Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement.

PubMed

Garner, Kimberly K; Dubbert, Patricia; Lensing, Shelly; Sullivan, Dennis H

2017-01-01

The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers. Published by Elsevier Inc.

40 CFR 164.4 - Arrangements for examining Agency records, transcripts, orders, and decisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... records, transcripts, orders, and decisions. 164.4 Section 164.4 Protection of Environment ENVIRONMENTAL..., CHANGES OF CLASSIFICATIONS, SUSPENSIONS OF REGISTRATIONS AND OTHER HEARINGS CALLED PURSUANT TO SECTION 6... signed documents required by the rules in this part, whether issued by the Environmental Appeals Board or...

40 CFR 164.4 - Arrangements for examining Agency records, transcripts, orders, and decisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... records, transcripts, orders, and decisions. 164.4 Section 164.4 Protection of Environment ENVIRONMENTAL..., CHANGES OF CLASSIFICATIONS, SUSPENSIONS OF REGISTRATIONS AND OTHER HEARINGS CALLED PURSUANT TO SECTION 6... signed documents required by the rules in this part, whether issued by the Environmental Appeals Board or...

42 CFR 426.518 - NCD record furnished to the aggrieved party.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL... section, the NCD record consists of any document or material that CMS considered during the development of... decision memoranda. (5) An index of documents considered that are excluded under paragraph (b) of this...

42 CFR 426.518 - NCD record furnished to the aggrieved party.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL... section, the NCD record consists of any document or material that CMS considered during the development of... decision memoranda. (5) An index of documents considered that are excluded under paragraph (b) of this...

Quality Document Examples (Record of Decision of the Year Contest)

EPA Pesticide Factsheets

This page provides document examples with clear documentation that are consistent with the Superfund Program's policy and regulations. The examples provided here are the winners of the Superfund ROD of the Year Contest (1999-2004)

Superfund record of decision amendment (EPA Region 5): Ninth Avenue Dump, Gary, IN, September 13, 1994

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

Not Available

The decision document, together with Records of Decision dated June 30, 1989 (PB90-114810) and September 20, 1988 (PB89-153837) and an Explanation of Significant Differences dated October 1991, present the selected remedial action for the Ninth Avenue Dump site. The remedial action for the site consists of two operable units. The first operable unit addressed an oil layer floating on the groundwater by means of oil and groundwater extraction, oil storage, reintroduction of the groundwater, containment with a slurry wall, and management of excess surface water. The extracted groundwater was treated prior to reintroduction. The second operable unit, which is beingmore » amended by this decision document, addresses the remaining threats at the site.« less

Facsimile Transmission of Microforms.

DTIC Science & Technology

1983-12-30

display terminals, high speed printers, conventional facsimile receivers, and/or graphics COM recorders. Microforms designed for storage, retrieval...author and Whould not be construed as an official Department of the Army position, policy, or decision, unless so designated by other documentation...beconstrued as an official Department of the Army position, policy, or decision, unless so designated by other documentation. ,, -- UNCLASSIFIED SECURITY

Superfund record of decision amendment (EPA Region 5): Sturgis Municipal Well Field Superfund Site, Sturgis, MI, September 10, 1996

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

NONE

This decision document amends the September 30, 1991 (PB92-964136) Record of Decision (ROD) for the Sturgis Municipal Well Field Superfund Site, in Sturgis, Michigan. The selected remedy is the final remedy for the site. The purpose of this remedy is to eliminate the source of groundwater contamination and restore the aquifer to its beneficial use.

Superfund record of decision amendment (EPA Region 5): Cannelton Industries Inc. Site, Sault Sainte Marie, Chippewa County, MI, September 27, 1996

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

NONE

This decision document amends the 1992 Record of Decision (ROD) for remedial action at the Cannelton Industries, Inc. site, in Sault Ste. Marie, Michigan. The final remedy addresses remediation of soil and sediment contamination by eliminating or reducing the principal threat posed by contaminated tannery waste, contaminated soil and sediment at the site, through containment and removal.

Superfund record of decision amendment (EPA Region 10): USAF Eielson Air Force Base, Operable Units 3, 4, and 5, Fairbanks North Star Borough, AK, September 29, 1998

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

NONE

This decision document presents the amended remedial action for Operable Units 3, 4, and 5 (OUs 3, 4, and 5) at Eielson Air Force Base (AFB). This decision is based on the Administrative Record for OU 3, 4, and 5, updated in July 1998, to include new information generated since the original Record of Decision was signed on 30 September 1995 (PB95-964618). This amendment applies to OU3 site DP44 (Battery Shop Leach Field Building), OU4 sites SS35 (Asphalt Mixing Area) and ST58 (Old Quartermaster Service Station), and OU5 sites LF03/FT09 (Current Inactive Base Landfill/Fire Training Area). Through new information, contaminantmore » levels than interpreted prior to signing the original ROD document. Proper enforcement of Institutional Controls (IC`s) at all sites will be effective in controlling and restricting access to contaminated media at the sites remediation goals are achieved.« less

Superfund record of decision (EPA Region 9): Riverbank Army Ammunition Plant Site, Riverbank, CA, March 1994

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

Not Available

1994-07-01

This decision document presents the selected remedial actions for the Riverbank Army Ammunition Plant (RBAAP) in Riverbank, California. This sitewide ROD contains two response actions that address the media of concern at RBAAP. This ROD also documents the decision that no further action is warranted at the Evaporation/Percolation (E/P) ponds. The two response actions for this ROD are a groundwater response action and a landfill response action.

Superfund record of decision amendment (EPA Region 5): Moss-American (Kerr-McGee Oil Co.), Milwaukee, WI, September 30, 1998

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

NONE

The purpose of this decision document is to present an amendment to the Record of Decision (ROD) for the Moss-American Site, which is located in Milwaukee, Wisconsin. The ROD amendment for the Moss-American site has three principal components: (1) changes in soil treatment technology, (2) potential changes in cleanup standards, and (3) changes in cover design and requirements.

24 CFR 55.27 - Documentation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... FLOODPLAIN MANAGEMENT Procedures for Making Determinations on Floodplain Management § 55.27 Documentation. (a... outside the floodplain, but within the local housing market area, the local public utility service area..., documentation of compliance with this part must be included as a part of the record of decision (or...

Superfund record of decision amendment (EPA Region 5): Arrowhead Refinery Company, Hermantown, MN, February 9, 1994

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

NONE

This decision document amends the selected remedial action for the Arrowhead Refinery Superfund Site (Arrowhead). This AROD does not make `fundamental changes` to the groundwater remedy selected in the ROD. Therefore, this AROD does not constitute an amendment of the groundwater remedy. However, this AROD does document minor differences in the groundwater remedy which the Agency intends to implement.

4 CFR 81.6 - Records which may be exempt from disclosure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... documents which would be detrimental to an agency decision making. (k) Records in addition to those... 4 Accounts 1 2010-01-01 2010-01-01 false Records which may be exempt from disclosure. 81.6 Section 81.6 Accounts GOVERNMENT ACCOUNTABILITY OFFICE RECORDS PUBLIC AVAILABILITY OF GOVERNMENT...

Superfund record of decision (EPA Region 1): Bennington Municipal Sanitary Landfill, Bennington, VT, September 29, 1998

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

NONE

1999-03-01

This decision document presents the selected No Further Action decision for the Bennington Landfill Site (the Site), located in Bennington, Vermont. EPA will perform 10 years of additional monitoring of the groundwater, surface water, and sediments starting with the completion of the NTCRA.

Superfund record of decision (EPA Region 6): Longhorn Army Ammunition Plant, IHAAP 12 and 16 Landfills, Karnack, TX, September 27, 1995

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

NONE

1996-03-01

This decision document presents the selected Early Interim Remedial Action for the LHAAP 12 and 16 landfills, Longhorn Army Ammunition Plant (LHAAP), Karnack, Texas. The Record of Decision for the sites addresses an Early Interim Remedial Action. The selected remedy consists of a multilayer landfill cap section which includes the following components: Foundation soil layer, Sodium Bentonite Geocomposite Liner, Geosynthetic Membrane Liner, Final soil cover, and Perimeter berms and drainage swales.

Superfund explanation of significant difference for the Record of Decision (EPA Region 10): Umatilla Army Depot (Lagoons), Hermiston, OR, September 30, 1997

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

NONE

1998-10-01

This document presents an Explanation of Significant Difference (ESD) from the Record of Decision (ROD) for the Umatilla Depot Activity (UMDA) Explosives Washout Lagoons Soils Operable Unit issued September 25, 1992 (PB93-964610). This ESD documents the significant differences to the selected remedy outlined in the ROD. In summary, the significant difference from the selected remedy in the ROD is the utilization of the treated soil as the organic component in the re-vegetation of several designated sites on the installation rather than backfilling the former Explosive Washout Lagoons with the compost.

Are electronic health records ready for genomic medicine?

PubMed

Scheuner, Maren T; de Vries, Han; Kim, Benjamin; Meili, Robin C; Olmstead, Sarah H; Teleki, Stephanie

2009-07-01

The goal of this project was to assess genetic/genomic content in electronic health records. Semistructured interviews were conducted with key informants. Questions addressed documentation, organization, display, decision support and security of family history and genetic test information, and challenges and opportunities relating to integrating genetic/genomics content in electronic health records. There were 56 participants: 10 electronic health record specialists, 18 primary care clinicians, 16 medical geneticists, and 12 genetic counselors. Few clinicians felt their electronic record met their current genetic/genomic medicine needs. Barriers to integration were mostly related to problems with family history data collection, documentation, and organization. Lack of demand for genetics content and privacy concerns were also mentioned as challenges. Data elements and functionality requirements that clinicians see include: pedigree drawing; clinical decision support for familial risk assessment and genetic testing indications; a patient portal for patient-entered data; and standards for data elements, terminology, structure, interoperability, and clinical decision support rules. Although most said that there is little impact of genetics/genomics on electronic records today, many stated genetics/genomics would be a driver of content in the next 5-10 years. Electronic health records have the potential to enable clinical integration of genetic/genomic medicine and improve delivery of personalized health care; however, structured and standardized data elements and functionality requirements are needed.

Comprehensible knowledge model creation for cancer treatment decision making.

PubMed

Afzal, Muhammad; Hussain, Maqbool; Ali Khan, Wajahat; Ali, Taqdir; Lee, Sungyoung; Huh, Eui-Nam; Farooq Ahmad, Hafiz; Jamshed, Arif; Iqbal, Hassan; Irfan, Muhammad; Abbas Hydari, Manzar

2017-03-01

A wealth of clinical data exists in clinical documents in the form of electronic health records (EHRs). This data can be used for developing knowledge-based recommendation systems that can assist clinicians in clinical decision making and education. One of the big hurdles in developing such systems is the lack of automated mechanisms for knowledge acquisition to enable and educate clinicians in informed decision making. An automated knowledge acquisition methodology with a comprehensible knowledge model for cancer treatment (CKM-CT) is proposed. With the CKM-CT, clinical data are acquired automatically from documents. Quality of data is ensured by correcting errors and transforming various formats into a standard data format. Data preprocessing involves dimensionality reduction and missing value imputation. Predictive algorithm selection is performed on the basis of the ranking score of the weighted sum model. The knowledge builder prepares knowledge for knowledge-based services: clinical decisions and education support. Data is acquired from 13,788 head and neck cancer (HNC) documents for 3447 patients, including 1526 patients of the oral cavity site. In the data quality task, 160 staging values are corrected. In the preprocessing task, 20 attributes and 106 records are eliminated from the dataset. The Classification and Regression Trees (CRT) algorithm is selected and provides 69.0% classification accuracy in predicting HNC treatment plans, consisting of 11 decision paths that yield 11 decision rules. Our proposed methodology, CKM-CT, is helpful to find hidden knowledge in clinical documents. In CKM-CT, the prediction models are developed to assist and educate clinicians for informed decision making. The proposed methodology is generalizable to apply to data of other domains such as breast cancer with a similar objective to assist clinicians in decision making and education. Copyright © 2017 Elsevier Ltd. All rights reserved.

Superfund Record of Decision (EPA Region 7): Cornhusker Army Ammunition Plant, Operable Unit 2, Hall County, NE, September 30, 1998

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

NONE

1999-03-01

This Record of Decision (ROD) document presents the selected remedial action for the six areas of concern (AOCs) located at the Cornhusker Army Ammunition Plant (CHAAP) in Grand Island, Nebraska designated as OU2. The remedial action is chosen in accordance with the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERLCA), as amended by the Superfund Amendments and Reauthorization Act (SARA) of 1986, and with the National Oil and Hazardous Substances Pollution Contingency Plan (NCP). The information supporting the decisions contained in the remedy is contained in the administrative record.

Semantic-Web Architecture for Electronic Discharge Summary Based on OWL 2.0 Standard.

PubMed

Tahmasebian, Shahram; Langarizadeh, Mostafa; Ghazisaeidi, Marjan; Safdari, Reza

2016-06-01

Patients' electronic medical record contains all information related to treatment processes during hospitalization. One of the most important documents in this record is the record summary. In this document, summary of the whole treatment process is presented which is used for subsequent treatments and other issues pertaining to the treatment. Using suitable architecture for this document, apart from the aforementioned points we can use it in other fields such as data mining or decision making based on the cases. In this study, at first, a model for patient's medical record summary has been suggested using semantic web-based architecture. Then, based on service-oriented architecture and using Java programming language, a software solution was designed and run in a way to generate medical record summary with this structure and at the end, new uses of this structure was explained. in this study a structure for medical record summaries along with corrective points within semantic web has been offered and a software running within Java along with special ontologies are provided. After discussing the project with the experts of medical/health data management and medical informatics as well as clinical experts, it became clear that suggested design for medical record summary apart from covering many issues currently faced in the medical records has also many advantages including its uses in research projects, decision making based on the cases etc.

12 CFR 19.100 - Filing documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... motions; briefs; the record filed by the administrative law judge after the issuance of a recommended decision; the recommended decision filed by the administrative law judge following a motion for summary disposition; referrals by the administrative law judge of motions for interlocutory review; exceptions and...

Superfund record of decision (EPA Region 2): Hercules Incorporated (Gibbstown Plant), Solid Waste Disposal Area, Operable Unit 3, Greenwich Township, Gloucester County, NJ, January 22, 1966

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

NONE

1996-10-01

This decision document presents the selected remedial action for the Solid Waste Disposal Area (SWDA) - Operable Unit 3, Hercules Incorporated, Higgins Plant (hereinafter Hercules site or site), in Greenwhich Township, Gloucester County, New Jersey. The Record of Decision (ROD) addresses all contaminated media at the SWDA portion of the site including soil and ground water. The selected remedy is a modified version of the `In-Place Containment` remedy of the Porposed Plan.

Superfund Record of Decision Amendment (EPA Region 6): Texarkana Wood Preserving Co. , Texarkana, TX, March 13, 1998

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

Not Available

This decision document presents an amendment to the selected remedial action for the Texarkana Wood Preserving Co. Superfund Site. This amendment fundamentally changes the Record of Decision (ROD) executed by the Regional Administrator on September 25, 1990. This amended remedy will seal and contain soils contaminated with greater than 3 ppm (parts per million) benzo(a)pyrene equivalents, 2450 ppm total poly aromatic hydrocarbons (PAH), 20 ppb (parts per billion) as 2,3,7,8 TCDD equivalents and 150 ppm pentachlorophenol beneath a soil cap.

“Smart Forms” in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management

PubMed Central

Schnipper, Jeffrey L.; Linder, Jeffrey A.; Palchuk, Matvey B.; Einbinder, Jonathan S.; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing “Smart Forms” to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions. PMID:18436911

"Smart Forms" in an Electronic Medical Record: documentation-based clinical decision support to improve disease management.

PubMed

Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Einbinder, Jonathan S; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing "Smart Forms" to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions.

32 CFR 317.4 - Responsibilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

...'s written Privacy Act request for access to or amendment of documents filed in Privacy Act systems... Privacy Act request for access to or amendment of documents filed in Privacy Act systems of records. This... decisions of respective initial denial authorities. (b) The Chief, Administrative Management Division under...

Superfund Record of Decision (EPA Region 8): Sand Creek Industrial Site, operable unit 5, Commerce City, CO, (amendment), September 1993

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

Not Available

This decision document is an amendment to the Record of Decision (ROD) signed September 28, 1990 (PB94-921479) and presents the new selected remedial action for cleanup of contaminated shallow soils at OU5 at the Sand Creek Industrial Superfund Site. OU5 is located immediately north of 52nd and Dahlia Street in Commerce City, Colorado. Based on new technical data and cost information obtained subsequent to the September 1990 ROD, EPA has reconsidered its decision to employ soil washing and incineration of the generated residuals as a source control measure for OU5.

EPA Concurrence/Approval of Federal Facility Proposed Plans and Records of Decision and other Documents

EPA Pesticide Factsheets

The purpose of this memorandum is to ensure that EPA Regions scrutinize all proposed plans, draft and final RODs, and post-ROD documents that address institutional controls (ICs) in order to verify that they adequately document the objectives of the ICs and clearly identify who has responsibility for implementation, monitoring, reporting, and enforcement of the IC.

Ground-Based Midcourse Defense (GMD) Sea-Based X-Band Radar (SBX) Placement and Operation, Adak, Alaska

DTIC Science & Technology

2005-08-03

Finding of No Significant Impact and the Environmental Assessment for Theater Missile Defense Ground- Based Radar Testing Program at Fort Devens ...2000 "* Record of Decision for Site Preparation Activities at the Missile Defense System Test Bed at Fort Greely, Alaska, 2001 "* Record of Decision...to Establish a Ground-Based Midcourse Defense Initial Defensive Operations Capability at Fort Greely, Alaska, 2003 These documents are available at the

Superfund Record of Decision (EPA Region 7): Cherokee County (Baxter Springs and Treece Subsites), Operable Unit 3/4, Cherokee County, KS, August 20, 1997

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

NONE

1997-11-01

This decision document presents the selected remedial action for the mining and milling wastes at the Baxter Springs and Treece subsites, which are part of the Cherokee County Superfund Site in Cherokee County, Kansas.

Report: EPA Has Not Reported to Congress on BEACH Act Progress as Statutorily Required or Fully Documented Budget Decisions

EPA Pesticide Factsheets

Report #18-P-0071, January 18, 2018. Failure to submit required reports and keep required records limits congressional, public and EPA knowledge about the impact of the agency's BEACH Act program and decisions regarding the use of taxpayer dollars.

Superfund Record of Decision (EPA Region 7): Bee Cee Manufacturing Co., Malden, MO, September 30, 1997

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

NONE

This decision document presents the remedial action selected to cleanup groundwater contaminant at the Bee Cee Manufacturing site in Malden, Missouri. The remedy selected to remediate contaminated groundwater at the Bee Cee Manufacturing site is natural attenuation, groundwater monitoring and institutional controls.

Superfund record of decision (EPA Region 3): Tyler Refrigeration Pit, Smyrna, DE, May 10, 1996

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

NONE

This decision document presents the Environmental Protection Agency`s selected remedial action for the Tyler Refrigeration Pit Site (Site) in Smyrna, Delaware. EPA has determined that no remedial action is necessary at the Site to ensure protection of human health and the environment.

32 CFR 1901.44 - Action by appeals authority.

Code of Federal Regulations, 2010 CFR

2010-07-01

... request, the document(s) (sanitized and full text) at issue, and the findings of the concerned Deputy... appearances shall be permitted without the express permission of the Panel. (c) Decision by the Historical... refer the request to the CIA Historical Records Policy Board which acts as the senior corporate board...

Superfund Record of Decision Amendment (EPA Region 5): Springfield Township Dump, Davisburg, MI, June 10, 1998

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

NONE

This decision document presents the amendments to the remedial action for the Springfield Township Dump site, Oakland County, Michigan. The amended remedial action changes the selected method of addressing PCB-laden soils and also changes certain soil and groundwater cleanup standards previously selected in the 1990 Record of Decision (ROD) to reflect current state standards: The groundwater and soil vapor extraction and treatment systems and the arsenic and lead groundwater cleanup standards identified as part of the selected remedy in the 1990 ROD and in the 1993 Explanation of Significant Difference remain unchanged.

5 CFR 293.403 - Contents of employee performance files.

Code of Federal Regulations, 2011 CFR

2011-01-01

... REGULATIONS PERSONNEL RECORDS Employee Performance File System Records § 293.403 Contents of employee performance files. (a) A decision on what constitutes a performance-related document within the meaning of... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Contents of employee performance files...

5 CFR 293.403 - Contents of employee performance files.

Code of Federal Regulations, 2013 CFR

2013-01-01

... REGULATIONS PERSONNEL RECORDS Employee Performance File System Records § 293.403 Contents of employee performance files. (a) A decision on what constitutes a performance-related document within the meaning of... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Contents of employee performance files...

5 CFR 293.403 - Contents of employee performance files.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REGULATIONS PERSONNEL RECORDS Employee Performance File System Records § 293.403 Contents of employee performance files. (a) A decision on what constitutes a performance-related document within the meaning of... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Contents of employee performance files...

5 CFR 293.403 - Contents of employee performance files.

Code of Federal Regulations, 2012 CFR

2012-01-01

... REGULATIONS PERSONNEL RECORDS Employee Performance File System Records § 293.403 Contents of employee performance files. (a) A decision on what constitutes a performance-related document within the meaning of... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Contents of employee performance files...

Superfund record of decision amendment (EPA Region 3): Tyson Dump Superfund Site, Upper Merion Township, Montgomergy County, PA, July 20, 1996

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

NONE

1996-08-01

The Record of Decision Amendment (`ROD Amendment`) modifies the selected remedy described in the Revised Record of Decision for the Tyson`s Superfund Site (Site) issued by the U.S. Environmental Protection Agency (EPA) on March 31, 1988 (1988 Revised ROD - PB89-233894). In the 1988 Revised ROD, EPA selected a soil vapor extraction (SVE) remedy for lagoon area soils. The SVE system has removed approximately 200,000 pounds of volatile organic compounds (VOCs) from the lagoon area soils. Although several enhancements and modifications have been employed to improve performance, the SVE system will not achieve the cleanup standards specified in the 1988more » Revised ROD. The decision document presents the selected remedial action for the lagoon area soils at the Tyson`s Site.« less

Superfund Record of Decision (EPA Region 9): San Fernando Valley Area 2, operable unit 2, Los Angeles County, CA, June 1993

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

Not Available

1993-06-01

This decision document presents the selected remedial action for the Glendale North Operable Unit, San Fernando Valley Area 2 Superfund site. The remedy involves groundwater extraction and treatment for the shallow aquifer system in the Glendale area of the San Fernando Valley.

Superfund Record of Decision (EPA Region 9): San Fernando Valley Area 2, operable unit 3, Los Angeles County, CA, June 1993

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

Not Available

1993-06-01

This decision document presents the selected remedial action for the Glendale South Operable Unit, San Fernando Valley Area 2 Superfund site. The remedy involves groundwater extraction and treatment for the shallow aquifer system in the Glendale area of the San Fernando Valley.

32 CFR 806.29 - Administrative processing of Air Force FOIA requests.

Code of Federal Regulations, 2010 CFR

2010-07-01

.../service/a nongovernment source (Exemption 4), records are part of the Air Force's decision-making process... explanation of the decision-making process for intra-agency documents denied under the deliberative process... specific “compelling need” or due process/humanitarian need is true and correct to the best of their...

46 CFR 502.226 - Decision based on official notice; public documents.

Code of Federal Regulations, 2014 CFR

2014-10-01

... judicially noticed by the courts, or of technical or scientific facts within the general knowledge of the... a material fact not appearing in the evidence in the record, the fact of official notice shall be so... official report, decision, opinion, or published scientific or economic statistical data issued by any of...

46 CFR 502.226 - Decision based on official notice; public documents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... judicially noticed by the courts, or of technical or scientific facts within the general knowledge of the... a material fact not appearing in the evidence in the record, the fact of official notice shall be so... official report, decision, opinion, or published scientific or economic statistical data issued by any of...

46 CFR 502.226 - Decision based on official notice; public documents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... judicially noticed by the courts, or of technical or scientific facts within the general knowledge of the... a material fact not appearing in the evidence in the record, the fact of official notice shall be so... official report, decision, opinion, or published scientific or economic statistical data issued by any of...

46 CFR 502.226 - Decision based on official notice; public documents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... judicially noticed by the courts, or of technical or scientific facts within the general knowledge of the... a material fact not appearing in the evidence in the record, the fact of official notice shall be so... official report, decision, opinion, or published scientific or economic statistical data issued by any of...

46 CFR 502.226 - Decision based on official notice; public documents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... judicially noticed by the courts, or of technical or scientific facts within the general knowledge of the... a material fact not appearing in the evidence in the record, the fact of official notice shall be so... official report, decision, opinion, or published scientific or economic statistical data issued by any of...

Superfund Record of Decision (EPA Region 4): Murray-Ohio Dump, Operable Unit 1, Lawrence County, Lawrenceburg, TN, June 17, 1994

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

NONE

1995-02-01

This decision document represents the selected remedial action for the Murray Ohio Dump Site. This final remedy addresses remediation of ground-water/seep contamination and soil contamination by eliminating or reducing the risks posed by the Site, through treatment, engineering and institutional controls.

78 FR 36164 - Tongass National Forest; Ketchikan-Misty Fiords Ranger District; Alaska; Saddle Lakes Timber Sale...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... District; Alaska; Saddle Lakes Timber Sale Environmental Impact Statement AGENCY: Forest Service, USDA... Notice of Intent (NOI) to prepare an Environmental Impact Statement for the Saddle Lakes Timber Sale... management plans documented with a Record of Decision or Decision Notice (reference 36 CFR part 218). This...

49 CFR 1001.1 - Records available from the Board.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Transportation Board Administrative Issuances. (b) The following records, so-called “reading room” documents, are... or date of issuance and are available for viewing and downloading from the Board's Electronic Reading Room at www.stb.dot.gov, the Board's website. Final decisions are maintained in a database that is full...

20 CFR 258.1 - Hearings.

Code of Federal Regulations, 2010 CFR

2010-04-01

... production of records and documents, administer oaths, take testimony, make all pertinent investigations and findings of fact, and render decisions upon such findings. (b) Where the Board determines that an oral...

Exploring Vital Sign Data Quality in Electronic Health Records with Focus on Emergency Care Warning Scores.

PubMed

Skyttberg, Niclas; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2017-08-30

Computerized clinical decision support and automation of warnings have been advocated to assist clinicians in detecting patients at risk of physiological instability. To provide reliable support such systems are dependent on high-quality vital sign data. Data quality depends on how, when and why the data is captured and/or documented. This study aims to describe the effects on data quality of vital signs by three different types of documentation practices in five Swedish emergency hospitals, and to assess data fitness for calculating warning and triage scores. The study also provides reference data on triage vital signs in Swedish emergency care. We extracted a dataset including vital signs, demographic and administrative data from emergency care visits (n=335027) at five Swedish emergency hospitals during 2013 using either completely paper-based, completely electronic or mixed documentation practices. Descriptive statistics were used to assess fitness for use in emergency care decision support systems aiming to calculate warning and triage scores, and data quality was described in three categories: currency, completeness and correctness. To estimate correctness, two further categories - plausibility and concordance - were used. The study showed an acceptable correctness of the registered vital signs irrespectively of the type of documentation practice. Completeness was high in sites where registrations were routinely entered into the Electronic Health Record (EHR). The currency was only acceptable in sites with a completely electronic documentation practice. Although vital signs that were recorded in completely electronic documentation practices showed plausible results regarding correctness, completeness and currency, the study concludes that vital signs documented in Swedish emergency care EHRs cannot generally be considered fit for use for calculation of triage and warning scores. Low completeness and currency were found if the documentation was not completely electronic.

Critical issues in an electronic documentation system.

PubMed

Weir, Charlene R; Nebeker, Jonathan R

2007-10-11

The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs has instituted a medical record (EMR) that includes electronic documentation of all narrative components of the medical record. To support clinicians using the system, multiple efforts have been instituted to ease the creation of narrative reports. Although electronic documentation is easier to read and improves access to information, it also may create new and additional hazards for users. This study is the first step in a series of studies to evaluate the issues surrounding the creation and use of electronic documentation. Eighty-eight providers across multiple clinical roles were interviewed in 10 primary care sites in the VA system. Interviews were tape-recorded, transcribed and qualitatively analyzed for themes. In addition, specific questions were asked about perceived harm due to electronic documentation practices. Five themes relating to difficulties with electronic documentation were identified: 1) information overload; 2) hidden information; 3) lack of trust; 4) communication; 5) decision-making. Three providers reported that they knew of an incident where current documentation practices had caused patient harm and over 75% of respondents reported significant mis-trust of the system.

Documenting the decision structure in software development

NASA Technical Reports Server (NTRS)

Wild, J. Christian; Maly, Kurt; Shen, Stewart N.

1990-01-01

Current software development paradigms focus on the products of the development process. Much of the decision making process which produces these products is outside the scope of these paradigms. The Decision-Based Software Development (DBSD) paradigm views the design process as a series of interrelated decisions which involve the identification and articulation of problems, alternates, solutions and justifications. Decisions made by programmers and analysts are recorded in a project data base. Unresolved problems are also recorded and resources for their resolution are allocated by management according to the overall development strategy. This decision structure is linked to the products affected by the relevant decision and provides a process oriented view of the resulted system. Software maintenance uses this decision view of the system to understand the rationale behind the decisions affecting the part of the system to be modified. D-HyperCase, a prototype Decision-Based Hypermedia System is described and results of applying the DBSD approach during its development are presented.

Superfund record of decision amendment (EPA Region 5): Carter Industrials Site, Detroit, MI, February 28, 1995

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

NONE

This decision document changes a decision made on September 18, 1991 in which the United States Environmental Protection Agency (U.S. EPA) chose low-temperature thermal desorption as the remedy for PCB contamination at the Carter Industrials Site in Detroit, Michigan. U.S. EPA is hereby amending the 1991 Record of Decision (PB92-964126) to select off-site disposal as the remedy. This response action addresses remediation of PCB-contaminated soil, debris, and buildings at the Carter Industrials Site. The principal threats posed by conditions at the Site include inhalation of volatilized PCBs and fugitive dust, and dermal contact with contaminated materials. The amended remedy willmore » eliminate these threats.« less

76 FR 34096 - Notice of Availability of the Record of Decision for the Final Environmental Impact Statement and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-10

... the South Gillette Area West Coal Creek Coal Lease-by-Application, Wyoming AGENCY: Bureau of Land... Decision (ROD) for the West Coal Creek Coal Lease-by- Application (LBA) included in the South Gillette Area Coal Lease Applications Final Environmental Impact Statement (EIS). ADDRESSES: The document is...

Superfund record of decision (EPA Region 4): Aberdeen Pesticide Dumps Site, Aberdeen, NC, October 1993

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

Not Available

1994-07-01

The decision document presents the selected remedial action for Operable Unit Three (OU3) of the Aberdeen Pesticide Dumps Site (the 'Site'), in Aberdeen, North Carolina. The remedy selected addresses groundwater, sediment, and surface water contamination and ecological concerns to eliminate or reduce the risks posed by the Site.

Evaluating the impact of an educational intervention on documentation of decision-making capacity in an emergency medical services system.

PubMed

Riley, Jennifer; Burgess, Rob; Schwartz, Brian

2004-07-01

To compare the documentation of decision-making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention. The intervention comprised a one-and-a-half-hour module on assessment and documentation of decision-making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two-month periods, and refusals of transport were recorded. Provider compliance with documentation of decision-making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty-percent double data entry was undertaken to evaluate accuracy. Ninety-five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation. From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods). An educational intervention resulted in no change in the rate of decision-making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients.

Superfund record of decision (EPA Region 3): Ohio River Park Site, Operable Unit 3, Neville Island, PA, September 17, 1998

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

NONE

1998-10-01

This Record of Decision (ROD) presents the selected remedial action plan for the Ohio River Park Superfund Site (the Site) in Allegheny County, Pennsylvania. The remedial action plan in this document is presented as the permanent remedy for controlling the groundwater at the Site. This remedy is comprised of: monitoring of natural attenuation processes to measure changes in contaminant concentrations in groundwater plume at the Site until the cleanup levels are achieved; deed restriction preventing residential use of groundwater at the Site.

United States Air Force 611th Civil Engineer Squadron, Elmendorf AFB, Alaska. Final engineering evaluation/cost analysis: Petroleum, oil, and lubricants area, Galena Airport, Alaska

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

NONE

1996-02-05

This decision document presents the selected removal action for the Installation Restoration Program (IRP) site ST005, otherwise known as the POL Tank Farm, at Galena Airport, Alaska. This decision is based on the administrative record for this site, specifically the draft Remedial Investigation Report (March 1995) and the Treatability Study Report (January 1995) (PB95-225314). The information from these documents is summarized, along with an analysis of potential removal action alternatives in the Engineering Evaluation/Cost Analysis (EE/CA).

The Role of Documentation Quality in Anesthesia-Related Closed Claims: A Descriptive Qualitative Study.

PubMed

Wilbanks, Bryan A; Geisz-Everson, Marjorie; Boust, Rebecca R

2016-09-01

Clinical documentation is a critical tool in supporting care provided to patients. Sound documentation provides a picture of clinical events that can be used to improve patient care. However, many other uses for clinical documentation are equally important. Such documentation informs clinical decision support tools, creates a legal record of patient care, assists in financial reimbursement of services, and serves as a repository for secondary data analysis. Conversely, poor documentation can impair patient safety and increase malpractice risk exposure by reflecting poor or inaccurate information that ultimately may guide patient care decisions.Through an examination of anesthesia-related closed claims, a descriptive qualitative study emerged, which explored the antecedents and consequences of documentation quality in the claims reviewed. A secondary data analysis utilized a database generated by the American Association of Nurse Anesthetists Foundation closed claim review team. Four major themes emerged from the analysis. Themes 1, 2, and 4 primarily describe how poor documentation quality can have negative consequences for clinicians. The third theme primarily describes how poor documentation quality that can negatively affect patient safety.

75 FR 39178 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-08

... referred to in this document may also be obtained from the Council. Copies of the Record of Decision (ROD... appear to be consistent with the Court's underlying reasoning in its Opinion. Thus, although NMFS is... revising the OY table to be consistent with the decision announced in the December 10, 2009, final rule...

Superfund record of decision (EPA Region 10): Standard Steel and Metals Salvage Yard, (USDOT), Superfund Site, Anchorage, AK, July 16, 1996

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

NONE

1996-08-01

The decision document presents the selected remedial action for the Standard Steel and Metals Salvage Yard, in Anchorage, Alaska. This is the final remedial action for the site. The site was not divided into operable units. The Removal Action utilized treatment as a principle element for the principle sources.

Superfund record of decision (EPA Region 6): Southern Shipbuilding Corp., Slidell, LA, July 20, 1995

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

NONE

1996-03-01

This decision document presents the selected remedial action for the source control operable unit of the Southern Shipbuilding Corporation (SSC) site in Slidell, Louisiana. This remedy represents the source control operable unit which addresses remediation of highly contaminated sludge and soil, the marginally contaminated soil, and the graving dock sediments at the Southern Shipbuilding Corporation site.

Interdisciplinary collaboration and the electronic medical record.

PubMed

Green, Shayla D; Thomas, Joan D

2008-01-01

To examine interdisciplinary collaboration via electronic medical records (EMRs) with a focus on physicians' perception of nursing documentation. Quality improvement project using a survey instrument. Tertiary care pediatric hospital. Thirty-seven physicians. Physicians perceptions of nursing documentation after EMR implementation Physicians desire nursing documentation with greater clarity and additional information. Physicians indicate checklists alone for patient assessment and intervention data are insufficient for effective nurse/physician collaboration. Narrative nursing summaries are invaluable references that guide medical treatment decisions. Physicians see detailed assessments and well-described interventions of nurses' as critical to their ability to effectively practice medicine. Health care technology is called to develop EMRs that enable nurses to document detailed patient data in a swift and straightforward manner. Joint collaboration between nurses, physicians, and technology specialists is recommended to develop effective EMR systems.

Data to DecisionsTerminate, Tolerate, Transfer, or Treat

DTIC Science & Technology

2016-07-25

and patching, a risk-based cyber - security decision model that enables a pre- dictive capability to respond to impending cyber -attacks is needed...States. This sensitive data includes business proprietary information on key programs of record and infrastructure, including government documents at...leverage nationally. The Institute for Defense Analyses (IDA) assisted the DoD CIO in formalizing a proof of concept for cyber initiatives and

Predictors of successful use of a web-based healthcare document storage and sharing system for pediatric cancer survivors: Cancer SurvivorLink™.

PubMed

Williamson, Rebecca; Meacham, Lillian; Cherven, Brooke; Hassen-Schilling, Leann; Edwards, Paula; Palgon, Michael; Espinoza, Sofia; Mertens, Ann

2014-09-01

Cancer SurvivorLink™, www.cancersurvivorlink.org , is a patient-controlled communication tool where survivors can electronically store and share documents with healthcare providers. Functionally, SurvivorLink serves as an electronic personal health record-a record of health-related information managed and controlled by the survivor. Recruitment methods to increase registration and the characteristics of registrants who completed each step of using SurvivorLink are described. Pediatric cancer survivors were recruited via mailings, survivor clinic, and community events. Recruitment method and Aflac Survivor Clinic attendance was determined for each registrant. Registration date, registrant type (parent vs. survivor), zip code, creation of a personal health record in SurvivorLink, storage of documents, and document sharing were measured. Logistic regression was used to determine the characteristics that predicted creation of a health record and storage of documents. To date, 275 survivors/parents have completed registration: 63 were recruited via mailing, 99 from clinic, 56 from community events, and 57 via other methods. Overall, 66.9 % registrants created a personal health record and 45.7 % of those stored a health document. There were no significant predictors for creating a personal health record. Attending a survivor clinic was the strongest predictor of document storage (p < 0.01). Of those with a document stored, 21.4 % shared with a provider. Having attended survivor clinic is the biggest predictor of registering and using SurvivorLink. Many survivors must advocate for their survivorship care. Survivor Link provides educational material and supports the dissemination of survivor-specific follow-up recommendations to facilitate shared clinical care decision making.

How to improve vital sign data quality for use in clinical decision support systems? A qualitative study in nine Swedish emergency departments.

PubMed

Skyttberg, Niclas; Vicente, Joana; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2016-06-04

Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Semi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data. Factors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control. Vital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings.

Superfund record of decision (EPA Region 9): Mather Air Force Base, Soil and Groundwater operable units, Sacramento, CA, June 21, 1996

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

NONE

The decision document presents the selected remedial actions for the Soil Operable Unit (OU) Sites and Groundwater OU Plumes, at the formerly active Mather Air Force Base (AFB), Sacramento County, California. The purpose of the Record of Decision (ROD) is to decide the appropriate level of remediation necessary to protect human health and the environment, and determine what requirements are applicable or relevant and appropriate requirements (ARARs) based on the groundwater beneficial use designation and site-specific conditions. The ROD has been divided into seven sections which specifically address the range of selected remedial actions for the Soil OU sites andmore » Groundwater OU plumes.« less

Sample Federal Facility Land Use Control ROD Checklist and Suggested Language (LUC Checklist)

EPA Pesticide Factsheets

The LUC Checklist provides direction on describing and documenting land use controls (LUCs) in federal facility actrions under CERCLA in Records of Decision (RODs), remedial designs (RDs), and remedial action work plans (RAWPs).

The effect of the quality of vital sign recording on clinical decision making in a regional acute care trauma ward.

PubMed

Keene, Claire M; Kong, Victor Y; Clarke, Damian L; Brysiewicz, Petra

2017-10-01

Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score (MEWS) uses vital signs to categorise the severity of a patient's physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making. Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator-measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL. The details of 181 newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88% for respiratory rate, 98% for blood pressure, 92% for temperature and 41% for GCS. The recorded heart rate was positively correlated with the investigator's measurement (Pearson's correlation coefficient of 0.76); while the respiratory rate did not correlate (Pearson's correlation coefficient of 0.02). In 59% of patients the recorded respiratory rate (RR) was exactly 20 breaths per minute and 27% had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded (MEWS(R)) and investigator (MEWS(I)) vitals, with the range of MEWS(R) 0-7 and MEWS(I) 0-9. Analysis showed 59% of the MEWS(R) underestimated the physiological derangement (scores were lower than the MEWS(I)); 80% of patients had a MEWS(R) requiring 4 hourly checks which was only completed in 2%; 86% of patients had a MEWS(R) of less than three (i.e. not necessitating escalation of care), but 33% of these showed a MEWS(I) greater than three (i.e. actually necessitating escalation of care). Documentation of vital signs aids management decisions, indicating the physiological derangement of a patient and dictating treatment. This study showed that there was a poor quality of vital sign recording in this acute care trauma setting, which led to underestimation of patients' physiological derangement and an inability to detect deteriorating patients. The MEWS could be a powerful tool to empower nurses to become involved in the diagnosis and detection of deteriorating patients, as well as providing a framework to communicate the severity of derangement between health workers. However, it requires a number of strategies to improve the quality of vital sign recording, including continuing education, increasing the numbers of competent staff and administrative changes in vital sign charts. Copyright © 2017. Production and hosting by Elsevier B.V.

