for the main analysis program, and Flexibility Enhanced Rolling Element Bearing Analysis (FEREBA), the main analysis program. This report addresses input instructions for and features of the computer codes. A companion report addresses the theoretical basis for the computer codes. REBANS extends the capabilities of the SHABERTH (Shaft and Bearing Thermal Analysis) code to include race and housing flexibility, including such effects as dead band and preload springs.

  8. Relation of knowledge and level of education to the rationality of self-medication on childhood diarrhea on the Code River banks in Jogoyudan, Jetis, Yogyakarta

    NASA Astrophysics Data System (ADS)

    Dania, H.; Ihsan, M. N.

    2017-11-01

    Self-medication as an alternative is used to reduce the severity of diarrhea. Optimal treatment can be done by increasing the rationalization of self-medication on diarrhea. This can be achieved with good knowledge about self-medication, which is in turn influenced by level of education. The aim of this study was to determine the relationship of knowledge and education level to rationality of self-medication on childhood diarrhea around the Code River in Jogoyudan, Jetis, Yogyakarta. The study was conducted by cross-sectional analytical observational design. The subjects were mothers who had children aged 2-11 years who had experienced diarrhea and had self-medication. Questionnaires were used to assess the rationality of self-medication on children's diarrhea by the parents. The respondents were askeds to fill out about indications, right drugs, doses, time intervals and periods of drug administration. Data were analyzed using chi- square. It was showed that of 40 respondents, 14 respondents (35%) performed rational self-medication on children's diarrhea and 26 respondents (65%). did not rationalize the treatment. The results of a bivariate test obtained a chi-square value of 9.808 (> 3.841) and a p value of 0.002 (<0.05) on the relationship between education level and rationality of self-medication and a chi-square value of 19.476 (> 3.841) and a p value of 0.000 (<0.05) on relationship between knowledge and rationality of self- medication. The conclusion of this study is that there is a correlation between knowledge and level of education and rationality of self-medication on childhood diarrhea on the Code River banks in Jogoyudan, Jetis, Yogyakarta.

  9. Balancing the benefits and risks of public-private partnerships to address the global double burden of malnutrition.

    PubMed

    Kraak, Vivica I; Harrigan, Paige B; Lawrence, Mark; Harrison, Paul J; Jackson, Michaela A; Swinburn, Boyd

    2012-03-01

    Transnational food, beverage and restaurant companies, and their corporate foundations, may be potential collaborators to help address complex public health nutrition challenges. While UN system guidelines are available for private-sector engagement, non-governmental organizations (NGO) have limited guidelines to navigate diverse opportunities and challenges presented by partnering with these companies through public-private partnerships (PPP) to address the global double burden of malnutrition. We conducted a search of electronic databases, UN system websites and grey literature to identify resources about partnerships used to address the global double burden of malnutrition. A narrative summary provides a synthesis of the interdisciplinary literature identified. We describe partnership opportunities, benefits and challenges; and tools and approaches to help NGO engage with the private sector to address global public health nutrition challenges. PPP benefits include: raising the visibility of nutrition and health on policy agendas; mobilizing funds and advocating for research; strengthening food-system processes and delivery systems; facilitating technology transfer; and expanding access to medications, vaccines, healthy food and beverage products, and nutrition assistance during humanitarian crises. PPP challenges include: balancing private commercial interests with public health interests; managing conflicts of interest; ensuring that co-branded activities support healthy products and healthy eating environments; complying with ethical codes of conduct; assessing partnership compatibility; and evaluating partnership outcomes. NGO should adopt a systematic and transparent approach using available tools and processes to maximize benefits and minimize risks of partnering with transnational food, beverage and restaurant companies to effectively target the global double burden of malnutrition.

  10. An Adaptive Source-Channel Coding with Feedback for Progressive Transmission of Medical Images

    PubMed Central

    Lo, Jen-Lung; Sanei, Saeid; Nazarpour, Kianoush

    2009-01-01

    A novel adaptive source-channel coding with feedback for progressive transmission of medical images is proposed here. In the source coding part, the transmission starts from the region of interest (RoI). The parity length in the channel code varies with respect to both the proximity of the image subblock to the RoI and the channel noise, which is iteratively estimated in the receiver. The overall transmitted data can be controlled by the user (clinician). In the case of medical data transmission, it is vital to keep the distortion level under control as in most of the cases certain clinically important regions have to be transmitted without any visible error. The proposed system significantly reduces the transmission time and error. Moreover, the system is very user friendly since the selection of the RoI, its size, overall code rate, and a number of test features such as noise level can be set by the users in both ends. A MATLAB-based TCP/IP connection has been established to demonstrate the proposed interactive and adaptive progressive transmission system. The proposed system is simulated for both binary symmetric channel (BSC) and Rayleigh channel. The experimental results verify the effectiveness of the design. PMID:19190770

  11. Developing Electronic Health Record Algorithms That Accurately Identify Patients With Systemic Lupus Erythematosus.

    PubMed

    Barnado, April; Casey, Carolyn; Carroll, Robert J; Wheless, Lee; Denny, Joshua C; Crofford, Leslie J

    2017-05-01

    To study systemic lupus erythematosus (SLE) in the electronic health record (EHR), we must accurately identify patients with SLE. Our objective was to develop and validate novel EHR algorithms that use International Classification of Diseases, Ninth Revision (ICD-9), Clinical Modification codes, laboratory testing, and medications to identify SLE patients. We used Vanderbilt's Synthetic Derivative, a de-identified version of the EHR, with 2.5 million subjects. We selected all individuals with at least 1 SLE ICD-9 code (710.0), yielding 5,959 individuals. To create a training set, 200 subjects were randomly selected for chart review. A subject was defined as a case if diagnosed with SLE by a rheumatologist, nephrologist, or dermatologist. Positive predictive values (PPVs) and sensitivity were calculated for combinations of code counts of the SLE ICD-9 code, a positive antinuclear antibody (ANA), ever use of medications, and a keyword of "lupus" in the problem list. The algorithms with the highest PPV were each internally validated using a random set of 100 individuals from the remaining 5,759 subjects. The algorithm with the highest PPV at 95% in the training set and 91% in the validation set was 3 or more counts of the SLE ICD-9 code, ANA positive (≥1:40), and ever use of both disease-modifying antirheumatic drugs and steroids, while excluding individuals with systemic sclerosis and dermatomyositis ICD-9 codes. We developed and validated the first EHR algorithm that incorporates laboratory values and medications with the SLE ICD-9 code to identify patients with SLE accurately. © 2016, American College of Rheumatology.

