Review of chart recognition in document images

NASA Astrophysics Data System (ADS)

Liu, Yan; Lu, Xiaoqing; Qin, Yeyang; Tang, Zhi; Xu, Jianbo

2013-01-01

As an effective information transmitting way, chart is widely used to represent scientific statistics datum in books, research papers, newspapers etc. Though textual information is still the major source of data, there has been an increasing trend of introducing graphs, pictures, and figures into the information pool. Text recognition techniques for documents have been accomplished using optical character recognition (OCR) software. Chart recognition techniques as a necessary supplement of OCR for document images are still an unsolved problem due to the great subjectiveness and variety of charts styles. This paper reviews the development process of chart recognition techniques in the past decades and presents the focuses of current researches. The whole process of chart recognition is presented systematically, which mainly includes three parts: chart segmentation, chart classification, and chart Interpretation. In each part, the latest research work is introduced. In the last, the paper concludes with a summary and promising future research direction.

The Impact of Adverse Childhood Experiences on an Urban Pediatric Population

ERIC Educational Resources Information Center

Burke, Nadine J.; Hellman, Julia L.; Scott, Brandon G.; Weems, Carl F.; Carrion, Victor G.

2011-01-01

Objective: The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community. Study design: Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were…

Classifying Adverse Events in the Dental Office.

PubMed

Kalenderian, Elsbeth; Obadan-Udoh, Enihomo; Maramaldi, Peter; Etolue, Jini; Yansane, Alfa; Stewart, Denice; White, Joel; Vaderhobli, Ram; Kent, Karla; Hebballi, Nutan B; Delattre, Veronique; Kahn, Maria; Tokede, Oluwabunmi; Ramoni, Rachel B; Walji, Muhammad F

2017-06-30

Dentists strive to provide safe and effective oral healthcare. However, some patients may encounter an adverse event (AE) defined as "unnecessary harm due to dental treatment." In this research, we propose and evaluate two systems for categorizing the type and severity of AEs encountered at the dental office. Several existing medical AE type and severity classification systems were reviewed and adapted for dentistry. Using data collected in previous work, two initial dental AE type and severity classification systems were developed. Eight independent reviewers performed focused chart reviews, and AEs identified were used to evaluate and modify these newly developed classifications. A total of 958 charts were independently reviewed. Among the reviewed charts, 118 prospective AEs were found and 101 (85.6%) were verified as AEs through a consensus process. At the end of the study, a final AE type classification comprising 12 categories, and an AE severity classification comprising 7 categories emerged. Pain and infection were the most common AE types representing 73% of the cases reviewed (56% and 17%, respectively) and 88% were found to cause temporary, moderate to severe harm to the patient. Adverse events found during the chart review process were successfully classified using the novel dental AE type and severity classifications. Understanding the type of AEs and their severity are important steps if we are to learn from and prevent patient harm in the dental office.

Estimating the Occupational Morbidity for Migrant and Seasonal Farmworkers in New York State: a Comparison of Two Methods

PubMed Central

Earle-Richardson, Giulia B.; Brower, Melissa A.; Jones, Amanda M.; May, John J.; Jenkins, Paul L.

2008-01-01

Purpose To compare occupational morbidity estimates for migrant and seasonal farmworkers obtained from survey methods versus chart review methods, and to estimate the proportion of morbidity treated at federally recognized migrant health centers (MHCs) in a highly agricultural region of New York. Methods Researchers simultaneously conducted: a) an occupational injury and illness survey among agricultural workers; b) MHC chart review; and c) hospital emergency room (ER) chart reviews. Results Of the 24 injuries reported by 550 survey subjects, 54.2% received treatment MHCs 16.7% at ERs, 16.7% at some other facility, and 12.5% were untreated. For injuries treated at MHCs or ERs, the incidence density based on survey methods was 29.3 injuries per 10,000 worker-weeks versus 27.4 by chart review. The standardized morbidity ratio (SMR) for this comparison was 1.07 (95% CI = 0.65 – 1.77). Conclusion Survey data indicate that 71% of agricultural injury and illness can be captured with MHC and ER chart review. MHC and ER incidence density estimates show strong correspondence between the two methods. A chart review-based surveillance system, in conjunction with a correction factor based on periodic worker surveys, would provide a cost-effective estimate of the occupational illness and injury rate in this population. PMID:18063238

Correlation of patient entry rates and physician documentation errors in dictated and handwritten emergency treatment records.

PubMed

Dawdy, M R; Munter, D W; Gilmore, R A

1997-03-01

This study was designed to examine the relationship between patient entry rates (a measure of physician work load) and documentation errors/omissions in both handwritten and dictated emergency treatment records. The study was carried out in two phases. Phase I examined handwritten records and Phase II examined dictated and transcribed records. A total of 838 charts for three common chief complaints (chest pain, abdominal pain, asthma/chronic obstructive pulmonary disease) were retrospectively reviewed and scored for the presence or absence of 11 predetermined criteria. Patient entry rates were determined by reviewing the emergency department patient registration logs. The data were analyzed using simple correlation and linear regression analysis. A positive correlation was found between patient entry rates and documentation errors in handwritten charts. No such correlation was found in the dictated charts. We conclude that work load may negatively affect documentation accuracy when charts are handwritten. However, the use of dictation services may minimize or eliminate this effect.

A brief review of vaccination coverage in immunization registries.

PubMed

Goldstein, Neal D; Maiese, Brett A

2011-01-01

Immunization registries are effective electronic tools for assessing vaccination coverage, but are only as good as the information reported to them. This review summarizes studies through August 2010 on vaccination coverage in registries and identifies key characteristics of successful registries. Based on the current state of registries, paper-based charts combined with electronic registry reporting provide the most cohesive picture of coverage. To ultimately supplant paper charts, registries must exhibit increased coverage and participation.

Which Chart Elements Accurately Identify Emergency Department Visits for Suicidal Ideation or Behavior?

PubMed

Arias, Sarah A; Boudreaux, Edwin D; Chen, Elizabeth; Miller, Ivan; Camargo, Carlos A; Jones, Richard N; Uebelacker, Lisa

2018-05-23

In an emergency department (ED) sample, we investigated the concordance between identification of suicide-related visits through standardized comprehensive chart review versus a subset of three specific chart elements: ICD-9-CM codes, free-text presenting complaints, and free-text physician discharge diagnoses. Review of medical records for adults (≥18 years) at eight EDs across the United States. A total of 3,776 charts were reviewed. A combination of the three chart elements (ICD-9-CM, presenting complaints, and discharge diagnoses) provided the most robust data with 85% sensitivity, 96% specificity, 92% PPV, and 92% NPV. These findings highlight the use of key discrete fields in the medical record that can be extracted to facilitate identification of whether an ED visit was suicide-related.

Improving preventive health services training in chiropractic colleges part II: enhancing outcomes through improved training and accountability processes.

PubMed

Globe, Gary; Redwood, Daniel; Brantingham, James W; Hawk, Cheryl; Terre, Lisa; Globe, Denise; Mayer, Stephan

2009-01-01

Over the past decade, chiropractic colleges have introduced clinical prevention services (CPS) training. This has included an updated public health curriculum and procedures for student interns to determine the need for preventive services and to provide these services directly or through referral to other health professionals. The purpose of this study was to evaluate the effect of a program to train chiropractic interns to deliver CPS to patients. Program evaluation used retrospective chart review, comparing the proportion of patients receiving CPS recommendations before and after implementation of the program. The main outcome measures were the percentage of appropriate CPS recommendations based upon chart reviews. Chart reviews in 2006 indicated appropriate CPS recommendations in 47.4% of cases (295/623). Chart reviews in 2007, after an additional year of sustained implementation of procedures to ensure intern and faculty accountability, showed appropriate counseling recommendations in 87% of files (137/156). Requiring interns to attend didactic presentations on CPS had no measurable effect on their performance. Major improvements occurred after a series of clinically relevant training interventions; new forms and audit procedures were implemented to increase intern and clinical faculty accountability.

Effects of concurrent drug therapy on technetium /sup 99m/Tc gluceptate biodistribution

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

Hinkle, G.H.; Basmadjian, G.P.; Peek, C.

Drug interactions with /sup 99m/Tc gluceptate resulting in altered biodistribution were studied using chart review and animal tests. Charts of nine patients who had abnormal gallbladder uptake of technetium /sup 99m/Tc gluceptate during a two-year period were reviewed to obtain data such as concurrent drug therapy, primary diagnosis, and laboratory values. Adult New Zealand white rabbits were then used for testing the biodistribution of technetium /sup 99m/Tc gluceptate when administered concurrently with possibly interacting drugs identified in the chart review--penicillamine, penicillin G potassium, penicillin V potassium, acetaminophen, and trimethoprim-sulfamethoxazole. Chart review revealed no conclusive patterns of altered biodistribution associated withmore » other factors. The data did suggest the possibility that the five drugs listed above might cause increased hepatobiliary clearance of the radiopharmaceutical. Animal tests showed that i.v. penicillamine caused substantial distribution of radioactivity into the gallbladder and small bowel. Minimally increased gallbladder radioactivity occurred when oral acetaminophen and trimethoprim-sulfamethoxazole were administered concurrently. Oral and i.v. penicillins did not increase gallbladder activity. Penicillamine may cause substantial alteration of the biodistribution of technetium /sup 99m/Tc gluceptate.« less

A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

PubMed Central

2013-01-01

Background The aim of this study was to revise the 2003 Fenton Preterm Growth Chart, specifically to: a) harmonize the preterm growth chart with the new World Health Organization (WHO) Growth Standard, b) smooth the data between the preterm and WHO estimates, informed by the Preterm Multicentre Growth (PreM Growth) study while maintaining data integrity from 22 to 36 and at 50 weeks, and to c) re-scale the chart x-axis to actual age (rather than completed weeks) to support growth monitoring. Methods Systematic review, meta-analysis, and growth chart development. We systematically searched published and unpublished literature to find population-based preterm size at birth measurement (weight, length, and/or head circumference) references, from developed countries with: Corrected gestational ages through infant assessment and/or statistical correction; Data percentiles as low as 24 weeks gestational age or lower; Sample with greater than 500 infants less than 30 weeks. Growth curves for males and females were produced using cubic splines to 50 weeks post menstrual age. LMS parameters (skew, median, and standard deviation) were calculated. Results Six large population-based surveys of size at preterm birth representing 3,986,456 births (34,639 births < 30 weeks) from countries Germany, United States, Italy, Australia, Scotland, and Canada were combined in meta-analyses. Smooth growth chart curves were developed, while ensuring close agreement with the data between 24 and 36 weeks and at 50 weeks. Conclusions The revised sex-specific actual-age growth charts are based on the recommended growth goal for preterm infants, the fetus, followed by the term infant. These preterm growth charts, with the disjunction between these datasets smoothing informed by the international PreM Growth study, may support an improved transition of preterm infant growth monitoring to the WHO growth charts. PMID:23601190

Development and validation of a case definition for epilepsy for use with administrative health data.

PubMed

Reid, Aylin Y; St Germaine-Smith, Christine; Liu, Mingfu; Sadiq, Shahnaz; Quan, Hude; Wiebe, Samuel; Faris, Peter; Dean, Stafford; Jetté, Nathalie

2012-12-01

The objective of this study was to develop and validate coding algorithms for epilepsy using ICD-coded inpatient claims, physician claims, and emergency room (ER) visits. 720/2049 charts from 2003 and 1533/3252 charts from 2006 were randomly selected for review from 13 neurologists' practices as the "gold standard" for diagnosis. Epilepsy status in each chart was determined by 2 trained physicians. The optimal algorithm to identify epilepsy cases was developed by linking the reviewed charts with three administrative databases (ICD 9 and 10 data from 2000 to 2008) including hospital discharges, ER visits and physician claims in a Canadian health region. Accepting chart review data as the gold standard, we calculated sensitivity, specificity, positive, and negative predictive value for each ICD-9 and ICD-10 administrative data algorithm (case definitions). Of 18 algorithms assessed, the most accurate algorithm to identify epilepsy cases was "2 physician claims or 1 hospitalization in 2 years coded" (ICD-9 345 or G40/G41) and the most sensitive algorithm was "1 physician clam or 1 hospitalization or 1 ER visit in 2 years." Accurate and sensitive case definitions are available for research requiring the identification of epilepsy cases in administrative health data. Copyright © 2012 Elsevier B.V. All rights reserved.

The Relationship between Health Survey and Medical Chart Review Results in a Rural Population

ERIC Educational Resources Information Center

Voaklander, Donald C.; Thommasen, Harvey V.; Michalos, Alex C.

2006-01-01

The objective of this study was to understand the relationship between health survey and medical chart based information. The study population consisted of adult patients (17 years of age and older) attending the Bella Coola Medical Clinic who also completed a detailed Health and Quality of Life Survey. A total of 674 adults completed the Health…

[Comparative study on four kinds of assessment methods of post-marketing safety of Danhong injection].

PubMed

Li, Xuelin; Tang, Jinfa; Meng, Fei; Li, Chunxiao; Xie, Yanming

2011-10-01

To study the adverse reaction of Danhong injection with four kinds of methods, central monitoring method, chart review method, literature study method and spontaneous reporting method, and to compare the differences between them, explore an appropriate method to carry out post-marketing safety evaluation of traditional Chinese medicine injection. Set down the adverse reactions' questionnaire of four kinds of methods, central monitoring method, chart review method, literature study method and collect the information on adverse reactions in a certain period. Danhong injection adverse reaction information from Henan Province spontaneous reporting system was collected with spontaneous reporting method. Carry on data summary and descriptive analysis. Study the adverse reaction of Danhong injection with four methods of central monitoring method, chart review method, literature study method and spontaneous reporting method, the rates of adverse events were 0.993%, 0.336%, 0.515%, 0.067%, respectively. Cyanosis, arrhythmia, hypotension, sweating, erythema, hemorrhage dermatitis, rash, irritability, bleeding gums, toothache, tinnitus, asthma, elevated aminotransferases, constipation, pain are new discovered adverse reactions. The central monitoring method is the appropriate method to carry out post-marketing safety evaluation of traditional Chinese medicine injection, which could objectively reflect the real world of clinical usage.

A Systematic Chart Review of Inpatient Population with Childhood Dissociative Disorder

ERIC Educational Resources Information Center

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

2006-01-01

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

Occupational Injury and Treatment Patterns of Migrant and Seasonal Farmworkers

PubMed Central

Brower, Melissa A.; Earle-Richardson, Giulia B.; May, John J.; Jenkins, Paul L.

2010-01-01

Migrant and seasonal farmworkers are thought to be at increased risk for occupational injury and illness. Past surveillance efforts that employed medical chart review may not be representative of all farmworkers, since the proportion of farmworkers using migrant health centers (MHC) and area hospital emergency rooms (ER) was unknown. The purpose of the current study was to determine the proportion of workers using MHCs versus other sources of occupational health care, and to use this data to correct previous occupational injury and illness rate estimates. Researchers conducted a survey of migrant and seasonal farmworkers in two sites: the Finger Lakes Region of New York and the apple, broccoli and blueberry regions of Maine. Researchers also conducted MHC and ER medical chart reviews in these regions for comparison purposes. Proportions of occupational morbidity by treatment location were calculated from the survey, and a correction factor was computed to adjust chart review morbidity estimates for Maine and New York State. Among 1,103 subjects, 56 work-related injuries were reported: 30 (53.6%) were treated at a MHC, 8 (14.3%) at an ER, 9 (16.1%) at some other location (e.g., home, relative, chiropractor), and 9 (16.1%) were untreated. Mechanisms of injuries treated at MHCs versus all other sources did not differ significantly. The survey-based multiplier (1.87) was applied to previous statewide MHC chart review injury counts from Maine and New York. The corrected injury rates were 7.9 per 100 full time equivalents (FTE) per year in Maine, and 11.7 per 100 FTE in New York. A chart-review based surveillance system, combined with a correction factor, may provide an effective method of estimating occupational illness and injury rates in this population. PMID:19437274

Briefing Number 3 to Space Station Operations Task Force Oversight Committee

NASA Technical Reports Server (NTRS)

Lyman, Peter; Shelley, Carl

1987-01-01

This document reviews certain issues in relationship to the operation of the Space Station Freedom. The document is in outline format and includes some organizational hierarchy charts, pert charts and decision charts.

A Retrospective Study of Amitriptyline in Youth with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Bhatti, Irfan; Thome, Andrew; Smith, Patricia Oxler; Cook-Wiens, Galen; Yeh, Hung Wen; Gaffney, Gary R.; Hellings, Jessica A.

2013-01-01

We performed a retrospective chart review of 50 youths with Autism Spectrum Disorder (ASD), prescribed amitriptyline (AMI) for hyperactivity and impulsivity. Data was systematically extracted from 50 outpatient clinic charts, including AMI treatment duration, dose, trough levels and adverse events. Mean age was 9.4 years (4.6-17.9); 40 were males…

Ten tools of continuous quality improvement: a review and case example of hospital discharge.

PubMed

Ziegenfuss, J T; McKenna, C K

1995-01-01

Concepts and methods of continuous quality improvement have been endorsed by quality specialists in American Health care, and their use has convinced CEOs that industrial methods can make a contribution to health and medical care. For all the quality improvement publications, there are still few that offer a clear, concise definition and an explanation of the primary tools for teaching purposes. This report reviews ten continuous quality improvement methods including: problem solving cycle, affinity diagrams, cause and effect diagrams, Pareto diagrams, histograms, bar charts, control charts, scatter diagrams, checklists, and a process decision program chart. These do not represent an exhaustive list, but a set of commonly used tools. They are applied to a case study of bed utilization in a university hospital.

Building a Better Model: A Personalized Breast Cancer Risk Model Incorporating Breast Density to Stratify Risk and Improve Application of Resources

DTIC Science & Technology

2014-10-01

density using automated methods will be optimized during this study through the evaluation of outlier correction, comparison of several different...7 VBD comparison y = 1.3477x - 1.3764 R2 = 0.8213 0 10 20 30 40 50 60 70 0 10 20 30 40 50 VBD volpara [%] VB D cu m ul us [% ] VBD cumulus...Access database and chart review. 5c. Conduct chart review for selected cases (month 4-6). Comparison of information from the Breast Cancer

Estimating anesthesia and surgical procedure times from medicare anesthesia claims.

PubMed

Silber, Jeffrey H; Rosenbaum, Paul R; Zhang, Xuemei; Even-Shoshan, Orit

2007-02-01

Procedure times are important variables that often are included in studies of quality and efficiency. However, due to the need for costly chart review, most studies are limited to single-institution analyses. In this article, the authors describe how well the anesthesia claim from Medicare can estimate chart times. The authors abstracted information on time of induction and entrance to the recovery room ("anesthesia chart time") from the charts of 1,931 patients who underwent general and orthopedic surgical procedures in Pennsylvania. The authors then merged the associated bills from claims data supplied from Medicare (Part B data) that included a variable denoting the time in minutes for the anesthesia service. The authors also investigated the time from incision to closure ("surgical chart time") on a subset of 1,888 patients. Anesthesia claim time from Medicare was highly predictive of anesthesia chart time (Kendall's rank correlation tau = 0.85, P < 0.0001, median absolute error = 5.1 min) but somewhat less predictive of surgical chart time (Kendall's tau = 0.73, P < 0.0001, median absolute error = 13.8 min). When predicting chart time from Medicare bills, variables reflecting procedure type, comorbidities, and hospital type did not significantly improve the prediction, suggesting that errors in predicting the chart time from the anesthesia bill time are not related to these factors; however, the individual hospital did have some influence on these estimates. Anesthesia chart time can be well estimated using Medicare claims, thereby facilitating studies with vastly larger sample sizes and much lower costs of data collection.

Detection of medication-related problems in hospital practice: a review

PubMed Central

Manias, Elizabeth

2013-01-01

This review examines the effectiveness of detection methods in terms of their ability to identify and accurately determine medication-related problems in hospitals. A search was conducted of databases from inception to June 2012. The following keywords were used in combination: medication error or adverse drug event or adverse drug reaction, comparison, detection, hospital and method. Seven detection methods were considered: chart review, claims data review, computer monitoring, direct care observation, interviews, prospective data collection and incident reporting. Forty relevant studies were located. Detection methods that were better able to identify medication-related problems compared with other methods tested in the same study included chart review, computer monitoring, direct care observation and prospective data collection. However, only small numbers of studies were involved in comparisons with direct care observation (n = 5) and prospective data collection (n = 6). There was little focus on detecting medication-related problems during various stages of the medication process, and comparisons associated with the seriousness of medication-related problems were examined in 19 studies. Only 17 studies involved appropriate comparisons with a gold standard, which provided details about sensitivities and specificities. In view of the relatively low identification of medication-related problems with incident reporting, use of this method in tracking trends over time should be met with some scepticism. Greater attention should be placed on combining methods, such as chart review and computer monitoring in examining trends. More research is needed on the use of claims data, direct care observation, interviews and prospective data collection as detection methods. PMID:23194349

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

PubMed

Kergoat, Marie-Jeanne; Leclerc, Bernard-Simon; Leduc, Nicole; Latour, Judith; Berg, Katherine; Bolduc, Aline

2009-07-29

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

Organization Charts in ARL Libraries. SPEC Kit #170.

ERIC Educational Resources Information Center

Association of Research Libraries, Washington, DC. Office of Management Studies.

This kit is based on a review of the organization charts of 71 member libraries of the Association of Research Libraries (ARL) gathered in January 1991, compared with an earlier SPEC Kit published in 1986, and contains charts of 29 of the libraries. A summary of the chart analyses presents information about the titles of library directors,…

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

PubMed

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

2012-01-01

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

23 CFR Appendix D to Subpart D of... - Equal Opportunity Compliance Review Process Flow Chart

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Equal Opportunity Compliance Review Process Flow Chart D Appendix D to Subpart D of Part 230 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION..., Subpt. D, App. D Appendix D to Subpart D of Part 230—Equal Opportunity Compliance Review Process Flow...

Symptomatology and health care utilization of women primary care patients who experienced childhood sexual abuse.

PubMed

Hulme, P A

2000-11-01

The purpose of this study was to (1) determine the symptomatology of women primary care patients who experienced childhood sexual abuse (CSA), using both a self-report survey and a chart review, and (2) determine their health care utilization patterns, using chart and information system reviews. An ex post facto research design was used. Women primary care patients who experienced CSA were compared with those who reported no CSA. Participants were recruited from a random sample of women patients from a large primary care clinic. They were mailed the survey; chart and information system reviews were conducted on those who returned surveys. Of the 395 participants, 23% reported past CSA on the survey. Women who experienced CSA reported 44 out of 51 physical and psychosocial symptoms more frequently than their counterparts who reported no past CSA. Further, they experienced these symptoms more intensely and in greater number. In their charts, however, far fewer differences in symptoms between groups were found. Nonetheless, women who experienced CSA visited the primary care clinic an average of 1.33 more times than women with no CSA, and they incurred an average of $150 more in primary care charges over a 2-year period. The findings indicate that many women primary care patients who experienced CSA suffer multiple symptoms that are not reflected in their charts. In addition, the findings demonstrate that not only is CSA associated with increased primary care visits, but also increased primary care costs, as measured by charges.

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

PubMed

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

2012-05-01

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

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

PubMed

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

2018-02-20

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

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

PubMed

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

2008-10-01

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

Coverage criteria for test case generation using UML state chart diagram

NASA Astrophysics Data System (ADS)

Salman, Yasir Dawood; Hashim, Nor Laily; Rejab, Mawarny Md; Romli, Rohaida; Mohd, Haslina

2017-10-01

To improve the effectiveness of test data generation during the software test, many studies have focused on the automation of test data generation from UML diagrams. One of these diagrams is the UML state chart diagram. Test cases are generally evaluated according to coverage criteria. However, combinations of multiple criteria are required to achieve better coverage. Different studies used various number and types of coverage criteria in their methods and approaches. The objective of this paper to propose suitable coverage criteria for test case generation using UML state chart diagram especially in handling loops. In order to achieve this objective, this work reviewed previous studies to present the most practical coverage criteria combinations, including all-states, all-transitions, all-transition-pairs, and all-loop-free-paths coverage. Calculation to determine the coverage percentage of the proposed coverage criteria were presented together with an example has they are applied on a UML state chart diagram. This finding would be beneficial in the area of test case generating especially in handling loops in UML state chart diagram.

Diagnostic Value of Run Chart Analysis: Using Likelihood Ratios to Compare Run Chart Rules on Simulated Data Series

PubMed Central

Anhøj, Jacob

2015-01-01

Run charts are widely used in healthcare improvement, but there is little consensus on how to interpret them. The primary aim of this study was to evaluate and compare the diagnostic properties of different sets of run chart rules. A run chart is a line graph of a quality measure over time. The main purpose of the run chart is to detect process improvement or process degradation, which will turn up as non-random patterns in the distribution of data points around the median. Non-random variation may be identified by simple statistical tests including the presence of unusually long runs of data points on one side of the median or if the graph crosses the median unusually few times. However, there is no general agreement on what defines “unusually long” or “unusually few”. Other tests of questionable value are frequently used as well. Three sets of run chart rules (Anhoej, Perla, and Carey rules) have been published in peer reviewed healthcare journals, but these sets differ significantly in their sensitivity and specificity to non-random variation. In this study I investigate the diagnostic values expressed by likelihood ratios of three sets of run chart rules for detection of shifts in process performance using random data series. The study concludes that the Anhoej rules have good diagnostic properties and are superior to the Perla and the Carey rules. PMID:25799549

Prevalence and management of back pain in adolescent idiopathic scoliosis patients: A retrospective study

PubMed Central

Théroux, Jean; Le May, Sylvie; Fortin, Carole; Labelle, Hubert

2015-01-01

BACKGROUND: Back pain (BP) has often been associated with adolescent idiopathic scoliosis (AIS), which is a three-dimensional deviation of the vertebral column. In adolescents, chronic pain appears to be a predictor of health care utilization and has a negative impact on physical, psychological and family well-being. In this population, BP tends to be persistent and may be a predictor of BP in adulthood. OBJECTIVE: To document the prevalence and management of BP in AIS patients. METHODS: A retrospective chart review of AIS patients who were referred to Sainte-Justine University Teaching Hospital (Montreal, Quebec) from 2006 to 2011 was conducted. RESULTS: A total of 310 randomly selected charts were reviewed. Nearly one-half of the patients (47.3%) mentioned that they experienced BP, most commonly in the lumbar (19.7%) and thoracic regions (7.7%). The type of BP was documented in only 36% (n=112) of the charts. Pain intensity was specified in only 21% (n=65) of the charts. In approximately 80% (n=248) of the charts, no pain management treatment plan was documented. CONCLUSIONS: The prevalence of BP was moderately high among the present sample of adolescents with AIS. An improved system for documenting BP assessment, type, treatment plan and treatment effectiveness would improve pain management for these patients. PMID:25831076

Automated chart review utilizing natural language processing algorithm for asthma predictive index.

PubMed

Kaur, Harsheen; Sohn, Sunghwan; Wi, Chung-Il; Ryu, Euijung; Park, Miguel A; Bachman, Kay; Kita, Hirohito; Croghan, Ivana; Castro-Rodriguez, Jose A; Voge, Gretchen A; Liu, Hongfang; Juhn, Young J

2018-02-13

Thus far, no algorithms have been developed to automatically extract patients who meet Asthma Predictive Index (API) criteria from the Electronic health records (EHR) yet. Our objective is to develop and validate a natural language processing (NLP) algorithm to identify patients that meet API criteria. This is a cross-sectional study nested in a birth cohort study in Olmsted County, MN. Asthma status ascertained by manual chart review based on API criteria served as gold standard. NLP-API was developed on a training cohort (n = 87) and validated on a test cohort (n = 427). Criterion validity was measured by sensitivity, specificity, positive predictive value and negative predictive value of the NLP algorithm against manual chart review for asthma status. Construct validity was determined by associations of asthma status defined by NLP-API with known risk factors for asthma. Among the eligible 427 subjects of the test cohort, 48% were males and 74% were White. Median age was 5.3 years (interquartile range 3.6-6.8). 35 (8%) had a history of asthma by NLP-API vs. 36 (8%) by abstractor with 31 by both approaches. NLP-API predicted asthma status with sensitivity 86%, specificity 98%, positive predictive value 88%, negative predictive value 98%. Asthma status by both NLP and manual chart review were significantly associated with the known asthma risk factors, such as history of allergic rhinitis, eczema, family history of asthma, and maternal history of smoking during pregnancy (p value < 0.05). Maternal smoking [odds ratio: 4.4, 95% confidence interval 1.8-10.7] was associated with asthma status determined by NLP-API and abstractor, and the effect sizes were similar between the reviews with 4.4 vs 4.2 respectively. NLP-API was able to ascertain asthma status in children mining from EHR and has a potential to enhance asthma care and research through population management and large-scale studies when identifying children who meet API criteria.

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

Hardin, M; Harrison, A; Lockamy, V

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

Clinical Inquiry: Is megestrol acetate safe and effective for malnourished nursing home residents?

PubMed

Wen, Frances K; Millar, James; Oberst-Walsh, Linda; Nashelsky, Joan

2018-02-01

No. Megestrol acetate (MA) is neither safe nor effective for stimulating appetite in malnourished nursing home residents. It increases the risk of deep vein thrombosis (strength of recommendation [SOR]: C, 2 retrospective chart reviews), but isn't associated with other new or worsening events or disorders (SOR: B, single randomized controlled trial [RCT]). Over a 25-week period, MA wasn't associated with increased mortality (SOR: B, single RCT). After 44 months, however, MA-treated patients showed decreased median survival (SOR: B, single case-control study). Consistent, meaningful weight gain was not observed with MA treatment (SOR: B, single case-control study, single RCT, 2 retrospective chart reviews, single prospective case-series).

Examining body mass index in an urban core population: from health screening to physician visit.

PubMed

O'Connor, Kaitlin Ann; Sahrmann, Julie Marie; Magie, Richard E; Segars, Larry W

2013-04-01

BACKGROUND. Childhood obesity is commonly encountered in the primary care office and disproportionately affects those from low income or minority backgrounds. To determine how accurately primary care clinicians in an urban setting identified patients with body mass indices (BMIs) at or above the 95th percentile for age and to determine which obesity treatment strategies are used. The study population consisted of school-aged, inner-city children with a BMI at or above the 95th percentile for age whose charts were made available for data collection by retrospective chart review. A total of 158 patient medical charts were reviewed. Of these, 90 (57%) patients failed to be identified by the provider as having an elevated BMI. Obesity treatment was initiated in only 68 (43%) of these patients. Providers are not effectively recognizing childhood obesity and are not consistently implementing effective obesity treatment strategies.

Growth assessment in diagnosis of Fetal Growth Restriction. Review.

PubMed

Albu, A R; Horhoianu, I A; Dumitrascu, M C; Horhoianu, V

2014-06-15

The assessment of fetal growth represents a fundamental step towards the identification of the true growth restricted fetus that is associated to important perinatal morbidity and mortality. The possible ways of detecting abnormal fetal growth are taken into consideration in this review and their strong and weak points are discussed. An important debate still remains about how to discriminate between the physiologically small fetus that does not require special surveillance and the truly growth restricted fetus who is predisposed to perinatal complications, even if its parameters are above the cut-off limits established. In this article, we present the clinical tools of fetal growth assessment: Symphyseal-Fundal Height (SFH) measurement, the fetal ultrasound parameters widely taken into consideration when discussing fetal growth: Abdominal Circumference (AC) and Estimated Fetal Weight (EFW); several types of growth charts and their characteristics: populational growth charts, standard growth charts, individualized growth charts, customized growth charts and growth trajectories.

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

PubMed

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

2005-03-01

In 2002, the Institute of Medicine called for the introduction of information technologies in health care settings to improve quality of care. We conducted a review of hospital charts of women who delivered before and after the implementation of an intranet-based computerized prenatal record in an inner-city practice. Our objective was to assess whether the use of this record improved communication among the outpatient office, the ultrasonography unit, and the labor floor. The charts of patients who delivered in August 2002 and August 2003 and received their prenatal care at the Comprehensive Family Care Center at Montefiore Medical Center were analyzed. Data collected included the presence of a copy of the prenatal record in the hospital chart, the date of the last documented prenatal visit, and documentation of any prenatal ultrasonograms performed. Forty-three charts in each group were available for review. The prenatal chart was absent in 16% of the charts of patients from August 2002 compared with only 2% in August 2003 charts (P < .05). Among charts with prenatal records available, the median length of time between the last documented prenatal visit and delivery was significantly longer for August 2002 patients compared with August 2003 patients (36 compared with 4 days, respectively, P < .001). All patients received prenatal ultrasonograms, but documentation of the ultrasonogram was missing from 16% of the August 2002 charts compared with none of the August 2003 charts (P = .01). The use of a paperless, hospital intranet-based prenatal chart significantly improves communication among providers.

A Tale of Two Methods: Chart and Interview Methods for Identifying Delirium

PubMed Central

Saczynski, Jane S.; Kosar, Cyrus M.; Xu, Guoquan; Puelle, Margaret R.; Schmitt, Eva; Jones, Richard N.; Marcantonio, Edward R.; Wong, Bonnie; Isaza, Ilean; Inouye, Sharon K.

2014-01-01

Background Interview and chart-based methods for identifying delirium have been validated. However, relative strengths and limitations of each method have not been described, nor has a combined approach (using both interviews and chart), been systematically examined. Objectives To compare chart and interview-based methods for identification of delirium. Design, Setting and Participants Participants were 300 patients aged 70+ undergoing major elective surgery (majority were orthopedic surgery) interviewed daily during hospitalization for delirium using the Confusion Assessment Method (CAM; interview-based method) and whose medical charts were reviewed for delirium using a validated chart-review method (chart-based method). We examined rate of agreement on the two methods and patient characteristics of those identified using each approach. Predictive validity for clinical outcomes (length of stay, postoperative complications, discharge disposition) was compared. In the absence of a gold-standard, predictive value could not be calculated. Results The cumulative incidence of delirium was 23% (n= 68) by the interview-based method, 12% (n=35) by the chart-based method and 27% (n=82) by the combined approach. Overall agreement was 80%; kappa was 0.30. The methods differed in detection of psychomotor features and time of onset. The chart-based method missed delirium in CAM-identified patients laacking features of psychomotor agitation or inappropriate behavior. The CAM-based method missed chart-identified cases occurring during the night shift. The combined method had high predictive validity for all clinical outcomes. Conclusions Interview and chart-based methods have specific strengths for identification of delirium. A combined approach captures the largest number and the broadest range of delirium cases. PMID:24512042

Twenty-Four-Hour Voiding Diaries Versus 3-Day Voiding Diaries: A Clinical Comparison.

PubMed

Elmer, Caroline; Murphy, Amber; Elliott, John O; Book, Nicole M

This study aimed to determine if 24-hour versus 3-day voiding diary affects medical decision making for women with urinary incontinence. A retrospective chart review was conducted of patients presenting to the OhioHealth Urogynecology Physician group for urinary incontinence from 2009 to 2011. Practice protocol includes patient completion of a 3-day voiding diary before their appointment. Diagnostic and treatment plans were extracted based on the initial patient encounter and 3-day voiding diary. A chart review was then completed with the first 24 hours of the same diaries, principal history, and physical examination data compiled into a separate chart. These charts were then reevaluated by the same physician who initially provided care to the patient but were blinded to their previous orders, impressions, and plans. New plans were then created based on the 24-hour diaries and compared with the original plans. One hundred eighty-six charts were reviewed. There was good agreement between 24-hour and 3-day diaries in recommendations for first-line behavioral modifications (Κ > 0.6) and moderate agreement between diaries in initiation of medical therapy or trial of incontinence pessary (Κ > 0.4). However, 24-hour diaries resulted in a statistically significant increase in invasive diagnostic tests (P < 0.019) and other treatment recommendations when compared with 3-day diaries. Use of 24-hour diaries may result in increased testing when compared with 3-day diaries. It may be prudent to postpone invasive testing in those patients who initially are noncompliant with a longer diary until a more complete history can be obtained.

Auditing psychiatric out-patient records.

PubMed

Pillay, Selena; O'Dwyer, Sarah; McCarthy, Marguerite

2010-01-01

Up-to-date patient records are essential for safe and professional practice. They are an intrinsic component for providing adequate care and ensuring appropriate and systematic treatment 2009 plans. Furthermore, accurate and contemporaneous notes are essential for achieving professional standards from a medico-legal perspective. The study's main aim was to investigate current record-keeping practices by looking at whether out-patient communication pathways to general practitioners, from letter dictation to insertion in the chart, were being satisfied. From current out-patient attendees over six months, 100 charts were chosen randomly, and reviewed. A pro-forma was used to collect data and this information was also checked against electronic records. Of the charts reviewed, 15 per cent had no letter. If one considers that one-month is an acceptable time for letters to be inserted into the chart, then only 11 per cent satisfied this condition. Electronic data were also missing. It is impossible to discern whether letters to GPs were dictated by the out-patient doctor for each patient reviewed. Another limitation was that some multidisciplinary hospital teams have different out-patient note-keeping procedures, which makes some findings difficult to interpret. The review drew attention to current record-keeping discrepancies, highlighting the need for medical record-keeping procedures and polices to be put in place. Also brought to light was the importance of providing a workforce sufficient to meet the out-patient team's administrative needs. An extended audit of other medical record-keeping aspects should be carried out to determine whether problems occur in other areas. The study highlights the importance of establishing agreed policies and procedures for out-patient record keeping and the need to have a checking mechanism to identify system weaknesses.

Muscle Tension Dysphagia: Symptomology and Theoretical Framework.

PubMed

Kang, Christina H; Hentz, Joseph G; Lott, David G

2016-11-01

To identify symptoms, common diagnostic findings, pattern of treatments and referrals offered, and their efficacy in a group of patients with idiopathic functional dysphagia in an otolaryngology setting with multiple providers. Case series with chart review. Tertiary academic center. Following Mayo Clinic Institutional Review Board approval, a retrospective chart review was conducted of patients with dysphagia who had a videofluoroscopic swallow study between January 1, 2013, and April 30, 2015. Each patient's dysphagia symptomology, videofluoroscopic swallow study, flexible laryngoscopy, and medical chart were reviewed to identify the treatment paradigms that were utilized. Sixty-seven adult patients met the inclusion criteria. Abnormal laryngeal muscle tension was present in 97% of patients. Eighty-two percent of patients also demonstrated signs of laryngeal hyperresponsiveness. Nonspecific laryngeal inflammation was evident in 52% of patients. Twenty-seven patients were referred to speech-language pathology for evaluation. Thirteen patients completed a course of voice therapy directed toward unloading muscle tension. All 13 patients self-reported resolution of dysphagia symptoms. The study results suggest that laryngeal muscle tension may be a factor in the underlying etiology in patients with idiopathic functional dysphagia. We propose the diagnostic term muscle tension dysphagia to describe a subset of patients with functional dysphagia. Further prospective studies are needed to better evaluate potential gastroesophageal confounders in this group of patients and to identify an effective paradigm for treatment. In our limited series, speech-language pathology intervention directed toward unloading muscle tension appears effective. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Differences in reported sepsis incidence according to study design: a literature review.

PubMed

Mariansdatter, Saga Elise; Eiset, Andreas Halgreen; Søgaard, Kirstine Kobberøe; Christiansen, Christian Fynbo

2016-10-12

Sepsis and severe sepsis are common conditions in hospital settings, and are associated with high rates of morbidity and mortality, but reported incidences vary considerably. In this literature review, we describe the variation in reported population-based incidences of sepsis and severe sepsis. We also examine methodological and demographic differences between studies that may explain this variation. We carried out a literature review searching three major databases and reference lists of relevant articles, to identify all original studies reporting the incidence of sepsis or severe sepsis in the general population. Two authors independently assessed all articles, and the final decision to exclude an article was reached by consensus. We extracted data according to predetermined variables, including study country, sepsis definition, and data source. We then calculated descriptive statistics for the reported incidences of sepsis and severe sepsis. The studies were classified according to the method used to identify cases of sepsis or severe sepsis: chart-based (i.e. review of patient charts) or code-based (i.e. predetermined International Classification of Diseases [ICD] codes). Among 482 articles initially screened, we identified 23 primary publications reporting incidence of sepsis and/or severe sepsis in the general population. The reported incidences ranged from 74 to 1180 per 100,000 person-years and 3 to 1074 per 100,000 person-years for sepsis and severe sepsis, respectively. Most chart-based studies used the Bone criteria (or a modification hereof) and Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study criteria to identify cases of sepsis and severe sepsis. Most code-based studies used ICD-9 codes, but the number of codes used ranged from 1 to more than 1200. We found that the incidence varied according to how sepsis was identified (chart-based vs. code-based), calendar year, data source, and world region. The reported incidences of sepsis and severe sepsis in the general population varied greatly between studies. Such differences may be attributable to differences in the methods used to collect the data, the study period, or the world region where the study was undertaken. This finding highlights the importance of standardised definitions and acquisition of data regarding sepsis and severe sepsis.

Drug interactions among commonly used medications. Chart simplifies data from critical literature review.

PubMed Central

Crowther, N. R.; Holbrook, A. M.; Kenwright, R.; Kenwright, M.

1997-01-01

OBJECTIVE: To simplify risk assessment, we have developed a way to present critically appraised drug interaction information through a chart. DATA SOURCES: Fifty drugs most frequently prescribed by Canadian family physicians and 16 drugs and substances that frequently interact with these drugs were the basis for a literature review. Drug interaction textbooks and MEDLINE (from 1966 to 1994) were searched for documented interactions. Reports of additive effects and animal or in vitro studies were excluded. STUDY SELECTION: All reports of interactions were evaluated for clinical effect, clinical significance, and quality of evidence. SYNTHESIS: Of the 464 drug-drug or drug-substance pairs evaluated, 387 (83.4%) demonstrated an interaction, 59 (12.7%) documented no effect, and 18 (3.9%) pairs had conflicting evidence. Five percent of interactions were of major clinical significance; only 1.3% were of major clinical significance and supported by good-quality evidence. By using symbols, colours, and legends in a "grid-map" format, a large amount of drug interaction information was reduced to a single-page chart suitable for a desk reference or wall mounting. CONCLUSIONS: Our chart organizes a large amount of drug interaction information in a format that allows for rapid appreciation of outcome, clinical significance, and quality of evidence. PMID:9386884

Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visits.

PubMed

Ginde, Adit A; Blanc, Phillip G; Lieberman, Rebecca M; Camargo, Carlos A

2008-04-01

Accurate identification of hypoglycemia cases by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes will help to describe epidemiology, monitor trends, and propose interventions for this important complication in patients with diabetes. Prior hypoglycemia studies utilized incomplete search strategies and may be methodologically flawed. We sought to validate a new ICD-9-CM coding algorithm for accurate identification of hypoglycemia visits. This was a multicenter, retrospective cohort study using a structured medical record review at three academic emergency departments from July 1, 2005 to June 30, 2006. We prospectively derived a coding algorithm to identify hypoglycemia visits using ICD-9-CM codes (250.3, 250.8, 251.0, 251.1, 251.2, 270.3, 775.0, 775.6, and 962.3). We confirmed hypoglycemia cases by chart review identified by candidate ICD-9-CM codes during the study period. The case definition for hypoglycemia was documented blood glucose 3.9 mmol/l or emergency physician charted diagnosis of hypoglycemia. We evaluated individual components and calculated the positive predictive value. We reviewed 636 charts identified by the candidate ICD-9-CM codes and confirmed 436 (64%) cases of hypoglycemia by chart review. Diabetes with other specified manifestations (250.8), often excluded in prior hypoglycemia analyses, identified 83% of hypoglycemia visits, and unspecified hypoglycemia (251.2) identified 13% of hypoglycemia visits. The absence of any predetermined co-diagnosis codes improved the positive predictive value of code 250.8 from 62% to 92%, while excluding only 10 (2%) true hypoglycemia visits. Although prior analyses included only the first-listed ICD-9 code, more than one-quarter of identified hypoglycemia visits were outside this primary diagnosis field. Overall, the proposed algorithm had 89% positive predictive value (95% confidence interval, 86-92) for detecting hypoglycemia visits. The proposed algorithm improves on prior strategies to identify hypoglycemia visits in administrative data sets and will enhance the ability to study the epidemiology and design interventions for this important complication of diabetes care.

Objective assessment of compliance and persistence among patients treated for glaucoma and ocular hypertension: a systematic review

PubMed Central

Reardon, Gregory; Kotak, Sameer; Schwartz, Gail F

2011-01-01

Purpose This study summarizes findings from objective assessments of compliance (or adherence) and persistence with ocular hypotensive agents in patients with glaucoma and ocular hypertension. Design Systematic literature review. Methods A PubMed and reference list search was conducted across publication years 1970–2010, using these terms and variants: “compliance,” the equivalent term “adherence,” and “persistence” in patients with these conditions and therapies. Summaries of selected studies were stratified by measurement method (electronic monitor, prescription fills review, medical chart review). Measures of central tendency across studies were calculated for commonly-reported compliance or persistence measures. Results Fifty-eight articles met all inclusion/exclusion criteria: measurement of compliance–electronic monitoring (seven studies reported in 14 articles), measurement of compliance/ persistence–prescription records (36 studies in 38 articles), and measurement of persistence– medical chart review (six studies in six articles). From electronic monitoring, most therapy-experienced patients took medication consistently, but ≥20% met criteria for poor compliance. From prescription records, only 56% (range 37%–92%) of the days in the first therapy year could be dosed with the medication supply dispensed over this period. At 12 months from therapy start, only 31% (range 10%–68%) of new therapy users had not discontinued, and 40% (range 14%–67%) had not discontinued or changed the initial therapy. From medical chart review, only 67% (range 62%–78%) of patients remained persistent 12 months after starting therapy. Conclusions Evidence provided by this review suggests that poor compliance and persistence has been and remains a common problem for many glaucoma patients, and is especially problematic for patients new to therapy. The direction of empirical research should shift toward a greater emphasis on understanding of root causes and identification and testing of solutions for this problem. PMID:22003282

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

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

Fong de los Santos, L; Dong, L; Greener, A

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

Methods for assessing patient-clinician communication about depression in primary care: what you see depends on how you look.

PubMed

Henry, Stephen G; Feng, Bo; Franks, Peter; Bell, Robert A; Tancredi, Daniel J; Gottfeld, Dustin; Kravitz, Richard L

2014-10-01

To advance research on depression communication and treatment by comparing assessments of communication about depression from patient report, clinician report, and chart review to assessments from transcripts. One hundred sixty-four primary care visits from seven health care systems (2010-2011). Presence or absence of discussion about depressive symptoms, treatment recommendations, and follow-up was measured using patient and clinician postvisit questionnaires, chart review, and coding of audio transcripts. Sensitivity and specificity of indirect measures compared to transcripts were calculated. Patient report was sensitive for mood (83 percent) and sleep (83 percent) but not suicide (55 percent). Patient report was specific for suicide (86 percent) but not for other symptoms (44-75 percent). Clinician report was sensitive for all symptoms (83-98 percent) and specific for sleep, memory, and suicide (80-87 percent), but not for other symptoms (45-48 percent). Chart review was not sensitive for symptoms (50-73 percent), but it was specific for sleep, memory, and suicide (88-96 percent). All indirect measures had low sensitivity for treatment recommendations (patient report: 24-42 percent, clinician report 38-50 percent, chart review 49-67 percent) but high specificity (89-96 percent). For definite follow-up plans, all three indirect measures were sensitive (82-96 percent) but not specific (40-57 percent). Clinician report and chart review generally had the most favorable sensitivity and specificity for measuring discussion of depressive symptoms and treatment recommendations, respectively. © Health Research and Educational Trust.

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

PubMed

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

2017-12-01

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

Comparing Resident Self-Report to Chart Audits for Quality Improvement Projects: Accurate Reflection or Cherry-Picking?

PubMed Central

Kuperman, Ethan F.; Tobin, Kristen; Kraschnewski, Jennifer L.

2014-01-01

Background Resident engagement in quality improvement is a requirement for graduate medical education, but the optimal means of instruction and evaluation of resident progress remain unknown. Objective To determine the accuracy of self-reported chart audits in measuring resident adherence to primary care clinical practice guidelines. Methods During the 2010–2011 academic year, second- and third-year internal medicine residents at a single, university hospital–based program performed chart audits on 10 patients from their primary care clinic to determine adherence to 16 US Preventive Services Task Force primary care guidelines. We compared residents' responses to independent audits of randomly selected patient charts by a single external reviewer. Results Self-reported data were collected by 18 second-year and 15 third-year residents for 330 patients. Independently, 70 patient charts were randomly selected for review by an external auditor. Overall guideline compliance was significantly higher on self-reported audits compared to external audits (82% versus 68%, P < .001). Of 16 guidelines, external audits found significantly lower rates of adherence for 5 (tetanus vaccination, osteoporosis screening, colon cancer screening, cholesterol screening, and obesity screening). Chlamydia screening was more common in audited charts than in self-reported data. Although third-year residents self-reported higher guideline adherence than second-year residents (86% versus 78%, P < .001), external audits for third-year residents found lower overall adherence (64% versus 72%, P  =  .040). Conclusions Residents' self-reported chart audits may significantly overestimate guideline adherence. Increased supervision and independent review appear necessary to accurately evaluate resident performance. PMID:26140117

Comparing Resident Self-Report to Chart Audits for Quality Improvement Projects: Accurate Reflection or Cherry-Picking?

PubMed

Kuperman, Ethan F; Tobin, Kristen; Kraschnewski, Jennifer L

2014-12-01

Resident engagement in quality improvement is a requirement for graduate medical education, but the optimal means of instruction and evaluation of resident progress remain unknown. To determine the accuracy of self-reported chart audits in measuring resident adherence to primary care clinical practice guidelines. During the 2010-2011 academic year, second- and third-year internal medicine residents at a single, university hospital-based program performed chart audits on 10 patients from their primary care clinic to determine adherence to 16 US Preventive Services Task Force primary care guidelines. We compared residents' responses to independent audits of randomly selected patient charts by a single external reviewer. Self-reported data were collected by 18 second-year and 15 third-year residents for 330 patients. Independently, 70 patient charts were randomly selected for review by an external auditor. Overall guideline compliance was significantly higher on self-reported audits compared to external audits (82% versus 68%, P < .001). Of 16 guidelines, external audits found significantly lower rates of adherence for 5 (tetanus vaccination, osteoporosis screening, colon cancer screening, cholesterol screening, and obesity screening). Chlamydia screening was more common in audited charts than in self-reported data. Although third-year residents self-reported higher guideline adherence than second-year residents (86% versus 78%, P < .001), external audits for third-year residents found lower overall adherence (64% versus 72%, P  =  .040). Residents' self-reported chart audits may significantly overestimate guideline adherence. Increased supervision and independent review appear necessary to accurately evaluate resident performance.

Loxapine for Reversal of Antipsychotic-Induced Metabolic Disturbances: A Chart Review

ERIC Educational Resources Information Center

Jain, Seema; Andridge, Rebecca; Hellings, Jessica A.

2016-01-01

Loxapine substitution is a promising option for patients with autism spectrum disorder (ASD) who develop antipsychotic-induced metabolic illness. We performed a chart review of 15 adolescents and adults meeting DSM-IV-TR criteria for ASD, all with antipsychotic-associated weight gain, who received low dose loxapine in an attempt to taper or…

Quantifying Dental Office-Originating Adverse Events: The Dental Practice Study Methods.

PubMed

Tokede, Oluwabunmi; Walji, Muhammad; Ramoni, Rachel; Rindal, Donald B; Worley, Donald; Hebballi, Nutan; Kumar, Krishna; van Strien, Claire; Chen, Mengxia; Navat-Pelli, Shaked; Liu, Hongchun; Etolue, Jini; Yansane, Alfa; Obadan-Udoh, Enihomo; Easterday, Casey; Enstad, Chris; Kane, Sheryl; Rush, William; Kalenderian, Elsbeth

2017-12-05

Preventable medical errors in hospital settings are the third leading cause of deaths in the United States. However, less is known about harm that occurs in patients in outpatient settings, where the majority of care is delivered. We do not know the likelihood that a patient sitting in a dentist chair will experience harm. Additionally, we do not know if patients of certain race, age, sex, or socioeconomic status disproportionately experience iatrogenic harm. We initiated the Dental Practice Study (DPS) with the aim of determining the frequency and types of adverse events (AEs) that occur in dentistry on the basis of retrospective chart audit. This article discusses the 6-month pilot phase of the DPS during which we explored the feasibility and efficiency of our multistaged review process to detect AEs. At sites 1, 2, and 3, respectively, 2 reviewers abstracted 21, 11, and 23 probable AEs, respectively, from the 100 patient charts audited per site. At site 2, a third reviewer audited the same 100 charts and found only 1 additional probable AE. Of the total 56 probable AEs (from 300 charts), the expert panel confirmed 9 AE cases. This equals 3 AEs per 100 patients per year. Patients who experienced an AE tended to be male and older and to have undergone more procedures within the study year. This article presents an overview of the DPS. It describes the methods used and summarizes the results of its pilot phase. To minimize threats to dental patient safety, a starting point is to understand their basic epidemiology, both in terms of their frequency and the extent to which they affect different populations.

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

PubMed

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

2014-12-01

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

Depression Screening Patterns for Women in Rural Health Clinics

ERIC Educational Resources Information Center

Tudiver, Fred; Edwards, Joellen Beckett; Pfortmiller, Deborah T.

2010-01-01

Context: Rates and types of screening for depression in rural primary care practices are unknown. Purpose: To identify rates of depression screening among rural women in a sample of rural health clinics (RHCs). Methods: A chart review of 759 women's charts in 19 randomly selected RHCs across the nation. Data were collected from charts of female…

Coding and Flow Charting as Applied to UICSM Programed Texts (1962-1963 Versions). Comparative Studies of Principles for Programming Mathematics in Automated Instruction. Technical Report.

ERIC Educational Resources Information Center

Stolurow, Lawrence M.; And Others

Coding systems need to be developed to account for computer decisions on every frame of a self-instructional program. In flow charts of the UICSM high school math programed series, each frame or page is represented by a diagramatic convention: diamond if a mainline frame, a rectangle if a quiz frame, a bottom-heavy trapezoid if a review or…

Software tool for physics chart checks.

PubMed

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

2014-01-01

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

Management Control Systems in Not-for-Profit Organizations: A Case Study.

DTIC Science & Technology

1982-12-01

UNCLASSIFIED F/G 5/1 NL mhmmhhhhhmhmmum IEIIEEIIIIIEEE EIIIIIIIIIIIIl Diiit 1.1_I220 H- M141116 MICROCOPY RESOLUION4 TEST CHART 14ATIONAL BUREAU Of... test case. C. RESEARCH RET HODS The first phase of the study was a review of current literature on management control procedures and systems in...RESOLUTION TEST CHART NATIONAL BUREAU 0f SIANDARD 96% A I II a U a .1 ii IiU- I! IA i -~ - U I -..................... I I ~ 3 ,’u!nAA~~ -~~j ~; Eu ~ II 8I~ ~B

A Retrospective Chart Review of Chronic Wound Patients Treated with Topical Oxygen Therapy.

PubMed

Copeland, Karen; Purvis, Angie R

2017-05-01

Objective: Topical oxygen devices are Food and Drug Administration (FDA) cleared for the following indications for use of various etiologies: skin ulcerations due to diabetes, venous stasis, postsurgical infections and gangrenous lesions, decubitus ulcers; amputations/infected stumps; skin grafts; burns; and frostbite. The goal of this study was to understand the impact of topical oxygen therapy (TOT) on patient outcomes, including amputation and healing rates. Approach: This retrospective chart review included records collected between January 1, 2007, and July 18, 2016, from male and female patients ranging in age from 4 years to 105 years. All wounds were at least 1 cm 2 and were treated with at least one separate modality before treatment with TOT and then treated with TOT for a minimum of 2 weeks in compliance with the FDA-approved indications. All records were from wounds that were no longer being treated with TOT. Results: In this study, TOT was associated with an overall rate of 59.4% for a reduction in chronic wound size, while 41.6% of wounds had no healing. The overall amputation rate was 2.4% for wounds in this study. Innovation: To our knowledge, this retrospective chart review represents one of the largest data sets (4,127 total wounds) collected over one of the longest time periods (9.5 years) to evaluate patient outcomes following TOT. Conclusion: This study revealed healing and amputation rates similar to those reported in controlled clinical studies using TOT to treat chronic wounds.

Correlational Study of Sleep Apnea Patient Characteristics With Discharge Locations.

PubMed

Lee, Esther; Daugherty, JoAnn; Burkard, Joseph

2016-10-01

To determine if a correlation exists between OSA patient characteristics and the PACU discharge location; and the characteristics of the patients at-risk for low saturation levels, increased number of desaturations, and longer length of stay in the PACU. Retrospective, correlational study design. Chart review of OSA patients ≥ 18 years old. Correlational analysis was performed between 15 high risk patient variables and the PACU discharge disposition: home or monitored bed. Complications resulting in monitored bed admission were reviewed. 153 patients' charts were reviewed. The results showed that age>60, ASA classification, anesthesia type and narcotics use in the PACU were significantly correlated (p≤.05) with a patient's discharge disposition. The findings are consistent with other OSA research except BMI was not significant in this study. The results highlighted areas for future research and implications for clinical practice that would enable the perioperative care team to deliver safe care based on evidence. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

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

PubMed

Sköld, Carl Magnus; Janson, Christer; Elf, Åsa Klackenberg; Fiaschi, Marie; Wiklund, Kerstin; Persson, Hans Lennart

2016-01-01

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

Diagnoses of Early and Late Readmissions after Hospitalization for Pneumonia. A Systematic Review

PubMed Central

Sjoding, Michael W.; Iwashyna, Theodore J.

2014-01-01

Rationale: Pneumonia is a frequent cause of hospitalization, yet drivers of post-pneumonia morbidity remain poorly characterized. Causes of hospital readmissions may elucidate important sources of morbidity and are of particular interest given the U.S. Hospital Readmission Reductions Program. Objectives: To review the primary diagnoses of early (≤30 d) and late (≥31 d) readmissions after pneumonia hospitalization. Methods: Systematic review of MEDLINE, Embase, and CINAHL databases. We identified original research studies of adults aged 18 years or older, hospitalized for pneumonia, and for whom cause-specific readmission rates were reported. Two authors abstracted study results and assessed study quality. Measurements and Main Results: Of the 1,243 citations identified, 12 met eligibility criteria. Included studies were conducted in the United States, Spain, Canada, Croatia, and Sweden. All-cause 30-day readmission rates ranged from 16.8 to 20.1% across administrative studies; the weighted average for the studies using chart review was 11.6% (15.6% in United States–based studies). Pneumonia, heart failure/cardiovascular causes, and chronic obstructive pulmonary disease/pulmonary causes are the most common reasons for early readmission after pneumonia hospitalization. Although it was the single most common cause for readmission, pneumonia accounted for only 17.9 to 29.4% of all 30-day readmissions in administrative studies and a weighted average of 23.0% in chart review studies. After accounting for study population, there was no clear difference in findings between claims-based versus chart-review studies. Few studies assessed readmissions beyond 30 days, although the limited available data suggest similar primary diagnoses for early and late readmissions. No studies assessed whether reasons for readmission were similar to patients’ reasons for healthcare use before hospitalization. Conclusions: Pneumonia, heart failure/cardiovascular disease, and chronic obstructive pulmonary disease/pulmonary disease are the most common readmission diagnoses after pneumonia hospitalization. Although pneumonia was the most common readmission diagnosis, it accounted for only a minority of all readmissions. Late readmission diagnoses are less thoroughly described, and further research is needed to understand how hospitalization for pneumonia fits within the broader context of patients’ health trajectory. PMID:25079245

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

PubMed

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

2017-08-22

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

The Eye Phone Study: reliability and accuracy of assessing Snellen visual acuity using smartphone technology

PubMed Central

Perera, C; Chakrabarti, R; Islam, F M A; Crowston, J

2015-01-01

Purpose Smartphone-based Snellen visual acuity charts has become popularized; however, their accuracy has not been established. This study aimed to evaluate the equivalence of a smartphone-based visual acuity chart with a standard 6-m Snellen visual acuity (6SVA) chart. Methods First, a review of available Snellen chart applications on iPhone was performed to determine the most accurate application based on optotype size. Subsequently, a prospective comparative study was performed by measuring conventional 6SVA and then iPhone visual acuity using the ‘Snellen' application on an Apple iPhone 4. Results Eleven applications were identified, with accuracy of optotype size ranging from 4.4–39.9%. Eighty-eight patients from general medical and surgical wards in a tertiary hospital took part in the second part of the study. The mean difference in logMAR visual acuity between the two charts was 0.02 logMAR (95% limit of agreement −0.332, 0.372 logMAR). The largest mean difference in logMAR acuity was noted in the subgroup of patients with 6SVA worse than 6/18 (n=5), who had a mean difference of two Snellen visual acuity lines between the charts (0.276 logMAR). Conclusion We did not identify a Snellen visual acuity app at the time of study, which could predict a patients standard Snellen visual acuity within one line. There was considerable variability in the optotype accuracy of apps. Further validation is required for assessment of acuity in patients with severe vision impairment. PMID:25931170

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

PubMed

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

2016-09-01

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

Are Anxiety and Depression Addressed in Primary Care Patients With Chronic Obstructive Pulmonary Disease? A Chart Review

PubMed Central

Roundy, Kent; Cully, Jeffrey A.; Stanley, Melinda A.; Veazey, Connie; Souchek, Julianne; Wray, Nelda P.; Kunik, Mark E.