Superfund record of decision (EPA Region 3): Letterkenny Army Depot (PDO and SE Areas), Chambersburg, Franklin County, PA, September 30, 1998

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

NONE

1998-11-01

The decision document presents the selected remedial action for the Phase 1 Parcels at Letterkenny Army Depot (LEAD), Chambersburg, Pennsylvania. Based on consideration of he CERCLA requirements, the NCP, the detailed analysis of the alternatives using the nine criteria, and public and state comments, the Army and EPA have selected an institutional controls remedy for this Site.

Superfund Record of Decision (EPA Region 9): El Toro Marine Corps Air Station, Operable Units 2A and 3A (no action sites), El Toro, CA, September 29, 1997

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

NONE

This decision document presents the selected remedial action for Sites 4, 6, 9, 10, 13, 15, 19, 20, 21, 22, and 25 at MCAS El Toro in Orange County, California. The selected remedy for Sites, 4, 6, 9, 19, 13, 15, 19, 20, 21, 22, and 25 is no action.

36 CFR 1256.36 - When can I appeal decisions about access to donated historical materials?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Presidential Libraries, and the Assistant Archivist for Records Services—Washington, DC, or their designated... documents in collections that have been open for research for less than 2 years. (c) In some cases, the...

36 CFR 1256.36 - When can I appeal decisions about access to donated historical materials?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Presidential Libraries, and the Assistant Archivist for Records Services—Washington, DC, or their designated... documents in collections that have been open for research for less than 2 years. (c) In some cases, the...

36 CFR 1256.36 - When can I appeal decisions about access to donated historical materials?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Presidential Libraries, and the Assistant Archivist for Records Services—Washington, DC, or their designated... documents in collections that have been open for research for less than 2 years. (c) In some cases, the...

36 CFR § 1256.36 - When can I appeal decisions about access to donated historical materials?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Presidential Libraries, and the Assistant Archivist for Records Services—Washington, DC, or their designated... documents in collections that have been open for research for less than 2 years. (c) In some cases, the...

36 CFR 1256.36 - When can I appeal decisions about access to donated historical materials?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Presidential Libraries, and the Assistant Archivist for Records Services—Washington, DC, or their designated... documents in collections that have been open for research for less than 2 years. (c) In some cases, the...

Translating eHealth Visions from Strategy to Practice - A Benefit Management Approach.

PubMed

Villumsen, Sidsel; Nøhr, Christian; Faxvaag, Arild

2018-01-01

The municipalities and the Regional Health Authorities in Central Norway have been assigned a mandate to implement a shared electronic health record, Helseplattformen, reflecting the visions set out in the national eHealth white paper 'One Citizen - One Record'. This study identifies and describe anticipated benefit streams of clinical decision support in 'One Citizen - One Record' and the user requirement specification documents of Helseplattformen. This study found that the benefit stream of clinical decision support translates from the health policy visions stated in 'One Citizen - One Record' into Helseplattformen. However, business changes, although a critical element of achieving benefits, were not emphasised in either. This calls for the programme of Helseplattformen to pay careful attention to how the information system and information technology requirements must be accompanied by enabling changes as well as business changes in order to achieve the identified benefits of 'One Citizen - One Record' and Helseplattformen.

Implementation of a scalable, web-based, automated clinical decision support risk-prediction tool for chronic kidney disease using C-CDA and application programming interfaces.

PubMed

Samal, Lipika; D'Amore, John D; Bates, David W; Wright, Adam

2017-11-01

Clinical decision support tools for risk prediction are readily available, but typically require workflow interruptions and manual data entry so are rarely used. Due to new data interoperability standards for electronic health records (EHRs), other options are available. As a clinical case study, we sought to build a scalable, web-based system that would automate calculation of kidney failure risk and display clinical decision support to users in primary care practices. We developed a single-page application, web server, database, and application programming interface to calculate and display kidney failure risk. Data were extracted from the EHR using the Consolidated Clinical Document Architecture interoperability standard for Continuity of Care Documents (CCDs). EHR users were presented with a noninterruptive alert on the patient's summary screen and a hyperlink to details and recommendations provided through a web application. Clinic schedules and CCDs were retrieved using existing application programming interfaces to the EHR, and we provided a clinical decision support hyperlink to the EHR as a service. We debugged a series of terminology and technical issues. The application was validated with data from 255 patients and subsequently deployed to 10 primary care clinics where, over the course of 1 year, 569 533 CCD documents were processed. We validated the use of interoperable documents and open-source components to develop a low-cost tool for automated clinical decision support. Since Consolidated Clinical Document Architecture-based data extraction extends to any certified EHR, this demonstrates a successful modular approach to clinical decision support. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Sifting Through Chaos: Extracting Information from Unstructured Legal Opinions.

PubMed

Oliveira, Bruno Miguel; Guimarães, Rui Vasconcellos; Antunes, Luís; Rodrigues, Pedro Pereira

2018-01-01

Abiding to the law is, in some cases, a delicate balance between the rights of different players. Re-using health records is such a case. While the law grants reuse rights to public administration documents, in which health records produced in public health institutions are included, it also grants privacy to personal records. To safeguard a correct usage of data, public hospitals in Portugal employ jurists that are responsible for allowing or withholding access rights to health records. To help decision making, these jurists can consult the legal opinions issued by the national committee on public administration documents usage. While these legal opinions are of undeniable value, due to their doctrine contribution, they are only available in a format best suited from printing, forcing individual consultation of each document, with no option, whatsoever of clustered search, filtering or indexing, which are standard operations nowadays in a document management system. When having to decide on tens of data requests a day, it becomes unfeasible to consult the hundreds of legal opinions already available. With the objective to create a modern document management system, we devised an open, platform agnostic system that extracts and compiles the legal opinions, ex-tracts its contents and produces metadata, allowing for a fast searching and filtering of said legal opinions.

EPA Superfund Records of Decision (RODs) for Region 7: Iowa, Kansas, Missouri, and Nebraska

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 10: Alaska, Idaho, Oregon, and Washington

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

Structured vs. Unstructured: Factors Affecting Adverse Drug Reaction Documentation in an EMR Repository

PubMed Central

Skentzos, Stephen; Shubina, Maria; Plutzky, Jorge; Turchin, Alexander

2011-01-01

Adverse reactions to medications to which the patient was known to be intolerant are common. Electronic decision support can prevent them but only if history of adverse reactions to medications is recorded in structured format. We have conducted a retrospective study of 31,531 patients with adverse reactions to statins documented in the notes, as identified with natural language processing. The software identified statin adverse reactions with sensitivity of 86.5% and precision of 91.9%. Only 9020 of these patients had an adverse reaction to a statin recorded in structured format. In multivariable analysis the strongest predictor of structured documentation was utilization of EMR functionality that integrated the medication list with the structured medication adverse reaction repository (odds ratio 48.6, p < 0.0001). Integration of information flow between EMR modules can help improve documentation and potentially prevent adverse drug events. PMID:22195188

20 CFR 410.692 - Hearing on charges.

Code of Federal Regulations, 2011 CFR

2011-04-01

...-BLACK LUNG BENEFITS (1969- ) Determinations of Disability, Other Determinations, Administrative Review... any interest in the matter pending for decision before him. Notice of any objection which a party to... books, records, correspondence, papers, or other documents which are relevant and material to any matter...

Medical decision-making during the guardianship process for incapacitated, hospitalized adults: a descriptive cohort study.

PubMed

Bandy, Robin J; Helft, Paul R; Bandy, Robert W; Torke, Alexia M

2010-10-01

It is sometimes necessary for courts to appoint guardians for adult, incapacitated patients. There are few data describing how medical decisions are made for such patients before and during the guardianship process. To describe the process of medical decision-making for incapacitated, hospitalized adults for whom court-appointed guardians are requested. Retrospective, descriptive cohort study. Patients were identified from the legal files of a public, urban hospital. Medical and legal records were reviewed for demographic data, code status, diagnoses, code status orders and invasive procedures and person authorizing the order or procedure, dates of incapacitation and appointment of temporary guardian, reason for guardianship, and documentation of communication with a guardian. A total of 79 patients met inclusion criteria; 68.4% were male and 56.2% African-American. The median age was 65 years. Of the 71 patients with medical records available 89% of patients had a temporary guardianship petitioned because of the need for placement only. Seventeen patients had a new DNR order written during hospitalization, eight of which were ordered by physicians without consultation with a surrogate decision maker. Overall, 32 patients underwent a total of 81 documented invasive procedures, 16 of which were authorized by the patient, 15 by family or friend, and 11 by a guardian; consent was not required for 39 of the procedures because of emergency conditions or because a procedure was medically necessary and no surrogate decision maker was available. Although most of the guardianships were requested for placement purposes, important medical decisions were made while patients were awaiting appointment of a guardian. Hospitalized, incapacitated adults awaiting guardianship may lack a surrogate decision maker when serious decisions must be made about their medical care.

Superfund record of decision (EPA region 6): Longhorn Army Ammunition Plant, (No Further Action at LHAAP 13 and 14), Karnack, TX, February 14, 1996

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

NONE

1997-03-01

This decision document presents the selected no Further Action alternative for LHAAP 13 and 14, Longhorn Army Ammunition Plant (LHAAP), in Karnack, Texas. There are no actual or threatened releases of hazardous substances as a result of suspected previous activities from these sites that may present an imminent and substantial endangerment to public health, welfare, or the environment.

Superfund Record of Decision (EPA Region 4): BMI-Textron Site, Lake Park, FL, August 1994

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

Not Available

1994-09-01

This decision document presents the selected remedial action for the Basic Microelectronic, Incorporated (BMI)-Textron Site (BMI-Textron Site or the Site), in Lake Park, Florida. This remedy addresses the contaminated principal threat of ground water at the Site. This remedy addresses the principal threat remaining at the Site, by using existing institutional controls, and monitoring ground water contaminated with arsenic, cyanide, sodium and fluoride.

Government documents and the online catalog.

PubMed

Lynch, F H; Lasater, M C

1990-01-01

Prior to planning for implementing the NOTIS system, the Vanderbilt Medical Center Library had not fully cataloged its government publications, and records for these materials were not in machine-readable format. A decision was made that patrons should need to look in only one place for all library materials, including the Health and Human Services Department publications received each year from the central library's Government Documents Unit. Beginning in 1985, these publications were added to the library's database, and the entire 7,200-piece collection is now in the online catalog. Working with these publications has taught the library much about the advantages and disadvantages of cataloging government documents in an online environment. It was found that OCLC cataloging copy is eventually available for most titles, although only about 10% of the records have MeSH headings. Staff time is the major expenditure; problems are caused by documents' irregular nature, frequent format changes, and difficult authority work. Since their addition to the online catalog, documents are used more and the library has better control.

Government documents and the online catalog.

PubMed Central

Lynch, F H; Lasater, M C

1990-01-01

Prior to planning for implementing the NOTIS system, the Vanderbilt Medical Center Library had not fully cataloged its government publications, and records for these materials were not in machine-readable format. A decision was made that patrons should need to look in only one place for all library materials, including the Health and Human Services Department publications received each year from the central library's Government Documents Unit. Beginning in 1985, these publications were added to the library's database, and the entire 7,200-piece collection is now in the online catalog. Working with these publications has taught the library much about the advantages and disadvantages of cataloging government documents in an online environment. It was found that OCLC cataloging copy is eventually available for most titles, although only about 10% of the records have MeSH headings. Staff time is the major expenditure; problems are caused by documents' irregular nature, frequent format changes, and difficult authority work. Since their addition to the online catalog, documents are used more and the library has better control. PMID:2295010

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

PubMed

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

2013-01-01

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

Information Management: The Challenges of Managing Electronic Records. Testimony Before the Subcommittee on Information Policy, Census and National Archives, Committee on Oversight and Government Reform, House of Representatives. GAO-10-838T

ERIC Educational Resources Information Center

Melvin, Valerie C.

2010-01-01

Federal agencies are increasingly using electronic means to create, exchange, and store information, and in doing so, they frequently create federal records: that is, information, in whatever form, that documents government functions, activities, decisions, and other important transactions. As the volume of electronic information grows, so does…

7 CFR 650.11 - Environmental documents.

Code of Federal Regulations, 2012 CFR

2012-01-01

... § 650.4): (1) Environmental assessments (EA) (2) Environmental impact statements (EIS) (3) Notice of intent (NOI) (4) Finding of no significant impact (FNSI) (5) Record of decision (ROD) (b) The format and... regulatory impact analysis as required by Executive Order 12044. This may necessitate modifying the...

New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis.

PubMed

Rhynas, Sarah J; Garrido, Azucena Garcia; Burton, Jennifer K; Logan, Gemma; MacArthur, Juliet

2018-03-24

To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient's voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patient's voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs. © 2018 John Wiley & Sons Ltd.

Decision-making and evidence use during the process of prenatal record review in Canada: a multiphase qualitative study.

PubMed

Semenic, Sonia; Edwards, Nancy; Premji, Shahirose; Olson, Joanne; Williams, Beverly; Montgomery, Phyllis

2015-03-31

Prenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada. Phase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2. Prenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications. Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.

Creation of structured documentation templates using Natural Language Processing techniques.

PubMed

Kashyap, Vipul; Turchin, Alexander; Morin, Laura; Chang, Frank; Li, Qi; Hongsermeier, Tonya

2006-01-01

Structured Clinical Documentation is a fundamental component of the healthcare enterprise, linking both clinical (e.g., electronic health record, clinical decision support) and administrative functions (e.g., evaluation and management coding, billing). One of the challenges in creating good quality documentation templates has been the inability to address specialized clinical disciplines and adapt to local clinical practices. A one-size-fits-all approach leads to poor adoption and inefficiencies in the documentation process. On the other hand, the cost associated with manual generation of documentation templates is significant. Consequently there is a need for at least partial automation of the template generation process. We propose an approach and methodology for the creation of structured documentation templates for diabetes using Natural Language Processing (NLP).

A written consent form dating back to 1524 in Bursa Ser'iye (Sharia Court) records and a proposal of a new start date for consent forms.

PubMed

Sayligil, Omur; Ozden, Hilmi

2014-01-01

Qadi registers are important documents for Ottoman medical history re.search. "Sharia Court Records (Ser'iyye Sicilleri)" are notebooks that include the records that qadis kept with regard to their decisions and deeds. These registers are the only authentic sources from which to acquire information on rural life, away from the center of the town, and to understand the daily practices of the Ottoman society. The objective of this study is to provide evidence for the fact that the concept of informed consent on medical interventions, and hence the written consent documents arranged between patients and physicians, dates back to older times in our history when compared to the Western world. A large number of Ser'iyye (Sharia Court) record originals have been surveyed. The consent form registered as A-40. 221a in Ser'iyye (Sharia Court) Records found in Bursa has been presented here as the earliest consent document found by the authors. Transcription of the original document has been performed and analyzed. The aforementioned consent form dates back to 26/Dhu al-Qi'dah/933 (August 24, 1524). The original version of the referenced consent document is the earliest consent document presented so far to the best of the authors' knowledge; it was found in Bursa Ser'iyye Records and evaluated accordingly. Based on the document, it is argued that the history of consent forms dates back about 500 years. Obtaining consent in scientific research from human beings was considered to have originated from the Nuremberg Code (1949). However, with this study, it has been shown that the concept of informed consent was already present in the Ottoman Period, during the 16th century, and that the original consent document dates back to 1524, pertaining to a surgical intervention.

Superfund Record of Decision (EPA Region 4): Agriculture and Nutrition (Montgomery), Operable Unit 2, Montgomery, AL, September 28, 1998

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

NONE

This decision document presents the selected remedial action for the T.H. Agriculture and Nutrition (THAN) Site, Montgomery, Alabama. Operable Unit Two (OU2) encompasses the remediation of the contaminated soils and sediments on the Site, and also establishes the performance standards for the groundwater remedy. Upon reaching the cleanup standards for groundwater at an established point(s) of compliance, the groundwater pumping system will be shut down.

Superfund record of decision (EPA Region 4): T. H. Agriculture and Nutrition Site, operable unit 1, Montgomery, AL, April 17, 1995

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

NONE

1995-04-01

This decision document presents the selected interim remedial action for the T H Agriculture and Nutrition (THAN) Site, Montgomery, Alabama. This interim remedial action employs the use of extraction wells combined with a pump and treat system to prevent further migration of contaminated groundwater from the Site and to initiate groundwater restoration pending completion of the RI/FS and implementation of the final remedial action.

Superfund Record of Decision (EPA Region 6): Texarkana Wood Preserving Company, Operable Unit 2, Texarkana, TX, September 1993

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

Not Available

This decision document presents the selected remedial action for Operable Unit Two for the Texarkana Wood Preserving Company (TWPC) Superfund Site (Site) in Texarkana, Texas. This operable unit is the second of two operable units planned for the Site. Operable Unit Two involves remediation of the deeper ground water contaminated above the action levels in a limited area of the Silty Sand Zone around Monitoring Well-16.

The Role of the New mTOR Complex, mTORC2, in Autism Spectrum Disorders

DTIC Science & Technology

2016-10-01

memory in Pten fb-KO mice. a, Schematic of experimental design . b, For contextual fear conditioning, freezing times were recorded 24 hr after...official Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No...fb-DKO mice, the opposite is true , namely mTORC2 activity remains up-regulated by mTORC1 activity is normalized (Fig. 1). Hence, conditional

Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care.

PubMed

Matthews, Veronica; Burgess, Christopher P; Connors, Christine; Moore, Elizabeth; Peiris, David; Scrimgeour, David; Thompson, Sandra C; Larkins, Sarah; Bailie, Ross

2017-01-01

Aboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD). Despite the importance of absolute cardiovascular risk assessment (CVRA) as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC) sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded. We undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012-2014). Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded. Approximately 23% ( n  = 478) of eligible clients had documented CVRA. Almost all assessments (99%) were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0-86%). Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4-82.4; p  < 0.001). Eleven percent ( n  = 53) of clients were found with moderate/high CVD risk, of whom almost one-third were under 35 years ( n  = 16). Documentation of follow-up varied with respect to the targeted risk factor. Fewer than 30% with abnormal blood lipid or glucose levels had follow-up management plans recorded. There was wide variation in CVRA between jurisdictions and between PHC centers. Learnings from successful interventions to educate and support centers in CVRA provision should be shared with stakeholders more widely. Where risk has been identified, further improvement in follow-up management is required to prevent CVD onset and reduce future burden in Australia's Indigenous population.

Development of a digital clinical pathway for emergency medicine: Lessons from usability testing and implementation failure.

PubMed

Gutenstein, Marc; Pickering, John W; Than, Martin

2018-06-01

Clinical pathways are used to support the management of patients in emergency departments. An existing document-based clinical pathway was used as the foundation on which to design and build a digital clinical pathway for acute chest pain, with the aim of improving clinical calculations, clinician decision-making, documentation, and data collection. Established principles of decision support system design were used to build an application within the existing electronic health record, before testing with a multidisciplinary team of doctors using a think-aloud protocol. Technical authoring was successful, however, usability testing revealed that the user experience and the flexibility of workflow within the application were critical barriers to implementation. Emergency medicine and acute care decision support systems face particular challenges to existing models of linear workflow that should be deliberately addressed in digital pathway design. We make key recommendations regarding digital pathway design in emergency medicine.

Superfund record of decision (EPA Region 3): William Dick Lagoons, West Caln Township, Chester County, PA, March 1993

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

Not Available

1993-03-31

This decision document presents the selected remedial action for Operable Unit 3 of the William Dick Lagoons Site (Site), in West Caln Township, Pennsylvania. The remedy described in this Record of Decision is for Operable Unit 3 at the Site. The remedy selected for Operable Unit 3 will reduce the concentrations of hazardous substances in the Site soils so that leaching of contaminants into the groundwater will be minimized. Reduction of the volatile organic compounds and semi-volatile organic compounds in the soils is necessary in order the groundwater will not continue to be impacted above acceptable levels. In addition, themore » installation of a vegetative soil cover or multi-layer cap will prevent the surrounding community from exposure to Site-related contaminants through inhalation, ingestion, and dermal contact.« less

40 CFR 35.4270 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Explanation of Significant Differences (ESD) means the document issued by the agency leading a cleanup that describes to the public significant changes made to a Record of Decision after the ROD has been signed. The ESD must also summarize the information that led to the changes and affirm that the revised remedy...

76 FR 45300 - Notice of Issuance of Materials License SUA-1597 and Record of Decision for Uranerz Energy...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-28

... considered but eliminated from detailed analysis include conventional uranium mining and milling, conventional mining and heap leach processing, alternative site location, alternate lixiviants, and alternate...'s Agencywide Document Access and Management System (ADAMS), which provides text and image files of...

77 FR 66432 - Privacy Act of 1974, System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-05

... #0; #0;Notices #0; Federal Register #0; #0; #0;This section of the FEDERAL REGISTER contains documents other than rules #0;or proposed rules that are applicable to the public. Notices of hearings #0;and investigations, committee meetings, agency decisions and rulings, #0;delegations of authority...

Development of a tool for documenting, tracking, recording, and analyzing improvements to intersection sites and roadway departures in curve locations.

DOT National Transportation Integrated Search

2015-04-01

The principal objectives and scope of this project were to provide a software tracking tool to improve : decision-making for highway safety. A literature search revealed that purchasing and customizing : existing software was not feasible and a new s...

Harnessing Digital Workflows for Conserving Historic Places

NASA Astrophysics Data System (ADS)

Santana Quintero, M.

2017-05-01

Recording the physical characteristics of historic structures and landscapes is a cornerstone of preventive maintenance, monitoring and conservation. The information produced by such work assists the decision-making process for property owners, site managers, public officials, and conservators. Rigorous documentation may also serve a broader purpose: over time, it becomes the primary means by which scholars and the public apprehend a site that has since changed radically or disappeared. These records also serve as posterity and monitoring records in the event of catastrophic or gradual loss of the heritage resource.

The effect of the electronic medical record on nurses' work.

PubMed

Robles, Jane

2009-01-01

The electronic medical record (EMR) is a workplace reality for most nurses. Its advantages include a single consolidated record for each person; capacity for data interfaces and alerts; improved interdisciplinary communication; and evidence-based decision support. EMRs can add to work complexity, by forcing better documentation of previously unrecorded data and/or because of poor design. Well-designed and well-implemented computerized provider order entry (CPOE) systems can streamline nurses' work. Generational differences in acceptance of and facility with EMRs can be addressed through open, healthy communication.

Automation of Design Engineering Processes

NASA Technical Reports Server (NTRS)

Torrey, Glenn; Sawasky, Gerald; Courey, Karim

2004-01-01

A method, and a computer program that helps to implement the method, have been developed to automate and systematize the retention and retrieval of all the written records generated during the process of designing a complex engineering system. It cannot be emphasized strongly enough that all the written records as used here is meant to be taken literally: it signifies not only final drawings and final engineering calculations but also such ancillary documents as minutes of meetings, memoranda, requests for design changes, approval and review documents, and reports of tests. One important purpose served by the method is to make the records readily available to all involved users via their computer workstations from one computer archive while eliminating the need for voluminous paper files stored in different places. Another important purpose served by the method is to facilitate the work of engineers who are charged with sustaining the system and were not involved in the original design decisions. The method helps the sustaining engineers to retrieve information that enables them to retrace the reasoning that led to the original design decisions, thereby helping them to understand the system better and to make informed engineering choices pertaining to maintenance and/or modifications of the system. The software used to implement the method is written in Microsoft Access. All of the documents pertaining to the design of a given system are stored in one relational database in such a manner that they can be related to each other via a single tracking number.

Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia

PubMed Central

Ruseckaite, Rasa; Detering, Karen M; Perera, Veronica; Walker, Lynne; Sinclair, Craig; Clayton, Josephine M; Nolte, Linda

2017-01-01

Introduction Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people’s self-reported use of ACP and views about the process. Methods and analysis Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person’s records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life. Ethics and dissemination This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number ACTRN12617000743369 PMID:29101142

Superfund record of decision (EPA Region 10): McCormick and Baxter Creosoting Company, Portland Plant, Portland, OR, March 29, 1996

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

NONE

1996-08-01

The decision document presents the selected final remedial actions for the McCormick and Baxter Creosoting Company, Portland Plant site (McCormick and Baxter or site) located in Portland, Oregon. The selected remedy is a series of remedial actions that address the principal threats at the site by treating the most highly contaminated soil, extracting nonaqueous phase liquid (NAPL) and treating contaminated groundwater, and capping the most highly contaminated sediment.

Superfund record of decision (EPA Region 6): Longhorn Army Ammunition Plant, Burning Ground Number 3, Karnack, TX, May 12, 1995

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

NONE

1996-03-01

This decision document presents the selected Early Interim Remedial Action for the Burning Ground No. 3 site (the site), Longhorn Army Ammunition Plant, in Karnack, Texas. The major components of the selected remedy include: extraction and Treatment of contaminated shallow groundwater using Organic Air Stripping and Off-gas Treatment and Metals precipitation, and Excavation and Treatment of Source Material using Low Temperature Thermal Desorption and Catalytic Oxidation for off-gas.

Final Record of Decision for the Defense Reutilization and Marketing Office Yard (AOC 32) and Petroleum, Oil, and Lubricants Storage Area (AOC 43A) Devens, Massachusetts.

DTIC Science & Technology

1998-02-01

decision document presents the U.S. Army’s (Army’s) selected remedial actions for AOCs 32 DRMO Yard, including Underground Storage Tank (UST) #13...of commencing the remedial action to ensure that the remedy at each AOC continues to provide adequate protection of human health and the environment... Devens , Massachusetts RAO remedial action objective RBC risk-based concentration RCRA Resource Conservation and Recovery Act RI remedial

AFSOC Assets Beddown at Cannon Air Force Base, New Mexico Environmental Impact Statement

DTIC Science & Technology

2007-07-01

3,000 feet AGL. Approximately 30 percent of bird strikes happen in the airfield environment. Bird-aircraft strike data from 1996 to 2003 indicate...submitted in September 2000. A Record of Decision (ROD)/Decision Document (DD) was submitted in 1996 ; this site is considered closed. ERP Site SS...conducted in 1985; an RI was conducted in 1992; a Feasibility Study (FS) was conducted in 1996 ; and a ROD/DD was submitted in 1996 indicating NFA was

EPA superfund Records of Decision (RODs) for region 3: New Jersey, New York, Puerto Rico, and Virgin Islands. Irregular report

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

NONE

1998-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA superfund Records of Decision (RODs) for region 7: Iowa, Kansas, Missouri, and Nebraska. Irregular report

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

NONE

1998-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA superfund Records of Decision (RODs) for region 3: Delaware, Washington DC, Maryland, Pennsylvania, and Virginia. Irregular report

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

NONE

1998-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 1: Connecticut, Maine, Massachussetts, New Hampshire, Rhode Island, and Vermont

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 3: Delaware, Washington DC, Maryland, Pennsylvania, and Virginia

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA superfund Records of Decision (RODs) for region 1: Connecticut, Maine, Massachussetts, New Hampshire, Rhode Island, and Vermont. Irregular report

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

NONE

1998-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA superfund Records of Decision (RODs) for region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. Irregular report

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

NONE

1998-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA superfund Records of Decision (RODs) for region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Irregular report

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

NONE

1998-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA superfund Records of Decision (RODs) for region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. Irregular report

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

NONE

1998-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 2: New Jersey, New York, Puerto Rico, and Virgin Islands

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

EPA Superfund Records of Decision (RODs) for Region 9: Arizona, California, Hawaii, Nevada, American Samoa, and Guam

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

NONE

1999-03-01

The purpose of an EPA Record of Decision is to evaluate a Superfund Site with the goal of protecting human health and the environment while ensuring consistency of evaluations in contamination and clean-up of all Superfund sites. The ROD is a public document signed by the appropriate Regional Administrator which details cleanup, cost estimates, and EPA`s responsiveness to the public comment summary. The ROD may be litigated, thus it is important to have all current updates to the signed EPA decision. The ROD may be amended with an Amendment or supplemented by an Explanation of Significant Difference (ESD). A Superfundmore » Site may have multiple RODs, as each Superfund Site may be further redefined as Operable Units and Events. This allows EPA`s decisions to evolve as new technology presents itself. Average clean-up time for a Superfund Site can range from 12 to 100 years.« less

Superfund Record of Decision (EPA Region 3): Buckingham County Landfill Superfund Site, VA, September 1994

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

Not Available

1994-10-01

The Record of Decision (ROD) presents the final remedial action selected for the Buckingham County Landfill Superfund Site (Site), located near the town of Sprouse's Corner in Buckingham County, Virginia. The remedial action was chosen in accordance with the requirements of the Comprehensive Environmental Response Compensation and Liability Act of 1980 (CERCLA), 42 U.S.C. Section 9601 et. seg., as amended by the Superfund Amendments and Reauthorization Act of 1986 (SARA), and the National Oil and Hazardous Substances Pollution Contingency Plan (NCP), 40 C.F.R. Part 300. The decision document explains the factual and legal basis for selecting the remedial action. Themore » selected remedy includes the two following options, both of which are fully protective of human health and the environment: Monitor the ground water and cap the hazardous waste disposal area; and Implement the source control measures.« less

Superfund record of decision (EPA Region 9): Aircraft Control and Warning Site, Mather Air Force Base, CA, December 1993

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

Not Available

This decision document, a Record of Decision (ROD), presents the selected remedial action for the AC W Site, Installation Restoration Program (IRP) Site 12, at Mather Air Force Base (AFB), Sacramento County, California. Reports indicate that from 1958 to 1966 waste solvents and transformer oils were disposed in a waste disposal pipe in the AC W area. Investigations conducted as part of the Air Force Installation Restoration Program (IRP) failed to locate the waste disposal pipe but did find trichloroethylene (TCE) contamination in the shallow water bearing zone (SWBZ) in the AC W area. The SWBZ is classified as amore » potential source of drinking water by the State of California, although it is not currently used in the AC W area. The selected remedy will address the potential threat to human health posed by TCE contamination in groundwater (primarily in the SWBZ).« less

[The electronic health record: computerised provider order entry and the electronic instruction document as new functionalities].

PubMed

Derikx, Joep P M; Erdkamp, Frans L G; Hoofwijk, A G M

2013-01-01

An electronic health record (EHR) should provide 4 key functionalities: (a) documenting patient data; (b) facilitating computerised provider order entry; (c) displaying the results of diagnostic research; and (d) providing support for healthcare providers in the clinical decision-making process.- Computerised provider order entry into the EHR enables the electronic receipt and transfer of orders to ancillary departments, which can take the place of handwritten orders.- By classifying the computer provider order entries according to disorders, digital care pathways can be created. Such care pathways could result in faster and improved diagnostics.- Communicating by means of an electronic instruction document that is linked to a computerised provider order entry facilitates the provision of healthcare in a safer, more efficient and auditable manner.- The implementation of a full-scale EHR has been delayed as a result of economic, technical and legal barriers, as well as some resistance by physicians.

Superfund record of decision (EPA region 10): Idaho National Engineering Lab, (USDOE) Operable Unit 26 (Stationary Low-Power Reactor-1 and Boiling Water Reactor Experiment-I Burial Grounds), Idaho Falls, ID, December 1, 1995

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

NONE

1997-03-01

This document presents the selected remedial action for the Stationary Low-Power Reactor-1 (SL-1) burial ground, the Boiling Water Reactor Experiment-I (BORAX-I) burial ground, and 10 no action sites in Waste Area Group 5. Actual or threatened releases of hazardous substances from the SL-1 and BORAX-I burial grounds, if not addressed by implementing the response action selected in this Record of Decision, may present a current or potential threat to public health, welfare, or the environment. The 10 no action sites do not present a threat to human health or the environment.

Fuel Characteristic Classification System version 3.0: technical documentation

Treesearch

Susan J. Prichard; David V. Sandberg; Roger D. Ottmar; Ellen Eberhardt; Anne Andreu; Paige Eagle; Kjell Swedin

2013-01-01

The Fuel Characteristic Classification System (FCCS) is a software module that records wildland fuel characteristics and calculates potential fire behavior and hazard potentials based on input environmental variables. The FCCS 3.0 is housed within the Integrated Fuels Treatment Decision Support System (Joint Fire Science Program 2012). It can also be run from command...

76 FR 40352 - National Nuclear Security Administration; Amended Record of Decision: Site-Wide Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... similar to those estimated for transportation of radioactive material in other DOE NEPA documents. The air... radiological materials located at civilian sites worldwide. Part of the GTRI mission is implemented through... specific actions analyzed in DOE/EIS-0380-SA-02 include packaging the sealed sources (sometimes with a part...

17 CFR 10.102 - Review of initial decisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the appeal with respect to the issues presented, and the reasons therefor, and citations to supporting... answering brief generally shall follow the same style as prescribed for the appeal brief but may omit a... reference citations to the record contained in its brief or in any other document. If an appellee deems it...

77 FR 38804 - Wireline Competition Bureau Seeks Comment on Model Design and Data Inputs for Phase II of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-29

...In this document, the Wireline Competition Bureau (the Bureau) seeks comment on a number of threshold decisions regarding the design of and data inputs to the forward looking cost model, and on other assumptions in the cost models currently in the record.

Medication communication through documentation in medical wards: knowledge and power relations.

PubMed

Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

2014-09-01

Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals. © 2013 John Wiley & Sons Ltd.

[Development and clinical evaluation of an anesthesia information management system].

PubMed

Feng, Jing-yi; Chen, Hua; Zhu, Sheng-mei

2010-09-21

To study the design, implementation and clinical evaluation of an anesthesia information management system. To record, process and store peri-operative patient data automatically, all kinds of bedside monitoring equipments are connected into the system based on information integrating technology; after a statistical analysis of those patient data by data mining technology, patient status can be evaluated automatically based on risk prediction standard and decision support system, and then anesthetist could perform reasonable and safe clinical processes; with clinical processes electronically recorded, standard record tables could be generated, and clinical workflow is optimized, as well. With the system, kinds of patient data could be collected, stored, analyzed and archived, kinds of anesthesia documents could be generated, and patient status could be evaluated to support clinic decision. The anesthesia information management system is useful for improving anesthesia quality, decreasing risk of patient and clinician, and aiding to provide clinical proof.

38 CFR 26.7 - VA environmental decision making and documents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental decision making and documents. (a) Relevant environmental documents shall accompany other decision documents as they proceed through the decision-making process. (b) The major decision points for VA actions... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA environmental decision...

Superfund Record of Decision (EPA Region 1): Salem Acres Site, Salem, MA, March 1993

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

Not Available

This decision document represents the selected remedial action for the Salem Acres Site in Salem, Massachusetts. The remedial action for the Salem Acres Site, as described in this ROD, addresses the principal threats to the human health and the environment posed by exposure of humans to contaminated soils from the Salem Acres Site. This remedy addresses all principal threats to human health and the environment posed by the sources of contamination at the Site resulting from dermal absorption and incidental ingestion of contaminants in surficial soils.

Superfund Record of Decision (EPA Region 6): Longhorn Army Ammunition Plant, Group 1 Sites, Karnack, TX, January 23, 1998

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

NONE

1998-10-01

This decision document presents the selected No Further Action alternative for Group 1 Sites, Longhorn Army Ammunition Plant (LHAAP), In Karnack, Texas. The public comment period for the Group 1 Sites No Further Action Proposed Plan ended August 20, 1997. During the public comment period, the Army received four comments. These comments were in regards to future excising of the facility property, PCB`s (no PCB`s found), off-site sampling, and the area`s regional water supply.

Superfund record of decision (EPA Region 3): US Defense General Supply Center (DLA), operable unit 3, Chesterfield County, Richmond, VA, September 29, 1995

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

NONE

This decision document presents the selected remedial action for the National Guard Source Area (NGA), Operable Unit (OU3) at the Defense General Supply Center (DGSC) in Richmond, Virginia. Operable Unit 3 addresses the contaminated soils at the National Guard . The selected alternative requires that institutional controls, including access restriction, property transfer restriction, and preconstruction assessment, be implemented or continued at the site. Also, contaminated soils posing human health risks will be excavated and disposed of.

Superfund record of decision (EPA Region 1): Tansitor Electronics, Inc., Bennington, VT, September 29, 1995

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

NONE

1996-03-01

This Decision Document presents the selected remedial action for the Tansitor Electronics, Inc. Superfund Site in Bennington, Vermont. This ROD sets forth the selected remedy for the Tansitor Electronics, Inc. Superfund Site, which includes management of migration components to obtain a comprehensive remedy. This ROD does not include any source control component because EPA`s risk assessment concluded that the surface and subsurface soils did not present an unacceptable risk either under current conditions or under a potential future residential scenario.

Superfund Record of Decision (EPA Region 3): Allegany Ballistics Laboratory (USNavy), Operable Unit 1, Mineral, WV, February 12, 1997

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

NONE

1998-01-01

This decision document presents the selected remedial action for Site 5 Landfill Contents and Surface Soil at the Allegany Ballistics Laboratory (ABL), Rocket Center, West Virginia. The major components of the selected remedy are: Deed notation along with property use and limited access restrictions; Installation of a composite CAP-GCL and FMC; Installation of a drainage layer utilizing a geonet; Installation of a passive landfill gas (LFG) venting system; Revegetation of the capped area; Installation of perimeter drainage system; and Post-closure requirements.

Superfund record of decision (EPA Region 3): Stanley Kessler Superfund Site, King of Prussia, PA, September 1994

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

Not Available

1994-09-29

This decision document presents the final selected remedial action for the Stanley Kessler Superfund Site (the Site). The selected remedy for the Site will restore contaminated ground water to its beneficial use by cleaning up the ground water to background levels as established by EPA or the appropriate Maximum Contaminant Levels or non-zero Maximum Contaminant Level Goals established under the Federal Safe Drinking Water Act whichever is more stringent. The selected remedy is the only planned action for the Site.

Superfund record of decision (EPA Region 9): Mather Air Force Base, Landfill Operable Unit, Sacramento County, CA, August 3, 1995

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

NONE

This decision document presents the selected remedial actions for the Landfill OU Sites, at the inactive Mather AFB, Sacramento County, California. The Installation Restoration Program (IRP) sites which comprise the Landfill OU at the inactive Mather AFB include: Site 1 - Runway Overrun Landfill; Site 2 - `8150` Area Landfill; Site 3 - Northeast Perimeter Landfill No. 1; Site 4 - Northeast Perimeter Landfill No. 2; Site 5 - Northeast Perimeter Landfill No. 3; and Site 6 - Firing Range Landfill Sites.

Applying language technology to nursing documents: pros and cons with a focus on ethics.

PubMed

Suominen, Hanna; Lehtikunnas, Tuija; Back, Barbro; Karsten, Helena; Salakoski, Tapio; Salanterä, Sanna

2007-10-01

The present study discusses ethics in building and using applications based on natural language processing in electronic nursing documentation. Specifically, we first focus on the question of how patient confidentiality can be ensured in developing language technology for the nursing documentation domain. Then, we identify and theoretically analyze the ethical outcomes which arise when using natural language processing to support clinical judgement and decision-making. In total, we put forward and justify 10 claims related to ethics in applying language technology to nursing documents. A review of recent scientific articles related to ethics in electronic patient records or in the utilization of large databases was conducted. Then, the results were compared with ethical guidelines for nurses and the Finnish legislation covering health care and processing of personal data. Finally, the practical experiences of the authors in applying the methods of natural language processing to nursing documents were appended. Patient records supplemented with natural language processing capabilities may help nurses give better, more efficient and more individualized care for their patients. In addition, language technology may facilitate patients' possibility to receive truthful information about their health and improve the nature of narratives. Because of these benefits, research about the use of language technology in narratives should be encouraged. In contrast, privacy-sensitive health care documentation brings specific ethical concerns and difficulties to the natural language processing of nursing documents. Therefore, when developing natural language processing tools, patient confidentiality must be ensured. While using the tools, health care personnel should always be responsible for the clinical judgement and decision-making. One should also consider that the use of language technology in nursing narratives may threaten patients' rights by using documentation collected for other purposes. Applying language technology to nursing documents may, on the one hand, contribute to the quality of care, but, on the other hand, threaten patient confidentiality. As an overall conclusion, natural language processing of nursing documents holds the promise of great benefits if the potential risks are taken into consideration.