  12. Relativity Screens for Misvalued Medical Services: Impact on Noninvasive Diagnostic Radiology.

    PubMed

    Rosenkrantz, Andrew B; Silva, Ezequiel; Hawkins, C Matthew

    2017-11-01

    In 2006, the AMA/Specialty Society Relative Value Scale Update Committee (RUC) introduced ongoing relativity screens to identify potentially misvalued medical services for payment adjustments. We assess the impact of these screens upon the valuation of noninvasive diagnostic radiology services. Data regarding relativity screens and relative value unit (RVU) changes were obtained from the 2016 AMA Relativity Assessment Status Report. All global codes in the 2016 Medicare Physician Fee Schedule with associated work RVUs were classified as noninvasive diagnostic radiology services versus remaining services. The frequency of having ever undergone a screen was compared between the two groups. Screened radiology codes were further evaluated regarding the RVU impact of subsequent revaluation. Of noninvasive diagnostic radiology codes, 46.0% (201 of 437) were screened versus 22.2% (1,460 of 6,575) of remaining codes (P < .001). Most common screens for which radiology codes were identified as potentially misvalued were (1) high expenditures (27.5%) and (2) high utilization (25.6%). The modality and body region most likely to be identified in a screen were CT (82.1%) and breast (90.9%), respectively. Among screened radiology codes, work RVUs, practice expense RVUs, and nonfacility total RVUs decreased in 20.3%, 65.9%, and 75.3%, respectively. All screened CT, MRI, brain, and spine codes exhibited decreased total RVUs. Policymakers' ongoing search for potentially misvalued medical services has disproportionately impacted noninvasive diagnostic radiology services, risking the introduction of unintended or artificial shifts in physician practice. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  13. Data integration of structured and unstructured sources for assigning clinical codes to patient stays

    PubMed Central

    Luyckx, Kim; Luyten, Léon; Daelemans, Walter; Van den Bulcke, Tim

    2016-01-01

    Objective Enormous amounts of healthcare data are becoming increasingly accessible through the large-scale adoption of electronic health records. In this work, structured and unstructured (textual) data are combined to assign clinical diagnostic and procedural codes (specifically ICD-9-CM) to patient stays. We investigate whether integrating these heterogeneous data types improves prediction strength compared to using the data types in isolation. Methods Two separate data integration approaches were evaluated. Early data integration combines features of several sources within a single model, and late data integration learns a separate model per data source and combines these predictions with a meta-learner. This is evaluated on data sources and clinical codes from a broad set of medical specialties. Results When compared with the best individual prediction source, late data integration leads to improvements in predictive power (eg, overall F-measure increased from 30.6% to 38.3% for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes), while early data integration is less consistent. The predictive strength strongly differs between medical specialties, both for ICD-9-CM diagnostic and procedural codes. Discussion Structured data provides complementary information to unstructured data (and vice versa) for predicting ICD-9-CM codes. This can be captured most effectively by the proposed late data integration approach. Conclusions We demonstrated that models using multiple electronic health record data sources systematically outperform models using data sources in isolation in the task of predicting ICD-9-CM codes over a broad range of medical specialties. PMID:26316458

  14. Problems and Processes in Medical Encounters: The CASES method of dialogue analysis

    PubMed Central

    Laws, M. Barton; Taubin, Tatiana; Bezreh, Tanya; Lee, Yoojin; Beach, Mary Catherine; Wilson, Ira B.

    2013-01-01

    Objective To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. Methods Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The Comprehensive Analysis of the Structure of Encounters System (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads – the problems or issues addressed; and processes within threads –basic tasks of clinical care labeled Presentation, Information, Resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. Results 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. Conclusions In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. Practice Implications Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective. PMID:23391684

  15. Problems and processes in medical encounters: the cases method of dialogue analysis.

    PubMed

    Laws, M Barton; Taubin, Tatiana; Bezreh, Tanya; Lee, Yoojin; Beach, Mary Catherine; Wilson, Ira B

    2013-05-01

    To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The comprehensive analysis of the structure of encounters system (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads--the problems or issues addressed; and processes within threads--basic tasks of clinical care labeled presentation, information, resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Coordinated Care Management For Dementia In A Large, Academic Health System

    PubMed Central

    Tan, Zaldy S.; Jennings, Lee; Reuben, David

    2014-01-01

    Alzheimer’s disease and other dementias are chronic, incurable diseases that require coordinated care that addresses the medical, behavioral, and social aspects of the disease. With funding from the Center for Medicare and Medicaid Innovation (the Innovation Center), we launched a dementia care program in which a nurse practitioner acting as a dementia care manager worked with primary care physicians to develop and implement a dementia care plan that offers training and support to caregivers, manages care transitions, and facilitates access to community-based services. Post-visit surveys showed high levels of caregiver satisfaction. As program enrollment grows, outcomes will be tracked based on the triple aim developed by the Institute for Healthcare Improvement and adopted by the Centers for Medicare and Medicaid Services: better care, better health, and lower cost and utilization. The program, if successful at achieving the triple aim, may serve as a national model for how dementia and other chronic diseases can be managed in partnership with primary care practices. The program may also inform policy and reimbursement decisions for the recently released transitional care management codes and the complex chronic care management codes to be released by Medicare in 2015. PMID:24711323

  17. Illuminating exemplary professionalism using appreciative inquiry dialogues between students and mentors.

    PubMed

    Butani, Lavjay; Bogetz, Alyssa; Plant, Jennifer

    2018-05-25

    To explore the types of exemplary professional behaviors and the facilitators and barriers to professional behavior discussed by student-mentor dyads during appreciative inquiry (AI) dialogs. We conducted a qualitative analysis of AI narratives discussing exemplary professional practice written by third-year medical students following a dialog with mentors. Narratives were thematically analyzed using directed content analysis to explore the types of exemplary professional behaviors discussed and the facilitators and barriers to professional practice. Narratives were coded independently by two investigators; codes were finalized, themes were derived, and a model on how exemplary professional behaviors are nurtured and reinforced was developed. Themes addressed humanism toward others and excellence, with altruism being an underlying implicit guiding principle behind professional behavior. Humanism toward self was infrequently discussed as an aspect of professionalism, but when discussed, was perceived to foster resilience. Principle-based attitudes and emotional intelligence facilitated professional behaviors. Programmatic scaffolds facilitated professional behavior and included curricula on reflective practice, mentorship, promoting learner autonomy and connectedness, and a safe environment. AI is an effective strategy that can be used to stimulate learner reflection on professionalism, humanism, and wellness and promote learner acknowledgement of positive aspects of the learning environment.

