Sample records for information document note
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In Search of Social Translucence: An Audit Log Analysis of Handoff Documentation Views and Updates.
Jiang, Silis Y; Hum, R Stanley; Vawdrey, David; Mamykina, Lena
2015-01-01
Communication and information sharing are critical parts of teamwork in the hospital; however, achieving open and fluid communication can be challenging. Finding specific patient information within documentation can be difficult. Recent studies on handoff documentation tools show that resident handoff notes are increasingly used as an alternative information source by non-physician clinicians. Previous findings also show that residents have become aware of this unintended use. This study investigated the alignment of resident note updating patterns and team note viewing patterns based on usage log data of handoff notes. Qualitative interviews with clinicians were used to triangulate findings based on the log analysis. The study found that notes that were frequently updated were viewed significantly more frequently than notes updated less often (p < 2.2 × 10(-16)). Almost 44% of all notes had aligned frequency of views and updates. The considerable percentage (56%) of mismatched note utilization suggests an opportunity for improvement.
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Code of Federal Regulations, 2014 CFR
2014-01-01
... bonds and bond transcript documents for public body applicants. 1942.19 Section 1942.19 Agriculture... of notes or bonds and bond transcript documents for public body applicants. (a) General. This section includes information for use by public body applicants in the preparation and issuance of evidence of debt...
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Code of Federal Regulations, 2012 CFR
2012-01-01
... bonds and bond transcript documents for public body applicants. 1942.19 Section 1942.19 Agriculture... of notes or bonds and bond transcript documents for public body applicants. (a) General. This section includes information for use by public body applicants in the preparation and issuance of evidence of debt...
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Code of Federal Regulations, 2011 CFR
2011-01-01
... bonds and bond transcript documents for public body applicants. 1942.19 Section 1942.19 Agriculture... of notes or bonds and bond transcript documents for public body applicants. (a) General. This section includes information for use by public body applicants in the preparation and issuance of evidence of debt...
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-09-18
... connection with the assignment, legal documents (e.g., mortgage, mortgage note, security agreement, title... Information Collection to OMB and Comment Request: Legal Instructions Concerning Applications for Full... mortgages to HUD. In connection with the assignment, legal documents (e.g., mortgage, mortgage note...
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The effect of point-of-care personal digital assistant use on resident documentation discrepancies.
Carroll, Aaron E; Tarczy-Hornoch, Peter; O'Reilly, Eamon; Christakis, Dimitri A
2004-03-01
We recently found documentation discrepancies in 60% of resident daily-progress notes with respect to patient weight, medications, or vascular lines. To what extent information systems can decrease such discrepancies is unknown. To determine whether a point-of-care personal digital assistant (PDA)-based patient record and charting system could reduce the number of resident progress-note documentation discrepancies in a neonatal intensive care unit (NICU). We conducted a before-and-after trial in an academic NICU. Our intervention was a PDA-based patient record and charting system used by all NICU resident physicians over the study period. We analyzed all resident daily-progress notes from 40 randomly selected days over 4 months in both the baseline and intervention periods. Using predefined reference standards, we determined the accuracy of recorded information for patient weights, medications, and vascular lines. Logistic and Poisson regression were used in analyses to control for potential confounding factors. A total of 339 progress notes in the baseline period and 432 progress notes in the intervention period were reviewed. When controlling for covariates in the regression, there were significantly fewer documentation discrepancies of patient weights in notes written by using the PDA system (14.4%-4.4% of notes; odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.15-0.56). When using the PDA system, there were no significant changes in the numbers of notes with documentation discrepancies of medications (27.7%-17.1% of notes; OR: 0.63; 95% CI: 0.35-1.13) or vascular lines (33.6%-36.1% of notes; OR: 1.11; 95% CI: 0.66-1.87). The use of our PDA-based point-of-care patient record and charting system showed a modest benefit in reducing the number of documentation discrepancies in resident daily-progress notes. Further study of PDAs in information systems is warranted before they are widely adopted.
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The essential SOAP note in an EHR age.
Pearce, Patricia F; Ferguson, Laurie Anne; George, Gwen S; Langford, Cynthia A
2016-02-18
This article reviews the traditional Subjective, Objective, Assessment, and Plan (SOAP) note documentation format. The information in the SOAP note is useful to both providers and students for history taking and physical exam, and highlights the importance of including critical documentation details with or without an electronic health record.
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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
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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.
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Koopman, Richelle J; Steege, Linsey M Barker; Moore, Joi L; Clarke, Martina A; Canfield, Shannon M; Kim, Min S; Belden, Jeffery L
2015-01-01
Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes. This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers. The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter. Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer. © Copyright 2015 by the American Board of Family Medicine.
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Standard Information Models for Representing Adverse Sensitivity Information in Clinical Documents.
Topaz, M; Seger, D L; Goss, F; Lai, K; Slight, S P; Lau, J J; Nandigam, H; Zhou, L
2016-01-01
Adverse sensitivity (e.g., allergy and intolerance) information is a critical component of any electronic health record system. While several standards exist for structured entry of adverse sensitivity information, many clinicians record this data as free text. This study aimed to 1) identify and compare the existing common adverse sensitivity information models, and 2) to evaluate the coverage of the adverse sensitivity information models for representing allergy information on a subset of inpatient and outpatient adverse sensitivity clinical notes. We compared four common adverse sensitivity information models: Health Level 7 Allergy and Intolerance Domain Analysis Model, HL7-DAM; the Fast Healthcare Interoperability Resources, FHIR; the Consolidated Continuity of Care Document, C-CDA; and OpenEHR, and evaluated their coverage on a corpus of inpatient and outpatient notes (n = 120). We found that allergy specialists' notes had the highest frequency of adverse sensitivity attributes per note, whereas emergency department notes had the fewest attributes. Overall, the models had many similarities in the central attributes which covered between 75% and 95% of adverse sensitivity information contained within the notes. However, representations of some attributes (especially the value-sets) were not well aligned between the models, which is likely to present an obstacle for achieving data interoperability. Also, adverse sensitivity exceptions were not well represented among the information models. Although we found that common adverse sensitivity models cover a significant portion of relevant information in the clinical notes, our results highlight areas needed to be reconciled between the standards for data interoperability.
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Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research.
Hanson, Janice L; Stephens, Mark B; Pangaro, Louis N; Gimbel, Ronald W
2012-11-19
There are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing and assessing quality of clinical documentation is a necessary improvement in an increasingly team-based healthcare delivery system. In this paper we describe the quality of outpatient clinical notes from the perspective of multiple stakeholders. Using purposeful sampling for maximum diversity, we conducted focus groups and individual interviews with clinicians, nursing and ancillary staff, patients, and healthcare administrators at six federal health care facilities between 2009 and 2011. All sessions were audio-recorded, transcribed and qualitatively analyzed using open, axial and selective coding. The 163 participants included 61 clinicians, 52 nurse/ancillary staff, 31 patients and 19 administrative staff. Three organizing themes emerged: 1) characteristics of quality in clinical notes, 2) desired elements within the clinical notes and 3) system supports to improve the quality of clinical notes. We identified 11 codes to describe characteristics of clinical notes, 20 codes to describe desired elements in quality clinical notes and 11 codes to describe clinical system elements that support quality when writing clinical notes. While there was substantial overlap between the aspects of quality described by the four stakeholder groups, only clinicians and administrators identified ease of translation into billing codes as an important characteristic of a quality note. Only patients rated prioritization of their medical problems as an aspect of quality. Nurses included care and education delivered to the patient, information added by the patient, interdisciplinary information, and infection alerts as important content. Perspectives of these four stakeholder groups provide a comprehensive description of quality in outpatient clinical documentation. The resulting description of characteristics and content necessary for quality notes provides a research-based foundation for assessing the quality of clinical documentation in outpatient health care settings.
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Redd, Andrew M; Gundlapalli, Adi V; Divita, Guy; Carter, Marjorie E; Tran, Le-Thuy; Samore, Matthew H
2017-07-01
Templates in text notes pose challenges for automated information extraction algorithms. We propose a method that identifies novel templates in plain text medical notes. The identification can then be used to either include or exclude templates when processing notes for information extraction. The two-module method is based on the framework of information foraging and addresses the hypothesis that documents containing templates and the templates within those documents can be identified by common features. The first module takes documents from the corpus and groups those with common templates. This is accomplished through a binned word count hierarchical clustering algorithm. The second module extracts the templates. It uses the groupings and performs a longest common subsequence (LCS) algorithm to obtain the constituent parts of the templates. The method was developed and tested on a random document corpus of 750 notes derived from a large database of US Department of Veterans Affairs (VA) electronic medical notes. The grouping module, using hierarchical clustering, identified 23 groups with 3 documents or more, consisting of 120 documents from the 750 documents in our test corpus. Of these, 18 groups had at least one common template that was present in all documents in the group for a positive predictive value of 78%. The LCS extraction module performed with 100% positive predictive value, 94% sensitivity, and 83% negative predictive value. The human review determined that in 4 groups the template covered the entire document, with the remaining 14 groups containing a common section template. Among documents with templates, the number of templates per document ranged from 1 to 14. The mean and median number of templates per group was 5.9 and 5, respectively. The grouping method was successful in finding like documents containing templates. Of the groups of documents containing templates, the LCS module was successful in deciphering text belonging to the template and text that was extraneous. Major obstacles to improved performance included documents composed of multiple templates, templates that included other templates embedded within them, and variants of templates. We demonstrate proof of concept of the grouping and extraction method of identifying templates in electronic medical records in this pilot study and propose methods to improve performance and scaling up. Published by Elsevier Inc.
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Code of Federal Regulations, 2010 CFR
2010-01-01
... includes information for use by public body applicants in the preparation and issuance of evidence of debt... 7 Agriculture 13 2010-01-01 2009-01-01 true Information pertaining to preparation of notes or... REGULATIONS (CONTINUED) ASSOCIATIONS Community Facility Loans § 1942.19 Information pertaining to preparation...
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Shoolin, J; Ozeran, L; Hamann, C; Bria, W
2013-01-01
In 2013, electronic documentation of clinical care stands at a crossroads. The benefits of creating digital notes are at risk of being overwhelmed by the inclusion of easily importable detail. Providers are the primary authors of encounters with patients. We must document clearly our understanding of patients and our communication with them and our colleagues. We want to document efficiently to meet without exceeding documentation guidelines. We copy and paste documentation, because it not only simplifies the documentation process generally, but also supports meeting coding and regulatory requirements specifically. Since the primary goal of our profession is to spend as much time as possible listening to, understanding and helping patients, clinicians need information technology to make electronic documentation easier, not harder. At the same time, there should be reasonable restrictions on the use of copy and paste to limit the growing challenge of 'note bloat'. We must find the right balance between ease of use and thoughtless documentation. The guiding principles in this document may be used to launch an interdisciplinary dialogue that promotes useful and necessary documentation that best facilitates efficient information capture and effective display.
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Classifying clinical notes with pain assessment using machine learning.
Fodeh, Samah Jamal; Finch, Dezon; Bouayad, Lina; Luther, Stephen L; Ling, Han; Kerns, Robert D; Brandt, Cynthia
2017-12-26
Pain is a significant public health problem, affecting millions of people in the USA. Evidence has highlighted that patients with chronic pain often suffer from deficits in pain care quality (PCQ) including pain assessment, treatment, and reassessment. Currently, there is no intelligent and reliable approach to identify PCQ indicators inelectronic health records (EHR). Hereby, we used unstructured text narratives in the EHR to derive pain assessment in clinical notes for patients with chronic pain. Our dataset includes patients with documented pain intensity rating ratings > = 4 and initial musculoskeletal diagnoses (MSD) captured by (ICD-9-CM codes) in fiscal year 2011 and a minimal 1 year of follow-up (follow-up period is 3-yr maximum); with complete data on key demographic variables. A total of 92 patients with 1058 notes was used. First, we manually annotated qualifiers and descriptors of pain assessment using the annotation schema that we previously developed. Second, we developed a reliable classifier for indicators of pain assessment in clinical note. Based on our annotation schema, we found variations in documenting the subclasses of pain assessment. In positive notes, providers mostly documented assessment of pain site (67%) and intensity of pain (57%), followed by persistence (32%). In only 27% of positive notes, did providers document a presumed etiology for the pain complaint or diagnosis. Documentation of patients' reports of factors that aggravate pain was only present in 11% of positive notes. Random forest classifier achieved the best performance labeling clinical notes with pain assessment information, compared to other classifiers; 94, 95, 94, and 94% was observed in terms of accuracy, PPV, F1-score, and AUC, respectively. Despite the wide spectrum of research that utilizes machine learning in many clinical applications, none explored using these methods for pain assessment research. In addition, previous studies using large datasets to detect and analyze characteristics of patients with various types of pain have relied exclusively on billing and coded data as the main source of information. This study, in contrast, harnessed unstructured narrative text data from the EHR to detect pain assessment clinical notes. We developed a Random forest classifier to identify clinical notes with pain assessment information. Compared to other classifiers, ours achieved the best results in most of the reported metrics. Graphical abstract Framework for detecting pain assessment in clinical notes.
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Supplemental information on National Woodland Owner Survey 2011-2013 two-page summary reports
Brett J. Butler; Sarah M. Butler
2016-01-01
This document provides explanations of the data sources, graphics, and summaries presented in the 41 national, regional, and state National Woodland Owner Survey 2011-2013 two-page research note summary reports (Research Note NRS-206 through Research Note NRS-246). All of these research notes can be accessed at ...
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National Earthquake Information Center systems overview and integration
Guy, Michelle R.; Patton, John M.; Fee, Jeremy; Hearne, Mike; Martinez, Eric; Ketchum, D.; Worden, Charles; Quitoriano, Vince; Hunter, Edward; Smoczyk, Gregory; Schwarz, Stan
2015-08-18
It is important to note that this document provides a brief introduction to the work of dozens of software developers and IT specialists, spanning in many cases more than a decade. References to significant amounts of supporting documentation, code, and information are supplied within.
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Learning from Lectures: The Implications of Note-Taking for Students with Learning Disabilities
ERIC Educational Resources Information Center
Boyle, Joseph R.
2006-01-01
Students with learning disabilities lack effective note-taking skills for a variety of reasons. Despite the important role that notes play in helping students to understand lecture content information and serving as documents for later review, many students with learning disabilities are simply not effective note-takers. Many of these students…
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38 CFR 17.108 - Copayments for inpatient hospital care and outpatient medical care.
Code of Federal Regulations, 2012 CFR
2012-07-01
... system and also is the document used for providing means-test information annually. (c) Copayments for... (CAT) scan, nuclear medicine studies, surgical consultative services, and ambulatory surgery. Note to... and also is the document used for providing means-test information annually. (d) Veterans not subject...
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38 CFR 17.108 - Copayments for inpatient hospital care and outpatient medical care.