2005-01-01

Objective: Screening for mental illness in primary care is widely recommended, but little is known about the evaluation, treatment, and long-term management processes that follow screening. The aim of this study was to examine and describe the quality of mental health care for persons with chronic obstructive pulmonary disease (COPD) and anxiety/depressive disorders, as measured by adherence to practice guidelines. Method: This retrospective chart review examined data for 102 primary care and mental health care patients with COPD who were diagnosed, using Structured Clinical Interview for DSM-IV criteria, with major depressive disorder, dysthymia, depression not otherwise specified, generalized anxiety disorder, or anxiety not otherwise specified. Data were gathered from primary care progress notes from the year prior to enrollment in a randomized controlled trial (enrollment was from July 2002 to April 2004). We compared the care received by these patients over 1 year with that recommended by practice guidelines. Charts were abstracted using a checklist of recommended practice guidelines for diagnostic evaluation, acute treatment, and long-term management of anxiety and depressive disorders. Results: Fifty (49%) of the 102 patients were recognized during the review year as having an anxiety or depressive disorder. Eighteen patients were newly assessed for depressive or anxiety disorders during the chart review year. Patients followed in primary care alone, compared with those who were comanaged by mental health care providers, were less likely to have guideline-adherent care. Conclusion: Depressive and anxiety disorders are recognized in about half of patients; however, guideline-supported diagnostic evaluation, acute treatment (except for medications), and long-term management rarely occur in the primary care setting. To improve the treatment of depressive and anxiety disorders in primary care, the process of care delivery must be understood and changed. PMID:16308576

Retrospective chart review of children with type 2 diabetes mellitus evaluating the efficacy of metformin vs. insulin vs. combination insulin/metformin.

PubMed

Meyer, Stacy L; Hoffman, Robert P

2011-10-01

Type 2 diabetes mellitus is a growing problem in pediatrics and there is no consensus on the best treatment. We conducted this chart review on newly diagnosed pediatric patients with type 2 diabetes mellitus to compare the effect of treatment regimen on body mass index (BMI) and hemoglobin A1c over a 6-month period. We conducted a retrospective chart review on patients with type 2 DM who presented to Nationwide Children's Hospital. Data were collected on therapy type, BMI, and hemoglobin A1c over a 6-month follow-up. Therapy type was divided into metformin, insulin, or combination insulin and metformin. 1,997 charts were reviewed for inclusion based on ICD-9 codes consistent with a diagnosis of diabetes, abnormal oral glucose tolerance test, or insulin resistance. Of the 47 charts eligible for the review, 26 subjects were treated with metformin 1000-1500 mg daily, 14 patients were treated with insulin therapy, and 7 patients were treated with a combination of insulin and metformin therapy. At baseline, the only significant difference among groups was A1c (P = 0.012). In regression analysis with baseline A1c as a covariate, the only predictor of change in A1c over time was the A1c at onset (P < 0.001). Therapy type was not predictive of change (P = 0.905). Regression analysis showed a greater BMI at onset predicted a greater decrease in BMI (P = 0.006), but therapy type did not predict a change (P = 0.517). Metformin may be as effective as insulin or combination therapy for treatment of diabetes from onset to 6-month follow-up.

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

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

Lawrence, Yaacov Richard, E-mail: yaacovla@gmail.com; Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer; Sackler School of Medicine, Tel Aviv University

Purpose: In light of concerns regarding the quality of radiation treatment delivery, we surveyed the practice of quality assurance peer review chart rounds at American academic institutions. Methods and Materials: An anonymous web-based survey was sent to the chief resident of each institution across the United States. Results: The response rate was 80% (57/71). The median amount of time spent per patient was 2.7 minutes (range, 0.6-14.4). The mean attendance by senior physicians and residents was 73% and 93%, respectively. A physicist was consistently present at peer review rounds in 66% of departments. There was a close association between attendancemore » by senior physicians and departmental organization: in departments with protected time policies, good attendance was 81% vs. 31% without protected time (p = 0.001), and in departments that documented attendance, attending presence was 69% vs. 29% in departments without documentation (p < 0.05). More than 80% of institutions peer review all external beam therapy courses; however, rates were much lower for other modalities (radiosurgery 58%, brachytherapy 40%-47%). Patient history, chart documentation, and dose prescription were always peer reviewed in >75% of institutions, whereas dosimetric details (beams, wedges), isodose coverage, intensity-modulated radiation therapy constraints, and dose-volume histograms were always peer reviewed in 63%, 59%, 42%, and 50% of cases, respectively. Chart rounds led to both minor (defined as a small multileaf collimator change/repeated port film) and major (change to dose prescription or replan with dosimetry) treatment changes. Whereas at the majority of institutions changes were rare (<10% of cases), 39% and 11% of institutions reported that minor and major changes, respectively, were made to more than 10% of cases. Conclusion: The implementation of peer review chart rounds seems inconsistent across American academic institutions. Brachytherapy and radiosurgical procedures are rarely reviewed. Attendance by senior physicians is variable, but it improves when scheduling clashes are avoided. The potential effect of a more thorough quality assurance peer review on patient outcomes is not known.« less

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

PubMed Central

Staton, Lisa J; Kraemer, Suzanne M; Patel, Sangnya; Talente, Gregg M; Estrada, Carlos A

2007-01-01

Background The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus. Methods A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided. Results Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33%) (p = 0.001), 26% (from 45% to 71%) (p < 0.001), and 18% (51%–72%) (p = 0.005), respectively. Similarly, the proportion of patients receiving a well-documented exam which includes all three components – neurological, vascular and skin foot exam – increased over time (6% to 24%, p < 0.001). Conclusion Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial. PMID:17662124

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

PubMed

Staton, Lisa J; Kraemer, Suzanne M; Patel, Sangnya; Talente, Gregg M; Estrada, Carlos A

2007-07-27

The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus. A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided. Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33%) (p = 0.001), 26% (from 45% to 71%) (p < 0.001), and 18% (51%-72%) (p = 0.005), respectively. Similarly, the proportion of patients receiving a well-documented exam which includes all three components - neurological, vascular and skin foot exam - increased over time (6% to 24%, p < 0.001). Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial.

An Assessment of an Outpatient Antimicrobial Therapy Program in a Rural Medical Center : A Retrospective Chart Review.

PubMed

Burkett, Matthew Shawn; Macci Bires, Angela; Cline, Thomas W; Knight, Anthony

Current literature supports outpatient parenteral antimicrobial therapy (OPAT). This article presents results from a research study that evaluated an OPAT program that treated community-acquired pneumonia. If patients had the opportunity to receive outpatient intravenous antibiotics for community-acquired pneumonia, would this prevent future hospitalization? Was there a decrease in hospital admissions? An informal cost-benefit analysis comparing OPAT with inpatient hospital admissions for the same disease was also reviewed to provide evidence whether there was a change. What was the overall health care cost savings? The medical charts of 50 patients with confirmed pneumonia who had received OPAT in a 3-month period were reviewed. A retrospective medical record review was performed. All patients were evaluated by the in-house OPAT team. The resulting analysis provided evidence that an estimated savings of approximately $2100 per day would be achieved by decreasing hospital readmissions for patient who had been treated with OPAT. The conclusion of this study provides evidence that the implement of an OPAT program was, and is, essential for patient care and evidence-based best practice adherence.

Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review.

PubMed

McDonald, Sarah D; Machold, Clea A; Marshall, Laura; Kingston, Dawn

2014-06-13

Documentation in medical records fulfills key functions, including management of care, communication, quality assurance and record keeping. We sought to describe: 1) rates of standard prenatal care as documented in medical charts, and given the higher risks with excess weight, whether this documentation varied among normal weight, overweight and obese women; and 2) adherence to obesity guidelines for obese women as documented in the chart. We conducted a chart review of 300 consecutive charts of women who delivered a live singleton at an academic tertiary centre from January to March 2012, computing Analysis of Variance and Chi Square tests. The proportion of completed fields on the mandatory antenatal forms varied from 100% (maternal age) to 52.7% (pre-pregnancy body mass index). Generally, documentation of care was similar across all weight categories for maternal and prenatal genetic screening tests, ranging from 54.0% (documentation of gonorrhea/chlamydia tests) to 85.0% (documentation of anatomy scan). Documentation of education topics varied widely, from fetal movement in almost all charts across all weight categories but discussion of preterm labour in only 20.6%, 12.7% and 13.4% of normal weight, overweight and obese women's charts (p = 0.224). Across all weight categories, documentation of discussion of exercise, breastfeeding and pain management occurred in less than a fifth of charts. Despite a predominance of excess weight in our region, as well as increasing perinatal risks with increasing maternal weight, weight-related issues and other elements of prenatal care were suboptimally documented across all maternal weight categories, despite an obesity guideline.

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

PubMed

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

2013-04-01

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

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

PubMed

Mador, Rebecca L; Shaw, Nicola T

2009-07-01

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

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

PubMed

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

2010-01-01

Relapse is a common measure of disease activity in relapsing-remitting multiple sclerosis (MS). The objective of this study was to test the content validity of an operational algorithm for detecting relapse in claims data. A claims-based relapse detection algorithm was tested by comparing its detection rate over a 1-year period with relapses identified based on medical chart review. According to the algorithm, MS patients in a US healthcare claims database who had either (1) a primary claim for MS during hospitalization or (2) a corticosteroid claim following a MS-related outpatient visit were designated as having a relapse. Patient charts were examined for explicit indication of relapse or care suggestive of relapse. Positive and negative predictive values were calculated. Medical charts were reviewed for 300 MS patients, half of whom had a relapse according to the algorithm. The claims-based criteria correctly classified 67.3% of patients with relapses (positive predictive value) and 70.0% of patients without relapses (negative predictive value; kappa 0.373: p < 0.001). Alternative algorithms did not improve on the predictive value of the operational algorithm. Limitations of the algorithm include lack of differentiation between relapsing-remitting MS and other types, and that it does not incorporate measures of function and disability. The claims-based algorithm appeared to successfully detect moderate-to-severe MS relapse. This validated definition can be applied to future claims-based MS studies.

Outcomes of Computerized Physician Order Entry in an Electronic Health Record After Implementation in an Outpatient Oncology Setting

PubMed Central

Harshberger, Cara A.; Harper, Abigail J.; Carro, George W.; Spath, Wayne E.; Hui, Wendy C.; Lawton, Jessica M.; Brockstein, Bruce E.

2011-01-01

Purpose: Computerized physician order entry (CPOE) in electronic health records (EHR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after implementation of an outpatient oncology EHR/ CPOE system in a hospital-based outpatient cancer center within three treatment sites. Methods: This study is a retrospective chart review of 90 patients who received one of the following regimens between 1999 and 2006: FOLFOX, AC, carboplatin + paclitaxel, ABVD, cisplatin + etoposide, R-CHOP, and clinical trials. Documentation completeness scores were assigned to each chart based on the number of documented data points found out of the total data points assessed. EHR/CPOE documentation completeness was compared with completeness of paper charts orders of the same regimens. A user satisfaction survey of the paper chart and EHR/CPOE system was conducted among the physicians, nurses, and pharmacists who worked with both systems. Results: The mean percentage of identified data points successfully found in the EHR/CPOE charts was 93% versus 67% in the paper charts (P < .001). Regimen complexity did not alter the number of data points found. The survey response rate was 64%, and the results showed that satisfaction was statistically significant in favor of the EHR/CPOE system. Conclusion: Using EHR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. EHR/CPOE requires constant vigilance and maintenance to optimize patient safety. PMID:22043187

Interobserver agreement in retrospective chart reviews for factors associated with cervical spine injuries in children.

PubMed

Olsen, Cody S; Kuppermann, Nathan; Jaffe, David M; Brown, Kathleen; Babcock, Lynn; Mahajan, Prashant V; Leonard, Julie C

2015-04-01

The objective was to describe the interobserver agreement between trained chart reviewers and physician reviewers in a multicenter retrospective chart review study of children with cervical spine injuries (CSIs). Medical records of children younger than 16 years old with cervical spine radiography from 17 Pediatric Emergency Care Applied Research Network (PECARN) hospitals from years 2000 through 2004 were abstracted by trained reviewers for a study aimed to identify predictors of CSIs in children. Independent physician-reviewers abstracted patient history and clinical findings from a random sample of study patient medical records at each hospital. Interobserver agreement was assessed using percent agreement and the weighted kappa (κ) statistic, with lower 95% confidence intervals. Moderate or better agreement (κ > 0.4) was achieved for most candidate CSI predictors, including altered mental status (κ = 0.87); focal neurologic findings (κ = 0.74); posterior midline neck tenderness (κ = 0.74); any neck tenderness (κ = 0.89); torticollis (κ = 0.79); complaint of neck pain (κ = 0.83); history of loss of consciousness (κ = 0.89); nonambulatory status (κ = 0.74); and substantial injuries to the head (κ = 0.50), torso/trunk (κ = 0.48), and extremities (κ = 0.59). High-risk mechanisms showed near-perfect agreement (diving, κ = 1.0; struck by car, κ = 0.93; other motorized vehicle crash, κ = 0.93; fall, κ = 0.92; high-risk motor vehicle collision, κ = 0.89; hanging, κ = 0.80). Fair agreement was found for clotheslining mechanisms (κ = 0.36) and substantial face injuries (κ = 0.40). Most retrospectively assessed variables thought to be predictive of CSIs in blunt trauma-injured children had at least moderate interobserver agreement, suggesting that these data are sufficiently valid for use in identifying potential predictors of CSI. © 2015 by the Society for Academic Emergency Medicine.

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

PubMed

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

2016-06-01

Objectives The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18min to 98h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers' orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners' orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers' orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers' electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility's pharmacy, could improve patient safety.

Opportunities and challenges in conducting secondary analysis of HIV programmes using data from routine health information systems and personal health information.

PubMed

Gloyd, Stephen; Wagenaar, Bradley H; Woelk, Godfrey B; Kalibala, Samuel

2016-01-01

HIV programme data from routine health information systems (RHIS) and personal health information (PHI) provide ample opportunities for secondary data analysis. However, these data pose unique opportunities and challenges for use in health system monitoring, along with process and impact evaluations. Analyses focused on retrospective case reviews of four of the HIV-related studies published in this JIAS supplement. We identify specific opportunities and challenges with respect to the secondary analysis of RHIS and PHI data. Challenges working with both HIV-related RHIS and PHI included missing, inconsistent and implausible data; rapidly changing indicators; systematic differences in the utilization of services; and patient linkages over time and different data sources. Specific challenges among RHIS data included numerous registries and indicators, inconsistent data entry, gaps in data transmission, duplicate registry of information, numerator-denominator incompatibility and infrequent use of data for decision-making. Challenges specific to PHI included the time burden for busy providers, the culture of lax charting, overflowing archives for paper charts and infrequent chart review. Many of the challenges that undermine effective use of RHIS and PHI data for analyses are related to the processes and context of collecting the data, excessive data requirements, lack of knowledge of the purpose of data and the limited use of data among those generating the data. Recommendations include simplifying data sources, analysis and reporting; conducting systematic data quality audits; enhancing the use of data for decision-making; promoting routine chart review linked with simple patient tracking systems; and encouraging open access to RHIS and PHI data for increased use.

Review and enhancement of CHART operations to maximize the benefit of incident response and management.

DOT National Transportation Integrated Search

2012-07-01

This project was focused on identifying potential areas for Marylands Coordinated Highway : Action Response Team (CHART) to enhance its incident management efficiency and to maximize the : resulting benefits under existing resource constraints. Us...

Adolescent build plotting on body composition chart and the type of diabetes mellitus.

PubMed

Park, Hye Won; Kim, Yong Hyuk; Cho, Myunghyun; Kwak, Byung Ok; Kim, Kyo Sun; Chung, Sochung

2012-11-01

Although the prevalence of type 2 diabetes is increasing, there are cases difficult to categorize into certain type in pediatric diabetic patients. The aims of this study were to detect and choose a proper treatment modality for atypical cases of diabetes mellitus, using the body composition chart. We conducted a retrospective study from August 2005 to 2012 with patients who visited Konkuk University Medical Center, and were diagnosed with diabetes mellitus. The medical records were reviewed for the anthropometric data and indices of body composition. The subjects were grouped by the type of diabetes and gender. We constructed a body composition chart plotting fat free mass index and fat mass index (FMI). Body mass index and all body composition indices were higher in type 2 diabetes, in each gender in analysis with Mann-Whitney test. Significant determinant of diabetes type was revealed as FMI and contributing factors on FMI were analyzed with regression analysis. Six atypical cases were identified by a body composition chart including non-obese type 2 diabetes showing suboptimal growth with lower BMI related to relatively lower insulin secretion and type 1 diabetes with insulin resistance resulted from obesity. Body composition chart analysis might be useful in characterization of diabetes type and detection of atypical cases and early adjustment of diabetes management strategy.

Quality and Efficiency Improvement Tools for Every Radiologist.

PubMed

Kudla, Alexei U; Brook, Olga R

2018-06-01

In an era of value-based medicine, data-driven quality improvement is more important than ever to ensure safe and efficient imaging services. Familiarity with high-value tools enables all radiologists to successfully engage in quality and efficiency improvement. In this article, we review the model for improvement, strategies for measurement, and common practical tools with real-life examples that include Run chart, Control chart (Shewhart chart), Fishbone (Cause-and-Effect or Ishikawa) diagram, Pareto chart, 5 Whys, and Root Cause Analysis. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Satellite Power System (SPS) concept definition study (exhibit C)

NASA Technical Reports Server (NTRS)

1978-01-01

The SPS program plan is outlined. An overall review of the component systems which comprise the SPS is presented. The report is presented in the form of charts, graphs, data tables, and engineering drawings.

Human Factors Design Principles for Instrument Approach Procedure Charts Volume I - Readability

DOT National Transportation Integrated Search

1992-08-01

This Handbook is the first of a series of handbooks which address thie issue of : Instrument Approach Procedure (IAP) chart improvement in design, The intent is : twofold: to review relevant literature that might be applicable to improving the : pres...

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

PubMed

Liddy, Clare; Wiens, Miriam; Hogg, William

2011-01-01

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

Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators.

PubMed

Mull, Hillary J; Borzecki, Ann M; Loveland, Susan; Hickson, Kathleen; Chen, Qi; MacDonald, Sally; Shin, Marlena H; Cevasco, Marisa; Itani, Kamal M F; Rosen, Amy K

2014-04-01

The Patient Safety Indicators (PSIs) use administrative data to screen for select adverse events (AEs). In this study, VA Surgical Quality Improvement Program (VASQIP) chart review data were used as the gold standard to measure the criterion validity of 5 surgical PSIs. Independent chart review was also used to determine reasons for PSI errors. The sensitivity, specificity, and positive predictive value of PSI software version 4.1a were calculated among Veterans Health Administration hospitalizations (2003-2007) reviewed by VASQIP (n = 268,771). Nurses re-reviewed a sample of hospitalizations for which PSI and VASQIP AE detection disagreed. Sensitivities ranged from 31% to 68%, specificities from 99.1% to 99.8%, and positive predictive values from 31% to 72%. Reviewers found that coding errors accounted for some PSI-VASQIP disagreement; some disagreement was also the result of differences in AE definitions. These results suggest that the PSIs have moderate criterion validity; however, some surgical PSIs detect different AEs than VASQIP. Future research should explore using both methods to evaluate surgical quality. Published by Elsevier Inc.

Today's DOT and the quest for more accountable organizational structures.

DOT National Transportation Integrated Search

2005-12-01

This study investigates the impact of DOT organizational structures on effective transportation planning and performance. A review of the 50 state DOT authorizing statutes and DOT organizational charts found minimal differences in organizational stru...

Manufacturer-provided effective orifice area index charts and the prevention of prosthesis-patient mismatch.

PubMed

House, Chad M; Nelson, William B; Kroshus, Timothy J; Dahiya, Ranjan; Pibarot, Philippe

2012-01-01

Prosthesis-patient mismatch (PPM) occurs when an implanted prosthesis is too small relative to the patient's body surface area (BSA). However, mismatch can often be prevented by indexing the expected effective orifice area (EOA) of a prosthesis to the patient's BSA and then selecting the largest implantable prosthesis to avoid mismatch. Previously, prosthesis manufacturers have attempted to simplify this process by providing charts that include the expected EOA for their prosthesis, already indexed into an array of BSA values. One caveat with these charts is that the expected EOA data must truly be reliable, or the charts will misguide the implanting surgeon. Manufacturer-provided charts could be improved by standardizing the EOA data, with one potential source being the hemodynamic data submitted to the United States Food and Drug Administration. This review discusses PPM, manufacturer-provided EOA charts, and the regulation of EOA data.

The Relationship of Welding Fume Exposure, Smoking, and Pulmonary Function in Welders.

PubMed

Roach, Laura L

2018-01-01

The purpose of this study was to explore the relationship between occupational exposure to welding fumes and pulmonary function in an effort to add supportive evidence and clarity to the current body of research. This study utilized a retrospective chart review of pulmonary function testing and pulmonary questionnaires already available in charts from preplacement physicals to the most recent test. When comparing smokers to nonsmokers, utilizing multiple regression and controlling for age and percentage of time using a respirator, years welding was statistically significant at p = .04. Data support that smoking has a synergistic effect when combined with welding fume exposure on pulmonary decline.

Balloon dilation of sinus ostia in the Department of Defense: Diagnoses, actual indications, and outcomes.

PubMed

Laury, Adrienne M; Bowe, Sarah N; Stramiello, Joshua; McMains, Kevin C

2017-03-01

To determine the primary diagnoses for which balloon catheter dilation (BCD) of sinus ostia is being employed in a profit-blind health care system, the Department of Defense. Retrospective chart review. From January 1, 2011 to December 31, 2013, 319 consecutive patient charts were reviewed for International Classification of Diseases, Ninth Edition (ICD-9) diagnoses, presence of chronic rhinosinusitis (CRS) defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), preoperative Lund-Mackay scores, nasal endoscopy findings, sinuses dilated, postoperative outcomes, and complications. Of the 319 patients identified, 217 had sufficient documentation to be included. A CRS ICD-9 code was applied in 182 of 217 (83.9%) and recurrent acute rhinosinusitis in 12 of 217 (5.6%). Only 50.5% of CRS patient charts met criteria using EPOS guidelines. In contrast, 39.6% met the ICD-9 criteria for atypical facial pain. Patients with Lund-Mackay scores ≤ 4 were reviewed for number of sinuses dilated. Eighty-eight of 123 patients (71.5%) had sinuses dilated that were free from opacification/mucosal edema on preoperative imaging. Balloon dilation of sinus ostia has an expanding role in treating sinus disease. In the studied population, BCD is often utilized for alternate indications for which there is currently no evidence of efficacy. Future studies are needed to evaluate the efficacy of this technology in treating these alternate indications. 4. Laryngoscope, 127:544-549, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Development of a Surgical Infection Surveillance Program at a Tertiary Hospital in Ethiopia: Lessons Learned from Two Surveillance Strategies.

PubMed

Forrester, Jared A; Koritsanszky, Luca; Parsons, Benjamin D; Hailu, Menbere; Amenu, Demisew; Alemu, Seifu; Jiru, Fekadu; Weiser, Thomas G

2018-01-01

Surgical site infections (SSIs) are a leading cause of post-operative morbidity and mortality. We developed Clean Cut, a surgical infection prevention program, with two goals: (1) Increase adherence to evidence-based peri-operative infection prevention standards and (2) establish sustainable surgical infection surveillance. Here we describe our infection surveillance strategy. Clean Cut was piloted and evaluated at a 523 bed tertiary hospital in Ethiopia. Infection prevention standards included: (1) Hand and surgical site decontamination; (2) integrity of gowns, drapes, and gloves; (3) instrument sterility; (4) prophylactic antibiotic administration; (5) surgical gauze tracking; and (6) checklist compliance. Primary outcome measure was SSI, with secondary outcomes including other infection, re-operation, and length of stay. We prospectively observed all post-surgical wounds in obstetrics over a 12 day period and separately recorded post-operative complications using chart review. Simultaneously, we reviewed the written hospital charts after patient discharge for all patients whose peri-operative adherence to infection prevention standards was captured. Fifty obstetric patients were followed prospectively with recorded rates of SSI 14%, re-operation 6%, and death 2%. Compared with direct observation, chart review alone had a high loss to follow-up (28%) and decreased capture of infectious complications (SSI [n = 2], endometritis [n = 3], re-operations [n = 2], death [n = 1]); further, documentation inconsistencies failed to capture two complications (SSI [n = 1], mastitis [n = 1]). Concurrently, 137 patients were observed for peri-operative infection prevention standard adherence. Of these, we were able to successfully review 95 (69%) patient charts with recorded rates of SSI 5%, re-operation 1%, and death 1%. Patient loss to follow-up and poor documentation of infections underestimated overall infectious complications. Direct, prospective follow-up is possible but requires increased time, clinical skill, and training. For accurate surgical infection surveillance, direct follow-up of patients during hospitalization is essential, because chart review does not accurately reflect post-operative complications.

Structured Analysis and the Data Flow Diagram: Tools for Library Analysis.

ERIC Educational Resources Information Center

Carlson, David H.

1986-01-01

This article discusses tools developed to aid the systems analysis process (program evaluation and review technique, Gantt charts, organizational charts, decision tables, flowcharts, hierarchy plus input-process-output). Similarities and differences among techniques, library applications of analysis, structured systems analysis, and the data flow…

Review of "Charting New Territory"

ERIC Educational Resources Information Center

Trujillo, Tina

2011-01-01

"Charting New Territory: Tapping Charter Schools to Turn Around the Nation's Dropout Factories" argues for a more prominent role for charter operators in turning around perennially low-performing high schools. However, the report's ultimate findings and conclusions are out of proportion to the strength of the research evidence on school…

Electric Propulsion Test & Evaluation Methodologies for Plasma in the Environments of Space and Testing (EP TEMPEST) (Briefing Charts)

DTIC Science & Technology

2015-04-01

in the Environments of Space and Testing (EP TEMPEST ) - Program Review (Briefing Charts) 5a. CONTRACT NUMBER In-House 5b. GRANT NUMBER 5c...of Space and Testing (EP TEMPEST ) AFOSR T&E Program Review 13-17 April 2015 Dr. Daniel L. Brown In-Space Propulsion Branch (RQRS) Aerospace Systems...Statement A: Approved for public release; distribution is unlimited. EP TEMPEST (Lab Task, FY14-FY16) Program Goals and Objectives Title: Electric

Clinical presentation of mania compared with depression: data from a geriatric clinic in India.

PubMed

Prakash, Om; Kumar, Channaveerachari Naveen; Shivakumar, P T; Bharath, Srikala; Varghese, Mathew

2009-08-01

This retrospective chart review evaluated a comparison of the clinical profiles of older outpatients having mania and those with unipolar depression. The charts of elderly outpatients with mania and unipolar depression in tertiary care settings were reviewed and relevant information incorporated regarding clinical presentation, past and family history of affective disorder, treatment history and previous psychiatric and neurological history. Charts for 30 patients with mania (23 men and 7 women with mean (+/-SD) age of 68.5(+/- 5.75 years) and 92 with depression (47 men and 45 women with mean (+/-SD) age of 68.18 (+/-6.0 years) were evaluated. Fifteen patients (50%) with manic episodes had psychotic symptoms in the form of delusions and hallucinations while only 33 (35.8%) depressed patients had psychotic symptoms. One-third of manic patients received mood stabilizers at index visit. More than half (n = 16; 53.3%) of the patients in the mania group were prescribed antipsychotic medications. On cognitive functions, patients with manic episodes scored poorly compared with those with depression. These findings suggest that mania in the elderly is a severe form of affective disorder with respect to psychotic and cognitive symptoms. Conclusions from this study are limited due to its retrospective design. Further studies in this area are warranted.

Extracting similar terms from multiple EMR-based semantic embeddings to support chart reviews.

PubMed

Cheng Ye, M S; Fabbri, Daniel

2018-05-21

Word embeddings project semantically similar terms into nearby points in a vector space. When trained on clinical text, these embeddings can be leveraged to improve keyword search and text highlighting. In this paper, we present methods to refine the selection process of similar terms from multiple EMR-based word embeddings, and evaluate their performance quantitatively and qualitatively across multiple chart review tasks. Word embeddings were trained on each clinical note type in an EMR. These embeddings were then combined, weighted, and truncated to select a refined set of similar terms to be used in keyword search and text highlighting. To evaluate their quality, we measured the similar terms' information retrieval (IR) performance using precision-at-K (P@5, P@10). Additionally a user study evaluated users' search term preferences, while a timing study measured the time to answer a question from a clinical chart. The refined terms outperformed the baseline method's information retrieval performance (e.g., increasing the average P@5 from 0.48 to 0.60). Additionally, the refined terms were preferred by most users, and reduced the average time to answer a question. Clinical information can be more quickly retrieved and synthesized when using semantically similar term from multiple embeddings. Copyright © 2018. Published by Elsevier Inc.

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

PubMed

Isojima, Tsuyoshi; Yokoya, Susumu

2017-12-01

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

Framing Teacher Preparation Research: An Overview of the Field, Part 1

ERIC Educational Resources Information Center

Cochran-Smith, Marilyn; Villegas, Ana Maria

2015-01-01

This is the first of a two-part article that aims to chart the contemporary landscape of research on teacher preparation and certification. It is based on a review of more than 1,500 studies published between 2000 and 2012. Part 1 provides information about how the review was conducted and describes the theoretical/analytic framework the authors…

UTILITY OF PSYCHOLOGICAL SCREENING OF YOUNG ADULTS WITH TYPE 1 DIABETES TRANSITIONING TO ADULT PROVIDERS.

PubMed

Quinn, Sheila M; Ambrosino, Jodie M; Doyle, Elizabeth A; Weyman, K; Tamborlane, William V; Jastreboff, Ania M

2016-09-01

Screening for depression, diabetes distress, and disordered eating in youth with type 1 diabetes (T1D) is recommended, as these comorbidities contribute to poor glycemic control. No consensus exists on which measures are optimal, and most previous studies have used nondisease-specific measures. We examined the utility of screening for these disorders using two disease-specific and one general measure at the time of transition from pediatric to adult care. Forty-three young adults from a T1D transition clinic completed the Patient Health Questionnaire, the Diabetes Distress Scale, and the Diabetes Eating Problem Survey-Revised. Chart review determined if clinicians noted similar symptoms during the year prior to transition. Metabolic data were also recorded. Chart review identified 5 patients with depressive symptoms and 8 patients with diabetes distress. Screening identified 2 additional patients with depressive symptoms and 1 additional patient with diabetes distress. Of those noted to have symptomatic depression or diabetes distress on chart review, several subsequently screened negative on transition. Disordered eating was not detected by chart review, but 23.5% screened positive on transition. While depression, diabetes distress, and disordered eating positively correlated with glycated hemoglobin (HbA1c) (r = 0.31, P = .05; r = 0.40, P = .009; r = 0.63, P<.001, respectively), disordered eating accounted for the majority of observed variance (df = 1; F = 18.6; P<.001). Even though HbA1c was higher in patients with versus without disordered eating (P<.001), body mass index did not differ between the 2 groups (P = .51). In young adults with T1D, formal screening provides an opportunity to detect psychological problems, which, when treated, may help optimize metabolic control during the transition process. T1D = type 1 diabetes HbA1C = hemoglobin A1c YCDP = Yale Children's Diabetes Program PHQ-8 = Patient Health Questionnaire-8 DDS = Diabetes Distress Scale DEPS-R = Diabetes Eating Problem Survey-Revised.

Improving blood pressure control in diabetes: limitations of a clinical reminder in influencing physician behavior.

PubMed

Sanders, Karen M; Satyvavolu, Anuradha

2002-01-01

Hypertension should be aggressively treated, especially in diabetic patients. But studies of physician prescribing habits reveal that physicians often delay making medication changes or initiating antihypertensive therapy. A chart-based reminder was designed to improve physician medication prescribing in this clinical situation. A randomized controlled trial was conducted at the Veterans Affairs Medical Center in Richmond, Virginia. Patients with diabetes and hypertension were selected. A highly visible chart reminder was applied to the front of outpatient charts in the intervention group practice. A chart review was conducted to assess physician-directed medication changes. A successful outcome was defined as any antihypertensive medication increase or addition at that same visit. Physicians were more likely to intensify antihypertensive medication as the blood pressure increased regardless of the reminder. Overall, only 33% of visits resulted in a medication change, even though 93% of patients had elevations over target blood pressure at the follow-up visit. Physicians in the intervention and control groups made changes to medication at similar rates (chi 2 = 0.621, p = .511). In this study, a chart reminder failed to improve physician compliance with the clinical guideline for hypertension management in diabetics, Sixth Report of the Joint National Committee on the Detection, Evaluation, Prevention and Treatment of High Blood Pressure. To inform the design of effective intervention strategies, further research should explore specific barriers to guideline adherence in this clinical situation.

75 FR 64909 - Fiduciary Requirements for Disclosure in Participant-Directed Individual Account Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-20

...- related information in a form that encourages and facilitates a comparative review among a plan's... alternatives, and, specifically, how participants would react to the Model Comparative Chart for plan... regulation and Model Comparative Chart. Set forth below is an overview of the final regulations and a...

Health Indicators: A Tool for Program Review

ERIC Educational Resources Information Center

Abou-Sayf, Frank K.

2006-01-01

A visual tool used to evaluate instructional program performance has been designed by the University of Hawaii Community College system. The tool combines features from traffic lights, blood-chemistry test reports, and industry production control charts, and is labeled the Program Health-Indicator Chart. The tool was designed to minimize the labor…

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

PubMed Central

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

2017-01-01

PURPOSE Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency. METHODS We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians’ perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close. RESULTS Scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028). CONCLUSIONS To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout. PMID:28893812

Vitamin D Levels and Monospot Tests in Military Personnel with Acute Pharyngitis: A Retrospective Chart Review

PubMed Central

Maloney, Sean R.; Almarines, David; Goolkasian, Paula

2014-01-01

Some recent studies have proposed an important role for vitamin D in reducing the risk of infection by assisting in the suppression of viruses and by controlling the inflammatory response. A low vitamin D state may have a detrimental effect on the immune system’s ability to produce activated CD8+ T cells, and it may increase the inflammatory reaction to Epstein Barr virus. The aim of this chart review was to see if serum 25 OH vitamin D3 levels in service members with acute pharyngitis were lower in those who had positive rather than negative monospot tests. A retrospective chart review was conducted on the medical records of service members who presented to sick call at Camp Lejeune, NC with acute pharyngitis from October 8, 2010 until June 30, 2011. Serum 25 OH vitamin D3 levels were compared between those with positive and negative monospot test results. Of the 25 records that were reviewed, there were 9 (36%) service members with positive results, and they were found to have lower vitamin D levels (Median = 20.80 ng/ml, Interquartile range = 10.15) than those with negative test results (Median = 30.35 ng/ml, Interquartile range = 17.05), Mann-Whitney U = 41, p = .039. Only 1 of the 9 with positive test results had a normal serum 25 OH vitamin D3 level (30 ng/ml or greater) compared with 9 of the 16 with negative test results. Optimal vitamin D stores may play a significant role in reducing the risk of developing acute mononucleosis but larger, prospective studies will be needed to verify these findings. PMID:25009977

Vitamin D levels and monospot tests in military personnel with acute pharyngitis: a retrospective chart review.

PubMed

Maloney, Sean R; Almarines, David; Goolkasian, Paula

2014-01-01

Some recent studies have proposed an important role for vitamin D in reducing the risk of infection by assisting in the suppression of viruses and by controlling the inflammatory response. A low vitamin D state may have a detrimental effect on the immune system's ability to produce activated CD8+ T cells, and it may increase the inflammatory reaction to Epstein Barr virus. The aim of this chart review was to see if serum 25 OH vitamin D3 levels in service members with acute pharyngitis were lower in those who had positive rather than negative monospot tests. A retrospective chart review was conducted on the medical records of service members who presented to sick call at Camp Lejeune, NC with acute pharyngitis from October 8, 2010 until June 30, 2011. Serum 25 OH vitamin D3 levels were compared between those with positive and negative monospot test results. Of the 25 records that were reviewed, there were 9 (36%) service members with positive results, and they were found to have lower vitamin D levels (Median = 20.80 ng/ml, Interquartile range = 10.15) than those with negative test results (Median = 30.35 ng/ml, Interquartile range = 17.05), Mann-Whitney U = 41, p = .039. Only 1 of the 9 with positive test results had a normal serum 25 OH vitamin D3 level (30 ng/ml or greater) compared with 9 of the 16 with negative test results. Optimal vitamin D stores may play a significant role in reducing the risk of developing acute mononucleosis but larger, prospective studies will be needed to verify these findings.

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

PubMed

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

2005-02-01

To assess the agreement between falls as recorded in the Minimum Data Set (MDS) and fall events abstracted from chart documentation of elderly nursing home (NH) residents. Secondary analysis of data from a longitudinal panel study. Fifty-six randomly selected NHs in Maryland stratified by facility size and geographic region. Four hundred sixty-two NH residents, aged 65 and older, in NHs for 1 year. Falls were abstracted from resident charts and compared with MDS fall variables. Fall events data obtained from other sources of chart documentation were matched for the corresponding periods of 30 and 180 days before the 1-year MDS assessment date. For a 30-day period, concordance between the MDS and chart abstractions of falls occurred in 65% of cases, with a kappa coefficient of 0.29 (P<.001), indicating fair agreement. Concordance occurred between the sources for 75% of cases for a 180-day period, with a kappa of 0.50 (P<.001), indicating moderate agreement. During the 180-day period, chart abstractions showed that 49% of the sample fell, whereas the MDS revealed that only 28% fell. An analysis of residents whose falls the MDS missed indicated that these residents had significantly more activity of daily living impairment and significantly less unsteady gait and cane/walker use. The MDS underreported falls. Nurses completing MDS assessments must carefully review residents' medical records for falls documentation. Future studies should use caution when employing MDS data as the only indicator of falls.

Improving Practice Guideline Adherence Through Peer Feedback: Impact of an Ambulatory Cardiology Curriculum.

PubMed

Richardson, Karl M; Singh, Jai; Muñoz, Dan; Damp, Julie B; Mendes, Lisa A

2018-01-01

Graduate medical trainees must be prepared to practice in a quality-driven system that values adherence to and documentation of evidence-based care. Few validated approaches exist to teach these skills. Our objective was to develop, implement, and evaluate an ambulatory practice improvement curriculum capitalizing on peer feedback aimed at improving cardiology fellow guideline knowledge, adherence, and chart documentation. Four outpatient topics were reviewed in dedicated 1-hour sessions: stable ischemic heart disease, heart failure, atrial fibrillation, and aortic valvular disease. Each session began with peer review, critique, and guideline adherence discussion of deidentified outpatient fellow clinic charts, followed by discussion of clinical guidelines. The open discussion of real clinic notes provided a forum for peer feedback exchange. Before each session and after the final session, participants completed a multiple-choice knowledge assessment and self-assessment of comfort with the guidelines. To evaluate the potential effect on patient care, random clinic chart audits were conducted before and after the curriculum using a chart scoring system. Although the format is broadly applicable, the specific curriculum content was designed for a cardiology fellowship cohort in a large academic medical center. It was organized and implemented by 2 cardiology fellows under the direction and supervision of program directors. The curriculum was implemented during prescheduled noon conference hours. The intention was to carry forward this ambulatory curriculum in subsequent years and to use the first 4 sessions to study its potential successes and opportunities for improvement. All 22 general cardiology fellows attended at least two sessions (M = 3.1). Knowledge test scores rose from 52.6% to 73.0% (20.4% increase, p < .001), 95% confidence interval (CI) [13.6%, 27.2%]. Self-reported guidelines knowledge improved by 15.1% (p = .002), 95% CI [6.2%, 24.0%], and self-reported documentation improved by 12.5% (p = .008), 95% CI [3.8%, 21.7%]. Chart audit scores improved by 17.8% (p < .001), 95% CI [10.6%, 25.0%], driven in part by 16.4% improvement in adherence to Class I therapies (p = .001). A targeted curriculum combining peer chart review, feedback, and guideline discussion was associated with significant improvement in fellows' knowledge and adherence to evidence-based therapies. Peer assessment and group-based education and feedback can be leveraged to improve trainee education and impact patient care.

Validation of Living Donor Nephrectomy Codes

PubMed Central

Lam, Ngan N.; Lentine, Krista L.; Klarenbach, Scott; Sood, Manish M.; Kuwornu, Paul J.; Naylor, Kyla L.; Knoll, Gregory A.; Kim, S. Joseph; Young, Ann; Garg, Amit X.

2018-01-01

Background: Use of administrative data for outcomes assessment in living kidney donors is increasing given the rarity of complications and challenges with loss to follow-up. Objective: To assess the validity of living donor nephrectomy in health care administrative databases compared with the reference standard of manual chart review. Design: Retrospective cohort study. Setting: 5 major transplant centers in Ontario, Canada. Patients: Living kidney donors between 2003 and 2010. Measurements: Sensitivity and positive predictive value (PPV). Methods: Using administrative databases, we conducted a retrospective study to determine the validity of diagnostic and procedural codes for living donor nephrectomies. The reference standard was living donor nephrectomies identified through the province’s tissue and organ procurement agency, with verification by manual chart review. Operating characteristics (sensitivity and PPV) of various algorithms using diagnostic, procedural, and physician billing codes were calculated. Results: During the study period, there were a total of 1199 living donor nephrectomies. Overall, the best algorithm for identifying living kidney donors was the presence of 1 diagnostic code for kidney donor (ICD-10 Z52.4) and 1 procedural code for kidney procurement/excision (1PC58, 1PC89, 1PC91). Compared with the reference standard, this algorithm had a sensitivity of 97% and a PPV of 90%. The diagnostic and procedural codes performed better than the physician billing codes (sensitivity 60%, PPV 78%). Limitations: The donor chart review and validation study was performed in Ontario and may not be generalizable to other regions. Conclusions: An algorithm consisting of 1 diagnostic and 1 procedural code can be reliably used to conduct health services research that requires the accurate determination of living kidney donors at the population level. PMID:29662679

Medical resource utilization and associated costs in patients with ulcerative colitis in the UK: a chart review analysis.

PubMed

Bodger, Keith; Yen, Linnette; Szende, Agota; Sharma, Gunjan; Chen, Yaozhu J; McDermott, John; Hodgkins, Paul

2014-02-01

Limited evidence is available on the economic burden of ulcerative colitis (UC) in the UK, particularly relating to the impact of relapse frequency on direct medical costs. This study identifies and assesses medical resource utilization (MRU) and associated direct costs in mild and moderate UC patients in the UK. A retrospective chart review of patients with mild-to-moderate UC diagnosed at least 1 year before the study was performed. From 33 general practitioner (GP) and 34 gastroenterologist sites, charts of the last three UC patients fulfilling the inclusion criteria were reviewed. Descriptive statistics were calculated for MRU and 2011 costs (GB£) by number of relapses. The study population included 201 patients with a mean age of 39.9 years; 44% were women and the mean disease duration was 7.4 years. UC-related costs of each MRU category increased with the number of relapses. Comparing patients without relapse with those with more than two relapses, the mean annual UC-related costs were £14 versus £2556 for hospitalizations; £218 versus £988 for visits (including nurse, GP, specialist, and other visits); £21 versus £1303 for procedures; £17 versus £188 for diagnostics; and £1168 versus £6660 for all-cause total costs. Age, sex, and site of data reporting (GP vs. gastroenterologist) were not associated with MRU or costs. Patients with mild-to-moderate UC incurred considerable costs that increased markedly with the number of relapses. These findings support the importance of maintenance therapies in UC that reduce or prevent relapses. Quantifying the relationship between relapse rate and costs will inform future health economic studies.

Gender Differences in Extrafamilial Sexual Abuse Experiences among Young Teens

ERIC Educational Resources Information Center

Edinburgh, Laurel; Saewyc, Elizabeth; Levitt, Carolyn

2006-01-01

Extrafamilial sexual abuse experiences of young adolescents (ages 10-14), particularly young teen boys, are not well studied. This retrospective chart review study compared psychosocial correlates and victimization experiences between young adolescent girls (n = 226) and boys (n = 64) referred to a hospital child advocacy center. Several…

Multidisciplinary Pediatric Obesity Clinic via Telemedicine Within the Los Angeles Metropolitan Area: Lessons Learned.

PubMed

Slusser, Wendy; Whitley, Margaret; Izadpanah, Nilufar; Kim, Sion L; Ponturo, Don

2016-03-01

Telemedicine has been shown to be effective for rural populations, but little is reported on pediatric obesity care via telemedicine in urban settings. This study aims to assess feasibility and acceptability of multidisciplinary pediatric obesity care via telemedicine within the same metropolitan area in terms of information technology, coordination, patient care, and clinical outcomes. All project notes and communications were reviewed to extract key lessons from implementation. Patient and Provider Satisfaction Questionnaires were conducted to assess overall satisfaction; baseline and follow-up information were collected from chart reviews to evaluate clinical outcomes. Based on the questionnaires, 93% of responding patients (n = 28) and 88.3% of referring providers (n = 17) felt satisfied with the appointment. Chart review indicated a trend for decreased or stabilized body mass index and blood pressure (n = 32). Implementation of telemedicine for tertiary multidisciplinary pediatric obesity care in urban settings is both feasible and acceptable to patients and health care providers. © The Author(s) 2015.

End-of-life choices for African-American and white infants in a neonatal intensive-care unit: a pilot study.

PubMed Central

Moseley, Kathryn L.; Church, Annamaria; Hempel, Bridget; Yuan, Harry; Goold, Susan Door; Freed, Gary L.

2004-01-01

BACKGROUND: African-American adults are more likely than white adults to desire the continuation of life-sustaining medical treatment (LSMT) at the end of life. No studies have examined racial differences in parental end-of-life decisions for neonates. OBJECTIVE: To collect preliminary data to determine whether differences exist in the choices made by parents of African-American and white infants when a physician has recommended withholding or withdrawing LSMT from their infant to develop hypotheses for future work. DESIGN/METHODS: A retrospective chart review of African-American and white infants who died in an urban neonatal intensive care unit (NICU) over a two-year period. Charts were abstracted for demographics, cause of death, and documentation of meetings where the physician recommended withholding or withdrawing LSMT. RESULTS: Thirty-eight infant charts met study criteria (58% African-American, 42% white). Documentation of physician recommendations to limit LSMT was present in 61% of charts. Approached families of white infants agreed to limit LSMT 80% of the time compared to 62% of the families of African-American infants. CONCLUSIONS: In this pilot study, parents of African-American and white infants appeared to make different end-of-life choices for their children. A larger study is needed to confirm these findings and further explore contributing factors such as mistrust, religiosity, and perceived discrimination. PMID:15253324

The Effects of Resident Peer- and Self-Chart Review on Outpatient Laboratory Result Follow-up.

PubMed

Hale, Andrew J; Nall, Ryan W; Mukamal, Kenneth J; Libman, Howard; Smith, C Christopher; Sternberg, Scot B; Kim, Hans S; Kriegel, Gila

2016-05-01

Performing and teaching appropriate follow-up of outpatient laboratory results (LRs) is a challenge. The authors tested peer-review among residents as a potentially valuable intervention. Investigators assigned residents to perform self-review (n = 27), peer-review (n = 21), or self- + peer-review (n = 30) of outpatient charts. They also compared residence performance with that of historical controls (n = 20). In September 2012, residents examined 10 LRs from April 2012 onward. A second review in November 2012 ascertained whether performing chart review improved residents' practice behaviors. Initially, the least-square (LS) mean number of LRs without documentation of follow-up per resident in the self-, peer-, and self- + peer-review group was, respectively, 0.5 (SD 1.0), 1.0 (SD 1.7), and 0.9 (SD 1.3), and post intervention, this was 1.0 (SD 0.2), 0.3 (SD 0.2), and 0.6 (SD 0.2) (self- versus peer-review P = .03). Initially the LS mean follow-up time per resident in the self-, peer-, and self- + peer-review group was, respectively, 4.2 (SD 1.2), 6.9 (SD 1.4), and 5.9 (SD 1.2) days, and after the intervention, LS mean time was 5.0 (SD 0.5), 2.5 (SD 0.6), and 3.9 (SD 0.5) days (self- versus peer-review P < .01). Self-review was not associated with significant improvements in practice. In this comparison of self- and peer-review, only residents who performed peer-review demonstrated significant improvements in their documentation practices. These findings support the use of resident peer-review in improving LR follow-up, and potentially, in other, broader resident quality improvement initiatives.

Premature return to play and return to learn after a sport-related concussion: physician's chart review.

PubMed

Carson, James D; Lawrence, David W; Kraft, Sari A; Garel, Alisha; Snow, Catherine L; Chatterjee, Ananda; Libfeld, Paula; MacKenzie, Heather M; Thornton, Jane S; Moineddin, Rahim; Frémont, Pierre

2014-06-01

To determine what proportion of patients experience an exacerbation of their symptoms as a result of premature return to play (RTP) and return to learn (RTL) following sport-related concussions. Retrospective study of electronic medical records from the office-based practice of one family and sport medicine physician who had systematically provided recommendations for cognitive and physical rest based on existing consensus recommendations. Two blinded authors independently reviewed each chart, which included Sport Concussion Assessment Tool (SCAT) and SCAT2 symptom self-report forms to determine whether an athlete had returned to play or learn prematurely. If there was a discrepancy between the 2 reviewers then a third author reviewed the charts. A sport medicine and family practice in Ontario. The physician assessed sport-related concussions after self-referral or referral from other primary care physicians, teams, and schools. A total of 170 charts of 159 patients were assessed for sport-related concussion during a 5-year period (April 2006 to March 2011). All participants were students who were participating in sports at the time of injury. There were 41 concussions in elementary students, 95 concussions in high school students, and 34 concussions in college or university students. Premature RTP and RTL were defined as chart records documenting the recurrence or worsening of symptoms that accompanied the patients' RTP or RTL. Measures were compared using the earliest available SCAT forms and self-reporting. In 43.5% of concussion cases, the patient returned to sport too soon and in 44.7% of concussion cases, the patient returned to school too soon. Patients with a history of previous concussion required more days of rest before being permitted to participate in any physical activity than those patients without a previous history of concussion. Elementary school students required fewer days of rest before being permitted to return to any physical activity compared with high school students and college or university students. Currently, physicians recommend restrictions on mental and physical activity following sport-related concussion. This is done without clear guidelines as to what cognitive rest entails for students. Further research is required to determine how to implement a management plan for student athletes to facilitate complete recovery after concussion. Copyright© the College of Family Physicians of Canada.

Is Routine Pathologic Evaluation of Sebaceous Cysts Necessary?: A 15-Year Retrospective Review of a Single Institution.

PubMed

Gargya, Vipul; Lucas, Heather D; Wendel Spiczka, Amy J; Mahabir, Raman Chaos

2017-02-01

A question arose in our practice of whether all cysts considered sebaceous should be sent for pathologic evaluation. To address this controversial topic, we performed a retrospective study of our single institution's histopathology database. A natural language search of the CoPath database across the institution was undertaken using the diagnosis of sebaceous cyst, epidermal cyst, epidermoid cyst, epithelial cyst, infundibular cyst, pilar cyst, trichilemmal cyst, and steatocystoma. A surgical pathologic review of all specimens with one of these preexcision diagnoses was included in the 15-year retrospective study of 1998 to 2013. All slides were confirmed to have undergone histopathologic review, and the preexcision diagnoses were compared with the postexcision diagnoses. Chart review was undertaken in instances of a diagnosis of malignancy. A total of 13,746 samples were identified. Forty-eight specimens had histopathologic diagnosis of malignancy, for an incidence of 0.3% and with the most common malignancy being squamous cell carcinoma. Chart review showed that for all cases, the surgeons reported uncertainty with regard to the diagnosis because of history or physical characteristics, or both. In addition, a comprehensive literature review showed results consistent with our data and illustrated 19 cases during the past 10 years in which most of the findings were squamous cell carcinoma. We propose the recommendation that routine pathologic evaluation of sebaceous cysts is necessary only when clinical suspicion exists.

Top Level Summary of Technologies

NASA Technical Reports Server (NTRS)

Craig, Douglas, A.

2009-01-01

This document is a chart that reviews the technology of various NASA projects. Included in the chart is the title, a brief description of the technology, the funding status, a statement of the benefits, the date required, how the element connects to the Constellation project architecture, and how critical the technology is to the Constellation project.

Collection of process data after cardiac surgery: initial implementation with a Java-based intranet applet.

PubMed

Ratcliffe, M B; Khan, J H; Magee, K M; McElhinney, D B; Hubner, C

2000-06-01

Using a Java-based intranet program (applet), we collected postoperative process data after coronary artery bypass grafting. A Java-based applet was developed and deployed on a hospital intranet. Briefly, the nurse entered patient process data using a point and click interface. The applet generated a nursing note, and process data were saved in a Microsoft Access database. In 10 patients, this method was validated by comparison with a retrospective chart review. In 45 consecutive patients, weekly control charts were generated from the data. When aberrations from the pathway occurred, feedback was initiated to restore the goals of the critical pathway. The intranet process data collection method was verified by a manual chart review with 98% sensitivity. The control charts for time to extubation, intensive care unit stay, and hospital stay showed a deviation from critical pathway goals after the first 20 patients. Feedback modulation was associated with a return to critical pathway goals. Java-based applets are inexpensive and can collect accurate postoperative process data, identify critical pathway deviations, and allow timely feedback of process data.

Refeeding syndrome as an iatrogenic cause of delirium: a retrospective pilot study.

PubMed

Caplan, Jason P; Chang, Grace

2010-01-01

Refeeding syndrome describes a pattern of electrolyte disturbances occurring after the reintroduction of nutrition to the malnourished patient; it is often associated with delirium. The authors investigated whether hospitalized elderly patients who develop delirium are more likely to have laboratory findings consistent with refeeding syndrome. The authors conducted a retrospective chart review of 100 patients over age 60. Charts were examined for indications of delirium and refeeding syndrome. Significantly lower serum levels of magnesium and phosphate were found in patients with delirium. Delirium was not associated with any significant difference in levels of potassium. This study supports an association between delirium in elderly patients and electrolyte changes consistent with those seen in refeeding syndrome.

Kidney Failure and ESRD in the Atherosclerosis Risk in Communities (ARIC) Study: Comparing Ascertainment of Treated and Untreated Kidney Failure in a Cohort Study

PubMed Central

Rebholz, Casey M.; Coresh, Josef; Ballew, Shoshana H.; McMahon, Blaithin; Whelton, Seamus P.; Selvin, Elizabeth; Grams, Morgan E.

2015-01-01

Background Linkage to the US Renal Data System (USRDS) registry is commonly used to identify end-stage renal disease (ESRD) cases, or kidney failure treated with dialysis or transplantation, but it underestimates the total burden of kidney failure. This study validates a kidney failure definition that includes both kidney failure treated and not treated by dialysis or transplantation. It compares kidney failure risk factors and outcomes using this broader definition to USRDS-identified ESRD risk factors and outcomes. Study Design Diagnostic test study with stratified random sampling of hospitalizations for chart review. Setting & Participants Atherosclerosis Risk in Communities Study (N=11,530; chart review n=546). Index Test USRDS-identified ESRD; treated or untreated kidney failure defined by USRDS-identified ESRD or International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM code from hospitalization or death. Reference Test For ESRD, determination of permanent dialysis or transplantation; for kidney failure, determination of permanent dialysis, transplantation, or eGFR <15 mL/min/1.73 m2. Results Over 13 years' median follow-up, 508 kidney failure cases were identified, including 173 (34.1%) from the USRDS registry. ESRD and kidney failure incidence were 1.23 and 3.66 cases per 1,000 person-years in the overall population, and 1.35 and 6.59 cases per 1,000 person-years among participants older than 70 years, respectively. Other risk factor associations were similar between ESRD and kidney failure, except diabetes and albuminuria which were stronger for ESRD. Survival at 1 and 5 years were 74.0% and 24.0% for ESRD and 59.8% and 31.6% for kidney failure, respectively. Sensitivity and specificity were 88.0% and 97.3% comparing the kidney failure ICD-9-CM/ICD-10-CM code algorithm to chart review; for USRDS-identified ESRD, sensitivity and specificity were 94.9% and 100.0%. Limitations Some medical charts were incomplete. Conclusions A kidney failure definition including treated and untreated disease identifies more cases than linkage to the USRDS registry alone, particularly among older adults. Future studies might consider reporting both USRDS-identified ESRD and a more inclusive kidney failure definition. PMID:25773483

Image-guided radiotherapy quality control: Statistical process control using image similarity metrics.

PubMed

Shiraishi, Satomi; Grams, Michael P; Fong de Los Santos, Luis E

2018-05-01

The purpose of this study was to demonstrate an objective quality control framework for the image review process. A total of 927 cone-beam computed tomography (CBCT) registrations were retrospectively analyzed for 33 bilateral head and neck cancer patients who received definitive radiotherapy. Two registration tracking volumes (RTVs) - cervical spine (C-spine) and mandible - were defined, within which a similarity metric was calculated and used as a registration quality tracking metric over the course of treatment. First, sensitivity to large misregistrations was analyzed for normalized cross-correlation (NCC) and mutual information (MI) in the context of statistical analysis. The distribution of metrics was obtained for displacements that varied according to a normal distribution with standard deviation of σ = 2 mm, and the detectability of displacements greater than 5 mm was investigated. Then, similarity metric control charts were created using a statistical process control (SPC) framework to objectively monitor the image registration and review process. Patient-specific control charts were created using NCC values from the first five fractions to set a patient-specific process capability limit. Population control charts were created using the average of the first five NCC values for all patients in the study. For each patient, the similarity metrics were calculated as a function of unidirectional translation, referred to as the effective displacement. Patient-specific action limits corresponding to 5 mm effective displacements were defined. Furthermore, effective displacements of the ten registrations with the lowest similarity metrics were compared with a three dimensional (3DoF) couch displacement required to align the anatomical landmarks. Normalized cross-correlation identified suboptimal registrations more effectively than MI within the framework of SPC. Deviations greater than 5 mm were detected at 2.8σ and 2.1σ from the mean for NCC and MI, respectively. Patient-specific control charts using NCC evaluated daily variation and identified statistically significant deviations. This study also showed that subjective evaluations of the images were not always consistent. Population control charts identified a patient whose tracking metrics were significantly lower than those of other patients. The patient-specific action limits identified registrations that warranted immediate evaluation by an expert. When effective displacements in the anterior-posterior direction were compared to 3DoF couch displacements, the agreement was ±1 mm for seven of 10 patients for both C-spine and mandible RTVs. Qualitative review alone of IGRT images can result in inconsistent feedback to the IGRT process. Registration tracking using NCC objectively identifies statistically significant deviations. When used in conjunction with the current image review process, this tool can assist in improving the safety and consistency of the IGRT process. © 2018 American Association of Physicists in Medicine.

Expert Review of Cervical Cytology: Does it Affect Patient Care?

PubMed

Mark, Jaron; Morrell, Kayla; Eng, Kevin; Alfiero, Alexandra; Frederick, Peter J

2018-04-01

The aim of the study was to evaluate whether expert review of outside cervical cytology affects patient care. A retrospective study was conducted of 424 new patient referrals for cervical dysplasia between 2004 and 2016 at Roswell Park Cancer Institute. Records were analyzed for outside cervical cytology reports and compared with expert cervical cytology review. Differences between expert review and outside reports were documented. Charts with a difference were then assessed for additional evaluation and procedures performed. We specifically analyzed the data for cytology being upgraded or downgraded after expert review. Two hundred forty-six patient charts were eligible for this study. We identified 165 patients with congruent pathology reports. Of the 81 different reports, 41 led to significant pathologic differences. Twenty-four reports with different pathology were low-grade squamous intraepithelial lesions (LSIL) upgraded to high-grade squamous intraepithelial lesions (HSIL). Six were HSIL downgraded to LSIL, 4 LSIL downgraded to negative, 3 AGC upgraded to HSIL, 2 AGC upgraded to cancer, 1 each for HSIL downgraded to negative, and AGC downgraded to negative. Of the 24 patients whose cytology changed from low grade to high grade, 17 underwent an excisional procedure and 1 had a laser ablative procedure. Cervical intraepithelial neoplasia 2 or 3 was found in 11 specimens. Cervical intraepithelial neoplasia 1 was found in 4 of excisional specimens and no dysplasia found in 2. Expert review of cervical cytology significantly impacts patient management at a tertiary referral center, resulting in both upgrading and downgrading of community cytology reports.

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

PubMed

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

2008-07-01

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

Characteristics, treatment patterns, and survival among ALK+ non-small cell lung cancer (NSCLC) patients treated with crizotinib: A chart review study.

