Standardization of clinical pharmacist's activities: Methodology.

PubMed

Gregorová, Jana; Rychlíčková, Jitka; Šaloun, Jan

2017-09-01

Establishing standardized and controlled system of work at a clinical pharmacy department and establishing effective recording of activities of a group of four clinical pharmacist when providing clinical pharmaceutical care (CPC) in a hospital. The duration of evaluated period is 5.5 years. The first part was defining the purpose, methods and activities of clinical pharmaceutical care, the next part was designing the software for recording patient's data and CPC activities. To verify the functionality of our system the third part was conducted (from January 1, 2015 to June 30, 2015). CPC activities were defined precisely. During the 6 months period, 3946 patients were reviewed (17% of patients admitted), in this group, 41% patients was labeled as risk (these patients had one or more risk factor). 1722 repeated reviews were performed, 884 drug therapy recommendations were recorded. The calculated average time necessary for one CPC activity is 28 min. During the 5 year period, standardized system of work in clinical pharmacy department was established. This system is based on clearly defined activities and it enables external control. Our results supply data for negotiations with health insurance companies.

The clinical nurse specialist: leadership in quality improvement.

PubMed

Finkelman, Anita

2013-01-01

Healthcare delivery is in a crisis, requiring improvement. How to improve and who should assume more leadership are not clear. At the same time, the nursing profession struggles with a weak education system, graduating students who require major support for an extended time. There is also confusion related to nursing roles, particularly with nurses who have a graduate degree. The Institute of Medicine has published a series of reports about the healthcare system and need for improvement and describes a structure for improvement. The clinical nurse specialist is particularly suited to assume a major role in nursing leadership to guide staff and the healthcare system to better ensure improved care. There is great need to communicate that the clinical nurse specialist can and should assume this role. This will require a review and development of more quality improvement content and experiences in clinical nurse specialist educational programs, but much of the content is already in programs. The clinical nurse specialist works in systems, impacts systems, works with staff, and can thus reach more patients with improvement approaches.

Louhi 2010: Special issue on Text and Data Mining of Health Documents

PubMed Central

2011-01-01

The papers presented in this supplement focus and reflect on computer use in every-day clinical work in hospitals and clinics such as electronic health record systems, pre-processing for computer aided summaries, clinical coding, computer decision systems, as well as related ethical concerns and security. Much of this work concerns itself by necessity with incorporation and development of language processing tools and methods, and as such this supplement aims at providing an arena for reporting on development in a diversity of languages. In the supplement we can read about some of the challenges identified above. PMID:21992545

A Semantic Web-based System for Managing Clinical Archetypes.

PubMed

Fernandez-Breis, Jesualdo Tomas; Menarguez-Tortosa, Marcos; Martinez-Costa, Catalina; Fernandez-Breis, Eneko; Herrero-Sempere, Jose; Moner, David; Sanchez, Jesus; Valencia-Garcia, Rafael; Robles, Montserrat

2008-01-01

Archetypes facilitate the sharing of clinical knowledge and therefore are a basic tool for achieving interoperability between healthcare information systems. In this paper, a Semantic Web System for Managing Archetypes is presented. This system allows for the semantic annotation of archetypes, as well for performing semantic searches. The current system is capable of working with both ISO13606 and OpenEHR archetypes.

Enhanced Cognitive Rehabilitation to Treat Comorbid TBI and PTSD

DTIC Science & Technology

2015-10-01

study brochures more widely to other relevant clinics within the VA (e.g., Member Services, Polytrauma , Social Work). The study coordinator 5  has also...In addition, the study coordinator worked closely with the Polytrauma Clinic at the VA to build a more efficient system to reach Veterans who are

[Introduction and some problems of the rapid time series laboratory reporting system].

PubMed

Kanao, M; Yamashita, K; Kuwajima, M

1999-09-01

We introduced an on-line system of biochemical, hematological, serological, urinary, bacteriological, and emergency examinations and associated office work using a client server system NEC PC-LACS based on a system consisting of concentration of outpatient blood collection, concentration of outpatient reception, and outpatient examination by reservation. Using this on-line system, results of 71 items in chemical serological, hematological, and urinary examinations are rapidly reported within 1 hour. Since the ordering system at our hospital has not been completed yet, we constructed a rapid time series reporting system in which time series data obtained on 5 serial occasions are printed on 2 sheets of A4 paper at the time of the final report. In each consultation room of the medical outpatient clinic, at the neuromedical outpatient clinic, and at the kidney center where examinations are frequently performed, terminal equipment and a printer for inquiry were established for real-time output of time series reports. Results are reported by FAX to the other outpatient clinics and wards, and subsequently, time series reports are output at the clinical laboratory department. This system allowed rapid examination, especially preconsultation examination. This system was also useful for reducing office work and effectively utilize examination data.

From Systems Understanding to Personalized Medicine: Lessons and Recommendations Based on a Multidisciplinary and Translational Analysis of COPD.

PubMed

Roca, Josep; Cano, Isaac; Gomez-Cabrero, David; Tegnér, Jesper

2016-01-01

Systems medicine, using and adapting methods and approaches as developed within systems biology, promises to be essential in ongoing efforts of realizing and implementing personalized medicine in clinical practice and research. Here we review and critically assess these opportunities and challenges using our work on COPD as a case study. We find that there are significant unresolved biomedical challenges in how to unravel complex multifactorial components in disease initiation and progression producing different clinical phenotypes. Yet, while such a systems understanding of COPD is necessary, there are other auxiliary challenges that need to be addressed in concert with a systems analysis of COPD. These include information and communication technology (ICT)-related issues such as data harmonization, systematic handling of knowledge, computational modeling, and importantly their translation and support of clinical practice. For example, clinical decision-support systems need a seamless integration with new models and knowledge as systems analysis of COPD continues to develop. Our experience with clinical implementation of systems medicine targeting COPD highlights the need for a change of management including design of appropriate business models and adoption of ICT providing and supporting organizational interoperability among professional teams across healthcare tiers, working around the patient. In conclusion, in our hands the scope and efforts of systems medicine need to concurrently consider these aspects of clinical implementation, which inherently drives the selection of the most relevant and urgent issues and methods that need further development in a systems analysis of disease.

Video observation in HIT development: lessons learned on benefits and challenges.

PubMed

Høstgaard, Anna Marie; Bertelsen, Pernille

2012-08-22

Experience shows that the precondition for the development of successful health information technologies is a thorough insight into clinical work practice. In contemporary clinical work practice, clinical work and health information technology are integrated, and part of the practice is tacit. When work practice becomes routine, it slips to the background of the conscious awareness and becomes difficult to recognize without the context to support recall. This means that it is difficult to capture with traditional ethnographic research methods or in usability laboratories or clinical set ups. Observation by the use of the video technique within healthcare settings has proven to be capable of providing a thorough insight into the complex clinical work practice and its context - including parts of the tacit practice. The objective of this paper is 1) to argue for the video observation technique to inform and improve health-information-technology development and 2) to share insights and lessons learned on benefits and challenges when using the video observation technique within healthcare settings. A multiple case study including nine case studies conducted by DaCHI researchers 2004-2011 using audio-visual, non-participant video observation for data collection within different healthcare settings. In HIT development, video observation is beneficial for 1) informing and improving system design 2) studying changes in work practice 3) identifying new potentials and 4) documenting current work practices. The video observation technique used within healthcare settings is superior to other ethnographic research methods when it comes to disclosing the complexity in clinical work practice. The insights gained are far more realistic compared to traditional ethnographic studies or usability studies and studies in clinical set ups. Besides, the data generated through video recordings provide a solid basis for dialog between the health care professionals involved. The most important lessons learned are that a well considered methodology and clear formulated objectives are imperative, in order to stay focused during the data rich analysis phase. Additionally, the video observation technique is primarily recommended for studies of specific clinical work practices within delimited clinical settings. Overall, the video observation technique has proven to be capable of improving our understanding of the interwoven relation between clinical work practice and HIT and to inform us about user requirements and needs for HIT, which is a precondition for the development of more successful HIT systems in the future.

Home monitoring of patients with Parkinson's disease via wearable technology and a web-based application.

PubMed

Patel, Shyamal; Chen, Bor-Rong; Buckley, Thomas; Rednic, Ramona; McClure, Doug; Tarsy, Daniel; Shih, Ludy; Dy, Jennifer; Welsh, Matt; Bonato, Paolo

2010-01-01

Objective long-term health monitoring can improve the clinical management of several medical conditions ranging from cardiopulmonary diseases to motor disorders. In this paper, we present our work toward the development of a home-monitoring system. The system is currently used to monitor patients with Parkinson's disease who experience severe motor fluctuations. Monitoring is achieved using wireless wearable sensors whose data are relayed to a remote clinical site via a web-based application. The work herein presented shows that wearable sensors combined with a web-based application provide reliable quantitative information that can be used for clinical decision making.

Reengineering a database for clinical trials management: lessons for system architects.

PubMed

Brandt, C A; Nadkarni, P; Marenco, L; Karras, B T; Lu, C; Schacter, L; Fisk, J M; Miller, P L

2000-10-01

This paper describes the process of enhancing Trial/DB, a database system for clinical studies management. The system's enhancements have been driven by the need to maximize the effectiveness of developer personnel in supporting numerous and diverse users, of study designers in setting up new studies, and of administrators in managing ongoing studies. Trial/DB was originally designed to work over a local area network within a single institution, and basic architectural changes were necessary to make it work over the Internet efficiently as well as securely. Further, as its use spread to diverse communities of users, changes were made to let the processes of study design and project management adapt to the working styles of the principal investigators and administrators for each study. The lessons learned in the process should prove instructive for system architects as well as managers of electronic patient record systems.

Simulation of digital mammography images

NASA Astrophysics Data System (ADS)

Workman, Adam

2005-04-01

A number of different technologies are available for digital mammography. However, it is not clear how differences in the physical performance aspects of the different imaging technologies affect clinical performance. Randomised controlled trials provide a means of gaining information on clinical performance however do not provide direct comparison of the different digital imaging technologies. This work describes a method of simulating the performance of different digital mammography systems. The method involves modifying the imaging performance parameters of images from a small field of view (SFDM), high resolution digital imaging system used for spot imaging. Under normal operating conditions this system produces images with higher signal-to-noise ratio (SNR) over a wide spatial frequency range than current full field digital mammography (FFDM) systems. The SFDM images can be 'degraded" by computer processing to simulate the characteristics of a FFDM system. Initial work characterised the physical performance (MTF, NPS) of the SFDM detector and developed a model and method for simulating signal transfer and noise properties of a FFDM system. It was found that the SNR properties of the simulated FFDM images were very similar to those measured from an actual FFDM system verifying the methodology used. The application of this technique to clinical images from the small field system will allow the clinical performance of different FFDM systems to be simulated and directly compared using the same clinical image datasets.

[Evaluation of production and clinical working time of computer-aided design/computer-aided manufacturing (CAD/CAM) custom trays for complete denture].

PubMed

Wei, L; Chen, H; Zhou, Y S; Sun, Y C; Pan, S X

2017-02-18

To compare the technician fabrication time and clinical working time of custom trays fabricated using two different methods, the three-dimensional printing custom trays and the conventional custom trays, and to prove the feasibility of the computer-aided design/computer-aided manufacturing (CAD/CAM) custom trays in clinical use from the perspective of clinical time cost. Twenty edentulous patients were recruited into this study, which was prospective, single blind, randomized self-control clinical trials. Two custom trays were fabricated for each participant. One of the custom trays was fabricated using functional suitable denture (FSD) system through CAD/CAM process, and the other was manually fabricated using conventional methods. Then the final impressions were taken using both the custom trays, followed by utilizing the final impression to fabricate complete dentures respectively. The technician production time of the custom trays and the clinical working time of taking the final impression was recorded. The average time spent on fabricating the three-dimensional printing custom trays using FSD system and fabricating the conventional custom trays manually were (28.6±2.9) min and (31.1±5.7) min, respectively. The average time spent on making the final impression with the three-dimensional printing custom trays using FSD system and the conventional custom trays fabricated manually were (23.4±11.5) min and (25.4±13.0) min, respectively. There was significant difference in the technician fabrication time and the clinical working time between the three-dimensional printing custom trays using FSD system and the conventional custom trays fabricated manually (P<0.05). The average time spent on fabricating three-dimensional printing custom trays using FSD system and making the final impression with the trays are less than those of the conventional custom trays fabricated manually, which reveals that the FSD three-dimensional printing custom trays is less time-consuming both in the clinical and laboratory process than the conventional custom trays. In addition, when we manufacture custom trays by three-dimensional printing method, there is no need to pour preliminary cast after taking the primary impression, therefore, it can save the impression material and model material. As to completing denture restoration, manufacturing custom trays using FSD system is worth being popularized.

Integrated therapy safety management system

PubMed Central

Podtschaske, Beatrice; Fuchs, Daniela; Friesdorf, Wolfgang

2013-01-01

Aims The aim is to demonstrate the benefit of the medico-ergonomic approach for the redesign of clinical work systems. Based on the six layer model, a concept for an ‘integrated therapy safety management’ is drafted. This concept could serve as a basis to improve resilience. Methods The concept is developed through a concept-based approach. The state of the art of safety and complexity research in human factors and ergonomics forms the basis. The findings are synthesized to a concept for ‘integrated therapy safety management’. The concept is applied by way of example for the ‘medication process’ to demonstrate its practical implementation. Results The ‘integrated therapy safety management’ is drafted in accordance with the six layer model. This model supports a detailed description of specific work tasks, the corresponding responsibilities and related workflows at different layers by using the concept of ‘bridge managers’. ‘Bridge managers’ anticipate potential errors and monitor the controlled system continuously. If disruptions or disturbances occur, they respond with corrective actions which ensure that no harm results and they initiate preventive measures for future procedures. The concept demonstrates that in a complex work system, the human factor is the key element and final authority to cope with the residual complexity. The expertise of the ‘bridge managers’ and the recursive hierarchical structure results in highly adaptive clinical work systems and increases their resilience. Conclusions The medico-ergonomic approach is a highly promising way of coping with two complexities. It offers a systematic framework for comprehensive analyses of clinical work systems and promotes interdisciplinary collaboration. PMID:24007448

[Awareness survey of Healthcare Number System pros and cons according to medical doctors in Japan].

PubMed

Takahashi, Yoshimitsu; Uryuhara, Yoko; Inoue, Machiko; Okamoto, Shigeru; Kashihara, Hidenori; Kito, Kumiko; Shinohara, Keiko; Mandai, Marie; Morioka, Miho; Tanaka, Shiro; Kawakami, Koji; Nakayama, Takeo

2015-01-01

After bills to launch the Social Security and Tax Number System were enacted in 2013, health and political officials have considered the Healthcare Number System (the System). However, little is known about doctors' awareness and concerns about the System. This study aimed to measure how many doctors disagree with the System, examine the doctors' characteristics, and analyze the benefits and harms of the System that they identified. A cross-sectional survey was conducted of doctors via the Internet. The participants were selected from a convenience sample of a panel of doctors based on stratified sampling including four groups: working at a hospital and <45 years; working at a hospital and ≥45 years; working at a clinic and <45 years; and working at a clinic and ≥45 years. The main outcome was how many doctors agreed or disagreed with the System. The prevalence was calculated for each group, and their characteristics were examined using multivariable logistic regression analysis. The responses to open-ended questions concerning the Systems' benefits and harms were analyzed using qualitative content analysis. There were 562 respondents (68%). By group, 16/143 (11%), 25/138 (18%), 31/132 (23%), and 43/149 (29%) doctors, respectively, thought that the System was unnecessary. The variables that correlated with the main outcome were age (per 5 years; odds ratio [95% confidence interval], 1.14 [1.01-1.29]) and type of medical facility (working at a clinic; 1.99 [1.30-3.08]). The doctors identified that unifying information could decrease administrative duties, facilitate inter-facility collaboration, and prevent inappropriate medical consultations. This could result in decreased healthcare costs and personalized healthcare. However, the doctors also identified that integrating information and dealing with big data could increase information leakage and information management, cause over-monitoring of doctors, and enable the inappropriate use of integrated information. This could result in deteriorating healthcare. Since some information should not be integrated, the System raises ethical considerations about privacy. Among the doctors surveyed here, 10-30% thought the System was unnecessary. These respondents tended to be older and work at a clinic. The System could decrease the cost of healthcare and enable personalized healthcare but could also increase information leakage and information management, cause over-monitoring of doctors, and enable the inappropriate use of integrated information. Prior to System introduction, we should facilitate consensus-building about protecting and utilizing personal information as well as consider the related ethical issues, and doctors' characteristics and concerns.

Clinically lean; "cutting the crap".

PubMed

Caldwell, G

2012-01-01

Proponents of Lean Philosophy believe that successful businesses must reduce waste in working time and resources to a minimum, and maximise their use in productive work. The productive work of the Acute Medical Unit is to provide effective clinical management to a daily cohort of acutely ill patients. Many Clinicians are cynical about Lean. In this article, Dr Caldwell discusses how many clinicians complain of too much crap in the workplace, which gets in the way of swift, safe high quality clinical care. He argues that "Cutting the Crap" in the Acute Medical Unit is entirely consistent with Lean approaches to management of complex systems.

Integrating Single-System Design Research into the Clinical Practice Class

ERIC Educational Resources Information Center

Cooper, Marlene G.

2006-01-01

Clinical practice and research are generally taught separately in Master of Social Work programs by faculty with distinct areas of expertise. This paper discusses the teaching of single-subject design research methodology by clinical faculty, in the clinical practice class. Examples from student papers demonstrate the effectiveness of integrating…

Aligning clinical compensation with clinical productivity: design and implementation of the financial value unit (FVU) system in an academic department of internal medicine.

PubMed

Stites, Steven; Steffen, Patrick; Turner, Scott; Pingleton, Susan

2013-07-01

A new metric was developed and implemented at the University of Kansas School of Medicine Department of Internal Medicine, the financial value unit (FVU). This metric analyzes faculty clinical compensation compared with clinical work productivity as a transparent means to decrease the physician compensation variability and compensate faculty equitably for clinical work.The FVU is the ratio of individual faculty clinical compensation compared with their total work relative value units (wRVUs) generated divided by Medical Group Management Association (MGMA) salary to wRVUs of a similar MGMA physician.The closer the FVU ratio is to 1.0, the closer clinical compensation is to that of an MGMA physician with similar clinical productivity. Using FVU metrics to calculate a faculty salary gap compared with MGMA median salary and wRVU productivity, a divisional production payment was established annually.From FY 2006 to FY 2011, both total faculty numbers and overall clinical activity increased. With the implementation of the FVU, both clinical productivity and compensation increased while, at the same time, physician retention rates remained high. Variability in physician compensation decreased. Dramatic clinical growth was associated with the alignment of clinical work and clinical compensation in a transparent and equable process.

Extending DICOM imaging to new clinical specialties in the healthcare enterprise

NASA Astrophysics Data System (ADS)

Kuzmak, Peter M.; Dayhoff, Ruth E.

2002-05-01

DICOM is a success for radiology and cardiology and it is now starting to be used for the other clinical specialties. The US Department of Veterans Affairs has been instrumental in promoting this advancement. We have worked with a number of non-radiology clinical speciality imaging vendors over the past two years, encouraging them to support DICOM, providing requirement specifications. Validating their implementations, using their products, and integrating their systems with the VA healthcare enterprise. We require each new clinical speciality vendor to support the DICOM Modality Worklist and Storage services and insist that they perform validation testing with us over the Internet. Two years ago we began working with two commercial DICOM image acquisition applications in ophthalmology and endoscopy. We are now dealing with over a dozen: five in ophthalmology, two in endoscopy, and six in dental. This has been a very productive endeavor. Because mature software development toolkits now exist, the vendors can quickly integrate DICOM with their existing imaging products. Each of the dental vendors, for example, was able to accomplish this task in less than three months. Getting the imaging modality vendors to support DICOM is only part of the story, however. We are also working on getting the VistA hospital information system to properly handle DICOM interfaces to various clinical specialties. This has been more difficult than expected because the workflow in clinical specialties is much more varied than that in radiology. This required us to develop software that is much more flexible than that used for radiology. Fortunately, the standard DICOM Modality Worklist and Storage services can be used without change. In addition to a more variable workflow, the use of structured reporting is much more advanced in clinical specialties than in radiology, and significant work is needed to define templates and communicate this data using DICOM. Since some speciality modules of our hospital information system currently store only report text, we also have to figure out how to store and display the discrete structured report data. The work involved in extending DICOM to the clinical specialties, and in integrating them with the hospital information system is an ongoing and worthwhile challenge. Our goal is to incorporate al of the patient's data into the electronic record, and DICOM is making this easier for everyone. Considerable investment, however, has to be made in the hospital information system software to accrue the full benefit.

[Robotics].

PubMed

Bier, J

2000-05-01

Content of this paper is the current state of the art of robots in surgery and the ongoing work on the field of surgical robotics at the Clinic for Maxillofacial Surgery at the Charité. Robots in surgery allows the surgeon to transform the accuracy of the imaging systems directly during the intervention and to plan an intervention beforehand. In this paper firstly the state of the art is described. Subsequently the scientific work at the clinic is described in detail. The paper closes with a outlook for future applications of robotics systems in maxillofacial surgery.

Enhancing Worker Health Through Clinical Decision Support (CDS): An Introduction to a Compilation.

PubMed

Filios, Margaret S; Storey, Eileen; Baron, Sherry; Luensman, Genevieve B; Shiffman, Richard N

2017-11-01

This article outlines an approach to developing clinical decision support (CDS) for conditions related to work and health. When incorporated in electronic health records, such CDS will assist primary care providers (PCPs) care for working patients. Three groups of Subject Matter Experts (SMEs) identified relevant clinical practice guidelines, best practices, and reviewed published literature concerning work-related asthma, return-to-work, and management of diabetes at work. SMEs developed one recommendation per topic that could be supported by electronic CDS. Reviews with PCPs, staff, and health information system implementers in five primary care settings confirmed that the approach was important and operationally sound. This compendium is intended to stimulate a dialogue between occupational health specialists and PCPs that will enhance the use of work information about patients in the primary care setting.

Orbital atherectomy: device evolution and clinical data.

PubMed

Staniloae, Cezar S; Korabathina, Ravikiran

2014-05-01

A number of atherectomy devices were developed in the last few years. Among them, the DiamondBack 360° Peripheral Orbital Atherectomy System (Cardiovascular Systems, Inc) was specifically designed to work in severely calcified plaque. This article reviews the history, mechanism of action, evolution, clinical data, and future applications of this particular atherectomy device.

Event (error and near-miss) reporting and learning system for process improvement in radiation oncology.

PubMed

Mutic, Sasa; Brame, R Scott; Oddiraju, Swetha; Parikh, Parag; Westfall, Melisa A; Hopkins, Merilee L; Medina, Angel D; Danieley, Jonathan C; Michalski, Jeff M; El Naqa, Issam M; Low, Daniel A; Wu, Bin

2010-09-01

The value of near-miss and error reporting processes in many industries is well appreciated and typically can be supported with data that have been collected over time. While it is generally accepted that such processes are important in the radiation therapy (RT) setting, studies analyzing the effects of organized reporting and process improvement systems on operation and patient safety in individual clinics remain scarce. The purpose of this work is to report on the design and long-term use of an electronic reporting system in a RT department and compare it to the paper-based reporting system it replaced. A specifically designed web-based system was designed for reporting of individual events in RT and clinically implemented in 2007. An event was defined as any occurrence that could have, or had, resulted in a deviation in the delivery of patient care. The aim of the system was to support process improvement in patient care and safety. The reporting tool was designed so individual events could be quickly and easily reported without disrupting clinical work. This was very important because the system use was voluntary. The spectrum of reported deviations extended from minor workflow issues (e.g., scheduling) to errors in treatment delivery. Reports were categorized based on functional area, type, and severity of an event. The events were processed and analyzed by a formal process improvement group that used the data and the statistics collected through the web-based tool for guidance in reengineering clinical processes. The reporting trends for the first 24 months with the electronic system were compared to the events that were reported in the same clinic with a paper-based system over a seven-year period. The reporting system and the process improvement structure resulted in increased event reporting, improved event communication, and improved identification of clinical areas which needed process and safety improvements. The reported data were also useful for the evaluation of corrective measures and recognition of ineffective measures and efforts. The electronic system was relatively well accepted by personnel and resulted in minimal disruption of clinical work. Event reporting in the quarters with the fewest number of reported events, though voluntary, was almost four times greater than the most events reported in any one quarter with the paper-based system and remained consistent from the inception of the process through the date of this report. However, the acceptance was not universal, validating the need for improved education regarding reporting processes and systematic approaches to reporting culture development. Specially designed electronic event reporting systems in a radiotherapy setting can provide valuable data for process and patient safety improvement and are more effective reporting mechanisms than paper-based systems. Additional work is needed to develop methods that can more effectively utilize reported data for process improvement, including the development of standardized event taxonomy and a classification system for RT.

Point-of-Care Technologies for Precision Cardiovascular Care and Clinical Research

PubMed Central

King, Kevin; Grazette, Luanda P.; Paltoo, Dina N.; McDevitt, John T.; Sia, Samuel K.; Barrett, Paddy M.; Apple, Fred S.; Gurbel, Paul A.; Weissleder, Ralph; Leeds, Hilary; Iturriaga, Erin J.; Rao, Anupama; Adhikari, Bishow; Desvigne-Nickens, Patrice; Galis, Zorina S.; Libby, Peter

2016-01-01

Point-of-care technologies (POC or POCT) are enabling innovative cardiovascular diagnostics that promise to improve patient care across diverse clinical settings. The National Heart, Lung, and Blood Institute convened a working group to discuss POCT in cardiovascular medicine. The multidisciplinary working group, which included clinicians, scientists, engineers, device manufacturers, regulatory officials, and program staff, reviewed the state of the POCT field; discussed opportunities for POCT to improve cardiovascular care, realize the promise of precision medicine, and advance the clinical research enterprise; and identified barriers facing translation and integration of POCT with existing clinical systems. A POCT development roadmap emerged to guide multidisciplinary teams of biomarker scientists, technologists, health care providers, and clinical trialists as they: 1) formulate needs assessments; 2) define device design specifications; 3) develop component technologies and integrated systems; 4) perform iterative pilot testing; and 5) conduct rigorous prospective clinical testing to ensure that POCT solutions have substantial effects on cardiovascular care. PMID:26977455

System light-loading technology for mHealth: Manifold-learning-based medical data cleansing and clinical trials in WE-CARE Project.

PubMed

Huang, Anpeng; Xu, Wenyao; Li, Zhinan; Xie, Linzhen; Sarrafzadeh, Majid; Li, Xiaoming; Cong, Jason

2014-09-01

Cardiovascular disease (CVD) is a major issue to public health. It contributes 41% to the Chinese death rate each year. This huge loss encouraged us to develop a Wearable Efficient teleCARdiology systEm (WE-CARE) for early warning and prevention of CVD risks in real time. WE-CARE is expected to work 24/7 online for mobile health (mHealth) applications. Unfortunately, this purpose is often disrupted in system experiments and clinical trials, even if related enabling technologies work properly. This phenomenon is rooted in the overload issue of complex Electrocardiogram (ECG) data in terms of system integration. In this study, our main objective is to get a system light-loading technology to enable mHealth with a benchmarked ECG anomaly recognition rate. To achieve this objective, we propose an approach to purify clinical features from ECG raw data based on manifold learning, called the Manifold-based ECG-feature Purification algorithm. Our clinical trials verify that our proposal can detect anomalies with a recognition rate of up to 94% which is highly valuable in daily public health-risk alert applications based on clinical criteria. Most importantly, the experiment results demonstrate that the WE-CARE system enabled by our proposal can enhance system reliability by at least two times and reduce false negative rates to 0.76%, and extend the battery life by 40.54%, in the system integration level.

A proposed computer diagnostic system for malignant melanoma (CDSMM).

PubMed

Shao, S; Grams, R R

1994-04-01

This paper describes a computer diagnostic system for malignant melanoma. The diagnostic system is a rule base system based on image analyses and works under the PC windows environment. It consists of seven modules: I/O module, Patient/Clinic database, image processing module, classification module, rule base module and system control module. In the system, the image analyses are automatically carried out, and database management is efficient and fast. Both final clinic results and immediate results from various modules such as measured features, feature pictures and history records of the disease lesion can be presented on screen or printed out from each corresponding module or from the I/O module. The system can also work as a doctor's office-based tool to aid dermatologists with details not perceivable by the human eye. Since the system operates on a general purpose PC, it can be made portable if the I/O module is disconnected.

An inexpensive modification of the laboratory computer display changes emergency physicians' work habits and perceptions.

PubMed

Marinakis, Harry A; Zwemer, Frank L

2003-02-01

Little is known about how the availability of laboratory data affects emergency physicians' practice habits and satisfaction. We modified our clinical information system to display laboratory test status with continuous updates, similar to an airport arrival display. The objective of this study was to determine whether the laboratory test status display altered emergency physicians' work habits and increased satisfaction compared with the time period before implementation of laboratory test status. A retrospective analysis was performed of emergency physicians' actual use of the clinical information system before and after implementation of the laboratory test status display. Emergency physicians were retrospectively surveyed regarding the effect of laboratory test status display on their practice habits and clinical information system use. Survey responses were matched with actual use of the clinical information system. Data were analyzed by using dependent t tests and Pearson correlation coefficients. The study was conducted at a university hospital. Clinical information system use by 46 emergency physicians was analyzed. Twenty-five surveys were returned (71.4% of available emergency physicians). All emergency physicians perceived fewer clinical information system log ons per day after laboratory test status display. The actual average decrease was 19%. Emergency physicians who reported the greatest decrease in log ons per day tended to have the greatest actual decrease (r =-0.36). There was no significant correlation between actual and perceived total time logged on (r =0.08). In regard to effect on emergency physicians' practice habits, 95% reported increased efficiency, 80% reported improved satisfaction with data access, and 65% reported improved communication with patients. An inexpensive computer modification, laboratory test status display, significantly increased subjective efficiency, changed work habits, and improved satisfaction regarding data access and patient communication among emergency physicians. Knowledge of the test queue changed emergency physician behavior and improved satisfaction.

Rationalisation in public dental care--impact on clinical work tasks and mechanical exposure for dentists--a prospective study.

PubMed

Jonker, D; Rolander, B; Balogh, I; Sandsjö, L; Ekberg, K; Winkel, J

2013-01-01

Swedish dentistry has been exposed to frequent rationalisation initiatives during the last half century. Previous research has shown that rationalisation often results in increased risk of developing work-related musculoskeletal disorders, thus reducing sustainability in the production system. In this prospective study, we assessed mechanical exposures among Swedish dentists in relation to specific rationalisations of clinical dental work during a six-year period. Body postures and movements of 12 dentists were assessed by inclinometry synchronised to video recordings of their work. No rationalisation effects could be shown in terms of a reduction in non-value-adding work ('waste'), and at job level, no major differences in mechanical exposure could be shown between baseline and follow-up. The present rationalisation measures in dentistry do not seem to result in rationalisation at job level, but may potentially be more successful at the overall dental system level. In contrast to many previous investigations of the mechanical exposure implications of rationalisation, the present rationalisation measures did not increase the level of risk for dentists. It is highlighted that all occupations involved in the production system should be investigated to assess production system sustainability.

MO-FG-207-03: Maximizing the Utility of Integrated PET/MRI in Clinical Applications

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

Behr, S.

2015-06-15

The use of integrated PET/MRI systems in clinical applications can best benefit from understanding their technological advances and limitations. The currently available clinical PET/MRI systems have their own characteristics. Thorough analyses of existing technical data and evaluation of necessary performance metrics for quality assurances could be conducted to optimize application-specific PET/MRI protocols. This Symposium will focus on technical advances and limitations of clinical PET/MRI systems, and how this exciting imaging modality can be utilized in applications that can benefit from both PET and MRI. Learning Objectives: To understand the technological advances of clinical PET/MRI systems To correctly identify clinical applicationsmore » that can benefit from PET/MRI To understand ongoing work to further improve the current PET/MRI technology Floris Jansen is a GE Healthcare employee.« less

AACN's healthy work environment standards and an empowering nurse advancement system.

PubMed

Vollers, Dawn; Hill, Edie; Roberts, Cynthia; Dambaugh, Lori; Brenner, Zara R

2009-12-01

An empowering clinical nurse advancement system can facilitate institutional behaviors that embrace all of AACN's healthy work environment standards and thus serve as a building block for developing a flourishing health care environment. The results generate positive outcomes that are evident to health care professionals, patients, patients' families, and health care organizations. Patients benefit from highly satisfied employees who work in a culture of caring and excellence.

The 1999 ICSI/IHI colloquium on clinical quality improvement--"quality: settling the frontier".

PubMed

Palmersheim, T M

1999-12-01

A Colloquium on Clinical Quality Improvement, "Quality: Setting the Frontier," held in May 1999, covered methods and programs in clinical quality improvement. Leadership and organizational behavior were the main themes of the breakout sessions; specific topics included implementing guidelines, applying continuous quality improvement (CQI) methods in preventive services and primary care, and using systems thinking to improve clinical outcomes. Three keynote addresses were presented. James L. Reinertsen, MD (CareGroup, Boston), characterized the financial challenges faced by many health care organizations as a "clarion call" for leadership on quality. "The leadership imperative is to establish an environment in which quality can thrive, despite unprecedented, severe economic pressures on our health systems." How do we make improvement more effective? G. Ross Baker, PhD (University of Toronto), reviewed what organizational literature says about making teams more effective, understanding the organizational context to enable improvement work, and augmenting existing methods for creating sustainable improvement. For example, he noted the increasing interest among may organizations in rapid-cycle improvement but cautioned that such efforts may work best where problems can be addressed by existing clinical teams (not cross-functional work groups) and where there are available solutions that have worked in other settings. Mark Chassin, MD (Mount Sinai School of Medicine, New York), stated that critical tasks for improving quality include increasing public awareness, engaging clinicians in improvement, increasing the investment in producing measures and improvement tools, and reinventing health care delivery, clinical education and training, and QI.

Establishing treatment protocols for clinical mastitis.

PubMed

Roberson, Jerry R

2003-03-01

Each farm has a unique mix of mastitis pathogens and management procedures that have evolved over time. The herd veterinarian should work with the manager/owner to systematically develop treatment protocols that meet the needs and management of the farm. To establish a mastitis treatment protocol, it is necessary to develop a system to routinely identify clinical mastitis cases, develop a herd-specific severity level assessment system, manage the clinical mastitis cases based on severity level and culture result (when available), avoid antibiotic residues, and monitor the success of the system and alter the protocol as necessary.

[work motivation -- assessment instruments and their relevance for medical care].

PubMed

Fiedler, Rolf G; Ranft, Andreas; Greitemann, Bernhard; Heuft, Gereon

2005-11-01

The relevance of work motivation for medical research and healthcare, in particular rehabilitation, is described. Four diagnostic instruments in the German language are introduced which can assess work motivation using a scale system: AVEM, JDS, LMI and FBTM. Their possible application and potential usage for the clinical area are discussed. Apart from the FBTM, none of these instruments can be directly used as a general instrument in a normal medical clinical setting. Finally, a current model for work motivation (compensatory model of work motivation and volition) is presented that contains basis concepts, which are judged as important for future research questions concerning the development of motivation diagnostic instruments.

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

Jansen, F.

The use of integrated PET/MRI systems in clinical applications can best benefit from understanding their technological advances and limitations. The currently available clinical PET/MRI systems have their own characteristics. Thorough analyses of existing technical data and evaluation of necessary performance metrics for quality assurances could be conducted to optimize application-specific PET/MRI protocols. This Symposium will focus on technical advances and limitations of clinical PET/MRI systems, and how this exciting imaging modality can be utilized in applications that can benefit from both PET and MRI. Learning Objectives: To understand the technological advances of clinical PET/MRI systems To correctly identify clinical applicationsmore » that can benefit from PET/MRI To understand ongoing work to further improve the current PET/MRI technology Floris Jansen is a GE Healthcare employee.« less

The McCarron-Dial System--An Approach to Clinical, Vocational, and Educational Evaluation.

ERIC Educational Resources Information Center

Dial, Jack G.; And Others

The McCarron-Dial System is useful for both vocational and clinical evaluation of neuropsychologically disabled adults. Five factors (verbal-cognitive, sensory, motor, emotional, and integration coping) are used to predict vocational competency, which is measured by work samples and behavior scales, during the first twelve months of a client's…

A framework of medical equipment management system for in-house clinical engineering department.

PubMed

Chien, Chia-Hung; Huang, Yi-You; Chong, Fok-Ching

2010-01-01

Medical equipment management is an important issue for safety and cost in modern hospital operation. In addition, the use of an efficient information system effectively promotes the managing performance. In this study, we designed a framework of medical equipment management system used for in-house clinical engineering department. The system was web-based, and it integrated clinical engineering and hospital information system components. Through related information application, it efficiently improved the operation management of medical devices immediately and continuously. This system has run in the National Taiwan University Hospital. The results showed only few examples in the error analysis of medical equipment by the maintenance sub-system. The information can be used to improve work quality, to reduce the maintenance cost, and to promote the safety of medical device used in patients and clinical staffs.

Toward Implementing Patient Flow in a Cancer Treatment Center to Reduce Patient Waiting Time and Improve Efficiency.

PubMed

Suss, Samuel; Bhuiyan, Nadia; Demirli, Kudret; Batist, Gerald

2017-06-01

Outpatient cancer treatment centers can be considered as complex systems in which several types of medical professionals and administrative staff must coordinate their work to achieve the overall goals of providing quality patient care within budgetary constraints. In this article, we use analytical methods that have been successfully employed for other complex systems to show how a clinic can simultaneously reduce patient waiting times and non-value added staff work in a process that has a series of steps, more than one of which involves a scarce resource. The article describes the system model and the key elements in the operation that lead to staff rework and patient queuing. We propose solutions to the problems and provide a framework to evaluate clinic performance. At the time of this report, the proposals are in the process of implementation at a cancer treatment clinic in a major metropolitan hospital in Montreal, Canada.

A Survey of U.S. Navy Medical Communications and Evacuations at Sea

DTIC Science & Technology

1984-07-05

specialized 0 sector of the health care system . The majority of these medical departments are headed by an independent duty corpsman who, unlike many...the U.S. Navy has focused increasing attention on the development and implementation of clinical algorithms and telemedicine systems to enhance...a computer assisted clinical algorithm system for use aboard submarines. 5- 7 Although initial work focused upon acute abdominal pain, future

Severity in irritable bowel syndrome: a Rome Foundation Working Team report.

PubMed

Drossman, Douglas A; Chang, L; Bellamy, N; Gallo-Torres, H E; Lembo, A; Mearin, F; Norton, N J; Whorwell, P

2011-10-01

The concept of severity in irritable bowel syndrome (IBS) is clinically recognized and operative in diagnostic decision making and treatment planning. Yet, there is no consensus on its definition, and there are limited data on the prevalence of severity subgroups, its medical and psychosocial determinants, and its association with other health status measures. The aims of the Rome Foundation Working Team Committee were to summarize current research, to develop a consensus of understanding on this concept, and to make recommendations for its use in research and clinical care. In 2006, a multinational committee of clinical investigators with expertise in IBS and/or psychometric research methods undertook a systematic review of the literature relating to severity in IBS. Owing to limited data, the Foundation commissioned three clinical studies to better characterize the concept of severity in IBS, and summary information and recommendations for future research and clinical care were developed. The main findings were: (i) severity in IBS is defined as a biopsychosocial composite of patient-reported gastrointestinal and extraintestinal symptoms, degree of disability, and illness-related perceptions and behaviors; (ii) both visceral and central nervous system physiological factors affect severity; as severity increases, the central nervous system provides a greater contribution; (iii) severity is related to and influences health-related quality of life and health behaviors and also guides diagnostic and therapeutic clinical decision making; (iv) severity can be subcategorized into clinically meaningful subgroups as mild (∼40%), moderate (∼35%), and severe (∼25%), and this provides a working model for use in future research and clinical care. Future work is required to understand more precisely the factors contributing to severity and to develop a valid patient-reported instrument to measure severity in IBS.

Wearable technology as a booster of clinical care

NASA Astrophysics Data System (ADS)

Jonas, Stephan; Hannig, Andreas; Spreckelsen, Cord; Deserno, Thomas M.

2014-03-01

Wearable technology defines a new class of smart devices that are accessories or clothing equipped with computational power and sensors, like Google Glass. In this work, we propose a novel concept for supporting everyday clinical pathways with wearable technology. In contrast to most prior work, we are not focusing on the omnipresent screen to display patient information or images, but are trying to maintain existing workflows. To achieve this, our system supports clinical staff as a documenting observer, only intervening adequately if problems are detected. Using the example of medication preparation and administration, a task known to be prone to errors, we demonstrate the full potential of the new devices. Patient and medication identifier are captured with the built-in camera, and the information is send to a transaction server. The server communicates with the hospital information system to obtain patient records and medication information. The system then analyses the new medication for possible side-effects and interactions with already administered drugs. The result is sent to the device while encapsulating all sensitive information respecting data security and privacy. The user only sees a traffic light style encoded feedback to avoid distraction. The server can reduce documentation efforts and reports in real-time on possible problems during medication preparation or administration. In conclusion, we designed a secure system around three basic principles with many applications in everyday clinical work: (i) interaction and distraction is kept as low as possible; (ii) no patient data is displayed; and (iii) device is pure observer, not part of the workflow. By reducing errors and documentation burden, our approach has the capability to boost clinical care.

The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature.

PubMed

Georgiou, Andrew; Prgomet, Mirela; Paoloni, Richard; Creswick, Nerida; Hordern, Antonia; Walter, Scott; Westbrook, Johanna

2013-06-01

We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre/post design; 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

A model-driven approach for representing clinical archetypes for Semantic Web environments.

PubMed

Martínez-Costa, Catalina; Menárguez-Tortosa, Marcos; Fernández-Breis, Jesualdo Tomás; Maldonado, José Alberto

2009-02-01

The life-long clinical information of any person supported by electronic means configures his Electronic Health Record (EHR). This information is usually distributed among several independent and heterogeneous systems that may be syntactically or semantically incompatible. There are currently different standards for representing and exchanging EHR information among different systems. In advanced EHR approaches, clinical information is represented by means of archetypes. Most of these approaches use the Archetype Definition Language (ADL) to specify archetypes. However, ADL has some drawbacks when attempting to perform semantic activities in Semantic Web environments. In this work, Semantic Web technologies are used to specify clinical archetypes for advanced EHR architectures. The advantages of using the Ontology Web Language (OWL) instead of ADL are described and discussed in this work. Moreover, a solution combining Semantic Web and Model-driven Engineering technologies is proposed to transform ADL into OWL for the CEN EN13606 EHR architecture.

[Computers in nursing: development of free software application with care and management].

PubMed

dos Santos, Sérgio Ribeiro

2010-06-01

This study aimed at developing an information system in nursing with the implementation of nursing care and management of the service. The SisEnf--Information System in Nursing--is a free software module that comprises the care of nursing: history, clinical examination and care plan; the management module consists of: service shifts, personnel management, hospital indicators and other elements. The system was implemented at the Medical Clinic of the Lauro Wanderley University Hospital, at Universidade Federal da Paraiba. In view of the need to bring user and developer closer, in addition to the constant change of functional requirements during the interactive process, the method of unified process was used. The SisEnf was developed on a WEB platform and using free software. Hence, the work developed aimed at assisting in the working process of nursing, which will now have the opportunity to incorporate information technology in their work routine.

The development and evaluation of a nursing information system for caring clinical in-patient.

PubMed

Fang, Yu-Wen; Li, Chih-Ping; Wang, Mei-Hua

2015-01-01

The research aimed to develop a nursing information system in order to simplify the admission procedure for caring clinical in-patient, enhance the efficiency of medical information documentation. Therefore, by correctly delivering patients’ health records, and providing continues care, patient safety and care quality would be effectively improved. The study method was to apply Spiral Model development system to compose a nursing information team. By using strategies of data collection, working environment observation, applying use-case modeling, and conferences of Joint Application Design (JAD) to complete the system requirement analysis and design. The Admission Care Management Information System (ACMIS) mainly included: (1) Admission nursing management information system. (2) Inter-shift meeting information management system. (3) The linkage of drug management system and physical examination record system. The framework contained qualitative and quantitative components that provided both formative and summative elements of the evaluation. System evaluation was to apply information success model, and developed questionnaire of consisting nurses’ acceptance and satisfaction. The results of questionnaires were users’ satisfaction, the perceived self-involvement, age and information quality were positively to personal and organizational effectiveness. According to the results of this study, the Admission Care Management Information System was practical to simplifying clinic working procedure and effective in communicating and documenting admission medical information.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.

PubMed

Shah, Hemant; Allard, Raymond D; Enberg, Robert; Krishnan, Ganesh; Williams, Patricia; Nadkarni, Prakash M

2012-03-09

A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts

PubMed Central

2012-01-01

Background A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. Methods In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). Results The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. Conclusions When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies. PMID:22405400

The feasibility, time savings and economic impact of a designated time appointment system at a busy HIV care clinic in Kenya: a randomized controlled trial.

PubMed

Kwena, Zachary A; Njoroge, Betty W; Cohen, Craig R; Oyaro, Patrick; Shikari, Rosemary; Kibaara, Charles K; Bukusi, Elizabeth A

2015-01-01

As efforts are made to reach universal access to ART in Kenya, the problem of congestion at HIV care clinics is likely to worsen. We evaluated the feasibility and the economic benefits of a designated time appointment system as a solution to decongest HIV care clinics. This was an explanatory two-arm open-label randomized controlled trial that enrolled 354 consenting participants during their normal clinic days and followed-up at subsequent clinic appointments for up to nine months. Intervention arm participants were given specific dates and times to arrive at the clinic for their next appointment while those in the control arm were only given the date and had the discretion to decide on the time to arrive as is the standard practice. At follow-up visits, we recorded arrival and departure times and asked the monetary value of work participants engaged in before and after clinic. We conducted multiple imputation to replace missing data in our primary outcome variables to allow for intention-to-treat analysis; and analyzed the data using Mann-Whitney U test. Overall, 72.1% of the intervention participants arrived on time, 13.3% arrived ahead of time and 14.6% arrived past scheduled time. Intervention arm participants spent a median of 65 [interquartile range (IQR), 52-87] minutes at the clinic compared to 197 (IQR, 173-225) minutes for control participants (p<0.01). Furthermore, intervention arm participants were more productively engaged on their clinic days valuing their cumulative work at a median of USD 10.5 (IQR, 60.0-16.8) compared to participants enrolled in the control arm who valued their work at USD 8.3 (IQR, 5.5-12.9; p=0.02). A designated time appointment system is feasible and provides substantial time savings associated with greater economic productivity for HIV patients attending a busy HIV care clinic.

Applying social network analysis to the examination of interruptions in healthcare.

PubMed

McCurdie, Tara; Sanderson, Penelope; Aitken, Leanne M

2018-02-01

Examinations of interruptions in healthcare often focus on a single clinical discipline, and solutions are targeted accordingly. This approach does not take into account the inter-disciplinary dependencies and other sociotechnical aspects that make up the healthcare work system, and suggested solutions may not meet the needs of all stakeholders. In this article a sociotechnical systems perspective is used to uncover the interdependencies between 16 unique work roles that result in interruptions in an intensive care unit (ICU). By applying social network analysis techniques to data collected using the Dual Perspectives Method, we identified targeted systems-based interventions that may reduce unnecessary interruptions while avoiding unintended consequences that impose additional burden on ICU staff. The rich insights gained into the interruptive communication patterns in the ICU work system stand in contrast to findings that would have otherwise been obtained by focusing only on a single clinical discipline or a single perspective. Copyright © 2017. Published by Elsevier Ltd.

Achieving organisational competence for clinical leadership: the role of high performance work systems.

PubMed

Leggat, Sandra G; Balding, Cathy

2013-01-01

While there has been substantial discussion about the potential for clinical leadership in improving quality and safety in healthcare, there has been little robust study. The purpose of this paper is to present the results of a qualitative study with clinicians and clinician managers to gather opinions on the appropriate content of an educational initiative being planned to improve clinical leadership in quality and safety among medical, nursing and allied health professionals working in primary, community and secondary care. In total, 28 clinicians and clinician managers throughout the state of Victoria, Australia, participated in focus groups to provide advice on the development of a clinical leadership program in quality and safety. An inductive, thematic analysis was completed to enable the themes to emerge from the data. Overwhelmingly the participants conceptualised clinical leadership in relation to organisational factors. Only four individual factors, comprising emotional intelligence, resilience, self-awareness and understanding of other clinical disciplines, were identified as being important for clinical leaders. Conversely seven organisational factors, comprising role clarity and accountability, security and sustainability for clinical leaders, selective recruitment into clinical leadership positions, teamwork and decentralised decision making, training, information sharing, and transformational leadership, were seen as essential, but the participants indicated they were rarely addressed. The human resource management literature includes these seven components, with contingent reward, reduced status distinctions and measurement of management practices, as the essential organisational underpinnings of high performance work systems. The results of this study propose that clinical leadership is an organisational property, suggesting that capability frameworks and educational programs for clinical leadership need a broader organisation focus. The paper makes clear that clinical leadership was not perceived to be about vesting leadership skills in individuals, but about ensuring health care organisations were equipped to conceptualise and support a model of distributive leadership.

Nursing Information Systems Requirements: A Milestone for Patient Outcome and Patient Safety Improvement.

PubMed

Farzandipour, Mehrdad; Meidani, Zahra; Riazi, Hossein; Sadeqi Jabali, Monireh

2016-12-01

Considering the integral role of understanding users' requirements in information system success, this research aimed to determine functional requirements of nursing information systems through a national survey. Delphi technique method was applied to conduct this study through three phases: focus group method modified Delphi technique and classic Delphi technique. A cross-sectional study was conducted to evaluate the proposed requirements within 15 general hospitals in Iran. Forty-three of 76 approved requirements were clinical, and 33 were administrative ones. Nurses' mean agreements for clinical requirements were higher than those of administrative requirements; minimum and maximum means of clinical requirements were 3.3 and 3.88, respectively. Minimum and maximum means of administrative requirements were 3.1 and 3.47, respectively. Research findings indicated that those information system requirements that support nurses in doing tasks including direct care, medicine prescription, patient treatment management, and patient safety have been the target of special attention. As nurses' requirements deal directly with patient outcome and patient safety, nursing information systems requirements should not only address automation but also nurses' tasks and work processes based on work analysis.

Clinical simulation as a boundary object in design of health IT-systems.

PubMed

Rasmussen, Stine Loft; Jensen, Sanne; Lyng, Karen Marie

2013-01-01

Healthcare organizations are very complex, holding numerous stakeholders with various approaches and goals towards the design of health IT-systems. Some of these differences may be approached by applying the concept of boundary objects in a participatory IT-design process. Traditionally clinical simulation provides the opportunity to evaluate the design and the usage of clinical IT-systems without endangering the patients and interrupting clinical work. In this paper we present how clinical simulation additionally holds the potential to function as a boundary object in the design process. The case points out that clinical simulation provides an opportunity for discussions and mutual learning among the various stakeholders involved in design of standardized electronic clinical documentation templates. The paper presents and discusses the use of clinical simulation in the translation, transfer and transformation of knowledge between various stakeholders in a large healthcare organization.

Optimising probe holder design for sentinel lymph node imaging using clinical photoacoustic system with Monte Carlo simulation

NASA Astrophysics Data System (ADS)

Sivasubramanian, Kathyayini; Periyasamy, Vijitha; Wen, Kew Kok; Pramanik, Manojit

2017-03-01

Photoacoustic tomography is a hybrid imaging modality that combines optical and ultrasound imaging. It is rapidly gaining attention in the field of medical imaging. The challenge is to translate it into a clinical setup. In this work, we report the development of a handheld clinical photoacoustic imaging system. A clinical ultrasound imaging system is modified to integrate photoacoustic imaging with the ultrasound imaging. Hence, light delivery has been integrated with the ultrasound probe. The angle of light delivery is optimized in this work with respect to the depth of imaging. Optimization was performed based on Monte Carlo simulation for light transport in tissues. Based on the simulation results, the probe holders were fabricated using 3D printing. Similar results were obtained experimentally using phantoms. Phantoms were developed to mimic sentinel lymph node imaging scenario. Also, in vivo sentinel lymph node imaging was done using the same system with contrast agent methylene blue up to a depth of 1.5 cm. The results validate that one can use Monte Carlo simulation as a tool to optimize the probe holder design depending on the imaging needs. This eliminates a trial and error approach generally used for designing a probe holder.

Building clinical and organizational resilience to reconcile safety threats, tensions and trade-offs: insights from theory and evidence.

PubMed

Jeffs, Lianne; Tregunno, Deborah; MacMillan, Kathleen; Espin, Sherry

2009-01-01

Healthcare delivery settings are complex adaptive and tightly coupled, interrelated systems. Within the larger healthcare system, a key subsystem is the "clinical microsystem" level. It is at this level that clinicians are faced with high levels of uncertainty in their daily work - uncertainty that impacts the quality and safety of care that patients receive. The first aim of this paper is to enhance healthcare leaders' understanding of what is currently known about safety threats and strategies to manage the inherent tensions and trade-offs that occur in everyday practice. The second aim is to inform strategies that build clinical and organizational resilience through a multi-level framework derived from the collective theoretical and empirical work. Together, this information can strengthen safety practices throughout healthcare organizations.

Clinical Teacher Education: Reflections from an Urban Professional Development School Network. Readings in Educational Thought

ERIC Educational Resources Information Center

Bohan, Chara Haeussler, Ed.; Many, Joyce E., Ed.

2011-01-01

Clinical Teacher Education focuses on how to build a school-university partnership network for clinical teacher education in urban school systems serving culturally and linguistically diverse populations. The labor intensive nature of professional development school work has resulted in research institutions being slow to fully adopt a clinical…

MO-FG-207-00: Technological Advances in PET/MR Imaging

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

NONE

2015-06-15

The use of integrated PET/MRI systems in clinical applications can best benefit from understanding their technological advances and limitations. The currently available clinical PET/MRI systems have their own characteristics. Thorough analyses of existing technical data and evaluation of necessary performance metrics for quality assurances could be conducted to optimize application-specific PET/MRI protocols. This Symposium will focus on technical advances and limitations of clinical PET/MRI systems, and how this exciting imaging modality can be utilized in applications that can benefit from both PET and MRI. Learning Objectives: To understand the technological advances of clinical PET/MRI systems To correctly identify clinical applicationsmore » that can benefit from PET/MRI To understand ongoing work to further improve the current PET/MRI technology Floris Jansen is a GE Healthcare employee.« less

[Immunologic response to microorganisms from a polluted ventilation system in a working environment].

PubMed

Cernelc, S; Vozelj, M

1991-01-01

Authors point out the morbidity of employees working in ventilation systems contaminated with various microorganisms. They analysed 96 workers exposed to air conditioning system (Group A), and 71 workers (Group B) breathing normal ambient air. The workers of both groups were subjected clinically by functionally and immunologically. Preparation of antigens "MMM" (Monday morning miseries) was used as an original method by Ajello et al. for producing antigens from systemic mycotic agents and subsequently modified. The aim of the present study is to evaluate the possibility of using ELISA in clinical practice for respiratory allergy diagnosis, and especially Hypersensitivity pneumonitis. Atopic status was determined by skin prick tests with common airborne allergens including Dermatophagoides pteronyssinus, ragweed, grasses and Aspergillus fumigatus., by Enzygnost--IgE (Behringwerke AG, Marburg) and for specific IgE by RAST technique (Pharmacia, Uppsala). The skin prick tests were performed with "MMM"-antigens. PEFR (Peak Expiratory Flow-Rate) was measured by using a Wright's peak flow meter. PEFR was recorded on Monday (first day at work) and Friday (the end of the working week). Measured values of PEFR in both groups of employees from Monday to Friday were elaborated by the Wilcoxon test. Culture of scrapings from air conditioning vents were obtained and water from the humidifier system also cultured. They were grown: T. vulgaris, Aspergillus fumigatus, Thermoactinomyces vulgaris and others. Results of questionnaires, clinical evaluation and diagnostical procedures in employees of Group A and B are as follows: Thirty eight workers in Group A had a positive clinical history of "Monday illness". In the symptomatic Group A we found in 8 cases abnormal chest roentgenogram. Further, there was no correlation between the presence of antibodies (ELISA) against MMM and pulmonary function abnormalities, as measured by either spirometry or DLCO. Further, we found good agreement between ELISA and prick test results with antigen MMM. Wilcoxon test showed a statistically significant difference between the two groups (0.01). The median or central value of PEFR reduction in Group A is 10.23 per cent, and in Group B 1.49 per cent. A 30 per cent reduction of PEFR was observed in 5.21 per cent of subjects in Group A. Exposure to ventilation systems contaminated with Thermophilic actinomyces may be responsible for increased morbidity and reduced performance of employees working in air conditioning systems. Particularly the main filter should be checked regularly. Moreover, regular microbiologic examinations of dust and water from air preventing chronic obstructive lung diseases in employees working in areas served by contaminated air conditioning systems.

CLINICAL SURFACES - Activity-Based Computing for Distributed Multi-Display Environments in Hospitals

NASA Astrophysics Data System (ADS)

Bardram, Jakob E.; Bunde-Pedersen, Jonathan; Doryab, Afsaneh; Sørensen, Steffen

A multi-display environment (MDE) is made up of co-located and networked personal and public devices that form an integrated workspace enabling co-located group work. Traditionally, MDEs have, however, mainly been designed to support a single “smart room”, and have had little sense of the tasks and activities that the MDE is being used for. This paper presents a novel approach to support activity-based computing in distributed MDEs, where displays are physically distributed across a large building. CLINICAL SURFACES was designed for clinical work in hospitals, and enables context-sensitive retrieval and browsing of patient data on public displays. We present the design and implementation of CLINICAL SURFACES, and report from an evaluation of the system at a large hospital. The evaluation shows that using distributed public displays to support activity-based computing inside a hospital is very useful for clinical work, and that the apparent contradiction between maintaining privacy of medical data in a public display environment can be mitigated by the use of CLINICAL SURFACES.

Design of an image-distribution service from a clinical PACS

NASA Astrophysics Data System (ADS)

Gehring, Dale G.; Persons, Kenneth R.; Rothman, Melvyn L.; Felmlee, Joel P.; Gerhart, D. J.; Hangiandreou, Nicholas J.; Reardon, Frank J.; Shirk, M.; Forbes, Glenn S.; Williamson, Byrn, Jr.

1994-05-01

A PACS system has been developed through a multi-phase collaboration between the Mayo Clinic and IBM/Rochester. The current system has been fully integrated into the clinical practice of the Radiology Department for the primary purpose of digital image archival, retrieval, and networked workstation review. Work currently in progress includes the design and implementation of a gateway device for providing digital image data to third-party workstations, laser printers, and other devices, for users both within and outside of the Radiology Department.

[Development of Diagrammatic Recording System for Choledochoscope and Its Clinical Application].

PubMed

Xue, Zhao; Hu, Liangshuo; Tang, Bo; Zhang, Xiaogang; Lyu, Yi

2017-11-30

To develop a diagrammatic recording system for choledochoscopy and evaluate the system with clinical application. To match the real-time image and procedure illustration during choledochoscopy examination, we combined video-image capture and speech recognition technology to quickly generate personalized choledochoscopy images and texts records. The new system could be used in sharing territorial electronic medical records, telecommuting, scientific research and education, et al. In the clinical application of 32 patients, the choledochoscopy diagrammatic recording system could significantly improve the surgeons' working efficiency and patients' satisfaction. It could also meet the design requirement of remote information interaction. The choledochoscopy diagrammatic recording system which is recommended could elevate the quality of medical service and promote academic exchange and training.

[Work schedules in the Hungarian health care system and the sleep quality of nurses].

PubMed

Fusz, Katalin; Pakai, Annamária; Kívés, Zsuzsanna; Szunomár, Szilvia; Regős, Annamária; Oláh, András

2016-03-06

One way of ensuring the continuity of health care is the shift work, which is burdensome and it can lead to sleep disturbances. The aim of the study was to measure the typical Hungarian nursing shift systems in hospitals, to analyse the causes of irregular work schedules, and to compare the sleep quality of nurses in different work schedules. 236 head nurses filled out the national online survey, and 217 nurses in clinics of the University of Pécs filled the Hungarian version of Bergen Shift Work Sleep Questionnaire. The head nurses provided data of 8697 nurses's schedules. 51.89% of nurses work in flexible shift system. 1944 employees work in regular shift system, most of them in the following order: 12-hour day shift and 12-hour night shift, followed by a one- or two-day rest. Where there is no system of shifts, the most frequent causes are the needs of nurses and the nurse shortage. Nurses who are working in irregular shift system had worse sleep quality than nurses who are working in flexible and regular shift system (p = 0.044). It would be helpful if the least burdensome shift system could be established.

[Family doctor clinical aptitude confronting gestational diabetes patients].

PubMed

Pivaral, Carlos Enrique Cabrera; Clara, Elizabeth Rivera; Peña, Luz María Adriana Balderas; Centeno, Mayari Cabrera; Reynoso, Carlos Alonso

2008-02-01

Gestational diabetes mellitus complicates 7% of all pregnancies. Recognizing and treating this entity result in a diminished number of materno-fetal complications; this study explores the family physician clinical aptitude to identify risk factors, to diagnose and treat gestational diabetes. Identify clinical aptitude level of family physician to the treatment of diabetes gestational patients. Transversal study to describe the level of clinical aptitude in 85 family physicians working in Guadalajara. Were studied: speciality, genre, work condition, working years, working hours, and place of work. The evaluation instrument was designed to this specific purpose and validated by an expert group; were evaluated four indicators: 1) identification of risk factors, 2) diagnosis, 3) use of therapeutic resources and 4) use of paraclinic resources. Confidence coefficient to the assessment instrument was (21 formula from Kuder-Richardson) 0.92 in global evaluation. The global clinical aptitude in the four family medicine units studied was less than 21 points in 41% of physician population and very low (22 a 40 points) in 38% of the evaluated physicians. The clinical aptitude from family physician in gestational diabetes is low, this situation represents an urgent need to design a system to provide to these groups of health providers specialized continuous education to enhance the attention quality to this group of patients in family medicine units.

Clinical decision-making and secondary findings in systems medicine.

PubMed

Fischer, T; Brothers, K B; Erdmann, P; Langanke, M

2016-05-21

Systems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology (especially systems biology); "big data" statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems medicine knowledge and clinicians working to apply it. This article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through "big data" approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the "death computer," to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their "quantified self." This paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care.

HIS-Based Support of Follow-Up Documentation – Concept and Implementation for Clinical Studies

PubMed Central

Herzberg, S.; Fritz, F.; Rahbar, K.; Stegger, L.; Schäfers, M.; Dugas, M.

2011-01-01

Objective Follow-up data must be collected according to the protocol of each clinical study, i.e. at certain time points. Missing follow-up information is a critical problem and may impede or bias the analysis of study data and result in delays. Moreover, additional patient recruitment may be necessary due to incomplete follow-up data. Current electronic data capture (EDC) systems in clinical studies are usually separated from hospital information systems (HIS) and therefore can provide limited functionality to support clinical workflow. In two case studies, we assessed the feasibility of HIS-based support of follow-up documentation. Methods We have developed a data model and a HIS-based workflow to provide follow-up forms according to clinical study protocols. If a follow-up form was due, a database procedure created a follow-up event which was translated by a communication server into an HL7 message and transferred to the import interface of the clinical information system (CIS). This procedure generated the required follow-up form and enqueued a link to it in a work list of the relating study nurses and study physicians, respectively. Results A HIS-based follow-up system automatically generated follow-up forms as defined by a clinical study protocol. These forms were scheduled into work lists of study nurses and study physicians. This system was integrated into the clinical workflow of two clinical studies. In a study from nuclear medicine, each scenario from the test concept according to the protocol of the single photon emission computer tomography/computer tomography (SPECT/CT) study was simulated and each scenario passed the test. For a study in psychiatry, 128 follow-up forms were automatically generated within 27 weeks, on average five forms per week (maximum 12, minimum 1 form per week). Conclusion HIS-based support of follow-up documentation in clinical studies is technically feasible and can support compliance with study protocols. PMID:23616857

[Innovative educational technology in the teaching of propaedeutic of internal diseases].

PubMed

Тusupbekova, К; Bakirova, R; Nursultanova, S

2015-03-01

This article presents analysis of the results of inculcation of innovative learning technologies in teaching on propaedeutic of internal diseases which is first clinical discipline faced by medical students of the University. Credit-modular training included integration of propaedeutic of internal diseases with basic disciplines of the third year (the normal anatomy, physiology, pathological anatomy, histology, pathophysiology, visual diagnostics and pharmacology). There are 8 models on following systems: respiratory, cardiovascular, musculoskeletal, endocrine, urogenital, hematopoietic, nervous, digestive. The innovative implementation of learning technologies (Problem-based learning, clinical cases, team-oriented teaching, lectures, symposium lectures, discussions, role plays, etc.) and knowledge control (mini-clinical examination, objective structured clinical exam, comprehensive testing) help students to acquire clinical skills, team working and skills of researching work.

Tensions of network security and collaborative work practice: understanding a single sign-on deployment in a regional hospital.

PubMed

Heckle, Rosa R; Lutters, Wayne G

2011-08-01

Healthcare providers and their IT staff, working in an effort to balance appropriate accessibility with stricter security mandates, are considering the use of a single network sign-on approach for authentication and password management. Single sign-on (SSO) promises to improve usability of authentication for multiple-system users, increase compliance, and help curb system maintenance costs. However, complexities are introduced when SSO is placed within a collaborative environment. These complexities include unanticipated workflow implications that introduce greater security vulnerability for the individual user. OBJECTIVES AND METHODOLOGY: In this work, we examine the challenges of implementing a single sign-on authentication technology in a hospital environment. The aim of the study was to document the factors that affected SSO adoption within the context of use. The ultimate goal is to better inform the design of usable authentication systems within collaborative healthcare work sites. The primary data collection techniques used are ethnographically informed - observation, contextual interviews, and document review. The study included a cross-section of individuals from various departments and varying rolls. These participants were a mix of both clinical and administrative staff, as well as the Information Technology group. The field work revealed fundamental mis-matches between the technology and routine work practices that will significantly impact its effective adoption. While single sign-on was effective in the administrative offices, SSO was not a good fit for collaborative areas. The collaborative needs of the clinical staff unearthed tensions in its implementation. An analysis of the findings revealed that the workflow, activities, and physical environment of the clinical areas create increased security vulnerabilities for the individual user. The clinical users were cognizant of these vulnerabilities and this created resistance to the implementation due to a concern for privacy. From a preliminary analysis of our on-going field study at a community hospital, there appears to be a number of mismatches between the SSO vision and the realities of routine work. While we cannot conclusively say if a SSO adoption will be effective in meeting its goals in a hospital environment, we do know that it will affect the work practice and that will make the management of the SSO system problematic. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

From Usability Testing to Clinical Simulations: Bringing Context into the Design and Evaluation of Usable and Safe Health Information Technologies. Contribution of the IMIA Human Factors Engineering for Healthcare Informatics Working Group.