Code of Federal Regulations, 2011 CFR
2011-07-01
... system and also is the document used for providing means-test information annually. (c) Copayments for... (CAT) scan, nuclear medicine studies, surgical consultative services, and ambulatory surgery. Note to... and also is the document used for providing means-test information annually. (d) Veterans not subject...
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38 CFR 17.108 - Copayments for inpatient hospital care and outpatient medical care.
Code of Federal Regulations, 2010 CFR
2010-07-01
... system and also is the document used for providing means-test information annually. (c) Copayments for... (CAT) scan, nuclear medicine studies, surgical consultative services, and ambulatory surgery. Note to... and also is the document used for providing means-test information annually. (d) Veterans not subject...
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A User-Centered View of Document Delivery and Interlibrary Loan.
ERIC Educational Resources Information Center
Martin, Harry S., III; Kendrick, Curtis L.
1994-01-01
Discusses reasons why libraries are being forced to seek new forms of information storage. A hypothetical scenario of user-initiated document delivery alternatives integrated with a search process used by a professor using the Harvard OnLine Library Information System is presented. Extensive notes elaborate on the process and the technology…
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Taming Big Data: An Information Extraction Strategy for Large Clinical Text Corpora.
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.
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Falzeder, Ernst
2007-01-01
This article presents an overview of the existing editions of what Freud wrote (works, letters, manuscripts and drafts, diaries and calendar notes, dedications and margin notes in books, case notes, and patient calendars) and what he is recorded as having said (minutes of meetings, interviews, memoirs of and interviews with patients, family members, and followers, and other quotes). There follows a short overview of biographies of Freud and other documentation on his life. It is concluded that a wealth of material is now available to Freud scholars, although more often than not this information is used in a biased and partisan way.
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Bergh, Anne-Louise; Bergh, Claes-Håkan; Friberg, Febe
2007-10-01
To describe the use of pedagogically related keywords and the content of notes connected to these keywords, as they appear in nursing records in a coronary artery bypass graft (CABG) surgery rehabilitation unit. Nursing documentation is an important component of clinical practice and is regulated by law in Sweden. Studies have been carried out in order to evaluate the educational and rehabilitative needs of patients following CABG surgery but, as yet, no study has contained an in-depth evaluation of how nurses document pedagogical activities in the records of these patients. The records of 265 patients admitted to a rehabilitation unit following CABG surgery were analysed. The records were structured in accordance with the VIPS model. Using this model, pedagogically related keywords: communication, cognition/development and information/education were selected. The analysis of the data consisted of three parts: the frequency with which pedagogically related keywords are used, the content and the structure of the notes. Apart from the term 'communication', pedagogically related keywords were seldom used. Communication appeared in all records describing limitations, although no explicit reference was made to pedagogical activities. The notes related to cognition/development were grouped into the following themes: nurses' actions, assessment of knowledge and provision of information, advice and instructions as well as patients' wishes and experiences. The themes related to information were the provision of information and advice in addition to relevant nursing actions. The structure of the documentation was simple. The documentation of pedagogical activities in nursing records was infrequent and inadequate. The patients' need for knowledge and the nurses' teaching must be documented in the patient records so as to clearly reflect the frequency and quality of pedagogical activities.
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Where do I find documentation/more information concerning a data set?
Atmospheric Science Data Center
2015-11-30
To access documentation, locate and select the link from the Projects Supported page for the project that you would like ... page where you can access it if it is available, note that a missing tab on the product page indicates that there is no documentation ...
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Soller, David R.
1996-01-01
This report summarizes a technical review of USGS Open-File Report 95-525, 'Cartographic and Digital Standard for Geologic Map Information' and OFR 95-526 (diskettes containing digital representations of the standard symbols). If you are considering the purchase or use of those documents, you should read this report first. For some purposes, OFR 95-525 (the printed document) will prove to be an excellent resource. However, technical review identified significant problems with the two documents that will be addressed by various Federal and State committees composed of geologists and cartographers, as noted below. Therefore, the 2-year review period noted in OFR 95-525 is no longer applicable. Until those problems are resolved and formal standards are issued, you may consult the following World-Wide Web (WWW) site which contains information about development of geologic map standards: URL: http://ncgmp.usgs.gov/ngmdbproject/home.html
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Research notes : information at your fingertips!
DOT National Transportation Integrated Search
2000-03-01
TRIS Online includes full-text reports or links to publishers or suppliers of the original documents. You will find titles, publication dates, authors, abstracts, and document sources. : Each year over 20,000 new records are added to TRIS. The databa...
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Gender Differences in Reading Performance on Documents across Countries.
ERIC Educational Resources Information Center
Rosen, Monica
2001-01-01
Notes how females are known to excel over males in most reading tasks, but not consistently so in tasks that require processing information from maps, tables, charts and diagrams, so called "Documents." Describes and analyzes gender differences on Document tasks, and investigates if and how the pattern of differences varies over countries. (SG)
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Skills Development Using Role-Play in a First-Year Pharmacy Practice Course
2011-01-01
Objectives. To evaluate the usefulness of a role-play model in developing students’ patient-care skills in a first-year undergraduate pharmacy practice course. Design. A role-play model was developed and implemented in workshops across 2 semesters of a year-long course. Students performed different roles, including that of a pharmacist and a patient, and documented case notes in a single interaction. Assessment. Student perceptions of the usefulness of the approach in acquiring skills were measured by surveying students during both semesters. All student assessments (N=130 in semester1; N=129 in semester 2) also were analyzed for skills in verbal communication, information gathering, counselling and making recommendations, and accurately documenting information. A majority of students found the approach useful in developing skills. An analysis of student assessments revealed that role-playing was not as effective in building skills related to accurate documentation as it was in other areas of patient care. Conclusions. Role play is useful for developing patient-care skills in communication and information gathering but not for documentation of case notes. PMID:21829258
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Hayes, D.F.; Schroeder, P.R.
This technical note documents the SETTLE computer program which facilitates the design of a confined disposal facility (CDF) to retain solids, provide initial storage, and meet effluent discharge limitations for suspended solids during a dredged matenal disposal operation. Detailed information can be found in Engineer Manual 1110-2-5027, Confined Dredged Material Disposal. SETTLE is a part of the Automated Dredging and Disposal Alternatives Management System (ADDAMS).
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Zhu, Vivienne J; Walker, Tina D; Warren, Robert W; Jenny, Peggy B; Meystre, Stephane; Lenert, Leslie A
2017-01-01
Quality reporting that relies on coded administrative data alone may not completely and accurately depict providers’ performance. To assess this concern with a test case, we developed and evaluated a natural language processing (NLP) approach to identify falls risk screenings documented in clinical notes of patients without coded falls risk screening data. Extracting information from 1,558 clinical notes (mainly progress notes) from 144 eligible patients, we generated a lexicon of 38 keywords relevant to falls risk screening, 26 terms for pre-negation, and 35 terms for post-negation. The NLP algorithm identified 62 (out of the 144) patients who falls risk screening documented only in clinical notes and not coded. Manual review confirmed 59 patients as true positives and 77 patients as true negatives. Our NLP approach scored 0.92 for precision, 0.95 for recall, and 0.93 for F-measure. These results support the concept of utilizing NLP to enhance healthcare quality reporting. PMID:29854264
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Notes on Literacy. Numbers 57-60, 1989.
ERIC Educational Resources Information Center
Notes on Literacy, 1989
1989-01-01
This document consists of all four 1989 issues of "Notes on Literacy", an occasional paper series published by the Summer Institute of Linguistics, Inc. as a means of "sharing information of a practical and theoretical nature with the literacy workers of each branch." Articles and authors in Number 57 are: "Orthography…
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1990-04-01
4r A 7 MIR COPY of Office of Naval Research European Office 90-03 S •Best Available Copy CVJ INFORMATION BULLETIN European Science Notes Information...REPORT DOCUMENTATION PAGE . a . REPORT SECURITY CLASSIFICATION lb RESTRICTIVE MARKINGS UNCLASSIFIED 2a SECURITY C.ASSIFICATION AUTHORITY 3...095100700 .% A .,E O ;,N••NG SPOSOR:.%G so O;F CE SYMBOL 9 PROCUREMENT .NSTRUMENT iOENrT1ICATiON ,UMBER ORCANIZATON 1 (If apphcable) 3c ADODRESS (City
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Client Oriented Management Documents.
ERIC Educational Resources Information Center
Limaye, Mohan R.; Hightower, Rick
Noting that accounting reports, including management advisory service (MAS) studies, reports on internal control, and tax memoranda, often appear rather dense and heavy in style--partly because of the legal environment's demand for careful expression and partly because such documents convey very complex information--this paper presents four…
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Hayes, D.F.; Schroeder, P.R.; Engler, R.M.
This technical note describes procedures for determining mean hydraulic retention time and efficiency of a confined disposal facility (CDF) from a dye tracer slug test. These parameters are required to properly design a CDF for solids retention and for effluent quality considerations. Detailed information on conduct and analysis of dye tracer studies can be found in Engineer Manual 1110-2-5027, Confined Dredged Material Disposal. This technical note documents the DYECON computer program which facilitates the analysis of dye tracer concentration data and computes the hydraulic efficiency of a CDF as part of the Automated Dredging and Disposal Alternatives Management System (ADDAMS).
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A Guide to Field Notes for Qualitative Research: Context and Conversation.
Phillippi, Julia; Lauderdale, Jana
2018-02-01
Field notes are widely recommended in qualitative research as a means of documenting needed contextual information. With growing use of data sharing, secondary analysis, and metasynthesis, field notes ensure rich context persists beyond the original research team. However, while widely regarded as essential, there is not a guide to field note collection within the literature to guide researchers. Using the qualitative literature and previous research experience, we provide a concise guide to collection, incorporation, and dissemination of field notes. We provide a description of field note content for contextualization of an entire study as well as individual interviews and focus groups. In addition, we provide two "sketch note" guides, one for study context and one for individual interviews or focus groups for use in the field. Our guides are congruent with many qualitative and mixed methodologies and ensure contextual information is collected, stored, and disseminated as an essential component of ethical, rigorous qualitative research.
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Yadav, Siddhartha; Kazanji, Noora; K C, Narayan; Paudel, Sudarshan; Falatko, John; Shoichet, Sandor; Maddens, Michael; Barnes, Michael A
2017-01-01
There have been several concerns about the quality of documentation in electronic health records (EHRs) when compared to paper charts. This study compares the accuracy of physical examination findings documentation between the two in initial progress notes. Initial progress notes from patients with 5 specific diagnoses with invariable physical findings admitted to Beaumont Hospital, Royal Oak, between August 2011 and July 2013 were randomly selected for this study. A total of 500 progress notes were retrospectively reviewed. The paper chart arm consisted of progress notes completed prior to the transition to an EHR on July 1, 2012. The remaining charts were placed in the EHR arm. The primary endpoints were accuracy, inaccuracy, and omission of information. Secondary endpoints were time of initiation of progress note, word count, number of systems documented, and accuracy based on level of training. The rate of inaccurate documentation was significantly higher in the EHRs compared to the paper charts (24.4% vs 4.4%). However, expected physical examination findings were more likely to be omitted in the paper notes compared to EHRs (41.2% vs 17.6%). Resident physicians had a smaller number of inaccuracies (5.3% vs 17.3%) and omissions (16.8% vs 33.9%) compared to attending physicians. During the initial phase of implementation of an EHR, inaccuracies were more common in progress notes in the EHR compared to the paper charts. Residents had a lower rate of inaccuracies and omissions compared to attending physicians. Further research is needed to identify training methods and incentives that can reduce inaccuracies in EHRs during initial implementation. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Toward Medical Documentation That Enhances Situational Awareness Learning
Lenert, Leslie A.
2016-01-01
The purpose of writing medical notes in a computer system goes beyond documentation for medical-legal purposes or billing. The structure of documentation is a checklist that serves as a cognitive aid and a potential index to retrieve information for learning from the record. For the past 50 years, one of the primary organizing structures for physicians’ clinical documentation have been the SOAP note (Subjective, Objective, Assessment, Plan). The cognitive check list is well-suited to differential diagnosis but may not support detection of changes in systems and/or learning from cases. We describe an alternative cognitive checklist called the OODA Loop (Observe, Orient, Decide, Act. Through incorporation of projections of anticipated course events with and without treatment and by making “Decisions” an explicit category of documentation in the medical record in the context of a variable temporal cycle for observations, OODA may enhance opportunities to learn from clinical care. PMID:28269872
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Questioned document workflow for handwriting with automated tools
NASA Astrophysics Data System (ADS)
Das, Krishnanand; Srihari, Sargur N.; Srinivasan, Harish
2012-01-01
During the last few years many document recognition methods have been developed to determine whether a handwriting specimen can be attributed to a known writer. However, in practice, the work-flow of the document examiner continues to be manual-intensive. Before a systematic or computational, approach can be developed, an articulation of the steps involved in handwriting comparison is needed. We describe the work flow of handwritten questioned document examination, as described in a standards manual, and the steps where existing automation tools can be used. A well-known ransom note case is considered as an example, where one encounters testing for multiple writers of the same document, determining whether the writing is disguised, known writing is formal while questioned writing is informal, etc. The findings for the particular ransom note case using the tools are given. Also observations are made for developing a more fully automated approach to handwriting examination.
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The Training Information Management System. Volume 2. Phase 2 evaluation Report
1986-07-01
The Training Information Management System (TIMS) is a computer-based system which can be used by Army personnel to collect and display training...but resides at a fixed location (e.g., the unit headquarters). This research note documents an evaluation of the Training Information Management System .
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Documentation of Dual Sensory Impairment in Electronic Medical Records.
Dullard, Brittney; Saunders, Gabrielle H
2016-04-01
To examine the documentation of sensory impairment in the electronic medical records (EMRs) of Veterans with both hearing and vision losses (dual sensory impairment [DSI]). A retrospective chart review of the EMRs of 20 patients with DSI was conducted. Providers' documentation of the presence of sensory impairment, the use of assistive technology during clinical appointments, and the content of notes mentioning communication issues were extracted from each chart note in the EMR for the prior 6 years. Primary care providers documented DSI in 50% of EMRs, vision loss alone in 40%, and hearing loss alone in 10% of EMRs. Audiologists documented vision loss in 50% of cases, whereas ophthalmologists/optometrists documented hearing loss in 15% of cases. Examination of two selected cases illustrates that care can be compromised when providers do not take note of sensory impairments during planning and provision of clinical care. Sensory impairment is poorly documented by most providers in EMRs. This is alarming because vision and hearing affect patient-physician communication and the use of medical interventions. The results of this study raise awareness about the need to document the presence of sensory impairments and use the information when planning treatment for individuals with DSI. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Challenges in reusing transactional data for daily documentation in neonatal intensive care.