PubMed

Cadranel, Jacques; Park, Keunchil; Arrieta, Oscar; Pless, Miklos; Bendaly, Edmond; Patel, Dony; Sasane, Medha; Nosal, Adam; Swallow, Elyse; Galebach, Philip; Kageleiry, Andrew; Stein, Karen; Degun, Ravi; Zhang, Jie

2016-08-01

Second-generation ALK inhibitors are recently available for ALK+ non-small cell lung cancer (NSCLC) patients previously treated with crizotinib. This study described characteristics, treatment sequencing, and outcomes among locally advanced/metastatic crizotinib-experienced ALK+ NSCLC patients. From July 2014 to June 2015, a retrospective patient chart review was conducted among physicians from the US, EU, Korea, and Latin America. Participating clinicians identified their ALK+ NSCLC patients who received crizotinib and reported on their clinical characteristics, treatments, and survival using a pre-defined case report form. Kaplan-Meier analyses were used to describe overall survival (OS) and clinician-defined progression-free survival (PFS). Participating clinicians reviewed charts of 158 ALK+ NSCLC patients treated with crizotinib during the study period. Crizotinib was most commonly received in the second-line setting (41% of patients), though this varied across geographical regions. Roughly half (53%) of the patients who discontinued crizotinib received further antineoplastic therapy; second-generation ALK inhibitors (44%) and chemotherapy (42%) regimens were used most frequently. Following crizotinib discontinuation, median OS was 8.2 months. Among patients who did not initiate a second-generation ALK inhibitor following crizotinib, median OS was 4.9 months; among those who did, median OS was not reached. Among patients who received chemotherapy immediately following crizotinib discontinuation, time to clinician-defined PFS from post-crizotinib chemotherapy initiation was 3.6 months. Following crizotinib discontinuation, many patients received no further antineoplastic therapy, and OS was poor among patients who did not receive a second-generation ALK inhibitor. Recently available second-generation ALK inhibitors may provide important treatment options for ALK+ NSCLC patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Inclusion of extremes of prematurity in ventricular index centile charts.

PubMed

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

2015-06-01

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

Chaplain Documentation and the Electronic Medical Record: A Survey of ACPE Residency Programs.

PubMed

Tartaglia, Alexander; Dodd-McCue, Diane; Ford, Timothy; Demm, Charles; Hassell, Alma

2016-01-01

This study explores the extent to which chaplaincy departments at ACPE-accredited residency programs make use of the electronic medical record (EMR) for documentation and training. Survey data solicited from 219 programs with a 45% response rate and interview findings from 11 centers demonstrate a high level of usage of the EMR as well as an expectation that CPE residents document each patient/family encounter. Centers provided considerable initial training, but less ongoing monitoring of chaplain documentation. Centers used multiple sources to develop documentation tools for the EMR. One center was verified as having created the spiritual assessment component of the documentation tool from a peer reviewed published model. Interviews found intermittent use of the student chart notes for educational purposes. One center verified a structured manner of monitoring chart notes as a performance improvement activity. Findings suggested potential for the development of a standard documentation tool for chaplain charting and training.

Kidney Failure and ESRD in the Atherosclerosis Risk in Communities (ARIC) Study: Comparing Ascertainment of Treated and Untreated Kidney Failure in a Cohort Study.

PubMed

Rebholz, Casey M; Coresh, Josef; Ballew, Shoshana H; McMahon, Blaithin; Whelton, Seamus P; Selvin, Elizabeth; Grams, Morgan E

2015-08-01

Linkage to the US Renal Data System (USRDS) registry commonly is used to identify end-stage renal disease (ESRD) cases, or kidney failure treated with dialysis or transplantation, but it underestimates the total burden of kidney failure. This study validates a kidney failure definition that includes both kidney failure treated and not treated by dialysis or transplantation. It compares kidney failure risk factors and outcomes using this broader definition with USRDS-identified ESRD risk factors and outcomes. Diagnostic test study with stratified random sampling of hospitalizations for chart review. Atherosclerosis Risk in Communities Study (n=11,530; chart review, n=546). USRDS-identified ESRD; treated or untreated kidney failure defined by USRDS-identified ESRD or International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification (ICD-9-CM/ICD-10-CM) code for hospitalization or death. For ESRD, determination of permanent dialysis therapy or transplantation; for kidney failure, determination of permanent dialysis therapy, transplantation, or estimated glomerular filtration rate < 15 mL/min/1.73 m(2). During 13 years' median follow-up, 508 kidney failure cases were identified, including 173 (34.1%) from the USRDS registry. ESRD and kidney failure incidence were 1.23 and 3.66 cases per 1,000 person-years in the overall population and 1.35 and 6.59 cases per 1,000 person-years among participants older than 70 years, respectively. Other risk-factor associations were similar between ESRD and kidney failure, except diabetes and albuminuria, which were stronger for ESRD. Survivals at 1 and 5 years were 74.0% and 24.0% for ESRD and 59.8% and 31.6% for kidney failure, respectively. Sensitivity and specificity were 88.0% and 97.3% comparing the kidney failure ICD-9-CM/ICD-10-CM code algorithm to chart review; for USRDS-identified ESRD, sensitivity and specificity were 94.9% and 100.0%. Some medical charts were incomplete. A kidney failure definition including treated and untreated disease identifies more cases than linkage to the USRDS registry alone, particularly among older adults. Future studies might consider reporting both USRDS-identified ESRD and a more inclusive kidney failure definition. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2017-01-01

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

Nursing diagnosis taxonomy across the Atlantic Ocean: congruence between nurses' charting and the NANDA taxonomy.

PubMed

Thoroddsen, Asta; Thorsteinsson, Hrund Sch

2002-02-01

The purpose of this study was to analyse expressions or terms used by nurses in Iceland to describe patient problems. The classification of NANDA was used as reference. The research questions were: (a) Does NANDA terminology represent patient problems documented by Icelandic nurses? (b) If so, what kind of nursing diagnoses does it represent? (c) What kind of patient problems are not represented by NANDA terminology? (d) What are the most frequent nursing diagnoses used? A retrospective chart review was conducted in a 400 bed acute care hospital in Iceland. The sample was defined as nursing diagnosis statements in charts of patients hospitalized in two 6-month periods in two separate years. The data were analysed according to a predefined grading system based on the PES format or Problem -- (A)aetiology -- Signs and symptoms. A total of 1217 charts were used for the study, which yielded 2171 nursing diagnoses statements for analysis. Charts with at least one nursing diagnosis documented were 60.1% and the number of diagnoses per patient ranged from 0 to 10, with 65% of charts with three diagnoses or less. The number of diagnoses correlated with patients' length of stay, but not with increased age of the patients. The average number of statements per patient was 3.28. Almost 60% of the diagnoses were according to NANDA terminology, another 20% were stated as procedures, medical diagnoses or risks for complications. The 20 most frequently used nursing diagnoses accounted for 80% of all diagnoses documented. Discrepancy between nurses' documentation on emotional problems and availability of diagnosis in the NANDA taxonomy was evident. It can be concluded that the NANDA taxonomy seems to be culturally relevant for nurses in different cultures.

The Anatomical Computer (CD-ROM).

ERIC Educational Resources Information Center

Duhrkopf, Richard

1996-01-01

Describes the Anatomical Computer (CD-ROM) that was designed as a self-study aid for undergraduate and graduate students in anatomy. Provides text with illustrations, definitions along with summary charts, and more than a thousand test questions. Provides a valuable resource for human gross anatomy review. (JRH)

77 FR 44699 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-30

..., Washington, DC 20549-0213. Extension: Rules 17h-1T and 17h-2T, SEC File No. 270-359, OMB Control No. 3235... that must draft an organizational chart required under Rule 17h-1T and establish a system for complying with the risk assessment rules. The staff estimates that drafting the required organizational chart...

Noncombatant Evacuation Operations: Department of State’s Lessons Learned Program

DTIC Science & Technology

2016-06-10

student author and do not necessarily represent the views of the U.S. Army Command and General Staff College or any other U.S. governmental agency...68 viii ACRONYMS AAR After Action Review CALL Center for Army Lessons Learned CMS Crisis Management Support CMU Crisis Management ...Knowledge Management Chart .......................................................................25 Figure 5. Organization Chart

Improvement of Curricular Offerings at the Satellite Center by Charting.

ERIC Educational Resources Information Center

Charles, Richard F.

This report analyzes enrollment figures at the Sunnyvale Center, one of the De Anza College Extended Campus satellite sites, from fall 1977 to spring 1978 in order to establish a course charting model that allows for historical consistency in examining course, instructor, and site success. In addition, the report reviews the operation and growth…

Hospice Care in Nursing Homes: Does It Contribute to Higher Quality Pain Management?

ERIC Educational Resources Information Center

Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.

2006-01-01

Purpose: The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods: In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication…

Size Distributions and Characterization of Native and Ground Samples for Toxicology Studies

NASA Technical Reports Server (NTRS)

McKay, David S.; Cooper, Bonnie L.; Taylor, Larry A.

2010-01-01

This slide presentation shows charts and graphs that review the particle size distribution and characterization of natural and ground samples for toxicology studies. There are graphs which show the volume distribution versus the number distribution for natural occurring dust, jet mill ground dust, and ball mill ground dust.

An Update on Reading in the Content Areas: Social Constructionist Dimensions.

ERIC Educational Resources Information Center

Bean, Thomas W.

2002-01-01

Summarizes key findings from a previous review of reading research in which the author charted a paradigm shift in content area reading research from strategy validation studies in the 1980s to qualitative studies aimed at understanding sociocultural dimensions in teaching and learning. Comments on issues presenting themselves now, at the outset…

Prevalence of Fractures in Women with Intellectual Disabilities: A Chart Review

ERIC Educational Resources Information Center

Schrager, S.; Kloss, C.; Ju, A. W.

2007-01-01

Background: Numerous studies have demonstrated high rates of osteoporosis and fractures in women with intellectual disabilities (IDs). All of the studies use either institutionalized women or women in the community recruited at adult day-care centres or specialty clinics. We examined the prevalence of fractures in women with IDs who attend a…

Acquired EGFR T790M Mutation After Relapse Following EGFR-TKI Therapy: A Population-based Multi-institutional Study.

PubMed

Kaburagi, Takayuki; Kiyoshima, Moriyuki; Nawa, Takeshi; Ichimura, Hideo; Saito, Takefumi; Hayashihara, Kenji; Yamada, Hideyasu; Satoh, Hiroaki; Endo, Takeo; Inage, Yoshihisa; Saito, Kazuhito; Inagaki, Masaharu; Hizawa, Nobuyuki; Sato, Yukio; Ishikawa, Hiroichi; Sakai, Mitsuaki; Kamiyama, Koichi; Kikuchi, Norihiro; Nakamura, Hiroyuki; Furukawa, Kinya; Kodama, Takahide; Yamashita, Takaaki; Nomura, Akihiro; Yoshida, Susumu

2018-05-01

To describe the prevalence and determinants of acquired epidermal growth factor receptor (EGFR) T790M gene mutation in a clinical practice setting. We performed a retrospective chart review study between January 2013 and November 2017 across multiple institutes, covering a population of 3 million people. We reviewed the charts of 233 patients non-small cell lung cancer with EGFR mutations. Of them, 99 (42.5%) patients had acquired T790M mutations in EGFR. Patients ≥75 years old and patients with an exon 19 deletion had higher rates of acquired T790M mutation than did younger patients and those with an exon 21 L858R mutation. In 75 patients treated with afatinib, 34 (45.3%) patients had acquired T790M mutation. The sensitivity of T790M mutation detection was lower in plasma specimens than in biopsy specimens. This population-based study confirms previous studies and highlights potential determinants of acquired T790M mutation to be considered in clinical practice. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

77 FR 42317 - Establish a Patient-Based Registry To Evaluate the Association of Gadolinium Based Contrast...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-18

... renal failure appear to be at highest risk. In one, early retrospective study of 370 patients with... (Ref. 1). In a recent retrospective chart review study by Wang of 52,954 contrast MR examinations with... prospective registry study of the risk of NSF associated with GBCAs among renal patients. Patients already...

Comparison of ICD-9-based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting.

PubMed

Campbell, Peter G; Malone, Jennifer; Yadla, Sanjay; Chitale, Rohan; Nasser, Rani; Maltenfort, Mitchell G; Vaccaro, Alex; Ratliff, John K

2011-01-01

large studies of ICD-9-based complication and hospital-acquired condition (HAC) chart reviews have not been validated through a comparison with prospective assessments of perioperative adverse event occurrence. Retrospective chart review, while generally assumed to underreport complication occurrence, has not been subjected to prospective study. It is unclear whether ICD-9-based population studies are more accurate than retrospective reviews or are perhaps equally susceptible to bias. To determine the validity of an ICD-9-based assessment of perioperative complications, the authors compared a prospective independent evaluation of such complications with ICD-9-based HAC data in a cohort of patients who underwent spine surgery. For further comparison, a separate retrospective review of the same cohort of patients was completed as well. a prospective assessment of complications in spine surgery over a 6-month period (May to December 2008) was completed using an independent auditor and a validated definition of perioperative complications. The auditor maintained a prospective database, which included complications occurring in the initial 30 days after surgery. All medical adverse events were included in the assessment. All patients undergoing spine surgery during the study period were eligible for inclusion; the only exclusionary criterion used was the availability of the auditor for patient assessment. From the overall patient database, 100 patients were randomly extracted for further review; in these patients ICD-9-based HAC data were obtained from coder data. Separately, a retrospective assessment of complication incidence was completed using chart and electronic medical record review. The same definition of perioperative adverse events and the inclusion of medical adverse events were applied in the prospective, ICD-9-based, and retrospective assessments. ninety-two patients had adequate records for the ICD-9 assessment, whereas 98 patients had adequate chart information for retrospective review. The overall complication incidence among the groups was similar (major complications: ICD-9 17.4%, retrospective 19.4%, and prospective 22.4%; minor complications: ICD-9 43.8%, retrospective 31.6%, and prospective 42.9%). However, the ICD-9-based assessment included many minor medical events not deemed complications by the auditor. Rates of specific complications were consistently underreported in both the ICD-9 and the retrospective assessments. The ICD-9 assessment underreported infection, the need for reoperation, deep wound infection, deep venous thrombosis, and new neurological deficits (p = 0.003, p < 0.0001, p < 0.0001, p = 0.0025, and p = 0.04, respectively). The retrospective review underestimated incidences of infection, the need for revision, and deep wound infection (p < 0.0001 for each). Only in the capture of new cardiac events was ICD-9-based reporting more accurate than prospective data accrual (p = 0.04). The most sensitive measure for the appreciation of complication occurrence was the prospective review, followed by the ICD-9-based assessment (p = 0.05). an ICD-9-based coding of perioperative adverse events and major complications in a cohort of spine surgery patients revealed an overall complication incidence similar to that in a prospectively executed measure. In contrast, a retrospective review underestimated complication incidence. The ICD-9-based review captured many medical events of limited clinical import, inflating the overall incidence of adverse events demonstrated by this approach. In multiple categories of major, clinically significant perioperative complications, ICD-9-based and retrospective assessments significantly underestimated complication incidence. These findings illustrate a significant potential weakness and source of inaccuracy in the use of population-based ICD-9 and retrospective complication recording.

Minimizing the Workup of Blood Culture Contaminants: Implementation and Evaluation of a Laboratory-Based Algorithm

PubMed Central

Richter, S. S.; Beekmann, S. E.; Croco, J. L.; Diekema, D. J.; Koontz, F. P.; Pfaller, M. A.; Doern, G. V.

2002-01-01

An algorithm was implemented in the clinical microbiology laboratory to assess the clinical significance of organisms that are often considered contaminants (coagulase-negative staphylococci, aerobic and anaerobic diphtheroids, Micrococcus spp., Bacillus spp., and viridans group streptococci) when isolated from blood cultures. From 25 August 1999 through 30 April 2000, 12,374 blood cultures were submitted to the University of Iowa Clinical Microbiology Laboratory. Potential contaminants were recovered from 495 of 1,040 positive blood cultures. If one or more additional blood cultures were obtained within ±48 h and all were negative, the isolate was considered a contaminant. Antimicrobial susceptibility testing (AST) of these probable contaminants was not performed unless requested. If no additional blood cultures were submitted or there were additional positive blood cultures (within ±48 h), a pathology resident gathered patient clinical information and made a judgment regarding the isolate's significance. To evaluate the accuracy of these algorithm-based assignments, a nurse epidemiologist in approximately 60% of the cases performed a retrospective chart review. Agreement between the findings of the retrospective chart review and the automatic classification of the isolates with additional negative blood cultures as probable contaminants occurred among 85.8% of 225 isolates. In response to physician requests, AST had been performed on 15 of the 32 isolates with additional negative cultures considered significant by retrospective chart review. Agreement of pathology resident assignment with the retrospective chart review occurred among 74.6% of 71 isolates. The laboratory-based algorithm provided an acceptably accurate means for assessing the clinical significance of potential contaminants recovered from blood cultures. PMID:12089259

Quality of Life in Patients with Neurocysticercosis in Mexico

PubMed Central

Bhattarai, Rachana; Budke, Christine M.; Carabin, Hélène; Proaño, Jefferson V.; Flores-Rivera, Jose; Corona, Teresa; Cowan, Linda D.; Ivanek, Renata; Snowden, Karen F.; Flisser, Ana

2011-01-01

The objective of this study was to compare quality of life measures in patients with neurocysticercosis (NCC) to those of a matched control group. The NCC outpatients and their controls were recruited from two neurology referral hospitals in Mexico City, Mexico during 2007–2008. The quality of life of 224 NCC patients was compared with 224 age-sex-hospital-day matched controls using the short form 12 v2 (SF-12 v2) quality of life survey. Medical chart reviews were also conducted for the NCC outpatients to evaluate presenting clinical manifestations. Compared with the controls, NCC patients had a significantly lower score for each of the eight domains of health evaluated and significantly lower Physical and Mental Component Summary scores. Chart reviews indicated that hydrocephalus (48%), severe headaches (47%), and epilepsy (31%) were the most common clinical manifestations in these NCC outpatients. PMID:21540389

Semi-supervised Learning for Phenotyping Tasks.

PubMed

Dligach, Dmitriy; Miller, Timothy; Savova, Guergana K

2015-01-01

Supervised learning is the dominant approach to automatic electronic health records-based phenotyping, but it is expensive due to the cost of manual chart review. Semi-supervised learning takes advantage of both scarce labeled and plentiful unlabeled data. In this work, we study a family of semi-supervised learning algorithms based on Expectation Maximization (EM) in the context of several phenotyping tasks. We first experiment with the basic EM algorithm. When the modeling assumptions are violated, basic EM leads to inaccurate parameter estimation. Augmented EM attenuates this shortcoming by introducing a weighting factor that downweights the unlabeled data. Cross-validation does not always lead to the best setting of the weighting factor and other heuristic methods may be preferred. We show that accurate phenotyping models can be trained with only a few hundred labeled (and a large number of unlabeled) examples, potentially providing substantial savings in the amount of the required manual chart review.

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

PubMed

Atik, Alp

2013-10-01

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

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

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

Sutlief, S.

2015-06-15

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

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

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

Richardson, S.

2015-06-15

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

Growth assessment in diagnosis of Fetal Growth Restriction. Review

PubMed Central

Albu, AR; Horhoianu, IA; Dumitrascu, MC; Horhoianu, V

2014-01-01

Abstract The assessment of fetal growth represents a fundamental step towards the identification of the true growth restricted fetus that is associated to important perinatal morbidity and mortality. The possible ways of detecting abnormal fetal growth are taken into consideration in this review and their strong and weak points are discussed. An important debate still remains about how to discriminate between the physiologically small fetus that does not require special surveillance and the truly growth restricted fetus who is predisposed to perinatal complications, even if its parameters are above the cut-off limits established. In this article, we present the clinical tools of fetal growth assessment: Symphyseal-Fundal Height (SFH) measurement, the fetal ultrasound parameters widely taken into consideration when discussing fetal growth: Abdominal Circumference (AC) and Estimated Fetal Weight (EFW); several types of growth charts and their characteristics: populational growth charts, standard growth charts, individualized growth charts, customized growth charts and growth trajectories. Abbreviations: FGR = Fetal growth restriction; IUGR = Intrauterine Growth Restriction; SGA = small for gestational age fetus; EFW = estimated fetal weight; AC = abdominal circumference; SD = Standard Deviation; SFH = Symphyseal-fundal height; US = ultrasound; 2D = bidimensional; 3D = tridimensional; RCOG = Royal College of Obstetricians and Gynecologists; FL = femur length; BPD = biparietal diameter; BW = birth weight; IGA = Individualized Growth Assessment; PIH = Pregnancy Induced hypertension; PE = Preeclampsia; NICU = Neonatal Intensive Care Unit. PMID:25408718

Screening pregnant women for suicidal behavior in electronic medical records: diagnostic codes vs. clinical notes processed by natural language processing.

PubMed

Zhong, Qiu-Yue; Karlson, Elizabeth W; Gelaye, Bizu; Finan, Sean; Avillach, Paul; Smoller, Jordan W; Cai, Tianxi; Williams, Michelle A

2018-05-29

We examined the comparative performance of structured, diagnostic codes vs. natural language processing (NLP) of unstructured text for screening suicidal behavior among pregnant women in electronic medical records (EMRs). Women aged 10-64 years with at least one diagnostic code related to pregnancy or delivery (N = 275,843) from Partners HealthCare were included as our "datamart." Diagnostic codes related to suicidal behavior were applied to the datamart to screen women for suicidal behavior. Among women without any diagnostic codes related to suicidal behavior (n = 273,410), 5880 women were randomly sampled, of whom 1120 had at least one mention of terms related to suicidal behavior in clinical notes. NLP was then used to process clinical notes for the 1120 women. Chart reviews were performed for subsamples of women. Using diagnostic codes, 196 pregnant women were screened positive for suicidal behavior, among whom 149 (76%) had confirmed suicidal behavior by chart review. Using NLP among those without diagnostic codes, 486 pregnant women were screened positive for suicidal behavior, among whom 146 (30%) had confirmed suicidal behavior by chart review. The use of NLP substantially improves the sensitivity of screening suicidal behavior in EMRs. However, the prevalence of confirmed suicidal behavior was lower among women who did not have diagnostic codes for suicidal behavior but screened positive by NLP. NLP should be used together with diagnostic codes for future EMR-based phenotyping studies for suicidal behavior.

Integration of oncology and palliative care: setting a benchmark.

PubMed

Vayne-Bossert, P; Richard, E; Good, P; Sullivan, K; Hardy, J R

2017-10-01

Integration of oncology and palliative care (PC) should be the standard model of care for patients with advanced cancer. An expert panel developed criteria that constitute integration. This study determined whether the PC service within this Health Service, which is considered to be fully "integrated", could be benchmarked against these criteria. A survey was undertaken to determine the perceived level of integration of oncology and palliative care by all health care professionals (HCPs) within our cancer centre. An objective determination of integration was obtained from chart reviews of deceased patients. Integration was defined as >70% of all respondents answered "agree" or "strongly agree" to each indicator and >70% of patient charts supported each criteria. Thirty-four HCPs participated in the survey (response rate 69%). Over 90% were aware of the outpatient PC clinic, interdisciplinary and consultation team, PC senior leadership, and the acceptance of concurrent anticancer therapy. None of the other criteria met the 70% agreement mark but many respondents lacked the necessary knowledge to respond. The chart review included 67 patients, 92% of whom were seen by the PC team prior to death. The median time from referral to death was 103 days (range 0-1347). The level of agreement across all criteria was below our predefined definition of integration. The integration criteria relating to service delivery are medically focused and do not lend themselves to interdisciplinary review. The objective criteria can be audited and serve both as a benchmark and a basis for improvement activities.

Audiovisuals for Nutrition Education; Selected Evaluative Reviews from the Journal of Nutrition Education.

ERIC Educational Resources Information Center

Rowe, Sue Ellen, Comp.

Audiovisual materials suitable for the teaching of nutrition are listed. Materials include coloring books, flannelboard stories, games, kits, audiotapes, records, charts, posters, study prints, films, videotapes, filmstrips, slides, and transparencies. Each entry contains bibliographic data, educational level, price and evaluation. Mateiral is…

Functional impairment in patients with sporadic Inclusion Body Myositis.

PubMed

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

2014-03-01

We conducted a retrospective chart review of 53 patients diagnosed with sporadic Inclusion Body Myositis (sIBM) who have been followed at the McMaster Neuromuscular Clinic since 1996. We reviewed patient medical histories in order to compare our findings with similar cohorts, and analyzed quantitative strength data to determine functionality in guiding decisions related to gait assistive devices. Patient information was acquired through retrospective clinic chart review. Our study found knee extension strength decreased significantly as patients transitioned to using more supportive gait assistive devices (P < 0.05). A decline to below 30 Nm was particularly indicative of the need for a preliminary device (i.e. cane)(P < 0.05). Falls and fear of falling poses a significant threat to patient physical well-being. The prevalence of dysphagia increased as patients required more supportive gait devices, and finally a significant negative correlation was found between time after onset and creatine kinase (CK) levels (P < 0.01). This study supports that knee extension strength may be a useful tool in advising patients concerning ambulatory assistance. Further investigations concerning gait assistive device use and patient history of falling would be beneficial in preventing future falls and improving long-term patient outcomes.

A scoping review on the conduct and reporting of scoping reviews.

PubMed

Tricco, Andrea C; Lillie, Erin; Zarin, Wasifa; O'Brien, Kelly; Colquhoun, Heather; Kastner, Monika; Levac, Danielle; Ng, Carmen; Sharpe, Jane Pearson; Wilson, Katherine; Kenny, Meghan; Warren, Rachel; Wilson, Charlotte; Stelfox, Henry T; Straus, Sharon E

2016-02-09

Scoping reviews are used to identify knowledge gaps, set research agendas, and identify implications for decision-making. The conduct and reporting of scoping reviews is inconsistent in the literature. We conducted a scoping review to identify: papers that utilized and/or described scoping review methods; guidelines for reporting scoping reviews; and studies that assessed the quality of reporting of scoping reviews. We searched nine electronic databases for published and unpublished literature scoping review papers, scoping review methodology, and reporting guidance for scoping reviews. Two independent reviewers screened citations for inclusion. Data abstraction was performed by one reviewer and verified by a second reviewer. Quantitative (e.g. frequencies of methods) and qualitative (i.e. content analysis of the methods) syntheses were conducted. After searching 1525 citations and 874 full-text papers, 516 articles were included, of which 494 were scoping reviews. The 494 scoping reviews were disseminated between 1999 and 2014, with 45% published after 2012. Most of the scoping reviews were conducted in North America (53%) or Europe (38%), and reported a public source of funding (64%). The number of studies included in the scoping reviews ranged from 1 to 2600 (mean of 118). Using the Joanna Briggs Institute methodology guidance for scoping reviews, only 13% of the scoping reviews reported the use of a protocol, 36% used two reviewers for selecting citations for inclusion, 29% used two reviewers for full-text screening, 30% used two reviewers for data charting, and 43% used a pre-defined charting form. In most cases, the results of the scoping review were used to identify evidence gaps (85%), provide recommendations for future research (84%), or identify strengths and limitations (69%). We did not identify any guidelines for reporting scoping reviews or studies that assessed the quality of scoping review reporting. The number of scoping reviews conducted per year has steadily increased since 2012. Scoping reviews are used to inform research agendas and identify implications for policy or practice. As such, improvements in reporting and conduct are imperative. Further research on scoping review methodology is warranted, and in particular, there is need for a guideline to standardize reporting.

Prescription errors in the National Health Services, time to change practice.

PubMed

Hamid, Tahir; Harper, Luke; Rose, Samman; Petkar, Sanjive; Fienman, Richard; Athar, Syed M; Cushley, Michael

2016-02-01

Medication error is a major source of iatrogenic illness. Error in prescription is the most common form of avoidable medication error. We present our study, performed at two, UK, National Health Services Hospitals. The prescription practice of junior doctor's working on general medical and surgical wards in National Health Service District General and University Teaching Hospitals in the UK was reviewed. Practice was assessed against standard hospital prescription charts, developed in accordance with local pharmacy guidance. A total of 407 prescription charts were reviewed in both initial audit and re-audit one year later. In the District General Hospital, documentation of allergy, weight and capital-letter prescription was achieved in 31, 5 and 40% of charts, respectively. Forty-nine per cent of discontinued prescriptions were properly deleted and signed for. In re-audit significant improvement was noted in documentation of the patient's name 100%, gender 54%, allergy status 51% and use of generic drug name 71%. Similarly, in the University Teaching Hospital, 82, 63 and 65% compliance was achieved in documentation of age, generic drug name prescription and capital-letter prescription, respectively. Prescription practice was reassessed one year later after recommendations and changes in the prescription practice, leading to significant improvement in documentation of unit number, generic drug name prescription, insulin prescription and documentation of the patient's ward. Prescription error remains an important, modifiable form of medical error, which may be rectified by introducing multidisciplinary assessment of practice, nationwide standardised prescription charts and revision of current prescribing clinical training. © The Author(s) 2016.

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

Mechalakos, J.

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

The high-functioning autistic experience: birth to preteen years.

PubMed

Church, C C; Coplan, J

1995-01-01

A retrospective chart review of 15 children with high-functioning autism was conducted for the years 1981 through 1992. The purpose of the study was to describe the experience of children with high-functioning autism from infancy through preadolescence. Chart data included clinic staff records, parent letters, academic program records, service records, and comments from the children themselves. The findings of this study support the proposition that children with autism who have an IQ above 70 follow a varied but improving course over time. All 15 children met the DSM-III-R criteria for autism when first evaluated. By middle elementary school, however, none of the children in this study met the DSM-III-R criteria for autism, although they continued to have various language disturbances, social skill deficits, and unique behavioral qualities.

Ecstasy-Associated Pneumomediastinum

PubMed Central

Marasco, Silvana F; Lim, H Kiat

2007-01-01

INTRODUCTION Ecstasy, also known as MDMA (3,4, methylenedioxymethamphetamine), is a popular illicit party drug amongst young adults. The drug induces a state of euphoria secondary to its stimulant activity in the central nervous system. PATIENTS AND METHODS A database review at two major inner city hospitals was undertaken to identify patients presenting with pneumomediastinum and their charts reviewed. A Medline review of all reported cases of pneumomediastinum associated with ecstasy abuse was undertaken. RESULTS A total of 56 patients presenting with pneumomediastinum were identified over a 5-year period. Review of the charts revealed a history of ecstasy use in the hours prior to presentation in six of these patients, representing the largest series reported to date. CONCLUSIONS Review of previously reported cases reveals the likely mechanism is due to Valsalva manoeuvre during periods of extreme physical exertion, and not a direct pharmacological effect of the drug. PMID:17535617

Control of psychomotor agitation and aggressive behavior in patients with autistic disorder: a retrospective chart review.

PubMed

Novaes, Camila Marinho; Pondé, Milena Pereira; Freire, Antonio Carlos Cruz

2008-09-01

To evaluate the efficacy of pharmacotherapy on the symptoms of psychomotor agitation and aggressive behavior in a sample of patients with autistic spectrum disorder. The charts of all patients with a diagnosis of autistic spectrum disorder, receiving care for psychomotor agitation and/or aggressive behavior in two psychiatric outpatient departments between 2001 and 2006, were reviewed. The Clinical Global Impression-Severity and -Improvement scales (CGI-S and CGI-I) were applied to the data retrieved from the charts. The majority of the 26 patients included were treated with second-generation antipsychotics. A positive, statistically significant correlation was found between the implementation of pharmacotherapy and a reduction in CGI-S scores (p<0.05). Treatment response in patients with no mental retardation was better than in those mentally retarded (p<0.05). The majority of patients in whom clinical improvement was found following implementation of treatment had participated in at least one form of intervention therapy in addition to the principal treatment (p<0.05). Second-generation antipsychotics seem to reduce psychomotor agitation and aggressive behavior in patients with autistic spectrum disorder; however, further studies are required to evaluate the side effects of these drugs in relation to their beneficial effects.

Event-related potentials in impulsively aggressive juveniles: a retrospective chart-review study.

PubMed

Fisher, William; Ceballos, Natalie; Matthews, Dan; Fisher, Larry

2011-05-30

The assessment, treatment and management of aggressive youth represent a major clinical challenge facing pediatric mental health professionals today. Although a number of studies have examined physiological differences among aggressive patients vs. controls, the current literature lacks a comprehensive examination of the electroencephalographic activity of impulsively aggressive juveniles. The current study was designed to fill this void in the literature via a retrospective chart review of 80 male and female juveniles undergoing inpatient treatment for pathologically impulsive aggression. Clinical reports for mid- and late-latency event-related potentials (ERPs) were examined to determine their correlations with aggression characteristics, as well as any differential predictive utility of hemispheric differences and auditory vs. visual potentials. Results indicated that decrements of mid-latency potentials and ERPs evoked by auditory stimuli (vs. late-latency components and visual ERPs) were more highly predictive of aggressive behavior. No significant hemispheric differences were noted. Taken together, these results have theoretical significance for the etiology of impulsive aggression, and perhaps also clinical relevance for the treatment of this condition. Copyright © 2011 Elsevier Ltd. All rights reserved.

Accuracy of administrative data versus clinical data to evaluate carotid endarterectomy and carotid stenting.

PubMed

Bensley, Rodney P; Yoshida, Shunsuke; Lo, Ruby C; Fokkema, Margriet; Hamdan, Allen D; Wyers, Mark C; Chaikof, Elliot L; Schermerhorn, Marc L

2013-08-01

Administrative data have been used to compare carotid endarterectomy (CEA) and carotid artery stenting (CAS). However, there are limitations in defining symptom status, Centers for Medicare and Medicaid Services high-risk status, as well as complications. Therefore, we did a direct comparison between administrative data and physician chart review as well as between data collected for the National Surgical Quality Improvement Program (NSQIP) and physician chart review for CEA and CAS. We performed an outcomes analysis on all CEA and CAS procedures from 2005 to 2011. We obtained International Classification of Diseases, Ninth Revision diagnosis codes from hospital discharge records regarding symptom status, high-risk status, and perioperative stroke. We also obtained data on all CEA patients submitted to NSQIP over the same time period. One of the study authors (R.B.) then performed a chart review of the same patients to determine symptom status, high-risk status, and perioperative strokes and the results were compared. We identified 1342 patients who underwent CEA or CAS between 2005 and 2011 and 392 patients who underwent CEA that were submitted to NSQIP. Administrative data identified fewer symptomatic patients (17.0% vs 34.0%), physiologic high-risk patients (9.3% vs 23.0%), and anatomic high-risk patients (0% vs 15.2%). Although administrative data identified a similar proportion of perioperative strokes (1.9% vs 2.0%), this was due to the fact that these data identified eight false positive and nine false negative perioperative strokes. NSQIP data identified more symptomatic patients compared with chart review (44.1% vs 30.3%), fewer physiologic high-risk patients (13.0% vs 18.6%), fewer anatomic high-risk patients (0% vs 6.6%), and a similar proportion of perioperative strokes (1.5% vs 1.8%, only one false negative stroke and no false positives). Administrative data are unreliable for determining symptom status, high-risk status, and perioperative stroke and should not be used to analyze CEA and CAS. NSQIP data do not adequately identify high-risk patients, but do accurately identify perioperative strokes and to a lesser degree, symptom status. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Email recruitment to use web decision support tools for pneumonia.

PubMed

Flanagan, James R; Peterson, Michael; Dayton, Charles; Strommer Pace, Lori; Plank, Andrew; Walker, Kristy; Carlson, William S

2002-01-01

Application of guidelines to improve clinical decisions for Community Acquired Pneumonia (CAP) patients depends on accurate information about specific facts of each case and on presenting guideline support at the time decisions are being made. We report here on a system designed to solicit information from physicians about their CAP patients in order to classify CAP and present appropriate guidelines for type of care, length of stay, and use of antibiotics. We used elements of three existing information systems to create a achieve these goals: professionals coding diagnoses captured by the existing clinical information system (CIS), email, and web-based decision support tools including a pneumonia severity evaluation tool (SET). The non-secure IS components (email and web) were able to link to information in the CIS using tokens that do not reveal confidential patient-identifiable information. We examined their response to this strategy and the accuracy of pneumonia classification using this approach compared to chart review as a gold standard. On average physicians responded to email solicitations 50% of the time over the 14 month study. Also using this standard, we examined various information triggers for case finding. Professional coding of the primary reason for admission as pneumonia was fairly sensitive as an indicator of CAP. Physician use of the web SET was insensitive but fairly specific. Pneumonia classification using the SET was very reliable compared to experts' chart review using the same algorithm. We examined the distribution of severity of pneumonia for cases of pneumonia found by the various information triggers and for each severity the average length of stay. The distribution found by both chart review and by SET has demonstrated a shift toward more severe cases being admitted compared to only 3 years ago. The length of stay for level of severity is above expectations published by guidelines even for cases of true CAP by chart review. We suggest that the Fine classification system may not adequately describe patients in this setting. Physicians frequently responded that the guidelines presented did not fit their patients.

Prescribing Patterns of Intravenous Golimumab for Rheumatoid Arthritis.

PubMed

Brady, Brenna L; Tkacz, Joseph P; Lofland, Jennifer; Meyer, Roxanne; Bolge, Susan C

2015-09-01

The use of intravenous golimumab (GLM-IV), in combination with methotrexate, was approved by the US Food and Drug Administration in July 2013 for the treatment of moderate to severe, active rheumatoid arthritis (RA). GLM-IV is available in 50-mg vials, and the prescribing information specifies a dosing regimen of 2 mg/kg at 0 and 4 weeks and then every 8 weeks thereafter. The purpose of this study was to examine the patterns of prescribing and administration of GLM-IV, including the demographic, clinical, and utilization characteristics of patients with RA newly treated with GLM-IV. Rheumatology practices across the continental United States were solicited for a chart-review study. Inclusion criteria were: (1) diagnosis of RA; (2) current treatment with GLM-IV; (3) age ≥18 years; and (4) lack of pregnancy (in female patients). Physicians were offered a monetary incentive for each eligible chart provided. An electronic case-report form was developed to aid in the chart data extraction and included fields for demographic characteristics, available comorbid diagnoses, prior RA treatments, and doses and dates of GLM-IV administration. A total of 117 eligible patient charts from 15 rheumatologist practices were reviewed. The patient sample was predominantly female (81.2%), with a mean (SD) age of 55.4 (14.5) years. A total of 55.6% of patients had evidence of biologic treatment before receiving GLM-IV, and 53% had at least 1 comorbid condition. In total, 300 individual GLM-IV infusions from this sample were reviewed. Due to the relatively recent approval of GLM-IV use by the US Food and Drug Administration, the majority of patients in this sample (69.2%) had received only between 2 and 4 infusions at the time of the review. For infusion records with valid dose data, the mean number of administered vials was 3.6 (0.8) (total dose, 180 mg); the majority of patients received a dose consistent with the prescribed dose of 2 mg/kg. Combination therapy with methotrexate was observed in the charts of a minority of patients (27.4%). The mean interval between induction and the first follow-up infusion was 32.9 (11.4) days, with a mean maintenance interval of 56.5 (13.3) days. This analysis provides an early glimpse of the patterns of prescribing GLM-IV. Overall, patients appeared to have been receiving GLM-IV in accordance with Food and Drug Administration labeling; although the rate of prescribing methotrexate was low, dosages and administration intervals were within the expected ranges. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Evaluating the care of general medicine inpatients: how good is implicit review?

PubMed

Hayward, R A; McMahon, L F; Bernard, A M

1993-04-01

Peer review often consists of implicit evaluations by physician reviewers of the quality and appropriateness of care. This study evaluated the ability of implicit review to measure reliably various aspects of care on a general medicine inpatient service. Retrospective review of patients' charts, using structured implicit review, of a stratified random sample of consecutive admissions to a general medicine ward. A university teaching hospital. Twelve internists were trained in structured implicit review and reviewed 675 patient admissions (with 20% duplicate reviews for a total of 846 reviews). Although inter-rater reliabilities for assessments of overall quality of care and preventable deaths (kappa = 0.5) were adequate for aggregate comparisons (for example, comparing mean ratings on two hospital wards), they were inadequate for reliable evaluations of single patients using one or two reviewers. Reviewers' agreement about most focused quality problems (for example, timeliness of diagnostic evaluation and clinical readiness at time of discharge) and about the appropriateness of hospital ancillary resource use was poor (kappa < or = 0.2). For most focused implicit measures, bias due to specific reviewers who were systematically more harsh or lenient (particularly for evaluation of resource-use appropriateness) accounted for much of the variation in reviewers' assessments, but this was not a substantial problem for the measure of overall quality. Reviewers rarely reported being unable to evaluate the quality of care because of deficiencies in documentation in the patient's chart. For assessment of overall quality and preventable deaths of general medicine inpatients, implicit review by peers had moderate degrees of reliability, but for most other specific aspects of care, physician reviewers could not agree. Implicit review was particularly unreliable at evaluating the appropriateness of hospital resource use and the patient's readiness for discharge, two areas where this type of review is often used.

Teaching residents screening, brief intervention, and referral to treatment (SBIRT) skills for alcohol use: Using chart-stimulated recall to assess curricular impact.

PubMed

Wamsley, Maria A; Steiger, Scott; Julian, Katherine A; Gleason, Nathaniel; O'Sullivan, Patricia S; Guy, Michelle; Satterfield, Jason M

2016-01-01

Screening, brief intervention, and referral to treatment (SBIRT) improves identification and intervention for patients at risk for developing an alcohol use disorder (AUD). Residency curriculum is designed to teach SBIRT skills, but resources are needed to promote skill implementation. The electronic health record (EHR) can facilitate implementation through integration of decision-support tools. The authors developed electronic tools to facilitate documentation of alcohol assessment and brief intervention and to reinforce skills from an SBIRT curriculum. This prospective cohort study assessed primary care internal medicine residents' use of SBIRT skills and EHR tools in practice using chart-stimulated recall (CSR). Postgraduate year 2 and 3 residents received a 5-hour SBIRT curriculum with skills practice and instruction on SBIRT electronic tools. Participants were then given a list of their patients seen in a 1-year period who were drinking at/above the recommended limit. Trainees selected 3 patients to review with a faculty member in a CSR. Faculty used a 24-item chart checklist to assess application of SBIRT skills and electronic tool use and met with residents to complete a CSR interview. CSR interview notes were analyzed qualitatively to understand application of SBIRT skills and EHR tool use. Eighteen of 20 residents participated in the CSR, and 5 faculty reviewed 46 patient charts. Residents documented alcohol use (84.2% of charts) and assessment of quantity/frequency of use (71.0%) but were less likely to document assessment for an AUD (34%), an appropriate plan (50.0%), or follow-up (55%). Few residents used EHR tools. Residents reported barriers in addressing alcohol use, including lack of knowledge, patient barriers, and time constraints. More intensive training in SBIRT with opportunities for practice and feedback may be necessary for residents to consistently apply SBIRT skills in practice. EHR tools need to be better integrated into the clinic workflow in order to be useful.

Opioid use following the introduction of an extended-release oxycodone formulation with tamper-resistant properties: Prospective historical chart review in methadone-maintained patients.

PubMed

Sankey, Christopher; Setnik, Beatrice; Harsanyi, Zoltan; Michalko, Ken; Yang, Zejiang; Geoffroy, Pierre

2016-01-01

Emerging data are demonstrating that tamper-resistant opioids may play an important role in changing prescription opioid abuse behaviors. This study was a chart review to examine if the reformulation of OxyContin® into a version with tamper-resistant properties (OxyNEO®) had an impact on oxycodone-positive urine drug screens (UDSs) in opioid-dependent patients receiving methadone maintenance therapy (MMT). The historical element of this study examined 250 eligible charts from patients on MMT who had data during the time periods when only OxyContin was available (baseline period), during the transition to OxyNEO, and when only OxyNEO was available. The prospective element included an exploratory questionnaire regarding retrospective opioid use. The study was conducted at three methadone clinics, in Oshawa, Peterborough, and Scarborough in Ontario, Canada. Male and female patients were eligible if they had a diagnosis of opioid dependency, received MMT, and had at least one oxycodone-positive UDS during the baseline period. This was a noninterventional study. The main outcome was the number of oxycodonepositive UDSs. The results demonstrated a marked reduction in oxycodone-positive UDSs that showed stepwise, statistically significant decreases during the transition and post-OxyContin periods relative to baseline. While the oxycodone-positive UDS results were decreasing, morphine-related-positive UDSs remained relatively stable during the same periods. There were no significant gender differences noted. The introduction of OxyNEO was associated with a statistically significant reduction in oxycodone exposure in a population of methadone-maintained patients.

Treatment patterns, health care utilization, and costs of ovarian cancer in Central and Eastern Europe using a Delphi panel based on a retrospective chart review.

PubMed

Kim, Kun; Hernlund, Emma; Hernadi, Zoltán; Révész, János; Pete, Imre; Szánthó, András; Bodnar, Lubomir; Madry, Rodoslaw; Timorek-Lemieszczuk, Agnieszka; Bozanovic, Tatjana; Vasovic, Suzana; Tomasevic, Zorica; Zivaljevic, Milica; Pazin, Vladimir; Minárik, Tomáš; Garanová, Hana; Helpianska, Lýdia; Justo, Nahila

2013-06-01

Despite the considerable disease burden of ovarian cancer, there were no cost studies in Central and Eastern Europe. This study aimed to describe treatment patterns, health care utilization, and costs associated with treating ovarian cancer in Hungary, Poland, Serbia, and Slovakia. Overall clinical practice for management of epithelial ovarian cancer was investigated through a 3-round Delphi panel. Experts completed a survey based on the chart review (n = 1542). The survey was developed based on clinical guidelines and the International Federation of Gynecology and Obstetrics Annual Report. Means, ranges, and outlier values were discussed with the experts during a telephone interview. Finally, consensus estimates were obtained in face-to-face workshops. Based on these results, overall cost of ovarian cancer was estimated using a Markov model. The patients included in the chart review were followed up from presurgical diagnosis and in each phase of treatment, that is, surgical staging and primary surgery, chemotherapy and chemotherapy monitoring, follow-up, and palliative care. The 5-year overall cost per patient was €14,100 to €16,300 in Hungary, €14,600 to €15,800 in Poland, €7600 to €8100 in Serbia, and €12,400 to €14,500 in Slovakia. The main components were chemotherapy-associated costs (68%-74% of the total cost), followed by cost of primary treatment with surgery (15%-21%) and palliative care (3%-10%). Patients with ovarian cancer consume considerable health care resources and incur substantial costs in Central and Eastern Europe. These findings may prove useful for clinicians and decision makers in understanding the economic implications of managing ovarian cancer in Central and Eastern Europe and the need for innovative therapies.

Variations in definition and method of retrieval of complications influence outcomes statistics after pancreatoduodenectomy: comparison of NSQIP with non-NSQIP methods.

PubMed

Sanford, Dominic E; Woolsey, Cheryl A; Hall, Bruce L; Linehan, David C; Hawkins, William G; Fields, Ryan C; Strasberg, Steven M

2014-09-01

NSQIP and the Accordion Severity Grading System have recently been used to develop quantitative methods for measuring the burden of postoperative complications. However, other audit methods such as chart reviews and prospective institutional databases are commonly used to gather postoperative complications. The purpose of this study was to evaluate discordance between different audit methods in pancreatoduodenectomy--a common major surgical procedure. The chief aim was to determine how these different methods could affect quantitative evaluations of postoperative complications. Three common audit methods were compared with NSQIP in 84 patients who underwent pancreatoduodenectomy. The methods were use of a prospective database, a chart review based on discharge summaries only, and a detailed retrospective chart review. The methods were evaluated for discordance with NSQIP and among themselves. Severity grading was performed using the Modified Accordion System. Fifty-three complications were listed by NSQIP and 31 complications were identified that were not listed by NSQIP. There was poor agreement for NSQIP-type complications between NSQIP and the other audit methods for mild and moderate complications (kappa 0.381 to 0.744), but excellent agreement for severe complications (kappa 0.953 to 1.00). Discordance was usually due to variations in definition of the complications in non-NSQIP methods. There was good agreement among non-NSQIP methods for non-NSQIP complications for moderate and severe complications, but not for mild complications. There are important differences in perceived surgical outcomes based on the method of complication retrieval. The non-NSQIP methods used in this study could not be substituted for NSQIP in a quantitative analysis unless that analysis was limited to severe complications. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Academic Attainment Findings in Children with Sickle Cell Disease

ERIC Educational Resources Information Center

Epping, Amanda S.; Myrvik, Matthew P.; Newby, Robert F.; Panepinto, Julie A.; Brandow, Amanda M.; Scott, J. Paul

2013-01-01

Background: Children with sickle cell disease (SCD) demonstrate deficits in cognitive and academic functioning. This study compared the academic attainment of children with SCD relative to national, state, and local school district rates for African American students. Methods: A retrospective chart review of children with SCD was completed and…

Prevalence and Correlates of Autism in a State Psychiatric Hospital

ERIC Educational Resources Information Center

Mandell, David S.; Lawer, Lindsay J.; Branch, Kira; Brodkin, Edward S.; Healey, Kristin; Witalec, Robert; Johnson, Donielle N.; Gur, Raquel E.

2012-01-01

This study estimated the ASD prevalence in a psychiatric hospital and evaluated the Social Responsiveness Scale (SRS) combined with other information for differential diagnosis. Chart review, SRS and clinical interviews were collected for 141 patients at one hospital. Diagnosis was determined at case conference. Receiver operating characteristic…

Teenage Pregnancy in the Texas Panhandle

ERIC Educational Resources Information Center

Galvez-Myles, Rosa; Myles, Thomas D.

2005-01-01

Purpose: This study compares rural and small-city teenage and adult pregnancies, with respect to complication rates and pregnancy outcomes. Methods: Chart review of Medicaid patients (513 teenage [under 20 years] and 174 adult controls [ages 25-34]) delivered (excluding multiple gestation) in Amarillo, Texas, from January 1999 to April 2001.…

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

PubMed

Frank, K; Esbensen, A J

2015-08-01

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

Preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission for surgical repair.

PubMed

Lucki, Michelle M; Napier, Deborah E; Wagner, Cynthia

2012-01-01

Recognizing a patient's needs during the emergency department to operating room interval is crucial to identify areas for improvement. A review of the literature provided no pertinent research regarding this phase of the preoperative experience. This descriptive study examined the preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission. Data were collected through a systematic retrospective chart review. Demographic variables included gender, age, and comorbidities. Preoperative patient variables included type of analgesia, level of pain, antiembolism interventions, fluid intake, sensory perception/cognition, mobility, and nutritional intake. Subjects were patients cared for at 3 sites in a large multihospital system. A total of 137 charts were reviewed. Although findings were not statistically significant, opportunities to improve care were identified. More attention is needed to evaluate patients effectively for pain, particularly where there are cognitive deficits. Designing and implementing a program for increased bed mobility and protocols that closely monitor and manage fluid intake may offset postoperative complications.

Visual Aids Reviews.

ERIC Educational Resources Information Center

School Science Review, 1983

1983-01-01

Provided are reviews of science films, slides, audio cassettes, and wall charts. Each review includes title, source, country of origin, description of subject matter presented, appraisal, and target audience. Among the topics considered are smell/taste, grasshopper behavior, photography, bat behavior/flight, pond life, exploring planets, locusts,…

Fourth-Year Medical Student Charting of Older Persons' Cognitive and Functional Status.

PubMed

Agens, John; Appelbaum, Jonathan S; Baker, Suzanne; Brummel-Smith, Kenneth; Friedman, Eli; Harrison, Suzanne L; Kutner, Mitchell; McKenzie, Jonathan

2016-01-01

Functional and cognitive impairment correlates with medical outcomes in older persons, yet documentation in the medical record is often inadequate. The purpose of this pilot study was to evaluate fourth year (M4) medical students' charting performance of cognition and functional status in older persons during non-geriatric clerkships using an audit tool. The research assistants used a chart abstracting tool to retrospectively review patients' charts. The abstracting tool contained keywords and phrases to prompt the research assistants to look for any documentation of patient status in four domains: (1) delirium or acute confusional state, (2) chronic cognitive impairment, (3) activities of daily living, and (4) instrumental activities of daily living. The threshold was any mention of keywords in these domains. On non-geriatrics M4 clerkships in the hospital, students documented acute cognitive status (ACS) and presence or absence of chronic cognitive impairment (CCI) in 57% and 68% of cases respectively, with physicians and/or nurses doing it more often at 63% and 84%. Both students and other care providers documented ACS and CCI in the same charts 41% and 59% of the time, respectively. Students documented activities of daily living (ADLs) and instrumental activities of daily living (IADLs) 31% and 3% respectively, physicians and/or nurses 59% and 0%. Documentation of cognitive status in hospital charts for students and physicians was somewhat higher than in the literature. This may be because geriatrics is integrated into our 4-year curriculum. Documentation by both students and physicians was better for ADLs than IADLs and poor for IADLs overall.

Does a dedicated program for young breast cancer patients affect the likelihood of fertility preservation discussion and referral?

PubMed

Srikanthan, Amirrtha; Amir, Eitan; Warner, Ellen

2016-06-01

To assess whether a dedicated program for young breast cancer patients, including a nurse navigator, improves the frequency of: a) fertility discussion documentation and b) fertility preservation (FP) referrals. A retrospective chart review and prospective survey were undertaken of breast cancer patients diagnosed at age 40 or younger between 2011 and 2013 who received adjuvant or neo-adjuvant chemotherapy at two academic cancer centers in Toronto, Canada. The Odette Cancer Centre (OCC) has a dedicated program for young breast cancer patients while Princess Margaret Cancer Centre (PM) does not. Patient demographics, tumor pathology, treatment and fertility discussion documentation prior to systemic chemotherapy administration were extracted from patient records. Prospective surveys were administered to the same cohort to corroborate data collected. Eighty-one patient charts were reviewed at both OCC and PM. Forty-seven and 49 at OCC and PM returned surveys for a response rate of 58% and 60% respectively. Chart reviews demonstrated no difference in the frequency of fertility discussion documentation (78% versus 75% for OCC and PM, p = 0.71); however, surveys demonstrated higher rates of recall of fertility discussion at OCC (96% versus 80%, p = 0.02). A greater proportion of women were offered FP referrals at OCC, as observed in chart reviews (56% versus 41%, p = 0.09), and surveys (73% versus 51%, p = 0.04). Time to initiation of chemotherapy did not differ between women who underwent FP and those who did not. A dedicated program for young breast cancer patients is associated with a higher frequency of FP referrals without delaying systemic therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review.

PubMed

Jusela, Cheryl; Struble, Laura; Gallagher, Nancy Ambrose; Redman, Richard W; Ziemba, Rosemary A

2017-03-01

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions. 2. Describe the significance of interprofessional collaboration in the delivery of quality health care. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The purpose of the current project was to (a) examine the type of information accompanying patients on transfer from acute care to skilled nursing facilities (SNFs), (b) discuss how these findings meet existing standards, and (c) make recommendations to improve transfer of essential information. The study was a retrospective convenience sample chart audit in one SNF. All patients admitted from an acute care hospital to the SNF were examined. The audit checklist was developed based on recommendations by local and national standards. One hundred fifty-five charts were reviewed. Transferring of physician contact information was missing in 65% of charts. The following information was also missing from charts: medication lists (1%), steroid tapering instructions (42%), antiarrhythmic instructions (38%), duration/indication of anticoagulant medications (25%), and antibiotic medications (22%). Findings support the need for improved transitional care models and better communication of information between care settings. Recommendations include designating accountability and chart audits comparing timeliness, completeness, and accuracy. [Journal of Gerontological Nursing, 43(3), 19-28.]. Copyright 2016, SLACK Incorporated.

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

PubMed

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

2018-03-01

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

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

PubMed

Gupta, Munish; Kaplan, Heather C

2017-09-01

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

Intranasal Hydrocodone-Acetaminophen Abuse Induced Necrosis of the Nasal Cavity and Pharynx

PubMed Central

Alexander, David; Alexander, Keith; Valentino, Joseph

2012-01-01

Objectives Two million new users will abuse prescription narcotics this year, most commonly hydrocodone. The most commonly prescribed form is hydrocodone-acetaminophen (HA). Many individuals crush the tablets and snort the product to take advantage of the rapid trans mucosal delivery of narcotics. The resultant pathology of intranasal hydrocodone acetaminophen abuse (INHAA) has been described only in a few case studies. Study Design Retrospective chart review. Methods Two private and one academic otolaryngology practices in Kentucky searched their patient charts for patients with morbidity from intranasal abuse of hydrocodone acetaminophen tablets. We identified thirty-five patients who presented for treatment between 2004 and 2011. Results The majority of patients will initially deny the behavior frequently delaying diagnosis. Physical exam findings of white powder covering an underlying nasal mucosal necrosis are characteristic of this condition during active INHAA. Follow up was limited as only 26% returned for follow up care. Patients commonly presented with orofacial-nasal pain (43%) and sino-nasal congestion and discharge (43%). Active necrosis or prior tissue loss was noted in 77% of patients. Fifty-one percent of patients presented with septal perforations, and 26% with palatal perforations. Two cases of invasive fungal sinusitis were clearly documented with one resulting in death. Conclusions The vast majority of cases presented with characteristic physical findings that included acute necrosis of soft tissue that can progress to destroy oronasal structures. In the absence of invasive fungal disease, the condition is self-limited after cessation of INHAA and performance of local nasal debridement and nasal hygiene. Study Design Chart review, level of evidence: 4 PMID:22965281

Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.

PubMed

Schiff, Gordon D; Reyes Nieva, Harry; Griswold, Paula; Leydon, Nicholas; Ling, Judy; Federico, Frank; Keohane, Carol; Ellis, Bonnie R; Foskett, Cathy; Orav, E John; Yoon, Catherine; Goldmann, Don; Weissman, Joel S; Bates, David W; Biondolillo, Madeleine; Singer, Sara J

2017-08-01

Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools. Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites. Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all P<0.001). Mean days between laboratory test date and evidence of completed action/treatment plan decreased by 19.4 days (P<0.001). Staff surveys showed modest but nonsignificant improvement for intervention practices relative to controls overall and for the 3 high-risk domains that were the focus of PROMISES. A consortium of stakeholders, quality improvement tools, coaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.

Remote Antimicrobial Stewardship in Community Hospitals

PubMed Central

Wood, Zachary H.; Nicolsen, Nicole C.; Allen, Nichole; Cook, Paul P.

2015-01-01

Antimicrobial stewardship has become standard practice at university medical centers, but the practice is more difficult to implement in remote community hospitals that lack infectious diseases trained practitioners. Starting in 2011, six community hospitals within the Vidant Health system began an antimicrobial stewardship program utilizing pharmacists who reviewed charts remotely from Vidant Medical Center. Pharmacists made recommendations within the electronic medical record (EMR) to streamline, discontinue, or switch antimicrobial agents. Totals of charts reviewed, recommendations made, recommendations accepted, and categories of intervention were recorded. Linear regression was utilized to measure changes in antimicrobial use over time. For the four larger hospitals, recommendations for changes were made in an average of 45 charts per month per hospital and physician acceptance of the pharmacists’ recommendations varied between 83% and 88%. There was no significant decrease in total antimicrobial use, but much of the use was outside of the stewardship program’s review. Quinolone use decreased by more than 50% in two of the four larger hospitals. Remote antimicrobial stewardship utilizing an EMR is feasible in community hospitals and is generally received favorably by physicians. As more community hospitals adopt EMRs, there is an opportunity to expand antimicrobial stewardship beyond the academic medical center. PMID:27025642

Chronic heart failure in Japan: implications of the CHART studies.

PubMed

Shiba, Nobuyuki; Shimokawa, Hiroaki

2008-01-01

The prognosis of patients with chronic heart failure (CHF) still remains poor, despite the recent advances in medical and surgical treatment. Furthermore, CHF is a major public health problem in most industrialized countries where the elderly population is rapidly increasing. Although the prevalence and mortality of CHF used to be relatively low in Japan, the disorder has been markedly increasing due to the rapid aging of the society and the Westernization of lifestyle that facilitates the development of coronary artery disease. The Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-1 study was one of the largest cohorts in Japan. The study has clarified the characteristics and prognosis of Japanese patients with CHF, demonstrating that their prognosis was similarly poor compared with those in Western countries. However, we still need evidence for the prevention and treatment of CHF based on the large cohort studies or randomized treatment trials in the Japanese population. Since the strategy for CHF management is now changing from treatment to prevention, a larger-size prospective cohort, called the CHART-2 study, has been initiated to evaluate the risk factors of CHF in Japan. This review summarizes the current status of CHF studies in Japan and discusses their future perspectives.

Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States.