Building Stakeholder Trust: Defensible Government Decisions - 13110

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

Franklin, Victor A.

Administrative decisions must be grounded in reasonable expectations, founded on sound principles, and bounded by societal norms. Without these first principles, attaining and retaining public trust is a Herculean task. Decisions made by governmental administrators must be both transparent and defensible: without the former the agency will lose the public's trust and support (possibly prompting a legal challenge to the decision) and without the latter the decision may fail to withstand judicial scrutiny. This presentation and accompanying paper delves into the process by which governmental decisions can achieve both defensibility and openness through building stakeholder trust with transparency. Achieving andmore » maintaining stakeholder trust is crucial, especially in the environs of nuclear waste management. Proving confidence, stability, and security to the surrounding citizenry as well as those throughout the country is the goal of governmental nuclear waste remediation. Guiding administrative decision-making processes and maintaining a broad bandwidth of communication are of incalculable importance to all those charged with serving the public, but are especially essential to those whose decisional impacts will be felt for millennia. A strong, clear, and concise administrative record documenting discrete decisions and overarching policy choices is the strongest defense to a decisional challenge. However, this can be accomplished using transparency as the fundamental building block. This documentation allows the decision-makers to demonstrate the synthesis of legal and technical challenges and fortifies the ground from which challenges will be defended when necessary. Further, administrative actions which capture the public's interest and captivate that interest throughout the process will result in a better-informed, more deeply-involved, and more heavily-invested group of interested parties. Management of information, involvement, and investment on the front-end of the process reaps rewards far more efficiently than attempts to assuage and mitigate the concerns of those parties after the fact and there are a number of tools Savannah River Remediation (SRR) has deployed that render transparency an ally in this context. The makers, applicators, and beneficiaries of policies and decisions will all benefit from strong administrative records which document decisional choices in an open and transparent manner and from timely, up-front management of concerns of interested parties. The strongest defense to decisional challenges is an ability to demonstrate the basis of the decision and the reason(s) that the decision was chosen over other alternatives. Providing a sound basis for defending challenges rather than avoiding or fighting over them allows the deciding entity the greatest opportunity to produce value for its customer. Often, a transparent process that invites public participation and is open for public review and comment will thwart challenge genesis. An entity that has to devote resources to defending its choices obviously cannot utilize those resources to further its mission. (authors)« less

76 FR 24516 - Glen Canyon Dam Adaptive Management Work Group

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

... Adaptive Management Program (AMP) was implemented as a result of the Record of Decision on the Operation of... Grand Canyon Protection Act (Pub. L. 102-575) of 1992. The AMP includes a Federal advisory committee... administrative and resource issues pertaining to the AMP. To view a copy of the agenda and documents related to...

77 FR 9265 - Glen Canyon Dam Adaptive Management Work Group

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-16

... (AMP) was implemented as a result of the Record of Decision on the Operation of Glen Canyon Dam Final.... L. 102-575) of 1992. The AMP includes a Federal advisory committee, the AMWG, a technical work group... administrative and resource issues pertaining to the AMP. To view a copy of the agenda and documents related to...

Handbook to strategy 1 fungal taxa from the Northwest Forest Plan.

Treesearch

Michael A. Castellano; Jane E. Smith; Thom O' Dell; Efrén Cázares; Susan Nugent

1999-01-01

There are 234 fungal species listed in the record of decision (ROD) for amendments to Forest Service and Bureau of Land Management planning documents within the range of the northern spotted owl. There are four strategies to established guidelines for the survey and management of various organisms, including amphibians, mammals, bryophytes, mollusks, vascular plants,...

76 FR 31598 - Record of Decision for the Barry M. Goldwater Range East Range Enhancements Final Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-01

... Statement. These six proposals include: Proposal 1, Developing a sensor training area; Proposal 4..., Converting a portion of Manned Range 3 into a helicopter gunnery range; Proposal 8, constructing a new... (Volume 75, Number 227, Page 72824) with a wait period that ended on December 27, 2010. The ROD documents...

Acute asthma severity identification of expert system flow in emergency department

NASA Astrophysics Data System (ADS)

Sharif, Nurul Atikah Mohd; Ahmad, Norazura; Ahmad, Nazihah; Desa, Wan Laailatul Hanim Mat

2017-11-01

Integration of computerized system in healthcare management help in smoothening the documentation of patient records, highly accesses of knowledge and clinical practices guideline, and advice on decision making. Exploit the advancement of artificial intelligent such as fuzzy logic and rule-based reasoning may improve the management of emergency department in terms of uncertainty condition and medical practices adherence towards clinical guideline. This paper presenting details of the emergency department flow for acute asthma severity identification with the embedding of acute asthma severity identification expert system (AASIES). Currently, AASIES is still in preliminary stage of system validation. However, the implementation of AASIES in asthma bay management is hope can reduce the usage of paper for manual documentation and be a pioneer for the development of a more complex decision support system to smoothen the ED management and more systematic.

Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia.

PubMed

Ruseckaite, Rasa; Detering, Karen M; Evans, Sue M; Perera, Veronica; Walker, Lynne; Sinclair, Craig; Clayton, Josephine M; Nolte, Linda

2017-11-03

Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people's self-reported use of ACP and views about the process. Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person's records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life. This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences. ACTRN12617000743369. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Review of ecological-based risk management approaches used at five Army Superfund sites.

PubMed

Poucher, Sherri L; Tracey, Gregory A; Johnson, Mark S; Haines, Laurie B

2012-04-01

Factors used in environmental remedial decision making concerning ecological risk are not well understood or necessarily consistent. Recent Records of Decision (RODs) for Army CERCLA sites were reviewed to select case studies where remedial management occurred in response to ecological risks. Thirty-four Army RODs were evaluated representing decisions promulgated between 1996 and 2004. Five were selected based on assessments that remedial actions were clearly linked to concern for ecological receptors. The Ecological Risk Assessment (ERA) approach and the subsequent risk management process were reviewed for each site. The case studies demonstrated that the ERA findings, as well as critical management decisions regarding interpretation of identified ecological risks, were determinants of remedial action objectives. Decisions regarding the selection of remedial alternatives were based on a set of criteria prescribed by Superfund requirements and guidance. Remedial alternative evaluations require protection of human health and the environment, but protective conditions were determined using different methods at each site. Examining the remedial management process for the 5 case study sites revealed that uncertainty in the risk assessment and decisions regarding appropriate spatial scales for both risk assessment and remediation were important factors influencing remedial action decisions. The case reviews also revealed that levels of documentation were variable from site to site. In the future, more detailed documentation of decision criteria and the development of criteria that consider the resilience of the site will result in more technically defensible ecological risk management. Copyright © 2011 SETAC.

Testing a Nursing-Specific Model of Electronic Patient Record documentation with regard to information completeness, comprehensiveness and consistency.

PubMed

von Krogh, Gunn; Nåden, Dagfinn; Aasland, Olaf Gjerløw

2012-10-01

To present the results from the test site application of the documentation model KPO (quality assurance, problem solving and caring) designed to impact the quality of nursing information in electronic patient record (EPR). The KPO model was developed by means of consensus group and clinical testing. Four documentation arenas and eight content categories, nursing terminologies and a decision-support system were designed to impact the completeness, comprehensiveness and consistency of nursing information. The testing was performed in a pre-test/post-test time series design, three times at a one-year interval. Content analysis of nursing documentation was accomplished through the identification, interpretation and coding of information units. Data from the pre-test and post-test 2 were subjected to statistical analyses. To estimate the differences, paired t-tests were used. At post-test 2, the information is found to be more complete, comprehensive and consistent than at pre-test. The findings indicate that documentation arenas combining work flow and content categories deduced from theories on nursing practice can influence the quality of nursing information. The KPO model can be used as guide when shifting from paper-based to electronic-based nursing documentation with the aim of obtaining complete, comprehensive and consistent nursing information. © 2012 Blackwell Publishing Ltd.

Superfund record of decision amendment (EPA Region 5): Ott/Story/Cordova Chemical Co., Dalton Township, MI, February 26, 1998

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

NONE

This decision document presents the amendment to the Record of Decision (ROD) for Operable Unit (O.U.) No. 3 at the Ott/Story/Cordova Site (the Site) in Muskegon, MI. On September 27, 1993 a ROD was signed for the O.U. No. 3 Remedial Action choosing Low Temperature Thermal Desorption (LTTD) to treat contaminated plant area soils and sediments in Little Bear Creek and its unnamed tributary. This amendment to the ROD: eliminates LTTD from the remedy; revises the volume of soils to be remediated by excavation and off-site disposal as a result of an understanding that the land use for the sitemore » will remain industrial instead of residential as provided for in the 1993 ROD; requires regular sampling of surface water and sediments to determine the need for remedial action in the Little Bear Creek; and requires deed restrictions to insure that use of the site remains industrial.« less

Understanding School District Budgets: A Guide For Local Leaders

ERIC Educational Resources Information Center

Perry, Mary

2005-01-01

A school district budget is more than numbers. It is a record of a district?s past decisions and a spending plan for its future. It shows a district?s priorities whether they have been clearly articulated or simply occurred by default. And it is a communications document that can tell constituents a lot about the district?s priorities and goals. A…

Creating Your Life's Work Portfolio. An Interactive Career and Life Planning Workbook.

ERIC Educational Resources Information Center

1998

Designed for those beginning a working life or with years of experience, this book leads the user through collecting records that document work history and affirm successes. It provides a step-by-step process to help plan one's life's work, make career decisions, and develop plans for new career directions and a structure to learn career planning…

Unpublished response to an inquiry from California State Senator Byron Sher

Treesearch

L. M. Reid

1998-01-01

You have asked for my response to the following questions. In each case, references to the "ROD" indicate the Record of Decision and Standards and Guidelines for Management of Habitat for Late-Successional and Old-Growth Forest Related Species Within the Range of the Northern Spotted Owl, the document published by the USDA and USDI in 1994 that outlines the...

"Dialogue Is Not a Chaste Event." Comments by Paulo Freire on Issues in Participatory Research.

ERIC Educational Resources Information Center

Jurmo, Paul, Comp.

This document records the reactions of the Brazilian author/educator Paulo Freire to the questions: (1) what should educators do when the people with whom they work are not interested in the ideas of dialogical analysis and participatory decision making?; (2) what should educators do when they encounter hostility from people who feel that a…

Breaching confidentiality to protect the public: evolving standards of medical confidentiality for military detainees.

PubMed

Wynia, Matthew K

2007-08-01

Confidentiality is a core value in medicine and public health yet, like other core values, it is not absolute. Medical ethics has typically allowed for breaches of confidentiality when there is a credible threat of significant harm to an identifiable third party. Medical ethics has been less explicit in spelling out criteria for allowing breaches of confidentiality to protect populations, instead tending to defer these decisions to the law. But recently, issues in military detention settings have raised the profile of decisions to breach medical confidentiality in efforts to protect the broader population. National and international ethics documents say little about the confidentiality of detainee medical records. But initial decisions to use detainee medical records to help craft coercive interrogations led to widespread condemnation, and might have contributed to detainee health problems, such as a large number of suicide attempts several of which have been successful. More recent military guidance seems to reflect lessons learned from these problems and does more to protect detainee records. For the public health system, this experience is a reminder of the importance of confidentiality in creating trustworthy, and effective, means to protect the public's health.

Inspection of the Department`s export licensing process for dual-use and munitions commodities

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

Not Available

1993-08-10

The purpose of our inspection was to review the Department of Energy`s (Energy) export licensing process for dual-use and military (munitions) commodities subject to nuclear nonproliferation controls. Specifically, we reviewed Energy`s authorities, procedures, and policies pertaining to the export licensing process and examined procedures for safeguarding data transmitted between Energy and other agencies involved in the export licensing process. We also reviewed Energy`s role as a member of the Subgroup on Nuclear Export Coordination. Our review of the sample of 60 export cases did not find evidence to lead us to believe that Energy`s recommendations for these cases were inappropriatemore » or incorrect. We identified, however, problems regarding management systems associated with the export license review process. We found that without documentation supporting export licensing decisions by the Export Control Operations Division (ECOD), we could not determine whether ECOD analysts considered all required criteria in their review of export cases referred to Energy. For example, we found that the ECOD did not retain records documenting the bases for its advice, recommendations, or decisions regarding its reviews of export license cases or revisions to lists of controlled commodities and, therefore, was not in compliance with certain provisions of the Export Administration Act, as amended, and Energy records management directives. Additionally, we found that the degree of compliance by Energy with the export licensing review criteria contained in the Export Administration Regulations and the Nuclear Non-Proliferation Act of 1978 could not be determined because ECOD did not retain records documenting the bases for its advice and recommendations on export cases.« less

Superfund Record of Decision (EPA Region 4): Milan Army Ammunition Plant, Milan, TN, March 11, 1998

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

NONE

1998-09-01

This decision document presents the selected action for the Salvage Yard, Former Ammunition Burnout Area (ABA), and Sanitary Landfill at MLAAP, located in Gibson and Carroll Counties, TN. This ROD addresses the final response action planned for the Salvage Yard, Former ABA, and Sanitary Landfill, including soil and groundwater. NFA is the selected remedy for soil and groundwater at the Salvage Yard, Former ABA, and Sanitary landfill. The selected remedy manages the risk to acceptable levels for both human health and the environment and is the final action planned.

Superfund record of decision (EPA Region 3): US Defense General Supply Center, Operable Unit 9, Chesterfield County, VA, September 1993

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

Not Available

1993-09-01

The decision document presents the selected interim remedial action for Operable Unit 9 (OU9) at the Defense General Supply Center (DGSC) in Chesterfield County, Virginia near Richmond. OU9 pertains to groundwater beneath Area 50, the Open Storage Area (OSA), and the Naitonal Guard Area (NGA). This operable unit is the third of nine operable units that are currently being addressed at the DGSC. OU9 addresses interim treatment and containment of groundwater in the upper and lower aquifers beneath Area 50, the OSA, and the NGA.

Superfund record of decision (EPA Region 5): Skinner Landfill, West Chester, OH, June 1993

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

Not Available

1993-06-04

The decision document presents the selected final remedial action for the Skinner Landfill site in West Chester, Ohio. The remedy is the second and final of two operable units for this site. The first operable unit addressed immediate site concerns, through the construction of a fence around the contaminated area, and by offering an alternate supply of drinking water to the potentially affected users of groundwater. This final operable unit addresses potential future migration of site contaminants into the groundwater and will limit the potential for direct exposure of site contaminants to humans through source control measures.

Impact of electronic health record clinical decision support on the management of pediatric obesity.

PubMed

Shaikh, Ulfat; Berrong, Jeanette; Nettiksimmons, Jasmine; Byrd, Robert S

2015-01-01

Clinicians vary significantly in their adherence to clinical guidelines for overweight/obesity. This study assessed the impact of electronic health record-based clinical decision support in improving the diagnosis and management of pediatric obesity. The study team programmed a point-of-care alert linked to a checklist and standardized documentation templates to appear during health maintenance visits for overweight/obese children in an outpatient teaching clinic and compared outcomes through medical record reviews of 574 (287 control and 287 intervention) visits. The results demonstrated a statistically significant increase in the diagnosis of overweight/obesity, scheduling of follow-up appointments, frequency of ordering recommended laboratory investigations, and assessment and counseling for nutrition and physical activity. Although clinical guideline adherence increased significantly, it was far from universal. It is unknown if modest improvements in adherence to clinical guidelines translate to improvements in children's health. However, this intervention was relatively easy to implement and produced measurable improvements in health care delivery. © 2014 by the American College of Medical Quality.

Capturing structured, pulmonary disease-specific data elements in electronic health records.

PubMed

Gronkiewicz, Cynthia; Diamond, Edward J; French, Kim D; Christodouleas, John; Gabriel, Peter E

2015-04-01

Electronic health records (EHRs) have the potential to improve health-care quality by allowing providers to make better decisions at the point of care based on electronically aggregated data and by facilitating clinical research. These goals are easier to achieve when key, disease-specific clinical information is documented as structured data elements (SDEs) that computers can understand and process, rather than as free-text/natural-language narrative. This article reviews the benefits of capturing disease-specific SDEs. It highlights several design and implementation considerations, including the impact on efficiency and expressivity of clinical documentation and the importance of adhering to data standards when available. Pulmonary disease-specific examples of collection instruments are provided from two commonly used commercial EHRs. Future developments that can leverage SDEs to improve clinical quality and research are discussed.

Testing of Triggers by Data Mining of Epilepsy Patients' Structured Nursing Records.

PubMed

Kinnunen, Ulla-Mari; Kivekäs, Eija; Paananen, Pekka; Kälviäinen, Reetta; Saranto, Kaija

2016-01-01

Epilepsies are neurological disorders with many different etiologies, symptoms and prognoses. Care for epilepsy patients should be uniform, homogeneous and optimized to avoid unnecessary hospitalizations or even worse outcomes. FinCC-based structured nursing documentation facilitates analyzing patient profiles and populations, developing care processes, nursing documentation, decision-making, and data reuse. This research aimed to determine the potential for finding possible risks for epilepsy patients' health and well-being from the structured nursing data with defined triggers for epilepsy patients. The research data included structured documentation of nursing diagnoses of and interventions for adult epilepsy patients (n = 100) at one neurological ward in a university hospital in 2009-2013. The results showed that nurses documented abundantly, and all triggers were mostly found. The study results will be reviewed by the neurological ward nurses to assess the FinCC and highlight the importance of documentation.

A quality improvement project using a problem based post take ward round proforma based on the SOAP acronym to improve documentation in acute surgical receiving.

PubMed

Dolan, R; Broadbent, P

2016-02-01

Ward round documentation provides one of the most important means of communication between healthcare professionals. We aimed to establish if the use of a problem based standardised proforma can improve documentation in acute surgical receiving. Gold standards were established using the RCSE record keeping guidelines. We audited documentation for seven days using the following headings: patient name/identification number, subjective findings, objective findings, clinical impression/diagnosis, plan, diet status, discharge decision, discharge planning, signature, and grade. After the initial audit cycle, a ward round proforma was introduced using the above headings and re-audited over a seven day period. The pre-intervention arm contained 50 patients and the post intervention arm contained 47. The following headings showed an improvement in documentation compliance to 100%: patient name/identification number vs 96%, subjective findings vs 84%, objective findings vs 48%, plan vs 98%, signature vs 96%, and grade vs 62%. Documentation of the clinical impression/diagnosis improved to 98% vs 30%, diet status rose to 83% vs 16%, discharge decision to 66% vs 16%, and discharge planning to 40% vs 20%. Standardised proformas improve the documentation of post-take ward round notes. This helps to clarify the onward management plan for all aspects of a patient's care and will help avoid adverse events and litigation. This should improve the quality and safety of Patient Care.

Effects of documentation-based decision support on chronic disease management.

PubMed

Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Yu, D Tony; McColgan, Kerry E; Volk, Lynn A; Tsurikova, Ruslana; Melnikas, Andrea J; Einbinder, Jonathan S; Middleton, Blackford

2010-12-01

To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM). Controlled trial randomized by physician. We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months. The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit. The Smart Form was used for 5.6% of eligible patients. In the intention-to-treat analysis, patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls (11.4% vs 10.1%, adjusted and clustered odds ratio =1.14; 95% confidence interval, 1.02-1.28; P = .02). Differences were more pronounced in the "on-treatment" analysis: 17.0% of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6% of deficiencies after visits in which it was not used (P <.001). Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate. Overall use of the CAD/DM Smart Form was low, and improvements in management were modest. When used, documentation-based decision support shows promise, and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.

Registered nurses' decision-making regarding documentation in patients' progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy; Green, Quentine; Dyer, Kirsten; Wallis, Marianne

2012-10-01

To examine registered nurses' decision-making when documenting care in patients' progress notes. What constitutes effective nursing documentation is supported by available guidelines. However, ineffective documentation continues to be cited as a major cause of adverse events for patients. Decision-making in clinical practice is a complex process. To make an effective decision, the decision-maker must be situationally aware. The concept of situation awareness and its implications for making safe decisions has been examined extensively in air safety and more recently is being applied to health. The study was situated in a naturalistic paradigm. Purposive sampling was used to recruit 17 registered nurses who used think-aloud research methods when making decisions about documenting information in patients' progress notes. Follow-up interviews were conducted to validate interpretations. Data were analysed systematically for evidence of cues that demonstrated situation awareness as nurses made decisions about documentation. Three distinct decision-making scenarios were illuminated from the analysis: the newly admitted patient, the patient whose condition was as expected and the discharging patient. Nurses used mental models for decision-making in documenting in progress notes, and the cues nurses used to direct their assessment of patients' needs demonstrated situation awareness at different levels. Nurses demonstrate situation awareness at different levels in their decision-making processes. While situation awareness is important, it is also important to use an appropriate decision-making framework. Cognitive continuum theory is suggested as a decision-making model that could support situation awareness when nurses made decisions about documenting patient care. Because nurses are key decision-makers, it is imperative that effective decisions are made that translate into safe clinical care. Including situation awareness training, combined with employing cognitive continuum theory as a decision-making framework, provides a powerful means of guiding nurses' decision-making. © 2012 Blackwell Publishing Ltd.

Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department.

PubMed

Grudzen, Corita R; Buonocore, Philip; Steinberg, Jonathan; Ortiz, Joanna M; Richardson, Lynne D

2016-04-01

Measuring What Matters identified quality indicators to examine the percentage of patients with documentation of a surrogate decision maker and preferences for life-sustaining treatments. To determine the rate of advance care planning in older adults presenting to the emergency department (ED) and translation into medical directives in the electronic medical record (EMR). A convenience sample of adults 65 years or older was recruited from a large urban ED beginning in January 2012. We administered a baseline interview and survey in English or Spanish, including questions about whether patients had a documented health care proxy or living will. For patients admitted to the hospital who had a health care proxy or living will, chart abstraction was performed to determine whether their advance care preferences were documented in the EMR. From February 2012 to May 2013, 53.8% (367 of 682) of older adults who completed the survey in the ED reported having a health care proxy, and 40.2% (274 of 682) had a living will. Of those admitted to the hospital, only 4% (4 of 94) of patients who said they had a living will had medical directives documented in the EMR. Similarly, only 4% (5 of 115) of patients who had a health care proxy had the person's name or contact information documented in their medical record. About half of the patients 65 years or older arriving in the ED have done significant advance care planning, but most plans are not recorded in the EMR. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Phase III of Early Restoration | NOAA Gulf Spill Restoration

Science.gov Websites

information about this phase of Early Restoration, including fact sheets on each project. The final Phase III 44 projects are documented in a final Record of Decision. Information about Phase III of Early Archive Home Phase III of Early Restoration Phase III of Early Restoration Beach habitat would be restored

Keeping health promotion in the pink. Documentation can show how programs contribute to hospital goals.

PubMed

Kernaghan, S G

1990-01-01

Health promotion encompasses a wide range of services, including health information, health education, wellness, and employee health programs--important efforts, but hardly life-or-death matters. So with increased pressure to put programs to an institutional "worth" test, few health promotion programs make the grade, not because they fail, but because their managers do not know how to document and demonstrate their contributions to hospital goals. The tools that can be used to track program impact range from simple hand-written record keeping on file cards to more complicated and computer-supported systems of data gathering and analysis. It is a mistake to assume that only computer-based systems can yield meaningful information. In the documentation process it may be necessary to start small, but it is necessary to start. Sound management decisions depend on practical evidence that a program is helping a hospital's operations. When one hospital implemented an employee assistance program, program managers set out to document how the program saved the hospital money, improved the work environment, and improved quality of care. At another hospital, the manager of the inpatient cardiac rehabilitation program enlisted the assistance of the medical records department to document to the hospital that patients not in the program had longer lengths of stay than program participants.

Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings.

PubMed

Lavin, Mary Ann; Harper, Ellen; Barr, Nancy

2015-04-14

The electronic health record (EHR) is a documentation tool that yields data useful in enhancing patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs. Although nurses applaud the EHR, they also indicate dissatisfaction with its design and cumbersome electronic processes. This article describes the views of nurses shared by members of the Nursing Practice Committee of the Missouri Nurses Association; it encourages nurses to share their EHR concerns with Information Technology (IT) staff and vendors and to take their place at the table when nursing-related IT decisions are made. In this article, we describe the experiential-reflective reasoning and action model used to understand staff nurses' perspectives, share committee reflections and recommendations for improving both documentation and documentation technology, and conclude by encouraging nurses to develop their documentation and informatics skills. Nursing issues include medication safety, documentation and standards of practice, and EHR efficiency. IT concerns include interoperability, vendors, innovation, nursing voice, education, and collaboration.

Superfund Record of Decision Amendment (EPA Region 10): McCormick and Baxter Creosoting Company (Portland Plant), Portland, OR, March 17, 1998

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

NONE

1998-09-01

This ROD Amendment changes a component of the selected remedial action for contaminated soil. The original selected remedy documented in the March 1996 Record of Decision (ROD) is a series of remedial actions that address the principal threats at the Site, by removing the most highly contaminated soil, extracting nonaqueous phase liquid (NAPL) from and treating contaminated groundwater, and capping the most highly contaminated sediment. Because significant levels of dioxin are present in soil areas originally identified for excavation and on-site biological treatment (i.e, areas where contamination exceeds the action levels for PCP and PAHs), it now appears unlikely thatmore » this intended treatment will achieve the level of risk reduction contemplated in the 1996 ROD. Accordingly, DEQ and EPA have selected an alternative remedy for contaminated soil at the McCormick and Baxter site.« less

Women's health nursing in the context of the National Health Information Infrastructure.

PubMed

Jenkins, Melinda L; Hewitt, Caroline; Bakken, Suzanne

2006-01-01

Nurses must be prepared to participate in the evolving National Health Information Infrastructure and the changes that will consequently occur in health care practice and documentation. Informatics technologies will be used to develop electronic health records with integrated decision support features that will likely lead to enhanced health care quality and safety. This paper provides a summary of the National Health Information Infrastructure and highlights electronic health records and decision support systems within the context of evidence-based practice. Activities at the Columbia University School of Nursing designed to prepare nurses with the necessary informatics competencies to practice in a National Health Information Infrastructure-enabled health care system are described. Data are presented from electronic (personal digital assistant) encounter logs used in our Women's Health Nurse Practitioner program to support evidence-based advanced practice nursing care. Implications for nursing practice, education, and research in the evolving National Health Information Infrastructure are discussed.

Superfund Record of Decision (EPA Region 6): Texarkana Wood Preserving Company, Texarkana, Bowie County, TX. (First remedial action), September 1990

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

Not Available

The 25-acre Texarkana Wood Preserving site is a former wood treating facility in Bowie County, Texas, within the Days Creek 100-year floodplain. Surrounding land use is industrial, residential, and agricultural. Since the early 1900s, several lumber-related businesses have operated at the site, with documented creosote-based wood treating operations starting in 1954. By 1971, Texarkana was also using creosote and pentachlorophenol for wood preserving. State investigations of the site between 1968 and 1984, showed Texarkana to be negligent or delinquent in fulfilling various permit requirements. The Record of Decision (ROD) addresses onsite contaminated soil near the processing ponds and contaminated groundmore » water in a shallow aquifer. The primary contaminants of concern affecting the soil, sediment, sludge, and ground water are organics including dioxin, PAHs, pesticides, and phenols.« less

Health check documentation of psychosocial factors using the WAI.

PubMed

Uronen, L; Heimonen, J; Puukka, P; Martimo, K-P; Hartiala, J; Salanterä, S

2017-03-01

Health checks in occupational health (OH) care should prevent deterioration of work ability and promote well-being at work. Documentation of health checks should reflect and support continuity of prevention and practice. To analyse how OH nurses (OHNs) undertaking health checks document psychosocial factors at work and use the Work Ability Index (WAI). Analysis of two consecutive OHN health check records and WAI scores with statistical analyses and annotations of 13 psychosocial factors based on a publicly available standard on psychosocial risk management: British Standards Institution specification PAS 1010, part of European Council Directive 89/391/EEC, with a special focus on work-related stress and workplace violence. We analysed health check records for 196 employees. The most frequently documented psychosocial risk factors were home-work interface, work environment and equipment, job content, workload and work pace and work schedule. The correlations between the number of documented risk and non-risk factors and WAI scores were significant: OHNs documented more risk factors in employees with lower WAI scores. However, documented psychosocial risk factors were not followed up, and the OHNs' most common response to detected psychosocial risks was an appointment with a physician. The number of psychosocial risk factors documented by OHNs correlated with subjects' WAI scores. However, the documentation was not systematic and the interventions were not always relevant. OHNs need a structure to document psychosocial factors and more guidance in how to use the documentation as a tool in their decision making in health checks. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Superfund record of decision amendment (EPA Region 5): Woodstock Municipal LF, Woodstock, IL, July 15, 1998

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

NONE

This decision document represents the United States Environmental Protection Agency`s (US EPA) selected final remedial action for the Site located in Woodstock, Illinois. The US EPA, in consultation with the IEPA, is modifying the landfill cap profile, and the requirement to construct a groundwater pump-and-treat system to address residual vinyl chloride contamination in the upper water-bearing unit, down gradient of the landfill. This remedy is intended to be the final action for the site, and addresses all contaminated media, including: contaminated soil, sediment, and groundwater, landfilled wastes, leachate generation and emission of landfill gases.

Superfund record of decision (EPA Region 4): Alabama Army Ammunition Plant, Area B soils operable unit, Childersburg, AL, November 14, 1995

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

NONE

1996-03-01

This decision document presents the selected remedial action for the contaminated soils and sediments in Study Areas, 6, 7, and 21, and the Industrial Sewer System (ISS) in Study Areas 6, 7, and 10 within Area B at the Alabama Army Ammunition Plant (ALAAP), Childersburg, Alabama. The Area B Soils Operable Unit addresses the principal threats from soils and sediments in Study Areas 6, 7, and 21, and underground industrial sewer lines in Study Areas 6, 7, and 10. The soils and sediments and the industrial sewer lines are contaminated with explosives and lead.

The Ethics of Rationing of Critical Care Services: Should Technology Assessment Play a Role?

PubMed Central

Bloomfield, Eric L.

2009-01-01

The costs of health care continue to increase rapidly and steeply in the United States. One area of great expense is that of intensive care units (ICUs). The causes of inflation have not been addressed effectively. ICU resources could become stretched such that they may no longer be available. This paper discusses some of the ethics and concerns behind decision making when providing ICU services in the United States. In particular, the use of electronic records with decision making tools, risk-analysis methods, and documentation of patient wishes for extraordinary care may help with better utilization of resources in the future. PMID:20798878

Superfund record of decision (EPA Region 4): Paducah Gaseous Diffusion Plant (USDOE), Operable Unit 15, Paducah, KY, August 10, 1998

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

NONE

1998-12-01

This decision document presents the remedial action for the Solid Waste Management Unit (SWMU) 91 of the Waste Area Group (WAG) 27 at the Paducah Gaseous Diffusion Plant (PGDP) near Paducah, Kentucky. The primary objective of this remedial action is to reduce the level of TCE-contaminated soil thereby reducing the potential future concentrations in ground water that could pose a threat to human health and the environment at the POE (i.e., the DOE property boundary). The potential for migration of the contamination from the soil of the off-site aquifer is the concern associated with the SWMU.

Superfund record of decision amendment (EPA Region 5): Allied Chemical and Ironton Coke, Ironton, OH, September 30, 1998

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

Not Available

This decision document, together with the Allied Chemical/Ironton Coke Record of Decision (ROD) dated December 28, 1990, the first Allied Chemical/Ironton Coke ROD Amendment dated July 31, 1995 (ROD Amendment No 1), and the second ROD Amendment dated September 4, 1997 (ROD Amendment No 2), presents the selected remedial action for the Allied Chemical/Ironton Coke site. The remedy selected in the 1990 ROD, 1995 ROD Amendment No. 1, and 1997 ROD Amendment No. 2 for the site is a final remedial action. Through ROD Amendment No. 3 the following components of the selected remedy are being modified: Replace in-situ bioremediationmore » of 457,000 cubic yards of soil in Lagoons 1--4 with hot spot excavation and wetland development; and Replace incineration of Lagoon 5 materials with recycling, treatment, and/or disposal of the K087 listed waste in an approved off-site hazardous waste facility and the use of the remaining material, excluding debris, as an alternative fuel.« less

Superfund record of decision (EPA Region 4): T H Agriculture and Nutrition Site, Dougherty County, Albany, GA, April 26, 1996

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

NONE

This decision document (Record of Decision), presents the selected Remedial Action for the Operable Unit Two for the T H Agriculture & Nutrition (THAN) Site, Albany, Georgia. The second operable unit addresses the source of the contamination on the eastern parcel of the Site. The major components of the selected remedy for operable unit two include: the excavation of all soil contaminated with organics necessary to meet performance standards; the staging and preconditioning of soil for low temperature thermal desorption treatment; the treatment of excavated soil by low temperature thermal desorption; the placement of treated, decontaminated soil back to themore » site; periodic sampling of treated soil during the treatment process to verify the effectiveness of the remedy; air monitoring to ensure safety of nearby residents and workers; groundwater monitoring to ensure that metals contaminated remaining in the subsurface soil will not result in contaminated groundwater migrating offsite in concentrations which exceed groundwater protection standards; and deed restrictions to prevent residential use of the property.« less

Disclosure of Federal Acquisition Records.

DTIC Science & Technology

1981-05-24

Parties. .. .. .. . ... .. ....... 170 Collateral Estoppel . .. ......... .. ... ...... 171 Basis for Relief and Scope ofReview .. .. .. ..... 1741Burden of...grounds to a decision by a co-ordinate court with which he disagreed is unworthy of comment. 𔄁 3 (2) Collateral estoppel --"If the FOIA applicant has...documents.ś 3 7 The Supreme Court did not discuss stare decisis, or collateral 1 estoppel , or comity, as had the D,C. Circuit Court of Appeals; instead

Battle Staff Operations: Synchronization of Planning at Battalion and Brigade Level

DTIC Science & Technology

1989-06-02

tactical employment of the tank and mechanized infantry battalion task force. In consonance with Airland Battle doctrine, the document emphasizes ...letter entitled *Emphasis on Rapid Estimates and Decisions on the Atomic Battlefield.’ Emphasizing the increased tempo of the post war mechanized army...If so, a copy of the message is automatically canted to the user(s) identified in the distribution field. Queries are messages retrived records from

Use of the Physician Orders for Life-Sustaining Treatment program for patients being discharged from the hospital to the nursing facility.

PubMed

Hickman, Susan E; Nelson, Christine A; Smith-Howell, Esther; Hammes, Bernard J

2014-01-01

The Physician Orders for Life-Sustaining Treatment (POLST) documents patient preferences as medical orders that transfer across settings with patients. The objectives were to pilot test methods and gather preliminary data about POLST including (1) use at time of hospital discharge, (2) transfers across settings, and (3) consistency with prior decisions. Descriptive with chart abstraction and interviews. Participants were hospitalized patients discharged to a nursing facility and/or their surrogates in La Crosse County, Wisconsin. POLST forms were abstracted from hospital records for 151 patients. Hospital and nursing facility chart data were abstracted and interviews were conducted with an additional 39 patients/surrogates. Overall, 176 patients had valid POLST forms at the time of discharge from the hospital, and many (38.6%; 68/176) only documented code status. When the whole POLST was completed, orders were more often marked as based on a discussion with the patient and/or surrogate than when the form was used just for code status (95.1% versus 13.8%, p<.001). In the follow-up and interview sample, a majority (90.6%; 29/32) of POLST forms written in the hospital were unchanged up to three weeks after nursing facility admission. Most (71.9%; 23/32) appeared consistent with patient or surrogate recall of prior treatment decisions. POLST forms generated in the hospital do transfer with patients across settings, but are often used only to document code status. POLST orders appeared largely consistent with prior treatment decisions. Further research is needed to assess the quality of POLST decisions.

Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation

PubMed Central

Allsop, Matthew J; Kite, Suzanne; McDermott, Sarah; Penn, Naomi; Millares-Martin, Pablo; Bennett, Michael I

2016-01-01

Background: The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. Aim: This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. Design: A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Setting/participants: Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths (n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. Results: The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient’s preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. Conclusion: This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems. PMID:27507636

Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation.

PubMed

Allsop, Matthew J; Kite, Suzanne; McDermott, Sarah; Penn, Naomi; Millares-Martin, Pablo; Bennett, Michael I

2017-05-01

The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths ( n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient's preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems.

Mentor judgements and decision-making in the assessment of student nurse competence in practice: A mixed-methods study.

PubMed

Burden, Sarah; Topping, Anne Elizabeth; O'Halloran, Catherine

2018-05-01

To investigate how mentors form judgements and reach summative assessment decisions regarding student competence in practice. Competence assessment is a significant component of pre-registration nursing programmes in the United Kingdom. Concerns exist that assessments are subjective, lack consistency and that mentors fail to judge student performance as unsatisfactory. A two-stage sequential embedded mixed-methods design. Data collected 2012-2013. This study involved a whole student cohort completing a UK undergraduate adult nursing programme (N = 41). Stage 1: quantitative data on mentor conduct of assessment interviews and the final decision recorded (N = 330 from 270 mentors) were extracted from student Practice Assessment Documents (PADs). Stage 2: mentor feedback in student PADs was used in Stimulated Recall interviews with a purposive sample of final placement mentors (N = 17). These were thematically analysed. Findings were integrated to develop a theoretically driven model of mentor decision-making. Course assessment strategies and documentation had limited effect in framing mentor judgements and decisions. Rather, mentors amassed impressions, moderated by expectations of an "idealized student" by practice area and programme stage that influenced their management and outcome of the assessment process. These impressions were accumulated and combined into judgements that informed the final decision. This process can best be understood and conceptualized through the Brunswik's lens model of social judgement. Mentor decisions were reasoned and there was a shared understanding of judgement criteria and their importance. This impression-based nature of mentor decision-making questions the reliability and validity of competency-based assessments used in nursing pre-registration programmes. © 2017 John Wiley & Sons Ltd.

12 CFR 408.5 - Ensuring environmental documents are actually considered in Agency decision-making.

Code of Federal Regulations, 2010 CFR

2010-01-01

... considered in Agency decision-making. 408.5 Section 408.5 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED... Procedures § 408.5 Ensuring environmental documents are actually considered in Agency decision-making... environmental documents in agency decision-making. To implement these requirements, Eximbank officials will: (a...

50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

Code of Federal Regulations, 2010 CFR

2010-10-01

... actually considered in agency decision-making. 530.2 Section 530.2 Wildlife and Fisheries MARINE MAMMAL... documents are actually considered in agency decision-making. Section 1505.1 of the NEPA regulations contains requirements to ensure adequate consideration of environmental documents in agency decision-making. To...

Multimedia platform for authoring and presentation of clinical rounds in cardiology

NASA Astrophysics Data System (ADS)

Ratib, Osman M.; Allada, Vivekanand; Dahlbom, Magdalena; Lapstra, Lorelle

2003-05-01

We developed a multimedia presentation platform that allows retrieving data from any digital and analog modalities and to prepare a script of a clinical presentation in an XML format. This system was designed for cardiac multi-disciplinary conferences involving different cardiology specialists as well as cardiovascular surgeons. A typical presentation requires preparation of summary reports of data obtained from the different investigations and imaging techniques. An XML-based scripting methodology was developed to allow for preparation of clinical presentations. The image display program uses the generated script for the sequential presentation of different images that are displayed on pre-determined presentation settings. The ability to prepare and present clinical conferences electronically is more efficient and less time consuming than conventional settings using analog and digital documents, films and videotapes. The script of a given presentation can further be saved as part of the patient record for subsequent review of the documents and images that supported a given medical or therapeutic decision. This also constitutes a perfect documentation method for surgeons and physicians responsible of therapeutic procedures that were decided upon during the clinical conference. It allows them to review the relevant data that supported a given therapeutic decision.

Integrated information systems for electronic chemotherapy medication administration.