Kim, G R; Lawson, E E; Lehmann, C U
2008-11-06
The reuse of transactional data for clinical documentation requires navigation of computational, institutional and adaptive barriers. We describe organizational and technical issues in developing and deploying a daily progress note tool in a tertiary neonatal intensive care unit that reuses and aggregates data from a commercial integrated clinical information system.
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Gilliam, Meredith; Krein, Sarah L; Belanger, Karen; Fowler, Karen E; Dimcheff, Derek E; Solomon, Gabriel
2017-01-01
Background: Incomplete or delayed access to discharge information by outpatient providers and patients contributes to discontinuity of care and poor outcomes. Objective: To evaluate the effect of a new electronic discharge summary tool on the timeliness of documentation and communication with outpatient providers. Methods: In June 2012, we implemented an electronic discharge summary tool at our 145-bed university-affiliated Veterans Affairs hospital. The tool facilitates completion of a comprehensive discharge summary note that is available for patients and outpatient medical providers at the time of hospital discharge. Discharge summary note availability, outpatient provider satisfaction, and time between the decision to discharge a patient and discharge note completion were all evaluated before and after implementation of the tool. Results: The percentage of discharge summary notes completed by the time of first post-discharge clinical contact improved from 43% in February 2012 to 100% in September 2012 and was maintained at 100% in 2014. A survey of 22 outpatient providers showed that 90% preferred the new summary and 86% found it comprehensive. Despite increasing required documentation, the time required to discharge a patient, from physician decision to discharge note completion, improved from 5.6 h in 2010 to 4.1 h in 2012 (p = 0.04), and to 2.8 h in 2015 (p < 0.001). Conclusion: The implementation of a novel discharge summary tool improved the timeliness and comprehensiveness of discharge information as needed for the delivery of appropriate, high-quality follow-up care, without adversely affecting the efficiency of the discharge process. PMID:28491308
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Gilliam, Meredith; Krein, Sarah L; Belanger, Karen; Fowler, Karen E; Dimcheff, Derek E; Solomon, Gabriel
2017-01-01
Incomplete or delayed access to discharge information by outpatient providers and patients contributes to discontinuity of care and poor outcomes. To evaluate the effect of a new electronic discharge summary tool on the timeliness of documentation and communication with outpatient providers. In June 2012, we implemented an electronic discharge summary tool at our 145-bed university-affiliated Veterans Affairs hospital. The tool facilitates completion of a comprehensive discharge summary note that is available for patients and outpatient medical providers at the time of hospital discharge. Discharge summary note availability, outpatient provider satisfaction, and time between the decision to discharge a patient and discharge note completion were all evaluated before and after implementation of the tool. The percentage of discharge summary notes completed by the time of first post-discharge clinical contact improved from 43% in February 2012 to 100% in September 2012 and was maintained at 100% in 2014. A survey of 22 outpatient providers showed that 90% preferred the new summary and 86% found it comprehensive. Despite increasing required documentation, the time required to discharge a patient, from physician decision to discharge note completion, improved from 5.6 h in 2010 to 4.1 h in 2012 (p = 0.04), and to 2.8 h in 2015 (p < 0.001). The implementation of a novel discharge summary tool improved the timeliness and comprehensiveness of discharge information as needed for the delivery of appropriate, high-quality follow-up care, without adversely affecting the efficiency of the discharge process.
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Integrated Risk Information System (IRIS)
EPA / 635 / R - 11 / 002F www.epa.gov / iris TOXICOLOGICAL REVIEW OF LIBBY AMPHIBOLE ASBESTOS In Support of Summary Information on the Integrated Risk Information System ( IRIS ) December 2014 ( Note : This document is an assessment of the noncancer and cancer health effects associated with the inha
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ERIC Educational Resources Information Center
Dominique, Philippe
1987-01-01
The second volume of a series of textbooks designed for young students of French is reviewed by examining how the dialogs, phonological information, grammar instruction and notes, exercises, characters and their language, cultural information, and photos and documents correspond to the authors' expressed instructional intentions. (MSE)
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Registered nurses' decision-making regarding documentation in patients' progress notes.
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.
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Medical Record Documentation Among Interns: A Prospective Quality Improvement Study.
Owen, Jm; Conway, R; Silke, B; O'Riordan, D
2015-06-01
Comprehensive record keeping is a key aspect of medical practice. The National Hospitals Office (NHO) and Irish Medical Council (IMC) have published guidelines in this area. A prospective audit of 100 patients assessed by interns was performed to quantify adherence with these guidelines followed by an educational session and email reminders. Adherence was reassessed in an incidental manner. Compliance was recorded in a number of areas including the reason for review and documentation of a plan both 98 (98%). However less than half of interns recorded the patient's name, background history or their impression of the case. Only 31(31%) noted the patient's MRN and only 1(1%) the information they gave to the patient. Significant improvements following the intervention were found, however significant deficits remained in a number of areas including the noting of an impression of the case 62(62%) and information given to patients 18(18%). Suboptimal documentation can be improved through education and clinical auditing.
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Tagline: Information Extraction for Semi-Structured Text Elements in Medical Progress Notes
ERIC Educational Resources Information Center
Finch, Dezon Kile
2012-01-01
Text analysis has become an important research activity in the Department of Veterans Affairs (VA). Statistical text mining and natural language processing have been shown to be very effective for extracting useful information from medical documents. However, neither of these techniques is effective at extracting the information stored in…
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Elder Abuse Prevention Project - Phase I. Literature Summary.
ERIC Educational Resources Information Center
Draper, Lori; And Others
This document summarizes information on elder abuse collected from various sources in Canada and the United States. It is noted that document entries are often representative of more than one source, and have been selected as each adds something new and valuable to the overall research on elder abuse. An attempt has been made to choose information…
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An Academic Library's Experience with Fee-Based Services.
ERIC Educational Resources Information Center
Hornbeck, Julia W.
1983-01-01
Profile of fee-based information services offered by the Information Exchange Center of Georgia Institute of Technology notes history and background, document delivery to commercial clients and on-campus faculty, online and manual literature searching, staff, cost analysis, fee schedule, operating methods, client relations, marketing, and current…
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Apprentice and Trainee Destinations 2010: Technical Notes. Support Document
ERIC Educational Resources Information Center
National Centre for Vocational Education Research (NCVER), 2010
2010-01-01
"Apprentice and Trainee Destinations" presents information about the destinations of apprentices and trainees approximately nine months after leaving their training. Information in this publication is derived from the Apprentice and Trainee Destinations Survey that covered apprentices and trainees who, between April and June 2009, either…
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19 CFR 141.61 - Completion of entry and entry summary documentation.
Code of Federal Regulations, 2010 CFR
2010-04-01
... on CBP Form 7501. (e) Statistical information—(1) Information required on entry summary or withdrawal... a separate statistical reporting number, the applicable information required by the General Statistical Notes, Harmonized Tariff Schedule of the United States (HTSUS), must be shown on the entry summary...
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Research Notes - Openness and Evolvability - Documentation Quality Assessment
2016-08-01
UNCLASSIFIED UNCLASSIFIED Notes – Openness and Evolvability – Documentation Quality Assessment Michael Haddy* and Adam Sbrana...Methods and Processes. This set of Research Notes focusses on Documentation Quality Assessment. This work was undertaken from the late 1990s to 2007...1 2. DOCUMENTATION QUALITY ASSESSMENT ......................................................... 1 2.1 Documentation Quality Assessment
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Booth, C; Grant-Casey, J; Lowe, D; Court, E L; Allard, S
2017-11-28
The aim of this study was to assess current practices around obtaining consent for blood transfusion and provision of patient information in hospitals across the UK and identify areas for improvement. Recommendations from the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) (2011) state that valid consent should be obtained for blood transfusion and documented in clinical records. A standardised source of information should be available to patients. Practices in relation to this have historically been inconsistent. The consent process was studied in hospitals across the UK over a 3-month period in 2014 by means of an audit of case notes and simultaneous surveys of patients and staff. In total, 2784 transfusion episodes were reviewed across 164 hospital sites. 85% of sites had a policy on consent for transfusion. Consent was documented in 43% of case notes. 68% of patients recalled being given information on benefits of transfusion, 38% on risks and 8% on alternatives and 28% reported receiving an information leaflet. In total, 85% of staff stated they had explained the reason for transfusion, but only 65% had documented this. 41% of staff had received training specifically on transfusion consent in the last 2 years. There is a need to improve clinical practice in obtaining valid consent for transfusion in line with existing national guidelines and local Trust policies, with emphasis on documentation within clinical records. Provision of patient information is an area particularly highlighted for action, and transfusion training for clinicians should be strengthened. © 2017 British Blood Transfusion Society.
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Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve
2015-01-01
Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care.
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ERIC Educational Resources Information Center
Zhang, Rui
2013-01-01
The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…
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Situation awareness and documentation of changes that affect patient outcomes in progress notes.
Tower, Marion; Chaboyer, Wendy
2014-05-01
To report on registered nurses' situation awareness as a precursor to decision-making when recording changes in patients' conditions. Progress notes are important to communicate patients' progress and detail changes in patients' conditions. However, documentation is often poorly completed. There is little work that examines nurses' decision-making during documentation. This study focused on describing situation awareness as a precursor to decision-making during documentation. This study used Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) work on situation awareness to guide and conceptualise information. The study was situated in a naturalistic paradigm to provide an interpretation of nurses' decision-making. Think-aloud research methods and semi-structured interviews were employed to illuminate decision-making processes. Audio recordings and interview texts were individually examined for evidence of cues, informed by Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) descriptions of situation awareness. As patients' conditions changed, nurses used complex mental models and pattern-matching of information, drawing on all 3 levels of situation awareness during documentation. Level 1 situation awareness provided context, level 2 situation awareness signified a change in condition and its significance for the patient, and level 3 situation awareness was evident when nurses thought aloud about what this information indicated. Three themes associated with changes in patients' conditions emerged: deterioration in condition, not responding to prescribed treatments as expected and issues related to professional practice that impacted on patients' conditions. Nurses used a complex mental model for decision-making, drawing on 3 levels of situation awareness. Hamm's cognitive continuum theory, when related to situation awareness, is a useful decision-making theory to provide a platform on which to draw together components of situation awareness and provide a framework on which to base decision-making regarding documentation. Understanding how RNs employ situation awareness and providing a framework for decision-making during documentation may assist effective documentation about changes in patients' conditions. © 2013 John Wiley & Sons Ltd.
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Data from clinical notes: a perspective on the tension between structure and flexible documentation
Denny, Joshua C; Xu, Hua; Lorenzi, Nancy; Stead, William W; Johnson, Kevin B
2011-01-01
Clinical documentation is central to patient care. The success of electronic health record system adoption may depend on how well such systems support clinical documentation. A major goal of integrating clinical documentation into electronic heath record systems is to generate reusable data. As a result, there has been an emphasis on deploying computer-based documentation systems that prioritize direct structured documentation. Research has demonstrated that healthcare providers value different factors when writing clinical notes, such as narrative expressivity, amenability to the existing workflow, and usability. The authors explore the tension between expressivity and structured clinical documentation, review methods for obtaining reusable data from clinical notes, and recommend that healthcare providers be able to choose how to document patient care based on workflow and note content needs. When reusable data are needed from notes, providers can use structured documentation or rely on post-hoc text processing to produce structured data, as appropriate. PMID:21233086
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Bell, Sigall K; Mejilla, Roanne; Anselmo, Melissa; Darer, Jonathan D; Elmore, Joann G; Leveille, Suzanne; Ngo, Long; Ralston, James D; Delbanco, Tom; Walker, Jan
2017-04-01
Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals. Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey. Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals. Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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The evolving story of information assurance at the DoD.
DOE Office of Scientific and Technical Information (OSTI.GOV)
Campbell, Philip LaRoche
2007-01-01
This document is a review of five documents on information assurance from the Department of Defense (DoD), namely 5200.40, 8510.1-M, 8500.1, 8500.2, and an ''interim'' document on DIACAP [9]. The five documents divide into three sets: (1) 5200.40 & 8510.1-M, (2) 8500.1 & 8500.2, and (3) the interim DIACAP document. The first two sets describe the certification and accreditation process known as ''DITSCAP''; the last two sets describe the certification and accreditation process known as ''DIACAP'' (the second set applies to both processes). Each set of documents describes (1) a process, (2) a systems classification, and (3) a measurement standard.more » Appendices in this report (a) list the Phases, Activities, and Tasks of DITSCAP, (b) note the discrepancies between 5200.40 and 8510.1-M concerning DITSCAP Tasks and the System Security Authorization Agreement (SSAA), (c) analyze the DIACAP constraints on role fusion and on reporting, (d) map terms shared across the documents, and (e) review three additional documents on information assurance, namely DCID 6/3, NIST 800-37, and COBIT{reg_sign}.« less
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Johnson, Kevin B; Ravich, William J; Cowan, John A
2004-09-01
Computer-based software to record histories, physical exams, and progress or procedure notes, known as computer-based documentation (CBD) software, has been touted as an important addition to the electronic health record. The functionality of CBD systems has remained static over the past 30 years, which may have contributed to the limited adoption of these tools. Early users of this technology, who have tried multiple products, may have insight into important features to be considered in next-generation CBD systems. We conducted a cross-sectional, observational study of the clinical working group membership of the American Medical Informatics Association (AMIA) to generate a set of features that might improve adoption of next-generation systems. The study was conducted online over a 4-month period; 57% of the working group members completed the survey. As anticipated, CBD tool use was higher (53%) in this population than in the US physician offices. The most common methods of data entry employed keyboard and mouse, with agreement that these modalities worked well. Many respondents had experience with pre-printed data collection forms before interacting with a CBD system. Respondents noted that CBD improved their ability to document large amounts of information, allowed timely sharing of information, enhanced patient care, and enhanced medical information with other clinicians (all P < 0.001). Respondents also noted some important but absent features in CBD, including the ability to add images, get help, and generate billing information. The latest generation of CBD systems is being used successfully by early adopters, who find that these tools confer many advantages over the approaches to documentation that they replaced. These users provide insights that may improve successive generations of CBD tools. Additional surveys of CBD non-users and failed adopters will be necessary to provide other useful insights that can address barriers to the adoption of CBD by less computer literate physicians.
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Functioning information in the learning health system.
Stucki, Gerold; Bickenbach, Jerome
2017-02-01
In this methodological note on applying the ICF in rehabilitation, we introduce functioning information as fundamental for the "learning health system" and the continuous improvement of the health system's response to people's functioning needs by means of the provision of rehabilitation. A learning health system for rehabilitation operates at the micro-level of the individual patient, meso-level of operational management, and the macro-level of policy that guides rehabilitation programming. All three levels rely on the capacity of the informational system of the health system for standardized documentation and coding of functioning information, and the development of national rehabilitation quality management systems. This methodological note describes how functioning information is used for the continuous improvement of functioning outcomes in a learning health system across these three levels.