PubMed

Grummer-Strawn, Laurence M; Reinold, Chris; Krebs, Nancy F

2010-09-10

In April 2006, the World Health Organization (WHO) released new international growth charts for children aged 0-59 months. Similar to the 2000 CDC growth charts, these charts describe weight for age, length (or stature) for age, weight for length (or stature), and body mass index for age. Whereas the WHO charts are growth standards, describing the growth of healthy children in optimal conditions, the CDC charts are a growth reference, describing how certain children grew in a particular place and time. However, in practice, clinicians use growth charts as standards rather than references. In 2006, CDC, the National Institutes of Health, and the American Academy of Pediatrics convened an expert panel to review scientific evidence and discuss the potential use of the new WHO growth charts in clinical settings in the United States. On the basis of input from this expert panel, CDC recommends that clinicians in the United States use the 2006 WHO international growth charts, rather than the CDC growth charts, for children aged <24 months (available at https://www.cdc.gov/growthcharts). The CDC growth charts should continue to be used for the assessment of growth in persons aged 2--19 years. The recommendation to use the 2006 WHO international growth charts for children aged <24 months is based on several considerations, including the recognition that breastfeeding is the recommended standard for infant feeding. In the WHO charts, the healthy breastfed infant is intended to be the standard against which all other infants are compared; 100% of the reference population of infants were breastfed for 12 months and were predominantly breastfed for at least 4 months. When using the WHO growth charts to screen for possible abnormal or unhealthy growth, use of the 2.3rd and 97.7th percentiles (or ±2 standard deviations) are recommended, rather than the 5th and 95th percentiles. Clinicians should be aware that fewer U.S. children will be identified as underweight using the WHO charts, slower growth among breastfed infants during ages 3-18 months is normal, and gaining weight more rapidly than is indicated on the WHO charts might signal early signs of overweight.

A Comparison Study of Adults with Intellectual Disability and Psychiatric Disorder with and without Forensic Involvement

ERIC Educational Resources Information Center

Raina, P.; Lunsky, Y.

2010-01-01

The current study describes and compares profiles of patients in the same specialized hospital program for patients with intellectual disability with and without forensic involvement. A retrospective chart review of 78 individuals (39 forensic and 39 non-forensic) served between 2006 and 2008 was completed. The forensic sample was more likely to…

Quality Measures for Hospice and Palliative Care: Piloting the PEACE Measures

PubMed Central

Rokoske, Franziska S.; Durham, Danielle; Cagle, John G.; Hanson, Laura C.

2014-01-01

Abstract Background: The Carolinas Center for Medical Excellence launched the PEACE project in 2006, under contract with the Centers for Medicare & Medicaid Services (CMS), to identify, develop, and pilot test quality measures for hospice and palliative care programs. Objectives: The project collected pilot data to test the usability and feasibility of potential quality measures and data collection processes for hospice and palliative care programs. Settings/subjects: Twenty-two hospices participating in a national Quality Improvement Collaborative (QIC) submitted data from 367 chart reviews for pain care and 45 chart reviews for nausea care. Fourteen additional hospices completed a one-time data submission of 126 chart reviews on 60 potential patient-level quality measures across eight domains of care and an organizational assessment evaluating structure and processes of care. Design: Usability was assessed by examining the range, variability and size of the populations targeted by each quality measure. Feasibility was assessed during the second pilot study by surveying data abstractors about the abstraction process and examining the rates of missing data. The impact of data collection processes was assessed by comparing results obtained using different processes. Results: Measures shown to be both usable and feasible included: screening for physical symptoms on admission and documentation of treatment preferences. Methods of data collection and measure construction appear to influence observed rates of quality of care. Conclusions: We successfully identified quality measures with potential for use in hospices and palliative care programs. Future research is needed to understand whether these measures are sensitive to quality improvement interventions. PMID:24921162

Contact lens assessment in youth: methods and baseline findings.

PubMed

Lam, Dawn Y; Kinoshita, Beth T; Jansen, Meredith E; Mitchell, G Lynn; Chalmers, Robin L; McMahon, Timothy T; Richdale, Kathryn; Sorbara, Luigina; Wagner, Heidi

2011-06-01

To describe the Contact Lens Assessment in Youth (CLAY) Study design and report baseline data for a multicenter, retrospective, observational chart review of children, teenagers, and young adult soft contact lens (SCL) wearers. Clinical charts of SCL wearers aged 8 to 33 years were reviewed at six colleges of optometry. Data were captured retrospectively for eye care visits from January 2006 through September 2009. Patient demographics, SCL parameters, wearing schedules, care systems, and biomicroscopy findings and complications that interrupted SCL wear were entered into an online database. Charts from 3549 patients (14,276 visits) were reviewed; 78.8% were current SCL wearers and 21.2% were new fits. Age distribution was 8 to <13 years (n = 260, 7.3%), 13 to <18 years (n = 879, 24.8%), 18 to <26 years (n = 1,274, 36.0%), and 26 to <34 years (n = 1,136, 32.0%). The sample was 63.2% females and 37.7% college students. At baseline, 85.2% wore spherical SCLs, 13.5% torics, and 0.1% multifocals. Silicone hydrogel lenses were worn by 39.3% of the cohort. Daily wear was reported by 82.1%, whereas 17.9% reported any or occasional overnight wear. Multipurpose care systems were used by 78.1%, whereas another 9.9% indicated hydrogen peroxide solutions use. This data represent the SCL prescribing and wearing patterns for children, teenager, and young adult SCL wearers who presented for eye care in North American academic clinics. This will provide insight into SCL utilization, change in SCL refractive correction, and risk factors for SCL-related complications by age group.

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

PubMed Central

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

2014-01-01

BACKGROUND: A subset of critically ill patients have end-of-life (EOL) goals that are unclear. Rapid response teams (RRTs) may aid in the identification of these patients and the delivery of their EOL care. OBJECTIVES: To characterize the impact of RRT discussion on EOL care, and to examine how a preprinted order (PPO) set for EOL care influenced EOL discussions and outcomes. METHODS: A single-centre retrospective chart review of all RRT calls (January 2009 to December 2010) was performed. The effect of RRT EOL discussions and the effect of a hospital-wide PPO set on EOL care was examined. Charts were from the Ontario Ministry of Health and Long-Term Care Critical Care Information Systemic database, and were interrogated by two reviewers. RESULTS: In patients whose EOL status changed following RRT EOL discussion, there were fewer intensive care unit (ICU) transfers (8.4% versus 17%; P<0.001), decreased ICU length of stay (5.8 days versus 20 days; P=0.08), increased palliative care consultations (34% versus 5.3%; P<0.001) and an increased proportion who died within 24 h of consultation (25% versus 8.3%; P<0.001). More patients experienced a change in EOL status following the introduction of an EOL PPO, from 20% (before) to 31% (after) (P<0.05). CONCLUSIONS: A change in EOL status following RRT-led EOL discussion was associated with reduced ICU transfers and enhanced access to palliative care services. Further study is required to identify and deconstruct barriers impairing timely and appropriate EOL discussions. PMID:25299222

Resident Self-Assessment and Self-Reflection: University of Wisconsin-Madison’s Five-Year Study

PubMed Central

Hildebrand, Christopher; Trowbridge, Elizabeth; Roach, Mary A.; Sullivan, Anne Gravel; Broman, Aimee Teo

2009-01-01

BACKGROUND Chart review represents a critical cornerstone for practice-based learning and improvement in our internal medicine residency program. OBJECTIVE To document residents’ performance monitoring and improvement skills in their continuity clinics, their satisfaction with practice-based learning and improvement, and their ability to self-reflect on their performance. DESIGN Retrospective longitudinal design with repeated measures. PARTICIPANTS Eighty Internal Medicine residents abstracted data for 3 consecutive years from the medical records of their 4,390 patients in the University of Wisconsin-Madison (UW) Hospital and Clinics and William S. Middleton Veterans Administration (VA) outpatient clinics. MEASUREMENT Logistic modeling was used to determine the effect of postgraduate year, resident sex, graduation cohort, and clinic setting on residents’ “compliance rate” on 17 nationally recognized health screening and chronic disease management parameters from 2003 to 2007. RESULTS Residents’ adherence to national preventive and chronic disease standards increased significantly from intern to subsequent years for administering immunizations, screening for diabetes, cholesterol, cancer, and behavioral risks, and for management of diabetes. Of the residents, 92% found the chart review exercise beneficial, with 63% reporting gains in understanding about their medical practices, 26% reflecting on specific gaps in their practices, and 8% taking critical action to improve their patient outcomes. CONCLUSIONS This paper provides support for the feasibility and practicality of this limited-cost method of chart review. It also directs our residency program’s attention in the continuity clinic to a key area important to internal medicine training programs by highlighting the potential benefit of enhancing residents’ self-reflection skills. PMID:19156469

Documentation of Functional Medication Management in Older Adults: A Retrospective Chart Review in Acute Care Hospitalization.

PubMed

Bolina, Monika; Jones, C Allyson; Koshman, Sheri; Heintz, Erin; Sadowski, Cheryl A

2016-12-01

Functional skills can affect the ability of older adults to appropriately manage their medication regimens. Research evaluating a patient's functional ability or the assessment of medication management is limited. Our objective was to describe the documented components of functional medication management (FMM) in adults aged ≥65 years during an acute hospital stay. The secondary objective was to describe the characteristics of the healthcare providers (HCP) who document FMM. This study was a retrospective chart review of a sample of patients aged ≥65 years admitted to medical units in a tertiary hospital from January 2013 to October 2014. FMM was defined as the steps required to take medications-including ordering, picking up, organizing, preparing, administering, and monitoring medications-and the functional abilities necessary to perform these tasks. The mean (standard deviation [SD]) age of patients was 78.9 (8.4) years; 72 (52 %) were female. Of the 190 charts screened, 140 were eligible for inclusion. The mean (SD) number of documented scheduled oral medications was eight (3.1) per patient, and 108 (77.1 %) charts contained documented FMM-related information. Commonly documented FMM components included whether the patient could administer medications independently (73 [52 %]) or schedule medication (46 [33 %]). These activities were most frequently documented by physicians (124 [39 %]) and occupational therapists (108 [34 %]). FMM assessments for older adult inpatients with multiple comorbidities and complex medication regimens were not documented comprehensively or frequently. Given the complexity of medication regimens and the functional skills required to manage medications at home, failing to document these assessments when evaluating patients in hospital reflects a lost opportunity.

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

PubMed

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

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

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

PubMed

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

2016-07-01

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

Multidisciplinary Developmental Evaluation Improves Early Diagnosis of Infantile Autism.

ERIC Educational Resources Information Center

Siegel, B.; And Others

A life-course perspective of the diagnostic histories of 75 autistic individuals (ages 4-25) was obtained through the use of parent surveys and a review of their charts. The study was made to understand better how children who presented with uneven or unusual behavioral development are identified as developmentally multihandicapped. Areas examined…

Coordinated California Corrections: Institutions. Correctional System Study. Final Report.

ERIC Educational Resources Information Center

California State Human Relations Agency, Sacramento. Board of Corrections.

This series of comprehensive task force reports on jails, prisons, and juvenile institutions presents overviews of corrective institutions in California, models, survey findings about the current systems, and a wide range of general and specific recommendations. Various tables and charts illustrate the data, which were collected by a review of the…

Drug-Refractory Aggression, Self-Injurious Behavior, and Severe Tantrums in Autism Spectrum Disorders: A Chart Review Study

ERIC Educational Resources Information Center

Adler, Benjamin A.; Wink, Logan K.; Early, Maureen; Shaffer, Rebecca; Minshawi, Noha; McDougle, Christopher J.; Erickson, Craig A.

2015-01-01

Aggression, self-injurious behavior, and severe tantrums are impairing symptoms frequently experienced by individuals with autism spectrum disorders. Despite US Food and Drug Administration approval of two atypical antipsychotics targeting these symptoms in youth with autistic disorder, they remain frequently drug refractory. We define…

Exploring Reasons for Bed Pressures in Winnipeg Acute Care Hospitals

ERIC Educational Resources Information Center

Menec, Verena H.; Bruce, Sharon; MacWilliam, Leonard R.

2005-01-01

Hospital overcrowding has plagued Winnipeg and other Canadian cities for years. This study explored factors related to overcrowding. Hospital files were used to examine patterns of hospital use from fiscal years 1996/1997 to 1999/2000. Chart reviews were conducted to examine appropriateness of admissions and hospital stays during one pressure…

The Development of Temporal Discrimination in Young Children.

ERIC Educational Resources Information Center

Walker, John

The purpose of this study was to perform pilot research upon two normal children aged six years (an age midway between complete absence of time conceptualization and maturation of time concepts) in order to chart the characteristic responses within a conditioning paradigm. Previous literature in the field is reviewed for the purpose of providing a…

Audubon Tree Study Program.

ERIC Educational Resources Information Center

National Audubon Society, New York, NY.

Included are an illustrated student reader, "The Story of Trees," a leaders' guide, and a large tree chart with 37 colored pictures. The student reader reviews several aspects of trees: a definition of a tree; where and how trees grow; flowers, pollination and seed production; how trees make their food; how to recognize trees; seasonal changes;…

Global Developmental Delay and Its Relationship to Cognitive Skills

ERIC Educational Resources Information Center

Riou, Emilie M.; Ghosh, Shuvo; Francoeur, Emmett; Shevell, Michael I.

2009-01-01

Global developmental delay (GDD) is defined as evidence of significant delays in two or more developmental domains. Our study determined the cognitive skills of a cohort of young children with GDD. A retrospective chart review of all children diagnosed with GDD within a single developmental clinic was carried out. Scores on fine motor (Peabody…

Overweight and Obesity among Children with Developmental Disabilities

ERIC Educational Resources Information Center

De, Sukanya; Small, Jacqueline; Baur, Louise A.

2008-01-01

Background: The aim of this study was to determine the prevalence of overweight and obesity in children with developmental disabilities attending a metropolitan Diagnosis and Assessment Service. Method: A retrospective chart review was carried out for 98 children (67 male) aged 2-18 years. Data on age, sex, weight, height, and severity of…

Learning Skills; Review and Domain Chart.

ERIC Educational Resources Information Center

Clark, N. Cecil; Thompson, Faith E.

A major goal of the elementary and secondary schools is to help each person become an efficient and autonomous learner. Outlined in this report are skills abstracted from the literature on such topics as verbal learning, problem solving, study habits, and behavior modification. The learner-oriented skills are presented so that they may be…

Functional Changes in Children, Adolescents, and Young Adults with Cerebral Palsy

ERIC Educational Resources Information Center

Krakovsky, Gina; Huth, Myra Martz; Lin, Li; Levin, Ron S.

2007-01-01

Children with multiple handicaps, including cerebral palsy (CP), often lose or regress in their functional ability through adolescence and young adulthood. The purpose of this study was to examine functional and psychosocial changes in children, adolescents, and young adults with CP. A retrospective chart review and a prospective telephone…

Detection of Intimate Partner Violence in a General Medicine Practice

ERIC Educational Resources Information Center

Soglin, Lenore F.; Bauchat, Jeanette; Soglin, David F.; Martin, Gary J.

2009-01-01

In this study, an assessment phase is undertaken to determine intimate partner violence (IPV) prevalence. An anonymous survey is followed by a chart review documenting identification of IPV. Two methods are attempted to increase assessment/documentation of IPV: a physician educational intervention and a nursing routine inquiry intervention in one…

Enhancing learning using questions, adjunct to science charts

NASA Astrophysics Data System (ADS)

Holliday, William G.; Benson, Garth

This study supported two hypotheses. First, adjunct questions interacted with a science chart so powerfully that content established as difficult to learn in the pilot and in this study's control groups became easier to learn when charted. Second, students familiar with the chart test before instruction (test exposure) were better prepared to take this test after instruction. This adjunct-question study examined the generalizability of selective-attention and academic-studying hypotheses to a modified science chart medium. About 300 high school students were randomly assigned to four conditions each including a vitamin chart (chart only, test exposure, importance of questions emphasized to students by teachers, and combinational conditions - test exposure and question importance) across 16 biology classrooms. Then these same students were again randomly assigned within each classroom to a control and to four question treatments no questions, questions focusing on easy-to-learn charted content, questions focusing on difficult-to-learn charted content, and a combinational treatment.

Enhancing learning using questions adjunct to science charts

NASA Astrophysics Data System (ADS)

Holliday, William G.; Benson, Garth

This study supported two hypotheses. First, adjunct questions interacted with a science chart so powerfully that content established as difficult to learn in the pilot and in this study's control groups became easier to learn when charted. Second, students familiar with the chart test before instruction (test exposure) were better prepared to take this test after instruction. This adjunct-question study examined the generalizability of selective-attention and academic-studying hypotheses to a modified science chart medium. About 300 high school students were randomly assigned to four conditions each including a vitamin chart (chart only, test exposure, importance of questions emphasized to students by teachers, and combinational conditions--test exposure and question importance) across 16 biology classrooms. Then these same students were again randomly assigned within each classroom to a control and to four question treatments (no questions, questions focusing on easy-to-learn charted content, questions focusing on difficult-to-learn charted content, and a combinational treatment).

The space exploration initiative

NASA Technical Reports Server (NTRS)

Priest, Pete

1991-01-01

A number of view graph charts are presented which outline the presentation. Outlined are reasons for going to Mars, why it is necessary to go to the Moon first, and the presidential decision on the space exploration initiative. Other representative charts are entitled: Lunar transportation system requirement drivers; Mars transportation system requirement drivers; National space policy goals; Exploration hardware needed; Mars mission profile; Science on the Moon and Mars; and Two independent reviews.

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

PubMed Central

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

2018-01-01

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

Characteristics associated with glycemic control among family medicine patients with type 2 diabetes.

PubMed

Kirk, Julienne K; Davis, Stephen W; Hildebrandt, Carol A; Strachan, Elizabeth N; Peechara, Madhavi L; Lord, Richard

2011-01-01

As new payment models are developed for chronic diseases such as diabetes, there is a need to understand which patient characteristics impact glycemic control. This study examines the relationship between patient variables and glycemic control, defined as a hemoglobin A1c (A1c) level of <7%, in a cohort of family medicine patients with type 2 diabetes. A total of 1,398 medical charts were selected using International Classification of Diseases, Ninth Revision, Clinical Modification codes for diabetes. To gather information not available through chart review, a survey was used to collect data on individual-level characteristics. Information included marital status, education level, income level, insurance status, activity level, receipt of diabetes education, living arrangement, employment status, and annual income. A cross-sectional design was used to obtain, via chart review, data about diabetes outcomes (ie, A1c level, blood pressure, and low-density lipoprotein cholesterol [LDL-C] level). A mailed survey was completed by 669 patients (response rate, 47.9%). Almost half of patients in this sample achieved the goal A1c level, LDL-C level (ie, <100 mg/dL), and/or blood pressure (ie, <130/<80 mm Hg). Medicare insurance (odds ratio [OR], 2.16 [95% confidence interval {CI}, 1.18-3.96]) and female sex (OR, 1.61 [95% CI, 1.01-2.56]) were associated with glycemic control. Other variables, such as annual income, education level, and receipt of diabetes education, that were expected to impact glycemic control were not significantly associated with an A1c level of <7%. The survey response rate was <50%, the study was conducted at a single site, and the chart data were retrospective. Our findings indicate that Medicare insurance and female sex were associated with glycemic control. Further evaluation is needed to identify determinants that lead to achievement of optimal glycemic control among individuals with type 2 diabetes.

Collection of family health history for assessment of chronic disease risk in primary care.

PubMed

Powell, Karen P; Christianson, Carol A; Hahn, Susan E; Dave, Gaurav; Evans, Leslie R; Blanton, Susan H; Hauser, Elizabeth; Agbaje, Astrid; Orlando, Lori A; Ginsburg, Geoffrey S; Henrich, Vincent C

2013-01-01

Family health history can predict a patient's risk for common complex diseases. This project assessed the completeness of family health history data in medical charts and evaluated the utility of these data for performing risk assessments in primary care. Family health history data were collected and analyzed to determine the presence of quality indicators that are necessary for effective and accurate assessment of disease risk. More than 99% of the 390 paper charts analyzed contained information about family health history, which was usually scattered throughout the chart. Information on the health of the patient's parents was collected more often than information on the health of other relatives. Key information that was often not collected included age of disease onset, affected side of the family, and second-degree relatives affected. Less than 4% of patient charts included family health histories that were informative enough to accurately assess risk for common complex diseases. Limitations of this study include the small number of charts reviewed per provider, the fact that the sample consisted of primary care providers in a single geographic location, and the inability to assess ethnicity, consanguinity, and other indicators of the informativeness of family health history. The family health histories collected in primary care are usually not complete enough to assess the patient's risk for common complex diseases. This situation could be improved with use of tools that analyze the family health history information collected and provide risk-stratified decision support recommendations for primary care.

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

PubMed

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

2016-06-14

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

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

PubMed

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

2013-04-01

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

Relationship between nighttime vital sign assessments and acute care transfers in the rehabilitation inpatient.

PubMed

Pellicane, Anthony J

2014-01-01

To investigate the role of nighttime vital sign assessment in predicting acute care transfers (ACT) from inpatient rehabilitation. Retrospective chart review. Fifty patients unexpectedly discharged to acute care underwent chart review to determine details of each ACT. Seven of 50 ACT possessed new vital sign abnormalities at the 11 pm vital sign assessment the night before ACT. None of these seven underwent ACT during the night shift the abnormalities were detected. Two of 50 ACT were transferred between 11 pm and 6:59 am; both demonstrating normal vital sign at the 11 pm assessment. During study period, an estimated 5,607 11 pm vital sign assessments were performed. Nighttime vital sign assessments do not seem to be a good screening tool for clinical instability in the rehabilitation hospital. Eliminating sleep disturbance is important to the rehabilitation inpatient as inadequate sleep hinders physical performance. Tailoring vital sign monitoring to fit patents' clinical presentation may benefit this population. © 2014 Association of Rehabilitation Nurses.

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

PubMed Central

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

2017-01-01

Background Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs. Methods and findings We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09–1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus. Conclusions Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa. PMID:28323868

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

PubMed

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

2017-01-01

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

Data Quality Screening Using Trend Charts. October, 2011 v.2

EPA Pesticide Factsheets

Frequently the quality of results from data collection activities are difficult to assess due to the number of reports one needs to review and digest. These reviews may take place months after data collection is conducted.

Increasing tobacco dependence treatment through continuing education training for behavioral health professionals.

PubMed

Williams, Jill M; Miskimen, Theresa; Minsky, Shula; Cooperman, Nina A; Miller, Michelle; Budsock, Patricia Dooley; Cruz, Jose; Steinberg, Marc L

2015-01-01

Few continuing education programs to train behavioral health professionals to deliver tobacco treatment services have been described and evaluated. The effectiveness of two-day training on changing practice was examined by review of clinical charts from 20 clinicians who attended in 2012. Ten medical records were randomly selected for review from each clinician's outpatient practice at a large behavioral health system. Five charts from smokers seen within six months before and after training were reviewed per clinician, for a total of 200. Records were electronically searched on "cigarette," "nicotine," "tobacco," "quit," "smoking," and "smoke." RESULTS were compared via chi square tests (all p<.05). Almost half of the smokers indicated that they were interested in quitting, although baseline rates of tobacco use treatment were very low. Documentation of tobacco use significantly increased between baseline and posttraining, both on the problem list (35% versus 74%) and treatment plan (20% versus 60%). Also posttraining, clinicians advised significantly more outpatients to quit (9% versus 36%) or referred them to individual or group counseling. Discussion of nicotine replacement was documented more frequently in charts (10% versus 31%), and prescriptions for tobacco treatment medications increased significantly in the posttraining period, although overall prescribing remained low. The proportion of patients making quit attempts also significantly increased in the posttraining period (10% versus 39%), suggesting that providers were delivering more tobacco treatment than was reflected in charts. An intensive training program for behavioral health professionals increased tobacco treatment and patient quit attempts. Strategies beyond training may be needed to enhance prescribing by these practitioners.

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

PubMed

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

2014-01-01

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

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

PubMed Central

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

2014-01-01

Background A reading chart that resembles real reading conditions is important to evaluate the quality of life in terms of reading performance. The purpose of this study was to compare the reading speed of UiTM Malay related words (UiTM-Mrw) reading chart with MNread Acuity Chart and Colenbrander Reading Chart. Materials and methods Fifty subjects with normal sight were randomly recruited through randomized sampling in this study (mean age = 22.98 ± 1.65 years). Subjects were asked to read three different near charts aloud and as quickly as possible at random sequence. The charts were the UiTM-Mrw Reading Chart, MNread Acuity Chart and Colenbrander Reading Chart, respectively. The time taken to read each chart was recorded and any errors while reading were noted. Reading performance was quantified in terms of reading speed as words per minute (wpm). Results The mean reading speed for UiTM-Mrw Reading Chart, MNread Acuity Chart and Colenbrander Reading Chart was 200 ± 30 wpm, 196 ± 28 wpm and 194 ± 31 wpm, respectively. Comparison of reading speed between UiTM-Mrw Reading Chart and MNread Acuity Chart showed no significant difference (t = −0.73, p = 0.72). The same happened with the reading speed between UiTM-Mrw Reading Chart and Colenbrander Reading Chart (t = −0.97, p = 0.55). Bland and Altman plot showed good agreement between reading speed of UiTM-Mrw Reading Chart with MNread Acuity Chart with the Colenbrander Reading Chart. Conclusion UiTM-Mrw Reading Chart in Malay language is highly comparable with standardized charts and can be used for evaluating reading speed. PMID:25323642

Cause of Death of Infants and Children in the Intensive Care Unit: Parents’ Recall vs Chart Review

PubMed Central

Brooten, Dorothy; Youngblut, JoAnne M.; Caicedo, Carmen; Seagrave, Lynn; Cantwell, G. Patricia; Totapally, Balagangadhar

2016-01-01

Background More than 55 000 children die annually in the United States, most in neonatal and pediatric intensive care units. Because of the stress and emotional turmoil of the deaths, the children’s parents have difficulty comprehending information. Objectives To compare parents’ reports and hospital chart data on cause of death and examine agreement on cause of death according to parents’ sex, race, participation in end-of-life decisions, and discussion with physicians; deceased child’s age; unit of care (neonatal or pediatric); and hospital and intensive care unit lengths of stay. Methods A descriptive, correlational design was used with a structured interview of parents 1 month after the death and review of hospital chart data. Parents whose children died in intensive care were recruited from 4 South Florida hospitals and from Florida Department of Health death records. Results Among 230 parents, 54% of mothers and 40% of fathers agreed with the chart cause of death. Agreement did not differ significantly for mothers or fathers by race/ ethnicity, participation in end-of-life decisions, discussions with physicians, or mean length of hospital stay. Agreement was better for mothers when the stay in the intensive care unit was the shortest. Fathers’ agreement with chart data was best when the deceased was an infant and death was in the pediatric intensive care unit. Conclusions Death of a child is a time of high stress when parents’ concentration, hearing, and information processing are diminished. Many parents have misconceptions about the cause of the death 1 month after the death. PMID:27134230

Is ridge preservation/augmentation at periodontally compromised extraction sockets safe? A retrospective study.

PubMed

Kim, Jung-Ju; Ben Amara, Heithem; Schwarz, Frank; Kim, Hae-Young; Lee, Jung-Won; Wikesjö, Ulf M E; Koo, Ki-Tae

2017-10-01

This study aimed to evaluate the safety of ridge preservation/augmentation procedures when performed at compromised extraction sockets. Patients subject to ridge preservation/augmentation at periodontally compromised sockets at Seoul National University Dental Hospital (SNUDH) were evaluated in a chart review. Tooth extractions due to acute infection were not included in our study as chronically formed lesions are the only lesions that can be detected from radiographic images. If inflammatory symptoms persisted following ridge preservation/augmentation and antimicrobial and anti-inflammatory therapy, the patient was categorized as a re-infection case and implanted biomaterial removed. Of 10,060 patients subject to tooth extractions at SNUDH, 2011 through 2015, 297 cases meeting inclusion criteria were reviewed. The severity and type of lesions were not specific because extracting data was only done by radiographic images and chart records. The review identified eight patients exhibiting inflammatory symptoms that required additional antimicrobial and anti-inflammatory therapy. Within this group, re-infection occurred in two patients requiring biomaterials removal. The final safety rate for the ridge preservation/augmentation was 99.3%. None of the demographic factors, systemic conditions or choice of biomaterial affected the safety of ridge preservation/augmentation. Alveolar ridge preservation/augmentation at periodontally compromised sockets appears safe following thorough removal of infectious source. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Maintenance ECT in schizophrenia: A systematic review.

PubMed

Ward, Heather Burrell; Szabo, Steven T; Rakesh, Gopalkumar

2018-03-20

Relapse after discontinuation of ECT is significant in patients with schizophrenia. The purpose of this systematic review was to examine use of M-ECT in schizophrenia to guide clinical decision making for relapse prevention in schizophrenia. We reviewed studies examining the role of continuation (C-ECT) and maintenance electroconvulsive therapy (M-ECT) in schizophrenia. Following PRISMA guidelines, we included randomized controlled trials, open label trials, retrospective chart reviews, case reports, and case series in this review. We evaluated adjunctive pharmacological regimens; ECT treatment parameters, including frequency, duration of continued treatment, electrode placement; clinical outcomes including cognitive side effects and relapse rates from included studies. Our findings suggest M-ECT could provide an effective form of relapse prevention in these patients and persistent cognitive side effects are minimal. Copyright © 2018 Elsevier B.V. All rights reserved.

The Impact of a Management Protocol on the Outcomes of Child Abuse in Hospitalized Children in Hong Kong

ERIC Educational Resources Information Center

Lee, Anselm C. W.; Li, C. H.; So, K. T.

2006-01-01

Objective: To study the outcomes of children hospitalized for suspected child abuse before and after the implementation of a management protocol in a hospital in Hong Kong. Study period: Two 2-year periods before (1994-1995) and after (2002-2003) the implementation of the protocol in 1998. Methods: This is a retrospective hospital chart review in…

A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents.

PubMed

van der Wurff, Inge S M; Meyer, Barbara J; de Groot, Renate H M

2017-05-10

The influence of n -3 long-chain polyunsaturated fatty acids ( n -3 LCPUFA) supplementation on health outcomes has been studied extensively with randomized controlled trials (RCT). In many research fields, difficulties with recruitment, adherence and high drop-out rates have been reported. However, what is unknown is how common these problems are in n -3 LCPUFA supplementation studies in children and adolescents. Therefore, this paper will review n -3 LCPUFA supplementation studies in children and adolescents with regard to recruitment, adherence and drop-out rates. The Web of Science, PubMed and Ovid databases were searched for papers reporting on RCT supplementing children and adolescents (2-18 years) with a form of n -3 LCPUFA (or placebo) for at least four weeks. As a proxy for abiding to CONSORT guidelines, we noted whether manuscripts provided a flow-chart and provided dates defining the period of recruitment and follow-up. Ninety manuscripts (reporting on 75 studies) met the inclusion criteria. The majority of the studies did not abide by the CONSORT guidelines: 55% did not provide a flow-chart, while 70% did not provide dates. The majority of studies provided minimal details about the recruitment process. Only 25 of the 75 studies reported an adherence rate which was on average 85%. Sixty-five of the 75 studies included drop-out rates which were on average 17%. Less than half of the included studies abided by the CONSORT guidelines (45% included a flow chart, while 30% reported dates). Problems with recruitment and drop-out seem to be common in n -3 LCPUFA supplementation trials in children and adolescents. However, reporting about recruitment, adherence and dropout rates was very heterogeneous and minimal in the included studies. Some techniques to improve recruitment, adherence and dropout rates were identified from the literature, however these techniques may need to be tailored to n -3 LCPUFA supplementation studies in children and adolescents.

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

PubMed

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

2002-10-01

Subsets of psychiatric patients gain excess body weight while receiving mood-stabilizing agents such as lithium carbonate or valproate sodium. Patients who gain excess weight may discontinue therapy, with severe consequences. Among the newer anticonvulsant agents, topiramate is a candidate agent for bipolar disorder and is associated with weight loss when used as adjunctive treatment. This open-label, nonrandomized, chart-review study assessed changes in body weight and body mass index (BMI) in patients receiving topiramate, lithium, or valproate. Data were extracted from the medical charts of patients admitted in 1999 and 2000 to a state psychiatric hospital with either schizophrenia, schizoaffective disorder, bipolar disorder, or other psychiatric diagnoses who were prescribed valproate, lithium, or topiramate and were reviewed for changes in body weight and BMI. The use of concomitant psychotropic medicines was recorded (eg, antipsychotic agents, antidepressant agents, other mood stabilizers such as gabapentin or carbamazepine). Continuous variables were analyzed using a factorial analysis of variance and the Student t test. Contingency statistics were used to analyze categorical variables. A total of 214 patients were included in the chart review (123 men, 91 women; mean age, 39.4 years). Significantly more women than men received topiramate (P = 0.004). Patients receiving either lithium or valproate gained a mean (SD) of 6.3 (9.0) kg and 6.4 (9.0) kg, respectively, whereas patients receiving topiramate lost a mean 1.2 (6.3) kg (F = 11.54, df = 2,198; P < 0.001). Lithium- or valproate-treated patients experienced an increase in BMI (mean, 2.1 [3.0] for both groups), whereas topiramate-treated patients experienced a reduction in BMI (mean, -0.5 [2.4]); this result was statistically significant (F = 11.40, df = 2,198; P < 0.001). Finally, lithium- or valproate-treated patients gained >8% of their baseline body weight (8.2% [11.5%] for lithium-treated patients and 8.5% [11.9%] for valproate-treated patients), whereas topiramate-treated patients lost 0.7% (7.2%) of their body weight (F = 9.93, df= 2,198; P < 0.001). Controlled studies for the efficacy of topiramate therapy in various psychiatric conditions are awaited. These data indicate that patients receiving topiramate experience body weight loss and a reduction in BMI. This advantage of topiramate may promote long-term adherence to treatment among psychiatric patients and possibly decrease the medical risks associated with obesity.

Digital In, Digital Out: Digital Editing with Firewire.

ERIC Educational Resources Information Center

Doyle, Bob; Sauer, Jeff

1997-01-01

Reviews linear and nonlinear digital video (DV) editing equipment and software, using the IEEE 1394 (FireWire) connector. Includes a chart listing specifications and rating eight DV editing systems, reviews two DV still-photo cameras, and previews beta DV products. (PEN)

Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand.

PubMed

Barton, Lorna; Futtermenger, Judith; Gaddi, Yash; Kang, Angela; Rivers, Jon; Spriggs, David; Jenkins, Paul F; Thompson, Campbell H; Thomas, Josephine S

2012-04-01

This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation.

Learning from Adverse Events in Obstetrics: Is a Standardized Computer Tool an Effective Strategy for Root Cause Analysis?

PubMed

Murray-Davis, Beth; McDonald, Helen; Cross-Sudworth, Fiona; Ahmed, Rashid; Simioni, Julia; Dore, Sharon; Marrin, Michael; DeSantis, Judy; Leyland, Nicholas; Gardosi, Jason; Hutton, Eileen; McDonald, Sarah

2015-08-01

Adverse events occur in up to 10% of obstetric cases, and up to one half of these could be prevented. Case reviews and root cause analysis using a structured tool may help health care providers to learn from adverse events and to identify trends and recurring systems issues. We sought to establish the reliability of a root cause analysis computer application called Standardized Clinical Outcome Review (SCOR). We designed a mixed methods study to evaluate the effectiveness of the tool. We conducted qualitative content analysis of five charts reviewed by both the traditional obstetric quality assurance methods and the SCOR tool. We also determined inter-rater reliability by having four health care providers review the same five cases using the SCOR tool. The comparative qualitative review revealed that the traditional quality assurance case review process used inconsistent language and made serious, personalized recommendations for those involved in the case. In contrast, the SCOR review provided a consistent format for recommendations, a list of action points, and highlighted systems issues. The mean percentage agreement between the four reviewers for the five cases was 75%. The different health care providers completed data entry and assessment of the case in a similar way. Missing data from the chart and poor wording of questions were identified as issues affecting percentage agreement. The SCOR tool provides a standardized, objective, obstetric-specific tool for root cause analysis that may improve identification of risk factors and dissemination of action plans to prevent future events.

A multicenter study of preventable contact burns from glass fronted gas fireplaces.

PubMed

Wibbenmeyer, Lucy; Gittelman, Michael A; Kluesner, Karen; Liao, Junlin; Xing, Yunfan; Faraklas, Iris; Anyan, Walter; Gamero, Chelsea; Moulton, Steven; Nederveld, Cindy; Banks, Ashley; Ryan, Colleen M; Conway, Jennifer A; Reilly, Debra A; Fish, Joel; Kelly, Charis; Peltier, George; Schwantke, Emily; Conrad, Peggie F; Caruso, Daniel M; Richey, Karen J; McCrory, Kristine; Elfar, Mohamed S A; Pittinger, Timothy; Sadie, Christine; Greenhalgh, David; Palmieri, Tina; Grossman, Peter H; Richards, Kurt M; Joyce, Teresa; Pozez, Andrea L; Savetamal, Alisa; Harrington, David T; Duncan, Kimberley; Pomerantz, Wendy J; Dillard, B Daniel

2015-01-01

Glass fronted gas fireplaces (GFGFs) have exterior surfaces that can reach extremely high temperatures. Burn injuries from contact with the glass front can be severe with long-term sequelae. The Consumer Product Safety Commission reported that these injuries are uncommon, whereas single-center studies indicate a much higher frequency. The purpose of this multi-institutional study was to determine the magnitude and severity of GFGF injuries in North America. Seventeen burn centers elected to participate in this retrospective chart review. Chart review identified 402 children ≤10 years of age who sustained contact burns from contact with GFGF, who were seen or admitted to the study hospitals from January 2006 to December 2010. Demographic, burn, treatment, and financial data were collected. The mean age of the study group was 16.8 ± 13.3 months. The majority suffered burns to their hands (396, 98.5%), with burns to the face being the second, much less common site (14, 3.5%). Two hundred and sixty-nine required rehabilitation therapy (66.9%). The number of GFGF injuries reported was 20 times greater than the approximately 30 injuries estimated by the Consumer Product Safety Commission's 10-year review. For the affected children, these injuries are painful, often costly and occasionally can lead to long-term sequelae. Given that less than a quarter of burn centers contributed data, the injury numbers reported herein support a need for broader safety guidelines for gas fireplaces in order to have a significant impact on future injuries.

Documentation of violence risk information in psychiatric hospital patient charts: an empirical examination.

PubMed

Elbogen, Eric B; Tomkins, Alan J; Pothuloori, Antara P; Scalora, Mario J

2003-01-01

Studies have identified risk factors that show a strong association with violent behavior in psychiatric populations. Yet, little research has been conducted on the documentation of violence risk information in actual clinical practice, despite the relevance of such documentation to risk assessment liability and to conducting effective risk management. In this study, the documentation of cues of risk for violence were examined in psychiatric settings. Patient charts (n = 283) in four psychiatric settings were reviewed for documentation of violence risk information summarized in the MacArthur Violence Risk Assessment Study. The results revealed that particular patient and institutional variables influenced documentation practices. The presence of personality disorder, for example, predicted greater documentation of cues of violence risk, regardless of clinical setting. These findings have medicolegal implications for risk assessment liability and clinical implications for optimizing risk management in psychiatric practice.

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

USDA-ARS?s Scientific Manuscript database

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

Analysis of the Final Report of the Fundamental Science Review: A Blueprint for Research, A Call for Action

ERIC Educational Resources Information Center

Canadian Association of University Teachers, 2017

2017-01-01

Canadian Association of University Teachers (CAUT) welcomes the report of the Advisory Panel on Federal Support for Fundamental Science "the Panel". It is a thoughtful and comprehensive study that correctly diagnoses problems that have plagued basic science for over a decade. The Panel's recommendations, if implemented, will chart a…

Measuring Change in Career Counseling: Validation of the "Career Futures Inventory-Revised"

ERIC Educational Resources Information Center

Rottinghaus, Patrick J.; Eshelman, Alec; Gore, Jonathan S.; Keller, Kari J.; Schneider, Madalyn; Harris, Kristine L.

2017-01-01

This retrospective chart review study examined the factor structure of the "Career Futures Inventory-Revised" (CFI-R; Rottinghaus et al. in "J Career Assess" 20:123-139, 2012) and its utility as a career counseling outcome measure using a sample of 332 clients from a university career center. The CFI-R examines career agency…

Psychiatric Impairment among Adolescents Engaging in Different Types of Deliberate Self-Harm

ERIC Educational Resources Information Center

Jacobson, Colleen M.; Muehlenkamp, Jennifer J.; Miller, Alec L.; Turner, J. Blake

2008-01-01

This retrospective chart review study of 227 participants examined the psychiatric profiles of outpatient adolescents ages 12 to 19 years (M = 15.08 years, SD = 1.72 years) engaging in different types of deliberate self-harm (DSH) behaviors. Participants were divided into four groups: no deliberate self-harm (NoDSH; n = 119), nonsuicidal…

Adequacy of Antidepressant Treatment by Psychiatric Residents: The Antidepressant Treatment History Form as a Possible Assessment Tool

ERIC Educational Resources Information Center

Dew, Rachel Elizabeth; Kramer, Stephen I.; McCall, W. Vaughn

2005-01-01

Objective: Facility in psychopharmacology is a major goal of psychiatric residency. This study assesses the adequacy of pharmacotherapy provided to depressed patients in a resident clinic. Methods: Charts of all 285 patients seen in an outpatient triage clinic during 2000 were reviewed. One hundred twelve patients had diagnoses of major…

New S control chart using skewness correction method for monitoring process dispersion of skewed distributions

NASA Astrophysics Data System (ADS)

Atta, Abdu; Yahaya, Sharipah; Zain, Zakiyah; Ahmed, Zalikha

2017-11-01

Control chart is established as one of the most powerful tools in Statistical Process Control (SPC) and is widely used in industries. The conventional control charts rely on normality assumption, which is not always the case for industrial data. This paper proposes a new S control chart for monitoring process dispersion using skewness correction method for skewed distributions, named as SC-S control chart. Its performance in terms of false alarm rate is compared with various existing control charts for monitoring process dispersion, such as scaled weighted variance S chart (SWV-S); skewness correction R chart (SC-R); weighted variance R chart (WV-R); weighted variance S chart (WV-S); and standard S chart (STD-S). Comparison with exact S control chart with regards to the probability of out-of-control detections is also accomplished. The Weibull and gamma distributions adopted in this study are assessed along with the normal distribution. Simulation study shows that the proposed SC-S control chart provides good performance of in-control probabilities (Type I error) in almost all the skewness levels and sample sizes, n. In the case of probability of detection shift the proposed SC-S chart is closer to the exact S control chart than the existing charts for skewed distributions, except for the SC-R control chart. In general, the performance of the proposed SC-S control chart is better than all the existing control charts for monitoring process dispersion in the cases of Type I error and probability of detection shift.

[Do pediatricians identify adverse drug reactions even when they do not report them?

PubMed

Morales-Ríos, Olga; Jasso-Gutiérrez, Luis; Garduño-Espinosa, Juan; Olivar-López, Víctor; Muñoz-Hernández, Onofre

Spontaneous notification depends on the ability of pediatricians to identify adverse drug reactions (ADRs) along with their habit of reporting these incidents. During the years 2008 and 2009, the frequency of reports of ADRs to the Electronic Program of Pharmacovigilance (SISFAR) in the Hospital Infantil of Mexico Federico Gomez (HIMFG) was low (0.44% and 0.20%, respectively). Because of the above, the ability of pediatricians from the Emergency Department (ED) to identify ADRs using the clinical chart review was evaluated in 2010 in this study. A descriptive, observational, cross-sectional retrospective study was conducted in the ED from March 1 to August 31. ADRs were classified and quantified as "ADRs identified by pediatricians" when there was evidence in the clinical chart that pediatricians associated a clinical sign, symptom and laboratory value with an ADR. The numbers of notifications reported in SISFAR were quantified. Descriptive analysis was done using SPSS v.18. Considering patients who were admitted to the ED, the frequency of ADRs was 21.8%. The frequency of ADRs identified by physicians in clinical charts was 86%. The pharmacist detected 14% of ADRs. The frequency of ADRs reported by physicians was 6.1%. Although identification of ADRs in the clinical charts by pediatricians was high, it is possible that some ADRs were undetected. Because underreporting was very high, it is necessary to take actions to improve the reporting process. Copyright © 2015. Publicado por Masson Doyma México S.A.

Metabolic effects of antipsychotics in prepubertal children: a retrospective chart review.

PubMed

Ebert, Tanya; Midbari, Yael; Shmilovitz, Ronen; Kosov, Ira; Kotler, Moshe; Weizman, Abraham; Ram, Anca

2014-05-01

Antipsychotics, especially atypical ones, are in common use in children and adolescents with psychotic or affective spectrum disorders, as well as in various other psychopathologies. The adverse effects of atypical antipsychotics in children and adolescents are similar to those seen in adults, and include weight gain, elevated blood glucose levels, and hyperlipidemia. In this retrospective chart review, we compared these adverse events in children who were treated with typical, atypical, or no antipsychotic treatment. The medical charts of 72 children, 65 boys and 7 girls, were reviewed. All children were 6-13 years old (mean age 9.5±1.7 years). In total, 48 children received antipsychotic treatment, and 24 children were in the control group. Data were extracted from the medical charts, including weight, height, body mass index (BMI), blood pressure, aspartate transaminase (AST), alanine transaminase (ALT), triglycerides, total cholesterol, and glucose blood levels. We examined the values in the beginning of the antipsychotic treatment and at release from the hospital in the study group, and at admission and in the end of the drug-free period or at release from the hospital (a duration of at least 4 weeks) in the control group. The average weight gain was 3.9±3.8 kg in the atypical antipsychotic treatment (AAT) group, 1.1±4.4 kg in the typical antipsychotic treatment (TAT) group, and 0.23±2.9 kg in the control group. The average increase in BMI was 15.1±22.0 percentiles in the AAT group, 6.4±14.2 percentiles in the TAT group, and 1.6±12.5 percentiles in the control group. No statistically significant difference was found in the increase in height percentile. There were no significant differences in the rates of elevated values of serum triglycerides, cholesterol, AST, ALT, or fasting blood glucose. We found a significant increase in both absolute weight gain and BMI percentile following atypical antipsychotic treatment. In contrast, typical antipsychotic treatment did not affect weight gain significantly, and the same was true for the control group. In addition, the rates of elevated values of biochemical parameters (AST, ALT, total cholesterol, triglycerides, and fasting blood glucose levels) were very low at the beginning of the study, and were not significantly altered by the various treatments.

A model for preemptive maintenance of medical linear accelerators-predictive maintenance.

PubMed

Able, Charles M; Baydush, Alan H; Nguyen, Callistus; Gersh, Jacob; Ndlovu, Alois; Rebo, Igor; Booth, Jeremy; Perez, Mario; Sintay, Benjamin; Munley, Michael T

2016-03-10

Unscheduled accelerator downtime can negatively impact the quality of life of patients during their struggle against cancer. Currently digital data accumulated in the accelerator system is not being exploited in a systematic manner to assist in more efficient deployment of service engineering resources. The purpose of this study is to develop an effective process for detecting unexpected deviations in accelerator system operating parameters and/or performance that predicts component failure or system dysfunction and allows maintenance to be performed prior to the actuation of interlocks. The proposed predictive maintenance (PdM) model is as follows: 1) deliver a daily quality assurance (QA) treatment; 2) automatically transfer and interrogate the resulting log files; 3) once baselines are established, subject daily operating and performance values to statistical process control (SPC) analysis; 4) determine if any alarms have been triggered; and 5) alert facility and system service engineers. A robust volumetric modulated arc QA treatment is delivered to establish mean operating values and perform continuous sampling and monitoring using SPC methodology. Chart limits are calculated using a hybrid technique that includes the use of the standard SPC 3σ limits and an empirical factor based on the parameter/system specification. There are 7 accelerators currently under active surveillance. Currently 45 parameters plus each MLC leaf (120) are analyzed using Individual and Moving Range (I/MR) charts. The initial warning and alarm rule is as follows: warning (2 out of 3 consecutive values ≥ 2σ hybrid) and alarm (2 out of 3 consecutive values or 3 out of 5 consecutive values ≥ 3σ hybrid). A customized graphical user interface provides a means to review the SPC charts for each parameter and a visual color code to alert the reviewer of parameter status. Forty-five synthetic errors/changes were introduced to test the effectiveness of our initial chart limits. Forty-three of the forty-five errors (95.6 %) were detected in either the I or MR chart for each of the subsystems monitored. Our PdM model shows promise in providing a means for reducing unscheduled downtime. Long term monitoring will be required to establish the effectiveness of the model.

Examining the sustainability of Screening for Distress, the sixth vital sign, in two outpatient oncology clinics: A mixed-methods study.

PubMed

Groff, Shannon; Holroyd-Leduc, Jayna; White, Deborah; Bultz, Barry D

2018-01-01

Research indicates that cancer patients experience significant multifactorial distress during their journey. To address this, cancer centers are implementing Screening for Distress programs; however, little is known about the sustainability of these programs. This study sought to examine the sustainability of a Screening for Distress program in 2 cancer clinics 6 months post implementation. A mixed-methods cross-sectional design was utilized. To determine if screening rates, screening conversations and appropriate interventions occurred and the charts of 184 consecutive patients attending the head and neck or neuro-oncology clinics over a 3 week period were reviewed. To examine the barriers and facilitators of sustainability, 16 semi-structured interviews with administrators, physicians, and nurses were conducted. Of the 184 charts reviewed, 163 (88.6%) had completed screening tools. Of these 163, 130 (79.8%) indicated that a conversation occurred with the patient about the identified distress as reported on the screening tool. Of the 89 (54.6%) charts where the need for an intervention was indicated, 68 (76.4%) had an intervention documented. Six oncologists, 7 nurses, and 3 administrators were interviewed, and 5 themes which influenced the sustainability of the program emerged: (1) attitudes, knowledge, and beliefs about the program; (2) implementation approach; (3) outcome expectancy of providers; (4) integration with existing practices; and (5) external factors. This study suggests that Screening for Distress was largely sustained, possibly due to positive attitudes and outcome expectancy. However, sustainability may be enhanced by formally integrating screening with existing practices, addressing potential knowledge gaps, and ensuring engagement with all stakeholder groups. Copyright © 2017 John Wiley & Sons, Ltd.

The Inaccuracy of Patient Recall for COPD Exacerbation Rate Estimation and Its Implications: Results from Central Adjudication.

PubMed

Frei, Anja; Siebeling, Lara; Wolters, Callista; Held, Leonhard; Muggensturm, Patrick; Strassmann, Alexandra; Zoller, Marco; Ter Riet, Gerben; Puhan, Milo A

2016-10-01

COPD exacerbation incidence rates are often ascertained retrospectively through patient recall and self-reports. We compared exacerbation ascertainment through patient self-reports and single-physician chart review to central adjudication by a committee and explored determinants and consequences of misclassification. Self-reported exacerbations (event-based definition) in 409 primary care patients with COPD participating in the International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts (ICE COLD ERIC) cohort were ascertained every 6 months over 3 years. Exacerbations were adjudicated by single experienced physicians and an adjudication committee who had information from patient charts. We assessed the accuracy (sensitivities and specificities) of self-reports and single-physician chart review against a central adjudication committee (AC) (reference standard). We used multinomial logistic regression and bootstrap stability analyses to explore determinants of misclassifications. The AC identified 648 exacerbations, corresponding to an incidence rate of 0.60 ± 0.83 exacerbations/patient-year and a cumulative incidence proportion of 58.9%. Patients self-reported 841 exacerbations (incidence rate, 0.75 ± 1.01; incidence proportion, 59.7%). The sensitivity and specificity of self-reports were 84% and 76%, respectively, those of single-physician chart review were between 89% and 96% and 87% and 99%, respectively. The multinomial regression model and bootstrap selection showed that having experienced more exacerbations was the only factor consistently associated with underreporting and overreporting of exacerbations (underreporters: relative risk ratio [RRR], 2.16; 95% CI, 1.76-2.65 and overreporters: RRR, 1.67; 95% CI, 1.39-2.00). Patient 6-month recall of exacerbation events are inaccurate. This may lead to inaccurate estimates of incidence measures and underestimation of treatment effects. The use of multiple data sources combined with event adjudication could substantially reduce sample size requirements and possibly cost of studies. www.ClinicalTrials.gov, NCT00706602. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Contract Training Services Strategic Business Plan.

ERIC Educational Resources Information Center

Sir Sandford Fleming Coll., Peterborough (Ontario).

Recommending organizational structures and strategies to achieve growth in contract training services (CTS) at Ontario's (Canada) Fleming College, this report reviews external conditions and proposes effective college responses. Following an overview of results and a recommended organizational chart, the planning process is reviewed and a…

Reasons for Not Treating Women with Postmenopausal Osteoporosis with Prescription Medications: Physicians' and Patients' Perspectives.

PubMed

Weaver, Jessica Papadopoulos; Olsson, Kelly; Sadasivan, Ravi; Modi, Ankita; Sen, Shuvayu

2017-12-01

In the United States, between one-third and two thirds of postmenopausal women do not begin treatment with a prescription osteoporosis medication after a diagnosis of osteoporosis. The objective of this study was to understand the reasons for this lack of treatment. Online physician and patient surveys were administered in 2013. The physician survey included a chart review of untreated postmenopausal women recently diagnosed with osteoporosis and gathered data on physicians' practices regarding the management of osteoporosis in postmenopausal women. The patient survey was given to untreated postmenopausal women with a recent osteoporosis diagnosis. The physician survey was completed by 224 physicians, who also reviewed 811 patient charts. A total of 165 patients completed the patient survey. In the chart review, physicians reported that 19% of the postmenopausal women they diagnosed with osteoporosis were not prescribed an osteoporosis medication. The patient declined a physician's recommendation for pharmacological treatment in 81% and 52% of cases in the physician and patient surveys, respectively. The most frequent reasons for physicians not recommending treatment were: low calcium and/or vitamin D levels, patients potentially at risk of medication side effects, pre-existing gastrointestinal problems, and polypharmacy. The most frequent reasons for patients deciding against treatment were: concerns about side effects, considering nonprescription options and behavioral modifications, and questioning the potential benefit of taking the medication. Patients decided against pharmacological treatment of newly diagnosed osteoporosis in at least half of the cases of nontreatment. The principal reasons for not being treated with a prescription medication, given by both physicians and patients, were that there were alternatives and concern about the risks of prescription medications.

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

NASA Technical Reports Server (NTRS)

Wood, Bill; Pate, Dennis; Thelen, David

2010-01-01

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

Accuracy of human motion capture systems for sport applications; state-of-the-art review.

PubMed

van der Kruk, Eline; Reijne, Marco M

2018-05-09

Sport research often requires human motion capture of an athlete. It can, however, be labour-intensive and difficult to select the right system, while manufacturers report on specifications which are determined in set-ups that largely differ from sport research in terms of volume, environment and motion. The aim of this review is to assist researchers in the selection of a suitable motion capture system for their experimental set-up for sport applications. An open online platform is initiated, to support (sport)researchers in the selection of a system and to enable them to contribute and update the overview. systematic review; Method: Electronic searches in Scopus, Web of Science and Google Scholar were performed, and the reference lists of the screened articles were scrutinised to determine human motion capture systems used in academically published studies on sport analysis. An overview of 17 human motion capture systems is provided, reporting the general specifications given by the manufacturer (weight and size of the sensors, maximum capture volume, environmental feasibilities), and calibration specifications as determined in peer-reviewed studies. The accuracy of each system is plotted against the measurement range. The overview and chart can assist researchers in the selection of a suitable measurement system. To increase the robustness of the database and to keep up with technological developments, we encourage researchers to perform an accuracy test prior to their experiment and to add to the chart and the system overview (online, open access).

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

PubMed

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

2014-06-01

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

Accuracy of administrative data versus clinical data to evaluate carotid endarterectomy and carotid stenting

PubMed Central

Bensley, Rodney P; Yoshida, Shunsuke; Lo, Ruby C; Fokkema, Margriet; Hamdan, Allen D; Wyers, Mark C; Chaikof, Elliot L; Schermerhorn, Marc L

2013-01-01

Objectives Administrative data have been used to compare carotid endarterectomy (CEA) and carotid artery stenting (CAS). However, there are limitations in defining symptom status, CMS high-risk status, as well as complications. Therefore, we did a direct comparison between administrative data and physician chart review as well as between data collected for the National Surgical Quality Improvement Program (NSQIP) and physician chart review for CEA and CAS. Methods We performed an outcomes analysis on all CEA and CAS procedures from 2005–2011. We obtained ICD-9 diagnosis codes from hospital discharge records regarding symptom status, high-risk status, and perioperative stroke. We also obtained data on all CEA patients submitted to NSQIP over the same time period. A physician then performed a chart review of the same patients to determine symptom status, high-risk status, and perioperative strokes and the results were compared. Results We identified 1342 patients who underwent CEA or CAS between 2005–2011 and 392 patients who underwent CEA that were submitted to NSQIP. Administrative data identified fewer symptomatic patients (17.0% vs. 34.0%), fewer physiologic high-risk patients (9.3% vs. 23.0%), fewer anatomic high-risk patients (0% vs. 15.2%), and a similar proportion of perioperative strokes (1.9% vs. 2.0%). However, administrative data identified 8 false positive and 9 false negative perioperative strokes. NSQIP data identified more symptomatic patients compared to chart review (44.1% vs. 30.3%), fewer physiologic high-risk patients (13.0% vs. 18.6%), fewer anatomic high-risk patients (0% vs. 6.6%), and a similar proportion of perioperative strokes (1.5% vs. 1.8%, only 1 false negative stroke and no false positives). Conclusions Administrative data are unreliable for determining symptom status, high-risk status, and perioperative stroke and should not be used to analyze CEA and CAS. NSQIP data do not adequately identify high-risk patients, but do accurately identify perioperative strokes and to a lesser degree, symptom status. PMID:23490294

Cigarette smoking and male sex are independent and age concomitant risk factors for the development of ocular sarcoidosis in a new orleans sarcoidosis population

PubMed Central

Janot, Adam C.; Huscher, Dörte; Walker, McCall; Grewal, Harmanjot K.; Yu, Mary; Lammi, Matthew R.; Saketkoo, Lesley Ann

2016-01-01

Introduction Sarcoidosis is a multi-organ system granulomatous disease of unknown origin with an incidence of 1–40/100,000. Though pulmonary manifestations are predominant, ocular sarcoidosis (OS) affects 25–50% of patients with sarcoidosis and can lead to blindness. Methods A retrospective, single-center chart review of sarcoidosis cases investigated variables associated with the development of OS. Inclusion criteria were biopsy-proven sarcoidosis, disease duration greater than 1 year, documented smoking status on chart review and documentation of sarcoid-related eye disease. Multivariate analysis identified independent risk factors for OS. Results Of 269 charts reviewed, 109 patients met inclusion criteria. The OS group had a significantly higher proportion of smokers (71.4%) than without OS (42.0%, p=0.027) with no difference (p=0.61) in median number of pack years. Male sex was significantly higher in the OS group (57.1% versus 26.1%, p=0.009). Median duration of sarcoidosis was higher in the OS group (10 versus 4 years, p=0.031). Multivariate regression identified tobacco exposure (OR=5.25, p=0.007, 95% CI 1.58–17.41), male sex (OR=7.48, p=0.002, 95% CI 2.15–26.01), and age (OR=1.114, p=0.002, 95% CI 1.04–1.19) as concomitant risk factors for the development of OS. Conclusion To date, there are few dedicated investigations of risk factors for OS, especially smoking. This investigation identified male sex, age, and tobacco exposure as independent risk factors for OS. Though disease duration did not withstand regression analysis in this moderately sized group, age at chart review suggests screening for OS should not remit but rather intensify in aging patients with sarcoidosis. PMID:26278693

Preparing for the future: a review of tools and strategies to support autonomous goal setting for children and youth with autism spectrum disorders.

PubMed

Hodgetts, Sandra; Park, Elly

2017-03-01

Despite recognized benefits, current clinical practice rarely includes direct input from children and youth with autism spectrum disorder (ASD) in setting rehabilitation goals. This study reviews tools and evidence-based strategies to assist with autonomous goal settings for children and youth with ASD. This study included two components: (1) A scoping review of existing tools and strategies to assist with autonomous goal setting in individuals with ASD and (2) a chart review of inter-disciplinary service plan goals for children and youth with ASD. Eleven data sources, evaluating five different tools to assist with autonomous goal setting for children and youth with ASD, were found. Three themes emerged from the integration of the scoping review and chart review, which are discussed in the paper: (1) generalizability of findings, (2) adaptations to support participation and (3) practice implications. Children and youth with ASD can participate in setting rehabilitation goals, but few tools to support their participation have been evaluated, and those tools that do exist do not align well with current services foci. Visual aids appear to be one effective support, but further research on effective strategies for meaningful engagement in autonomous goal setting for children and youth with ASD is warranted. Implications for rehabilitation Persons with ASD are less self-determined than their peers. Input into one's own rehabilitation goals and priorities is an important component of self-determination. Few tools exist to help engage children and youth with ASD in setting their own rehabilitation goals. An increased focus on identifying, developing and evaluating effective tools and strategies to facilitate engagement of children and youth with ASD in setting their own rehabilitation goals is warranted.

Impact of Quality Improvement Educational Interventions on Documented Adherence to Quality Measures for Adults with Crohn's Disease.