PubMed

Levy, Mia A; Giuse, Dario A; Eck, Carol; Holder, Gwen; Lippard, Giles; Cartwright, Julia; Rudge, Nancy K

2011-07-01

Chemotherapy administration is a highly complex and distributed task in both the inpatient and outpatient infusion center settings. The American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) have developed standards that specify procedures and documentation requirements for safe chemotherapy administration. Yet paper-based approaches to medication administration have several disadvantages and do not provide any decision support for patient safety checks. Electronic medication administration that includes bar coding technology may provide additional safety checks, enable consistent documentation structure, and have additional downstream benefits. We describe the specialized configuration of clinical informatics systems for electronic chemotherapy medication administration. The system integrates the patient registration system, the inpatient order entry system, the pharmacy information system, the nursing documentation system, and the electronic health record. We describe the process of deploying this infrastructure in the adult and pediatric inpatient oncology, hematology, and bone marrow transplant wards at Vanderbilt University Medical Center. We have successfully adapted the system for the oncology-specific documentation requirements detailed in the ASCO/ONS guidelines for chemotherapy administration. However, several limitations remain with regard to recording the day of treatment and dose number. Overall, the configured systems facilitate compliance with the ASCO/ONS guidelines and improve the consistency of documentation and multidisciplinary team communication. Our success has prompted us to deploy this infrastructure in our outpatient chemotherapy infusion centers, a process that is currently underway and that will require a few unique considerations.

Medical errors in primary care clinics – a cross sectional study

PubMed Central

2012-01-01

Background Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics. Methods This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors. Results The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable. Conclusions The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors. PMID:23267547

IHE cross-enterprise document sharing for imaging: design challenges

NASA Astrophysics Data System (ADS)

Noumeir, Rita

2006-03-01

Integrating the Healthcare Enterprise (IHE) has recently published a new integration profile for sharing documents between multiple enterprises. The Cross-Enterprise Document Sharing Integration Profile (XDS) lays the basic framework for deploying regional and national Electronic Health Record (EHR). This profile proposes an architecture based on a central Registry that holds metadata information describing published Documents residing in one or multiple Documents Repositories. As medical images constitute important information of the patient health record, it is logical to extend the XDS Integration Profile to include images. However, including images in the EHR presents many challenges. The complete image set is very large; it is useful for radiologists and other specialists such as surgeons and orthopedists. The imaging report, on the other hand, is widely needed and its broad accessibility is vital for achieving optimal patient care. Moreover, a subset of relevant images may also be of wide interest along with the report. Therefore, IHE recently published a new integration profile for sharing images and imaging reports between multiple enterprises. This new profile, the Cross-Enterprise Document Sharing for Imaging (XDS-I), is based on the XDS architecture. The XDS-I integration solution that is published as part of the IHE Technical Framework is the result of an extensive investigation effort of several design solutions. This paper presents and discusses the design challenges and the rationales behind the design decisions of the IHE XDS-I Integration Profile, for a better understanding and appreciation of the final published solution.

Protecting Unesco World Heritage PROPERTIES'S Integrity: the Role of Recording and Documentation in Risk Management for PETRA

NASA Astrophysics Data System (ADS)

Santana Quintero, M.; Cesaro, G.; Ishakat, F.; Vandesande, A.; Vileikis, O.; Vadafari, A.; Paolini, A.; Van Balen, K.; Fakhoury, L.

2012-07-01

Risk management - as it has been defined - involves the decision-making process following a risk assessment (Ball, Watt, 2003). It is the process that involves managing to minimize losses and impacts on the significant of historic structures and to reach the balance between gaining and losing opportunities. This contribution explains the "heritage information" platform developed using low-cost recording, documentation and information management tools to serve as container for assessments resulting from the application of a risk methodology at a pilot area of the Petra Archaeological Park, in particular those that permit digitally and cost effective to prepare an adequate baseline record to identify disturbances and threats. Furthermore, this paper will reflect on the issue of mapping the World Heritage property's boundaries by illustrating a methodology developed during the project and further research to overcome the lack of boundaries and buffer zone for the protection of the Petra World Heritage site, as identified in this project. This paper is based on on-going field project from a multidisciplinary team of experts from the Raymond Lemaire International Centre for Conservation (University of Leuven), UNESCO Amman, Petra Development Tourism and Region Authority (PDTRA), and Jordan's Department of Antiquities (DoA), as well as, experts from Jordan. The recording and documentation approach included in this contribution is part of an on-going effort to develop a methodology for mitigating (active and preventive) risks on the Petra Archaeological Park (Jordan). The risk assessment has been performed using non-intrusive techniques, which involve simple global navigation satellite system (GNSS), photography, and structured visual inspection, as well as, a heritage information framework based on Geographic Information Systems. The approach takes into consideration the comparison of vulnerability to sites with the value assessment to prioritize monuments at risk based on their importance of significance and magnitude of risk, in order for the authorities to plan more in-depth assessment for those highly significant monuments or areas at risk. A decision tool is envisaged as outcome of this project.

Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

PubMed

Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

2016-10-06

Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation.

PubMed

Shiffman, Richard N; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

2004-01-01

A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge.

Digital Tools for Documenting and Conserving Bahrain's Built Heritage for Posterity

NASA Astrophysics Data System (ADS)

Mezzino, D.; Barazzetti, L.; Santana Quintero, M.; El-Habashi, A.

2017-08-01

Documenting the physical characteristics of historic structures is the first step for any preventive maintenance, monitoring, conservation, planning and promotion action. Metric documentation supports informative decision-making process for property owners, site managers, public officials, and conservators. This information serves also a broader purpose, over time, it becomes the primary means by which scholars, heritage professionals, and the general public understand a site that radically changed or disappeared. Further, documentation supports monitoring as well as the character-defining elements analysis, relevant to define the values of the building for the local and international community. The awareness of these concepts oriented the digital documentation and training activities, developed between 2016 and 2017, for the Bahrain Authority for Culture and Antiquities (BACA) in Bahrain. The developed activities had two main aims: a) support the local staff in using specific recording techniques to efficiently document and consequently preserve built heritage sites with appropriate accuracy and in a relatively short period; b) develop a pilot project in collaboration with BACA to validate the capacity of the team to accurately document and produce measured records for the conservation and management of Bahrain built heritage. The documentation project has been developed by a multidisciplinary team of experts from BACA, Carleton Immersive Media Studio (CIMS), Carleton University, Canada and a contracted researcher from the Gicarus Lab, Politecnico di Milano (POLIMI) in Italy. In the training activities, the participants have been exposed to a wide range of recording techniques, illustrating them the selection criteria for the most suitable one, according to requirements, site specifications, categories of values identified for the various built elements, and budget. The pilot project has been tested on three historical structures, both with strong connotations in the Bahrain cultural identity: the Shaikh Isa bin Ali house, Aljazzaf house and the Siyadi Majlis. These two buildings, outstanding examples of Bahrain architecture as well as tangible memory of the country history, have been documented employing several digital techniques, including: aerial and terrestrial photogrammetry, rectifying photography, total station and 3D laser scanning.

40 CFR 300.700 - Activities by other persons.

Code of Federal Regulations, 2010 CFR

2010-07-01

... action is conducted in accordance with the preauthorization decision document, and costs are reasonable... preauthorization decision document. (8) For a claim to be awarded under section 111 of CERCLA, EPA must certify that the costs were necessary and consistent with the preauthorization decision document. (e) Section...

77 FR 22316 - Notification of a Public Teleconference of the Science Advisory Board Ecological Processes and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-13

...) document, ``Integrating Ecological Assessment and Decision-Making at EPA, 2011 RAF Ecological Assessment... document, ``Integrating Ecological Assessment and Decision- Making at EPA, 2011 RAF Ecological Assessment... review comments on the EPA RAF draft document ``Integrating Ecological Assessment and Decision-Making at...

[Electronic data records in primary health care and aspects of their development in Bosnia and Herzegovina].

PubMed

Novo, Ahmed; Masić, Izet; Toromanović, Selim; Karić, Mediha; Zunić, Lejla

2004-01-01

In Medical Informatics medical documentation and evidention are most probably the key areas. Also, in primary health care it is very important and part of daily activity of medical staff. Bosnia and Herzegovina is trying to be close to developed countries and to modernize and computerize current systems of documentation and to cross over from manual and semi manual methods to computerized medical data analysis. The most of European countries have developed standards and classification systems in primary health care for collecting, examination, analysis and interpretation of medical data assessed. One of possibilities as well as dilemma, which data carrier should be used for storage and manipulation of patient data in primary health care, is use of electronic medical record. Most of the South East European countries use chip or smart card and some of countries in neighborhood (Italy) choose laser card as patient data carrier. Both technologies have the advantages and disadvantages what was comprehensively colaborated by the authors in this paper, with intention to help experts who make decisions in this segment to create and to correctly influence on improvement of quality, correctness and accuracy of medical documentation in primary health care.

Exploring patients' perceptions of accessing electronic health records: Innovation in healthcare.

PubMed

Wass, Sofie; Vimarlund, Vivian; Ros, Axel

2017-04-01

The more widespread implementation of electronic health records has led to new ways of providing access to healthcare information, allowing patients to view their medical notes, test results, medicines and so on. In this article, we explore how patients perceive the possibility to access their electronic health record online and whether this influences patient involvement. The study includes interviews with nine patients and a survey answered by 56 patients. Our results show that patients perceive healthcare information to be more accessible and that electronic health record accessibility improves recall, understanding and patient involvement. However, to achieve the goal of involving patients as active decision-makers in their own treatment, electronic health records need to be fully available and test results, referrals and information on drug interactions need to be offered. As patient access to electronic health records spreads, it is important to gain a deeper understanding of how documentation practices can be changed to serve healthcare professionals and patients.

Superfund record of decision amendment (EPA Region 5): Allied Chemical/Ironton Coke Superfund Site, Ironton, OH, July 31, 1995

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

NONE

The Allied Chemical/Ironton Coke Superfund Site, located in Ironton, Lawrence County, Ohio is approximately 95 acres in size. The Allied Chemical/Ironton Coke site is divided into two operable units, the Goldcamp Disposal Area (GDA) and the Coke Plant/Lagoon Area (CPLA). The GDA Record of Decision (ROD) which describes the GDA site remedy was executed on September 29, 1988 (PB89-206221). The CPLA RD/RA is also through a CERCLA Section 106 Unilateral Administrative Order which was signed on July 1, 1991 and was issued to Allied Signal, Inc (PB92-964115). During the pre-design and design for the CPLA, new information discovered in whichmore » fundamental changes to the original CPLA and GDA ROD`s are required. This ROD Amendment documents four fundamental changes that will affect the CPLA ROD and one of the four changes that will affect the GDA ROD.« less

Maintenance action readiness assessment plan for White Oak Creek and Melton Branch Weir Stilling Pool cleanout at Oak Ridge National Laboratory

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

NONE

1995-08-01

This Readiness Assessment Plan has been prepared to document operational readiness for the following maintenance action: (1) removal of sediment from the White Oak Creek and Melton Branch Weir Stilling Pools and (2) disposal of the radiologically contaminated sediment in another location upstream of the weirs in an area previously contaminated by stream overflow from Melton Branch in Waste Area Grouping 2 (WAG) at Oak Ridge National Laboratory. This project is being performed as a maintenance action rather than an action under the Comprehensive Environmental Response, Compensation, and Liability Act because the risk to human health and environment is wellmore » below the US Environmental Protection Agency`s level of concern. The decision to proceed as a maintenance action was documented by an interim action proposed plan, which is included in the administrative record. The administrative record is available for review at the US Department of Energy Information Resource Center, 105 Broadway Avenue, Oak Ridge, Tennessee 37830.« less

[Challenges of Digital Medicine].

PubMed

Blaser, Jürg

2018-06-01

Challenges of Digital Medicine Abstract. Digitization is increasingly covering more and more sectors, including medicine. To ensure medical operation 365 × 24 hours, progressively more human and financial resources are necessary. The transformation of patient histories from paper into electronic patient records focused initially on documentation. Today, hospital information systems are increasingly used as a platform for the communication of all professionals involved in the patient process - in Switzerland, however, so far without providing patients direct access to their data. Digititizing processes intend to increase efficiency, but also to enhance clinical and administrative decision support and quality assurance. The introduction of the electronic patient record in Switzerland in 2020 is expected to provide cross-company, more complete documentation of patient care. Multimorbid patients, often treated in different institutions and by different specialists, should benefit from this in particular. Advances in artificial intelligence offer new opportunities in medicine. Challenges include ensuring reliable data protection, and better interoperability of the systems involved. Semantically structured, machine-readable data exchange is a necessity for both networked services and internationally competitive research.

Implementation of an Anesthesia Information Management System (AIMS)

PubMed Central

Douglas, James R.; Ritter, Melody J.

2011-01-01

During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care–related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. The AIMS facilitates chart entries such as drug doses and case narratives. Benefits of an AIMS include improved legibility of the anesthesia record and greater efficiency in documentation efforts. Use of the AIMS assists the practitioner with decision support logic, such as the timing of antibiotic administration and the inclusion of legally required documentation. Upon case completion, the AIMS data are immediately available to other information systems, such as billing and medical records. Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges. PMID:21734847

Implementation of an Anesthesia Information Management System (AIMS).

PubMed

Douglas, James R; Ritter, Melody J

2011-01-01

During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care-related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. The AIMS facilitates chart entries such as drug doses and case narratives. Benefits of an AIMS include improved legibility of the anesthesia record and greater efficiency in documentation efforts. Use of the AIMS assists the practitioner with decision support logic, such as the timing of antibiotic administration and the inclusion of legally required documentation. Upon case completion, the AIMS data are immediately available to other information systems, such as billing and medical records. Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges.

Is documentation of TOLAC counseling a good measure of quality of care?

PubMed

Friedman, Alexander Michael; Srinivas, Sindhu K

2016-01-01

The objective of this study is to determine whether chart documentation of patient counseling on trial of labor after cesarean (TOLAC) during prenatal care is associated with patient knowledge of risks and benefits of TOLAC and repeat cesarean delivery (RCD). Prenatal patients eligible for TOLAC completed a questionnaire that assessed their knowledge of basic maternal and neonatal risks and benefits of TOLAC versus planned repeat cesarean delivery. Patient electronic medical records were reviewed for documentation of TOLAC counseling. Women were included at both early and late time points in pregnancy to include those who both had and had not undergone counseling. Patients with documented completed TOLAC counseling did not perform better on the knowledge survey. Patients who had documentation of counseling on specific subjects such as TOLAC success rates, risk of uterine rupture, and downstream health risks of cesarean section were no more likely to answer questions on these topics correctly than patients without counseling. However, patients with documented completed counseling generally felt that they were well informed. Chart documentation of TOLAC counseling was not correlated with patient knowledge. Patients may not be gaining the knowledge from counseling that providers believe is important for informed decision making.

Tactical Approaches for Making a Successful Satellite Passive Microwave ESDR

NASA Astrophysics Data System (ADS)

Hardman, M.; Brodzik, M. J.; Gotberg, J.; Long, D. G.; Paget, A. C.

2014-12-01

Our NASA MEaSUREs project is producing a new, enhanced resolution gridded Earth System Data Record for the entire satellite passive microwave (SMMR, SSM/I-SSMIS and AMSR-E) time series. Our project goals are twofold: to produce a well-documented, consistently processed, high-quality historical record at higher spatial resolutions than have previously been available, and to transition the production software to the NSIDC DAAC for ongoing processing after our project completion. In support of these goals, our distributed team at BYU and NSIDC faces project coordination challenges to produce a high-quality data set that our user community will accept as a replacement for the currently available historical versions of these data. We work closely with our DAAC liaison on format specifications, data and metadata plans, and project progress. In order for the user community to understand and support our project, we have solicited a team of Early Adopters who are reviewing and evaluating a prototype version of the data. Early Adopter feedback will be critical input to our final data content and format decisions. For algorithm transparency and accountability, we have released an Algorithm Theoretical Basis Document (ATBD) and detailed supporting technical documentation, with rationale for all algorithm implementation decisions. For distributed team management, we are using collaborative tools for software revision control and issue tracking. For reliably transitioning a research-quality image reconstruction software system to production-quality software suitable for use at the DAAC, we have adopted continuous integration methods for running automated regression testing. Our presentation will summarize bothadvantages and challenges of each of these tactics in ensuring production of a successful ESDR and an enduring production software system.

Reduced use of occult bacteremia blood screens by emergency medicine physicians using immunization registry for children presenting with fever without a source.

PubMed

Zeretzke, Cristina M; McIntosh, Mark S; Kalynych, Colleen J; Wylie, Todd; Lott, Michelle; Wood, David

2012-07-01

This study examined whether utilization of the Florida State Health Online Tracking System (SHOTS) immunization registry to determine Haemophilus influenzae type B and heptavalent pneumococcal conjugate (PCV7) vaccine status impacts the protocolized decision to perform a screening blood draw for occult bacteremia (OB) in young children. A convenience sample of children 6 to 24 months of age presenting to the pediatric emergency department with fever of greater than 39°C without a source was enrolled. Physicians were trained to use the SHOTS immunization registry and reviewed the emergency department's fever protocol. A "preregistry" workup plan was documented for each patient based on clinical history, immunization status before accessing SHOTS, and physical examination. A "postregistry" workup plan was then documented based on the SHOTS record. Demographic and registry data were recorded. Preregistry workup plans indicated OB screening blood draws for 100% (n = 91; 95% confidence interval [CI], 96-100) of patients with unconfirmed immunization status. Of those 91 children, 58% (n = 53; 95% CI, 55-61) were documented in SHOTS as having received their primary conjugate vaccine series at ages 2, 4, and 6 months. Registry access reduced the percentage of screening blood draws from 100% (n = 91) to 42% (n = 38; 95% CI, 37-53; P < 0.001). The state immunization registry is an adjunctive tool to caregiver recall, which can be used by emergency medicine practitioners to confirm completion of the primary conjugate vaccine series before making the decision to perform blood screens for OB in children aged 6 to 24 months who present with fever without a source.

Integrated Information Systems for Electronic Chemotherapy Medication Administration

PubMed Central

Levy, Mia A.; Giuse, Dario A.; Eck, Carol; Holder, Gwen; Lippard, Giles; Cartwright, Julia; Rudge, Nancy K.

2011-01-01

Introduction: Chemotherapy administration is a highly complex and distributed task in both the inpatient and outpatient infusion center settings. The American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) have developed standards that specify procedures and documentation requirements for safe chemotherapy administration. Yet paper-based approaches to medication administration have several disadvantages and do not provide any decision support for patient safety checks. Electronic medication administration that includes bar coding technology may provide additional safety checks, enable consistent documentation structure, and have additional downstream benefits. Methods: We describe the specialized configuration of clinical informatics systems for electronic chemotherapy medication administration. The system integrates the patient registration system, the inpatient order entry system, the pharmacy information system, the nursing documentation system, and the electronic health record. Results: We describe the process of deploying this infrastructure in the adult and pediatric inpatient oncology, hematology, and bone marrow transplant wards at Vanderbilt University Medical Center. We have successfully adapted the system for the oncology-specific documentation requirements detailed in the ASCO/ONS guidelines for chemotherapy administration. However, several limitations remain with regard to recording the day of treatment and dose number. Conclusion: Overall, the configured systems facilitate compliance with the ASCO/ONS guidelines and improve the consistency of documentation and multidisciplinary team communication. Our success has prompted us to deploy this infrastructure in our outpatient chemotherapy infusion centers, a process that is currently underway and that will require a few unique considerations. PMID:22043185

A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions.

PubMed

Johnson, Mae; Whyte, Martin; Loveridge, Robert; Yorke, Richard; Naleem, Shairana

2017-01-01

The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report 'Time to Intervene' (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016). Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital. A unifying paper based form was successfully piloted in the Acute Medical Unit, introducing the TEP and bringing together decision making around both treatment escalation and CPR status. Subsequently an electronic order-set for CPR status and treatment escalation was launched in April 2015 which led to a highly visible CPR and escalation status banner on the main screen at the top of the patient's electronic record. Ultimately due to further iterations in the electronic process by December 2016, all escalation decisions for acutely admitted patients now have high quality supporting, explanatory documentation with 100% having TEPs in place. There is now widespread multidisciplinary engagement in the process of defining limits of care for acutely admitted medical patients within the first 14 hours of admission and a strategy for rolling this process out across all the divisions of the hospital through our Deteriorating Patient Group (DPG). The collaborative design with acute medical, palliative and intensive care teams and the high visibility provided by the electronic process in the Electronic Patient Record (EPR) has enhanced communication with these teams, patients, nursing staff and the multidisciplinary team by ensuring clarity through a universally understood process about escalation and CPR. Clarity and openness about these discussions have been welcomed by patient focus groups facilitated via our acute medicine patient experience committee. There has been a shift in medical culture where transparency about limits of care has contributed to improving patient safety and quality of care through reducing unnecessary CPR supported by focus groups of staff.

Technical challenges, past and future, in implementing THERESA: a one million patient, one billion item computer-based patient record and decision support system

NASA Astrophysics Data System (ADS)

Camp, Henry N.

1996-02-01

Challenges in implementing a computer-based patient record (CPR)--such as absolute data integrity, high availability, permanent on-line storage of very large complex records, rapid search times, ease of use, commercial viability, and portability to other hospitals and doctor's offices--are given along with their significance, the solutions, and their successes. The THERESA CPR has been used sine 1983 in direct patient care by a public hospital that is the primary care provider to 350,000 people. It has 1000 beds with 45,000 admissions and 750,000 outpatient visits annually. The system supports direct provider entry, including by physicians, of complete medical `documents'. Its demonstration site currently contains 1.1 billion data items on 1 million patients. It is also a clinical decision-aiding tool used for quality assurance and cost containment, for teaching as faculty and students can easily find and `thumb through' all cases similar to a particular study, and for research with over a billion medical items that can be searched and analyzed on-line within context and with continuity. The same software can also run in a desktop microcomputer managing a private practice physician's office.

'Big Data' Collaboration: Exploring, Recording and Sharing Enterprise Knowledge

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

Sukumar, Sreenivas R; Ferrell, Regina Kay

2013-01-01

As data sources and data size proliferate, knowledge discovery from "Big Data" is starting to pose several challenges. In this paper, we address a specific challenge in the practice of enterprise knowledge management while extracting actionable nuggets from diverse data sources of seemingly-related information. In particular, we address the challenge of archiving knowledge gained through collaboration, dissemination and visualization as part of the data analysis, inference and decision-making lifecycle. We motivate the implementation of an enterprise data-discovery and knowledge recorder tool, called SEEKER based on real world case-study. We demonstrate SEEKER capturing schema and data-element relationships, tracking the data elementsmore » of value based on the queries and the analytical artifacts that are being created by analysts as they use the data. We show how the tool serves as digital record of institutional domain knowledge and a documentation for the evolution of data elements, queries and schemas over time. As a knowledge management service, a tool like SEEKER saves enterprise resources and time by avoiding analytic silos, expediting the process of multi-source data integration and intelligently documenting discoveries from fellow analysts.« less

Effect of introduction of electronic patient reporting on the duration of ambulance calls.

PubMed

Kuisma, Markku; Väyrynen, Taneli; Hiltunen, Tuomas; Porthan, Kari; Aaltonen, Janne

2009-10-01

We examined the effect of the change from paper records to the electronic patient records (EPRs) on ambulance call duration. We retrieved call duration times 6 months before (group 1) and 6 months after (group 2) the introduction of EPR. Subgroup analysis of group 2 was fulfilled depending whether the calls were made during the first or last 3 months after EPR introduction. We analyzed 37 599 ambulance calls (17 950 were in group 1 and 19 649 were in group 2). The median call duration in group 1 was 48 minutes and in group 2 was 49 minutes (P = .008). In group 2, call duration was longer during the first 3 months after EPR introduction. In multiple linear regression analysis, urgency category (P < .0001), unit level (P < .0001), and transportation decision (P < .0001) influenced the call duration. The documentation method was not a significant factor. Electronic patient record system can be implemented in an urban ambulance service in such a way that documentation method does not become a significant factor in determining call duration in the long run. Temporary performance drop during the first 3 months after introduction was noticed, reflecting adaptation process to a new way of working.

Mental Status Documentation: Information Quality and Data Processes

PubMed Central

Weir, Charlene; Gibson, Bryan; Taft, Teresa; Slager, Stacey; Lewis, Lacey; Staggers, Nancy

2016-01-01

Delirium is a fluctuating disturbance of cognition and/or consciousness associated with poor outcomes. Caring for patients with delirium requires integration of disparate information across clinicians, settings and time. The goal of this project was to characterize the information processes involved in nurses’ assessment, documentation, decisionmaking and communication regarding patients’ mental status in the inpatient setting. VA nurse managers of medical wards (n=18) were systematically selected across the US. A semi-structured telephone interview focused on current assessment, documentation, and communication processes, as well as clinical and administrative decision-making was conducted, audio-recorded and transcribed. A thematic analytic approach was used. Five themes emerged: 1) Fuzzy Concepts, 2) Grey Data, 3) Process Variability 4) Context is Critical and 5) Goal Conflict. This project describes the vague and variable information processes related to delirium and mental status that undermine effective risk, prevention, identification, communication and mitigation of harm. PMID:28269919

Mental Status Documentation: Information Quality and Data Processes.

PubMed

Weir, Charlene; Gibson, Bryan; Taft, Teresa; Slager, Stacey; Lewis, Lacey; Staggers, Nancy

2016-01-01

Delirium is a fluctuating disturbance of cognition and/or consciousness associated with poor outcomes. Caring for patients with delirium requires integration of disparate information across clinicians, settings and time. The goal of this project was to characterize the information processes involved in nurses' assessment, documentation, decisionmaking and communication regarding patients' mental status in the inpatient setting. VA nurse managers of medical wards (n=18) were systematically selected across the US. A semi-structured telephone interview focused on current assessment, documentation, and communication processes, as well as clinical and administrative decision-making was conducted, audio-recorded and transcribed. A thematic analytic approach was used. Five themes emerged: 1) Fuzzy Concepts, 2) Grey Data, 3) Process Variability 4) Context is Critical and 5) Goal Conflict. This project describes the vague and variable information processes related to delirium and mental status that undermine effective risk, prevention, identification, communication and mitigation of harm.

Superfund record of decision (EPA Region 1): Peterson/Puritan Site, Operable Unit 1, Cumberland/Lincoln, RI, September 1993

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

Not Available

1993-09-01

This Decision Document presents the selected remedial action for the Peterson/Puritan, Inc. Superfund Site, Operable Unit 1, in Cumberland and Lincoln, Rhode Island. Operable Unit 1 contains two remediation areas. The CCL remediation area, a source of volatile organic contamination, includes the former Peterson/Puritan, Inc. facility, which is the Site's namesake (currently the CCL Custom Manufacturing facility, and referred to as CCL). The PAC remediation area includes the Pacific Anchor Chemical Corporation (PAC ) facility (formerly the Lonza and Universal Chemical Company facility), which is a source of arsenic and volatile organic contamination. Each remediation area is further split intomore » source and downgradient area components, respectively.« less

No Further Action Decision Document for Site 8 at Alpena Combat Readiness Training Center, Alpena, Michigan.

DTIC Science & Technology

1998-04-01

INSTALLATION RESTORATION PROGRAM No FURTHER REMEDIAL ACTION PLANNED DECISION DOCUMENT FOR SITE 8 FINAL MICHIGAN AIR NATIONAL GUARD ALPENA ...COMBAT READINESS TRAINING CENTER ALPENA , MICHIGAN April 1998 Air National Guard Andrews AFB, Maryland fr r=.~r i^:r^f>^’ m% Approved for public...Document 4. TITLE AND SUBTITLE No Further Action Decision Document for Site 8 at Alpena CRTC, Alpena , MI. 6. AUTHOR(S) N/A 7. PERFORMING

Semantic Clinical Guideline Documents

PubMed Central

Eriksson, Henrik; Tu, Samson W.; Musen, Mark

2005-01-01

Decision-support systems based on clinical practice guidelines can support physicians and other health-care personnel in the process of following best practice consistently. A knowledge-based approach to represent guidelines makes it possible to encode computer-interpretable guidelines in a formal manner, perform consistency checks, and use the guidelines directly in decision-support systems. Decision-support authors and guideline users require guidelines in human-readable formats in addition to computer-interpretable ones (e.g., for guideline review and quality assurance). We propose a new document-oriented information architecture that combines knowledge-representation models with electronic and paper documents. The approach integrates decision-support modes with standard document formats to create a combined clinical-guideline model that supports on-line viewing, printing, and decision support. PMID:16779037

Built Heritage Documentation and Management: AN Integrated Conservation Approach in Bagan

NASA Astrophysics Data System (ADS)

Mezzino, D.; Chan, L.; Santana Quintero, M.; Esponda, M.; Lee, S.; Min, A.; Pwint, M.

2017-08-01

Good practices in heritage conservation are based on accurate information about conditions, materials, and transformation of built heritage sites. Therefore, heritage site documentation and its analysis are essential parts for their conservation. In addition, the devastating effects of recent catastrophic events in different geographical areas have highly affected cultural heritage places. Such areas include and are not limited to South Europe, South East Asia, and Central America. Within this framework, appropriate acquisition of information can effectively provide tools for the decision-making process and management. Heritage documentation is growing in innovation, providing dynamic opportunities for effectively responding to the alarming rate of destruction by natural events, conflicts, and negligence. In line with these considerations, a multidisciplinary team - including students and faculty members from Carleton University and Yangon Technological University, as well as staff from the Department of Archaeology, National Museum and Library (DoA) and professionals from the CyArk foundation - developed a coordinated strategy to document four temples in the site of Bagan (Myanmar). On-field work included capacity-building activities to train local emerging professionals in the heritage field (graduate and undergraduate students from the Yangon Technological University) and to increase the technical knowledge of the local DoA staff in the digital documentation field. Due to the short time of the on-field activity and the need to record several monuments, a variety of documentation techniques, including image and non-image based ones, were used. Afterwards, the information acquired during the fieldwork was processed to develop a solid base for the conservation and monitoring of the four documented temples. The relevance of developing this kind of documentation in Bagan is related to the vulnerability of the site, often affected by natural seismic events and flooding, as well as the lack of maintenance. Bagan provided an excellent case study to test the effectiveness of the proposed approach, to prevent and manage the damages of catastrophic events, and to support retrofitting actions. In order to test the flexibility of adopted methodology and workflow, temples with different features - in terms of architectural design, shape, and geometry - were selected. The goals of these documentation activities range from testing digital documentation workflows for the metric and visual recording of the site (reviewing strengths and limitations of particular recording techniques), to the definition of effective conditions assessment strategies.

Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury.

PubMed

Malec, James F; Mandrekar, Jayawant N; Brown, Allen W; Moessner, Anne M

2009-01-01

To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases. Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.

Context-based electronic health record: toward patient specific healthcare.

PubMed

Hsu, William; Taira, Ricky K; El-Saden, Suzie; Kangarloo, Hooshang; Bui, Alex A T

2012-03-01

Due to the increasingly data-intensive clinical environment, physicians now have unprecedented access to detailed clinical information from a multitude of sources. However, applying this information to guide medical decisions for a specific patient case remains challenging. One issue is related to presenting information to the practitioner: displaying a large (irrelevant) amount of information often leads to information overload. Next-generation interfaces for the electronic health record (EHR) should not only make patient data easily searchable and accessible, but also synthesize fragments of evidence documented in the entire record to understand the etiology of a disease and its clinical manifestation in individual patients. In this paper, we describe our efforts toward creating a context-based EHR, which employs biomedical ontologies and (graphical) disease models as sources of domain knowledge to identify relevant parts of the record to display. We hypothesize that knowledge (e.g., variables, relationships) from these sources can be used to standardize, annotate, and contextualize information from the patient record, improving access to relevant parts of the record and informing medical decision making. To achieve this goal, we describe a framework that aggregates and extracts findings and attributes from free-text clinical reports, maps findings to concepts in available knowledge sources, and generates a tailored presentation of the record based on the information needs of the user. We have implemented this framework in a system called Adaptive EHR, demonstrating its capabilities to present and synthesize information from neurooncology patients. This paper highlights the challenges and potential applications of leveraging disease models to improve the access, integration, and interpretation of clinical patient data. © 2012 IEEE

Improving Primary Care Provider Practices in Youth Concussion Management.

PubMed

Arbogast, Kristy B; Curry, Allison E; Metzger, Kristina B; Kessler, Ronni S; Bell, Jeneita M; Haarbauer-Krupa, Juliet; Zonfrillo, Mark R; Breiding, Matthew J; Master, Christina L

2017-08-01

Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care-based intervention including an electronic health record-based clinical decision support tool ("SmartSet") and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.

Bridging the Guideline Implementation Gap: A Systematic, Document-Centered Approach to Guideline Implementation

PubMed Central

Shiffman, Richard N.; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

2004-01-01

Objective: A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. Design: This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. Results: The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Conclusion: Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge. PMID:15187061

Benavides v. U.S. Bureau of Prisons.

PubMed

1993-06-11

The U.S. Court of Appeals, District of Columbia Circuit, held that merely complying with government regulations regarding the release of medical records fails to satisfy the Bureau of Prisons' obligation to provide prisoners access to such information. Prisoners have an unqualified right of access to these records, provided the documents are deemed non-exempt by the Privacy Act of 1974. The obligation to disclose personal information to a patient is not alleviated by disclosure to a designated doctor or other third party. The court found that potential harm resulting from unrestricted access to medical or psychological records could be limited by special procedures, provided agencies guarantee the ultimate disclosure of the non-exempt information. The court reversed the district court's decision in favor of the Bureau and remanded the case for further proceedings consistent with the appeals court opinion.

Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases.

PubMed

Nair, Bala G; Newman, Shu-Fang; Peterson, Gene N; Wu, Wei-Ying; Schwid, Howard A

2010-11-01

Administration of prophylactic antibiotics during surgery is generally performed by the anesthesia providers. Timely antibiotic administration within the optimal time window before incision is critical for prevention of surgical site infections. However, this often becomes a difficult task for the anesthesia team during the busy part of a case when the patient is being anesthetized. Starting with the implementation of an anesthesia information management system (AIMS), we designed and implemented several feedback mechanisms to improve compliance of proper antibiotic delivery and documentation. This included generating e-mail feedback of missed documentation, distributing monthly summary reports, and generating real-time electronic alerts with a decision support system. In 20,974 surgical cases for the period, June 2008 to January 2010, the interventions of AIMS install, e-mail feedback, summary reports, and real-time alerts changed antibiotic compliance by -1.5%, 2.3%, 4.9%, and 9.3%, respectively, when compared with the baseline value of 90.0% ± 2.9% when paper anesthesia records were used. Highest antibiotic compliance was achieved when using real-time alerts. With real-time alerts, monthly compliance was >99% for every month between June 2009 and January 2010. Installation of AIMS itself did not improve antibiotic compliance over that achieved with paper anesthesia records. However, real-time guidance and reminders through electronic messages generated by a computerized decision support system (Smart Anesthesia Messenger, or SAM) significantly improved compliance. With such a system a consistent compliance of >99% was achieved.

The Wildland Fire Decision Support System: Integrating science, technology, and fire management

Treesearch

Morgan Pence; Tom Zimmerman

2011-01-01

Federal agency policy requires documentation and analysis of all wildland fire response decisions. In the past, planning and decision documentation for fires were completed using multiple unconnected processes, yielding many limitations. In response, interagency fire management executives chartered the development of the Wildland Fire Decision Support System (WFDSS)....

Integration of clinical research documentation in electronic health records.

PubMed

Broach, Debra

2015-04-01

Clinical trials of investigational drugs and devices are often conducted within healthcare facilities concurrently with clinical care. With implementation of electronic health records, new communication methods are required to notify nonresearch clinicians of research participation. This article reviews clinical research source documentation, the electronic health record and the medical record, areas in which the research record and electronic health record overlap, and implications for the research nurse coordinator in documentation of the care of the patient/subject. Incorporation of clinical research documentation in the electronic health record will lead to a more complete patient/subject medical record in compliance with both research and medical records regulations. A literature search provided little information about the inclusion of clinical research documentation within the electronic health record. Although regulations and guidelines define both source documentation and the medical record, integration of research documentation in the electronic health record is not clearly defined. At minimum, the signed informed consent(s), investigational drug or device usage, and research team contact information should be documented within the electronic health record. Institutional policies should define a standardized process for this integration in the absence federal guidance. Nurses coordinating clinical trials are in an ideal position to define this integration.

Comparison of handheld computer-assisted and conventional paper chart documentation of medical records. A randomized, controlled trial.

PubMed

Stengel, Dirk; Bauwens, Kai; Walter, Martin; Köpfer, Thilo; Ekkernkamp, Axel

2004-03-01

Daily documentation and maintenance of medical record quality is a crucial issue in orthopaedic surgery. The purpose of the present study was to determine whether the introduction of a handheld computer could improve both the quantitative and qualitative aspects of medical records. A series of consecutive patients who were admitted for the first time to a thirty-six-bed orthopaedic ward of an academic teaching hospital for a planned operation or any other treatment of an acute injury or chronic condition were randomized to daily documentation of their clinical charts on a handheld computer or on conventional paper forms. The electronic documentation consisted of a specially designed software package on a handheld computer for bedside use with structured decision trees for examination, obtaining a history, and coding. In the control arm, chart notes were compiled on standard paper forms and were subsequently entered into the hospital's information system. The number of documented ICD (International Classification of Diseases) diagnoses was the primary end point for sample size calculations. All patient charts were reread by an expert panel consisting of two surgeons and the surgical quality assurance manager. These experts assigned quality ratings to the different documentation systems by scrutinizing the extent and accuracy of the patient histories and the physical findings as assessed by daily chart notes. Eighty patients were randomized to one of the two documentation arms, and seventy-eight (forty-seven men and thirty-one women) of them were eligible for final analysis. Documentation with the handheld computer increased the median number of diagnoses per patients from four to nine (p < 0.0001), but it produced some overcoding for false or redundant items. Documentation quality ratings improved significantly with the introduction of the handheld device (p < 0.01) with respect to the correct assessment of a patient's progress and translation into ICD diagnoses. Various learning curve effects were observed with different operators. Study physicians assigned slightly better practicability ratings to the handheld device. The preliminary data from this study suggest that handheld computers may improve the quality of hospital charts in orthopaedic surgery. Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

An Internationally Consented Standard for Nursing Process-Clinical Decision Support Systems in Electronic Health Records.

PubMed

Müller-Staub, Maria; de Graaf-Waar, Helen; Paans, Wolter

2016-11-01

Nurses are accountable to apply the nursing process, which is key for patient care: It is a problem-solving process providing the structure for care plans and documentation. The state-of-the art nursing process is based on classifications that contain standardized concepts, and therefore, it is named Advanced Nursing Process. It contains valid assessments, nursing diagnoses, interventions, and nursing-sensitive patient outcomes. Electronic decision support systems can assist nurses to apply the Advanced Nursing Process. However, nursing decision support systems are missing, and no "gold standard" is available. The study aim is to develop a valid Nursing Process-Clinical Decision Support System Standard to guide future developments of clinical decision support systems. In a multistep approach, a Nursing Process-Clinical Decision Support System Standard with 28 criteria was developed. After pilot testing (N = 29 nurses), the criteria were reduced to 25. The Nursing Process-Clinical Decision Support System Standard was then presented to eight internationally known experts, who performed qualitative interviews according to Mayring. Fourteen categories demonstrate expert consensus on the Nursing Process-Clinical Decision Support System Standard and its content validity. All experts agreed the Advanced Nursing Process should be the centerpiece for the Nursing Process-Clinical Decision Support System and should suggest research-based, predefined nursing diagnoses and correct linkages between diagnoses, evidence-based interventions, and patient outcomes.

42 CFR 420.303 - HHS criteria for requesting books, documents, and records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false HHS criteria for requesting books, documents, and... Books, Documents, and Records of Subcontractors § 420.303 HHS criteria for requesting books, documents, and records. HHS will generally request books, documents, and records from a subcontractor only if one...

42 CFR 420.303 - HHS criteria for requesting books, documents, and records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false HHS criteria for requesting books, documents, and... Books, Documents, and Records of Subcontractors § 420.303 HHS criteria for requesting books, documents, and records. HHS will generally request books, documents, and records from a subcontractor only if one...

42 CFR 420.303 - HHS criteria for requesting books, documents, and records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false HHS criteria for requesting books, documents, and... Books, Documents, and Records of Subcontractors § 420.303 HHS criteria for requesting books, documents, and records. HHS will generally request books, documents, and records from a subcontractor only if one...