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Mission Connect Mild TBI Translational Research Consortium
2010-08-31
symptoms are known to be associated with the study drug, atorvastatin , and they are listed in the Informed Consent document. In this second year of the...confirm that atorvastatin (see note below) given during the acute phase of MTBI has no adverse effects in patients with MTBI NOTE: Due to an...FDA hold on all human studies involving erythropoietin, the neuroprotective agent for this phase II clinical trial was changed to atorvastatin
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2011-11-01
Intelligence Community (IC). All contracts to support human -derived information gathering activities shall have proper USG oversight and undergo a policy...later in subsequent assignments. This booklet begins with an overview of Information Operations, Strategic Communication and Cyberspace Operations. At... communication related websites. Readers will note that many of the concepts, documents, and organizations are "works in progress" as DoD and the
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Technological Imperatives: Using Computers in Academic Debate.
ERIC Educational Resources Information Center
Ticku, Ravinder; Phelps, Greg
Intended for forensic educators and debate teams, this document details how one university debate team, at the University of Iowa, makes use of computer resources on campus to facilitate storage and retrieval of information useful to debaters. The introduction notes the problem of storing and retrieving the amount of information required by debate…
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Historical Note: The Past Thirty Years in Information Retrieval.
ERIC Educational Resources Information Center
Salton, Gerard
1987-01-01
Briefly reviews early work in documentation and text processing, and predictions that were made about the creative role of computers in information retrieval. An attempt is made to explain why these predictions were not fulfilled and conclusions are drawn regarding the limits of computer power in text retrieval applications. (Author/CLB)
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Development of an information retrieval tool for biomedical patents.
Alves, Tiago; Rodrigues, Rúben; Costa, Hugo; Rocha, Miguel
2018-06-01
The volume of biomedical literature has been increasing in the last years. Patent documents have also followed this trend, being important sources of biomedical knowledge, technical details and curated data, which are put together along the granting process. The field of Biomedical text mining (BioTM) has been creating solutions for the problems posed by the unstructured nature of natural language, which makes the search of information a challenging task. Several BioTM techniques can be applied to patents. From those, Information Retrieval (IR) includes processes where relevant data are obtained from collections of documents. In this work, the main goal was to build a patent pipeline addressing IR tasks over patent repositories to make these documents amenable to BioTM tasks. The pipeline was developed within @Note2, an open-source computational framework for BioTM, adding a number of modules to the core libraries, including patent metadata and full text retrieval, PDF to text conversion and optical character recognition. Also, user interfaces were developed for the main operations materialized in a new @Note2 plug-in. The integration of these tools in @Note2 opens opportunities to run BioTM tools over patent texts, including tasks from Information Extraction, such as Named Entity Recognition or Relation Extraction. We demonstrated the pipeline's main functions with a case study, using an available benchmark dataset from BioCreative challenges. Also, we show the use of the plug-in with a user query related to the production of vanillin. This work makes available all the relevant content from patents to the scientific community, decreasing drastically the time required for this task, and provides graphical interfaces to ease the use of these tools. Copyright © 2018 Elsevier B.V. All rights reserved.
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2016-09-01
about people, especially information collected from documents like case notes (not all law enforcement officers have easy-to-read handwriting ). As...the precision of say , the supercomputer in Willy Wonka and the Chocolate Factory, which could tell the exact location of the golden tickets.93 Rather...various documents, including any bad handwriting , in order to convert the data into the standardized numerical codes needed for the analytic process to
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Jagannathan, V; Mullett, Charles J; Arbogast, James G; Halbritter, Kevin A; Yellapragada, Deepthi; Regulapati, Sushmitha; Bandaru, Pavani
2009-04-01
We assessed the current state of commercial natural language processing (NLP) engines for their ability to extract medication information from textual clinical documents. Two thousand de-identified discharge summaries and family practice notes were submitted to four commercial NLP engines with the request to extract all medication information. The four sets of returned results were combined to create a comparison standard which was validated against a manual, physician-derived gold standard created from a subset of 100 reports. Once validated, the individual vendor results for medication names, strengths, route, and frequency were compared against this automated standard with precision, recall, and F measures calculated. Compared with the manual, physician-derived gold standard, the automated standard was successful at accurately capturing medication names (F measure=93.2%), but performed less well with strength (85.3%) and route (80.3%), and relatively poorly with dosing frequency (48.3%). Moderate variability was seen in the strengths of the four vendors. The vendors performed better with the structured discharge summaries than with the clinic notes in an analysis comparing the two document types. Although automated extraction may serve as the foundation for a manual review process, it is not ready to automate medication lists without human intervention.
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-11-13
... DEPARTMENT OF EDUCATION [Docket No.: ED-2013-ICCD-0108] Agency Information Collection Activities; Submission to the Office of Management and Budget for Review and Approval; Comment Request; Federal Direct Stafford/Ford Loan and Federal Direct Subsidized/Unsubsidized Stafford/Ford Loan Master Promissory Note Correction In notice document 2013...
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ERIC Educational Resources Information Center
Payne, David, Ed.
1994-01-01
This document contains the 1994 edition of a publication designed to share information in the field of linguistics that is of practical, theoretical, administrative, or general interest. Articles in these issues include: "Ethnography Vs. Questionnaire" (Thomas E. Murray); "Differences: A Diary Entry"--concerning structuralism…
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A pilot study on the evaluation of medical student documentation: assessment of SOAP notes.
Seo, Ji-Hyun; Kong, Hyun-Hee; Im, Sun-Ju; Roh, HyeRin; Kim, Do-Kyong; Bae, Hwa-Ok; Oh, Young-Rim
2016-06-01
The purpose of this study was evaluation of the current status of medical students' documentation of patient medical records. We checked the completeness, appropriateness, and accuracy of 95 Subjective-Objective-Assessment-Plan (SOAP) notes documented by third-year medical students who participated in clinical skill tests on December 1, 2014. Students were required to complete the SOAP note within 15 minutes of an standard patient (SP)-encounter with a SP complaining rhinorrhea and warring about meningitis. Of the 95 SOAP notes reviewed, 36.8% were not signed. Only 27.4% documented the patient's symptoms under the Objective component, although all students completed the Subjective notes appropriately. A possible diagnosis was assessed by 94.7% students. Plans were described in 94.7% of the SOAP notes. Over half the students planned workups (56.7%) for diagnosis and treatment (52.6%). Accurate documentation of the symptoms, physical findings, diagnoses, and plans were provided in 78.9%, 9.5%, 62.1%, and 38.0% notes, respectively. Our results showed that third-year medical students' SOAP notes were not complete, appropriate, or accurate. The most significant problems with completeness were the omission of students' signatures, and inappropriate documentation of the physical examinations conducted. An education and assessment program for complete and accurate medical recording has to be developed.
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Levy, Rebecca; Pantanowitz, Liron; Cloutier, Darlene; Provencher, Jean; McGirr, Joan; Stebbins, Jennifer; Cronin, Suzanne; Wherry, Josh; Fenton, Joseph; Donelan, Eileen; Johari, Vandita; Andrzejewski, Chester
2010-01-01
Background: Electronic medical records (EMRs) provide universal access to health care information across multidisciplinary lines. In pathology departments, transfusion and apheresis medicine services (TAMS) involved in direct patient care activities produce data and documentation that typically do not enter the EMR. Taking advantage of our institution's initiative for implementation of a paperless medical record, our TAMS division set out to develop an electronic charting (e-charting) strategy within the EMR. Methods: A focus group of our hospital's transfusion committee consisting of transfusion medicine specialists, pathologists, residents, nurses, hemapheresis specialists, and information technologists was constituted and charged with the project. The group met periodically to implement e-charting TAMS workflow and produced electronic documents within the EMR (Cerner Millenium) for various service line functions. Results: The interdisciplinary working group developed and implemented electronic versions of various paper-based clinical documentation used by these services. All electronic notes collectively gather and reside within a unique Transfusion Medicine Folder tab in the EMR, available to staff with access to patient charts. E-charting eliminated illegible handwritten notes, resulted in more consistent clinical documentation among staff, and provided greater realered. However, minor updates and corrections to documents as well as select work re-designs were required for optimal use of e-charting-time review/access of hemotherapy practices. No major impediments to workflow or inefficiencies have been encount by these services. Conclusion: Documentation of pathology subspecialty activities such as TAMS can be successfully incorporated into the EMR. E-charting by staff enhances communication and helps promote standardized documentation of patient care within and across service lines. Well-constructed electronic documents in the EMR may also enhance data mining, quality improvement, and biovigilance monitoring activities. PMID:20805955
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XML Schema Guide for Primary CDR Submissions
This document presents the extensible markup language (XML) schema guide for the Office of Pollution Prevention and Toxics’ (OPPT) e-CDRweb tool. E-CDRweb is the electronic, web-based tool provided by Environmental Protection Agency (EPA) for the submission of Chemical Data Reporting (CDR) information. This document provides the user with tips and guidance on correctly using the version 1.7 XML schema. Please note that the order of the elements must match the schema.
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-09-11
.... SUPPLEMENTARY INFORMATION: Maritime Administration (MARAD). Title: Request for Transfer of Ownership, Registry... who have applied for foreign transfer of U.S.-flag vessels. Forms: MA-29, MA-29A, MA-29B (Note: MA-29A... necessary for MARAD to approve the sale, transfer, charter, lease, or mortgage of U.S. documented vessels to...
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Martin, Krystle; Ham, Elke; Hilton, Zoe
2018-05-12
To describe the documentation of pro re nata (PRN) medication for anxiety, and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., De Marinis, Piredda, Pascarella et al., 2009) and considerable information missing (e.g., Marinis et al., 2010). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker, Lovell, & Harris, 2008). The project was a mixed method, two-phase study that collected data from two sites. In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be done through training, using structured report templates, and switching to electronic databases. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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A Qualitative Analysis Evaluating The Purposes And Practices Of Clinical Documentation
Ho, Y.-X.; Gadd, C. S.; Kohorst, K.L.; Rosenbloom, S.T.
2014-01-01
Summary Objectives An important challenge for biomedical informatics researchers is determining the best approach for healthcare providers to use when generating clinical notes in settings where electronic health record (EHR) systems are used. The goal of this qualitative study was to explore healthcare providers’ and administrators’ perceptions about the purpose of clinical documentation and their own documentation practices. Methods We conducted seven focus groups with a total of 46 subjects composed of healthcare providers and administrators to collect knowledge, perceptions and beliefs about documentation from those who generate and review notes, respectively. Data were analyzed using inductive analysis to probe and classify impressions collected from focus group subjects. Results We observed that both healthcare providers and administrators believe that documentation serves five primary domains: clinical, administrative, legal, research, education. These purposes are tied closely to the nature of the clinical note as a document shared by multiple stakeholders, which can be a source of tension for all parties who must use the note. Most providers reported using a combination of methods to complete their notes in a timely fashion without compromising patient care. While all administrators reported relying on computer-based documentation tools to review notes, they expressed a desire for a more efficient method of extracting relevant data. Conclusions Although clinical documentation has utility, and is valued highly by its users, the development and successful adoption of a clinical documentation tool largely depends on its ability to be smoothly integrated into the provider’s busy workflow, while allowing the provider to generate a note that communicates effectively and efficiently with multiple stakeholders. PMID:24734130
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Panesar, Rahul S; Albert, Ben; Messina, Catherine; Parker, Margaret
2016-01-01
The Situation, Background, Assessment, Recommendation (SBAR) handoff tool is designed to improve communication. The effects of integrating an electronic medical record (EMR) with a SBAR template are unclear. The research team hypothesizes that an electronic SBAR template improves documentation and communication between nurses and physicians. In all, 84 patient events were recorded from 542 admissions to the pediatric intensive care unit. Three time periods were studied: (a) paper documentation only, (b) electronic documentation, and (c) electronic documentation with an SBAR template. Documentation quality was assessed using a 4-point scoring system. The frequency of event notes increased progressively during the 3 study periods. Mean quality scores improved significantly from paper documentation to EMR free-text notes and to electronic SBAR-template notes, as did nurse and attending physician notification. The implementation of an electronic SBAR note is associated with more complete documentation and increased frequency of documentation of communication among nurses and physicians. © The Author(s) 2014.
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Benefits of an Electronic Consultation-Liaison Note System: Better Notes Faster
ERIC Educational Resources Information Center
Sola, Christopher L.; Bostwick, J. Michael; Sampson, Shirlene
2007-01-01
Objective: The authors determined the efficiency of electronic documentation in consultation-liaison psychiatry. METHOD: An electronic note system was customized for a psychiatric consultation note. Specific attention given to common diagnoses permitted rapid documentation. Results: Residents learned the system quickly. The standardized nature of…
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ERIC Educational Resources Information Center
Research Notes, 2001
2001-01-01
This document consists of the three 2001 issues of a newsletter that provides current information and research on leadership and administrative issues in early childhood education. The Summer 2001 issue examines practitioners' preferences about terminology, focusing on: (1) vocabulary used to describe the field and different program types as seen…
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China: Background Notes Series.
ERIC Educational Resources Information Center
Reams, Joanne Reppert
Concise background information on the People's Republic of China is provided. The publication begins with a profile of the country, outlining the people, geography, economy, and membership in international organizations. The bulk of the document then discusses in more detail China's people, geography, history, government, education, economy, and…
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Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.
Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C
2015-08-01
This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.
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XML Schema Guide for Secondary CDR Submissions
This document presents the extensible markup language (XML) schema guide for the Office of Pollution Prevention and Toxics’ (OPPT) e-CDRweb tool. E-CDRweb is the electronic, web-based tool provided by Environmental Protection Agency (EPA) for the submission of Chemical Data Reporting (CDR) information. This document provides the user with tips and guidance on correctly using the version 1.1 XML schema for the Joint Submission Form. Please note that the order of the elements must match the schema.
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Whitewater Kayaking. A Bibliography.
ERIC Educational Resources Information Center
Marshall, Patrick W
This document presents an annotated bibliography listing 34 available sources describing the sport of kayaking, with an emphasis on whitewater. The bibliography is divided into three sections: books, journals, and videos. Older material with useful information is included. Unless otherwise noted, each item is geared towards adults and can be…
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Searching Lexis and Westlaw: Part III.
ERIC Educational Resources Information Center
Franklin, Carl
1986-01-01
This last installment in a three-part series covers several important areas in the searching of legal information: online (group) training and customer service, documentation (search manuals and other aids), account representatives, microcomputer software, and pricing. Advantages and drawbacks of both the LEXIS and WESTLAW databases are noted.…
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Family-Focused Workplace Guide.
ERIC Educational Resources Information Center
SERVE: SouthEastern Regional Vision for Education.
The relationship between family and the workplace and the impact of both on school readiness are well documented. As society changes, home, work, and school relationships are being reassessed and retooled. Noting that employers are taking an increasing role in helping families cope with societal changes, this handbook offers information to…
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31 CFR 592.307 - Kimberley Process Certificate.