PubMed

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

2015-09-01

In recent years, leading organizations in inflammatory bowel disease (IBD) have developed quality measures for the care of adults with Crohn's disease or ulcerative colitis. We used chart audits to assess the impact of quality improvement educational activities on documented adherence to Physician Quality Reporting System measures for IBD. Twenty community-based gastroenterologists were recruited to participate in baseline chart audits (n = 200), a series of 4 accredited educational activities with feedback, and follow-up chart audits (n = 200). Trained abstractors reviewed randomly selected charts of adults with moderate or severe Crohn's disease. The charts were retrospectively abstracted for physicians' documented performance of the 2013 Physician Quality Reporting System IBD quality measures. We compared the physicians' baseline and posteducation rates of documented adherence with 10 of these measures. In a secondary analysis, we compared preeducation with posteducation difference scores of low-performing physicians, those whose baseline documentation rates were in the lowest quartile, and the rest of the cohort. At baseline, documentation of mean provider-level adherence to the 10 quality measures ranged from 3% to 98% (grand mean = 35.8%). In the overall analysis, baseline and posteducation rates of documented adherence did not differ significantly for any of the measures. However, for 4 measures, preeducation to posteducation difference scores were significantly greater among low performers than physicians in the highest 3 quartiles. The results of this preliminary pragmatic study indicate that quality improvement education affords the potential to improve adherence to Physician Quality Reporting System quality measures for IBD among low-performing gastroenterologists.

Racial and ethnic disparity in food allergy in the United States: a systematic review.

PubMed

Greenhawt, Matthew; Weiss, Christopher; Conte, Marisa L; Doucet, Marlie; Engler, Amy; Camargo, Carlos A

2013-01-01

The prevalence of food allergy is rising among US children. Little is known about racial/ethnic disparities in food allergy. We performed a systematic literature review to understand racial/ethnic disparities in food allergy in the United States. We searched PubMed/MEDLINE, Embase, and Scopus for original data about racial/ethnic disparities in the diagnosis, prevalence, treatment, or clinical course of food allergy or sensitization, with a particular focus on black (African American) race. Articles were analyzed by study methodology, racial/ethnic composition, food allergy definition, outcomes, summary statistic used, and covariate adjustment. Twenty of 645 identified articles met inclusion criteria. The studies used multiple differing criteria to define food allergy, including self-report, sensitization assessed by serum food-specific IgE to selected foods without corroborating history, discharge codes, clinic chart review, and event-reporting databases. None used oral food challenge. In 12 studies, black persons (primarily children) had significantly increased adjusted odds of food sensitization or significantly higher proportion or odds of food allergy by self-report, discharge codes, or clinic-based chart review than white children. Major differences in study methodology and reporting precluded calculation of a pooled estimate of effect. Sparse and methodologically limited data exist about racial/ethnic disparity in food allergy in the United States. Available data lack a common definition for food allergy and use indirect measures of allergy, not food challenge. Although data suggest an increased risk of food sensitization, self-reported allergy, or clinic-based diagnosis of food allergy among black children, no definitive racial/ethnic disparity could be found among currently available studies. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Impact of a Pharmacist-Provided Spirometry Service on Access to Results in a Primary Care Setting.

PubMed

Mueller, Lisa A; Valentino, Alexa Sevin; Clark, Aaron D; Li, Junan

2018-01-01

The primary objective of this study was to determine the effect of a pharmacist-provided spirometry service within a federally qualified health center on the percentage of spirometry referrals completed with results reviewed by the ordering provider. Secondary objectives evaluated differences between internal and external referrals, medication recommendations made by the pharmacist, and revenue brought in by the service. Chart reviews were completed to determine the referral completion rates between patients who received a spirometry referral before (December 2014-September 2015) and after (January 2016-October 2016) the implementation of the pharmacy-provided spirometry service. Chart reviews were also used to determine the number and completion rate among referrals for internal and external services in the postimplementation time frame. Chart reviews also assessed medication recommendations made by the pharmacist. The results demonstrate an increase in referral completion rate from 38.1% to 47.0% ( P = .08) between the pre- and postimplementation time frames. In the postimplementation time frame, there was a statistically significant difference in the percentage of referrals completed between in-house referrals and external referrals (70.0% and 40.9%, respectively, P = .0004). Comparing clinics with and without the spirometry service, there was a statistically significant difference in the total number of spirometry referrals (1.13% and 0.59%, respectively, P < .0001) and the percent of referrals completed (0.55% and 0.27%, respectively, P = .0002). The results suggest that offering spirometry within the primary care setting helps to increase the rate of completed spirometry tests with results available to the primary care provider. Additionally, the results show that there is an increased completion rate in patients who receive an internal spirometry referral, which may be due to reduced barriers in obtaining this testing. Overall, these results demonstrate that providing spirometry in the primary care setting helps to increase spirometry results obtained and could be beneficial in other primary care settings.

The role of anti-cyclic citrullinated peptide antibodies in predicting rheumatoid arthritis.

PubMed

Rexhepi, Sylejman; Rexhepi, Mjellma; Sahatçiu-Meka, Vjollca; Tafaj, Argjend; Izairi, Remzi; Rexhepi, Blerta

2011-01-01

The study presents the results of predicting role of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis, compared to rheumatoid factor. 32 patients with rheumatoid arthritis were identified from a retrospective chart review. The results of our study show that presence of the rheumatoid factor has less diagnostic and prognostic significance than the anti-cyclic citrullinated peptide, and suggests its superiority in predicting an erosive disease course.

MCPS Curriculum Development Planning Process.

ERIC Educational Resources Information Center

Montgomery County Public Schools, Rockville, MD. Dept. of Instructional Planning and Development.

The procedure documented is used for the systemwide planning of curriculum development in Montgomery County, Maryland, and consists of three parts: a planning and review process; an instructional design and development model; and a proposed calendar for cyclical review of programs. Specific position responsibilities, organizational charts, and…

New aids for the non-invasive prenatal diagnosis of achondroplasia: dysmorphic features, charts of fetal size and molecular confirmation using cell-free fetal DNA in maternal plasma.

PubMed

Chitty, L S; Griffin, D R; Meaney, C; Barrett, A; Khalil, A; Pajkrt, E; Cole, T J

2011-03-01

To improve the prenatal diagnosis of achondroplasia by constructing charts of fetal size, defining frequency of sonographic features and exploring the role of non-invasive molecular diagnosis based on cell-free fetal deoxyribonucleic acid (DNA) in maternal plasma. Data on fetuses with a confirmed diagnosis of achondroplasia were obtained from our databases, records reviewed, sonographic features and measurements determined and charts of fetal size constructed using the LMS (lambda-mu-sigma) method and compared with charts used in normal pregnancies. Cases referred to our regional genetics laboratory for molecular diagnosis using cell-free fetal DNA were identified and results reviewed. Twenty-six cases were scanned in our unit. Fetal size charts showed that femur length was usually on or below the 3(rd) centile by 25 weeks' gestation, and always below the 3(rd) by 30 weeks. Head circumference was above the 50(th) centile, increasing to above the 95(th) when compared with normal for the majority of fetuses. The abdominal circumference was also increased but to a lesser extent. Commonly reported sonographic features were bowing of the femora, frontal bossing, short fingers, a small chest and polyhydramnios. Analysis of cell-free fetal DNA in six pregnancies confirmed the presence of the c.1138G > A mutation in the FGRF3 gene in four cases with achondroplasia, but not the two subsequently found to be growth restricted. These data should improve the accuracy of diagnosis of achondroplasia based on sonographic findings, and have implications for targeted molecular confirmation that can reliably and safely be carried out using cell-free fetal DNA. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

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

Tan, J; Yan, Y; Hager, F

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

A longitudinal study of adult-onset asthma incidence among HMO members

PubMed Central

Sama, Susan R; Hunt, Phillip R; Cirillo, CIH Priscilla; Marx, Arminda; Rosiello, Richard A; Henneberger, Paul K; Milton, Donald K

2003-01-01

Background HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. Methods We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. Results The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Conclusion Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of provider consideration of etiologies. We demonstrated that clinicians attribute most AOA to infection and tend to ignore the contribution of environmental and occupational exposures. PMID:12952547

A longitudinal study of adult-onset asthma incidence among HMO members.

PubMed

Sama, Susan R; Hunt, Phillip R; Cirillo, C I H Priscilla; Marx, Arminda; Rosiello, Richard A; Henneberger, Paul K; Milton, Donald K

2003-08-07

HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of provider consideration of etiologies. We demonstrated that clinicians attribute most AOA to infection and tend to ignore the contribution of environmental and occupational exposures.

Affinity Chart Analysis: A Method for Structured Collection, Aggregation, and Response to Customer Needs in Radiology.

PubMed

Boll, Daniel T; Rubin, Geoffrey D; Heye, Tobias; Pierce, Laura J

2017-04-01

The objective of this study is to analyze implementation of the voice-of-the-customer method to assess the current state of image postprocessing and reporting delivered by a radiology department and to plan improvements on the basis of referring physicians' preferences. The voice-of-the-customer method consisted of discovery, analysis, and optimization phases. Fifty referring physicians were invited to be interviewed. Interviews addressed the topics of structure, process, outcome, and support. Interviews were dissected into individual statements categorized as fact or feeling. Statements were grouped to find collective voices. Improvements were compiled from affinity charts and were processed by identifying insights. Ninety-four percent (47/50) of physicians participated, generating 352 statements (81 facts and 271 feelings) that subsequently underwent affinity chart clustering. The resultant affinity charts covered distinct themes: "we need you to know us better," "we need you to consider our workflow," "we need more from your services," "we want to review your data in certain ways," and "we want to do more with you." As a result of the insights gained, the following optimizations were implemented: a software application that improves study requesting, performance tracking, study prioritization, and longitudinal data archiving; six prototype reports containing tabulated data and annotated images; two prototype longitudinal reporting templates assessing aneurysm evolution and treatment-induced changes in organ size over time; and a teaching curriculum for trainees. This study has shown the clinical feasibility to assess the current state of image postprocessing and reporting and to implement improvements of and investments in image postprocessing and reporting infrastructure on the basis of referring physicians' preferences using the voice-of-the-customer method.

The Effect of Physiotherapy on Ventilatory Dependency and the Length of Stay in an Intensive Care Unit

ERIC Educational Resources Information Center

Malkoc, Mehtap; Karadibak, Didem; Yldrm, Yucel

2009-01-01

The aim of this study was to assess the effect of physiotherapy on ventilator dependency and lengths of intensive care unit (ICU) stay. Patients were divided into two groups. The control group, which received standard nursing care, was a retrospective chart review. The data of control patients who were not receiving physiotherapy were obtained…

Portraits of Caregivers of End-Stage Dementia Patients Receiving Hospice Care

ERIC Educational Resources Information Center

Sanders, Sara; Butcher, Howard K.; Swails, Peggy; Power, James

2009-01-01

The purpose of this study was to investigate how caregivers respond to the end stages of dementia with the assistance from hospice. Data were collected from 27 family caregivers over the course of 10 months, with each caregiver being interviewed up to 4 times during the time that the patient received hospice care. Chart review data were also…

Psychopathological Profile in Children with Chronic Tic Disorder and Co-Existing ADHD: Additive Effects

ERIC Educational Resources Information Center

Roessner, Veit; Becker, Andreas; Banaschewski, Tobias; Rothenberger, Aribert

2007-01-01

The nature of the co-occurrence of chronic tic disorders (CTD) and attention deficit hyperactivity disorder (ADHD) is unclear. Especially in the field of psychopathology, the relationship of CTD and ADHD remains to be clarified. Thus, the aim of the present chart review study was to specify the contribution of CTD and/or ADHD to the…

Outcome of Isolated Premature Menarche: A Retrospective and Follow-Up Study.

PubMed

Ejaz, Sehar; Lane, Andrew; Wilson, Thomas

2015-01-01

Isolated premature menarche is isolated or recurrent vaginal bleeding in a female in the absence of appropriate secondary sexual characters. Retrospective chart review of patients with premature menarche, followed by a telephone questionnaire. Charts of patients evaluated in the Pediatric Endocrine Clinic for premature vaginal bleeding from 1982-2013 were reviewed. Of 21 patients identified, 17 could be contacted. Five newly diagnosed patients were recruited during the course of the study. The median age at initial presentation was 7 years. Most patients presented with Tanner I sexual development. Some had more advanced breast staging, which regressed later. All had prepubertal baseline and stimulated gonadotropins. Most of the patients reported a single or few episodes of menses. Two reported continuation of irregular bleeding into adulthood. All reported an adult height within the midparental target height. Premature menarche in the absence of other appropriate secondary sexual characteristics is a benign entity. Most patients have a few isolated episodes of menses that stop spontaneously; some may continue to have periods into adulthood. Unlike true puberty, these patients do not demonstrate advanced skeletal maturation, and the adult height is normal. Fertility appears to be normal. © 2015 S. Karger AG, Basel.

Predictors of readmission after successful electroconvulsive therapy for depression: a chart review study.

PubMed

Uchida, Takahito; Kishimoto, Taishiro; Koreki, Akihiro; Nakao, Shigetsugu; Owada, Ai; Koizumi, Teruki; Saito, Atsuyuki; Sato, Minako; Sawada, Shinya; Matsuzaki, Ryuta; Petrides, Georgios; Mimura, Masaru

2016-11-01

The study aimed to identify the predictors for readmission after a successful electroconvulsive therapy (ECT) course. Medical charts of patients who received ECT for major depressive episodes were reviewed. Patients' demographic characteristics and treatment parameters, such as ECT charge, seizure duration, the number of ECT sessions and pharmacotherapy, were extracted. We compared differences between those who were readmitted after successful ECT within 6 and 12 months, versus those not readmitted. We also conducted a multivariate logistic regression analysis to identify the predictors for readmission. Out of 51 patients who were discharged after ECT, 27 patients met the inclusion criteria and were included in the analysis. Eight patients were readmitted within 6 months after discharge, and four more patients were readmitted during the next 6-month follow up. Comparing patients who were and were not readmitted, we found no significant differences between groups, including ECT parameters such as the number of ECT sessions, average charge and final charge. No predictors for readmission were found through multivariate analysis. Although patients who require higher ECT charge and more sessions seem to be prone to readmission, our dataset suggested that none of these types of ECT parameters were risk factors for readmission.

Cognitive Effects of ThinkRx Cognitive Rehabilitation Training for Eleven Soldiers with Brain Injury: A Retrospective Chart Review

PubMed Central

Ledbetter, Christina; Moore, Amy Lawson; Mitchell, Tanya

2017-01-01

Cognitive rehabilitation training is a promising technique for remediating the cognitive deficits associated with brain injury. Extant research is dominated by computer-based interventions with varied results. Results from clinician-delivered cognitive rehabilitation are notably lacking in the literature. The current study examined the cognitive outcomes following ThinkRx, a clinician-delivered cognitive rehabilitation training program for soldiers recovering from traumatic brain injury and acquired brain injury. In a retrospective chart review, we examined cognitive outcomes of 11 cases who had completed an average of 80 h of ThinkRx cognitive rehabilitation training delivered by clinicians and supplemented with digital training exercises. Outcome measures included scores from six cognitive skill batteries on the Woodcock Johnson – III Tests of Cognitive Abilities. Participants achieved gains in all cognitive skills tested and achieved statistically significant changes in long-term memory, processing speed, auditory processing, and fluid reasoning with very large effect sizes. Clinically significant changes in multiple cognitive skills were also noted across cases. Results of the study suggest that ThinkRx clinician-delivered cognitive training supplemented with digital exercises may be a viable method for targeting the cognitive deficits associated with brain injury. PMID:28588534

Vision loss among diabetics in a group model Health Maintenance Organization (HMO).

PubMed

Fong, Donald S; Sharza, Mohktar; Chen, Wansu; Paschal, John F; Ariyasu, Reginald G; Lee, Paul P

2002-02-01

To report the management of diabetic retinopathy in one group model health maintenance organization and assess the quality of care. Cross-sectional study. A chart review of 1200 randomly identified patients with diabetes mellitus, continuously enrolled for 3 years in Kaiser Permanente (KP) Southern California, the largest provider of managed care in Southern California, was performed. A total of 1047 patients were included in the analyses. Patient characteristics as well as information from the last eye examination were abstracted. Charts from patients with visual acuity less than 20/200 in their better eye (legal blindness) were selected for extensive chart review to determine the cause of visual loss and the antecedent process of care. T tests or the Wilcoxon rank sum test was used to compare continuous variables. The chi(2) test or the Fisher exact test was used to compare categorical variables. All analyses were performed on the Statistical Analyses System (SAS Institute, North Carolina). Our study population of 1047 diabetic patients was 51.7% male, had a mean age of 60.4 years, a mean duration of diabetes of 9.6 years, and a mean hemoglobin A1c of 8.3%. During the study period, 77.5% of patients received a screening eye examination with examination by an ophthalmologist, an optometrist, or review of a retinal photograph. Of those with a visual acuity assessment (n = 687, 65.6% of 1047), 1.5% had visual acuity of 20/200 or worse (legally blind) in the better eye, while 8.2% had this level of visual acuity in the worse eye. Of eyes with new onset clinically significant macular edema and visual acuity < 20/40, 40% had documentation of focal laser performed within 1 month of diagnosis. Of eyes with vitreous hemorrhage and visual acuity < 20/40, 50% had documentation of vitrectomy. Among eyes that had vitrectomy, over 80% had this procedure within 1 year of diagnosis of vitreous hemorrhage. The current report is the largest study of diabetic retinopathy outcomes among patients enrolled in a prepaid health plan. Further research is necessary to investigate the impact of managed care on health outcomes.

Impact of format and content of visual display of data on comprehension, choice and preference: a systematic review.

PubMed

Hildon, Zoe; Allwood, Dominique; Black, Nick

2012-02-01

Displays comparing the performance of healthcare providers are largely based on commonsense. To review the literature on the impact of compositional format and content of quantitative data displays on people's comprehension, choice and preference. Ovid databases, expert recommendations and snowballing techniques. Evaluations of the impact of different formats (bar charts, tables and pictographs) and content (ordering, explanatory visual cues, etc.) of quantitative data displays meeting defined quality criteria. Data extraction Type of decision; decision-making domains; audiences; formats; content; methodology; findings. Most of the 30 studies used quantitative (n= 26) methods with patients or public groups (n= 28) rather than with professionals (n= 2). Bar charts were the most frequent format, followed by pictographs and tables. As regards format, tables and pictographs appeared better understood than bar charts despite the latter being preferred. Although accessible to less numerate and older populations, pictographs tended to lead to more risk avoidance. Tables appeared accessible to all. Aspects of content enhancing the impact of data displays included giving visual explanatory cues and contextual information while still attempting simplicity ('less is more'); ordering data; consistency. Icons rather than numbers were more user-friendly but could lead to over-estimation of risk. Uncertainty was not widely understood, nor well represented. Though heterogeneous and limited in scope, there is sufficient research evidence to inform the presentation of quantitative data that compares the performance of healthcare providers. The impact of new formats, such as funnel plots, needs to be evaluated.

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

PubMed Central

Levy, Rebecca; Pantanowitz, Liron; Cloutier, Darlene; Provencher, Jean; McGirr, Joan; Stebbins, Jennifer; Cronin, Suzanne; Wherry, Josh; Fenton, Joseph; Donelan, Eileen; Johari, Vandita; Andrzejewski, Chester

2010-01-01

Background: Electronic medical records (EMRs) provide universal access to health care information across multidisciplinary lines. In pathology departments, transfusion and apheresis medicine services (TAMS) involved in direct patient care activities produce data and documentation that typically do not enter the EMR. Taking advantage of our institution's initiative for implementation of a paperless medical record, our TAMS division set out to develop an electronic charting (e-charting) strategy within the EMR. Methods: A focus group of our hospital's transfusion committee consisting of transfusion medicine specialists, pathologists, residents, nurses, hemapheresis specialists, and information technologists was constituted and charged with the project. The group met periodically to implement e-charting TAMS workflow and produced electronic documents within the EMR (Cerner Millenium) for various service line functions. Results: The interdisciplinary working group developed and implemented electronic versions of various paper-based clinical documentation used by these services. All electronic notes collectively gather and reside within a unique Transfusion Medicine Folder tab in the EMR, available to staff with access to patient charts. E-charting eliminated illegible handwritten notes, resulted in more consistent clinical documentation among staff, and provided greater realered. However, minor updates and corrections to documents as well as select work re-designs were required for optimal use of e-charting-time review/access of hemotherapy practices. No major impediments to workflow or inefficiencies have been encount by these services. Conclusion: Documentation of pathology subspecialty activities such as TAMS can be successfully incorporated into the EMR. E-charting by staff enhances communication and helps promote standardized documentation of patient care within and across service lines. Well-constructed electronic documents in the EMR may also enhance data mining, quality improvement, and biovigilance monitoring activities. PMID:20805955

Thyroid Surgery in a Resource-Limited Setting.

PubMed

Jafari, Aria; Campbell, David; Campbell, Bruce H; Ngoitsi, Henry Nono; Sisenda, Titus M; Denge, Makaya; James, Benjamin C; Cordes, Susan R

2017-03-01

Objective The present study reviews a series of patients who underwent thyroid surgery in Eldoret, Kenya, to demonstrate the feasibility of conducting long-term (>1 year) outcomes research in a resource-limited setting, impact on the quality of life of the recipient population, and inform future humanitarian collaborations. Study Design Case series with chart review. Setting Tertiary public referral hospital in Eldoret, Kenya. Subjects and Methods Twenty-one patients were enrolled during the study period. A retrospective chart review was performed for all adult patients who underwent thyroid surgery during humanitarian trips (2010-2015). Patients were contacted by mobile telephone. Medical history and physical examination, including laryngoscopy, were performed, and the SF-36 was administered (a quality-of-life questionnaire). Laboratory measurements of thyroid function and neck ultrasound were obtained. Results The mean follow-up was 33.6 ± 20.2 months after surgery: 37.5% of subtotal thyroidectomy patients and 15.4% of lobectomy patients were hypothyroid postoperatively according to serologic studies. There were no cases of goiter recurrence or malignancy. All patients reported postoperative symptomatic improvement and collectively showed positive pre- and postoperative score differences on the SF-36. Conclusion Although limited by a small sample size and the retrospective nature, our study demonstrates the feasibility of long-term surgical and quality-of-life outcomes research in a resource-limited setting. The low complication rates suggest minimal adverse effects of performing surgery in this context. Despite a considerable rate of postoperative hypothyroidism, it is in accordance with prior studies and emphasizes the need for individualized, longitudinal, and multidisciplinary care. Quality-of-life score improvements suggest benefit to the recipient population.

Space Shuttle Program Primary Avionics Software System (PASS) Success Legacy - Quality and Reliability Date

NASA Technical Reports Server (NTRS)

Orr, James K.; Peltier, Daryl

2010-01-01

Thsi slide presentation reviews the avionics software system on board the space shuttle, with particular emphasis on the quality and reliability. The Primary Avionics Software System (PASS) provides automatic and fly-by-wire control of critical shuttle systems which executes in redundant computers. Charts given show the number of space shuttle flights vs time, PASS's development history, and other charts that point to the reliability of the system's development. The reliability of the system is also compared to predicted reliability.

US antibiotic stewardship and penicillin allergy.

PubMed

Wada, Kara J; Calhoun, Karen H

2017-06-01

The purpose of this review is to improve otolaryngologists' antibiotic stewardship by detailing current approaches to penicillin allergy. Although up to 15% of hospitalized patients in the United States have a penicillin allergy recorded on their charts, fewer than 10% of these have a true penicillin allergy. Using a combination of a detailed allergy history, skin testing and graded-dose administration, many patients whose charts say 'penicillin-allergic' can safely be treated with penicillin and cross-reacting antibiotics. This permits use of narrower-spectrum antibiotics and saves money.

Best Practices in Shift Handover Communication: Mars Exploration Rover Surface Operations

NASA Astrophysics Data System (ADS)

Parke, Bonny; Mishkin, Andrew

2005-12-01

During its prime mission, Mars Exploration Rover (MER) had many shift handovers in its surface operations. Because of the increased rates of accidents and errors historically associated with shift handovers, MER Mission management paid close attention to shift handovers and, when possible, developed them in accordance with best handover practices.We review the most important of these best practices, and include a generic "Checklist for Effective Handovers" to aid in the development of handovers.We present charts that depict structured information transfer across shifts. These charts show personnel schedules, meetings attended, handovers, and hand-offs on both the MER and on the earlier Mars Pathfinder Mission (MPF). It is apparent from these charts that although the MER Mission had a much larger number of surface operations personnel than MPF (approximately 300 vs. 178), and had three shifts instead of two, that it used many of the successful MPF communication strategies. Charts such as these can be helpful to those designing complicated and unique mission surface operations.

Computers in Astronomy: Astronomy on an Apple Macintosh.

ERIC Educational Resources Information Center

Mosley, John E.

1987-01-01

Presents a review of computer programs written for the Apple Macintosh computer that teach astronomy. Reviews general programs, along with some which deal more specifically with sky travel, star charting, the solar system, Halley's Comet, and stargazing. Includes the name and address of each producer. (TW)

Accreditation of Predoctoral Dental Education: Clinical Outcomes Assessment.

ERIC Educational Resources Information Center

Boyd, Marcia A.; And Others

1991-01-01

The Curriculum Outcomes Review and Evaluation system of outcomes assessment for accreditation of Canadian dental faculties is described. Features include chart reviews; evaluation of diagnosis and treatment planning and case presentation for a student sample; structured clinical observation; presite visit survey; and solicitation of feedback from…

Graphical aids for visualizing and interpreting patterns in departures from agreement in ordinal categorical observer agreement data.

PubMed

Bangdiwala, Shrikant I

2017-01-01

When studying the agreement between two observers rating the same n units into the same k discrete ordinal categories, Bangdiwala (1985) proposed using the "agreement chart" to visually assess agreement. This article proposes that often it is more interesting to focus on the patterns of disagreement and visually understanding the departures from perfect agreement. The article reviews the use of graphical techniques for descriptively assessing agreement and disagreements, and also reviews some of the available summary statistics that quantify such relationships.

A monitoring tool for performance improvement in plastic surgery at the individual level.

PubMed

Maruthappu, Mahiben; Duclos, Antoine; Orgill, Dennis; Carty, Matthew J

2013-05-01

The assessment of performance in surgery is expanding significantly. Application of relevant frameworks to plastic surgery, however, has been limited. In this article, the authors present two robust graphic tools commonly used in other industries that may serve to monitor individual surgeon operative time while factoring in patient- and surgeon-specific elements. The authors reviewed performance data from all bilateral reduction mammaplasties performed at their institution by eight surgeons between 1995 and 2010. Operative time was used as a proxy for performance. Cumulative sum charts and exponentially weighted moving average charts were generated using a train-test analytic approach, and used to monitor surgical performance. Charts mapped crude, patient case-mix-adjusted, and case-mix and surgical-experience-adjusted performance. Operative time was found to decline from 182 minutes to 118 minutes with surgical experience (p < 0.001). Cumulative sum and exponentially weighted moving average charts were generated using 1995 to 2007 data (1053 procedures) and tested on 2008 to 2010 data (246 procedures). The sensitivity and accuracy of these charts were significantly improved by adjustment for case mix and surgeon experience. The consideration of patient- and surgeon-specific factors is essential for correct interpretation of performance in plastic surgery at the individual surgeon level. Cumulative sum and exponentially weighted moving average charts represent accurate methods of monitoring operative time to control and potentially improve surgeon performance over the course of a career.

Validation of life-charts documented with the personal life-chart app - a self-monitoring tool for bipolar disorder.

PubMed

Schärer, Lars O; Krienke, Ute J; Graf, Sandra-Mareike; Meltzer, Katharina; Langosch, Jens M

2015-03-14

Long-term monitoring in bipolar affective disorders constitutes an important therapeutic and preventive method. The present study examines the validity of the Personal Life-Chart App (PLC App), in both German and in English. This App is based on the National Institute of Mental Health's Life-Chart Method, the de facto standard for long-term monitoring in the treatment of bipolar disorders. Methods have largely been replicated from 2 previous Life-Chart studies. The participants documented Life-Charts with the PLC App on a daily basis. Clinicians assessed manic and depressive symptoms in clinical interviews using the Inventory of Depressive Symptomatology, clinician-rated (IDS-C) and the Young Mania Rating Scale (YMRS) on a monthly basis on average. Spearman correlations of the total scores of IDS-C and YMRS were calculated with both the Life-Chart functional impairment rating and mood rating documented with the PLC App. 44 subjects used the PLC App in German and 10 subjects used the PLC App in English. 118 clinical interviews from the German sub-sample and 97 from the English sub-sample were analysed separately. The results in both sub-samples are similar to previous Life-Chart validation studies. Again statistically significant high correlations were found between the Life-Chart function rating assigned through the PLC App and well-established observer-rated methods. Again correlations were weaker for the Life-Chart mood rating than for the Life-Chart function impairment. No relevant correlation was found between the Life-chart mood rating and YMRS in the German sub-sample. This study gives further evidence for the validity of the Life-Chart method as a valid tool for the recognition of both manic and depressive episodes. Documenting Life-Charts with the PLC App (English and German) does not seem to impair the validity of patient ratings.

Beyond the false negative rate: development of quality indicators for sentinel lymph node biopsy in breast cancer.

PubMed

Quan, May Lynn; Wells, Bryan J; McCready, David; Wright, Frances C; Fraser, Novlette; Gagliardi, Anna R

2010-02-01

Sentinel lymph node biopsy (SNLB) has been adopted as the standard method of axillary staging for women with clinically node-negative early-stage breast cancer. The false negative rate as a quality indicator is impractical given the need for a completion axillary dissection to calculate. The objective of this study was to develop practical quality indicators for SLNB using an expert consensus method and to determine if they were feasible to measure. We used a modified Delphi consensus process to develop quality indicators for SLNB. A multidisciplinary expert panel reviewed potential indicators extracted from the medical literature to select quality indicators that were relevant and measurable. Feasibility was determined by abstracting the quality indicator variables from a retrospective chart review. The expert panel prioritized 11 quality indicators as benchmarks for assessing the quality of surgical care in SNLB. Nine of the indicators were measurable at the chart or institutional level. A systematic evidence- and consensus-based approach was used to develop measurable quality indicators that could be used by practicing surgeons and administrators to evaluate performance of SLNB in breast cancer.

What was your question again? Types of medical studies.

PubMed

Jupiter, Daniel C

2014-01-01

Medical literature comes in all shapes and sizes, from animal studies to prospective clinical trials to retrospective chart reviews. In all of these cases, it is worth asking: What are the intellectual goals of the study: description, hypothesis testing, or hypothesis generating? This differentiation can help shape our view of the success or failure of the scientific effort. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

PS2-06: Best Practices for Advancing Multi-site Chart Abstraction Research

PubMed Central

Blick, Noelle; Cole, Deanna; King, Colleen; Riordan, Rick; Von Worley, Ann; Yarbro, Patty

2012-01-01

Background/Aims Multi-site chart abstraction studies are becoming increasingly common within the HMORN. Differences in systems among HMORN sites can pose significant obstacles to the success of these studies. It is therefore crucial to standardize abstraction activities by following best practices for multi-site chart abstraction, as consistency of processes across sites will increase efficiencies and enhance data quality. Methods Over the past few months the authors have been meeting to identify obstacles to multi-site chart abstraction and to address ways in which multi-site chart abstraction processes can be systemized and standardized. The aim of this workgroup is to create a best practice guide for multi-site chart abstraction studies. Focus areas include: abstractor training, format for chart abstraction (database, paper, etc), data quality, redaction, mechanism for transferring data, site specific access to medical records, IRB/HIPAA concerns, and budgetary issues. Results The results of the workgroup’s efforts (the best practice guide) will be presented by a panel of experts at the 2012 HMORN conference. The presentation format will also focus on discussion among attendees to elicit further input and to identify areas that need to be further addressed. Subsequently, the best practice guide will be posted on the HMORN website. Discussion The best practice guide for multi-site chart abstraction studies will establish sound guidelines and serve as an aid to researchers embarking on multi-site chart abstraction studies. Efficiencies and data quality will be further enhanced with standardized multi-site chart abstraction practices.

Magnetic resonance imaging in evaluating workers' compensation patients.

PubMed

Babbel, Daniel; Rayan, Ghazi

2012-04-01

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

Predictive value of autoantibody testing for validating self-reported diagnoses of rheumatoid arthritis in the Women's Health Initiative.

PubMed

Walitt, Brian; Mackey, Rachel; Kuller, Lewis; Deane, Kevin D; Robinson, William; Holers, V Michael; Chang, Yue-Fang; Moreland, Larry

2013-05-01

Rheumatoid arthritis (RA) research using large databases is limited by insufficient case validity. Of 161,808 postmenopausal women in the Women's Health Initiative, 15,691 (10.2%) reported having RA, far higher than the expected 1% population prevalence. Since chart review for confirmation of an RA diagnosis is impractical in large cohort studies, the current study (2009-2011) tested the ability of baseline serum measurements of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, second-generation assay (anti-CCP2), to identify physician-validated RA among the chart-review study participants with self-reported RA (n = 286). Anti-CCP2 positivity had the highest positive predictive value (PPV) (80.0%), and rheumatoid factor positivity the lowest (44.6%). Together, use of disease-modifying antirheumatic drugs and anti-CCP2 positivity increased PPV to 100% but excluded all seronegative cases (approximately 15% of all RA cases). Case definitions inclusive of seronegative cases had PPVs between 59.6% and 63.6%. False-negative results were minimized in these test definitions, as evidenced by negative predictive values of approximately 90%. Serological measurements, particularly measurement of anti-CCP2, improved the test characteristics of RA case definitions in the Women's Health Initiative.

Spaceflight Toxicology

NASA Technical Reports Server (NTRS)

Meyers, Valerie

2008-01-01

This viewgraph presentation provides a review of NASA Johnson Space Center's Toxicology program. The mission of this program is to protect crews from toxic exposures during spaceflight. The presentation reviews some of the health hazards. A toxicological hazard level chart is presented that reviews the rating of hazard level, irritancy, systemic effects and containability. The program also participates in the Lunar Airborne Dust Toxicity Advisory Group.

On Effective Graphic Communication of Health Inequality: Considerations for Health Policy Researchers.

PubMed

Asada, Yukiko; Abel, Hannah; Skedgel, Chris; Warner, Grace

2017-12-01

Policy Points: Effective graphs can be a powerful tool in communicating health inequality. The choice of graphs is often based on preferences and familiarity rather than science. According to the literature on graph perception, effective graphs allow human brains to decode visual cues easily. Dot charts are easier to decode than bar charts, and thus they are more effective. Dot charts are a flexible and versatile way to display information about health inequality. Consistent with the health risk communication literature, the captions accompanying health inequality graphs should provide a numerical, explicitly calculated description of health inequality, expressed in absolute and relative terms, from carefully thought-out perspectives. Graphs are an essential tool for communicating health inequality, a key health policy concern. The choice of graphs is often driven by personal preferences and familiarity. Our article is aimed at health policy researchers developing health inequality graphs for policy and scientific audiences and seeks to (1) raise awareness of the effective use of graphs in communicating health inequality; (2) advocate for a particular type of graph (ie, dot charts) to depict health inequality; and (3) suggest key considerations for the captions accompanying health inequality graphs. Using composite review methods, we selected the prevailing recommendations for improving graphs in scientific reporting. To find the origins of these recommendations, we reviewed the literature on graph perception and then applied what we learned to the context of health inequality. In addition, drawing from the numeracy literature in health risk communication, we examined numeric and verbal formats to explain health inequality graphs. Many disciplines offer commonsense recommendations for visually presenting quantitative data. The literature on graph perception, which defines effective graphs as those allowing the easy decoding of visual cues in human brains, shows that with their more accurate and easier-to-decode visual cues, dot charts are more effective than bar charts. Dot charts can flexibly present a large amount of information in limited space. They also can easily accommodate typical health inequality information to describe a health variable (eg, life expectancy) by an inequality domain (eg, income) with domain groups (eg, poor and rich) in a population (eg, Canada) over time periods (eg, 2010 and 2017). The numeracy literature suggests that a health inequality graph's caption should provide a numerical, explicitly calculated description of health inequality expressed in absolute and relative terms, from carefully thought-out perspectives. Given the ubiquity of graphs, the health inequality field should learn from the vibrant multidisciplinary literature how to construct effective graphic communications, especially by considering to use dot charts. © 2017 Milbank Memorial Fund.

Outcomes of chlorine exposure: a 5-year poison center experience in 598 patients.

PubMed

LoVecchio, Frank; Blackwell, Scott; Stevens, Donna

2005-06-01

The outcome after chlorine exposures has been poorly described. We conducted a 5-year retrospective poison control center review of chlorine exposure cases. The inclusion criteria were self (or surrogate) reported concentrated 'chlorine' liquid (> or =10% concentration of sodium hypochorite) or tablet (> or =90% concentration) exposure. Two reviewers blinded to the main purpose of the study reviewed charts and a third reviewed 10% of the charts, and a kappa score was calculated. Parameters reviewed included the type of exposure (tablets, liquid or both), symptoms (cough, chest pain, etc.), time to symptom onset, treatment received, hospital referral rate and outcomes. A total of 598 patient records were reviewed, with a mean age of 29.63 years (range 11-82); 41.5% (248) were exposures to tablets and 53.5% (320) were exposed to liquid chlorine, with the remainder exposed to both. Complaints included shortness of breath, eye irritation, nasal complaints, cough, and skin complaints. Sixty-nine patients were evaluated at a healthcare facility (11 referred by a poison control center and 58 were self-referrals). Five patients were admitted and four out of the five had a history of reactive airway disease. The mean time to peak symptoms was 94.4 min, 63.2% reached peak symptoms within 30 min, and 82% within 120 min, with 74% of all patients asymptomatic within 150 min. All five admitted patients were discharged within 48 h, and all others remained clinically well at a 24 h telephone follow-up. Exposure to chlorine tablets and liquid rarely requires hospital referral with almost all symptoms resolving within 24 h.

Introductory Programs: Kindergarten to Junior High.

ERIC Educational Resources Information Center

Curriculum Review, 1980

1980-01-01

Reviews two supplementary series and four new or significantly revised basal reading series: American Readers; Houghton Mifflin Reading Program 1980; Series R: Macmillan Reading; and the Merrill Linguistic Reading Program. A chart compares features of these programs and an index cites other recent reviews of basal series in this magazine. (SJL)

A Review of Literacy Frameworks for Learning Environments Design

ERIC Educational Resources Information Center

Rebmann, Kristen Radsliff

2013-01-01

This article charts the development of three literacy research frameworks: multiliteracies, new literacies, and popular literacies. By reviewing the literature surrounding three current conceptions of literacy, an attempt is made to form an integrative grouping that captures the most relevant elements of each for learning environments design.…

Detecting and addressing adolescent issues and concerns: evaluating the efficacy of a primary care previsit questionnaire.

PubMed

Lewin, Warren; Knäuper, Bärbel; Roseman, Michelle; Adler, Perry; Malus, Michael

2009-07-01

To assess the efficacy of a previsit questionnaire (PVQ), implemented without formal training, that was designed to screen for biomedical and psychosocial health issues and concerns among adolescent patients in a hospital-based primary care clinic, and to examine the subsequent action taken for health issues and concerns identified with the PVQ. Retrospective review of adolescent medical charts, using a pre-post design. An outpatient primary care clinic located in an urban teaching hospital in Montreal, Que. A total of 210 adolescent patients aged 13 to 19 who visited the clinic between 2000 and 2004. The type (medical vs psychosocial) and number of issues detected and actions taken by physicians in one-to-one consultations with adolescent patients 2 years before (2000-2002) and 2 years after (2002-2004) PVQ implementation, as noted in the patients' medical charts. In total, 105 charts were reviewed for each group. An increase in the number of psychosocial issues was detected following the introduction of the PVQ. An increase in the frequency of action taken for psychosocial concerns and a decrease in the frequency of medical action taken by physicians were found after PVQ implementation. More notations related to psychosocial concerns were also found in the adolescents' charts after introduction of the PVQ. A PVQ is an effective strategy to improve adolescent screening for psychosocial issues and concerns. Implementing such a questionnaire requires no training and can therefore be easily incorporated into clinical practice.

Communicating Value in Health Care Using Radar Charts: A Case Study of Prostate Cancer.

PubMed

Thaker, Nikhil G; Ali, Tariq N; Porter, Michael E; Feeley, Thomas W; Kaplan, Robert S; Frank, Steven J

2016-09-01

The transformation from volume to value will require communication of outcomes and costs of therapies; however, outcomes are usually nonstandardized, and cost of therapy differs among stakeholders. We developed a standardized value framework by using radar charts to visualize and communicate a wide range of patient outcomes and cost for three forms of prostate cancer treatment. We retrospectively reviewed data from men with low-risk prostate cancer who were treated with low-dose rate brachytherapy (LDR-BT), proton beam therapy, or robotic-assisted prostatectomy. Patient-reported outcomes comprised the Expanded Prostate Cancer Index Composite-50 domains for sexual function, urinary incontinence and/or bother, bowel bother, and vitality 12 months after treatment. Costs were measured by time-driven activity-based costing for the first 12 months of the care cycle. Outcome and cost data were plotted on a single radar chart for each treatment modality. Outcome and cost data from patients who were treated with robotic-assisted prostatectomy (n = 381), proton beam therapy (n = 165), and LDR-BT (n = 238) were incorporated into the radar chart. LDR-BT seemed to deliver the highest overall value of the three treatment modalities; however, incorporation of patient preferences regarding outcomes may allow other modalities to be considered high-value treatment options. Standardization and visualization of outcome and cost metrics may allow more comprehensive and collaborative discussions about the value of health care services. Communicating the value framework by using radar charts may be an effective method to present total value and the value of all outcomes and costs in a manner that is accessible to all stakeholders. Variations in plotting of costs and outcomes will require future focus group initiatives. Copyright © 2016 by American Society of Clinical Oncology.

Communicating Value in Health Care Using Radar Charts: A Case Study of Prostate Cancer

PubMed Central

Thaker, Nikhil G.; Ali, Tariq N.; Porter, Michael E.; Feeley, Thomas W.; Kaplan, Robert S.

2016-01-01

Purpose: The transformation from volume to value will require communication of outcomes and costs of therapies; however, outcomes are usually nonstandardized, and cost of therapy differs among stakeholders. We developed a standardized value framework by using radar charts to visualize and communicate a wide range of patient outcomes and cost for three forms of prostate cancer treatment. Materials and Methods: We retrospectively reviewed data from men with low-risk prostate cancer who were treated with low-dose rate brachytherapy (LDR-BT), proton beam therapy, or robotic-assisted prostatectomy. Patient-reported outcomes comprised the Expanded Prostate Cancer Index Composite-50 domains for sexual function, urinary incontinence and/or bother, bowel bother, and vitality 12 months after treatment. Costs were measured by time-driven activity-based costing for the first 12 months of the care cycle. Outcome and cost data were plotted on a single radar chart for each treatment modality. Results: Outcome and cost data from patients who were treated with robotic-assisted prostatectomy (n = 381), proton beam therapy (n = 165), and LDR-BT (n = 238) were incorporated into the radar chart. LDR-BT seemed to deliver the highest overall value of the three treatment modalities; however, incorporation of patient preferences regarding outcomes may allow other modalities to be considered high-value treatment options. Conclusion: Standardization and visualization of outcome and cost metrics may allow more comprehensive and collaborative discussions about the value of health care services. Communicating the value framework by using radar charts may be an effective method to present total value and the value of all outcomes and costs in a manner that is accessible to all stakeholders. Variations in plotting of costs and outcomes will require future focus group initiatives. PMID:27577622

Use of a monitoring tool for growth and development in Brazilian children – systematic review

PubMed Central

de Almeida, Ana Claudia; Mendes, Larissa da Costa; Sad, Izabela Rocha; Ramos, Eloane Gonçalves; Fonseca, Vânia Matos; Peixoto, Maria Virginia Marques

2016-01-01

Abstract Objective: To assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care. Data source: A systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were “growth and development”, “child development”, “child health record”, “child health handbook”, “health record and child” and “child handbook”, as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full. Data synthesis: Sixty-eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Child's Health Record and three of the Child's Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools. Conclusions: The results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the child's health monitoring document. PMID:26705605

Systematic review of proposed definitions of nocturnal polyuria and population-based evidence of their diagnostic accuracy.

PubMed

Olesen, Tine Kold; Denys, Marie-Astrid; Vande Walle, Johan; Everaert, Karel

2018-02-06

Background Evidence of diagnostic accuracy for proposed definitions of nocturnal polyuria is currently unclear. Purpose Systematic review to determine population-based evidence of the diagnostic accuracy of proposed definitions of nocturnal polyuria based on data from frequency-volume charts. Methods Seventeen pre-specified search terms identified 351 unique investigations published from 1990 to 2016 in BIOSIS, Embase, Embase Alerts, International Pharmaceutical Abstract, Medline, and Cochrane. Thirteen original communications were included in this review based on pre-specified exclusion criteria. Data were extracted from each paper regarding subject age, sex, ethnicity, health status, sample size, data collection methods, and diagnostic discrimination of proposed definitions including sensitivity, specificity, positive and negative predictive value. Results The sample size of study cohorts, participant age, sex, ethnicity, and health status varied considerably in 13 studies reporting on the diagnostic performance of seven different definitions of nocturnal polyuria using frequency-volume chart data from 4968 participants. Most study cohorts were small, mono-ethnic, including only Caucasian males aged 50 or higher with primary or secondary polyuria that were compared to a control group of healthy men without nocturia in prospective or retrospective settings. Proposed definitions had poor discriminatory accuracy in evaluations based on data from subjects independent from the original study cohorts with findings being similar regarding the most widely evaluated definition endorsed by ICS. Conclusions Diagnostic performance characteristics for proposed definitions of nocturnal polyuria show poor to modest discrimination and are not based on sufficient level of evidence from representative, multi-ethnic population-based data from both females and males of all adult ages.

[Use of a monitoring tool for growth and development in Brazilian children - systematic literature review].

PubMed

de Almeida, Ana Claudia; Mendes, Larissa da Costa; Sad, Izabela Rocha; Ramos, Eloane Gonçalves; Fonseca, Vânia Matos; Peixoto, Maria Virginia Marques

2016-01-01

To assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care. A systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were "growth and development", "child development", "child health record", "child health handbook", "health record and child" and "child handbook", as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full. Sixty-eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Child's Health Record and three of the Child's Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools. The results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the child's health monitoring document. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Utilization rates of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: a 2012 calculation for a midwestern health referral region.

PubMed

Hoang, Allen; Shen, Changyu; Zheng, James; Taylor, Stanley; Groh, William J; Rosenman, Marc; Buxton, Alfred E; Chen, Peng-Sheng

2014-05-01

Utilization rates (URs) for implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. The purpose of this study was to establish the ICD UR in central Indiana. A query run on 2 hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) ≤0.35. ICD eligibility and utilization were determined from chart review. We identified 1863 patients with at least 1 low EF study. Two cohorts were analyzed: 1672 patients without and 191 patients with International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% confidence interval [CI] 28%-49%). URs were 48% for males (95% CI 34%-61%), 21% for females (95% CI 16%-26%, P = .0002 vs males), 40% for whites (95% CI 27%-53%), and 37% for blacks (95% CI 28%-46%, P = .66 vs whites). ICD UR is 38% among patients meeting class I indications, suggesting further opportunities for improving guideline compliance. This study also illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Electromyography findings of the cricopharyngeus in association with ipsilateral pharyngeal and laryngeal muscles.

PubMed

Halum, Stacey L; Shemirani, Nima L; Merati, Albert L; Jaradeh, Safwan; Toohill, Robert J

2006-04-01

We reviewed a large series of cricopharyngeal (CP) muscle electromyography (EMG) results and compared them with the EMG results from the inferior constrictor (IC), thyroarytenoid, (TA), cricothyroid (CT), and posterior cricoarytenoid (PCA) muscles. We performed a retrospective review of all CP muscle EMG reports from studies performed between January 1996 and June 2003. All of the tested elements from the CP muscle EMG reports were recorded. The EMG results were recorded for the ipsilateral IC, TA, CT, and PCA muscles if they were simultaneously tested. Each muscle result was classified as normal, neurogenic inactive axonal injury (IAI), or neurogenic active axonal injury (AAI), and the muscle findings were compared. A patient chart review was performed to determine a clinical correlation. Fifty-nine patients underwent CP muscle EMG. Eighteen patients had bilateral EMG studies, making a total of 77 CP muscle studies. Nineteen sets of CP muscle results were normal, 43 demonstrated neurogenic IAI, and 15 demonstrated neurogenic AAI. The ipsilateral IC and CP muscles had the same innervation status in 27 of 28 studies (p < .0001). When the ipsilateral TA muscle was studied simultaneously with the CP muscle, 31 of 50 studies had the same innervation status (p = .005). The ipsilateral CT and CP muscles demonstrated the same innervation status in 40 of 50 studies (p < .0001). The correlations between the CP and IC muscle findings and between the CP and CT muscle findings were both stronger than the correlation between the CP and TA muscle findings (p < .0001 and p = .024, respectively). The chart review demonstrated the clinical findings to be consistent with the EMG results. The EMG studies demonstrated that CP muscle findings have the strongest correlation with IC muscle findings, followed by the CT and TA muscles. This outcome does not support theories indicating that the recurrent laryngeal nerve innervates the CP muscle in all cases.

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

PubMed

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

2016-04-01

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

Particle Data Group - 2017 Review

Science.gov Websites

, Tables, Plots Particle Listings Search Order: Book & Booklet Download or Print: Book, Booklet Astrophysics & Cosmology PDG Outreach Particle Adventure & Apps CPEP Charts History book Non-PDG

Identification of adverse events in ground transport emergency medical services.

PubMed

Patterson, P Daniel; Weaver, Matthew D; Abebe, Kaleab; Martin-Gill, Chris; Roth, Ronald N; Suyama, Joseph; Guyette, Francis X; Rittenberger, Jon C; Krackhardt, David; Arnold, Robert; Yealy, Donald M; Lave, Judith

2012-01-01

The purpose of this study was to develop a method to define and rate the severity of adverse events (AEs) in emergency medical services (EMS) safety research. They used a modified Delphi technique to develop a consensus definition of an AE. The consensus definition was as follows: "An adverse event in EMS is a harmful or potentially harmful event occurring during the continuum of EMS care that is potentially preventable and thus independent of the progression of the patient's condition." Physicians reviewed 250 charts from 3 EMS agencies for AEs. The authors examined physician agreement using κ, Fleiss's κ, and corresponding 95% confidence intervals (CIs). Overall physician agreement on presence of an AE per chart was fair (κ = 0.24; 95% CI = 0.19, 0.29). These findings should serve as a basis for refining and implementing an AE evaluation instrument.

Field Dependence-Independence Cognitive Style and Academic Achievement: A Review of Research and Theory.

ERIC Educational Resources Information Center

Tinajero, Carolina; Paramo, M. Fernanda

1998-01-01

Reviews research into the possible effects of field dependence/independence on achievement at school. Finds that field-independent subjects perform better than field-dependent subjects, whether in a specific discipline or across all subjects. Discusses possible explanations for this difference in performance. Includes a chart summarizing the…

The Evaluation of Physical Learning Environments: A Critical Review of the Literature

ERIC Educational Resources Information Center

Cleveland, Benjamin; Fisher, Kenn

2014-01-01

This article critically reviews the methodologies and methods that have been used for the evaluation of physical learning environments. To contextualize discussion about the evaluation of learning spaces, we initially chart the development of post-occupancy evaluation (POE) for non-domestic buildings. We then discuss the recent evolution of POE…

Re-Imagining Science Education: Engaging Students in Science for Australia's Future. Australian Education Review 51

ERIC Educational Resources Information Center

Tytler, Russell

2007-01-01

Australian Education Review (AER) 51 elaborates on issues raised by the Australian Council for Educational Research (ACER) Research Conference 2006: "Boosting Science Learning--What Will It Take?" It challenges current orthodoxies in science education and proposes a re-imagining that charts new directions for science teaching and…

A Review of Critical, Person-Centred and Clinical Approaches to Reminiscence Work for People with Intellectual Disabilities

ERIC Educational Resources Information Center

Van Puyenbroeck, Joris; Maes, Bea

2008-01-01

The present article reviews reminiscence research with regard to people with intellectual disabilities. Although the term "reminiscence" is not often used in intellectual disability research, the concept offers a useful framework for charting the different approaches in literature, thanks to its multidisciplinary character and eclectic theoretical…

15 CFR 325.3 - Applying for a certificate of review.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Applying for a certificate of review. 325.3 Section 325.3 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade... which it deals, and the places where it does business. This description may be supplemented by a chart...

Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines.

PubMed

Edwards, Dorothy F; Hahn, Michele G; Baum, Carolyn M; Perlmutter, Monica S; Sheedy, Catherine; Dromerick, Alexander W

2006-03-01

The authors assessed patients with acute stroke to determine whether the systematic use of brief screening measures would more efficiently detect cognitive and sensory impairment than standard clinical practice. Fifty-three patients admitted to an acute stroke unit were assessed within 10 days of stroke onset. Performance on the screening measures was compared to information obtained from review of the patient's chart at discharge. Cognition, language, visual acuity, visual-spatial neglect, hearing, and depression were evaluated. Formal screening detected significantly more impairments than were noted in patient charts in every domain. Only 3 patients had no impairments identified on screening; all remaining patients had at least 1 impairment detected by screening that was not documented in the chart. Thirty-five percent had 3 or more undetected impairments. Memory impairment was most likely to be noted in the chart; for all other domains tested, undocumented impairment ranged from 61% (neglect) to 97% (anomia). Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke.

Qualities of dental chart recording and coding.

PubMed

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

2013-01-01

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

Education in Neurology Resident Documentation Using Payroll Simulation.

PubMed

Liang, John W; Shanker, Vicki L

2017-04-01

Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. To improve the quality of neurology resident documentation through payroll simulation. A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors. Current E/M level, ideal E/M level, and financial loss were calculated by the evaluators. Ideal E/M level was defined as the highest billable level based on the documented problems, alongside a supporting history and examination. We implemented an educational intervention that consisted of a 1-hour didactic lecture, followed by e-mail feedback "paystubs" every 2 weeks detailing the number of patients seen, income generated, income loss, and areas for improvement. Follow-up charts were assessed in a similar fashion over a 16-week postintervention period. Ten of 11 residents (91%) participated. Of 214 charts that were reviewed preintervention, 114 (53%) had insufficient documentation to support the ideal E/M level, leading to a financial loss of 24% ($5,800). Inadequate documentation was seen in all 3 components: history (47%), examination (27%), and medical decision making (37%). Underdocumentation did not differ across residency years. Postintervention, underdocumentation was reduced to 14% of 273 visits ( P < .001), with a reduction in the financial loss to 6% ($1,880). Improved documentation and increased potential reimbursement was attained following a didactic lecture and a 16-week period in which individual, specific feedback to neurology residents was provided.

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

PubMed

Janssen, Aron; Huang, Howard; Duncan, Christina

2016-01-01

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

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

PubMed

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

2015-06-01

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

Review of educational interventions to increase traditional birth attendants' neonatal resuscitation self-efficacy.

PubMed

Mendhi, Marvesh M; Cartmell, Kathleen B; Newman, Susan D; Premji, Shahirose; Pope, Charlene

2018-05-21

Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality. This review will evaluate the effectiveness of neonatal resuscitation educational interventions in improving traditional birth attendants' knowledge, perceived self-efficacy, and infant mortality outcomes in low-and-middle-income countries. An integrative review was conducted to identify studies pertaining to neonatal resuscitation training of traditional birth attendants and midwives for home-based births in low-and-middle-income countries. Ten studies met inclusion criteria. Most interventions were based on the American Association of Pediatrics Neonatal Resuscitation Program, World Health Organization Safe Motherhood Guidelines and American College of Nurse-Midwives Life Saving Skills protocols. Three studies exclusively for traditional birth attendants reported decreases in neonatal mortality rates ranging from 22% to 65%. These studies utilized pictorial and oral forms of teaching, consistent in addressing the social cognitive theory. Studies employing skill demonstration, role-play, and pictorial charts showed increased pre- to post-knowledge scores and high self-efficacy scores. In two studies, a team approach, where traditional birth attendants were assisted, was reported to decrease neonatal mortality rate from 49-43/1000 births to 10.5-3.7/1000 births. Culturally appropriate methods, such as role-play, demonstration, and pictorial charts, can contribute to increased knowledge and self-efficacy related to neonatal resuscitation. A team approach to training traditional birth attendants, assisted by village health workers during home-based childbirths may reduce neonatal mortality rates. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Genital Problems in Men

MedlinePlus

... Toddlers Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of- ... chart for more information about genital problems in men. Our trusted Symptom Checker is written and reviewed ...

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

PubMed

Dainton, Christopher; Chu, Charlene H

2017-02-01

Electronic medical records (EMRs) may address the need for decision and language support for Western clinicians on mobile medical service trips (MSTs) in low resource settings abroad, while providing improved access to records and data management. However, there has yet to be a review of this emerging technology used by MSTs in low-resource settings. The aim of this study is to describe EMR systems designed specifically for use by mobile MSTs in remote settings, and accordingly, determine new opportunities for this technology to improve quality of healthcare provided by MSTs. A MEDLINE, EMBASE, and Scopus/IEEE search and supplementary Google search were performed for EMR systems specific to mobile MSTs. Information was extracted regarding EMR name, organization, scope of use, platform, open source coding, commercial availability, data integration, and capacity for linguistic and decision support. Missing information was requested by email. After screening of 122 abstracts, two articles remained that discussed deployment of EMR systems in MST settings (iChart, SmartList To Go), and thirteen additional EMR systems were found through the Google search. Of these, three systems (Project Buendia, TEBOW, and University of Central Florida's internally developed EMR) are based on modified versions of Open MRS software, while three are smartphone apps (QuickChart EMR, iChart, NotesFirst). Most of the systems use a local network to manage data, while the remaining systems use opportunistic cloud synchronization. Three (TimmyCare, Basil, and Backpack EMR) contain multilingual user interfaces, and only one (QuickChart EMR) contained MST-specific clinical decision support. There have been limited attempts to tailor EMRs to mobile MSTs. Only Open MRS has a broad user base, and other EMR systems should consider interoperability and data sharing with larger systems as a priority. Several systems include tablet compatibility, or are specifically designed for smartphone, which may be helpful given the environment and low resource context. Results from this review may be useful to non-government organizations (NGOs) considering modernization of their medical records practices as EMR use facilitates research, decreases paper administration costs, and improves perceptions of professionalism; however, most MST-specific EMRs remain in their early stages, and further development and research is required before reaching the stage of widespread adoption. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Premature return to play and return to learn after a sport-related concussion

PubMed Central

Carson, James D.; Lawrence, David W.; Kraft, Sari A.; Garel, Alisha; Snow, Catherine L.; Chatterjee, Ananda; Libfeld, Paula; MacKenzie, Heather M.; Thornton, Jane S.; Moineddin, Rahim; Frémont, Pierre

2014-01-01

Abstract Objective To determine what proportion of patients experience an exacerbation of their symptoms as a result of premature return to play (RTP) and return to learn (RTL) following sport-related concussions. Design Retrospective study of electronic medical records from the office-based practice of one family and sport medicine physician who had systematically provided recommendations for cognitive and physical rest based on existing consensus recommendations. Two blinded authors independently reviewed each chart, which included Sport Concussion Assessment Tool (SCAT) and SCAT2 symptom self-report forms to determine whether an athlete had returned to play or learn prematurely. If there was a discrepancy between the 2 reviewers then a third author reviewed the charts. Setting A sport medicine and family practice in Ontario. The physician assessed sport-related concussions after self-referral or referral from other primary care physicians, teams, and schools. Participants A total of 170 charts of 159 patients were assessed for sport-related concussion during a 5-year period (April 2006 to March 2011). All participants were students who were participating in sports at the time of injury. There were 41 concussions in elementary students, 95 concussions in high school students, and 34 concussions in college or university students. Main outcome measures Premature RTP and RTL were defined as chart records documenting the recurrence or worsening of symptoms that accompanied the patients’ RTP or RTL. Measures were compared using the earliest available SCAT forms and self-reporting. Results In 43.5% of concussion cases, the patient returned to sport too soon and in 44.7% of concussion cases, the patient returned to school too soon. Patients with a history of previous concussion required more days of rest before being permitted to participate in any physical activity than those patients without a previous history of concussion. Elementary school students required fewer days of rest before being permitted to return to any physical activity compared with high school students and college or university students. Conclusion Currently, physicians recommend restrictions on mental and physical activity following sport-related concussion. This is done without clear guidelines as to what cognitive rest entails for students. Further research is required to determine how to implement a management plan for student athletes to facilitate complete recovery after concussion. PMID:24925965

Identifying Patients with Severe Sepsis Using Administrative Claims: Patient-Level Validation of the Angus Implementation of the International Consensus Conference Definition of Severe Sepsis

PubMed Central

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

2012-01-01

Background Severe sepsis is a common and costly problem. Although consistently defined clinically by consensus conference since 1991, there have been several different implementations of the severe sepsis definition using ICD-9-CM codes for research. We conducted a single center, patient-level validation of one common implementation of the severe sepsis definition, the so-called “Angus” implementation. Methods Administrative claims for all hospitalizations for patients initially admitted to general medical services from an academic medical center in 2009–2010 were reviewed. On the basis of ICD-9-CM codes, hospitalizations were sampled for review by three internal medicine-trained hospitalists. Chart reviews were conducted with a structured instrument, and the gold standard was the hospitalists’ summary clinical judgment on whether the patient had severe sepsis. Results 3,146 (13.5%) hospitalizations met ICD-9-CM criteria for severe sepsis by the Angus implementation (“Angus-positive”) and 20,142 (86.5%) were Angus-negative. Chart reviews were performed for 92 randomly-selected Angus-positive and 19 randomly-selected Angus-negative hospitalizations. Reviewers had a kappa of 0.70. The Angus implementation’s positive predictive value (PPV) was 70.7% (95%CI: 51.2%, 90.5%). The negative predictive value was 91.5% (95%CI: 79.0%, 100%). The sensitivity was 50.4% (95%CI: 14.8%, 85.7%). Specificity was 96.3% (95%CI: 92.4%, 100%). Two alternative ICD-9-CM implementations had high PPVs but sensitivities of less than 20%. Conclusions The Angus implementation of the international consensus conference definition of severe sepsis offers a reasonable but imperfect approach to identifying patients with severe sepsis when compared with a gold standard of structured review of the medical chart by trained hospitalists. PMID:23001437

Mycobacterium africanum, an emerging disease in high-income countries?