DNR Recorder's Office

Science.gov Websites

and/or purchase. Why are documents recorded in the official records? What types of documents are recorded in the official records? A: Documents are recorded in the Official Records of the State of Alaska to declare their enactment and existence. Individuals research the state records to identify property

Superfund record of decision (EPA Region 7): Cornhusker Army Ammunition Plant, Operable Unit 1, Hall County, Grand Island, NE, September 29, 1994

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

NONE

1995-04-01

The decision document presents the selected interim remedial action for the groundwater operable unit at the Cornhusker Army Ammunition Plant (CAAP). Operable Unit One encompasses the explosives groundwater plume(s), both on-post and off-post. Explosives of concern in the contaminant plume include RDX, TNT, HMX, and their decomposition products. The objective of the interim action is to contain the plume and prevent further migration of contaminants, and does not encompass full restoration of the plume of contaminated groundwater. The recommended alternatives provide an approach to containing and removing contaminant mass from the groundwater plume. This approach will control further migration ofmore » the plume and reduce the levels of the contamination in groundwater.« less

Superfund Record of Decision (EPA Region 4): Milan Army Ammunition Plant, O-Line Ponds Area, Milan, TN, September 1993

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

Not Available

1993-09-01

The decision document presents the selected remedial action for Operable Unit Two (OU2) at the O-Line Ponds Area, Milan Army Ammunition Plant, Milan, Tennessee. The goal of the overall cleanup activities at the site is to prevent migration of contaminants from soil at the site and to prevent exposures to these contaminants, so that no adverse health effects will result from current or future off-post or on-post use. Soil contaminated with explosives compounds is known to exist in the O-Line Ponds area, and under current conditions, this contamination poses a potential threat to groundwater at the site. Currently contaminated groundwatermore » is being addressed by separate remedial actions under different Operable Units (OUs).« less

Superfund Record of Decision (EPA Region 7): Lake City Army Ammunition Plant (NW Lagoon), Independence, MO, September 29, 1998

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

Not Available

1999-03-01

This decision document describes the selected Interim Remedial Action (IRA) for the Northeast Corner Operable Unit (NECOU), Lake City Army Ammunition Plant (LCAAP). The major components of the selected IRA for the NECOU include: Installation of a subsurface permeable reactive wall (PRW) to treat contaminated ground water in place (in-situ); A monitoring program to evaluate the effectiveness of The PRW in treating the contaminated ground water and to determine the replacement period of the reactive media; and Installation of a soil cover over the Area 17 Oil and Solvent Pits (a principal threat waste) located adjacent to the current sanitarymore » landfill in the NECOU to minimize infiltration of water through the pits and subsequently into ground water.« less

Superfund record of decision (EPA Region 1): Loring Air Force Base, operable unit 3 (Debris Disposal Unit), Limestone, ME, September 27, 1996

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

NONE

1997-04-01

This decision document presents the final remedies for OU3, which consists of 17 sites: No further action for the following 14 NFA (no further action) sites - Ohio Road Debris Area, Oklahoma Road Debris Area, KC-135 Crash Area, Dumpster Cleaning Area Site/Building 7841, Explosive Ordnance Disposal (EOD) Area-Cylinders, Golf Course Maintenance Shed Area, Chapman Pit Debris Area, 9000 Debris Area, Solvent/Paint Dock Area, Prima Beef Debris Area, Buildings 8951 and 8960 (DRMO), Old PX Gas Station UST, F-106A Crash Area, and Demineralization Plant; Further investigation for the Outdoor Firing Range and EOD Range; and Remedial action for the Contract Storagemore » Shed Area site to address the contaminated soils/sediments.« less

Superfund record of decision (EPA Region 3): Allegany Ballistics Laboratory (USNavy) Site 10, Mineral, WV, June 30, 1998

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

NONE

1998-12-01

This decision document presents the selected remedial action for Site 10 (the Site) Groundwater at the Allegany Ballistics Laboratory (ABL), Rocket Center, West Virginia. The major components of the selected remedy are: Institutional controls, including land use restrictions imposed through appropriate administrative mechanisms to prevent groundwater use; Groundwater pumping from a minimum of three extraction wells to capture the hot spot of the VOC contaminant plume; Installation of a pipeline to transport groundwater from Site 10 to the Site 1 treatment plant; Discharge to the North Branch Potomac River; and Groundwater monitoring on a timely basis, quarterly to semi-annually, willmore » evaluate groundwater quality, contaminant migration, and degradation for inclusion in the 5-year site reviews.« less

Superfund record of decision (EPA Region 4): Marine Corps Base (site 35), operable unit 10, Camp Lejeune, NC, September 22, 1995

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

NONE

1996-01-01

This decision document presents the selected remedy for surficial groundwater for a portion of Operable Unit (OU) No. 10 (Site 35), Marine Corps Base (MCB), Camp Lejeune, North Carolina. Five Remedial Action Alternatives (RAAs) were evaluated as part of an interim remedial investigation/feasibility study for surficial groundwater at OU No. 10 (Site 35). These RAAs included RAA 1 (No Action), RAA 2 (No Action With Institutional Controls), RAA 3 (Groundwater Collection and On-site Treatment), RAA 4 (In Situ Air Sparging and Off-Gas Carbon Adsorption) and RAA 5 (In Well Aeration and Off-Gas Adsorption). After all five RAAs were compared tomore » established criteria, RAA 5 was selected as the preferred alternative.« less

Taming Big Data: An Information Extraction Strategy for Large Clinical Text Corpora.

PubMed

Gundlapalli, Adi V; Divita, Guy; Carter, Marjorie E; Redd, Andrew; Samore, Matthew H; Gupta, Kalpana; Trautner, Barbara

2015-01-01

Concepts of interest for clinical and research purposes are not uniformly distributed in clinical text available in electronic medical records. The purpose of our study was to identify filtering techniques to select 'high yield' documents for increased efficacy and throughput. Using two large corpora of clinical text, we demonstrate the identification of 'high yield' document sets in two unrelated domains: homelessness and indwelling urinary catheters. For homelessness, the high yield set includes homeless program and social work notes. For urinary catheters, concepts were more prevalent in notes from hospitalized patients; nursing notes accounted for a majority of the high yield set. This filtering will enable customization and refining of information extraction pipelines to facilitate extraction of relevant concepts for clinical decision support and other uses.

Efficient Workflows for Curation of Heterogeneous Data Supporting Modeling of U-Nb Alloy Aging

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

Ward, Logan Timothy; Hackenberg, Robert Errol

These are slides from a presentation summarizing a graduate research associate's summer project. The following topics are covered in these slides: data challenges in materials, aging in U-Nb Alloys, Building an Aging Model, Different Phase Trans. in U-Nb, the Challenge, Storing Materials Data, Example Data Source, Organizing Data: What is a Schema?, What does a "XML Schema" look like?, Our Data Schema: Nice and Simple, Storing Data: Materials Data Curation System (MDCS), Problem with MDCS: Slow Data Entry, Getting Literature into MDCS, Staging Data in Excel Document, Final Result: MDCS Records, Analyzing Image Data, Process for Making TTT Diagram, Bottleneckmore » Number 1: Image Analysis, Fitting a TTP Boundary, Fitting a TTP Curve: Comparable Results, How Does it Compare to Our Data?, Image Analysis Workflow, Curating Hardness Records, Hardness Data: Two Key Decisions, Before Peak Age? - Automation, Interactive Viz, Which Transformation?, Microstructure-Informed Model, Tracking the Entire Process, General Problem with Property Models, Pinyon: Toolkit for Managing Model Creation, Tracking Individual Decisions, Jupyter: Docs and Code in One File, Hardness Analysis Workflow, Workflow for Aging Models, and conclusions.« less

Superfund Record of Decision (EPA Region 8): Anaconda Smelter site, (Operable Unit 11 - Flue Dust), Deer Lodge County, Anaconda, MT. (Second remedial action), September 1991

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

Not Available

1991-09-23

The 6,000-acre Anaconda Smelter site is a former copper and ore processing facility in Deer Lodge County, Montana. Land use in the area is predominantly residential. The site is bounded on the north and east, respectively, by the Warm Springs Creek and Mill Creek, both of which are potential sources of drinking water. From 1884 until 1980 when activities ceased, the site was used for ore processing and smelting operations. In 1988, EPA conducted an investigation to determine the nature and extent of the flue dust contamination. A 1988 ROD addressed the Mill Creek Operable Unit (OU15) and documented themore » relocation of residents from the community surrounding the smelter site as the selected remedial action. The Record of Decision (ROD) addresses the Flue Dust Operable Unit (OU11). The primary contaminants of concern affecting this site from the flue dust materials are metals including arsenic, cadmium, and lead. The selected remedial action for the site is included.« less

Installation restoration program. Decision document for soil and groundwater at the storage area at the USMC Subleased Area, Site 3. 144th Fighter Wing, California Air National Guard, Fresno Air Terminal, California

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

NONE

1996-01-01

Decision Document for IRP Site No. 3 - Storage Area at the USMC Sublease Area, California Air National Guard, 144th Fighter Wing, Fresno Air Terminal, Fresno, California. This report documents the data, conclusion, and recommendation to support a No Further Remedial Action Planned decision at Site 3 under the IRP.

49 CFR 237.155 - Documents and records.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF TRANSPORTATION BRIDGE SAFETY STANDARDS Documentation, Records, and Audits of Bridge Management Programs § 237.155 Documents and records. Each track owner required to implement a bridge management... 49 Transportation 4 2012-10-01 2012-10-01 false Documents and records. 237.155 Section 237.155...

Impact of an educational intervention on medical records documentation.

PubMed

Vahedi, Hojat Sheikhmotahar; Mirfakhrai, Minasadat; Vahidi, Elnaz; Saeedi, Morteza

2018-01-01

Inaccurate and incomplete documentation can lead to poor treatment and medico-legal consequences. Studies indicate that teaching programs in this field can improve the documentation of medical records. The study aimed to evaluate the effect of an educational workshop on medical record documentation by emergency medicine residents in the emergency department. An interventional study was performed on 30 residents in their first year of training emergency medicine (PGY1), in three tertiary referral hospitals of Tehran University of Medical Sciences. The essential information that should be documented in a medical record was taught in a 3-day-workshop. The medical records completed by these residents before the training workshop were randomly selected and scored (300 records), as was a random selection of the records they completed one (300 records) and six months (300 records) after the workshop. Documentation of the majority of the essential items of information was improved significantly after the workshop. In particular documentation of the patients' date and time of admission, past medical and social history. Documentation of patient identity, requests for consultations by other specialties, first and final diagnoses were 100% complete and accurate up to 6 months of the workshop. This study confirms that an educational workshop improves medical record documentation by physicians in training.

Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma.

PubMed

Goldberg, Howard S; Paterno, Marilyn D; Grundmeier, Robert W; Rocha, Beatriz H; Hoffman, Jeffrey M; Tham, Eric; Swietlik, Marguerite; Schaeffer, Molly H; Pabbathi, Deepika; Deakyne, Sara J; Kuppermann, Nathan; Dayan, Peter S

2016-03-01

To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma. We integrated the Epic(®) electronic health record (EHR) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments. Patterns of CDS review included either a delayed, near-real-time review, where the physician viewed CDS recommendations generated by the nursing assessment, or a real-time review, where the physician viewed recommendations generated by their own documentation. A backstopping, vendor-based CDS triggered with zero delay when no recommendation was available in the EHR from the web-service. We assessed the execution characteristics of the integrated system and the source of the generated recommendations viewed by physicians. The ECRS mean execution time was 0.74 ±0.72 s. Overall execution time was substantially different at the two sites, with mean total transaction times of 19.67 and 3.99 s. Of 1930 analyzed transactions from the two sites, 60% (310/521) of all physician documentation-initiated recommendations and 99% (1390/1409) of all nurse documentation-initiated recommendations originated from the remote web service. The remote CDS system was the source of recommendations in more than half of the real-time cases and virtually all the near-real-time cases. Comparisons are limited by allowable variation in user workflow and resolution of the EHR clock. With maturation and adoption of standards for CDS services, remote CDS shows promise to decrease time-to-trial for multicenter evaluations of candidate decision support interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2017-06-01

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

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

Report on the remedial investigation of Bear Creek Valley at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Volume 5: Appendix F -- Baseline human health risk assessment report

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

NONE

1996-09-01

This Remedial Investigation (RI) Report characterizes the nature and extent of contamination, evaluates the fate and transport of contaminants, and assesses risk to human health and the environment resulting from waste disposal and other US Department of Energy (DOE) operations in Bear Creek Valley (BCV). BCV, which is located within the DOE Oak Ridge Reservation (ORR) encompasses multiple waste units containing hazardous and radioactive wastes arising from operations at the adjacent Oak Ridge Y-12 Plant. The primary waste units discussed in this RI Report are the S-3 Site, Oil Landfarm (OLF), Boneyard/Burnyard (BYBY), Sanitary Landfill 1 (SL 1), and Bearmore » Creek Burial Grounds (BCBG). These waste units, plus the contaminated media resulting from environmental transport of the wastes from these units, are the subject of this RI. This BCV RI Report represents the first major step in the decision-making process for the BCV watershed. The RI results, in concert with the follow-on FS will form the basis for the Proposed Plan and Record of Decision for all BCV sites. This comprehensive decision document process will meet the objectives of the watershed approach for BCV. Appendix F documents potential risks and provides information necessary for making remediation decisions. A quantitative analysis of the inorganic, organic, and radiological site-related contaminants found in various media is used to characterize the potential risks to human health associated with exposure to these contaminants.« less

Glossary

MedlinePlus

... healthcare A document that designates the person you trust to make medical decisions on your behalf if ... healthcare: a document that designates the person you trust to make medical decisions on your behalf if ...

Applying LD Documentation Guidelines at the Postsecondary Level: Decision Making with Sparse or Missing Data

ERIC Educational Resources Information Center

Banerjee, Manju; Madaus, Joseph W.; Gelbar, Nicholas

2015-01-01

A key issue in fostering transition to postsecondary education for students with disabilities is documentation verifying the nature of the disability and supporting the need for services and reasonable accommodations. Documentation guidelines assist postsecondary disability service providers in making decisions about eligibility and reasonable…

41 CFR 51-7.3 - Ensuring environmental documents are actually considered in agency determinations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... contains requirements to ensure adequate consideration of environmental documents in agency decision-making... environmental documents as a part of their decision-making: (1) Action: Request. (2) Start of NEPA process: Upon... Property Management Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO...

76 FR 49526 - Environmental Impact Statement; Saint Louis County, MN

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

... environmental impacts of alternatives, including (1) No-build, (2) Purchasing title and possession of the.... The Scoping Document/Draft Scoping Decision Document is anticipated to be published in late 2011. A... Decision Document will be published after the public comment period has closed. A Draft EIS will be...

Automated Data Management Information System (ADMIS)

NASA Technical Reports Server (NTRS)

Blackstone, C.; Dunn, D.; Sullivan, E.; Whitlock, J.; Buehler, D.; Pratt, L.; Hoffiditz, T.; Rose, J.; Smithson, M.; Feeley, J.

1974-01-01

ADMIS stores and controls data and documents associated with manned space flight effort. System contains all data oriented toward a specific document; it is primary source of reports generated by the system. Each group of records is composed of one document record, one distribution record for each recipient of the document, and one summary record.

77 FR 31895 - Energy Northwest, Columbia Generating Station; Record of Decision and Issuance of Renewed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

... no-action alternative. The factors considered in the record of decision can be found in the final... Generating Station; Record of Decision and Issuance of Renewed Facility Operating License for an Additional... the record of decision for the renewal of facility operating license No. NPF-21, consistent with the...

36 CFR § 1222.22 - What records are required to provide for adequate documentation of agency business?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE... documentation, agencies must prescribe the creation and maintenance of records that: (a) Document the persons...

Evaluation of prescriber responses to pharmacogenomics clinical decision support for thiopurine S-methyltransferase testing.

PubMed

Ubanyionwu, Samuel; Formea, Christine M; Anderson, Benjamin; Wix, Kelly; Dierkhising, Ross; Caraballo, Pedro J

2018-02-15

Results of a study of prescribers' responses to a pharmacogenomics-based clinical decision support (CDS) alert designed to prompt thiopurine S -methyltransferase (TPMT) status testing are reported. A single-center, retrospective, chart review-based study was conducted to evaluate prescriber compliance with a pretest CDS alert that warned of potential thiopurine drug toxicity resulting from deficient TPMT activity due to TPMT gene polymorphism. The CDS alert was triggered when prescribers ordered thiopurine drugs for patients whose records did not indicate TPMT status or when historical thiopurine use was documented in the electronic health record. The alert pop-up also provided a link to online educational resources to guide thiopurine dosing calculations. During the 9-month study period, 500 CDS alerts were generated: in 101 cases (20%), TPMT phenotyping or TPMT genotyping was ordered; in 399 cases (80%), testing was not ordered. Multivariable regression analysis indicated that documentation of historical thiopurine use was the only independent predictor of test ordering. Among the 99 patients tested subsequent to CDS alerts, 70 (71%) had normal TPMT activity, 29 (29%) had intermediate activity, and none had deficient activity. The online resources provided thiopurine dosing recommendations applicable to 24 patients, but only 3 were prescribed guideline-supported doses after CDS alerts. The pretest CDS rule resulted in a large proportion of neglected alerts due to poor alerting accuracy and consequent alert fatigue. Prescriber usage of online thiopurine dosing resources was low. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Healthy eating decisions require efficient dietary self-control in children: A mouse-tracking food decision study.

PubMed

Ha, Oh-Ryeong; Bruce, Amanda S; Pruitt, Stephen W; Cherry, J Bradley C; Smith, T Ryan; Burkart, Dominic; Bruce, Jared M; Lim, Seung-Lark

2016-10-01

Learning how to make healthy eating decisions, (i.e., resisting unhealthy foods and consuming healthy foods), enhances physical development and reduces health risks in children. Although healthy eating decisions are known to be challenging for children, the mechanisms of children's food choice processes are not fully understood. The present study recorded mouse movement trajectories while eighteen children aged 8-13 years were choosing between eating and rejecting foods. Children were inclined to choose to eat rather than to reject foods, and preferred unhealthy foods over healthy foods, implying that rejecting unhealthy foods could be a demanding choice. When children rejected unhealthy foods, mouse trajectories were characterized by large curvature toward an eating choice in the beginning, late decision shifting time toward a rejecting choice, and slowed response times. These results suggested that children exercised greater cognitive efforts with longer decision times to resist unhealthy foods, providing evidence that children require dietary self-control to make healthy eating-decisions by resisting the temptation of unhealthy foods. Developmentally, older children attempted to exercise greater cognitive efforts for consuming healthy foods than younger children, suggesting that development of dietary self-control contributes to healthy eating-decisions. The study also documents that healthy weight children with higher BMIs were more likely to choose to reject healthy foods. Overall, findings have important implications for how children make healthy eating choices and the role of dietary self-control in eating decisions. Published by Elsevier Ltd.

Use of an electronic problem list by primary care providers and specialists.

PubMed

Wright, Adam; Feblowitz, Joshua; Maloney, Francine L; Henkin, Stanislav; Bates, David W

2012-08-01

Accurate patient problem lists are valuable tools for improving the quality of care, enabling clinical decision support, and facilitating research and quality measurement. However, problem lists are frequently inaccurate and out-of-date and use varies widely across providers. Our goal was to assess provider use of an electronic problem list and identify differences in usage between medical specialties. Chart review of a random sample of 100,000 patients who had received care in the past two years at a Boston-based academic medical center. Counts were collected of all notes and problems added for each patient from 1/1/2002 to 4/30/2010. For each entry, the recording provider and the clinic in which the entry was recorded was collected. We used the Healthcare Provider Taxonomy Code Set to categorize each clinic by specialty. We analyzed the problem list use across specialties, controlling for note volume as a proxy for visits. A total of 2,264,051 notes and 158,105 problems were recorded in the electronic medical record for this population during the study period. Primary care providers added 82.3% of all problems, despite writing only 40.4% of all notes. Of all patients, 49.1% had an assigned primary care provider (PCP) affiliated with the hospital; patients with a PCP had an average of 4.7 documented problems compared to 1.5 problems for patients without a PCP. Primary care providers were responsible for the majority of problem documentation; surgical and medical specialists and subspecialists recorded a disproportionately small number of problems on the problem list.

7 CFR 7.34 - Custody and use of books, records, and documents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Custody and use of books, records, and documents. 7.34... STABILIZATION AND CONSERVATION STATE, COUNTY AND COMMUNITY COMMITTEES § 7.34 Custody and use of books, records, and documents. (a) All books, records, and documents of or used by the county committee in the...

7 CFR 7.34 - Custody and use of books, records, and documents.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 1 2012-01-01 2012-01-01 false Custody and use of books, records, and documents. 7.34... STABILIZATION AND CONSERVATION STATE, COUNTY AND COMMUNITY COMMITTEES § 7.34 Custody and use of books, records, and documents. (a) All books, records, and documents of or used by the county committee in the...

The Importance of the Medical Record: A Critical Professional Responsibility.

PubMed

Ngo, Elizabeth; Patel, Nachiket; Chandrasekaran, Krishnaswamy; Tajik, A Jamil; Paterick, Timothy E

2016-01-01

Comprehensive, detailed documentation in the medical record is critical to patient care and to a physician when allegations of negligence arise. Physicians, therefore, would be prudent to have a clear understanding of this documentation. It is important to understand who is responsible for documentation, what is important to document, when to document, and how to document. Additionally, it should be understood who owns the medical record, the significance of the transition to the electronic medical record, problems and pitfalls when using the electronic medical record, and how the Health Information Technology for Economic and Clinical Health Act affects healthcare providers and health information technology.

30 CFR 746.13 - Decision document and recommendation on mining plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Decision document and recommendation on mining plan. 746.13 Section 746.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR FEDERAL LANDS PROGRAM REVIEW AND APPROVAL OF MINING PLANS § 746.13 Decision...

Superfund Record of Decision (EPA Region 5): Spickler Landfill, Operable Unit 2, Spencer, WI, September 29, 1998

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

NONE

This decision document represents the selected remedial action for Operable Unit (OU) No. 2 at the Spickler Landfill Superfund Site (the Site) in Specer, Wisconsin. The United States Environmental Protection Agency (US EPA) has found that no further action is appropriate due to the effectiveness of the remedial action for the first operable unit. Proper closure of the landfills and mercury brine pit, installation of a landfill gas collection and flare and leachate collection systems and continued operation have eliminated the primary human health risk posed by direct contact with contaminated soils, eliminated the threat to the environment, and mitigatedmore » the primary human health risk posed by contaminated Site groundwater and landfill gas. The remedy established by this ROD is the final Remedial Action for this Site.« less

Superfund Record of Decision (EPA Region 8): California Gulch, Operable Unit 10, Leadville, CO, August 8, 1997

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

NONE

1998-01-01

This decision document presents the Selected Remedy for Oregon Gulch OU10 within the California Gulch Superfund Site in Leadville, Colorado. The Selected Remedy includes active management of the seep currently discharging at the toe of the Oregon Gulch Tailing Impoundment during the interim period from implementation until the seep does not negatively impact surface water quality. Active management of the seep discharge will be performed during non-freezing conditions and will include collection and either pumping or transport of the collected flow to the Yak Tunnel Treatment Plant or other suitable treatment options. Design of the Selected Remedy will include amore » drain system at the toe of the embankment to allow the seep discharge to flow unrestricted and to be collected in a controlled manner.« less

Use of Mobile Apps Among Medical and Nursing Students in Iran.

PubMed

Sheikhtaheri, Abbas; Kermani, Farzaneh

2018-01-01

Mobile technologies have a positive impact on patient care and cause to improved decision making, reduced medical errors and improved communication in care team. The purpose of this study was to investigate the use of mobile technologies by medical and nursing students and their tendency in future. This study was conducted among 372 medical and nursing students of Tehran University of Medical Science. Respectively, 60.8% and 62.4% of medical and nursing students use smartphone. The most commonly used apps among medical students were medical dictionary, drug apps, medical calculators and anatomical atlases and among nursing students were medical dictionary, anatomical atlases and nursing care guides. Also, the use of decision support systems, remote monitoring, patient imagery and remote diagnosis, patient records documentation, diagnostic guidelines and laboratory tests will be increased in the future.

A service oriented approach for guidelines-based clinical decision support using BPMN.

PubMed

Rodriguez-Loya, Salvador; Aziz, Ayesha; Chatwin, Chris

2014-01-01

Evidence-based medical practice requires that clinical guidelines need to be documented in such a way that they represent a clinical workflow in its most accessible form. In order to optimize clinical processes to improve clinical outcomes, we propose a Service Oriented Architecture (SOA) based approach for implementing clinical guidelines that can be accessed from an Electronic Health Record (EHR) application with a Web Services enabled communication mechanism with the Enterprise Service Bus. We have used Business Process Modelling Notation (BPMN) for modelling and presenting the clinical pathway in the form of a workflow. The aim of this study is to produce spontaneous alerts in the healthcare workflow in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The use of BPMN as a tool to automate clinical guidelines has not been previously employed for providing Clinical Decision Support (CDS).

Visualizing unstructured patient data for assessing diagnostic and therapeutic history.

PubMed

Deng, Yihan; Denecke, Kerstin

2014-01-01

Having access to relevant patient data is crucial for clinical decision making. The data is often documented in unstructured texts and collected in the electronic health record. In this paper, we evaluate an approach to visualize information extracted from clinical documents by means of tag cloud. Tag clouds will be generated using a bag of word approach and by exploiting part of speech tags. For a real word data set comprising radiological reports, pathological reports and surgical operation reports, tag clouds are generated and a questionnaire-based study is conducted as evaluation. Feedback from the physicians shows that the tag cloud visualization is an effective and rapid approach to represent relevant parts of unstructured patient data. To handle the different medical narratives, we have summarized several possible improvements according to the user feedback and evaluation results.

15 CFR 904.270 - Record of decision.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS CIVIL PROCEDURES Hearing and Appeal Procedures Decision § 904.270 Record of decision. (a) The exclusive record of...

15 CFR 904.270 - Record of decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS CIVIL PROCEDURES Hearing and Appeal Procedures Decision § 904.270 Record of decision. (a) The exclusive record of...

43 CFR 46.315 - How to format an environmental assessment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... planning, decision-making, and appropriate public participation. (b) An environmental assessment may be accompanied by any other planning or decision-making document. The portion of the document that analyzes the...

Superfund record of decision amendment (EPA Region 5): H. Brown Company, Inc., Grand Rapids, MI, February 25, 1998

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

NONE

This decision document amends the September 29, 1995, Record of Decision (ROD) Amendment for the H. Brown Co., Inc. site, in Walker, Michigan. The major components of the selected remedy include: Consolidating contaminated surface soil and sediment requiring cleanup onto the H. Brown property (2200 Turner Avenue N.W.); Redevelopment of the site, by private parties, with warehousing facilities constructed above the contaminated soil; A cover system comprised of clean fill to develop appropriate grades and elevations, concrete slab foundations, asphalt parking areas, and landscaped areas; Long-term maintenance of the cover system to ensure that the cover will continue to preventmore » direct contact with contaminated soil and minimize infiltration of precipitation; Long-term monitoring of the shallow and intermediate aquifers to monitor the effectiveness of the remedy; Monitoring and/or treatment of landfill gas; Restricting the use of the land and the groundwater; Demolishing on-site buildings to accommodate redevelopment; and Cleanup standards for soil will remain the same as in the 1992 ROD. The purpose of this ROD Amendment is to facilitate the re-development of the H. Brown Co., Inc. Site, and if re-development does not occur or proves to be unsuccessful then the remedy selected in the September 29, 1995 ROD Amendment will be implemented.« less

Columnar processing in primate pFC: evidence for executive control microcircuits.

PubMed

Opris, Ioan; Hampson, Robert E; Gerhardt, Greg A; Berger, Theodore W; Deadwyler, Sam A

2012-12-01

A common denominator for many cognitive disorders of human brain is the disruption of neural activity within pFC, whose structural basis is primarily interlaminar (columnar) microcircuits or "minicolumns." The importance of this brain region for executive decision-making has been well documented; however, because of technological constraints, the minicolumnar basis is not well understood. Here, via implementation of a unique conformal multielectrode recording array, the role of interlaminar pFC minicolumns in the executive control of task-related target selection is demonstrated in nonhuman primates performing a visuomotor DMS task. The results reveal target-specific, interlaminar correlated firing during the decision phase of the trial between multielectrode recording array-isolated minicolumnar pairs of neurons located in parallel in layers 2/3 and layer 5 of pFC. The functional significance of individual pFC minicolumns (separated by 40 μm) was shown by reduced correlated firing between cell pairs within single minicolumns on error trials with inappropriate target selection. To further demonstrate dependence on performance, a task-disrupting drug (cocaine) was administered in the middle of the session, which also reduced interlaminar firing in minicolumns that fired appropriately in the early (nondrug) portion of the session. The results provide a direct demonstration of task-specific, real-time columnar processing in pFC indicating the role of this type of microcircuit in executive control of decision-making in primate brain.

15 CFR 930.130 - Closure of the decision record and issuance of decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., when the information in the decision record supports this conclusion. (e)(1) If the Secretary finds... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Closure of the decision record and issuance of decision. 930.130 Section 930.130 Commerce and Foreign Trade Regulations Relating to Commerce...

36 CFR 1232.16 - What documentation must an agency create before it transfers records to a records storage facility?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What documentation must an agency create before it transfers records to a records storage facility? 1232.16 Section 1232.16 Parks... RECORDS TO RECORDS STORAGE FACILITIES § 1232.16 What documentation must an agency create before it...

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.

75 FR 18205 - Notice of Peer Review Meeting for the External Peer Review Drafts of Two Documents on Using...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-09

... Role of Risk Analysis in Decision-Making AGENCY: Environmental Protection Agency (EPA). ACTION: Notice... documents entitled, ``Using Probabilistic Methods to Enhance the Role of Risk Analysis in Decision- Making... Probabilistic Methods to Enhance the Role of Risk Analysis in Decision-Making, with Case Study Examples'' and...

Power, Authority and Decision Making in Teacher Education. Yearbook 1971.

ERIC Educational Resources Information Center

American Association of Colleges for Teacher Education, Washington, DC.

This document is a collection of reports of the American Association of Colleges for Teacher Education (AACTE) for 1971. The title of the document reflects much of the association's concern for that year and is close to the theme of the association's 1971 annual meeting, "Power and Decision Making in Teacher Education." The document is divided…

Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model.

PubMed

Ben-Assuli, Ofir; Leshno, Moshe

2016-09-01

In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. © The Author(s) 2015.

SAMS--a systems architecture for developing intelligent health information systems.

PubMed

Yılmaz, Özgün; Erdur, Rıza Cenk; Türksever, Mustafa

2013-12-01

In this paper, SAMS, a novel health information system architecture for developing intelligent health information systems is proposed and also some strategies for developing such systems are discussed. The systems fulfilling this architecture will be able to store electronic health records of the patients using OWL ontologies, share patient records among different hospitals and provide physicians expertise to assist them in making decisions. The system is intelligent because it is rule-based, makes use of rule-based reasoning and has the ability to learn and evolve itself. The learning capability is provided by extracting rules from previously given decisions by the physicians and then adding the extracted rules to the system. The proposed system is novel and original in all of these aspects. As a case study, a system is implemented conforming to SAMS architecture for use by dentists in the dental domain. The use of the developed system is described with a scenario. For evaluation, the developed dental information system will be used and tried by a group of dentists. The development of this system proves the applicability of SAMS architecture. By getting decision support from a system derived from this architecture, the cognitive gap between experienced and inexperienced physicians can be compensated. Thus, patient satisfaction can be achieved, inexperienced physicians are supported in decision making and the personnel can improve their knowledge. A physician can diagnose a case, which he/she has never diagnosed before, using this system. With the help of this system, it will be possible to store general domain knowledge in this system and the personnel's need to medical guideline documents will be reduced.

Capturing patient information at nursing shift changes: methodological evaluation of speech recognition and information extraction

PubMed Central

Suominen, Hanna; Johnson, Maree; Zhou, Liyuan; Sanchez, Paula; Sirel, Raul; Basilakis, Jim; Hanlen, Leif; Estival, Dominique; Dawson, Linda; Kelly, Barbara

2015-01-01

Objective We study the use of speech recognition and information extraction to generate drafts of Australian nursing-handover documents. Methods Speech recognition correctness and clinicians’ preferences were evaluated using 15 recorder–microphone combinations, six documents, three speakers, Dragon Medical 11, and five survey/interview participants. Information extraction correctness evaluation used 260 documents, six-class classification for each word, two annotators, and the CRF++ conditional random field toolkit. Results A noise-cancelling lapel-microphone with a digital voice recorder gave the best correctness (79%). This microphone was also the most preferred option by all but one participant. Although the participants liked the small size of this recorder, their preference was for tablets that can also be used for document proofing and sign-off, among other tasks. Accented speech was harder to recognize than native language and a male speaker was detected better than a female speaker. Information extraction was excellent in filtering out irrelevant text (85% F1) and identifying text relevant to two classes (87% and 70% F1). Similarly to the annotators’ disagreements, there was confusion between the remaining three classes, which explains the modest 62% macro-averaged F1. Discussion We present evidence for the feasibility of speech recognition and information extraction to support clinicians’ in entering text and unlock its content for computerized decision-making and surveillance in healthcare. Conclusions The benefits of this automation include storing all information; making the drafts available and accessible almost instantly to everyone with authorized access; and avoiding information loss, delays, and misinterpretations inherent to using a ward clerk or transcription services. PMID:25336589

10 CFR 76.41 - Record underlying decisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 2 2013-01-01 2013-01-01 false Record underlying decisions. 76.41 Section 76.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.41 Record underlying decisions. (a) Any decision of the Commission or its designee under this part in any...

10 CFR 76.41 - Record underlying decisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 2 2012-01-01 2012-01-01 false Record underlying decisions. 76.41 Section 76.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.41 Record underlying decisions. (a) Any decision of the Commission or its designee under this part in any...

10 CFR 76.41 - Record underlying decisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 2 2014-01-01 2014-01-01 false Record underlying decisions. 76.41 Section 76.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.41 Record underlying decisions. (a) Any decision of the Commission or its designee under this part in any...

10 CFR 76.41 - Record underlying decisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Record underlying decisions. 76.41 Section 76.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.41 Record underlying decisions. (a) Any decision of the Commission or its designee under this part in any...

10 CFR 76.41 - Record underlying decisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Record underlying decisions. 76.41 Section 76.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.41 Record underlying decisions. (a) Any decision of the Commission or its designee under this part in any...

Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients.

PubMed

Lapham, Gwen T; Rubinsky, Anna D; Shortreed, Susan M; Hawkins, Eric J; Richards, Julie; Williams, Emily C; Berger, Douglas; Chavez, Laura J; Kivlahan, Daniel R; Bradley, Katharine A

2015-08-01

Performance measures for brief alcohol interventions (BIs) are currently based on provider documentation of BI. However, provider documentation may not be a reliable measure of whether or not patients are offered clinically meaningful BIs. In particular, BI documented with clinical decision support in an electronic medical record (EMR) could appear identical irrespective of the quality of BI provided. We hypothesized that differences in how BI was implemented across health systems could lead to differences in the proportion of documented BI recalled and reported by patients across health systems. Male outpatients with unhealthy alcohol use identified by confidential satisfaction surveys (2009-2012) were assessed for whether they reported receiving BI in the past year (patient-reported BI) and whether they had BI documented in the EMR during the same period (documented BI). We evaluated and compared the prevalence of documented BI to patient-reported BI across 21 VA networks to determine whether documented BI had a variable association with patient-reported BI across the networks. Of 9896 eligible male outpatients with unhealthy alcohol use, 59.0% (95% CI 57.4-60.5%) reported BI (50.4-64.9% across networks) and 37.4% (95% CI 36.0-38.9%) had BI documented in the EMR (28.0-44.2% across networks). Overall, 72.9% (95% CI 70.8-75.5%) of patients with documented BI also reported BI. The association between documented BI and patient-reported BI did not vary across VA networks in adjusted logistic regression models. Performance measures of BI that rely on provider documentation in EMRs appear comparable to patient report for comparing care across VA networks. Published by Elsevier Ireland Ltd.

A two-stage clinical decision support system for early recognition and stratification of patients with sepsis: an observational cohort study.

PubMed

Amland, Robert C; Lyons, Jason J; Greene, Tracy L; Haley, James M

2015-10-01

To examine the diagnostic accuracy of a two-stage clinical decision support system for early recognition and stratification of patients with sepsis. Observational cohort study employing a two-stage sepsis clinical decision support to recognise and stratify patients with sepsis. The stage one component was comprised of a cloud-based clinical decision support with 24/7 surveillance to detect patients at risk of sepsis. The cloud-based clinical decision support delivered notifications to the patients' designated nurse, who then electronically contacted a provider. The second stage component comprised a sepsis screening and stratification form integrated into the patient electronic health record, essentially an evidence-based decision aid, used by providers to assess patients at bedside. Urban, 284 acute bed community hospital in the USA; 16,000 hospitalisations annually. Data on 2620 adult patients were collected retrospectively in 2014 after the clinical decision support was implemented. 'Suspected infection' was the established gold standard to assess clinical decision support clinimetric performance. A sepsis alert activated on 417 (16%) of 2620 adult patients hospitalised. Applying 'suspected infection' as standard, the patient population characteristics showed 72% sensitivity and 73% positive predictive value. A postalert screening conducted by providers at bedside of 417 patients achieved 81% sensitivity and 94% positive predictive value. Providers documented against 89% patients with an alert activated by clinical decision support and completed 75% of bedside screening and stratification of patients with sepsis within one hour from notification. A clinical decision support binary alarm system with cross-checking functionality improves early recognition and facilitates stratification of patients with sepsis.

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

The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

PubMed

Rodriguez Torres, Yasaira; Huang, Jordan; Mihlstin, Melanie; Juzych, Mark S; Kromrei, Heidi; Hwang, Frank S

2017-01-01

This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p < 0.0005). Electronic Health Record A had high compliance (>90%) in 13 elements while Electronic Health Record B had high compliance (>90%) in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

42 CFR 420.303 - HHS criteria for requesting books, documents, and records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false HHS criteria for requesting books, documents, and... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROGRAM INTEGRITY: MEDICARE Access to Books, Documents, and Records of Subcontractors § 420.303 HHS criteria for requesting books, documents, and records...

Model Development for EHR Interdisciplinary Information Exchange of ICU Common Goals

PubMed Central

Collins, Sarah A.; Bakken, Suzanne; Vawdrey, David K.; Coiera, Enrico; Currie, Leanne

2010-01-01

Purpose Effective interdisciplinary exchange of patient information is an essential component of safe, efficient, and patient–centered care in the intensive care unit (ICU). Frequent handoffs of patient care, high acuity of patient illness, and the increasing amount of available data complicate information exchange. Verbal communication can be affected by interruptions and time limitations. To supplement verbal communication, many ICUs rely on documentation in electronic health records (EHRs) to reduce errors of omission and information loss. The purpose of this study was to develop a model of EHR interdisciplinary information exchange of ICU common goals. Methods The theoretical frameworks of distributed cognition and the clinical communication space were integrated and a previously published categorization of verbal information exchange was used. 59.5 hours of interdisciplinary rounds in a Neurovascular ICU were observed and five interviews and one focus group with ICU nurses and physicians were conducted. Results Current documentation tools in the ICU were not sufficient to capture the nurses' and physicians' collaborative decision-making and verbal communication of goal-directed actions and interactions. Clinicians perceived the EHR to be inefficient for information retrieval, leading to a further reliance on verbal information exchange. Conclusion The model suggests that EHRs should support: 1) Information tools for the explicit documentation of goals, interventions, and assessments with synthesized and summarized information outputs of events and updates; and 2) Messaging tools that support collaborative decision-making and patient safety double checks that currently occur between nurses and physicians in the absence of EHR support. PMID:20974549

Using Option Grids: steps toward shared decision-making for neonatal circumcision.

PubMed

Fay, Mary; Grande, Stuart W; Donnelly, Kyla; Elwyn, Glyn

2016-02-01

To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement. We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention. Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process. Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making. Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

EHR Documentation: The Hype and the Hope for Improving Nursing Satisfaction and Quality Outcomes.