Code of Federal Regulations, 2010 CFR
2010-07-01
...- and forgery-resistant document that bears the following information in any language, provided that an... shipment; (k) Relevant Harmonized Commodity Description and Coding System; and (l) Validation by the exporting authority. Note to paragraph (l): See § 592.301(a)(4) for procedures governing the validation of...
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Krishnan, B; Prasad, G Arun; Madhan, B
2016-09-01
Proper and adequate documentation in operation notes is a basic tool of clinical practice with medical and legal implications. An audit was done to ascertain if oral and maxillofacial surgery operative notes in an Indian public sector hospital adhered to the guidelines published by the Royal College of Surgeons England. Fifty randomly selected operative notes were evaluated against the guidelines by RCS England with regards to the essential generic components of an operation note. Additional criteria relevant to oral and Maxillofacial Surgery were also evaluated. Changes were introduced in the form of Oral and Maxillofacial Surgery specific consent forms, diagram sheets and a computerized operation note proforma containing all essential and additional criteria along with prefilled template of operative findings. Re-audit of 50 randomly selected operation notes was performed after a 6 month period. In the 1st audit cycle, excellent documentation ranging from 94 to 100 % was seen in 9 essential criteria. Unsatisfactory documentation was observed in criteria like assistant name, date of surgery. Most consent forms contained abbreviations and some did not provide all details. Additional criteria specific to Oral and Maxillofacial Surgery scored poorly. In the 2nd Audit for loop completion, excellent documentation was seen in almost all essential and additional criteria. Mean percentage of data point inclusion improved from 84.6 to 98.4 % (0.001< P value <0.005). The use of abbreviations was seen in only 6 notes. Regular audits are now considered a mandatory quality improvement process that seeks to improve patient care and outcomes. To the best of our knowledge, this is the first completed audit on operation notes documentation in Oral and Maxillofacial Surgery from India. The introduction of a computerized operation note proforma showed excellent improvement in operation note documentation. Surgeons can follow the RCS guidelines to ensure standardization of operation notes.
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Advancing Home-School Relations through Parent Support?
ERIC Educational Resources Information Center
Bergnehr, Disa
2015-01-01
The present study explores a local initiative to develop parent support services through the school system. In focus are the discourse on home-school relations and parent support and the interplay between discourse and practical occurrences. Official documents, interviews and notes from municipal meetings and informal conversations were obtained…
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ERIC Educational Resources Information Center
Scofield, Richard T., Ed.
2001-01-01
This document is comprised of the 12 monthly issues of a newsletter providing support and information for providers of child care for school-age children. The featured articles for each month are: (1) "Re-Evaluating Praise" (September); (2) "Making the Season Brighter: Tips To Create More Inclusive Holiday Programs" (October);…
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The History, Biology and Medical Aspects of Leprosy.
ERIC Educational Resources Information Center
Eichman, Phillip
1999-01-01
Presents information about the history, biology, and medical aspects of leprosy, including its description in historical documents, its cause and effects, statistics on its prevalence, and various attempts at treatment. Notes that leprosy is one of the few infectious diseases that, although treatable with medication, remains incurable. Contains 30…
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Outcomes from the Productivity Places Program 2009: Technical Notes. Support Document
ERIC Educational Resources Information Center
National Centre for Vocational Education Research (NCVER), 2009
2009-01-01
This paper was produced as an added resource for the report "Outcomes from the Productivity Places Program 2009." "Outcomes from the Productivity Places Program 2009" presents information about the outcomes of students who completed their vocational education and training (VET) under the Productivity Places Program (PPP)…
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ERIC Educational Resources Information Center
Research Notes, 2000
2000-01-01
This document consists of the two 2000 issues of a semiannual newsletter that provides current information and research on leadership and administrative issues in early childhood education. The Fall 2000 issue discusses the use of research to promote sound policy and practice in early care and education, focusing on the implications of research in…
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Title list of documents made publicly available, March 1--31, 1995: Volume 17, No. 3
DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
The Title List of Documents Made Publicly Available is a monthly publication. It contains descriptions of the information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials and (2) nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. As used here, docketed does not refer to Court dockets; it refers to the system by which NRC maintains its regulatory records. This series of documents is indexed by a Personal Author Index, a Corporate Source Index,more » and a Report Number Index. The docketed information contained in the Title List includes the information formerly issued through the Department of Energy publication Power Reactor Docket Information, last published in January 1979. NRC documents that are publicly available may be examined without charge at the NRC Public Document Room (PDR). Duplicate copies may be obtained for a fee. Standing orders for certain categories of documents are also available. Clients may search for and order desired titles through the PDR computerized Bibliographic Retrieval System, which is accessible both at the PDR and remotely. The PDR is staffed by professional technical librarians, who provide reference assistance to users. See NOTES at the end of the preface for information about reaching the PDR. Microfiche of the docketed information listed in the Title List is available for sale on a subscription basis from the National Technical Information Service (NTIS).« less
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Electronic Documentation Support Tools and Text Duplication in the Electronic Medical Record
ERIC Educational Resources Information Center
Wrenn, Jesse
2010-01-01
In order to ease the burden of electronic note entry on physicians, electronic documentation support tools have been developed to assist in note authoring. There is little evidence of the effects of these tools on attributes of clinical documentation, including document quality. Furthermore, the resultant abundance of duplicated text and…
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Usability Evaluation of NLP-PIER: A Clinical Document Search Engine for Researchers.
Hultman, Gretchen; McEwan, Reed; Pakhomov, Serguei; Lindemann, Elizabeth; Skube, Steven; Melton, Genevieve B
2017-01-01
NLP-PIER (Natural Language Processing - Patient Information Extraction for Research) is a self-service platform with a search engine for clinical researchers to perform natural language processing (NLP) queries using clinical notes. We conducted user-centered testing of NLP-PIER's usability to inform future design decisions. Quantitative and qualitative data were analyzed. Our findings will be used to improve the usability of NLP-PIER.
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Development of True Time Delay Circuits
2014-06-13
public release Distribution is unlimited DATA SHEET SKY65014-70LF: 0.1-7.0 GHz InGaP Cascadable Amplifier Applications • Wireless infrastructure: WLAN ...decoupling network out of band. For low frequency applications , R1 may be used to conveniently limit supply current on the Evaluation Board. The Evaluation...additional information, refer to the Skyworks Application Note, Solder Reflow Information, document number 200164. Care must be taken when attaching this
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Bowles, K. H.; Adelsberger, M. C.; Chittams, J. L.; Liao, C.
2014-01-01
Summary Background Homecare is an important and effective way of managing chronic illnesses using skilled nursing care in the home. Unlike hospitals and ambulatory settings, clinicians visit patients at home at different times, independent of each other. Twenty-nine percent of 10,000 homecare agencies in the United States have adopted point-of-care EHRs. Yet, relatively little is known about the growing use of homecare EHRs. Objective Researchers compared workflow, financial billing, and patient outcomes before and after implementation to evaluate the impact of a homecare point-of-care EHR. Methods The design was a pre/post observational study embedded in a mixed methods study. The setting was a Philadelphia-based homecare agency with 137 clinicians. Data sources included: (1) clinician EHR documentation completion; (2) EHR usage data; (3) Medicare billing data; (4) an EHR Nurse Satisfaction survey; (5) clinician observations; (6) clinician interviews; and (7) patient outcomes. Results Clinicians were satisfied with documentation timeliness and team communication. Following EHR implementation, 90% of notes were completed within the 1-day compliance interval (n = 56,702) compared with 30% of notes completed within the 7-day compliance interval in the pre-implementation period (n = 14,563; OR 19, p <. 001). Productivity in the number of clinical notes documented post-implementation increased almost 10-fold compared to pre-implementation. Days to Medicare claims fell from 100 days pre-implementation to 30 days post-implementation, while the census rose. EHR implementation impact on patient outcomes was limited to some behavioral outcomes. Discussion Findings from this homecare EHR study indicated clinician EHR use enabled a sustained increase in productivity of note completion, as well as timeliness of documentation and billing for reimbursement with limited impact on improving patient outcomes. As EHR adoption increases to better meet the needs of the growing population of older people with chronic health conditions, these results can inform homecare EHR development and implementation. PMID:25024760
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[Knowledge and attitudes toward vaccination among midwives in Quebec].
Dubé, Eve; Vivion, Maryline; Valderrama, Alena; Sauvageau, Chantal
2013-01-01
Vaccine acceptability among Quebec midwives is not well documented. The purpose of this study was to examine midwives' knowledge, attitudes and practices relating to immunization in Quebec. Semi-structured interviews were conducted with 25 participants (17 midwives and 8 midwifery students). The mean duration of the interviews was 1 hour. The interviews were conducted in 2010 and were audiotaped, transcribed and submitted to content analysis using NVivo 8 software. In addition to the laws regulating midwifery practice in Quebec, the findings suggest that most midwifery interventions are based on midwifery philosophy. Informed choice is one of the key principles of this philosophy. In order to help women make an informed decision about vaccination, midwives seek to outline the pros and cons of vaccination using government documentation, as well as other sources such as books on naturopathy. Most of the participating midwives recognized that vaccination has advantages, including disease prevention and free vaccines. Various arguments against vaccination were also identified. Most of these were related to the vaccination schedule and to combined vaccines. Some of the participants noted that it was difficult to find unbiased information about vaccination. This study highlights the key role of midwifery philosophy in midwifery practice. Most decisions (such as vaccination) are made on the basis of the principle of informed choice. Most of the participants noted that they lacked information on vaccination.
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Speech Recognition as a Transcription Aid: A Randomized Comparison With Standard Transcription
Mohr, David N.; Turner, David W.; Pond, Gregory R.; Kamath, Joseph S.; De Vos, Cathy B.; Carpenter, Paul C.
2003-01-01
Objective. Speech recognition promises to reduce information entry costs for clinical information systems. It is most likely to be accepted across an organization if physicians can dictate without concerning themselves with real-time recognition and editing; assistants can then edit and process the computer-generated document. Our objective was to evaluate the use of speech-recognition technology in a randomized controlled trial using our institutional infrastructure. Design. Clinical note dictations from physicians in two specialty divisions were randomized to either a standard transcription process or a speech-recognition process. Secretaries and transcriptionists also were assigned randomly to each of these processes. Measurements. The duration of each dictation was measured. The amount of time spent processing a dictation to yield a finished document also was measured. Secretarial and transcriptionist productivity, defined as hours of secretary work per minute of dictation processed, was determined for speech recognition and standard transcription. Results. Secretaries in the endocrinology division were 87.3% (confidence interval, 83.3%, 92.3%) as productive with the speech-recognition technology as implemented in this study as they were using standard transcription. Psychiatry transcriptionists and secretaries were similarly less productive. Author, secretary, and type of clinical note were significant (p < 0.05) predictors of productivity. Conclusion. When implemented in an organization with an existing document-processing infrastructure (which included training and interfaces of the speech-recognition editor with the existing document entry application), speech recognition did not improve the productivity of secretaries or transcriptionists. PMID:12509359
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Integrating the Four Streams. CGEA Information Sheet No. 7.
ERIC Educational Resources Information Center
National Languages and Literacy Inst. of Australia, Melbourne. Adult Education Resource and Information Service.
Ways to integrate the four streams of the Certificates in General Education for Adults (CGEA) are presented in this document. The four streams of Australia's CGEAs are as follows: reading and writing, oral communication, numeracy and mathematics, and general curriculum options. This guide notes that the CGEA aims to promote a holistic approach to…
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AIDS: It's Not What You Know, It's What You Do.
ERIC Educational Resources Information Center
Hochhauser, Mark
This document reviews five psychological domains of prevention of the behavioral disease of Acquired Immune Deficiency Syndrome (AIDS). First the limits of AIDS education are discussed, noting that increasing amounts of education will not necessarily reduce the spread of the virus, since information and education do not control behavior. Research…
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How To Celebrate National Women's History Month.
ERIC Educational Resources Information Center
Stern, Majorie
Intended for teachers, this guide is designed as an aid to mark Women's History Month with special thought and activity, and to offer suggestions for further information and resources. Noting that "history doesn't only happen to men," the document stresses that "history is made at home, in the community, in the factories, offices,…
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-06-24
... design engineer. The supporting documentation and independent research and communication with select... constraints involved with the proposed project. For example, one of the design requirements noted by the City..., 5 Post Office Square, Suite 100, Boston, MA 02109-3912. SUPPLEMENTARY INFORMATION: In accordance...
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Reading Records of Literary Authors: A Comparison of Some Published Notebooks.
ERIC Educational Resources Information Center
Murray, Robin Mark
The significance of authors' reading notes may lie not only in their mechanical function as information storage devices providing raw materials for writing, but also in their ability to concentrate and to mobilize the latent emotional and creative resources of their keepers. This document examines records of reading found in the published…
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ERIC Educational Resources Information Center
Scofield, Richard T., Ed.
1999-01-01
This document is comprised of the 12 monthly issues of a newsletter providing support and information for providers of child care for school-age children. The featured articles for each month are: (1) "Tips for New and Old for the New School Year" (September); (2) "Train Them and Retain Them: Keeping Quality Staff" (October); (3) "What Older Kids…
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-06-27
... warranted. However, FAA's review of current information did note that some social and environmental changes... alternatives conducted in this FEIS. However, to document and disclose the social and environmental changes... discusses any potential impacts related to the changed social and environmental conditions. The technical...
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Perchlorate Remediation Using New Nanoscale Polymer Technology
2009-11-01
Michigan University/Dendritic Nanotechnologies, Inc./CMU-RC Distribution Statement A: Approved for Public Release, Distribution is...Unlimited Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour...DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Principal Ideas
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Assessing usage patterns of electronic clinical documentation templates.
Vawdrey, David K
2008-11-06
Many vendors of electronic medical records support structured and free-text entry of clinical documents using configurable templates. At a healthcare institution comprising two large academic medical centers, a documentation management data mart and a custom, Web-accessible business intelligence application were developed to track the availability and usage of electronic documentation templates. For each medical center, template availability and usage trends were measured from November 2007 through February 2008. By February 2008, approximately 65,000 electronic notes were authored per week on the two campuses. One site had 934 available templates, with 313 being used to author at least one note. The other site had 765 templates, of which 480 were used. The most commonly used template at both campuses was a free text note called "Miscellaneous Nursing Note," which accounted for 33.3% of total documents generated at one campus and 15.2% at the other.