PubMed

Kushniruk, A; Nohr, C; Jensen, S; Borycki, E M

2013-01-01

The objective of this paper is to explore human factors approaches to understanding the use of health information technology (HIT) by extending usability engineering approaches to include analysis of the impact of clinical context through use of clinical simulations. Methods discussed are considered on a continuum from traditional laboratory-based usability testing to clinical simulations. Clinical simulations can be conducted in a simulation laboratory and they can also be conducted in real-world settings. The clinical simulation approach attempts to bring the dimension of clinical context into stronger focus. This involves testing of systems with representative users doing representative tasks, in representative settings/environments. Application of methods where realistic clinical scenarios are used to drive the study of users interacting with systems under realistic conditions and settings can lead to identification of problems and issues with systems that may not be detected using traditional usability engineering methods. In conducting such studies, careful consideration is needed in creating ecologically valid test scenarios. The evidence obtained from such evaluation can be used to improve both the usability and safety of HIT. In addition, recent work has shown that clinical simulations, in particular those conducted in-situ, can lead to considerable benefits when compared to the costs of running such studies. In order to bring context of use into the testing of HIT, clinical simulation, involving observing representative users carrying out tasks in representative settings, holds considerable promise.

Electrophysiological Repetition Effects in Persons with Mild Cognitive Impairment depend upon Working Memory Demand.

PubMed

Broster, Lucas S; Jenkins, Shonna L; Holmes, Sarah D; Edwards, Matthew G; Jicha, Gregory A; Jiang, Yang

2018-05-07

Forms of implicit memory, including repetition effects, are preserved relative to explicit memory in clinical Alzheimer's disease. Consequently, cognitive interventions for persons with Alzheimer's disease have been developed that leverage this fact. However, despite the clinical robustness of behavioral repetition effects, altered neural mechanisms of repetition effects are studied as biomarkers of both clinical Alzheimer's disease and pre-morbid Alzheimer's changes in the brain. We hypothesized that the clinical preservation of behavioral repetition effects results in part from concurrent operation of discrete memory systems. We developed two experiments that included probes of emotional repetition effects differing in that one included an embedded working memory task. We found that neural repetition effects manifested in patients with amnestic mild cognitive impairment, the earliest form of clinical Alzheimer's disease, during emotional working memory tasks, but they did not manifest during the task that lacked the embedded working memory manipulation. Specifically, the working memory task evoked neural repetition effects in the P600 time-window, but the same neural mechanism was only minimally implicated in the task without a working memory component. We also found that group differences in behavioral repetition effects were smaller in the experiment with a working memory task. We suggest that cross-domain cognitive challenge can expose "defunct" neural capabilities of individuals with amnestic mild cognitive impairment. Copyright © 2018. Published by Elsevier Ltd.

Nursing Faculty Experiences of Virtual Learning Environments for Teaching Clinical Reasoning

ERIC Educational Resources Information Center

Zacharzuk-Marciano, Tara

2017-01-01

Nurses need sharp, clinical reasoning skills to respond to critical situations and to be successful at work in a complex and challenging healthcare system. While past research has focused on using virtual learning environments to teach clinical reasoning, there has been limited research on the experiences of nursing faculty and there is a need for…

Incorporating injured employee outcomes into physical and occupational therapists' practice: a controlled trial of the Worker-Based Outcomes Assessment System.

PubMed

Ross, Robert H; Callas, Peter W; Sargent, Jesse Q; Amick, Benjamin C; Rooney, Ted

2006-12-01

Work related musculoskeletal disorders (WRMSDs) remain costly. The Worker-Based Outcomes Assessment System (WBOAS) is an injury treatment improvement tool. Its purpose is to increase treatment effectiveness and decrease the cost of care delivered in Occupational Health Service clinics. The study used a non-randomized (parallel cohort) control trial design to test the effects on injured employee outcomes of augmenting the standard care delivered by physical and occupational therapists (PT/OTs) with the WBOAS. The WBOAS works by putting patient-reported functional health status, pain symptom, and work role performance outcomes data into the hands of PT/OTs and their patients. Test clinic therapists were trained to incorporate WBOAS trends data into standard practice. Control clinic therapists delivered standard care alone. WBOAS-augmented PT/OT care did improve (p< or =.05) physical functioning and new injury/re-injury avoidance and, on these same dimensions, cost-adjusted outcome. It did not improve (p>.05) mental health or pain symptoms or return-to-work or stay-at-work success nor, on these same dimensions, cost-adjusted outcome. Training PT/OTs to incorporate patient-reported health status, pain symptom, and work role performance outcomes trends data into standard practice does appear to improve treatment effectiveness and cost on some (e.g. physical functioning) but not other (e.g. mental health, pain symptoms) outcomes.

MO-FG-207-01: Technological Advances and Challenges: Experience with the First Integrated Whole-Body PET/MRI

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

Laforest, R.

2015-06-15

The use of integrated PET/MRI systems in clinical applications can best benefit from understanding their technological advances and limitations. The currently available clinical PET/MRI systems have their own characteristics. Thorough analyses of existing technical data and evaluation of necessary performance metrics for quality assurances could be conducted to optimize application-specific PET/MRI protocols. This Symposium will focus on technical advances and limitations of clinical PET/MRI systems, and how this exciting imaging modality can be utilized in applications that can benefit from both PET and MRI. Learning Objectives: To understand the technological advances of clinical PET/MRI systems To correctly identify clinical applicationsmore » that can benefit from PET/MRI To understand ongoing work to further improve the current PET/MRI technology Floris Jansen is a GE Healthcare employee.« less

[Cross-sectional study of the variability of work-related stress among post-graduate medical residents at the main University Polyclinic of Sicily].

PubMed

Costantino, Claudio; Albeggiani, Valentina; Bonfante, Maria Stefania; Monte, Caterina; Lo Cascio, Nunzio; Mazzucco, Walter

2015-02-10

Among health care workers (HCWs), work-related stress is one of the main topics in risk assessment and prevention at the workplace. Post-graduate medical residents (MRs) are a group of HCWs comparable to medical doctors in terms of occupational exposure and occurrence of work-related stress syndromes. Risk assessment of work-related stress among MRs attending the major University Hospital of Sicily. A cross-sectional survey via an anonymous and self-administered questionnaire. 45% of clinical MRs and 37% of surgical MRs had access to compensatory rest days against 92% of MRs of the services area (p<0.001). A work attendance recording system for MRs was available in 80% of the postgraduate medical schools of the services area, in 60% of the clinical postgraduate schools and in 50% of the surgical postgraduate schools (p<0.001). MRs of the postgraduate surgical schools reported having access to work breaks (41%) with less frequency compared to clinical (60%) and services MRs (74%) (p<0.001). Both clinical (47%) and surgical MRs (47%) were more exposed to work-related stress than MRs of the services area (27%) (p<0.001). The survey demonstrated excess exposure to work-related stress for all the considered variables in MRs of the surgical area, compared with MRs of clinical and services areas. It is strongly recommended to provide specific training programmes aimed at managing the MRs' risk of exposure to work-related stress, focusing both on the workers and the work environment.

Cardiac surgical outcomes improvement led by a physician champion working with a nurse clinical coordinator.

PubMed

Stanford, John R; Swaney-Berghoff, Laurie; Recht, Kimberly

2012-01-01

Cardiac surgical outcomes improvement in a community hospital was driven by a physician champion working with a nurse clinical coordinator. Specific system improvements implemented were (1) nurse checklists of vital signs, cardiovascular function parameters, and life support appliance operation; (2) use of the EuroSCORE system of preoperative patient risk assessment; (3) monthly morbidity and mortality conferences; and (4) daily patient progress tracking. The hospital received 1 star (bottom 12% of hospitals for quality outcomes) from the Society of Thoracic Surgeons Adult Cardiac Database in 2006 prior to program inception, 2 stars (middle 76% of hospitals for quality outcomes) in 2007 and 2008, and 3 stars (top 12% of hospitals) in 2009. The physician and nurse together combined a strategy for clinical improvement with the cultural practices at the hospital to ensure that system improvements approved at the strategic level were implemented at the point of care. Both strategy and culture must be addressed to ensure patient outcomes improvement.

An Analysis of the Patient Appointing System of the 121st Combat Support Hospital to Determine an Optimal Appointing System

DTIC Science & Technology

2008-06-01

Their dedication and hard work for the students has ensured the success of myself and all other students who have had the privilege to earn their...Defense Inspector General, 2006). As the next generation medical and dental clinical information system, AHLTA will produce and maintain a life-long...of being focused only on a specific clinic or section. Cross training will also help to prevent burnout by providing staff with a change of pace. A

A patient workflow management system built on guidelines.

PubMed Central

Dazzi, L.; Fassino, C.; Saracco, R.; Quaglini, S.; Stefanelli, M.

1997-01-01

To provide high quality, shared, and distributed medical care, clinical and organizational issues need to be integrated. This work describes a methodology for developing a Patient Workflow Management System, based on a detailed model of both the medical work process and the organizational structure. We assume that the medical work process is represented through clinical practice guidelines, and that an ontological description of the organization is available. Thus, we developed tools 1) for acquiring the medical knowledge contained into a guideline, 2) to translate the derived formalized guideline into a computational formalism, precisely a Petri Net, 3) to maintain different representation levels. The high level representation guarantees that the Patient Workflow follows the guideline prescriptions, while the low level takes into account the specific organization characteristics and allow allocating resources for managing a specific patient in daily practice. PMID:9357606

Social Work's Role in Medicaid Reform: A Qualitative Study.

PubMed

Bachman, Sara S; Wachman, Madeline; Manning, Leticia; Cohen, Alexander M; Seifert, Robert W; Jones, David K; Fitzgerald, Therese; Nuzum, Rachel; Riley, Patricia

2017-12-01

To critically analyze social work's role in Medicaid reform. We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work's practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work's involvement in systems-level practice include lack of visibility, insufficient clarity on social work's role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level.

Effects of reflection on clinical decision-making of intensive care unit nurses.

PubMed

Razieh, Shahrokhi; Somayeh, Ghafari; Fariba, Haghani

2018-07-01

Nurses are one of the most influential factors in overcoming the main challenges faced by health systems throughout the world. Every health system should, hence, empower nurses in clinical judgment and decision-making skills. This study evaluated the effects of implementing Tanner's reflection method on clinical decision-making of nurses working in an intensive care unit (ICU). This study used an experimental, pretest, posttest design. The setting was the intensive care unit of Amin Hospital Isfahan, Iran. The convenience sample included 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). This clinical trial was performed on 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). The nurses were selected by census sampling and randomly allocated to either the case or the control group. Data were collected using a questionnaire containing demographic characteristics and the clinical decision-making scale developed by Laurie and Salantera (NDMI-14). The questionnaire was completed before and one week after the intervention. The data were analyzed using SPSS 21.0. The two groups were not significantly different in terms of the level and mean scores of clinical decision-making before the intervention (P = 0.786). Based on the results of independent t-test, the mean score of clinical decision-making one week after the intervention was significantly higher in the case group than in the control group (P = 0.009; t = -2.69). The results of Mann Whitney test showed that one week after the intervention, the nurses' level of clinical decision-making in the case group rose to the next level (P = 0.001). Reflection could improve the clinical decision-making of ICU nurses. It is, thus, recommended to incorporate this method into the nursing curriculum and care practices. Copyright © 2018. Published by Elsevier Ltd.

[Case histories and other stories in the multimedia era... but was there something else?...].

PubMed

Kohler, Hans-Peter

2010-12-01

The multimedia era is fascinating and limitless! The advances in the field of consumer and entertainment electronics are impressive. Our private as well as business life is very much accompanied and influenced by numerous technical gadgets. These advancements should have many positive implications on our clinical work. Do they? Using modern personal computers and clinic information systems (CIS) the access to patients' data, the prescription of drugs, or x-ray diagnostics on high-resolution laptop screens became as easy as pie. This affects the doctor-patient relationship but also the communication between physicians and nurses. Computers also affect our daily clinical work and therefore the treatment of our patients. Do our patients take benefit from these technical achievements? Does the use of clinic information systems positively influence diagnosis, treatment and finally patient outcome but also doctors' performances? What has really changed in the last couples of years? The present article tries to critically review these major changes in patient care.

Using a Malcolm Baldrige framework to understand high-performing clinical microsystems.

PubMed

Foster, Tina C; Johnson, Julie K; Nelson, Eugene C; Batalden, Paul B

2007-10-01

BACKGROUND, OBJECTIVES AND METHOD: The Malcolm Baldrige National Quality Award (MBNQA) provides a set of criteria for organisational quality assessment and improvement that has been used by thousands of business, healthcare and educational organisations for more than a decade. The criteria can be used as a tool for self-evaluation, and are widely recognised as a robust framework for design and evaluation of healthcare systems. The clinical microsystem, as an organisational construct, is a systems approach for providing clinical care based on theories from organisational development, leadership and improvement. This study compared the MBNQA criteria for healthcare and the success factors of high-performing clinical microsystems to (1) determine whether microsystem success characteristics cover the same range of issues addressed by the Baldrige criteria and (2) examine whether this comparison might better inform our understanding of either framework. Both Baldrige criteria and microsystem success characteristics cover a wide range of areas crucial to high performance. Those particularly called out by this analysis are organisational leadership, work systems and service processes from a Baldrige standpoint, and leadership, performance results, process improvement, and information and information technology from the microsystem success characteristics view. Although in many cases the relationship between Baldrige criteria and microsystem success characteristics are obvious, in others the analysis points to ways in which the Baldrige criteria might be better understood and worked with by a microsystem through the design of work systems and a deep understanding of processes. Several tools are available for those who wish to engage in self-assessment based on MBNQA criteria and microsystem characteristics.

Using a Malcolm Baldrige framework to understand high‐performing clinical microsystems

PubMed Central

Foster, Tina C; Johnson, Julie K; Nelson, Eugene C; Batalden, Paul B

2007-01-01

Background, objectives and method The Malcolm Baldrige National Quality Award (MBNQA) provides a set of criteria for organisational quality assessment and improvement that has been used by thousands of business, healthcare and educational organisations for more than a decade. The criteria can be used as a tool for self‐evaluation, and are widely recognised as a robust framework for design and evaluation of healthcare systems. The clinical microsystem, as an organisational construct, is a systems approach for providing clinical care based on theories from organisational development, leadership and improvement. This study compared the MBNQA criteria for healthcare and the success factors of high‐performing clinical microsystems to (1) determine whether microsystem success characteristics cover the same range of issues addressed by the Baldrige criteria and (2) examine whether this comparison might better inform our understanding of either framework. Results and conclusions Both Baldrige criteria and microsystem success characteristics cover a wide range of areas crucial to high performance. Those particularly called out by this analysis are organisational leadership, work systems and service processes from a Baldrige standpoint, and leadership, performance results, process improvement, and information and information technology from the microsystem success characteristics view. Although in many cases the relationship between Baldrige criteria and microsystem success characteristics are obvious, in others the analysis points to ways in which the Baldrige criteria might be better understood and worked with by a microsystem through the design of work systems and a deep understanding of processes. Several tools are available for those who wish to engage in self‐assessment based on MBNQA criteria and microsystem characteristics. PMID:17913773

Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home

DTIC Science & Technology

2011-01-01

The Quadruple Aim: Working Together, Achieving Success 2011 Military Health System Conference TMA and Services Using Technology, Clinical Workflow...Redesign, and Team Solutions to Achieve the Patient Centered Medical Home LTC Nicole Kerkenbush, MHA, MN Army Medical Department, Office of the...Surgeon General Chief Medical Information Officer 1 Military Health System Conference Report Documentation Page Form ApprovedOMB No. 0704-0188 Public

Family Systems Theory: A Unifying Framework for Codependence.

ERIC Educational Resources Information Center

Prest, Layne A.; Protinsky, Howard

1993-01-01

Considers addictions and construct of codependence. Offers critical review and synthesis of codependency literature, along with an intergenerational family systems framework for conceptualizing the relationship of the dysfunctional family to the construct of codependence. Presents theoretical basis for systemic clinical work and research in this…

TU-FG-201-01: 18-Month Clinical Experience of a Linac Daily Quality Assurance (QA) Solution Using Only EPID and OBI

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

Cai, B; Sun, B; Yaddanapudi, S

Purpose: To describe the clinical use of a Linear Accelerator (Linac) DailyQA system with only EPID and OBI. To assess the reliability over an 18-month period and improve the robustness of this system based on QA failure analysis. Methods: A DailyQA solution utilizing an in-house designed phantom, combined EPID and OBI image acquisitions, and a web-based data analysis and reporting system was commissioned and used in our clinic to measure geometric, dosimetry and imaging components of a Varian Truebeam Linac. During an 18-month period (335 working days), the Daily QA results, including the output constancy, beam flatness and symmetry, uniformity,more » TPR20/10, MV and KV imaging quality, were collected and analyzed. For output constancy measurement, an independent monthly QA system with an ionization chamber (IC) and annual/incidental TG51 measurements with ADCL IC were performed and cross-compared to Daily QA system. Thorough analyses were performed on the recorded QA failures to evaluate the machine performance, optimize the data analysis algorithm, adjust the tolerance setting and improve the training procedure to prevent future failures. Results: A clinical workflow including beam delivery, data analysis, QA report generation and physics approval was established and optimized to suit daily clinical operation. The output tests over the 335 working day period cross-correlated with the monthly QA system within 1.3% and TG51 results within 1%. QA passed with one attempt on 236 days out of 335 days. Based on the QA failures analysis, the Gamma criteria is revised from (1%, 1mm) to (2%, 1mm) considering both QA accuracy and efficiency. Data analysis algorithm is improved to handle multiple entries for a repeating test. Conclusion: We described our 18-month clinical experience on a novel DailyQA system using only EPID and OBI. The long term data presented demonstrated the system is suitable and reliable for Linac daily QA.« less

Review: evaluating information systems in nursing.

PubMed

Oroviogoicoechea, Cristina; Elliott, Barbara; Watson, Roger

2008-03-01

To review existing nursing research on inpatient hospitals' information technology (IT) systems in order to explore new approaches for evaluation research on nursing informatics to guide further design and implementation of effective IT systems. There has been an increase in the use of IT and information systems in nursing in recent years. However, there has been little evaluation of these systems and little guidance on how they might be evaluated. A literature review was conducted between 1995 and 2005 inclusive using CINAHL and Medline and the search terms 'nursing information systems', 'clinical information systems', 'hospital information systems', 'documentation', 'nursing records', 'charting'. Research in nursing information systems was analysed and some deficiencies and contradictory results were identified which impede a comprehensive understanding of effective implementation. There is a need for IT systems to be understood from a wider perspective that includes aspects related to the context where they are implemented. Social and organizational aspects need to be considered in evaluation studies and realistic evaluation can provide a framework for the evaluation of information systems in nursing. The rapid introduction of IT systems for clinical practice urges evaluation of already implemented systems examining how and in what circumstances they work to guide effective further development and implementation of IT systems to enhance clinical practice. Evaluation involves more factors than just involving technologies such as changing attitudes, cultures and healthcare practices. Realistic evaluation could provide configurations of context-mechanism-outcomes that explain the underlying relationships to understand why and how a programme or intervention works.

A clinical perspective on mucoadhesive buccal drug delivery systems

PubMed Central

Gilhotra, Ritu M; Ikram, Mohd; Srivastava, Sunny; Gilhotra, Neeraj

2014-01-01

Mucoadhesion can be defined as a state in which two components, of which one is of biological origin, are held together for extended periods of time by the help of interfacial forces. Among the various transmucosal routes, buccal mucosa has excellent accessibility and relatively immobile mucosa, hence suitable for administration of retentive dosage form. The objective of this paper is to review the works done so far in the field of mucoadhesive buccal drug delivery systems (MBDDS), with a clinical perspective. Starting with a brief introduction of the mucoadhesive drug delivery systems, oral mucosa, and the theories of mucoadhesion, this article then proceeds to cover the works done so far in the field of MBDDS, categorizing them on the basis of ailments they are meant to cure. Additionally, we focus on the various patents, recent advancements, and challenges as well as the future prospects for mucoadhesive buccal drug delivery systems. PMID:24683406

Mobile task management tool that improves workflow of an acute general surgical service.

PubMed

Foo, Elizabeth; McDonald, Rod; Savage, Earle; Floyd, Richard; Butler, Anthony; Rumball-Smith, Alistair; Connor, Saxon

2015-10-01

Understanding and being able to measure constraints within a health system is crucial if outcomes are to be improved. Current systems lack the ability to capture decision making with regard to tasks performed within a patient journey. The aim of this study was to assess the impact of a mobile task management tool on clinical workflow within an acute general surgical service by analysing data capture and usability of the application tool. The Cortex iOS application was developed to digitize patient flow and provide real-time visibility over clinical decision making and task performance. Study outcomes measured were workflow data capture for patient and staff events. Usability was assessed using an electronic survey. There were 449 unique patient journeys tracked with a total of 3072 patient events recorded. The results repository was accessed 7792 times. The participants reported that the application sped up decision making, reduced redundancy of work and improved team communication. The mode of the estimated time the application saved participants was 5-9 min/h of work. Of the 14 respondents, nine discarded their analogue methods of tracking tasks by the end of the study period. The introduction of a mobile task management system improved the working efficiency of junior clinical staff. The application allowed capture of data not previously available to hospital systems. In the future, such data will contribute to the accurate mapping of patient journeys through the health system. © 2015 Royal Australasian College of Surgeons.

Framework for a clinical information system.

PubMed

Van de Velde, R

2000-01-01

The current status of our work towards the design and implementation of a reference architecture for a Clinical Information System is presented. This architecture has been developed and implemented based on components following a strong underlying conceptual and technological model. Common Object Request Broker and n-tier technology featuring centralised and departmental clinical information systems as the back-end store for all clinical data are used. Servers located in the 'middle' tier apply the clinical (business) model and application rules to communicate with so-called 'thin client' workstations. The main characteristics are the focus on modelling and reuse of both data and business logic as there is a shift away from data and functional modelling towards object modelling. Scalability as well as adaptability to constantly changing requirements via component driven computing are the main reasons for that approach.

Private primary care physicians' perspectives on factors affecting the adoption of electronic medical records: a qualitative pre-implementation study.

PubMed

Or, Calvin; Wong, Katie; Tong, Ellen; Sek, Antonio

2014-01-01

Use of electronic medical records (EMR) has the potential to offer quality and safety benefits, but without the adoption of the technology, the benefits will not be realized. This study aimed to identify the factors perceived as relevant by private physicians when considering EMR adoption. A qualitative pre-implementation study was conducted using semi-structured, face to face interviews to explore the perspectives of physicians (n=16) operating in private clinics on the factors affecting their adoption of EMR. A multilevel, work system approach and the immersion/crystallization data analysis technique guided the researchers in examining the data, identifying patterns and key themes, and extracting representative quotes to illustrate these themes. The major factors associated with EMR adoption, which relate to the five categories of a work system, were system usefulness; user interface design; technical support; cost; system reliability; the privacy, confidentiality, and security of patient information; physical space in the clinic; data migration process; adverse work-related factors; and the computer and systems skills of physicians. Pre-implementation identification of factors important to adoption can allow system developers to focus proactively on these factors when developing the system and its implementation strategies, to maximize the likelihood of successful introduction.

Determining the Performance of Fluorescence Molecular Imaging Devices using Traceable Working Standards with SI Units of Radiance

PubMed Central

Zhu, Banghe; Rasmussen, John C.; Litorja, Maritoni

2017-01-01

To date, no emerging preclinical or clinical near-infrared fluorescence (NIRF) imaging devices for non-invasive and/or surgical guidance have their performances validated on working standards with SI units of radiance that enable comparison or quantitative quality assurance. In this work, we developed and deployed a methodology to calibrate a stable, solid phantom for emission radiance with units of mW · sr−1 · cm−2 for use in characterizing the measurement sensitivity of ICCD and IsCMOS detection, signal-to-noise ratio, and contrast. In addition, at calibrated radiances, we assess transverse and lateral resolution of ICCD and IsCMOS camera systems. The methodology allowed determination of superior SNR of the ICCD over the IsCMOS camera system and superior resolution of the IsCMOS over the ICCD camera system. Contrast depended upon the camera settings (binning and integration time) and gain of intensifier. Finally, because of architecture of CMOS and CCD camera systems resulting in vastly different performance, we comment on the utility of these systems for small animal imaging as well as clinical applications for non-invasive and surgical guidance. PMID:26552078

Integration of academic and clinical performance-based faculty compensation plans: a system and its impact on an anaesthesiology department.

PubMed

Sakai, T; Hudson, M; Davis, P; Williams, J

2013-10-01

The current economic environment makes it difficult for academic institutions to maintain academic activities with necessary clinical coverage. Productivity-based faculty compensation is reported to improve clinical work output; however, the impact on academic productivity has not been fully described. An academic anaesthesiology department has used a comprehensive clinical and academic performance-based faculty compensation programme as fiscal year (FY) 2004. Faculty choosing to pursue an academic track can devote up to 80% of their time to non-clinical activities. Payment for this time is 'salary at risk', which is earned through a merit matrix system, which was newly developed to award points for various academic activities. Unclaimed portions of the salary at risk are absorbed into the department budget at the conclusion of the FY. Clinical activities are measured chiefly based on total hours of anaesthetic care. Academic full-time equivalents (FTEs) decreased by 12.0% in FY2005 (FTE of 16.0-14.1) but recovered to the baseline level in FY2006 and remained stable. Clinical FTE also decreased by 6.6% in FY2005 (FTE of 109.1-101.9), then increased in FY2006-FY2010. Increased clinical work output was observed among the clinical and academic faculty members. Each academic faculty member successfully earned their salary at risk in each FY. The annual number of peer-reviewed publications per academic FTE in original research increased from 0.31 (0.18) (FY2001-FY2003) to 0.73 (0.14) (FY2006-FY2011), P=0.024. Integration of clinical and academic performance-based faculty compensation systems is feasible and can be efficacious in a large academic anaesthesiology department.

Jamaican family structure: the paradox of normalcy.

PubMed

Dechesnay, M

1986-06-01

The relationship between basic research, theory, and clinical work with families is conceptualized during a discussion of Jamaican family structure and the application of change theory to a clinical case of depression in a Jamaican woman. It was found that three types of family structure are prevalent in Jamaica. The European ideal of a patriarchal-patrifocal structure creates problems for working-class Jamaicans. General system theory provides support for a different model. Change theory is applied to resolve the paradox created by the European model.

Feasibility and implementation of a literature information management system for human papillomavirus in head and neck cancers with imaging.

PubMed

Wu, Dee H; Matthiesen, Chance L; Alleman, Anthony M; Fournier, Aaron L; Gunter, Tyler C

2014-01-01

This work examines the feasibility and implementation of information service-orientated architecture (ISOA) on an emergent literature domain of human papillomavirus, head and neck cancer, and imaging. From this work, we examine the impact of cancer informatics and generate a full set of summarizing clinical pearls. Additionally, we describe how such an ISOA creates potential benefits in informatics education, enhancing utility for creating enduring digital content in this clinical domain.

An initiative to improve the management of clinically significant test results in a large health care network.

PubMed

Roy, Christopher L; Rothschild, Jeffrey M; Dighe, Anand S; Schiff, Gordon D; Graydon-Baker, Erin; Lenoci-Edwards, Jennifer; Dwyer, Cheryl; Khorasani, Ramin; Gandhi, Tejal K

2013-11-01

The failure of providers to communicate and follow up clinically significant test results (CSTR) is an important threat to patient safety. The Massachusetts Coalition for the Prevention of Medical Errors has endorsed the creation of systems to ensure that results can be received and acknowledged. In 2008 a task force was convened that represented clinicians, laboratories, radiology, patient safety, risk management, and information systems in a large health care network with the goals of providing recommendations and a road map for improvement in the management of CSTR and of implementing this improvement plan during the sub-force sequent five years. In drafting its charter, the task broadened the scope from "critical" results to "clinically significant" ones; clinically significant was defined as any result that requires further clinical action to avoid morbidity or mortality, regardless of the urgency of that action. The task force recommended four key areas for improvement--(1) standardization of policies and definitions, (2) robust identification of the patient's care team, (3) enhanced results management/tracking systems, and (4) centralized quality reporting and metrics. The task force faced many challenges in implementing these recommendations, including disagreements on definitions of CSTR and on who should have responsibility for CSTR, changes to established work flows, limitations of resources and of existing information systems, and definition of metrics. This large-scale effort to improve the communication and follow-up of CSTR in a health care network continues with ongoing work to address implementation challenges, refine policies, prepare for a new clinical information system platform, and identify new ways to measure the extent of this important safety problem.

Experience with DICOM for the clinical specialties in the healthcare enterprise

NASA Astrophysics Data System (ADS)

Kuzmak, Peter M.; Dayhoff, Ruth E.

2003-05-01

DICOM is a success for radiology and cardiology and it is now beginning to be used for other clinical specialties. The US Department of Veterans Affairs has been instrumental in promoting this technological advancement. We have worked with a number of non-radiology imaging vendors over the past several years, encouraging them to support DICOM, providing requirement specifications, validating their implementations, installing their products, and integrating their systems with the VA healthcare enterprise. We require each new non-radiology vendor to support the DICOM Modality Worklist and Storage services, as specified in the IHE Technical Framework, and insist that they perform validation testing with us over the Internet before installing at a VA site. Three years ago we began working with commercial DICOM image acquisition applications in ophthalmology and endoscopy. Today we are interfacing with six vendors in ophthalmology, six in dental, and two in endoscopy. Getting imaging modality vendors to support DICOM is only part of the story, however. We have also developed the capabilities of the VistA hospital information system to properly handle DICOM interfaces to the different clinical specialties. The workflow in the clinical specialties is different than that of radiology, and is much more diverse. We designed the VistA DICOM image acquisition and display interface to use the generic order entry, result entry, result reporting, and appointment scheduling applications of our hospital information system, which are common to other hospital information systems, in order to maintain existing clinical workflow, minimize operational disruptions, simplify training, and win user acceptance. This software is now being field tested with dental and ophthalmology systems at a large number of VA medical centers. We have learned several things from this field test. The DICOM Modality Worklist and Storage services can be successfully used for image acquisition in the clinical specialties, although the specifications for some of the clinical specialty image types need to be enhanced. Special consideration needs to be given to the healthcare provider workflow in order to support DICOM requirements and to minimize change. The clinical specialties handle a large number of different kinds of requests, and imaging procedures may comprise only a small subset, which may need to be isolated out for efficient operation of DICOM Modality Worklist. The clinical specialties will acquire a large volume of images. Our goal is to incorporate all of the patient"s data into the electronic medical record and DICOM is making this easier for everyone. The work involved in extending DICOM to the clinical specialties and integrating them with the hospital information systems continues to be an ongoing and worthwhile challenge.

International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)?: The unmet needs and the clinical grey zone in autoimmune disease management.

PubMed

Giacomelli, Roberto; Afeltra, Antonella; Alunno, Alessia; Baldini, Chiara; Bartoloni-Bocci, Elena; Berardicurti, Onorina; Carubbi, Francesco; Cauli, Alberto; Cervera, Ricard; Ciccia, Francesco; Cipriani, Paola; Conti, Fabrizio; De Vita, Salvatore; Di Benedetto, Paola; Doria, Andrea; Drosos, Alexandros A; Favalli, Ennio Giulio; Gandolfo, Saviana; Gatto, Mariele; Grembiale, Rosa Daniela; Liakouli, Vasiliki; Lories, Rik; Lubrano, Ennio; Lunardi, Claudio; Margiotta, Domenico Paolo Emanuele; Massaro, Laura; Meroni, Pierluigi; Minniti, Antonia; Navarini, Luca; Pendolino, Monica; Perosa, Federico; Pers, Jacques-Olivier; Prete, Marcella; Priori, Roberta; Puppo, Francesco; Quartuccio, Luca; Ruffatti, Amelia; Ruscitti, Piero; Russo, Barbara; Sarzi-Puttini, Piercarlo; Shoenfeld, Yehuda; Somarakis, George A; Spinelli, Francesca Romana; Tinazzi, Elisa; Triolo, Giovanni; Ursini, Francesco; Valentini, Gabriele; Valesini, Guido; Vettori, Serena; Vitali, Claudio; Tzioufas, Athanasios G

2017-09-01

Autoimmune diseases are a complex set of diseases characterized by immune system activation and, although many progresses have been done in the last 15years, several unmet needs in the management of these patients may be still identified. Recently, a panel of international Experts, divided in different working groups according to their clinical and scientific expertise, were asked to identify, debate and formulate a list of key unmet needs within the field of rheumatology, serving as a roadmap for research as well as support for clinicians. After a systematic review of the literature, the results and the discussions from each working group were summarised in different statements. Due to the differences among the diseases and their heterogeneity, a large number of statements was produced and voted by the Experts to reach a consensus in a plenary session. At all the steps of this process, including the initial discussions by the steering committee, the identification of the unmet needs, the expansion of the working group and finally the development of statements, a large agreement was attained. This work confirmed that several unmet needs may be identified and despite the development of new therapeutic strategies as well as a better understanding of the effects of existing therapies, many open questions still remain in this field, suggesting a research agenda for the future and specific clinical suggestions which may allow physicians to better manage those clinical conditions still lacking of scientific clarity. Copyright © 2017. Published by Elsevier B.V.

Chemotherapy and treatment scheduling: the Johns Hopkins Oncology Center Outpatient Department.

PubMed Central

Majidi, F.; Enterline, J. P.; Ashley, B.; Fowler, M. E.; Ogorzalek, L. L.; Gaudette, R.; Stuart, G. J.; Fulton, M.; Ettinger, D. S.

1993-01-01

The Chemotherapy and Treatment Scheduling System provides integrated appointment and facility scheduling for very complex procedures. It is fully integrated with other scheduling systems at The Johns Hopkins Oncology Center and is supported by the Oncology Clinical Information System (OCIS). It provides a combined visual and textual environment for the scheduling of events that have multiple dimensions and dependencies on other scheduled events. It is also fully integrated with other clinical decision support and ancillary systems within OCIS. The system has resulted in better patient flow through the ambulatory care areas of the Center. Implementing the system required changes in behavior among physicians, staff, and patients. This system provides a working example of building a sophisticated rule-based scheduling system using a relatively simple paradigm. It also is an example of what can be achieved when there is total integration between the operational and clinical components of patient care automation. PMID:8130453

A qualitative analysis of how advanced practice nurses use clinical decision support systems.

PubMed

Weber, Scott

2007-12-01

The purpose of this study was to generate a grounded theory that will reflect the experiences of advanced practice nurses (APNs) working as critical care nurse practitioners (NPs) and clinical nurse specialists (CNS) with computer-based decision-making systems. A study design using grounded theory qualitative research methods and convenience sampling was employed in this study. Twenty-three APNs (13 CNS and 10 NPs) were recruited from 16 critical care units located in six large urban medical centers in the U.S. Midwest. Single-structured in-depth interviews with open-ended audio-taped questions were conducted with each APN. Through this process, APNs defined what they consider to be relevant themes and patterns of clinical decision system use in their critical care practices, and they identified the interrelatedness of the conceptual categories that emerged from the results. Data were analyzed using the constant comparative analysis method of qualitative research. APN participants were predominantly female, white/non-Hispanic, had a history of access to the clinical decision system used in their critical care settings for an average of 14 months, and had attended a formal training program to learn how to use clinical decision systems. "Forecasting decision outcomes," which was defined as the voluntary process employed to forecast the outcomes of patient care decisions in critical care prior to actual decision making, was the core variable describing system use that emerged from the responses. This variable consisted of four user constructs or components: (a) users' perceptions of their initial system learning experience, (b) users' sense of how well they understand how system technology works, (c) users' understanding of how system inferences are created or derived, and (d) users' relative trust of system-derived data. Each of these categories was further described through the grounded theory research process, and the relationships between the categories were identified. The findings of this study suggest that the main reason critical care APNs choose to integrate clinical decision systems into their practices is to provide an objective, scientifically derived, technology-based backup for human forecasting of the outcomes of patient care decisions prior to their actual decision making. Implications for nursing, health care, and technology research are presented.

Quality of human-computer interaction - results of a national usability survey of hospital-IT in Germany

PubMed Central

2011-01-01

Background Due to the increasing functionality of medical information systems, it is hard to imagine day to day work in hospitals without IT support. Therefore, the design of dialogues between humans and information systems is one of the most important issues to be addressed in health care. This survey presents an analysis of the current quality level of human-computer interaction of healthcare-IT in German hospitals, focused on the users' point of view. Methods To evaluate the usability of clinical-IT according to the design principles of EN ISO 9241-10 the IsoMetrics Inventory, an assessment tool, was used. The focus of this paper has been put on suitability for task, training effort and conformity with user expectations, differentiated by information systems. Effectiveness has been evaluated with the focus on interoperability and functionality of different IT systems. Results 4521 persons from 371 hospitals visited the start page of the study, while 1003 persons from 158 hospitals completed the questionnaire. The results show relevant variations between different information systems. Conclusions Specialised information systems with defined functionality received better assessments than clinical information systems in general. This could be attributed to the improved customisation of these specialised systems for specific working environments. The results can be used as reference data for evaluation and benchmarking of human computer engineering in clinical health IT context for future studies. PMID:22070880

[Advances of Molecular Diagnostic Techniques Application in Clinical Diagnosis.

PubMed

Ying, Bin-Wu

2016-11-01

Over the past 20 years,clinical molecular diagnostic technology has made rapid development,and became the most promising field in clinical laboratory medicine.In particular,with the development of genomics,clinical molecular diagnostic methods will reveal the nature of clinical diseases in a deeper level,thus guiding the clinical diagnosis and treatments.Many molecular diagnostic projects have been routinely applied in clinical works.This paper reviews the advances on application of clinical diagnostic techniques in infectious disease,tumor and genetic disorders,including nucleic acid amplification,biochip,next-generation sequencing,and automation molecular system,and so on.

Workplace-Based Assessments in Psychiatry: Evaluation of a Whole Assessment System

ERIC Educational Resources Information Center

Brittlebank, Andrew; Archer, Julian; Longson, Damien; Malik, Amit; Bhugra, Dinesh K.

2013-01-01

Objective: Work Place-Based Assessments (WPBAs) were introduced into psychiatry along with the new curriculum in 2005. The Royal College of Psychiatrists decided to pilot several WPBAs to ascertain their suitability. Method: Eight types of assessments (Case-Based Discussion, Assessment of Clinical Expertise, Mini-Assessed Clinical Encounter,…

A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial.

PubMed

Roy, Pierre-Marie; Durieux, Pierre; Gillaizeau, Florence; Legall, Catherine; Armand-Perroux, Aurore; Martino, Ludovic; Hachelaf, Mohamed; Dubart, Alain-Eric; Schmidt, Jeannot; Cristiano, Mirko; Chretien, Jean-Marie; Perrier, Arnaud; Meyer, Guy

2009-11-17

Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines. To assess the effectiveness of a handheld clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department. Cluster randomized trial. Assignment was by random-number table, providers were not blinded, and outcome assessment was automated. (ClinicalTrials.gov registration number: NCT00188032). 20 emergency departments in France. 1103 and 1768 consecutive outpatients with suspected pulmonary embolism. After a preintervention period involving 20 centers and 1103 patients, in which providers grew accustomed to inputting clinical data into handheld devices and investigators assessed baseline testing, emergency departments were randomly assigned to activation of a decision-support system on the devices (10 centers, 753 patients) or posters and pocket cards that showed validated diagnostic strategies (10 centers, 1015 patients). Appropriateness of diagnostic work-up, defined as any sequence of tests that yielded a posttest probability less than 5% or greater than 85% (primary outcome) or as strict adherence to guideline recommendations (secondary outcome); number of tests per patient (secondary outcome). The proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the preintervention period in both groups, but the increase was greater in the computer-based guidelines group (adjusted mean difference in increase, 19.3 percentage points favoring computer-based guidelines [95% CI, 2.9 to 35.6 percentage points]; P = 0.023). Among patients with appropriate work-ups, those in the computer-based guidelines group received slightly fewer tests than did patients in the paper guidelines group (mean tests per patient, 1.76 [SD, 0.98] vs. 2.25 [SD, 1.04]; P < 0.001). The study was not designed to show a difference in the clinical outcomes of patients during follow-up. A handheld decision-support system improved diagnostic decision making for patients with suspected pulmonary embolism in the emergency department.

Testing devices or experimental systems? Cancer clinical trials take the genomic turn.

PubMed

Nelson, Nicole C; Keating, Peter; Cambrosio, Alberto; Aguilar-Mahecha, Adriana; Basik, Mark

2014-06-01

Clinical trials are often described as machine-like systems for generating specific information concerning drug safety and efficacy, and are understood as a component of the industrial drug development processes. This paper argues that contemporary clinical trials in oncology are not reducible to mere drug testing. Drawing on ethnographic fieldwork and interviews with researchers in the field of oncology from 2010 to 2013, we introduce a conceptual contrast between trials as testing machines and trials as clinical experimental systems to draw attention to the ways trials are increasingly being used to ask open-ended scientific questions. When viewed as testing machines, clinical trials are seen as a means to produce answers to straightforward questions and deviations from the protocol are seen as bugs in the system; but practitioners can also treat trials as clinical experimental systems to investigate as yet undefined problems and where heterogeneity becomes a means to produce novel biological or clinical insights. The rise of "biomarker-driven" clinical trials in oncology, which link measurable biological characteristics such as genetic mutations to clinical features such as a patient's response to a particular drug, exemplifies a trend towards more experimental styles of clinical work. These transformations are congruent with changes in the institutional structure of clinical research in oncology, including a movement towards more flexible, networked research arrangements, and towards using individual patients as model systems for asking biological questions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Improving the CellSearch® system.

PubMed

Swennenhuis, J F; van Dalum, G; Zeune, L L; Terstappen, L W M M

2016-12-01

The CellSearch® CTC test enumerates tumor cells present in 7.5 ml blood of cancer patients. improvements, extensions and different utilities of the cellsearch system are discussed in this paper. Areas covered: This paper describes work performed with the CellSearch system, which go beyond the normal scope of the test. All results from searches with the search term 'CellSearch' from Web of Science and PubMed were categorized and discussed. Expert commentary: The CellSearch Circulating Tumor Cell test captures and identifies tumor cells in blood that are associated with poor clinical outcome. How to best use CTC in clinical practice is being explored in many clinical trials. The ability to extract information from the CTC to guide therapy will expand the potential clinical utility of CTC.

An introduction to statistical process control in research proteomics.

PubMed

Bramwell, David

2013-12-16

Statistical process control is a well-established and respected method which provides a general purpose, and consistent framework for monitoring and improving the quality of a process. It is routinely used in many industries where the quality of final products is critical and is often required in clinical diagnostic laboratories [1,2]. To date, the methodology has been little utilised in research proteomics. It has been shown to be capable of delivering quantitative QC procedures for qualitative clinical assays [3] making it an ideal methodology to apply to this area of biological research. To introduce statistical process control as an objective strategy for quality control and show how it could be used to benefit proteomics researchers and enhance the quality of the results they generate. We demonstrate that rules which provide basic quality control are easy to derive and implement and could have a major impact on data quality for many studies. Statistical process control is a powerful tool for investigating and improving proteomics research work-flows. The process of characterising measurement systems and defining control rules forces the exploration of key questions that can lead to significant improvements in performance. This work asserts that QC is essential to proteomics discovery experiments. Every experimenter must know the current capabilities of their measurement system and have an objective means for tracking and ensuring that performance. Proteomic analysis work-flows are complicated and multi-variate. QC is critical for clinical chemistry measurements and huge strides have been made in ensuring the quality and validity of results in clinical biochemistry labs. This work introduces some of these QC concepts and works to bridge their use from single analyte QC to applications in multi-analyte systems. This article is part of a Special Issue entitled: Standardization and Quality Control in Proteomics. Copyright © 2013 The Author. Published by Elsevier B.V. All rights reserved.

Relations between the Woodcock-Johnson III Clinical Clusters and Measures of Executive Functions from the Delis-Kaplan Executive Function System

ERIC Educational Resources Information Center

Floyd, Randy G.; McCormack, Allison C.; Ingram, Elizabeth L.; Davis, Amy E.; Bergeron, Renee; Hamilton, Gloria

2006-01-01

This study examined the convergent relations between scores from four clinical clusters from the Woodcock-Johnson III Tests of Cognitive Abilities (WJ III) and measures of executive functions using a sample of school-aged children and a sample of adults. The WJ III clinical clusters included the Working Memory, Cognitive Fluency, Broad Attention,…

Integrated management of depression: improving system quality and creating effective interfaces.

PubMed

Myette, Thomas L

2008-04-01

Depression is a chronic recurrent condition and is a leading cause of work disability. Improving occupational outcomes for depression will require an integrated approach that incorporates best practices from the clinical, community, and workplace systems. This article briefly reviews recent quality improvement initiatives and promising practices in each system and then shifts to the importance of systems integration. An integrated chronic care model uses a sophisticated case management process to support essential relationships, facilitate key plans, and efficiently link the three systems to optimize clinical, economic, and occupational outcomes. An expanded role for employers and their agents in the management of depression and other chronic diseases is seen as fundamental to maintaining a healthy and productive workforce. To improve occupational outcomes for depression by integrating best practices from the clinical, community, and workplace systems. After a brief review of quality improvement initiatives and promising practices in each system, an integrated chronic care model is introduced. A case management process that links critical systems, supports essential relationships, and facilitates key plans is expected to result in improvements in clinical, economic, and occupational outcomes. Employers should be more engaged with clinical and community partners in the prevention and control of depression in affected employees.

Challenges and strategies for sustaining youth-friendly health services - a qualitative study from the perspective of professionals at youth clinics in northern Sweden.

PubMed

Thomée, Suzanne; Malm, Desiré; Christianson, Monica; Hurtig, Anna-Karin; Wiklund, Maria; Waenerlund, Anna-Karin; Goicolea, Isabel

2016-12-21

Youth-friendly health-care services - those that are accessible, acceptable, equitable, appropriate and effective for different youth subpopulations - are beneficial for youth health, but not easy to implement and sustain. Sweden is among the few countries where youth-friendly health-care services have been integrated within the public health system and sustained for a long time. This study explores the challenges and strategies in providing sustainable youth-friendly health-care services, from the perspective of professionals working in youth clinics in northern Sweden. Eleven semi-structured interviews with various health-care professionals working in youth clinics in northern Sweden were conducted. The interviews were transcribed verbatim, and analysed using thematic analysis in relation to the World Health Organization domains of youth friendliness. Four themes emerged from the analysis of the data: 1) 'Meeting youths on their own terms - the key to ensuring a holistic and youth-centred care' was related to the acceptability and appropriateness of the services; 2) 'Organizational challenges and strategies in keeping professionals' expertise on youth updated' referred to the domain of effectiveness; 3) 'Youth clinics are accessible for those who know and can reach them' was related to the domains of accessibility and equity, and 4) 'The challenge of combining strong directions and flexibility in diverse local realities' focused on the struggle to sustain the youth clinics organization and their goals within the broader health system. Professionals working in youth clinics are perceived as motivated, interested and knowledgeable about youth, and the clinics ensure confidentiality and a youth-centred and holistic approach. Challenges remain, especially in terms of ensuring equitable access to different youth subpopulations, improving monitoring routines and ensuring training and competence for all professionals, independently of the location and characteristics of the clinic. Youth clinics are perceived as an indisputable part of the Swedish health system, but organizational challenges are also pointed out in terms of weak clear directives and leadership, heavy workload, local/regional diversity and unequitable distribution of resources.

Observing the work of the Clinical Nurse Specialist: a pilot study.

PubMed

Darmody, Julie V

2005-01-01

The Clinical Nurse Specialist (CNS) is an advanced practice nurse (APN) with graduate preparation as a clinical expert within a specialty area of nursing practice. There is a need for information about the work of the CNS in order to link CNS activities to outcomes and costs of care. To describe the work of the CNS in the acute care setting using the National Association of Clinical Nurse Specialists (NACNS) model as an organizing framework. Descriptive pilot study of the work of the CNS in acute care. A 500-bed academic medical center located in the Midwestern United States. Five masters-prepared APNs in a unit-based CNS role. Direct observation and time study were used to record activities and time for 4 hours with each CNS (n = 5) for a total of 20 hours of observation. CNS activity and time within each practice domain included patient/client (30%), nursing (44%), organization/system (10%), and other activities (16%). Specific activities observed were linked to possible outcomes in the NACNS framework. The NACNS model provided a useful framework for developing a data collection tool that can be used in a larger study that analyzes the work of the acute care CNS. Describing the work of the CNS is an important preliminary step to measuring outcomes and costs of care.

Developing a clinical information system: the role of the chief information officer.

PubMed

Glaser, J

1994-11-01

Chief information officers (CIOs) must play a pivotal role in the formation and implementation of a clinical information system, the subset of an organizational information system that deals specifically with support of clinical care activities. Major elements include the applications software, technology and data architecture, databases, and analysis. The organizational structures and processes that manage the development of improvement activities, including the clinical information system itself, are just as vital to the design of an information system as the hardware and software. To develop, sustain, and advance an information infrastructure, the CIO must help establish certain organizational precursors, such as medical staff involvement, experience with quality improvement, and ability to meet data needs. The CIO must then work with the senior administrative and medical leadership in developing a vision for the information system. The CIO must also create new roles and knowledge for information system and medical staff members. Interaction between information services and medical staff is vitally important to the success of a clinical information system. Organizational committees and structures that Brigham and Women's Hospital in Boston put in place to formalize the relationship between information systems and medical staff include the Clinical Initiative Development Program and the Center for Applied Medical Information Systems Research. Improving the clinical management of care and the efficacy of care processes involves complex changes in organizational culture and processes, medical practice and information system applications, technologies, staff, and data.

Dermatologic surgery emergencies: Complications caused by systemic reactions, high-energy systems, and trauma.

PubMed

Minkis, Kira; Whittington, Adam; Alam, Murad

2016-08-01

While the overall incidence of emergencies in dermatologic surgery is low, emergent situations can occasionally pose a risk to patients undergoing such procedures. The clinical importance of several types of emergences related to systemic reactions, high energy systems, and trauma are reviewed, and relevant epidemiology, clinical manifestations, diagnosis, work-up, management, and prevention are discussed. Early detection of surgical emergencies can mitigate any associated adverse outcomes, thereby allowing the outstanding record of safety of dermatologic surgery to continue. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Information needs research in the era of the digital medical library.

PubMed Central

Lomax, E. C.; Lowe, H. J.

1998-01-01

The rapid adoption of Internet-accessible information resources by the clinical community, has resulted in an exponential growth in the variety and type of clinical information resources along with an increasing diversity of information technologies to deliver clinical information. To date, little formal work has been done to investigate the significance of new information technologies such as Internet-based digital libraries and multimedia record systems on clinical information need or information seeking behavior. In the work described in this paper, we highlight some results from our recent multimethod research design and investigation of the information-seeking behavior of Pittsburgh area medical oncologists to argue for the use of a multimethod research design as an essential component of any investigation of clinical information need and information-seeking behavior in the era of the digital medical library. PMID:9929301

The value of participatory development to support antimicrobial stewardship with a clinical decision support system.

PubMed

Beerlage-de Jong, Nienke; Wentzel, Jobke; Hendrix, Ron; van Gemert-Pijnen, Lisette

2017-04-01

Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs. A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians. The prototype evaluations resulted in insight into the end-users and their way of working, as well as their needs and expectations. The online questionnaire that was distributed among a larger group of medical specialists, including lung and infection experts, complemented the findings of the prototype evaluations. It revealed a say/do problem concerning the unrecognized need of support for selecting diagnostic tests. Low-fidelity prototypes of a technology allow researchers to get to know the end-users, their way of working, and their work context. Involving experts allows technology developers to continuously check the fit between technology and clinical practice. The combination enables the participatory development of technology to successfully support ASPs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A presentation system for just-in-time learning in radiology.

PubMed

Kahn, Charles E; Santos, Amadeu; Thao, Cheng; Rock, Jayson J; Nagy, Paul G; Ehlers, Kevin C

2007-03-01

There is growing interest in bringing medical educational materials to the point of care. We sought to develop a system for just-in-time learning in radiology. A database of 34 learning modules was derived from previously published journal articles. Learning objectives were specified for each module, and multiple-choice test items were created. A web-based system-called TEMPO-was developed to allow radiologists to select and view the learning modules. Web services were used to exchange clinical context information between TEMPO and the simulated radiology work station. Preliminary evaluation was conducted using the System Usability Scale (SUS) questionnaire. TEMPO identified learning modules that were relevant to the age, sex, imaging modality, and body part or organ system of the patient being viewed by the radiologist on the simulated clinical work station. Users expressed a high degree of satisfaction with the system's design and user interface. TEMPO enables just-in-time learning in radiology, and can be extended to create a fully functional learning management system for point-of-care learning in radiology.

What factors are associated with the integration of evidence retrieval technology into routine general practice settings?

PubMed

Magrabi, Farah; Westbrook, Johanna I; Coiera, Enrico W

2007-10-01

Information retrieval systems have the potential to improve patient care but little is known about the variables which influence clinicians' uptake and use of systems in routine work. To determine which factors influenced use of an online evidence retrieval system. Computer logs and pre- and post-system survey analysis of a 4-week clinical trial of the Quick Clinical online evidence system involving 227 general practitioners across Australia. Online evidence use was not linked to general practice training or clinical experience but female clinicians conducted more searches than their male counterparts (mean use=14.38 searches, S.D.=11.68 versus mean use=8.50 searches, S.D.=9.99; t=2.67, d.f.=157, P=0.008). Practice characteristics such as hours worked, type and geographic location of clinic were not associated with search activity. Information seeking was also not related to participants' perceived information needs, computer skills, training nor Internet connection speed. Clinicians who reported direct improvements in patient care as a result of system use had significantly higher rates of system use than other users (mean use=12.55 searches, S.D.=13.18 versus mean use=8.15 searches, S.D.=9.18; t=2.322, d.f.=154 P=0.022). Comparison of participants' views pre- and post- the trial, showed that post-trial clinicians expressed more positive views about searching for information during a consultation (chi(2)=27.40, d.f.=4, P< or =0.001) and a significantly greater number reported seeking information between consultations as a result of having access to an online evidence system in their consulting rooms (chi(2)=9.818, d.f.=2, P=0.010). Clinicians' use of an online evidence system was directly related to their reported experiences of improvements in patient care. Post-trial clinicians positively changed their views about having time to search for information and pursued more questions during clinic hours.

Measures and predictors of community-based employment and earnings of persons with schizophrenia in a multisite study.

PubMed

Salkever, David S; Karakus, Mustafa C; Slade, Eric P; Harding, Courtenay M; Hough, Richard L; Rosenheck, Robert A; Swartz, Marvin S; Barrio, Concepcion; Yamada, Anne Marie

2007-03-01

Data from a national study of persons with schizophrenia-related disorders were examined to determine clinical factors and labor-market conditions related to employment outcomes. Data were obtained from the U.S. Schizophrenia Care and Assessment Program, a naturalistic study of more than 2,300 persons from organized care systems in six U.S. regions. Data were collected via surveys and from medical records and clinical assessments at baseline and for three years. Outcome measures included any community-based (nonsheltered) employment, 40 or more hours of work in the past month, employment at or above the federal minimum wage, days and hours of work, and earnings. Bivariate and multiple regression analyses of data from more than 7,000 assessments tested relationships between outcomes and sociodemographic, clinical, and local labor market characteristics. The employment rate was 17.2%; only 57.1% of participants who worked reported 40 or more hours of past-month employment. The mean hourly wage was $7.05, and mean monthly earnings were $494.20. Employment rates and number of hours worked were substantially below those found in household surveys or in baseline data from trials of employment programs but substantially higher than those found in a recent large clinical trial. Strong positive relationships were found between clinical factors and work outcomes, but evidence of a relationship between local unemployment rates and outcomes was weak. Work attachment and earnings were substantially lower than in previous survey data, not very sensitive to labor market conditions, and strongly related to clinical status.

Update of the Mexican College of Rheumatology guidelines for the pharmacologic treatment of rheumatoid arthritis.

PubMed

Cardiel, Mario H; Díaz-Borjón, Alejandro; Vázquez del Mercado Espinosa, Mónica; Gámez-Nava, Jorge Iván; Barile Fabris, Leonor A; Pacheco Tena, César; Silveira Torre, Luis H; Pascual Ramos, Virginia; Goycochea Robles, María Victoria; Aguilar Arreola, Jorge Enrique; González Díaz, Verónica; Alvarez Nemegyei, José; González-López, Laura del Carmen; Salazar Páramo, Mario; Portela Hernández, Margarita; Castro Colín, Zully; Xibillé Friedman, Daniel Xavier; Alvarez Hernández, Everardo; Casasola Vargas, Julio; Cortés Hernández, Miguel; Flores-Alvarado, Diana E; Martínez Martínez, Laura A; Vega-Morales, David; Flores-Suárez, Luis Felipe; Medrano Ramírez, Gabriel; Barrera Cruz, Antonio; García González, Adolfo; López López, Susana Marisela; Rosete Reyes, Alejandra; Espinosa Morales, Rolando

2014-01-01

The pharmacologic management of rheumatoid arthritis has progressed substantially over the past years. It is therefore desirable that existing information be periodically updated. There are several published international guidelines for the treatment of rheumatoid arthritis that hardly adapt to the Mexican health system because of its limited healthcare resources. Hence, it is imperative to unify the existing recommendations and to incorporate them to a set of clinical, updated recommendations; the Mexican College of Rheumatology developed these recommendations in order to offer an integral management approach of rheumatoid arthritis according to the resources of the Mexican health system. To review, update and improve the available evidence within clinical practice guidelines on the pharmacological management of rheumatoid arthritis and produce a set of recommendations adapted to the Mexican health system, according to evidence available through December 2012. The working group was composed of 30 trained and experienced rheumatologists with a high quality of clinical knowledge and judgment. Recommendations were based on the highest quality evidence from the previously established treatment guidelines, meta-analysis and controlled clinical trials for the adult population with rheumatoid arthritis. During the conformation of this document, each working group settled the existing evidence from the different topics according to their experience. Finally, all the evidence and decisions were unified into a single document, treatment algorithm and drug standardization tables. This update of the Mexican Guidelines for the Pharmacologic Treatment of Rheumatoid Arthritis provides the highest quality information available at the time the working group undertook this review and contextualizes its use for the complex Mexican health system. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Innovations in clinical trials informatics.

PubMed

Summers, Ron; Vyas, Hiten; Dudhal, Nilesh; Doherty, Neil F; Coombs, Crispin R; Hepworth, Mark

2008-01-01

This paper will investigate innovations in information management for use in clinical trials. The application typifies a complex, adaptive, distributed and information-rich environment for which continuous innovation is necessary. Organisational innovation is highlighted as well as the technical innovations in workflow processes and their representation as an integrated set of web services. Benefits realization uncovers further innovations in the business strand of the work undertaken. Following the description of the development of this information management system, the semantic web is postulated as a possible solution to tame the complexity related to information management issues found within clinical trials support systems.

A comprehensive clinical research database based on CDISC ODM and i2b2.

PubMed

Meineke, Frank A; Stäubert, Sebastian; Löbe, Matthias; Winter, Alfred

2014-01-01

We present a working approach for a clinical research database as part of an archival information system. The CDISC ODM standard is target for clinical study and research relevant routine data, thus decoupling the data ingest process from the access layer. The presented research database is comprehensive as it covers annotating, mapping and curation of poorly annotated source data. Besides a conventional relational database the medical data warehouse i2b2 serves as main frontend for end-users. The system we developed is suitable to support patient recruitment, cohort identification and quality assurance in daily routine.

Automated Transformation of CDISC ODM to OpenClinica.

PubMed

Gessner, Sophia; Storck, Michael; Hegselmann, Stefan; Dugas, Martin; Soto-Rey, Iñaki

2017-01-01

Due to the increasing use of electronic data capture systems for clinical research, the interest in saving resources by automatically generating and reusing case report forms in clinical studies is growing. OpenClinica, an open-source electronic data capture system enables the reuse of metadata in its own Excel import template, hampering the reuse of metadata defined in other standard formats. One of these standard formats is the Operational Data Model for metadata, administrative and clinical data in clinical studies. This work suggests a mapping from Operational Data Model to OpenClinica and describes the implementation of a converter to automatically generate OpenClinica conform case report forms based upon metadata in the Operational Data Model.

Evidence in Practice - A Pilot Study Leveraging Companion Animal and Equine Health Data from Primary Care Veterinary Clinics in New Zealand.

PubMed

Muellner, Petra; Muellner, Ulrich; Gates, M Carolyn; Pearce, Trish; Ahlstrom, Christina; O'Neill, Dan; Brodbelt, Dave; Cave, Nick John

2016-01-01

Veterinary practitioners have extensive knowledge of animal health from their day-to-day observations of clinical patients. There have been several recent initiatives to capture these data from electronic medical records for use in national surveillance systems and clinical research. In response, an approach to surveillance has been evolving that leverages existing computerized veterinary practice management systems to capture animal health data recorded by veterinarians. Work in the United Kingdom within the VetCompass program utilizes routinely recorded clinical data with the addition of further standardized fields. The current study describes a prototype system that was developed based on this approach. In a 4-week pilot study in New Zealand, clinical data on presentation reasons and diagnoses from a total of 344 patient consults were extracted from two veterinary clinics into a dedicated database and analyzed at the population level. New Zealand companion animal and equine veterinary practitioners were engaged to test the feasibility of this national practice-based health information and data system. Strategies to ensure continued engagement and submission of quality data by participating veterinarians were identified, as were important considerations for transitioning the pilot program to a sustainable large-scale and multi-species surveillance system that has the capacity to securely manage big data. The results further emphasized the need for a high degree of usability and smart interface design to make such a system work effectively in practice. The geospatial integration of data from multiple clinical practices into a common operating picture can be used to establish the baseline incidence of disease in New Zealand companion animal and equine populations, detect unusual trends that may indicate an emerging disease threat or welfare issue, improve the management of endemic and exotic infectious diseases, and support research activities. This pilot project is an important step toward developing a national surveillance system for companion animals and equines that moves beyond emerging infectious disease detection to provide important animal health information that can be used by a wide range of stakeholder groups, including participating veterinary practices.

Lightweight application for generating clinical research information systems: MAGIC.

PubMed

Leskošek, Brane; Pajntar, Marjan

2015-12-01

Our purpose was to build and test a lightweight solution for generating clinical research information systems (CRIS) that would allow non-IT professionals with basic knowledge of computer usage to quickly define and build a ready-to-use, safe and secure web-based clinical research system for data management. We use the acronym MAGIC (Medical Application Generator InteraCtive) for the system. The generated CRIS should be very easy to build and use, so a common LAMP (Linux Apache MySQL Perl) platform was used, which also enables short development cycles. The application was built and tested using eXtreme Programming (XP) principles by a small development team consisting of one informatics specialist, one physician and one graphical designer/programmer. The parameter and graphical user interface (GUI) definitions for the CRIS can be made by non-IT professionals using an intuitive English-language-like formalism called application definition language (ADL). From these definitions, the MAGIC builds an end-user CRIS that can be used on a wide variety of platforms (from standard workstations to hand-held devices). A working example of a national health-care-quality assessment program is presented to illustrate this process. The lightweight application for generating CRIS (MAGIC) has proven to be useful for both clinical and analytical users in real working environment. To achieve better performance and interoperability, we are planning to recompile the application using XML schemas (XSD) in HL7 CDA or openEHR archetypes formats used for parameters definition and for data interchange between different information systems.

An ontologically founded architecture for information systems in clinical and epidemiological research.

PubMed

Uciteli, Alexandr; Groß, Silvia; Kireyev, Sergej; Herre, Heinrich

2011-08-09

This paper presents an ontologically founded basic architecture for information systems, which are intended to capture, represent, and maintain metadata for various domains of clinical and epidemiological research. Clinical trials exhibit an important basis for clinical research, and the accurate specification of metadata and their documentation and application in clinical and epidemiological study projects represents a significant expense in the project preparation and has a relevant impact on the value and quality of these studies.An ontological foundation of an information system provides a semantic framework for the precise specification of those entities which are presented in this system. This semantic framework should be grounded, according to our approach, on a suitable top-level ontology. Such an ontological foundation leads to a deeper understanding of the entities of the domain under consideration, and provides a common unifying semantic basis, which supports the integration of data and the interoperability between different information systems.The intended information systems will be applied to the field of clinical and epidemiological research and will provide, depending on the application context, a variety of functionalities. In the present paper, we focus on a basic architecture which might be common to all such information systems. The research, set forth in this paper, is included in a broader framework of clinical research and continues the work of the IMISE on these topics.

[ADP system for automatic production of physician's letters as well as statistics analyses in the area of obstetrics and perinatology].

PubMed

Heinrich, J; Putzar, H; Seidenschnur, G

1977-01-01

Report about an electronic data processing system for obstetrics and perinatology. The developed data document design and data flowchart are shown. The continuously accumulated data allowed everytime a detailed interpretation record. For all clinical treated patients the computer printed out a final obstetrical report (physician report). By means of this simple system there is an improvement of the information and the typewriting work of medical staff has been reduced. Cost and work-expenditure for this system are limited in relation to our earlier hand made procedure.

Pharmaceutical liposomal drug delivery: a review of new delivery systems and a look at the regulatory landscape.

PubMed

Zylberberg, Claudia; Matosevic, Sandro

2016-11-01

Liposomes were the first nanoscale drug to be approved for clinical use in 1995. Since then, the technology has grown considerably, and pioneering recent work in liposome-based delivery systems has brought about remarkable developments with significant clinical implications. This includes long-circulating liposomes, stimuli-responsive liposomes, nebulized liposomes, elastic liposomes for topical, oral and transdermal delivery and covalent lipid-drug complexes for improved drug plasma membrane crossing and targeting to specific organelles. While the regulatory bodies' opinion on liposomes is well-documented, current guidance that address new delivery systems are not. This review describes, in depth, the current state-of-the-art of these new liposomal delivery systems and provides a critical overview of the current regulatory landscape surrounding commercialization efforts of higher-level complexity systems, the expected requirements and the hurdles faced by companies seeking to bring novel liposome-based systems for clinical use to market.