PubMed

Isea-Peña, M C; Brezmes-Valdivieso, M F; González-Velasco, M C; Lezcano-Carrera, M A; López-Urrutia-Lorente, L; Martín-Casabona, N; Monforte-Cirac, M L; Palacios, J J; Penedo-Pallares, A; Ramirez-Rosales, A; Sánchez-Silos, R; Tórtola-Fernández, T; Viñuelas-Bayón, J; Vitoria-Agreda, A; Esteban, J

2012-10-01

Mycobacterium africanum is a cause of tuberculosis (TB) that has mainly been described in Africa, but immigration and travel patterns have contributed to the spread of the disease to other countries. We retrospectively reviewed TB cases due to M. africanum during 2000-2010 in seven Spanish hospitals. Selected clinical charts were reviewed using a predefined protocol that included demographical, clinical and microbiological data and outcome. Although 57 cases were diagnosed, only 36 clinical charts were available for review: 82.8% were men and the mean age was 31.6 years (range 12-81). Forty-four cases were from Africa, 1 from the Philippines, 1 from India, and 4 from Spain, while the country of origin was unknown in 7 cases. The most frequent site of infection was the lung (58.3%). Four cases (6.9%) were resistant to at least one first-line anti-tuberculosis drug. Disease due to M. africanum in industrialised countries is mainly associated with immigration from endemic areas, although some cases also occur among native-born populations.

Review: Abortion care in Ghana: A critical review of the literature

PubMed Central

Rominski, Sarah D; Lori, Jody R

2015-01-01

The Government of Ghana has taken important steps to mitigate the impact of unsafe abortion. However, the expected decline in maternal deaths is yet to be realized. This literature review aims to present findings from empirical research directly related to abortion provision in Ghana and identify gaps for future research. A total of four (4) databases were searched with the keywords “Ghana and abortion” and hand review of reference lists was conducted. All abstracts were reviewed. The final include sample was 39 articles. Abortion-related complications represent a large component of admissions to gynecological wards in hospitals in Ghana as well as a large contributor to maternal mortality. Almost half of the included studies were hospital-based, mainly chart reviews. This review has identified gaps in the literature including: interviewing women who have sought unsafe abortions and with healthcare providers who may act as gatekeepers to women wishing to access safe abortion services. PMID:25438507

Digital Bridge or Digital Divide? A Case Study Review of the Implementation of the "Computers for Pupils Programme" in a Birmingham Secondary School

ERIC Educational Resources Information Center

Morris, Jonathan Padraig

2011-01-01

Attempts to bridge the Digital Divide have seen vast investment in Information Communication Technology in schools. In the United Kingdom, the Computers for Pupils initiative has invested 60 million British Pounds of funds to help some of the most disadvantaged secondary school pupils by putting a computer in their home. This paper charts and…

A Review of Extra-Syllabus Programmes of Government College of Teacher Education, Trivandrum on the Eve of Its Centenary

ERIC Educational Resources Information Center

Praveen, C.

2010-01-01

Most teacher education institutions in India have charted out programmes well in tune with the syllabus prescribed by the University to which they are affiliated. But some institutions have tended to tread a different path. These are institutions which are over fifty years old and have set a tradition of its own. A closer study of older teacher…

76 FR 80885 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... follows the guidelines contained in the OMB Resource Manual for Customer Surveys. In accordance with... being conducted include Web site satisfaction surveys, a Chart Users survey, and a Coastal Services...

ROMPS critical design review. Volume 3: Furnace module design documentation

NASA Technical Reports Server (NTRS)

Dobbs, M. E.

1992-01-01

As part of the furnace module design documentation, the furnace module Easylab programs definitions and command variables are described. Also included are Easylab commands flow charts and fault conditions.

A preliminary typology of caregivers and effects on service utilization of caregiver counseling.

PubMed

Pepin, Renee; Williams, Ashley A; Anderson, Lindsay N; Qualls, Sara H

2013-01-01

Caregivers (CGs) of older adults have unique and diverse needs for intervention. The present studies describe the characteristics of CGs and caregiving situations and how these relate to CG therapy utilization patterns in a community mental health setting. Study 1: Through chart review, the researchers explored service utilization patterns and identified preliminary typologies of Caregiver Family Therapy (CFT) clients, N = 23. Study 2: By conducting a second chart review, the researchers sought to determine whether the categories that emerged in Study 1 applied to a second group of CFT clients, N = 36. Study 1: Four distinct categories of CGs emerged: High-Distress (high disorganization, high complexity), Resourceful but At-Risk (low disorganization, high complexity), Non-Committal (high disorganization, low complexity), and Model CGs (low disorganization, low complexity). Study 2: While the ability to classify CGs into category proved to have some inconsistencies, preliminary evidence suggests the ability to predict utilization once CGs were placed into category was good. In Study 2 a fifth category emerged: High Functioning but Static, which suggests CGs were on a continuum ranging from high to low on family organizational style and CG situation complexity. While caregiving situations vary widely among families and across time, this article provides a preliminary typology of CGs that may assist clinicians in tailoring CG interventions to meet the needs of their clients based on information garnered early in therapy, perhaps as early as the intake process.

A Preliminary Typology of Caregivers and Effects on Service Utilization of Caregiver Counseling

PubMed Central

Pepin, Renee; Williams, Ashley A.; Anderson, Lindsay N.; Qualls, Sara H.

2014-01-01

Objectives Caregivers (CGs) of older adults have unique and diverse needs for intervention. The present studies describe the characteristics of CGs and caregiving situations and how these relate to CG therapy utilization patterns in a community mental health setting. Method Study 1: Through chart review, the researchers explored service utilization patterns and identified preliminary typologies of Caregiver Family Therapy (CFT) clients, N = 23. Study 2: By conducting a second chart review, the researchers sought to determine whether the categories that emerged in Study 1 applied to a second group of CFT clients, N = 36. Results Study 1: Four distinct categories of caregivers emerged: High-Distress (high disorganization, high complexity), Resourceful but At-Risk (low disorganization, high complexity), Non-Committal (high disorganization, low complexity), and Model CGs (low disorganization, low complexity). Study 2: While the ability to classify CGs into category proved to have some inconsistencies, preliminary evidence suggests the ability to predict utilization once CGs were placed into category was good. In Study 2 a fifth category emerged: High Functioning but Static, which suggests CGs were on a continuum ranging from high to low on family organizational style and CG situation complexity. Conclusion While caregiving situations vary widely among families and across time, this paper provides a preliminary typology of CGs that may assist clinicians in tailoring CG interventions to meet the needs of their clients based on information garnered early in therapy, perhaps as early as the intake process. PMID:23336319

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

PubMed

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

2017-01-01

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

"My Heart Die in Me": Idioms of Distress and the Development of a Screening Tool for Mental Suffering in Southeast Liberia.

PubMed

Fabian, Katrin; Fannoh, Josiah; Washington, George G; Geninyan, Wilfred B; Nyachienga, Bethuel; Cyrus, Garmai; Hallowanger, Joyce N; Beste, Jason; Rao, Deepa; Wagenaar, Bradley H

2018-05-04

The integration of culturally salient idioms of distress into mental healthcare delivery is essential for effective screening, diagnosis, and treatment. This study systematically explored idioms, explanatory models, and conceptualizations in Maryland County, Liberia to develop a culturally-resonant screening tool for mental distress. We employed a sequential mixed-methods process of: (1) free-lists and semi-structured interviews (n = 20); patient chart reviews (n = 315); (2) pile-sort exercises, (n = 31); and (3) confirmatory focus group discussions (FGDs); (n = 3) from June to December 2017. Free-lists identified 64 idioms of distress, 36 of which were eliminated because they were poorly understood, stigmatizing, irrelevant, or redundant. The remaining 28 terms were used in pile-sort exercises to visualize the interrelatedness of idioms. Confirmatory FDGs occurred before and after the pile-sort exercise to explain findings. Four categories of idioms resulted, the most substantial of which included terms related to the heart and to the brain/mind. The final screening tool took into account 11 idioms and 6 physical symptoms extracted from patient chart reviews. This study provides the framework for culturally resonant mental healthcare by cataloguing language around mental distress and designing an emic screening tool for validation in a clinical setting.

Diagnosis and Management of Intraoperative Colorectal Anastomotic Leaks: A Global Retrospective Patient Chart Review Study.

PubMed

Schiff, A; Roy, S; Pignot, M; Ghosh, S K; Fegelman, E J

2017-01-01

This targeted chart review study reports the first ever detailed global account of clinical approaches adopted to detect and manage anastomotic leaks identified during surgery in routine clinical practice. 156 surgeons from eight countries retrospectively extracted data from surgical records of 458 patients who underwent colorectal surgery with an identified intraoperative leak at the circular anastomosis. Demographic details, procedures, and outcomes were analyzed descriptively, by country. Most surgeries were performed laparoscopically (57.6%), followed by open surgeries (35.8%). The burden of intraoperative leaks on the healthcare system is driven in large part by the additional interventions such as using a sealant, recreating the anastomosis, and diverting the anastomosis to a colostomy bag, undertaken to manage the leak. The mean duration of hospitalization was 19.9 days. Postoperative anastomotic leaks occurred in 62 patients (13.5%), most frequently 4 to 7 days after surgery. Overall, country-specific differences were observed in patient characteristics, surgical procedures, method of diagnosis of intraoperative leak, interventions, and length of hospital stay. The potential cost of time and material needed to repair intraoperative leaks during surgery is substantial and often hidden to the healthcare system, potentially leading to an underestimation of the impact of this complication.

Prophylactic Antibiotics for Enucleation and Evisceration: A Retrospective Study and Systematic Literature Review.

PubMed

Pariseau, Brett; Fox, Barry; Dutton, Jonathan J

To report surgical site infection (SSI) rates of eviscerations and enucleations with implants performed without perioperative intravenous (IV) antibiotics or postoperative oral antibiotics, and to give SSI prevention recommendations. A single-center retrospective chart review was performed after obtaining institutional review board approval. Charts were found by Current Procedural Terminology codes. Demographics, surgical indication, procedure, implant, antibiotic use, and postoperative course were recorded. SSIs occurring within 30 days after surgery were reviewed and postoperative infection rates were determined. Four hundred eighty-one cases from January 1999 to December 2015 were analyzed. There were 102 eviscerations with implants, 314 enucleations with implants, 23 enucleations without implants, 23 implant exchanges, 15 implants placed secondarily after enucleation, and 4 implant removals. Seventy cases (14.6%) were given perioperative IV antibiotics, and in this group one periorbital infection occurred unrelated to orbital surgery (1.4%). Of the 411 cases (85.4%) not given perioperative IV antibiotics, 1 of 87 eviscerations with implants developed an SSI (1.1%), 2 of 273 enucleations with implants developed SSIs (0.7%), and none of the 13 enucleations without implants developed SSIs. To our knowledge, this is the first published case series reporting SSI rates of enucleations and eviscerations with implants performed without perioperative IV antibiotics or postoperative oral antibiotics. With infection rates comparing favorably to other case series where antibiotics were given, the routine use of perioperative IV antibiotics and postoperative oral antibiotics for enucleations and eviscerations may not be indicated.

Clinical Decision Support Alert Appropriateness: A Review and Proposal for Improvement

PubMed Central

McCoy, Allison B.; Thomas, Eric J.; Krousel-Wood, Marie; Sittig, Dean F.

2014-01-01

Background Many healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes. Methods We present a review of CDS alerts and describe a proposal to develop novel methods for evaluating and improving CDS alerts that builds upon traditional informatics approaches. Our proposal incorporates previously described models for predicting alert overrides that utilize retrospective chart review to determine which alerts are clinically relevant and which overrides are justifiable. Results Despite increasing implementations of CDS alerts, detailed evaluations rarely occur because of the extensive labor involved in manual chart reviews to determine alert and response appropriateness. Further, most studies have solely evaluated alert overrides that are appropriate or justifiable. Our proposal expands the use of web-based monitoring tools with an interactive dashboard for evaluating CDS alert and response appropriateness that incorporates the predictive models. The dashboard provides 2 views, an alert detail view and a patient detail view, to provide a full history of alerts and help put the patient's events in context. Conclusion The proposed research introduces several innovations to address the challenges and gaps in alert evaluations. This research can transform alert evaluation processes across healthcare settings, leading to improved CDS, reduced alert fatigue, and increased patient safety. PMID:24940129

Wikis and Collaborative Writing Applications in Health Care: A Scoping Review Protocol

PubMed Central

van de Belt, Tom H; Grajales III, Francisco J; Eysenbach, Gunther; Aubin, Karine; Gold, Irving; Gagnon, Marie-Pierre; Kuziemsky, Craig E; Turgeon, Alexis F; Poitras, Julien; Faber, Marjan J; Kremer, Jan A.M; Heldoorn, Marcel; Bilodeau, Andrea; Légaré, France

2012-01-01

The rapid rise in the use of collaborative writing applications (eg, wikis, Google Documents, and Google Knol) has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. While researchers have conducted systematic reviews on a range of software-based information and communication technologies as well as other social media (eg, virtual communities of practice, virtual peer-to-peer communities, and electronic support groups), none have reviewed collaborative writing applications in the medical sector. The overarching goal of this project is to explore the depth and breadth of evidence for the use of collaborative writing applications in health care. Thus, the purposes of this scoping review will be to (1) map the literature on collaborative writing applications; (2) compare the applications’ features; (3) describe the evidence of each application’s positive and negative effects as a KT intervention in health care; (4) inventory and describe the barriers and facilitators that affect the applications’ use; and (5) produce an action plan and a research agenda. A six-stage framework for scoping reviews will be used: (1) identifying the research question; (2) identifying relevant studies within the selected databases (using the EPPI-Reviewer software to classify the studies); (3) selecting studies (an iterative process in which two reviewers search the literature, refine the search strategy, and review articles for inclusion); (4) charting the data (using EPPI-Reviewer’s data-charting form); (5) collating, summarizing, and reporting the results (performing a descriptive, numerical, and interpretive synthesis); and (6) consulting knowledge users during three planned meetings. Since this scoping review concerns the use of collaborative writing applications as KT interventions in health care, we will use the Knowledge to Action (KTA) framework to describe and compare the various studies and collaborative writing projects we find. In addition to guiding the use of collaborative writing applications in health care, this scoping review will advance the science of KT by testing tools that could be used to evaluate other social media. We also expect to identify areas that require further systematic reviews and primary research and to produce a highly relevant research agenda that explores and leverages the potential of collaborative writing software. To date, this is the first study to use the KTA framework to study the role collaborative writing applications in KT, and the first to involve three national and international institutional knowledge users as part of the research process. PMID:23612481

Avenues into Food Planning: A Review of Scholarly Food System Research

PubMed Central

Brinkley, Catherine

2014-01-01

This review summarizes several avenues of planning inquiry into food systems research, revealing gaps in the literature, allied fields of study and mismatches between scholarly disciplines and the food system life cycle. Planners and scholars in associated fields have identified and defined problems in the food system as ‘wicked’ problems, complex environmental issues that require systemic solutions at the community scale. While food justice scholars have contextualized problem areas, planning scholars have made a broad case for planning involvement in solving these wicked problems while ensuring that the functional and beneficial parts of the food system continue to thrive. This review maps the entry points of scholarly interest in food systems and planning’s contributions to its study, charting a research agenda for the future. PMID:24932131

Pregnancy outcomes and the use of two standards to assess adequacy of maternal body mass index in early gestation.

PubMed

Mardones, F; Rosso, P; Villarroel, L; Bacallao, J; Dominguez, A; Passi, A; Rojas, I; Farias, M; Margozzini, P

2016-02-01

The maternal weight gain chart proposed by Rosso and Mardones (RM) was subsequently modified by Atalah et al. (AEA). Both charts are widely used in Latin America. The purpose of this study was to compare birth length (BL) and birth weight (BW) outcomes of both charts. A prospective study of pregnant women and their offspring's was performed in Santiago, Chile. From a total sample of 27,613 pregnant women a sub-sample of 11,465 term healthy singleton pregnant women was selected for additional analyses. κ statistics was used to study the degree of agreement of both charts in the diagnosis of maternal nutritional status. Obese and underweight women were classified using both standards at the beginning of pregnancy and compared in terms of BL4250 g proportions. Sensitivity and specificity values of at risk newborns, whose categories were considered as gold standard, were obtained for obese and underweight women of each chart. There was a moderate agreement in the nutritional classification of these charts. Proportions of BL4250 g were similar at each nutritional category; however, absolute figures for at risk newborns were much higher in the RM underweight and obese women. The RM chart showed higher sensitivity values than the AEA chart. The higher sensitivity of the RM chart would support its use for prevention purposes. This chart is advisable for Latin American countries and also for most developing countries.

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

PubMed

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

2017-08-01

To compare the effectiveness of customized vs population-based growth charts for the prediction of adverse pregnancy outcomes. MEDLINE, ClinicalTrials.gov and The Cochrane Library were searched up to 31 May 2016 to identify interventional and observational studies comparing adverse outcomes among large- (LGA) and small- (SGA) for-gestational-age neonates, when classified according to customized vs population-based growth charts. Perinatal mortality and admission to the neonatal intensive care unit (NICU) of both SGA and LGA neonates, intrauterine fetal demise (IUFD) and neonatal mortality of SGA neonates, and neonatal shoulder dystocia and hypoglycemia as well as maternal third- and fourth-degree perineal lacerations in LGA pregnancies were evaluated. The electronic search identified 237 records that were examined based on title and abstract, of which 27 full-text articles were examined for eligibility. After excluding seven articles, 20 observational studies were included in a Bayesian meta-analysis. Neonates classified as SGA according to customized growth charts had higher risks of IUFD (odds ratio (OR), 7.8 (95% CI, 4.2-12.3)), neonatal death (OR, 3.5 (95% CI, 1.1-8.0)), perinatal death (OR, 5.8 (95% CI, 3.8-7.8)) and NICU admission (OR, 3.6 (95% CI, 2.0-5.5)) than did non-SGA cases. Neonates classified as SGA according to population-based growth charts also had increased risk for adverse outcomes, albeit the point estimates of the pooled ORs were smaller: IUFD (OR, 3.3 (95% CI, 1.9-5.0)), neonatal death (OR, 2.9 (95% CI, 1.2-4.5)), perinatal death (OR, 4.0 (95% CI, 2.8-5.1)) and NICU admission (OR, 2.4 (95% CI, 1.7-3.2)). For LGA vs non-LGA, there were no differences in pooled ORs for perinatal death, NICU admission, hypoglycemia and maternal third- and fourth-degree perineal lacerations when classified according to either the customized or the population-based approach. In contrast, both approaches indicated that LGA neonates are at increased risk for shoulder dystocia than are non-LGA ones (OR, 7.4 (95% CI, 4.9-9.8) using customized charts; OR, 8.0 (95% CI, 5.3-10.1) using population-based charts). Both customized and population-based growth charts can identify SGA neonates at risk for adverse outcomes. Although the point estimates of the pooled ORs may differ for some outcomes, the overlapping CIs and lack of direct comparisons prevent conclusions from being drawn on the superiority of one method. Future clinical trials should compare directly the two approaches in the management of fetuses of abnormal size. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Feeding outcomes in infants after supraglottoplasty.

PubMed

Eustaquio, Marcia; Lee, Erika Nevin; Digoy, G Paul

2011-11-01

Review the impact of bilateral supraglottoplasty on feeding and compare the risk of postoperative feeding difficulties between infants with and without additional comorbidities. Case series with chart review. Children's hospital. The medical records of all patients between birth and 12 months of age treated for laryngomalacia with bilateral supraglottoplasty by a single surgeon (GPD) between December 2005 and September 2009 and followed for a minimum of 1 month were reviewed. Infants with significant comorbidities were evaluated separately. Nutritional intake before and after surgery, as well as speech and language pathology reports, was reviewed to qualify any feeding difficulties. Age at the time of surgery, additional surgical interventions, medical comorbidities, and length of follow-up were also noted during chart review. Of 81 infants who underwent bilateral supraglottoplasty, 75 were eligible for this review. In the cohort of infants without comorbidities, 46 of 48 (96%) had no change or an improvement in their oral intake after surgery. Of the 2 patients with initial worsening of feeding, all resumed oral intake within 2 months. In the group of patients with additional medical comorbidities, 22% required further interventions such as nasogastric tube, dietary modification, or gastrostomy tube placement. Supraglottoplasty in infants has a low incidence of persistent postoperative dysphagia. Infants with additional comorbidities are at a higher risk of feeding difficulty than otherwise healthy infants.

Characteristics and psychosocial predictors of psychiatric emergency center transport and length of stay in patients with dementia and Alzheimer's disease: a preliminary report.

PubMed

Nejtek, Vicki A; Hardy, Sarah; Hall, James R; Winter, A Scott

2011-07-01

Agitation and aggression are common behaviors that often lead to psychiatric emergency center (PEC) admission of nursing home patients with dementia or Alzheimer's disease. However, few if any data are available that adequately describe characteristics and psychosocial triggers of agitation and aggression leading to transport and admission to a PEC. A preliminary investigation to explore all possible characteristics and psychosocial predictors of PEC transport and length of stay in men and women nursing home patients with dementia or Alzheimer's disease was designed. Frequency distributions, chi-square, analyses of variance, and regression analyses were used to analyze the data. One hundred PEC patient charts were reviewed, of which 58 charts were missing information and 42 charts provided evaluable data. Nursing homes located in impoverished areas transported patients to the PEC significantly more often than those in affluent areas. A disconnect between the agitated/aggressive mental state reported by nursing home staff leading to the PEC transport and the calm/cooperative mental status PEC clinicians observed during the admission process was evident. Data from the charts also showed that 74% of patients received off-label antipsychotics rather than FDA-approved medications to treat dementia or Alzheimer's disease. This is one of the few studies to identify characteristics and psychosocial triggers of PEC use and length of stay in nursing home patients. We also highlight potentially dangerous antipsychotic use in dementia and Alzheimer disease. Thus, our data add to the existing knowledge base regarding PEC utilization, length of stay, and pharmacotherapy in nursing home patients with dementia and Alzheimer's disease. Given the preliminary nature of this study, however, the results should be interpreted with caution.

Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the EHR for disease management and prevention.

PubMed

Milano, Christina E; Hardman, Joseph A; Plesiu, Adeline; Rdesinski, Rebecca E; Biagioli, Frances E

2014-03-01

Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum's general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts.In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care.

Treatment Patterns and Early Outcomes of ALK-Positive Non-Small Cell Lung Cancer Patients Receiving Ceritinib: A Chart Review Study.

PubMed

Bendaly, Edmond; Dalal, Anand A; Culver, Kenneth; Galebach, Philip; Bocharova, Iryna; Foster, Rebekah; Sasane, Medha; Macalalad, Alexander R; Guérin, Annie

2017-05-01

This study aimed to provide the first real-world description of the characteristics, treatments, dosing patterns, and early outcomes of patients with ALK-positive non-small cell lung cancer (NSCLC) who received ceritinib in US clinical practice. US oncologists provided data from medical charts of adult patients diagnosed with locally advanced or metastatic ALK-positive NSCLC who received ceritinib following crizotinib. Patient characteristics, treatment patterns, ceritinib dosing, early outcomes, and occurrence of gastrointestinal adverse events (AEs) by dose and instructions on food intake were assessed, and Kaplan-Meier analysis was used to describe clinician-defined progression-free survival (PFS) on ceritinib. Medical charts of 58 ALK-positive NSCLC patients treated with ceritinib were reviewed (median age 63 years; 41% male; 21% with prior chemotherapy experience). At ceritinib initiation, 44 patients had multiple distant metastases, most commonly in the liver (60%), bone (53%), and brain (38%). Initial ceritinib dose varied: 71% received 750 mg, 19% 600 mg, and 10% 450 mg. Although median follow-up after ceritinib initiation was short (3.8 months), most patients achieved either a complete or partial response (69%) on ceritinib, regardless of metastatic sites present at initiation or initial dose. Median PFS on ceritinib was 12.9 months. 17% of patients had a gastrointestinal AE reported during follow-up. The majority of events occurred in patients instructed to fast; no patients instructed to take a lower dose of ceritinib with food reported gastrointestinal AEs. These early findings of ceritinib use in clinical practice suggest that ceritinib is effective at treating crizotinib-experienced ALK-positive NSCLC patients, regardless of metastatic sites or initial dose, and dosing ceritinib with food may lead to fewer gastrointestinal AEs. Future studies with larger sample size and longer follow-up are warranted, including an ongoing randomized trial to assess the gastrointestinal tolerability of ceritinib 450 and 600 mg with low-fat meals. Novartis Pharmaceutical Corporation.

[An Introduction to Methods for Evaluating Health Care Technology].

PubMed

Lee, Ting-Ting

2015-06-01

The rapid and continual advance of healthcare technology makes ensuring that this technology is used effectively to achieve its original goals a critical issue. This paper presents three methods that may be applied by healthcare professionals in the evaluation of healthcare technology. These methods include: the perception/experiences of users, user work-pattern changes, and chart review or data mining. The first method includes two categories: using interviews to explore the user experience and using theory-based questionnaire surveys. The second method applies work sampling to observe the work pattern changes of users. The last method conducts chart reviews or data mining to analyze the designated variables. In conclusion, while evaluative feedback may be used to improve the design and development of healthcare technology applications, the informatics competency and informatics literacy of users may be further explored in future research.

A design of experiments approach to validation sampling for logistic regression modeling with error-prone medical records.

PubMed

Ouyang, Liwen; Apley, Daniel W; Mehrotra, Sanjay

2016-04-01

Electronic medical record (EMR) databases offer significant potential for developing clinical hypotheses and identifying disease risk associations by fitting statistical models that capture the relationship between a binary response variable and a set of predictor variables that represent clinical, phenotypical, and demographic data for the patient. However, EMR response data may be error prone for a variety of reasons. Performing a manual chart review to validate data accuracy is time consuming, which limits the number of chart reviews in a large database. The authors' objective is to develop a new design-of-experiments-based systematic chart validation and review (DSCVR) approach that is more powerful than the random validation sampling used in existing approaches. The DSCVR approach judiciously and efficiently selects the cases to validate (i.e., validate whether the response values are correct for those cases) for maximum information content, based only on their predictor variable values. The final predictive model will be fit using only the validation sample, ignoring the remainder of the unvalidated and unreliable error-prone data. A Fisher information based D-optimality criterion is used, and an algorithm for optimizing it is developed. The authors' method is tested in a simulation comparison that is based on a sudden cardiac arrest case study with 23 041 patients' records. This DSCVR approach, using the Fisher information based D-optimality criterion, results in a fitted model with much better predictive performance, as measured by the receiver operating characteristic curve and the accuracy in predicting whether a patient will experience the event, than a model fitted using a random validation sample. The simulation comparisons demonstrate that this DSCVR approach can produce predictive models that are significantly better than those produced from random validation sampling, especially when the event rate is low. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

PubMed

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

2017-04-01

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

An analysis of characteristics of post-authorisation studies registered on the ENCePP EU PAS Register

PubMed Central

Carroll, Robert; Ramagopalan, Sreeram V.; Cid-Ruzafa, Javier; Lambrelli, Dimitra; McDonald, Laura

2017-01-01

Background: The objective of this study was to investigate the study design characteristics of Post-Authorisation Studies (PAS) requested by the European Medicines Agency which were recorded on the European Union (EU) PAS Register held by the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP). Methods: We undertook a cross-sectional descriptive analysis of all studies registered on the EU PAS Register as of 18 th October 2016. Results: We identified a total of 314 studies on the EU PAS Register, including 81 (26%) finalised, 160 (51%) ongoing and 73 (23%) planned. Of those studies identified, 205 (65%) included risk assessment in their scope, 133 (42%) included drug utilisation and 94 (30%) included effectiveness evaluation. Just over half of the studies (175; 56%) used primary data capture, 135 (43%) used secondary data and 4 (1%) used a hybrid design combining both approaches. Risk assessment and effectiveness studies were more likely to use primary data capture (60% and 85% respectively as compared to 39% and 14% respectively for secondary). The converse was true for drug utilisation studies where 59% were secondary vs. 39% for primary. For type 2 diabetes mellitus, database studies were more commonly used (80% vs 3% chart review, 3% hybrid and 13% primary data capture study designs) whereas for studies in oncology, primary data capture were more likely to be used (85% vs 4% chart review, and 11% database study designs). Conclusions: Results of this analysis show that PAS design varies according to study objectives and therapeutic area. PMID:29188016

Teaching the Interpretation of Maps and Landscapes through Examples from Four Books. Special Review Section.

ERIC Educational Resources Information Center

Kelly, James L.

1994-01-01

Asserts that geography teachers teach how to derive information about history and culture from maps, photographs, and observations of real landscapes. Reviews four books: (1) "From Sea Charts to Satellite Images;" (2) "Historic Illinois From the Air;" (3) "Cultural Geography on Topographic Maps;" and (4) "US 40." Includes suggested student…

Differences in presenting advance directives in the chart, in the minimum data set, and through the staff's perceptions.

PubMed

Cohen-Mansfield, Jiska; Libin, Alexander; Lipson, Steven

2003-06-01

Decisions concerning end-of-life care depend on information contained in advance directives that are documented in residents' charts in the nursing home. The availability of that information depends on the quality of the chart and on the location of the information in the chart. No research was found that compared directives by the manner in which they are collected and summarized in the chart. The goal of the proposed study was to clarify how advance directives are summarized in the patient's record and to clarify how physicians perceive the same advance directives and formal orders. The study involved 122 elderly persons who reside in one large (587 beds) nursing home. The authors collected data regarding the advance directives from three sources-Minimum Data Set (MDS), the front cover of the resident's chart, and from inside the chart. The rates of documented advance directives found in this study are higher than those reported in the literature. Agreement rates between sources varied as a function of which sources were compared, as well as on the basis of which directive was examined. More specifically, the authors found higher rates of agreement between the information inside the chart and on the cover of the chart than between the MDS and the other two sources. The reasons for discrepancies may lie in the different functions and procedures pertaining to these source documents.

Revised Indian Academy of Pediatrics 2015 growth charts for height, weight and body mass index for 5-18-year-old Indian children.

PubMed

Khadilkar, Vaman V; Khadilkar, Anuradha V

2015-01-01

Growth chart committee of Indian Academy of Pediatrics (IAP) has revised growth charts for 5-18-year-old Indian children in Jan 2015. The last IAP growth charts (2007) were based on data collected in 1989-92 which is now >2 decades old. India is in an economic and nutrition transition and hence growth pattern of Indian children has changed over last few years. Thus, it was necessary to produce contemporary, updated growth references for Indian children. The new IAP charts were prepared by collating data from nine groups who had published studies in indexed journals on growth from India in the last decade. Growth charts were constructed from a total of 87022 middle and upper socioeconomic class children (m 54086, f 32936) from all five zones of India. Data from middle and upper socioeconomic class children are likely to have higher prevalence of overweight and obesity and hence growth charts produced on such populations are likely to "normalize" obesity. To remove such unhealthy weights form the data, method suggested by World Health Organization was used to produce weight charts. Thus, the new IAP weight charts are much lower than the recently published studies on affluent Indian children. Since Indian's are at a higher risk of obesity-related cardiometabolic complications at lower body mass index (BMI), BMI charts adjusted for 23, and 27 adult equivalent cut-offs as per International obesity task force guidelines were constructed. IAP now recommends use of these new charts to replace the 2007 IAP charts.

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

PubMed

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

2013-10-15

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

Primary-Care Weight-Management Strategies: Parental Priorities and Preferences.

PubMed

Turer, Christy Boling; Upperman, Carla; Merchant, Zahra; Montaño, Sergio; Flores, Glenn

2016-04-01

To examine parental perspectives/rankings of the most important weight-management clinical practices and to determine whether preferences/rankings differ when parents disagree that their child is overweight. We performed mixed-methods analysis of a 32-question survey of parents of 2- to 18-year-old overweight children assessing parental agreement that their child is overweight, the single most important thing providers can do to improve weight status, ranking American Academy of Pediatrics-recommended clinical practices, and preferred follow-up interval. Four independent reviewers analyzed open-response data to identify qualitative themes/subthemes. Multivariable analyses examined parental rankings, preferred follow-up interval, and differences by agreement with their child's overweight assessment. Thirty-six percent of 219 children were overweight, 42% obese, and 22% severely obese; 16% of parents disagreed with their child's overweight assessment. Qualitative analysis of the most important practice to help overweight children yielded 10 themes; unique to parents disagreeing with their children's overweight assessments was "change weight-status assessments." After adjustment, the 3 highest-ranked clinical practices included, "check for weight-related problems," "review growth chart," and "recommend general dietary changes" (all P < .01); parents disagreeing with their children's overweight assessments ranked "review growth chart" as less important and ranked "reducing screen time" and "general activity changes" as more important. The mean preferred weight-management follow-up interval (10-12 weeks) did not differ by agreement with children's overweight assessments. Parents prefer weight-management strategies that prioritize evaluating weight-related problems, growth-chart review, and regular follow-up. Parents who disagree that their child is overweight want changes in how overweight is assessed. Using parent-preferred weight-management strategies may prove useful in improving child weight status. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2017-08-02

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

[Morbidity and risk behavior regarding street-children in Medellin, Colombia, 2008].

PubMed

Muñoz-Echeverri, Iván F; Noreña-Herrera, Camilo; Londoño, Beatriz E; Rojas-Arbeláez, Carlos A

2011-04-01

Describing the characteristics, morbidity and risk behaviour of street children from Medellin. This was a descriptive, retrospective study. The medical charts of children aged less than 17 who sought medical attention in five protection institutions in Medellin during 2008 were reviewed. The analysis included descriptive statistics and bivariate analysis. Age was categorised into two groups: boys/girls (0- 12 years) and adolescents (13-17 years). The following characteristicswere found after reviewing 483 medical charts: being male (73.1 %), adolescent (73.1 %) and living in the streets (44.7 %). The most common diagnoses were for infectious and parasite illnesses (21.8 %), factors that affected health status and contact with health services (13.7 %), respiratory diseases (11.8 %). A total of 81.0 % of all children were engaged in psychoactive substance abuse,smoking marijuana being the most common (80.0 %);84.0 % reported engaging in sexual activity. Infectious diseases, sexual activity and usingpsychoactive substances placed this population in a high vulnerability category. This situation demands that local health-policy makers guarantee thispopulation's constitutional right to health, through health-promotion programmes and sexual and reproductive health strategies to prevent disease and psychoactive substance abuse.

The diagnosis and management of recurrent tracheoesophageal fistulas.

PubMed

Bruch, Steven W; Hirschl, Ronald B; Coran, Arnold G

2010-02-01

This review provides a blueprint to deal with the diagnosis and management of recurrent tracheoesophageal fistulas. A retrospective review over 27 years found 26 recurrent tracheoesophageal fistulas. Descriptive statistical analyses were performed. In this cohort of 26 patients, 18 had a leak after their primary operation; and 22 had respiratory symptoms leading to the discovery of the recurrent fistula. The diagnosis was made by contrast study in 24. The repairs entailed placing a catheter through the fistula; separating the trachea and esophagus using sharp dissection; and placing tissue, preferably pericardium, between the suture lines. Postoperative complications included 7 anastamotic leaks, 4 strictures, and 3 recurrent fistulas. Long-term follow-up (median of 84 months) showed that 21 took all of their nutrition by mouth, 3 were tube fed, and 2 required a combination. Of the 23 patients with growth chart data, 16 fell in the first quartile of the growth chart, whereas none fell between the 75th and 100th percentile. This series, the largest to date, describes characteristics of recurrent tracheoesophageal fistulas, including techniques to make the diagnosis and provide a secure closure of the fistula, and the long-term outcomes of these patients. Copyright 2010. Published by Elsevier Inc.

Treatment of Chronic Cough.

PubMed

Soni, Resha S; Ebersole, Barbara; Jamal, Nausheen

2017-01-01

Objective Chronic cough remains a challenging condition, especially in cases where it persists despite comprehensive medical management. For these particular patients, there appears to be an emerging role for behavior modification therapy. We report a series of patients with refractory chronic cough to assess if there is any benefit of adding behavioral therapy to their treatment regimen. Study Design A case series with planned chart review of patients treated for chronic cough. Setting The review was performed with an outpatient electronic health record system at a tertiary care center. Subjects and Methods The charts of all patients treated for chronic cough by a single laryngologist over a 30-month period were analyzed. Patients' response to treatment and rate of cough improvement were assessed for those with refractory chronic cough who underwent behavior modification therapy. Results Thirty-eight patients with chronic cough were initially treated empirically for the most common causes of cough, of which 32% experienced improvement. Nineteen patients who did not significantly improve with medical management underwent behavior modification therapy with a speech-language pathologist. Of these patients, 84% experienced resolution or marked improvement of their symptoms. Conclusion Behavioral therapy may be underutilized in practice and could lead to improvement of otherwise recalcitrant cough.

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

PubMed

Sada, Oumer; Melkie, Addisu; Shibeshi, Workineh

2015-09-16

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

Medication Use Patterns, Treatment Satisfaction, and Inadequate Control of Osteoporosis Study in the Asia-Pacific Region (MUSIC OS-AP): Design of a multinational, prospective, observational study examining the impact of gastrointestinal events on osteoporosis management in postmenopausal women.

PubMed

Modi, Ankita; Ebeling, Peter R; Lee, Mel S; Min, Yong-Ki; Mithal, Ambrish; Yang, Xiaoqin; Sajjan, Shiva

2015-12-01

The burden of osteoporosis in the Asia-Pacific region is not well characterized. The Medication Use Patterns, Treatment Satisfaction, and Inadequate Control of Osteoporosis Study in the Asia-Pacific Region (MUSIC OS-AP) was designed to better understand the association of gastrointestinal events with patient-reported outcomes in postmenopausal women of this region. MUSIC OS-AP is a prospective, multinational, observational cohort study of postmenopausal women ≥ 50 years of age diagnosed with osteoporosis. The study was conducted in five Asia-Pacific countries: Australia, New Zealand, Taiwan, Korea, and India. MUSIC OS-AP has three components: a physician questionnaire, a retrospective chart review, and a prospective cohort study. The physician questionnaire investigated the role of gastrointestinal events in physicians' pharmacologic management of osteoporosis. The retrospective chart review, also completed by physicians, recorded rate of osteoporosis treatment and the types of osteoporosis medications prescribed to osteoporosis patients. The prospective cohort study investigated the associations between gastrointestinal events and patient-reported outcomes among patients taking oral medications for osteoporosis as well as reasons for non-treatment in patients who remained untreated. The prospective cohort study enrolled two groups of patients: untreated, and treated with oral osteoporosis medications. Untreated patients completed only the baseline surveys, providing information on gastrointestinal event rates, quality of life, health care resource use, and reasons for non-treatment. Treated patients, who were either new to osteoporosis medication or continuing an ongoing medication course, completed surveys at baseline and 3, 6, and 12 months post-baseline. The evaluations recorded patient characteristics, gastrointestinal events, health-related and osteoporosis-specific quality of life, health care resource use, medication adherence, and satisfaction with treatment. Physicians at 59 sites completed the physician questionnaire, and data for 300 patients from 26 sites were abstracted for the retrospective chart review. Enrollment and baseline data collection for the prospective cohort study were conducted between July 2013 and August 2014 for 301 untreated and 3287 treated patients, of whom 1416 were new users and 1871 were experienced users of oral osteoporosis medications. The results of MUSIC OS-AP will highlight the association of gastrointestinal events with patient-reported outcomes among postmenopausal women with osteoporosis and elucidate physicians' management of gastrointestinal events among this patient population in the Asia-Pacific region.

Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet.

PubMed

Suskind, David L; Wahbeh, Ghassan; Gregory, Nila; Vendettuoli, Heather; Christie, Dennis

2014-01-01

Crohn disease is characterized by chronic intestinal inflammation in the absence of a recognized etiology. Nutritional therapy in the form of exclusive enteral nutrition (EEN) has an established role within pediatric Crohn disease. Following exclusive enteral nutrition's success, many dietary therapies focusing on the elimination of specific complex carbohydrates have been anecdotally reported to be successful. Many of these therapies have not been evaluated scientifically; therefore, we reviewed the medical records of our patients with Crohn disease on the specific carbohydrate diet (SCD). Seven children with Crohn disease receiving the SCD and no immunosuppressive medications were retrospectively evaluated. Duration of the dietary therapy ranged from 5 to 30 months, with an average of 14.6±10.8 months. Although the exact time of symptom resolution could not be determined through chart review, all symptoms were notably resolved at a routine clinic visit 3 months after initiating the diet. Each patient's laboratory indices, including serum albumin, C-reactive protein, hematocrit, and stool calprotectin, either normalized or significantly, improved during follow-up clinic visits. This chart review suggests that the SCD and other low complex carbohydrate diets may be possible therapeutic options for pediatric Crohn disease. Further prospective studies are required to fully assess the safety and efficacy of the SCD, or any other low complex SCDs in pediatric patients with Crohn disease.

Utilization Rates of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death: A 2012 Calculation for a Midwestern Health Referral Region

PubMed Central

Hoang, Allen; Shen, Changyu; Zheng, James; Taylor, Stanley; Groh, William J; Rosenman, Marc; Buxton, Alfred E.; Chen, Peng-Sheng

2014-01-01

Background Utilization rates (URs) for implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. Objective To establish the ICD UR in central Indiana. Methods A query run on two hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) ≤0.35. ICD-eligibility and utilization were determined from chart review. Results We identified 1,863 patients with at least one low-EF study. Two cohorts were analyzed: 1,672 patients without, and 191 patients with, ICD-9-CM procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% CI 28–49%). URs were 48% for males (95% CI 34–61%), 21% for females (95% CI 16–26%, p=0.0002 vs males), 40% for whites (95% CI 27–53%), and 37% for blacks (95% CI 28–46%, p=0.66 vs whites). Conclusions The ICD UR is 38% among patients meeting Class I indications, suggesting further opportunities to improve guideline compliance. Furthermore, this study illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review. PMID:24566233

Small-for-gestational age and large-for-gestational age thresholds to predict infants at risk of adverse delivery and neonatal outcomes: are current charts adequate? An observational study from the Born in Bradford cohort

PubMed Central

Norris, T; Johnson, W; Farrar, D; Tuffnell, D; Wright, J; Cameron, N

2015-01-01

Objectives Construct an ethnic-specific chart and compare the prediction of adverse outcomes using this chart with the clinically recommended UK-WHO and customised birth weight charts using cut-offs for small-for-gestational age (SGA: birth weight <10th centile) and large-for-gestational age (LGA: birth weight >90th centile). Design Prospective cohort study. Setting Born in Bradford (BiB) study, UK. Participants 3980 White British and 4448 Pakistani infants with complete data for gestational age, birth weight, ethnicity, maternal height, weight and parity. Main outcome measures Prevalence of SGA and LGA, using the three charts and indicators of diagnostic utility (sensitivity, specificity and area under the receiver operating characteristic (AUROC)) of these chart-specific cut-offs to predict delivery and neonatal outcomes and a composite outcome. Results In White British and Pakistani infants, the prevalence of SGA and LGA differed depending on the chart used. Increased risk of SGA was observed when using the UK-WHO and customised charts as opposed to the ethnic-specific chart, while the opposite was apparent when classifying LGA infants. However, the predictive utility of all three charts to identify adverse clinical outcomes was poor, with only the prediction of shoulder dystocia achieving an AUROC>0.62 on all three charts. Conclusions Despite being recommended in national clinical guidelines, the UK-WHO and customised birth weight charts perform poorly at identifying infants at risk of adverse neonatal outcomes. Being small or large may increase the risk of an adverse outcome; however, size alone is not sensitive or specific enough with current detection to be useful. However, a significant amount of missing data for some of the outcomes may have limited the power needed to determine true associations. PMID:25783424

CPM and PERT in Library Management.

ERIC Educational Resources Information Center

Main, Linda

1989-01-01

Discusses two techniques of systems analysis--Critical Path Method (CPM) and Program Evaluation Review Techniques (PERT)--and their place in library management. An overview of CPM and PERT charting procedures is provided. (11 references) (Author/MES)

Making strides in women’s mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006–2008)

PubMed Central

Chemali, Zeina N; Borba, Christina PC; Henderson, Tanya E; Tesfaye, Markos

2013-01-01

This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women’s mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services. PMID:23901297

The unsuitability of HTML-based colour charts for estimating animal colours--a comment on Berggren and Merilä (2004).

PubMed

Stevens, Martin; Cuthill, Innes C

2005-08-30

A variety of techniques are used to study the colours of animal signals, including the use of visual matching to colour charts. This paper aims to highlight why they are generally an unsatisfactory tool for the measurement and classification of animal colours and why colour codes based on HTML (really RGB) standards, as advocated in a recent paper, are particularly inappropriate. There are many theoretical arguments against the use of colour charts, not least that human colour vision differs markedly from that of most other animals. However, the focus of this paper is the concern that, even when applied to humans, there is no simple 1:1 mapping from an RGB colour space to the perceived colours in a chart (the results are both printer- and illumination-dependent). We support our criticisms with data from colour matching experiments with humans, involving self-made, printed colour charts. Colour matching experiments with printed charts involving 11 subjects showed that the choices made by individuals were significantly different between charts that had exactly the same RGB values, but were produced from different printers. Furthermore, individual matches tended to vary under different lighting conditions. Spectrophotometry of the colour charts showed that the reflectance spectra of the charts varied greatly between printers and that equal steps in RGB space were often far from equal in terms of reflectance on the printed charts. In addition to outlining theoretical criticisms of the use of colour charts, our empirical results show that: individuals vary in their perception of colours, that different printers produce strikingly different results when reproducing what should be the same chart, and that the characteristics of the light irradiating the surface do affect colour perception. Therefore, we urge great caution in the use of colour charts to study animal colour signals. They should be used only as a last resort and in full knowledge of their limitations, with specially produced charts made to high industry standards.

Airborne Science Program: Observing Platforms for Earth Science Investigations

NASA Technical Reports Server (NTRS)

Mace, Thomas H.

2009-01-01

This slide presentation reviews the Airborne Science Program and the platforms used for conducting investigations for the Earth System Science. Included is a chart that shows some of the aircraft and the operational altitude and the endurance of the aircraft, views of the Dryden Aircraft Operation Facility, and some of the current aircraft that the facility operates, and the varieties of missions that are flown and the type of instrumentation. Also included is a chart showing the attributes of the various aircraft (i.e., duration, weight for a payload, maximum altitude, airspeed and range) for comparison

Orion Launch Abort Vehicle Separation Analysis Using OVERFLOW

NASA Technical Reports Server (NTRS)

Booth, Tom

2010-01-01

This slide presentation reviews the use of OVERFLOW, a flow solver, to analyze the effect of separation for a launch abort vehicle (i.e., Orion capsule) if required. Included in the presentation are views of the geometry, and the Overset grids, listing of the assumptions, the general run strategy, inputs into the Overflow solver, the required computational resources, the results of the convergence study. Charts and graphics are presented to show the results.

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

PubMed

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

2014-12-01

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

A novel decision-making process for tooth retention or extraction.

PubMed

Avila, Gustavo; Galindo-Moreno, Pablo; Soehren, Stephen; Misch, Carl E; Morelli, Thiago; Wang, Hom-Lay

2009-03-01

Implant-supported restorations have become the most popular therapeutic option for professionals and patients for the treatment of total and partial edentulism. When implants are placed in an ideal position, with adequate prosthetic loading and proper maintenance, they can have success rates >90% over 15 years of function. Implants may be considered a better therapeutic alternative than performing more extensive conservative procedures in an attempt to save or maintain a compromised tooth. Inadequate indication for tooth extraction has resulted in the sacrifice of many sound savable teeth. This article presents a chart that can assist clinicians in making the right decision when they are deciding which route to take. Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed. Book sources were also searched. Individual tooth- and patient-related features were thoroughly analyzed, particularly when determining if a tooth should be indicated for extraction. A color-based decision-making chart with six different levels, including several factors, was developed based upon available scientific literature. The rationale for including these factors is provided, and its interpretation is justified with literature support. The decision-making chart provided may serve as a reference guide for dentists when making the decision to save or extract a compromised tooth.

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

PubMed

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

2017-09-22

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

A case study: application of statistical process control tool for determining process capability and sigma level.

PubMed

Chopra, Vikram; Bairagi, Mukesh; Trivedi, P; Nagar, Mona

2012-01-01

Statistical process control is the application of statistical methods to the measurement and analysis of variation process. Various regulatory authorities such as Validation Guidance for Industry (2011), International Conference on Harmonisation ICH Q10 (2009), the Health Canada guidelines (2009), Health Science Authority, Singapore: Guidance for Product Quality Review (2008), and International Organization for Standardization ISO-9000:2005 provide regulatory support for the application of statistical process control for better process control and understanding. In this study risk assessments, normal probability distributions, control charts, and capability charts are employed for selection of critical quality attributes, determination of normal probability distribution, statistical stability, and capability of production processes, respectively. The objective of this study is to determine tablet production process quality in the form of sigma process capability. By interpreting data and graph trends, forecasting of critical quality attributes, sigma process capability, and stability of process were studied. The overall study contributes to an assessment of process at the sigma level with respect to out-of-specification attributes produced. Finally, the study will point to an area where the application of quality improvement and quality risk assessment principles for achievement of six sigma-capable processes is possible. Statistical process control is the most advantageous tool for determination of the quality of any production process. This tool is new for the pharmaceutical tablet production process. In the case of pharmaceutical tablet production processes, the quality control parameters act as quality assessment parameters. Application of risk assessment provides selection of critical quality attributes among quality control parameters. Sequential application of normality distributions, control charts, and capability analyses provides a valid statistical process control study on process. Interpretation of such a study provides information about stability, process variability, changing of trends, and quantification of process ability against defective production. Comparative evaluation of critical quality attributes by Pareto charts provides the least capable and most variable process that is liable for improvement. Statistical process control thus proves to be an important tool for six sigma-capable process development and continuous quality improvement.

SU-E-T-201: Safety-Focused Customization of Treatment Plan Documentation.

PubMed

Schubert, L; Westerly, D; Stuhr, K; Miften, M

2012-06-01

Plan report documentation contains numerous details about the treatment plan, but critical information for patient safety is often presented without special emphasis. This can make it difficult to detect errors from treatment planning and data transfer during the initial chart review. The objective of this work is to improve safety measures in radiation therapy practice by customizing the treatment plan report to emphasize safety-critical information. Commands within the template file from a commercial planning system (Eclipse, Varian Medical Systems) that automatically generates the treatment plan report were reviewed and modified. Safety-critical plan parameters were identified from published risks known to be inherent in the treatment planning process. Risks having medium to high potential impact on patient safety included incorrect patient identifiers, erroneous use of the treatment prescription, and incorrect transfer of beam parameters or consideration of accessories. Specific examples of critical information in the treatment plan report that can be overlooked during a chart review included prescribed dose per fraction and number of fractions, wedge and open field monitor units, presence of beam accessories, and table shifts for patient setup. Critical information was streamlined and concentrated. Patient and plan identification, dose prescription details, and patient positioning couch shift instructions were placed on the first page. Plan information to verify the correct data transfer to the record and verify system was re-organized in an easy to review tabular format and placed in the second page of the customized printout. Placeholders were introduced to indicate both the presence and absence of beam modifiers. Font sizes and spacing were adjusted for clarity, and departmental standards and terminology were introduced to streamline data communication among staff members. Plan reporting documentation has been customized to concentrate and emphasize safety-critical information, which should allow for a more efficient, robust chart review process. © 2012 American Association of Physicists in Medicine.

Education in Neurology Resident Documentation Using Payroll Simulation

PubMed Central

Liang, John W.

2017-01-01

Background Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. Objective To improve the quality of neurology resident documentation through payroll simulation. Methods A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors. Current E/M level, ideal E/M level, and financial loss were calculated by the evaluators. Ideal E/M level was defined as the highest billable level based on the documented problems, alongside a supporting history and examination. We implemented an educational intervention that consisted of a 1-hour didactic lecture, followed by e-mail feedback “paystubs” every 2 weeks detailing the number of patients seen, income generated, income loss, and areas for improvement. Follow-up charts were assessed in a similar fashion over a 16-week postintervention period. Results Ten of 11 residents (91%) participated. Of 214 charts that were reviewed preintervention, 114 (53%) had insufficient documentation to support the ideal E/M level, leading to a financial loss of 24% ($5,800). Inadequate documentation was seen in all 3 components: history (47%), examination (27%), and medical decision making (37%). Underdocumentation did not differ across residency years. Postintervention, underdocumentation was reduced to 14% of 273 visits (P < .001), with a reduction in the financial loss to 6% ($1,880). Conclusions Improved documentation and increased potential reimbursement was attained following a didactic lecture and a 16-week period in which individual, specific feedback to neurology residents was provided. PMID:28439359

Electronic Health Record Tools to Care for At-Risk Older Drivers: A Quality Improvement Project.

PubMed

Casey, Colleen M; Salinas, Katherine; Eckstrom, Elizabeth

2015-06-01

Evaluating driving safety of older adults is an important health topic, but primary care providers (PCP) face multiple barriers in addressing this issue. The study's objectives were to develop an electronic health record (EHR)-based Driving Clinical Support Tool, train PCPs to perform driving assessments utilizing the tool, and systematize documentation of assessment and management of driving safety issues via the tool. The intervention included development of an evidence-based Driving Clinical Support Tool within the EHR, followed by training of internal medicine providers in the tool's content and use. Pre- and postintervention provider surveys and chart review of driving-related patient visits were conducted. Surveys included self-report of preparedness and knowledge to evaluate at-risk older drivers and were analyzed using paired t-test. A chart review of driving-related office visits compared documentation pre- and postintervention including: completeness of appropriate focused history and exam, identification of deficits, patient education, and reporting to appropriate authorities when indicated. Data from 86 providers were analyzed. Pre- and postintervention surveys showed significantly increased self-assessed preparedness (p < .001) and increased driving-related knowledge (p < .001). Postintervention charts showed improved documentation of correct cognitive testing, more referrals/consults, increased patient education about community resources, and appropriate regulatory reporting when deficits were identified. Focused training and an EHR-based clinical support tool improved provider self-reported preparedness and knowledge of how to evaluate at-risk older drivers. The tool improved documentation of driving-related issues and led to improved access to interdisciplinary care coordination. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

Examining the Benefits and Challenges of Using Audience Response Systems: A Review of the Literature

ERIC Educational Resources Information Center

Kay, Robin H.; LeSage, Ann

2009-01-01

Audience response systems (ARSs) permit students to answer electronically displayed multiple choice questions using a remote control device. All responses are instantly presented, in chart form, then reviewed and discussed by the instructor and the class. A brief history of ARSs is offered including a discussion of the 26 labels used to identify…

Evaluation and Improved Use of Fecal Occult Blood Test in the Constipated Child.

PubMed

Kilway, Denise M

2016-01-01

This quality improvement project examined the use of fecal occult blood test in the constipated child in a pediatric gastroenterology outpatient clinic. A retrospective chart review was completed on 100 children seen for an initial visit with the gastroenterology provider. The number of fecal occult blood tests performed and the child's coinciding symptoms were tallied and compared with the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition recommendations. An educational intervention was held with the pediatric gastroenterology providers consisting of a PowerPoint presentation summarizing aims of the quality improvement project and reviewing recommendations for use of fecal occult blood test in the constipated child. Pre- and post-intervention chart review data sets were compared. Results showed a 19.6% decrease in the use of fecal occult blood tests performed during the post-intervention timeframe. However, when used in conjunction with North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition recommendations, the appropriateness of fecal occult blood test use increased by 71.4% in the post-intervention patients. Reviewing the recommendations with gastroenterology providers assisted in optimizing the meaningful use of fecal occult blood test, improving quality and safety of care for children seen in the pediatric gastroenterology outpatient clinic.

Endodontic-related inferior alveolar nerve injuries: A review and a therapeutic flow chart.

PubMed

Castro, R; Guivarc'h, M; Foletti, J M; Catherine, J H; Chossegros, C; Guyot, L

2018-05-03

Inferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. The aim of this article is to review the management of inferior alveolar nerve lesions due to endodontic treatments and to establish a therapeutic flow chart. A review of publications reporting IAN damage related to endodontic treatment over the past 20 years has been conducted, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combines an electronic search of the Pubmed ® and Google Scholar ® databasis. Forty-two full-text articles corresponding to 115 clinical cases have been selected. Two personal clinical cases were additionally reported. IAN lesions due to endodontic treatments require urgent management. Early surgical removal of the excess of endodontic material, in contact with the nerve allows the best recovery prognosis (72h). Beyond this delay, irreversible nervous lesions prevail and a medical symptomatic treatment, most of the time with pregabalin, must be/can be carried out. A delayed surgical procedure shows some good benefits for patients. However, the healing prognosis remains poorly predictable. Copyright © 2018. Published by Elsevier Masson SAS.

Review of Designs for Haptic Data Visualization.

PubMed

Paneels, Sabrina; Roberts, Jonathan C

2010-01-01

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

Reduction and analysis of data collected during the electromagnetic tornado experiment

NASA Technical Reports Server (NTRS)

Davisson, L. D.; Bradbury, J.

1975-01-01

Progress is reviewed on the reduction and analysis of tornado data collected on analog tape. The strip chart recording of 7 tracks from all available analog data for quick look analysis is emphasized.

25 CFR 63.17 - How does an employer determine suitability for employment and efficiency of service?

Code of Federal Regulations, 2013 CFR

2013-04-01

... rights of applicants and employees. Adjudication requires uniform evaluation to ensure fair and... schools; and (3) Review the results of the fingerprint charts maintained by the Federal Bureau of...

Age-related gender differences in reporting ictal fear: analysis of case histories and review of the literature.

PubMed

Chiesa, Valentina; Gardella, Elena; Tassi, Laura; Canger, Raffaele; Lo Russo, Giorgio; Piazzini, Ada; Turner, Katherine; Canevini, Maria Paola

2007-12-01

To determine if there are age or gender-related differences in reporting fear as a symptom of epileptic seizure, all clinical charts of patients evaluated at the "C. Munari - Epilepsy Surgery Center" of Milan from 1990 to June 2005 were analyzed, looking for patients with ictal fear. Among the 2,530 clinical charts examined (1,330 male and 1,200 female), 265 patients were found with ictal fear (100 men, 165 women). The gender difference in reporting ictal fear was not so marked in the pediatric age group (98 girls, 74 boys), whereas in adult patients the difference was significant (158 women, 83 men). Interestingly, more men than women (14:3) had ictal fear during childhood that disappeared during adulthood. The literature review confirmed that ictal fear is significantly more common in women, though there is no gender difference in the pediatric age group.

Incidence and clinical characteristics of interstitial cystitis in the community.

PubMed

Patel, Ronak; Calhoun, Elizabeth A; Meenan, Richard T; O'Keeffe Rosetti, Maureen C; Kimes, Terry; Clemens, J Quentin

2008-08-01

We utilized physician-coded diagnoses and chart reviews to estimate the incidence of interstitial cystitis (IC) in women. A computer search of the Kaiser Permanente database was performed to identify newly coded diagnoses of IC (ICD-9 code 595.1) between May 2002 and May 2005. Chart reviews were performed and patient demographics, diagnosing physicians, and symptom characteristics were recorded. The IC incidence rate was 15 per 100,000 women per year. The mean age of the patients was 51 years (range 31-81 years). The most common presenting symptoms were frequency (70%), dysuria (52%), urgency (50%), suprapubic pain (50%), nocturia (35%), and dyspareunia (13%). Cases diagnosed by primary care physicians had a shorter median symptom duration (9 months) compared with those diagnosed by urologists (1 year) and gynecologists (3 years). IC is an uncommon diagnosis in the community setting, with an incidence rate of 15 per 100,000 women per year.

Educational Intervention Improves Compliance With AAN Guidelines for Return Epilepsy Visits: A Quality Improvement Project.