  18. Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context.

    PubMed

    London, Leslie; Tangwa, Godfrey; Matchaba-Hove, Reginald; Mkhize, Nhlanhla; Nwabueze, Remi; Nyika, Aceme; Westerholm, Peter

    2014-06-23

    International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace. A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region.

  19. Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context

    PubMed Central

    2014-01-01

    Background International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Discussion Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace. Summary A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region. PMID:24957477

  20. Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds.

    PubMed

    Miller, Daniel F; Fortier, Christopher R; Garrison, Kelli L

    2011-02-01

    Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors. To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR). Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted. Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time. BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes must be continually analyzed and restructured to yield the intended full benefits of BCMA technology. © 2011 SAGE Publications.

  1. 48 CFR 52.204-6 - Data Universal Numbering System (DUNS) Number.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of business (industry). (x) Company Headquarters name and address (reporting relationship within your... office. (2) The offeror should be prepared to provide the following information: (i) Company legal.... (iii) Company physical street address, city, state and Zip Code. (iv) Company mailing address, city...

  2. "Looking out for each other": a qualitative study on the role of social network interactions in asthma management among adult Latino patients presenting to an emergency department.

    PubMed

    Pai, Sucheta; Boutin-Foster, Carla; Mancuso, Carol A; Loganathan, Raghu; Basir, Riyad; Kanna, Balavenkatesh

    2014-09-01

    The objective of this study was to identify the types of interactions between asthma patients and their social networks such as close family and friends that influence the management of asthma. Participants were Latino adults presenting for a repeat visit to the emergency department for asthma treatment. Qualitative interviews were conducted with 76 participants. They were asked to describe the experiences of their social networks that have asthma and how interactions with these individuals influenced their own asthma management. Responses were transcribed and analyzed using Grounded Theory as a qualitative analytic approach. Responses were assigned codes; similar codes were grouped into concepts and then categorized to form overarching themes. Four themes emerged: (1) Perceptions of severity of asthma may be based on the experiences of social networks; (2) Economic factors may contribute to the sharing and borrowing of asthma medications between patients and their social networks; (3) Economic factors may contribute to using home remedies instead of prescribed medications; (4) Social network members may be unaware of the factors that trigger asthma and therefore, contribute to asthma exacerbations. This study identified important social network interactions that may impact asthma management in Latino adults. These results can be used to broaden the current focus of asthma self-management programs to incorporate discussions on the role of social networks. A focus on social network interactions addresses the social epidemiology of asthma and advances our understanding of root causes that may underlie the high prevalence of asthma in many Latino communities.

  3. The prevalence of obesity documentation in Primary Care Electronic Medical Records. Are we acknowledging the problem?

    PubMed

    Mattar, Ahmed; Carlston, David; Sariol, Glen; Yu, Tongle; Almustafa, Ahmad; Melton, Genevieve B; Ahmed, Adil

    2017-01-25

    Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient's problem list for patients with eligible body mass indexes (BMI) as contained in the patients' electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese.

  4. Exploring Canadian Physicians' Experiences Providing Medical Assistance in Dying: A Qualitative Study.

    PubMed

    Khoshnood, Narges; Hopwood, Marie-Clare; Lokuge, Bhadra; Kurahashi, Allison; Tobin, Anastasia; Isenberg, Sarina; Husain, Amna

    2018-05-15

    MAiD allows a practitioner to administer or prescribe medication for the purpose of ending a patient's life. In 2016, Canada was the latest country, following several European countries and American states, to legalize physician-assisted death. Although some studies report on physician attitudes towards MAiD or describe patient characteristics, there are few that explore the professional challenges faced by physicians who provide MAiD. To explore the professional challenges faced by Canadian physicians who provide MAiD. Sixteen physicians from across Canada who provide MAiD completed in-depth, semi-structured telephone interviews. An inductive thematic analysis approach guided data collection and the iterative, interpretive analysis of interview transcripts. Three members of the research team systematically co-coded interview transcripts and the emerging themes were developed with the broader research team. NVivo was used to manage the coded data. Participants described three challenges associated with providing MAiD: 1) their relationships with other MAiD providers were enhanced and relationships with objecting colleagues were sometimes strained, 2) they received inadequate financial compensation for time, and, 3) they experienced increased workload, resulting in sacrifices to personal time. Although these providers did not intend to stop providing MAiD at the time of the interview, they indicated their concerns about whether they would be able to sustain this service over time. Physicians described relationship, financial, and workload challenges to providing MAiD. We provide several recommendations to address these challenges and help ensure the sustainability of MAiD in countries that provide this service. Copyright © 2018. Published by Elsevier Inc.

  5. The ethically trained physician: myth or reality?

    PubMed Central

    Balkos, G. K.

    1983-01-01

    Through a questionnaire distributed to 300 physicians in the Toronto area, three aspects of their ethical awareness were examined: the formal codes, the need for consultation in making decisions and the need for training in medical ethics. Most of the physicians (81%) felt that they were facing ethical problems in their daily practice. A majority of these would try to solve the problems either themselves (30%) or through discussion with a colleague (43%). When they turned outside the profession it was sometimes to a lawyer (12%), which suggests concern with the legalities of some situations. Only a small proportion of the respondents were found to be familiar with two of the established codes of ethics, yet 13% would still turn to the code of the Canadian Medical Association for guidance. Finally, there was widespread recognition of the need for proper training in medical ethics and for the establishment of a specialty in this field. PMID:6825034

  6. [New forms of medical profession--advertising].

    PubMed

    Wolter, Udo

    2005-04-01

    Particularly in the last two years, the legislation of Part V of the German Social Code has challenged the time-honoured system of the physician's own medical practice as the panel doctor's registered office. New forms of outpatient care, for example the health centres, "Heilkunde-GmbHs", and the recently-developed medical care centres, are intended to impact on patients' ambulatory healthcare. Due to the partial employee status of practice owners, and thus the relinquishing of the independent entrepreneurial structuring of their own practices, the construct of the traditional professional code of conduct for physicians is beginning to totter. It remains to be seen whether liberalisation of the model code of conduct will provide a remedy. The principle should, however, be adhered to that advertising in the physician sector must not be unethical, if we understand this to mean not strident, not confusing, and not comparative.

  7. The role of the medical laboratory technologist in drinking and driving cases. Part 1: The Criminal Code and blood collection for alcohol analysis.