Quality management and job related factors predicting satisfaction of dental clinic staff in Estonia.

PubMed

Merisalu, Eda; Männik, Georg; Põlluste, Kaja

2014-01-01

The aim of the study was to explore the role of managerial style, work environment factors and burnout in determining job satisfaction during the implementation of quality improvement activities in a dental clinic. Quantitative research was carried out using a prestructured anonymous questionnaire to survey 302 respondents in Kaarli Dental Clinic, Estonia. Dental clinic staff assessed job satisfaction, managerial style, work stress and burnout levels through the implementation period of ISO 9000 quality management system in 2003 and annually during 2006-2009. Binary logistic regression was used to explain the impact of satisfaction with management and work organisation, knowledge about managerial activities, work environment and psychosocial stress and burnout on job satisfaction. The response rate limits were between 60% and 89.6%. Job satisfaction increased significantly from 2003 to 2006 and the percentage of very satisfied staff increased from 17 to 38 (p<0.01) over this period. In 2007, the proportion of very satisfied people dropped to 21% before increasing again in 2008-2009 (from 24% to 35%). Binary logistic regression analysis resulted in a model that included five groups of factors: managerial support, information about results achieved and progress to goals, work organisation and working environment, as well as factors related to career, security and planning. The average scores of emotional exhaustion showed significant decrease, correlating negatively with job satisfaction (p<0.05). The implementation of quality improvement activities in the Kaarli Dental Clinic has improved the work environment by decreasing burnout symptoms and increased job satisfaction in staff.

The AcCell series 2000 as a support system for training and evaluation in educational and clinical settings.

PubMed

Greening, S E; Grohs, D H; Guidos, B J

1997-01-01

Providing effective training, retraining and evaluation programs, including proficiency testing programs, for cytoprofessionals is a challenge shared by many academic and clinical educators internationally. In cytopathology the quality of training has immediately transferable and critically important impacts on satisfactory performance in the clinical setting. Well-designed interactive computer-assisted instruction and testing programs have been shown to enhance initial learning and to reinforce factual and conceptual knowledge. Computer systems designed not only to promote diagnostic accuracy but to integrate and streamline work flow in clinical service settings are candidates for educational adaptation. The AcCell 2000 system, designed as a diagnostic screening support system, offers technology that is adaptable to educational needs during basic and in-service training as well as testing of screening proficiency in both locator and identification skills. We describe the considerations, approaches and applications of the AcCell 2000 system in education programs for both training and evaluation of gynecologic diagnostic screening proficiency.

Toward a low-cost gait analysis system for clinical and free-living assessment.

PubMed

Ladha, Cassim; Del Din, Silvia; Nazarpour, Kianoush; Hickey, Aodhan; Morris, Rosie; Catt, Michael; Rochester, Lynn; Godfrey, Alan

2016-08-01

Gait is an important clinical assessment tool since changes in gait may reflect changes in general health. Measurement of gait is a complex process which has been restricted to bespoke clinical facilities until recently. The use of inexpensive wearable technologies is an attractive alternative and offers the potential to assess gait in any environment. In this paper we present the development of a low cost analysis gait system built using entirely open source components. The system is used to capture spatio-temporal gait characteristics derived from an existing conceptual model, sensitive to ageing and neurodegenerative pathology (e.g. Parkinson's disease). We demonstrate the system is suitable for use in a clinical unit and will lead to pragmatic use in a free-living (home) environment. The system consists of a wearable (tri-axial accelerometer and gyroscope) with a Raspberry Pi module for data storage and analysis. This forms ongoing work to develop gait as a low cost diagnostic in modern healthcare.

Examining the controllability of sepsis using genetic algorithms on an agent-based model of systemic inflammation.

PubMed

Cockrell, Robert Chase; An, Gary

2018-02-01

Sepsis, a manifestation of the body's inflammatory response to injury and infection, has a mortality rate of between 28%-50% and affects approximately 1 million patients annually in the United States. Currently, there are no therapies targeting the cellular/molecular processes driving sepsis that have demonstrated the ability to control this disease process in the clinical setting. We propose that this is in great part due to the considerable heterogeneity of the clinical trajectories that constitute clinical "sepsis," and that determining how this system can be controlled back into a state of health requires the application of concepts drawn from the field of dynamical systems. In this work, we consider the human immune system to be a random dynamical system, and investigate its potential controllability using an agent-based model of the innate immune response (the Innate Immune Response ABM or IIRABM) as a surrogate, proxy system. Simulation experiments with the IIRABM provide an explanation as to why single/limited cytokine perturbations at a single, or small number of, time points is unlikely to significantly improve the mortality rate of sepsis. We then use genetic algorithms (GA) to explore and characterize multi-targeted control strategies for the random dynamical immune system that guide it from a persistent, non-recovering inflammatory state (functionally equivalent to the clinical states of systemic inflammatory response syndrome (SIRS) or sepsis) to a state of health. We train the GA on a single parameter set with multiple stochastic replicates, and show that while the calculated results show good generalizability, more advanced strategies are needed to achieve the goal of adaptive personalized medicine. This work evaluating the extent of interventions needed to control a simplified surrogate model of sepsis provides insight into the scope of the clinical challenge, and can serve as a guide on the path towards true "precision control" of sepsis.

Exploring extended scope of practice in dietetics: A systems approach.

PubMed

Ryan, Dominique; Pelly, Fiona; Purcell, Elizabeth

2017-09-01

The aim of this study was to explore health professionals' perceptions of an extended scope of a practice clinic, and develop a framework using a systems approach to facilitate extended scope models across various health settings. A qualitative investigation using semi-structured interviews with four health professionals involved in an extended scope dietitian-led gastroenterology clinic in a hospital in regional Queensland was conducted. A case study design was utilised to investigate interviewees' perceptions of the clinic. Participants were conveniently, purposively sampled. Transcript analysis involved a descriptive analytical approach. Interviewee responses were coded and categorised into themes, and investigator triangulation was used to ensure consistency between individual analyses. A secondary interpretative analysis was conducted where relationships between key themes were mapped to the Systems Engineering Initiative for Patient Safety work system model. Interviewees identified various factors as vital inputs to the work system. These were categorised into the four key elements: stakeholder support, resources, planning and the dietitian. Clinic outcomes were categorised into the impact on four key groups: patients, the dietitian, the multidisciplinary team and the health system. Mapping of the relationships between inputs and outcomes resulted in an implementation framework for extended scope of practice. Extended scope of practice in dietetics may provide positive outcomes for various stakeholders. However, further development of extended scope roles for dietitians requires increased advocacy and support from governments, professional bodies, training institutions and dietitians. We have developed an implementation framework which can be utilised by health professionals interested in embracing an extended scope model of care. © 2016 Dietitians Association of Australia.

Integration of a Computer-Based Consultant into the Clinical Setting*

PubMed Central

Bischoff, Miriam B.; Shortliffe, Edward H.

1983-01-01

Studies of the attitudes of medical personnel regarding computer-based clinical consultation systems have shown that successful programs must be designed not only to satisfy a need for expert level advice but also to fit smoothly into the dally routine of physician/users. Planning for system use should accordingly be emphasized in all aspects of the system design. ONCOCIN is an oncology protocol management system that assists physicians with the management of outpatients enrolled in experimental cancer chemotherapy protocols. ONCOCIN was designed for initial implementation in the Stanford Oncology Day Care Center, where it has been in limited use since May of 1981. The clinic's physicians currently use the system dally in the management of patients with Hodgkin's and non-Hodgkin's lymphoma. This work has allowed us to study physician-computer interaction and to explore artificial intelligence research issues. This paper discusses the practical issues to consider when designing a consultation system for physicians and the logistical issues to address when integrating such a system into a clinic setting. We describe how ONCOCIN has addressed these issues, the problems encountered, their resolution, and the lessons learned.

Clinical laboratory analytics: Challenges and promise for an emerging discipline.

PubMed

Shirts, Brian H; Jackson, Brian R; Baird, Geoffrey S; Baron, Jason M; Clements, Bryan; Grisson, Ricky; Hauser, Ronald George; Taylor, Julie R; Terrazas, Enrique; Brimhall, Brad

2015-01-01

The clinical laboratory is a major source of health care data. Increasingly these data are being integrated with other data to inform health system-wide actions meant to improve diagnostic test utilization, service efficiency, and "meaningful use." The Academy of Clinical Laboratory Physicians and Scientists hosted a satellite meeting on clinical laboratory analytics in conjunction with their annual meeting on May 29, 2014 in San Francisco. There were 80 registrants for the clinical laboratory analytics meeting. The meeting featured short presentations on current trends in clinical laboratory analytics and several panel discussions on data science in laboratory medicine, laboratory data and its role in the larger healthcare system, integrating laboratory analytics, and data sharing for collaborative analytics. One main goal of meeting was to have an open forum of leaders that work with the "big data" clinical laboratories produce. This article summarizes the proceedings of the meeting and content discussed.

Clinical laboratory analytics: Challenges and promise for an emerging discipline

PubMed Central

Shirts, Brian H.; Jackson, Brian R.; Baird, Geoffrey S.; Baron, Jason M.; Clements, Bryan; Grisson, Ricky; Hauser, Ronald George; Taylor, Julie R.; Terrazas, Enrique; Brimhall, Brad

2015-01-01

The clinical laboratory is a major source of health care data. Increasingly these data are being integrated with other data to inform health system-wide actions meant to improve diagnostic test utilization, service efficiency, and “meaningful use.” The Academy of Clinical Laboratory Physicians and Scientists hosted a satellite meeting on clinical laboratory analytics in conjunction with their annual meeting on May 29, 2014 in San Francisco. There were 80 registrants for the clinical laboratory analytics meeting. The meeting featured short presentations on current trends in clinical laboratory analytics and several panel discussions on data science in laboratory medicine, laboratory data and its role in the larger healthcare system, integrating laboratory analytics, and data sharing for collaborative analytics. One main goal of meeting was to have an open forum of leaders that work with the “big data” clinical laboratories produce. This article summarizes the proceedings of the meeting and content discussed. PMID:25774320

[Local information systems at the Pediatric Clinic at the University Clinical Center in Sarajevo--experience and perspectives].

PubMed

Buljina, A; Zubcević, S; Hadziselimović, E; Zecević, E; Dzumhur, Z

1999-01-01

Computer were first introduced at Pediatric hospital in Sarajevo in 1989 and since 1990 first programs for managing data have been started. They were used for administration of patients and history taking, as well as for collecting clinical data of them. In the beginning, introduction was slow because lot of doctors and nurses were reluctant in using new techniques. But, in a year most of them realized all the advantages PC offers. At that time all the PCs were separated, that has limited their full facilitated data gathering especially in the periods when we lacked all other office materials (paper, typing machines ... even pencils). Thanks to them we have preserved all medical data about patients in 4 years war period. After the end of the War we started project of making clinical network and program that should run most of the work that is performed at Pediatric Hospital in Sarajevo. Everything that is done at hospital and could be helped by the use of the computers was recorded and algorithms were made. The network consists of 15 PC units. Program was developed through several phases from the admittance of the patients and administration regarding it to the discharge letter. Outpatient work was incorporated, as well as gathering all the medical findings of the patients at one place. First experiences are extremely positive. We have speeded up "paper work" and freed much time that medical stuff can spend with patients. The main problems that we encounter are need for permanent education in working with system, lack of more powerful server that can handle more data and introducing of the pictures in the medical records. We conclude that clinical network with the use of good program for managing all the data gathered in the hospital is essential for today's work.

Scaling an expert system data mart: more facilities in real-time.

PubMed

McNamee, L A; Launsby, B D; Frisse, M E; Lehmann, R; Ebker, K

1998-01-01

Clinical Data Repositories are being rapidly adopted by large healthcare organizations as a method of centralizing and unifying clinical data currently stored in diverse and isolated information systems. Once stored in a clinical data repository, healthcare organizations seek to use this centralized data to store, analyze, interpret, and influence clinical care, quality and outcomes. A recent trend in the repository field has been the adoption of data marts--specialized subsets of enterprise-wide data taken from a larger repository designed specifically to answer highly focused questions. A data mart exploits the data stored in the repository, but can use unique structures or summary statistics generated specifically for an area of study. Thus, data marts benefit from the existence of a repository, are less general than a repository, but provide more effective and efficient support for an enterprise-wide data analysis task. In previous work, we described the use of batch processing for populating data marts directly from legacy systems. In this paper, we describe an architecture that uses both primary data sources and an evolving enterprise-wide clinical data repository to create real-time data sources for a clinical data mart to support highly specialized clinical expert systems.

Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review.

PubMed

Keller, Sara C; Tamma, Pranita D; Cosgrove, Sara E; Miller, Melissa A; Sateia, Heather; Szymczak, Julie; Gurses, Ayse P; Linder, Jeffrey A

2018-01-01

In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. This model describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes. The work system consists of 5 components, tools and technology, organization, person, tasks, and environment, within an external environment. Of 1,288 abstracts initially identified, 42 quantitative studies and 17 qualitative studies met inclusion criteria. Effective interventions focused on tools and technology (eg, clinical decision support and point-of-care testing), the person (eg, clinician education), organization (eg, audit and feedback and academic detailing), tasks (eg, delayed antibiotic prescribing), the environment (eg, commitment posters), and the external environment (media campaigns). Studies have not focused on clinic-wide approaches to AS. A human factors engineering approach suggests that investigating the role of the clinic's processes or physical layout or external pressures' role in antibiotic prescribing may be a promising way to improve ambulatory AS. © Copyright 2018 by the American Board of Family Medicine.

Strategic planning for clinical services: St. Joseph Hospital and Health Care Center.

PubMed

Linggi, A; Pelham, L D

1986-09-01

A pharmacy department at a 340-bed community hospital based its strategic plan for developing patient-oriented services on a sound drug distribution system, a credible work-measurement program, and fiscal responsibility. In 1982 the department of pharmacy and i.v. therapy implemented a strategic plan for improving pharmaceutical services. The plan involved developing goals and objectives for the department; marketing the department's services and fiscal management to hospital administrators, medical staff, and nursing staff; building teamwork among the pharmacy staff; and improving the drug distribution system before instituting clinical services. Hiring of additional pharmacy staff was justified on the basis of work-measurement data. By adjusting staffing levels every two weeks based on work-measurement data, the department increased the efficiency of drug distribution activities; the pharmacy also implemented cost-saving programs like selection of therapeutic alternates and formulary restrictions. The savings were then reinvested in labor-intensive patient-oriented pharmaceutical services. A staff development program using staff pharmacists as preceptors expanded the breadth and depth of pharmacists' clinical skills. The planning efforts were successful because the needs of hospital administrators, the pharmacy department, and staff members were addressed.

Multi-task functional MRI in multiple sclerosis patients without clinical disability.

PubMed

Colorado, René A; Shukla, Karan; Zhou, Yuxiang; Wolinsky, Jerry S; Narayana, Ponnada A

2012-01-02

While the majority of individuals with multiple sclerosis (MS) develop significant clinical disability, a subset experiences a disease course with minimal impairment even in the presence of significant apparent tissue damage on magnetic resonance imaging (MRI). Functional magnetic resonance imaging (fMRI) in MS patients with low disability suggests that increased use of the cognitive control system may limit the clinical manifestation of the disease. The current fMRI studies tested the hypothesis that nondisabled MS patients show increased recruitment of cognitive control regions while performing sensory, motor and cognitive tasks. Twenty two patients with relapsing-remitting MS and an Expanded Disability Status Scale (EDSS) score of ≤1.5 and 23 matched healthy controls were recruited. Subjects underwent fMRI while observing flashing checkerboards, performing right or left hand movements, or executing the 2-back working memory task. Compared to control subjects, patients demonstrated increased activation of the right dorsolateral prefrontal cortex and anterior cingulate cortex during the performance of the working memory task. This pattern of functional recruitment also was observed during the performance of non-dominant hand movements. These results support the mounting evidence of increased functional recruitment of cognitive control regions in the working memory system of MS patients with low disability and provide new evidence for the role of increased cognitive control recruitment in the motor system. Copyright © 2011 Elsevier Inc. All rights reserved.

Security and Privacy in a DACS.

PubMed

Delgado, Jaime; Llorente, Silvia; Pàmies, Martí; Vilalta, Josep

2016-01-01

The management of electronic health records (EHR), in general, and clinical documents, in particular, is becoming a key issue in the daily work of Healthcare Organizations (HO). The need for providing secure and private access to, and storage for, clinical documents together with the need for HO to interoperate, raises a number of issues difficult to solve. Many systems are in place to manage EHR and documents. Some of these Healthcare Information Systems (HIS) follow standards in their document structure and communications protocols, but many do not. In fact, they are mostly proprietary and do not interoperate. Our proposal to solve the current situation is the use of a DACS (Document Archiving and Communication System) for providing security, privacy and standardized access to clinical documents.

Design of an Intelligent Nursing Clinical Pathway and Nursing Order Support System for Traditional Chinese Medicine.

PubMed

Ding, Bao-Fen; Chang, Polun; Wang, Ping; Li, Hai-Ting; Kuo, Ming-Chuan

2017-01-01

With an in-depth analysis of nursing work in 14 hospitals over a period of two years, one unique total nursing information system framework was established where the nursing clinical pathways are used as the main frame and the nursing orders as the nodes on the frame. We used the nursing order concept with the principles of nursing process. A closed-loop management model composed of the nursing orders was set up to solve nursing problems. Based on the principles of traditional Chinese medicine, we further designed an intelligent support module to automatically deduct clinical nursing pathways to promote standardized management and improve the quality of nursing care. The system has successfully been implemented in some facilities since 2015.

MO-A-213-00: Economics Update

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

NONE

2015-06-15

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a Medical Physicist. This will include general information about the different categories of payers and payees, how work is described by CPT© codes, and how various payers set values for this work in different clinical settings. 2015 is a year of significant changes to the payment system. Many CPT© codes have been deleted and replaced with new CPT© codes. These codes define some of the most common work performed in our clinics including treatment planning and delivery.more » This presentation will describe what work is encompassed in these codes and will give attendees an overview of the changes for 2015 as they apply to radiation oncology. Finally, some insight into what can be expected during 2016 will be presented. This includes what information is typically released by the Centers for Medicaid & Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning Objectives: Basics of how Medicare is structured and how reimbursement rates are set. Basic understanding of proposed changes to the 2016 Medicare rules. What resources are available from the AAPM and how to interact with the professional economics committee. Ownership in pxAlpha, LLC, a medical device start up company.« less

MO-A-213-01: 2015 Economics Update Part 1

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

Dirksen, B.

2015-06-15

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a Medical Physicist. This will include general information about the different categories of payers and payees, how work is described by CPT© codes, and how various payers set values for this work in different clinical settings. 2015 is a year of significant changes to the payment system. Many CPT© codes have been deleted and replaced with new CPT© codes. These codes define some of the most common work performed in our clinics including treatment planning and delivery.more » This presentation will describe what work is encompassed in these codes and will give attendees an overview of the changes for 2015 as they apply to radiation oncology. Finally, some insight into what can be expected during 2016 will be presented. This includes what information is typically released by the Centers for Medicaid & Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning Objectives: Basics of how Medicare is structured and how reimbursement rates are set. Basic understanding of proposed changes to the 2016 Medicare rules. What resources are available from the AAPM and how to interact with the professional economics committee. Ownership in pxAlpha, LLC, a medical device start up company.« less

MO-A-213-02: 2015 Economics Update Part 2

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

Fontenot, J.

2015-06-15

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a Medical Physicist. This will include general information about the different categories of payers and payees, how work is described by CPT© codes, and how various payers set values for this work in different clinical settings. 2015 is a year of significant changes to the payment system. Many CPT© codes have been deleted and replaced with new CPT© codes. These codes define some of the most common work performed in our clinics including treatment planning and delivery.more » This presentation will describe what work is encompassed in these codes and will give attendees an overview of the changes for 2015 as they apply to radiation oncology. Finally, some insight into what can be expected during 2016 will be presented. This includes what information is typically released by the Centers for Medicaid & Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning Objectives: Basics of how Medicare is structured and how reimbursement rates are set. Basic understanding of proposed changes to the 2016 Medicare rules. What resources are available from the AAPM and how to interact with the professional economics committee. Ownership in pxAlpha, LLC, a medical device start up company.« less

START: an advanced radiation therapy information system.

PubMed

Cocco, A; Valentini, V; Balducci, M; Mantello, G

1996-01-01

START is an advanced radiation therapy information system (RTIS) which connects direct information technology present in the devices with indirect information technology for clinical, administrative, information management integrated with the hospital information system (HIS). The following objectives are pursued: to support decision making in treatment planning and functional and information integration with the rest of the hospital; to enhance organizational efficiency of a Radiation Therapy Department; to facilitate the statistical evaluation of clinical data and managerial performance assessment; to ensure the safety and confidentiality of used data. For its development a working method based on the involvement of all operators of the Radiation Therapy Department, was applied. Its introduction in the work activity was gradual, trying to reuse and integrate the existing information applications. The START information flow identifies four major phases: admission, visit of admission, planning, therapy. The system main functionalities available to the radiotherapist are: clinical history/medical report linking function; folder function; planning function; tracking function; electronic mail and banner function; statistical function; management function. Functions available to the radiotherapy technician are: the room daily list function; management function: to the nurse the following functions are available: patient directing function; management function. START is a departmental client (pc-windows)-server (unix) developed on an integrated database of all information of interest (clinical, organizational and administrative) coherent with the standard and with a modular architecture which can evolve with additional functionalities in subsequent times. For a more thorough evaluation of its impact on the daily activity of a radiation therapy facility, a prolonged clinical validation is in progress.

Gallstones

MedlinePlus

... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... NASH Understanding Adult Overweight and Obesity Related Diagnostic Tests ERCP Your Digestive System and How it Works ...

Enhanced data consistency of a portable gait measurement system.

PubMed

Lin, Hsien-I; Chiang, Y P

2013-11-01

A gait measurement system is a useful tool for rehabilitation applications. Such a system is used to conduct gait experiments in large workplaces such as laboratories where gait measurement equipment can be permanently installed. However, a gait measurement system should be portable if it is to be used in clinics or community centers for aged people. In a portable gait measurement system, the workspace is limited and landmarks on a subject may not be visible to the cameras during experiments. Thus, we propose a virtual-marker function to obtain positions of unseen landmarks for maintaining data consistency. This work develops a portable clinical gait measurement system consisting of lightweight motion capture devices, force plates, and a walkway assembled from plywood boards. We evaluated the portable clinic gait system with 11 normal subjects in three consecutive days in a limited experimental space. Results of gait analysis based on the verification of within-day and between-day coefficients of multiple correlations show that the proposed portable gait system is reliable.

Enhanced data consistency of a portable gait measurement system

NASA Astrophysics Data System (ADS)

Lin, Hsien-I.; Chiang, Y. P.

2013-11-01

A gait measurement system is a useful tool for rehabilitation applications. Such a system is used to conduct gait experiments in large workplaces such as laboratories where gait measurement equipment can be permanently installed. However, a gait measurement system should be portable if it is to be used in clinics or community centers for aged people. In a portable gait measurement system, the workspace is limited and landmarks on a subject may not be visible to the cameras during experiments. Thus, we propose a virtual-marker function to obtain positions of unseen landmarks for maintaining data consistency. This work develops a portable clinical gait measurement system consisting of lightweight motion capture devices, force plates, and a walkway assembled from plywood boards. We evaluated the portable clinic gait system with 11 normal subjects in three consecutive days in a limited experimental space. Results of gait analysis based on the verification of within-day and between-day coefficients of multiple correlations show that the proposed portable gait system is reliable.

Safe disposal of cytotoxic waste: an evaluation of an air-tight system.

PubMed

Craig, Gemma; Wadey, Charlotte

2017-09-07

A 3-month evaluation was undertaken at the Kent Oncology Centre's chemotherapy day unit (CDU) to trial an air-tight sealing disposal system for cytotoxic waste management. Research has identified the potential risk to staff who handle waste products that are hazardous to health. Staff safety was a driving force behind a trial of a new way of working. This article provides an overview of the evaluation of the Pactosafe system in one clinical area, examining reviews by oncology healthcare workers, the practicalities in the clinical setting, training, cost effectiveness and the environmental benefits.

Finnish physicians' experiences with computer-supported patient information exchange and communication in clinical work.

PubMed

Viitanen, Johanna; Nieminen, Marko; Hypponen, Hannele; Laaveri, Tinja

2011-01-01

Several researchers share the concern of healthcare information systems failing to support communication and collaboration in clinical practices. The objective of this paper is to investigate the current state of computer-supported patient information exchange and associated communication between clinicians. We report findings from a national survey on Finnish physicians? experiences with their currently used clinical information systems with regard to patient information documentation, retrieval, management and exchange-related tasks. The questionnaire study with 3929 physicians indicated the main concern being cross-organisational patient information delivery. In addition, physicians argued computer usage increasingly steals time and attention from caring activities and even disturbs physician?nurse collaboration. Problems in information management were particularly emphasised among those physicians working in hospitals and wards. The survey findings indicated that collaborative applications and mobile or wireless solutions have not been widely adapted in Finnish healthcare and suggested an urgent need for adopting appropriate information and communication technology applications to support information exchange and communication between physicians, and physicians and nurses.

Use of electronic monitoring in clinical nursing research.

PubMed

Ailinger, Rita L; Black, Patricia L; Lima-Garcia, Natalie

2008-05-01

In the past decade, the introduction of electronic monitoring systems for monitoring medication adherence has contributed to the dialog about what works and what does not work in monitoring adherence. The purpose of this article is to describe the use of the Medication Event Monitoring System (MEMS) in a study of patients receiving isoniazid for latent tuberculosis infection. Three case examples from the study illustrate the data that are obtained from the electronic device compared to self-reports and point to the disparities that may occur in electronic monitoring. The strengths and limitations of using the MEMS and ethical issues in utilizing this technology are discussed. Nurses need to be aware of these challenges when using electronic measuring devices to monitor medication adherence in clinical nursing practice and research.

European Society of Clinical Pharmacy (ESCP) glossary of scientific terms: a tool for standardizing scientific jargon.

PubMed

Carollo, Anna; Rieutord, André; Launay-Vacher, Vincent

2012-04-01

This glossary is a tool for clinicians who have to confront topics in which medical, scientific and technical jargon is closely linked. It provides definitions for the key concepts and terms of pharmaceutical care, clinical pharmacy, and research in the health care system in clinical settings. It includes items that are not particularly technical, but that should be part of the know-how of staff working in medical and scientific fields. In fact, the glossary can also help clinical technicians who want to understand the precise definition of scientific terms, which often do not coincide with the ones used in the practice setting. PRINCIPAL GOALS AND OBJECTIVES: The aim of this glossary is to aid in the development of more standardized and established terminology for clinical pharmacy, facilitate communication among different stakeholders and, ultimately, contribute to a higher-quality health care system. The glossary contains 165 definitions of concepts and principles in clinical pharmacy, and terms widely used in this field. The criteria for the inclusion of terms were specific applications in health promotion, or terms used in other fields that have a specific meaning or application when used in reference to clinical activity. The glossary arose from the need to standardize terminology in the scientific field. It was not intended as a comprehensive listing that would include all medical terms, but as a useful tool for clinical pharmacists working in this area, and for users who occasionally encounter unusual, often hard to understand, terminology.

Los Angeles Free Clinic [and]"Adolescent Health Care Programs That Work."

ERIC Educational Resources Information Center

Rainwater, Mary; De Caprio, Chris

The first paper describes The Los Angeles Free Clinic and its services, which are specifically designed to respond to the needs of low-income and homeless youth within the community. The paper describes a free-of-charge, free-of-judgment comprehensive response system that exists because of collaboration with other health facilities such as…

Family physicians' suggestions to improve the documentation, coding, and billing system: a study from the residency research network of Texas.

PubMed

Young, Richard A; Bayles, Bryan; Hill, Jason H; Kumar, Kaparabonya A; Burge, Sandra

2014-06-01

The study's aim was to ascertain family physicians' suggestions on how to improve the commonly used US evaluation and management (E/M) rules for primary care. A companion paper published in Family Medicine's May 2014 journal describes our study methods (Fam Med 2014;46(5):378-84). Study subjects supported preserving the overall SOAP note structure. They especially suggested eliminating bullet counting in the E/M rules. For payment reform, respondents stated that brief or simple work should be paid less than long or complex work, and that family physicians should be paid for important tasks they currently are not, such as spending extra time with patients, phone and email clinical encounters, and extra paperwork. Subjects wanted shared savings when their decisions and actions created system efficiencies and savings. Some supported recent payment reforms such as monthly retainer fees and pay-for-performance bonuses. Others expressed skepticism about the negative consequences of each. Aligned incentives among all stakeholders was another common theme. Family physicians wanted less burdensome documentation requirements. They wanted to be paid more for complex work and work that does not include traditional face-to-face clinic visits, and they wanted the incentives of other stakeholders in the health care systems to be aligned with their priorities.

Electronic Self-report Assessment--Cancer (ESRA-C): Working towards an integrated survey system.

PubMed

Karras, Bryant T; Wolpin, Seth; Lober, William B; Bush, Nigel; Fann, Jesse R; Berry, Donna L

2006-01-01

The Clinical Informatics Research Group and Biobehavioral Nursing and Health Systems at the University of Washington are working with interdisciplinary teams to improve patient care and tracking of patient-reported symptoms and outcomes by creating an extensible web-based survey and intervention platform. The findings and cumulative experience from these processes have led to incremental improvements and variations in each new implementation of the platform. This paper presents progress in the first year of a three-year NIH study entitled Electronic Self Report Assessment--Cancer (ESRA-C). The project's goals are to enhance and evaluate the web-based computerized patient self-reporting and assessment system at the Seattle Cancer Care Alliance. Preliminary work and lessons learned in the modification of the platform and enhancements to the system will be described.

Performance of the Mayo-IBM PAC system

NASA Astrophysics Data System (ADS)

Persons, Kenneth R.; Reardon, Frank J.; Gehring, Dale G.; Hangiandreou, Nicholas J.

1994-05-01

The Mayo Clinic and IBM (at Rochester, Minnesota) have jointly developed a picture archived system for use with Mayo's MRI and CT imaging modalities. This PACS is made up of over 50 computers that work cooperatively to provide archival, retrieval and image distribution services for Mayo's Department of Radiology. This paper will examine the performance characteristics of the system.

[Manpower of rheumatology in catalonia (Spain)].

PubMed

Ortiz-Santamaría, V; Olivé, A

2005-12-01

To determine the changes in Rheumatology provision and working practice that have occurred on the basis of the 1990, 1996 surveys carried out to update the Catalan Society for Rheumatology register The register includes all rheumatologists in Catalonia (Spain) who are registered and who do clinical work. Questionnaires were sent to all rheumatologists on the register. The questionnaires asked about location and clinical commitments. One hundred twenty-four rheumatologists work at the public system in Catalonia, 80 (65%) work at hospitals. The majority of rheumatologists (105; 84,6%) are located in the province of Barcelona. One fith of the rheumatologists have a temporal work. Ten general hospitals are still lacking of rheumatologists. Although the number of rheumatologists in Catalonia has increased there are ongoing inequalities in the provision of Rheumatology, especially between Barcelona and the rest of provinces. Copyright © 2005 Elsevier España S.L. Barcelona. Published by Elsevier Espana. All rights reserved.

Digital diagnosis of medical images

NASA Astrophysics Data System (ADS)

Heinonen, Tomi; Kuismin, Raimo; Jormalainen, Raimo; Dastidar, Prasun; Frey, Harry; Eskola, Hannu

2001-08-01

The popularity of digital imaging devices and PACS installations has increased during the last years. Still, images are analyzed and diagnosed using conventional techniques. Our research group begun to study the requirements for digital image diagnostic methods to be applied together with PACS systems. The research was focused on various image analysis procedures (e.g., segmentation, volumetry, 3D visualization, image fusion, anatomic atlas, etc.) that could be useful in medical diagnosis. We have developed Image Analysis software (www.medimag.net) to enable several image-processing applications in medical diagnosis, such as volumetry, multimodal visualization, and 3D visualizations. We have also developed a commercial scalable image archive system (ActaServer, supports DICOM) based on component technology (www.acta.fi), and several telemedicine applications. All the software and systems operate in NT environment and are in clinical use in several hospitals. The analysis software have been applied in clinical work and utilized in numerous patient cases (500 patients). This method has been used in the diagnosis, therapy and follow-up in various diseases of the central nervous system (CNS), respiratory system (RS) and human reproductive system (HRS). In many of these diseases e.g. Systemic Lupus Erythematosus (CNS), nasal airways diseases (RS) and ovarian tumors (HRS), these methods have been used for the first time in clinical work. According to our results, digital diagnosis improves diagnostic capabilities, and together with PACS installations it will become standard tool during the next decade by enabling more accurate diagnosis and patient follow-up.

Standardizing clinical laboratory data for secondary use.

PubMed

Abhyankar, Swapna; Demner-Fushman, Dina; McDonald, Clement J

2012-08-01

Clinical databases provide a rich source of data for answering clinical research questions. However, the variables recorded in clinical data systems are often identified by local, idiosyncratic, and sometimes redundant and/or ambiguous names (or codes) rather than unique, well-organized codes from standard code systems. This reality discourages research use of such databases, because researchers must invest considerable time in cleaning up the data before they can ask their first research question. Researchers at MIT developed MIMIC-II, a nearly complete collection of clinical data about intensive care patients. Because its data are drawn from existing clinical systems, it has many of the problems described above. In collaboration with the MIT researchers, we have begun a process of cleaning up the data and mapping the variable names and codes to LOINC codes. Our first step, which we describe here, was to map all of the laboratory test observations to LOINC codes. We were able to map 87% of the unique laboratory tests that cover 94% of the total number of laboratory tests results. Of the 13% of tests that we could not map, nearly 60% were due to test names whose real meaning could not be discerned and 29% represented tests that were not yet included in the LOINC table. These results suggest that LOINC codes cover most of laboratory tests used in critical care. We have delivered this work to the MIMIC-II researchers, who have included it in their standard MIMIC-II database release so that researchers who use this database in the future will not have to do this work. Published by Elsevier Inc.

Developing professional status: an investigation into the working patterns, working relationships and vision for the future of UK clinical dental technicians.

PubMed

Leyssen, W; Clark, R K F; Gallagher, J E; Radford, D R

2013-01-01

To investigate the working patterns and patient base of registered clinical dental technicians (CDTs); their relationships with dentists and other professionals in the dental team; their willingness to work within the NHS and their expectations for the future as a new professional group. Face-to-face qualitative interviews of registered CDTs, selected because of their geographic representation and mode of working, informed the development of a postal questionnaire survey of all early registrants with the General Dental Council (GDC). The majority of CDTs reported working part-time, often combining clinical practice with their role as a dental technician. They reported both positive and negative working relationships with dentists and dental technicians, demonstrating collaboration and/or competition depending on whether the scope of CDTs was respected and patient care was shared or lost. CDTs role in the NHS was limited because they did not have the status of becoming a recognised provider of dental care. There was a desire to expand their scope of practice in future. CDTs are embracing their new status as an occupational group within dentistry. Core features of becoming a professional group were exhibited including the importance of social and financial status and the need to negotiate their current and future roles in the healthcare system.

Employing clinical decision support to attain our strategic goal: the safe care of the surgical patient.

PubMed

Magid, Steven K; Pancoast, Paul E; Fields, Theodore; Bradley, Diane G; Williams, Robert B

2007-01-01

Clinical decision support can be employed to increase patient safety and improve workflow efficiencies for physicians and other healthcare providers. Physician input into the design and deployment of clinical decision support systems can increase the utility of the alerts and reduce the likelihood of "alert fatigue." The Hospital for Special Surgery is a 146-bed orthopedic facility that performs approximately 18,000 surgeries a year Efficient work processes are a necessity. The facility began implementing a new electronic health record system in June 2005 and plan to go live in summer 2007. This article reports on some of the clinical decision support rules and alerts being incorporated into the facility's system in the following categories--high-risk, high-frequency scenarios, rules that provide efficiencies and value from the presciber perspective, and rules that relate to patient safety.

Does the choice of display system influence perception and visibility of clinically relevant features in digital pathology images?

NASA Astrophysics Data System (ADS)

Kimpe, Tom; Rostang, Johan; Avanaki, Ali; Espig, Kathryn; Xthona, Albert; Cocuranu, Ioan; Parwani, Anil V.; Pantanowitz, Liron

2014-03-01

Digital pathology systems typically consist of a slide scanner, processing software, visualization software, and finally a workstation with display for visualization of the digital slide images. This paper studies whether digital pathology images can look different when presenting them on different display systems, and whether these visual differences can result in different perceived contrast of clinically relevant features. By analyzing a set of four digital pathology images of different subspecialties on three different display systems, it was concluded that pathology images look different when visualized on different display systems. The importance of these visual differences is elucidated when they are located in areas of the digital slide that contain clinically relevant features. Based on a calculation of dE2000 differences between background and clinically relevant features, it was clear that perceived contrast of clinically relevant features is influenced by the choice of display system. Furthermore, it seems that the specific calibration target chosen for the display system has an important effect on the perceived contrast of clinically relevant features. Preliminary results suggest that calibrating to DICOM GSDF calibration performed slightly worse than sRGB, while a new experimental calibration target CSDF performed better than both DICOM GSDF and sRGB. This result is promising as it suggests that further research work could lead to better definition of an optimized calibration target for digital pathology images resulting in a positive effect on clinical performance.

Artificial intelligence-assisted occupational lung disease diagnosis.

PubMed

Harber, P; McCoy, J M; Howard, K; Greer, D; Luo, J

1991-08-01

An artificial intelligence expert-based system for facilitating the clinical recognition of occupational and environmental factors in lung disease has been developed in a pilot fashion. It utilizes a knowledge representation scheme to capture relevant clinical knowledge into structures about specific objects (jobs, diseases, etc) and pairwise relations between objects. Quantifiers describe both the closeness of association and risk, as well as the degree of belief in the validity of a fact. An independent inference engine utilizes the knowledge, combining likelihoods and uncertainties to achieve estimates of likelihood factors for specific paths from work to illness. The system creates a series of "paths," linking work activities to disease outcomes. One path links a single period of work to a single possible disease outcome. In a preliminary trial, the number of "paths" from job to possible disease averaged 18 per subject in a general population and averaged 25 per subject in an asthmatic population. Artificial intelligence methods hold promise in the future to facilitate diagnosis in pulmonary and occupational medicine.

Terminology Services: Standard Terminologies to Control Health Vocabulary.

PubMed

González Bernaldo de Quirós, Fernán; Otero, Carlos; Luna, Daniel

2018-04-22

Healthcare Information Systems should capture clinical data in a structured and preferably coded format. This is crucial for data exchange between health information systems, epidemiological analysis, quality and research, clinical decision support systems, administrative functions, among others. Structured data entry is an obstacle for the usability of electronic health record (EHR) applications and their acceptance by physicians who prefer to document patient EHRs using "free text". Natural language allows for rich expressiveness but at the same time is ambiguous; it has great dependence on context and uses jargon and acronyms. Although much progress has been made in knowledge and natural language processing techniques, the result is not yet satisfactory enough for the use of free text in all dimensions of clinical documentation. In order to address the trade-off between capturing data with free text and at the same time coding data for computer processing, numerous terminological systems for the systematic recording of clinical data have been developed. The purpose of terminology services consists of representing facts that happen in the real world through database management in order to allow for semantic interoperability and computerized applications. These systems interrelate concepts of a particular domain and provide references to related terms with standards codes. In this way, standard terminologies allow the creation of a controlled medical vocabulary, making terminology services a fundamental component for health data management in the healthcare environment. The Hospital Italiano de Buenos Aires has been working in the development of its own terminology server. This work describes its experience in the field. Georg Thieme Verlag KG Stuttgart.

Interventional robotic systems: Applications and technology state-of-the-art

PubMed Central

CLEARY, KEVIN; MELZER, ANDREAS; WATSON, VANCE; KRONREIF, GERNOT; STOIANOVICI, DAN

2011-01-01

Many different robotic systems have been developed for invasive medical procedures. In this article we will focus on robotic systems for image-guided interventions such as biopsy of suspicious lesions, interstitial tumor treatment, or needle placement for spinal blocks and neurolysis. Medical robotics is a young and evolving field and the ultimate role of these systems has yet to be determined. This paper presents four interventional robotics systems designed to work with MRI, CT, fluoroscopy, and ultrasound imaging devices. The details of each system are given along with any phantom, animal, or human trials. The systems include the AcuBot for active needle insertion under CT or fluoroscopy, the B-Rob systems for needle placement using CT or ultrasound, the INNOMOTION for MRI and CT interventions, and the MRBot for MRI procedures. Following these descriptions, the technology issues of image compatibility, registration, patient movement and respiration, force feedback, and control mode are briefly discussed. It is our belief that robotic systems will be an important part of future interventions, but more research and clinical trials are needed. The possibility of performing new clinical procedures that the human cannot achieve remains an ultimate goal for medical robotics. Engineers and physicians should work together to create and validate these systems for the benefits of patients everywhere. PMID:16754193

Evaluating the working conditions and exposure to abuse of Filipino home care workers in Israel: characteristics and clinical correlates.

PubMed

Ayalon, Liat

2009-02-01

Filipino home care workers provide the majority of around-the-clock personal care to frail individuals in Israel. To date, the working conditions as well as exposure to work-related abuse of Filipino home care workers in Israel have not been evaluated. A survey of 245 Filipino home care workers was conducted to evaluate their working conditions and exposure to abuse as well as their clinical correlates (e.g. burnout as measures by the Maslach Burnout Inventory). This was integrated with findings from interviews with Filipino home care workers, social workers, and family members of care recipients cared by Filipino home care workers. A majority of the workers (88%) reported paying large amounts of money in order to work in the country. Overall, 43% reported being asked to do more than was specified in their job description, 41% reported being verbally abused, and 40% reported not receiving adequate food. Almost half reported work-related injuries. The most consistent predictor of burnout (as measured by the Emotional Exhaustion and Depersonalization scales) was exposure to work-related abuse. Interview data identified system and societal barriers that prevent workers from using the legal system for their protection. The present study calls for further supervision of this caregiving arrangement. Psychoeducational programs directed towards all stakeholders (e.g. social workers, home care workers, care recipients, and family members of care recipients) are needed.

Managing and Communicating Operational Workflow: Designing and Implementing an Electronic Outpatient Whiteboard.

PubMed

Steitz, Bryan D; Weinberg, Stuart T; Danciu, Ioana; Unertl, Kim M

2016-01-01

Healthcare team members in emergency department contexts have used electronic whiteboard solutions to help manage operational workflow for many years. Ambulatory clinic settings have highly complex operational workflow, but are still limited in electronic assistance to communicate and coordinate work activities. To describe and discuss the design, implementation, use, and ongoing evolution of a coordination and collaboration tool supporting ambulatory clinic operational workflow at Vanderbilt University Medical Center (VUMC). The outpatient whiteboard tool was initially designed to support healthcare work related to an electronic chemotherapy order-entry application. After a highly successful initial implementation in an oncology context, a high demand emerged across the organization for the outpatient whiteboard implementation. Over the past 10 years, developers have followed an iterative user-centered design process to evolve the tool. The electronic outpatient whiteboard system supports 194 separate whiteboards and is accessed by over 2800 distinct users on a typical day. Clinics can configure their whiteboards to support unique workflow elements. Since initial release, features such as immunization clinical decision support have been integrated into the system, based on requests from end users. The success of the electronic outpatient whiteboard demonstrates the usefulness of an operational workflow tool within the ambulatory clinic setting. Operational workflow tools can play a significant role in supporting coordination, collaboration, and teamwork in ambulatory healthcare settings.

What is the impact of an electronic test result acknowledgement system on Emergency Department physicians' work processes? A mixed-method pre-post observational study.

PubMed

Georgiou, Andrew; McCaughey, Euan J; Tariq, Amina; Walter, Scott R; Li, Julie; Callen, Joanne; Paoloni, Richard; Runciman, William B; Westbrook, Johanna I

2017-03-01

To examine the impact of an electronic Results Acknowledgement (eRA) system on emergency physicians' test result management work processes and the time taken to acknowledge microbiology and radiology test results for patients discharged from an Emergency Department (ED). The impact of the eRA system was assessed in an Australian ED using: a) semi-structured interviews with senior emergency physicians; and b) a time and motion direct observational study of senior emergency physicians completing test acknowledgment pre and post the implementation of the eRA system. The eRA system led to changes in the way results and actions were collated, stored, documented and communicated. Although there was a non-significant increase in the average time taken to acknowledge results in the post period, most types of acknowledgements (other than simple acknowledgements) took less time to complete. The number of acknowledgements where physicians sought additional information from the Electronic Medical Record (EMR) rose from 12% pre to 20% post implementation of eRA. Given that the type of results are unlikely to have changed significantly across the pre and post implementation periods, the increase in the time physicians spent accessing additional clinical information in the post period likely reflects the greater access to clinical information provided by the integrated electronic system. Easier access to clinical information may improve clinical decision making and enhance the quality of patient care. For instance, in situations where a senior clinician, not initially involved in the care process, is required to deal with the follow-up of non-normal results. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Extending Our Understanding of Burnout and Its Associated Factors: Providers and Staff in Primary Care Clinics.

PubMed

Spinelli, William M; Fernstrom, Karl M; Galos, Dylan L; Britt, Heather R

2016-09-01

Burnout has been identified as an occupational hazard in the helping professions for many years and is often overlooked, as health-care systems strive to improve cost and quality. The Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS) are tools for assessing burnout prevalence and its associated factors. We describe how we used them in outpatient clinics to assess burnout for multiple job types. Traditional statistical techniques and seemingly unrelated regression were used to describe the sample and evaluate the association between work life domains and burnout. Of 838 eligible participants, 467 (55.7%) were included for analysis. Burnout prevalence varied across three job categories: providers (37.5%), clinical assistants (24.6%), and other staff (28.0%). It was not related to age, gender, or years of tenure but was lower in part-time workers (24.6%) than in full-time workers (33.9%). Analysis of the AWS subscales identified organizational correlates of burnout. Accurately identifying and defining the operative system factors associated with burnout will make it possible to create successful interventions. Using the MBI and the AWS together can highlight the relationship between system work experiences and burnout. © The Author(s) 2016.

Metrix Matrix: A Cloud-Based System for Tracking Non-Relative Value Unit Value-Added Work Metrics.

PubMed

Kovacs, Mark D; Sheafor, Douglas H; Thacker, Paul G; Hardie, Andrew D; Costello, Philip

2018-03-01

In the era of value-based medicine, it will become increasingly important for radiologists to provide metrics that demonstrate their value beyond clinical productivity. In this article the authors describe their institution's development of an easy-to-use system for tracking value-added but non-relative value unit (RVU)-based activities. Metrix Matrix is an efficient cloud-based system for tracking value-added work. A password-protected home page contains links to web-based forms created using Google Forms, with collected data populating Google Sheets spreadsheets. Value-added work metrics selected for tracking included interdisciplinary conferences, hospital committee meetings, consulting on nonbilled outside studies, and practice-based quality improvement. Over a period of 4 months, value-added work data were collected for all clinical attending faculty members in a university-based radiology department (n = 39). Time required for data entry was analyzed for 2 faculty members over the same time period. Thirty-nine faculty members (equivalent to 36.4 full-time equivalents) reported a total of 1,223.5 hours of value-added work time (VAWT). A formula was used to calculate "value-added RVUs" (vRVUs) from VAWT. VAWT amounted to 5,793.6 vRVUs or 6.0% of total work performed (vRVUs plus work RVUs [wRVUs]). Were vRVUs considered equivalent to wRVUs for staffing purposes, this would require an additional 2.3 full-time equivalents, on the basis of average wRVU calculations. Mean data entry time was 56.1 seconds per day per faculty member. As health care reimbursement evolves with an emphasis on value-based medicine, it is imperative that radiologists demonstrate the value they add to patient care beyond wRVUs. This free and easy-to-use cloud-based system allows the efficient quantification of value-added work activities. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Mentor relationship as a tool of professional development of student nurses in clinical practice.

PubMed

Saarikoski, Mikko

2003-09-01

This is a condensed version of a research project relating to the design and the development of a research instrument concerning 'Mentor Relationship as a Tool of Professional Development of Student Nurses in Clinical Practice'. This short research paper is taken from and reproduces the research work undertaken by Saarikoski (2002). The main themes refer to: (1) Evaluation scale to assess the quality of clinical learning environment and (2) Supervision of student nurses during their clinical placements. Parts one and two are taken from the main research study and include the following (i) developing and testing an evaluation tool (ii) describing how nursing students experience their clinical learning environment and (iii) the supervision given by qualified staff nurses working in a hospital setting. This abridged report discusses the methodology approaches undertaken by the author and includes: (a) comparative phased twin centred study (b) a pilot scheme and (c) a primary research instrument that was developed into an extensively validated assessment-measuring tool. This report strongly suggests that there is clear evidence in this research report that the supervisory relationship is the most important single element of pedagogical activities of staff nurses. The total satisfaction of students correlated most clearly with the method of supervision and that those satisfied students had a successful mentor relationship and frequently enough access to private supervision sessions with mentor. In the sample of this empirical study (n = 279 student nurses in Finland) individualized supervision system was most common on psychiatric wards. All nurse educators and clinical practitioners working across Europe and around the World in clinical learning environments will find this paper very useful in helping them to improve and quantify the supervisory process. This study starts bridging the gap between using and integrating both at a National and European level qualitative assessment systems that relate to the learning and supervisory process. The study encourages the need for professionals to test these new instruments in other nursing cultures and reflects upon the need for further research work in this area.

Task-oriented evaluation of electronic medical records systems: development and validation of a questionnaire for physicians

PubMed Central

2004-01-01

Background Evaluation is a challenging but necessary part of the development cycle of clinical information systems like the electronic medical records (EMR) system. It is believed that such evaluations should include multiple perspectives, be comparative and employ both qualitative and quantitative methods. Self-administered questionnaires are frequently used as a quantitative evaluation method in medical informatics, but very few validated questionnaires address clinical use of EMR systems. Methods We have developed a task-oriented questionnaire for evaluating EMR systems from the clinician's perspective. The key feature of the questionnaire is a list of 24 general clinical tasks. It is applicable to physicians of most specialties and covers essential parts of their information-oriented work. The task list appears in two separate sections, about EMR use and task performance using the EMR, respectively. By combining these sections, the evaluator may estimate the potential impact of the EMR system on health care delivery. The results may also be compared across time, site or vendor. This paper describes the development, performance and validation of the questionnaire. Its performance is shown in two demonstration studies (n = 219 and 80). Its content is validated in an interview study (n = 10), and its reliability is investigated in a test-retest study (n = 37) and a scaling study (n = 31). Results In the interviews, the physicians found the general clinical tasks in the questionnaire relevant and comprehensible. The tasks were interpreted concordant to their definitions. However, the physicians found questions about tasks not explicitly or only partially supported by the EMR systems difficult to answer. The two demonstration studies provided unambiguous results and low percentages of missing responses. In addition, criterion validity was demonstrated for a majority of task-oriented questions. Their test-retest reliability was generally high, and the non-standard scale was found symmetric and ordinal. Conclusion This questionnaire is relevant for clinical work and EMR systems, provides reliable and interpretable results, and may be used as part of any evaluation effort involving the clinician's perspective of an EMR system. PMID:15018620

Task-oriented evaluation of electronic medical records systems: development and validation of a questionnaire for physicians.

PubMed

Laerum, Hallvard; Faxvaag, Arild

2004-02-09

Evaluation is a challenging but necessary part of the development cycle of clinical information systems like the electronic medical records (EMR) system. It is believed that such evaluations should include multiple perspectives, be comparative and employ both qualitative and quantitative methods. Self-administered questionnaires are frequently used as a quantitative evaluation method in medical informatics, but very few validated questionnaires address clinical use of EMR systems. We have developed a task-oriented questionnaire for evaluating EMR systems from the clinician's perspective. The key feature of the questionnaire is a list of 24 general clinical tasks. It is applicable to physicians of most specialties and covers essential parts of their information-oriented work. The task list appears in two separate sections, about EMR use and task performance using the EMR, respectively. By combining these sections, the evaluator may estimate the potential impact of the EMR system on health care delivery. The results may also be compared across time, site or vendor. This paper describes the development, performance and validation of the questionnaire. Its performance is shown in two demonstration studies (n = 219 and 80). Its content is validated in an interview study (n = 10), and its reliability is investigated in a test-retest study (n = 37) and a scaling study (n = 31). In the interviews, the physicians found the general clinical tasks in the questionnaire relevant and comprehensible. The tasks were interpreted concordant to their definitions. However, the physicians found questions about tasks not explicitly or only partially supported by the EMR systems difficult to answer. The two demonstration studies provided unambiguous results and low percentages of missing responses. In addition, criterion validity was demonstrated for a majority of task-oriented questions. Their test-retest reliability was generally high, and the non-standard scale was found symmetric and ordinal. This questionnaire is relevant for clinical work and EMR systems, provides reliable and interpretable results, and may be used as part of any evaluation effort involving the clinician's perspective of an EMR system.

An Environment for Guideline-based Decision Support Systems for Outpatients Monitoring.

PubMed

Zini, Elisa M; Lanzola, Giordano; Bossi, Paolo; Quaglini, Silvana

2017-08-11

We propose an architecture for monitoring outpatients that relies on mobile technologies for acquiring data. The goal is to better control the onset of possible side effects between the scheduled visits at the clinic. We analyze the architectural components required to ensure a high level of abstraction from data. Clinical practice guidelines were formalized with Alium, an authoring tool based on the PROforma language, using SNOMED-CT as a terminology standard. The Alium engine is accessible through a set of APIs that may be leveraged for implementing an application based on standard web technologies to be used by doctors at the clinic. Data sent by patients using mobile devices need to be complemented with those already available in the Electronic Health Record to generate personalized recommendations. Thus a middleware pursuing data abstraction is required. To comply with current standards, we adopted the HL7 Virtual Medical Record for Clinical Decision Support Logical Model, Release 2. The developed architecture for monitoring outpatients includes: (1) a guideline-based Decision Support System accessible through a web application that helps the doctors with prevention, diagnosis and treatment of therapy side effects; (2) an application for mobile devices, which allows patients to regularly send data to the clinic. In order to tailor the monitoring procedures to the specific patient, the Decision Support System also helps physicians with the configuration of the mobile application, suggesting the data to be collected and the associated collection frequency that may change over time, according to the individual patient's conditions. A proof of concept has been developed with a system for monitoring the side effects of chemo-radiotherapy in head and neck cancer patients. Our environment introduces two main innovation elements with respect to similar works available in the literature. First, in order to meet the specific patients' needs, in our work the Decision Support System also helps the physicians in properly configuring the mobile application. Then the Decision Support System is also continuously fed by patient-reported outcomes.

Health Informatics via Machine Learning for the Clinical Management of Patients.

PubMed

Clifton, D A; Niehaus, K E; Charlton, P; Colopy, G W

2015-08-13

To review how health informatics systems based on machine learning methods have impacted the clinical management of patients, by affecting clinical practice. We reviewed literature from 2010-2015 from databases such as Pubmed, IEEE xplore, and INSPEC, in which methods based on machine learning are likely to be reported. We bring together a broad body of literature, aiming to identify those leading examples of health informatics that have advanced the methodology of machine learning. While individual methods may have further examples that might be added, we have chosen some of the most representative, informative exemplars in each case. Our survey highlights that, while much research is taking place in this high-profile field, examples of those that affect the clinical management of patients are seldom found. We show that substantial progress is being made in terms of methodology, often by data scientists working in close collaboration with clinical groups. Health informatics systems based on machine learning are in their infancy and the translation of such systems into clinical management has yet to be performed at scale.

Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis

PubMed Central

Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A.; Ward, David K.

2013-01-01

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting. PMID:23613858

Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

PubMed

Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

2013-01-01

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

The clinical educator and complexity: a review.

PubMed

Schoo, Adrian; Kumar, Koshila

2018-02-08

Complexity science perspectives have helped in examining fundamental assumptions about learning and teaching in the health professions. The implications of complexity thinking for how we understand the role and development of the clinical educator is less well articulated. This review article outlines: the key principles of complexity science; a conceptual model that situates the clinical educator in a complex system; and the implications for the individual, organisation and the system. Our conceptual model situates the clinical educator at the centre of a complex and dynamic system spanning four domains and multiple levels. The four domains are: personal (encompassing personal/professional needs and expectations); health services (health agencies and their consumers); educational (educational institutions and their health students); and societal (local community/region and government). The system also comprises: micro or individual, meso or organisational, and macro or socio-political levels. Our model highlights that clinical educators are situated within a complex system comprising different agents and connections. It emphasises that individuals, teams and organisations need to recognise and be responsive to the unpredictability, interconnectedness and evolving nature of this system. Importantly, our article also calls for an epistemological shift from faculty development to capacity building in health professions education, aimed at developing individual, team, organisational and system capabilities to work with(in) complexity. Clinical educators are situated within a complex system comprising different agents and connections. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

The educational needs of health information managers in an electronic environment: what information technology and health informatics skills and knowledge are required?

PubMed

Robertson, Merryn; Callen, Joanne

The profile of health information managers (HIMs) employed within one metropolitan area health service in New South Wales (NSW) was identified, together with which information technology and health informatics knowledge and skills they possess, and which ones they require in their workplace. The subjects worked in a variety of roles: 26% were employed in the area's Information Systems Division developing and implementing point-of-care clinical systems. Health information managers perceived they needed further continuing and formal education in point-of-care clinical systems, decision support systems, the electronic health record, privacy and security, health data collections, and database applications.

Optimizing point-of-care testing in clinical systems management.

PubMed

Kost, G J

1998-01-01

The goal of improving medical and economic outcomes calls for leadership based on fundamental principles. The manager of clinical systems works collaboratively within the acute care center to optimize point-of-care testing through systematic approaches such as integrative strategies, algorithms, and performance maps. These approaches are effective and efficacious for critically ill patients. Optimizing point-of-care testing throughout the entire health-care system is inherently more difficult. There is potential to achieve high-quality testing, integrated disease management, and equitable health-care delivery. Despite rapid change and economic uncertainty, a macro-strategic, information-integrated, feedback-systems, outcomes-oriented approach is timely, challenging, effective, and uplifting to the creative human spirit.

Mobile Clinical Decision Support Systems in Our Hands - Great Potential but also a Concern.

PubMed

Masic, Izet; Begic, Edin

2016-01-01

Due to the powerful computer resources as well as the availability of today's mobile devices, a special field of mobile systems for clinical decision support in medicine has been developed. The benefits of these applications (systems) are: availability of necessary hardware (mobile phones, tablets and phablets are widespread, and can be purchased at a relatively affordable price), availability of mobile applications (free or for a "small" amount of money) and also mobile applications are tailored for easy use and save time of clinicians in their daily work. In these systems lies a huge potential, and certainly a great economic benefit, so this issue must be approached multidisciplinary.

How reliable are clinical systems in the UK NHS? A study of seven NHS organisations

PubMed Central

Franklin, Bryony Dean; Moorthy, Krishna; Cooke, Matthew W; Vincent, Charles

2012-01-01

Background It is well known that many healthcare systems have poor reliability; however, the size and pervasiveness of this problem and its impact has not been systematically established in the UK. The authors studied four clinical systems: clinical information in surgical outpatient clinics, prescribing for hospital inpatients, equipment in theatres, and insertion of peripheral intravenous lines. The aim was to describe the nature, extent and variation in reliability of these four systems in a sample of UK hospitals, and to explore the reasons for poor reliability. Methods Seven UK hospital organisations were involved; each system was studied in three of these. The authors took delivery of the systems' intended outputs to be a proxy for the reliability of the system as a whole. For example, for clinical information, 100% reliability was defined as all patients having an agreed list of clinical information available when needed during their appointment. Systems factors were explored using semi-structured interviews with key informants. Common themes across the systems were identified. Results Overall reliability was found to be between 81% and 87% for the systems studied, with significant variation between organisations for some systems: clinical information in outpatient clinics ranged from 73% to 96%; prescribing for hospital inpatients 82–88%; equipment availability in theatres 63–88%; and availability of equipment for insertion of peripheral intravenous lines 80–88%. One in five reliability failures were associated with perceived threats to patient safety. Common factors causing poor reliability included lack of feedback, lack of standardisation, and issues such as access to information out of working hours. Conclusions Reported reliability was low for the four systems studied, with some common factors behind each. However, this hides significant variation between organisations for some processes, suggesting that some organisations have managed to create more reliable systems. Standardisation of processes would be expected to have significant benefit. PMID:22495099

Classification of patients with low back-related leg pain: a systematic review.

PubMed

Stynes, Siobhán; Konstantinou, Kika; Dunn, Kate M

2016-05-23

The identification of clinically relevant subgroups of low back pain (LBP) is considered the number one LBP research priority in primary care. One subgroup of LBP patients are those with back related leg pain. Leg pain frequently accompanies LBP and is associated with increased levels of disability and higher health costs than simple low back pain. Distinguishing between different types of low back-related leg pain (LBLP) is important for clinical management and research applications, but there is currently no clear agreement on how to define and identify LBLP due to nerve root involvement. The aim of this systematic review was to identify, describe and appraise papers that classify or subgroup populations with LBLP, and summarise how leg pain due to nerve root involvement is described and diagnosed in the various systems. The search strategy involved nine electronic databases including Medline and Embase, reference lists of eligible studies and relevant reviews. Selected papers were appraised independently by two reviewers using a standardised scoring tool. Of 13,358 initial potential eligible citations, 50 relevant papers were identified that reported on 22 classification systems. Papers were grouped according to purpose and criteria of the classification systems. Five themes emerged: (i) clinical features (ii) pathoanatomy (iii) treatment-based approach (iv) screening tools and prediction rules and (v) pain mechanisms. Three of the twenty two systems focused specifically on LBLP populations. Systems that scored highest following quality appraisal were ones where authors generally included statistical methods to develop their classifications, and supporting work had been published on the systems' validity, reliability and generalisability. There was lack of consistency in how LBLP due to nerve root involvement was described and diagnosed within the systems. Numerous classification systems exist that include patients with leg pain, a minority of them focus specifically on distinguishing between different presentations of leg pain. Further work is needed to identify clinically meaningful subgroups of LBLP patients, ideally based on large primary care cohort populations and using recommended methods for classification system development.

Applications for detection of acute kidney injury using electronic medical records and clinical information systems: workgroup statements from the 15(th) ADQI Consensus Conference.

PubMed

James, Matthew T; Hobson, Charles E; Darmon, Michael; Mohan, Sumit; Hudson, Darren; Goldstein, Stuart L; Ronco, Claudio; Kellum, John A; Bagshaw, Sean M

2016-01-01

Electronic medical records and clinical information systems are increasingly used in hospitals and can be leveraged to improve recognition and care for acute kidney injury. This Acute Dialysis Quality Initiative (ADQI) workgroup was convened to develop consensus around principles for the design of automated AKI detection systems to produce real-time AKI alerts using electronic systems. AKI alerts were recognized by the workgroup as an opportunity to prompt earlier clinical evaluation, further testing and ultimately intervention, rather than as a diagnostic label. Workgroup members agreed with designing AKI alert systems to align with the existing KDIGO classification system, but recommended future work to further refine the appropriateness of AKI alerts and to link these alerts to actionable recommendations for AKI care. The consensus statements developed in this review can be used as a roadmap for development of future electronic applications for automated detection and reporting of AKI.

Leadership, Organizational Climate, and Working Alliance in a Children's Mental Health Service System

PubMed Central

Green, Amy E.; Albanese, Brian J.; Cafri, Guy; Aarons, Gregory A.

2014-01-01

The goal of this study was to examine the relationships of transformational leadership and organizational climate with working alliance, in a children's mental health service system. Using multilevel structural equation modeling, the effect of leadership on working alliance was mediated by organizational climate. These results suggest that supervisors may be able to impact quality of care through improving workplace climate. Organizational factors should be considered in efforts to improve public sector services. Understanding these issues is important for program leaders, mental health service providers, and consumers because they can affect both the way services are delivered and ultimately, clinical outcomes. PMID:24323137

Leadership, organizational climate, and working alliance in a children's mental health service system.

PubMed

Green, Amy E; Albanese, Brian J; Cafri, Guy; Aarons, Gregory A

2014-10-01

The goal of this study was to examine the relationships of transformational leadership and organizational climate with working alliance, in a children's mental health service system. Using multilevel structural equation modeling, the effect of leadership on working alliance was mediated by organizational climate. These results suggest that supervisors may be able to impact quality of care through improving workplace climate. Organizational factors should be considered in efforts to improve public sector services. Understanding these issues is important for program leaders, mental health service providers, and consumers because they can affect both the way services are delivered and ultimately, clinical outcomes.

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients.

PubMed

Velickovski, Filip; Ceccaroni, Luigi; Roca, Josep; Burgos, Felip; Galdiz, Juan B; Marina, Nuria; Lluch-Ariet, Magí

2014-11-28

The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients

PubMed Central

2014-01-01

Background The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. Objectives The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. Methods The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. Results A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Conclusions Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems. PMID:25471545

Interprofessional collaboration within Canadian integrative healthcare clinics: Key components.

PubMed

Gaboury, Isabelle; Bujold, Mathieu; Boon, Heather; Moher, David

2009-09-01

Research shows that interprofessional collaboration has become an important factor in the implementation of effective healthcare models. To date, the literature has not focused on the collaboration between medical doctors and complementary and alternative medicine (CAM) healthcare practitioners, an example of interdisciplinary collaboration called integrative healthcare (IHC). Drawing on in-depth, semi-standardized interviews conducted with 21 practitioners working in Canadian IHC clinics, this paper explored and interpreted how IHC is experienced by those working in Canadian IHC clinics. The interview questions and analysis were guided by the Input, Process, Output conceptual framework drawn from the organizational management theory (McGrath, J. E. (1964). Social psychology: A brief introduction. New York: Holt, Rinehart and Winston.) to study collaboration within teams. We found that constructs contributing to collaboration included practitioners' attitudes and educational background, as well as external factors such as the healthcare system and financial pressures. Major processes affecting collaboration included communication, patient referral and power relationships. These determinants of collaboration were found to result in learning opportunities for practitioners, modified burden of work and ultimately, higher affective commitment toward the clinic. These constructs serve as a guide for further investigation of interprofessional collaboration within an IHC clinic. This exploration of interprofessional collaboration in IHC identified a broad array of key factors associated with interprofessional collaboration. These factors are critical to better understand the functioning of IHC clinics, and provide guidance for creation or maintenance of successful clinics.