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Fanucchi, Laura; Yan, Donglin; Conigliaro, Rosemarie L
2016-07-06
Communication errors are identified as a root cause contributing to a majority of sentinel events. The clinical note is a cornerstone of physician communication, yet there are few published interventions on teaching note writing in the electronic health record (EHR). This is a prospective, two-site, quality improvement project to assess and improve the quality of clinical documentation in the EHR using a validated assessment tool. Internal Medicine (IM) residents at the University of Kentucky College of Medicine (UK) and Montefiore Medical Center/Albert Einstein College of Medicine (MMC) received one of two interventions during an inpatient ward month: either a lecture, or a lecture and individual feedback on progress notes. A third group of residents in each program served as control. Notes were evaluated with the Physician Documentation Quality Instrument 9 (PDQI-9). Due to a significant difference in baseline PDQI-9 scores at MMC, the sites were not combined. Of 75 residents at the UK site, 22 were eligible, 20 (91%) enrolled, 76 notes in total were scored. Of 156 residents at MMC, 22 were eligible, 18 (82%) enrolled, 40 notes in total were scored. Note quality did not improve as measured by the PDQI-9. This educational quality improvement project did not improve the quality of clinical documentation as measured by the PDQI-9. This project underscores the difficulty in improving note quality. Further efforts should explore more effective educational tools to improve the quality of clinical documentation in the EHR.
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1987-03-01
intelligent way, assemble those documents and data in usable formats, examine the communications tapes available for this project, and to develop a sampling...Lifetime Learning Publications, Belmont. CA. 1982. Rowe. Neil C.. Artifcial Intelligence , Draft Copv, Class Notes for Winter Quarter. CS 33 10, \\aval...AT2 122 BATTLEFIELD MANAGEMENT SYSTEM DATA REQUIRENTS TO 1/2 SUPPORT PASSAGE OF COMPANY LEVEL TACTICAL INFORMATION (U) NVALE POSTGRADUATE SCHOOL
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Heuristic evaluation of eNote: an electronic notes system.
Bright, Tiffani J; Bakken, Suzanne; Johnson, Stephen B
2006-01-01
eNote is an electronic health record (EHR) system based on semi-structured narrative documents. A heuristic evaluation was conducted with a sample of five usability experts. eNote performed highly in: 1)consistency with standards and 2)recognition rather than recall. eNote needs improvement in: 1)help and documentation, 2)aesthetic and minimalist design, 3)error prevention, 4)helping users recognize, diagnosis, and recover from errors, and 5)flexibility and efficiency of use. The heuristic evaluation was an efficient method of evaluating our interface.
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Front-Row Seat at the IPY: The Field Notes Electronic Newsletter
NASA Astrophysics Data System (ADS)
Rithner, P. K.; Zager, S. D.; Garcia-Lavigne, D. N.
2007-12-01
As employees of Polar Field Services/VPR, the arctic logistics provider to the US National Science Foundation, we bear witness to the exploration, documentation, and celebration of the International Polar Year (IPY). Our front- row vantage point (logisticians working with field scientists) offers us a rare opportunity to report on developments at the frontiers of polar research and to describe how scientists work in the Arctic. Our reporting mechanism is field notes, a weekly (summer) to monthly (winter) electronic digest of information about the IPY research we support. Each issue showcases a short "cover" piece highlighting science projects or profiling arctic program participants. In addition, field notes offers news updates, short interviews, and blog-style dispatches contributed by researchers and support personnel. Wherever possible, we include URLs so readers may find more information via the Web: we link to an online database of projects we maintain for the NSF, to university Web sites, project blogs, and so on. We aim to inform the interested layperson about the myriad of activity in the IPY. We like to show that arctic science is interesting, relevant--and a great adventure. We've found field notes to be an excellent outreach venue. By no means a slick media outlet, field notes is published "on the side" by a small but dedicated group of employees who are endlessly fascinated by, and who enjoy an engaging perspective on, contemporary arctic research. Newsletter
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Euro-NOTES Status Paper: from the concept to clinical practice.
Fuchs, K H; Meining, A; von Renteln, D; Fernandez-Esparrach, G; Breithaupt, W; Zornig, C; Lacy, A
2013-05-01
The concept of natural orifice transluminal endoscopic surgery (NOTES) consists of the reduction of access trauma by using a natural orifice access to the intra-abdominal cavity. This could possibly lead to less postoperative pain, quicker recovery from surgery, fewer postoperative complications, fewer wound infections, and fewer long-term problems such as hernias. The Euro-NOTES Foundation has organized yearly meetings to work on this concept to bring it safely into clinical practice. The aim of this Euro-NOTES status update is to assess the yearly scientific working group reports and provide an overview on the current clinical practice of NOTES procedures. After the Euro-NOTES meeting 2011 in Frankfurt, Germany, an analysis was started regarding the most important topics of the European working groups. All prospectively documented information was gathered from Euro-NOTES and D-NOTES working groups from 2007 to 2011. The top five topics were analyzed. The statements of the working group activities demonstrate the growing information and changing insights. The most important selected topics were infection issue, peritoneal access, education and training, platforms and new technology, closure, suture, and anastomosis. The focus on research topics changed over time. The principle of hybrid access has overcome the technical and safety limitations of pure NOTES. Currently the following NOTES access routes are established for several indications: transvaginal access for cholecystectomy, appendectomy and colon resections; transesophageal access for myotomy; transgastric access for full-thickness small-tumor resections; and transanal/transcolonic access for rectal and colon resections. NOTES and hybrid NOTES techniques have emerged for all natural orifices and were introduced into clinical practice with a good safety record. There are different indications for different natural orifices. Each technique has been optimized for the purpose of finding a safe and realistic solution to perform the procedure according to the specific indication.
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Electronic health record systems in ophthalmology: impact on clinical documentation.
Sanders, David S; Lattin, Daniel J; Read-Brown, Sarah; Tu, Daniel C; Wilson, David J; Hwang, Thomas S; Morrison, John C; Yackel, Thomas R; Chiang, Michael F
2013-09-01
To evaluate quantitative and qualitative differences in documentation of the ophthalmic examination between paper and electronic health record (EHR) systems. Comparative case series. One hundred fifty consecutive pairs of matched paper and EHR notes, documented by 3 attending ophthalmologist providers. An academic ophthalmology department implemented an EHR system in 2006. Database queries were performed to identify cases in which the same problems were documented by the same provider on different dates, using paper versus EHR methods. This was done for 50 consecutive pairs of examinations in 3 different diseases: age-related macular degeneration (AMD), glaucoma, and pigmented choroidal lesions (PCLs). Quantitative measures were used to compare completeness of documenting the complete ophthalmologic examination, as well as disease-specific critical findings using paper versus an EHR system. Qualitative differences in paper versus EHR documentation were illustrated by selecting representative paired examples. (1) Documentation score, defined as the number of examination elements recorded for the slit-lamp examination, fundus examination, and complete ophthalmologic examination and for critical clinical findings for each disease. (2) Paired comparison of qualitative differences in paper versus EHR documentation. For all 3 diseases (AMD, glaucoma, PCL), the number of complete examination findings recorded was significantly lower with paper than the EHR system (P ≤ 0.004). Among the 3 individual examination sections (general, slit lamp, fundus) for the 3 diseases, 5 of the 9 possible combinations had significantly lower mean documentation scores with paper than EHR notes. For 2 of the 3 diseases, the number of critical clinical findings recorded was significantly lower using paper versus EHR notes (P ≤ 0.022). All (150/150) paper notes relied on graphical representations using annotated hand-drawn sketches, whereas no (0/150) EHR notes contained drawings. Instead, the EHR systems documented clinical findings using textual descriptions and interpretations. There were quantitative and qualitative differences in the nature of paper versus EHR documentation of ophthalmic findings in this study. The EHR notes included more complete documentation of examination elements using structured textual descriptions and interpretations, whereas paper notes used graphical representations of findings. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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Kepler Data Release 25 Notes (Q0-Q17)
NASA Technical Reports Server (NTRS)
Mullally, Susan E.; Caldwell, Douglas A.; Barclay, Thomas Stewart; Barentsen, Geert; Clarke, Bruce Donald; Bryson, Stephen T.; Burke, Christopher James; Campbell, Jennifer Roseanna; Catanzarite, Joseph H.; Christiansen, Jessie;
2016-01-01
These Data Release Notes provide information specific to the current reprocessing and re-export of the Q0-Q17 data. The data products included in this data release include target pixel files, light curve files, FFIs,CBVs, ARP, Background, and Collateral files. This release marks the final processing of the Kepler Mission Data. See Tables 1 and 2 for a list of the reprocessed Kepler cadence data. See Table 3 for a list of the available FFIs. The Long Cadence Data, Short Cadence Data, and FFI data are documented in these data release notes. The ancillary files (i.e., cotrending basis vectors, artifact removal pixels, background, and collateral data) are described in the Archive Manual (Thompson et al., 2016).
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Teamwork for Healthy Campuses. NYS College Alcohol and Other Drug Programs.
ERIC Educational Resources Information Center
Harding, Frances M.
This manual offers information on developing, implementing, and maintaining college alcohol and other drug programs at New York institutions of higher education. The document notes that alcohol is the drug of choice for college students and that therefore alcohol-related issues and programs are the primary focus of the manual. Part 1 of the manual…
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Changing Patterns in Internal Communication in Large Academic Libraries. Occasional Paper Number 6.
ERIC Educational Resources Information Center
Euster, Joanne R.
Based on data from a 1979 survey of ARL member libraries, this study by the Office of Management Studies analyzes the responses of selected libraries which had provided internal studies or planning documents on the subject of internal communication and notes the extent of resulting changes in procedures. The studies yielded information on staff…
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The focus series: A collection of single-concept remote sensing educational materials
NASA Technical Reports Server (NTRS)
Davis, S. M.
1977-01-01
The FOCUS series is a collection of two-page foldout documents each consisting of a diagram or photograph and an extended option of three to four hundred words. The series was developed to present basic remote sensing concepts in a simple, concise way. Issues currently available are collected in this information note.
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Carrell, David S.; Halgrim, Scott; Tran, Diem-Thy; Buist, Diana S. M.; Chubak, Jessica; Chapman, Wendy W.; Savova, Guergana
2014-01-01
The increasing availability of electronic health records (EHRs) creates opportunities for automated extraction of information from clinical text. We hypothesized that natural language processing (NLP) could substantially reduce the burden of manual abstraction in studies examining outcomes, like cancer recurrence, that are documented in unstructured clinical text, such as progress notes, radiology reports, and pathology reports. We developed an NLP-based system using open-source software to process electronic clinical notes from 1995 to 2012 for women with early-stage incident breast cancers to identify whether and when recurrences were diagnosed. We developed and evaluated the system using clinical notes from 1,472 patients receiving EHR-documented care in an integrated health care system in the Pacific Northwest. A separate study provided the patient-level reference standard for recurrence status and date. The NLP-based system correctly identified 92% of recurrences and estimated diagnosis dates within 30 days for 88% of these. Specificity was 96%. The NLP-based system overlooked 5 of 65 recurrences, 4 because electronic documents were unavailable. The NLP-based system identified 5 other recurrences incorrectly classified as nonrecurrent in the reference standard. If used in similar cohorts, NLP could reduce by 90% the number of EHR charts abstracted to identify confirmed breast cancer recurrence cases at a rate comparable to traditional abstraction. PMID:24488511
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ERIC Educational Resources Information Center
Musana, Augustes, Ed.; Huttemann, Lutz, Ed.
From 1989 to 1991, the German Foundation for International Development has organized a series of seminars and training courses for Eastern African countries given in concert with national and regional partner organizations to assist in providing improved information and documentation services. Selected papers and lecture notes from three training…
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Advance care planning and end-of-life care in a network of rural Western Australian hospitals.
Auret, Kirsten; Sinclair, Craig; Averill, Barbara; Evans, Sharon
2015-08-01
To provide a current perspective on end-of-life (EOL) care in regional Western Australia, with a particular focus on the final admission prior to death and the presence of documented advance care planning (ACP). Retrospective medical notes audit. One regional hospital (including colocated hospice) and four small rural hospitals in the Great Southern region of Western Australia. Ninety recently deceased patients, who died in hospitals in the region. Fifty consecutive patients from the regional hospital and 10 consecutive patients from each of the four rural hospitals were included in the audit. A retrospective medical notes audit was undertaken. A 94-item audit tool assessed patient demographics, primary diagnosis, family support, status on admission and presence of documented ACP. Detailed items described the clinical care delivered during the final admission, including communication with family, referral to palliative care, transfers, medical investigations, medical treatments and use of EOL care pathways. Fifty-two per cent were women; median age was 82 years old. Forty per cent died of malignancy. Median length of stay was 7 days. Thirty-nine per cent had formal or informal ACP documented. Rural hospitals performed comparably with the regional hospital on all measures. This study provides benchmarking information that can assist other rural hospitals and suggests ongoing work on optimal methods of measuring quality in EOL care. © 2015 National Rural Health Alliance Inc.
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Surficial geologic map of the Amboy 30' x 60' quadrangle, San Bernardino County, California
Bedford, David R.; Miller, David M.; Phelps, Geoffrey A.
2010-01-01
The surficial geologic map of the Amboy 30' x 60' quadrangle presents characteristics of surficial materials for an area of approximately 5,000 km2 in the eastern Mojave Desert of southern California. This map consists of new surficial mapping conducted between 2000 and 2007, as well as compilations from previous surficial mapping. Surficial geologic units are mapped and described based on depositional process and age categories that reflect the mode of deposition, pedogenic effects following deposition, and, where appropriate, the lithologic nature of the material. Many physical properties were noted and measured during the geologic mapping. This information was used to classify surficial deposits and to understand their ecological importance. We focus on physical properties that drive hydrologic, biologic, and physical processes such as particle-size distribution (PSD) and bulk density. The database contains point data representing locations of samples for both laboratory determined physical properties and semiquantitative field-based information in the database. We include the locations of all field observations and note the type of information collected in the field to help assist in assessing the quality of the mapping. The publication is separated into three parts: documentation, spatial data, and printable map graphics of the database. Documentation includes this pamphlet, which provides a discussion of the surficial geology and units and the map. Spatial data are distributed as ArcGIS Geodatabase in Microsoft Access format and are accompanied by a readme file, which describes the database contents, and FGDC metadata for the spatial map information. Map graphics files are distributed as Postscript and Adobe Portable Document Format (PDF) files that provide a view of the spatial database at the mapped scale.
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Documentation of Gender Identity in an Adolescent and Young Adult Clinic.
Vance, Stanley R; Mesheriakova, Veronika V
2017-03-01
To determine if changing electronic health record (EHR) note templates can increase documentation of gender identity in an adolescent and young adult clinic. A two-step gender question was added to EHR note templates for physicals in February 2016. A retrospective chart review was performed 3 months before and after this addition. The primary measure was whether answers to the two-step question were documented. Gender identity/birth-assigned sex discordance, age, and use of the appropriate note template post-template change were also measured. One hundred twenty-five pretemplate change and 106 post-template change physicals were reviewed with an inter-rater reliability of 97%. Documentation of answers to the two-step gender identity question increased from 11% to 84% (p < .001). This study suggests that incorporating a standardized question into EHR note templates is effective at improving the documentation of gender identity in youth presenting for annual physicals. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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Natural language generation in health care.