    PubMed

    Westenbrink, W

    1992-01-01

    Police officers can now demand blood samples from suspected impaired drivers in Canada to determine their Blood Alcohol Concentration. The medical laboratory technologist has been given the authority to take blood samples for legal purposes, as well as the authorization to complete certificates used as evidence in court. The proper procedures for the taking of blood samples and the completion of certificates are described in detail. The Criminal Code offences dealing with drinking and driving, the means by which police officers can legally obtain blood samples, the Blood Alcohol Kit, and the provision of providing blood collection evidence in court are discussed to aid the technologists in understanding their role in this process. The Criminal Code definitions of a "qualified medical practitioner", a "qualified technician", and "approved containers" are also described.

  8. VeryVote: A Voter Verifiable Code Voting System

    NASA Astrophysics Data System (ADS)

    Joaquim, Rui; Ribeiro, Carlos; Ferreira, Paulo

    Code voting is a technique used to address the secure platform problem of remote voting. A code voting system consists in secretly sending, e.g. by mail, code sheets to voters that map their choices to entry codes in their ballot. While voting, the voter uses the code sheet to know what code to enter in order to vote for a particular candidate. In effect, the voter does the vote encryption and, since no malicious software on the PC has access to the code sheet it is not able to change the voter’s intention. However, without compromising the voter’s privacy, the vote codes are not enough to prove that the vote is recorded and counted as cast by the election server.

  9. [Standardization of terminology in laboratory medicine I].

    PubMed

    Yoon, Soo Young; Yoon, Jong Hyun; Min, Won Ki; Lim, Hwan Sub; Song, Junghan; Chae, Seok Lae; Lee, Chang Kyu; Kwon, Jung Ah; Lee, Kap No

    2007-04-01

    Standardization of medical terminology is essential for data transmission between health-care institutions or clinical laboratories and for maximizing the benefits of information technology. Purpose of our study was to standardize the medical terms used in the clinical laboratory, such as test names, units, terms used in result descriptions, etc. During the first year of the study, we developed a standard database of concept names for laboratory terms, which covered the terms used in government health care centers, their branch offices, and primary health care units. Laboratory terms were collected from the electronic data interchange (EDI) codes from National Health Insurance Corporation (NHIC), Logical Observation Identifier Names and Codes (LOINC) database, community health centers and their branch offices, and clinical laboratories of representative university medical centers. For standard expression, we referred to the English-Korean/ Korean-English medical dictionary of Korean Medical Association and the rules for foreign language translation. Programs for mapping between LOINC DB and EDI code and for translating English to Korean were developed. A Korean standard laboratory terminology database containing six axial concept names such as components, property, time aspect, system (specimen), scale type, and method type was established for 7,508 test observations. Short names and a mapping table for EDI codes and Unified Medical Language System (UMLS) were added. Synonym tables for concept names, words used in the database, and six axial terms were prepared to make it easier to find the standard terminology with common terms used in the field of laboratory medicine. Here we report for the first time a Korean standard laboratory terminology database for test names, result description terms, result units covering most laboratory tests in primary healthcare centers.

  10. Falling short: how state laws can address health information exchange barriers and enablers.

    PubMed

    Schmit, Cason D; Wetter, Sarah A; Kash, Bita A

    2018-06-01

    Research on the implementation of health information exchange (HIE) organizations has identified both positive and negative effects of laws relating to governance, incentives, mandates, sustainability, stakeholder participation, patient engagement, privacy, confidentiality, and security. We fill a substantial research gap by describing whether comprehensive state and territorial HIE legal frameworks address identified legal facilitators and barriers. We used the Westlaw database to identify state and territorial laws relating to HIEs in effect on June 7, 2016 (53 jurisdictions). We blind-coded all laws and addressed coding discrepancies in peer-review meetings. We recorded a consensus code for each law in a master database. We compared 20 HIE legal attributes with identified barriers to and enablers of HIE activity in the literature. Forty-two states, the District of Columbia, and 2 territories have laws relating to HIEs. On average, jurisdictions address 8.32 of the 20 criteria selected in statutes and regulations. Twenty jurisdictions unambiguously address ≤5 criteria in statutes and regulations. None of the significant legal criteria are unambiguously addressed in >60% of the 53 jurisdictions. Laws can be barriers to or enablers of HIEs. However, jurisdictions are not addressing many significant issues identified by researchers. Consequently, there is a substantial risk that existing legal frameworks are not adequately supporting HIEs. The current evidence base is insufficient for comparative assessments or impact rankings of the various factors. However, the detailed Centers for Disease Control and Prevention dataset of HIE laws could enable investigations into the types of laws that promote or impede HIEs.

  11. Social media and the medical profession.

    PubMed

    Mansfield, Sarah J; Morrison, Stewart G; Stephens, Hugh O; Bonning, Michael A; Wang, Sheng-Hui; Withers, Aaron H J; Olver, Rob C; Perry, Andrew W

    2011-06-20

    Use of social media by doctors and medical students is common and growing. Although professional standards and codes of ethics that govern the behaviour of medical practitioners in Australia and New Zealand do not currently encompass social media, these codes need to evolve, because professional standards continue to apply in this setting. Inappropriate use of social media can result in harm to patients and the profession, including breaches of confidentiality, defamation of colleagues or employers, and violation of doctor-patient boundaries. The professional integrity of doctors and medical students can also be damaged through problematic interprofessional online relationships, and unintended exposure of personal information to the public, employers or universities. Doctors need to exercise extreme care in their use of social media to ensure they maintain professional standards.

  12. Coding for urologic office procedures.

    PubMed

    Dowling, Robert A; Painter, Mark

    2013-11-01

    This article summarizes current best practices for documenting, coding, and billing common office-based urologic procedures. Topics covered include general principles, basic and advanced urologic coding, creation of medical records that support compliant coding practices, bundled codes and unbundling, global periods, modifiers for procedure codes, when to bill for evaluation and management services during the same visit, coding for supplies, and laboratory and radiology procedures pertinent to urology practice. Detailed information is included for the most common urology office procedures, and suggested resources and references are provided. This information is of value to physicians, office managers, and their coding staff. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Runtime Detection of C-Style Errors in UPC Code

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Pirkelbauer, P; Liao, C; Panas, T