An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholders' perceptions about clinical mentoring.

PubMed

Okereke, Ekechi; Tukur, Jamilu; Aminu, Amina; Butera, Jean; Mohammed, Bello; Tanko, Mustapha; Yisa, Ibrahim; Obonyo, Benson; Egboh, Mike

2015-02-15

An effective capacity building process for healthcare workers is required for the delivery of quality health care services. Work-based training can be applied for the capacity building of health care workers while causing minimum disruption to service delivery within health facilities. In 2012, clinical mentoring was introduced into the Jigawa State Health System through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 (PATHS2). This study evaluates the perceptions of different stakeholders about clinical mentoring as a strategy for improving maternal, newborn and child health service delivery in Jigawa State, northern Nigeria. Interviews were conducted in February 2013 with different stakeholders within Jigawa State in Northern Nigeria. There were semi-structured interviews with 33 mentored health care workers as well as the health facility departmental heads for Obstetrics and Pediatrics in the selected clinical mentoring health facilities. In-depth interviews were also conducted with the clinical mentors and two senior government health officials working within the Jigawa State Ministry of Health. The qualitative data were audio-recorded; transcribed and thematically analysed. The study findings suggest that clinical mentoring improved service delivery within the clinical mentoring health facilities. Significant improvements in the professional capacity of mentored health workers were observed by clinical mentors, heads of departments and the mentored health workers. Best practices were introduced with the support of the clinical mentors such as appropriate baseline investigations for pediatric patients, the use of magnesium sulphate and misoprostol for the management of eclampsia and post-partum hemorrhage respectively. Government health officials indicate that clinical mentoring has led to more emphasis on the need for the provision of better quality health services. Stakeholders report that the introduction of clinical mentoring into the Jigawa State health system gave rise to an improved capacity of the mentored health care workers to deliver better quality maternal, newborn and child health services. It is anticipated that with a scale up of clinical mentoring, health outcomes will also significantly improve across northern Nigeria.

An Integrated Nutrition Education Program for Dental Students.

ERIC Educational Resources Information Center

DePaola, Dominick P.; And Others

1978-01-01

Presents a diagonal system of nutrition education in a dental program that integrates didactic, clinical work, and community sites. Discusses the three phases including educational methodology, evaluation strategy, and unique program features. (MA)

Pathogenic mechanisms and therapeutic strategies in spinobulbar muscular atrophy

PubMed Central

Chua, Jason P.; Lieberman, Andrew P.

2014-01-01

We review the genetic and clinical features of spinobulbar muscular atrophy (SBMA), a progressive neuromuscular disorder caused by a CAG/glutamine tract expansion in the androgen receptor. SBMA was the first polyglutamine disease to be discovered, and we compare and contrast it with related degenerative disorders of the nervous system caused by expanded glutamine tracts. We review the cellular and animals models that have been most widely used to study this disorder, and highlight insights into disease pathogenesis derived from this work. These model systems have revealed critical aspects of the disease, including its hormone dependence, a feature that underlies disease occurrence only in men with the mutant allele. We discuss how this and other findings have been translated to clinical trials for SBMA patients, and examine emerging therapeutic targets that have been identified by recent work. PMID:24040817

Recommendations of the Global Multiple System Atrophy Research Roadmap Meeting.

PubMed

Walsh, Ryan R; Krismer, Florian; Galpern, Wendy R; Wenning, Gregor K; Low, Phillip A; Halliday, Glenda; Koroshetz, Walter J; Holton, Janice; Quinn, Niall P; Rascol, Olivier; Shaw, Leslie M; Eidelberg, David; Bower, Pam; Cummings, Jeffrey L; Abler, Victor; Biedenharn, Judy; Bitan, Gal; Brooks, David J; Brundin, Patrik; Fernandez, Hubert; Fortier, Philip; Freeman, Roy; Gasser, Thomas; Hewitt, Art; Höglinger, Günter U; Huentelman, Matt J; Jensen, Poul H; Jeromin, Andreas; Kang, Un Jung; Kaufmann, Horacio; Kellerman, Lawrence; Khurana, Vikram; Klockgether, Thomas; Kim, Woojin Scott; Langer, Carol; LeWitt, Peter; Masliah, Eliezer; Meissner, Wassilios; Melki, Ronald; Ostrowitzki, Susanne; Piantadosi, Steven; Poewe, Werner; Robertson, David; Roemer, Cyndi; Schenk, Dale; Schlossmacher, Michael; Schmahmann, Jeremy D; Seppi, Klaus; Shih, Lily; Siderowf, Andrew; Stebbins, Glenn T; Stefanova, Nadia; Tsuji, Shoji; Sutton, Sharon; Zhang, Jing

2018-01-09

Multiple system atrophy (MSA) is a rare neurodegenerative disorder with substantial knowledge gaps despite recent gains in basic and clinical research. In order to make further advances, concerted international collaboration is vital. In 2014, an international meeting involving leaders in the field and MSA advocacy groups was convened in Las Vegas, Nevada, to identify critical research areas where consensus and progress was needed to improve understanding, diagnosis, and treatment of the disease. Eight topic areas were defined: pathogenesis, preclinical modeling, target identification, endophenotyping, clinical measures, imaging biomarkers, nonimaging biomarkers, treatments/trial designs, and patient advocacy. For each topic area, an expert served as a working group chair and each working group developed priority-ranked research recommendations with associated timelines and pathways to reach the intended goals. In this report, each groups' recommendations are provided. Copyright © 2017 American Academy of Neurology.

The N-CODES project moves to user testing.

PubMed

Chin, Elizabeth F; Sosa, Mary-Elizabeth; O'Neill, Eileen S

2006-01-01

For a technology to be implemented successfully, it must be thoroughly tested by the stakeholders who will use it in practice. This article reports on the user testing of the Nurse Computer Decision Support working prototype. Ten acute care nurses with varying levels of education and experience participated in the testing. The study's protocol consisted of a series of tasks requiring the participants to use the system while solving patient problems. Both quantitative and qualitative data on usability, ease of navigation, and nurse satisfaction were collected. The nurses ranked usability and ease of navigation highly. Nurses were excited about the system's clinical potential and felt that it would be useful to all practitioners regardless of experience. Testing the system in an actual clinical setting is the next step, but it is clear that the system has extraordinary potential to improve clinical decision making and patient outcomes.

A CMOS camera-based system for clinical photoplethysmographic applications

NASA Astrophysics Data System (ADS)

Humphreys, Kenneth; Markham, Charles; Ward, Tomas E.

2005-06-01

In this work an image-based photoplethysmography (PPG) system is developed and tested against a conventional finger-based system as commonly used in clinical practise. A PPG is essentially an optical instrument consisting of a near infrared (NIR) source and detector that is capable of tracking blood flow changes in body tissue. When used with a number of wavelengths in the NIR band blood oxygenation changes as well as other blood chemical signatures can be ascertained yielding a very useful device in the clinical realm. Conventionally such a device requires direct contact with the tissue under investigation which eliminates the possibility of its use for applications like wound management where the tissue oxygenation measurement could be extremely useful. To circumnavigate this shortcoming we have developed a CMOS camera-based system, which can successfully extract the PPG signal without contact with the tissue under investigation. A comparison of our results with conventional techniques has yielded excellent results.

Randomized pilot study and qualitative evaluation of a clinical decision support system for brain tumour diagnosis based on SV ¹H MRS: evaluation as an additional information procedure for novice radiologists.

PubMed

Sáez, Carlos; Martí-Bonmatí, Luis; Alberich-Bayarri, Angel; Robles, Montserrat; García-Gómez, Juan M

2014-02-01

The results of a randomized pilot study and qualitative evaluation of the clinical decision support system Curiam BT are reported. We evaluated the system's feasibility and potential value as a radiological information procedure complementary to magnetic resonance (MR) imaging to assist novice radiologists in diagnosing brain tumours using MR spectroscopy (1.5 and 3.0T). Fifty-five cases were analysed at three hospitals according to four non-exclusive diagnostic questions. Our results show that Curiam BT improved the diagnostic accuracy in all the four questions. Additionally, we discuss the findings of the users' feedback about the system, and the further work to optimize it for real environments and to conduct a large clinical trial. © 2013 Published by Elsevier Ltd.

[Systemic lupus erythematosus masking the acquired immunodeficiency syndrome. A report on four cases].

PubMed

Kotyla, Przemysław; Kucharz, Eugeniusz J

2012-01-01

Systemic lupus erythematosus (SLE) is a systemic inflammatory disease of connective tissue with an unknown etiology and a rich clinical picture with involvement of multiple organs. Given the rich symptomatology, application of the current classification criteria is associated with a significant risk of attributing symptoms of other pathologies to lupus and/or other connective tissue disease. Inherited and acquired immune deficiencies may sometimes demonstrate a lupus-like clinical symptomatology. In this work we reviewed 4 of cases referred to the Department of Internal Diseases and Rheumatology of the Silesian Medical University in Katowice with suspected or confirmed systemic lupus erythematosus. A positive anti-HIV antibody test led to the diagnosis of the acquired immunodeficiency syndrome (AIDS). Due to the close similarity of the clinical picture and the presence of antinuclear antibodies in both diseases, the authors postulate that the anti-HIV antibody test should be done routinely in patients with connective tissue diseases.

WE-F-201-03: Evaluate Clinical Cases Using Commercially Available Systems and Compare to TG-43 Dosimetry

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

Beaulieu, L.

With the recent introduction of heterogeneity correction algorithms for brachytherapy, the AAPM community is still unclear on how to commission and implement these into clinical practice. The recently-published AAPM TG-186 report discusses important issues for clinical implementation of these algorithms. A charge of the AAPM-ESTRO-ABG Working Group on MBDCA in Brachytherapy (WGMBDCA) is the development of a set of well-defined test case plans, available as references in the software commissioning process to be performed by clinical end-users. In this practical medical physics course, specific examples on how to perform the commissioning process are presented, as well as descriptions of themore » clinical impact from recent literature reporting comparisons of TG-43 and heterogeneity-based dosimetry. Learning Objectives: Identify key clinical applications needing advanced dose calculation in brachytherapy. Review TG-186 and WGMBDCA guidelines, commission process, and dosimetry benchmarks. Evaluate clinical cases using commercially available systems and compare to TG-43 dosimetry.« less

A case-based assistant for clinical psychiatry expertise.

PubMed

Bichindaritz, I

1994-01-01

Case-based reasoning is an artificial intelligence methodology for the processing of empirical knowledge. Recent case-based reasoning systems also use theoretic knowledge about the domain to constrain the case-based reasoning. The organization of the memory is the key issue in case-based reasoning. The case-based assistant presented here has two structures in memory: cases and concepts. These memory structures permit it to be as skilled in problem-solving tasks, such as diagnosis and treatment planning, as in interpretive tasks, such as clinical research. A prototype applied to clinical work about eating disorders in psychiatry, reasoning from the alimentary questionnaires of these patients, is presented as an example of the system abilities.

Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

PubMed Central

Johannessen, Anne-Kari; Ådnanes, Marian; Paulsen, Bård; Mannion, Russell

2016-01-01

Introduction: This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles. Methods: The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work. Results: Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients. Conclusion: Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients. PMID:28435416

Career pathways of board-certified surgeons in Japan.

PubMed

Koike, Soichi; Shimizu, Atsushi; Matsumoto, Masatoshi; Ide, Hiroo; Atarashi, Hidenao; Yasunaga, Hideo

2016-06-01

To investigate the career pathways of board-certified surgeons' and the factors associated with them maintaining their certification in Japan. We analyzed data from the surveys of physicians, dentists and pharmacists. A multivariate logistic regression model was used to investigate whether factors such as gender, year of registration, place of work, and subspecialty board certification were associated with maintaining board certification. Most Japanese surgeons attain board certification within 5-10 years of initial medical registration. After adjusting for possible confounding factors, the odds of maintaining board certification were significantly lower for women, those who were beyond 20 years post-registration, those who worked in hospitals other than academic hospitals or clinics, and those who had board certification in surgery only. Of the total board-certified surgeons analyzed, 93.2 % continued to work in hospitals and 2.8 % moved to clinics within 2 years. Of those who moved from hospitals to clinics, half continued to practice surgery, while nearly 40 % changed their specialty to internal medicine. It is necessary to establish a special training system for mature surgeons who move from surgery to general practice later in their careers. As the number of female surgeon increases, a support system is also required to secure the future supply of surgeons.

Developing a Cognitive and Communications Tool for Burn Intensive Care Unit Clinicians.

PubMed

Nemeth, Christopher; Anders, Shilo; Strouse, Robert; Grome, Anna; Crandall, Beth; Pamplin, Jeremy; Salinas, Jose; Mann-Salinas, Elizabeth

2016-05-01

Burn Intensive Care Unit (BICU) work is necessarily complex and depends on clinician actions, resources, and variable patient responses to interventions. Clinicians use large volumes of data that are condensed in time, but separated across resources, to care for patients. Correctly designed health information technology (IT) systems may help clinicians to treat these patients more efficiently, accurately, and reliably. We report on a 3-year project to design and develop an ecologically valid IT system for use in a military BICU. We use a mixed methods Cognitive Systems Engineering approach for research and development. Observations, interviews, artifact analysis, survey, and thematic analysis methods were used to reveal underlying factors that mold the work environment and affect clinician decisions that may affect patient outcomes. Participatory design and prototyping methods have been used to develop solutions. We developed 39 requirements for the IT system and used them to create three use cases to help developers better understand how the system might support clinician work to develop interface prototypes. We also incorporated data mining functions that offer the potential to aid clinicians by recognizing patterns recognition of clinically significant events, such as incipient sepsis. The gaps between information sources and accurate, reliable, and efficient clinical decision that we have identified will enable us to create scenarios to evaluate prototype systems with BICU clinicians, to develop increasingly improved designs, and to measure outcomes. The link from data to analyses, requirements, prototypes, and their evaluation ensures that the solution will reflect and support work in the BICU as it actually occurs, improving staff efficiency and patient care quality. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Creating integrative work: a qualitative study of how massage therapists work with existing clients.

PubMed

Fortune, Luann Drolc; Hymel, Glenn M

2015-01-01

As one of the most often used complementary treatments, massage is increasingly positioned as an essential component of integrative medicine. Recent studies evaluate the clinical efficacy of massage therapy, but few studies explore how massage therapists (MTs) execute their work and exercise clinical reasoning in natural settings. To gain foundational knowledge about clinical reasoning and applied knowledge, this study examined how 10 MTs executed an entire session with established clients. Results support translational research design and inform educators. Ethnomethodology and phenomenology informed the qualitative design. Data were collected by videotaping actual sessions and interviewing the participants immediately afterward while viewing the videos. Computer-aided analysis identified data patterns for thematic interpretation. The MTs shared tacit knowledge that directed their work: a) maintaining a primarily biomechanical focus, b) prerequisite safe touch, c) multitasking not allowed, d) MTs assume physical risk, and e) the work affects multiple bodily systems. The MTs sensed effectiveness experientially by adopting common tactics: a) visualizing the manual engagement points, b) assuming the client controlled the physiological release, and c) educating the client. Within these commonalities, they operationalized their work in complex and singular ways, with the particular client relationship critical to structuring the session and evaluating the outcome. MTs viewed their work primarily as a biomechanical intervention, but understood therapeutic massage as serving multiple functions. Process-oriented clinical reasoning mirrored models found in psychotherapy and was informed by experience, intuition, and training, which resulted in an intentionally holistic approach. Copyright © 2014 Elsevier Ltd. All rights reserved.

A computer-based maintenance reminder and record-keeping system for clinical laboratories.

PubMed

Roberts, B I; Mathews, C L; Walton, C J; Frazier, G

1982-09-01

"Maintenance" is all the activity an organization devotes to keeping instruments within performance specifications to assure accurate and precise operation. The increasing use of complex analytical instruments as "workhorses" in clinical laboratories requires more maintenance awareness by laboratory personnel. Record-keeping systems that document maintenance completion and that should prompt the continued performance of maintenance tasks have not kept up with instrumentation development. We report here a computer-based record-keeping and reminder system that lists weekly the maintenance items due for each work station in the laboratory, including the time required to complete each item. Written in BASIC, the system uses a DATABOSS data base management system running on a time-shared Digital Equipment Corporation PDP 11/60 computer with a RSTS V 7.0 operating system.

Teaching undergraduate nursing students critical thinking: An innovative informatics strategy.

PubMed

Warren, Judith J; Connors, Helen R; Weaver, Charlotte; Simpson, Roy

2006-01-01

Simulated e-Health Delivery System (SEEDS) uses a clinical information system (CIS) to teach students how to process data from virtual patient case studies and work with information technology. SEEDS was developed in response to the Institute of Medicine recommendation that students be taught about information systems in order to improve quality patient care and reduce errors. Curriculum implications, implementation of the system, and technology challenges are discussed.

Relational Algebra in Spatial Decision Support Systems Ontologies.

PubMed

Diomidous, Marianna; Chardalias, Kostis; Koutonias, Panagiotis; Magnita, Adrianna; Andrianopoulos, Charalampos; Zimeras, Stelios; Mechili, Enkeleint Aggelos

2017-01-01

Decision Support Systems (DSS) is a powerful tool, for facilitates researchers to choose the correct decision based on their final results. Especially in medical cases where doctors could use these systems, to overcome the problem with the clinical misunderstanding. Based on these systems, queries must be constructed based on the particular questions that doctors must answer. In this work, combination between questions and queries would be presented via relational algebra.

A Sociotechnical Approach to Evaluating the Impact of ICT on Clinical Care Environments

PubMed Central

Li, Julie

2010-01-01

Introduction: Process-supporting information technology holds the potential to increase efficiency, reduce errors, and alter professional roles and responsibilities in a manner which allows improvement in the delivery of patient care. However, clashes between the model of health care work inscribed in these tools with the actual nature of work has resulted in staff resistance and decreased organisational uptake of ICT, as well as the facilitation of unexpected and negative effects in efficiency and patient safety. Sociotechnical theory provides a paradigm against which workflow and transfusion of ICT in healthcare could be better explored and understood. Design: This paper will conceptualise a formative, multi-method longitudinal evaluation process to explore the impact of ICT with an appreciation of the relationship between the social and technical systems within a clinical department. Method: Departmental culture, including clinical work processes and communication patterns will be thoroughly explored before system implementation using both quantitative and qualitative research methods. Findings will be compared with post implementation data, which will incorporate measurement of safety and workflow efficiency indicators. Discussion: Sociotechnical theory provides a paradigm against which workflow and transfusion of ICT in healthcare could be better explored and understood. However, sociotechnical and multimethod approaches to evaluation do not exist without criticism. Inherent in the protocol are limitations of sociotechnical theory and criticism of the multimethod approach; testing of the methodology in real clinical settings will serve to verify efficacy and refine the process. PMID:21594005

Electronic workflow for imaging in clinical research.

PubMed

Hedges, Rebecca A; Goodman, Danielle; Sachs, Peter B

2014-08-01

In the transition from paper to electronic workflow, the University of Colorado Health System's implementation of a new electronic health record system (EHR) forced all clinical groups to reevaluate their practices including the infrastructure surrounding clinical trials. Radiological imaging is an important piece of many clinical trials and requires a high level of consistency and standardization. With EHR implementation, paper orders were manually transcribed into the EHR, digitizing an inefficient work flow. A team of schedulers, radiologists, technologists, research personnel, and EHR analysts worked together to optimize the EHR to accommodate the needs of research imaging protocols. The transition to electronic workflow posed several problems: (1) there needed to be effective communication throughout the imaging process from scheduling to radiologist interpretation. (2) The exam ordering process needed to be automated to allow scheduling of specific research studies on specific equipment. (3) The billing process needed to be controlled to accommodate radiologists already supported by grants. (4) There needed to be functionality allowing exams to finalize automatically skipping the PACS and interpretation process. (5) There needed to be a way to alert radiologists that a specialized research interpretation was needed on a given exam. These issues were resolved through the optimization of the "visit type," allowing a high-level control of an exam at the time of scheduling. Additionally, we added columns and fields to work queues displaying grant identification numbers. The build solutions we implemented reduced the mistakes made and increased imaging quality and compliance.

Coordination patterns related to high clinical performance in a simulated anesthetic crisis.

PubMed

Manser, Tanja; Harrison, Thomas Kyle; Gaba, David M; Howard, Steven K

2009-05-01

Teamwork is an integral component in the delivery of safe patient care. Several studies highlight the importance of effective teamwork and the need for teams to respond dynamically to changing task requirements, for example, during crisis situations. In this study, we address one of the many facets of "effective teamwork" in medical teams by investigating coordination patterns related to high performance in the management of a simulated malignant hyperthermia (MH) scenario. We hypothesized that (a) anesthesia crews dynamically adapt their work and coordination patterns to the occurrence of a simulated MH crisis and that (b) crews with higher clinical performance scores (based on a time-based scoring system for critical MH treatment steps) exhibit different coordination patterns. This observational study investigated differences in work and coordination patterns of 24 two-person anesthesia crews in a simulated MH scenario. Clinical and coordination behavior were coded using a structured observation system consisting of 36 mutually exclusive observation categories for clinical activities, coordination activities, teaching, and other communication. Clinical performance scores for treating the simulated episode of MH were calculated using a time-based scoring system for critical treatment steps. Coordination patterns in response to the occurrence of a crisis situation were analyzed using multivariate analysis of variance and the relationship between coordination patterns and clinical performance was investigated using hierarchical regression analyses. Qualitative analyses of the three highest and lowest performing crews were conducted to complement the quantitative analysis. First, a multivariate analysis of variance revealed statistically significant changes in the proportion of time spent on clinical and coordination activities once the MH crisis was declared (F [5,19] = 162.81, P < 0.001, eta(p)(2) = 0.98). Second, hierarchical regression analyses controlling for the effects of cognitive aid use showed that higher performing anesthesia crews exhibit statistically significant less task distribution (beta = -0.539, P < 0.01) and significantly more situation assessment (beta = 0.569, P < 0.05). Additional qualitative video analysis revealed, for example, that lower scoring crews were more likely to split into subcrews (i.e., both anesthesiologists worked with other members of the perioperative team without maintaining a shared plan among the two-person anesthesia crew). Our results of the relationship of coordination patterns and clinical performance will inform future research on adaptive coordination in medical teams and support the development of specific training to improve team coordination and performance.

Why wait so long for child care? An analysis of waits, queues and work in a South African urban health centre.

PubMed

Bachmann, M O; Barron, P

1997-01-01

Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school children, and thereafter to evaluate changes. The study had a cross-sectional work study design, with repeated measurement of waiting times after 13 months. At baseline the preventive clinic was found to have several inessential processes and waits; these were eliminated or overlapped, and clinic sessions per week were increased. A year later median waiting times had decreased substantially in the preventive clinic, but had increased in the curative clinic. Simple research can explain long waits, inform and measure changes, and provide evidence to justify primary care integration and would be useful in health centres and hospital outpatient departments in developing countries.

Clinical genomics information management software linking cancer genome sequence and clinical decisions.

PubMed

Watt, Stuart; Jiao, Wei; Brown, Andrew M K; Petrocelli, Teresa; Tran, Ben; Zhang, Tong; McPherson, John D; Kamel-Reid, Suzanne; Bedard, Philippe L; Onetto, Nicole; Hudson, Thomas J; Dancey, Janet; Siu, Lillian L; Stein, Lincoln; Ferretti, Vincent

2013-09-01

Using sequencing information to guide clinical decision-making requires coordination of a diverse set of people and activities. In clinical genomics, the process typically includes sample acquisition, template preparation, genome data generation, analysis to identify and confirm variant alleles, interpretation of clinical significance, and reporting to clinicians. We describe a software application developed within a clinical genomics study, to support this entire process. The software application tracks patients, samples, genomic results, decisions and reports across the cohort, monitors progress and sends reminders, and works alongside an electronic data capture system for the trial's clinical and genomic data. It incorporates systems to read, store, analyze and consolidate sequencing results from multiple technologies, and provides a curated knowledge base of tumor mutation frequency (from the COSMIC database) annotated with clinical significance and drug sensitivity to generate reports for clinicians. By supporting the entire process, the application provides deep support for clinical decision making, enabling the generation of relevant guidance in reports for verification by an expert panel prior to forwarding to the treating physician. Copyright © 2013 Elsevier Inc. All rights reserved.

Save medical personnel's time by improved user interfaces.

PubMed

Kindler, H

1997-01-01

Common objectives in the industrial countries are the improvement of quality of care, clinical effectiveness, and cost control. Cost control, in particular, has been addressed through the introduction of case mix systems for reimbursement by social-security institutions. More data is required to enable quality improvement, increases in clinical effectiveness and for juridical reasons. At first glance, this documentation effort is contradictory to cost reduction. However, integrated services for resource management based on better documentation should help to reduce costs. The clerical effort for documentation should be decreased by providing a co-operative working environment for healthcare professionals applying sophisticated human-computer interface technology. Additional services, e.g., automatic report generation, increase the efficiency of healthcare personnel. Modelling the medical work flow forms an essential prerequisite for integrated resource management services and for co-operative user interfaces. A user interface aware of the work flow provides intelligent assistance by offering the appropriate tools at the right moment. Nowadays there is a trend to client/server systems with relational databases or object-oriented databases as repository. The work flows used for controlling purposes and to steer the user interfaces must be represented in the repository.

TU-D-201-01: 2016 Economics Update

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

Fontenot, J; Fuss, W

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a medical physicist. This will include general information about the different categories of payers and payees, how work is described by CPT codes, and how various payers set values for this work in different clinical settings. 2016 is another year of significant changes to the payment system. This presentation will describe the work encompassed in these codes and will give attendees an overview of the changes for 2016 as they apply to radiation oncology. Finally, some insightmore » into what can be expected during 2017 will be presented. This includes what information is typically released by the Centers for Medicaid and Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning objectives1) Basics of how Medicare is structured and how reimbursement rates are set.2) Basic understanding of proposed changes to the 2016 Medicare rules.3) Describe economics and policy resources that are available from the AAPM and how to interact with the professional economics committee.« less

Development of a competency based training programme to support multidisciplinary working in a combined biochemistry/haematology laboratory

PubMed Central

Woods, R; Longmire, W; Galloway, M; Smellie, W

2000-01-01

The aim of this study was to develop a competency based training programme to support multidisciplinary working in a combined biochemistry and haematology laboratory. The training programme was developed to document that staff were trained in the full range of laboratory tests that they were expected to perform. This programme subsequently formed the basis for the annual performance review of all staff. All staff successfully completed the first phase of the programme. This allowed laboratory staff to work unsupervised at night as part of a partial shift system. All staff are now working towards achieving a level of competence equivalent to the training level required for state registration by the Council for Professions Supplementary to Medicine. External evaluation of the training programme has included accreditation by the Council for Professions Supplementary to Medicine and reinspection by Clinical Pathology Accreditation (UK) Ltd. The development of a competency based training system has facilitated the introduction of multidisciplinary working in the laboratory. In addition, it enables the documentation of all staff to ensure that they are fully trained and are keeping up to date, because the continuing professional development programme in use in our laboratory has been linked to this training scheme. This approach to documentation of training facilitated a recent reinspection by Clinical Pathology Accreditation (UK) Ltd. Key Words: Keyword: multidisciplinary working • competency based training PMID:10889827

No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record.

PubMed

Lium, Jan-Tore; Tjora, Aksel; Faxvaag, Arild

2008-01-10

It has been shown that implementation of electronic medical records (EMR) and withdrawal of the paper-based medical record is feasible, but represents a drastic change in the information environment of hospital physicians. Previous investigations have revealed considerable inter-hospital variations in EMR system use and user satisfaction. The aim of this study was to further explore changes of clinicians' work after the EMR system implementation process and how they experienced working in a paper-deprived information environment. Qualitative study based on 18 semi-structured interviews with physicians in two Norwegian hospitals. Ten different but related characteristics of work within the EMR-based practice were identified; (1) there was closer clinical and administrative cooperation during the implementation processes; (2) there were greater benefits when everybody used the system; (3) systems supported freshmen better than experienced physicians; (4) the EMR was useful in regard to professional learning; (5) new users were given an introduction to the system by experienced; (6) younger clinicians reported different attitudes than senior clinicians, but this might be related to more than age and previous experience with computers; (7) the EMR made it easier to generate free-text notes, but this also created a potential for information overflow; (8) there is little or no support for mobile work; (9) instances of downtime are still experienced, and this influenced the attitude towards the system and (10) clinicians preferred EMR-only compared to combined paper and electronic systems. Despite the removal of paper-based records from clinical workflow (a change that hospital clinicians perceived as highly useful), many of the old routines remained unchanged, limiting the potential of the EMR system. Thus, there is a need to not only remove paper in the physical sense, but also to established routines to fully achieve the benefits of an EMR system.

No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record

PubMed Central

Lium, Jan-Tore; Tjora, Aksel; Faxvaag, Arild

2008-01-01

Background It has been shown that implementation of electronic medical records (EMR) and withdrawal of the paper-based medical record is feasible, but represents a drastic change in the information environment of hospital physicians. Previous investigations have revealed considerable inter-hospital variations in EMR system use and user satisfaction. The aim of this study was to further explore changes of clinicians' work after the EMR system implementation process and how they experienced working in a paper-deprived information environment. Methods Qualitative study based on 18 semi-structured interviews with physicians in two Norwegian hospitals. Results Ten different but related characteristics of work within the EMR-based practice were identified; (1) there was closer clinical and administrative cooperation during the implementation processes; (2) there were greater benefits when everybody used the system; (3) systems supported freshmen better than experienced physicians; (4) the EMR was useful in regard to professional learning; (5) new users were given an introduction to the system by experienced; (6) younger clinicians reported different attitudes than senior clinicians, but this might be related to more than age and previous experience with computers; (7) the EMR made it easier to generate free-text notes, but this also created a potential for information overflow; (8) there is little or no support for mobile work; (9) instances of downtime are still experienced, and this influenced the attitude towards the system and (10) clinicians preferred EMR-only compared to combined paper and electronic systems. Conclusion Despite the removal of paper-based records from clinical workflow (a change that hospital clinicians perceived as highly useful), many of the old routines remained unchanged, limiting the potential of the EMR system. Thus, there is a need to not only remove paper in the physical sense, but also to established routines to fully achieve the benefits of an EMR system. PMID:18186935

Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California.

PubMed

Ackerman, Sara L; Sarkar, Urmimala; Tieu, Lina; Handley, Margaret A; Schillinger, Dean; Hahn, Kenneth; Hoskote, Mekhala; Gourley, Gato; Lyles, Courtney

2017-09-01

US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations. Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives ( n  = 12), informal focus groups with front-line staff ( n  = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey ( n  = 45). Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain "meaningful use" as defined by and for their patients. Health systems' efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU's assumptions about patients' demand for electronic access to health information and ability to make use of it directed clinics' attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context. We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

An automated system for assessing cognitive function in any environment

NASA Astrophysics Data System (ADS)

Wesnes, Keith A.

2005-05-01

The Cognitive Drug Research (CDR) computerized assessment system has been in use in worldwide clinical trials for over 20 years. It is a computer based system which assesses core aspects of human cognitive function including attention, information, working memory and long-term memory. It has been extensively validated and can be performed by a wide range of clinical populations including patients with various types of dementia. It is currently in worldwide use in clinical trials to evaluate new medicines, as well as a variety of programs involving the effects of age, stressors illnesses and trauma upon human cognitive function. Besides being highly sensitive to drugs which will impair or improve function, its utility has been maintained over the last two decades by constantly increasing the number of platforms upon which it can operate. Besides notebook versions, the system can be used on a wrist worn device, PDA, via tht telephone and over the internet. It is the most widely used automated cognitive function assessment system in worldwide clinical research. It has dozens of parallel forms and requires little training to use or administer. The basic development of the system wil be identified, and the huge databases (normative, patient population, drug effects) which have been built up from hundreds of clinical trials will be described. The system is available for use in virtually any environment or type of trial.

Incorporation of Scribes Into the Inflammatory Bowel Disease Clinic Improves Quality of Care and Physician Productivity.

PubMed

Ewelukwa, Ofor; Perez, Roque; Carter, Lee Ellen; Fernandez, Alyka; Glover, Sarah

2018-02-15

Electronic health records (EHRs), despite their positive attributes, increase physician workload and decrease efficiency. The aim of this study was to evaluate the impact of scribes in the Inflammatory Bowel Disease Clinic on improvement of the physician-patient relationship, physician productivity, clinical efficiency, and achievement of some Physician Quality Reporting System (PQRS) metrics. We analyzed of pre- and postscribe data between fiscal years 2015 (FY15) and 2016 (FY16) using data from patients at the Inflammatory Bowel Clinic at the University of Florida. The main outcomes were patient satisfaction scores (PSS), qualitative physician interview, clinic appointment lengths, work relative value units (wRVUs), level of coding, revenue, and PQRS data on bone density screening and vaccination. PSS increased from 6.8/10 to 9.2/10 (P < 0.01), clinic appointment length decreased by 13.5 minutes (P < 0.05), and documentation stress decreased. Clinic visits increased by 76, leading to an increase in work RVUs by 332.55, total charges billed by $71,439, and total charges collected by $27,387 between the first quarters of FY15 and FY16. The extra revenue for the first quarter was 536% higher than the salary of the scribe for the same period ($4302.84). There was a 1.8-fold increase in referrals for bone density scans and 2.9-fold and 4.8-fold increases in vaccination rates for influenza and pneumonia, respectively. The use of scribes improved the physician-patient relationship, clinical efficiency, physician productivity, bone density screening, and vaccinations for flu and pneumonia. If adopted by health systems, it may lead to significant cost savings and improved clinical outcomes.

A generic, web-based clinical information system architecture using HL7 CDA: successful implementation in dermatological routine care.

PubMed

Schuler, Thilo; Boeker, Martin; Klar, Rüdiger; Müller, Marcel

2007-01-01

The requirements of highly specialized clinical domains are often underrepresented in hospital information systems (HIS). Common consequences are that documentation remains to be paper-based or external systems with insufficient HIS integration are used. This paper presents a solution to overcome this deficiency in the form of a generic framework based on the HL7 Clinical Document Architecture. The central architectural idea is the definition of customized forms using a schema-controlled XML language. These flexible form definitions drive the user interface, the data storage, and standardized data exchange. A successful proof-of-concept application in a dermatologic outpatient wound care department has been implemented, and is well accepted by the clinicians. Our work with HL7 CDA revealed the need for further practical research in the health information standards realm.

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

PubMed

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

Quality requirements for EHR archetypes.

PubMed

Kalra, Dipak; Tapuria, Archana; Austin, Tony; De Moor, Georges

2012-01-01

The realisation of semantic interoperability, in which any EHR data may be communicated between heterogeneous systems and fully understood by computers as well as people on receipt, is a challenging goal. Despite the use of standardised generic models for the EHR and standard terminology systems, too much optionality and variability exists in how particular clinical entries may be represented. Clinical archetypes provide a means of defining how generic models should be shaped and bound to terminology for specific kinds of clinical data. However, these will only contribute to semantic interoperability if libraries of archetypes can be built up consistently. This requires the establishment of design principles, editorial and governance policies, and further research to develop ways for archetype authors to structure clinical data and to use terminology consistently. Drawing on several years of work within communities of practice developing archetypes and implementing systems from them, this paper presents quality requirements for the development of archetypes. Clinical engagement on a wide scale is also needed to help grow libraries of good quality archetypes that can be certified. Vendor and eHealth programme engagement is needed to validate such archetypes and achieve safe, meaningful exchange of EHR data between systems.

Developing academic surgery in a socialized health care system: a 35-year experience.

PubMed

Duranceau, Andre; Martin, Jocelyne; Liberman, Moishe; Ferraro, Pasquale

2012-07-01

The most important benefit of a socialized health care system is the elimination of the threat of personal financial ruin to pay for medical care. Serious disadvantages of a socialized health care system, particularly in a university hospital setting, include restricted financial resources for education and patient care, limited working facilities, and loss of physician-directed decision making in planning and prioritizing. This article describes how a group practice model has supported clinical and academic activities within the faculty of medicine of our university and offers this model as a possible template for other surgical and medical disciplines working in an academic socialized environment.

Automated high-grade prostate cancer detection and ranking on whole slide images

NASA Astrophysics Data System (ADS)

Huang, Chao-Hui; Racoceanu, Daniel

2017-03-01

Recently, digital pathology (DP) has been largely improved due to the development of computer vision and machine learning. Automated detection of high-grade prostate carcinoma (HG-PCa) is an impactful medical use-case showing the paradigm of collaboration between DP and computer science: given a field of view (FOV) from a whole slide image (WSI), the computer-aided system is able to determine the grade by classifying the FOV. Various approaches have been reported based on this approach. However, there are two reasons supporting us to conduct this work: first, there is still room for improvement in terms of detection accuracy of HG-PCa; second, a clinical practice is more complex than the operation of simple image classification. FOV ranking is also an essential step. E.g., in clinical practice, a pathologist usually evaluates a case based on a few FOVs from the given WSI. Then, makes decision based on the most severe FOV. This important ranking scenario is not yet being well discussed. In this work, we introduce an automated detection and ranking system for PCa based on Gleason pattern discrimination. Our experiments suggested that the proposed system is able to perform high-accuracy detection ( 95:57% +/- 2:1%) and excellent performance of ranking. Hence, the proposed system has a great potential to support the daily tasks in the medical routine of clinical pathology.

A new infant hybrid respiratory simulator: preliminary evaluation based on clinical data.

PubMed

Stankiewicz, Barbara; Pałko, Krzysztof J; Darowski, Marek; Zieliński, Krzysztof; Kozarski, Maciej

2017-11-01

A new hybrid (numerical-physical) simulator of the respiratory system, designed to simulate spontaneous and artificial/assisted ventilation of preterm and full-term infants underwent preliminary evaluation. A numerical, seven-compartmental model of the respiratory system mechanics allows the operator to simulate global and peripheral obstruction and restriction of the lungs. The physical part of the simulator is a piston-based construction of impedance transformer. LabVIEW real-time software coordinates the work of both parts of the simulator and its interaction with a ventilator. Using clinical data, five groups of "artificial infants" were examined: healthy full-term infants, very low-birth-weight preterm infants successfully (VLBW) and unsuccessfully extubated (VLBWun) and extremely low-birth-weight preterm infants without (ELBW) and with bronchopulmonary dysplasia (ELBW_BPD). Pressure-controlled ventilation was simulated to measure peak inspiratory pressure, mean airway pressure, total (patient + endotracheal tube) airway resistance (R), total dynamic compliance of the respiratory system (C), and total work of breathing by the ventilator (WOB). The differences between simulation and clinical parameters were not significant. High correlation coefficients between both types of data were obtained for R, C, and WOB (γ R  = 0.99, P < 0.0005; γ C  = 0.85, P < 0.005; γ WOB  = 0.96, P < 0.05, respectively). Thus, the simulator accurately reproduces infant respiratory system mechanics.

Information extraction from Italian medical reports: An ontology-driven approach.

PubMed

Viani, Natalia; Larizza, Cristiana; Tibollo, Valentina; Napolitano, Carlo; Priori, Silvia G; Bellazzi, Riccardo; Sacchi, Lucia

2018-03-01

In this work, we propose an ontology-driven approach to identify events and their attributes from episodes of care included in medical reports written in Italian. For this language, shared resources for clinical information extraction are not easily accessible. The corpus considered in this work includes 5432 non-annotated medical reports belonging to patients with rare arrhythmias. To guide the information extraction process, we built a domain-specific ontology that includes the events and the attributes to be extracted, with related regular expressions. The ontology and the annotation system were constructed on a development set, while the performance was evaluated on an independent test set. As a gold standard, we considered a manually curated hospital database named TRIAD, which stores most of the information written in reports. The proposed approach performs well on the considered Italian medical corpus, with a percentage of correct annotations above 90% for most considered clinical events. We also assessed the possibility to adapt the system to the analysis of another language (i.e., English), with promising results. Our annotation system relies on a domain ontology to extract and link information in clinical text. We developed an ontology that can be easily enriched and translated, and the system performs well on the considered task. In the future, it could be successfully used to automatically populate the TRIAD database. Copyright © 2017 Elsevier B.V. All rights reserved.

A review of wearable sensors and systems with application in rehabilitation

PubMed Central

2012-01-01

The aim of this review paper is to summarize recent developments in the field of wearable sensors and systems that are relevant to the field of rehabilitation. The growing body of work focused on the application of wearable technology to monitor older adults and subjects with chronic conditions in the home and community settings justifies the emphasis of this review paper on summarizing clinical applications of wearable technology currently undergoing assessment rather than describing the development of new wearable sensors and systems. A short description of key enabling technologies (i.e. sensor technology, communication technology, and data analysis techniques) that have allowed researchers to implement wearable systems is followed by a detailed description of major areas of application of wearable technology. Applications described in this review paper include those that focus on health and wellness, safety, home rehabilitation, assessment of treatment efficacy, and early detection of disorders. The integration of wearable and ambient sensors is discussed in the context of achieving home monitoring of older adults and subjects with chronic conditions. Future work required to advance the field toward clinical deployment of wearable sensors and systems is discussed. PMID:22520559

Assessment of Suicidal Ideation and Behavior: Report of the International Society for CNS Clinical Trials and Methodology Consensus Meeting.

PubMed

Chappell, Phillip B; Stewart, Michelle; Alphs, Larry; DiCesare, Franco; DuBrava, Sarah; Harkavy-Friedman, Jill; Lim, Pilar; Ratcliffe, Sian; Silverman, Morton M; Targum, Steven D; Marder, Stephen R

2017-06-01

To develop consensus recommendations for assessment of suicidal ideation/suicidal behavior (SI/SB) in clinical trials. Stakeholders from academia, industry, regulatory agencies, National Institutes of Health, National Institute of Mental Health, and patient advocacy organizations participated in a consensus meeting that was sponsored by the International Society for CNS Clinical Trials and Methodology and held November 17-18, 2015. Prior to the meeting, teams of experts identified key areas of consensus and dissent related to SI/SB. The most critical issues were presented and discussed in the consensus meeting. Literature reviews and a pre-meeting survey were conducted. Findings were discussed in pre-meeting working group sessions and at the consensus meeting. Five pre-meeting working groups reviewed (1) nomenclature and classification schemes for SI/SB, (2) detection and assessment of SI/SB, (3) analysis of SI/SB data, (4) design of clinical trials for new treatments of SI/SB, and (5) public health approaches to SI/SB. A modification of the RAND/UCLA Appropriateness Method was used to combine review of scientific evidence with the collective views of experts and stakeholders to reach the final consensus statements. After discussion, all attendees voted using an electronic interactive audience response system. Areas of agreement and areas of continuing dissent were recorded. All 5 working groups agreed that a major barrier to advancement of the field of SI/SB research and the development of new treatments for SI/SB remains the lack of a universally accepted standardized nomenclature and classification system. Achieving alignment on definitions and classification of suicide-related phenomena is critical to improving the detection and assessment of SI/SB, the design of clinical trials for new treatments, and effective public health interventions. © Copyright 2017 Physicians Postgraduate Press, Inc.

Multichannel System Based on a High Sensitivity Superconductive Sensor for Magnetoencephalography

PubMed Central

Rombetto, Sara; Granata, Carmine; Vettoliere, Antonio; Russo, Maurizio

2014-01-01

We developed a multichannel system based on superconducting quantum interference devices (SQUIDs) for magnetoencephalography measurements. Our system consists of 163 fully-integrated SQUID magnetometers, 154 channels and 9 references, and all of the operations are performed inside a magnetically-shielded room. The system exhibits a magnetic field noise spectral density of approximatively 5 fT/Hz1/2. The presented magnetoencephalography is the first system working in a clinical environment in Italy. PMID:25006995

Expert Systems and Diagnostic Monitors in Psychiatry

PubMed Central

Gelernter, David; Gelernter, Joel

1984-01-01

We argue that existing expert systems for medical diagnosis have not satisfactorily addressed an important problem: how are such systems to be integrated into the clinical environment? This problem should be addressed before and not after a working system is developed, because its solution might well determine important aspects of the ultimate system structure. We propose as one solution the online diagnostic monitor, which is a diagnostic expert system designed for interactive use by a clinican during the course of a patient interview. The exchange between a diagnostic monitor and its clinican user is guided by the user, not the system, and the monitor functions as a passive advisor rather than an active decision-maker. We discuss why a system of this sort might be particularly well-suited to psychiatric diagnosis, and describe preliminary work on an experimental prototype.

Connecting the clinical IT infrastructure to a service-oriented architecture of medical devices.

PubMed

Andersen, Björn; Kasparick, Martin; Ulrich, Hannes; Franke, Stefan; Schlamelcher, Jan; Rockstroh, Max; Ingenerf, Josef

2018-02-23

The new medical device communication protocol known as IEEE 11073 SDC is well-suited for the integration of (surgical) point-of-care devices, so are the established Health Level Seven (HL7) V2 and Digital Imaging and Communications in Medicine (DICOM) standards for the communication of systems in the clinical IT infrastructure (CITI). An integrated operating room (OR) and other integrated clinical environments, however, need interoperability between both domains to fully unfold their potential for improving the quality of care as well as clinical workflows. This work thus presents concepts for the propagation of clinical and administrative data to medical devices, physiologic measurements and device parameters to clinical IT systems, as well as image and multimedia content in both directions. Prototypical implementations of the derived components have proven to integrate well with systems of networked medical devices and with the CITI, effectively connecting these heterogeneous domains. Our qualitative evaluation indicates that the interoperability concepts are suitable to be integrated into clinical workflows and are expected to benefit patients and clinicians alike. The upcoming HL7 Fast Healthcare Interoperability Resources (FHIR) communication standard will likely change the domain of clinical IT significantly. A straightforward mapping to its resource model thus ensures the tenability of these concepts despite a foreseeable change in demand and requirements.

Are some health professionals more cognizant of clinical governance development concepts than others? Findings from a New Zealand study.

PubMed

Gauld, Robin; Horsburgh, Simon

2016-06-01

Clinical governance has been promoted in recent years as core to improving patient safety. Effective clinical governance requires partnerships between 'management' and health professionals as well as equal involvement of all professional groups. Professionals must also be willing to engage in clinical governance activities such as working to improve care systems and patient safety. There is limited research into the relative understanding of core clinical governance concepts amongst different professional groups or the extent to which professionals are prepared to take up opportunities to 'change the system'. A 2012 national survey study of health professionals employed in New Zealand health boards sought to probe understanding of and commitment to clinical governance following introduction of a 2009 policy. Respondent data showed only limited policy implementation had occurred. Regression analyses revealed statistically significant differences in perceptions of knowledge of clinical governance concepts and structures by gender, age, experience and profession, as well as in seeking opportunities to change the system. These findings have implications for policy makers in terms of ensuring that clinical governance implementation provides equal opportunity for engendering involvement of different health professionals. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Comprehensive Psychopathological Assessment Based on the Association for Methodology and Documentation in Psychiatry (AMDP) System: Development, Methodological Foundation, Application in Clinical Routine, and Research.

PubMed

Stieglitz, Rolf-Dieter; Haug, Achim; Fähndrich, Erdmann; Rösler, Michael; Trabert, Wolfgang

2017-01-01

The documentation of psychopathology is core to the clinical practice of the psychiatrist and clinical psychologist. However, both in initial as well as further training and specialization in their fields, this particular aspect of their work receives scanty attention only. Yet, for the past 50 years, the Association for Methodology and Documentation in Psychiatry (AMDP) System has been in existence and available as a tool to serve precisely the purpose of offering a systematic introduction to the terminology and documentation of psychopathology. The motivation for its development was based on the need for an assessment procedure for the reliable documentation of the effectiveness of newly developed psychopharmacological substances. Subsequently, the AMDP-System began to be applied in the context of investigations into a number of methodological issues in psychiatry (e.g., the frequency and specificity of particular symptoms, the comparison of rating scales). The System then became increasingly important also in clinical practice and, today, represents the most used instrument for the documentation of psychopathology in the German-speaking countries of Europe. This paper intends to offer an overview of the AMDP-System, its origins, design, and functionality. After an initial account of the history and development of the AMDP-System, the discussion will in turn focus on the System's underlying methodological principles, the transfer of clinical skills and competencies in its practical application, and its use in research and clinical practice. Finally, potential future areas of development in relation to the AMDP-System are explored.

Postmarketing Safety Study Tool: A Web Based, Dynamic, and Interoperable System for Postmarketing Drug Surveillance Studies

PubMed Central

Sinaci, A. Anil; Laleci Erturkmen, Gokce B.; Gonul, Suat; Yuksel, Mustafa; Invernizzi, Paolo; Thakrar, Bharat; Pacaci, Anil; Cinar, H. Alper; Cicekli, Nihan Kesim

2015-01-01

Postmarketing drug surveillance is a crucial aspect of the clinical research activities in pharmacovigilance and pharmacoepidemiology. Successful utilization of available Electronic Health Record (EHR) data can complement and strengthen postmarketing safety studies. In terms of the secondary use of EHRs, access and analysis of patient data across different domains are a critical factor; we address this data interoperability problem between EHR systems and clinical research systems in this paper. We demonstrate that this problem can be solved in an upper level with the use of common data elements in a standardized fashion so that clinical researchers can work with different EHR systems independently of the underlying information model. Postmarketing Safety Study Tool lets the clinical researchers extract data from different EHR systems by designing data collection set schemas through common data elements. The tool interacts with a semantic metadata registry through IHE data element exchange profile. Postmarketing Safety Study Tool and its supporting components have been implemented and deployed on the central data warehouse of the Lombardy region, Italy, which contains anonymized records of about 16 million patients with over 10-year longitudinal data on average. Clinical researchers in Roche validate the tool with real life use cases. PMID:26543873

Workplace and non-workplace mild traumatic brain injuries in an outpatient clinic sample: A case-control study.

PubMed

Terry, Douglas P; Iverson, Grant L; Panenka, William; Colantonio, Angela; Silverberg, Noah D

2018-01-01

Individuals who are injured in the workplace typically have a greater risk of delayed return to work (RTW) and other poor health outcomes compared to those not injured at work. It is not known whether these differences hold true for mild traumatic brain injuries (MTBI). The present study examined differences associated with workplace and non-workplace MTBI upon intake to a specialty MTBI clinic, their outcomes, and risk factors that influence RTW. Slow-to-recover participants were recruited from consecutive referrals to four outpatient MTBI clinics from March 2015 to February 2017. Two clinics treat Worker's Compensation claimants and two clinics serve patients with non-work related injuries in the publically funded health care system. Of 273 eligible patients, 102 completed an initial study assessment (M age = 41.2 years, SD age = 11.7; 54% women) at an average of 2-3 months post injury. Participants were interviewed about their MTBI and completed a battery of standardized questionnaires and performance validity testing. Outcomes, including RTW, were assessed via telephone follow-up 4-5 months later. Workplace injuries comprised 45.1% of the sample. The workplace MTBI group had a greater proportion of men and lower education levels compared to the non-workplace MTBI group. The two groups had a comparable post-concussion symptom burden and performance validity test failure rate. Workplace MTBI was associated with greater post-traumatic stress symptoms. Fifteen patients (14.7%) were lost to follow-up. There were no workplace/non-workplace MTBI differences in RTW outcome at 6-7 months post injury. Of the entire sample, 42.5% of patients had full RTW, 18.4% had partial RTW, and 39.1% had no RTW. Greater post-concussion symptom burden was most predictive of no RTW at follow-up. There was no evidence that the workplace and non-workplace MTBI groups had different risk factors associated with prolonged work absence. Despite systemic differences in compensation and health care access, the workplace and non-workplace MTBI groups were similar at clinic intake and indistinguishable at follow-up, 6-7 months post injury.

Managing and Communicating Operational Workflow

PubMed Central

Weinberg, Stuart T.; Danciu, Ioana; Unertl, Kim M.

2016-01-01

Summary Background Healthcare team members in emergency department contexts have used electronic whiteboard solutions to help manage operational workflow for many years. Ambulatory clinic settings have highly complex operational workflow, but are still limited in electronic assistance to communicate and coordinate work activities. Objective To describe and discuss the design, implementation, use, and ongoing evolution of a coordination and collaboration tool supporting ambulatory clinic operational workflow at Vanderbilt University Medical Center (VUMC). Methods The outpatient whiteboard tool was initially designed to support healthcare work related to an electronic chemotherapy order-entry application. After a highly successful initial implementation in an oncology context, a high demand emerged across the organization for the outpatient whiteboard implementation. Over the past 10 years, developers have followed an iterative user-centered design process to evolve the tool. Results The electronic outpatient whiteboard system supports 194 separate whiteboards and is accessed by over 2800 distinct users on a typical day. Clinics can configure their whiteboards to support unique workflow elements. Since initial release, features such as immunization clinical decision support have been integrated into the system, based on requests from end users. Conclusions The success of the electronic outpatient whiteboard demonstrates the usefulness of an operational workflow tool within the ambulatory clinic setting. Operational workflow tools can play a significant role in supporting coordination, collaboration, and teamwork in ambulatory healthcare settings. PMID:27081407

Nurses' perceptions of e-portfolio use for on-the-job training in Taiwan.

PubMed

Tsai, Pei-Rong; Lee, Ting-Ting; Lin, Hung-Ru; Lee-Hsieh, Jane; Mills, Mary Etta

2015-01-01

Electronic portfolios can be used to record user performance and achievements. Currently, clinical learning systems and in-service education systems lack integration of nurses' clinical performance records with their education or training outcomes. For nurses with less than 2 years' work experience (nursing postgraduate year), use of an electronic portfolio is essential. This study aimed to assess the requirements of using electronic portfolios in continuing nursing education for clinical practices. Fifteen nurses were recruited using a qualitative purposive sampling approach between April 2013 and May 2013. After obtaining participants' consent, data were collected in a conference room of the study hospital by one-on-one semistructured in-depth interviews. Through data analyses, the following five main themes related to electronic learning portfolios were identified: instant access to in-service education information, computerized nursing postgraduate year training manual, diversity of system functions and interface designs, need for sufficient computers, and protection of personal documents. Because electronic portfolios are beginning to be used in clinical settings, a well-designed education information system not only can meet the needs of nurses but also can facilitate their learning progress.

Stroke: Working toward a Prioritized World Agenda

PubMed Central

Hachinski, Vladimir; Donnan, Geoffrey A.; Gorelick, Philip B.; Hacke, Werner; Cramer, Steven C.; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M.; Lo, Eng H.; Skolnick, Brett E.; Furie, Karen L.; Hankey, Graeme J.; Kivipelto, Miia; Morris, John; Rothwell, Peter M.; Sacco, Ralph L.; Smith, Sidney C.; Wang, Yulun; Bryer, Alan; Ford, Gary A.; Iadecola, Costantino; Martins, Sheila C.O.; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M.; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A.; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P.; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H.; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K.; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M.; Davis, Stephen M.; Goldstein, Larry B.; Leys, Didier; Tuomilehto, Jaakko

2013-01-01

Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a ‘Brain Health’ concept that enables promotion of preventive measures. Conclusions To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress PMID:20636706

Stroke: Working toward a Prioritized World Agenda

PubMed Central

Hachinski, Vladimir; Donnan, Geoffrey A.; Gorelick, Philip B.; Hacke, Werner; Cramer, Steven C.; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M.; Lo, Eng H.; Skolnick, Brett E.; Furie, Karen L.; Hankey, Graeme J.; Kivipelto, Miia; Morris, John; Rothwell, Peter M.; Sacco, Ralph L.; Smith, Jr., Sidney C.; Wang, Yulun; Bryer, Alan; Ford, Gary A.; Iadecola, Costantino; Martins, Sheila C.O.; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M.; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A.; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P.; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H.; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K.; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M.; Davis, Stephen M.; Goldstein, Larry B.; Leys, Didier; Tuomilehto, Jaakko

2010-01-01

Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a ‘Brain Health’ concept that enables promotion of preventive measures. Conclusions To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress. PMID:20516682

Stroke: Working Toward a Prioritized World Agenda

PubMed Central

Hachinski, Vladimir; Donnan, Geoffrey A.; Gorelick, Philip B.; Hacke, Werner; Cramer, Steven C.; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M.; Lo, Eng H.; Skolnick, Brett E.; Furie, Karen L.; Hankey, Graeme J.; Kivipelto, Miia; Morris, John; Rothwell, Peter M.; Sacco, Ralph L.; Smith, Sidney C.; Wang, Yulun; Bryer, Alan; Ford, Gary A.; Iadecola, Costantino; Martins, Sheila C.O.; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M.; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A.; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P.; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H.; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K.; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M.; Davis, Stephen M.; Edin, FRCP; Goldstein, Larry B.; Leys, Didier; Tuomilehto, Jaakko

2013-01-01

Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent “silo” mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a “Brain Health” concept that enables promotion of preventive measures. Conclusions To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress. PMID:20498453

Stroke: working toward a prioritized world agenda.

PubMed

Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko

2010-01-01

The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent 'silo' mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a 'Brain Health' concept that enables promotion of preventive measures. To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress. Copyright (c) 2010 American Heart Association. Inc., S. Karger AG, Basel, and John Wiley & Sons, Inc.

Stroke: working toward a prioritized world agenda.

PubMed

Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko

2010-06-01

The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent "silo" mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a "Brain Health" concept that enables promotion of preventive measures. To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.

Stroke: working toward a prioritized world agenda.

PubMed

Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko

2010-08-01

The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by seven working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent 'silo' mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a 'Brain Health' concept that enables promotion of preventive measures. To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.

Distributed user interfaces for clinical ubiquitous computing applications.

PubMed

Bång, Magnus; Larsson, Anders; Berglund, Erik; Eriksson, Henrik

2005-08-01

Ubiquitous computing with multiple interaction devices requires new interface models that support user-specific modifications to applications and facilitate the fast development of active workspaces. We have developed NOSTOS, a computer-augmented work environment for clinical personnel to explore new user interface paradigms for ubiquitous computing. NOSTOS uses several devices such as digital pens, an active desk, and walk-up displays that allow the system to track documents and activities in the workplace. We present the distributed user interface (DUI) model that allows standalone applications to distribute their user interface components to several devices dynamically at run-time. This mechanism permit clinicians to develop their own user interfaces and forms to clinical information systems to match their specific needs. We discuss the underlying technical concepts of DUIs and show how service discovery, component distribution, events and layout management are dealt with in the NOSTOS system. Our results suggest that DUIs--and similar network-based user interfaces--will be a prerequisite of future mobile user interfaces and essential to develop clinical multi-device environments.

A component-based problem list subsystem for the HOLON testbed. Health Object Library Online.

PubMed Central

Law, V.; Goldberg, H. S.; Jones, P.; Safran, C.

1998-01-01

One of the deliverables of the HOLON (Health Object Library Online) project is the specification of a reference architecture for clinical information systems that facilitates the development of a variety of discrete, reusable software components. One of the challenges facing the HOLON consortium is determining what kinds of components can be made available in a library for developers of clinical information systems. To further explore the use of component architectures in the development of reusable clinical subsystems, we have incorporated ongoing work in the development of enterprise terminology services into a Problem List subsystem for the HOLON testbed. We have successfully implemented a set of components using CORBA (Common Object Request Broker Architecture) and Java distributed object technologies that provide a functional problem list application and UMLS-based "Problem Picker." Through this development, we have overcome a variety of obstacles characteristic of rapidly emerging technologies, and have identified architectural issues necessary to scale these components for use and reuse within an enterprise clinical information system. PMID:9929252

A component-based problem list subsystem for the HOLON testbed. Health Object Library Online.

PubMed

Law, V; Goldberg, H S; Jones, P; Safran, C

1998-01-01

One of the deliverables of the HOLON (Health Object Library Online) project is the specification of a reference architecture for clinical information systems that facilitates the development of a variety of discrete, reusable software components. One of the challenges facing the HOLON consortium is determining what kinds of components can be made available in a library for developers of clinical information systems. To further explore the use of component architectures in the development of reusable clinical subsystems, we have incorporated ongoing work in the development of enterprise terminology services into a Problem List subsystem for the HOLON testbed. We have successfully implemented a set of components using CORBA (Common Object Request Broker Architecture) and Java distributed object technologies that provide a functional problem list application and UMLS-based "Problem Picker." Through this development, we have overcome a variety of obstacles characteristic of rapidly emerging technologies, and have identified architectural issues necessary to scale these components for use and reuse within an enterprise clinical information system.

DECIDE: a software for computer-assisted evaluation of diagnostic test performance.

PubMed

Chiecchio, A; Bo, A; Manzone, P; Giglioli, F

1993-05-01

The evaluation of the performance of clinical tests is a complex problem involving different steps and many statistical tools, not always structured in an organic and rational system. This paper presents a software which provides an organic system of statistical tools helping evaluation of clinical test performance. The program allows (a) the building and the organization of a working database, (b) the selection of the minimal set of tests with the maximum information content, (c) the search of the model best fitting the distribution of the test values, (d) the selection of optimal diagnostic cut-off value of the test for every positive/negative situation, (e) the evaluation of performance of the combinations of correlated and uncorrelated tests. The uncertainty associated with all the variables involved is evaluated. The program works in a MS-DOS environment with EGA or higher performing graphic card.

Doctors and managers: poor relationships may be damaging patients—what can be done?

PubMed Central

Edwards, N

2003-01-01

The problem of poor relationships between doctors and managers is a common feature of many healthcare systems. This problem needs to be explicitly addressed and there are a number of positive steps that could be taken. Firstly, there would be value in working to improve the quality of relationships and better mutual understanding of the necessarily different positions of doctors and managers. Finding a common approach to managing resources, accountability, autonomy, and the creation of more systematic ways of working seems to be important. The use of costed clinical pathways may be one approach. Rather than seeing guidelines and accountability systems as a threat to autonomy there is an argument that they are an essential adjunct to it. Redefining autonomy in order to preserve it and to ensure that it encompasses accountability and responsibility will be an important step. A key step is the development of clinical leadership. PMID:14645744

Clinical EPR: Unique Opportunities and Some Challenges

PubMed Central

Swartz, Harold M.; Williams, Benjamin B.; Zaki, Bassem I.; Hartford, Alan C.; Jarvis, Lesley A.; Chen, Eunice; Comi, Richard J.; Ernstoff, Marc S.; Hou, Huagang; Khan, Nadeem; Swarts, Steven G.; Flood, Ann B.; Kuppusamy, Periannan

2014-01-01

Electron paramagnetic resonance (EPR) spectroscopy has been well established as a viable technique for measurement of free radicals and oxygen in biological systems, from in vitro cellular systems to in vivo small animal models of disease. However, the use of EPR in human subjects in the clinical setting, although attractive for a variety of important applications such as oxygen measurement, is challenged with several factors including the need for instrumentation customized for human subjects, probe and regulatory constraints. This paper describes the rationale and development of the first clinical EPR systems for two important clinical applications, namely, measurement of tissue oxygen (oximetry), and radiation dose (dosimetry) in humans. The clinical spectrometers operate at 1.2 GHz frequency and use surface loop resonators capable of providing topical measurements up to 1 cm depth in tissues. Tissue pO2 measurements can be carried out noninvasively and repeatedly after placement of an oxygen-sensitive paramagnetic material (currently India ink) at the site of interest. Our EPR dosimetry system is capable of measuring radiation-induced free radicals in the tooth of irradiated human subjects to determine the exposure dose. These developments offer potential opportunities for clinical dosimetry and oximetry, which include guiding therapy for individual patients with tumors or vascular disease, by monitoring of tissue oxygenation. Further work is in progress to translate this unique technology to routine clinical practice. PMID:24439333

Development of the Lymphoma Enterprise Architecture Database: a caBIG Silver level compliant system.

PubMed

Huang, Taoying; Shenoy, Pareen J; Sinha, Rajni; Graiser, Michael; Bumpers, Kevin W; Flowers, Christopher R

2009-04-03

Lymphomas are the fifth most common cancer in United States with numerous histological subtypes. Integrating existing clinical information on lymphoma patients provides a platform for understanding biological variability in presentation and treatment response and aids development of novel therapies. We developed a cancer Biomedical Informatics Grid (caBIG) Silver level compliant lymphoma database, called the Lymphoma Enterprise Architecture Data-system (LEAD), which integrates the pathology, pharmacy, laboratory, cancer registry, clinical trials, and clinical data from institutional databases. We utilized the Cancer Common Ontological Representation Environment Software Development Kit (caCORE SDK) provided by National Cancer Institute's Center for Bioinformatics to establish the LEAD platform for data management. The caCORE SDK generated system utilizes an n-tier architecture with open Application Programming Interfaces, controlled vocabularies, and registered metadata to achieve semantic integration across multiple cancer databases. We demonstrated that the data elements and structures within LEAD could be used to manage clinical research data from phase 1 clinical trials, cohort studies, and registry data from the Surveillance Epidemiology and End Results database. This work provides a clear example of how semantic technologies from caBIG can be applied to support a wide range of clinical and research tasks, and integrate data from disparate systems into a single architecture. This illustrates the central importance of caBIG to the management of clinical and biological data.

Knowledge management for the protection of information in electronic medical records.

PubMed

Lea, Nathan; Hailes, Stephen; Austin, Tony; Kalra, Dipak

2008-01-01

This paper describes foundational work investigating the protection requirements of sensitive medical information, which is being stored more routinely in repository systems for electronic medical records. These systems have increasingly powerful sharing capabilities at the point of clinical care, in medical research and for clinical and managerial audit. The potential for sharing raises concerns about the protection of individual patient privacy and challenges the duty of confidentiality by which medical practitioners are ethically and legally bound. By analysing the protection requirements and discussing the need to apply policy-based controls to discrete items of medical information in a record, this paper suggests that this is a problem for which existing privacy management solutions are not sufficient or appropriate to the protection requirements. It proposes that a knowledge management approach is required and it introduces a new framework based on the knowledge management techniques now being used to manage electronic medical record data. The background, existing work in this area, initial investigation methods, results to date and discussion are presented, and the paper is concluded with the authors' comments on the ramifications of the work.

A survey on clinical governance awareness among clinical staff: a cross-sectional study.