PubMed

OʼBrien, Ann; Weaver, Charlotte; Settergren, Theresa Tess; Hook, Mary L; Ivory, Catherine H

2015-01-01

The phenomenon of "data rich, information poor" in today's electronic health records (EHRs) is too often the reality for nursing. This article proposes the redesign of nursing documentation to leverage EHR data and clinical intelligence tools to support evidence-based, personalized nursing care across the continuum. The principles consider the need to optimize nurses' documentation efficiency while contributing to knowledge generation. The nursing process must be supported by EHRs through integration of best care practices: seamless workflows that display the right tools, evidence-based content, and information at the right time for optimal clinical decision making. Design of EHR documentation must attain a balance that ensures the capture of nursing's impact on safety, quality, highly reliable care, patient engagement, and satisfaction, yet minimizes "death by data entry." In 2014, a group of diverse informatics leaders from practice, academia, and the vendor community formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. As our health care system moves toward reimbursement on the basis of quality outcomes and prevention, the value of nursing data in this business proposition will become a key differentiator for health care organizations' economic success.

A Framework for Comprehensive Health Terminology Systems in the United States

PubMed Central

Chute, Christopher G.; Cohn, Simon P.; Campbell, James R.

1998-01-01

Health care in the United States has become an information-intensive industry, yet electronic health records represent patient data inconsistently for lack of clinical data standards. Classifications that have achieved common acceptance, such as the ICD-9-CM or ICD, aggregate heterogeneous patients into broad categories, which preclude their practical use in decision support, development of refined guidelines, or detailed comparison of patient outcomes or benchmarks. This document proposes a framework for the integration and maturation of clinical terminologies that would have practical applications in patient care, process management, outcome analysis, and decision support. Arising from the two working groups within the standards community—the ANSI (American National Standards Institute) Healthcare Informatics Standards Board Working Group and the Computer-based Patient Records Institute Working Group on Codes and Structures—it outlines policies regarding 1) functional characteristics of practical terminologies, 2) terminology models that can broaden their applications and contribute to their sustainability, 3) maintenance attributes that will enable terminologies to keep pace with rapidly changing health care knowledge and process, and 4) administrative issues that would facilitate their accessibility, adoption, and application to improve the quality and efficiency of American health care. PMID:9824798

Superfund Explanation of Significant Difference for the Record of Decision (EPA Region 8): Silver Bow Creek/Butte Area, Silver Bow and Deer Lodge, MT, August 31, 1998

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

Not Available

1998-12-01

This document presents an Explanation of Significant Differences from the Record of Decision (ROD) for one Streamside Tailings Operable Unit (SSTOU) of the Silver Bow Creek/Butte Area National Priorities List (NPL) Site. The significant differences discussed in this ESD are: An increase in the volume of tailings/impacted soil in the operable unit; Modifications to the alignment of Silver Bow Creek and the channel profile (i.e., elevation profile); Use of a temporary stream diversion during and after construction to facilitate dewatering and excavation of near-stream tailings and to enhance floodplain and streambank revegetation efforts; Changes in the criteria for in-stream sedimentmore » removal as a result of other design changes; Modifications to the mine waste relocation repository (MWRR) design; The inclusion of sediment basins to contain contaminated overland flow run-on from off-site mine waste sources; Elimination of treatment wetlands as the end land use in Subarea 1; Changes in the estimated schedule to implement the SSTOU remedy; and An increase in the estimated cost of the SSTOU remedy.« less

Communal visual histories to detect environmental change in northern areas: Examples of emerging North American and Eurasian practices.

PubMed

Mustonen, Tero

2015-12-01

This article explores the pioneering potential of communal visual-optic histories which are recorded, painted, documented, or otherwise expressed. These materials provide collective meanings of an image or visual material within a specific cultural group. They potentially provide a new method for monitoring and documenting changes to ecosystem health and species distribution, which can effectively inform society and decision makers of Arctic change. These visual histories can be positioned in a continuum that extends from rock art to digital photography. They find their expressions in forms ranging from images to the oral recording of knowledge and operate on a given cultural context. For monitoring efforts in the changing boreal zone and Arctic, a respectful engagement with visual histories can reveal emerging aspects of change. The examples from North America and case studies from Eurasia in this article include Inuit sea ice observations, Yu'pik visual traditions of masks, fish die-offs in a sub-boreal catchment area, permafrost melt in the Siberian tundra and early, first detection of a scarabaeid beetle outbreak, a Southern species in the Skolt Sámi area. The pros and cons of using these histories and their reliability are reviewed.

Exploring medical student decisions regarding attending live lectures and using recorded lectures.

PubMed

Gupta, Anmol; Saks, Norma Susswein

2013-09-01

Student decisions about lecture attendance are based on anticipated effect on learning. Factors involved in decision-making, the use of recorded lectures and their effect on lecture attendance, all warrant investigation. This study was designed to identify factors in student decisions to attend live lectures, ways in which students use recorded lectures, and if their use affects live lecture attendance. A total of 213 first (M1) and second year (M2) medical students completed a survey about lecture attendance, and rated factors related to decisions to attend live lectures and to utilize recorded lectures. Responses were analyzed overall and by class year and gender. M1 attended a higher percentage of live lectures than M2, while both classes used the same percentage of recorded lectures. Females attended more live lectures, and used a smaller percentage of recorded lectures. The lecturer was a key in attendance decisions. Also considered were the subject and availability of other learning materials. Students use recorded lectures as replacement for live lectures and as supplement to them. Lectures, both live and recorded, are important for student learning. Decisions about lecture placement in the curriculum need to be based on course content and lecturer quality.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 541: Small Boy Nevada National Security Site and Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

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

Kidman, Raymond; Matthews, Patrick

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 541 based on the no further action alternative listed in Table ES-1.

25 CFR 1000.69 - How can a Tribe/Consortium obtain comments or selection documents received or utilized after OSG...

Code of Federal Regulations, 2010 CFR

2010-04-01

...-DETERMINATION AND EDUCATION ACT Other Financial Assistance for Planning and Negotiation Grants for Non-BIA... documents received or utilized after OSG has made a decision on a planning grant application? 1000.69... selection documents received or utilized after OSG has made a decision on a planning grant application? A...

Phytotechnology Technical and Regulatory Guidance Document

DTIC Science & Technology

2001-04-01

contaminated media is rather new. Throughout the development process of this document, we referred to the science as “ phytoremediation .” Recently...the media containing contaminants, we now refer to “phytotechnologies” as the overarching terminology, while using “ phytoremediation ” more...publication of the ITRC document, Phytoremediation Decision Tree. The decision tree was designed to allow potential users to take basic information

77 FR 2993 - Final Environmental Impact Statement and Record of Decision on Oncor Electric Delivery Company's...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-20

...-FF02ENEH00] Final Environmental Impact Statement and Record of Decision on Oncor Electric Delivery Company's... the final environmental impact statement (EIS), and final record of decision under the National... implementation of the final Oncor Electric Delivery LLC's Habitat Conservation Plan (HCP). Our decision is to...

Assessing decision quality in patient-centred care requires a preference-sensitive measure

PubMed Central

Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack

2014-01-01

A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term ‘decision quality’ have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient’s individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient’s record. PMID:24335587

Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya.

PubMed

Omondi, Stephen; Weru, John; Shaikh, Asim Jamal; Yonga, Gerald

2017-01-25

An advance directive (AD) is a written or verbal document that legally stipulates a person's health care preference while they are competent to make decisions for themselves and is used to guide decisions on life-sustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of terminally ill patients with AD and to identify the factors that influence the completion of AD amongst terminally ill patients at a tertiary hospital in Kenya. The study was a retrospective survey. All available records of terminally ill patients seen at Aga Khan University Hospital, Nairobi, between July 2010 and December 2015, and that met the inclusion criteria were included in the study. In total, 216 records of terminally ill patients were analyzed: 89 records were of patients that had AD and 127 records were of patients that did not have AD. The proportion of terminally ill patients that had completed AD was 41.2%. The factors that were associated with the completion of AD on bivariate analysis were history of ICU admission, history of endotracheal intubation, functional status of the patient, the medical specialty taking care of the patient, patient's caregiver discussing the AD with the patient, and a palliative specialist review. On multivariate regression analysis, discussion of AD with a caregiver and patient's functional impairment were the factors with statistically significant association with completion of AD. The proportion of terminally ill patients that had AD in their medical records was significant. However, most terminally ill patients did not have AD. Our data, perhaps the first on the subject in East Africa, suggest that most of the factors associated with AD completion mirrored those seen in other regions of the world. Discussion between patient and their physician and patient's functional impairment were the factors independently associated with completion of AD. Therefore, physicians need to be aware of the importance of discussions of AD with their patients.

42 CFR 420.304 - Procedures for obtaining access to books, documents, and records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Procedures for obtaining access to books, documents... Books, Documents, and Records of Subcontractors § 420.304 Procedures for obtaining access to books... following elements: (1) Reasonable identification of the books, documents, and records to which access is...

Quality of nursing documentation: Paper-based health records versus electronic-based health records.

PubMed

Akhu-Zaheya, Laila; Al-Maaitah, Rowaida; Bany Hani, Salam

2018-02-01

To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes. © 2017 John Wiley & Sons Ltd.

Quality and correlates of medical record documentation in the ambulatory care setting

PubMed Central

Soto, Carlos M; Kleinman, Kenneth P; Simon, Steven R

2002-01-01

Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Methods We reviewed electronic medical records from 834 patients receiving care from 167 physicians (117 internists and 50 pediatricians) at 14 sites of a multi-specialty medical group in Massachusetts. We abstracted information for five measures of medical record documentation quality: smoking history, medications, drug allergies, compliance with screening guidelines, and immunizations. From other sources we determined physicians' specialty, gender, year of medical school graduation, and self-reported time spent teaching and in patient care. Results Among internists, unadjusted rates of documentation were 96.2% for immunizations, 91.6% for medications, 88% for compliance with screening guidelines, 61.6% for drug allergies, 37.8% for smoking history. Among pediatricians, rates were 100% for immunizations, 84.8% for medications, 90.8% for compliance with screening guidelines, 50.4% for drug allergies, and 20.4% for smoking history. While certain physician and patient characteristics correlated with some measures of documentation quality, documentation varied depending on the measure. For example, female internists were more likely than male internists to document smoking history (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.27 – 2.83) but were less likely to document drug allergies (OR, 0.51; 95% CI, 0.35 – 0.75). Conclusions Medical record documentation varied depending on the measure, with room for improvement in most domains. A variety of characteristics correlated with medical record documentation, but no pattern emerged. Further study could lead to targeted interventions to improve documentation. PMID:12473161

Superfund Site Information

EPA Pesticide Factsheets

This asset includes a number of individual data sets related to site-specific information for Superfund, which is governed under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) of 1980, which was amended by the Superfund Amendments and Reauthorization Act (SARA) in 1986. The Superfund Enterprise Management System (SEMS) contains basic site description, location, schedule of activities, enforcement and settlement data, contaminants and selected remedy and much more, as well as the records that clearly document site decisions. This asset also includes sampling data and lab results (CLPSS, EDDs), redevelopment and technical assistance case studies, site reuse and land revitalization information, EPAOSC.net information, Superfund Technical Assistance Grants information, site management information records (RODs, Remediation plans, cleanup directives), contract management information, and more.Superfund site management information can also be found in agency wide systems such as EAS and COMPASS.

75 FR 137 - Amended Record of Decision: Idaho High-Level Waste and Facilities Disposition Final Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

... DEPARTMENT OF ENERGY Amended Record of Decision: Idaho High-Level Waste and Facilities Disposition Final Environmental Impact Statement Revised by State 12/ 21/09 AGENCY: Department of Energy. ACTION: Amended Record of Decision. SUMMARY: The U.S. Department of Energy (DOE) is amending its initial Record of...

If you did not document it, it did not happen: rates of documentation of discussion of infertility risk in adolescent and young adult oncology patients' medical records.

PubMed

Quinn, Gwendolyn P; Block, Rebecca G; Clayman, Marla L; Kelvin, Joanne; Arvey, Sarah R; Lee, Ji-Hyun; Reinecke, Joyce; Sehovic, Ivana; Jacobsen, Paul B; Reed, Damon; Gonzalez, Luis; Vadaparampil, Susan T; Laronga, Christine; Lee, M Catherine; Pow-Sang, Julio; Eggly, Susan; Franklin, Anna; Shah, Bijal; Fulp, William J; Hayes-Lattin, Brandon

2015-03-01

The adolescent and young adult (AYA) population is underserved because of unique late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients' medical records at four cancer centers. All centers reviewed randomized records within the top four AYA disease sites (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible records included those of patients: diagnosed in 2011, with no prior receipt of gonadotoxic therapy; age 18 to 45 years; with no multiple primary cancers; and for whom record was not second opinion. Quality Oncology Practice Initiative methods were used to evaluate documentation of discussion of risk of infertility, discussion of FP options, and referral to a fertility specialist. Of 231 records, 26% documented infertility risk discussion, 24% documented FP option discussion, and 13% documented referral to a fertility specialist. Records were less likely to contain evidence of infertility risk and FP option discussions for female patients (P = .030 and .004, respectively) and those with breast cancer (P = .021 and < .001, respectively). Records for Hispanic/Latino patients were less likely to contain evidence of infertility risk discussion (P = .037). Records were less likely to document infertility risk discussion, FP option discussion, and fertility specialist referral for patients age ≥ 40 years (P < .001, < .001, and .002, respectively) and those who already had children (all P < .001). The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups. Although greater numbers of discussions may be occurring, there is a need to create interventions to improve documentation. Copyright © 2014 by American Society of Clinical Oncology.

Superfund record of decision (EPA Region 4): Milan Army Ammunition Plant, operable units 3 and 4, Milan, TN, October 2, 1995

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

NONE

1996-03-01

This decision document presents the selected remedial action for the soil within the northern industrial area of Milan Army Ammunition Plant, Milan, Tennessee. The goal of the cleanup activities at the northern industrial areas of MAAP is to remove the soil contaminated with explosives compounds above risk-based levels. The excavated soil will be treated using a bioremediation process to reduce the concentrations of explosives compounds, the toxicity of the leachate, and the mobility of the remaining organic compounds. The treated soil will then be placed in an on-site solid waste landfill in compliance with State of Tennessee regulations. Additionally, inmore » areas where excavation of the explosives-contaminated soil is infeasible, the soil will be covered with an engineered cap to prevent worker exposure to the explosives compounds and prevent leaching of these compounds to groundwater.« less

Autopsy issues in German Federal Republic transplantation legislation until 1997.

PubMed

Schweikardt, Christoph

2014-01-01

This article analyzes the relevance of autopsy issues for German Federal Republic transplantation legislation until 1997 against the background of legal traditions and the distribution of constitutional legislative powers. It is based on Federal Ministry of Justice records and German Parliament documents on transplantation legislation. Transplantation and autopsy legislation started with close ties in the 1970s. Viewing transplantation legislation as relevant for future autopsy regulation contributed to the decision to stall transplantation legislation, because the interests of the federal government and the medical profession converged to avoid subsequent restrictions on the practice of conducting autopsies and procuring tissues for transplantation. Sublegal norms were insufficient for the prosecution of the organ trade and area-wide transplantation regulation after the reunification of Germany. In contrast to autopsy issues, legislative power for transplantation issues was extended to the federal level by an amendment to the constitution, allowing decision making for Germany as a whole.

Big Data and Perioperative Nursing.

PubMed

Westra, Bonnie L; Peterson, Jessica J

2016-10-01

Big data are large volumes of digital data that can be collected from disparate sources and are challenging to analyze. These data are often described with the five "Vs": volume, velocity, variety, veracity, and value. Perioperative nurses contribute to big data through documentation in the electronic health record during routine surgical care, and these data have implications for clinical decision making, administrative decisions, quality improvement, and big data science. This article explores methods to improve the quality of perioperative nursing data and provides examples of how these data can be combined with broader nursing data for quality improvement. We also discuss a national action plan for nursing knowledge and big data science and how perioperative nurses can engage in collaborative actions to transform health care. Standardized perioperative nursing data has the potential to affect care far beyond the original patient. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Enduring powers of attorney: promoting attorneys' accountability as substitute decision makers.

PubMed

Tilse, Cheryl; Wilson, Jill; White, Ben; Willmott, Lindy; McCawley, Anne-Louise

2014-09-01

The misuse and abuse of Enduring Powers of Attorney (EPAs) by attorneys, particularly in relation to financial decision-making, is a growing concern. This paper explores the opportunities to enhance accountability of attorneys at the time of the execution of the document in Queensland. A four-stage multi-method design comprised a critical reference group; semi-structured interviews with 32 principals or potential principals, attorneys and witnesses; two focus groups with service providers and a state-wide survey of 76 principals, attorneys and witnesses. Across all methods and user groups, understanding the role and obligations of the attorney in an EPA was consistently identified as problematic. Promoting accountability and understanding can be addressed by greater attention to the role of the attorney in the forms/ guidelines and in the structure and witnessing of the forms, increased direction about record keeping and access to appropriate advice and support. © 2013 ACOTA.

Using the eXtensible Markup Language (XML) in a regional electronic patient record for patients with malignant diseases.

PubMed

Wolff, A C; Mludek, V; van der Haak, M; Bork, W; Bülzebruck, H; Drings, P; Schmücker, P; Wannenmacher, M; Haux, R

2001-01-01

Communication between different institutions which are responsible for the treatment of the same patient is of outstanding significance, especially in the field of tumor diseases. Regional electronic patient records could support the co-operation of different institutions by providing ac-cess to all necessary information whether it belongs to the own institution or to a partner. The Department of Medical Informatics, University of Heidelberg is performing a project in co-operation with the Thoraxclinic-Heidelberg and the Department of Clinical Radiology, University of Heidelberg with the goal: to define an architectural concept for interlinking the electronic patient record of the two clinical institutions to build a common virtual electronic patient record and carry out an exemplary implementation, to examine composition, structure and content of medical documents for tumor patients with the aim of defining an XML-based markup language allowing summarizing overviews and suitable granularities, and to integrate clinical practice guidelines and other external knowledge with the electronic patient record using XML-technologies to support the physician in the daily decision process. This paper will show, how a regional electronic patient record could be built on an architectural level and describe elementary steps towards a on content-oriented structuring of medical records.

2011 Remediation Effectiveness Report for the U.S. Department of Energy Oak Ridge Reservation, Oak Ridge, Tennessee - Data and Evaluations

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

Bechtel Jacobs

2011-03-01

Under the requirements of the Oak Ridge Reservation (ORR) Federal Facility Agreement (FFA) established between the U.S. Department of Energy (DOE), the U.S. Environmental Protection Agency, (EPA) and the Tennessee Department of Environment and Conservation (TDEC) in 1992, all environmental restoration activities on the ORR are performed in accordance with the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Since the 1990s, the environmental restoration activities have experienced a gradual shift from characterization to remediation. As this has occurred, it has been determined that the assessment of the individual and cumulative performance of all ORR CERCLA remedial actionsmore » (RAs) is most effectively tracked in a single document. The Remediation Effectiveness Report (RER) is an FFA document intended to collate all ORR CERCLA decision requirements, compare pre- and post-remediation conditions at CERCLA sites, and present the results of any required post-decision remediation effectiveness monitoring. First issued in 1997, the RER has been reissued annually to update the performance histories of completed actions and to add descriptions of new CERCLA actions. Monitoring information used in the 2011 RER to assess remedy performance was collected and/or compiled by DOE's Water Resources Restoration Program (WRRP). Only data used to assess performance of completed actions are provided. In addition to collecting CERCLA performance assessment data, the WRRP also collects baseline data to be used to gauge the effectiveness of future actions once implemented. These baseline data are maintained in the Oak Ridge Environmental Information System and will be reported in future RERs, as necessary, once the respective actions are completed. However, when insufficient data exist to assess the impact of the RAs, e.g., when the RA was only recently completed, a preliminary evaluation is made of early indicators of effectiveness at the watershed scale, such as contaminant trends at surface water integration points (IFs). Long-term stewardship (LTS) information used in this report is collected, compiled, and tracked by the WRRP in conjunction with the Bechtel Jacobs Company LLC (BJC) Surveillance and Maintenance (S&M) program, the BJC Radiation Protection Organization at East Tennessee Technology Park (ETTP), ETTP Environmental Compliance Program, B&W Y-12 Liquid Waste Treatment Operations, and UT Battelle Facilities Management Division. Additionally, documentation verifying the implementation of administrative land use controls (LUCs) [i.e., property record restrictions, property record notices, zoning notices, and excavation/penetration permit (EPP) program] is also obtained from many sources throughout the fiscal year (FY), including County Register of Deeds offices for property record restrictions and property record notices, City Planning Commission for zoning notices, and BJC project engineers for EPP program verification. Copies of this documentation are obtained by the WRRP and maintained with the project RER files.« less

42 CFR 420.304 - Procedures for obtaining access to books, documents, and records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Procedures for obtaining access to books, documents... Access to Books, Documents, and Records of Subcontractors § 420.304 Procedures for obtaining access to books, documents, and records. (a) Contents of the request. Requests for access will be in writing and...

42 CFR 420.304 - Procedures for obtaining access to books, documents, and records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Procedures for obtaining access to books, documents... Access to Books, Documents, and Records of Subcontractors § 420.304 Procedures for obtaining access to books, documents, and records. (a) Contents of the request. Requests for access will be in writing and...

42 CFR 420.304 - Procedures for obtaining access to books, documents, and records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Procedures for obtaining access to books, documents... Access to Books, Documents, and Records of Subcontractors § 420.304 Procedures for obtaining access to books, documents, and records. (a) Contents of the request. Requests for access will be in writing and...

Superfund Public Information System (SPIS), January 1999

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

NONE

1999-01-01

The Superfund Public Information System (SPIS) on CD-ROM contains Superfund data for the United States Environmental Protection Agency. The Superfund data is a collection of three databases: Records of Decision (RODS); Comprehensive Environmental, Response, Compensation, and Liability Information System (CERCLIS); and Archive (NFRAP). Descriptions of these databases and CD contents are listed below. Data content: The CD contains the complete text of the official ROD documents signed and issued by EPA from fiscal years 1982--1996; 147 RODs for fiscal year 1997; and seven RODs for fiscal year 1998. The CD also contains 89 Explanation of Significant Difference (ESD) documents, asmore » well as 48 ROD Amendments. CERCLIS and Archive (NFRAP) data is through January 19, 1999. RODS is the Records Of Decision System. RODS is used to track site clean-ups under the Superfund program to justify the type of treatment chosen at each site. RODS contains information on technology justification, site history, community participation, enforcement activities, site characteristics, scope and role of response action, and remedy. Explanation of Significant Differences (ESDs) are also available on the CD. CERCLIS is the Comprehensive Environmental Response, Compensation, and Liability Information System. It is the official repository for all Superfund site and incident data. It contains comprehensive information on hazardous waste sites, site inspections, preliminary assessments, and remedial status. The system is sponsored by the EPA`s Office of Emergency and Remedial Response, Information Management Center. Archive (NFRAP) consists of hazardous waste sites that have no further remedial action planned; only basic identifying information is provided for archive sites. The sites found in the Archive database were originally in the CERCLIS database, but were removed beginning in the fall of 1995.« less

Towards a deeper understanding of parenting on farms: A qualitative study.

PubMed

Elliot, Valerie; Cammer, Allison; Pickett, William; Marlenga, Barbara; Lawson, Joshua; Dosman, James; Hagel, Louise; Koehncke, Niels; Trask, Catherine

2018-01-01

Children living on farms experience exceptionally high risks for traumatic injury. There is a large body of epidemiological research documenting this phenomenon, yet few complementary studies that have explored the deep underlying reasons for such trends. Fundamental to this is understanding the decision-making processes of parents surrounding their choice to bring children, or not, into the farm worksite. To (1) document farm parent views of the risks and benefits of raising children on a family farm, and, (2) understand more deeply why children are brought into the farm worksite. Interviews were conducted as part of a larger cohort study, The Saskatchewan Farm Injury Cohort. Subsequent to an initial mail-out question focused on parental decision-making, 11 semi-structured telephone interviews were conducted with rural Saskatchewan farm parents. Interviews were digitally recorded and transcribed verbatim, then thematically analyzed using interpretive description methodology. This parental decision-making process on farms fundamentally involves weighing the risks vs. benefits of bringing children into the worksite, as if on a balance scale. One side of this scale holds potential risks such as exposure to physical and chemical farm hazards, in the absence of full supervision. The other side holds potential benefits such as meeting family needs for childcare, labour, and family time; building work ethic and pride; and the positive impacts of involvement and responsibility. Decision-making 'tips the scales', in part dependent upon parental perceptions of the risk-benefit trade-off. This 'perceptual lens' is influenced by factors such as: the agricultural way of life, parents' prior knowledge and past experience, characteristics of children, and safety norms. This novel qualitative study provides deep insight into how Saskatchewan farm parents approach a fundamental decision-making process associated with their parenting. The proposed model provides insight into the etiology of pediatric farm injuries as well as their prevention.

Towards a deeper understanding of parenting on farms: A qualitative study

PubMed Central

Elliot, Valerie; Cammer, Allison; Pickett, William; Marlenga, Barbara; Lawson, Joshua; Dosman, James; Hagel, Louise; Koehncke, Niels

2018-01-01

Background Children living on farms experience exceptionally high risks for traumatic injury. There is a large body of epidemiological research documenting this phenomenon, yet few complementary studies that have explored the deep underlying reasons for such trends. Fundamental to this is understanding the decision-making processes of parents surrounding their choice to bring children, or not, into the farm worksite. Objectives To (1) document farm parent views of the risks and benefits of raising children on a family farm, and, (2) understand more deeply why children are brought into the farm worksite. Methods Interviews were conducted as part of a larger cohort study, The Saskatchewan Farm Injury Cohort. Subsequent to an initial mail-out question focused on parental decision-making, 11 semi-structured telephone interviews were conducted with rural Saskatchewan farm parents. Interviews were digitally recorded and transcribed verbatim, then thematically analyzed using interpretive description methodology. Findings This parental decision-making process on farms fundamentally involves weighing the risks vs. benefits of bringing children into the worksite, as if on a balance scale. One side of this scale holds potential risks such as exposure to physical and chemical farm hazards, in the absence of full supervision. The other side holds potential benefits such as meeting family needs for childcare, labour, and family time; building work ethic and pride; and the positive impacts of involvement and responsibility. Decision-making 'tips the scales', in part dependent upon parental perceptions of the risk-benefit trade-off. This 'perceptual lens' is influenced by factors such as: the agricultural way of life, parents' prior knowledge and past experience, characteristics of children, and safety norms. Conclusions This novel qualitative study provides deep insight into how Saskatchewan farm parents approach a fundamental decision-making process associated with their parenting. The proposed model provides insight into the etiology of pediatric farm injuries as well as their prevention. PMID:29897960

Promoting advance planning for health care and research among older adults: A randomized controlled trial

PubMed Central

2012-01-01

Background Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/Design Dyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments. Discussion This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system. Trial Registration ISRCTN89993391 PMID:22221980

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

Moren, Richard J.; Grindstaff, Keith D.

Hanford's Long-Term Stewardship (LTS) Program has evolved from a small, informal process, with minimal support, to a robust program that provides comprehensive transitions from cleanup contractors to long-term stewardship for post-cleanup requirements specified in the associated cleanup decision documents. The LTS Program has the responsibility for almost 100,000 acres of land, along with over 200 waste sites and will soon have six cocooned reactors. Close to 2,600 documents have been identified and tagged for storage in the LTS document library. The program has successfully completed six consecutive transitions over the last two years in support of the U.S. DOE Richlandmore » Operations Office's (DOE-RL) near-term cleanup objectives of significantly reducing the footprint of active cleanup operations for the River Corridor. The program has evolved from one that was initially responsible for defining and measuring Institutional Controls for the Hanford Site, to a comprehensive, post remediation surveillance and maintenance program that begins early in the transition process. In 2013, the first reactor area -- the cocooned 105-F Reactor and its surrounding 1,100 acres, called the F Area was transitioned. In another first, the program is expected to transition the five remaining cocooned reactors into the program through using a Transition and Turnover Package (TTP). As Hanford's LTS Program moves into the next few years, it will continue to build on a collaborative approach. The program has built strong relationships between contractors, regulators, tribes and stakeholders and with the U.S. Department of Energy's Office of Legacy Management (LM). The LTS Program has been working with LM since its inception. The transition process utilized LM's Site Transition Framework as one of the initial requirement documents and the Hanford Program continues to collaborate with LM today. One example of this collaboration is the development of the LTS Program's records management system in which, LM has been instrumental. The development of a rigorous data collection and records management systems has been influenced and built off of LMs success, which also ensures compatibility between what Hanford's LTS Program develops and LM. In another example, we are exploring a pilot project to ship records from the Hanford Site directly to LM for long-term storage. This pilot would gain program efficiencies so that records would be handled only once. Rather than storage on-site, then shipment to an interim Federal Records Center in Seattle, records would be shipped directly to LM. The Hanford LTS Program is working to best align programmatic processes, find efficiencies, and to benchmark site transition requirements. Involving the Hanford LTS Program early in the transition process with an integrated contractor and DOE team is helping to ensure that there is time to work through details on the completed remediation of transitioning areas. It also will allow for record documentation and storage for the future, and is an opportunity for the program to mature through the experiences that will be gained by implementing LTS Program activities over time.« less

Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

PubMed Central

2014-01-01

Background Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings. Methods A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session. Results Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 – 0.95, p = 0.016). Conclusion The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women. PMID:24884597

Introduction to cognitive processes of expert pilots.

PubMed

Adams, R J; Ericsson, A E

2000-10-01

This report addresses the historical problem that a very high percentage of accidents have been classified as involving "pilot error." Through extensive research since 1977, the Federal Aviation Administration determined that the predominant underlying cause of these types of accidents involved decisional problems or cognitive information processing. To attack these problems, Aeronautical Decision Making (ADM) training materials were developed and tested for ten years. Since the publication of the ADM training manuals in 1987, significant reductions in human performance error (HPE) accidents have been documented both in the U.S. and world wide. However, shortcomings have been observed in the use of these materials for recurrency training and in their relevance to more experienced pilots. The following discussion defines the differences between expert and novice decision makers from a cognitive information processing perspective, correlates the development of expert pilot cognitive processes with training and experience, and reviews accident scenarios which exemplify those processes. This introductory material is a necessary prerequisite to an understanding of how to formulate expert pilot decision making training innovations; and, to continue the record of improved safety through ADM training.

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

Tiradani, Tiradani,Anthony; Altunay, Mine; Dagenhart, David

The Decision Engine is a critical component of the HEP Cloud Facility. It provides the functionality of resource scheduling for disparate resource providers, including those which may have a cost or a restricted allocation of cycles. Along with the architecture, design, and requirements for the Decision Engine, this document will provide the rationale and explanations for various design decisions. In some cases, requirements and interfaces for a limited subset of external services will be included in this document. This document is intended to be a high level design. The design represented in this document is not complete and does notmore » break everything down in detail. The class structures and pseudo-code exist for example purposes to illustrate desired behaviors, and as such, should not be taken literally. The protocols and behaviors are the important items to take from this document. This project is still in prototyping mode so flaws and inconsistencies may exist and should be noted and treated as failures.« less

Identification of pseudobulbar affect symptoms in the nursing home setting: Development and assessment of a screening tool.

PubMed

Allen, Carrie; Zarowitz, Barbara; O'Shea, Terrence; Peterson, Edward; Yonan, Charles; Waterman, Fanta

Pseudobulbar Affect (PBA) is a neurologic condition characterized by involuntary outbursts of crying and/or laughing disproportionate to patient mood or social context. Although an estimated 9% of nursing home residents have symptoms suggestive of PBA, they are not routinely screened. Our goal was to develop an electronic screening tool based upon characteristics common to nursing home residents with PBA identified through medical record data. Nursing home residents with PBA treated with dextromethorphan hydrobromide/quinidine sulfate (n = 140) were compared to age-, gender-, and dementia-diagnosis-matched controls without PBA or treatment (n = 140). Comparative categories included diagnoses, medication use and symptom documentation. Using a multivariable regression and best decision rule analysis, we found PBA in nursing home residents was associated with chart documentation of uncontrollable crying, presence of a neurologic disorder (e.g., Parkinson's disease), or by the documented presence of at least 2 of the following: stroke, severe cognitive impairment, and schizophrenia. Based on these risk factors, an electronic screening tool was created. Copyright © 2017 Elsevier Inc. All rights reserved.

The military health system's personal health record pilot with Microsoft HealthVault and Google Health.

PubMed

Do, Nhan V; Barnhill, Rick; Heermann-Do, Kimberly A; Salzman, Keith L; Gimbel, Ronald W

2011-01-01

To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft® HealthVault and Google® Health infrastructure based on user preference. A pilot project was conducted in 2008-2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft® HealthVault and Google® Health based on user preference. The project design and implementation were guided by provider and patient advisory panels with formal user evaluation. The pilot project included 250 beneficiary users. Approximately 73.2% of users were < 65 years of age, and 38.4% were female. Of the users, 169 (67.6%) selected Microsoft® HealthVault, and 81 (32.4%) selected Google® Health as their PHR of preference. Sample evaluation of users reflected 100% (n = 60) satisfied with convenience of record access and 91.7% (n = 55) satisfied with overall functionality of PHR. Key lessons learned related to data-transfer decisions (push vs pull), purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow, and decisions on information patients may choose to share with their provider. Currently PHRs are being viewed as empowering tools for patient activation. Design and implementation issues (eg, technical, organizational, information security) are substantial and must be thoughtfully approached. Adopting standards into design can enhance the national goal of portability and interoperability.

77 FR 5780 - Record of Decision for the White Elk Military Operations Area White Pine and Elko Counties...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-06

... DEPARTMENT OF DEFENSE Department of the Air Force Record of Decision for the White Elk Military... Availability (NOA) of a Record of Decision (ROD). SUMMARY: On November 4, 2011, the United States Air Force... states the Air Force decision to select the Proposed Action to establish the White Elk MOA airspace...

Promoting advance care planning among community-based older adults: A randomized controlled trial.

PubMed

Bravo, Gina; Trottier, Lise; Arcand, Marcel; Boire-Lavigne, Anne-Marie; Blanchette, Danièle; Dubois, Marie-France; Guay, Maryse; Lane, Julie; Hottin, Paule; Bellemare, Suzanne

2016-11-01

To test an intervention designed to motivate older adults in documenting their healthcare preferences in advance, and to guide proxies in making hypothetical decisions that match those of the older adult. The trial involved 235 older adults, of which half were assisted in communicating their wishes to their proxy. Hypothetical vignettes were used at baseline and twice after the intervention to elicit older adults' preferences and assess their proxy's ability to predict them. By the end of the trial, 80% of older adults allocated to the experimental group had documented their wishes. Changes over time in mean accuracy scores did not differ between groups for any hypothetical situations, except when limiting the sample to dyads that were highly discordant at baseline. The intervention motivated a large proportion of older adults to express their preferences but had little effect on proxies' ability to predict them. Educational tools developed for this study will assist healthcare providers in helping older adults to record their wishes in advance. Clients must be informed of the challenge of making substitute decisions and of the need to discuss the amount of leeway the proxy should have in interpreting expressed wishes. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

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

NONE

In the Bear Creek Valley Watershed Remedial Investigation, the Boneyard/Burnyard was identified as the source of the largest releases of uranium into groundwater and surface water in Bear Creek Valley. The proposed action for remediation of this site is selective excavation and removal of source material and capping of the remainder of the site. The schedule for this action has been accelerated so that this is the first remedial action planned to be implemented in the Bear Creek Valley Record of Decision. Additional data needs to support design of the remedial action were identified at a data quality objectives meetingmore » held for this project. Sampling at the Boneyard/Burnyard will be conducted through the use of a phased approach. Initial or primary samples will be used to make in-the-field decisions about where to locate follow-up or secondary samples. On the basis of the results of surface water, soil, and groundwater analysis, up to six test pits will be dug. The test pits will be used to provide detailed descriptions of source materials and bulk samples. This document sets forth the requirements and procedures to protect the personnel involved in this project. This document also contains the health and safety plan, quality assurance project plan, waste management plan, data management plan, implementation plan, and best management practices plan for this project as appendices.« less

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

PubMed

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

2016-03-01

Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. © The Author(s) 2014.

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false How is the decision made to issue or deny..., PURCHASE, BARTER, EXPORTATION, AND IMPORTATION OF WILDLIFE AND PLANTS (CONTINUED) CONVENTION ON... Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

No Further Remedial Action Planned Decision Document for Site 3.

DTIC Science & Technology

1998-04-01

INSTALLATION RESTORATION PROGRAM No FURTHER REMEDIAL ACTION PLANNED DECISION DOCUMENT FOR SITE 3 FINAL MICHIGAN AIR NATIONAL GUARD ALPENA ...COMBAT READINESS TRAINING CENTER ALPENA , MICHIGAN April 1998 Air National Guard Andrews AFB, Maryland &nc QUALITY IMSmm«^ 19980519 204 XA REPORT...Document for Site 3 at Alpena CRTC, Alpena , MI. 6. AUTHOR(S) N/A 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Montgomery

Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.

PubMed

Narayanan, Jaishree; Dobrin, Sofia; Choi, Janet; Rubin, Susan; Pham, Anna; Patel, Vimal; Frigerio, Roberta; Maurer, Darryck; Gupta, Payal; Link, Lourdes; Walters, Shaun; Wang, Chi; Ji, Yuan; Maraganore, Demetrius M

2017-01-01

Using the electronic medical record (EMR) to capture structured clinical data at the point of care would be a practical way to support quality improvement and practice-based research in epilepsy. We describe our stepwise process for building structured clinical documentation support tools in the EMR that define best practices in epilepsy, and we describe how we incorporated these toolkits into our clinical workflow. These tools write notes and capture hundreds of fields of data including several score tests: Generalized Anxiety Disorder-7 items, Neurological Disorders Depression Inventory for Epilepsy, Epworth Sleepiness Scale, Quality of Life in Epilepsy-10 items, Montreal Cognitive Assessment/Short Test of Mental Status, and Medical Research Council Prognostic Index. The tools summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments. The tools provide Best Practices Advisories and other clinical decision support when appropriate. The tools prompt enrollment in a DNA biobanking study. We have thus far enrolled 231 patients for initial visits and are starting our first annual follow-up visits and provide a brief description of our cohort. We are sharing these EMR tools and captured data with other epilepsy clinics as part of a Neurology Practice Based Research Network, and are using the tools to conduct pragmatic trials using subgroup-based adaptive designs. © 2016 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

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

PubMed Central

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

2017-01-01

Introduction: Accurate coded data in the healthcare are critical. Computer-Assisted Coding (CAC) is an effective tool to improve clinical coding in particular when a new classification will be developed and implemented. But determine the appropriate method for development need to consider the specifications of existing CAC systems, requirements for each type, our infrastructure and also, the classification scheme. Aim: The aim of the study was the development of a decision model for determining accurate code of each medical intervention in Iranian Classification of Health Interventions (IRCHI) that can be implemented as a suitable CAC system. Methods: first, a sample of existing CAC systems was reviewed. Then feasibility of each one of CAC types was examined with regard to their prerequisites for their implementation. The next step, proper model was proposed according to the structure of the classification scheme and was implemented as an interactive system. Results: There is a significant relationship between the level of assistance of a CAC system and integration of it with electronic medical documents. Implementation of fully automated CAC systems is impossible due to immature development of electronic medical record and problems in using language for medical documenting. So, a model was proposed to develop semi-automated CAC system based on hierarchical relationships between entities in the classification scheme and also the logic of decision making to specify the characters of code step by step through a web-based interactive user interface for CAC. It was composed of three phases to select Target, Action and Means respectively for an intervention. Conclusion: The proposed model was suitable the current status of clinical documentation and coding in Iran and also, the structure of new classification scheme. Our results show it was practical. However, the model needs to be evaluated in the next stage of the research. PMID:28883671

Basic Requirements for Collecting, Documenting, and Reporting Precipitation and Stormwater-Flow Measurements

USGS Publications Warehouse

Church, Peter E.; Granato, Gregory E.; Owens, David W.