    2011-09-29

    Unified Parallel C (UPC) extends the C programming language (ISO C 99) with explicit parallel programming support for the partitioned global address space (PGAS), which provides a global memory space with localized partitions to each thread. Like its ancestor C, UPC is a low-level language that emphasizes code efficiency over safety. The absence of dynamic (and static) safety checks allows programmer oversights and software flaws that can be hard to spot. In this paper, we present an extension of a dynamic analysis tool, ROSE-Code Instrumentation and Runtime Monitor (ROSECIRM), for UPC to help programmers find C-style errors involving the globalmore » address space. Built on top of the ROSE source-to-source compiler infrastructure, the tool instruments source files with code that monitors operations and keeps track of changes to the system state. The resulting code is linked to a runtime monitor that observes the program execution and finds software defects. We describe the extensions to ROSE-CIRM that were necessary to support UPC. We discuss complications that arise from parallel code and our solutions. We test ROSE-CIRM against a runtime error detection test suite, and present performance results obtained from running error-free codes. ROSE-CIRM is released as part of the ROSE compiler under a BSD-style open source license.« less

  14. DRG coding practice: a nationwide hospital survey in Thailand.

    PubMed

    Pongpirul, Krit; Walker, Damian G; Rahman, Hafizur; Robinson, Courtland

    2011-10-31

    Diagnosis Related Group (DRG) payment is preferred by healthcare reform in various countries but its implementation in resource-limited countries has not been fully explored. This study was aimed (1) to compare the characteristics of hospitals in Thailand that were audited with those that were not and (2) to develop a simplified scale to measure hospital coding practice. A questionnaire survey was conducted of 920 hospitals in the Summary and Coding Audit Database (SCAD hospitals, all of which were audited in 2008 because of suspicious reports of possible DRG miscoding); the questionnaire also included 390 non-SCAD hospitals. The questionnaire asked about general demographics of the hospitals, hospital coding structure and process, and also included a set of 63 opinion-oriented items on the current hospital coding practice. Descriptive statistics and exploratory factor analysis (EFA) were used for data analysis. SCAD and Non-SCAD hospitals were different in many aspects, especially the number of medical statisticians, experience of medical statisticians and physicians, as well as number of certified coders. Factor analysis revealed a simplified 3-factor, 20-item model to assess hospital coding practice and classify hospital intention. Hospital providers should not be assumed capable of producing high quality DRG codes, especially in resource-limited settings.

  15. The Sensitivity of Adverse Event Cost Estimates to Diagnostic Coding Error

    PubMed Central

    Wardle, Gavin; Wodchis, Walter P; Laporte, Audrey; Anderson, Geoffrey M; Baker, Ross G

    2012-01-01

    Objective To examine the impact of diagnostic coding error on estimates of hospital costs attributable to adverse events. Data Sources Original and reabstracted medical records of 9,670 complex medical and surgical admissions at 11 hospital corporations in Ontario from 2002 to 2004. Patient specific costs, not including physician payments, were retrieved from the Ontario Case Costing Initiative database. Study Design Adverse events were identified among the original and reabstracted records using ICD10-CA (Canadian adaptation of ICD10) codes flagged as postadmission complications. Propensity score matching and multivariate regression analysis were used to estimate the cost of the adverse events and to determine the sensitivity of cost estimates to diagnostic coding error. Principal Findings Estimates of the cost of the adverse events ranged from $16,008 (metabolic derangement) to $30,176 (upper gastrointestinal bleeding). Coding errors caused the total cost attributable to the adverse events to be underestimated by 16 percent. The impact of coding error on adverse event cost estimates was highly variable at the organizational level. Conclusions Estimates of adverse event costs are highly sensitive to coding error. Adverse event costs may be significantly underestimated if the likelihood of error is ignored. PMID:22091908

  16. Guide for Training Medical Laboratory Technicians. Fourth Edition.

    ERIC Educational Resources Information Center

    American Medical Technologists, Park Ridge, IL.

    This document is intended to assist educators in the development of medical laboratory technician training programs. The following elements are included in the document: (1) an introduction; (2) the American Medical Technologists' Code of Ethics; (3) suggested curricula for medical laboratory technician programs for a 12-month course and an…

  17. 78 FR 41125 - Interim Enforcement Policy for Permanent Implant Brachytherapy Medical Event Reporting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-09

    ... Brachytherapy Medical Event Reporting AGENCY: Nuclear Regulatory Commission. ACTION: Policy statement; revision... medical events occurring under an NRC licensee's permanent implant brachytherapy program. This interim..., ``Adequacy of Medical Event Definitions in 10 CFR [Title 10 of the Code of Federal Regulations] 35.3045, and...

  18. The Effect of Medical Socialization on Medical Students' Need for Power.

    ERIC Educational Resources Information Center

    Kressin, Nancy R.

    1996-01-01

    Examines whether the individual personality characteristic of power motivation increases during medical school. Recorded interviews with a diverse group of medical students at two points in time were coded for power motivation. Results showed that white students' power motivation decreased, whereas minority students' levels remained the same,…

  19. Galen-In-Use: using artificial intelligence terminology tools to improve the linguistic coherence of a national coding system for surgical procedures.

    PubMed

    Rodrigues, J M; Trombert-Paviot, B; Baud, R; Wagner, J; Meusnier-Carriot, F

    1998-01-01

    GALEN has developed a language independent common reference model based on a medically oriented ontology and practical tools and techniques for managing healthcare terminology including natural language processing. GALEN-IN-USE is the current phase which applied the modelling and the tools to the development or the updating of coding systems for surgical procedures in different national coding centers co-operating within the European Federation of Coding Centre (EFCC) to create a language independent knowledge repository for multicultural Europe. We used an integrated set of artificial intelligence terminology tools named CLAssification Manager workbench to process French professional medical language rubrics into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation we generate controlled French natural language. The French national coding centre is then able to retrieve the initial professional rubrics with different categories of concepts, to compare the professional language proposed by expert clinicians to the French generated controlled vocabulary and to finalize the linguistic labels of the coding system in relation with the meanings of the conceptual system structure.

  20. Stress analysis and evaluation of a rectangular pressure vessel

    NASA Astrophysics Data System (ADS)

    Rezvani, M. A.; Ziada, H. H.; Shurrab, M. S.

    1992-10-01

    This study addresses structural analysis and evaluation of an abnormal rectangular pressure vessel, designed to house equipment for drilling and collecting samples from Hanford radioactive waste storage tanks. It had to be qualified according to ASME boiler and pressure vessel code, section 8; however, it had the cover plate bolted along the long face, a configuration not addressed by the code. Finite element method was used to calculate stresses resulting from internal pressure; these stresses were then used to evaluate and qualify the vessel. Fatigue is not a concern; thus, it can be built according to section 8, division 1 instead of division 2. Stress analysis was checked against the code. A stayed plate was added to stiffen the long side of the vessel.