PubMed

Nelson, Gary R; Filloux, Francis M; Kerr, Lynne M

2016-10-01

In 2011, the American Academy of Neurology (AAN) released guidelines for return seizure visits detailing 8 points that should be addressed during such visits. These guidelines are designed to improve routine follow-up care for epilepsy patients. The authors performed a quality improvement project aimed at increasing compliance with these guidelines after educating providers about them. The authors performed a chart review before and after an intervention which included: education regarding the guidelines, providing materials to remind providers of the guidelines, and templates to facilitate compliance. The authors reviewed charts at 2 and 6 months after the intervention. Significant improvement in documentation of 4 of the 8 measures was observed after this educational intervention. This suggests that simple educational interventions may help providers change practice and can improve compliance with new guidelines while requiring minimal time and resources to implement. © The Author(s) 2016.

Testing Electronic Algorithms to Create Disease Registries in a Safety Net System

PubMed Central

Hanratty, Rebecca; Estacio, Raymond O.; Dickinson, L. Miriam; Chandramouli, Vijayalaxmi; Steiner, John F.; Havranek, Edward P.

2008-01-01

Electronic disease registries are a critical feature of the chronic disease management programs that are used to improve the care of individuals with chronic illnesses. These registries have been developed primarily in managed care settings; use in safety net institutions—organizations whose mission is to serve the uninsured and underserved—has not been described. We sought to assess the feasibility of developing disease registries from electronic data in a safety net institution, focusing on hypertension because of its importance in minority populations. We compared diagnoses obtained from algorithms utilizing electronic data, including laboratory and pharmacy records, against diagnoses derived from chart review. We found good concordance between diagnoses identified from electronic data and those identified by chart review, suggesting that registries of patients with chronic diseases can be developed outside the setting of closed panel managed care organizations. PMID:18469416

Intrathecal Baclofen Dosing Regimens: A Retrospective Chart Review.

PubMed

Clearfield, Jacob S; Nelson, Mary Elizabeth S; McGuire, John; Rein, Lisa E; Tarima, Sergey

2016-08-01

To examine dosing patterns in patients receiving baclofen via intrathecal baclofen pumps to assess for common patterns by diagnosis, ambulation ability, and affected limbs distribution. This trial study included 25 patients with baclofen pumps selected from the 356 patients enrolled in our center's baclofen pump program. Selection was done by splitting all patients into diagnostic categories of stroke, multiple sclerosis, traumatic/anoxic brain injury, cerebral palsy, and spinal cord injury, and then, five patients were randomly selected from each diagnosis.A systematic chart review was then conducted for each patient from Jan 1, 2008, through September 16, 2013, to look at factors including mean daily dose at end of study, and among those implanted during the study mean initial stable dose and time to initial stable dose. Analysis of mean daily dose across diagnoses found significant differences, with brain injury, cerebral palsy, and spinal cord injury patients having higher doses while multiple sclerosis and stroke patients required lower doses. Nonambulatory patients strongly trended to have higher daily doses than ambulatory patients. Similar trends of mean initial stable dose being higher in a similar pattern as that of end mean daily dose were seen according to diagnoses and ambulatory status, although statistical significance could not be achieved with the small sample size. Significant differences in dosing were found between diagnoses and trended to differ by ambulatory status at the end of the study, and similar trends could be observed in achieving initial stable dose. © 2015 International Neuromodulation Society.

Management of BB shot wounds to the heart.

PubMed

Thompson, E C; Block, E F; Mancini, M C

1996-01-01

The aim of this study was to review our experience with BB shot injuries to the heart. This is a retrospective chart review. Three patients were found to have BB injuries to the heart. All patients were stable upon presentation. Echocardiography localized the BB pellets to the muscular septum. All patients were treated with nonoperative therapy. There was not mortality. One patient developed an interventricular conduction delay that resolved before discharge. Nonoperative management of stable patients who present with BB wounds to the heart is safe and effective if the BB is intramuscular. An echocardiogram should be used to localize the pellets and evaluate the pericardium.

Munchausen by proxy: a case, chart series, and literature review of older victims.

PubMed

Awadallah, Nida; Vaughan, Aaron; Franco, Kathleen; Munir, Farah; Sharaby, Na'ama; Goldfarb, Johanna

2005-08-01

The history of an older child victim of Munchausen by proxy (MBP) is described. He was referred for evaluation after repeated sinus surgeries for recurrent sinus infections believed to be related to a falsified history of an immunodeficiency. The perpetrator was the mother of this 14-year-old victim, consistent with the majority of such cases. This case prompted a review of cases of MBP in older children reported in our hospital as well as a literature search for other cases in older children. This study was a chart review of children over 6 years of age who had been evaluated by social services at the Children's Hospital at the Cleveland Clinic and reported as cases of Munchausen by proxy to Child Protective Services between January 2001 and June 2003. Also, an OVID, Psychline, and Pubmed literature review of published cases of Munchausen by proxy were identified, and cases occurring in the older child were selected for review. Older children who are the victims of Munchausen by proxy may have an induced illness, but falsified reports of symptoms and medical history to coerce the child to undergo medical procedures may be more common. Collusion of the victim with the perpetrator may also become a factor as the child ages and adopts the deception. Given the complex relationship that exists between the parent and child, it is difficult to predict whether the victim either will assist the caregiver in maintaining the factitious illness or be able to recognize the falsification. Older children who are the victims of Munchausen by proxy may fear consequences of revealing the factitious illness. Physicians must consider the possibility of this diagnosis whenever there are discrepancies in a child's illness that makes a factitious illness a consideration.

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

PubMed

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

2010-01-01

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

Quality of life of persons with severe mental illness living in an intermediate care facility.

PubMed

Anderson, R L; Lewis, D A

2000-04-01

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.

Maternal bacteremia and the Irish maternity early warning system.

PubMed

Maguire, Patrick J; O'Higgins, Amy C; Power, Karen A; Daly, Niamh; McKeating, Aoife; Turner, Michael J

2015-05-01

To assess whether introduction of the Irish maternity early warning system (IMEWS) in 2013 has improved the recording of vital signs among women with proven maternal bacteremia. In a mixed retrospective and prospective study at a single center in Dublin, Ireland, the patient records of all cases of maternal bacteremia between January 1, 2009, and March 31, 2014, were reviewed. The IMEWS chart was applied retrospectively to records of vital signs from January 2009 to March 2013, and prospectively from April 2013 to March 2014. For the 61 cases from the period before IMEWS introduction, vital signs were recorded inconsistently on multiple pages. The frequency of recordings was not standardized. Respiratory rate, in particular, was under-recorded. Among the 17 cases between April 2013 and March 2014 that were eligible for IMEWS chart use, 14 women had vital signs recorded on an IMEWS chart. As compared with the period before IMEWS introduction, there was an improvement in respiratory rate recording as part of the first set of observations. Among pregnant women with proven bacteremia, introduction of IMEWS has been associated with an improvement in the recording of vital signs, particularly respiratory rate. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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

Brewer, M; Gordon, C; Tien, C

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

Increasing Communication in Geometry by Using a Personal Math Concept Chart

ERIC Educational Resources Information Center

Friedman, Rhonda; Kazerouni, Gety; Lax, Stacey; Weisdorf, Elli

2011-01-01

The action research team developed a "Personal Math Concept Chart". This chart required students to describe the mathematical concepts that they were studying in the Geometry strand of Mathematics using their own images and words. In this study, students were encouraged to express their own understanding of geometric concepts in order to…

A global perspective of the roles of the pharmacist in the NICU.

PubMed

Krzyzaniak, Natalia; Bajorek, Beata

2017-04-01

To describe pharmacist practice and roles performed in the neonatal intensive care unit (NICU) worldwide and to map these findings along the medicines management pathway (MMP). Quasi-systematic review. Google Scholar, Medline/PubMed and Embase were searched utilising the selected MeSH terms. Thirty sources of information were reviewed. Overall, pharmacist practice in the NICU involves a wide-range of roles, with the most commonly reported involving patient medication chart review, therapeutic drug monitoring and the provision of medication information. Studies highlight that pharmacist contribution to total parenteral nutrition (TPN) regimens and patient medication chart review is beneficial to patient outcomes. Roles beyond the regular scope of practice included involvement in immunisation programmes and research. Most of the data were collected from the USA (13 of 30), followed by the UK (6 of 30) and reports from other countries. The American, British, South African and Australian articles have reported very similar roles, with a pharmacist firmly integrated into the overall structure of the NICU team. The literature identifies that there is insufficient evidence to describe what roles are currently performed in NICUs worldwide. This is due to the lack of recently published articles leading to a large gap in knowledge in understanding what contemporary pharmaceutical services in the NICU comprise. Further research is required to address these gaps in knowledge, and identify the impact of the pharmacist's role on neonatal patient outcomes as well as to determine how to better resource NICUs to access pharmacy services. © 2016 Royal Pharmaceutical Society.

Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children.

PubMed

Khadilkar, Vaman; Yadav, Sangeeta; Agrawal, K K; Tamboli, Suchit; Banerjee, Monidipa; Cherian, Alice; Goyal, Jagdish P; Khadilkar, Anuradha; Kumaravel, V; Mohan, V; Narayanappa, D; Ray, I; Yewale, Vijay

2015-01-01

The need to revise Indian Academy of Pediatrics (IAP) growth charts for 5- to 18-year-old Indian children and adolescents was felt as India is in nutrition transition and previous IAP charts are based on data which are over two decades old. The Growth Chart Committee was formed by IAP in January 2014 to design revised growth charts. Consultative meeting was held in November 2014 in Mumbai. Studies performed on Indian children's growth, nutritional assessment and anthropometry from upper and middle socioeconomic classes in last decade were identified. Committee contacted 13 study groups; total number of children in the age group of 5 to 18 years were 87022 (54086 boys). Data from fourteen cities (Agartala, Ahmadabad, Chandigarh, Chennai, Delhi, Hyderabad, Kochi, Kolkata, Madurai, Mumbai, Mysore, Pune, Raipur and Surat) in India were collated. Data of children with weight for height Z scores >2 SD were removed from analyses. Data on 33148 children (18170 males, 14978 females) were used to construct growth charts using Cole's LMS method. To construct revised IAP growth charts for 5-18 year old Indian children based on collated national data from published studies performed on apparently healthy children and adolescents in the last 10 years. The IAP growth chart committee recommends these revised growth charts for height, weight and body mass index (BMI) for assessment of growth of 5-18 year old Indian children to replace the previous IAP charts; rest of the recommendations for monitoring height and weight remain as per the IAP guidelines published in 2007. To define overweight and obesity in children from 5-18 years of age, adult equivalent of 23 and 27 cut-offs presented in BMI charts may be used. IAP recommends use of WHO standards for growth assessment of children below 5 years of age.

Effect of a Reminder Statement on Echocardiography Reports on Referrals for Implantable Cardioverter-Defibrillators for Primary Prevention.

PubMed

Chokshi, Moulin; McNamara, Robert L; Rajeswaran, Yasotha; Lampert, Rachel

2017-02-01

Numerous trials show the benefit of implantable cardioverter-defibrillators (ICDs) for primary prevention in patients with low ejection fraction (EF), a class I indication. However, underutilization is well documented. We retrospectively reviewed charts to see whether placing a reminder statement into echocardiogram reports for appropriate patients increased adherence to guidelines. From January through June 2013, a brief reminder of the ICD guidelines was automatically inserted into echocardiogram reports with EF ≤ 35% (reminder period). Charts were reviewed to determine if these patients (1) were referred to Electrophysiology (EP) within 6 months of the index echo and (2) received an ICD within 6 months of EP referral. Chart review of all patients who had an echocardiogram performed between March and August 2012 with an EF ≤ 35% provided a control period. More patients were referred to EP in the reminder period compared with control period, 68% (54 of 80) versus 51% (53 of 104), p = 0.03. There was also a higher rate of discussions in the reminder period between patients and physicians about ICD therapy (71% vs 54%, p = 0.02). Among patients appropriate for ICD, 52% of patients during the reminder period received an ICD versus 38% of patients during the control period (p = 0.11). A simple reminder statement on echocardiography reports led to a significant improvement in appropriate EP referrals and a trend toward increased ICD implantation in appropriate patients. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2013-03-01

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

The scope and value of an anticoagulation stewardship program at a community teaching hospital.

PubMed

Wychowski, Maura K; Ruscio, Christina I; Kouides, Peter A; Sham, Ronald L

2017-04-01

To report the impact of an inpatient anticoagulation stewardship program at a community hospital to promote optimal anticoagulant use. The anticoagulation team (ACT) stewardship program consists of two clinical pharmacists and hematologists to provide oversight of anticoagulants, high cost reversal agents including prothrombin complex concentrate (PCC, Kcentra™), and heparin-induced thrombocytopenia (HIT) management. Intervention data and number of charts reviewed were collected. Average cost avoidance data was applied to ACT interventions to estimate cost savings. The PCC analysis was conducted via retrospective chart review during the pre-intervention period. Prospective monitoring continued in the post-intervention period to determine the percentage of PCC use within the institution's guidelines or approved by ACT or hematology. A total of 19,445 patient charts were reviewed, and 1930 (10%) contained stewardship opportunity. Of the interventions, 71% were provided to the medical service and 22% to surgical services with acceptance rates of 91 and 83%, respectively. Intervention cost-avoidance calculated to be $694,217. Regarding HIT interventions, 52% of interventions involved pharmacokinetic/pharmacodynamics optimization in 18 patients with suspected or confirmed HIT. Regarding PCC use, 55.8% of PCC orders were considered inappropriate in the pre-invention period versus 2.6% post-intervention. Appropriate PCC doses per month post-intervention were consistent with pre-intervention doses (7.67 vs. 6.73, respectively). The projected annual PCC cost savings is $385,473. The overall estimated financial impact of ACT is $799,690 saved. Implementation of an anticoagulation stewardship program reduced costs and improved clinical outcomes. It is also expected that anticoagulant optimization and provider education improved overall safety.

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

PubMed

Anhøj, Jacob; Olesen, Anne Vingaard

2014-01-01

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

Head circumference during infancy in a birth cohort of Sri Lankan children: are we using the correct chart?

PubMed

Perera, P J; Fernando, M P; Samaranayake, R

2014-12-01

Measuring head circumference and plotting it in centile charts is a routine practice in paediatrics. However if wrong charts are used, serious misinterpretations can ensue. This study was carried out to ascertain the appropriateness of charts used in Sri Lanka. Out of a birth cohort of 2215 children, 250 from each sex were invited for a follow up study. Head circumference was measured at 2, 4, 6, 9 and 12 months. Statistical characteristics of head circumference for each sex, at each age were calculated. At the first follow up 244 boys and 241 girls were assessed. Out of this, 85% of boys and 86% of girls completed the follow up. Head circumference of both sexes deviated significantly at all ages from the charts available in the Child Health Developmental Record (CHDR). Head circumference charts available in the CHDR are inappropriate for use in Sri Lankan children.

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

PubMed

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

2017-08-17

To examine the development and implementation of a novel income security intervention in primary care. A retrospective, descriptive chart review of all patients referred to the Income Security Heath Promotion service during the first year of the service (December 2013-December 2014). A multisite interdisciplinary primary care organisation in inner city Toronto, Canada, serving over 40 000 patients. The study population included 181 patients (53% female, mean age 48 years) who were referred to the Income Security Health Promotion service and engaged in care. The Income Security Health Promotion service consists of a trained health promoter who provides a mixture of expert advice and case management to patients to improve income security. An advisory group, made up of physicians, social workers, a community engagement specialist and a clinical manager, supports the service. Sociodemographic information, health status, referral information and encounter details were collected from patient charts. Encounters focused on helping patients with increasing their income (77.4%), reducing their expenses (58.6%) and improving their financial literacy (26.5%). The health promoter provided an array of services to patients, including assistance with taxes, connecting to community services, budgeting and accessing free services. The service could be improved with more specific goal setting, better links to other members of the healthcare team and implementing routine follow-up with each patient after discharge. Income Security Health Promotion is a novel service within primary care to assist vulnerable patients with a key social determinant of health. This study is a preliminary look at understanding the functioning of the service. Future research will examine the impact of the Income Security Health Promotion service on income security, financial literacy, engagement with health services and health outcomes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Documentation of pain care processes does not accurately reflect pain management delivered in primary care.

PubMed

Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris

2010-03-01

Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately reflect the pain management patients receive in primary care.

Characteristics of patients with spondyloarthritis followed in rheumatology units in Spain. emAR II study.

PubMed

Casals-Sánchez, José Luis; García De Yébenes Prous, María Jesús; Descalzo Gallego, Miguel Ángel; Barrio Olmos, Juan Manuel; Carmona Ortells, Loreto; Hernández García, Cesar

2012-01-01

To describe the main demographic and clinical features of patients with spondyloarthropaties in Spain. Review of randomized clinical charts of patients with spondyloarthropaties with at least one visit to the rheumatologist in the previous two years. Information was collected on demographic and clinical data (duration of illness, diagnostic category, disease activity, extrarticular manifestations, comorbidity and work disability). 1,168 patients were included in the study. Their median age was 49.2 years (39.7-60.5), 68.0% were males, and median time of disease was 105.1 month (48.4-192.5). The diagnoses and clinical data such as the BASDAI were reported only in 34,0% of the patients. The most widely used measure of metrology, the Schober test, was missing in 37.7% of the clinical charts. The patients included had the following diagnoses: Ankylosing spondylitis (n = 629, 55.2%), Psoriatic arthritis (n= 253, 22.2%), Undifferentiated spondyloarthritis (n = 184, 16.1%), Arthritis associated to Inflammatory bowel disease (n= 50, 4.4%), and Reactive arthritis (n= 16, 1.4%). The most common extraarticular manifestations were psoriasis (20.8%), anterior uveitis (19.4%), and enthesitis (16.9%). Some kind of work disability was reported in 8.3% of the patients. Demographic and clinical characteristics of patients with spondyloarthropaties in Spain do not differ as a whole from other published studies, except for Undifferentiated Spondyloarthritis, which was more likely in our patients than in other studies. The quality of the records of activity in the clinical charts could be improved. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Prescribed targets for titration of vasopressors in septic shock: a retrospective cohort study

PubMed Central

St-Arnaud, Charles; Éthier, Jean-François; Hamielec, Cindy; Bersten, Andrew; Guyatt, Gordon; Meade, Maureen; Zhou, Qi; Leclair, Marc-André; Patel, Alpesh

2013-01-01

Background Without robust clinical evidence to guide titration of vasopressors in septic shock, it is unclear how dosing of these potent medications occurs. We sought to measure the proportion of vasopressor prescriptions for septic shock that were missing explicit targets and to describe the targets that we identified. Methods We conducted a multicentre, retrospective cohort study involving 9 intensive care units (ICUs) located at 3 academic hospitals in Canada and Australia. We reviewed charts of consecutive patients aged 18 years or older who were admitted to the ICU for a presumptive diagnosis of sepsis. Other inclusion criteria were hypotension (systolic arterial pressure ≤ 90 mm Hg or mean arterial pressure [MAP] ≤ 65 mm Hg) and continuous infusion of vasopressors for at least 1 hour within the initial 48 hours of ICU stay, the period of observation for this study. Results We included data from 369 patient charts. At least 1 target was specified in 99% of charts. The most common targets were MAP measurements (73%). The median initial MAP target was 65 (range 55–90) mm Hg. In multivariable regression models, hospital site and older age of the patient, but not comorbidities of the patient, were associated with MAP targets. In 40% of patients, the treating team modified the initial target at least once. Interpretation This study suggests that an explicit blood pressure target accompanies nearly every vasopressor prescription and that patient characteristics have little influence on its value. Identification of a titration strategy that will maximize benefit and minimize harm constitutes a research priority. PMID:25077114

The Effects of Postoperative Intralesional Corticosteroids in the Prevention of Recurrent Earlobe Keloids: A Multispecialty Retrospective Review.

PubMed

Gold, Daniel A; Sheinin, Renee; Jacobsen, Gordon; Jones, Lamont R; Ozog, David M

2018-06-01

Effective treatment of keloids is challenging because the recurrence rate after surgical excision is high. Data on the best treatment practices are lacking. To investigate the recurrence rate after surgical excision of earlobe keloids based on a postoperative intralesional corticosteroid injection protocol. Retrospective chart review was performed from January 1, 2005, to March 31, 2016, of patients who had excision of ear keloids within the departments of dermatology, otorhinolaryngology, and plastic surgery. The number of postoperative injections was recorded, recurrence was reported by the patient, and the efficacy of an injection protocol was evaluated. There were 277 charts reviewed. Appropriate data were available for 184 patients. A statistically significant difference was found with recurrence associated with a lower number of injections (p < .001). Keloids were more likely to recur if they were not treated with a planned serial injection protocol (p < .001) or if they were treated outside the department of dermatology (p < .001). Intralesional corticosteroid injection after surgical excision of earlobe keloids statistically minimizes the risk of recurrence.

Growth Charts for Children With Down Syndrome in the United States.

PubMed

Zemel, Babette S; Pipan, Mary; Stallings, Virginia A; Hall, Waynitra; Schadt, Kim; Freedman, David S; Thorpe, Phoebe

2015-11-01

Children with Down syndrome (DS) have lower birth weights and grow more slowly than children without DS. Advances in and increased access to medical care have improved the health and well-being of individuals with DS; however, it is unknown whether their growth has also improved. Our objective was to develop new growth charts for children with DS and compare them to older charts from the United States and more contemporary charts from the United Kingdom. The Down Syndrome Growing Up Study (DSGS) enrolled a convenience sample of children with DS up to 20 years of age and followed them longitudinally. Growth parameters were measured by research anthropometrists. Sex-specific growth charts were generated for the age ranges birth to 36 months and 2 to 20 years using the LMS method. Weight-for-length and BMI charts were also generated. Comparisons with other curves were presented graphically. New DSGS growth charts were developed by using 1520 measurements on 637 participants. DSGS growth charts for children <36 months of age showed marked improvements in weight compared with older US charts. DSGS charts for 2- to 20-year-olds showed that contemporary males are taller than previous charts showed. Generally, the DSGS growth charts are similar to the UK charts. The DSGS growth charts can be used as screening tools to assess growth and nutritional status and to provide indications of how growth of an individual child compares with peers of the same age and sex with DS. Copyright © 2015 by the American Academy of Pediatrics.

Growth Charts for Children With Down Syndrome in the United States

PubMed Central

Zemel, Babette S.; Pipan, Mary; Stallings, Virginia A.; Hall, Waynitra; Schadt, Kim; Freedman, David S.; Thorpe, Phoebe

2017-01-01

BACKGROUND AND OBJECTIVES Children with Down syndrome (DS) have lower birth weights and grow more slowly than children without DS. Advances in and increased access to medical care have improved the health and well-being of individuals with DS; however, it is unknown whether their growth has also improved. Our objective was to develop new growth charts for children with DS and compare them to older charts from the United States and more contemporary charts from the United Kingdom. METHODS The Down Syndrome Growing Up Study (DSGS) enrolled a convenience sample of children with DS up to 20 years of age and followed them longitudinally. Growth parameters were measured by research anthropometrists. Sex-specific growth charts were generated for the age ranges birth to 36 months and 2 to 20 years using the LMS method. Weight-for-length and BMI charts were also generated. Comparisons with other curves were presented graphically. RESULTS New DSGS growth charts were developed by using 1520 measurements on 637 participants. DSGS growth charts for children <36 months of age showed marked improvements in weight compared with older US charts. DSGS charts for 2- to 20-year-olds showed that contemporary males are taller than previous charts showed. Generally, the DSGS growth charts are similar to the UK charts. CONCLUSIONS The DSGS growth charts can be used as screening tools to assess growth and nutritional status and to provide indications of how growth of an individual child compares with peers of the same age and sex with DS. PMID:26504127

Construction and validation of logMAR visual acuity charts in seven Indian languages.

PubMed

Negiloni, Kalpa; Mazumdar, Deepmala; Neog, Aditya; Das, Biman; Medhi, Jnanankar; Choudhury, Mitalee; George, Ronnie Jacob; Ramani, Krishna Kumar

2018-05-01

The evaluation of visual impairment requires the measurement of visual acuity with a validated and standard logMAR visual acuity chart. We aimed to construct and validate new logMAR visual acuity chart in Indian languages (Hindi, Bengali, Telugu, Urdu, Kannada, Malayalam, and Assamese). The commonly used font in each language was chosen as the reference and designed to fit the 5 × 5 grid (Adobe Photoshop). Ten letters (easiest to difficult) around median legibility score calculated for each language based on the results of legibility experiment and differing by 10% were selected. The chart was constructed based on the standard recommendations. The repeatability of charts was tested and also compared with a standard English Early Treatment Diabetic Retinopathy Study (ETDRS) logMAR chart for validation. A total of 14 rows (1.0 to -0.3 logMAR) with five letters in each line were designed with the range of row legibility between 4.7 and 5.3 for all the language charts. Each chart showed good repeatability, and a maximum difference of four letters was noted. The median difference in visual acuity was 0.16 logMAR for Urdu and Assamese chart compared to ETDRS English chart. Hindi and Malayalam chart had a median difference of 0.12 logMAR. When compared to the English chart a median difference of 0.14 logMAR was noted in Telugu, Kannada, and Bengali chart. The newly developed Indian language visual acuity charts are designed based on the standard recommendations and will help to assess visual impairment in people of these languages across the country.

15 CFR 732.3 - Steps regarding the ten general prohibitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Country Chart does not apply to Cuba, Iran, North Korea, and Syria. For those countries you should review... destination for any item is Cuba, Iran, Iraq, North Korea, Rwanda, or Syria you must consider the requirements...

The unsuitability of html-based colour charts for estimating animal colours – a comment on Berggren and Merilä (2004)

PubMed Central

Stevens, Martin; Cuthill, Innes C

2005-01-01

Background A variety of techniques are used to study the colours of animal signals, including the use of visual matching to colour charts. This paper aims to highlight why they are generally an unsatisfactory tool for the measurement and classification of animal colours and why colour codes based on HTML (really RGB) standards, as advocated in a recent paper, are particularly inappropriate. There are many theoretical arguments against the use of colour charts, not least that human colour vision differs markedly from that of most other animals. However, the focus of this paper is the concern that, even when applied to humans, there is no simple 1:1 mapping from an RGB colour space to the perceived colours in a chart (the results are both printer- and illumination-dependent). We support our criticisms with data from colour matching experiments with humans, involving self-made, printed colour charts. Results Colour matching experiments with printed charts involving 11 subjects showed that the choices made by individuals were significantly different between charts that had exactly the same RGB values, but were produced from different printers. Furthermore, individual matches tended to vary under different lighting conditions. Spectrophotometry of the colour charts showed that the reflectance spectra of the charts varied greatly between printers and that equal steps in RGB space were often far from equal in terms of reflectance on the printed charts. Conclusion In addition to outlining theoretical criticisms of the use of colour charts, our empirical results show that: individuals vary in their perception of colours, that different printers produce strikingly different results when reproducing what should be the same chart, and that the characteristics of the light irradiating the surface do affect colour perception. Therefore, we urge great caution in the use of colour charts to study animal colour signals. They should be used only as a last resort and in full knowledge of their limitations, with specially produced charts made to high industry standards. PMID:16131394

Effect of Home Exercise Program Performance in Patients with Osteoarthritis of the Knee or the Spine on the Visual Analog Scale after Discharge from Physical Therapy

ERIC Educational Resources Information Center

Chen, Hamilton; Onishi, Kentaro

2012-01-01

The aim of our study was to assess the effect of the frequency of home exercise program (HEP) performance on pain [10-point visual analog scale (VAS)] in patients with osteoarthritis of the spine or knee after more than 6 months discharge from physical therapy (PT). We performed a retrospective chart review of 48 adult patients with a clinical…

Incidence of kidney stones with topiramate treatment in pediatric patients.

PubMed

Mahmoud, Adel A H; Rizk, Tamer; El-Bakri, Nahid K; Riaz, Muhammad; Dannawi, Samer; Al Tannir, Mohamad

2011-10-01

We ran this study to assess the incidence of nephrolithiasis in a group of children on topiramate (TPM) therapy for at least 1 year. In this retrospective observational surveillance study, we reviewed the medical charts of children on TPM for at least 1 year seen at the pediatric neurology department during the period from 2005 to 2010 at King Fahad Medical City. Children with a normal baseline ultrasound report were included. Follow-up ultrasound reports after at least 1 year were collected. However, patients with any evidence of chronic illness or medications that may affect the kidney functions in addition to those who are not compliant with the prescribed dose were excluded. Family history of renal stones, symptoms suggestive of urologic disorders, and comorbidities were recorded. Medical charts of 96 children on TPM with a mean age of 6.9 (±3.8) years were reviewed; 52 (54.2%) of the children were male. The follow-up ultrasound showed that five children (5.2%) had developed kidney stones. The occurrence of kidney stones was found in four female patients (80%) versus one male (20%) (p > 0.05). Long-term use of TPM may result in increased incidence of asymptomatic kidney stones in the pediatric population. Hence, routine baseline and follow-up ultrasound of the urinary system should be recommended during the use of TPM in children. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

Clinical utility of transthoracic two-dimensional and Doppler echocardiography.

PubMed

Krumholz, H M; Douglas, P S; Goldman, L; Waksmonski, C

1994-07-01

The purpose of this study was to determine the value of contemporary echocardiography for patient diagnosis and management in clinical practice. Although the use of echocardiography is growing rapidly, there is little information about its clinical utility. A prospective observational study was performed at a community-based, tertiary care teaching hospital. Physicians were interviewed before and after learning the result of their patients' echocardiographic examination. Chart reviews were performed to confirm reports of new diagnoses and treatments that resulted from echocardiography. Physician interviews were successfully completed for 244 (49%) of 497 inpatients and 101 (30%) of 336 outpatients. Among patients with moderate or greater mitral regurgitation, the diagnosis of "clinically significant" mitral regurgitation was unsuspected in 5 (31%) of 16 outpatients and 28 (60%) of 47 inpatients. Among the patients with left ventricular wall motion abnormalities, the result was unsuspected in 7 (50%) of 14 outpatients and 18 (22%) of 81 inpatients. As assessed by chart review, echocardiography produced a definite new diagnosis in 25 inpatients (10%) and 5 outpatients (5%) and was responsible for changes in pharmacologic treatment in at least 16 inpatients (7%) and 2 outpatients (2%). The echocardiogram commonly provided information that was unexpected. This information provided a definite new diagnosis or treatment in a smaller proportion of the patients. Further research is necessary to define the appropriate yield that would warrant echocardiography on the basis of both clinical and cost-effectiveness criteria.

How global MS prevalence is changing: A retrospective chart review in the United Arab Emirates.

PubMed

Schiess, Nicoline; Huether, Katherine; Fatafta, Taghreed; Fitzgerald, Kathryn C; Calabresi, Peter A; Blair, Iain; Alsaadi, Taoufik; Szolics, Miklos

2016-09-01

Multiple Sclerosis (MS) is an autoimmune disorder leading to central nervous system inflammation. Traditionally, reported MS prevalence rates in the Middle East are low. Few studies include age/sex standardization giving an unreliable estimate of regional prevalence. to determine the prevalence, incidence and characteristics of MS in Abu Dhabi, United Arab Emirates. A retrospective chart review was conducted at the four largest hospitals in Abu Dhabi Emirate between 2010 and 2014. Data collected included MS type, age and symptoms at onset, expanded disability status scale, treatment, laboratory findings and family history. 510 patients were identified consisting of 318 (62.2%) Emiratis and 192 (37.6%) expatriates. Total crude prevalence rate was 18/100,000 (95% CI: 10-30/100,000). Crude prevalence rate in Emiratis was 57.09 (95% CI:50 to 63/100,000) but increased to 64.44 (95% CI: 57 to 72/100,000) when age standardized. Age-standardized incidence rate in Emiratis was 6.0 MS cases per 100,000 person-years (95% CI: 5.5 to 6.5 cases per 100,000 person-years). At 64.44/100,000, the Abu Dhabi Emirati population has one of the highest, most reliable prevalence rate on the Arab peninsula. Age/sex standardized prevalence rates, uncommonly reported in the Middle East, should be standard for all prevalence studies. Copyright © 2016 Elsevier B.V. All rights reserved.

The rate of epinephrine administration associated with allergy skin testing in a suburban allergy practice from 1997 to 2010.

PubMed

Swender, David A; Chernin, Leah R; Mitchell, Chris; Sher, Theodore; Hostoffer, Robert; Tcheurekdjian, Haig

2012-01-01

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT.

The rate of epinephrine administration associated with allergy skin testing in a suburban allergy practice from 1997 to 2010

PubMed Central

Chernin, Leah R.; Mitchell, Chris; Sher, Theodore; Hostoffer, Robert; Tcheurekdjian, Haig

2012-01-01

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT. PMID:23342290

Domestic violence screening in pregnancy.

PubMed

Bunn, Mikiko Yazawa; Higa, Nicole A; Parker, Willie J; Kaneshiro, Bliss

2009-11-01

Domestic violence is an important health concern that has been shown to have adverse effects on maternal and neonatal outcomes. The objectives of this study were to compare the prevalence of prenatal screening for domestic violence in a hospital-based resident clinic setting with screening practices in private obstetric offices in Honolulu, Hawai'i and to explore physician attitudes towards domestic violence screening during pregnancy. A retrospective chart review was conducted at Queen's Medical Center in Honolulu, Hawai'i in women who delivered between 2003 and 2004. A 6 item written survey was also given to all attending and resident physicians with obstetric privileges. Descriptive statistics including frequency measures were generated and chi square tests were used to compare categorical variables. A total of 270 charts were reviewed. There was a statistically significant difference (p < 0.01) between the number of antepartum patients from the resident clinic (2.4 percent) and antepartum patients from private obstetric practices (39.3 percent) that were screened for domestic violence. While the majority of respondents (77.6%) to the domestic violence survey were aware that the American College of Obstetricians and Gynecologists recommends domestic violence screening in pregnancy most respondents (69.0 percent) indicated that they "never or rarely" screened their patients for domestic violence. Despite professional recommendations and an awareness of these recommendations, between 2003 and 2004, routine prenatal screening for domestic violence was markedly lacking for patients in this study population.

Evaluation of prototype air carrier instrument approach procedure charts.

DOT National Transportation Integrated Search

1995-07-31

The objective of this study was to evaluate the design features of two prototype Instrument Approach Procedure (IAP) charts. The John A. Volpe National Transportation System's Center in cooperation with the Air Transport Association's Chart and Data ...

Evaluation of prototype air carrier instrument approach procedure charts

DOT National Transportation Integrated Search

1995-07-01

The objective of this study was to evaluate the design features of two prototype Instrument Approach Procedure (IAP) charts. The John A. Volpe National Transportation Systems Center in cooperation with the Air Transport Association's Chart and Data D...

Charts for Estimating Tail-rotor Contribution to Helicopter Directional Stability and Control in Low-Speed Flight

NASA Technical Reports Server (NTRS)

Amer, Kenneth B; Gessow, Alfred

1955-01-01

Theoretically derived charts and equations are presented by which tail-rotor design studies of directional trim and control response at low forward speed can be conveniently made. The charts can also be used to obtain the main-rotor stability derivatives of thrust with respect to collective pitch and angle of attack at low forward speeds. The use of the charts and equations for tail-rotor design studies is illustrated. Comparisons between theoretical and experimental results are presented. The charts indicate, and flight tests confirm, that the region of vortex roughness which is familiar for the main rotor is also encountered by the tail rotor and that prolonged operation at the corresponding flight conditions would be difficult.

Intracranial incidental findings on brain MR images in a pediatric neurology practice: a retrospective study.

PubMed

Gupta, Surya N; Belay, Brook

2008-01-15

Previous studies have addressed the prevalence of incidental findings largely in healthy adult and pediatric populations. Our study aims to elucidate the prevalence of incidental findings in a pediatric neurology practice. We reviewed the charts of 1618 patients seen at a pediatric neurology practice at a tertiary care center from September 2003 to December 2005 for clinical data and incidental intracranial findings on brain magnetic resonance imaging reports. Incidental findings were divided into two categories: normal or abnormal variants. Clinical and demographic data were assessed for associations with incidental findings. From 1618 charts reviewed, only 666 patients (41% of all patients) had brain MRIs ordered. One-hundred and seventy-one (171) patients (25.7% of all patients; 95% CI: 22.6, 29.0) had incidental findings. Of these, 113 (17.0%; 95% CI: 14.1, 19.8) were classified as normal-variants and 58 (8.7%; 95% CI: 6.6, 10.9) were classified as abnormal. The nature of incidental findings was not related to age group, sex or clinical diagnosis (p=0.29, p=0.31 and p=0.69 respectively). Two patients (0.3%; 95% CI: approximately 0.0, 0.7) required neurosurgical referral. We report a high prevalence of and a low rate of referrals for incidental findings in comparison to previous studies. The present study may help guide management decisions and discussions with patients and families. Future studies should attempt to address issues of associations between primary or secondary diagnoses and intracranial incidental findings in a controlled, prospective fashion.

Accuracy and generalizability of using automated methods for identifying adverse events from electronic health record data: a validation study protocol.

PubMed

Rochefort, Christian M; Buckeridge, David L; Tanguay, Andréanne; Biron, Alain; D'Aragon, Frédérick; Wang, Shengrui; Gallix, Benoit; Valiquette, Louis; Audet, Li-Anne; Lee, Todd C; Jayaraman, Dev; Petrucci, Bruno; Lefebvre, Patricia

2017-02-16

Adverse events (AEs) in acute care hospitals are frequent and associated with significant morbidity, mortality, and costs. Measuring AEs is necessary for quality improvement and benchmarking purposes, but current detection methods lack in accuracy, efficiency, and generalizability. The growing availability of electronic health records (EHR) and the development of natural language processing techniques for encoding narrative data offer an opportunity to develop potentially better methods. The purpose of this study is to determine the accuracy and generalizability of using automated methods for detecting three high-incidence and high-impact AEs from EHR data: a) hospital-acquired pneumonia, b) ventilator-associated event and, c) central line-associated bloodstream infection. This validation study will be conducted among medical, surgical and ICU patients admitted between 2013 and 2016 to the Centre hospitalier universitaire de Sherbrooke (CHUS) and the McGill University Health Centre (MUHC), which has both French and English sites. A random 60% sample of CHUS patients will be used for model development purposes (cohort 1, development set). Using a random sample of these patients, a reference standard assessment of their medical chart will be performed. Multivariate logistic regression and the area under the curve (AUC) will be employed to iteratively develop and optimize three automated AE detection models (i.e., one per AE of interest) using EHR data from the CHUS. These models will then be validated on a random sample of the remaining 40% of CHUS patients (cohort 1, internal validation set) using chart review to assess accuracy. The most accurate models developed and validated at the CHUS will then be applied to EHR data from a random sample of patients admitted to the MUHC French site (cohort 2) and English site (cohort 3)-a critical requirement given the use of narrative data -, and accuracy will be assessed using chart review. Generalizability will be determined by comparing AUCs from cohorts 2 and 3 to those from cohort 1. This study will likely produce more accurate and efficient measures of AEs. These measures could be used to assess the incidence rates of AEs, evaluate the success of preventive interventions, or benchmark performance across hospitals.

Review of 125 Children 6 Years of Age and under Who Were Sexually Abused.

ERIC Educational Resources Information Center

Mian, Marcellina; And Others

1986-01-01

The authors present a chart review of 125 children referred in 1981-1983 because of sexual abuse. Among findings were that 60 percent were victims of intrafamilial abuse. Of the preschoolers, 72.5 percent were victims of intrafamilial abuse. At school age there was a reversal with 73 percent of 6-year-olds being abused by extrafamilial offenders.…

UAS NAS IHITL Test Readiness Review (TRR)

NASA Technical Reports Server (NTRS)

Murphy, Jim; Brignola, Michael P.; Rorie, Conrad; Santiago, Confesor; Guminsky, Mike; Cross, Ken

2014-01-01

Requesting release of IHITL test readiness review (TRR) charts to ensure UAS-NAS project primary stakeholders, the Federal Aviation Administration through the RTCA special committee -228 and the Office of the Secretary of Defense Sense and Avoid Science and Research Panel, are well informed on the IHITL test plan and expected outcomes as they relate to their needs to safely fly UAS in the NAS.

Charting the Routes to Revision: An Interplay of Writing Goals, Peer Comments, and Self-Reflections from Peer Reviews

ERIC Educational Resources Information Center

Zhang, Fuhui; Schunn, Christian D.; Baikadi, Alok

2017-01-01

Building upon self-regulated learning theories, we examined the nature of student writing goals and the relationship of these writing goals to revision alone and in combination with two other important sources of students' self-regulated revision--peer comments on their writing, and reflections for their own writing obtained from reviewing others'…

Effect of automatic record keeping on vigilance and record keeping time.

PubMed

Allard, J; Dzwonczyk, R; Yablok, D; Block, F E; McDonald, J S

1995-05-01

We have evaluated the effect of an automatic anaesthesia record keeper (AARK) on record keeping time and vigilance. With informed patient consent and institutional approval, we videotaped the attending anaesthetist and his/her immediate surroundings during 66 surgical procedures. Thirty-seven cases were charted manually and the remaining 29 were charted with a commercially available AARK. In order to evaluate vigilance, a physician examiner entered the operating room unannounced once during 33 of the manually charted cases and during 22 of the automatically charted cases and asked the anaesthetist to turn away from the monitors and recall the current value of eight patient physiological variables. The examiner recorded the recalled values and also the actual current monitor values of these variables. The videotapes were reviewed and the anaesthetist's intraoperative time was categorized into 15 predefined activities, including intraoperative anaesthesia record keeping time. We compared recalled and actual variable values to determine if the recalled values were within clinically relevant error limits. There was no statistical difference between the mean percentage case time spent recording manually (14.11 (SD 3.98)%) and automatically (12.39 (3.92)%). Moreover, use of the AARK did not significantly affect vigilance. Despite major advances in monitoring technology over the past 14 years, record keeping still occupies 10-15% of the anaesthetist's intraoperative time. It appears that in using an AARK, the anaesthetist reallocates intraoperative record keeping time from manual charting to dealing with problems in the anaesthetist machine interface caused by inadequate design.

Clinician Assessment of the Driving Competence of Patients with Dementia

PubMed Central

Ott, Brian R.; Anthony, David; Papandonatos, George D.; D’Abreu, Anelyssa; Burock, Jeffrey; Curtin, Alicia; Wu, Chuang-Kuo; Morris, John C.

2012-01-01

OBJECTIVES To determine the validity and reliability of clinician ratings of the driving competence of patients with mild dementia. DESIGN Observational study of a cross-section of drivers with mild dementia based on chart review by clinicians with varying types of expertise and experience. SETTING Outpatient dementia clinic. PARTICIPANTS Fifty dementia subjects from a longitudinal study of driving and dementia. MEASUREMENTS Each clinician reviewed information from the clinic charts and the first study visit. The clinician then rated the drivers as safe, marginal, or unsafe. A professional driving instructor compared these ratings with total driving scores on a standardized road test and categorical ratings of driving competence. Clinicians also completed a visual analog scale assessment of variables that led to their determinations of driving competence. RESULTS Accuracy of clinician ratings ranged from 62% to 78% for the instructor’s global rating of safe versus marginal or unsafe. In general, there was moderate accuracy and interrater reliability. Accuracy could have been improved in the least-accurate raters by greater attention to dementia duration and severity ratings, as well as less reliance on the history and physical examination. The most accurate predictors were clinicians specially trained in dementia assessment, who were not necessarily the most experienced in their years of clinical experience. CONCLUSION Although a clinician may be able to identify many potentially hazardous drivers, accuracy is insufficient to suggest that a clinician’s assessment alone is adequate to determine driving competence in those with mild dementia. PMID:15877559

Underdiagnosis of bipolar disorder in men with substance use disorder.

PubMed

Albanese, Mark J; Clodfelter, Reynolds C; Pardo, Tamara B; Ghaemi, S Nassir

2006-03-01

Recent reports indicate that bipolar disorder is frequently underdiagnosed in the clinical population, leading to overuse of antidepressants and underuse of mood stabilizers. This study assessed rates of diagnosis of bipolar disorder in a substance abuse population. The study involved a retrospective chart review of data from 295 patients admitted to an inpatient substance abuse program for men. Data were then analyzed from the 85 patients in the sample who were diagnosed as meeting DSM-IV criteria for bipolar disorder on intake into the program. Charts were reviewed for relevant clinical and demographic data. The primary outcome measure was the rate of previous misdiagnosis. Of the 85 patients diagnosed with bipolar disorder upon intake, 42 (49%) had not been previously diagnosed with bipolar disorder; of these 42, 6 (14%) patients had not been assessed previously, while 36 (86%) had been assessed previously and had received many other psychiatric diagnoses, including major depression (77%), attention-deficit/hyperactivity disorder (20%), and panic disorder (3%). Among the comorbid substance use disorders in these patients, alcohol dependence was the most common (62%), followed by cocaine (38%), opioid (26%), polysubstance (12%), and sedative-hypnotic (2%) dependence. Other comorbid Axis I disorders included posttraumatic stress disorder (14%), attention-deficit/hyperactivity disorder (10%), panic disorder (2%), and generalized anxiety disorder (2%). This study found that bipolar disorder had not been previously diagnosed in approximately 50% of a sample of Caucasian males in a substance abuse population who were diagnosed with bipolar disorder upon admission to an inpatient substance abuse program.

Validity of diagnoses, procedures, and laboratory data in Japanese administrative data.

PubMed

Yamana, Hayato; Moriwaki, Mutsuko; Horiguchi, Hiromasa; Kodan, Mariko; Fushimi, Kiyohide; Yasunaga, Hideo

2017-10-01

Validation of recorded data is a prerequisite for studies that utilize administrative databases. The present study evaluated the validity of diagnoses and procedure records in the Japanese Diagnosis Procedure Combination (DPC) data, along with laboratory test results in the newly-introduced Standardized Structured Medical Record Information Exchange (SS-MIX) data. Between November 2015 and February 2016, we conducted chart reviews of 315 patients hospitalized between April 2014 and March 2015 in four middle-sized acute-care hospitals in Shizuoka, Kochi, Fukuoka, and Saga Prefectures and used them as reference standards. The sensitivity and specificity of DPC data in identifying 16 diseases and 10 common procedures were identified. The accuracy of SS-MIX data for 13 laboratory test results was also examined. The specificity of diagnoses in the DPC data exceeded 96%, while the sensitivity was below 50% for seven diseases and variable across diseases. When limited to primary diagnoses, the sensitivity and specificity were 78.9% and 93.2%, respectively. The sensitivity of procedure records exceeded 90% for six procedures, and the specificity exceeded 90% for nine procedures. Agreement between the SS-MIX data and the chart reviews was above 95% for all 13 items. The validity of diagnoses and procedure records in the DPC data and laboratory results in the SS-MIX data was high in general, supporting their use in future studies. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction.

PubMed

Engel, Josien; van der Wulp, Ineke; de Bruijne, Martine; Wagner, Cordula

2015-11-24

Quantitative risk assessment in unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI), by using cardiac risk scores, is recommended in international guidelines. However, a gap between recommended care and actual practice exists, as these instruments seem underused in practice. The present study aimed to determine the extent of cardiac risk score use and to study factors associated with lower or higher cardiac risk score use. 13 hospitals throughout the Netherlands. A retrospective chart review of 1788 charts of patients with UA and NSTEMI, discharged in 2012. The extent of cardiac risk score use reflected in a documented risk score outcome in the patient's chart. Factors associated with cardiac risk score use determined by generalised linear mixed models. In 57% (n=1019) of the charts, physicians documented the use of a cardiac risk score. Substantial variation between hospitals was observed (16.7-87%), although this variation could not be explained by the presence of on-site revascularisation facilities or a hospitals' teaching status. Obese patients (OR=1.49; CI 95%1.03 to 2.15) and former smokers (OR=1.56; CI 95%1.15 to 2.11) were more likely to have a cardiac risk score documented. Risk scores were less likely to be used among patients diagnosed with UA (OR=0.60; CI 95% 0.46 to 0.77), in-hospital resuscitation (OR=0.23; CI 95% 0.09 to 0.64), in-hospital heart failure (OR=0.46; CI 95% 0.27 to 0.76) or tachycardia (OR=0.45; CI 95% 0.26 to 0.75). Despite recommendations in cardiac guidelines, the use of cardiac risk scores has not been fully implemented in Dutch practice. A substantial number of patients did not have a cardiac risk score documented in their chart. Strategies to improve cardiac risk score use should pay special attention to patient groups in which risk scores were less often documented, as these patients may currently be undertreated. 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/

A Review of Shock Mitigation Techniques (Briefing Charts)

DTIC Science & Technology

2015-04-01

Public Release; Distribution Unlimited (PA# 96TW- 2014-0154). 6 Viscoelastic • Polyurea – energy dissipation from hard and soft...Response of Coarse-Grained Models of Multiblock versus Diblock Copolymers: Insights into Dissipative Properties of Polyurea ”, Macromolecules, 2012, 45 (7

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

Tan, J; Pompos, A; Jiang, S

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

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

PubMed

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

2015-06-01

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

Hearing loss and speech perception in noise difficulties in Fanconi anemia.

PubMed

Verheij, Emmy; Oomen, Karin P Q; Smetsers, Stephanie E; van Zanten, Gijsbert A; Speleman, Lucienne

2017-10-01

Fanconi anemia is a hereditary chromosomal instability disorder. Hearing loss and ear abnormalities are among the many manifestations reported in this disorder. In addition, Fanconi anemia patients often complain about hearing difficulties in situations with background noise (speech perception in noise difficulties). Our study aimed to describe the prevalence of hearing loss and speech perception in noise difficulties in Dutch Fanconi anemia patients. Retrospective chart review. A retrospective chart review was conducted at a Dutch tertiary care center. All patients with Fanconi anemia at clinical follow-up in our hospital were included. Medical files were reviewed to collect data on hearing loss and speech perception in noise difficulties. In total, 49 Fanconi anemia patients were included. Audiograms were available in 29 patients and showed hearing loss in 16 patients (55%). Conductive hearing loss was present in 24.1%, sensorineural in 20.7%, and mixed in 10.3%. A speech in noise test was performed in 17 patients; speech perception in noise was subnormal in nine patients (52.9%) and abnormal in two patients (11.7%). Hearing loss and speech perception in noise abnormalities are common in Fanconi anemia. Therefore, pure tone audiograms and speech in noise tests should be performed, preferably already at a young age, because hearing aids or assistive listening devices could be very valuable in developing language and communication skills. 4. Laryngoscope, 127:2358-2361, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Validating abortion procedure coding in Canadian administrative databases.

PubMed

Samiedaluie, Saied; Peterson, Sandra; Brant, Rollin; Kaczorowski, Janusz; Norman, Wendy V

2016-07-12

The British Columbia (BC) Ministry of Health collects abortion procedure data in the Medical Services Plan (MSP) physician billings database and in the hospital information Discharge Abstracts Database (DAD). Our study seeks to validate abortion procedure coding in these databases. Two randomized controlled trials enrolled a cohort of 1031 women undergoing abortion. The researcher collected database includes both enrollment and follow up chart review data. The study cohort was linked to MSP and DAD data to identify all abortions events captured in the administrative databases. We compared clinical chart data on abortion procedures with health administrative data. We considered a match to occur if an abortion related code was found in administrative data within 30 days of the date of the same event documented in a clinical chart. Among 1158 abortion events performed during enrollment and follow-up period, 99.1 % were found in at least one of the administrative data sources. The sensitivities for the two databases, evaluated using a gold standard, were 97.7 % (95 % confidence interval (CI): 96.6-98.5) for the MSP database and 91.9 % (95 % CI: 90.0-93.4) for the DAD. Abortion events coded in the BC health administrative databases are highly accurate. Single-payer health administrative databases at the provincial level in Canada have the potential to offer valid data reflecting abortion events. ClinicalTrials.gov Identifier NCT01174225 , Current Controlled Trials ISRCTN19506752 .

From distributions of deviance to definitions of difference: past and future mental health geographies.

PubMed

Wolch, J; Philo, C

2000-09-01

This paper reviews research in mental health geography that has examined landscapes of deinstitutionalisation, community care and everyday social life. It complements Philo's (1997, Across the water: reviewing geographical studies of asylums and other mental health facilities. Health and Place 3, 73-89) review of geographical studies concerned with asylums and other mental health facilities. Offering an interpretation of developments in this research sub-field, it charts a 'first wave' and a 'second wave' of inquiries, identifying shifts of substantive emphasis, theoretical approach and methodological practice. The gains and drawbacks of both 'waves' are discussed, with particular attention to absences both in what is researched and in the extent of political and policy engagement. The possible contours of a 'third wave' mental health geography, building on the strengths of earlier research but addressing new questions in new ways, are outlined in conclusion.

Methods for computational disease surveillance in infection prevention and control: Statistical process control versus Twitter's anomaly and breakout detection algorithms.

PubMed

Wiemken, Timothy L; Furmanek, Stephen P; Mattingly, William A; Wright, Marc-Oliver; Persaud, Annuradha K; Guinn, Brian E; Carrico, Ruth M; Arnold, Forest W; Ramirez, Julio A

2018-02-01

Although not all health care-associated infections (HAIs) are preventable, reducing HAIs through targeted intervention is key to a successful infection prevention program. To identify areas in need of targeted intervention, robust statistical methods must be used when analyzing surveillance data. The objective of this study was to compare and contrast statistical process control (SPC) charts with Twitter's anomaly and breakout detection algorithms. SPC and anomaly/breakout detection (ABD) charts were created for vancomycin-resistant Enterococcus, Acinetobacter baumannii, catheter-associated urinary tract infection, and central line-associated bloodstream infection data. Both SPC and ABD charts detected similar data points as anomalous/out of control on most charts. The vancomycin-resistant Enterococcus ABD chart detected an extra anomalous point that appeared to be higher than the same time period in prior years. Using a small subset of the central line-associated bloodstream infection data, the ABD chart was able to detect anomalies where the SPC chart was not. SPC charts and ABD charts both performed well, although ABD charts appeared to work better in the context of seasonal variation and autocorrelation. Because they account for common statistical issues in HAI data, ABD charts may be useful for practitioners for analysis of HAI surveillance data. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Do parents understand growth charts? A national, Internet-based survey.

PubMed

Ben-Joseph, Elana Pearl; Dowshen, Steven A; Izenberg, Neil

2009-10-01

The objective of this study was to assess parental knowledge and understanding of growth charts. An online survey was conducted with 1000 parents selected to be demographically representative of the US population. Questions explored awareness of, knowledge of, and attitudes toward growth monitoring, as well as the ability to interpret growth chart data. Seventy-nine percent of parents surveyed claimed to have seen a growth chart before, with the majority thinking that they understood it well. Sixty-four percent of parents thought it was important to be shown growth charts to see how their child was growing, and 40% expressed the need to see their child's growth chart as confirmation of their health care provider's verbal interpretation. However, when provided with multiple-choice questions and answers, only 64% could identify a child's weight when shown a plotted point on a growth chart. Ninety-six percent had heard of the term "percentile," but only 68% identified the percentile of the plotted point, and only 56% could identify the definition of percentile. Up to 77% interpreted incorrectly charts containing height/weight measurements in tandem. Although growth charts are used frequently as visual aids to educate parents about their children's growth, many parents cannot comprehend the data. This finding is significant because many parents prefer to be shown growth charts by their health care provider, and many parents report recording their children's measurements on growth charts at home.

Validation of Computerized Automatic Calculation of the Sequential Organ Failure Assessment Score

PubMed Central

Harrison, Andrew M.; Pickering, Brian W.; Herasevich, Vitaly

2013-01-01

Purpose. To validate the use of a computer program for the automatic calculation of the sequential organ failure assessment (SOFA) score, as compared to the gold standard of manual chart review. Materials and Methods. Adult admissions (age > 18 years) to the medical ICU with a length of stay greater than 24 hours were studied in the setting of an academic tertiary referral center. A retrospective cross-sectional analysis was performed using a derivation cohort to compare automatic calculation of the SOFA score to the gold standard of manual chart review. After critical appraisal of sources of disagreement, another analysis was performed using an independent validation cohort. Then, a prospective observational analysis was performed using an implementation of this computer program in AWARE Dashboard, which is an existing real-time patient EMR system for use in the ICU. Results. Good agreement between the manual and automatic SOFA calculations was observed for both the derivation (N=94) and validation (N=268) cohorts: 0.02 ± 2.33 and 0.29 ± 1.75 points, respectively. These results were validated in AWARE (N=60). Conclusion. This EMR-based automatic tool accurately calculates SOFA scores and can facilitate ICU decisions without the need for manual data collection. This tool can also be employed in a real-time electronic environment. PMID:23936639

Increasing referral rate for screening colonoscopy through patient education and activation at a primary care clinic in New York City.

PubMed

Sriphanlop, Pathu; Hennelly, Marie Oliva; Sperling, Dylan; Villagra, Cristina; Jandorf, Lina

2016-08-01

Colorectal cancer could be prevented through regular screening. Individuals age 50 and older are recommended to get screened via colonoscopy. Because physician referral is a major predictor of colonoscopy completion, two low-cost, evidence-based interventions were tested to increase referrals by activating patients to self-advocate. This study compared the impact of a pre-visit educational handout that prompts patients to discuss colonoscopy with their physician with the handout plus brief counseling through exit interviews and chart reviews. The main outcome was physician referral. Medical charts were reviewed for eligibility: 130 control patients (Arm 1), 45 patients who received the educational handout and health counseling (Arm 2), and 50 patients who received only the handout (Arm 3). Colonoscopy referral rates increased from 24.6% in Arm 1 to 44.4% and 52.0% in Arms 2 and 3, respectively (p=0.001). The proportion of exit interview participants who discussed colonoscopy with their doctor increased from 68.8% in Arm 1 to 76.5% and 88.9% in Arms 2 and 3, respectively. Results indicate that both interventions are effective at increasing colonoscopy referrals. Results suggest that an educational handout alone is sufficient in prompting patient-initiated discussions about colonoscopy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Refractive errors in presbyopic patients in Kano, Nigeria.

PubMed

Lawan, Abdu; Okpo, Eme; Philips, Ebisike

2014-01-01

The study is a retrospective review of the pattern of refractive errors in presbyopic patients seen in the eye clinic from January to December, 2009. The clinic refraction register was used to retrieve the case folders of all patients refracted during the review period. Information extracted includes patient's age, sex, and types of refractive error. Unaided and pin hole visual acuity was done with Snellen's or "E" Charts and near vision with Jaeger's chart in English or Hausa. All patients had basic eye examination and streak retinoscopy at two third meter working distance. The final subjective refractive correction given to the patients was used to categorize the type of refractive error. There were 5893 patients, 1584 had refractive error and 644 were presbyopic. There were 289 males and 355 females (M:F= 1:1.2). Presbyopia accounted for 10.9% of clinic attendance and 40% of patients with refractive error. Presbyopia was seen in 17%, the remaining 83% required distance correction; astigmatism was seen in 41%, hypermetropia 29%, myopia 9% and aphakia 4%. Refractive error was commoner in females than males and the relationship was statistically significant (P-value = 0.017; P < 0.05 considered significant). Presbyopia is common and most of the patients had other refractive errors. Full refraction is advised for all patients.

Beta-blocker use in the emergency department in patients with acute myocardial infarction undergoing primary angioplasty.

PubMed

Pancu, Diana; Lee, David C

2003-05-01

Our objectives were to evaluate the frequency of beta-blocker administration in the setting of acute myocardial infarction (AMI) where angioplasty is the primary treatment, and to investigate emergency physician's (EPs) attitudes toward beta-blockers. We performed a retrospective chart review of all patients who presented with symptoms and electrocardiogram (EKG) criteria consistent with AMI in the defined study period. Charts were reviewed for beta-blocker administration and other treatments. A survey was subsequently distributed to all EPs to determine self-reported reasons for withholding beta-blockers. There were 91 patients identified. Of those who did not have contraindications, 99% (89/90) received aspirin, 97% (88/91) received heparin, 94% (84/89) received nitrates, but only 28% (19/68) received beta-blockers. Ninety-six percent of beta-blocker-eligible patients received them as inpatients. Eighty-six percent (44/52) of EPs completed the survey. Physicians felt strongly about avoiding beta-blockers in patients with asthma exacerbation, severe congestive heart failure, and high degree AV block. Bradycardia was the most frequent reason for withholding beta-blockers. In this series of patients presenting with AMI, beta-blockers were greatly underutilized. The self-reported reasons of EPs for withholding beta-blocker therapy did not explain why 72% (49/68) of patients without contraindications did not receive beta-blockers.

Interrelated effects of substance use diagnosis, race, and smoking severity on abstinence initiation in dually dependent male smokers: results of a retrospective chart review.