PubMed

Ravaghi, Hamid; Zarnaq, Rahim Khodayari; Adel, Amin; Badpa, Mahnaz; Adel, Moein; Abolhassani, Nazanin

2014-06-25

Clinical Governance (CG) program has been raised in Iran in order to improve the quality of clinical care. The purpose of this study is to investigate the awareness of clinical governance program among clinical staff working in selected teaching hospitals in Tehran, Iran. To investigate the CG awareness, a cross-sectional survey was conducted among 345 clinical staff working in 20 selected public hospitals in Tehran. Data were gathered using the standardized clinical governance awareness questionnaire. Descriptive statistics were used to analyze the data. The results showed that the level of staff awareness about the concept of CG was low. They perceived continuous quality improvement, responsibility, medical errors reduction and patient safety as the main concepts of the CG framework. Reaching agreement of standards concepts among staff and positive changes in attitudes were considered as two most observed changes. The main perceived barriers to the implementation of clinical governance included lack of proper management and leadership, lack of full support, inappropriate organizational culture, lack of knowledge, poor communication system and insufficient training. The concepts and goals of clinical governance have not been effectively conveyed to the staff and despite its implementation in the hospitals, there has been low clinical governance awareness among the staff. Clinical Governance must be implemented through comprehensive management support and participation of all staff and health professionals at both hospital and policy making level.

[Implementation of a new electronic patient record in surgery].

PubMed

Eggli, S; Holm, J

2001-12-01

The increasing amount of clinical data, intensified interest of patients in medical information, medical quality management and the recent cost explosion in health care systems have forced medical institutions to improve their strategy in handling medical data. In the orthopedic department (3,600 surgeries, 75 beds, 14,000 consultations) software application for comprehensive patient data management has been developed. When implementing the electronic patient history following criteria were evaluated: 1. software evaluation, 2. implementation, 3. work flow, 4. data security/system stability. In the first phase the functional character was defined. Implementation required 3 months after parametrization. The expense amounted to 130,000 DM (30 clients). The training requirements were one afternoon for the secretaries and a 2-h session for the residents. The access speed on medically relevant data averaged under 3 s. The average saving in working hours was approximately 5 h/week for the secretaries and 4 h/week for the residents. The saving in paper amounted to 36,000 sheets/year. In 3 operational years there were 3 server breakdowns. Evaluation of the saving on working hours showed that such a system can amortize within a year. The latest improvements in hardware and software technology made the electronic medical record with integrated quality-control practicable without massive expenditure. The system supplies an extensive platform of information for patient treatment and an instrument to evaluate the efficiency of therapy strategies independent of the clinical field.

[Inpatient psychiatry in Denmark].

PubMed

Gnirss, M

1993-01-01

The paper describes organization and clinical aspects of Danish psychiatry seen from the view of a psychiatrist trained in Switzerland. Differences of the two societies, the description of the hospital, the psychiatrist's daily work as well as juridical aspects and their effects to the work on a psychiatric ward form the main themes of this article. At the end the author tries to value the two different systems.

Venous Return and Clinical Hemodynamics: How the Body Works during Acute Hemorrhage

ERIC Educational Resources Information Center

Shen, Tao; Baker, Keith

2015-01-01

Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of…

Pediatric oncology clinical trial participation where the geography is vast: Development of a clinical research system for tertiary and satellite centers in Ontario, Canada.

PubMed

Alexander, Sarah; Greenberg, Mark; Malkin, David; Portwine, Carol; Johnston, Donna; Silva, Mariana; Zelcer, Shayna; Sonshine, Samantha; Manzo, Janet; Bennett, Carla; Brodeur-Robb, Kathy; Deveault, Catherine; Ramachandran, Nivetha; Gibson, Paul

2018-04-01

Opportunities for participation in clinical trials are a core component of the care of children with cancer. In Ontario, many pediatric patients live long distances from their cancer center. This paper describes the work that was done in order to allow patients participating in Children's Oncology Group trials to receive care, including research protocol related care, jointly between the tertiary pediatric cancer center and the closer-to-home satellite center. The system is a pragmatic risk-based model, supporting excellence in care while ensuring good conduct of the research in compliance with applicable regulations and guidelines, including ethics oversight. © 2017 Wiley Periodicals, Inc.

Physicians as Executives: Opportunities and Strategies for Health-System Pharmacy Leaders

PubMed Central

Harvin, Andre; Griffith, Niesha; Weber, Robert J.

2014-01-01

To deal with the pressures in health care that stress clinical excellence and profitability, health systems are increasingly recruiting physician executives or physicians in leadership and management positions. Physicians occupy less than 5% of all hospital leadership positions, but there is an apparent increase in the recruitment of physician executives. With the growth in the number of physician executives, pharmacy leaders must capitalize on their existing clinical relationship and apply it to health care leadership and management. By focusing on developing an executive presence, by clearly describing a patient-centered strategy and vision for pharmacy, and by nurturing the existing clinical relationships, the pharmacy director can work with physician executives to promote patient-centered pharmacy services. PMID:25477571

Translating Alcohol Research

PubMed Central

Batman, Angela M.; Miles, Michael F.

2015-01-01

Alcohol use disorder (AUD) and its sequelae impose a major burden on the public health of the United States, and adequate long-term control of this disorder has not been achieved. Molecular and behavioral basic science research findings are providing the groundwork for understanding the mechanisms underlying AUD and have identified multiple candidate targets for ongoing clinical trials. However, the translation of basic research or clinical findings into improved therapeutic approaches for AUD must become more efficient. Translational research is a multistage process of streamlining the movement of basic biomedical research findings into clinical research and then to the clinical target populations. This process demands efficient bidirectional communication across basic, applied, and clinical science as well as with clinical practitioners. Ongoing work suggests rapid progress is being made with an evolving translational framework within the alcohol research field. This is helped by multiple interdisciplinary collaborative research structures that have been developed to advance translational work on AUD. Moreover, the integration of systems biology approaches with collaborative clinical studies may yield novel insights for future translational success. Finally, appreciation of genetic variation in pharmacological or behavioral treatment responses and optimal communication from bench to bedside and back may strengthen the success of translational research applications to AUD. PMID:26259085

Translating Alcohol Research: Opportunities and Challenges.

PubMed

Batman, Angela M; Miles, Michael F

2015-01-01

Alcohol use disorder (AUD) and its sequelae impose a major burden on the public health of the United States, and adequate long-term control of this disorder has not been achieved. Molecular and behavioral basic science research findings are providing the groundwork for understanding the mechanisms underlying AUD and have identified multiple candidate targets for ongoing clinical trials. However, the translation of basic research or clinical findings into improved therapeutic approaches for AUD must become more efficient. Translational research is a multistage process of stream-lining the movement of basic biomedical research findings into clinical research and then to the clinical target populations. This process demands efficient bidirectional communication across basic, applied, and clinical science as well as with clinical practitioners. Ongoing work suggests rapid progress is being made with an evolving translational framework within the alcohol research field. This is helped by multiple interdisciplinary collaborative research structures that have been developed to advance translational work on AUD. Moreover, the integration of systems biology approaches with collaborative clinical studies may yield novel insights for future translational success. Finally, appreciation of genetic variation in pharmacological or behavioral treatment responses and optimal communication from bench to bedside and back may strengthen the success of translational research applications to AUD.

Clinical engagement: improving healthcare together.

PubMed

Riches, E; Robson, B

2014-02-01

Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

The role of Epstein-Barr virus in systemic lupus erythematosus.

PubMed

McClain, M T; Harley, J B; James, J A

2001-10-01

Systemic lupus erythematosus (SLE) is a devastating autoimmune disease with no known cure. Lupus patients suffer from a myriad of clinical symptoms which variably include arthritis, pleuritis, pericarditis, vasculitis, and nephritis. The underlying mechanisms behind these clinical findings and the etiologic events preceding and causing disease onset, however, remain largely unknown. For many years, investigators have suspected that Epstein-Barr virus might somehow be involved in the etiology and/or pathogenesis of systemic lupus. Numerous studies have examined this possibility from various angles and have arrived at different conclusions. This work reviews these historical papers in the context of new results and presents a hypothetical role for this virus as an etiological environmental trigger for SLE.

Melanoma detection using smartphone and multimode hyperspectral imaging

NASA Astrophysics Data System (ADS)

MacKinnon, Nicholas; Vasefi, Fartash; Booth, Nicholas; Farkas, Daniel L.

2016-04-01

This project's goal is to determine how to effectively implement a technology continuum from a low cost, remotely deployable imaging device to a more sophisticated multimode imaging system within a standard clinical practice. In this work a smartphone is used in conjunction with an optical attachment to capture cross-polarized and collinear color images of a nevus that are analyzed to quantify chromophore distribution. The nevus is also imaged by a multimode hyperspectral system, our proprietary SkinSpect™ device. Relative accuracy and biological plausibility of the two systems algorithms are compared to assess aspects of feasibility of in-home or primary care practitioner smartphone screening prior to rigorous clinical analysis via the SkinSpect.

Performance evaluation of integrating detectors for near-infrared fluorescence molecular imaging

NASA Astrophysics Data System (ADS)

Zhu, Banghe; Rasmussen, John C.; Sevick-Muraca, Eva M.

2014-05-01

Although there has been a plethora of devices advanced for clinical translation, there has been no standards to compare and determine the optical device for fluorescence molecular imaging. In this work, we compare different CCD configurations using a solid phantom developed to mimic pM - fM concentrations of near-infrared fluorescent dyes in tissues. Our results show that intensified CCD systems (ICCDs) offer greater contrast at larger signal-tonoise ratios (SNRs) in comparison to their un-intensified CCD systems operated at clinically reasonable, sub-second acquisition times. Furthermore, we compared our investigational ICCD device to the commercial NOVADAQ SPY system, demonstrating different performance in both SNR and contrast.

Turning Access into a web-enabled secure information system for clinical trials.

PubMed

Dongquan Chen; Chen, Wei-Bang; Soong, Mayhue; Soong, Seng-Jaw; Orthner, Helmuth F

2009-08-01

Organizations that have limited resources need to conduct clinical studies in a cost-effective, but secure way. Clinical data residing in various individual databases need to be easily accessed and secured. Although widely available, digital certification, encryption, and secure web server, have not been implemented as widely, partly due to a lack of understanding of needs and concerns over issues such as cost and difficulty in implementation. The objective of this study was to test the possibility of centralizing various databases and to demonstrate ways of offering an alternative to a large-scale comprehensive and costly commercial product, especially for simple phase I and II trials, with reasonable convenience and security. We report a working procedure to transform and develop a standalone Access database into a secure Web-based secure information system. For data collection and reporting purposes, we centralized several individual databases; developed, and tested a web-based secure server using self-issued digital certificates. The system lacks audit trails. The cost of development and maintenance may hinder its wide application. The clinical trial databases scattered in various departments of an institution could be centralized into a web-enabled secure information system. The limitations such as the lack of a calendar and audit trail can be partially addressed with additional programming. The centralized Web system may provide an alternative to a comprehensive clinical trial management system.

[Development and integration of the Oncological Documentation System ODS].

PubMed

Raab, G; van Den Bergh, M

2001-08-01

To simplify clinical routine and to improve medical quality without exceeding the existing resources. Intensifying communication and cooperation between all institutions of patients' health care. The huge amount of documentation work of physicians can no longer be done without modern tools of paperless data processing. The development of ODS was a tight cooperation between physician and technician which resulted in a mutual understanding and led to a high level of user convenience. - At present all cases of gynecology, especially gynecologic oncology can be documented and processed by ODS. Users easily will adopt the system as data entry within different program areas follows the same rules. In addition users can choose between an individual input of data and assistants guiding them through highly specific areas of documentation. ODS is a modern, modular structured and very fast multiuser database environment for in- and outpatient documentation. It automatically generates a lot of reports for clinical day to day business. Statistical routines will help the user reflecting his work and its quality. Documentation of clinical trials according to the GCP guidelines can be done by ODS using the internet or offline datasharing. As ODS is the synthesis of a computer based patient administration system and an oncological documentation database, it represents the basis for the construction of the electronical patient chart as well as the digital documentation of clinical trials. The introduction of this new technology to physicians and nurses has to be done slowly and carefully, in order to increase motivation and to improve the results.

Microbial environmental contamination in Italian dental clinics: A multicenter study yielding recommendations for standardized sampling methods and threshold values.

PubMed

Pasquarella, Cesira; Veronesi, Licia; Napoli, Christian; Castiglia, Paolo; Liguori, Giorgio; Rizzetto, Rolando; Torre, Ida; Righi, Elena; Farruggia, Patrizia; Tesauro, Marina; Torregrossa, Maria V; Montagna, Maria T; Colucci, Maria E; Gallè, Francesca; Masia, Maria D; Strohmenger, Laura; Bergomi, Margherita; Tinteri, Carola; Panico, Manuela; Pennino, Francesca; Cannova, Lucia; Tanzi, Marialuisa

2012-03-15

A microbiological environmental investigation was carried out in ten dental clinics in Italy. Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days, for one week per month, for a three-month period. Water and surfaces were sampled before and after clinical activity; air was sampled before, after, and during clinical activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and for the different sampling times. Before clinical activity, microbial water contamination in tap water reached 51,200cfu/mL (colony forming units per milliliter), and that in Dental Unit Water Systems (DUWSs) reached 872,000cfu/mL. After clinical activity, there was a significant decrease in the Total Viable Count (TVC) in tap water and in DUWSs. Pseudomonas aeruginosa was found in 2.38% (7/294) of tap water samples and in 20.06% (59/294) of DUWS samples; Legionella spp. was found in 29.96% (89/297) of tap water samples and 15.82% (47/297) of DUWS samples, with no significant difference between pre- and post-clinical activity. Microbial air contamination was highest during dental treatments, and decreased significantly at the end of the working activity (p<0.05). The microbial buildup on surfaces increased significantly during the working hours. This study provides data for the establishment of standardized sampling methods, and threshold values for contamination monitoring in dentistry. Some very critical situations have been observed which require urgent intervention. Furthermore, the study emphasizes the need for research aimed at defining effective managing strategies for dental clinics. Copyright © 2012 Elsevier B.V. All rights reserved.

Approaches for estimating minimal clinically important differences in systemic lupus erythematosus.

PubMed

Rai, Sharan K; Yazdany, Jinoos; Fortin, Paul R; Aviña-Zubieta, J Antonio

2015-06-03

A minimal clinically important difference (MCID) is an important concept used to determine whether a medical intervention improves perceived outcomes in patients. Prior to the introduction of the concept in 1989, studies focused primarily on statistical significance. As most recent clinical trials in systemic lupus erythematosus (SLE) have failed to show significant effects, determining a clinically relevant threshold for outcome scores (that is, the MCID) of existing instruments may be critical for conducting and interpreting meaningful clinical trials as well as for facilitating the establishment of treatment recommendations for patients. To that effect, methods to determine the MCID can be divided into two well-defined categories: distribution-based and anchor-based approaches. Distribution-based approaches are based on statistical characteristics of the obtained samples. There are various methods within the distribution-based approach, including the standard error of measurement, the standard deviation, the effect size, the minimal detectable change, the reliable change index, and the standardized response mean. Anchor-based approaches compare the change in a patient-reported outcome to a second, external measure of change (that is, one that is more clearly understood, such as a global assessment), which serves as the anchor. Finally, the Delphi technique can be applied as an adjunct to defining a clinically important difference. Despite an abundance of methods reported in the literature, little work in MCID estimation has been done in the context of SLE. As the MCID can help determine the effect of a given therapy on a patient and add meaning to statistical inferences made in clinical research, we believe there ought to be renewed focus on this area. Here, we provide an update on the use of MCIDs in clinical research, review some of the work done in this area in SLE, and propose an agenda for future research.

Comprehensive Psychopathological Assessment Based on the Association for Methodology and Documentation in Psychiatry (AMDP) System: Development, Methodological Foundation, Application in Clinical Routine, and Research

PubMed Central

Stieglitz, Rolf-Dieter; Haug, Achim; Fähndrich, Erdmann; Rösler, Michael; Trabert, Wolfgang

2017-01-01

The documentation of psychopathology is core to the clinical practice of the psychiatrist and clinical psychologist. However, both in initial as well as further training and specialization in their fields, this particular aspect of their work receives scanty attention only. Yet, for the past 50 years, the Association for Methodology and Documentation in Psychiatry (AMDP) System has been in existence and available as a tool to serve precisely the purpose of offering a systematic introduction to the terminology and documentation of psychopathology. The motivation for its development was based on the need for an assessment procedure for the reliable documentation of the effectiveness of newly developed psychopharmacological substances. Subsequently, the AMDP-System began to be applied in the context of investigations into a number of methodological issues in psychiatry (e.g., the frequency and specificity of particular symptoms, the comparison of rating scales). The System then became increasingly important also in clinical practice and, today, represents the most used instrument for the documentation of psychopathology in the German-speaking countries of Europe. This paper intends to offer an overview of the AMDP-System, its origins, design, and functionality. After an initial account of the history and development of the AMDP-System, the discussion will in turn focus on the System’s underlying methodological principles, the transfer of clinical skills and competencies in its practical application, and its use in research and clinical practice. Finally, potential future areas of development in relation to the AMDP-System are explored. PMID:28439242

Management of high-risk perioperative systems.

PubMed

Dain, Steven

2006-06-01

The perioperative system is a complex system that requires people, materials, and processes to come together in a highly ordered and timely manner. However, when working in this high-risk system, even well-organized, knowledgeable, vigilant, and well-intentioned individuals will eventually make errors. All systems need to be evaluated on a continual basis to reduce the risk of errors, make errors more easily recognizable, and provide methods for error mitigation. A simple approach to risk management that may be applied in clinical medicine is discussed.

Biological effects of direct and indirect manipulation of the fascial system. Narrative review.

PubMed

Parravicini, Giovanni; Bergna, Andrea

2017-04-01

Osteopathic Manipulative Treatment (OMT) is effective in improving function, movement and restoring pain conditions. Despite clinical results, the mechanisms of how OMT achieves its' effects remain unclear. The fascial system is described as a tensional network that envelops the human body. Direct or indirect manipulations of the fascial system are a distinctive part of OMT. This review describes the biological effects of direct and indirect manipulation of the fascial system. Literature search was performed in February 2016 in the electronic databases: Cochrane, Medline, Scopus, Ostmed, Pedro and authors' publications relative to Fascia Research Congress Website. Manipulation of the fascial system seems to interfere with some cellular processes providing various pro-inflammatory and anti-inflammatory cells and molecules. Despite growing research in the osteopathic field, biological effects of direct or indirect manipulation of the fascial system are not conclusive. To elevate manual medicine as a primary intervention in clinical settings, it's necessary to clarify how OMT modalities work in order to underpin their clinical efficacies. Copyright © 2017 Elsevier Ltd. All rights reserved.

The National Institutes of Health Clinical Center Digital Imaging Network, Picture Archival and Communication System, and Radiology Information System.

PubMed

Goldszal, A F; Brown, G K; McDonald, H J; Vucich, J J; Staab, E V

2001-06-01

In this work, we describe the digital imaging network (DIN), picture archival and communication system (PACS), and radiology information system (RIS) currently being implemented at the Clinical Center, National Institutes of Health (NIH). These systems are presently in clinical operation. The DIN is a redundant meshed network designed to address gigabit density and expected high bandwidth requirements for image transfer and server aggregation. The PACS projected workload is 5.0 TB of new imaging data per year. Its architecture consists of a central, high-throughput Digital Imaging and Communications in Medicine (DICOM) data repository and distributed redundant array of inexpensive disks (RAID) servers employing fiber-channel technology for immediate delivery of imaging data. On demand distribution of images and reports to clinicians and researchers is accomplished via a clustered web server. The RIS follows a client-server model and provides tools to order exams, schedule resources, retrieve and review results, and generate management reports. The RIS-hospital information system (HIS) interfaces include admissions, discharges, and transfers (ATDs)/demographics, orders, appointment notifications, doctors update, and results.

A clinic compatible, open source electrophysiology system.

PubMed

Hermiz, John; Rogers, Nick; Kaestner, Erik; Ganji, Mehran; Cleary, Dan; Snider, Joseph; Barba, David; Dayeh, Shadi; Halgren, Eric; Gilja, Vikash

2016-08-01

Open source electrophysiology (ephys) recording systems have several advantages over commercial systems such as customization and affordability enabling more researchers to conduct ephys experiments. Notable open source ephys systems include Open-Ephys, NeuroRighter and more recently Willow, all of which have high channel count (64+), scalability, and advanced software to develop on top of. However, little work has been done to build an open source ephys system that is clinic compatible, particularly in the operating room where acute human electrocorticography (ECoG) research is performed. We developed an affordable (<; $10,000) and open system for research purposes that features power isolation for patient safety, compact and water resistant enclosures and 256 recording channels sampled up to 20ksam/sec, 16-bit. The system was validated by recording ECoG with a high density, thin film device for an acute, awake craniotomy study at UC San Diego, Thornton Hospital Operating Room.

Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews.

PubMed

Mickan, Sharon; Tilson, Julie K; Atherton, Helen; Roberts, Nia Wyn; Heneghan, Carl

2013-10-28

Handheld computers and mobile devices provide instant access to vast amounts and types of useful information for health care professionals. Their reduced size and increased processing speed has led to rapid adoption in health care. Thus, it is important to identify whether handheld computers are actually effective in clinical practice. A scoping review of systematic reviews was designed to provide a quick overview of the documented evidence of effectiveness for health care professionals using handheld computers in their clinical work. A detailed search, sensitive for systematic reviews was applied for Cochrane, Medline, EMBASE, PsycINFO, Allied and Complementary Medicine Database (AMED), Global Health, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. All outcomes that demonstrated effectiveness in clinical practice were included. Classroom learning and patient use of handheld computers were excluded. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A previously published conceptual framework was used as the basis for dual data extraction. Reported outcomes were summarized according to the primary function of the handheld computer. Five systematic reviews met the inclusion and quality criteria. Together, they reviewed 138 unique primary studies. Most reviewed descriptive intervention studies, where physicians, pharmacists, or medical students used personal digital assistants. Effectiveness was demonstrated across four distinct functions of handheld computers: patient documentation, patient care, information seeking, and professional work patterns. Within each of these functions, a range of positive outcomes were reported using both objective and self-report measures. The use of handheld computers improved patient documentation through more complete recording, fewer documentation errors, and increased efficiency. Handheld computers provided easy access to clinical decision support systems and patient management systems, which improved decision making for patient care. Handheld computers saved time and gave earlier access to new information. There were also reports that handheld computers enhanced work patterns and efficiency. This scoping review summarizes the secondary evidence for effectiveness of handheld computers and mhealth. It provides a snapshot of effective use by health care professionals across four key functions. We identified evidence to suggest that handheld computers provide easy and timely access to information and enable accurate and complete documentation. Further, they can give health care professionals instant access to evidence-based decision support and patient management systems to improve clinical decision making. Finally, there is evidence that handheld computers allow health professionals to be more efficient in their work practices. It is anticipated that this evidence will guide clinicians and managers in implementing handheld computers in clinical practice and in designing future research.

Clinical Decision Support Knowledge Management: Strategies for Success.

PubMed

Khalifa, Mohamed; Alswailem, Osama

2015-01-01

Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital.

Integrating cancer genomic data into electronic health records.

PubMed

Warner, Jeremy L; Jain, Sandeep K; Levy, Mia A

2016-10-26

The rise of genomically targeted therapies and immunotherapy has revolutionized the practice of oncology in the last 10-15 years. At the same time, new technologies and the electronic health record (EHR) in particular have permeated the oncology clinic. Initially designed as billing and clinical documentation systems, EHR systems have not anticipated the complexity and variety of genomic information that needs to be reviewed, interpreted, and acted upon on a daily basis. Improved integration of cancer genomic data with EHR systems will help guide clinician decision making, support secondary uses, and ultimately improve patient care within oncology clinics. Some of the key factors relating to the challenge of integrating cancer genomic data into EHRs include: the bioinformatics pipelines that translate raw genomic data into meaningful, actionable results; the role of human curation in the interpretation of variant calls; and the need for consistent standards with regard to genomic and clinical data. Several emerging paradigms for integration are discussed in this review, including: non-standardized efforts between individual institutions and genomic testing laboratories; "middleware" products that portray genomic information, albeit outside of the clinical workflow; and application programming interfaces that have the potential to work within clinical workflow. The critical need for clinical-genomic knowledge bases, which can be independent or integrated into the aforementioned solutions, is also discussed.

Implant retention systems for implant-retained overdentures.

PubMed

Laverty, D P; Green, D; Marrison, D; Addy, L; Thomas, M B M

2017-03-10

Implant retained overdentures are being increasingly utilised in both general and specialist practice to rehabilitate patients with missing teeth, particularly those that are edentate. This article aims to inform the reader of a variety of retention systems that are available to retain an implant overdenture and to understand how these systems work, their advantages and disadvantages and to outline some of the clinical and treatment planning considerations involved in selecting the most appropriate retention system for patients.

Articulatory rehearsal in verbal working memory: a possible neurocognitive endophenotype that differentiates between schizophrenia and schizoaffective disorder.

PubMed

Gruber, Oliver; Gruber, Eva; Falkai, Peter

2006-09-11

Recent fMRI studies have identified brain systems underlying different components of working memory in healthy individuals. The aim of this study was to compare the functional integrity of these neural networks in terms of behavioural performance in patients with schizophrenia, schizoaffective disorder and healthy controls. In order to detect specific working memory deficits based on dysfunctions of underlying brain circuits we used the same verbal and visuospatial Sternberg item-recognition tasks as in previous neuroimaging studies. Clinical and performance data from matched groups consisting of 14 subjects each were statistically analyzed. Schizophrenic patients exhibited pronounced impairments of both verbal and visuospatial working memory, whereas verbal working memory performance was preserved in schizoaffective patients. The findings provide first evidence that dysfunction of a brain system subserving articulatory rehearsal could represent a biological marker which differentiates between schizophrenia and schizoaffective disorder.

Working Memory and Hearing Aid Processing: Literature Findings, Future Directions, and Clinical Applications

PubMed Central

Souza, Pamela; Arehart, Kathryn; Neher, Tobias

2015-01-01

Working memory—the ability to process and store information—has been identified as an important aspect of speech perception in difficult listening environments. Working memory can be envisioned as a limited-capacity system which is engaged when an input signal cannot be readily matched to a stored representation or template. This “mismatch” is expected to occur more frequently when the signal is degraded. Because working memory capacity varies among individuals, those with smaller capacity are expected to demonstrate poorer speech understanding when speech is degraded, such as in background noise. However, it is less clear whether (and how) working memory should influence practical decisions, such as hearing treatment. Here, we consider the relationship between working memory capacity and response to specific hearing aid processing strategies. Three types of signal processing are considered, each of which will alter the acoustic signal: fast-acting wide-dynamic range compression, which smooths the amplitude envelope of the input signal; digital noise reduction, which may inadvertently remove speech signal components as it suppresses noise; and frequency compression, which alters the relationship between spectral peaks. For fast-acting wide-dynamic range compression, a growing body of data suggests that individuals with smaller working memory capacity may be more susceptible to such signal alterations, and may receive greater amplification benefit with “low alteration” processing. While the evidence for a relationship between wide-dynamic range compression and working memory appears robust, the effects of working memory on perceptual response to other forms of hearing aid signal processing are less clear cut. We conclude our review with a discussion of the opportunities (and challenges) in translating information on individual working memory into clinical treatment, including clinically feasible measures of working memory. PMID:26733899

How Can Medical Students Add Value? Identifying Roles, Barriers, and Strategies to Advance the Value of Undergraduate Medical Education to Patient Care and the Health System.

PubMed

Gonzalo, Jed D; Dekhtyar, Michael; Hawkins, Richard E; Wolpaw, Daniel R

2017-09-01

As health systems evolve, the education community is seeking to reimagine student roles that combine learning with meaningful contributions to patient care. The authors sought to identify potential stakeholders regarding the value of student work, and roles and tasks students could perform to add value to the health system, including key barriers and associated strategies to promote value-added roles in undergraduate medical education. In 2016, 32 U.S. medical schools in the American Medical Association's (AMA's) Accelerating Change in Education Consortium met for a two-day national meeting to explore value-added medical education; 121 educators, systems leaders, clinical mentors, AMA staff leadership and advisory board members, and medical students were included. A thematic qualitative analysis of workshop discussions and written responses was performed, which extracted key themes. In current clinical roles, students can enhance value by performing detailed patient histories to identify social determinants of health and care barriers, providing evidence-based medicine contributions at the point-of-care, and undertaking health system research projects. Novel value-added roles include students serving as patient navigators/health coaches, care transition facilitators, population health managers, and quality improvement team extenders. Six priority areas for advancing value-added roles are student engagement, skills, and assessments; balance of service versus learning; resources, logistics, and supervision; productivity/billing pressures; current health systems design and culture; and faculty factors. These findings provide a starting point for collaborative work to positively impact clinical care and medical education through the enhanced integration of value-added medical student roles into care delivery systems.

Using experts feedback in clinical case resolution and arbitration as accuracy diagnosis methodology.

PubMed

Rodríguez-González, Alejandro; Torres-Niño, Javier; Valencia-Garcia, Rafael; Mayer, Miguel A; Alor-Hernandez, Giner

2013-09-01

This paper proposes a new methodology for assessing the efficiency of medical diagnostic systems and clinical decision support systems by using the feedback/opinions of medical experts. The methodology behind this work is based on a comparison between the expert feedback that has helped solve different clinical cases and the expert system that has evaluated these same cases. Once the results are returned, an arbitration process is carried out in order to ensure the correctness of the results provided by both methods. Once this process has been completed, the results are analyzed using Precision, Recall, Accuracy, Specificity and Matthews Correlation Coefficient (MCC) (PRAS-M) metrics. When the methodology is applied, the results obtained from a real diagnostic system allow researchers to establish the accuracy of the system based on objective facts. The methodology returns enough information to analyze the system's behavior for each disease in the knowledge base or across the entire knowledge base. It also returns data on the efficiency of the different assessors involved in the evaluation process, analyzing their behavior in the diagnostic process. The proposed work facilitates the evaluation of medical diagnostic systems, having a reliable process based on objective facts. The methodology presented in this research makes it possible to identify the main characteristics that define a medical diagnostic system and their values, allowing for system improvement. A good example of the results provided by the application of the methodology is shown in this paper. A diagnosis system was evaluated by means of this methodology, yielding positive results (statistically significant) when comparing the system with the assessors that participated in the evaluation process of the system through metrics such as recall (+27.54%) and MCC (+32.19%). These results demonstrate the real applicability of the methodology used. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

Verburg, J; Bortfeld, T

Purpose: We present a new system to perform prompt gamma-ray spectroscopy during proton pencil-beam scanning treatments, which enables in vivo verification of the proton range. This system will be used for the first clinical studies of this technology. Methods: After successful pre-clinical testing of prompt gamma-ray spectroscopy, a full scale system for clinical studies is now being assembled. Prompt gamma-rays will be detected during patient treatment using an array of 8 detector modules arranged behind a tungsten collimator. Each detector module consists of a lanthanum(III) bromide scintillator, a photomultiplier tube, and custom electronics for stable high voltage supply and signalmore » amplification. A new real-time data acquisition and control system samples the signals from the detectors with analog-to-digital converters, analyses events of interest, and communicates with the beam delivery systems. The timing of the detected events was synchronized to the cyclotron radiofrequency and the pencil-beam delivery. Range verification is performed by matching measured energy- and timeresolved gamma-ray spectra to nuclear reaction models based on the clinical treatment plan. Experiments in phantoms were performed using clinical beams in order to assess the performance of the systems. Results: The experiments showed reliable real-time analysis of more than 10 million detector events per second. The individual detector modules acquired accurate energy- and time-resolved gamma-ray measurements at a rate of 1 million events per second, which is typical for beams delivered with a clinical dose rate. The data acquisition system successfully tracked the delivery of the scanned pencil-beams to determine the location of range deviations within the treatment field. Conclusion: A clinical system for proton range verification using prompt gamma-ray spectroscopy has been designed and is being prepared for use during patient treatments. We anticipate to start a first clinical study in the near future. This work was supported by the Federal Share of program income earned by Massachusetts; General Hospital on C06-CA059267, Proton Therapy Research and Treatment Center.« less

Medical student perspective: working toward specific and actionable clinical clerkship feedback.

PubMed

Moss, Haley A; Derman, Peter B; Clement, R Carter

2012-01-01

Feedback on the wards is an important component of medical student education. Medical schools have incorporated formalized feedback mechanisms such as clinical encounter cards and standardized patient encounters into clinical curricula. However, the system could be further improved as medical students frequently feel uncomfortable requesting feedback, and are often dissatisfied with the quality of the feedback they receive. This article explores the shortcomings of the existing medical student feedback system and examines the relevant literature in an effort to shed light on areas in which the system can be enhanced. The discussion focuses on resident-provided feedback but is broadly applicable to delivering feedback in general. A review of the organizational psychology and business administration literature on fostering effective feedback was performed. These insights were then applied to the setting of medical education. Providing effective feedback requires training and forethought. Feedback itself should be specific and actionable. Utilizing these strategies will help medical students and educators get the most out of existing feedback systems.

A Business Case for Tele-Intensive Care Units

PubMed Central

Coustasse, Alberto; Deslich, Stacie; Bailey, Deanna; Hairston, Alesia; Paul, David

2014-01-01

Objectives: A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. Methods: This literature review examined a large number of studies of implementation of tele-ICU systems in hospitals. Results: The evidence supporting cost savings was mixed. Implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality. However, two studies suggested increased hospital cost after implementation of tele-ICUs is initially expensive but eventually results in cost savings and better clinical outcomes. Conclusions: Intensivists working these systems are able to more effectively treat ICU patients, providing better clinical outcomes for patients at lower costs compared with hospitals without a tele-ICU. PMID:25662529

[Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians].

PubMed

Díaz-Portillo, Sandra P; Reyes-Morales, Hortensia; Cuadra-Hernández, Silvia Magali; Idrovo, Álvaro J; Nigenda, Gustavo; Dreser, Anahí

To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity.

PubMed

Sarma, Sisira; Devlin, Rose Anne; Belhadji, Bachir; Thind, Amardeep

2010-12-01

To investigate the impact of the mode of remuneration on the work activities of Canadian family physicians on: (a) direct patient care in office/clinic, (b) direct patient care in other settings and (c) indirect patient care. Because the mode of remuneration is potentially endogenous to the work activities undertaken by family physicians, an instrumental variable estimation procedure is considered. We also account for the fact that the determination of the allocation of time to different activities by physicians may be undertaken simultaneously. To this end, we estimate a system of work activity equations and allow for correlated errors. Our results show that the mode of remuneration has little effect on the total hours worked after accounting for the endogeneity of remuneration schemes; however it does affect the allocation of time to different activities. We find that physicians working in non-fee-for-service remuneration schemes spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings, and more hours on indirect patient care. Canadian family physicians working in non-fee-for-service settings spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings and devote more hours to indirect patient care. The allocation of time in non-fee-for-service practices may have some implications for quality improvement. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

A GPU-accelerated and Monte Carlo-based intensity modulated proton therapy optimization system.

PubMed

Ma, Jiasen; Beltran, Chris; Seum Wan Chan Tseung, Hok; Herman, Michael G

2014-12-01

Conventional spot scanning intensity modulated proton therapy (IMPT) treatment planning systems (TPSs) optimize proton spot weights based on analytical dose calculations. These analytical dose calculations have been shown to have severe limitations in heterogeneous materials. Monte Carlo (MC) methods do not have these limitations; however, MC-based systems have been of limited clinical use due to the large number of beam spots in IMPT and the extremely long calculation time of traditional MC techniques. In this work, the authors present a clinically applicable IMPT TPS that utilizes a very fast MC calculation. An in-house graphics processing unit (GPU)-based MC dose calculation engine was employed to generate the dose influence map for each proton spot. With the MC generated influence map, a modified least-squares optimization method was used to achieve the desired dose volume histograms (DVHs). The intrinsic CT image resolution was adopted for voxelization in simulation and optimization to preserve spatial resolution. The optimizations were computed on a multi-GPU framework to mitigate the memory limitation issues for the large dose influence maps that resulted from maintaining the intrinsic CT resolution. The effects of tail cutoff and starting condition were studied and minimized in this work. For relatively large and complex three-field head and neck cases, i.e., >100,000 spots with a target volume of ∼ 1000 cm(3) and multiple surrounding critical structures, the optimization together with the initial MC dose influence map calculation was done in a clinically viable time frame (less than 30 min) on a GPU cluster consisting of 24 Nvidia GeForce GTX Titan cards. The in-house MC TPS plans were comparable to a commercial TPS plans based on DVH comparisons. A MC-based treatment planning system was developed. The treatment planning can be performed in a clinically viable time frame on a hardware system costing around 45,000 dollars. The fast calculation and optimization make the system easily expandable to robust and multicriteria optimization.

Doctors' use of electronic medical records systems in hospitals: cross sectional survey

PubMed Central

Lærum, Hallvard; Ellingsen, Gunnar; Faxvaag, Arild

2001-01-01

Objectives To compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks. Design Cross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems. Setting 32 hospital units in 19 Norwegian hospitals with electronic medical records systems. Participants 227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems. Main outcome measures Proportion of respondents who used the electronic system, calculated for each of 23 tasks; difference in proportions of users of different systems when functionality of systems was similar. Results Most tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems. Conclusions Doctors used electronic medical records systems for far fewer tasks than the systems supported. What is already known on this topicElectronic information systems in health care have not undergone systematic evaluation, and few comparisons between electronic medical records systems have been madeGiven the information intensive nature of clinical work, electronic medical records systems should be of help to doctors for most clinical tasksWhat this study addsDoctors in Norwegian hospitals reported a low level of use of all electronic medical records systemsThe systems were mainly used for reading patient data, and doctors used the systems for less than half of the tasks for which the systems were functionalAnalyses of actual use of electronic medical records provide more information than user satisfaction or functionality of such records systems PMID:11739222

Preliminary results of miniaturized and robust ultrasound guided diffuse optical tomography system for breast cancer detection

NASA Astrophysics Data System (ADS)

Vavadi, Hamed; Mostafa, Atahar; Li, Jinglong; Zhou, Feifei; Uddin, Shihab; Xu, Chen; Zhu, Quing

2017-02-01

According to the World Health Organization, breast cancer is the most common cancer among women worldwide, claiming the lives of hundreds of thousands of women each year. Near infrared diffuse optical tomography (DOT) has demonstrated a great potential as an adjunct modality for differentiation of malignant and benign breast lesions and for monitoring treatment response of patients with locally advanced breast cancers. The path toward commercialization of DOT techniques depends upon the improvement of robustness and user-friendliness of this technique in hardware and software. In the past, our group have developed three frequency domain prototype systems which were used in several clinical studies. In this study, we introduce our newly under development US-guided DOT system which is being improved in terms of size, robustness and user friendliness by several custom electronic and mechanical design. A new and robust probe designed to reduce preparation time in clinical process. The processing procedure, data selection and user interface software also updated. With all these improvements, our new system is more robust and accurate which is one step closer to commercialization and wide use of this technology in clinical settings. This system is aimed to be used by minimally trained user in the clinical settings with robust performance. The system performance has been tested in the phantom experiment and initial results are demonstrated in this study. We are currently working on finalizing this system and do further testing to validate the performance of this system. We are aiming toward use of this system in clinical setting for patients with breast cancer.

Clinical recommendations of cardiac magnetic resonance, Part II: inflammatory and congenital heart disease, cardiomyopathies and cardiac tumors: a position paper of the working group 'Applicazioni della Risonanza Magnetica' of the Italian Society of Cardiology.

PubMed

Pontone, Gianluca; Di Bella, Gianluca; Silvia, Castelletti; Maestrini, Viviana; Festa, Pierluigi; Ait-Ali, Lamia; Masci, Pier Giorgio; Monti, Lorenzo; di Giovine, Gabriella; De Lazzari, Manuel; Cipriani, Alberto; Guaricci, Andrea I; Dellegrottaglie, Santo; Pepe, Alessia; Marra, Martina Perazzolo; Aquaro, Giovanni D

2017-04-01

The current document was developed by the working group on the 'application of cardiac magnetic resonance' of the Italian Society of Cardiology to provide a perspective on the current state of technical advances and clinical cardiac magnetic resonance applications and to inform cardiologists how to implement their clinical and diagnostic pathway with the introduction of this technique in the clinical practice. Appropriateness criteria were defined using a score system: score 1-3 = inappropriate (test is not generally acceptable and is not a reasonable approach for the indication), score 4-6 = uncertain (test may be generally acceptable and may be a reasonable approach for the indication but more research and/or patient information is needed to classify the indication definitively) and score 7-9 = appropriate (test is generally acceptable and is a reasonable approach for the indication).

Development of an Ontology to Model Medical Errors, Information Needs, and the Clinical Communication Space

PubMed Central

Stetson, Peter D.; McKnight, Lawrence K.; Bakken, Suzanne; Curran, Christine; Kubose, Tate T.; Cimino, James J.

2002-01-01

Medical errors are common, costly and often preventable. Work in understanding the proximal causes of medical errors demonstrates that systems failures predispose to adverse clinical events. Most of these systems failures are due to lack of appropriate information at the appropriate time during the course of clinical care. Problems with clinical communication are common proximal causes of medical errors. We have begun a project designed to measure the impact of wireless computing on medical errors. We report here on our efforts to develop an ontology representing the intersection of medical errors, information needs and the communication space. We will use this ontology to support the collection, storage and interpretation of project data. The ontology’s formal representation of the concepts in this novel domain will help guide the rational deployment of our informatics interventions. A real-life scenario is evaluated using the ontology in order to demonstrate its utility.

Smart Extraction and Analysis System for Clinical Research.

PubMed

Afzal, Muhammad; Hussain, Maqbool; Khan, Wajahat Ali; Ali, Taqdir; Jamshed, Arif; Lee, Sungyoung

2017-05-01

With the increasing use of electronic health records (EHRs), there is a growing need to expand the utilization of EHR data to support clinical research. The key challenge in achieving this goal is the unavailability of smart systems and methods to overcome the issue of data preparation, structuring, and sharing for smooth clinical research. We developed a robust analysis system called the smart extraction and analysis system (SEAS) that consists of two subsystems: (1) the information extraction system (IES), for extracting information from clinical documents, and (2) the survival analysis system (SAS), for a descriptive and predictive analysis to compile the survival statistics and predict the future chance of survivability. The IES subsystem is based on a novel permutation-based pattern recognition method that extracts information from unstructured clinical documents. Similarly, the SAS subsystem is based on a classification and regression tree (CART)-based prediction model for survival analysis. SEAS is evaluated and validated on a real-world case study of head and neck cancer. The overall information extraction accuracy of the system for semistructured text is recorded at 99%, while that for unstructured text is 97%. Furthermore, the automated, unstructured information extraction has reduced the average time spent on manual data entry by 75%, without compromising the accuracy of the system. Moreover, around 88% of patients are found in a terminal or dead state for the highest clinical stage of disease (level IV). Similarly, there is an ∼36% probability of a patient being alive if at least one of the lifestyle risk factors was positive. We presented our work on the development of SEAS to replace costly and time-consuming manual methods with smart automatic extraction of information and survival prediction methods. SEAS has reduced the time and energy of human resources spent unnecessarily on manual tasks.

A novel multiwavelength fluorescence image-guided surgery imaging system

NASA Astrophysics Data System (ADS)

Volpi, D.; Tullis, I. D. C.; Laios, A.; Pathiraja, P. N. J.; Haldar, K.; Ahmed, A. A.; Vojnovic, B.

2014-02-01

We describe the development and performance analysis of two clinical near-infrared fluorescence image-guided surgery (FIGS) devices that aim to overcome some of the limitations of current FIGS systems. The devices operate in a widefield-imaging mode and can work (1) in conjunction with a laparoscope, during minimally invasive surgery, and (2) as a hand-held, open surgery imaging system. In both cases, narrow-band excitation light, delivered at multiple wavelengths, is efficiently combined with white reflectance light. Light is delivered to ~100 cm2 surgical field at 1-2 mW/cm2 for white light and 3-7 mW/cm2 (depending on wavelength) of red - near infrared excitation, at a typical working distance of 350 mm for the hand-held device and 100 mm for the laparoscope. A single, sensitive, miniaturized color camera collects both fluorescence and white reflectance light. The use of a single imager eliminates image alignment and software overlay complexity. A novel filtering and illumination arrangement allows simultaneous detection of white reflectance and fluorescence emission from multiple dyes in real-time. We will present both fluorescence detection sensitivity modeling and practical performance data. We have demonstrated the efficiency and the advantages of the devices both pre-clinically and during live surgery on humans. Both the hand-held and the laparoscopic systems have proved to be reliable and beneficial in an ongoing clinical trial involving sentinel lymph node detection in gynecological cancers. We will show preliminary results using two clinically approved dyes, Methylene blue and indocyanine green. We anticipate that this technology can be integrated and routinely used in a larger variety of surgical procedures.

Meeting the imperative to improve physician well-being: assessment of an innovative program.

PubMed

Dunn, Patrick M; Arnetz, Bengt B; Christensen, John F; Homer, Louis

2007-11-01

Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. From 2000 to 2005, 22-32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk.

NOSTOS: a paper-based ubiquitous computing healthcare environment to support data capture and collaboration.

PubMed

Bång, Magnus; Larsson, Anders; Eriksson, Henrik

2003-01-01

In this paper, we present a new approach to clinical workplace computerization that departs from the window-based user interface paradigm. NOSTOS is an experimental computer-augmented work environment designed to support data capture and teamwork in an emergency room. NOSTOS combines multiple technologies, such as digital pens, walk-up displays, headsets, a smart desk, and sensors to enhance an existing paper-based practice with computer power. The physical interfaces allow clinicians to retain mobile paper-based collaborative routines and still benefit from computer technology. The requirements for the system were elicited from situated workplace studies. We discuss the advantages and disadvantages of augmenting a paper-based clinical work environment.

NOSTOS: A Paper–Based Ubiquitous Computing Healthcare Environment to Support Data Capture and Collaboration

PubMed Central

Bång, Magnus; Larsson, Anders; Eriksson, Henrik

2003-01-01

In this paper, we present a new approach to clinical workplace computerization that departs from the window–based user interface paradigm. NOSTOS is an experimental computer–augmented work environment designed to support data capture and teamwork in an emergency room. NOSTOS combines multiple technologies, such as digital pens, walk–up displays, headsets, a smart desk, and sensors to enhance an existing paper–based practice with computer power. The physical interfaces allow clinicians to retain mobile paper–based collaborative routines and still benefit from computer technology. The requirements for the system were elicited from situated workplace studies. We discuss the advantages and disadvantages of augmenting a paper–based clinical work environment. PMID:14728131

Progress in defining clinically meaningful changes for clinical trials in nonrenal manifestations of SLE disease activity.

PubMed

Choi, Chan-Bum; Liang, Matthew H; Bae, Sang-Cheol

2016-01-06

Since the 2002 Dusseldorf meeting, one new agent, Benlysta, has been approved by the US Food and Drug Administration for systemic lupus erythematosus. Experiences from the field in conducting trials of all the agents tested during this period have provided valuable practical insights. There has been incremental progress in defining the minimal clinically important difference (MCID) of key disease manifestations and the view is largely that of the health care providers and not that of the person suffering the disease. This basic methodological work on the MCID should improve the efficiency and the clinical relevance of future trials and their design.

Regenerative endodontics: barriers and strategies for clinical translation.

PubMed

Mao, Jeremy J; Kim, Sahng G; Zhou, Jian; Ye, Ling; Cho, Shoko; Suzuki, Takahiro; Fu, Susan Y; Yang, Rujing; Zhou, Xuedong

2012-07-01

Regenerative endodontics has encountered substantial challenges toward clinical translation. The adoption by the American Dental Association of evoked pulp bleeding in immature permanent teeth is an important step for regenerative endodontics. However, there is no regenerative therapy for most endodontic diseases. Simple recapitulation of cell therapy and tissue engineering strategies that are under development for other organ systems has not led to clinical translation in regeneration endodontics. Recent work using novel biomaterial scaffolds and growth factors that orchestrate the homing of host endogenous cells represents a departure from traditional cell transplantation approaches and may accelerate clinical translation. Copyright © 2012 Elsevier Inc. All rights reserved.

Using Fast Healthcare Interoperability Resources (FHIR) for the Integration of Risk Minimization Systems in Hospitals.

PubMed

Saleh, Kutaiba; Stucke, Stephan; Uciteli, Alexandr; Faulbrück-Röhr, Sebastian; Neumann, Juliane; Tahar, Kais; Ammon, Danny; Schmidt, Tobias; Neumuth, Thomas; Besting, Andreas; Portheine, Frank; Herre, Heinrich; Kaeding, André; Specht, Martin

2017-01-01

With the growing strain of medical staff and complexity of patient care, the risk of medical errors increases. In this work we present the use of Fast Healthcare Interoperability Resources (FHIR) as communication standard for the integration of an ontology- and agent-based system to identify risks across medical processes in a clinical environment.

Computers working for medicine

PubMed Central

Richmond, Gillian

1985-01-01

1 A demonstration of the use of Viewdata Systems in clinical trials is presented. 2 The potential of these systems in several areas of medicine is shown and related to their speed of development in the last 2 years. 3 Particular reference is made to the use of computers in the assessment of patients with affective disorders. ImagesFigure 1Figure 2 PMID:3994904

The non specialist paediatric training registrar in the healthcare system.

PubMed

O'Neill, M B; Kumar, A

2012-01-01

This study evaluated the experiences of non Specialist Paediatric Training Registrars (nonSPTR) in the Irish Healthcare system. The survey explored their adaptation to the healthcare system, skill development, perceptions of training and career development inclusive of working conditions. Thirty nine (53%) doctors responded. The time spent in Paediatrics ranged from 3 to 19 years with a mean of 8.9 years. Nineteen (49%) had only worked in non regional hospitals and for 20 (51%) the mean time spent in regional hospitals was 2.6 years. The very positives experiences (likert scores 5/6) included journal appraisal for 19 (49%), clinical skill development for 17 (44%) and consultant feedback for 11 (28%).The very negative experiences were difficulty obtaining desired clinical posts for 16 (43%) doctors and only 5 (13%) were happy with their career progression. Thirty one (79.5%) cited specific barriers to career progression, with only 10 (25%) making an application to the Specialist Paediatrics Registrar (SPR) training programme. Solutions for the non SPTR difficulties include the expansion of the SPR programme and the utilization of a criterion based portfolio system to integrate the nonSPTR into formal training.

A multiscale modeling approach to inflammation: A case study in human endotoxemia

NASA Astrophysics Data System (ADS)

Scheff, Jeremy D.; Mavroudis, Panteleimon D.; Foteinou, Panagiota T.; An, Gary; Calvano, Steve E.; Doyle, John; Dick, Thomas E.; Lowry, Stephen F.; Vodovotz, Yoram; Androulakis, Ioannis P.

2013-07-01

Inflammation is a critical component in the body's response to injury. A dysregulated inflammatory response, in which either the injury is not repaired or the inflammatory response does not appropriately self-regulate and end, is associated with a wide range of inflammatory diseases such as sepsis. Clinical management of sepsis is a significant problem, but progress in this area has been slow. This may be due to the inherent nonlinearities and complexities in the interacting multiscale pathways that are activated in response to systemic inflammation, motivating the application of systems biology techniques to better understand the inflammatory response. Here, we review our past work on a multiscale modeling approach applied to human endotoxemia, a model of systemic inflammation, consisting of a system of compartmentalized differential equations operating at different time scales and through a discrete model linking inflammatory mediators with changing patterns in the beating of the heart, which has been correlated with outcome and severity of inflammatory disease despite unclear mechanistic underpinnings. Working towards unraveling the relationship between inflammation and heart rate variability (HRV) may enable greater understanding of clinical observations as well as novel therapeutic targets.

A framework for evaluating the appropriateness of clinical decision support alerts and responses

PubMed Central

Waitman, Lemuel R; Lewis, Julia B; Wright, Julie A; Choma, David P; Miller, Randolph A; Peterson, Josh F

2011-01-01

Objective Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the need for better evaluation to inform future designs. The authors present a comprehensive framework for evaluating the clinical appropriateness of synchronous, interruptive medication safety alerts. Methods Through literature review and iterative testing, metrics were developed that describe successes, justifiable overrides, provider non-adherence, and unintended adverse consequences of clinical decision support alerts. The framework was validated by applying it to a medication alerting system for patients with acute kidney injury (AKI). Results Through expert review, the framework assesses each alert episode for appropriateness of the alert display and the necessity and urgency of a clinical response. Primary outcomes of the framework include the false positive alert rate, alert override rate, provider non-adherence rate, and rate of provider response appropriateness. Application of the framework to evaluate an existing AKI medication alerting system provided a more complete understanding of the process outcomes measured in the AKI medication alerting system. The authors confirmed that previous alerts and provider responses were most often appropriate. Conclusion The new evaluation model offers a potentially effective method for assessing the clinical appropriateness of synchronous interruptive medication alerts prior to evaluating patient outcomes in a comparative trial. More work can determine the generalizability of the framework for use in other settings and other alert types. PMID:21849334

A Statewide Approach to Health Care Personnel Maldistribution—The California Area Health Education Center System

PubMed Central

Crowder, John E.; Schnepper, James E.; Gessert, Charles

1984-01-01

An Area Health Education Center (AHEC) system has been established in California to address the maldistribution of physicians and other health care professionals. The AHEC program uses educational incentives to recruit and retain health care personnel in underserved areas by linking the academic resources of university health science centers with local educational and clinical facilities. The medical schools, working in partnership with urban or rural AHECs throughout the state, are implementing educational programs to attract trainees and licensed professionals to work in underserved communities. The California AHEC project entered its fifth year in October of 1983 with the participation of all eight medical schools and the Charles Drew Postgraduate School of Medicine, 35 other health professions schools, 17 independent AHECs and more than 400 clinical training sites. Educational programs are reaching more than 22,000 students and practicing health professionals throughout California. We review the current status of the California AHEC system and use the AHEC programs at Loma Linda University to illustrate the effect this intervention is having. PMID:6730500

GELLO: an object-oriented query and expression language for clinical decision support.

PubMed

Sordo, Margarita; Ogunyemi, Omolola; Boxwala, Aziz A; Greenes, Robert A

2003-01-01

GELLO is a purpose-specific, object-oriented (OO) query and expression language. GELLO is the result of a concerted effort of the Decision Systems Group (DSG) working with the HL7 Clinical Decision Support Technical Committee (CDSTC) to provide the HL7 community with a common format for data encoding and manipulation. GELLO will soon be submitted for ballot to the HL7 CDSTC for consideration as a standard.

Design Recommendations for Pharmacogenomics Clinical Decision Support Systems

PubMed Central

Khelifi, Maher; Tarczy-Hornoch, Peter; Devine, Emily B.; Pratt, Wanda

2017-01-01

The use of pharmacogenomics (PGx) in clinical practice still faces challenges to fully adopt genetic information in targeting drug therapy. To incorporate genetics into clinical practice, many support the use of Pharmacogenomics Clinical Decision Support Systems (PGx-CDS) for medication prescriptions. This support was fueled by new guidelines to incorporate genetics for optimizing drug dosage and reducing adverse events. In addition, the complexity of PGx led to exploring CDS outside the paradigm of the basic CDS tools embedded in commercial electronic health records. Therefore, designing the right CDS is key to unleashing the full potential of pharmacogenomics and making it a part of clinicians’ daily workflow. In this work, we 1) identify challenges and barriers of the implementation of PGx-CDS in clinical settings, 2) develop a new design approach to CDS with functional characteristics that can improve the adoption of pharmacogenomics guidelines and thus patient safety, and 3) create design guidelines and recommendations for such PGx-CDS tools. PMID:28815136

Roadmap to a Comprehensive Clinical Data Warehouse for Precision Medicine Applications in Oncology

PubMed Central

Foran, David J; Chen, Wenjin; Chu, Huiqi; Sadimin, Evita; Loh, Doreen; Riedlinger, Gregory; Goodell, Lauri A; Ganesan, Shridar; Hirshfield, Kim; Rodriguez, Lorna; DiPaola, Robert S

2017-01-01

Leading institutions throughout the country have established Precision Medicine programs to support personalized treatment of patients. A cornerstone for these programs is the establishment of enterprise-wide Clinical Data Warehouses. Working shoulder-to-shoulder, a team of physicians, systems biologists, engineers, and scientists at Rutgers Cancer Institute of New Jersey have designed, developed, and implemented the Warehouse with information originating from data sources, including Electronic Medical Records, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology and Pathology archives, and Next Generation Sequencing services. Innovative solutions were implemented to detect and extract unstructured clinical information that was embedded in paper/text documents, including synoptic pathology reports. Supporting important precision medicine use cases, the growing Warehouse enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information of patient tumors individually or as part of large cohorts to identify changes and patterns that may influence treatment decisions and potential outcomes. PMID:28469389

Current neurosurgical trainees' perception of the European Working Time Directive and shift work.

PubMed

Tait, M J; Fellows, G A; Pushpananthan, S; Sergides, Y; Papadopoulos, M C; Bell, B A

2008-02-01

The introduction of the shift system in response to the European Working Time Directive has had an enormous impact on the running of neurosurgical units in the UK. This study seeks to establish what provisions are currently in place for out of hours cover and what has been the effect of the introduction of shifts in three main areas: patient safety, training and 'work/life balance'. The on-call registrar at each UK neurosurgical unit was contacted by telephone. Data regarding current emergency provision were sought. Registrars who had worked both on-calls and the shift system during their career as a neurosurgical registrar were asked to make a comparison. Data were collected from all 33 UK units. Twenty-two still use a traditional 24-h on-call system. Twenty-one on-call rotas were classed as non-resident although 12/21 of those officially on non-resident rotas were in fact resident whilst on call. Twenty-two registrars had worked both systems as a neurosurgical registrar. Twenty-one (95.45%) felt that traditional on-calls gave better clinical exposure. Twenty-one (95.45%) felt that on-calls allowed the provision of better patient care. Nineteen (86.36%) felt that on-calls were safer. Thirteen (59.09%) reported that they were more tired when doing shift work than on-calls. Fourteen (63.63%) found that the on-call system gives more useful spare time and more time to deal with family commitments. Current neurosurgery registrars feel the shift system is less safe, harmful to training and worse in terms of work/life balance. More than one-third of units are claiming to have non-resident on-call systems in order to appear compliant with EWTD when registrars are in fact resident.

[TDM management system for contribution to proper use of anti-mRSA drugs--establishment of cooperation support system between pharmacy and clinical laboratory in hospital].

PubMed

Yodoshi, Masahiro; Iwasaki, Naomi; Satoh, Kaori; Nomura, Morihiro; Morishima, Yoshiyuki; Nakae, Kenichi; Yamazoe, Yuzuru

2013-02-01

In team medicine, highly specialized pharmacists have recently been in demand. As one of the specialties, there is therapeutic drug monitoring (TDM). It is important for the optimal dosing of a wide range of drugs. In our hospital, a TDM service was started in 1987 at the clinical laboratory. A clinical laboratory technologist with the license of a pharmacist has performed administration plans for anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs, vancomycin, teicoplanin, and arbekacin. In particular, the pharmacist in charge of TDM services, a TDM-specialized pharmacist, plays a central role in administration plans for anti MRSA drugs. Furthermore, we examined the active use of the TDM service to expand pharmaceutical care. Therefore, at first, we have worked in partnership with the clinical laboratory, as it is called the "Cooperation Support System", since September 2010. As a result, after the introduction of this system, from August 2011 to July 2012, the rate that the doctor referred to the administration plan was markedly improved by approximately 90%. We have been able to enhance TDM in practical training for pharmacology as an extension of this system. We thought that drug therapy can be performed more appropriately by increasing the number of executions of TDM in the future. For drug therapy to be done more appropriately, efforts made through cooperation with the clinical laboratory are essential for an effective TDM system. Naturally, an effective TDM process requires a collaborative, multidisciplinary approach with input from doctors, nurses, and clinical pharmacists.

Investigation of image components affecting the detection of lung nodules in digital chest radiography

NASA Astrophysics Data System (ADS)

Bath, Magnus; Hakansson, Markus; Borjesson, Sara; Hoeschen, Christoph; Tischenko, Oleg; Bochud, Francois O.; Verdun, Francis R.; Ullman, Gustaf; Kheddache, Susanne; Tingberg, Anders; Mansson, Lars Gunnar

2005-04-01

The aim of this work was to investigate and quantify the effects of system noise, nodule location, anatomical noise and anatomical background on the detection of lung nodules in different regions of the chest x-ray. Simulated lung nodules of diameter 10 mm but with varying detail contrast were randomly positioned in four different kinds of images: 1) clinical images collected with a 200 speed CR system, 2) images containing only system noise (including quantum noise) at the same level as the clinical images, 3) clinical images with removed anatomical noise, 4) artificial images with similar power spectrum as the clinical images but random phase spectrum. An ROC study was conducted with 5 observers. The detail contrast needed to obtain an Az of 0.80, C0.8, was used as measure of detectability. Five different regions of the chest x-ray were investigated separately. The C0.8 of the system noise images ranged from only 2% (the hilar regions) to 20% (the lateral pulmonary regions) of those of the clinical images. Compared with the original clinical images, the C0.8 was 16% lower for the de-noised clinical images and 71% higher for the random phase images, respectively, averaged over all five regions. In conclusion, regarding the detection of lung nodules with a diameter of 10 mm, the system noise is of minor importance at clinically relevant dose levels. The removal of anatomical noise and other noise sources uncorrelated from image to image leads to somewhat better detection, but the major component disturbing the detection is the overlapping of recognizable structures, which are, however, the main aspect of an x-ray image.

[Implementation of the new clinical practice training model in Andalusia: a qualitative evaluation of the Nursing and Physiotherapy degrees].

PubMed

Fernández-Sola, Cayetano; Granero-Molina, José; Márquez-Membrive, Josefa; Aguilera-Manrique, Gabriel; Castro-Sánchez, Adelaida M

2014-01-01

The design of new Bachelor degree courses, together with the agreement reached between the Regional Government of Andalusia and Andalusian universities shape the new clinical training model for Health Science students. The aim of this project is to present a qualitative evaluation of the implementation of the new model in Nursing and Physiotherapy degrees at the University of Almeria and the Andalusian Public Health System. An exploratory qualitative study using document content analysis techniques, by analyzing 12 reports from teachers and those responsible for Practicum in Nursing and Physiotherapy degrees at the University of Almeria. The reports included opinions and proposals from university and clinical placement teachers, healthcare professionals or clinical placement tutors, students, and those in positions of responsibility as regards clinical placements. Three categories emerged in the data analysis: Health system organization, with sub-categories of disparity between shifts, difficulties with supervisor coordination, feelings of a lack of control, disparities in evaluation criteria and geographic distribution; academic organization, with sub-categories of short rotations, a lack of information received by the clinical placement tutor, and carrying out placements without studying the theory; and management of the work agreement, with sub-categories of being discouraged by what is received in return, extra work for those in charge, and delays in evaluations. The study suggests a need to support and guide clinical tutors, to increase coordination between the university and health services, to organize the students' theoretical and practical training and to provide the management of the model with flexibility and transparency. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Traceable working standards with SI units of radiance for characterizing the measurement performance of investigational clinical NIRF imaging devices

NASA Astrophysics Data System (ADS)

Zhu, Banghe; Rasmussen, John C.; Litorja, Maritoni; Sevick-Muraca, Eva M.

2017-03-01

All medical devices for Food and Drug market approval require specifications of performance based upon International System of Units (SI) or units derived from SI for reasons of traceability. Recently, near-infrared fluorescence (NIRF) imaging devices of a variety of designs have emerged on the market and in investigational clinical studies. Yet the design of devices used in the clinical studies vary widely, suggesting variable device performance. Device performance depends upon optimal excitation of NIRF imaging agents, rejection of backscattered excitation and ambient light, and selective collection of fluorescence emanating from the fluorophore. There remains no traceable working standards with SI units of radiance to enable prediction that a given molecular imaging agent can be detected in humans by a given NIRF imaging device. Furthermore, as technologies evolve and as NIRF imaging device components change, there remains no standardized means to track device improvements over time and establish clinical performance without involving clinical trials, often costly. In this study, we deployed a methodology to calibrate luminescent radiance of a stable, solid phantom in SI units of mW/cm2/sr for characterizing the measurement performance of ICCD and IsCMOS camera based NIRF imaging devices, such as signal-to-noise ratio (SNR) and contrast. The methodology allowed determination of superior SNR of the ICCD over the IsCMOS system; comparable contrast of ICCD and IsCMOS depending upon binning strategies.

Versatile clinical information system design for emergency departments.

PubMed

Amouh, Teh; Gemo, Monica; Macq, Benoît; Vanderdonckt, Jean; El Gariani, Abdul Wahed; Reynaert, Marc S; Stamatakis, Lambert; Thys, Frédéric

2005-06-01

Compared to other hospital units, the emergency department presents some distinguishing characteristics of its own. Emergency health-care delivery is a collaborative process involving the contribution of several individuals who accomplish their tasks while working autonomously under pressure and sometimes with limited resources. Effective computerization of the emergency department information system presents a real challenge due to the complexity of the scenario. Current computerized support suffers from several problems, including inadequate data models, clumsy user interfaces, and poor integration with other clinical information systems. To tackle such complexity, we propose an approach combining three points of view, namely the transactions (in and out of the department), the (mono and multi) user interfaces and data management. Unlike current systems, we pay particular attention to the user-friendliness and versatility of our system. This means that intuitive user interfaces have been conceived and specific software modeling methodologies have been applied to provide our system with the flexibility and adaptability necessary for the individual and group coordinated tasks. Our approach has been implemented by prototyping a web-based, multiplatform, multiuser, and versatile clinical information system built upon multitier software architecture, using the Java programming language.

Automation in drug inventory management saves personnel time and budget.

PubMed

Awaya, Toshio; Ohtaki, Ko-ichi; Yamada, Takehiro; Yamamoto, Kuniko; Miyoshi, Toshiyuki; Itagaki, Yu-ichi; Tasaki, Yoshikazu; Hayase, Nobumasa; Matsubara, Kazuo

2005-05-01

Automation in the drug distribution processes is helpful to pharmacists in creating new clinical services. We have ameliorated the drug inventory control system seamlessly connected with the physician order-entry system. This control system application, named Artima, allows inventory functions to be faster and more efficient in real time. The medicines used in our hospital are automatically fixed and arranged to sold-packages, and are ordered from each wholesaler by a fax-modem every day. Artima can search the lot number and expiration date of drug in the purchase and delivery records. These functions are powerful and useful in patient's safety and cost containment. We surveyed the inventory amount stored in the computer database, and evaluated time required for inventory management by tabulating working records of employees during past decades. Inventory decreased by 70% along with the continuous improvement of the system during the past decade. The workload in the inventory management in each section of the Pharmacy Department as well as in clinical units was dramatically reduced after the implementation of this system. The automation system in the drug inventory management allows creating new clinical positions for pharmacists. This system also could pay for itself in time.