  1. The Coding of Biological Information: From Nucleotide Sequence to Protein Recognition

    NASA Astrophysics Data System (ADS)

    Štambuk, Nikola

    The paper reviews the classic results of Swanson, Dayhoff, Grantham, Blalock and Root-Bernstein, which link genetic code nucleotide patterns to the protein structure, evolution and molecular recognition. Symbolic representation of the binary addresses defining particular nucleotide and amino acid properties is discussed, with consideration of: structure and metric of the code, direct correspondence between amino acid and nucleotide information, and molecular recognition of the interacting protein motifs coded by the complementary DNA and RNA strands.

  2. Epigenetic Machinery Regulates Alternative Splicing of Androgen Receptor (AR) Gene in Castration-Resistant Prostate Cancer (CRPC)

    DTIC Science & Technology

    2017-09-01

    Dallas, TX 75390 REPORT DATE: September 2017 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick...AND ADDRESS(ES) 5323 Harry Hines Blvd., Dallas, TX 75390 AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER UT Southwestern Me ical Center 5323...Harry Hines Blvd., Dallas, TX 75390 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical

  3. 21 CFR 1321.01 - DEA mailing addresses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Addresses Code of Federal Regulations Section—Topic DEA Mailing address DEA Administrator 1308.43(b)—Petition to initiate proceedings for rulemaking316.23(b)—Petition for grant of confidentiality for research..., Springfield, VA 22152-2639. 1301.18(c)—Research project controlled substance increase request. 1301.51...

  4. 21 CFR 1321.01 - DEA mailing addresses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Addresses Code of Federal Regulations Section—Topic DEA Mailing address DEA Administrator 1308.43(b)—Petition to initiate proceedings for rulemaking316.23(b)—Petition for grant of confidentiality for research..., Springfield, VA 22152-2639. 1301.18(c)—Research project controlled substance increase request. 1301.51...

  5. 21 CFR 1321.01 - DEA mailing addresses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Addresses Code of Federal Regulations Section—Topic DEA Mailing address DEA Administrator 1308.43(b)—Petition to initiate proceedings for rulemaking316.23(b)—Petition for grant of confidentiality for research..., Springfield, VA 22152-2639. 1301.18(c)—Research project controlled substance increase request. 1301.51...

  6. 21 CFR 1321.01 - DEA mailing addresses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Addresses Code of Federal Regulations Section—Topic DEA Mailing address DEA Administrator 1308.43(b)—Petition to initiate proceedings for rulemaking316.23(b)—Petition for grant of confidentiality for research..., Springfield, VA 22152-2639. 1301.18(c)—Research project controlled substance increase request. 1301.51...

  7. 21 CFR 1321.01 - DEA mailing addresses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Addresses Code of Federal Regulations Section—Topic DEA Mailing address DEA Administrator 1308.43(b)—Petition to initiate proceedings for rulemaking316.23(b)—Petition for grant of confidentiality for research..., Springfield, VA 22152-2639. 1301.18(c)—Research project controlled substance increase request. 1301.51...

  8. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Watson, C.R.

    The SNODOG Glossary is used by the DOE-supported life-span beagle studies to describe medical observations in a standardized format. It is an adaptation of the human medical glossary, SNOMED, which lists 107,165 terms. Each of the five laboratories, Argonne National Laboratory, the Inhalation Toxicology Research Institute, the Pacific Northwest Laboratory, the University of California at Davis, and the University of Utah, has selected an appropriate subset from the published SNOMED glossary and added beagle and research-specific terms. The National Radiobiology Archives is the coordinator of these enhancements, and periodically distributes SNODOG to the respective laboratories. Information donated by Colorado Statemore » University and Oak Ridge National Laboratory has been related to SNODOG and is available in a standardized format. This document is designed for the database manager and the scientist who will be managing or coding medical observations. It is also designed for the scientist analyzing coded information. The document includes: an overview of the NRA and the SNODOG glossary, a discussion of hardware requirements, a review of the SNODOG code structure and printed lists of the 4,770 terms which have been used at least once. Instructions for obtaining electronic copies of the glossary and for nominating additional terms are provided. This document describes the origins and structure of the SNODOG codes, explains code usage at each participating institution, and presents a usage frequency tabulation of the terms for neoplasia. A diskette or magnetic tape containing 15,641 SNODOG codes and translations is available on request.« less

  9. SNODOG Glossary: Part 1, Introduction

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Watson, C.R.

    The SNODOG Glossary is used by the DOE-supported life-span beagle studies to describe medical observations in a standardized format. It is an adaptation of the human medical glossary, SNOMED, which lists 107,165 terms. Each of the five laboratories, Argonne National Laboratory, the Inhalation Toxicology Research Institute, the Pacific Northwest Laboratory, the University of California at Davis, and the University of Utah, has selected an appropriate subset from the published SNOMED glossary and added beagle and research-specific terms. The National Radiobiology Archives is the coordinator of these enhancements, and periodically distributes SNODOG to the respective laboratories. Information donated by Colorado Statemore » University and Oak Ridge National Laboratory has been related to SNODOG and is available in a standardized format. This document is designed for the database manager and the scientist who will be managing or coding medical observations. It is also designed for the scientist analyzing coded information. The document includes: an overview of the NRA and the SNODOG glossary, a discussion of hardware requirements, a review of the SNODOG code structure and printed lists of the 4,770 terms which have been used at least once. Instructions for obtaining electronic copies of the glossary and for nominating additional terms are provided. This document describes the origins and structure of the SNODOG codes, explains code usage at each participating institution, and presents a usage frequency tabulation of the terms for neoplasia. A diskette or magnetic tape containing 15,641 SNODOG codes and translations is available on request.« less

  10. The MIMIC Code Repository: enabling reproducibility in critical care research.

    PubMed

    Johnson, Alistair Ew; Stone, David J; Celi, Leo A; Pollard, Tom J

    2018-01-01

    Lack of reproducibility in medical studies is a barrier to the generation of a robust knowledge base to support clinical decision-making. In this paper we outline the Medical Information Mart for Intensive Care (MIMIC) Code Repository, a centralized code base for generating reproducible studies on an openly available critical care dataset. Code is provided to load the data into a relational structure, create extractions of the data, and reproduce entire analysis plans including research studies. Concepts extracted include severity of illness scores, comorbid status, administrative definitions of sepsis, physiologic criteria for sepsis, organ failure scores, treatment administration, and more. Executable documents are used for tutorials and reproduce published studies end-to-end, providing a template for future researchers to replicate. The repository's issue tracker enables community discussion about the data and concepts, allowing users to collaboratively improve the resource. The centralized repository provides a platform for users of the data to interact directly with the data generators, facilitating greater understanding of the data. It also provides a location for the community to collaborate on necessary concepts for research progress and share them with a larger audience. Consistent application of the same code for underlying concepts is a key step in ensuring that research studies on the MIMIC database are comparable and reproducible. By providing open source code alongside the freely accessible MIMIC-III database, we enable end-to-end reproducible analysis of electronic health records. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  11. QR codes: next level of social media.