1999-01-01

Accurate and representative precipitation and stormwater-flow data are crucial for use of highway- or urban-runoff study results, either individually or in a regional or national synthesis of stormwater-runoff data. Equally important is information on the level of accuracy and representativeness of this precipitation and stormwaterflow data. Accurate and representative measurements of precipitation and stormwater flow, however, are difficult to obtain because of the rapidly changing spatial and temporal distribution of precipitation and flows during a storm. Many hydrologic and hydraulic factors must be considered in performing the following: selecting sites for measuring precipitation and stormwater flow that will provide data that adequately meet the objectives and goals of the study, determining frequencies and durations of data collection to fully characterize the storm and the rapidly changing stormwater flows, and selecting methods that will yield accurate data over the full range of both rainfall intensities and stormwater flows. To ensure that the accuracy and representativeness of precipitation and stormwater-flow data can be evaluated, decisions as to (1) where in the drainage system precipitation and stormwater flows are measured, (2) how frequently precipitation and stormwater flows are measured, (3) what methods are used to measure precipitation and stormwater flows, and (4) on what basis are these decisions made, must all be documented and communicated in an accessible format, such as a project description report, a data report or an appendix to a technical report, and (or) archived in a State or national records center. A quality assurance/quality control program must be established to ensure that this information is documented and reported, and that decisions made in the design phase of a study are continually reviewed, internally and externally, throughout the study. Without the supporting data needed to evaluate the accuracy and representativeness of the precipitation and stormwater-flow measurements, the data collected and interpretations made may have little meaning.

14 CFR 1245.118 - Record of decisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Record of decisions. 1245.118 Section 1245.118 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PATENTS AND OTHER INTELLECTUAL PROPERTY RIGHTS Patent Waiver Regulations § 1245.118 Record of decisions. The findings of fact and...

14 CFR 1245.118 - Record of decisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Record of decisions. 1245.118 Section 1245.118 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PATENTS AND OTHER INTELLECTUAL PROPERTY RIGHTS Patent Waiver Regulations § 1245.118 Record of decisions. The findings of fact and...

[Potential of Information and Communications Technology to Improve Intersectoral Processes of Care: A Case Study of the Specialised Outpatient Palliative Care].

PubMed

Meyer-Delpho, C; Schubert, H-J

2015-09-01

The added value of information and communications technologies should be demonstrated precisely in such areas of care in which the importance of intersectoral and interdisciplinary cooperation is particularly high. In the context of the accompanying research of a supply concept for palliative care patients, the potential of a digital documentation process was comparatively analysed with the conventional paper-based workflow. Data were collected in the form of a multi-methodological approach and processed for the project in 3 stages: (1) Development and analysis of a palliative care process with the focus on all relevant steps of documentation. (2) Questionnaire design and the comparative mapping of specific process times. (3) Sampling, selection, and analysis of patient records and their derivable insights of process iterations. With the use of ICT, the treatment time per patient is reduced by up to 53% and achieves a reduction in costs and workload by up to 901 min. The result of an up to 213% increase in the number of patient contacts allows a higher continuity of care. Although the 16% increase in documentation loyalty improves the usability of cross-team documented information, it partially extends the workload on the level of individual actors. By using a digital health record around 31% more patients could be treated with the same staffing ratio. The multi-stage analysis of the palliative care process showed that ICT has a decisive influence on the process dimension of intersectoral cooperation. Due to favourable organisational conditions the pioneering work of palliative care also provides important guidance for a successful use of ICT technologies in the context of innovative forms of care. © Georg Thieme Verlag KG Stuttgart · New York.

Documentation: Records and Reports.

PubMed

Akers, Michael J

2017-01-01

This article deals with documentation to include the beginning of documentation, the requirements of Good Manufacturing Practice reports and records, and the steps that can be taken to minimize Good Manufacturing Practice documentation problems. It is important to remember that documentation for 503a compounding involves the Formulation Record, Compounding Record, Standard Operating Procedures, Safety Data Sheets, etc. For 503b outsourcing facilities, compliance with Current Good Manufacturing Practices is required, so this article is applicable to them. For 503a pharmacies, one can see the development and modification of Good Manufacturing Practice and even observe changes as they are occurring in 503a documentation requirements and anticipate that changes will probably continue to occur. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

The Vietnam Conflict: "America's Best Documented War?"

ERIC Educational Resources Information Center

Shaughnessy, C. A.

1991-01-01

Discusses problems with military documentation during the Vietnam War. Reports poor record keeping practices, destruction of permanent files, and mislabeled and missing records. Describes the National Archives' Vietnam project that organized and preserved the remaining military records. Concludes that the Vietnam War was better documented than the…

15 CFR 764.5 - Voluntary self-disclosure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... retained by the person making the disclosure until OEE requests them, or until a final decision on the disclosed information has been made. After a final decision, the documents should be maintained in... account and supporting documentation. If the person making the disclosure believes otherwise, a request...

36 CFR 1232.16 - What documentation must an agency create before it transfers records to a records storage facility?

Code of Federal Regulations, 2011 CFR

2011-07-01

... agency create before it transfers records to a records storage facility? 1232.16 Section 1232.16 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF RECORDS TO RECORDS STORAGE FACILITIES § 1232.16 What documentation must an agency create before it...

36 CFR 1232.16 - What documentation must an agency create before it transfers records to a records storage facility?

Code of Federal Regulations, 2014 CFR

2014-07-01

... agency create before it transfers records to a records storage facility? 1232.16 Section 1232.16 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF RECORDS TO RECORDS STORAGE FACILITIES § 1232.16 What documentation must an agency create before it...

36 CFR 1232.16 - What documentation must an agency create before it transfers records to a records storage facility?

Code of Federal Regulations, 2012 CFR

2012-07-01

... agency create before it transfers records to a records storage facility? 1232.16 Section 1232.16 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF RECORDS TO RECORDS STORAGE FACILITIES § 1232.16 What documentation must an agency create before it...

Implementation and Use of Anesthesia Information Management Systems for Non-operating Room Locations.

PubMed

Bouhenguel, Jason T; Preiss, David A; Urman, Richard D

2017-12-01

Non-operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Continued future innovation of AIMS technology only promises to further improve on our NORA experience and improve care quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

32 CFR 989.21 - Record of decision (ROD).

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Record of decision (ROD). 989.21 Section 989.21 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE ENVIRONMENTAL PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.21 Record of decision (ROD). (a) The proponent and the EPF...

75 FR 17763 - National Park Service Benefits-Sharing Final Environmental Impact Statement Record of Decision

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

... DEPARTMENT OF THE INTERIOR National Park Service National Park Service Benefits-Sharing Final Environmental Impact Statement Record of Decision AGENCY: National Park Service, Department of the Interior.... 4332(2)(C), the National Park Service announces the availability of the Record of Decision for the...

77 FR 18857 - Final Environmental Impact Statement and Record of Decision for Alabama Beach Mouse General...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

...] Final Environmental Impact Statement and Record of Decision for Alabama Beach Mouse General Conservation... mouse (Peromyscus polionotus ammobates). For record of decision (ROD) availability, see DATES. DATES... beach mouse incidental to construction of up to 500 single-family developments potentially affecting an...

18 CFR 401.93 - The record for decision-making.

Code of Federal Regulations, 2010 CFR

2010-04-01

... record for decision-making. (a) Written submission. In addition to the information required by the... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false The record for decision-making. 401.93 Section 401.93 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION...

45 CFR 99.28 - Record for decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Record for decision. 99.28 Section 99.28 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROCEDURE FOR HEARINGS FOR THE CHILD CARE AND DEVELOPMENT FUND Hearing Procedures § 99.28 Record for decision. The transcript of...

76 FR 31303 - Notice of Availability or Record of Decision and Final Findings of Approvability to the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... continued comprehensive protection of Washington's coastal resources. OCRM did not select either Alternative... Record of Decision and Final Findings of Approvability to the Washington Coastal Zone Management Program... and Coastal Resource Management. ACTION: Notice of Availability or Record of Decision and Final...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 8 2011-10-01 2011-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

An interdisciplinary framework for participatory modeling design and evaluation—What makes models effective participatory decision tools?

NASA Astrophysics Data System (ADS)

Falconi, Stefanie M.; Palmer, Richard N.

2017-02-01

Increased requirements for public involvement in water resources management (WRM) over the past century have stimulated the development of more collaborative decision-making methods. Participatory modeling (PM) uses computer models to inform and engage stakeholders in the planning process in order to influence collaborative decisions in WRM. Past evaluations of participatory models focused on process and final outcomes, yet, were hindered by diversity of purpose and inconsistent documentation. This paper presents a two-stage framework for evaluating PM based on mechanisms for improving model effectiveness as participatory tools. The five dimensions characterize the "who, when, how, and why" of each participatory effort (stage 1). Models are evaluated as "boundary objects," a concept used to describe tools that bridge understanding and translate different bodies of knowledge to improve credibility, salience, and legitimacy (stage 2). This evaluation framework is applied to five existing case studies from the literature. Though the goals of participation can be diverse, the novel contribution of the two-stage proposed framework is the flexibility it has to evaluate a wide range of cases that differ in scope, modeling approach, and participatory context. Also, the evaluation criteria provide a structured vocabulary based on clear mechanisms that extend beyond previous process-based and outcome-based evaluations. Effective models are those that take advantage of mechanisms that facilitate dialogue and resolution and improve the accessibility and applicability of technical knowledge. Furthermore, the framework can help build more complete records and systematic documentation of evidence to help standardize the field of PM.

Residential aged care residents and components of end of life care in an Australian hospital.

PubMed

Leong, Laurence Jee Peng; Crawford, Gregory Brian

2018-06-09

With ageing of Australians, the numbers of residential aged care (RAC) residents is rising. This places a spotlight on decisions about appropriate care for this population, including hospitalisation and end-of-life (EOL) care. The aim was to study a sample of RAC residents who attended and died in hospital, to quantify measurable components of EOL care so as to describe the extent of palliative care required. A retrospective case-note review of hospital records was conducted in Adelaide, Australia. Participants were 109 RAC residents who attended from July 2013 to June 2014 and died in hospital. Measurements were advance care planning, health care input from the RAC facilities to hospital and components of EOL care. Residents with and without advanced dementia were compared. Advance care directives (ACDs) were present from 11 to 50%, and advance care plans (ACPs) at 60%. There were more ACPs, resuscitation orders (for/against) and do-not-hospitalise orders in residents with advanced dementia than those without. General practitioner (GP) and extended care paramedic (ECP) input on decisions for hospital transfer were 30% and 1 %. Mean hospital stay to death was 5.2 days. For residents admitted under non-palliative care teams, specialist palliative care (SPC) was needed for phone advice in 5%, consultation in 45%, transfer to palliative care unit in 37%, and takeover by SPC team in 19%. Mean number of documented goals-of-care discussions with family/caregiver was 1.7. In the last 3 days of life, the mean daily number of doses of EOL medications was 4.2. Continuous subcutaneous infusion was commenced in 35%. Staff in RAC need to be adequately resourced to make complex decisions about whether to transfer to hospital. RAC nurses are mainly making these decisions as GP and ECP input were suboptimal. Ways to support nurses and optimise decision-making are needed. Advance care planning can be improved, especially documentation of EOL wishes and hospitalisation orders. By describing the components of EOL care, it is hoped providers and policy makers have more information to assist with making decisions about what is the most appropriate care for this population.

Clinical decision support improves quality of telephone triage documentation - an analysis of triage documentation before and after computerized clinical decision support

PubMed Central

2014-01-01

Background Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. Methods We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Results Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). Conclusions CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care. PMID:24645674

Clinical decision support improves quality of telephone triage documentation--an analysis of triage documentation before and after computerized clinical decision support.

PubMed

North, Frederick; Richards, Debra D; Bremseth, Kimberly A; Lee, Mary R; Cox, Debra L; Varkey, Prathibha; Stroebel, Robert J

2014-03-20

Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care.

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

PubMed Central

Rinkus, Susan M.; Chitwood, Ainsley

2002-01-01

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

36 CFR 1222.22 - What records are required to provide for adequate documentation of agency business?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF..., agencies must prescribe the creation and maintenance of records that: (a) Document the persons, places...

36 CFR 1222.22 - What records are required to provide for adequate documentation of agency business?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF..., agencies must prescribe the creation and maintenance of records that: (a) Document the persons, places...

36 CFR 1222.22 - What records are required to provide for adequate documentation of agency business?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF..., agencies must prescribe the creation and maintenance of records that: (a) Document the persons, places...

36 CFR 1222.22 - What records are required to provide for adequate documentation of agency business?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF..., agencies must prescribe the creation and maintenance of records that: (a) Document the persons, places...

Tobacco industry use of judicial seminars to influence rulings in products liability litigation

PubMed Central

Friedman, L C

2006-01-01

Objectives This paper examines the tobacco industry's efforts to influence litigation by sponsoring judicial seminars. Methods Thousands of internal tobacco documents were examined, including memos, reports, presentations, and newsletters. Connections to outside organisations were corroborated by examining tobacco industry financial records, budgets, and letters pledging funds. Facts about outside organisations were triangulated through examining their websites and publicly‐filed financial records, and verifying facts through their representatives' statements in newspaper and law review articles. Results There are direct financial ties between the tobacco industry and groups that organise judicial seminars in an effort to influence jurisprudence, and judges who attend these seminars may be breaching judicial ethics either by not inquiring about the source of funding or by ignoring funding by potential litigants. Conclusions The tobacco industry's attempts to clandestinely influence judges' decisions in cases to which they are a party endangers the integrity of the judiciary. PMID:16565460

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

Text mining approach to predict hospital admissions using early medical records from the emergency department.

PubMed

Lucini, Filipe R; S Fogliatto, Flavio; C da Silveira, Giovani J; L Neyeloff, Jeruza; Anzanello, Michel J; de S Kuchenbecker, Ricardo; D Schaan, Beatriz

2017-04-01

Emergency department (ED) overcrowding is a serious issue for hospitals. Early information on short-term inward bed demand from patients receiving care at the ED may reduce the overcrowding problem, and optimize the use of hospital resources. In this study, we use text mining methods to process data from early ED patient records using the SOAP framework, and predict future hospitalizations and discharges. We try different approaches for pre-processing of text records and to predict hospitalization. Sets-of-words are obtained via binary representation, term frequency, and term frequency-inverse document frequency. Unigrams, bigrams and trigrams are tested for feature formation. Feature selection is based on χ 2 and F-score metrics. In the prediction module, eight text mining methods are tested: Decision Tree, Random Forest, Extremely Randomized Tree, AdaBoost, Logistic Regression, Multinomial Naïve Bayes, Support Vector Machine (Kernel linear) and Nu-Support Vector Machine (Kernel linear). Prediction performance is evaluated by F1-scores. Precision and Recall values are also informed for all text mining methods tested. Nu-Support Vector Machine was the text mining method with the best overall performance. Its average F1-score in predicting hospitalization was 77.70%, with a standard deviation (SD) of 0.66%. The method could be used to manage daily routines in EDs such as capacity planning and resource allocation. Text mining could provide valuable information and facilitate decision-making by inward bed management teams. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

ENVIRONMENTAL BASELINE SURVEY REPORT FOR WEST BLACK OAK RIDGE, EAST BLACK OAK RIDGE, MCKINNEY RIDGE, WEST PINE RIDGE, AND PARCEL 21D IN THE VICINITY OF THE EAST TENNESSEE TECHNOLOGY PARK, OAK RIDGE, TENNESSEE

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

David A. King

2012-11-29

This environmental baseline survey (EBS) report documents the baseline environmental conditions of five land parcels located near the U.S. Department of Energy’s (DOE’s) East Tennessee Technology Park (ETTP), including West Black Oak Ridge, East Black Oak Ridge, McKinney Ridge, West Pine Ridge, and Parcel 21d. The goal is to obtain all media no-further-investigation (NFI) determinations for the subject parcels considering existing soils. To augment the existing soils-only NFI determinations, samples of groundwater, surface water, soil, and sediment were collected to support all media NFI decisions. The only updates presented here are those that were made after the original issuance ofmore » the NFI documents. In the subject parcel where the soils NFI determination was not completed for approval (Parcel 21d), the full process has been performed to address the soils as well. Preparation of this report included the detailed search of federal government records, title documents, aerial photos that may reflect prior uses, and visual inspections of the property and adjacent properties. Interviews with current employees involved in, or familiar with, operations on the real property were also conducted to identify any areas on the property where hazardous substances and petroleum products, or their derivatives, and acutely hazardous wastes may have been released or disposed. In addition, a search was made of reasonably obtainable federal, state, and local government records of each adjacent facility where there has been a release of any hazardous substance or any petroleum product or their derivatives, including aviation fuel and motor oil, and which is likely to cause or contribute to a release of any hazardous substance or any petroleum product or its derivatives, including aviation fuel or motor oil, on the real property. A radiological survey and soil/sediment sampling was conducted to assess baseline conditions of Parcel 21d that were not addressed by the soils-only NFI reports. Groundwater sampling was also conducted to support a Parcel 21d decision.« less

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre.

PubMed

Summers, Alexander; Ruderman, Carly; Leung, Fok-Han; Slater, Morgan

2017-09-22

Studies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre. A retrospective chart review of the electronic medical records of the St. Michael's Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed. Among 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%. Trade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees' clinical knowledge and decision-making.

Computerized clinical documentation system in the pediatric intensive care unit

PubMed Central

2001-01-01

Background To determine whether a computerized clinical documentation system (CDS): 1) decreased time spent charting and increased time spent in patient care; 2) decreased medication errors; 3) improved clinical decision making; 4) improved quality of documentation; and/or 5) improved shift to shift nursing continuity. Methods Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. Results With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc); a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. Conclusions When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs. PMID:11604105

78 FR 16296 - Record of Decision for the Coral Reef Restoration Plan, Biscayne National Park, FL

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-14

...] Record of Decision for the Coral Reef Restoration Plan, Biscayne National Park, FL AGENCY: National Park... Record of Decision (ROD) for the Coral Reef Restoration Plan (Plan) for Biscayne National Park, Florida... Biscayne National Park, causing injuries to submerged resources. The goal of coral reef restoration actions...

78 FR 4435 - Notice of Availability of the Restoration Design Energy Project Record of Decision/Approved...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-22

... Project (RDEP) Record of Decision (ROD)/approved Resource Management Plan (RMP) amendments for BLM... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLAZ910000.L13400000.DT0000.LXSS058A0000] Notice of Availability of the Restoration Design Energy Project Record of Decision/Approved Resource...

76 FR 20435 - Notice of Approval of the Supplemental Finding of No Significant Impact and Record of Decision...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-12

.../Record of Decision (FONSI/ROD) for the Supplemental Environmental Assessment (EA) for changes proposed to... previously addressed in the December 2007 environmental assessment FONSI/ROD. The proposed changes include... Supplemental Finding of No Significant Impact and Record of Decision for the Supplemental Environmental...

21 CFR 25.43 - Records of decision.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Records of decision. 25.43 Section 25.43 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT... environmental impact statements, at the time of its decision, the agency shall prepare a concise public record...

10 CFR 501.66 - OFE evaluation of the record, decision and order.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false OFE evaluation of the record, decision and order. 501.66 Section 501.66 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS ADMINISTRATIVE PROCEDURES AND SANCTIONS Exemptions and Certifications § 501.66 OFE evaluation of the record, decision and order. (a) The...

75 FR 34714 - Updated Record of Decision (ROD) for Revised Army Growth and Force; Structure Realignment Decisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-18

...-making process for decisions contained in the updated ROD (2010). The conversion of an HBCT to an SBCT at... DEPARTMENT OF DEFENSE Department of the Army Updated Record of Decision (ROD) for Revised Army Growth and Force; Structure Realignment Decisions AGENCY: Department of the Army, DoD. ACTION: Notice of...

X-33 Environmental Impact Statement: A Fast Track Approach

NASA Technical Reports Server (NTRS)

McCaleb, Rebecca C.; Holland, Donna L.

1998-01-01

NASA is required by the National Environmental Policy Act (NEPA) to prepare an appropriate level environmental analysis for its major projects. Development of the X-33 Technology Demonstrator and its associated flight test program required an environmental impact statement (EIS) under the NEPA. The EIS process is consists of four parts: the "Notice of Intent" to prepare an EIS and scoping; the draft EIS which is distributed for review and comment; the final ETS; and the "Record of Decision." Completion of this process normally takes from 2 - 3 years, depending on the complexity of the proposed action. Many of the agency's newest fast track, technology demonstration programs require NEPA documentation, but cannot sustain the lengthy time requirement between program concept development to implementation. Marshall Space Flight Center, in cooperation with Kennedy Space Center, accomplished the NEPA process for the X-33 Program in 13 months from Notice of Intent to Record of Decision. In addition, the environmental team implemented an extensive public involvement process, conducting a total of 23 public meetings for scoping and draft EIS comment along with numerous informal meetings with public officials, civic organizations, and Native American Indians. This paper will discuss the fast track approach used to successfully accomplish the NEPA process for X-33 on time.

The Beringian coevolution project: Holistic collections of mammals and associated parasites reveal novel perspectives on evolutionary and environmental change in the North

USGS Publications Warehouse

Cook, Joseph A.; Galbreath, Kurt E.; Campbell, Mariel; Carrière, Susanne; Colella, Jocelyn P.; Dawson, Natalie G.; Dunnum, Jonathan L.; Eckerlin, Ralph P.; Greiman, Stephen E.; Fedorov, Vadim B.; Haas, Genevieve M. S.; Haukisalmi, Voitto; Henttonen, Heikki; Hope, Andrew G.; Jackson, Donavan; Jung, Tom; Koehler, Anson V.; Kinsella, John M.; Krejsa, Dianna; Kutz, Susan J.; Liphardt, Schuyler; MacDonald, Stephen O.; Malaney, Jason L.; Makarikov, Arseny; Martin, Jon; McLean, Bryan S.; Mulders, Robert; Nyamsuren, Batsaikhan; Talbot, Sandra L.; Tkach, Vasyl V.; Tsvetkova, Albina; Toman, Heather M.; Waltari, Eric C.; Whitman, Jackson S.; Hoberg, Eric P.

2017-01-01

The Beringian Coevolution Project (BCP), a field program underway in the high northern latitudes since 1999, has focused on building key scientific infrastructure for integrated specimen-based studies on mammals and their associated parasites. BCP has contributed new insights across temporal and spatial scales into how ancient climate and environmental change have shaped faunas, emphasizing processes of assembly, persistence, and diversification across the vast Beringian region. BCP collections also represent baseline records of biotic diversity from across the northern high latitudes at a time of accelerated environmental change. These specimens and associated data form an unmatched resource for identifying hidden diversity, interpreting past responses to climate oscillations, documenting contemporary conditions, and anticipating outcomes for complex biological systems in a regime of ecological perturbation. Because of its dual focus on hosts and parasites, the BCP record also provides a foundation for comparative analyses that can document the effects of dynamic change on the geographic distribution, transmission dynamics, and emergence of pathogens. By using specific examples from carnivores, shrews, lagomorphs, rodents and their associated parasites, we demonstrate how broad, integrated field collections provide permanent infrastructure that informs policy decisions regarding human impact and the effect of climate change on natural populations.

Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

PubMed

Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen

2018-06-26

Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations. ©Seuli Bose-Brill, Michelle Feeney, Laura Prater, Laura Miles, Angela Corbett, Stephen Koesters. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.06.2018.

Accuracy of Vasopressor Documentation in Anesthesia Records.

PubMed

Wax, David B; Feit, Justin B

2016-06-01

To determine the accuracy of documentation of vasoactive medication administration in anesthetic records. Cross-sectional observational study. Single academic center. Attending and resident anesthesiologists. None. An auditor inspected the anesthesia worktop between cases looking for partially used syringes of vasopressors, and the anesthesia record for the preceding case was reviewed for entries related to administration of these agents. In 100 anesthesia records for cases in which a phenylephrine and/or ephedrine bolus was apparently administered, 26% (95% CI: 18-35%) had full documentation and 36% (95% CI: 27-46%) had no documentation. In the 38% of cases that had partial documentation, a median of 50% (interquartile range 33%, 67%) of the total amounts given were documented. The authors found complete or partial omission of documentation of bolus doses of vasopressors in anesthesia records in the majority of cases in which such drugs were given. This finding has the potential to jeopardize the data integrity of local and pooled case registries and conclusions of retrospective studies that utilize these data. Copyright © 2016 Elsevier Inc. All rights reserved.

Systematic review of interventions to improve appropriate use and outcomes associated with do-not-attempt-cardiopulmonary-resuscitation decisions.

PubMed

Field, Richard A; Fritz, Zoë; Baker, Annalie; Grove, Amy; Perkins, Gavin D

2014-11-01

The treatment for a cardiac arrest, cardiopulmonary resuscitation (CPR), may be lifesaving following an acute, potentially reversible illness. Yet this treatment is unlikely to be effective if cardiac arrest occurs as part of the dying process towards the end of a person's natural life. Do not attempt CPR (DNACPR) decisions allow resuscitation to be withheld when it has little chance of success, or where the patient, or those close to the patient, indicate the burdens of CPR outweigh the benefits. This review sought to identify evidence for systems that improve the appropriate use of DNACPR decisions. Electronic databases were searched (Medline, CINAHL and Embase) for English language articles from 2001 to 2014. 4090 citations were identified of which 37 studies were relevant. The overall quality of evidence was moderate to poor. Thematic synthesis identified key interventions which may improve DNACPR decision making. The most promising interventions involved structured discussion at the time of acute admission to hospital and review by specialist teams at the point of an acute deterioration. Linking DNACPR decisions to discussions about overall treatment plans provided greater clarity about goals of care, aided communication between clinicians and reduced harms. Standardised documentation proved helpful for improving the frequency and quality of recording DNACPR decisions. Patient and clinician education in isolation were associated with limited or no effects. Relatively simple process changes may enhance the appropriate use of and outcomes associated with DNACPR decisions. Systematic review registration number: PROSPERO2012:CRD42012002669. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

76 FR 46321 - Record of Decision

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-02

... involvement in the decision-making process. The approved General Management Plan will guide long-term... management plan for the park; it is intended to be a useful, long-term decision- making tool, providing a... DEPARTMENT OF THE INTERIOR National Park Service [4240-CEBE-409] Record of Decision AGENCY...

The Effect of Structured Decision-Making Techniques and Gender on Student Reaction and Quality of Written Documents.

ERIC Educational Resources Information Center

Neal, Joan; Echternacht, Lonnie

1995-01-01

Experimental groups used four decision-making techniques--reverse brainstorming (RS), dialectical inquiry (DI), devil's advocacy (DA), and consensus--in evaluating writing assignments. Control group produced a better quality document. Student reaction to negative features of RS, DI, and DA were not significant. (SK)

Report: Administrative Leave Decisions for EPA Employee Disciplinary Actions Should Be Better Documented, and Parameters on Use of Such Leave Should Be Established

EPA Pesticide Factsheets

Report #16-P-0036, November 9, 2015. EPA’s use of extended administrative leave can result in unnecessary and excessive payroll costs, and lack of documentation and justification can lead others to second guess the agency’s decisions.

Corrective Action Decision Document for Corrective Action Unit 340: Pesticide Release sites, Nevada Test Site, Nevada

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

DOE /NV

This Corrective Action Decision Document has been prepared for Corrective Action Unit 340, the NTS Pesticide Release Sites, in accordance with the Federal Facility Agreement and Consent Order of 1996 (FFACO, 1996). Corrective Action Unit 340 is located at the Nevada Test Site, Nevada, and is comprised of the following Corrective Action Sites: 23-21-01, Area 23 Quonset Hut 800 Pesticide Release Ditch; 23-18-03, Area 23 Skid Huts Pesticide Storage; and 15-18-02, Area 15 Quonset Hut 15-11 Pesticide Storage. The purpose of this Corrective Action Decision Document is to identify and provide a rationale for the selection of a recommended correctivemore » action alternative for each Corrective Action Site. The scope of this Corrective Action Decision Document consists of the following tasks: Develop corrective action objectives; Identify corrective action alternative screening criteria; Develop corrective action alternatives; Perform detailed and comparative evaluations of the corrective action alternatives in relation to the corrective action objectives and screening criteria; and Recommend and justify a preferred corrective action alternative for each Corrective Action Site.« less

77 FR 5781 - Record of Decision for the Air Space Training Initiative Shaw Air Force Base, South Carolina...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-06

... DEPARTMENT OF DEFENSE Department of the Air Force Record of Decision for the Air Space Training Initiative Shaw Air Force Base, South Carolina Final Environmental Impact Statement ACTION: Notice of Availability (NOA) of a Record of Decision (ROD). SUMMARY: On December 9, 2011, the United States Air Force...

76 FR 80961 - Notice of Availability of the Record of Decision for the Sonoran Solar Energy Project, Arizona

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... following major components or systems: PV modules/arrays; solar trackers and/or fixed support structures; an...;AZA34187] Notice of Availability of the Record of Decision for the Sonoran Solar Energy Project, Arizona... Management (BLM) announces the availability of the Record of Decision (ROD) for the Sonoran Solar Energy...

77 FR 47826 - Record of Decision for F35A Training Basing Final Environmental Impact Statement

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... DEPARTMENT OF DEFENSE Department of the Air Force Record of Decision for F35A Training Basing Final Environmental Impact Statement ACTION: Notice of Availability (NOA) of a Record of Decision ([email protected]us.af.mil . Henry Williams Jr., Acting Air Force Federal Register Liaison Officer. [FR Doc...

78 FR 32442 - Record of Decision for the General Management Plan, Blue Ridge Parkway, Virginia and North Carolina

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-30

....YP0000] Record of Decision for the General Management Plan, Blue Ridge Parkway, Virginia and North... the availability of the Record of Decision (ROD) for the General Management Plan (GMP) for Blue Ridge... will provide a better balance between traditional parkway experiences and modern-day management...

75 FR 21034 - Notice of Availability of Record of Decision for the Agua Fria National Monument and Bradshaw...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

....241A] Notice of Availability of Record of Decision for the Agua Fria National Monument and Bradshaw... availability of the Record of Decision (ROD)/Approved Resource Management Plan (RMP) for the Agua Fria National... of the planning area during prehistoric or historic times. The Agua Fria National Monument includes...

[Information and Communication Technology in medicine in Italy: problems and perspectives. A document by the "e-cardio" area of the Italian Association of Hospital Cardiologists (ANMCO)].

PubMed

Mantero, Antonio; Posteraro, Alfredo; Giordano, Guido; Tonti, Gianni; Pinciroli, Francesco

2013-12-01

In Italy, health protection is an individual right protected by the article 32 of the Constitution, granted to everyone since 1978 by the foundation of the National Health Service. However, regionalization of the healthcare system has caused noticeable discrepancies among the different areas of the country. The use of the Information and Communication Technology (ICT) may be useful to solve them. The purpose of this document is to analyze the implementation of ICT in Italy, on the basis of the suggestions given by the Italian Association of Hospital Cardiologists (ANMCO). In 2010, the Italian government introduced the electronic health record (EHR), which includes a minimum core of essential documents that should be created and updated by general practitioners. The obvious limitations of this methodology become clear in the urgency-emergency clinical setting, where the availability of particular clinical data may influence both patient prognosis and cost reduction. Also the privacy rules, currently very restrictive, cause a drawback in reliability of the data reported in the EHR, thus arising the need for a balance shift from privacy to health rights at the level of both the individual and the community. A minimum core of mandatory clinical data to be included in the EHR should be defined. No formal indications for filling out the medical records are available and most few experiences concern "bureaucratic documents" on the diagnostic and therapeutic process. Conversely, we believe that medical records should become a diagnostic and therapeutic tool that makes health rights uniform across the country. Each medical record form should include the following features: a simple interface, a mandatory association of clinical findings and reports, data portability and accessibility, and adherence of the information to a minimal dataset. Additionally, medical records data should merge into a modified EHR available at any time and place through network access points with adequate connection speed. In this respect, inhomogeneous availability of broadband in Italy is at present a major challenging issue. Finally, current training programs in medicine do not allow for widespread application of ICT among young physicians. Some essential topics should be covered by university formative credits. It is crucial to address different needs: the patient needs, making data on "biological heritage" always available; the physician needs, providing them with professional tools able to improve their daily quality of work; the managers' and public decision makers' needs, helping to optimize costs of the healthcare system.

Maintaining the continuity of HIV-care records for patients transferring care between centers: challenges, workloads, needs and risks.

PubMed

Gill, M John; Ody, Meagan; Lynch, Tarah; Jessiman-Perreault, Lynn; Krentz, Hartmut B

2016-08-01

With improved life expectancy, the medical records of HIV-infected patients are likely to be transferred repeatedly between HIV caregivers. The challenges, and risk for introducing medical error from incomplete record transfers are poorly understood. We measured number of requests for record transfer, the workload incurred, and explore, using genotypic antiretroviral resistance testing results (GART), the potential risk of incomplete records. Using retrospective database and chart review, we examined all patients followed at the Southern Alberta Clinic between 1 January 2004 and 1 January 2015, and determined how many patients transferred care into and out our program, the associated requests and the workload for record transfer. Using a complete record of all GART tests, the potential importance of absent historic records in current treatment decisions was analyzed. The annual churn rate was 22 ± 3.4%. We received requests for only 70% of patient records who had left our care. Median time for receipt of incoming medical records was 28 days; average clerical time for processing data was 2 hours/record. Of all GART results, 25% exhibited resistance. Of 111 patients with potentially misleading GART results (i.e., documented historical resistance not visible on more recent GART), 34 (30.6%) had moved in from elsewhere. Rigorous maintenance of the continuity of the HIV record is not universally practiced. Resources, costs and logistic challenges as well as a lack of appreciation of risks clearly shown by GART testing, may be relevant barriers. Addressing such issues is pressing as aging and transfers of care are increasingly common.

The military health system's personal health record pilot with Microsoft HealthVault and Google Health

PubMed Central

Barnhill, Rick; Heermann-Do, Kimberly A; Salzman, Keith L; Gimbel, Ronald W

2011-01-01

Objective To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft® HealthVault and Google® Health infrastructure based on user preference. Materials and methods A pilot project was conducted in 2008–2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft® HealthVault and Google® Health based on user preference. The project design and implementation were guided by provider and patient advisory panels with formal user evaluation. Results The pilot project included 250 beneficiary users. Approximately 73.2% of users were <65 years of age, and 38.4% were female. Of the users, 169 (67.6%) selected Microsoft® HealthVault, and 81 (32.4%) selected Google® Health as their PHR of preference. Sample evaluation of users reflected 100% (n=60) satisfied with convenience of record access and 91.7% (n=55) satisfied with overall functionality of PHR. Discussion Key lessons learned related to data-transfer decisions (push vs pull), purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow, and decisions on information patients may choose to share with their provider. Conclusion Currently PHRs are being viewed as empowering tools for patient activation. Design and implementation issues (eg, technical, organizational, information security) are substantial and must be thoughtfully approached. Adopting standards into design can enhance the national goal of portability and interoperability. PMID:21292705

25 CFR 162.533 - Must a WEEL lease document be recorded?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Must a WEEL lease document be recorded? 162.533 Section 162.533 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Weel Approval § 162.533 Must a WEEL lease document be recorded? (a) Any...

25 CFR 162.568 - Must a WSR lease document be recorded?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Must a WSR lease document be recorded? 162.568 Section 162.568 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Approval § 162.568 Must a WSR lease document be recorded? (a...

25 CFR 162.533 - Must a WEEL lease document be recorded?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Must a WEEL lease document be recorded? 162.533 Section 162.533 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Weel Approval § 162.533 Must a WEEL lease document be recorded? (a) Any...

25 CFR 162.568 - Must a WSR lease document be recorded?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Must a WSR lease document be recorded? 162.568 Section 162.568 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Approval § 162.568 Must a WSR lease document be recorded? (a...

7 CFR 7.30 - Custody and use of books, records, and documents.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 1 2013-01-01 2013-01-01 false Custody and use of books, records, and documents. 7.30... AGENCY STATE AND COUNTY COMMITTEES § 7.30 Custody and use of books, records, and documents. (a) All books... containers and retained for 1 year unless otherwise determined by the Deputy Administrator. (c) The books...

7 CFR 7.30 - Custody and use of books, records, and documents.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 1 2014-01-01 2014-01-01 false Custody and use of books, records, and documents. 7.30... AGENCY STATE AND COUNTY COMMITTEES § 7.30 Custody and use of books, records, and documents. (a) All books... containers and retained for 1 year unless otherwise determined by the Deputy Administrator. (c) The books...

24 CFR 5.502 - Requirements concerning documents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Requirements concerning documents... § 5.502 Requirements concerning documents. For any notice or document (decision, declaration, consent... regulations for requirements concerning communications with persons with disabilities.) ...

Providing Greater Protection for Environmental Audits: A Proposal for a Self-Evaluative Privilege

DTIC Science & Technology

1993-04-01

make the government more accountable to the people. It also intended to encourage governmental responsibility. FOIA provides, in part, that any person ...document is exempt.84 Pre- decisional documents lose their exempt status if the documents are incorporated by reference in the agency’s final decision .85 E...the employee making the communication, of whatever rank he may be, is in a position to control or even to take a substantial part in a decision about

7 CFR 274.5 - Record retention and forms security.

Code of Federal Regulations, 2014 CFR

2014-01-01

... reconciliation process. (c) Accountable documents. (1) EBT cards shall be considered accountable documents. The... validation of inventory controls and records by parties not otherwise involved in maintaining control records...

7 CFR 274.5 - Record retention and forms security.

Code of Federal Regulations, 2013 CFR

2013-01-01

... reconciliation process. (c) Accountable documents. (1) EBT cards shall be considered accountable documents. The... validation of inventory controls and records by parties not otherwise involved in maintaining control records...

7 CFR 274.5 - Record retention and forms security.

Code of Federal Regulations, 2012 CFR

2012-01-01

... reconciliation process. (c) Accountable documents. (1) EBT cards shall be considered accountable documents. The... validation of inventory controls and records by parties not otherwise involved in maintaining control records...

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

None

The Office of Legacy Management (LM) is an integral part of the U.S. Department of Energy’s (DOE’s) strategy to ensure that legacy liabilities of former nuclear weapons production sites are properly managed following the completion of environmental cleanup activities. LM will work with each site using an integrated team approach to ensure a successful transition. Part of this process will include transition of Government records and information. The Office of Legacy Management Information and Records Management Transition Guidance focuses on LM’s goal to preserve and protect legacy records and information. This guidance document establishes a framework for the transfer ofmore » records management responsibilities for sites transferring to LM. It describes the requirements, responsibilities, and procedures for the efficient and cost-effective transfer of custody, ownership, and management of records and other information products from the transfer site to LM. Records management practices are critical to the functions of Federal agencies because records provide information about, or evidence of, the organization, functions, policies, decisions, procedures, operations, or other activities. Therefore, the information generated by an agency is created, maintained, and dispositioned through records management processes that ensure the appropriate preservation and retrieval of essential information. Because of their intrinsic value, best practices to preserve information and records should be utilized when records are transferred from one organization to another. As the transfer program completes cleanup activities at closure sites, a transitional process will facilitate the transparent shift in the management of site records activities to LM. The roles and responsibilities of the transfer site and/or program and LM described in this document are a necessary foundation for cooperation and coordination and are essential to the successful transition of records and information responsibilities. The DOE Office of the Chief Information Officer (OCIO) has a central role in DOE records management by providing guidance, expertise, and coordination to all DOE offices and organizations and coordination with the National Archives and Records Administration (NARA). LM and the transfer site will complete an integrated transition plan which will integrate all transition elements including information and records. As part of the overall transition plan, an Information and Records Transition Plan will be developed consistent with the integrated transition plan for the site transfer and included as an attachment. The Information and Records Management Transition Plan will be developed to assist both organizations in organizing the tasks; establishing a timetable and milestones for their completion; and identifying manpower, funding and other resources that will be needed to complete the ownership transfer. In addition, the plan will provide a valuable exchange of institutional knowledge that will assist LM in meeting the obligations of responsibly managing legacy records. Guidance for the development of the plan is included in this document. Records management concerns that may arise during site closure, such as management support, contract language and agreements, interactions with the OCIO and NARA, resource and budget considerations, and procedures to safeguard records are addressed. Guidelines and criteria for records management transition activities are also provided. These include LM expectations for the inventory, scheduling, and disposition of records; the management and transfer of electronic files, including databases and software; records finding aids, indices, and recordkeeping systems; and the process for the transfer of hard copy and electronic records to LM.« less

5 CFR 850.303 - Return of personal documents.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REGULATIONS (CONTINUED) ELECTRONIC RETIREMENT PROCESSING Records § 850.303 Return of personal documents. An..., OPM may provide the individual with a copy of the document that is derived from electronic records. ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Return of personal documents. 850.303...

5 CFR 1631.34 - Certification and authentication of records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... records. 1631.34 Section 1631.34 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD... individual shall authenticate copies of books, records, papers, writings, and documents by attaching a... required. Copies of any books, records, papers, or other documents in the Federal Retirement Thrift...