Cawsey, A J; Webber, B L; Jones, R B
1997-01-01
Good communication is vital in health care, both among health care professionals, and between health care professionals and their patients. And well-written documents, describing and/or explaining the information in structured databases may be easier to comprehend, more edifying, and even more convincing than the structured data, even when presented in tabular or graphic form. Documents may be automatically generated from structured data, using techniques from the field of natural language generation. These techniques are concerned with how the content, organization and language used in a document can be dynamically selected, depending on the audience and context. They have been used to generate health education materials, explanations and critiques in decision support systems, and medical reports and progress notes.
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Dunleavy, Leah; Preissner, Katharine L; Finlayson, Marcia L
2013-12-01
Telehealth refers to the provision of health information and services across a geographical distance. Little is known about the experiences of occupational therapists using this method of service delivery. The study explored the process of facilitating a telehealth intervention from the perspective of occupational therapists. Occupational therapists completed SOAP (Subjective, Objective, Assessment, and Plan) notes after facilitating group-based, teleconference-delivered fatigue management groups to people with multiple sclerosis. Notes were also documented after therapist team meetings. All SOAP notes and field notes were subjected to thematic analysis. Five major themes were identified. "Managing time" was the central theme and was facilitated by professional foundation and challenged by logistics. Managing time contributed to challenging work, which led to the realization that it can work! Based on study findings, the theory and research on clinical reasoning, professional development, and adult learning are relevant to developing curricula that prepare occupational therapists for using telehealth approaches in practice.
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Dillahunt-Aspillaga, Christina; Finch, Dezon; Massengale, Jill; Kretzmer, Tracy; Luther, Stephen L.; McCart, James A.
2014-01-01
Objective The purpose of this pilot study is 1) to develop an annotation schema and a training set of annotated notes to support the future development of a natural language processing (NLP) system to automatically extract employment information, and 2) to determine if information about employment status, goals and work-related challenges reported by service members and Veterans with mild traumatic brain injury (mTBI) and post-deployment stress can be identified in the Electronic Health Record (EHR). Design Retrospective cohort study using data from selected progress notes stored in the EHR. Setting Post-deployment Rehabilitation and Evaluation Program (PREP), an in-patient rehabilitation program for Veterans with TBI at the James A. Haley Veterans' Hospital in Tampa, Florida. Participants Service members and Veterans with TBI who participated in the PREP program (N = 60). Main Outcome Measures Documentation of employment status, goals, and work-related challenges reported by service members and recorded in the EHR. Results Two hundred notes were examined and unique vocational information was found indicating a variety of self-reported employment challenges. Current employment status and future vocational goals along with information about cognitive, physical, and behavioral symptoms that may affect return-to-work were extracted from the EHR. The annotation schema developed for this study provides an excellent tool upon which NLP studies can be developed. Conclusions Information related to employment status and vocational history is stored in text notes in the EHR system. Information stored in text does not lend itself to easy extraction or summarization for research and rehabilitation planning purposes. Development of NLP systems to automatically extract text-based employment information provides data that may improve the understanding and measurement of employment in this important cohort. PMID:25541956
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Effects of 4-ter-Octylphenol on Xenopus tropicalis in a Long Term Exposure
2011-03-17
Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per...subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1 . REPORT DATE 17...STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT We exposed Xenopus tropicalis to 1 , 3.3, 11 and 36 ug/L
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Waste-to-Energy Projects at Army Installations
2011-01-13
JAN 2011 US Army Corps of Engineers BUILDING STRONG® Distribution Statement A -- Approved for public release; distribution is unlimited. Report...Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response...NUMBER(S) 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES presented at the DOE
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Portable Fuel Quality Analyzer
2014-01-27
other transportation industries, such as trucking. The PFQA could also be used in fuel blending operations performed at petroleum, ethanol and biodiesel plants. ...Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per...24476 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT The
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Development of Electro-Optical Standard Processes for Application
2011-11-01
AERONAUTICS AND SPACE ADMINISTRATION DISTRIBUTION A: APPROVED FOR PUBLIC RELEASE DISTRIBUTION IS UNLIMITED Report Documentation Page Form ApprovedOMB No...0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing...DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Defines the process of
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Palermo, M.R.; Schroeder, P.R.
This technical note describes a technique for comparison of the predicted quality of effluent discharged from confined dredged material disposal areas with applicable water quality standards. This note also serves as documentation of a computer program called EFQUAL written for that purpose as part of the Automated Dredging and Disposal Alternatives Management System (ADDAMS).
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Turchin, Alexander; Shubina, Maria; Breydo, Eugene; Pendergrass, Merri L; Einbinder, Jonathan S
2009-01-01
OBJECTIVE To compare information obtained from narrative and structured electronic sources using anti-hypertensive medication intensification as an example clinical issue of interest. DESIGN A retrospective cohort study of 5,634 hypertensive patients with diabetes from 2000 to 2005. MEASUREMENTS The authors determined the fraction of medication intensification events documented in both narrative and structured data in the electronic medical record. The authors analyzed the relationship between provider characteristics and concordance between intensifications in narrative and structured data. As there is no gold standard data source for medication information, the authors clinically validated medication intensification information by assessing the relationship between documented medication intensification and the patients' blood pressure in univariate and multivariate models. RESULTS Overall, 5,627 (30.9%) of 18,185 medication intensification events were documented in both sources. For a medication intensification event documented in narrative notes the probability of a concordant entry in structured records increased by 11% for each study year (p < 0.0001) and decreased by 19% for each decade of provider age (p = 0.035). In a multivariate model that adjusted for patient demographics and intraphysician correlations, an increase of one medication intensification per month documented in either narrative or structured data were associated with a 5-8 mm Hg monthly decrease in systolic and 1.5-4 mm Hg decrease in diastolic blood pressure (p < 0.0001 for all). CONCLUSION Narrative and structured electronic data sources provide complementary information on anti-hypertensive medication intensification. Clinical validity of information in both sources was demonstrated by correlation with changes in blood pressure.
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Documentation and environment of the Apollo 16 samples: A preliminary report
NASA Technical Reports Server (NTRS)
1972-01-01
A catalog which is a working document that shows the locations from which samples were collected during the Apollo 16 mission, and that provides a descriptive geologic context for each sample is presented. It is a compilation of notes from work in progress, and supersedes an earlier report prepared by the Apollo Lunar Geology Investigation Team. The information was obtained from the Air-to-Ground transcript from the astronaut crew, from lunar surface television, from 60 mm Hasselblad camera photographs, and from available LRL mugshot photographs of the samples. The sample descriptions are based on these sources of data.
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The law on what documents scientists must keep and disclose
NASA Astrophysics Data System (ADS)
Gerrard, Michael B.; Sheargold, Elizabeth
2012-10-01
Recently, several climate scientists have received demands to produce their raw data, working notes, e-mails, letters, or other communications. These demands may come in the form of subpoenas, U.S. Freedom of Information Act (FOIA) requests, or requests during litigation. Below are some general guidelines for scientists about complying with their document retention and disclosure obligations, both as a matter of routine practice and in the event of legal action. This article concerns only U.S. laws and is not legal advice, which should be sought from the scientist's lawyers or those of his or her employer.
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Can physicians recognize their own patients in de-identified notes?
Meystre, Stéphane; Shen, Shuying; Hofmann, Deborah; Gundlapalli, Adi
2014-01-01
The adoption of Electronic Health Records is growing at a fast pace, and this growth results in very large quantities of patient clinical information becoming available in electronic format, with tremendous potentials, but also equally growing concern for patient confidentiality breaches. De-identification of patient information has been proposed as a solution to both facilitate secondary uses of clinical information, and protect patient information confidentiality. Automated approaches based on Natural Language Processing have been implemented and evaluated, allowing for much faster text de-identification than manual approaches. A U.S. Veterans Affairs clinical text de-identification project focused on investigating the current state of the art of automatic clinical text de-identification, on developing a best-of-breed de-identification application for clinical documents, and on evaluating its impact on subsequent text uses and the risk for re-identification. To evaluate this risk, we de-identified discharge summaries from 86 patients using our 'best-of-breed' text de-identification application with resynthesis of the identifiers detected. We then asked physicians working in the ward the patients were hospitalized in if they could recognize these patients when reading the de-identified documents. Each document was examined by at least one resident and one attending physician, and with 4.65% of the documents, physicians thought they recognized the patient because of specific clinical information, but after verification, none was correctly re-identified.
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Development and Evaluation of a Clinical Note Section Header Terminology
Denny, Joshua C.; Miller, Randolph A.; Johnson, Kevin B.; Spickard, Anderson
2008-01-01
Clinical documentation is often expressed in natural language text, yet providers often use common organizations that segment these notes in sections, such as “history of present illness” or “physical examination.” We developed a hierarchical section header terminology, supporting mappings to LOINC and other vocabularies; it contained 1109 concepts and 4332 synonyms. Physicians evaluated it compared to LOINC and the Evaluation and Management billing schema using a randomly selected corpus of history and physical notes. Evaluated documents contained a median of 54 sections and 27 “major sections.” There were 16,196 total sections in the evaluation note corpus. The terminology contained 99.9% of the clinical sections; LOINC matched 77% of section header concepts and 20% of section header strings in those documents. The section terminology may enable better clinical note understanding and interoperability. Future development and integration into natural language processing systems is needed. PMID:18999303
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MARC ES: a computer program for estimating medical information storage requirements.
Konoske, P J; Dobbins, R W; Gauker, E D
1998-01-01
During combat, documentation of medical treatment information is critical for maintaining continuity of patient care. However, knowledge of prior status and treatment of patients is limited to the information noted on a paper field medical card. The Multi-technology Automated Reader Card (MARC), a smart card, has been identified as a potential storage mechanism for casualty medical information. Focusing on data capture and storage technology, this effort developed a Windows program, MARC ES, to estimate storage requirements for the MARC. The program calculates storage requirements for a variety of scenarios using medical documentation requirements, casualty rates, and casualty flows and provides the user with a tool to estimate the space required to store medical data at each echelon of care for selected operational theaters. The program can also be used to identify the point at which data must be uploaded from the MARC if size constraints are imposed. Furthermore, this model can be readily extended to other systems that store or transmit medical information.
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Writing and reading in the electronic health record: an entirely new world.
Han, Heeyoung; Lopp, Lauri
2013-02-05
Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians' electronic health record (EHR)-writing and -reading competence. This study aims to investigate physicians' self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= - 0.33, p<0.001) and narrative (r= - 0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians' perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001). Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes.
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Cohen, Stephanie A; McIlvried, Dawn E
2011-06-01
Cancer genetic counseling sessions traditionally encompass collecting medical and family history information, evaluating that information for the likelihood of a genetic predisposition for a hereditary cancer syndrome, conveying that information to the patient, offering genetic testing when appropriate, obtaining consent and subsequently documenting the encounter with a clinic note and pedigree. Software programs exist to collect family and medical history information electronically, intending to improve efficiency and simplicity of collecting, managing and storing this data. This study compares the genetic counselor's time spent in cancer genetic counseling tasks in a traditional model and one using computer-assisted data collection, which is then used to generate a pedigree, risk assessment and consult note. Genetic counselor time spent collecting family and medical history and providing face-to-face counseling for a new patient session decreased from an average of 85-69 min when using the computer-assisted data collection. However, there was no statistically significant change in overall genetic counselor time on all aspects of the genetic counseling process, due to an increased amount of time spent generating an electronic pedigree and consult note. Improvements in the computer program's technical design would potentially minimize data manipulation. Certain aspects of this program, such as electronic collection of family history and risk assessment, appear effective in improving cancer genetic counseling efficiency while others, such as generating an electronic pedigree and consult note, do not.
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Rapid Implementation of Inpatient Electronic Physician Documentation at an Academic Hospital
Hahn, J.S.; Bernstein, J.A.; McKenzie, R.B.; King, B.J.; Longhurst, C.A.
2012-01-01
Electronic physician documentation is an essential element of a complete electronic medical record (EMR). At Lucile Packard Children’s Hospital, a teaching hospital affiliated with Stanford University, we implemented an inpatient electronic documentation system for physicians over a 12-month period. Using an EMR-based free-text editor coupled with automated import of system data elements, we were able to achieve voluntary, widespread adoption of the electronic documentation process. When given the choice between electronic versus dictated report creation, the vast majority of users preferred the electronic method. In addition to increasing the legibility and accessibility of clinical notes, we also decreased the volume of dictated notes and scanning of handwritten notes, which provides the opportunity for cost savings to the institution. PMID:23620718
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Validating a strategy for psychosocial phenotyping using a large corpus of clinical text.
Gundlapalli, Adi V; Redd, Andrew; Carter, Marjorie; Divita, Guy; Shen, Shuying; Palmer, Miland; Samore, Matthew H
2013-12-01
To develop algorithms to improve efficiency of patient phenotyping using natural language processing (NLP) on text data. Of a large number of note titles available in our database, we sought to determine those with highest yield and precision for psychosocial concepts. From a database of over 1 billion documents from US Department of Veterans Affairs medical facilities, a random sample of 1500 documents from each of 218 enterprise note titles were chosen. Psychosocial concepts were extracted using a UIMA-AS-based NLP pipeline (v3NLP), using a lexicon of relevant concepts with negation and template format annotators. Human reviewers evaluated a subset of documents for false positives and sensitivity. High-yield documents were identified by hit rate and precision. Reasons for false positivity were characterized. A total of 58 707 psychosocial concepts were identified from 316 355 documents for an overall hit rate of 0.2 concepts per document (median 0.1, range 1.6-0). Of 6031 concepts reviewed from a high-yield set of note titles, the overall precision for all concept categories was 80%, with variability among note titles and concept categories. Reasons for false positivity included templating, negation, context, and alternate meaning of words. The sensitivity of the NLP system was noted to be 49% (95% CI 43% to 55%). Phenotyping using NLP need not involve the entire document corpus. Our methods offer a generalizable strategy for scaling NLP pipelines to large free text corpora with complex linguistic annotations in attempts to identify patients of a certain phenotype.