    PubMed

    Gottesman, Wesley; Baum, Neil

    2013-01-01

    The OR code, which is short for quick response code, system was invented in Japan for the auto industry. Its purpose was to track vehicles during manufacture; it was designed to allow high-speed component scanning. Now the scanning can be easily accomplished via cell phone, making the technology useful and within reach of your patients. There are numerous applications for OR codes in the contemporary medical practice. This article describes QR codes and how they might be applied for marketing and practice management.

  12. The availability of web sites offering to sell opioid medications without prescriptions.

    PubMed

    Forman, Robert F; Woody, George E; McLellan, Thomas; Lynch, Kevin G

    2006-07-01

    This study was designed to determine the availability of web sites offering to sell opioid medications without prescriptions. Forty-seven Internet searches were conducted with a variety of opioid medication terms, including "codeine," "no prescription Vicodin," and "OxyContin." Two independent raters examined the links generated in each search and resolved any coding disagreements. The resulting links were coded as "no prescription web sites" (NPWs) if they offered to sell opioid medications without prescriptions. In searches with terms such as "no prescription codeine" and "Vicodin," over 50% of the links obtained were coded as "NPWs." The proportion of links yielding NPWs was greater when the phrase "no prescription" was added to the opioid term. More than 300 opioid NPWs were identified and entered into a database. Three national drug-use monitoring studies have cited significant increases in prescription opioid use over the past 5 years, particularly among young people. The emergence of NPWs introduces a new vector for unregulated access to opioids. Research is needed to determine the effect of NPWs on prescription opioid use initiation, misuse, and dependence.

  13. [Introduction of a bar coding pharmacy stock replenishment system in a prehospital emergency medical unit: economical impact].

    PubMed

    Dupuis, S; Fecci, J-L; Noyer, P; Lecarpentier, E; Chollet-Xémard, C; Margenet, A; Marty, J; Combes, X

    2009-01-01

    To assess economical impact after introduction of a bar coding pharmacy stock replenishment system in a prehospital emergency medical unit. Observational before and after study. A computer system using specific software and bare-code technology was introduced in the pre hospital emergency medical unit (Smur). Overall activity and costs related to pharmacy were recorded annually during two periods: the first 2 years period before computer system introduction and the second one during the 4 years following this system installation. The overall clinical activity increased by 10% between the two periods whereas pharmacy related costs continuously decreased after the start of pharmacy management computer system use. Pharmacy stock management was easier after introduction of the new stock replenishment system. The mean pharmacy related cost of one patient management was 13 Euros before and 9 Euros after the introduction of the system. The overall cost savings during the studied period was calculated to reach 134,000 Euros. The introduction of a specific pharmacy management computer system allowed to do important costs savings in a prehospital emergency medical unit.

  14. [ENT medicine and head and neck surgery in the G-DRG system 2008].

    PubMed

    Franz, D; Roeder, N; Hörmann, K; Alberty, J

    2008-09-01

    Further developments in the German DRG system have been incorporated into the 2008 version. For ENT medicine and head and neck surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2007 and 2008 based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2008 focussed on the development of DRG structure, DRG validation and codes for medical procedures. The outcome of these changes for German hospitals may vary depending on the range of activities. The G-DRG system has gained in complexity again. High demands are made on correct and complete coding of complex ENT and head and neck surgery cases. Quality of case allocation within the G-DRG system has been improved. For standard cases quality of case allocation is adequate. Nevertheless, further adjustments of the G-DRG system especially for cases with complex neck surgery are necessary.

  15. Hormone replacement therapy advertising: sense and nonsense on the web pages of the best-selling pharmaceuticals in Spain.

    PubMed

    Chilet-Rosell, Elisa; Martín Llaguno, Marta; Ruiz Cantero, María Teresa; Alonso-Coello, Pablo

    2010-03-16

    The balance of the benefits and risks of long term use of hormone replacement therapy (HRT) have been a matter of debate for decades. In Europe, HRT requires medical prescription and its advertising is only permitted when aimed at health professionals (direct to consumer advertising is allowed in some non European countries). The objective of this study is to analyse the appropriateness and quality of Internet advertising about HRT in Spain. A search was carried out on the Internet (January 2009) using the eight best-selling HRT drugs in Spain. The brand name of each drug was entered into Google's search engine. The web sites appearing on the first page of results and the corresponding companies were analysed using the European Code of Good Practice as the reference point. Five corporate web pages: none of them included bibliographic references or measures to ensure that the advertising was only accessible by health professionals. Regarding non-corporate web pages (n = 27): 41% did not include the company name or address, 44% made no distinction between patient and health professional information, 7% contained bibliographic references, 26% provided unspecific information for the use of HRT for osteoporosis and 19% included menstrual cycle regulation or boosting feminity as an indication. Two online pharmacies sold HRT drugs which could be bought online in Spain, did not include the name or contact details of the registered company, nor did they stipulate the need for a medical prescription or differentiate between patient and health professional information. Even though pharmaceutical companies have committed themselves to compliance with codes of good practice, deficiencies were observed regarding the identification, information and promotion of HRT medications on their web pages. Unaffected by legislation, non-corporate web pages are an ideal place for indirect HRT advertising, but they often contain misleading information. HRT can be bought online from Spain, without a medical consultation or prescription constituting a serious issue for public health. In our information society, it is the right and obligation of public health bodies to ensure that such information is not misleading.