Documentation of medication changes in inpatient clinical notes: an audit to support quality improvement.

PubMed

Peusschers, Elsie; Twine, Jaryth; Wheeler, Amanda; Moudgil, Vikas; Patterson, Sue

2015-04-01

To describe completeness and accuracy of recording medication changes in progress notes during psychiatric inpatient admissions. A retrospective audit of records of 54 randomly selected psychiatric admissions at a metropolitan tertiary hospital. Medication changes recorded on National Inpatient Medication Chart (NIMC) were compared to documentation in the clinical progress records and assessed for completeness against seven quality criteria. With between one and 32 medication changes per admission, a total of 519 changes were recorded in NIMCs. Just over half were documented in progress notes. Psychotropic and regular medications were more frequently charted than 'other' and 'if required' medications. Documentation was seldom comprehensive. Medication name was most frequently documented; desired therapeutic effect or potential adverse effects were rarely documented. Evidence of patient involvement in, and an explicit rationale for, a change were infrequently recorded. Revealing substantial gaps in communication about medication changes during psychiatric admission, this audit sheds light on a previously undescribed source of medication error, warranting attention. Further research is needed to examine barriers to best practice, to support design and implementation of quality improvement activities but in the interim, attention should be addressed to development and articulation of content and procedures for documentation. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Usage experience with the document archiving and communication system for the storage and retrieval of medical records.

PubMed

Takeda, Toshihiro; Ueda, Kanayo; Manabe, Shiro; Teramoto, Kei; Mihara, Naoki; Matsumura, Yasushi

2013-01-01

Standard Japanese electronic medical record (EMR) systems are associated with major shortcomings. For example, they do not assure lifelong readability of records because each document requires its own viewing software program, a system that is difficult to maintain over long periods of time. It can also be difficult for users to comprehend a patient's clinical history because different classes of documents can only be accessed from their own window. To address these problems, we developed a document-based electronic medical record that aggregates all documents for a patient in a PDF or DocuWorks format. We call this system the Document Archiving and Communication System (DACS). There are two types of viewers in the DACS: the Matrix View, which provides a time line of a patient's history, and the Tree View, which stores the documents in hierarchical document classes. We placed 2,734 document classes into 11 categories. A total of 22,3972 documents were entered per month. The frequency of use of the DACS viewer was 268,644 instances per month. The DACS viewer was used to assess a patient's clinical history.

20 CFR 404.707 - Original records or copies as evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Original records or copies as evidence. 404... DISABILITY INSURANCE (1950- ) Evidence General § 404.707 Original records or copies as evidence. (a) General... original document or record. These original records or documents will be returned to you after we have...

78 FR 48543 - Notice of Approval of Finding of No Significant Impact-Record of Decision (FONSI/ROD) for Sioux...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-08

... Significant Impact--Record of Decision (FONSI/ROD) for Sioux Falls Regional Airport, Sioux Falls, South Dakota... approval of Finding of No Significant Impact--Record of Decision (FONSI/ROD) for proposed development at the Sioux Falls Regional Airport, Sioux Falls, South Dakota. The FAA approved the FONSI/ROD on July 22...

76 FR 54525 - Notice of Availability of a Final Environmental Assessment (Final EA) and a Finding of No...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-01

... Environmental Assessment (Final EA) and a Finding of No Significant Impact (FONSI)/Record of Decision (ROD) for... Environmental Assessment (Final EA) and Finding of No Significant Impact (FONSI)/Record of Decision (ROD) for a...)/Record of Decision (ROD) based on the Final Environmental Assessment (Final EA) for a Proposed Airport...

76 FR 45301 - PSEG Nuclear LLC, Hope Creek Generating Station; Notice of Issuance of Renewed Facility Operating...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-28

... alternative, and the no-action alternative. The factors considered in the record of decision can be found in...-Year Period; Record of Decision Notice is hereby given that the U.S. Nuclear Regulatory Commission (the.... The notice also serves as the record of decision for the Renewal of Facility Operating License No. NPF...

76 FR 17162 - Entergy Nuclear Operations, Inc.; Vermont Yankee Nuclear Power Station; Notice of Issuance of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-28

... that included the no-action alternative. The factors considered in the record of decision can be found... for an Additional 20-Year Period; Record of Decision Notice is hereby given that the U.S. Nuclear... renewed license and its technical specifications. The notice also serves as the record of decision for the...

Developing an Interface to Order and Document Health Education Videos in the Electronic Health Record.

PubMed

Wojcik, Lauren

2015-01-01

Transitioning to electronic health records (EHRs) provides an opportunity for health care systems to integrate educational content available on interactive patient systems (IPS) with the medical documentation system. This column discusses how one hospital simplified providers' workflow by making it easier to order educational videos and ensure that completed education is documented within the medical record. Integrating the EHR and IPS streamlined the provision of patient education, improved documentation, and supported the organization in meeting core requirements for Meaningful Use.

Safety and fitness electronic records (SAFER) system : logical architecture document : working draft

DOT National Transportation Integrated Search

1997-01-31

This Logical Architecture Document includes the products developed during the functional analysis of the Safety and Fitness Electronic Records (SAFER) System. This document, along with the companion Operational Concept and Physical Architecture Docum...

76 FR 65512 - Record of Decision Addendum for the Department of Homeland Security Headquarters Consolidation at...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-21

... parts 1500-1508), GSA Order PBS P 1095.1F (Environmental considerations in decision-making, dated... Decision Addendum for the Department of Homeland Security Headquarters Consolidation at St. Elizabeths in...). ACTION: Record of Decision Addendum. SUMMARY: Pursuant to the requirements of the National Environmental...

75 FR 71729 - Notice of Availability of the Record of Decision (ROD) for the Tuskegee Airmen National Historic...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-24

...'s Order Number 12 (Conservation Planning, Environmental Impact Analysis, and Decision- making) the... DEPARTMENT OF THE INTERIOR National Park Service Notice of Availability of the Record of Decision... ROD for the project. The ROD includes a description of the project's background, a decision statement...

36 CFR 251.99 - Appeal decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... decision. (a) The Reviewing Officer shall base the appeal decision on the appeal record and applicable laws... level of appeal, the Reviewing Officer shall make and issue an appeal decision within 30 days of the date the record is closed. (d) At the second level of appeal provided in § 251.87(c), the Reviewing...

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

PubMed

Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

2018-04-01

To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

Decision Support System for Evaluation of Gunnison River Flow Regimes With Respect To Resources of the Black Canyon of the Gunnison National Park

USGS Publications Warehouse

Auble, Gregor T.; Wondzell, Mark; Talbert, Colin

2009-01-01

This report describes and documents a decision support system for the Gunnison River in Black Canyon of the Gunnison National Park. It is a macro-embedded EXCEL program that calculates and displays indicators representing valued characteristics or processes in the Black Canyon based on daily flows of the Gunnison River. The program is designed to easily accept input from downloaded stream gage records or output from the RIVERWARE reservoir operations model being used for the upstream Aspinall Unit. The decision support system is structured to compare as many as eight alternative flow regimes, where each alternative is represented by a daily sequence of at least 20 calendar years of streamflow. Indicators include selected flow statistics, riparian plant community distribution, clearing of box elder by inundation and scour, several measures of sediment mobilization, trout fry habitat, and federal reserved water rights. Calculation of variables representing National Park Service federal reserved water rights requires additional secondary input files pertaining to forecast and actual basin inflows and storage levels in Blue Mesa reservoir. Example input files representing a range of situations including historical, reconstructed natural, and simulated alternative reservoir operations are provided with the software.

Superfund record of decision (EPA Region 5): Feed Materials Production Center, (USDOE), Operable Unit 4, Fernald, Hamilton County, OH, December 7, 1995

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

NONE

This decision document presents the selected remedial action for Operable Unit 4 of the Fernald Site in Fernald, Ohio. The materials within Operable Unit 4 exhibit a wide range of properties. Most notable would be the elevated direct radiation associated with the K-65 residues versus the much lower direct radiation associated with cold metal oxides in Silo 3. Even more significant would be the much lower levels of contamination associated with the soils and building materials, like concrete, within the Operable Unit 4 Study Area. On the basis of the evaluation of final alternatives, the selected remedy addressing Operable Unitmore » 4 at the FEMP is a combination of Alternatives 3A.1/Vit - Removal, Vitrification, and Off-site Disposal - Nevada Test Site (NTS); 3B.1/Vit - Removal, Vitrification, and Off-site Disposal - NTS; and 2C - Demolition, Removal and On-Property Disposal.« less

ISO9000 and the quality management system in the digital hospital.

PubMed

Liu, Yalan; Yao, Bin; Zhang, Zigang

2002-01-01

ISO9000 quality management system (ISO9000QMS) emphasize on the customer-oriented, managers' leadership and all staff's joining, adopt the process method and system management, spread the taking facts as a basis to make decision and improve consistently, and establish win-win relation with the suppliers. So, the digital hospital can adopt the ISO9000QMS. In order to establish the ISO9000QMS, the digital hospital should: (1) Design integrally, including analyzing the operation procedure, clarifying the job duties, setting up the spreading team and setting the quality policy and objectives: (2) Learning the ISO9000 quality standards; (3) Drawing up the documents, including the quality manual, program files and operation guiding files; (4) Training according the documents; (5) Executing the quality standard, including the service quality auditing, quality record auditing and quality system auditing; (6) Improving continually. With the establishment of ISO900QMS, the digital hospital can appraise more accurately, analyze quality matters statistically and avoid the interference of artificial factors.

The York Gospels: a 1000-year biological palimpsest

PubMed Central

Fiddyment, Sarah; Vnouček, Jiří; Mattiangeli, Valeria; Speller, Camilla; Binois, Annelise; Carver, Martin; Dand, Catherine; Newfield, Timothy P.; Webb, Christopher C.; Bradley, Daniel G.; Collins, Matthew J.

2017-01-01

Medieval manuscripts, carefully curated and conserved, represent not only an irreplaceable documentary record but also a remarkable reservoir of biological information. Palaeographic and codicological investigation can often locate and date these documents with remarkable precision. The York Gospels (York Minster Ms. Add. 1) is one such codex, one of only a small collection of pre-conquest Gospel books to have survived the Reformation. By extending the non-invasive triboelectric (eraser-based) sampling technique eZooMS, to include the analysis of DNA, we report a cost-effective and simple-to-use biomolecular sampling technique for parchment. We apply this combined methodology to document for the first time a rich palimpsest of biological information contained within the York Gospels, which has accumulated over the 1000-year lifespan of this cherished object that remains an active participant in the life of York Minster. These biological data provide insights into the decisions made in the selection of materials, the construction of the codex and the use history of the object. PMID:29134095

Patient safety in primary allied health care: what can we learn from incidents in a Dutch exploratory cohort study?

PubMed

van Dulmen, Simone A; Tacken, Margot A J B; Staal, J Bart; Gaal, Sander; Wensing, Michel; Nijhuis-van der Sanden, Maria W G

2011-12-01

Research on patient safety in allied healthcare is scarce. Our aim was to document patient safety in primary allied healthcare in the Netherlands and to identify factors associated with incidents. DESIGN AND SUBJECT: A retrospective study of 1000 patient records in a representative sample of 20 allied healthcare practices was combined with a prospective incident-reporting study. All records were reviewed by trained researchers to identify patient safety incidents. The incidents were classified and analyzed, using the Prevention and Recovery Information System for Monitoring and Analysis method. Factors associated with incidents were examined in a logistic regression analysis. In 18 out of 1000 (1.8%; 95% confidence interval: 1.0-2.6) records an incident was detected. The main causes of incidents were related to errors in clinical decisions (89%), communication with other healthcare providers (67%), and monitoring (56%). The probability of incidents was higher if more care providers had been involved and if patient records were incomplete (37% of the records). No incidents were reported in the prospective study. The absolute number of incidents was low, which could imply a low risk of harm in Dutch primary allied healthcare. Nevertheless, incompleteness of the patient records and the fact that incidents were mainly caused through human actions suggest that a focus on clinical reasoning and record keeping is needed to further enhance patient safety. Improvements in record keeping will be necessary before accurate incident reporting will be feasible and valid.

Understanding Clinician Information Demands and Synthesis of Clinical Documents in Electronic Health Record Systems

ERIC Educational Resources Information Center

Farri, Oladimeji Feyisetan

2012-01-01

Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while…

Designing a Hydro-Economic Collaborative Computer Decision Support System: Approaches, Best Practices, Lessons Learned, and Future Trends

NASA Astrophysics Data System (ADS)

Rosenberg, D. E.

2008-12-01

Designing and implementing a hydro-economic computer model to support or facilitate collaborative decision making among multiple stakeholders or users can be challenging and daunting. Collaborative modeling is distinguished and more difficult than non-collaborative efforts because of a large number of users with different backgrounds, disagreement or conflict among stakeholders regarding problem definitions, modeling roles, and analysis methods, plus evolving ideas of model scope and scale and needs for information and analysis as stakeholders interact, use the model, and learn about the underlying water system. This presentation reviews the lifecycle for collaborative model making and identifies some key design decisions that stakeholders and model developers must make to develop robust and trusted, verifiable and transparent, integrated and flexible, and ultimately useful models. It advances some best practices to implement and program these decisions. Among these best practices are 1) modular development of data- aware input, storage, manipulation, results recording and presentation components plus ways to couple and link to other models and tools, 2) explicitly structure both input data and the meta data that describes data sources, who acquired it, gaps, and modifications or translations made to put the data in a form usable by the model, 3) provide in-line documentation on model inputs, assumptions, calculations, and results plus ways for stakeholders to document their own model use and share results with others, and 4) flexibly program with graphical object-oriented properties and elements that allow users or the model maintainers to easily see and modify the spatial, temporal, or analysis scope as the collaborative process moves forward. We draw on examples of these best practices from the existing literature, the author's prior work, and some new applications just underway. The presentation concludes by identifying some future directions for collaborative modeling including geo-spatial display and analysis, real-time operations, and internet-based tools plus the design and programming needed to implement these capabilities.

Documentation of Sexual Partner Gender Is Low in Electronic Health Records: Observations, Predictors, and Recommendations to Improve Population Health Management in Primary Care

PubMed Central

Yehia, Baligh R.

2015-01-01

Abstract The 2011 Institute of Medicine report on LGBT health recommended that sexual orientation and gender identity (SO/GI) be documented in electronic health records (EHRs). Most EHRs cannot document all aspects of SO/GI, but some can record gender of sexual partners. This study sought to determine the proportion of patients who have the gender of sexual partners recorded in the EHR and to identify factors associated with documentation. A retrospective analysis was done of EHR data for 40 family medicine (FM) and general internal medicine (IM) practices, comprising 170,570 adult patients seen in 2012. The primary outcome was EHR documentation of sexual partner gender. Multivariate logistic regression assessed the impact of patient, provider, and practice factors on documentation. In all, 76,767 patients (45%) had the gender of sexual partners recorded, 4.3% of whom had same-gender partners (3.5% of females, 5.6% of males). Likelihood of documentation was independently higher for women; blacks; those with a preventive visit; those with a physician assistant, nurse practitioner, or resident primary care provider (vs. attending); those at urban practices; those at smaller practices; and those at a residency FM practice. Older age and Medicare insurance were associated with lower documentation. Sexual partner gender documentation is important to identify patients for targeted prevention and support, and holds great potential for population health management, yet documentation in the EHR currently is low. Primary care practices should routinely record the gender of sexual partners, and additional work is needed to identify best practices for collecting and using SO/GI data in this setting. (Population Health Management 2015;18:217–222). PMID:25290634

The Application of Recognition-Primed Decision Theory to Decisions Made in an Outdoor Education Context

ERIC Educational Resources Information Center

Boyes, Mike; Potter, Tom

2015-01-01

This research examined the decisions that highly experienced outdoor leaders made on backpacking expeditions conducted by a tertiary institution in the Southern Alps of New Zealand. The purpose of the research was to document decision problems and explore them as Recognition-Primed Decisions (RPD) within naturalistic decision making (NDM)…

[The 1918 influenza epidemic in Bogota].

PubMed

Martínez Martín, Abel Fernando; Manrique Abril, Fred Gustavo; Meléndez Alvarez, Bernardo Francisco

2007-01-01

The influenza pandemic of 1918-1919 was one of the most severe recorded in Colombia. There were 1,900 deaths in the capital, Bogota. The poor and unprotected were the most affected. Care of victims was the responsibility of the Junta de Socorros, a private body. Based on different primary sources (mostly official documents, Junta de Socorros reports, newspapers, and medical journals) this article explores how the 1918 influenza pandemic altered Bogotá's social dynamics, with particular attention to its impact on disease and mortality rates and to an analysis of how the city's sanitary conditions and political-institutional decisions and the reactions of different social sectors influenced the response of this human community to the pandemic.

36 CFR 1010.13 - Trust decision-making procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... environmental document (i.e., the EA, finding of no significant impact, EIS, or notice of intent), in addition... environmental factors. (b) The Trust shall consider in its decision-making process only decision alternatives...

Structured data entry for narrative data in a broad specialty: patient history and physical examination in pediatrics

PubMed Central

Bleeker, Sacha E; Derksen-Lubsen, Gerarda; van Ginneken, Astrid M; van der Lei, Johan; Moll, Henriëtte A

2006-01-01

Background Whereas an electronic medical record (EMR) system can partly address the limitations, of paper-based documentation, such as fragmentation of patient data, physical paper records missing and poor legibility, structured data entry (SDE, i.e. data entry based on selection of predefined medical concepts) is essential for uniformity of data, easier reporting, decision support, quality assessment, and patient-oriented clinical research. The aim of this project was to explore whether a previously developed generic (i.e. content independent) SDE application to support the structured documentation of narrative data (called OpenSDE) can be used to model data obtained at history taking and physical examination of a broad specialty. Methods OpenSDE was customized for the broad domain of general pediatrics: medical concepts and its descriptors from history taking and physical examination were modeled into a tree structure. Results An EMR system allowing structured recording (OpenSDE) of pediatric narrative data was developed. Patient history is described by 20 main concepts and physical examination by 11. In total, the thesaurus consists of about 1800 items, used in 8648 nodes in the tree with a maximum depth of 9 levels. Patient history contained 6312 nodes, and physical examination 2336. User-defined entry forms can be composed according to individual needs, without affecting the underlying data representation. The content of the tree can be adjusted easily and sharing records among different disciplines is possible. Data that are relevant in more than one context can be accessed from multiple branches of the tree without duplication or ambiguity of data entry via "shortcuts". Conclusion An expandable EMR system with structured data entry (OpenSDE) for pediatrics was developed, allowing structured documentation of patient history and physical examination. For further evaluation in other environments, the tree structure for general pediatrics is available at the Erasmus MC Web site (in Dutch, translation into English in progress) [1]. The generic OpenSDE application is available at the OpenSDE Web site [2]. PMID:16839414

76 FR 40944 - PSEG Nuclear, LLC, Salem Nuclear Generating Station, Units 1 and 2; Notice of Issuance of Renewed...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... no-action alternative. The factors considered in the record of decision can be found in the... serves as the record of decision for the renewal of Facility Operating License Nos. DPR-70 and DPR-75, consistent with Title 10 of the Code of Federal Regulations (10 CFR) 51.103, ``Record of Decision--General...

A case study of the introduction of the International Classification for Nursing Practice(®) in Poland.

PubMed

Kilańska, D; Gaworska-Krzemińska, A; Grabowska, H; Gorzkowicz, B

2016-09-01

The development of a nursing practice, improvements in nurses' autonomy, and increased professional and personal responsibility for the medical services provided all require professional documentation with records of health status assessments, decisions undertaken, actions and their outcomes for each patient. The International Classification for Nursing Practice is a tool that meets all of these needs, and although it requires continuous evaluation, it offers professional documentation and communication in the practitioner and researcher community. The aim of this paper is to present a theoretical critique of an issue related to policy and experience of the current situation in Polish nursing - especially of the efforts to standardize nursing practices through the introduction and development of the Classification in Poland. Despite extensive promotion and training by International Council of Nurses members worldwide, there are still many countries where the Classification has not been implemented as a standard tool in healthcare facilities. Recently, a number of initiatives were undertaken in cooperation with the local and state authorities to disseminate the Classification in healthcare facilities. Thanks to intense efforts by the Polish Nurses Association and the International Council of Nurses Accredited Center for ICNP(®) Research & Development at the Medical University of Łódź, the Classification is known in Poland and has been tested at several centres. Nevertheless, an actual implementation that would allow for national and international interoperability requires strategic governmental decisions and close cooperation with information technology companies operating in the country. Discussing the barriers to the implementation of the Classification can improve understanding of it and its use. At a policy level, decision makers need to understand that use Classification in eHealth services and tools it is necessary to achieve interoperability. © 2016 International Council of Nurses.

40 CFR 792.195 - Retention of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... section, documentation records, raw data, and specimens pertaining to a study and required to be retained... records, raw data, and specimens pertaining to a study and required to be retained by this part shall be... those items listed in paragraph (c) of this section, documentation records, raw data, and specimens...

75 FR 74708 - Magnum Gas Storage, LLC; Magnum Solutions, LLC; Notice of Availability of the Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-01

... separate Decision Record (DR) for this project. As part of the BLM decision-making process, certain..., the BLM will present its own conclusions and recommendations in its respective Record of Decision for... considered prior to a Commission decision on the proposal, it is important that we receive your comments in...

Design of the SGML-based electronic patient record system with the use of object-oriented analysis methods.

PubMed

Kuikka, E; Eerola, A; Porrasmaa, J; Miettinen, A; Komulainen, J

1999-01-01

Since a patient record is typically a document updated by many users, required to be represented in many different layouts, and transferred from place to place, it is a good candidate to be represented structured and coded using the SGML document standard. The use of the SGML requires that the structure of the document is defined in advance by a Document Type Definition (DTD) and the document follows it. This paper represents a method which derives an SGML DTD by starting from the description of the usage of the patient record in medical care and nursing.

Ad-Hoc Queries over Document Collections - A Case Study

NASA Astrophysics Data System (ADS)

Löser, Alexander; Lutter, Steffen; Düssel, Patrick; Markl, Volker

We discuss the novel problem of supporting analytical business intelligence queries over web-based textual content, e.g., BI-style reports based on 100.000's of documents from an ad-hoc web search result. Neither conventional search engines nor conventional Business Intelligence and ETL tools address this problem, which lies at the intersection of their capabilities. "Google Squared" or our system GOOLAP.info, are examples of these kinds of systems. They execute information extraction methods over one or several document collections at query time and integrate extracted records into a common view or tabular structure. Frequent extraction and object resolution failures cause incomplete records which could not be joined into a record answering the query. Our focus is the identification of join-reordering heuristics maximizing the size of complete records answering a structured query. With respect to given costs for document extraction we propose two novel join-operations: The multi-way CJ-operator joins records from multiple relationships extracted from a single document. The two-way join-operator DJ ensures data density by removing incomplete records from results. In a preliminary case study we observe that our join-reordering heuristics positively impact result size, record density and lower execution costs.

77 FR 20688 - 29th Meeting: RTCA Special Committee 206, Aeronautical Information and Meteorological Data Link...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

.... SC-206 Related Work in SESAR--Progress Status. Discuss previously proposed TOR changes and DO-252 Revision. [cir] Discuss TOR changes for the June PMC meeting. PMC decision on OSED document. ConUse FRAC... dates. Decision to approve the ConUse document for release to the PMC. Agree upon TOR changes for June...

Issues in Peer Review of the Scientific Basis for Regulatory Decisions.

ERIC Educational Resources Information Center

American Chemical Society, Washington, DC.

This document is intended to provide a discussion of the issues that need to be addressed in the development of peer review guidelines, the options for addressing the issues, and a range of views about such options. The document focuses on peer review with regard to regulatory decisions and contains major sections which deal with: (1) what should…

Global Grid Telemedicine System: Expert Consult Manager

DTIC Science & Technology

2000-10-01

Department of the Army position, policy or decision unless so designated by other documentation. DTIC QUALITY iw^^rxi 20010122 014 REPORT DOCUMENTATION...processes and personnel for collecting, processing, storing, disseminating and managing information on demand to warfighters, policy makers, and...to be responsive to and incorporate current and future policy decisions. (7) Be continuously aware, along with Network and Bandwidth managers, of

Medical record keeping and system performance in orthopaedic trauma patients.

PubMed

Cosic, Filip; Kimmel, Lara; Edwards, Elton

2016-01-01

Objective The medical record is critical for documentation and communication between healthcare professionals. The aim of the present study was to evaluate important aspects of the orthopaedic medical record and system performance to determine whether any deficiencies exist in these areas. Methods Review of 200 medical records of surgically treated traumatic lower limb injury patients was undertaken. The operative report, discharge summary and first and second outpatient reviews were evaluated. Results In all cases, an operative report was completed by a senior surgeon. Weight-bearing status was adequately documented in 91% of reports. Discharge summaries were completed for 82.5% of admissions, with 87.3% of these having instructions reflective of those in the operative report. Of first and second outpatient reviews, 69% and 73%, respectively, occurred within 1 week of the requested time. Previously documented management plans were changed in 30% of reviews. At 6-months post-operatively, 42% of patients had been reviewed by a member of their operating team. Discussion Orthopaedic medical record documentation remains an area for improvement. In addition, hospital out-patient systems perform suboptimally and may affect patient outcomes. What is known about the topic? Medical records are an essential tool in modern medical practice. Despite the importance of comprehensive documentation in the medical record, numerous examples of poor documentation have been demonstrated, including substandard documentation during consultant ward rounds by junior doctors leading to a breakdown in healthcare professional communication and potential patient mismanagement. Further inadequacies of medical record documentation have been demonstrated in surgical discharge notes, with complete and correct documentation reported to be as low as 65%. What does this paper add? Standards of patient care should be constantly monitored and deficiencies identified in order to implement a remedy and close the quality loop. The present study has highlighted that the standard of orthopaedic trauma medical record keeping at an Australian Level 1 trauma centre is below what is expected and several key areas of documentation require improvement. This paper further evaluates the system performance of the out-patient system, an area where, to the authors knowledge, there is no previous work published. The findings show that the performance was below what is expected for surgical review, with many patients failing to be reviewed by their operating surgeon. What are the implications for practitioners? The present study shows that there is a poor level of documentation and a standard of out-patient review below what is expected. The implications of these findings will be to highlight current deficiencies to practitioners and promote change in current practice to improve the quality of medical record documentation among medical staff. Further, the findings of poor system performance will promote change in the current system of delivering out-patient care to patients.

Challenges and methodology for indexing the computerized patient record.

PubMed

Ehrler, Frédéric; Ruch, Patrick; Geissbuhler, Antoine; Lovis, Christian

2007-01-01

Patient records contain most crucial documents for managing the treatments and healthcare of patients in the hospital. Retrieving information from these records in an easy, quick and safe way helps care providers to save time and find important facts about their patient's health. This paper presents the scalability issues induced by the indexing and the retrieval of the information contained in the patient records. For this study, EasyIR, an information retrieval tool performing full text queries and retrieving the related documents has been used. An evaluation of the performance reveals that the indexing process suffers from overhead consequence of the particular structure of the patient records. Most IR tools are designed to manage very large numbers of documents in a single index whereas in our hypothesis, one index per record, which usually implies few documents, has been imposed. As the number of modifications and creations of patient records are significant in a day, using a specialized and efficient indexation tool is required.

Chemicals identified in human biological media: a data base. Third annual report, October 1981

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

Cone, M.V.; Baldauf, M.F.; Martin, F.M.

Data from almost 1600 of the 3800 body-burden documents collected to date have been entered in the data base as of October 1981. The emphasis on including recent literature and significant research documents has resulted in a chronological mix of articles from 1974 to the present. When body-burden articles are identified, data are extracted and entered in the data base by chemical and tissue/body fluid. Each data entry comprises a single record (or line entry) and is assigned a record number. If a particular document deals with more than one chemical and/or tissue, there will be multiple records for thatmore » document. For example, a study of 5 chemicals in each of 3 tissues has 15 different records (or 15 line entries) in the data base with 15 record numbers. Record numbers are assigned consecutively throughout the entire data base and appear in the upper left corner of the first column for each record.« less

Task Shifting: The Use of Laypersons for Acquisition of Vital Signs Data for Clinical Decision Making in the Emergency Room Following Traumatic Injury.

PubMed

Haac, Bryce E; Gallaher, Jared R; Mabedi, Charles; Geyer, Andrew J; Charles, Anthony G

2017-12-01

In resource-limited settings, identification of successful and sustainable task-shifting interventions is important for improving care. To determine whether the training of lay people to take vital signs as trauma clerks is an effective and sustainable method to increase availability of vital signs in the initial evaluation of trauma patients. We conducted a quasi-experimental study of patients presenting with traumatic injury pre- and post-intervention. The study was conducted at Kamuzu Central Hospital, a tertiary care referral hospital, in Lilongwe, Malawi. All adult (age ≥ 18 years) trauma patients presenting to emergency department over a six-month period from January to June prior to intervention (2011), immediately post-intervention (2012), 1 year post-intervention (2013) and 2 years post-intervention (2014). Lay people were trained to take and record vital signs. The number of patients with recorded vital signs pre- and post-intervention and sustainability of the intervention as determined by time-series analysis. Availability of vital signs on initial evaluation of trauma patients increased significantly post-intervention. The percentage of patients with at least one vital sign recorded increased from 23.5 to 92.1%, and the percentage of patients with all vital signs recorded increased from 4.1 to 91.4%. Availability of Glasgow Coma Scale also increased from 40.3 to 88.6%. Increased documentation of vital signs continued at 1 year and 2 years post-intervention. However, the percentage of documented vital signs did decrease slightly after the US-trained medical student and surgeon who trained the trauma clerks were no longer available in country, except for Glasgow Coma Scale. Patients who died during emergency department evaluation were significantly less likely to have vital signs recorded. The training of lay people to collect vital signs and Glasgow Coma Scale is an effective and sustainable method of task shifting in a resource-limited setting.

A 156 kyr smoothed history of the atmospheric greenhouse gases CO2, CH4, and N2O and their radiative forcing

NASA Astrophysics Data System (ADS)

Köhler, Peter; Nehrbass-Ahles, Christoph; Schmitt, Jochen; Stocker, Thomas F.; Fischer, Hubertus

2017-06-01

Continuous records of the atmospheric greenhouse gases (GHGs) CO2, CH4, and N2O are necessary input data for transient climate simulations, and their associated radiative forcing represents important components in analyses of climate sensitivity and feedbacks. Since the available data from ice cores are discontinuous and partly ambiguous, a well-documented decision process during data compilation followed by some interpolating post-processing is necessary to obtain those desired time series. Here, we document our best possible data compilation of published ice core records and recent measurements on firn air and atmospheric samples spanning the interval from the penultimate glacial maximum ( ˜ 156 kyr BP) to the beginning of the year 2016 CE. We use the most recent age scales for the ice core data and apply a smoothing spline method to translate the discrete and irregularly spaced data points into continuous time series. These splines are then used to compute the radiative forcing for each GHG using well-established, simple formulations. We compile only a Southern Hemisphere record of CH4 and discuss how much larger a Northern Hemisphere or global CH4 record might have been due to its interpolar difference. The uncertainties of the individual data points are considered in the spline procedure. Based on the given data resolution, time-dependent cutoff periods of the spline, defining the degree of smoothing, are prescribed, ranging from 5000 years for the less resolved older parts of the records to 4 years for the densely sampled recent years. The computed splines seamlessly describe the GHG evolution on orbital and millennial timescales for glacial and glacial-interglacial variations and on centennial and decadal timescales for anthropogenic times. Data connected with this paper, including raw data and final splines, are available at doi:10.1594/PANGAEA.871273.

Computers in the examination room and the electronic health record: physicians' perceived impact on clinical encounters before and after full installation and implementation.

PubMed

Doyle, Richard J; Wang, Nina; Anthony, David; Borkan, Jeffrey; Shield, Renee R; Goldman, Roberta E

2012-10-01

We compared physicians' self-reported attitudes and behaviours regarding electronic health record (EHR) use before and after installation of computers in patient examination rooms and transition to full implementation of an EHR in a family medicine training practice to identify anticipated and observed effects these changes would have on physicians' practices and clinical encounters. We conducted two individual qualitative interviews with family physicians. The first interview was before and second interview was 8 months later after full implementation of an EHR and computer installation in the examination rooms. Data were analysed through project team discussions and subsequent coding with qualitative analysis software. At the first interviews, physicians frequently expressed concerns about the potential negative effect of the EHR on quality of care and physician-patient interaction, adequacy of their skills in EHR use and privacy and confidentiality concerns. Nevertheless, most physicians also anticipated multiple benefits, including improved accessibility of patient data and online health information. In the second interviews, physicians reported that their concerns did not persist. Many anticipated benefits were realized, appearing to facilitate collaborative physician-patient relationships. Physicians reported a greater teaching role with patients and sharing online medical information and treatment plan decisions. Before computer installation and full EHR implementation, physicians expressed concerns about the impact of computer use on patient care. After installation and implementation, however, many concerns were mitigated. Using computers in the examination rooms to document and access patients' records along with online medical information and decision-making tools appears to contribute to improved physician-patient communication and collaboration.

The impact of using computer decision-support software in primary care nurse-led telephone triage: interactional dilemmas and conversational consequences.

PubMed

Murdoch, Jamie; Barnes, Rebecca; Pooler, Jillian; Lattimer, Valerie; Fletcher, Emily; Campbell, John L

2015-02-01

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients.

PubMed

Johnson, Claire E; Chong, Jeffrey C; Wilkinson, Anne; Hayes, Barbara; Tait, Sonia; Waldron, Nicholas

2017-07-01

Advance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. A pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer. When compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03). An increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care. © 2017 Royal Australasian College of Physicians.

22 CFR 1101.14 - Appeal of agency decision not to correct or amend a record.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Appeal of agency decision not to correct or amend a record. 1101.14 Section 1101.14 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.14 Appeal of agency decision not to correct or amend a record. (a) An appea...

How IRBs View and Make Decisions About Consent Forms

PubMed Central

Klitzman, Robert L.

2013-01-01

IRBs have been criticized for long and complicated consent forms, but how IRBs make decisions about these issues hasn’t been examined. I contacted leaders of 60 IRBs, and interviewed IRB leaders from 34 (response rate = 55%), and 13 members and administrators. IRBs confront challenges and dilemmas regarding these documents: what and how much these forms should include (e.g., how “perfect” forms should be). While IRBs generally seek to decrease the length and complexity, institutions and industry funders often want these forms to be legal documents. IRBs may also “nitpick” these documents without realizing the costs. This study, the first to explore how IRBs view and make decisions about consent forms, suggests underlying tensions, ambiguities, and subjectivities that have important implications for future policy, practice, education, and research. PMID:23485667

36 CFR 220.4 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... agency decisionmaking by: (1) Completing the environmental document review before making a decision on...(s) before rendering a decision on the proposal; and (5) Making a decision encompassed within the... preparing to make a decision on one or more alternative means of accomplishing that goal and the effects can...

Documenting Employee Conduct

ERIC Educational Resources Information Center

Dalton, Jason

2009-01-01

One of the best ways for a child care program to lose an employment-related lawsuit is failure to document the performance of its employees. Documentation of an employee's performance can provide evidence of an employment-related decision such as discipline, promotion, or discharge. When properly implemented, documentation of employee performance…

Semantic Metadata for Heterogeneous Spatial Planning Documents

NASA Astrophysics Data System (ADS)

Iwaniak, A.; Kaczmarek, I.; Łukowicz, J.; Strzelecki, M.; Coetzee, S.; Paluszyński, W.

2016-09-01

Spatial planning documents contain information about the principles and rights of land use in different zones of a local authority. They are the basis for administrative decision making in support of sustainable development. In Poland these documents are published on the Web according to a prescribed non-extendable XML schema, designed for optimum presentation to humans in HTML web pages. There is no document standard, and limited functionality exists for adding references to external resources. The text in these documents is discoverable and searchable by general-purpose web search engines, but the semantics of the content cannot be discovered or queried. The spatial information in these documents is geographically referenced but not machine-readable. Major manual efforts are required to integrate such heterogeneous spatial planning documents from various local authorities for analysis, scenario planning and decision support. This article presents results of an implementation using machine-readable semantic metadata to identify relationships among regulations in the text, spatial objects in the drawings and links to external resources. A spatial planning ontology was used to annotate different sections of spatial planning documents with semantic metadata in the Resource Description Framework in Attributes (RDFa). The semantic interpretation of the content, links between document elements and links to external resources were embedded in XHTML pages. An example and use case from the spatial planning domain in Poland is presented to evaluate its efficiency and applicability. The solution enables the automated integration of spatial planning documents from multiple local authorities to assist decision makers with understanding and interpreting spatial planning information. The approach is equally applicable to legal documents from other countries and domains, such as cultural heritage and environmental management.

37 CFR 3.54 - Effect of recording.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Effect of recording. 3.54... COMMERCE GENERAL ASSIGNMENT, RECORDING AND RIGHTS OF ASSIGNEE Date and Effect of Recording § 3.54 Effect of... validity of the document or the effect that document has on the title to an application, a patent, or a...

7 CFR 760.405 - Application process.

Code of Federal Regulations, 2011 CFR

2011-01-01

... death documentation is not available, the participant may provide reliable records, in conjunction with verifiable beginning and ending inventory records, as proof of death. Reliable records may include..., pictures, and other similar reliable documents as determined by FSA. (f) Certification of livestock deaths...

Advanced decision support for winter road maintenance

DOT National Transportation Integrated Search

2008-01-01

This document provides an overview of the Federal Highway Administration's winter Maintenance Decision Support System (MDSS). The MDSS is a decision support tool that has the ability to provide weather predictions focused toward the road surface. The...

An Overview of R in Health Decision Sciences.

PubMed

Jalal, Hawre; Pechlivanoglou, Petros; Krijkamp, Eline; Alarid-Escudero, Fernando; Enns, Eva; Hunink, M G Myriam

2017-10-01

As the complexity of health decision science applications increases, high-level programming languages are increasingly adopted for statistical analyses and numerical computations. These programming languages facilitate sophisticated modeling, model documentation, and analysis reproducibility. Among the high-level programming languages, the statistical programming framework R is gaining increased recognition. R is freely available, cross-platform compatible, and open source. A large community of users who have generated an extensive collection of well-documented packages and functions supports it. These functions facilitate applications of health decision science methodology as well as the visualization and communication of results. Although R's popularity is increasing among health decision scientists, methodological extensions of R in the field of decision analysis remain isolated. The purpose of this article is to provide an overview of existing R functionality that is applicable to the various stages of decision analysis, including model design, input parameter estimation, and analysis of model outputs.

10 CFR 34.89 - Location of documents and records.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Location of documents and records. 34.89 Section 34.89 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.89 Location of documents...

10 CFR 34.89 - Location of documents and records.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Location of documents and records. 34.89 Section 34.89 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.89 Location of documents...

10 CFR 34.89 - Location of documents and records.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Location of documents and records. 34.89 Section 34.89 Energy NUCLEAR REGULATORY COMMISSION LICENSES FOR INDUSTRIAL RADIOGRAPHY AND RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIOGRAPHIC OPERATIONS Recordkeeping Requirements § 34.89 Location of documents...

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

Zining, Jin, E-mail: jinzn@pkusz.edu.cn

The article explores the practices of Environmental Impact Assessment (EIA) Law in China's courts by examining 107 judicial decisions. Each of the 107 judicial decisions has been analyzed to determine the time/location of the decision, what type of EIA document was referred to, what specific claim was made by the plaintiffs, and what the court's ruling was on the case. The results indicate that: unlike in Germany or Japan, all kinds of EIA decisions made by environment protect bureaus (EPBs) in China were widely taken as justiciable, and China's courts generally allowed local residents to have standing and thus challengemore » the EPBs' decisions made during the EIA process. On the other hand, the research also shows the EPBs overwhelmingly prevailed in those EIA lawsuits. It is also found that China's reviewing judges were highly self-restrained, giving obvious deference to the technocrat with the substantial contents of EIA documents. Also, the concept of “flaw” was created when it came to procedural issues. These two factors, among others, were both helping the EPBs' prevailing successes. - Highlights: • 107 judicial decisions referring to China's EIA law are examined. • The justiciability of EPB's EIA decisions were taken for granted. • The defenders overwhelmingly prevailed in those EIA lawsuits. • The reviewing judges were highly self-restrained, defering to the technocrat with the EIA documents. • A functional concept, “flaw”, was created by reviewing judges when it came to procedural issues.« less