PubMed

Heffner, Jaimee L; Blom, Thomas J; Camerota, Elaine; Sansone, Linda E; Bodie, Linda; Smith, Joshua; Lin, Show; Drake, J Michael; Meyer, Corey; Anthenelli, Robert M

2007-12-01

: Study goals were 2-fold: 1) to examine differences in demographic and clinical characteristics of smokers who fell into 3 diagnostic groups: alcohol abuse/dependence only (ALC), cocaine abuse/dependence only (COC), and mixed alcohol and cocaine abuse/dependence (ALC + COC); and 2) to determine the degree to which diagnostic grouping predicted short-term abstinence from smoking. : Retrospective chart reviews were conducted by using the treatment records of male veterans (N = 175) who participated in a voluntary smoking cessation program during their stay in residential substance dependence treatment. : The ALC group smoked more heavily, had higher levels of nicotine dependence, and reported more emotional problems than the other 2 groups. Short-term abstinence rates were high across the 3 groups (38%, 58%, and 57% for the ALC, COC, and ALC + COC groups, respectively). Lighter smoking at treatment entry, non-white race, and a diagnosis of cocaine abuse/dependence (with or without alcohol abuse/dependence) predicted short-term abstinence in the program. : Substance misusers motivated to quit smoking can initiate smoking abstinence at relatively high rates with the aid of combined pharmacotherapy and intensive group counseling. White subjects who smoke more heavily and have a diagnosis of alcohol abuse/dependence only have lower success rates for abstinence initiation.

Community awareness and utilization of growth chart in a semi-urban Nigerian community.

PubMed

Fagbule, D O; Olaosebikan, A; Parakoyi, D B

1990-02-01

Five hundred and eighteen mothers resident in Adeta, Sawmill and Baboko Communities of Ilorin Local Government Area of Kwara State, Nigeria, were interviewed to assess their knowledge, utilization, and understanding of the growth chart. Five health facilities in the communities studied were visited to assess the availability, utilization and understanding of growth charts by health workers. Over half (53.7%) of the mothers interviewed have heard about growth charts. The level of awareness was significantly influenced by maternal age, educational status and parity (PLO.OS). Of those who have heard about growth chart, only 155 (55.8%) have it, and 150 of these (96.8%) use it regularly. One hundred and seventy four (33.6%) of all mothers, but 62.6% of those who have heard about the chart demonstrated an understanding of the markings on it. One hundred and sixteen mothers found the growth chart useful for immunization record, nutrition advice, clinic appointment dates, and assessment of developmental milestones. Two of the five health facilities visited had, and used growth charts. The health workers, however, demonstrated a clear understanding of weighing, plotting, and interpretation of the chart, and gave appropriate advice to mothers. Ways of improving growth monitoring in the community using the growth chart are suggested.

Shoulder dystocia documentation: an evaluation of a documentation training intervention.

PubMed

LeRiche, Tammy; Oppenheimer, Lawrence; Caughey, Sharon; Fell, Deshayne; Walker, Mark

2015-03-01

To evaluate the quality and content of nurse and physician shoulder dystocia delivery documentation before and after MORE training in shoulder dystocia management skills and documentation. Approximately 384 charts at the Ottawa Hospital General Campus involving a diagnosis of shoulder dystocia between the years of 2000 and 2006 excluding the training year of 2003 were identified. The charts were evaluated for 14 key components derived from a validated instrument. The delivery notes were then scored based on these components by 2 separate investigators who were blinded to delivery note author, date, and patient identification to further quantify delivery record quality. Approximately 346 charts were reviewed for physician and nurse delivery documentation. The average score for physician notes was 6 (maximum possible score of 14) both before and after the training intervention. The nurses' average score was 5 before and after the training intervention. Negligible improvement was observed in the content and quality of shoulder dystocia documentation before and after nurse and physician training.

Use of volunteer student abstractors for a retrospective cohort analysis: a study of inter-rater reliability.

PubMed

Gritsiouk, Yaroslav; Hegsted, Damian; Gardiner, Stuart; Merriman, Lisa; Gubler, Kelly Dean

2013-05-01

Little is known about the reliability of data collected by abstractors without professional medical training. This investigation sought to determine the level of agreement among untrained volunteer abstractors as part of a study to evaluate the risk assessment of venous thromboembolism in patients who have undergone trauma. Forty-nine paper charts were chosen randomly from a volunteer-reviewed cohort of 2,339 and were compared with those of a single experienced abstractor. Inter-rater agreement was assessed using percent agreement, Cohen's kappa, and prevalence-adjusted bias-adjusted kappa (PABAK). Of the 71 data points, 28 had perfect agreement. The average agreement across all charts was 97%. Data with imperfect agreement had kappa values between .27 and .96 (mean, .75), with one additional value at zero even though it was associated with an agreement of 94%. PABAK values ranged from .67 to .98 (mean, .91), an average increase of .17 compared with kappa values. The performance of volunteers showed outstanding inter-rater reliability; however, limitations of interpretation can influence reliability. Copyright © 2013 Elsevier Inc. All rights reserved.

Estimating Anesthesia Time Using the Medicare Claim: A Validation Study

PubMed Central

Silber, Jeffrey H.; Rosenbaum, Paul R.; Even-Shoshan, Orit; Mi, Lanyu; Kyle, Fabienne; Teng, Yun; Bratzler, Dale W.; Fleisher, Lee A.

2012-01-01

Introduction Procedure length is a fundamental variable associated with quality of care, though seldom studied on a large scale. We sought to estimate procedure length through information obtained in the anesthesia claim submitted to Medicare to validate this method for future studies. Methods The Obesity and Surgical Outcomes Study enlisted 47 hospitals located across New York, Texas and Illinois to study patients undergoing hip, knee, colon and thoracotomy procedures. 15,914 charts were abstracted to determine body mass index and initial patient physiology. Included in this abstraction were induction, cut, close and recovery room times. This chart information was merged to Medicare claims which included anesthesia Part B billing information. Correlations between chart times and claim times were analyzed, models developed, and median absolute differences in minutes calculated. Results Of the 15,914 eligible patients, there were 14,369 where both chart and claim times were available for analysis. In these 14,369, the Spearman correlation between chart and claim time was 0.94 (95% CI 0.94, 0.95) and the median absolute difference between chart and claim time was only 5 minutes (95% CI: 5.0, 5.5). The anesthesia claim can also be used to estimate surgical procedure length, with only a modest increase in error. Conclusion The anesthesia bill found in Medicare claims provides an excellent source of information for studying operative time on a vast scale throughout the United States. However, errors in both chart abstraction and anesthesia claims can occur. Care must be taken in the handling of outliers in this data. PMID:21720242

HET2 Overview

NASA Technical Reports Server (NTRS)

Fong, Terrence W.; Bualat, Maria Gabriele; Diftler, Myron A.

2015-01-01

2015 mid-year review charts of the Human Exploration Telerobotics 2 project that describe the Astrobee free-flying robot and the Robonaut 2 humanoid robot. A planned replacement for Synchronized Position Hold, Engage, Reorient, Experimental Satellite (SPHERES), which is currently in use in the International Space Station (ISS).

Airline Quarterly Financial Review - Second Quarter 1997 Majors

DOT National Transportation Integrated Search

1997-01-01

This report contains staff comments, tables and charts on the financial condition of the U.S. major airlines. The data are presented on both a carrier group and an individual carrier basis, but the primary focus is on the individual major carrier and...

Airline Quarterly Financial Review - Fourth Quarter 1997 Majors

DOT National Transportation Integrated Search

1997-01-01

This report contains staff comments, tables and charts on the financial : condition of the U.S. major airlines. An electronic version of this document can be obtained via the World Wide Web at: http://dms.dot.gov/ost/aviation/analysis.html : The data...

HUMAN ELECTRORETINOGRAPHY AS A GAUGE OF VISUAL PERFORMANCE.

DTIC Science & Technology

arthritis, congenital aphakia, high myopia, primary and secondary retinitis pigmentosa , optic atrophy, glaucoma, trauma, cataract and neonates. A chart of...A short review of the clinical findings with the Cordis ERG apparatus to date is presented on: night-blindness, retinal detachment, rheumatoid

Natural Hazards within the West Indies.

ERIC Educational Resources Information Center

Cross, John A.

1992-01-01

Outlines the vulnerability of the West Indies to various natural hazards, especially hurricanes, earthquakes, and volcanic eruptions. Reviews the geologic and meteorologic causes and consequences of the hazards. Suggests methods of incorporating hazards information in geography classes. Includes maps and a hurricane tracking chart. (DK)

Sexual Abuse: Somatic and Emotional Reactions.

ERIC Educational Resources Information Center

Rimza, Mary Ellen; And Others

1988-01-01

Chart reviews and telephone interviews with 72 sexual abuse victims found that 48 of the children had symptoms similar to the "rape trauma" syndrome. Two-thirds of victims commonly had somatic complaints (such as abdominal pain) and emotional/behavioral problems (runaway behavior, suicide attempts). (DB)

Decisions, Decisions....

ERIC Educational Resources Information Center

White, Owen Roberts

1985-01-01

The author reviews systems providing objective guidelines to facilitate ongoing, daily instructional decisions, focusing on those which utilize the sensitive datum and uniform charting procedures of precision teaching. Potential users are warned that the special education teacher must remain a critical and vigilant analyst of the learning process.…

Monitoring Poisson observations using combined applications of Shewhart and EWMA charts

NASA Astrophysics Data System (ADS)

Abujiya, Mu'azu Ramat

2017-11-01

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

Comparison of Lichtenstein inguinal hernia repair with the tension-free Desarda technique: a clinical audit and review of the literature.

PubMed

Zulu, Halalisani Goodman; Mewa Kinoo, Suman; Singh, Bhugwan

2016-07-01

Ours was a retrospective chart review of all elective open inguinal hernia repairs performed in a single unit at King Edward VIII Hospital, South Africa over an 18-month period. Comparison was made regarding duration of operation, length of hospital stay and complications such as pain, haematoma formation and recurrence between the Lichtenstein and Desarda techniques. The latter was noted to have a shorter operative time and avoided cost and possible complications of mesh usage, which are significant in resource-deprived settings. A larger comparative study with longer follow-up is needed to evaluate the wider suitability of the Desarda repair. © The Author(s) 2016.

Prescience as an aura of temporal lobe epilepsy.

PubMed

Sadler, R Mark; Rahey, Susan

2004-08-01

A patient with a distinct aura of prescience as a manifestation of temporal lobe epilepsy was encountered. The experience prompted a review of this ictal phenomenon among patients attending a tertiary care epilepsy outpatient clinic. A computer epilepsy database was searched for patients with simple partial sensory seizures and complex partial seizures with auras. Identified patients had charts reviewed for details of the auras; patients were contacted and asked to provide written descriptions of their experiences. Literature searches (PubMed) were done by using the terms "precognition" or "prescience" and "seizures" or "epilepsy." Standard comprehensive epilepsy textbooks were reviewed. The charts of 218 patients were reviewed from 927 in the database; three had prescience as an ictal feature. The patients' descriptions were very similar in all cases (a profound sense of "knowing" what was going to happen in their environment in the immediate future). The experience was distinct from déjà vu and other psychic experiences. All patients probably have temporal lobe epilepsy. Only one other description of prescience as an ictal feature was found in the literature. Prescience can occur as an ictal feature of temporal lobe epilepsy and represents a previously underreported psychic phenomenon. The potential lateralizing value of this symptom is yet to be determined.

School Mathematics Study Group, Unit Number Two. Chapter 3 - Informal Algorithms and Flow Charts. Chapter 4 - Applications and Mathematics Models.

ERIC Educational Resources Information Center

Stanford Univ., CA. School Mathematics Study Group.

This is the second unit of a 15-unit School Mathematics Study Group (SMSG) mathematics text for high school students. Topics presented in the first chapter (Informal Algorithms and Flow Charts) include: changing a flat tire; algorithms, flow charts, and computers; assignment and variables; input and output; using a variable as a counter; decisions…

Classroom Wall Charts and Biblical History: A Study of Educational Technology in Elementary Schools in Late Nineteenth- and Early Twentieth-Century Sweden

ERIC Educational Resources Information Center

Evertsson, Jakob

2014-01-01

This article considers the emergence of classroom wall charts as a teaching technology in Swedish elementary schools in the late nineteenth and early twentieth centuries, using Biblical history teaching as an example. There has been some work done internationally on wall charts as an instructional technology, but few studies have looked at their…

Utility and recognition of lines and linear patterns on electronic displays depicting aeronautical charting information

DOT National Transportation Integrated Search

2009-04-28

A study was conducted to explore the utility and recognition of lines and linear patterns on electronic displays depicting aeronautical charting information, such as electronic charts and moving map displays. The goal of this research is to support t...

Clinical comparison of the Treponema pallidum CAPTIA syphilis-G enzyme immunoassay with the fluorescent treponemal antibody absorption immunoglobulin G assay for syphilis testing.

PubMed

Halling, V W; Jones, M F; Bestrom, J E; Wold, A D; Rosenblatt, J E; Smith, T F; Cockerill, F R

1999-10-01

Recently, a treponema-specific immunoglobulin G (IgG) enzyme immunoassay (EIA), the CAPTIA Syphilis-G (Trinity Biotech, Jamestown, N.Y.), has become available as a diagnostic test for syphilis. A total of 89 stored sera previously tested by the fluorescent treponemal antibody absorption (FTA-ABS) IgG assay were evaluated by the CAPTIA EIA. The FTA-ABS IgG procedure was performed by technologists unblinded to results of rapid plasmid reagin (RPR) testing of the same specimens. Borderline CAPTIA-positive samples (antibody indices of >/=0.650 and 0.900, the sample was considered positive. Thirteen of 89 (15%) samples had discrepant results. Compared to the FTA-ABS assay, the CAPTIA EIA had a sensitivity and specificity and positive and negative predictive values of 70.7, 97.9, 96.7, and 79.7%, respectively. In another analysis, discrepancies between results were resolved by repeated FTA-ABS testing (technologists were blinded to previous RPR results) and patient chart reviews. Seven CAPTIA-negative samples which were previously interpreted (unblinded) as minimally reactive by the FTA method were subsequently interpreted (blinded) as nonreactive. One other discrepant sample (CAPTIA negative and FTA-ABS positive [at an intensity of 3+], unblinded) was FTA negative with repeated testing (blinded). For the five remaining discrepant samples, chart reviews indicated that one patient (CAPTIA negative and FTA-ABS positive [minimally reactive], blinded) had possible syphilis. These five samples were also evaluated and found to be negative by another treponema-specific test, the Treponema pallidum microhemagglutination assay. Therefore, after repeated testing and chart reviews, 2 of the 89 (2%) samples had discrepant results; the adjusted sensitivity, specificity, and positive and negative predictive values were 96.7, 98.3, 96.7, and 98.3%, respectively. This study demonstrates that the CAPTIA IgG EIA is a reliable method for syphilis testing and that personnel performing tests which require subjective interpretation, like the FTA-ABS test, may be biased by RPR test results.

Clinical Comparison of the Treponema pallidum CAPTIA Syphilis-G Enzyme Immunoassay with the Fluorescent Treponemal Antibody Absorption Immunoglobulin G Assay for Syphilis Testing

PubMed Central

Halling, V. W.; Jones, M. F.; Bestrom, J. E.; Wold, A. D.; Rosenblatt, J. E.; Smith, T. F.; Cockerill, F. R.

1999-01-01

Recently, a treponema-specific immunoglobulin G (IgG) enzyme immunoassay (EIA), the CAPTIA Syphilis-G (Trinity Biotech, Jamestown, N.Y.), has become available as a diagnostic test for syphilis. A total of 89 stored sera previously tested by the fluorescent treponemal antibody absorption (FTA-ABS) IgG assay were evaluated by the CAPTIA EIA. The FTA-ABS IgG procedure was performed by technologists unblinded to results of rapid plasmid reagin (RPR) testing of the same specimens. Borderline CAPTIA-positive samples (antibody indices of ≥0.650 and ≤0.900) were retested; if the second analysis produced an index of >0.900, the sample was considered positive. Thirteen of 89 (15%) samples had discrepant results. Compared to the FTA-ABS assay, the CAPTIA EIA had a sensitivity and specificity and positive and negative predictive values of 70.7, 97.9, 96.7, and 79.7%, respectively. In another analysis, discrepancies between results were resolved by repeated FTA-ABS testing (technologists were blinded to previous RPR results) and patient chart reviews. Seven CAPTIA-negative samples which were previously interpreted (unblinded) as minimally reactive by the FTA method were subsequently interpreted (blinded) as nonreactive. One other discrepant sample (CAPTIA negative and FTA-ABS positive [at an intensity of 3+], unblinded) was FTA negative with repeated testing (blinded). For the five remaining discrepant samples, chart reviews indicated that one patient (CAPTIA negative and FTA-ABS positive [minimally reactive], blinded) had possible syphilis. These five samples were also evaluated and found to be negative by another treponema-specific test, the Treponema pallidum microhemagglutination assay. Therefore, after repeated testing and chart reviews, 2 of the 89 (2%) samples had discrepant results; the adjusted sensitivity, specificity, and positive and negative predictive values were 96.7, 98.3, 96.7, and 98.3%, respectively. This study demonstrates that the CAPTIA IgG EIA is a reliable method for syphilis testing and that personnel performing tests which require subjective interpretation, like the FTA-ABS test, may be biased by RPR test results. PMID:10488183

Assessing prescribing of NSAIDs, antiplatelets, and anticoagulants in Canadian family medicine using chart review.

PubMed

Hamilton, Kevin; Davis, Christine; Falk, Jamie; Singer, Alex; Bugden, Shawn

2016-10-01

Background Drug-related problems have been identified as a major contributor to emergency room visits, hospitalizations, and death. The most commonly implicated medications are nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelets, and anticoagulants. Considering a significant proportion of these harms are preventable, indicators to identify risky prescribing before they lead to harm have been developed. Objective To examine the prevalence and patterns of potentially inappropriate prescriptions (PIPs) in a primary care population who are using high-risk medications. Setting This study was performed within two multi-disciplinary family medicine teaching clinics in Winnipeg, Canada. Method A cross-sectional electronic/paper chart audit was conducted within two multi-disciplinary family medicine teaching clinics to evaluate the prevalence of 13 evidence-based high-risk prescriptions. Patients were included if they were prescribed an oral NSAID, antiplatelet, or an anticoagulant within the 12 month period between June 2012 and June 2013. Main outcome measure The proportion of PIPs associated with an increased bleeding risk for NSAIDs, antiplatelets, and anticoagulants. Results Of the 567 patients included in the review, 198 (35 %) patients had received at least 1 PIP in the past year. The most common PIP was the use of an oral NSAID with one or more GI risk factors without adequate gastro-protection. Only 34 (6 %) of these patients received a full medication review performed by a pharmacist. Although not statistically significant, patients who received a medication review had fewer inappropriate prescriptions (27 % with review, 35 % without). Conclusion Over one-third of the patients who were using high-risk medications were using them potentially inappropriately. Although pharmacists have been shown to reduce the amount of inappropriate prescribing, very few patients using these medications were referred to the pharmacist for a full medication review. These data suggest that there is opportunity for the identification and assessment of these patients when prescribing or dispensing these high-risk medications.

Attempted Suicide Among Students and Young Adults in Montreal, Quebec, Canada: A Retrospective Cross-Sectional Study of Hospitalized and Nonhospitalized Suicide Attempts Based on Chart Review

PubMed Central

Rahme, Elham; Low, Nancy C. P.; Lamarre, Suzanne; Turecki, Gustavo; Bonin, Jean-Pierre; Daneau, Diane; Habel, Youssef; Yung, Emily C. C.; Morin, Suzanne; Szkrumelak, Nadia; Singh, Santokh; Renaud, Johanne; Lesage, Alain

2015-01-01

Objective We conducted a chart review to identify postsecondary students and nonstudents in the same age range who presented to the emergency department following a suicide attempt to (1) compare demographic characteristics and suicide risk factors and (2) determine factors associated with more serious attempts requiring hospitalizations. Method The study was conducted in 1 tertiary trauma hospital and 1 community hospital affiliated with McGill University, Montreal, Quebec, Canada, between January 1, 2009, and March 31, 2010. Charts of patients with potential suicide attempts were identified from medical records using ICD-10 codes that indicated traumatic injury, intentional self-harm, poisoning, and psychiatric or perception/cognition disorders and from the emergency department triage file using keywords that indicated suicidality or self-harm at presentation. Results In multivariable logistic regression models (odds ratio, 95% CI), students were younger (per 5-year increase: 0.22, 0.12–0.41), less likely to be born in Canada (0.17, 0.06–0.44), and more likely to use less violent methods (laceration, poisoning, other, multiple methods) versus more violent methods (collision, jump, fire burns, firearm, hanging) in their attempt. Fewer students had a history of substance abuse (0.12, 0.02–0.94) but were not different from nonstudents on history of other mental disorders. Less students attempted suicide in the winter/spring (January–April) versus fall (September–December) semester (0.32, 0.11–0.91). Students who attempted suicide were more likely to have family/social support. Those who attempted suicide in the previous year were more likely to require hospitalization for their current suicide attempt. Conclusions Knowledge of specific factors associated with suicide attempts in young people can help inform and guide suicide prevention efforts in both academic and community settings. Specific to the findings of this study regarding the method of suicide attempt used, for example, limiting access to dangerous substances or large quantities of medications may help prevent or reduce suicide attempts in this population. PMID:26835175

Treatment patterns and duration in post-menopausal women with HR+/HER2- metastatic breast cancer in the US: a retrospective chart review in community oncology practices (2004-2010).

PubMed

Macalalad, Alexander R; Hao, Yanni; Lin, Peggy L; Signorovitch, James E; Wu, Eric Q; Ohashi, Erika; Zhou, Zhou; Kelley, Caroline

2015-02-01

Clinical guidelines prefer endocrine therapy (ET) as initial treatment for post-menopausal women with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC). Chemotherapy (CT) should be reserved for patients who develop symptomatic visceral disease or have no clinical benefit after three sequential ET regimens. It is unclear if real-world clinical practice reflects these guidelines. To describe treatment patterns and treatment durations by lines of therapy for ET and CT among post-menopausal HR+/HER2- mBC patients. Charts were reviewed from a network of community-based oncology practices of eligible patients who had progressed after initiating adjuvant or first-line treatment for mBC between 1 January 2004 and 30 September 2010. Extracted chart data included demographics, treatment histories, and outcomes. Treatment duration was estimated using Kaplan-Meier estimators. A total of 144 patients were studied. Patients received a median of two lines of ET, and <10% had three or more lines of ET before receiving CT. From first line to second line, the median treatment duration was 11.6 to 4.9 months for ET overall; 13.8 to 10.5 months for anastrozole; 18.6 to 7.0 months for letrozole; and 5.1 to 2.9 months for fulvestrant. For CT, the median duration was 5.1 months in the first line and 3.7 months and below in subsequent lines. During the study period (1 January 2004 - 30 September 2012), most patients received <3 lines of ET before receiving CT. The drop in median duration of ET from first to second line suggests that single agent ETs might not be as effective beyond the first line. A key limitation of this study was the small sample size. In addition, more research is needed to further investigate the short treatment duration of fulvestrant across early lines of therapy (which could indicate lack of efficacy).

Assessing electronic health record phenotypes against gold-standard diagnostic criteria for diabetes mellitus.

PubMed

Spratt, Susan E; Pereira, Katherine; Granger, Bradi B; Batch, Bryan C; Phelan, Matthew; Pencina, Michael; Miranda, Marie Lynn; Boulware, Ebony; Lucas, Joseph E; Nelson, Charlotte L; Neely, Benjamin; Goldstein, Benjamin A; Barth, Pamela; Richesson, Rachel L; Riley, Isaretta L; Corsino, Leonor; McPeek Hinz, Eugenia R; Rusincovitch, Shelley; Green, Jennifer; Barton, Anna Beth; Kelley, Carly; Hyland, Kristen; Tang, Monica; Elliott, Amanda; Ruel, Ewa; Clark, Alexander; Mabrey, Melanie; Morrissey, Kay Lyn; Rao, Jyothi; Hong, Beatrice; Pierre-Louis, Marjorie; Kelly, Katherine; Jelesoff, Nicole

2017-04-01

We assessed the sensitivity and specificity of 8 electronic health record (EHR)-based phenotypes for diabetes mellitus against gold-standard American Diabetes Association (ADA) diagnostic criteria via chart review by clinical experts. We identified EHR-based diabetes phenotype definitions that were developed for various purposes by a variety of users, including academic medical centers, Medicare, the New York City Health Department, and pharmacy benefit managers. We applied these definitions to a sample of 173 503 patients with records in the Duke Health System Enterprise Data Warehouse and at least 1 visit over a 5-year period (2007-2011). Of these patients, 22 679 (13%) met the criteria of 1 or more of the selected diabetes phenotype definitions. A statistically balanced sample of these patients was selected for chart review by clinical experts to determine the presence or absence of type 2 diabetes in the sample. The sensitivity (62-94%) and specificity (95-99%) of EHR-based type 2 diabetes phenotypes (compared with the gold standard ADA criteria via chart review) varied depending on the component criteria and timing of observations and measurements. Researchers using EHR-based phenotype definitions should clearly specify the characteristics that comprise the definition, variations of ADA criteria, and how different phenotype definitions and components impact the patient populations retrieved and the intended application. Careful attention to phenotype definitions is critical if the promise of leveraging EHR data to improve individual and population health is to be fulfilled. © 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

A Multicenter Collaborative to Improve Care of Community Acquired Pneumonia in Hospitalized Children.

PubMed

Parikh, Kavita; Biondi, Eric; Nazif, Joanne; Wasif, Faiza; Williams, Derek J; Nichols, Elizabeth; Ralston, Shawn

2017-03-01

The Value in Inpatient Pediatrics Network sponsored the Improving Care in Community Acquired Pneumonia collaborative with the goal of increasing evidence-based management of children hospitalized with community acquired pneumonia (CAP). Project aims included: increasing use of narrow-spectrum antibiotics, decreasing use of macrolides, and decreasing concurrent treatment of pneumonia and asthma. Data were collected through chart review across emergency department (ED), inpatient, and discharge settings. Sites reviewed up to 20 charts in each of 6 3-month cycles. Analysis of means with 3-σ control limits was the primary method of assessment for change. The expert panel developed project measures, goals, and interventions. A change package of evidence-based tools to promote judicious use of antibiotics and raise awareness of asthma and pneumonia codiagnosis was disseminated through webinars. Peer coaching and periodic benchmarking were used to motivate change. Fifty-three hospitals enrolled and 48 (91%) completed the 1-year project (July 2014-June 2015). A total of 3802 charts were reviewed for the project; 1842 during baseline cycles and 1960 during postintervention cycles. The median before and after use of narrow-spectrum antibiotics in the collaborative increased by 67% in the ED, 43% in the inpatient setting, and 25% at discharge. Median before and after use of macrolides decreased by 22% in the ED and 27% in the inpatient setting. A decrease in asthma and CAP codiagnosis was noted, but the change was not sustained. Low-cost strategies, including collaborative sharing, peer benchmarking, and coaching, increased judicious use of antibiotics in a diverse range of hospitals for pediatric CAP. Copyright © 2017 by the American Academy of Pediatrics.

Correlates of Attempted Suicide from the Emergency Room of 2 General Hospitals in Montreal, Canada

PubMed Central

Low, Nancy C. P.; Lamarre, Suzanne; Daneau, Diane; Habel, Youssef; Turecki, Gustavo; Bonin, Jean-Pierre; Morin, Suzanne; Szkrumelak, Nadia; Singh, Santokh; Lesage, Alain

2016-01-01

Introduction: The epidemiology of attempted suicide has not been well characterized because of lack of national data or an International Classification of Diseases (ICD) code for suicide attempts. We conducted a retrospective chart review in 2 adult general hospitals (tertiary and community) in Montreal, Canada, in 2009-2010 to 1) describe the characteristics of men and women who presented to the emergency department (ED) and/or were hospitalized following a suicide attempt, 2) identify factors associated with attempts requiring hospitalizations, and 3) validate the use of International Classification of Diseases, 10th Revision (ICD-10) codes for “intentional self-harm” as a method to detect suicide attempts from hospital abstract summary records. Method: All potential suicide attempts were identified from hospital abstract summary records and ED nursing triage file using ICD-10 codes and keywords suggestive of suicide attempts. All identified charts were examined, and those with confirmed suicide attempts were fully reviewed. Results: Of the 5746 identified charts, 369 were fully reviewed. Of these, 176 were for suicide attempters treated in the ED and 193 for hospitalized attempters, of whom 46% had an ICD-10 code for intentional self-harm. Poisoning (46%) was the most frequent method of suicide used. Half of attempters were younger than 34 years, 53% were female, and 75% had a history of mental disorders. Conclusion: About half of individuals who seek medical care for attempted suicide are admitted to hospital. About half of attempters use poisoning as a method of suicide, and a quarter do not have a history of mental disorders. Intentional self-harm codes capture only about half of hospitalized attempters.

Lost in translation: Focused documentation improvement benefits trauma surgeons.

PubMed

Fox, Nicole; Swierczynski, Patricia; Willcutt, Rebecca; Elberfeld, Adrienne; Mazzarelli, Anthony J

2016-09-01

There is a translational gap between physicians who document in the medical record and coders, who ultimately determine which codes are submitted. This gap exists because physicians are never formally educated about documentation strategies despite the fact that the quality of physician documentation directly affects revenue, outcomes and public profiling. We evaluated the effect of a formal model of focused documentation improvement (FDI) on the trauma/critical care division. We hypothesized that FDI would improve physician documentation, resulting in revenue recovery and a shift in the case mix index (CMI) to more accurately reflect the clinical complexity of trauma patients. FDI is defined as targeted physician education followed by concurrent inpatient chart review for documentation improvement opportunities by a clinical documentation specialist (CDS). All trauma surgeons (n=9) at our Level 1 trauma center first completed three hours of mandatory training on documentation improvement. A CDS was subsequently assigned to the trauma service. They reviewed the charts of Medicare patients (n=776) from January-December 2014 to identify opportunities for documentation improvement, participated in ICU rounds and provided ongoing education. Requests to clarify documentation (queries) were posted in the electronic medical record (EMR) and physicians were required to respond within 48h. Data was collected on physician response rate, CMI and revenue recovery. 411 of 776 (57%) charts were reviewed. Opportunities for FDI were identified in 177 (43%) cases. The physician response rate to queries was 100%. The CMI for reviewed cases increased (1.80 (SD 0.15) vs. 2.11 (SD 0.19); p<0.001) after FDI. Overall revenue recovery was $1,132,581 with an average of $154,092 in revenue recovery/clinical full time equivalent. The total cost for administration of FDI was $353,265 resulting in a 220% return on investment (ROI). FDI is an effective strategy to engage physicians in documentation improvement. It provides an infrastructure to assist physicians and yields a significant ROI. Copyright © 2016 Elsevier Ltd. All rights reserved.

High cost of stage IV pressure ulcers.

PubMed

Brem, Harold; Maggi, Jason; Nierman, David; Rolnitzky, Linda; Bell, David; Rennert, Robert; Golinko, Michael; Yan, Alan; Lyder, Courtney; Vladeck, Bruce

2010-10-01

The aim of this study was to calculate and analyze the cost of treatment for stage IV pressure ulcers. A retrospective chart analysis of patients with stage IV pressure ulcers was conducted. Hospital records and treatment outcomes of these patients were followed up for a maximum of 29 months and analyzed. Costs directly related to the treatment of pressure ulcers and their associated complications were calculated. Nineteen patients with stage IV pressure ulcers (11 hospital-acquired and 8 community-acquired) were identified and their charts were reviewed. The average hospital treatment cost associated with stage IV pressure ulcers and related complications was $129,248 for hospital-acquired ulcers during 1 admission, and $124,327 for community-acquired ulcers over an average of 4 admissions. The costs incurred from stage IV pressure ulcers are much greater than previously estimated. Halting the progression of early stage pressure ulcers has the potential to eradicate enormous pain and suffering, save thousands of lives, and reduce health care expenditures by millions of dollars. Copyright © 2010 Elsevier Inc. All rights reserved.

Development of an objective tool for the diagnosis of myxedema coma.

PubMed

Chiong, Yien V; Bammerlin, Elaine; Mariash, Cary N

2015-09-01

Myxedema coma, a rare entity, with a reported 25%-65% mortality had no objective criteria for making the diagnosis when we began our study. We developed an objective screening tool for myxedema coma to more easily identify patients and examine the best treatment method in future prospective studies to reduce the mortality of this entity. We conducted a retrospective chart review to find all patients aged ≥18 years admitted with myxedema coma from January 1, 2005 through June 13, 2010 at Indiana University Health Methodist Hospital. On the basis of both our retrospective chart review and on literature accounts, we identified 6 criteria to diagnose myxedema coma. We identified 10 patients initially diagnosed with myxedema coma and established a control group consisting of 13 patients identified with altered mental status and increased thyroid-stimulating hormone (TSH) levels. The 6 variables we created for the screening tool were heart rate, temperature, Glasgow coma scale, TSH, free thyroxine, and precipitating factors. The screening tool has a sensitivity and specificity of about 80%. We ran a logistic regression model using the 10 study patients and 13 controls with the 6 variables. No variables alone significantly contributed to the model. However, the overall model was highly significant (P = 0.012), providing strong support for a scoring system that uses these variables simultaneously. This screening tool enables physicians to rapidly diagnose myxedema coma to expedite treatment. A more refined diagnostic tool may be used in future clinical studies designed to determine the optimal treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of malicious ocular laser exposure in commercial airline pilots.

PubMed

Palakkamanil, Mathew M; Fielden, Michael P

2015-12-01

Intentional malicious laser strikes on commercial pilots are committed by individuals who target a laser into airplane cockpits during takeoff and landing. Because laser exposure to pilots is a relatively new but growing occurrence, our study investigates the ocular effect of this laser exposure in pilots. Retrospective chart review by a single ophthalmologist. All commercial airline pilots (58 male, 3 female) who experienced a laser strike while flying between April 2012 and November 2014 who presented to our clinic were included. A retrospective chart review was performed in a retinal specialist's practice. Ocular assessment was performed within 3 days of laser exposure. A complete ophthalmic evaluation was conducted, including Early Treatment Diabetic Retinopathy Study visual acuity, colour vision, visual fields, intraocular pressure, slit-lamp examination, dilated fundus examination, colour fundus photographs, and ocular coherence tomography. Sixty-four laser strike incidents involving commercial pilots were included. All pilots in the study experienced some degree of immediate ocular irritation or light sensitivity. No definite cases of ocular damage were attributed to laser strikes. No pilot had any functional ocular deficits. Our study revealed that laser strikes on aircraft did not result in permanent visual functional or structural deficits. However, laser strikes cause immediate visual effects, including glare, flash blindness, and ocular irritation that can interfere with a pilot's visual function. Given the widespread accessibility of high-power lasers and the rapid increase in incidents, laser strikes threaten to jeopardize aviation safety unless effective preventative measures are put in place. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Diagnostic accuracy of the Amsler grid and the preferential hyperacuity perimetry in the screening of patients with age-related macular degeneration: systematic review and meta-analysis.

PubMed

Faes, L; Bodmer, N S; Bachmann, L M; Thiel, M A; Schmid, M K

2014-07-01

To clarify the screening potential of the Amsler grid and preferential hyperacuity perimetry (PHP) in detecting or ruling out wet age-related macular degeneration (AMD). Medline, Scopus and Web of Science (by citation of reference) were searched. Checking of reference lists of review articles and of included articles complemented electronic searches. Papers were selected, assessed, and extracted in duplicate. Systematic review and meta-analysis. Twelve included studies enrolled 903 patients and allowed constructing 27 two-by-two tables. Twelve tables reported on the Amsler grid and its modifications, twelve tables reported on the PHP, one table assessed the MCPT and two tables assessed the M-charts. All but two studies had a case-control design. The pooled sensitivity of studies assessing the Amsler grid was 0.78 (95% confidence intervals; 0.64-0.87), and the pooled specificity was 0.97 (95% confidence intervals; 0.91-0.99). The corresponding positive and negative likelihood ratios were 23.1 (95% confidence intervals; 8.4-64.0) and 0.23 (95% confidence intervals; 0.14-0.39), respectively. The pooled sensitivity of studies assessing the PHP was 0.85 (95% confidence intervals; 0.80-0.89), and specificity was 0.87 (95% confidence intervals; 0.82-0.91). The corresponding positive and negative likelihood ratios were 6.7 (95% confidence intervals; 4.6-9.8) and 0.17 (95% confidence intervals; 0.13-0.23). No pooling was possible for MCPT and M-charts. Results from small preliminary studies show promising test performance characteristics both for the Amsler grid and PHP to rule out wet AMD in the screening setting. To what extent these findings can be transferred to a real clinic practice still needs to be established.

Guided medication dosing for elderly emergency patients using real-time, computerized decision support.

PubMed

Griffey, Richard T; Lo, Helen G; Burdick, Elisabeth; Keohane, Carol; Bates, David W

2012-01-01

To evaluate the impact of a real-time computerized decision support tool in the emergency department that guides medication dosing for the elderly on physician ordering behavior and on adverse drug events (ADEs). A prospective controlled trial was conducted over 26 weeks. The status of the decision support tool alternated OFF (7/17/06-8/29/06), ON (8/29/06-10/10/06), OFF (10/10/06-11/28/06), and ON (11/28/06-1/16/07) in consecutive blocks during the study period. In patients ≥65 who were ordered certain benzodiazepines, opiates, non-steroidals, or sedative-hypnotics, the computer application either adjusted the dosing or suggested a different medication. Physicians could accept or reject recommendations. The primary outcome compared medication ordering consistent with recommendations during ON versus OFF periods. Secondary outcomes included the admission rate, emergency department length of stay for discharged patients, 10-fold dosing orders, use of a second drug to reverse the original medication, and rate of ADEs using previously validated explicit chart review. 2398 orders were placed for 1407 patients over 1548 visits. The majority (49/53; 92.5%) of recommendations for alternate medications were declined. More orders were consistent with dosing recommendations during ON (403/1283; 31.4%) than OFF (256/1115; 23%) periods (p≤0.0001). 673 (43%) visits were reviewed for ADEs. The rate of ADEs was lower during ON (8/237; 3.4%) compared with OFF (31/436; 7.1%) periods (p=0.02). The remaining secondary outcomes showed no difference. Single institution study, retrospective chart review for ADEs. Though overall agreement with recommendations was low, real-time computerized decision support resulted in greater acceptance of medication recommendations. Fewer ADEs were observed when computerized decision support was active.

Gender differences in onabotulinum toxin A dosing for adductor spasmodic dysphonia.

PubMed

Lerner, Michael Z; Lerner, Benjamin A; Patel, Amit A; Blitzer, Andrew

2017-05-01

The objective of this study was to determine the influence of gender on onabotulinum toxin A dosing for the treatment of adductor spasmodic dysphonia symptoms. Retrospective review. A chart review of the senior author's database of botulinum toxin injections was performed. Patients diagnosed with adductor spasmodic dysphonia who received onabotulinum toxin A (BoNTA) injections to the thyroarytenoid muscle for at least 5 years were included for study. Patients who received alternate formulations of botulinum toxin (Myobloc, Dysport, or Xeomin) and patients with alternate diagnoses, such as abductor spasmodic dysphonia, tremor, and oromandibular dystonia, were excluded. The average BoNTA dose was calculated for each patient and statistical analysis was performed comparing the male and female groups. A total of 201 patients (52 males and 149 females) met inclusion criteria. The average follow-up times for the male and female groups were 10.2 ± 3.6 and 11.1 ± 4 years, respectively. The average BoNTA doses for the male and female groups were 0.6 ± 0.42 U and 1.3 ± 1.1 U, respectively. Statistical analysis was performed using an independent samples two-tailed t test yielding a P value of .0000000002. A large effect size was noted with Cohen's d = 0.85. The data from this retrospective chart review reveal a statistically and clinically significant correlation between female gender and higher average BoNTA dose for symptom control in adductor spasmodic dysphonia. Explanations for this observation are speculative and include a possible inverse relationship between optimal BoNTA dose and vocal fold mass and possibly greater neutralizing antibody formation among female patients. 4. Laryngoscope, 127:1131-1134, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Effect of a Dedicated Orthopaedic Advanced Practice Provider in a Level I Trauma Center: Analysis of Length of Stay and Cost.

PubMed

Hiza, Elise A; Gottschalk, Michael B; Umpierrez, Erica; Bush, Patricia; Reisman, William M

2015-07-01

The objective of this study is to analyze the effect of an orthopaedic trauma advanced practice provider on length of stay (LOS) and cost in a level I trauma center. The hypothesis of this study is that the addition of a single full-time nurse practitioner (NP) to the orthopaedic trauma team at a level I Trauma center would decrease overall LOS and hospital cost. A retrospective chart review of all patients discharged from the orthopaedic surgery service 1 year before the addition of a NP (pre-NP) and 1 year after the hiring of a NP (post-NP) were reviewed. Chart review included age, gender, LOS, discharge destination, intravenous antibiotic use, wound VAC therapy, admission location, and length of time to surgery. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test. The hiring of a NP yielded a statistically significant decrease in the LOS across the following patient subgroups: patients transferred from the trauma service (13.56 compared with 7.02 days, P < 0.001), patients aged 60 years and older (7.34 compared with 5.04 days, P = 0.037), patients discharged to a rehabilitation facility (10.84 compared with 8.31 days, P = 0.002), and patients discharged on antibiotics/wound VAC therapy (15.16 compared with 11.24 days, P = 0.017). Length of time to surgery was also decreased (1.48 compared with 1.31 days, P = 0.37). The addition of a dedicated orthopaedic trauma advanced practice provider at a county level I trauma center resulted in a statistically significant decrease in LOS and thus reduced indirect costs to the hospital. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The accuracy of International Classification of Diseases coding for dental problems not associated with trauma in a hospital emergency department.

PubMed

Figueiredo, Rafael L F; Singhal, Sonica; Dempster, Laura; Hwang, Stephen W; Quinonez, Carlos

2015-01-01

Emergency department (ED) visits for nontraumatic dental conditions (NTDCs) may be a sign of unmet need for dental care. The objective of this study was to determine the accuracy of the International Classification of Diseases codes (ICD-10-CA) for ED visits for NTDC. ED visits in 2008-2099 at one hospital in Toronto were identified if the discharge diagnosis in the administrative database system was an ICD-10-CA code for a NTDC (K00-K14). A random sample of 100 visits was selected, and the medical records for these visits were reviewed by a dentist. The description of the clinical signs and symptoms were evaluated, and a diagnosis was assigned. This diagnosis was compared with the diagnosis assigned by the physician and the code assigned to the visit. The 100 ED visits reviewed were associated with 16 different ICD-10-CA codes for NTDC. Only 2 percent of these visits were clearly caused by trauma. The code K0887 (toothache) was the most frequent diagnostic code (31 percent). We found 43.3 percent disagreement on the discharge diagnosis reported by the physician, and 58.0 percent disagreement on the code in the administrative database assigned by the abstractor, compared with what it was suggested by the dentist reviewing the chart. There are substantial discrepancies between the ICD-10-CA diagnosis assigned in administrative databases and the diagnosis assigned by a dentist reviewing the chart retrospectively. However, ICD-10-CA codes can be used to accurately identify ED visits for NTDC. © 2015 American Association of Public Health Dentistry.

In-office drainage of sinus Mucoceles: An alternative to operating-room drainage.

PubMed

Barrow, Emily M; DelGaudio, John M

2015-05-01

Endoscopic drainage has become the standard of care for the treatment of mucoceles. In many patients this can be performed in the office. This study reviews our experience with in-office endoscopic mucocele drainage. Retrospective chart review. A retrospective review of one surgeon's experience with in-office endoscopic drainage of sinus mucoceles between 2006 and 2014 was performed. Charts were reviewed for patient demographics, previous surgery, mucocele location, bone erosion, and outcomes. Thirty-two patients underwent 36 in-office drainage procedures. All procedures were performed under topical/local anesthesia. The mean age was 55 years (range, 17-92 years). The mean follow-up time was 444 days. Fifty-five percent had previous sinus surgery. The primary sinus involved was the frontal (12), anterior (11), posterior ethmoid (six), maxillary (four), and sphenoid (two). Bone erosion was noted to be present on computed tomography in 18 mucoceles (51%) (16 orbital, seven skull-base). All mucoceles were successfully accessed in the office with the exception of one, which was aborted due to neo-osteogenesis. Five patients (14% of mucoceles) required additional surgery, two for mucocele recurrence and three for septated mucoceles not completely drained in the office. No treatment complications occurred. All but one patient preferred in-office to operating-room drainage. In-office drainage of sinus mucoceles is well tolerated by patients, with high success and low complication rates, even in large mucoceles with bone erosion. The presence of septations and neo-osteogenesis reduce the likelihood of complete drainage and are relative contraindications. Orbital and skull base erosion are not contraindications. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Effective solutions for monitoring the electrostatic separation of metal and plastic granular waste from electric and electronic equipment.

PubMed

Senouci, Khouira; Medles, Karim; Dascalescu, Lucian

2013-02-01

The variability of the quantity and purity of the recovered materials is a serious drawback for the application of electrostatic separation technologies to the recycling of granular wastes. In a series of previous articles we have pointed out how capability and classic control chart concepts could be employed for better mastering the outcome of such processes. In the present work, the multiple exponentially weighted moving average (MEWMA) control chart is introduced and shown to be more effective than the Hotelling T2 chart for monitoring slow varying changes in the electrostatic separation of granular mixtures originating from electric and electronic equipment waste. The operation of the industrial process was simulated by using a laboratory roll-type electrostatic separator and granular samples resulting from shredded electric cable wastes. The 25 tests carried out during the observation phase enabled the calculation of the upper and lower control limits for the two control charts considered in the present study. The 11 additional tests that simulated the monitoring phase pointed out that the MEWMA chart is more effective than Hotelling's T(2) chart in detecting slow varying changes in the outcome of a process. As the reverse is true in the case of abrupt alterations of monitored process performances, simultaneous usage of the two control charts is strongly recommended. While this study focused on a specific electrostatic separation process, using the MEWMA chart together with the well known Hotelling's T(2) chart should be applicable to the statistical control of other complex processes in the field of waste processing.

Synthetic-Type Control Charts for Time-Between-Events Monitoring

PubMed Central

Yen, Fang Yen; Chong, Khoo Michael Boon; Ha, Lee Ming

2013-01-01

This paper proposes three synthetic-type control charts to monitor the mean time-between-events of a homogenous Poisson process. The first proposed chart combines an Erlang (cumulative time between events, Tr) chart and a conforming run length (CRL) chart, denoted as Synth-Tr chart. The second proposed chart combines an exponential (or T) chart and a group conforming run length (GCRL) chart, denoted as GR-T chart. The third proposed chart combines an Erlang chart and a GCRL chart, denoted as GR-Tr chart. By using a Markov chain approach, the zero- and steady-state average number of observations to signal (ANOS) of the proposed charts are obtained, in order to evaluate the performance of the three charts. The optimal design of the proposed charts is shown in this paper. The proposed charts are superior to the existing T chart, Tr chart, and Synth-T chart. As compared to the EWMA-T chart, the GR-T chart performs better in detecting large shifts, in terms of the zero- and steady-state performances. The zero-state Synth-T4 and GR-Tr (r = 3 or 4) charts outperform the EWMA-T chart for all shifts, whereas the Synth-Tr (r = 2 or 3) and GR-T 2 charts perform better for moderate to large shifts. For the steady-state process, the Synth-Tr and GR-Tr charts are more efficient than the EWMA-T chart in detecting small to moderate shifts. PMID:23755231

Quality Assurance of Chemical Measurements.

ERIC Educational Resources Information Center

Taylor, John K.

1981-01-01

Reviews aspects of quality control (methods to control errors) and quality assessment (verification that systems are operating within acceptable limits) including an analytical measurement system, quality control by inspection, control charts, systematic errors, and use of SRMs, materials for which properties are certified by the National Bureau…

Long-Term Aripiprazole in Youth with Developmental Disabilities Including Autism

ERIC Educational Resources Information Center

Hellings, Jessica A.; Boehm, Danna; Yeh, Hung Wen; Butler, Merlin G.; Schroeder, Stephen R.

2011-01-01

We retrospectively reviewed clinic charts of 21 children and adolescents with developmental disabilities including autism spectrum disorders (ASD) treated consecutively with aripiprazole (ARI) for irritability and severe challenging behaviors. Data extracted include age, sex, and race; level of intellectual disability (ID); "Diagnostic and…

Water Pollution Control Across the Nation

ERIC Educational Resources Information Center

Environmental Science and Technology, 1973

1973-01-01

Reviewed are accomplishments, problems, and frustrations faced by individual states in meeting requirements of P.L. 92-500, Federal Water Pollution Control Act Amendments of 1972. State Environmental officials complain the new law may be a hindrance to established cleanup programs. Statistics and charts are given. (BL)

Risk Factors for Retreatment Following Myopic LASIK with Femtosecond Laser and Custom Ablation for the Treatment of Myopia.

PubMed

Kruh, Jonathan N; Garrett, Kenneth A; Huntington, Brian; Robinson, Steve; Melki, Samir A

2017-01-01

To identify risks factors for retreatment post-laser in situ keratomeliusis (LASIK). A retrospective chart review from December 2008 to September 2012 identified 1,402 patients (2,581 eyes) that underwent LASIK treatment for myopia with the Intralase™ FS, STAR S4 IR™ Excimer Laser, and WaveScan WaveFront™ technology. In this group, 83 patients were retreated. All charts were reviewed for preoperative age, gender, initial manifest refraction spherical equivalent (MRSE), total astigmatism, and iris registration. Increased incidence rates of retreatment post-LASIK were preoperative age >40 years (p < 0.001), initial MRSE > -3.0 D (p = 0.02), and astigmatism >1D (p = 0.001). Iris registration capture did not significantly reduce the retreatment rate (p = 0.12). Risk factors for retreatment included preoperative age >40 years, initial MRSE > -3.0 D, and astigmatism >1D. There was no difference in retreatment rate for patients based on gender or iris registration capture.

Haloperidol for severe anorexia nervosa restricting type with delusional body image disturbance: a nine-case chart review.

PubMed

Mauri, Mauro; Miniati, Mario; Mariani, Michela Giorgi; Ciberti, Agnese; Dell'Osso, Liliana

2013-09-01

Here we report on a case series chart review conducted on nine severe and treatment-resistant patients with anorexia nervosa, body mass index < 13 kg/m(2), and a delusional body image disturbance. Patients received low doses of haloperidol during hospitalization. Haloperidol was well tolerated. The delusional body image disturbance and the drive for thinness were subjectively perceived as less intense. BMI increased from the initial 12.2 ± 0.5 to 16.0 ± 1.5 kg/m(2). Mean pulse rate and blood pressure did not change significantly from admission to discharge (66 ± 11.6 bpm; 91/56 mmHg vs 77 ± 12.0 bpm; 102/66 mmHg). Mean of QTc, available from electrocardiograms performed during hospitalization, was 413 ± 38.5 ms (range 342-469 ms). Further investigations are warranted to elucidate clinical usefulness and safety of low doses of haloperidol for patients with treatment-resistant anorexia and delusional body image disturbance.

Sequelae and Other Conditions in Ebola Virus Disease Survivors, Sierra Leone, 2015.

PubMed

Mohammed, Hamish; Vandy, Alren O; Stretch, Rebecca; Otieno, David; Prajapati, Mukesh; Calderon, Mauricio; Vandi, Mohamed

2017-01-01

We rapidly assessed the health of Ebola virus disease (EVD) survivors in Kenema, Sierra Leone, by reviewing medical charts of all patients attending the Survivor Clinic of Kenema Government Hospital. Data were abstracted on signs and symptoms at every attendance. As of November 2015, a total of 621 attendances by 115 survivors with laboratory-confirmed EVD were made to the Survivor Clinic. Most (60.9%) survivors were women. Survivors' median age was 28 years (range 0.25-70 years). Survivors attended the clinic a median of 5 times (range 1-21 times) each, and the median time from EVD discharge to attendance was 261 days (range 4-504 days). The most commonly reported signs and symptoms among the 621 attendances were headache (63.1%), fever (61.7%), and myalgia (43.3%). Because health needs of EVD survivors are complex, rapid chart reviews at survivor clinics should be repeated regularly to assess the extent of illness and prioritize service delivery.

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

PubMed

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

2015-09-01

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

System Study at SUNY College Bookstore/Oswego

ERIC Educational Resources Information Center

DeVita, Richard; And Others

1975-01-01

A system study of the textbook ordering department is presented including systems flow chart, chart of activities, and description of operations and procedures for utilizing the computer system. Changes based on the study are noted. (JT)

A Retrospective Review of Forensic Odontology Reports Written by the Joint POW/MIA Accounting Command Central Identification Laboratory for Remains Identified from the Korean War.

PubMed

Shiroma, Calvin Y

2016-01-01

As of August 2014, the Joint POW/MIA Accounting Command has identified the remains of 1980 previously unknown U.S. service members; 280 were from the Korean War. To determine the accuracy and completeness of the available antemortem (AM) dental records, a review of the AM/postmortem (AM/PM) dental record comparisons from 233 Forensic Odontology Reports written in support of remains identified from the Korean War was performed. Seventy-two AM/PM comparisons resulted in exact dental chartings while 161 contained discrepancies which were explainable. Explainable discrepancies include undocumented treatment (103), incorrectly charted third molars as missing (82), differing opinions of specific molars present/missing (20), and erroneous treatment documentation and/or misidentification of teeth present/missing (22, other than molars). Reassessment has revealed varying levels of completeness for our available AM dental records, the need to thoroughly review our computerized comparisons, adjust our comparisons to include molar pattern variations/third molars, and updating our database comparison program. Published 2015. This article is a U.S. Government work and is in the public domain in the U.S.A.

Using a Chart-table Medium to Focus Students' Attention on Science Concepts.

ERIC Educational Resources Information Center

Holliday, William G.; Benson, Garth D.

A study is presented which utilizes a selective attention model to investigate the learning effects of different questioning strategies under four experimental conditions using a non-prose medium (science textbook chart) containing information of varying established difficulty. A 14-row, 4-column chart describing 14 vitamins was used to present…

Needle aponeurotomy for Dupuytren contracture: Effectiveness of postoperative night extension splinting.

PubMed

Tam, Louisa; Chung, Yin-Yin

2016-01-01

Night extension splinting has been used to treat patients with Dupuytren contracture to improve active range of motion (AROM) of the hand. A published case study demonstrated the benefit of splinting following needle aponeurotomy; however, no larger studies have evaluated the impact of postoperative splinting. To compare the impact of night extension splinting on AROM, specifically extension, following needle aponeurotomy for Dupuytren contracture. A retrospective chart review was conducted in which the charts of 53 patients who underwent needle aponeurotomy for Dupuytren contracture between 2009 and 2013 were reviewed. The control group consisted of patients who underwent needle aponeurotomy only, whereas the treatment group was also referred for fabrication of custom night extension splints after surgery. Comparisons in pre- and postoperative AROM measurements for the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were made between both groups of patients. The degrees of change in AROM for each joint were categorized in terms of levels of change: mild (0° to 29°); moderate (30° to 60°); and significant (≥61°). All patients exhibited increased AROM after surgery for both MCP and PIP joints. Both groups had a greater increase in AROM in the MCP joint. Twelve joints from the control group had moderate changes and two from the treatment group had significant changes. When both groups were compared, the levels of change of AROM between both groups did not vary significantly. Night extension splinting following needle aponeurotomy may not improve AROM of the MCP or PIP joints.

Applying Classification Trees to Hospital Administrative Data to Identify Patients with Lower Gastrointestinal Bleeding

PubMed Central

Siddique, Juned; Ruhnke, Gregory W.; Flores, Andrea; Prochaska, Micah T.; Paesch, Elizabeth; Meltzer, David O.; Whelan, Chad T.

2015-01-01

Background Lower gastrointestinal bleeding (LGIB) is a common cause of acute hospitalization. Currently, there is no accepted standard for identifying patients with LGIB in hospital administrative data. The objective of this study was to develop and validate a set of classification algorithms that use hospital administrative data to identify LGIB. Methods Our sample consists of patients admitted between July 1, 2001 and June 30, 2003 (derivation cohort) and July 1, 2003 and June 30, 2005 (validation cohort) to the general medicine inpatient service of the University of Chicago Hospital, a large urban academic medical center. Confirmed cases of LGIB in both cohorts were determined by reviewing the charts of those patients who had at least 1 of 36 principal or secondary International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) diagnosis codes associated with LGIB. Classification trees were used on the data of the derivation cohort to develop a set of decision rules for identifying patients with LGIB. These rules were then applied to the validation cohort to assess their performance. Results Three classification algorithms were identified and validated: a high specificity rule with 80.1% sensitivity and 95.8% specificity, a rule that balances sensitivity and specificity (87.8% sensitivity, 90.9% specificity), and a high sensitivity rule with 100% sensitivity and 91.0% specificity. Conclusion These classification algorithms can be used in future studies to evaluate resource utilization and assess outcomes associated with LGIB without the use of chart review. PMID:26406318

The costs and utility of imaging in evaluating dizzy patients in the emergency room.

PubMed

Ahsan, Syed F; Syamal, Mausumi N; Yaremchuk, Kathleen; Peterson, Edward; Seidman, Michael

2013-09-01

To determine the usefulness and the costs of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of patients with dizziness in the emergency department (ED). Retrospective chart review. Charts of patients with a specific health maintenance insurance plan presenting with dizziness and vertigo to a large health system's ED between January 2008 and January 2011 were reviewed. Patient demographics, signs/symptoms, and CT and MRI results were assessed. CT and MRI charges were determined based on positive versus unremarkable findings. Data analysis included stepwise logistic regressions. Of 1681 patients identified, 810 (48%) received CT brain/head scan totaling $988,200 in charges. Of these, only 0.74% yielded clinically significant pathology requiring intervention. However, 12.2% of MRI studies yielded discovery of significant abnormalities. Logistic regression analysis revealed that older patients (P = .001) were more likely to receive a CT scan. In the 3-year period studied, CT scans for ED patients with dizziness and vertigo yielded a low predictive value for significant pathology. These data reveal a great opportunity for cost savings by developing stricter guidelines for ordering CT scans for this set of ED patients. The use of MRI in all cases of dizziness was found to be neither practical nor useful. However, appropriately directed MRI of the brain is recommended in patients with dizziness and other neurological signs or symptoms. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

INCIDENCE OF CENTRAL DIABETES INSIPIDUS IN CHILDREN PRESENTING WITH POLYDIPSIA AND POLYURIA.

PubMed

Haddad, Nadine G; Nabhan, Zeina M; Eugster, Erica A

2016-12-01

Polydipsia and polyuria are common reasons for referral to the Pediatric Endocrine clinic. In the absence of hyperglycemia, diabetes insipidus (DI) should be considered. The objectives of the study were to determine the prevalence of central DI (CDI) in a group of children presenting for evaluation of polydipsia and polyuria, and to determine if predictive features were present in patients in whom the diagnosis of DI was made. The study was a retrospective chart review of children presenting to the endocrine clinic with complaints of polydipsia and polyuria over a 5-year period. The charts of 41 patients (mean age 4.9 ± 3.7 years, 28 males) were reviewed. CDI was diagnosed in 8 (20%) children based on abnormal water deprivation test (WDT) results. All but one patient had abnormal magnetic resonance imaging (MRI) findings, the most common being pituitary stalk thickening. Children with DI were older (7.86 ± 4.40 vs. 4.18 ± 3.20 years, P = .01) and had a higher propensity for cold beverages intake and unusual water-seeking behaviors compared to those without DI. Baseline WDT also revealed higher serum sodium (Na) and osmolality. The incidence of CDI in children presenting with polydipsia and polyuria is low. Factors associated with higher likelihood of pathology include older age, propensity for cold beverage intake, and higher baseline serum Na and osmolality on a WDT. BMI = body mass index CDI = central diabetes insipidus DI = diabetes insipidus Na = sodium WDT = water deprivation test.

Risk factors for interruption to soft contact lens wear in children and young adults.

PubMed

Wagner, Heidi; Chalmers, Robin L; Mitchell, G Lynn; Jansen, Meredith E; Kinoshita, Beth T; Lam, Dawn Y; McMahon, Timothy T; Richdale, Kathryn; Sorbara, Luigina

2011-08-01

The purpose of this study was to describe age and other risk factors for ocular events that interrupt soft contact lens (SCL) wear in youth. A retrospective chart review of SCL wearers aged 8 to 33 years at the first observed visit was conducted at six academic eye care centers in North America. Data were extracted from all visits during the observation period (>3 years). Clinical records that documented conditions resulting in an interruption of SCL wear "events" were scanned, masked for age and SCL parameters, and then adjudicated to consensus diagnosis. Generalized estimating equations were used to examine the effect of selected covariates, including age, on the risk of an event. Chart review of 3549 SCL wearers yielded 522 events among 426 wearers (12%). The risk of an event increased from ages 8 to 18 years, showed modest increases between ages 19 and 25 years, and then began to decline after age 25 years. New lens wearers (<1 year) were less likely to experience events (p = 0.001). Lens replacement schedule and material were also predictive of interruptions to SCL wear with the lowest risk in daily replacement and hydrogel lens wearers (both p < 0.0001). These results suggest that the risk of events that interrupt SCL wear peaks in late adolescence and early adulthood and reflects risk factors identified in prospective contact lens studies. Relative to older teens and young adults, patients younger than 14 years presented with significantly fewer events resulting in interrupted lens wear.