  16. Hormone Replacement Therapy advertising: sense and nonsense on the web pages of the best-selling pharmaceuticals in Spain

    PubMed Central

    2010-01-01

    Background The balance of the benefits and risks of long term use of hormone replacement therapy (HRT) have been a matter of debate for decades. In Europe, HRT requires medical prescription and its advertising is only permitted when aimed at health professionals (direct to consumer advertising is allowed in some non European countries). The objective of this study is to analyse the appropriateness and quality of Internet advertising about HRT in Spain. Methods A search was carried out on the Internet (January 2009) using the eight best-selling HRT drugs in Spain. The brand name of each drug was entered into Google's search engine. The web sites appearing on the first page of results and the corresponding companies were analysed using the European Code of Good Practice as the reference point. Results Five corporate web pages: none of them included bibliographic references or measures to ensure that the advertising was only accessible by health professionals. Regarding non-corporate web pages (n = 27): 41% did not include the company name or address, 44% made no distinction between patient and health professional information, 7% contained bibliographic references, 26% provided unspecific information for the use of HRT for osteoporosis and 19% included menstrual cycle regulation or boosting feminity as an indication. Two online pharmacies sold HRT drugs which could be bought online in Spain, did not include the name or contact details of the registered company, nor did they stipulate the need for a medical prescription or differentiate between patient and health professional information. Conclusions Even though pharmaceutical companies have committed themselves to compliance with codes of good practice, deficiencies were observed regarding the identification, information and promotion of HRT medications on their web pages. Unaffected by legislation, non-corporate web pages are an ideal place for indirect HRT advertising, but they often contain misleading information. HRT can be bought online from Spain, without a medical consultation or prescription constituting a serious issue for public health. In our information society, it is the right and obligation of public health bodies to ensure that such information is not misleading. PMID:20233393

  17. Hospital financing of ischaemic stroke: determinants of funding and usefulness of DRG subcategories based on severity of illness.

    PubMed

    Dewilde, Sarah; Annemans, Lieven; Pincé, Hilde; Thijs, Vincent

    2018-05-11

    Several Western and Arab countries, as well as over 30 States in the US are using the "All-Patient Refined Diagnosis-Related Groups" (APR-DRGs) with four severity-of-illness (SOI) subcategories as a model for hospital funding. The aim of this study is to verify whether this is an adequate model for funding stroke hospital admissions, and to explore which risk factors and complications may influence the amount of funding. A bottom-up analysis of 2496 ischaemic stroke admissions in Belgium compares detailed in-hospital resource use (including length of stay, imaging, lab tests, visits and drugs) per SOI category and calculates total hospitalisation costs. A second analysis examines the relationship between the type and location of the index stroke, medical risk factors, patient characteristics, comorbidities and in-hospital complications on the one hand, and the funding level received by the hospital on the other hand. This dataset included 2513 hospitalisations reporting on 35,195 secondary diagnosis codes, all medically coded with the International Classification of Disease (ICD-9). Total costs per admission increased by SOI (€3710-€16,735), with severe patients costing proportionally more in bed days (86%), and milder patients costing more in medical imaging (24%). In all resource categories (bed days, medications, visits and imaging and laboratory tests), the absolute utilisation rate was higher among severe patients, but also showed more variability. SOI 1-2 was associated with vague, non-specific stroke-related ICD-9 codes as primary diagnosis (71-81% of hospitalisations). 24% hospitalisations had, in addition to the primary diagnosis, other stroke-related codes as secondary diagnoses. Presence of lung infections, intracranial bleeding, severe kidney disease, and do-not-resuscitate status were each associated with extreme SOI (p < 0.0001). APR-DRG with SOI subclassification is a useful funding model as it clusters stroke patients in homogenous groups in terms of resource use. The data on medical care utilisation can be used with unit costs from other countries with similar healthcare set-ups to 1) assess stroke-related hospital funding versus actual costs; 2) inform economic models on stroke prevention and treatment. The data on diagnosis codes can be used to 3) understand which factors influence hospital funding; 4) raise awareness about medical coding practices.

  18. Promoting Interdisciplinary Collaboration: Trainees Addressing Siloed Medical Education

    ERIC Educational Resources Information Center

    Kitts, Robert Li; Christodoulou, Joanna; Goldman, Stuart

    2011-01-01

    Objective: Professional siloing within medical institutions has been identified as a problem in medical education, including resident training. The authors discuss how trainees from different disciplines can collaborate to address this problem. Method: A group of trainees from psychiatry, developmental medicine, neurology, and education came…

  19. Independent Assessment Plan: LAV-25

    DTIC Science & Technology

    1989-06-27

    Pages. Enter the total Block 7. Performing Organization Name(s) and number of pages. Address(es. Self -explanatory. Block 16. Price Code, Enter...organization Blocks 17. - 19. Security Classifications. performing the report. Self -explanatory. Enter U.S. Security Classification in accordance with U.S...Security Block 9. S oonsorina/Monitoring Acenc Regulations (i.e., UNCLASSIFIED). If form .Names(s) and Address(es). Self -explanatory. contains classified

  20. Reliability of diagnostic coding in intensive care patients

    PubMed Central

    Misset, Benoît; Nakache, Didier; Vesin, Aurélien; Darmon, Mickael; Garrouste-Orgeas, Maïté; Mourvillier, Bruno; Adrie, Christophe; Pease, Sébastian; de Beauregard, Marie-Aliette Costa; Goldgran-Toledano, Dany; Métais, Elisabeth; Timsit, Jean-François

    2008-01-01

    Introduction Administrative coding of medical diagnoses in intensive care unit (ICU) patients is mandatory in order to create databases for use in epidemiological and economic studies. We assessed the reliability of coding between different ICU physicians. Method One hundred medical records selected randomly from 29,393 cases collected between 1998 and 2004 in the French multicenter Outcomerea ICU database were studied. Each record was sent to two senior physicians from independent ICUs who recoded the diagnoses using the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision (ICD-10) after being trained according to guidelines developed by two French national intensive care medicine societies: the French Society of Intensive Care Medicine (SRLF) and the French Society of Anesthesiology and Intensive Care Medicine (SFAR). These codes were then compared with the original codes, which had been selected by the physician treating the patient. A specific comparison was done for the diagnoses of septicemia and shock (codes derived from A41 and R57, respectively). Results The ICU physicians coded an average of 4.6 ± 3.0 (range 1 to 32) diagnoses per patient, with little agreement between the three coders. The primary diagnosis was matched by both external coders in 34% (95% confidence interval (CI) 25% to 43%) of cases, by only one in 35% (95% CI 26% to 44%) of cases, and by neither in 31% (95% CI 22% to 40%) of cases. Only 18% (95% CI 16% to 20%) of all codes were selected by all three coders. Similar results were obtained for the diagnoses of septicemia and/or shock. Conclusion In a multicenter database designed primarily for epidemiological and cohort studies in ICU patients, the coding of medical diagnoses varied between different observers. This could limit the interpretation and validity of research and epidemiological programs using diagnoses as inclusion criteria. PMID:18664267

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