Bioengineering Spin-Offs from Dynamical Systems Theory

NASA Astrophysics Data System (ADS)

Collins, J. J.

1997-03-01

Recently, there has been considerable interest in applying concepts and techniques from dynamical systems and statistical physics to physiological systems. In this talk, we present work dealing which two active topics in this area: stochastic resonance and (2) chaos control. Stochastic resonance is a phenomenon wherein the response of nonlinear system to a weak input signal is optimally enhanced by the presence of a particular level of noise. Here we demonstrate that noise-based techniques can be used to lower sensory detection thresholds in humans. We discuss how from a bioengineering and clinical standpoint, these developments may be particularly relevant for individuals with elevated sensory thresholds, such as older adults and patients with peripheral neuropathy. Chaos control techniques have been applied to a wide range of experimental systems, including biological preparations. The application of chaos control to biological systems has led to speculations that these methods may be clinically useful. Here we demonstrate that the principles of chaos control can be utilized to stabilize underlying unstable periodic orbits in non-chaotic biological systems. We discuss how from a bioengineering and clinical standpoint, these developments may be important for suppressing or eliminating certain types of cardiac arrhythmias.

Development of a computer-based clinical decision support tool for selecting appropriate rehabilitation interventions for injured workers.

PubMed

Gross, Douglas P; Zhang, Jing; Steenstra, Ivan; Barnsley, Susan; Haws, Calvin; Amell, Tyler; McIntosh, Greg; Cooper, Juliette; Zaiane, Osmar

2013-12-01

To develop a classification algorithm and accompanying computer-based clinical decision support tool to help categorize injured workers toward optimal rehabilitation interventions based on unique worker characteristics. Population-based historical cohort design. Data were extracted from a Canadian provincial workers' compensation database on all claimants undergoing work assessment between December 2009 and January 2011. Data were available on: (1) numerous personal, clinical, occupational, and social variables; (2) type of rehabilitation undertaken; and (3) outcomes following rehabilitation (receiving time loss benefits or undergoing repeat programs). Machine learning, concerned with the design of algorithms to discriminate between classes based on empirical data, was the foundation of our approach to build a classification system with multiple independent and dependent variables. The population included 8,611 unique claimants. Subjects were predominantly employed (85 %) males (64 %) with diagnoses of sprain/strain (44 %). Baseline clinician classification accuracy was high (ROC = 0.86) for selecting programs that lead to successful return-to-work. Classification performance for machine learning techniques outperformed the clinician baseline classification (ROC = 0.94). The final classifiers were multifactorial and included the variables: injury duration, occupation, job attachment status, work status, modified work availability, pain intensity rating, self-rated occupational disability, and 9 items from the SF-36 Health Survey. The use of machine learning classification techniques appears to have resulted in classification performance better than clinician decision-making. The final algorithm has been integrated into a computer-based clinical decision support tool that requires additional validation in a clinical sample.

Assessing an AI knowledge-base for asymptomatic liver diseases.

PubMed

Babic, A; Mathiesen, U; Hedin, K; Bodemar, G; Wigertz, O

1998-01-01

Discovering not yet seen knowledge from clinical data is of importance in the field of asymptomatic liver diseases. Avoidance of liver biopsy which is used as the ultimate confirmation of diagnosis by making the decision based on relevant laboratory findings only, would be considered an essential support. The system based on Quinlan's ID3 algorithm was simple and efficient in extracting the sought knowledge. Basic principles of applying the AI systems are therefore described and complemented with medical evaluation. Some of the diagnostic rules were found to be useful as decision algorithms i.e. they could be directly applied in clinical work and made a part of the knowledge-base of the Liver Guide, an automated decision support system.

Nose-to-brain drug delivery: An update on clinical challenges and progress towards approval of anti-Alzheimer drugs.

PubMed

Agrawal, Mukta; Saraf, Swarnlata; Saraf, Shailendra; Antimisiaris, Sophia G; Chougule, Mahavir Bhupal; Shoyele, Sunday A; Alexander, Amit

2018-07-10

According to the Alzheimer Association Report (2017), Alzheimer's disease (AD) is the 6th primary cause of death in the USA, which affects nearly 5.5 million people. In the year 2017 itself, the cost of AD treatment in the USA has been reported to rise to $259 billion. This statistic shows the severity of the disease in the USA which is very much similar across the globe. On the other hand, the treatment remains limited to a few conventional oral medications (approved by FDA). These are mainly acting superficially from mild to the moderate AD. The therapeutic efficacy of the drug is not only affected by its reduced concentration in the brain owing to the existence of blood-brain-barrier (BBB) but also due to its low brain permeability. In this context, the intranasal (IN) route of drug administration has emerged as an alternative route over the systemic (oral and parenteral) drug delivery to the brain. The delivery of the drug via an IN route offers various advantages over systemic drug delivery system, as it directly delivers the drug into the brain via olfactory route. Presence of drug in the olfactory bulb, in turn, increases the drug bioavailability in the brain and reduces the drug degradation as well as wastage of the drug through` systemic clearance. However, there is also some limitation associated with IN like poor drug permeation through the nasal mucosa and mucociliary clearance. The delivery system various through novel strategies (nano drug carrier system, colloidal carriers, mucoadhesive devices, controlled delivery system, pro-drug, etc.) are adapted to overcome the above-stated limitations. Although, after all, such successful research claims, very few of the nose-to-brain drug delivery of anti-AD drugs have gained market approval due to lack of sufficient clinical evidence. Onzetra Xsail® is one such marketed preparations approved for IN delivery used for the treatment of a brain disorder; migraine. In the field of patents also, no work is found which could present sufficient experimental findings to support its clinical safety profile. It also underlines the fact that majority of work related to the nose-to-brain delivery of anti-AD drugs is limited only up to preclinical studies. In this review article, we have discussed the latest works on various novel formulations loaded with various anti-Alzheimer agents. These agents include galantamine, deferoxamine, tacrine, tarenflurbil, rivastigmine, risperidone, curcumin, quercetin, piperine, insulin, etc. and various peptides towards the development of a promising IN drug delivery system for the treatment of AD. Through this review article, we want to drag the attention of the researchers working in this field towards the challenges and hurdles of practical applicability IN delivery of anti-AD drugs. Moreover, the attention towards the clinical studies will ease the approval process for the administration of anti-Alzheimer drugs via IN route. Copyright © 2018 Elsevier B.V. All rights reserved.

Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis.

PubMed

Kelley, B P; Patel, S C; Marin, H L; Corrigan, J J; Mitsias, P D; Griffith, B

2017-06-01

Autoimmune encephalitis is a relatively new category of immune-mediated disease involving the central nervous system that demonstrates a widely variable spectrum of clinical presentations, ranging from the relatively mild or insidious onset of cognitive impairment to more complex forms of encephalopathy with refractory seizure. Due to its diverse clinical features, which can mimic a variety of other pathologic processes, autoimmune encephalitis presents a diagnostic challenge to clinicians. Imaging findings in patients with these disorders can also be quite variable, but recognizing characteristic findings within limbic structures suggestive of autoimmune encephalitis can be a key step in alerting clinicians to the potential diagnosis and ensuring a prompt and appropriate clinical work-up. In this article, we review antibody-mediated encephalitis and its various subtypes with a specific emphasis on the role of neuroimaging in the diagnostic work-up. © 2017 by American Journal of Neuroradiology.

Electronic SSKIN pathway: reducing device-related pressure ulcers.

PubMed

Campbell, Natalie

2016-08-11

This article describes how an interprofessional project in a London NHS Foundation Trust was undertaken to develop an intranet-based medical device-related pressure ulcer prevention and management pathway for clinical staff working across an adult critical care directorate, where life-threatening events require interventions using medical devices. The aim of this project was to improve working policies and processes to define key prevention strategies and provide clinicians with a clear, standardised approach to risk and skin assessment, equipment use, documentation and reporting clinical data using the Trust's CareVue (electronic medical records), Datix (incident reporting and risk-management tool) and eTRACE (online clinical protocol ordering) systems. The process included the development, trial and local implementation of the pathway using collaborative teamwork and the SSKIN care bundle tool. The experience of identifying issues, overcoming challenges, defining best practice and cascading SSKIN awareness training is shared.

Transfer learning for diabetic retinopathy

NASA Astrophysics Data System (ADS)

Benson, Jeremy; Carrillo, Hector; Wigdahl, Jeff; Nemeth, Sheila; Maynard, John; Zamora, Gilberto; Barriga, Simon; Estrada, Trilce; Soliz, Peter

2018-03-01

Diabetic Retinopathy (DR)1, 2 is a leading cause of blindness worldwide and is estimated to threaten the vision of nearly 200 million by 2030.3 To work with the ever-increasing population, the use of image processing algorithms to screen for those at risk has been on the rise. Research-oriented solutions have proven effective in classifying images with or without DR, but often fail to address the true need of the clinic - referring only those who need to be seen by a specialist, and reading every single case. In this work, we leverage an array of image pre-preprocessing techniques, as well as Transfer Learning to re-purpose an existing deep network for our tasks in DR. We train, test, and validate our system on 979 clinical cases, achieving a 95% Area Under the Curve (AUC) for referring Severe DR with an equal error Sensitivity and Specificity of 90%. Our system does not reject any images based on their quality, and is agnostic in terms of eye side and field. These results show that general purpose classifiers can, with the right type of input, have a major impact in clinical environments or for teams lacking access to large volumes of data or high-throughput supercomputers.

[Introduction of a quality management system compliant with DIN EN 9001:2000 in a university department of nuclear medicine].

PubMed

Jansen-Schmidt, V; Paschen, U; Kröger, S; Bohuslavizki, K H; Clausen, M

2001-12-01

In 1995, the management of the University Clinic Hamburg-Eppendorf proposed to establish a total quality assurance (QA) system. A revised QA-system has been introduced stepwise in the department of nuclear medicine since 1997, and certification was achieved in accordance with DIN EN ISO 9001:2000 on February 14, 2001. The QA-handbook is divided into two parts. The first part contains operational (diagnostic and therapeutic) procedures in so-called standard operating procedures (SOP). They describe the indication of procedures as well as the competences and time necessary in a standardized manner. Up to now, more than 70 SOPs have been written as a collaborative approach between technicians and physicians during daily clinical routine after analysing and discussing the procedures. Thus, the results were more clearly defined processes and more satisfied employees. The second part consists of general rules and directions concerning the security of work and equipment as well as radiation protection tasks, hygiene etc. as it is required by the law. This part was written predominantly by the management of the department of nuclear-medicine and the QA-coordinator. Detailed information for the patients, documentation of the work-flows as well as the medical report was adopted to the QM-system. Although in the introduction phase of a QA-system a vast amount of time is necessary, some months later a surplus for the clinical workday will become available. The well defined relations of competences and procedures will result in a gain of time, a reduction of costs and a help to ensure the legal demands. Last but not least, the QA-system simply helps to build up confidence and acceptance both by the patients and the referring physicians.

Impact of data governance on a nation's healthcare system building blocks.

PubMed

Hovenga, Evelyn J S

2013-01-01

This chapter gives an overview of a nation's healthcare system, particularly for those who are familiar with IT but not healthcare or for those working in one area of healthcare who may not be familiar with the system and data requirements across the care continuum. The structure of this chapter uses the World Health Organisation's (WHO) Health systems framework with a focus on the need for data and information governance to achieve a sustainable health system delivering improved health for all, responsively and equitably meeting genuine demands for health services, with social and financial risk protection and overall improved efficiency. It is argued that there is a need to gather the right data and to process these data in a manner that provides good information in order to more fully understand how the health system is working and where and when it isn't working well. This needs to be achieved in the most cost effective manner that doesn't detract from the allocation of resources to healthcare or the clinical workflow required to achieve quality healthcare.

[Hygienic evaluation of risk factors on powder metallurgy production].

PubMed

2011-01-01

Complex hygienic, clinical, sociologic and epidemiologic studies revealed reliable relationship between work conditions and arterial hypertension, locomotory system disorders, monocytosis in powder metallurgy production workers. Findings are more probable cardiovascular and respiratory diseases, digestive tract diseases due to influence of lifestyle factors.

Recommendations for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration

PubMed Central

Bossuyt, V.; Provenzano, E.; Symmans, W. F.; Boughey, J. C.; Coles, C.; Curigliano, G.; Dixon, J. M.; Esserman, L. J.; Fastner, G.; Kuehn, T.; Peintinger, F.; von Minckwitz, G.; White, J.; Yang, W.; Badve, S.; Denkert, C.; MacGrogan, G.; Penault-Llorca, F.; Viale, G.; Cameron, D.; Earl, Helena; Alba, Emilio; Lluch, Ana; Albanell, Joan; Amos, Keith; Biernat, Wojciech; Bonnefoi, Hervé; Buzdar, Aman; Cane, Paul; Pinder, Sarah; Carson, Lesley; Dickson-Witmer, Diana; Gong, Gyungyub; Green, Jimmy; Hsu, Chih-Yi; Tseng, Ling-Ming; Kroep, Judith; Leitch, A. Marilyn; Sarode, Venetia; Mamounas, Eleftherios; Marcom, Paul Kelly; Nuciforo, Paolo; Paik, Soonmyung; Peg, Vicente; Peston, David; Pierga, Jean-Yves; Quintela-Fandino, Miguel; Salgado, Roberto; Sikov, William; Thomas, Jeremy; Unzeitig, Gary; Wesseling, Jelle

2015-01-01

Neoadjuvant systemic therapy (NAST) provides the unique opportunity to assess response to treatment after months rather than years of follow-up. However, significant variability exists in methods of pathologic assessment of response to NAST, and thus its interpretation for subsequent clinical decisions. Our international multidisciplinary working group was convened by the Breast International Group-North American Breast Cancer Group (BIG-NABCG) collaboration and tasked to recommend practical methods for standardized evaluation of the post-NAST surgical breast cancer specimen for clinical trials that promote accurate and reliable designation of pathologic complete response (pCR) and meaningful characterization of residual disease. Recommendations include multidisciplinary communication; clinical marking of the tumor site (clips); and radiologic, photographic, or pictorial imaging of the sliced specimen, to map the tissue sections and reconcile macroscopic and microscopic findings. The information required to define pCR (ypT0/is ypN0 or ypT0 yp N0), residual ypT and ypN stage using the current AJCC/UICC system, and the Residual Cancer Burden system were recommended for quantification of residual disease in clinical trials. PMID:26019189

Robotic ICSI (intracytoplasmic sperm injection).

PubMed

Lu, Zhe; Zhang, Xuping; Leung, Clement; Esfandiari, Navid; Casper, Robert F; Sun, Yu

2011-07-01

This paper is the first report of robotic intracytoplasmic sperm injection (ICSI). ICSI is a clinical procedure performed worldwide in fertility clinics, requiring pick-up of a single sperm and insertion of it into an oocyte (i.e., egg cell). Since its invention 20 years ago, ICSI has been conducted manually by a handful of highly skilled embryologists; however, success rates vary significantly among clinics due to poor reproducibility and inconsistency across operators. We leverage our work in robotic cell injection to realize robotic ICSI and aim ultimately, to standardize how clinical ICSI is performed. This paper presents some of the technical aspects of our robotic ICSI system, including a cell holding device, motion control, and computer vision algorithms. The system performs visual tracking of single sperm, robotic immobilization of sperm, aspiration of sperm with picoliter volume, and insertion of sperm into an oocyte with a high degree of reproducibility. The system requires minimal human involvement (requiring only a few computer mouse clicks), and is human operator skill independent. Using the hamster oocyte-human sperm model in preliminary trials, the robotic system demonstrated a high success rate of 90.0% and survival rate of 90.7% (n=120). © 2011 IEEE

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

PubMed

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

2016-01-01

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

Bridging the gap between primary care and the cancer system

PubMed Central

Sisler, Jeffrey; McCormack-Speak, Pat

2009-01-01

ABSTRACT PROBLEM BEING ADDRESSED Patient care is poorly coordinated between family physicians and the cancer system and the working relationships are not strong. OBJECTIVE OF PROGRAM To improve integration of patient care and communication between FPs and cancer specialists; enhance FPs’ knowledge of cancer and the cancer system; and promote the role of primary care within the cancer care system. PROGRAM DESCRIPTION The Uniting Primary Care and Oncology (UPCON) Network of CancerCare Manitoba has created partnerships with 12 primary care clinics in Winnipeg, Man, by providing the following: access to the provincial electronic medical record for cancer; small group continuing professional development for a “lead physician” from each clinic to make him or her the local cancer resource; educational outreach to all clinic staff; and changes within CancerCare Manitoba to highlight the role of FPs. CONCLUSION Lead physicians are appreciated by their clinic colleagues, and these FPs are the main users of the cancer electronic medical record. A strong cancer continuing professional development program has been implemented and a voice for primary care has been created within the agency. The UPCON Network is now expanding throughout Manitoba. PMID:19282538

Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

PubMed

Barken, Tina Lien; Thygesen, Elin; Söderhamn, Ulrika

2017-12-28

Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses' reasoning process. Nurses' reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses' reasoning process.

Comparing safety climate for nurses working in operating theatres, critical care and ward areas in the UK: a mixed methods study

PubMed Central

Tarling, Maggie; Jones, Anne; Murrells, Trevor; McCutcheon, Helen

2017-01-01

Objectives The main aim of the study was to explore the potential sources of variation and understand the meaning of safety climate for nursing practice in acute hospital settings in the UK. Design A sequential mixed methods design included a cross-sectional survey using the Safety Climate Questionnaire (SCQ) and thematic analysis of focus group discussions. Confirmatory factor analysis (CFA) was used to validate the factor structure of the SCQ. Factor scores were compared between nurses working in operating theatres, critical care and ward areas. Results from the survey and the thematic analysis were then compared and synthesised. Setting A London University. Participants 319 registered nurses working in acute hospital settings completed the SCQ and a further 23 nurses participated in focus groups. Results CFA indicated that there was a good model fit on some criteria (χ2=1683.699, df=824, p<0.001; χ2/df=2.04; root mean square error of approximation=0.058) but a less acceptable fit on comparative fit index which is 0.804. There was a statistically significant difference between clinical specialisms in management commitment (F (4,266)=4.66, p=0.001). Nurses working in operating theatres had lower scores compared with ward areas and they also reported negative perceptions about management in their focus group. There was significant variation in scores for communication across clinical specialism (F (4,266)=2.62, p=0.035) but none of the pairwise comparisons achieved statistical significance. Thematic analysis identified themes of human factors, clinical management and protecting patients. The system and the human side of caring was identified as a meta-theme. Conclusions The results suggest that the SCQ has some utility but requires further exploration. The findings indicate that safety in nursing practice is a complex interaction between safety systems and the social and interpersonal aspects of clinical practice. PMID:29084793

Experiences with a generator tool for building clinical application modules.

PubMed

Kuhn, K A; Lenz, R; Elstner, T; Siegele, H; Moll, R

2003-01-01

To elaborate main system characteristics and relevant deployment experiences for the health information system (HIS) Orbis/OpenMed, which is in widespread use in Germany, Austria, and Switzerland. In a deployment phase of 3 years in a 1.200 bed university hospital, where the system underwent significant improvements, the system's functionality and its software design have been analyzed in detail. We focus on an integrated CASE tool for generating embedded clinical applications and for incremental system evolution. We present a participatory and iterative software engineering process developed for efficient utilization of such a tool. The system's functionality is comparable to other commercial products' functionality; its components are embedded in a vendor-specific application framework, and standard interfaces are being used for connecting subsystems. The integrated generator tool is a remarkable feature; it became a key factor of our project. Tool generated applications are workflow enabled and embedded into the overall data base schema. Rapid prototyping and iterative refinement are supported, so application modules can be adapted to the users' work practice. We consider tools supporting an iterative and participatory software engineering process highly relevant for health information system architects. The potential of a system to continuously evolve and to be effectively adapted to changing needs may be more important than sophisticated but hard-coded HIS functionality. More work will focus on HIS software design and on software engineering. Methods and tools are needed for quick and robust adaptation of systems to health care processes and changing requirements.

Making Sense of Missense in the Lynch Syndrome: The Clinical Perspective

PubMed Central

Lynch, Henry T.; Jascur, Thomas; Lanspa, Stephen; Boland, C. Richard

2010-01-01

The DNA mismatch repair system provides critical genetic housekeeping, and its failure is associated with tumorigenesis. Through distinct domains on the DNA mismatch repair proteins, the system recognizes and repairs errors occurring during DNA synthesis, but signals apoptosis when the DNA damage cannot be repaired. Certain missense mutations in the mismatch repair genes can selectively alter just one of these functions. This impacts the clinical features of tumors associated with defective DNA mismatch repair activity. New work reported by Xie et al. in this issue of the journal (beginning on page XXX) adds to the understanding of DNA mismatch repair. PMID:20978117

[The place and the role of topographic and clinical anatomy in the modern system of higher medical education].

PubMed

Bol'shakov, O P

2008-01-01

Modern data on studying and teaching topographic and clinical anatomy in Russia and in the foreign countries at the boundary between the XX and the XXI centuries are analyzed. Definitions of some concepts are given; methodological and organizational bases of studying topographic and clinical anatomy are examined in historical aspect. Various approaches to the teaching and studying of these disciplines in different countries, are demonstrated. Special attention is given to the use of new technologies in teaching; the experience of virtual mode of studying of applied anatomy and surgical techniques is critically evaluated. Article presents author's own opinion and analyzes the conceptions of the foreign authors on the necessity of rational combination of computer and other modem technologies with traditional methods of work using biological materials and experiments on laboratory animals. The longstanding experience of the departments of operative surgery and clinical anatomy is summarized and the benefits of the national system of teaching of applied (topographic and clinical) anatomy are shown. Modem tendencies and priorities in the development of topographic and clinical anatomy are demonstrated.

[Exploring nurse, usage effectiveness of mobile nursing station].

PubMed

Chang, Fang-Mei; Lee, Ting-Ting

2013-04-01

A mobile nursing station is an innovative cart that integrates a wireless network, information technology devices, and online charts. In addition to improving clinical work and workflow efficiencies, data is integrated among different information systems and hardware devices to promote patient safety. This study investigated the effectiveness of mobile nursing cart use. We compared different distributions of nursing activity working samples to evaluate the nursing information systems in terms of interface usability and usage outcomes. There were two parts of this study. Part one used work sampling to collect nursing activity data necessary to compare a unit that used a mobile nursing cart (mobile group, n = 18) with another that did not (traditional group, n = 14). Part two applied a nursing information system interface usability questionnaire to survey the mobile unit with nurses who had used a mobile nursing station (including those who had worked in this unit as floating nurses) (n = 30) in order to explore interface usability and effectiveness. We found that using the mobile nursing station information system increased time spent on direct patient care and decreased time spent on indirect patient care and documentation. Results further indicated that participants rated interface usability as high and evaluated usage effectiveness positively. Comments made in the open-ended question section raised several points of concern, including problems / inadequacies related to hardware devices, Internet speed, and printing. This study indicates that using mobile nursing station can improve nursing activity distributions and that nurses hold generally positive attitudes toward mobile nursing station interface usability and usage effectiveness. The authors thus encourage the continued implementation of mobile nursing stations and related studies to further enhance clinical nursing care.

A clinical nutritional information system with personalized nutrition assessment.

PubMed

Kuo, Su-E; Lai, Hui-San; Hsu, Jen-Ming; Yu, Yao-Chang; Zheng, Dong-Zhe; Hou, Ting-Wei

2018-03-01

Traditional nutrition evaluations not only require the use of numerous tables and lists to provide sufficient recommendations for patients' diets but are also very time-consuming due to cross-referencing and calculations. To personalize patient assessments, this study implemented a Clinical Nutritional Information System (CNIS) to help hospital dietitians perform their daily work more effectively in terms of time management and paper work. The CNIS mainly targets in-patients who require cancer-nutrition counselling. The development of the CNIS occurred in three phases. Phase 1 included system design and implementation based on the Nutrition Care Process and Model (NCPM) and the Patient Nutrition Care Process. Phase 2 involved a survey to characterize the efficiency, quality and accuracy of the CNIS. In Phase 3, a second survey was conducted to determine how well dietitians had adapted to the system and the extent of improvement in efficiency after the CNIS had been available online for three years. The work time requirements decreased by approximately 58% with the assistance of the CNIS. Of the dietitians who used the CNIS, 95% reported satisfaction, with 91.66% indicating that the CNIS was really helpful in their work. However, some shortcomings were also evident according to the results. Dietitians favoured the standardization of nutritional intervention and monitoring. The CNIS meets the needs of dietitians by increasing the quality of nutritional interventions by providing accurate calculations and cross-referencing for information regarding patients' conditions, with the benefit of decreasing the processing time, such as handwritten documentation. In addition, the CNIS also helps dietitians statistically analyse each patient's personal nutritional needs to achieve nutritional improvement. Copyright © 2017 Elsevier B.V. All rights reserved.

A practical guide for implementing and maintaining value-added clinical systems learning roles for medical students using a diffusion of innovations framework.

PubMed

Gonzalo, Jed D; Graaf, Deanna; Ahluwalia, Amarpreet; Wolpaw, Dan R; Thompson, Britta M

2018-03-21

After emphasizing biomedical and clinical sciences for over a century, US medical schools are expanding experiential roles that allow students to learn about health care delivery while also adding value to patient care. After developing a program where all 1st-year medical students are integrated into interprofessional care teams to contribute to patient care, authors use a diffusion of innovations framework to explore and identify barriers, facilitators, and best practices for implementing value-added clinical systems learning roles. In 2016, authors conducted 32 clinical-site observations, 29 1:1 interviews with mentors, and four student focus-group interviews. Data were transcribed verbatim, and a thematic analysis was used to identify themes. Authors discussed drafts of the categorization scheme, and agreed upon results and quotations. Of 36 sites implementing the program, 17 (47%) remained, 8 (22%) significantly modified, and 11 (31%) withdrew from the program. Identified strategies for implementing value-added roles included: student education, patient characteristics, patient selection methods, activities performed, and resources. Six themes influencing program implementation and maintenance included: (1) educational benefit, (2) value added to patient care from student work, (3) mentor time and site capacity, (4) student engagement, (5) working relationship between school, site, and students, and, (6) students' continuity at the site. Health systems science is an emerging focus for medical schools, and educators are challenged to design practice-based roles that enhance education and add value to patient care. Health professions' schools implementing value-added roles will need to invest resources and strategize about best-practice strategies to guide efforts.

Mapping ASTI patient’s therapeutic-data model to virtual Medical Record: can VMR represent therapeutic data elements used by ASTI in clinical guideline implementations?

PubMed Central

Ebrahiminia, Vahid; Yasini, Mobin; Lamy, Jean Baptiste

2013-01-01

Lack of interoperability between health information systems is a major obstacle in implementing Clinical decision supports systems (CDSS) and their widespread disseminations. Virtual Medical Record (vMR) proposed by HL7 is a common data model for representing clinical information Inputs and outputs that can be used by CDSS and local clinical systems. A CDSS called ASTI used a similar model to represent clinical data and therapeutic history of patient. In order to evaluate the compatibility of ASTI with vMR, we started to map the ASTI model of representing patient’s therapeutic data to vMR. We compared the data elements and associated terminologies used in ASTI and vMR and we evaluated the semantic fidelity between the models. Only one data element the qualitative description of drug dosage, did not match the vMR model. However, it can be calculated in the execution engine. The semantic fidelity was satisfactorily preserved in 12 of 17 elements mapped between the models. This model of ASTI seems compatible to vMR. Further work is necessary to evaluate the compatibility of clinical data model of ASTI to vMR and the use of vMR in implementing practice guidelines. PMID:24551344

Systems biology approaches for identifying adverse drug reactions and elucidating their underlying biological mechanisms.

PubMed

Boland, Mary Regina; Jacunski, Alexandra; Lorberbaum, Tal; Romano, Joseph D; Moskovitch, Robert; Tatonetti, Nicholas P

2016-01-01

Small molecules are indispensable to modern medical therapy. However, their use may lead to unintended, negative medical outcomes commonly referred to as adverse drug reactions (ADRs). These effects vary widely in mechanism, severity, and populations affected, making ADR prediction and identification important public health concerns. Current methods rely on clinical trials and postmarket surveillance programs to find novel ADRs; however, clinical trials are limited by small sample size, whereas postmarket surveillance methods may be biased and inherently leave patients at risk until sufficient clinical evidence has been gathered. Systems pharmacology, an emerging interdisciplinary field combining network and chemical biology, provides important tools to uncover and understand ADRs and may mitigate the drawbacks of traditional methods. In particular, network analysis allows researchers to integrate heterogeneous data sources and quantify the interactions between biological and chemical entities. Recent work in this area has combined chemical, biological, and large-scale observational health data to predict ADRs in both individual patients and global populations. In this review, we explore the rapid expansion of systems pharmacology in the study of ADRs. We enumerate the existing methods and strategies and illustrate progress in the field with a model framework that incorporates crucial data elements, such as diet and comorbidities, known to modulate ADR risk. Using this framework, we highlight avenues of research that may currently be underexplored, representing opportunities for future work. © 2015 Wiley Periodicals, Inc.

Use of Flowchart for Automation of Clinical Protocols in mHealth.

PubMed

Dias, Karine Nóra; Welfer, Daniel; Cordeiro d'Ornellas, Marcos; Pereira Haygert, Carlos Jesus; Dotto, Gustavo Nogara

2017-01-01

For healthcare professionals to use mobile applications we need someone who knows software development, provide them. In healthcare institutions, health professionals use clinical protocols to govern care, and sometimes these documents are computerized through mobile applications to assist them. This work aims to present a proposal of an application of flow as a way of describing clinical protocols for automatic generation of mobile applications to assist health professionals. The purpose of this research is to enable health professionals to develop applications from the description of their own clinical protocols. As a result, we developed a web system that automates clinical protocols for an Android platform, and we validated with two clinical protocols used in a Brazilian hospital. Preliminary results of the developed architecture demonstrate the feasibility of this study.

Safety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol

PubMed Central

2013-01-01

Background Implementation and use of electronic health records (EHRs) could lead to potential improvements in quality of care. However, the use of EHRs also introduces unique and often unexpected patient safety risks. Proactive assessment of risks and vulnerabilities can help address potential EHR-related safety hazards before harm occurs; however, current risk assessment methods are underdeveloped. The overall objective of this project is to develop and validate proactive assessment tools to ensure that EHR-enabled clinical work systems are safe and effective. Methods/Design This work is conceptually grounded in an 8-dimension model of safe and effective health information technology use. Our first aim is to develop self-assessment guides that can be used by health care institutions to evaluate certain high-risk components of their EHR-enabled clinical work systems. We will solicit input from subject matter experts and relevant stakeholders to develop guides focused on 9 specific risk areas and will subsequently pilot test the guides with individuals representative of likely users. The second aim will be to examine the utility of the self-assessment guides by beta testing the guides at selected facilities and conducting on-site evaluations. Our multidisciplinary team will use a variety of methods to assess the content validity and perceived usefulness of the guides, including interviews, naturalistic observations, and document analysis. The anticipated output of this work will be a series of self-administered EHR safety assessment guides with clear, actionable, checklist-type items. Discussion Proactive assessment of patient safety risks increases the resiliency of health care organizations to unanticipated hazards of EHR use. The resulting products and lessons learned from the development of the assessment guides are expected to be helpful to organizations that are beginning the EHR selection and implementation process as well as those that have already implemented EHRs. Findings from our project, currently underway, will inform future efforts to validate and implement tools that can be used by health care organizations to improve the safety of EHR-enabled clinical work systems. PMID:23587208

Using information technology to improve adult immunization delivery in an integrated urban health system.

PubMed

Swenson, Carolyn J; Appel, Alicia; Sheehan, Moira; Hammer, Anne; Fenner, Zita; Phibbs, Stephanie; Harbrecht, Marjie; Main, Deborah S

2012-01-01

Adult immunizations prevent morbidity and mortality yet coverage remains suboptimal, in part due to missed opportunities. Clinical decision support systems (CDSSs) can improve immunization rates when integrated into routine work flow, implemented wherever care is delivered, and used by staff who can act on the recommendation. An adult immunization improvement project was undertaken in a large integrated, safety-net health care system. A CDSS was developed to query patient records and identify patients eligible for pneumococcal, influenza, or tetanus immunization and then generate a statement that recommends immunization or indicates a previous refusal. A new agency policy authorized medical assistants and nurses in clinics, and nurses in the hospital, to use the CDSS as a standing order. Immunization delivery work flow was standardized, and staff received feedback on immunization rates. The CDSS identified more patients than a typical paper standing order and can be easily modified to incorporate changes in vaccine indications. The intervention led to a 10% improvement in immunization rates in adults 65 years of age or older and in younger adults with diabetes or chronic obstructive pulmonary disease. Overall, the improvements were sustained beyond the project period. The CDSS was expanded to encompass additional vaccines. Interdepartmental collaboration was critical to identify needs, challenges, and solutions. Implementing the standing order policy in clinics and the hospital usually allowed immunizations to be taken out of the hands of clinicians. As an on-demand tool, CDSS must be used at each patient encounter to avoid missed opportunities. Staff retraining accompanied by ongoing assessment of immunization rates, work flow, and missed opportunities to immunize patients are critical to sustain and enhance improvements.

Structural Competency in the U.S. Healthcare Crisis: Putting Social and Policy Interventions Into Clinical Practice.

PubMed

Hansen, H; Metzl, J

2016-06-01

This symposium of the Journal of Bioethical Inquiry illustrates structural competency: how clinical practitioners can intervene on social and institutional determinants of health. It will require training clinicians to see and act on structural barriers to health, to adapt imaginative structural approaches from fields outside of medicine, and to collaborate with disciplines and institutions outside of medicine. Case studies of effective work on all of these levels are presented in this volume. The contributors exemplify structural competency from many angles, from the implications of epigenetics for environmental intervention in personalized medicine to the ways clinicians can act on fundamental causes of disease, address abuses of power in clinical training, racially desegregate cities to reduce health disparities, address the systemic causes of torture by police, and implement harm-reduction programs for addiction in the face of punitive drug laws. Together, these contributors demonstrate the unique roles that clinicians can play in breaking systemic barriers to health and the benefit to the U.S. healthcare system of adopting innovations from outside of the United States and outside of clinical medicine.

A breast cancer clinical registry in an Italian comprehensive cancer center: an instrument for descriptive, clinical, and experimental research.

PubMed

Baili, Paolo; Torresani, Michele; Agresti, Roberto; Rosito, Giuseppe; Daidone, Maria Grazia; Veneroni, Silvia; Cavallo, Ilaria; Funaro, Francesco; Giunco, Marco; Turco, Alberto; Amash, Hade; Scavo, Antonio; Minicozzi, Pamela; Bella, Francesca; Meneghini, Elisabetta; Sant, Milena

2015-01-01

In clinical research, many potentially useful variables are available via the routine activity of cancer center-based clinical registries (CCCR). We present the experience of the breast cancer clinical registry at Fondazione IRCCS "Istituto Nazionale dei Tumori" to give an example of how a CCCR can be planned, implemented, and used. Five criteria were taken into consideration while planning our CCCR: (a) available clinical and administrative databases ought to be exploited to the maximum extent; (b) open source software should be used; (c) a Web-based interface must be designed; (d) CCCR data must be compatible with population-based cancer registry data; (e) CCCR must be an open system, able to be connected with other data repositories. The amount of work needed for the implementation of a CCCR is inversely linked with the amount of available coded data: the fewer data are available in the input databases as coded variables, the more work will be necessary, for information technology staff, text mining analysis, and registrars (for collecting data from clinical records). A cancer registry in a comprehensive cancer center can be used for several research aspects, such as estimate of the number of cases needed for clinical studies, assessment of biobank specimens with specific characteristics, evaluation of clinical practice and adhesion to clinical guidelines, comparative studies between clinical and population sets of patients, studies on cancer prognosis, and studies on cancer survivorship.

Towards clinically translatable in vivo nanodiagnostics

NASA Astrophysics Data System (ADS)

Park, Seung-Min; Aalipour, Amin; Vermesh, Ophir; Yu, Jung Ho; Gambhir, Sanjiv S.

2017-05-01

Nanodiagnostics as a field makes use of fundamental advances in nanobiotechnology to diagnose, characterize and manage disease at the molecular scale. As these strategies move closer to routine clinical use, a proper understanding of different imaging modalities, relevant biological systems and physical properties governing nanoscale interactions is necessary to rationally engineer next-generation bionanomaterials. In this Review, we analyse the background physics of several clinically relevant imaging modalities and their associated sensitivity and specificity, provide an overview of the materials currently used for in vivo nanodiagnostics, and assess the progress made towards clinical translation. This work provides a framework for understanding both the impressive progress made thus far in the nanodiagnostics field as well as presenting challenges that must be overcome to obtain widespread clinical adoption.

A fluid collection system for dermal wounds in clinical investigations

PubMed Central

Klopfer, Michael; Li, G.-P.; Widgerow, Alan; Bachman, Mark

2016-01-01

In this work, we demonstrate the use of a thin, self adherent, and clinically durable patch device that can collect fluid from a wound site for analysis. This device is manufactured from laminated silicone layers using a novel all-silicone double-molding process. In vitro studies for flow and delivery were followed by a clinical demonstration for exudate collection efficiency from a clinically presented partial thickness burn. The demonstrated utility of this device lends itself for use as a research implement used to clinically sample wound exudate for analysis. This device can serve as a platform for future integration of wearable technology into wound monitoring and care. The demonstrated fabrication method can be used for devices requiring thin membrane construction. PMID:27051470

Follow up investigation of workers in synthetic fibre plants with humidifier disease and work related asthma.

PubMed

Pal, T M; de Monchy, J G; Groothoff, J W; Post, D

1999-06-01

To investigate the clinical and sociomedical outcome in patients with various clinical manifestations of humidifier disease and work related asthma after removal from further exposure. Follow up investigation (range 1-13 years) of respiratory symptoms, spirometry, airway responsiveness, sickness absence, and working situation in patients with (I) humidifier fever (n = 12), (II) obstructive type of humidifier lung (n = 8), (III) restrictive type of humidifier lung (n = 4), and (IV) work related asthma (n = 22). All patients were working at departments in synthetic fibre plants with microbiological exposure from contaminated humidification systems or exposure to small particles (< 1 micron) of oil mist. At follow up patients with work related asthma were less often symptom free (37%, 7/19) than patients with humidifier disease (I, II, III) (67%, 16/24). Mean forced expiratory volume in one second (FEV1) of patients with obstructive impairment had been increased significantly at follow up but still remained below the predicted value. Mean forced vital capacity (FVC) of patients with initially restrictive impairment had returned to normal values at follow up. Airway hyperresponsiveness at diagnosis persisted in patients with obstructive impairment (II + IV 14/17, but disappeared in patients with humidifier fever (3/3) and restrictive type of humidifier lung (2/2). In patients with obstructive impairment (II + IV), FVC and FEV1 at diagnosis were negatively associated with the duration between onset of symptoms and diagnosis and the number of years of exposure. Those with positive pre-employment history of respiratory disease had a lower FEV1 at diagnosis. Sickness absence due to respiratory symptoms decreased in all groups of patients after removal from further exposure, but this was most impressive in patients with the humidifier lung (II, III) and patients with work related asthma (IV). At follow up 83% of the patients were still at work at the same production site, whereas 11% received a disability pension because of respiratory disease. In patients with work related respiratory disease caused by exposure from contaminated humidification systems or oil mist, removal from further exposure resulted in clinical improvement, although, especially in those with obstructive impairment, signs persisted. Because of the possibility of transferring patients to exposure-free departments most patients could be kept at work.

Taxonomy development and knowledge representation of nurses' personal cognitive artifacts.

PubMed

McLane, Sharon; Turley, James P

2009-11-14

Nurses prepare knowledge representations, or summaries of patient clinical data, each shift. These knowledge representations serve multiple purposes, including support of working memory, workload organization and prioritization, critical thinking, and reflection. This summary is integral to internal knowledge representations, working memory, and decision-making. Study of this nurse knowledge representation resulted in development of a taxonomy of knowledge representations necessary to nursing practice.This paper describes the methods used to elicit the knowledge representations and structures necessary for the work of clinical nurses, described the development of a taxonomy of this knowledge representation, and discusses translation of this methodology to the cognitive artifacts of other disciplines. Understanding the development and purpose of practitioner's knowledge representations provides important direction to informaticists seeking to create information technology alternatives. The outcome of this paper is to suggest a process template for transition of cognitive artifacts to an information system.

Strategies to teach family assessment and intervention through an online international curriculum.

PubMed

Anderson, Kathryn Hoehn; Friedemann, Marie-Luise

2010-05-01

A Web-based certificate program for international health professionals to acquire understanding of family health and strategies to implement culturally sensitive health care of families is outlined. In four Web courses and a project, students progress interactively to apply culture, family, and interdisciplinary health system theories to assessments and clinical interventions with families in the interdisciplinary setting. Four online educational strategies to facilitate student success from the virtual classroom to actual clinical care are described: adjusting to the technology, communicating the learning progress openly, giving mutual feedback, and implementing evidence-based family care. Outcomes addressing student learning and skill enhancement, family interaction, and student and faculty experiences in the virtual learning environment are explored. Overall, students learned to work successfully with families in health care, experienced increasing comfort and competency in challenging situations, introduced family care in their work setting, and emerged as leaders while working in interdisciplinary teams.

"Are We hurting ourselves?" What is the prevalence of back pain in anesthesia providers?

PubMed

Anson, Jonathan A; Mets, Elbert J; Vaida, Sonia J; King, Tonya S; Ochoa, Tim; Gordin, Vitaly

2016-11-01

Back injuries are a highly reported category of occupational injury in the health care setting. The daily clinical activities of an anesthesia provider, including lifting, pushing stretchers, transferring patients, and bending for procedures, are risk factors for developing low back pain. The purpose of this study is to investigate the prevalence of work related low back pain in anesthesia providers. We conducted a cross-sectional survey study of anesthesia providers at an academic institution. The target population included all 141 clinical anesthesia providers employed by the Penn State Milton S. Hershey Medical Center Department of Anesthesia. A survey study was conducted using the Oswestry Disability Index (ODI), a validated scoring system for low back pain. Additional questions related to the daily activities of clinical anesthesia practice were also asked. The survey instrument underwent pretesting and clinical sensibility testing to ensure validity and consistent interpretation. The primary self-reported measures were the prevalence of low back pain in anesthesia providers and an assessment of disability based on the ODI. Secondary functional measures included the impact of low back pain on work flow. Nearly half (46.6%) of respondents suffer from low back pain attributed to clinical practice. In this subset of respondents, 70.1% reported not having back pain prior to their anesthesia training. Of those with low back pain, 44% alter their work flow, and 9.8% reported missing at least one day of work. Six providers (5.3%) required surgical intervention. Using the ODI score interpretation guidelines, 46% of respondents had a "mild disability" and 2% had a "moderate disability." Respondents reporting feeling "burned out" from their job had a significantly higher average ODI score compared to those who did not (6.8 vs 3.3, respectively; P=.01). Nearly half of all anesthesia providers sampled suffer from low back pain subjectively attributed to their clinical practice. This leads to changes in work flow and missed days of work. The results of this study suggest a deficiency in the effectiveness of anesthesia training programs in teaching proper techniques to prevent musculoskeletal injuries. Copyright © 2016 Elsevier Inc. All rights reserved.

Empowering occupational therapists to become evidence-based work rehabilitation practitioners.

PubMed

Vachon, Brigitte; Durand, Marie-José; LeBlanc, Jeannette

2010-01-01

Occupational therapists (OTs) engage in continuing education to integrate best available knowledge and skills into their practice. However, many barriers influence the degree to which they are currently able to integrate research evidence into their clinical decision making process. The specific objectives were to explore the clinical decision-making processes they used, and to describe the empowerment process they developed to become evidence-based practitioners. Eight OTs, who had attended a four-day workshop on evidence-based work rehabilitation, were recruited to participate to a reflective practice group. A collaborative research methodology was used. The group was convened for 12 meetings and held during a 15-month period. The data collected was analyzed using the grounded theory method. The results revealed the different decision-making modes used by OTs: defensive, repressed, cautious, autonomous intuitive and autonomous thoughtful. These modes influenced utilization of evidence and determined the stances taken toward practice change. Reflective learning facilitated their utilization of an evidence-based practice model through a three-level empowerment process: deliberateness, client-centeredness and system mindedness. During the course of this study, participants learned to become evidence-based practitioners. This process had an impact on how they viewed their clients, their practice and the work rehabilitation system.

[Research and Implementation of Vital Signs Monitoring System Based on Cloud Platform].

PubMed

Yu, Man; Tan, Anzu; Huang, Jianqi

2018-05-30

Through analyzing the existing problems in the current mode, the vital signs monitoring information system based on cloud platform is designed and developed. The system's aim is to assist nurse carry out vital signs nursing work effectively and accurately. The system collects, uploads and analyzes patient's vital signs data by PDA which connecting medical inspection equipments. Clinical application proved that the system can effectively improve the quality and efficiency of medical care and may reduce medical expenses. It is alse an important practice result to build a medical cloud platform.

Interviewing patients and practitioners working together in teams. A multi-layered puzzle: putting the pieces together.

PubMed

Ringstad, Oystein

2010-08-01

This paper presents and evaluates a methodological approach aiming at analysing some of the complex interaction between patients and different health care practitioners working together in teams. Qualitative health care research describes the values, perceptions and conceptions of patients and practitioners. In modern clinical work patients and professional practitioners often work together on complex cases involving different kinds of knowledge and values, each of them representing different perspectives. We need studies designed to capture this complexity. The methodological approach presented here is exemplified with a study in rehabilitation medicine. In this part of the health care system the clinical work is organized in multi-professional clinical teams including patients, handling complex rehabilitation processes. In the presented approach data are collected in individual in-depth interviews to have thorough descriptions of each individual perspective. The interaction in the teams is analysed by comparing different descriptions of the same situations from the involved individuals. We may then discuss how these perceptions relate to each other and how the individuals in the team interact. Two examples from an empirical study are presented and discussed, illustrating how communication, differences in evaluations and the interpretation of incidents, arguments, emotions and interpersonal relations may be discussed. It is argued that this approach may give information which can supplement the methods commonly applied in qualitative health care research today.

[Formation of epicrises using the ESER computer R 21 based on the data-marking technic in gynecology].

PubMed

Jäger, G; Hagemeier, J H; Schneider, P; Heber, E

1978-01-01

Report about an electronic data processing system for gynaecology. The developed data document design and data flowchart are shown. The accumulated data allowed a detailed interpretation record. For all clinical treated patients the computer printed out a final gynaecological epicrisis. The system is an improvement of the information and the typewriting work of medial staff has been reduced.

A compact two-wave dichrometer of an optical biosensor analytical system for medicine

NASA Astrophysics Data System (ADS)

Chulkov, D. P.; Gusev, V. M.; Kompanets, O. N.; Vereschagin, F. V.; Skuridin, S. G.; Yevdokimov, Yu. M.

2017-01-01

An experimental model has been developed of a compact two-wave dichrometer on the base of LEDs that is well-suited to work with "liquid" DNA nanoconstructions as biosensing units. The mobile and inexpensive device is intended for use in a biosensor analytical system for rapid determination of biologically active compounds in liquids to solve practical problems of clinic medicine and pharmacology.

OCT-based angiography in real time with hand-held probe

NASA Astrophysics Data System (ADS)

Gelikonov, Grigory V.; Moiseev, Alexander A.; Ksenofontov, Sergey Y.; Terpelov, Dmitry A.; Gelikonov, Valentine M.

2018-03-01

This work is dedicated to development of the OCT system capable to visualize blood vessel network for everyday clinical use. Following problems were solved during the development: compensation of specific natural tissue displacements, induced by contact scanning mode and physiological motion of patients (e.g. respiratory and cardiac motions) and on-line visualization of vessel net to provide the feedback for system operator.

Bootstrapping a de-identification system for narrative patient records: cost-performance tradeoffs.

PubMed

Hanauer, David; Aberdeen, John; Bayer, Samuel; Wellner, Benjamin; Clark, Cheryl; Zheng, Kai; Hirschman, Lynette

2013-09-01

We describe an experiment to build a de-identification system for clinical records using the open source MITRE Identification Scrubber Toolkit (MIST). We quantify the human annotation effort needed to produce a system that de-identifies at high accuracy. Using two types of clinical records (history and physical notes, and social work notes), we iteratively built statistical de-identification models by annotating 10 notes, training a model, applying the model to another 10 notes, correcting the model's output, and training from the resulting larger set of annotated notes. This was repeated for 20 rounds of 10 notes each, and then an additional 6 rounds of 20 notes each, and a final round of 40 notes. At each stage, we measured precision, recall, and F-score, and compared these to the amount of annotation time needed to complete the round. After the initial 10-note round (33min of annotation time) we achieved an F-score of 0.89. After just over 8h of annotation time (round 21) we achieved an F-score of 0.95. Number of annotation actions needed, as well as time needed, decreased in later rounds as model performance improved. Accuracy on history and physical notes exceeded that of social work notes, suggesting that the wider variety and contexts for protected health information (PHI) in social work notes is more difficult to model. It is possible, with modest effort, to build a functioning de-identification system de novo using the MIST framework. The resulting system achieved performance comparable to other high-performing de-identification systems. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Towards a Clinical Trial Protocol to Evaluate Health Information Systems: Evaluation of a Computerized System for Monitoring Tuberculosis from a Patient Perspective in Brazil.

PubMed

Crepaldi, Nathalia Yukie; de Lima, Inacia Bezerra; Vicentine, Fernanda Bergamini; Rodrigues, Lídia Maria Lourençon; Sanches, Tiago Lara Michelin; Ruffino-Netto, Antonio; Alves, Domingos; Rijo, Rui Pedro Charters Lopes

2018-05-08

Assessment of health information systems consider different aspects of the system itself. They focus or on the professional who will use the software or on its usability or on the software engineering metrics or on financial and managerial issues. The existent approaches are very resources consuming, disconnected, and not standardized. As the software becomes more critical in the health organizations and in patients, becoming used as a medical device or a medicine, there is an urgency to identify tools and methods that can be applied in the development process. The present work is one of the steps of a broader study to identify standardized protocols to evaluate the health information systems as medicines and medical devices are evaluated by clinical trials. The goal of the present work was to evaluate the effect of the introduction of an information system for monitoring tuberculosis treatment (SISTB) in a Brazilian municipality from the patients' perspective. The Patient Satisfaction Questionnaire and the Hospital Consumer Assessment of Healthcare Providers and Systems were answered by the patients before and after the SISTB introduction, for comparison. Patients from an outpatient clinic, formed the control group, that is, at this site was not implanted the SISTB. Descriptive statistics and mixed effects model were used for data analysis. Eighty-eight interviews were conducted in the study. The questionnaire's results presented better averages after the system introduction but were not considered statistically significant. Therefore, it was not possible to associate system implantation with improved patient satisfaction. The HIS evaluation need be complete, the technical and managerial evaluation, the safety, the impact on the professionals and direct and/or indirect impact on patients are important. Developing the right tools and methods that can evaluate the software in its entirety, from the beginning of the development cycle with a normalized scale, are needed.

Clinical research in implant dentistry: evaluation of implant-supported restorations, aesthetic and patient-reported outcomes.

PubMed

Lang, Niklaus P; Zitzmann, Nicola U

2012-02-01

The articles discussed in working group 3 dealt with specific aspects of clinical research. In this context, the literature reporting on survival and complication rates of implant-supported or implant-tooth supported restorations in longitudinal studies of at least 5 years were discussed. The second aspect dealt with the evaluation of aesthetic outcomes in clinical studies and the related index systems available. Finally, the third aspect discussed dealt with patient-reported outcome measures (PROMs). A detailed appraisal of the available methodology was presented. © 2012 John Wiley & Sons A/S.

Sir Walter Langdon-Brown (1870-1946).

PubMed

Keynes, Milo

2008-02-01

Sir Walter Langdon-Brown, born of robust Puritan stock, was a distinguished physician, teacher, medical historian and humanist at St Bartholomew's Hospital, London, before becoming Regius Professor of Physics at Cambridge. His contributions to clinical medicine were wide in relating symptoms and signs of disease to physiology, putting therapeutics on a scientific basis, showing the close linkage of the sympathetic nervous system to the ductless glands, and being regarded as a founder of clinical endocrinology. He was the first English physician to relate the work of Freud, Jung and Adler to clinical medicine and a pioneer in psychosomatic medicine and the study of neurotic behaviour.

Development and Implementation of Team-Based Panel Management Tools: Filling the Gap between Patient and Population Information Systems.

PubMed

Watts, Brook; Lawrence, Renée H; Drawz, Paul; Carter, Cameron; Shumaker, Amy Hirsch; Kern, Elizabeth F

2016-08-01

Effective team-based models of care, such as the Patient-Centered Medical Home, require electronic tools to support proactive population management strategies that emphasize care coordination and quality improvement. Despite the spread of electronic health records (EHRs) and vendors marketing population health tools, clinical practices still may lack the ability to have: (1) local control over types of data collected/reports generated, (2) timely data (eg, up-to-date data, not several months old), and accordingly (3) the ability to efficiently monitor and improve patient outcomes. This article describes a quality improvement project at the hospital system level to develop and implement a flexible panel management (PM) tool to improve care of subpopulations of patients (eg, panels of patients with diabetes) by clinical teams. An in-depth case analysis approach is used to explore barriers and facilitators in building a PM registry tool for team-based management needs using standard data elements (eg, laboratory values, pharmacy records) found in EHRs. Also described are factors that may contribute to sustainability; to date the tool has been adapted to 6 disease-focused subpopulations encompassing more than 200,000 patients. Two key lessons emerged from this initiative: (1) though challenging, team-based clinical end users and information technology needed to work together consistently to refine the product, and (2) locally developed population management tools can provide efficient data tracking for frontline clinical teams and leadership. The preliminary work identified critical gaps that were successfully addressed by building local PM registry tools from EHR-derived data and offers lessons learned for others engaged in similar work. (Population Health Management 2016;19:232-239).

Hot and steamy: outbreak of Bacillus cereus in Singapore associated with construction work and laundry practices.

PubMed

Balm, M N D; Jureen, R; Teo, C; Yeoh, A E J; Lin, R T P; Dancer, S J; Fisher, D A

2012-08-01

A sudden increase in invasive infections caused by Bacillus cereus group organisms prompted an investigation at the National University Hospital in Singapore. To describe the investigation and management and subsequent difficulties controlling the outbreak. Clinical case reviews were performed on all patients with B. cereus group recovered from clinical samples. Widespread environmental sampling was performed followed by review of hospital ventilation systems, domestic cleaning and laundry practices. B. cereus was recovered from 171 patients during a six-month period coinciding with large-scale construction work beside the hospital. Most patients presented with bacteraemia (146/171; 85.4%) with 46/171 (26.9%) requiring extended treatment courses with vancomycin or other interventions. Sampling confirmed extensive airborne dispersal inside the hospital, including isolation rooms and air-conditioned wards. Hospital linen was heavily contaminated [7403 cfu/cm(2); 95% confidence interval (CI): 6349-8457; for 30 towels sampled], encouraged by inappropriate storage in airtight plastic bags (4437 cfu/cm(2); CI: 3125-5750) compared with storage in porous canvas bags (166 cfu/cm(2); CI: 76-256; P < 0.001). Interventions introduced included revision of laundry practices, transport and storage of hospital linen and towels; bleach-based environmental cleaning; and upgrading of ventilation systems throughout the hospital. Clinical case numbers returned to baseline levels within three months, only to rise again following relaxation of laundry practices. Construction work beside this Singapore hospital encouraged heavy contamination of air and environment with Bacillus spp., assumed to be responsible for the outbreak described. Failure to maintain revised laundry practices allowed resurgence of clinical cases, particularly among immunocompromised patients. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Development of a Kinect-based exergaming system for motor rehabilitation in neurological disorders

NASA Astrophysics Data System (ADS)

Estepa, A.; Sponton Piriz, S.; Albornoz, E.; Martínez, C.

2016-04-01

The development of videogames for physical therapy, known as exergames, has gained much interest in the last years. In this work, a sytem for rehabilitation and clinical evaluation of neurological patients is presented. The Microsoft Kinect device is used to track the full body of patients, and three games were developed to exercise and assess different aspects of balance and gait rehabilitation. The system provides visual feedback by means of an avatar that follows the movements of the patients, and sound and visual stimuli for giving orders during the experience. Also, the system includes a database and management tools for further analysis and monitoring of therapies. The results obtained show, on the one side, a great reception and interest of patients to use the system. On the other side, the specialists considered very useful the data collected and the quantitative analysis provided by the system, which was then adopted for the clinical routine.

Automated gastric cancer diagnosis on H&E-stained sections; ltraining a classifier on a large scale with multiple instance machine learning

NASA Astrophysics Data System (ADS)

Cosatto, Eric; Laquerre, Pierre-Francois; Malon, Christopher; Graf, Hans-Peter; Saito, Akira; Kiyuna, Tomoharu; Marugame, Atsushi; Kamijo, Ken'ichi

2013-03-01

We present a system that detects cancer on slides of gastric tissue sections stained with hematoxylin and eosin (H&E). At its heart is a classi er trained using the semi-supervised multi-instance learning framework (MIL) where each tissue is represented by a set of regions-of-interest (ROI) and a single label. Such labels are readily obtained because pathologists diagnose each tissue independently as part of the normal clinical work ow. From a large dataset of over 26K gastric tissue sections from over 12K patients obtained from a clinical load spanning several months, we train a MIL classi er on a patient-level partition of the dataset (2/3 of the patients) and obtain a very high performance of 96% (AUC), tested on the remaining 1/3 never-seen before patients (over 8K tissues). We show this level of performance to match the more costly supervised approach where individual ROIs need to be labeled manually. The large amount of data used to train this system gives us con dence in its robustness and that it can be safely used in a clinical setting. We demonstrate how it can improve the clinical work ow when used for pre-screening or quality control. For pre-screening, the system can diagnose 47% of the tissues with a very low likelihood (< 1%) of missing cancers, thus halving the clinicians' caseload. For quality control, compared to random rechecking of 33% of the cases, the system achieves a three-fold increase in the likelihood of catching cancers missed by pathologists. The system is currently in regular use at independent pathology labs in Japan where it is used to double-check clinician's diagnoses. At the end of 2012 it will have analyzed over 80,000 slides of gastric and colorectal samples (200,000 tissues).

Development of the Lymphoma Enterprise Architecture Database: A caBIG(tm) Silver level compliant System

PubMed Central

Huang, Taoying; Shenoy, Pareen J.; Sinha, Rajni; Graiser, Michael; Bumpers, Kevin W.; Flowers, Christopher R.

2009-01-01

Lymphomas are the fifth most common cancer in United States with numerous histological subtypes. Integrating existing clinical information on lymphoma patients provides a platform for understanding biological variability in presentation and treatment response and aids development of novel therapies. We developed a cancer Biomedical Informatics Grid™ (caBIG™) Silver level compliant lymphoma database, called the Lymphoma Enterprise Architecture Data-system™ (LEAD™), which integrates the pathology, pharmacy, laboratory, cancer registry, clinical trials, and clinical data from institutional databases. We utilized the Cancer Common Ontological Representation Environment Software Development Kit (caCORE SDK) provided by National Cancer Institute’s Center for Bioinformatics to establish the LEAD™ platform for data management. The caCORE SDK generated system utilizes an n-tier architecture with open Application Programming Interfaces, controlled vocabularies, and registered metadata to achieve semantic integration across multiple cancer databases. We demonstrated that the data elements and structures within LEAD™ could be used to manage clinical research data from phase 1 clinical trials, cohort studies, and registry data from the Surveillance Epidemiology and End Results database. This work provides a clear example of how semantic technologies from caBIG™ can be applied to support a wide range of clinical and research tasks, and integrate data from disparate systems into a single architecture. This illustrates the central importance of caBIG™ to the management of clinical and biological data. PMID:19492074

Creating and sharing clinical decision support content with Web 2.0: Issues and examples.

PubMed

Wright, Adam; Bates, David W; Middleton, Blackford; Hongsermeier, Tonya; Kashyap, Vipul; Thomas, Sean M; Sittig, Dean F

2009-04-01

Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.

[The clinical phenomenology of Rett's syndrome].

PubMed

Calderón-González, R; Calderón-Sepulveda, R F; Treviño-Welsh, J

1999-01-01

The work was done to facilitate the clinical diagnosis and understanding of Rett syndrome (RS) by grouping the symptoms and signs in areas of neurological disfunction. This is a retrospective, longitudinal and observational study of 30 young females whose clinical manifestations were grouped using a modified Fitzgerald et al. scale for motor and behavior evaluation of patients with RS. All patients were videotaped at least during one or several appointments during their follow-up for a period of 1 to 10 years. All patients and videotapes were reviewed independently by the three authors. We followed the clinical diagnostic criteria of classic RS, and grouped the symptoms and signs in 12 groups of clinical phenomenology that represented specific areas of central or peripheral nervous system involvement: 1) dementia syndrome (fronto-temporo-parietal and limbic dysfunction); 2) extrapyramidal syndrome (basal ganglia dysfunction); 3) respiratory function disorders (brain stem reticular system disfunction); 4) sleep disorders (reticular system and limbic dysfunction); 5) epilepsy (cortico-subcortical paroxysmal bioelectrical dysfunction); 6) lower motor neuron syndrome (neuropathic dysfunction and/or peripheral neuropathy); 7) body growth retardation; 8) tonic-postural skeletal deformities; 9) deficit of pain sensation (nociceptive deficit); 10) pseudobulbar dysfunction; 11) autonomic dysfunction and 12) others (microcephaly and bruxism). In clinical practice, we recommend the use of this grouping of symptoms and signs because it makes facilities the clinical study, definition of areas of dysfunction and diagnosis of the patient with RS.

Using the web for recruitment, screen, tracking, data management, and quality control in a dietary assessment clinical validation trial.

PubMed

Arab, Lenore; Hahn, Harry; Henry, Judith; Chacko, Sara; Winter, Ashley; Cambou, Mary C

2010-03-01

Screening and tracking subjects and data management in clinical trials require significant investments in manpower that can be reduced through the use of web-based systems. To support a validation trial of various dietary assessment tools that required multiple clinic visits and eight repeats of online assessments, we developed an interactive web-based system to automate all levels of management of a biomarker-based clinical trial. The "Energetics System" was developed to support 1) the work of the study coordinator in recruiting, screening and tracking subject flow, 2) the need of the principal investigator to review study progress, and 3) continuous data analysis. The system was designed to automate web-based self-screening into the trial. It supported scheduling tasks and triggered tailored messaging for late and non-responders. For the investigators, it provided real-time status overviews on all subjects, created electronic case reports, supported data queries and prepared analytic data files. Encryption and multi-level password protection were used to insure data privacy. The system was programmed iteratively and required six months of a web programmer's time along with active team engagement. In this study the enhancement in speed and efficiency of recruitment and quality of data collection as a result of this system outweighed the initial investment. Web-based systems have the potential to streamline the process of recruitment and day-to-day management of clinical trials in addition to improving efficiency and quality. Because of their added value they should be considered for trials of moderate size or complexity. Copyright 2009 Elsevier Inc. All rights reserved.

A Multi-Axial Scheme for Assessment and Intervention.

ERIC Educational Resources Information Center

Kirkland, John; Morgan, Griffith

1984-01-01

Describes a scheme consisting of nine elements or "themes" ordered in terms of their more probable links developed from clinical work with crying infants. Theme categories are genetic/hereditary, psychiatric disorder, central nervous system, medical health (chronic), medical health (acute), nutrition/allergy, form, psychosocial…

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report

PubMed Central

Carpenter, Paul A.; Kitko, Carrie L.; Elad, Sharon; Flowers, Mary E.D.; Gea-Banacloche, Juan C.; Halter, Jörg P.; Hoodin, Flora; Johnston, Laura; Lawitschka, Anita; McDonald, George B.; Opipari, Anthony W.; Savani, Bipin N.; Schultz, Kirk R.; Smith, Sean R.; Syrjala, Karen L.; Treister, Nathaniel; Vogelsang, Georgia B.; Williams, Kirsten M.; Pavletic, Steven Z.; Martin, Paul J.; Lee, Stephanie J.; Couriel, Daniel R.

2016-01-01

The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence. PMID:25838185

Biodegradable lipids enabling rapidly eliminated lipid nanoparticles for systemic delivery of RNAi therapeutics.

PubMed

Maier, Martin A; Jayaraman, Muthusamy; Matsuda, Shigeo; Liu, Ju; Barros, Scott; Querbes, William; Tam, Ying K; Ansell, Steven M; Kumar, Varun; Qin, June; Zhang, Xuemei; Wang, Qianfan; Panesar, Sue; Hutabarat, Renta; Carioto, Mary; Hettinger, Julia; Kandasamy, Pachamuthu; Butler, David; Rajeev, Kallanthottathil G; Pang, Bo; Charisse, Klaus; Fitzgerald, Kevin; Mui, Barbara L; Du, Xinyao; Cullis, Pieter; Madden, Thomas D; Hope, Michael J; Manoharan, Muthiah; Akinc, Akin

2013-08-01

In recent years, RNA interference (RNAi) therapeutics, most notably with lipid nanoparticle-based delivery systems, have advanced into human clinical trials. The results from these early clinical trials suggest that lipid nanoparticles (LNPs), and the novel ionizable lipids that comprise them, will be important materials in this emerging field of medicine. A persistent theme in the use of materials for biomedical applications has been the incorporation of biodegradability as a means to improve biocompatibility and/or to facilitate elimination. Therefore, the aim of this work was to further advance the LNP platform through the development of novel, next-generation lipids that combine the excellent potency of the most advanced lipids currently available with biodegradable functionality. As a representative example of this novel class of biodegradable lipids, the lipid evaluated in this work displays rapid elimination from plasma and tissues, substantially improved tolerability in preclinical studies, while maintaining in vivo potency on par with that of the most advanced lipids currently available.

Psychiatric education in the correctional setting: challenges and opportunities.

PubMed

Holoyda, Brian J; Scott, Charles L

2017-02-01

As the need for mental healthcare services within correctional settings in the US increases, so does the need for a mental health workforce that is motivated to work within such systems. One potentially effective method by which to increase the number of psychiatrists working in jails, prisons, and parole clinics is to provide exposure to these environments during their training. Correctional settings can serve as unique training sites for medical students and psychiatric residents and fellows. Such training experiences can provide a host of benefits to both trainees and staff within the correctional mental health system. Alongside many potential benefits exist substantial potential barriers to coordinating correctional training experiences, including both programme directors' and residents' concerns regarding safety and enjoyment and negative perceptions of inmate and prisoner patients. The establishment of academic affiliations with correctional institutions and didactic instruction on commonly encountered clinical issues with inmate populations may be methods of diffusing these concerns. Improving residents' and fellows' training experiences offers a hope for increasing the attractiveness of a career in correctional psychiatry.

Re-establishing clean water in a disaster.

PubMed

Fournier, Chris

2011-09-01

When a disaster occurs, water systems can be overwhelmed with sediment, chemicals, microbes, and other harmful organisms. Dialysis clinics need to have disaster management plans and protocols in place to meet the demands of any situation. During emergency events, such as large widespread natural disasters, it is necessary to have the support of outside resources to keep the clinic operating or to aid in returning it to service as quickly and as safely as possible. Before proceeding with any medical treatments that use water, such as dialysis, facilities should address five different response actions to establish the safety and effectiveness of their water system. Test the water quality prior to treating patients. Make sure the system is working properly by performing critical water tests. Compare all results with pre-disaster data to help spot any warning signs. Inspect the water system, including all connections, timers, and settings. Consider contacting your water treatment vendor for additional verification and support. Be sure to closely monitor the water system equipment; make sure it is not overwhelmed by staying in touch with local water authorities. They may "shock" their distribution system to regain compliance. Make every effort to conserve water during this time. Change the water system. If the central water system has been compromised, consider using portable RO units or portable exchange DI tanks. Finally, moving your patients to another facility may be the only alternative, so work with other local facilities unaffected by the disaster.

Improving care by understanding the way we work: human factors and behavioural science in the context of intensive care

PubMed Central

Sevdalis, Nick; Brett, Stephen J

2009-01-01

Effectiveness and efficiency of care of the critically ill patient are subject to a number of systemic influences, including skills of individual physicians/nurses (technical and non-technical), team-working in the intensive care unit (ICU), and the ICU environment. We first discuss the paper of Fackler and colleagues as a contribution to the systems approach to clinical performance in the context of intensive care. We then highlight features of care delivery that are unique to intensive care and discuss the need for better understanding of human and non-human elements of the system of care of the critically ill patient as a driver for improvement of care delivery. PMID:19439048

[Surgical History Taking and Clinical Examination: Establishing a Standardised System by Means of a Nation-Wide Academic Teaching Project].

PubMed

von Bernstorff, W; Irmer, H; Menges, P; Peters, S; Heidecke, C-D; Busemann, A

2017-02-01

Background: History taking and systematic clinical examination are central techniques of physicians. Medicine in general and surgery in particular frequently require immediate decisions and start of therapies. So far, a standardised surgical system for history taking and clinical examination in teaching has been lacking at our faculty. A consensus of all medical faculties on a standardised system could be a tool to improve the medical teaching and education at our teaching institutions. Methods: The established Anglo-Saxonian system of history taking and clinical examination was adapted to our own clinical needs. Thereafter, this system was sent out to all chairmen of general and visceral surgery departments in German University Hospitals asking for evaluation and improvements. We adapted the system according to the chairmen's comments and suggestions. Since winter semester 2011 this system has been integrated into the clinical course of history taking and examination. It is compulsory for all 5th semester students (first clinical year/graduate course) at the Universitätsmedizin Greifswald. In addition, a video was produced demonstrating all major techniques of clinical examination. This video is available for all students on a password blocked site of the World Wide Web. Results: Altogether, 89 % of all contacted chairmen returned their comments and suggestions for improvements. After implementation of the new system, positive evaluations of students increased significantly from 63.5 to 77.0 % in general and abdominal surgery (p < 0.0001) and from 76.4 to 83.5 % in vascular and thoracic surgery (p < 0.0001). Conclusions: The presented system is a standardised tool of history taking and clinical examination applicable for students as well as qualified surgeons in daily routine work. It has been approved by the majority of the departments of surgery of all German university hospitals. Furthermore, it can be applied by other medical specialties, in particular, internal medicine. Furthermore, the standardisation of history taking and clinical examination can contribute to improve patients' safety as well as medical documentation. Also, the standardisation will be a sound basis for expert medical opinions in legal actions. Finally, it has improved the value of medical education at our medical faculty and could form the basis for the development of national medical standards. Georg Thieme Verlag KG Stuttgart · New York.

A 6-DOF parallel bone-grinding robot for cervical disc replacement surgery.

PubMed

Tian, Heqiang; Wang, Chenchen; Dang, Xiaoqing; Sun, Lining

2017-12-01

Artificial cervical disc replacement surgery has become an effective and main treatment method for cervical disease, which has become a more common and serious problem for people with sedentary work. To improve cervical disc replacement surgery significantly, a 6-DOF parallel bone-grinding robot is developed for cervical bone-grinding by image navigation and surgical plan. The bone-grinding robot including mechanical design and low level control is designed. The bone-grinding robot navigation is realized by optical positioning with spatial registration coordinate system defined. And a parametric robot bone-grinding plan and high level control have been developed for plane grinding for cervical top endplate and tail endplate grinding by a cylindrical grinding drill and spherical grinding for two articular surfaces of bones by a ball grinding drill. Finally, the surgical flow for a robot-assisted cervical disc replacement surgery procedure is present. The final experiments results verified the key technologies and performance of the robot-assisted surgery system concept excellently, which points out a promising clinical application with higher operability. Finally, study innovations, study limitations, and future works of this present study are discussed, and conclusions of this paper are also summarized further. This bone-grinding robot is still in the initial stage, and there are many problems to be solved from a clinical point of view. Moreover, the technique is promising and can give a good support for surgeons in future clinical work.

The impact of individual factors on healthcare staff's computer use in psychiatric hospitals.

PubMed

Koivunen, Marita; Välimäki, Maritta; Koskinen, Anita; Staggers, Nancy; Katajisto, Jouko

2009-04-01

The study examines whether individual factors of healthcare staff are associated with computer use in psychiatric hospitals. In addition, factors inhibiting staff's optimal use of computers were explored. Computer applications have developed the content of clinical practice and changed patterns of professional working. Healthcare staff need new capacities to work in clinical practice, including the basic computers skills. Computer use amongst healthcare staff has widely been studied in general, but cogent information is still lacking in psychiatric care. Staff's computer use was assessed using a structured questionnaire (The Staggers Nursing Computer Experience Questionnaire). The study population was healthcare staff working in two psychiatric hospitals in Finland (n = 470, response rate = 59%). The data were analysed with descriptive statistics and manova with main effects and two-way interaction effects of six individual factors. Nurses who had more experience of computer use or of the implementation processes of computer systems were more motivated to use computers than those who had less experience of these issues. Males and administrative personnel who were younger had also participated more often than women in implementation processes of computer systems. The most significant factor inhibiting the use of computers was lack of interest in them. In psychiatric hospitals, more direct attention should focus on staff's capacities to use computers and to increase their understanding of the benefits in clinical care, especially for women and ageing staff working in psychiatric hospitals. To avoid exclusion amongst healthcare personnel in information society and to ensure that they have capacities to guide patients on how to use computers or to evaluate the quality of health information on the web, staff's capacities and motivation to use computers in mental health and psychiatric nursing should be ensured.

A Systematic Review of Wearable Systems for Cancer Detection: Current State and Challenges.

PubMed

Ray, Partha Pratim; Dash, Dinesh; De, Debashis

2017-10-02

Rapid growth of sensor and computing platforms have introduced the wearable systems. In recent years, wearable systems have led to new applications across all medical fields. The aim of this review is to present current state-of-the-art approach in the field of wearable system based cancer detection and identify key challenges that resist it from clinical adoption. A total of 472 records were screened and 11 were finally included in this study. Two types of records were studied in this context that includes 45% research articles and 55% manufactured products. The review was performed per PRISMA guidelines where considerations was given to records that were published or reported between 2009 and 2017. The identified records included 4 cancer detecting wearable systems such as breast cancer (36.3%), skin cancer (36.3%), prostate cancer (18.1%), and multi-type cancer (9%). Most works involved sensor based smart systems comprising of microcontroller, Bluetooth module, and smart phone. Few demonstrated Ultra-Wide Band (i.e. UWB) antenna based wearable systems. Skin cancer detecting wearable systems were most comprehensible ones. The current works are gradually progressing with seamless integration of sensory units along with smart networking. However, they lack in cloud computing and long-range communication paradigms. Artificial intelligence and machine learning are key ports that need to be attached with current wearable systems. Further, clinical inertia, lack of awareness, and high cost are altogether pulling back the actual growth of such system. It is well comprehended that upon sincere orientation of all identified challenges, wearable systems would emerge as vital alternative to futuristic cancer detection.

Retinal and choroidal imaging in vivo using integrated photoacoustic microscopy and optical coherence tomography

NASA Astrophysics Data System (ADS)

Tian, Chao; Zhang, Wei; Nguyen, Van Phuc; Huang, Ziyi; Wang, Xueding; Paulus, Yannis M.

2018-02-01

Most reported photoacoustic ocular imaging work to date uses small animals, such as mice and rats, the eyes of which are small and less than one-third the size of a human eye, which poses a challenge for clinical translation. Here we achieved chorioretinal imaging of larger animals, i.e. rabbits, using a dual-modality photoacoustic microscopy (PAM) and optical coherence tomography (OCT) system. Preliminary experimental results in living rabbits demonstrate that the PAM can noninvasively visualize depth-resolved retinal and choroidal vessels using a safe laser exposure dose; and the OCT can finely distinguish different retinal layers, the choroid, and the sclera. This reported work might be a major step forward in clinical translation of photoacoustic microscopy.

Clinical Proton MR Spectroscopy in Central Nervous System Disorders

PubMed Central

Alger, Jeffry R.; Barker, Peter B.; Bartha, Robert; Bizzi, Alberto; Boesch, Chris; Bolan, Patrick J.; Brindle, Kevin M.; Cudalbu, Cristina; Dinçer, Alp; Dydak, Ulrike; Emir, Uzay E.; Frahm, Jens; González, Ramón Gilberto; Gruber, Stephan; Gruetter, Rolf; Gupta, Rakesh K.; Heerschap, Arend; Henning, Anke; Hetherington, Hoby P.; Howe, Franklyn A.; Hüppi, Petra S.; Hurd, Ralph E.; Kantarci, Kejal; Klomp, Dennis W. J.; Kreis, Roland; Kruiskamp, Marijn J.; Leach, Martin O.; Lin, Alexander P.; Luijten, Peter R.; Marjańska, Małgorzata; Maudsley, Andrew A.; Meyerhoff, Dieter J.; Mountford, Carolyn E.; Nelson, Sarah J.; Pamir, M. Necmettin; Pan, Jullie W.; Peet, Andrew C.; Poptani, Harish; Posse, Stefan; Pouwels, Petra J. W.; Ratai, Eva-Maria; Ross, Brian D.; Scheenen, Tom W. J.; Schuster, Christian; Smith, Ian C. P.; Soher, Brian J.; Tkáč, Ivan; Vigneron, Daniel B.; Kauppinen, Risto A.

2014-01-01

A large body of published work shows that proton (hydrogen 1 [1H]) magnetic resonance (MR) spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Herein, the authors present a summary of brain disorders in which MR spectroscopy has an impact on patient management, together with a critical consideration of common data acquisition and processing procedures. The article documents the impact of 1H MR spectroscopy in the clinical evaluation of disorders of the central nervous system. The clinical usefulness of 1H MR spectroscopy has been established for brain neoplasms, neonatal and pediatric disorders (hypoxia-ischemia, inherited metabolic diseases, and traumatic brain injury), demyelinating disorders, and infectious brain lesions. The growing list of disorders for which 1H MR spectroscopy may contribute to patient management extends to neurodegenerative diseases, epilepsy, and stroke. To facilitate expanded clinical acceptance and standardization of MR spectroscopy methodology, guidelines are provided for data acquisition and analysis, quality assessment, and interpretation. Finally, the authors offer recommendations to expedite the use of robust MR spectroscopy methodology in the clinical setting, including incorporation of technical advances on clinical units. © RSNA, 2014 Online supplemental material is available for this article. PMID:24568703

"That's your patient. There's your ventilator": exploring induction to work experiences in a group of non-UK EEA trained anaesthetists in a London hospital: a qualitative study.

PubMed

Snelgrove, Huon; Kuybida, Yuriy; Fleet, Mark; McAnulty, Greg

2015-03-17

European health systems depend increasingly on the services of health professionals who obtained their primary medical qualification from other countries. There has been a significant increase recently in fully qualified specialist doctors arriving from the European Union to provide short term or longer-term solutions to health human resources needs in the UK National Health System. These doctors often take up senior consultant positions. As a result, the NHS has had to learn to deal with both expatriation and repatriation of EU doctors as a constant dynamic characteristic of its own ability to deliver services. We conducted a qualitative study to explore the acclimatisation experience of EU doctors with qualifications in anaesthesia arriving in the United Kingdom to take up clinical employment in the NHS. The question we ask is: how do specialty registered anaesthetists who trained in other European countries experience the process of acclimatisation to practice in the United Kingdom in a large hospital in London? We did individual interviews with non-UK, EU-qualified doctors with Certification of Completion of specialty Training who were registered with the General Medical Council in the UK and could practice in the NHS as specialist anaesthetists. The doctors were all interviewed whilst working in a large NHS teaching hospital in London, UK. We analysed qualitative data from interview transcripts to identity themes and patterns regarding senior doctor's acclimatisation to the British system. Acclimatisation conceived of as transfer of clinical expertise was problematic for doctors who felt they lacked the right kind of support. Doctors sought different opportunities to share wider perspectives on care deriving from their previous experience. Hospital conceptions of acclimatisation as a highly individual process can offer an idealized view of clinical work and learning in the new system. Socio-cultural theories suggest we create regular learning opportunities for international staff to critically reflect on practice with local staff to acclimatise more effectively.

Clinical time series prediction: Toward a hierarchical dynamical system framework.

PubMed

Liu, Zitao; Hauskrecht, Milos

2015-09-01

Developing machine learning and data mining algorithms for building temporal models of clinical time series is important for understanding of the patient condition, the dynamics of a disease, effect of various patient management interventions and clinical decision making. In this work, we propose and develop a novel hierarchical framework for modeling clinical time series data of varied length and with irregularly sampled observations. Our hierarchical dynamical system framework for modeling clinical time series combines advantages of the two temporal modeling approaches: the linear dynamical system and the Gaussian process. We model the irregularly sampled clinical time series by using multiple Gaussian process sequences in the lower level of our hierarchical framework and capture the transitions between Gaussian processes by utilizing the linear dynamical system. The experiments are conducted on the complete blood count (CBC) panel data of 1000 post-surgical cardiac patients during their hospitalization. Our framework is evaluated and compared to multiple baseline approaches in terms of the mean absolute prediction error and the absolute percentage error. We tested our framework by first learning the time series model from data for the patients in the training set, and then using it to predict future time series values for the patients in the test set. We show that our model outperforms multiple existing models in terms of its predictive accuracy. Our method achieved a 3.13% average prediction accuracy improvement on ten CBC lab time series when it was compared against the best performing baseline. A 5.25% average accuracy improvement was observed when only short-term predictions were considered. A new hierarchical dynamical system framework that lets us model irregularly sampled time series data is a promising new direction for modeling clinical time series and for improving their predictive performance. Copyright © 2014 Elsevier B.V. All rights reserved.

Resolving Rivalries and Realigning Goals: Challenges of Clinical and Research Multiteam Systems

PubMed Central

Reimer, Torsten; Williams, Erin L.; Gill, Mary; Loudat Priddy, Laurin; Bergestuen, Deidi; Schiller, Joan H.; Kirkpatrick, Haskell; Craddock Lee, Simon J.

2016-01-01

This article describes the care processes for a 64-year-old man with newly diagnosed advanced non–small-cell lung cancer who was enrolled in a first-line clinical trial of a new immunotherapy regimen. The case highlights the concept of multiteam systems in cancer clinical research and clinical care. Because clinical research represents a highly dynamic entity—with studies frequently opening, closing, and undergoing modifications—concerted efforts of multiple teams are needed to respond to these changes while continuing to provide consistent, high-level care and timely, accurate clinical data. The case illustrates typical challenges of multiteam care processes. Compared with clinical tasks that are routinely performed by single teams, multiple-team care greatly increases the demands for communication, collaboration, cohesion, and coordination among team members. As the case illustrates, the described research team and clinical team are separated, resulting in suboptimal function. Individual team members interact predominantly with members of their own team. A considerable number of team members lack regular interaction with anyone outside their team. Accompanying this separation, the teams enact rivalries that impede collaboration. The teams have misaligned goals and competing priorities that create competition. Collective identity and cohesion across the two teams are low. Research team and clinical team members have limited knowledge of the roles and work of individuals outside their team. Recommendations to increase trust and collaboration are provided. Clinical providers and researchers may incorporate these themes into development and evaluation of multiteam systems, multidisciplinary teams, and cross-functional teams within their own institutions. PMID:27624948

Resolving Rivalries and Realigning Goals: Challenges of Clinical and Research Multiteam Systems.

PubMed

Gerber, David E; Reimer, Torsten; Williams, Erin L; Gill, Mary; Loudat Priddy, Laurin; Bergestuen, Deidi; Schiller, Joan H; Kirkpatrick, Haskell; Craddock Lee, Simon J

2016-11-01

This article describes the care processes for a 64-year-old man with newly diagnosed advanced non-small-cell lung cancer who was enrolled in a first-line clinical trial of a new immunotherapy regimen. The case highlights the concept of multiteam systems in cancer clinical research and clinical care. Because clinical research represents a highly dynamic entity-with studies frequently opening, closing, and undergoing modifications-concerted efforts of multiple teams are needed to respond to these changes while continuing to provide consistent, high-level care and timely, accurate clinical data. The case illustrates typical challenges of multiteam care processes. Compared with clinical tasks that are routinely performed by single teams, multiple-team care greatly increases the demands for communication, collaboration, cohesion, and coordination among team members. As the case illustrates, the described research team and clinical team are separated, resulting in suboptimal function. Individual team members interact predominantly with members of their own team. A considerable number of team members lack regular interaction with anyone outside their team. Accompanying this separation, the teams enact rivalries that impede collaboration. The teams have misaligned goals and competing priorities that create competition. Collective identity and cohesion across the two teams are low. Research team and clinical team members have limited knowledge of the roles and work of individuals outside their team. Recommendations to increase trust and collaboration are provided. Clinical providers and researchers may incorporate these themes into development and evaluation of multiteam systems, multidisciplinary teams, and cross-functional teams within their own institutions.

Developing a Decision Support System for Tobacco Use Counseling Using Primary Care Physicians

PubMed Central

Marcy, Theodore W.; Kaplan, Bonnie; Connolly, Scott W.; Michel, George; Shiffman, Richard N.; Flynn, Brian S.

2009-01-01

Background Clinical decision support systems (CDSS) have the potential to improve adherence to guidelines, but only if they are designed to work in the complex environment of ambulatory clinics as otherwise physicians may not use them. Objective To gain input from primary care physicians in designing a CDSS for smoking cessation to ensure that the design is appropriate to a clinical environment before attempts to test this CDSS in a clinical trial. This approach is of general interest to those designing similar systems. Design and Approach We employed an iterative ethnographic process that used multiple evaluation methods to understand physician preferences and workflow integration. Using results from our prior survey of physicians and clinic managers, we developed a prototype CDSS, validated content and design with an expert panel, and then subjected it to usability testing by physicians, followed by iterative design changes based on their feedback. We then performed clinical testing with individual patients, and conducted field tests of the CDSS in two primary care clinics during which four physicians used it for routine patient visits. Results The CDSS prototype was substantially modified through these cycles of usability and clinical testing, including removing a potentially fatal design flaw. During field tests in primary care clinics, physicians incorporated the final CDSS prototype into their workflow, and used it to assist in smoking cessation interventions up to eight times daily. Conclusions A multi-method evaluation process utilizing primary care physicians proved useful for developing a CDSS that was acceptable to physicians and patients, and feasible to use in their clinical environment. PMID:18713526

Noradrenergic dysregulation in the pathophysiology of PTSD.

PubMed

Hendrickson, Rebecca C; Raskind, Murray A

2016-10-01

A central role for noradrenergic dysregulation in the pathophysiology of post-traumatic stress disorder (PTSD) is increasingly suggested by both clinical and basic neuroscience research. Here, we integrate recent findings from clinical and animal research with the earlier literature. We first review the evidence for net upregulation of the noradrenergic system and its responsivity to stress in individuals with PTSD. Next, we trace the evidence that the α 1 noradrenergic receptor antagonist prazosin decreases many of the symptoms of PTSD from initial clinical observations, to case series, to randomized controlled trials. Finally, we review the basic science work that has begun to explain the mechanism for this efficacy, as well as to explore its possible limitations and areas for further advancement. We suggest a view of the noradrenergic system as a central, modifiable link in a network of interconnected stress-response systems, which also includes the amygdala and its modulation by medial prefrontal cortex. Particular attention is paid to the evidence for bidirectional signaling between noradrenaline and corticotropin-releasing factor (CRF) in coordinating these interconnected systems. The multiple different ways in which the sensitivity and reactivity of the noradrenergic system may be altered in PTSD are highlighted, as is the evidence for possible heterogeneity in the pathophysiology of PTSD between different individuals who appear clinically similar. We conclude by noting the importance moving forward of improved measures of noradrenergic functioning in clinical populations, which will allow better recognition of clinical heterogeneity and further assessment of the functional implications of different aspects of noradrenergic dysregulation. Published by Elsevier Inc.

Sharing Annotated Audio Recordings of Clinic Visits With Patients—Development of the Open Recording Automated Logging System (ORALS): Study Protocol

PubMed Central

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

2017-01-01

Background Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. Objective The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. Methods We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth’s Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. Results We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a US-wide network of primary care practices (www.iorahealth.com), has indicated a willingness to implement ORALS on a larger scale upon completion of this development project. Conclusions Upon the completion of this project we will have developed a novel recording system that will be ready for large-scale testing. Our long-term goal is for ORALS to seamlessly fit into a clinic’s and patient’s daily routine, increasing levels of patient engagement and transparency of care. PMID:28684387

Computer-assisted identification and volumetric quantification of dynamic contrast enhancement in brain MRI: an interactive system

NASA Astrophysics Data System (ADS)

Wu, Shandong; Avgeropoulos, Nicholas G.; Rippe, David J.

2013-03-01

We present a dedicated segmentation system for tumor identification and volumetric quantification in dynamic contrast brain magnetic resonance (MR) scans. Our goal is to offer a practically useful tool at the end of clinicians in order to boost volumetric tumor assessment. The system is designed to work in an interactive mode such that maximizes the integration of computing capacity and clinical intelligence. We demonstrate the main functions of the system in terms of its functional flow and conduct preliminary validation using a representative pilot dataset. The system is inexpensive, user-friendly, easy to deploy and integrate with picture archiving and communication systems (PACS), and possible to be open-source, which enable it to potentially serve as a useful assistant for radiologists and oncologists. It is anticipated that in the future the system can be integrated into clinical workflow so that become routine available to help clinicians make more objective interpretations of treatment interventions and natural history of disease to best advocate patient needs.

Can smartwatches replace smartphones for posture tracking?

PubMed

Mortazavi, Bobak; Nemati, Ebrahim; VanderWall, Kristina; Flores-Rodriguez, Hector G; Cai, Jun Yu Jacinta; Lucier, Jessica; Naeim, Arash; Sarrafzadeh, Majid

2015-10-22

This paper introduces a human posture tracking platform to identify the human postures of sitting, standing or lying down, based on a smartwatch. This work develops such a system as a proof-of-concept study to investigate a smartwatch's ability to be used in future remote health monitoring systems and applications. This work validates the smartwatches' ability to track the posture of users accurately in a laboratory setting while reducing the sampling rate to potentially improve battery life, the first steps in verifying that such a system would work in future clinical settings. The algorithm developed classifies the transitions between three posture states of sitting, standing and lying down, by identifying these transition movements, as well as other movements that might be mistaken for these transitions. The system is trained and developed on a Samsung Galaxy Gear smartwatch, and the algorithm was validated through a leave-one-subject-out cross-validation of 20 subjects. The system can identify the appropriate transitions at only 10 Hz with an F-score of 0.930, indicating its ability to effectively replace smart phones, if needed.

Understanding critical barriers to implementing a clinical information system in a nursing home through the lens of a socio-technical perspective.

PubMed

Or, Calvin; Dohan, Michael; Tan, Joseph

2014-09-01

This paper addresses key barriers to implementing a clinical information system (CIS) in a Hong Kong nursing home setting, from a healthcare specific socio-technical perspective. Data was collected through field observations (n = 12) and semi-structured individual interviews (n = 18) of CIS stakeholders in a Hong Kong nursing home, and analyzed using the immersion/crystallization approach. Complex interactions relevant to our case were contextualized and interpreted within the perspective of the Sittig-Singh Healthcare Socio-Technical Framework (HSTF). Three broad clusters of implementation barriers from the eight HSTF dimensions were identified: (a) Infrastructure-based barriers, which relate to conflict between government regulations and system functional needs of users; lack of financial support; inconsistency between workflow, work policy, and procedures; and inadequacy of hardware-software infrastructural and technical support; (b) Process-based barriers, which relate to mismatch between the technology, existing work practice and workflow, and communication; low system speed, accessibility, and stability; deficient computer literacy; more experience in health care profession; clinical content inadequacy and unavailability; as well as poor system usefulness and user interface design; and (c) Outcome-based barriers, which relate to the lack of measurement and monitoring of system effectiveness. Two additional dimensions underlining the importance of the ability of a CIS to change are proposed to extend the Sittig-Singh HSTF. First, advocacy would promote the articulation and influence of changes in the system and subsequent outcomes by CIS stakeholders, and second, adaptability would ensure the ability of the system to adjust to emerging needs. The broad set of discovered implementation shortcomings expands prior research on why CIS can fail in nursing home settings. Moreover, our investigation offers a knowledge base and recommendations that can serve as a guide for future implementation strategies and policies in CIS initiatives.

Evidence of Effectiveness of Health Care Professionals Using Handheld Computers: A Scoping Review of Systematic Reviews

PubMed Central

2013-01-01

Background Handheld computers and mobile devices provide instant access to vast amounts and types of useful information for health care professionals. Their reduced size and increased processing speed has led to rapid adoption in health care. Thus, it is important to identify whether handheld computers are actually effective in clinical practice. Objective A scoping review of systematic reviews was designed to provide a quick overview of the documented evidence of effectiveness for health care professionals using handheld computers in their clinical work. Methods A detailed search, sensitive for systematic reviews was applied for Cochrane, Medline, EMBASE, PsycINFO, Allied and Complementary Medicine Database (AMED), Global Health, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. All outcomes that demonstrated effectiveness in clinical practice were included. Classroom learning and patient use of handheld computers were excluded. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A previously published conceptual framework was used as the basis for dual data extraction. Reported outcomes were summarized according to the primary function of the handheld computer. Results Five systematic reviews met the inclusion and quality criteria. Together, they reviewed 138 unique primary studies. Most reviewed descriptive intervention studies, where physicians, pharmacists, or medical students used personal digital assistants. Effectiveness was demonstrated across four distinct functions of handheld computers: patient documentation, patient care, information seeking, and professional work patterns. Within each of these functions, a range of positive outcomes were reported using both objective and self-report measures. The use of handheld computers improved patient documentation through more complete recording, fewer documentation errors, and increased efficiency. Handheld computers provided easy access to clinical decision support systems and patient management systems, which improved decision making for patient care. Handheld computers saved time and gave earlier access to new information. There were also reports that handheld computers enhanced work patterns and efficiency. Conclusions This scoping review summarizes the secondary evidence for effectiveness of handheld computers and mhealth. It provides a snapshot of effective use by health care professionals across four key functions. We identified evidence to suggest that handheld computers provide easy and timely access to information and enable accurate and complete documentation. Further, they can give health care professionals instant access to evidence-based decision support and patient management systems to improve clinical decision making. Finally, there is evidence that handheld computers allow health professionals to be more efficient in their work practices. It is anticipated that this evidence will guide clinicians and managers in implementing handheld computers in clinical practice and in designing future research. PMID:24165786

Lightweight fuzzy processes in clinical computing.

PubMed

Hurdle, J F

1997-09-01

In spite of advances in computing hardware, many hospitals still have a hard time finding extra capacity in their production clinical information system to run artificial intelligence (AI) modules, for example: to support real-time drug-drug or drug-lab interactions; to track infection trends; to monitor compliance with case specific clinical guidelines; or to monitor/ control biomedical devices like an intelligent ventilator. Historically, adding AI functionality was not a major design concern when a typical clinical system is originally specified. AI technology is usually retrofitted 'on top of the old system' or 'run off line' in tandem with the old system to ensure that the routine work load would still get done (with as little impact from the AI side as possible). To compound the burden on system performance, most institutions have witnessed a long and increasing trend for intramural and extramural reporting, (e.g. the collection of data for a quality-control report in microbiology, or a meta-analysis of a suite of coronary artery bypass grafts techniques, etc.) and these place an ever-growing burden on typical the computer system's performance. We discuss a promising approach to adding extra AI processing power to a heavily-used system based on the notion 'lightweight fuzzy processing (LFP)', that is, fuzzy modules designed from the outset to impose a small computational load. A formal model for a useful subclass of fuzzy systems is defined below and is used as a framework for the automated generation of LFPs. By seeking to reduce the arithmetic complexity of the model (a hand-crafted process) and the data complexity of the model (an automated process), we show how LFPs can be generated for three sample datasets of clinical relevance.

[The value of using administrative data in public health research: the Continuous Working Life Sample].

PubMed

López, María Andrée; Benavides, Fernando G; Alonso, Jordi; Espallargues, Mireia; Durán, Xavier; Martínez, José Miguel

2014-01-01

The use of administrative data is common practice in public health research. The present field note describes the Continuous Working Life Sample (CWLS) and its use in health research. The CWLS is built on records generated by all contacts with the social security system (work contracts, disability, etc.), plus tax data (monetary gains, income, etc.) and census data (level of education, country of birth, etc.), but does not allow individuals to be identified. The CWLS was started in 2004 with 4% (1.1 million persons) of the total population who were either contributors to or beneficiaries of the social security system. The information on the individuals in the CWLS is updated annually and lost individuals are replaced. This continuous design allows the construction of a cohort with information on working life and financial status and evaluation of their relationship with work disability. Future connection with clinical records would enable analysis of other health-related outcomes. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

PubMed Central

Arnetz, Bengt B.; Christensen, John F.; Homer, Louis

2007-01-01

BACKGROUND Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. OBJECTIVE To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. DESIGN AND PARTICIPANTS From 2000 to 2005, 22–32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. MEASUREMENTS Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. RESULTS Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. CONCLUSIONS A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk. PMID:17891503

DRUGS System Improving the Effects of Clinical Pathways: A Systematic Study.

PubMed

Wang, Shan; Zhu, Xiaohe; Zhao, Xian; Lu, Yang; Yang, Zhifu; Qian, Xiaoliang; Li, Weiwei; Ma, Lixiazi; Guo, Huning; Wang, Jingwen; Wen, Aidong

2016-03-01

The aim of the study is to assess the feasibility of Drugs Rational Usage Guideline System (DRUGS)-supported clinical pathway (CP) for breast carcinoma, cataract, inguinal hernia and 2-diabetes mellitus whether the application of such a system could improve work efficiency, medical safety, and decrease hospital cost. Four kinds of diseases which included 1773 cases (where 901 cases using paper-based clinical pathways and 872 cases using DRUGS-supported clinical pathways) were selected and their demographic and clinical data were collected. The evaluation criteria were length of stay, preoperative length of stay, hospital cost, antibiotics prescribed during hospitalization, unscheduled surgery, complications and prognosis. The median total LOS was 1 to 3 days shorter in the DRUGS-supported CP group as compared to the Paper-based CP group for all types (p < 0.05). Totel hospital cost decreased significantly in the DRUGS-supported CP group than that in Paper-based CP group. About antibiotics prescribed during hospitalization, there were no statistically differences in the time of initial dose of antibiotic and the duration of administration except the choice of antibiotic categories. The proportion of DRUGS-supported clinical pathway conditions where a broad-spectrum antibiotic was prescribed decreased from 63.6 to 34.5 % (p < 0.01) in the Paper-based group. While after the intervention, the differences were statistically not significant in unscheduled surgery, complications and prognosis. In this study, DRUGS-supported clinical pathway for breast carcinoma, cataract, inguinal hernia, 2-diabetes mellitus was smoothly shifted from a paper-based to an electronic system, and confer benefits at the hospital level.

From PACS to Web-based ePR system with image distribution for enterprise-level filmless healthcare delivery.

PubMed

Huang, H K

2011-07-01

The concept of PACS (picture archiving and communication system) was initiated in 1982 during the SPIE medical imaging conference in New Port Beach, CA. Since then PACS has been matured to become an everyday clinical tool for image archiving, communication, display, and review. This paper follows the continuous development of PACS technology including Web-based PACS, PACS and ePR (electronic patient record), enterprise PACS to ePR with image distribution (ID). The concept of large-scale Web-based enterprise PACS and ePR with image distribution is presented along with its implementation, clinical deployment, and operation. The Hong Kong Hospital Authority's (HKHA) integration of its home-grown clinical management system (CMS) with PACS and ePR with image distribution is used as a case study. The current concept and design criteria of the HKHA enterprise integration of the CMS, PACS, and ePR-ID for filmless healthcare delivery are discussed, followed by its work-in-progress and current status.

Neuroendocrine tumors of colon and rectum: validation of clinical and prognostic values of the World Health Organization 2010 grading classifications and European Neuroendocrine Tumor Society staging systems.

PubMed

Shen, Chaoyong; Yin, Yuan; Chen, Huijiao; Tang, Sumin; Yin, Xiaonan; Zhou, Zongguang; Zhang, Bo; Chen, Zhixin

2017-03-28

This study evaluated and compared the clinical and prognostic values of the grading criteria used by the World Health Organization (WHO) and the European Neuroendocrine Tumors Society (ENETS). Moreover, this work assessed the current best prognostic model for colorectal neuroendocrine tumors (CRNETs). The 2010 WHO classifications and the ENETS systems can both stratify the patients into prognostic groups, although the 2010 WHO criteria is more applicable to CRNET patients. Along with tumor location, the 2010 WHO criteria are important independent prognostic parameters for CRNETs in both univariate and multivariate analyses through Cox regression (P<0.05). Data from 192 consecutive patients histopathologically diagnosed with CRNETs and had undergone surgical resection from January 2009 to May 2016 in a single center were retrospectively analyzed. Findings suggest that the WHO classifications are superior over the ENETS classification system in predicting the prognosis of CRNETs. Additionally, the WHO classifications can be widely used in clinical practice.

Recruit--An Ontology Based Information Retrieval System for Clinical Trials Recruitment.

PubMed

Patrão, Diogo F C; Oleynik, Michel; Massicano, Felipe; Morassi Sasso, Ariane

2015-01-01

Clinical trials are studies designed to assess whether a new intervention is better than the current alternatives. However, most of them fail to recruit participants on schedule. It is hard to use Electronic Health Record (EHR) data to find eligible patients, therefore studies rely on manual assessment, which is time consuming, inefficient and requires specialized training. In this work we describe the design and development of an information retrieval system with the objective of finding eligible patients for cancer trials. The Recruit system has been in use at A. C. Camargo Cancer Center since August/2014 and contains data from more than 500,000 patients and 9 databases. It uses ontologies to integrate data from several sources and represent medical knowledge, which helps enhance results. One can search both in structured data and inside free text reports. The preliminary quality assessments shows excellent recall rates. Recruit proved to be an useful tool for researchers and its modular design could be applied to other clinical conditions and hospitals.

Investigating the Heart Pump Implant Decision Process: Opportunities for Decision Support Tools to Help

PubMed Central

Yang, Qian; Zimmerman, John; Steinfeld, Aaron; Carey, Lisa; Antaki, James F.

2016-01-01

Clinical decision support tools (DSTs) are computational systems that aid healthcare decision-making. While effective in labs, almost all these systems failed when they moved into clinical practice. Healthcare researchers speculated it is most likely due to a lack of user-centered HCI considerations in the design of these systems. This paper describes a field study investigating how clinicians make a heart pump implant decision with a focus on how to best integrate an intelligent DST into their work process. Our findings reveal a lack of perceived need for and trust of machine intelligence, as well as many barriers to computer use at the point of clinical decision-making. These findings suggest an alternative perspective to the traditional use models, in which clinicians engage with DSTs at the point of making a decision. We identify situations across patients’ healthcare trajectories when decision supports would help, and we discuss new forms it might take in these situations. PMID:27833397

Harnessing the Promise of Moral Distress: A Call for Re-Orientation.

PubMed

Carse, Alisa; Rushton, Cynda Hylton

2017-01-01

Despite over three decades of research into the sources and costs of what has become an "epidemic" of moral distress among healthcare professionals, spanning many clinical disciplines and roles, there has been little significant progress in effectively addressing moral distress. We believe the persistent sense of frustration, helplessness, and despair still dominating the clinical moral distress narrative signals a need for re-orientation in the way moral distress is understood and worked with. Most fundamentally, moral distress reveals moral investment and energy. It is the troubled call of conscience, an expression of fidelity to moral commitments seen as imperiled or compromised. It is crucial that we find ways to empower clinicians in heeding this call-to support clinicians' moral agency and voice, foster their moral resilience, and facilitate their ability to contribute to needed reform within the organizations and systems in which they work. These objectives must inform creative expansion in the design of strategies for addressing moral distress in the day-to-day of clinical practice. We include suggestions about promising directions such strategies might take in the hope of spurring further innovation within clinical environments. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

The intelligent clinical laboratory as a tool to increase cancer care management productivity.

PubMed

Mohammadzadeh, Niloofar; Safdari, Reza

2014-01-01

Studies of the causes of cancer, early detection, prevention or treatment need accurate, comprehensive, and timely cancer data. The clinical laboratory provides important cancer information needed for physicians which influence clinical decisions regarding treatment, diagnosis and patient monitoring. Poor communication between health care providers and clinical laboratory personnel can lead to medical errors and wrong decisions in providing cancer care. Because of the key impact of laboratory information on cancer diagnosis and treatment the quality of the tests, lab reports, and appropriate lab management are very important. A laboratory information management system (LIMS) can have an important role in diagnosis, fast and effective access to cancer data, decrease redundancy and costs, and facilitate the integration and collection of data from different types of instruments and systems. In spite of significant advantages LIMS is limited by factors such as problems in adaption to new instruments that may change existing work processes. Applications of intelligent software simultaneously with existing information systems, in addition to remove these restrictions, have important benefits including adding additional non-laboratory-generated information to the reports, facilitating decision making, and improving quality and productivity of cancer care services. Laboratory systems must have flexibility to change and have the capability to develop and benefit from intelligent devices. Intelligent laboratory information management systems need to benefit from informatics tools and latest technologies like open sources. The aim of this commentary is to survey application, opportunities and necessity of intelligent clinical laboratory as a tool to increase cancer care management productivity.

Increasing consumer demand for tobacco treatments: Ten design recommendations for clinicians and healthcare systems.

PubMed

Woods, Susan Swartz; Jaén, Carlos Roberto

2010-03-01

Health professionals play an important role in addressing patient tobacco use in clinical settings. While there is clear evidence that identifying tobacco use and assisting smokers in quitting affects outcomes, challenges to improve routine, clinician-delivered tobacco intervention persist. The Consumer Demand Initiative has identified simple design principles to increase consumers' use of proven tobacco treatments. Applying these design strategies to activities across the healthcare system, we articulate ten recommendations that can be implemented in the context of most clinical systems where most clinicians work. The recommendations are: (1) reframe the definition of success, (2) portray proven treatments as the best care, (3) redesign the 5A's of tobacco intervention, (4) be ready to deliver the right treatment at the right time, (5) move tobacco from the social history to the problem list, (6) use words as therapy and language that makes sense, (7) fit tobacco treatment into clinical team workflows, (8) embed tobacco treatment into health information technology, (9) make every encounter an opportunity to intervene, and (10) end social disparities for tobacco users. Clinical systems need to change to improve tobacco treatment implementation. The consumer- and clinician-centered recommendations provide a roadmap that focuses on increasing clinician performance through greater understanding of the clinician's role in helping tobacco users, highlighting the value of evidence-based tobacco treatments, employing shared decision-making skills, and integrating routine tobacco treatment into clinical system routines. Published by Elsevier Inc.

Stakeholder challenges in purchasing medical devices for patient safety.

PubMed

Hinrichs, Saba; Dickerson, Terry; Clarkson, John

2013-03-01

This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

Developing clinical indicators for the secondary health system in India.

PubMed

Thakur, Harshad; Chavhan, S; Jotkar, Raju; Mukherjee, Kanchan

2008-08-01

One of the prime goals of any health system is to deliver good and competent quality of healthcare. Through World Bank-assisted Maharashtra Health Systems Development Project, Government of Maharashtra in India developed and implemented clinical indicators to improve quality. During this, clinical areas eligible for monitoring quality of care and roles of health staff working at various levels were identified. Brainstorming discussion sessions were conducted to refine list of potential clinical indicators and to identify implementation problems. It was implemented in four stages. (a) Self-explanatory tool of record, standard operating procedures and training manual were prepared during tools preparation stage. (b) Pilot implementation was done to monitor the usefulness of indicators, document the experiences and standardize the system accordingly. (c) The final selection of indicators was done taking into consideration points like data reliability, indicator usefulness etc. For final implementation, 15 indicators for district and 6 indicators for rural hospitals were selected. (d) Transfer of skills was done through training of various hospital functionaries. Selection and prioritization of clinical indicators is the most crucial part. Active participation of local employees is essential for sustainability of the scheme. It is also important to ensure that data recorded/reported is both reliable and valid, to conduct monthly review of the scheme at various levels and to link it with the quality improvement programme.

[Strategy Development for International Cooperation in the Clinical Laboratory Field].

PubMed

Kudo, Yoshiko; Osawa, Susumu

2015-10-01

The strategy of international cooperation in the clinical laboratory field was analyzed to improve the quality of intervention by reviewing documents from international organizations and the Japanese government. Based on the world development agenda, the target of action for health has shifted from communicable diseases to non-communicable diseases (NCD). This emphasizes the importance of comprehensive clinical laboratories instead of disease-specific examinations in developing countries. To achieve this goal, the World Health Organization (WHO) has disseminated to the African and Asian regions the Laboratory Quality Management System (LQMS), which is based on the same principles of the International Organization of Standardization (ISO) 15189. To execute this strategy, international experts must have competence in project management, analyze information regarding the target country, and develop a strategy for management of the LQMS with an understanding of the technical aspects of laboratory work. However, there is no appropriate pre- and post-educational system of international health for Japanese international workers. Universities and academic organizations should cooperate with the government to establish a system of education for international workers. Objectives of this education system must include: (1) training for the organization and understanding of global health issues, (2) education of the principles regarding comprehensive management of clinical laboratories, and (3) understanding the LQMS which was employed based on WHO's initiative. Achievement of these objectives will help improve the quality of international cooperation in the clinical laboratory field.

Design and implementation of the GLIF3 guideline execution engine.

PubMed

Wang, Dongwen; Peleg, Mor; Tu, Samson W; Boxwala, Aziz A; Ogunyemi, Omolola; Zeng, Qing; Greenes, Robert A; Patel, Vimla L; Shortliffe, Edward H

2004-10-01

We have developed the GLIF3 Guideline Execution Engine (GLEE) as a tool for executing guidelines encoded in the GLIF3 format. In addition to serving as an interface to the GLIF3 guideline representation model to support the specified functions, GLEE provides defined interfaces to electronic medical records (EMRs) and other clinical applications to facilitate its integration with the clinical information system at a local institution. The execution model of GLEE takes the "system suggests, user controls" approach. A tracing system is used to record an individual patient's state when a guideline is applied to that patient. GLEE can also support an event-driven execution model once it is linked to the clinical event monitor in a local environment. Evaluation has shown that GLEE can be used effectively for proper execution of guidelines encoded in the GLIF3 format. When using it to execute each guideline in the evaluation, GLEE's performance duplicated that of the reference systems implementing the same guideline but taking different approaches. The execution flexibility and generality provided by GLEE, and its integration with a local environment, need to be further evaluated in clinical settings. Integration of GLEE with a specific event-monitoring and order-entry environment is the next step of our work to demonstrate its use for clinical decision support. Potential uses of GLEE also include quality assurance, guideline development, and medical education.

[Clinical nursing manpower: development and future prospects].

PubMed

Lin, Chiou-Fen; Kao, Ching-Chiu

2014-04-01

The significant changes in nursing manpower utilization in Taiwan over the past two decades are due in large part to the implementation of the National Health Insurance program and the rising need for long-term care. The changes have impacted clinical nursing manpower utilization in two important ways. Firstly, there has been a substantial increase in overall demand for nursing manpower. In particular, the need for clinical nurses has nearly quadrupled during this time period. Secondly, the level of difficulty involved in patient care has risen dramatically, with factors including increased disease severity and increased care quality expectations, among others. These changes, coupled with demands on nursing manpower imposed from other sectors, underpin and further exacerbate the problem of nursing manpower shortages throughout the healthcare system. To raise the quality of the nursing work environment, the Ministry of Health and Welfare (MOHW) brought together Taiwan's key professional nursing organizations to promote 10 care-reform strategies, establish the nursing-aid manpower system, and create the nursing classification system as an approach to effectively attract nurses to take positions in the medical system.

Supportive intervention using a mobile phone in behavior modification.

PubMed

Hareva, David H; Okada, Hiroki; Kitawaki, Tomoki; Oka, Hisao

2009-04-01

The authors previously developed a mobile ecological momentary assessment (EMA) system as a real-time data collection device using a mobile phone. In this study, a real-time advice function and real-time reporting function were added to the previous system as a supportive intervention. The improved system was found to work effectively and was applied to several clinical cases, including patients with depressive disorder, dizziness, smoking habit, and bronchial asthma. The average patient compliance rate was high (89%) without the real-time advice and higher (93%) with the advice. The trends in clinical data for patients using a mobile EMA with/without the new function were analyzed for up to several months. In the case of dizziness, an improving trend in its clinical data was observed after applying the real-time advice, and in the case of depressive disorder, a stabilizing trend was observed. The mobile EMA system with the real-time advice function could be useful as a supportive intervention in behavior modification and for motivating patients in self-management of their disease.

Towards public health decision support: a systematic review of bidirectional communication approaches.

PubMed

Dixon, Brian E; Gamache, Roland E; Grannis, Shaun J

2013-05-01

To summarize the literature describing computer-based interventions aimed at improving bidirectional communication between clinical and public health. A systematic review of English articles using MEDLINE and Google Scholar. Search terms included public health, epidemiology, electronic health records, decision support, expert systems, and decision-making. Only articles that described the communication of information regarding emerging health threats from public health agencies to clinicians or provider organizations were included. Each article was independently reviewed by two authors. Ten peer-reviewed articles highlight a nascent but promising area of research and practice related to alerting clinicians about emerging threats. Current literature suggests that additional research and development in bidirectional communication infrastructure should focus on defining a coherent architecture, improving interoperability, establishing clear governance, and creating usable systems that will effectively deliver targeted, specific information to clinicians in support of patient and population decision-making. Increasingly available clinical information systems make it possible to deliver timely, relevant knowledge to frontline clinicians in support of population health. Future work should focus on developing a flexible, interoperable infrastructure for bidirectional communications capable of integrating public health knowledge into clinical systems and workflows.

Brainstorming about next-generation computer-based documentation: an AMIA clinical working group survey.

PubMed

Johnson, Kevin B; Ravich, William J; Cowan, John A

2004-09-01

Computer-based software to record histories, physical exams, and progress or procedure notes, known as computer-based documentation (CBD) software, has been touted as an important addition to the electronic health record. The functionality of CBD systems has remained static over the past 30 years, which may have contributed to the limited adoption of these tools. Early users of this technology, who have tried multiple products, may have insight into important features to be considered in next-generation CBD systems. We conducted a cross-sectional, observational study of the clinical working group membership of the American Medical Informatics Association (AMIA) to generate a set of features that might improve adoption of next-generation systems. The study was conducted online over a 4-month period; 57% of the working group members completed the survey. As anticipated, CBD tool use was higher (53%) in this population than in the US physician offices. The most common methods of data entry employed keyboard and mouse, with agreement that these modalities worked well. Many respondents had experience with pre-printed data collection forms before interacting with a CBD system. Respondents noted that CBD improved their ability to document large amounts of information, allowed timely sharing of information, enhanced patient care, and enhanced medical information with other clinicians (all P < 0.001). Respondents also noted some important but absent features in CBD, including the ability to add images, get help, and generate billing information. The latest generation of CBD systems is being used successfully by early adopters, who find that these tools confer many advantages over the approaches to documentation that they replaced. These users provide insights that may improve successive generations of CBD tools. Additional surveys of CBD non-users and failed adopters will be necessary to provide other useful insights that can address barriers to the adoption of CBD by less computer literate physicians.

Implementing a mission-based reporting system at an academic health center: a method for mission enhancement.

PubMed

Howell, Lydia Pleotis; Hogarth, Michael A; Anders, Thomas F

2003-06-01

To describe the utility of school-wide use of mission-based reporting (MBR) for medical school deans and department chairs. All faculty members in the University of California, Davis, School of Medicine reported their clinical, creative, teaching, and service activities for 2000-2001 to the MBR system. The authors report on school-wide and department MBR profiles, and profiles by rank and academic series. They validate MBR by comparing individual results with actual merit actions reviewed independently by the school's academic personnel committee. A total of 419 faculty members (85%) completed their MBR reports. The average faculty member spent considerably more than 50 hours per week fulfilling the missions of the school, and full professors and faculty members in academic series supported by state funds were the most productive in investigative and creative work. The teaching load was shared equally by all the academic ranks, although the clinician-scholars taught more than did faculty members in the other series. There was an inverse relationship between clinical load and academic rank, with the majority of the clinical work performed by junior faculty members. MBR results compared favorably with the merit review process, although MBR is not expected to replace the traditional peer review system. The creation of these graphic profiles and summaries is a valuable feature of MBR that would not have been possible without such quantitative data. The profiles allow monitoring to ensure that workload conforms to established objectives for individuals, departments, academic ranks and series. Finally, the authors discuss future directions for their MBR system.

The PolyScope: a modular design, semidisposable flexible ureterorenoscope system.

PubMed

Bader, Markus Juergen; Gratzke, Christian; Walther, Sebastian; Schlenker, Boris; Tilki, Derya; Hocaoglu, Yasemin; Sroka, Ronald; Stief, Christian Georg; Reich, Oliver

2010-07-01

To characterize the mechanical and optical properties of the PolyScope endoscope system and to examine the clinical outcome in patients who were undergoing ureteronephroscopy. Mechanical assessment involved measurement of the deflection angle and irrigation flow rate. Optical resolution and distortion, field and angle of view, and light transmission and output formed the optical assessment. Clinical assessment was made in a series of consecutive ureteronephroscopy procedures. The optical cord was disconnected after each procedure, and the image fiber was assessed for damage. The mean value for the angle of maximum active tip deflection with an empty working channel was 265 degrees (261-275 degrees). Deflection was impaired most with insertion of the 3.0 F basket (10% decrease) and least with an indwelling 220 microm laser fiber (2% decrease). Irrigation flow rate was 57 mL/min with an empty working channel. Flow was reduced by 50% and 68%, with the insertion of a 200 microm or 365 microm laser probe, respectively, and by 92.5% with a 3.2F basket. No damage to the image fiber occurred. The PolyScope optics system could identify a target of about 0.125 mm at a distance of 2 to 4 mm, based on 3 line-pairs/mm needed for clear identification. Lithotripsy of renal calculi was performed for 40 stone burdens in 32 patients; the resulting stone-free rate was 87.5%. The novel semidisposable ureteroscope system PolyScope was simple to use, effective, and reliable in this preliminary clinical evaluation. It overcomes the inherent fragility of comparable devices, which renders the need for maintenance unnecessary.

Development of practice principles for the management of ongoing suicidal ideation in young people diagnosed with major depressive disorder.

PubMed

Rice, Simon M; Simmons, Magenta B; Bailey, Alan P; Parker, Alexandra G; Hetrick, Sarah E; Davey, Christopher G; Phelan, Mark; Blaikie, Simon; Edwards, Jane

2014-01-01

There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation. In-depth focus groups were undertaken with a specialist multidisciplinary clinical team (the Youth Mood Clinic at Orygen Youth Health Clinical Program, Melbourne) working with young people aged 15-25 years experiencing ongoing suicidal ideation. Each focus group was audio recorded and transcribed verbatim using orthographic conventions. Principles of grounded theory and thematic analysis were used to analyse and code the resultant data. The identified codes were subsequently synthesised into eight practice principles reflecting engagement and consistency of care, ongoing risk assessment and documentation, individualised crisis planning, engaging systems of support, engendering hopefulness, development of adaptive coping, management of acute risk, and consultation and supervision. The identified practice principles provide a broad management framework, and may assist to improve treatment consistency and clinical management of young people experiencing ongoing suicidal ideation. The practice principles may be of use to health professionals working within a team-based setting involved in the provision of care, even if peripherally, to young people with ongoing suicidal ideation. Findings address the lack of treatment consistency and shared terminology and may provide containment and guidance to multidisciplinary clinicians working with this at-risk group.

Italian multicentre study on microbial environmental contamination in dental clinics: a pilot study.

PubMed

Pasquarella, Cesira; Veronesi, Licia; Castiglia, Paolo; Liguori, Giorgio; Montagna, Maria Teresa; Napoli, Christian; Rizzetto, Rolando; Torre, Ida; Masia, Maria Dolores; Di Onofrio, Valeria; Colucci, Maria Eugenia; Tinteri, Carola; Tanzi, Marialuisa

2010-09-01

The dental practice is associated with a high risk of infections, both for patients and healthcare operators, and the environment may play an important role in the transmission of infectious diseases. A microbiological environmental investigation was carried out in six dental clinics as a pilot study for a larger multicentre study that will be performed by the Italian SItI (Society of Hygiene, Preventive Medicine and Public Health) working group "Hygiene in Dentistry". Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days of the week, before and during treatments. Air and surfaces were also examined at the end of the daily activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and relative to the different sampling times. Microbial water contamination in Dental Unit Water Systems (DUWS) reached values of up to 26x10(4)cfu/mL (colony forming units per millilitre). P. aeruginosa was found in 33% of the sampled DUWS and Legionella spp. in 50%. A significant decrease in the Total Viable Count (TVC) was recorded during the activity. Microbial air contamination showed the highest levels during dental treatments and tended to decrease at the end of the working activity (p<0.05). Microbial buildup on surfaces increased significantly during the working hours. As these findings point out, research on microbial environmental contamination and the related risk factors in dental clinics should be expanded and should also be based on larger collections of data, in order to provide the essential knowledge aimed at targeted preventive interventions. Copyright 2010 Elsevier B.V. All rights reserved.

Fighting liver cancer with combination immunotherapies | Center for Cancer Research

Cancer.gov

A new clinical trial testing the effectiveness of immunotherapy treatment combinations against liver cancer is enrolling patients at the NIH Clinical Center in Bethesda, Maryland. Individually, immunotherapy drugs harness the power of the human immune system to better identify and kill cancer cells. Now, researchers at the NIH’s Center for Cancer Research have begun to find evidence that the drugs may work far more effectively when taken in combination with other therapies and with each other than when taken alone.

In silico cancer modeling: is it ready for primetime?

PubMed Central

Deisboeck, Thomas S; Zhang, Le; Yoon, Jeongah; Costa, Jose

2011-01-01

SUMMARY At the dawn of the era of personalized, systems-driven medicine, computational or in silico modeling and the simulation of disease processes is becoming increasingly important for hypothesis generation and data integration in both experiment and clinics alike. Arguably, this is nowhere more visible than in oncology. To illustrate the field’s vast potential as well as its current limitations we briefly review selected works on modeling malignant brain tumors. Implications for clinical practice, including trial design and outcome prediction are also discussed. PMID:18852721

Perceived Workforce Challenges among Clinical Social Workers in Hematopoietic Cell Transplantation Programs.

PubMed

Stickney Ferguson, Stacy; Randall, Jill; Dabney, Jane; Kalbacker, Marion E; Boyle, Nancy; Thao, Viengneesee; Murphy, Elizabeth A; Denzen, Ellen M

2018-05-01

Clinical social workers are psychosocial care experts who provide interventions that aim to address the emotional, relational, financial, and logistical challenges that arise throughout the hematopoietic cell transplantation (HCT) treatment and recovery process. Interventions that contribute to better patient outcomes can include cognitive behavioral therapy and counseling for adaptation to illness, family planning for 24/7 caregiver availability and strategies to support patient activities of daily living, instruction on guided imagery and relaxation techniques for symptom management and to decrease anxiety, psychoeducation on the treatment trajectory, and linkage with financial resources. A Social Work Workforce Group (SWG) was established through the System Capacity Initiative, led by the National Marrow Donor Program/Be The Match, to characterize the current social work workforce capacity and challenges. The SWG conducted a web-based survey of HCT clinical social workers in the United States. The response rate was 57% (n = 90), representing 76 transplant centers. Survey results indicated that the clinical social worker role and scope of practice varies significantly between centers; less than half of respondents reported that their clinical social work expertise was used to its fullest potential. With an estimated 3-fold increase in HCT patient volume by 2020, the need for specialized psychosocial health services will increase. The SWG makes recommendations to build capacity for the psychosocial care of HCT patients and to more fully integrate the social worker as a core member of the HCT team. The SWG created a Blood and Marrow Transplant (BMT) Clinical Social Worker role description that can be used by transplant centers to educate healthcare professionals, benchmark utilization of clinical social workers, and improve comprehensive psychosocial health programs. Copyright © 2018 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Mothering: an unacknowledged aspect of undergraduate clinical teachers' work in nursing.

PubMed

McKenna, Lisa; Wellard, Sally

2009-05-01

Clinical education is an important component of undergraduate nurse education, in which clinical teachers facilitate students' application of theoretical classroom knowledge into the clinical practice setting. Mothering as part of clinical teachers' work was a major finding from a larger study exploring clinical teaching work to identify what shaped their work and barriers to their work in clinical settings. The study used semi-structured interviews, informed by the work of Foucault. Maternal discourses emerged as a predominant one as participants presented their relationships with students describing examples of nurturing, protecting, supporting, guiding and providing discipline. The unexpected finding contradicted the dominant view of students as adult learners, and potentially positions them as dependent in their learning in clinical environments. Exploration of this discourse in the context of the study forms the basis of this paper. It is argued that the overall impact of maternal discourses on clinical teaching and learning is unclear but warrants more detailed investigation.

Analysis of dental treatment performed by dental residents at General Dentistry Department of Tokyo Dental College Chiba Hospital over 6 years following introduction of mandatory dental clinical training system.

PubMed

Yamakura, Daiki; Takahashi, Toshiyuki; Kameyama, Atsushi; Noro, Akio; Sugiyama, Toshiko; Kondo, Yoshihiro; Sugiyama, Setsuko; Haruyama, Akiko; Takeda, Tomotaka; Nakajima, Kazunori

2013-01-01

Six years have passed since the introduction of legislation mandating at least 1 year of clinical training for those who have passed the national dentist examination. To determine whether clinical training has been appropriately implemented at the General Dentistry Department of Tokyo Dental College Chiba Hospital, a managed-type clinical training facility, the number of patients treated and types of dental and dental technical work performed by dental residents trained by the department were summarized and analyzed. The number of patients treated per dental resident increased from 11 in 2006 to 15 in 2011. By treatment type, periodontic treatment was the most frequently performed throughout the study period, followed by endodontic treatment. Conservation treatment, prosthodontic treatment with crowns/bridges, and prosthodontic treatment with dentures were performed at a similar moderate frequency, while oral surgical treatment was performed least frequently throughout the study period. The frequency of periodontic treatment increased slightly, whereas that of endodontic treatment decreased slightly or remained almost unchanged after introduction of the mandatory clinical training system. When the distribution of dental treatment performed at our department was compared with that of dental treatment performed by general dentists across Japan in 2011, our department showed a slightly lower frequency of periodontic treatment and higher frequency of endodontic treatment than the national total, whereas the frequency of other types of treatment was similar between the two populations. These results demonstrated that appropriate clinical training has been provided by our department to meet the purpose of offering dentists the opportunity to acquire the basic diagnostic and treatment abilities that would enable them to provide appropriate treatment for injuries and diseases frequently encountered in daily practice. The study also revealed some problems, such as a decreasing number of residents engaging in dental technical work each year. For additional improvement in the quality of dental clinical training, more analyses are needed to further identify and address potential problems in the system.

Open Source 3D Multipurpose Measurement System with Submillimetre Fidelity and First Application in Magnetic Resonance.

PubMed

Han, Haopeng; Moritz, Raphael; Oberacker, Eva; Waiczies, Helmar; Niendorf, Thoralf; Winter, Lukas

2017-10-18

Magnetic resonance imaging (MRI) is the mainstay of diagnostic imaging, a versatile instrument for clinical science and the subject of intense research interest. Advancing clinical science, research and technology of MRI requires high fidelity measurements in quantity, location and time of the given physical property. To meet this goal a broad spectrum of commercial measurement systems has been made available. These instruments frequently share in common that they are costly and typically employ closed proprietary hardware and software. This shortcoming makes any adjustment for a specified application difficult if not prohibitive. Recognizing this limitation this work presents COSI Measure, an automated open source measurement system that provides submillimetre resolution, robust configuration and a large working volume to support a versatile range of applications. The submillimetre fidelity and reproducibility/backlash performance were evaluated experimentally. Magnetic field mapping of a single ring Halbach magnet, a 3.0 T and a 7.0 T MR scanner as well as temperature mapping of a radio frequency coil were successfully conducted. Due to its open source nature and versatile construction, the system can be easily modified for other applications. In a resource limited research setting, COSI Measure makes efficient use of laboratory space, financial resources and collaborative efforts.

Knowledge retrieval as one type of knowledge-based decision support in medicine: results of an evaluation study.

PubMed

Haux, R; Grothe, W; Runkel, M; Schackert, H K; Windeler, H J; Winter, A; Wirtz, R; Herfarth, C; Kunze, S

1996-04-01

We report on a prospective, prolective observational study, supplying information on how physicians and other health care professionals retrieve medical knowledge on-line within the Heidelberg University Hospital information system. Within this hospital information system, on-line access to medical knowledge has been realised by installing a medical knowledge server in the range of about 24 GB and by providing access to it by health care professional workstations in wards, physicians' rooms, etc. During the study, we observed about 96 accesses per working day. The main group of health care professionals retrieving medical knowledge were physicians and medical students. Primary reasons for its utilisation were identified as support for the users' scientific work (50%), own clinical cases (19%), general medical problems (14%) and current clinical problems (13%). Health care professionals had accesses to medical knowledge bases such as MEDLINE (79%), drug bases ('Rote Liste', 6%), and to electronic text books and knowledge base systems as well. Sixty-five percent of accesses to medical knowledge were judged to be successful. In our opinion, medical knowledge retrieval can serve as a first step towards knowledge processing in medicine. We point out the consequences for the management of hospital information systems in order to provide the prerequisites for such a type of knowledge retrieval.

A preliminary study into performing routine tube output and automatic exposure control quality assurance using radiology information system data.

PubMed

Charnock, P; Jones, R; Fazakerley, J; Wilde, R; Dunn, A F

2011-09-01

Data are currently being collected from hospital radiology information systems in the North West of the UK for the purposes of both clinical audit and patient dose audit. Could these data also be used to satisfy quality assurance (QA) requirements according to UK guidance? From 2008 to 2009, 731 653 records were submitted from 8 hospitals from the North West England. For automatic exposure control QA, the protocol from Institute of Physics and Engineering in Medicine (IPEM) report 91 recommends that milliamperes per second can be monitored for repeatability and reproducibility using a suitable phantom, at 70-81 kV. Abdomen AP and chest PA examinations were analysed to find the most common kilovoltage used with these records then used to plot average monthly milliamperes per second with time. IPEM report 91 also recommends that a range of commonly used clinical settings is used to check output reproducibility and repeatability. For each tube, the dose area product values were plotted over time for two most common exposure factor sets. Results show that it is possible to do performance checks of AEC systems; however more work is required to be able to monitor tube output performance. Procedurally, the management system requires work and the benefits to the workflow would need to be demonstrated.

[Disorders of locomotor system and effectiveness of physiotherapy in coal miners].

PubMed

Bilski, Bartosz; Bednarek, Agata

2003-01-01

The aim of the survey was to analyze the efficacy of physiotherapy applied in coal miners as well as to assess their locomotor system load and the effects of working conditions in mines. The questionnaire survey covered a group of 51 miners, aged 28-76 years (mean, 54 years), undergoing physiotherapeutic procedures in the mine out-patient clinic during the first quarter of 2003. The survey revealed that lumbosacral disorders were the most frequent locomotor system complaints reported by miners, especially those who work in a bending down position. According to the clinical data, spondylosis and allied disorders were the main reasons for pain in this part of the body. Having analyzed the relationship between age and occurrence of back pains, the majority of complaints were found in the 46-55 age group (two complaints per one respondent). The analysis of the association between back pains and duration of employment revealed that the complaints for the locomotor system occurred already after a five-year employment. The survey showed that the application of physiotherapeutic procedures diminished the back pain in the study group by 2.83 on average on the 0-10 scale. It was also found that magnetotherapy proved to be the most effective method in treating the spinal degenerative changes.

[A medical consumable material management information system].

PubMed

Tang, Guoping; Hu, Liang

2014-05-01

Medical consumables material is essential supplies to carry out medical work, which has a wide range of varieties and a large amount of usage. How to manage it feasibly and efficiently that has been a topic of concern to everyone. This article discussed about how to design a medical consumable material management information system that has a set of standardized processes, bring together medical supplies administrator, suppliers and clinical departments. Advanced management mode, enterprise resource planning (ERP) applied to the whole system design process.

Inside marginal adaptation of crowns by X-ray micro-computed tomography

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

Dos Santos, T. M.; Lima, I.; Lopes, R. T.

The objective of this work was to access dental arcade by using X-ray micro-computed tomography. For this purpose high resolution system was used and three groups were studied: Zirkonzahn CAD-CAM system, IPS e.max Press, and metal ceramic. The three systems assessed in this study showed results of marginal and discrepancy gaps clinically accepted. The great result of 2D and 3D evaluations showed that the used technique is a powerful method to investigate quantitative characteristics of dental arcade. (authors)

Knowledge mining from clinical datasets using rough sets and backpropagation neural network.

PubMed

Nahato, Kindie Biredagn; Harichandran, Khanna Nehemiah; Arputharaj, Kannan

2015-01-01

The availability of clinical datasets and knowledge mining methodologies encourages the researchers to pursue research in extracting knowledge from clinical datasets. Different data mining techniques have been used for mining rules, and mathematical models have been developed to assist the clinician in decision making. The objective of this research is to build a classifier that will predict the presence or absence of a disease by learning from the minimal set of attributes that has been extracted from the clinical dataset. In this work rough set indiscernibility relation method with backpropagation neural network (RS-BPNN) is used. This work has two stages. The first stage is handling of missing values to obtain a smooth data set and selection of appropriate attributes from the clinical dataset by indiscernibility relation method. The second stage is classification using backpropagation neural network on the selected reducts of the dataset. The classifier has been tested with hepatitis, Wisconsin breast cancer, and Statlog heart disease datasets obtained from the University of California at Irvine (UCI) machine learning repository. The accuracy obtained from the proposed method is 97.3%, 98.6%, and 90.4% for hepatitis, breast cancer, and heart disease, respectively. The proposed system provides an effective classification model for clinical datasets.

Standardizing patient-reported outcomes assessment in cancer clinical trials: a patient-reported outcomes measurement information system initiative.

PubMed

Garcia, Sofia F; Cella, David; Clauser, Steven B; Flynn, Kathryn E; Lad, Thomas; Lai, Jin-Shei; Reeve, Bryce B; Smith, Ashley Wilder; Stone, Arthur A; Weinfurt, Kevin

2007-11-10

Patient-reported outcomes (PROs), such as symptom scales or more broad-based health-related quality-of-life measures, play an important role in oncology clinical trials. They frequently are used to help evaluate cancer treatments, as well as for supportive and palliative oncology care. To be most beneficial, these PROs must be relevant to patients and clinicians, valid, and easily understood and interpreted. The Patient-Reported Outcomes Measurement Information System (PROMIS) Network, part of the National Institutes of Health Roadmap Initiative, aims to improve appreciably how PROs are selected and assessed in clinical research, including clinical trials. PROMIS is establishing a publicly available resource of standardized, accurate, and efficient PRO measures of major self-reported health domains (eg, pain, fatigue, emotional distress, physical function, social function) that are relevant across chronic illnesses including cancer. PROMIS is also developing measures of self-reported health domains specifically targeted to cancer, such as sleep/wake function, sexual function, cognitive function, and the psychosocial impacts of the illness experience (ie, stress response and coping; shifts in self-concept, social interactions, and spirituality). We outline the qualitative and quantitative methods by which PROMIS measures are being developed and adapted for use in clinical oncology research. At the core of this activity is the formation and application of item banks using item response theory modeling. We also present our work in the fatigue domain, including a short-form measure, as a sample of PROMIS methodology and work to date. Plans for future validation and application of PROMIS measures are discussed.

[Clinical governance and patient safety culture in clinical laboratories in the Spanish National Health System].

PubMed

Giménez-Marín, Á; Rivas-Ruiz, F

To conduct a situational analysis of patient safety culture in public laboratories in the Spanish National Health System and to determine the clinical governance variables that most strongly influence patient safety. A descriptive cross-sectional study was carried out, in which a Survey of Patient Safety in Clinical Laboratories was addressed to workers in 26 participating laboratories. In this survey, which consisted of 45 items grouped into 6 areas, scores were assigned on a scale from 0 to 100 (where 0 is the lowest perception of patient safety). Laboratory managers were asked specific questions about quality management systems and technology. The mean scores for the 26 participating hospitals were evaluated, and the following results observed: in 4of the 6areas, the mean score was higher than 70 points. In the third area (equipment and resources) and the fourth area (working conditions), the scores were lower than 60 points. Every hospital had a digital medical record system. This 100% level of provision was followed by that of an electronic request management system, which was implemented in 82.6% of the hospitals. The results obtained show that the culture of security is homogeneous and of high quality in health service laboratories, probably due to the steady improvement observed. However, in terms of clinical governance, there is still some way to go, as shown by the presence of weaknesses in crucial dimensions of safety culture, together with variable levels of implementation of fail-safe technologies and quality management systems. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Heterogeneity prevails: the state of clinical trial data management in Europe - results of a survey of ECRIN centres

PubMed Central

2010-01-01

Background The use of Clinical Data Management Systems (CDMS) has become essential in clinical trials to handle the increasing amount of data that must be collected and analyzed. With a CDMS trial data are captured at investigator sites with "electronic Case Report Forms". Although more and more of these electronic data management systems are used in academic research centres an overview of CDMS products and of available data management and quality management resources for academic clinical trials in Europe is missing. Methods The ECRIN (European Clinical Research Infrastructure Network) data management working group conducted a two-part standardized survey on data management, software tools, and quality management for clinical trials. The questionnaires were answered by nearly 80 centres/units (with an overall response rate of 47% and 43%) from 12 European countries and EORTC. Results Our survey shows that about 90% of centres have a CDMS in routine use. Of these CDMS nearly 50% are commercial systems; Open Source solutions don't play a major role. In general, solutions used for clinical data management are very heterogeneous: 20 different commercial CDMS products (7 Open Source solutions) in addition to 17/18 proprietary systems are in use. The most widely employed CDMS products are MACRO™ and Capture System™, followed by solutions that are used in at least 3 centres: eResearch Network™, CleanWeb™, GCP Base™ and SAS™. Although quality management systems for data management are in place in most centres/units, there exist some deficits in the area of system validation. Conclusions Because the considerable heterogeneity of data management software solutions may be a hindrance to cooperation based on trial data exchange, standards like CDISC (Clinical Data Interchange Standard Consortium) should be implemented more widely. In a heterogeneous environment the use of data standards can simplify data exchange, increase the quality of data and prepare centres for new developments (e.g. the use of EHR for clinical research). Because data management and the use of electronic data capture systems in clinical trials are characterized by the impact of regulations and guidelines, ethical concerns are discussed. In this context quality management becomes an important part of compliant data management. To address these issues ECRIN will establish certified data centres to support electronic data management and associated compliance needs of clinical trial centres in Europe. PMID:20663165

Will the future of knowledge work automation transform personalized medicine?

PubMed

Naik, Gauri; Bhide, Sanika S

2014-09-01

Today, we live in a world of 'information overload' which demands high level of knowledge-based work. However, advances in computer hardware and software have opened possibilities to automate 'routine cognitive tasks' for knowledge processing. Engineering intelligent software systems that can process large data sets using unstructured commands and subtle judgments and have the ability to learn 'on the fly' are a significant step towards automation of knowledge work. The applications of this technology for high throughput genomic analysis, database updating, reporting clinically significant variants, and diagnostic imaging purposes are explored using case studies.

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

PubMed

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

2017-07-06

Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth's Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a US-wide network of primary care practices (www.iorahealth.com), has indicated a willingness to implement ORALS on a larger scale upon completion of this development project. Upon the completion of this project we will have developed a novel recording system that will be ready for large-scale testing. Our long-term goal is for ORALS to seamlessly fit into a clinic's and patient's daily routine, increasing levels of patient engagement and transparency of care. ©Paul J Barr, Michelle D Dannenberg, Craig H Ganoe, William Haslett, Rebecca Faill, Saeed Hassanpour, Amar Das, Roger Arend, Meredith C Masel, Sheryl Piper, Haley Reicher, James Ryan, Glyn Elwyn. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 06.07.2017.

[Conceptual foundation of the operational diagnostic approach in psychiatry].

PubMed

Jäger, M; Strauss, A; Frasch, K; Becker, T

2007-08-01

Based on the pioneering work of Emil Kraepelin, Karl Jaspers, Kurt Schneider and representatives of logical empiricism, the basic principles of the operational diagnostic approach in psychiatry are described. Operational diagnostic systems like ICD-10 and DSM-IV aimed at a standardisation of psychiatric language which can be accepted by different schools in psychiatry. However, ICD-10 and DSM-IV should not be misinterpreted as "nosology" because they do not reflect a specific model of psychiatric diseases. The advantages of operational diagnostic systems as instruments for communication in a clinical and scientific context are limited by the fact that they disregard the subjective psychopathology. This dimension, however, deserves attention in clinic and research.

Ceramics in Restorative and Prosthetic DENTISTRY1

NASA Astrophysics Data System (ADS)

Kelly, J. Robert

1997-08-01

This review is intended to provide the ceramic engineer with information about the history and current use of ceramics in dentistry, contemporary research topics, and potential research agenda. Background material includes intra-oral design considerations, descriptions of ceramic dental components, and the origin, composition, and microstructure of current dental ceramics. Attention is paid to efforts involving net-shape processing, machining as a forming method, and the analysis of clinical failure. A rationale is presented for the further development of all-ceramic restorative systems. Current research topics receiving attention include microstructure/processing/property relationships, clinical failure mechanisms and in vitro testing, wear damage and wear testing, surface treatments, and microstructural modifications. The status of the field is critically reviewed with an eye toward future work. Significant improvements seem possible in the clinical use of ceramics based on engineering solutions derived from the study of clinically failed restorations, on the incorporation of higher levels of "biomimicry" in new systems, and on the synergistic developments in dental cements and adhesive dentin bonding.

Emerging medical informatics with case-based reasoning for aiding clinical decision in multi-agent system.

PubMed

Shen, Ying; Colloc, Joël; Jacquet-Andrieu, Armelle; Lei, Kai

2015-08-01

This research aims to depict the methodological steps and tools about the combined operation of case-based reasoning (CBR) and multi-agent system (MAS) to expose the ontological application in the field of clinical decision support. The multi-agent architecture works for the consideration of the whole cycle of clinical decision-making adaptable to many medical aspects such as the diagnosis, prognosis, treatment, therapeutic monitoring of gastric cancer. In the multi-agent architecture, the ontological agent type employs the domain knowledge to ease the extraction of similar clinical cases and provide treatment suggestions to patients and physicians. Ontological agent is used for the extension of domain hierarchy and the interpretation of input requests. Case-based reasoning memorizes and restores experience data for solving similar problems, with the help of matching approach and defined interfaces of ontologies. A typical case is developed to illustrate the implementation of the knowledge acquisition and restitution of medical experts. Copyright © 2015 Elsevier Inc. All rights reserved.

Helminth parasitic infections of the central nervous system: a diagnostic approach.

PubMed

Othman, Ahmad A; Bruschi, Fabrizio; Ganna, Ahmed A

2014-04-01

Helminth parasitic infections of the central nervous system (CNS) occur worldwide with high prevalence in tropical and subtropical countries. Clinical evaluation of patients is mandatory, and it is convenient to group the clinical manifestations into syndromes: for example space-occupying lesions, meningitis, and encephalitis. The history should focus on residence or travel to endemic areas, diet, activities, intercurrent medical conditions, and associated clinical clues. Direct parasitological diagnosis can be reached by cerebrospinal fluid and cerebral tissue examination either by microscopy, culture, or immunological techniques. Immunodiagnosis by detection of parasite antibodies or antigens in serum could provide indirect evidence of parasitic infections. In addition, various imaging and radiological techniques e.g., computed tomography (CT) scan and magnetic resonance imaging (MRI) complement the diagnostic work-up of CNS diseases. Finally, the helminthic CNS infections of global impact, such as schistosomiasis, neurotoxocariasis, Strongyloides infection, neurotrichinosis, neurocysticercosis, and echinococcosis will be briefly discussed as regards the principal clinical and diagnostic features.

A usability study of a mobile health application for rural Ghanaian midwives.

PubMed

Vélez, Olivia; Okyere, Portia Boakye; Kanter, Andrew S; Bakken, Suzanne

2014-01-01

Midwives in rural Ghana work at the frontline of the health care system, where they have access to essential data about the patient population. However, current methods of data capture, primarily pen and paper, make the data neither accessible nor usable for monitoring patient care or program evaluation. Electronic health (eHealth) systems present a potential mechanism for enhancing the roles of midwives by providing tools for collecting, exchanging, and viewing patient data as well as offering midwives the possibility for receiving information and decision support. Introducing such technology in low-resource settings has been challenging because of low levels of user acceptance, software design that does not match the end-user environment, and/or unforeseen challenges such as irregular power availability. These challenges are often attributable to a lack of understanding by the software developers of the end users' needs and work environment. A mobile health (mHealth) application known as mClinic was designed to support midwife access to the Millennium Village-Global Network, an eHealth delivery platform that captures data for managing patient care as well as program evaluation and monitoring, decision making, and management. We conducted a descriptive usability study composed of 3 phases to evaluate an mClinic prototype: 1) hybrid lab-live software evaluation of mClinic to identify usability issues; 2) completion of a usability questionnaire; and 3) interviews that included low-fidelity prototyping of new functionality proposed by midwives. The heuristic evaluation identified usability problems related to 4 of 8 usability categories. Analysis of usability questionnaire data indicated that the midwives perceived mClinic as useful but were more neutral about the ease of use. Analysis of midwives' reactions to low-fidelity prototypes during the interview process supported the applicability of mClinic to midwives' work and identified the need for additional functionality. User acceptance is essential for the success of any mHealth implementation. Usability testing identified mClinic development flaws and needed software enhancements. © 2014 by the American College of Nurse-Midwives.

Family Health Conversations: How Do They Support Health?

PubMed Central

Benzein, Eva

2014-01-01

Research shows that living with illness can be a distressing experience for the family and may result in suffering and reduced health. To meet families' needs, family systems intervention models are developed and employed in clinical contexts. For successful refinement and implementation it is important to understand how these models work. The aim of this study was therefore to describe the dialogue process and possible working mechanisms of one systems nursing intervention model, the Family Health Conversation model. A descriptive evaluation design was applied and 15 transcribed conversations with five families were analyzed within a hermeneutic tradition. Two types of interrelated dialogue events were identified: narrating and exploring. There was a flow between these events, a movement that was generated by the interaction between the participants. Our theoretically grounded interpretation showed that narrating, listening, and reconsidering in interaction may be understood as supporting family health by offering the families the opportunity to constitute self-identity and identity within the family, increasing the families' understanding of multiple ways of being and acting, to see new possibilities and to develop meaning and hope. Results from this study may hopefully contribute to the successful implementation of family systems interventions in education and clinical praxis. PMID:24800068

Setting performance standards for medical practice: a theoretical framework.

PubMed

Southgate, L; Hays, R B; Norcini, J; Mulholland, H; Ayers, B; Woolliscroft, J; Cusimano, M; McAvoy, P; Ainsworth, M; Haist, S; Campbell, M

2001-05-01

The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily reflect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that reflect the more complex world in which experienced medical practitioners work. The paper reflects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. Standards that reflect the complexity of medical practice may best be developed through an "expert systems" analysis of clinical conditions for which desired health care outcomes reflect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.

Augmented Reality Image Guidance in Minimally Invasive Prostatectomy

NASA Astrophysics Data System (ADS)

Cohen, Daniel; Mayer, Erik; Chen, Dongbin; Anstee, Ann; Vale, Justin; Yang, Guang-Zhong; Darzi, Ara; Edwards, Philip'eddie'

This paper presents our work aimed at providing augmented reality (AR) guidance of robot-assisted laparoscopic surgery (RALP) using the da Vinci system. There is a good clinical case for guidance due to the significant rate of complications and steep learning curve for this procedure. Patients who were due to undergo robotic prostatectomy for organ-confined prostate cancer underwent preoperative 3T MRI scans of the pelvis. These were segmented and reconstructed to form 3D images of pelvic anatomy. The reconstructed image was successfully overlaid onto screenshots of the recorded surgery post-procedure. Surgeons who perform minimally-invasive prostatectomy took part in a user-needs analysis to determine the potential benefits of an image guidance system after viewing the overlaid images. All surgeons stated that the development would be useful at key stages of the surgery and could help to improve the learning curve of the procedure and improve functional and oncological outcomes. Establishing the clinical need in this way is a vital early step in development of an AR guidance system. We have also identified relevant anatomy from preoperative MRI. Further work will be aimed at automated registration to account for tissue deformation during the procedure, using a combination of transrectal ultrasound and stereoendoscopic video.

Evaluating the Surveillance System for Spotted Fever in Brazil Using Machine-Learning Techniques.

PubMed

Lopez, Diego Montenegro; de Mello, Flávio Luis; Giordano Dias, Cristina Maria; Almeida, Paula; Araújo, Milton; Magalhães, Monica Avelar; Gazeta, Gilberto Salles; Brasil, Reginaldo Peçanha

2017-01-01

This work analyses the performance of the Brazilian spotted fever (SF) surveillance system in diagnosing and confirming suspected cases in the state of Rio de Janeiro (RJ), from 2007 to 2016 (July) using machine-learning techniques. Of the 890 cases reported to the Disease Notification Information System (SINAN), 11.7% were confirmed as SF, 2.9% as dengue, 1.6% as leptospirosis, and 0.7% as tick bite allergy, with the remainder being diagnosed as other categories (10.5%) or unspecified (72.7%). This study confirms the existence of obstacles in the diagnostic classification of suspected cases of SF by clinical signs and symptoms. Unlike man-capybara contact (1.7% of cases), man-tick contact (71.2%) represents an important risk indicator for SF. The analysis of decision trees highlights some clinical symptoms related to SF patient death or cure, such as: respiratory distress, convulsion, shock, petechiae, coma, icterus, and diarrhea. Moreover, cartographic techniques document patient transit between RJ and bordering states and within RJ itself. This work recommends some changes to SINAN that would provide a greater understanding of the dynamics of SF and serve as a model for other endemic areas in Brazil.

Evaluating the Surveillance System for Spotted Fever in Brazil Using Machine-Learning Techniques

PubMed Central

Lopez, Diego Montenegro; de Mello, Flávio Luis; Giordano Dias, Cristina Maria; Almeida, Paula; Araújo, Milton; Magalhães, Monica Avelar; Gazeta, Gilberto Salles; Brasil, Reginaldo Peçanha

2017-01-01

This work analyses the performance of the Brazilian spotted fever (SF) surveillance system in diagnosing and confirming suspected cases in the state of Rio de Janeiro (RJ), from 2007 to 2016 (July) using machine-learning techniques. Of the 890 cases reported to the Disease Notification Information System (SINAN), 11.7% were confirmed as SF, 2.9% as dengue, 1.6% as leptospirosis, and 0.7% as tick bite allergy, with the remainder being diagnosed as other categories (10.5%) or unspecified (72.7%). This study confirms the existence of obstacles in the diagnostic classification of suspected cases of SF by clinical signs and symptoms. Unlike man–capybara contact (1.7% of cases), man–tick contact (71.2%) represents an important risk indicator for SF. The analysis of decision trees highlights some clinical symptoms related to SF patient death or cure, such as: respiratory distress, convulsion, shock, petechiae, coma, icterus, and diarrhea. Moreover, cartographic techniques document patient transit between RJ and bordering states and within RJ itself. This work recommends some changes to SINAN that would provide a greater understanding of the dynamics of SF and serve as a model for other endemic areas in Brazil. PMID:29250519

Programmatic assessment of a university-based implant training program using patient-reported outcomes.

PubMed

Al-Sabbagh, Mohanad; Jenkins, Diane W; de Leeuw, Reny; Nihill, Patricia; Robinson, Fonda G; Thomas, Mark V

2014-11-01

The University of Kentucky College of Dentistry (UKCD) established an implant training program that provides training in the use of a single implant system, evidence-based diagnostic and treatment protocols (standardized work practices), and a total quality management system (Implant Quality Assurance Program). The aim of this study was to assess the programmatic effectiveness of the UKCD implant training program by reporting the success and survival of implants placed, using patient-reported outcomes and comparing them to previously established benchmarks. A total of 415 patients (963 implants) were interviewed, approximately 50 percent of all qualified patients. The implant survival rate was 97 percent, and 88 percent of the implants were considered successful (as determined by patient-centric criteria). These outcomes were consistent with the program's previously established benchmarks of 90 percent. These results suggest that work standardization (in the form of specific treatment protocols) and the use of a formal, incremental learning system can result in positive patient outcomes. Clinical outcomes should be monitored in academic dental settings as part of clinical process improvement, and these outcomes can provide a means of assessing the effectiveness of the training program.

Affordable, automatic quantitative fall risk assessment based on clinical balance scales and Kinect data.

PubMed

Colagiorgio, P; Romano, F; Sardi, F; Moraschini, M; Sozzi, A; Bejor, M; Ricevuti, G; Buizza, A; Ramat, S

2014-01-01

The problem of a correct fall risk assessment is becoming more and more critical with the ageing of the population. In spite of the available approaches allowing a quantitative analysis of the human movement control system's performance, the clinical assessment and diagnostic approach to fall risk assessment still relies mostly on non-quantitative exams, such as clinical scales. This work documents our current effort to develop a novel method to assess balance control abilities through a system implementing an automatic evaluation of exercises drawn from balance assessment scales. Our aim is to overcome the classical limits characterizing these scales i.e. limited granularity and inter-/intra-examiner reliability, to obtain objective scores and more detailed information allowing to predict fall risk. We used Microsoft Kinect to record subjects' movements while performing challenging exercises drawn from clinical balance scales. We then computed a set of parameters quantifying the execution of the exercises and fed them to a supervised classifier to perform a classification based on the clinical score. We obtained a good accuracy (~82%) and especially a high sensitivity (~83%).

Group Psychotherapy in Italy.

PubMed

Giannone, Francesca; Giordano, Cecilia; Di Blasi, Maria

2015-10-01

This article describes the history and the prevailing orientations of group psychotherapy in Italy (psychoanalytically oriented, psychodrama, CBT groups) and particularly group analysis. Provided free of charge by the Italian health system, group psychotherapy is growing, but its expansion is patchy. The main pathways of Italian training in the different group psychotherapy orientations are also presented. Clinical-theoretical elaboration on self development, psychopathology related to group experiences, and the methodological attention paid to objectives and methods in different clinical groups are issues related to group therapy in Italy. Difficulties in the relationship between research and clinical practice are discussed, as well as the empirical research network that tries to bridge the gap between research and clinical work in group psychotherapy. The economic crisis in Italy has led to massive cuts in health care and to an increasing demand for some forms of psychological treatment. For these reasons, and because of its positive cost-benefit ratio, group psychotherapy is now considered an important tool in the national health care system to expand the clinical response to different forms of psychological distress.

A non-invasive navigation system for retargeting gastroscopic lesions.

PubMed

Liu, Jiquan; Wang, Bin; Hu, Weiling; Zong, Yun; Si, Jianmin; Duan, Huilong

2014-01-01

Biopsy is a traditional endoscopic surveillance of premalignant gastric lesions, and endoscopic tattooing is used for marking the biopsy's location. However, the tattooing has several disadvantages. For example, the procedure is an invasive operation and may not be durable due to the diffusion. Moreover, it is procedurally cumbersome with an associated risk of technical failure. In this study, a computer aided endoscopic navigation system (CAEN system) was developed for a non-invasive biopsy procedure. The CAEN system consists of a new, designed six degree of freedom (6-DOF) tracking endoscope device and a computer simulated work station. During the procedure, the endoscopist uses the tip of the tracking endoscope to touch the lesion. Then, the lesion's location is recorded in the work station, which then guides the endoscopist in retargeting the lesions in the follow-ups. The clinical experimental results demonstrate that the accuracy at the angularis is 5.2 ± 2.8 mm, at the antral lesser curvature is 7.2 ± 2.0 mm, at the antral greater curvature is 6.3 ± 3.1 mm, at the antral posterior wall is 8.2 ± 1.6 mm, and at the antral anterior wall is 7.9 ± 1.3 mm. The mean accuracy is 7.5 mm, and the P-value is 0.023, which is likely suitable for clinical practice. Furthermore, the proposed CAEN system requires less procedural time than the tattooing.

Multiple neural network approaches to clinical expert systems

NASA Astrophysics Data System (ADS)

Stubbs, Derek F.

1990-08-01

We briefly review the concept of computer aided medical diagnosis and more extensively review the the existing literature on neural network applications in the field. Neural networks can function as simple expert systems for diagnosis or prognosis. Using a public database we develop a neural network for the diagnosis of a major presenting symptom while discussing the development process and possible approaches. MEDICAL EXPERTS SYSTEMS COMPUTER AIDED DIAGNOSIS Biomedicine is an incredibly diverse and multidisciplinary field and it is not surprising that neural networks with their many applications are finding more and more applications in the highly non-linear field of biomedicine. I want to concentrate on neural networks as medical expert systems for clinical diagnosis or prognosis. Expert Systems started out as a set of computerized " ifthen" rules. Everything was reduced to boolean logic and the promised land of computer experts was said to be in sight. It never came. Why? First the computer code explodes as the number of " ifs" increases. All the " ifs" have to interact. Second experts are not very good at reducing expertise to language. It turns out that experts recognize patterns and have non-verbal left-brain intuition decision processes. Third learning by example rather than learning by rule is the way natural brains works and making computers work by rule-learning is hideously labor intensive. Neural networks can learn from example. They learn the results

Comparison of work and time estimates by chiropractic physicians with those of medical and osteopathic providers.

PubMed

Hess, J A; Mootz, R D

1999-06-01

Resource-based relative value scales (RBRVS) have become a standard method for identifying costs and determining reimbursement for physician services. Development of RBRVS systems and methods are reviewed, and the RBRVS concept of physician "work" is defined. Results of work and time inputs from chiropractic physicians are compared with those reported by osteopathic and medical specialties. Last, implications for reimbursement of chiropractic fee services are discussed. Total work, intraservice work, and time inputs for clinical vignettes reported by chiropractic, osteopathic, and medical physicians are compared. Data for chiropractic work and time reports were drawn from a national random sample of chiropractors conducted as part of a 1997 workers' compensation chiropractic fee schedule development project. Medical and osteopathic inputs were drawn from RBRVS research conducted at Harvard University under a federal contract reported in 1990. Both data sets used the same or similar clinical vignettes and similar methods. Comparisons of work and time inputs are made for clinical vignettes to assess whether work reported by chiropractors is of similar magnitude and variability as work reported by other specialties. Chiropractic inputs for vignettes related to evaluation and management services are similar to those reported by medical specialists and osteopathic physicians. The range of variation between chiropractic work input and other specialties is of similar magnitude to that within other specialties. Chiropractors report greater work input for radiologic interpretation and lower work input for manipulation services. Chiropractors seem to perform similar total "work" for evaluation and management services as other specialties. No basis exists for excluding chiropractors from using evaluation and management codes for reimbursement purposes on grounds of dissimilar physician time or work estimates. Greater work input by chiropractors in radiology interpretation may be related to a greater importance placed on findings in care planning. Consistently higher reports for osteopathic work input on manipulation are likely attributable to differences in reference vignettes used in the respective populations. Research with a common reference vignette used for manipulation providers is recommended, as is development of a single generic approach to coding for manipulation services.

Organisational reporting and learning systems: Innovating inside and outside of the box.

PubMed

Sujan, Mark; Furniss, Dominic

2015-01-01

Reporting and learning systems are key organisational tools for the management and prevention of clinical risk. However, current approaches, such as incident reporting, are struggling to meet expectations of turning health systems like the UK National Health Service (NHS) into learning organisations. This article aims to open up debate on the potential for novel reporting and learning systems in healthcare, by reflecting on experiences from two recent projects: Proactive Risk Monitoring in Healthcare (PRIMO) and Errordiary in Healthcare. These two approaches demonstrate how paying attention to ordinary, everyday clinical work can derive useful learning and active discussion about clinical risk. We argue that innovations in reporting and learning systems might come from both inside and outside of the box. 'Inside' being along traditional paths of controlled organisational innovation. 'Outside' in the sense that inspiration comes outside of the healthcare domain, or more extremely, outside official channels through external websites and social media (e.g. patient forums, public review sites, whistleblower blogs and Twitter streams). Reporting routes that bypass official channels could empower staff and patient activism, and turn out to be a driver to challenge organisational processes, assumptions and priorities where the organisation is failing and has become unresponsive.

Development of a standardized, citywide process for managing smart-pump drug libraries.

PubMed

Walroth, Todd A; Smallwood, Shannon; Arthur, Karen; Vance, Betsy; Washington, Alana; Staublin, Therese; Haslar, Tammy; Reddan, Jennifer G; Fuller, James

2018-06-15

Development and implementation of an interprofessional consensus-driven process for review and optimization of smart-pump drug libraries and dosing limits are described. The Indianapolis Coalition for Patient Safety (ICPS), which represents 6 Indianapolis-area health systems, identified an opportunity to reduce clinically insignificant alerts that smart infusion pumps present to end users. Through a consensus-driven process, ICPS aimed to identify best practices to implement at individual hospitals in order to establish specific action items for smart-pump drug library optimization. A work group of pharmacists, nurses, and industrial engineers met to evaluate variability within and lack of scrutiny of smart-pump drug libraries. The work group used Lean Six Sigma methodologies to generate a list of key needs and barriers to be addressed in process standardization. The group reviewed targets for smart-pump drug library optimization, including dosing limits, types of alerts reviewed, policies, and safety best practices. The work group also analyzed existing processes at each site to develop a final consensus statement outlining a model process for reviewing alerts and managing smart-pump data. Analysis of the total number of alerts per device across ICPS-affiliated health systems over a 4-year period indicated a 50% decrease (from 7.2 to 3.6 alerts per device per month) after implementation of the model by ICPS member organizations. Through implementation of a standardized, consensus-driven process for smart-pump drug library optimization, ICPS member health systems reduced clinically insignificant smart-pump alerts. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Value of the dorsal cutaneous guinea pig model in selecting topical antiviral formulations for the treatment of recurrent herpes simplex type 1 disease.

PubMed

Poli, G; Dall'Ara, P; Binda, S; Santus, G; Poli, A; Cocilovo, A; Ponti, W

2001-01-01

Recurrent herpes simplex labialis represents a disease still difficult to treat, despite the availability of many established antiviral drugs used in clinical research since 30 years ago. Although differences between the human disease and that obtained in experimental animal suggest caution in predicting an effective clinical response from the experimental results, some of the animal models seem to be useful in optimising the topical formulation of single antiviral drugs. In the present work the dorsal cutaneous guinea pig model was used to compare 5 different topical antiviral formulations with clinical promise (active molecule: 5% w/w micronized aciclovir, CAS 59277-89-3), using both roll-on and lipstick application systems. The aim being to evaluate which vehicle (water, oil, low melting and high melting fatty base) and application system (roll-on, lipstick) enhances the skin penetration and the antiviral activity of the drug, after an experimental intradermal infection with Herpes simplex virus type 1 (HSV-1). As reference, a commercial formulation (5% aciclovir ointment) was used. The cumulative results of this study showed that the formulation A, containing 5% aciclovir in an aqueous base in a roll-on application system, has the better antiviral efficacy in reducing the severity of cutaneous lesions and the viral titer; among the lipsticks preparations, the formulation D, containing 5% aciclovir in a low melting fatty base, demonstrates a very strong antiviral activity, though slightly less than formulation A. This experimental work confirms the validity of the dorsal cutaneous guinea pig model as a rapid and efficient method to compare the antiviral efficacy of new formulations, with clinical promise, to optimise the topical formulation of the active antiviral drugs.

Sibling Kinnections: A Clinical Visitation Program

ERIC Educational Resources Information Center

Pavao, Joyce Maguire; St. John, Melissa; Cannole, Rebecca Ford; Fischer, Tara; Maluccio, Anthony; Peining, Suzanne

2007-01-01

The growing literature on sibling relationships throughout their lifespans is of great importance to those working in the child welfare system, and in adoption services in particular. Sibling bonds are important to all of us, but they are particularly vital to children from disorganized or dysfunctional families. These relationships assume even…

Preventing Schizophrenia and Severe Mental Illness: A Grand Challenge for Social Work

ERIC Educational Resources Information Center

DeVylder, Jordan E.

2016-01-01

Schizophrenia is a leading cause of disability and health expenditure worldwide and is associated with homelessness, substance use, familial and social isolation, unemployment, involvement with the criminal justice system, stigma, and excess mortality. Prevention may be feasible through intervention with help-seeking "clinical high-risk"…

Efficiency of a Care Coordination Model: A Randomized Study with Stroke Patients

ERIC Educational Resources Information Center

Claiborne, Nancy

2006-01-01

Objectives: This study investigated the efficiency of a social work care coordination model for stroke patients. Care coordination addresses patient care and treatment resources across the health care system to reduce risk, improve clinical outcomes, and maximize efficiency. Method: A randomly assigned, pre-post experimental design measured…

Patient centered integrated clinical resource management.

PubMed

Hofdijk, Jacob

2011-01-01

The impact of funding systems on the IT systems of providers has been enormous and have prevented the implementation of designs to focused on the health issue of patients. The paradigm shift the Dutch Ministry of Health has taken in funding health care has a remarkable impact on the orientation of IT systems design. Since 2007 the next step is taken: the application of the funding concept on chronic diseases using clinical standards as the norm. The focus on prevention involves the patient as an active partner in the care plan. The impact of the new dimension in funding has initiated a process directed to the development of systems to support collaborative working and an active involvement of the patient and its informal carers. This national approach will be presented to assess its international potential, as all countries face the long term care crisis lacking resources to meet the health needs of the population.

An XML-based system for the flexible classification and retrieval of clinical practice guidelines.

PubMed Central

Ganslandt, T.; Mueller, M. L.; Krieglstein, C. F.; Senninger, N.; Prokosch, H. U.

2002-01-01

Beneficial effects of clinical practice guidelines (CPGs) have not yet reached expectations due to limited routine adoption. Electronic distribution and reminder systems have the potential to overcome implementation barriers. Existing electronic CPG repositories like the National Guideline Clearinghouse (NGC) provide individual access but lack standardized computer-readable interfaces necessary for automated guideline retrieval. The aim of this paper was to facilitate automated context-based selection and presentation of CPGs. Using attributes from the NGC classification scheme, an XML-based metadata repository was successfully implemented, providing document storage, classification and retrieval functionality. Semi-automated extraction of attributes was implemented for the import of XML guideline documents using XPath. A hospital information system interface was exemplarily implemented for diagnosis-based guideline invocation. Limitations of the implemented system are discussed and possible future work is outlined. Integration of standardized computer-readable search interfaces into existing CPG repositories is proposed. PMID:12463831

Implementation of standardization in clinical practice: not always an easy task.

PubMed

Panteghini, Mauro

2012-02-29

As soon as a new reference measurement system is adopted, clinical validation of correctly calibrated commercial methods should take place. Tracing back the calibration of routine assays to a reference system can actually modify the relation of analyte results to existing reference intervals and decision limits and this may invalidate some of the clinical decision-making criteria currently used. To maintain the accumulated clinical experience, the quantitative relationship to the previous calibration system should be established and, if necessary, the clinical decision-making criteria should be adjusted accordingly. The implementation of standardization should take place in a concerted action of laboratorians, manufacturers, external quality assessment scheme organizers and clinicians. Dedicated meetings with manufacturers should be organized to discuss the process of assay recalibration and studies should be performed to obtain convincing evidence that the standardization works, improving result comparability. Another important issue relates to the surveillance of the performance of standardized assays through the organization of appropriate analytical internal and external quality controls. Last but not least, uncertainty of measurement that fits for this purpose must be defined across the entire traceability chain, starting with the available reference materials, extending through the manufacturers and their processes for assignment of calibrator values and ultimately to the final result reported to clinicians by laboratories.

Recommendations for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration.

PubMed

Bossuyt, V; Provenzano, E; Symmans, W F; Boughey, J C; Coles, C; Curigliano, G; Dixon, J M; Esserman, L J; Fastner, G; Kuehn, T; Peintinger, F; von Minckwitz, G; White, J; Yang, W; Badve, S; Denkert, C; MacGrogan, G; Penault-Llorca, F; Viale, G; Cameron, D

2015-07-01

Neoadjuvant systemic therapy (NAST) provides the unique opportunity to assess response to treatment after months rather than years of follow-up. However, significant variability exists in methods of pathologic assessment of response to NAST, and thus its interpretation for subsequent clinical decisions. Our international multidisciplinary working group was convened by the Breast International Group-North American Breast Cancer Group (BIG-NABCG) collaboration and tasked to recommend practical methods for standardized evaluation of the post-NAST surgical breast cancer specimen for clinical trials that promote accurate and reliable designation of pathologic complete response (pCR) and meaningful characterization of residual disease. Recommendations include multidisciplinary communication; clinical marking of the tumor site (clips); and radiologic, photographic, or pictorial imaging of the sliced specimen, to map the tissue sections and reconcile macroscopic and microscopic findings. The information required to define pCR (ypT0/is ypN0 or ypT0 yp N0), residual ypT and ypN stage using the current AJCC/UICC system, and the Residual Cancer Burden system were recommended for quantification of residual disease in clinical trials. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

[Clinical Work Experience of Korean Immigrant Nurses in U.S. Hospitals].

PubMed

Seo, Kumsook; Kim, Miyoung

2016-04-01

The purpose of this qualitative study was to explore the meaning of the experience of Korean immigrant nurses working in US hospitals. Purposive sampling yielded 15 Korean immigrant nurses who had more than one year of clinical experience in US hospitals. Data were collected from March to August 2012 through in-depth interviews and thematic analysis was conducted using van Manen's hermeneutic phenomenological approach. The findings were classified into eight themes: 'struggling from staff at workplace being territorial to outsiders', 'feeling oppressed due to language barrier', 'accepting rational and horizontal relationships at work', 'staying alert in the environment where lawsuits are rife', 'feeling a sense of stability from the social system that values human dignity', 'maintaining self-confidence from prominent nursing practices and senior Korean nurses' professional reputation', 'performing essential comprehensive nursing care', 'promoting self-development to be equipped with professionalism.' The findings indicate that the Korean immigrant nurses were able to excel in their workplace when their clinical experience at US hospitals was combined with the lived space in US politics and environment, lived time of patience, lived body to be alert, and lived others with multi cultural characteristics.

The scope of private practice nursing in an Australian sample.

PubMed

Wilson, Anne; Averis, Andrea; Walsh, Ken

2004-01-01

The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.

Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times.

PubMed

Inal, Tamer C; Goruroglu Ozturk, Ozlem; Kibar, Filiz; Cetiner, Salih; Matyar, Selcuk; Daglioglu, Gulcin; Yaman, Akgun

2018-01-01

Organizing work flow is a major task of laboratory management. Recently, clinical laboratories have started to adopt methodologies such as Lean Six Sigma and some successful implementations have been reported. This study used Lean Six Sigma to simplify the laboratory work process and decrease the turnaround time by eliminating non-value-adding steps. The five-stage Six Sigma system known as define, measure, analyze, improve, and control (DMAIC) is used to identify and solve problems. The laboratory turnaround time for individual tests, total delay time in the sample reception area, and percentage of steps involving risks of medical errors and biological hazards in the overall process are measured. The pre-analytical process in the reception area was improved by eliminating 3 h and 22.5 min of non-value-adding work. Turnaround time also improved for stat samples from 68 to 59 min after applying Lean. Steps prone to medical errors and posing potential biological hazards to receptionists were reduced from 30% to 3%. Successful implementation of Lean Six Sigma significantly improved all of the selected performance metrics. This quality-improvement methodology has the potential to significantly improve clinical laboratories. © 2017 Wiley Periodicals, Inc.

Working appreciatively to improve services for children and families.

PubMed

Onyett, Steve

2009-10-01

Service improvement approaches are described that specifically focus on appreciating the positive that individuals bring to contexts related to children and family services. This includes application of Solution-Focused approaches, Appreciative Inquiry and other approaches that promote a positive emotional climate and focus on what works. Their conceptual foundations are explored and particularly their value in supporting working well with complex adaptive systems. Specific applications described include leadership and management practice, work in school settings, engaging clinicians in healthcare improvement, establishing clinical networks, work with homeless youth, child protection and approaches to drawing out best practice and community development. The theme that unites is a focus on developing effective relationships at all levels and a pragmatic focus on what works so that we can find opportunities to do more of it.

Toward a more professional and practical medical education: a novel Central European approach.

PubMed

Drexel, Heinz; Vonbank, Alexander; Fraunberger, Peter; Riesen, Walter F; Saely, Christoph H

2015-01-01

We here present an innovative curriculum for a complete medical education that conforms to the current European Bologna system of academic training. The curriculum aims at raising doctors who are excellently prepared for clinical work over as short a time as 5 years; it provides a comprehensive, yet shorter than usual, education that strongly pronounces the importance of increasing the students' practical clinical competences and rigorously excludes superfluous contents. The curriculum encompasses 52 modules, 32 at the bachelor's and 20 at the master's level. Already at the level of the bachelor degree, full employability is given; the students finish the master's course as medical doctors optimally prepared to manage patients at the level of postgraduate medical education. The structure of the curriculum is modular; each modular component is essential for medical education and contains an average of five European Credit Transfer System credits, amounting to 150 hours of education. Depending on the subspecialty, the courses include lectures, seminars, practical laboratory training, and clinical training at varying quantities. In addition to attendance times, sufficient time slots are prepared for self-study in lectures, seminars, and practical work. With our curriculum, we provide an easily applicable backbone for a modern course of medicine that can be installed also at smaller academic institutions.

How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

PubMed Central

2010-01-01

Background Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. Methods We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. Results Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. Conclusion We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices. PMID:20509903

Increasing your HCAHPS scores with Extreme Customer Service.

PubMed

Clouarte, Joe

2016-10-01

Providing great customer service is extremely critical in the healthcare setting, especially when it comes to HCAHBPS (Hospital Consumer Assessment of Health care Providers and Systems) scores, the author says. While there are several service training programs within healthcare, they often require six to eight minutes of interaction with patients or guests. This works well for clinical staff, he says, but when it comes to non-clinical staff, including security officers, many times they only have fifteen or thirty seconds to create positive patient or guest experience. In this article he describes Extreme Customer Service © a program he has developed to fill that customer gap for non-clinical staff.

E-facts: business process management in clinical data repositories.

PubMed

Wattanasin, Nich; Peng, Zhaoping; Raine, Christine; Mitchell, Mariah; Wang, Charles; Murphy, Shawn N

2008-11-06

The Partners Healthcare Research Patient Data Registry (RPDR) is a centralized data repository that gathers clinical data from various hospital systems. The RPDR allows clinical investigators to obtain aggregate numbers of patients with user-defined characteristics such as diagnoses, procedures, medications, and laboratory values. They may then obtain patient identifiers and electronic medical records with prior IRB approval. Moreover, the accurate identification and efficient population of worthwhile and quantifiable facts from doctor's report into the RPDR is a significant process. As part of our ongoing e-Fact project, this work describes a new business process management technology that helps coordinate and simplify this procedure.

The Arden Syntax standard for clinical decision support: experiences and directions.

PubMed

Samwald, Matthias; Fehre, Karsten; de Bruin, Jeroen; Adlassnig, Klaus-Peter

2012-08-01

Arden Syntax is a widely recognized standard for representing clinical and scientific knowledge in an executable format. It has a history that reaches back until 1989 and is currently maintained by the Health Level 7 (HL7) organization. We created a production-ready development environment, compiler, rule engine and application server for Arden Syntax. Over the course of several years, we have applied this Arden - Syntax - based CDS system in a wide variety of clinical problem domains, such as hepatitis serology interpretation, monitoring of nosocomial infections or the prediction of metastatic events in melanoma patients. We found the Arden Syntax standard to be very suitable for the practical implementation of CDS systems. Among the advantages of Arden Syntax are its status as an actively developed HL7 standard, the readability of the syntax, and various syntactic features such as flexible list handling. A major challenge we encountered was the technical integration of our CDS systems in existing, heterogeneous health information systems. To address this issue, we are currently working on incorporating the HL7 standard GELLO, which provides a standardized interface and query language for accessing data in health information systems. We hope that these planned extensions of the Arden Syntax might eventually help in realizing the vision of a global, interoperable and shared library of clinical decision support knowledge. Copyright © 2012 Elsevier Inc. All rights reserved.

Confirmation of Expectations and Satisfaction with Hospital Information Systems: A Nursing Perspective.

PubMed

Ayatollahi, Haleh; Langarizadeh, Mostafa; Chenani, Habib

2016-10-01

This study aimed to compare nurses' satisfaction with, and expectations of, hospital information systems in two teaching hospitals. This was a survey study, which was completed in 2014. The potential participants were 267 nurses who worked in two teaching hospitals and used the same hospital information system. Data were collected using two questionnaires. Both questionnaires were examined in terms of content validity and reliability. The results showed that, for a majority of nurses, their expectations of the system were not met in either hospital. Moreover, there was a significant association between the nurses' expectations and the perceived usefulness of the systems ( p < 0.001), between the nurses' expectations and their satisfaction with the systems ( p < 0.001), and between the perceived usefulness and nurses' satisfaction with the systems ( p < 0.001). The results suggested that, apart from the technical issues of implementing clinical information systems, non-technical factors should be taken into account. Among them, the nature of clinical tasks and the organizational culture require more attention to allow a successful system to be designed and implemented.

Career development: graduate nurse views.

PubMed

Cleary, Michelle; Horsfall, Jan; Muthulakshmi, Paulpandi; Happell, Brenda; Hunt, Glenn E

2013-09-01

To explore recent Singapore nursing graduates' experience of and views about their career development and progress. The recruitment and retention of an adequate number of registered nurses is a continuing workforce issue in Singapore and other major cities. Survey of recent nursing graduates. Recent nursing graduates from the Bachelor programme (n = 147) were sent an individual survey; a response rate of 54% was achieved. Findings show that nurses rated their self-concept in a positive manner and were most satisfied (moderately to very) with helping patients and providing effective care, and the level of patient involvement. They were least satisfied (moderately to only a little) with prestige among the general medical community and the general public, hours of work, lifestyle factors and research opportunities. The following four factors were identified as significant impediments to career development; lack of support in the work place; perceived insufficient clinical career development opportunities; excessive work hours; and limited access to merit-based places in further education. Suggestions made to overcome perceived career development barriers are as follows: broad multifactorial healthcare system changes; decreased and more flexible working hours; and fairer access to further clinical and higher education. Results highlight the value clinical nurses place on having access to career development opportunities, merit-based further education and work place supports. These factors also have the potential to influence patient care and impact on the retention of nurses in their present job and satisfaction with their nursing career. © 2013 Blackwell Publishing Ltd.

Creating a professional development platform to transform social work clinical practice in health care.

PubMed

Xenakis, Nancy

2018-07-01

Since U.S. Congress' 2010 passing of the Affordable Care Act and the creation of numerous care coordination programs, Mount Sinai Hospital's Department of Social Work Services has experienced exponential growth. The Department is deeply committed to recruiting and developing the most talented social workers to best meet the needs of patients and family caregivers and to serve as integral, valued members of interdisciplinary care teams. Traditional learning methods are insufficient for a staff of hundreds, given the changes in health care and the complexity of the work. This necessitates the use of new training and education methods to maintain the quality of professional development. This article provides an overview of the Department's strategy and creation of a professional development learning platform to transform clinical social work practice. It reviews various education models that utilize an e-learning management system and case studies using standardized patients. These models demonstrate innovative learning approaches for both new and experienced social workers in health care. The platform's successes and challenges and recommendations for future development and sustainability are outlined.

Measuring the Impact of Online Evidence Retrieval Systems using Critical Incidents & Journey Mapping.

PubMed

Westbrook, Johanna I; Coiera, Enrico W; Braithwaite, Jeffrey

2005-01-01

Online evidence retrieval systems are one potential tool in supporting evidence-based practice. We have undertaken a program of research to investigate how hospital-based clinicians (doctors, nurses and allied health professionals) use these systems, factors influencing use and their impact on decision-making and health care delivery. A central component of this work has been the development and testing of a broad range of evaluation techniques. This paper provides an overview of the results obtained from three stages of this evaluation and details the results derived from the final stage which sought to test two methods for assessing the integration of an online evidence system and its impact on decision making and patient care. The critical incident and journey mapping techniques were applied. Semi-structured interviews were conducted with 29 clinicians who were experienced users of the online evidence system. Clinicians were asked to described recent instances in which the information obtained using the online evidence system was especially helpful with their work. A grounded approach to data analysis was taken producing three categories of impact. The journey mapping technique was adapted as a method to describe and quantify clinicians' integration of CIAP into their practice and the impact of this on patient care. The analogy of a journey is used to capture the many stages in this integration process, from introduction to the system to full integration into everyday clinical practice with measurable outcomes. Transcribed interview accounts of system use were mapped against the journey stages and scored. Clinicians generated 85 critical incidents and one quarter of these provided specific examples of system use leading to improvements in patient care. The journey mapping technique proved to be a useful method for providing a quantification of the ways and extent to which clincians had integrated system use into practice, and insights into how information systems can influence organisational culture. Further work is required on this technique to assess its value as an evaluation method. The study demonstrates the strength of a triangulated evidence approach to assessing the use and impact of online clinical evidence systems.

Proposal for Development of EBM-CDSS (Evidence-Based Clinical Decision Support System) to Aid Prognostication in Terminally Ill Patients

DTIC Science & Technology

2013-10-01

monthly basis. The similar process is followed at TGH, where the research team mostly works with palliative care service. Through this process, the... Palliative Care at TGH. • We continue to regularly conduct meetings with TGH palliative care team and present the ongoing experience of our research study...to the TGH palliative care team. These meeting established a fruitful and trustful and working relationship with TGH palliative care team, which is

A radical proposition: the brief but exceptional history of the Seattle school clinic, 1914-21.

PubMed

Woolworth, Stephen

2013-04-01

This article examines the history of the Seattle school clinic (1914-21) and the efforts of public school administrators to institutionalize a full-service medical program for poor and working class children. At its height, thirty-six volunteer physicians and thirteen partially paid dentists organized within nine departments performed a range of diagnostic and "corrective" surgical procedures, including tonsillectomies, circumcisions, and eye surgeries. These practices were not funded by other public school systems across the United States, almost all of which delineated between prevention and treatment services. This article explains the exceptional nature of the clinic, examines the institutional tensions instigated by the expression of medical authority within the schools, and considers how clinic technologies influenced state-school-child relations.

Clinical pathologist in Korea--training program and its roles in laboratories.

PubMed

Cho, Han-Ik; Lee, Kap No; Park, Jong-Woo; Park, Hyosoon; Kwak, Yun Sik

2002-01-01

A rapid development of practice of laboratory medicine in Korea owes its success to the clinical pathologists (CP), who have played a role of a pathfinder for laboratories. The Korean CP postgraduate education (residency) program is unique in that it is exclusively for laboratory medicine. The training program for clinical pathologists includes diagnostic hematology, diagnostic immunology, clinical microbiology, clinical chemistry, blood bank, diagnostic genetics, informatics and laboratory management. The program has produced a strong group of about 600 laboratory physicians, officially clinical pathologists since 1963. Most of Korean clinical pathologists work as laboratory directors, directors of university hospital laboratories or teaching faculty members in medical schools. The roles of clinical pathologists are laboratory management, interpretation of laboratory test results, clinical consulting services to clinicians and patients, ordering secondary tests after reviews of requested test results and utilization management. The clinical pathologists have developed clinical laboratories to be a main contributor for improved medical practice. During the last 40 years under the turbulent healthcare system, clinical pathologists have significantly contributed to safeguard the laboratory interests. The education program and the role of clinical pathologists are described.

[Effects of practical training to increase motivation for learning and related factors].

PubMed

Yamaguchi, Takumi; Akiyama, Shinji; Sagara, Hidenori; Tanaka, Akihiro; Miyauchi, Yoshirou; Araki, Hiroaki; Shibata, Kazuhiko; Izushi, Fumio; Namba, Hiroyuki

2014-01-01

Under the six-year pharmaceutical education system that was initiated in April 2006, students who had completed the course in March 2012 became the first graduates. The six-year system encourages students to develop a well-rounded personality, a deep sense of ethics, knowledge required for health care professionals, abilities to identify and solve problems, and practical skills required in clinical settings, as well as basic knowledge and skills. Under the new education system based on the "pharmaceutical education model core curriculums" and "practical training model core curriculums", general pharmaceutical education is implemented in each college, and five-month practical training is conducted in clinical settings. Clinical tasks experienced by students for the first time are expected to significantly influence their motivation to learn and future prospects. In the present survey research, students who had completed practical training evaluated the training program, and correspondence and logistic regression analyses of the results were conducted to examine the future effects and influences of the training on the students. The results suggest that the students viewed the practical training program positively. In addition, clinical experience during the training sessions not only influenced their decisions on future careers, but also significantly increased their motivation to learn. Furthermore, their motivation for learning was increased most by the enthusiasm of pharmacists who advised them in clinical settings, rather than the training program itself. To improve pharmaceutical clinical learning, it is important to develop teaching and working environments for pharmacists in charge of advising students in clinical training.

Role of OpenEHR as an open source solution for the regional modelling of patient data in obstetrics.

PubMed

Pahl, Christina; Zare, Mojtaba; Nilashi, Mehrbakhsh; de Faria Borges, Marco Aurélio; Weingaertner, Daniel; Detschew, Vesselin; Supriyanto, Eko; Ibrahim, Othman

2015-06-01

This work investigates, whether openEHR with its reference model, archetypes and templates is suitable for the digital representation of demographic as well as clinical data. Moreover, it elaborates openEHR as a tool for modelling Hospital Information Systems on a regional level based on a national logical infrastructure. OpenEHR is a dual model approach developed for the modelling of Hospital Information Systems enabling semantic interoperability. A holistic solution to this represents the use of dual model based Electronic Healthcare Record systems. Modelling data in the field of obstetrics is a challenge, since different regions demand locally specific information for the process of treatment. Smaller health units in developing countries like Brazil or Malaysia, which until recently handled automatable processes like the storage of sensitive patient data in paper form, start organizational reconstruction processes. This archetype proof-of-concept investigation has tried out some elements of the openEHR methodology in cooperation with a health unit in Colombo, Brazil. Two legal forms provided by the Brazilian Ministry of Health have been analyzed and classified into demographic and clinical data. LinkEHR-Ed editor was used to read, edit and create archetypes. Results show that 33 clinical and demographic concepts, which are necessary to cover data demanded by the Unified National Health System, were identified. Out of the concepts 61% were reused and 39% modified to cover domain requirements. The detailed process of reuse, modification and creation of archetypes is shown. We conclude that, although a major part of demographic and clinical patient data were already represented by existing archetypes, a significant part required major modifications. In this study openEHR proved to be a highly suitable tool in the modelling of complex health data. In combination with LinkEHR-Ed software it offers user-friendly and highly applicable tools, although the complexity built by the vast specifications requires expert networks to define generally excepted clinical models. Finally, this project has pointed out main benefits enclosing high coverage of obstetrics data on the Clinical Knowledge Manager, simple modelling, and wide network and support using openEHR. Moreover, barriers described are enclosing the allocation of clinical content to respective archetypes, as well as stagnant adaption of changes on the Clinical Knowledge Manager leading to redundant efforts in data contribution that need to be addressed in future works. Copyright © 2015 Elsevier Inc. All rights reserved.

Integrated data management for clinical studies: automatic transformation of data models with semantic annotations for principal investigators, data managers and statisticians.

PubMed

Dugas, Martin; Dugas-Breit, Susanne

2014-01-01

Design, execution and analysis of clinical studies involves several stakeholders with different professional backgrounds. Typically, principle investigators are familiar with standard office tools, data managers apply electronic data capture (EDC) systems and statisticians work with statistics software. Case report forms (CRFs) specify the data model of study subjects, evolve over time and consist of hundreds to thousands of data items per study. To avoid erroneous manual transformation work, a converting tool for different representations of study data models was designed. It can convert between office format, EDC and statistics format. In addition, it supports semantic annotations, which enable precise definitions for data items. A reference implementation is available as open source package ODMconverter at http://cran.r-project.org.

Hydra: A web-based system for cardiovascular analysis, diagnosis and treatment.

PubMed

Novo, J; Hermida, A; Ortega, M; Barreira, N; Penedo, M G; López, J E; Calvo, C

2017-02-01

Cardiovascular (CV) risk stratification is a highly complex process involving an extensive set of clinical trials to support the clinical decision-making process. There are many clinical conditions (e.g. diabetes, obesity, stress, etc.) that can lead to the early diagnosis or establishment of cardiovascular disease. In order to determine all these clinical conditions, a complete set of clinical patient analyses is typically performed, including a physical examination, blood analysis, electrocardiogram, blood pressure (BP) analysis, etc. This article presents a web-based system, called Hydra, which integrates a full and detailed set of services and functionalities for clinical decision support in order to help and improve the work of clinicians in cardiovascular patient diagnosis, risk assessment, treatment and monitoring over time. Hydra integrates a number of different services: a service for inputting all the information gathered by specialists (physical examination, habits, BP, blood analysis, electrocardiogram, etc.); a tool to automatically determine the CV risk stratification, including well-known standard risk stratification tables; and, finally, various tools to incorporate, analyze and graphically present the records of the ambulatory BP monitoring that provides BP analysis over a given period of time (24 or 48 hours). In addition, the platform presents a set of reports derived from all the information gathered from the patient in order to support physicians in their clinical decisions. Hydra was tested and validated in a real domain. In particular, internal medicine specialists at the Hypertension Unit of the Santiago de Compostela University Hospital (CHUS) validated the platform and used it in different clinical studies to demonstrate its utility. It was observed that the platform increased productivity and accuracy in the assessment of patient data yielding a cost reduction in clinical practice. This paper proposes a complete platform that includes different services for cardiovascular clinical decision support. It was also run as a web-based application to facilitate its use by clinicians, who can access the platform from any remote computer with Internet access. Hydra also includes different automated methods to facilitate the physicians' work and avoid potential errors in the analysis of patient data. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Insuring Care: Paperwork, Insurance Rules, and Clinical Labor at a U.S. Transgender Clinic.

PubMed

van Eijk, Marieke

2017-12-01

What is a clinician to do when people needing medical care do not have access to consistent or sufficient health insurance coverage and cannot pay for care privately? Analyzing ethnographically how clinicians at a university-based transgender clinic in the United States responded to this challenge, I examine the U.S. health insurance system, insurance paperwork, and administrative procedures that shape transgender care delivery. To buffer the impact of the system's failure to provide sufficient health insurance coverage for transgender care, clinicians blended administrative routines with psychological therapy, counseled people's minds and finances, and leveraged the prestige of their clinic in attempts to create space for gender nonconforming embodiments in gender conservative insurance policies. My analysis demonstrates that in a market-based health insurance system with multiple payers and gender binary insurance rules, health care may be unaffordable, or remain financially challenging, even for transgender people with health insurance. Moreover, insurance carriers' "reliance" on clinicians' insurance-related labor is problematic as it exacerbates existing insurance barriers to the accessibility and affordability of transgender care and obscures the workings of a financial payment model that prioritizes economic expediency over gender nonconforming health.

Site management of health issues in the 2001 World Trade Center disaster.

PubMed

Bradt, David A

2003-06-01

The terrorist destruction of the World Trade Center led to the greatest loss of life from a criminal incident in the history of the United States. There were 2,801 persons killed or missing at the disaster site, including 147 dead on two hijacked aircraft. Hundreds of buildings sustained direct damage or contamination. Forty different agencies responded with command and control exercised by an incident command system as well as an emergency operations center. Dozens of hazards complicated relief and recovery efforts. Five victims were rescued from the rubble. Up to 1,000 personnel worked daily at the World Trade Center disaster site. These workers collectively made an average of 270 daily presentations to health care providers in the first month post-disaster. Of presentations for clinical symptoms, leading clinical diagnoses were ocular injuries, headaches, and lung injuries. Mechanical injury accounted for 39% of clinical presentations and appeared preventable by personal protective equipment. Limitations emerged in the site application of emergency triage and clinical care. Notable assets in the site management of health issues include action plans from the incident command system, geographic information system products, wireless application technology, technical consensus among health and safety authorities, and workers' respite care.

[Artificial Intelligence in Drug Discovery].

PubMed

Fujiwara, Takeshi; Kamada, Mayumi; Okuno, Yasushi

2018-04-01

According to the increase of data generated from analytical instruments, application of artificial intelligence(AI)technology in medical field is indispensable. In particular, practical application of AI technology is strongly required in "genomic medicine" and "genomic drug discovery" that conduct medical practice and novel drug development based on individual genomic information. In our laboratory, we have been developing a database to integrate genome data and clinical information obtained by clinical genome analysis and a computational support system for clinical interpretation of variants using AI. In addition, with the aim of creating new therapeutic targets in genomic drug discovery, we have been also working on the development of a binding affinity prediction system for mutated proteins and drugs by molecular dynamics simulation using supercomputer "Kei". We also have tackled for problems in a drug virtual screening. Our developed AI technology has successfully generated virtual compound library, and deep learning method has enabled us to predict interaction between compound and target protein.

Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS)

PubMed Central

Anastasiadis, Kyriakos; Murkin, John; Antonitsis, Polychronis; Bauer, Adrian; Ranucci, Marco; Gygax, Erich; Schaarschmidt, Jan; Fromes, Yves; Philipp, Alois; Eberle, Balthasar; Punjabi, Prakash; Argiriadou, Helena; Kadner, Alexander; Jenni, Hansjoerg; Albrecht, Guenter; van Boven, Wim; Liebold, Andreas; de Somer, Fillip; Hausmann, Harald; Deliopoulos, Apostolos; El-Essawi, Aschraf; Mazzei, Valerio; Biancari, Fausto; Fernandez, Adam; Weerwind, Patrick; Puehler, Thomas; Serrick, Cyril; Waanders, Frans; Gunaydin, Serdar; Ohri, Sunil; Gummert, Jan; Angelini, Gianni; Falk, Volkmar; Carrel, Thierry

2016-01-01

Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society was founded to create an international forum for the exchange of ideas on clinical application and research of minimal invasive extracorporeal circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations for the clinical practice. The goal of this manuscript is to promote the use of MiECC systems into clinical practice as a multidisciplinary strategy involving cardiac surgeons, anaesthesiologists and perfusionists. PMID:26819269

An approach for the semantic interoperability of ISO EN 13606 and OpenEHR archetypes.

PubMed

Martínez-Costa, Catalina; Menárguez-Tortosa, Marcos; Fernández-Breis, Jesualdo Tomás

2010-10-01

The communication between health information systems of hospitals and primary care organizations is currently an important challenge to improve the quality of clinical practice and patient safety. However, clinical information is usually distributed among several independent systems that may be syntactically or semantically incompatible. This fact prevents healthcare professionals from accessing clinical information of patients in an understandable and normalized way. In this work, we address the semantic interoperability of two EHR standards: OpenEHR and ISO EN 13606. Both standards follow the dual model approach which distinguishes information and knowledge, this being represented through archetypes. The solution presented here is capable of transforming OpenEHR archetypes into ISO EN 13606 and vice versa by combining Semantic Web and Model-driven Engineering technologies. The resulting software implementation has been tested using publicly available collections of archetypes for both standards.

Asklepian dreams: the ethos of the wounded-healer in the clinical encounter.

PubMed

Kirmayer, Laurence J

2003-06-01

The clinical encounter is structured hierarchically: explicit technical action is embedded in levels of organization that reflect the personality and biography of the clinician, which in turn, are embedded in a larger matrix of cultural values or ethos. Systems of medicine can be compared at each of these levels. Shamanism and other elementary systems of medicine are built on an ethos that identifies healers' calling, authority and effectiveness with their own initiatory illness experiences. The Asklepian religious cults of ancient Greece also drew from the image of the wounded-healer. This essay argues that ethos of the wounded-healer remains relevant to contemporary medicine, psychiatry and psychotherapy. Developmental changes in the relationship of the healer to his wounds during psychiatric training are illustrated by a series of dreams. The ethos of the wounded-healer has implications for the training of clinicians, as well as for the ethics and pragmatics of clinical work.

[Acute inpatient conservative multimodal treatment of complex and multifactorial orthopedic diseases in the ANOA concept].

PubMed

Psczolla, M

2013-10-01

In Germany there is a clear deficit in the non-operative treatment of chronic and complex diseases and pain disorders in acute care hospitals. Only about 20 % of the treatments are carried out in orthopedic hospitals. Hospitals specialized in manual medicine have therefore formed a working group on non-operative orthopedic manual medicine acute care clinics (ANOA). The ANOA has developed a multimodal assessment procedure called the OPS 8-977 which describes the structure and process quality of multimodal and interdisciplinary diagnosis and treatment of the musculoskeletal system. Patients are treated according to clinical pathways oriented on the clinical findings. The increased duration of treatment in the German diagnosis-related groups (DRG) system is compensated for with a supplemental remuneration. Thus, complex and multifactorial orthopedic diseases and pain disorders are conservatively and appropriately treated as inpatient departments of acute care hospitals.

Adeno-associated Virus as a Mammalian DNA Vector

PubMed Central

SALGANIK, MAX; HIRSCH, MATTHEW L.; SAMULSKI, RICHARD JUDE

2015-01-01

In the nearly five decades since its accidental discovery, adeno-associated virus (AAV) has emerged as a highly versatile vector system for both research and clinical applications. A broad range of natural serotypes, as well as an increasing number of capsid variants, has combined to produce a repertoire of vectors with different tissue tropisms, immunogenic profiles and transduction efficiencies. The story of AAV is one of continued progress and surprising discoveries in a viral system that, at first glance, is deceptively simple. This apparent simplicity has enabled the advancement of AAV into the clinic, where despite some challenges it has provided hope for patients and a promising new tool for physicians. Although a great deal of work remains to be done, both in studying the basic biology of AAV and in optimizing its clinical application, AAV vectors are currently the safest and most efficient platform for gene transfer in mammalian cells. PMID:26350320

MedTxting: Learning based and Knowledge Rich SMS-style Medical Text Contraction

PubMed Central

Liu, Feifan; Moosavinasab, Soheil; Houston, Thomas K.; Yu, Hong

2012-01-01

In mobile health (M-health), Short Message Service (SMS) has shown to improve disease related self-management and health service outcomes, leading to enhanced patient care. However, the hard limit on character size for each message limits the full value of exploring SMS communication in health care practices. To overcome this problem and improve the efficiency of clinical workflow, we developed an innovative system, MedTxting (available at http://medtxting.askhermes.org), which is a learning-based but knowledge-rich system that compresses medical texts in a SMS style. Evaluations on clinical questions and discharge summary narratives show that MedTxting can effectively compress medical texts with reasonable readability and noticeable size reduction. Findings in this work reveal potentials of MedTxting to the clinical settings, allowing for real-time and cost-effective communication, such as patient condition reporting, medication consulting, physicians connecting to share expertise to improve point of care. PMID:23304328