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Validating a strategy for psychosocial phenotyping using a large corpus of clinical text
Gundlapalli, Adi V; Redd, Andrew; Carter, Marjorie; Divita, Guy; Shen, Shuying; Palmer, Miland; Samore, Matthew H
2013-01-01
Objective To develop algorithms to improve efficiency of patient phenotyping using natural language processing (NLP) on text data. Of a large number of note titles available in our database, we sought to determine those with highest yield and precision for psychosocial concepts. Materials and methods From a database of over 1 billion documents from US Department of Veterans Affairs medical facilities, a random sample of 1500 documents from each of 218 enterprise note titles were chosen. Psychosocial concepts were extracted using a UIMA-AS-based NLP pipeline (v3NLP), using a lexicon of relevant concepts with negation and template format annotators. Human reviewers evaluated a subset of documents for false positives and sensitivity. High-yield documents were identified by hit rate and precision. Reasons for false positivity were characterized. Results A total of 58 707 psychosocial concepts were identified from 316 355 documents for an overall hit rate of 0.2 concepts per document (median 0.1, range 1.6–0). Of 6031 concepts reviewed from a high-yield set of note titles, the overall precision for all concept categories was 80%, with variability among note titles and concept categories. Reasons for false positivity included templating, negation, context, and alternate meaning of words. The sensitivity of the NLP system was noted to be 49% (95% CI 43% to 55%). Conclusions Phenotyping using NLP need not involve the entire document corpus. Our methods offer a generalizable strategy for scaling NLP pipelines to large free text corpora with complex linguistic annotations in attempts to identify patients of a certain phenotype. PMID:24169276
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Yang, X Jessie; Wickens, Christopher D; Park, Taezoon; Fong, Liesel; Siah, Kewin T H
2015-12-01
We aimed to examine the effects of information access cost and accountability on medical residents' information retrieval strategy and performance during prehandover preparation. Prior studies observing doctors' prehandover practices witnessed the use of memory-intensive strategies when retrieving patient information. These strategies impose potential threats to patient safety as human memory is prone to errors. Of interest in this work are the underlying determinants of information retrieval strategy and the potential impacts on medical residents' information preparation performance. A two-step research approach was adopted, consisting of semistructured interviews with 21 medical residents and a simulation-based experiment with 32 medical residents. The semistructured interviews revealed that a substantial portion of medical residents (38%) relied largely on memory for preparing handover information. The simulation-based experiment showed that higher information access cost reduced information access attempts and access duration on patient documents and harmed information preparation performance. Higher accountability led to marginally longer access to patient documents. It is important to understand the underlying determinants of medical residents' information retrieval strategy and performance during prehandover preparation. We noted the criticality of easy access to patient documents in prehandover preparation. In addition, accountability marginally influenced medical residents' information retrieval strategy. Findings from this research suggested that the cost of accessing information sources should be minimized in developing handover preparation tools. © 2015, Human Factors and Ergonomics Society.
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NASA Technical Reports Server (NTRS)
Schmidt, A. F. (Editor)
1972-01-01
Selected information is presented from an assemblage of reports and publications on heat transfer and fluid dynamics with direct applicability to oxygen systems. For each document cited, an abstract has been prepared together with key words and a listing of most important references found in the document. Additionally, an author index, a subject index, and a key word index have been provided to simplify the retrieval of specific information from this work. In each subject area - e.g., boiling heat transfer - the individual citations are listed alphabetically by first author, with review papers dually noted under the appropriate subject category and under review papers. Of the documents reviewed and evaluated for inclusion in this publication, coverage of existing information directly concerned with oxygen was given primary emphasis. However, work not specifically oxygen-designated but considered applicable to oxygen by the reviewer e.g., a two-phase friction factor correlation derived from nitrogen experiments is occasionally given where no actual oxygen data exist, as an aid to the reader. Approximately 130 abstracts are listed.
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Häyrinen, Kristiina; Saranto, Kaija; Nykänen, Pirkko
2008-05-01
This paper reviews the research literature on electronic health record (EHR) systems. The aim is to find out (1) how electronic health records are defined, (2) how the structure of these records is described, (3) in what contexts EHRs are used, (4) who has access to EHRs, (5) which data components of the EHRs are used and studied, (6) what is the purpose of research in this field, (7) what methods of data collection have been used in the studies reviewed and (8) what are the results of these studies. A systematic review was carried out of the research dealing with the content of EHRs. A literature search was conducted on four electronic databases: Pubmed/Medline, Cinalh, Eval and Cochrane. The concept of EHR comprised a wide range of information systems, from files compiled in single departments to longitudinal collections of patient data. Only very few papers offered descriptions of the structure of EHRs or the terminologies used. EHRs were used in primary, secondary and tertiary care. Data were recorded in EHRs by different groups of health care professionals. Secretarial staff also recorded data from dictation or nurses' or physicians' manual notes. Some information was also recorded by patients themselves; this information is validated by physicians. It is important that the needs and requirements of different users are taken into account in the future development of information systems. Several data components were documented in EHRs: daily charting, medication administration, physical assessment, admission nursing note, nursing care plan, referral, present complaint (e.g. symptoms), past medical history, life style, physical examination, diagnoses, tests, procedures, treatment, medication, discharge, history, diaries, problems, findings and immunization. In the future it will be necessary to incorporate different kinds of standardized instruments, electronic interviews and nursing documentation systems in EHR systems. The aspects of information quality most often explored in the studies reviewed were the completeness and accuracy of different data components. It has been shown in several studies that the use of an information system was conducive to more complete and accurate documentation by health care professionals. The quality of information is particularly important in patient care, but EHRs also provide important information for secondary purposes, such as health policy planning. Studies focusing on the content of EHRs are needed, especially studies of nursing documentation or patient self-documentation. One future research area is to compare the documentation of different health care professionals with the core information about EHRs which has been determined in national health projects. The challenge for ongoing national health record projects around the world is to take into account all the different types of EHRs and the needs and requirements of different health care professionals and consumers in the development of EHRs. A further challenge is the use of international terminologies in order to achieve semantic interoperability.
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Chen, Jinying; Yu, Hong
2017-04-01
Allowing patients to access their own electronic health record (EHR) notes through online patient portals has the potential to improve patient-centered care. However, EHR notes contain abundant medical jargon that can be difficult for patients to comprehend. One way to help patients is to reduce information overload and help them focus on medical terms that matter most to them. Targeted education can then be developed to improve patient EHR comprehension and the quality of care. The aim of this work was to develop FIT (Finding Important Terms for patients), an unsupervised natural language processing (NLP) system that ranks medical terms in EHR notes based on their importance to patients. We built FIT on a new unsupervised ensemble ranking model derived from the biased random walk algorithm to combine heterogeneous information resources for ranking candidate terms from each EHR note. Specifically, FIT integrates four single views (rankers) for term importance: patient use of medical concepts, document-level term salience, word co-occurrence based term relatedness, and topic coherence. It also incorporates partial information of term importance as conveyed by terms' unfamiliarity levels and semantic types. We evaluated FIT on 90 expert-annotated EHR notes and used the four single-view rankers as baselines. In addition, we implemented three benchmark unsupervised ensemble ranking methods as strong baselines. FIT achieved 0.885 AUC-ROC for ranking candidate terms from EHR notes to identify important terms. When including term identification, the performance of FIT for identifying important terms from EHR notes was 0.813 AUC-ROC. Both performance scores significantly exceeded the corresponding scores from the four single rankers (P<0.001). FIT also outperformed the three ensemble rankers for most metrics. Its performance is relatively insensitive to its parameter. FIT can automatically identify EHR terms important to patients. It may help develop future interventions to improve quality of care. By using unsupervised learning as well as a robust and flexible framework for information fusion, FIT can be readily applied to other domains and applications. Copyright © 2017 Elsevier Inc. All rights reserved.
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The Role of Emotions in Fieldwork: A Self-Study of Family Research in a Corrections Setting
ERIC Educational Resources Information Center
Arditti, Joyce A.; Joest, Karen S.; Lambert-Shute, Jennifer; Walker, Latanya
2010-01-01
In this study, we document a reflexive process via bracketing techniques and the development of a conceptual map in order to better understand how emotions that arise in the field can inform research design, implementation, and results. We conducted a content analysis of field notes written by a team of researchers who administered an interview to…
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The Origins and Development of A Cooperative Strategy for 21st Century Seapower (2015)
2017-09-01
Strategic Studies REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is...unlimited. 13. SUPPLEMENTARY NOTES 14. ABSTRACT This study describes and analyzes the origins, creation, announcement, and dissemination of the...i Executive Summary This study describes and analyzes the origins, creation, announcement, and dissemination of the U.S. Navy–Marine Corps
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Alaska and the Alaska Federal Health Care Partnership
2002-08-01
SUPPLEMENTARY NOTES The original document contains color images. 14. ABSTRACT The intent of the Alaska Federal Healthcare Partnership is to expand clinical and... intent of the Alaska Federal Healthcare Partnership is to expand clinical and support capabilities of the Alaska Native Medical Center (ANMC), Third...the formation of the Partnership. Although lengthy, the information is essential to appreciate the magnitude of the Partnership and the intent behind
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Hiring Practices Used to Staff the Iraqi Provisional Authorities
2009-01-16
Report No. D-2009-042 January 16 , 2009 Hiring Practices Used To Staff the Iraqi Provisional Authorities Report Documentation Page Form...with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 16 JAN 2009 2. REPORT TYPE 3. DATES...AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT 15. SUBJECT TERMS 16 . SECURITY
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Is Japanese Education Becoming Less Egalitarian? Notes on High School Stratification and Reform.
ERIC Educational Resources Information Center
Rohlen, Thomas P.
The topic of equality in education, as it has existed in post-war Japanese cities to date and as it appears to be changing under the influence of the new high school reforms, are discussed in this paper. The document has gathered together a variety of materials collected rather incidentally, and the information presented in each section focuses on…
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2006-05-16
Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including...DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT The interaction of...Introduction The subject of microbiological contamination in water has long been a major public concern, where microorganisms such as coliform bacteria
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Shoulder dystocia documentation: an evaluation of a documentation training intervention.
LeRiche, Tammy; Oppenheimer, Lawrence; Caughey, Sharon; Fell, Deshayne; Walker, Mark
2015-03-01
To evaluate the quality and content of nurse and physician shoulder dystocia delivery documentation before and after MORE training in shoulder dystocia management skills and documentation. Approximately 384 charts at the Ottawa Hospital General Campus involving a diagnosis of shoulder dystocia between the years of 2000 and 2006 excluding the training year of 2003 were identified. The charts were evaluated for 14 key components derived from a validated instrument. The delivery notes were then scored based on these components by 2 separate investigators who were blinded to delivery note author, date, and patient identification to further quantify delivery record quality. Approximately 346 charts were reviewed for physician and nurse delivery documentation. The average score for physician notes was 6 (maximum possible score of 14) both before and after the training intervention. The nurses' average score was 5 before and after the training intervention. Negligible improvement was observed in the content and quality of shoulder dystocia documentation before and after nurse and physician training.
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Experiments with the Dragon Machine
DOE Office of Scientific and Technical Information (OSTI.GOV)
R.E. Malenfant
2005-08-12
The basic characteristics of a self-sustaining chain reaction were demonstrated with the Chicago Pile in 1943, but it was not until early 1945 that sufficient enriched material became available to experimentally verify fast-neutron cross-sections and the kinetic characteristics of a nuclear chain reaction sustained with prompt neutrons alone. However, the demands of wartime and the rapid decline in effort following the cessation of hostilities often resulted in the failure to fully document the experiments or in the loss of documentation as personnel returned to civilian pursuits. When documented, the results were often highly classified. Even when eventually declassified, the datamore » were often not approved for public release until years later.2 Even after declassification and approval for public release, the records are sometimes difficult to find. Through a fortuitous discovery, a set of handwritten notes by ''ORF July 1945'' entitled ''Dragon - Research with a Pulsed Fission Reactor'' was found by William L. Myers in an old storage safe at Pajarito Site of the Los Alamos National Laboratory3. Of course, ORF was identified as Otto R. Frisch. The document was attached to a page in a nondescript spiral bound notebook labeled ''494 Book'' that bore the signatures of Louis Slotin and P. Morrison. The notes also reference an ''Idea LS'' that can only be Louis Slotin. The discovery of the notes led to a search of Laboratory Archives, the negative files of the photo lab, and the Report Library for additional details of the experiments with the Dragon machine that were conducted between January and July 1945. The assembly machine and the experiments were carefully conceived and skillfully executed. The analyses--without the crutch of computers--display real insight into the characteristics of the nuclear chain reaction. The information presented here provides what is believed to be a complete collection of the original documentation of the observations made with the Dragon Machine in early 1945.« less
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Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J
2015-01-01
This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. © Copyright 2015 by the American Board of Family Medicine.
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Lamba, Sangeeta; Berlin, Ana; Goett, Rebecca; Ponce, Christopher B; Holland, Bart; Walther, Susanne
2016-07-01
Documentation of the emotional or psychological needs of seriously ill patients receiving specialty palliative care is endorsed by the "Measuring What Matters" project as a quality performance metric and recommended for use by hospice and palliative care programs for program improvement. The aim of this study was to increase the proportion of inpatient palliative care team encounters in which emotional or psychological needs of patients and family members were documented and to qualitatively enrich the nature of this documentation. This is a mixed-methods retrospective study of 200 patient charts reviewed before and after implementation of a structured note template (SmartPhrase) for palliative care encounters. Patterns of documentation of emotional needs pre- and post-implementation were assessed quantitatively and qualitatively using thematic analysis. A total of 158 of 200 pre-intervention charts and 185 of 200 post-intervention charts included at least one note from the palliative care team. Documentation of emotional assessment increased after SmartPhrase implementation (63.9% [101 of 158] vs. 74.6% [138 of 185]; P < 0.03). Qualitative analysis revealed a post-intervention reduction in the use of generic phrases ("emotional support provided") and an increase in the breadth and depth of emotion-related documentation. A structured note template with a prompt for emotional assessment increases the overall quantity and richness of documentation related to patient and family emotions. However, this documentation remains mostly descriptive. Additional prompting for documentation of recommendations to address identified emotional needs, and the use of screening tools for depression and anxiety, when appropriate, may be necessary for clinically meaningful quality improvements in patient care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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Cucina, Russell J; Bokser, Seth J; Carter, Jonathan T; McLaren, Kevin M; Blum, Michael S
2007-10-11
We report the development and implementation of an electronic inpatient physician documentation system using off-the-shelf components, rapidly and at low cost. Within 9 months of deployment, over half of physician notes were electronic, and within 20 months, paper physician notes were eliminated. Our results suggest institutions can prioritize conversion to inpatient electronic physician documentation without waiting for development of sophisticated software packages or large capital investments.
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Zhou, Li; Collins, Sarah; Morgan, Stephen J.; Zafar, Neelam; Gesner, Emily J.; Fehrenbach, Martin; Rocha, Roberto A.
2016-01-01
Structured clinical documentation is an important component of electronic health records (EHRs) and plays an important role in clinical care, administrative functions, and research activities. Clinical data elements serve as basic building blocks for composing the templates used for generating clinical documents (such as notes and forms). We present our experience in creating and maintaining data elements for three different EHRs (one home-grown and two commercial systems) across different clinical settings, using flowsheet data elements as examples in our case studies. We identified basic but important challenges (including naming convention, links to standard terminologies, and versioning and change management) and possible solutions to address them. We also discussed more complicated challenges regarding governance, documentation vs. structured data capture, pre-coordination vs. post-coordination, reference information models, as well as monitoring, communication and training. PMID:28269927
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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
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Friedman, Erica; Sainte, Michelle; Fallar, Robert
2010-09-01
To determine the extent of restrictions to medical student documentation in patients' records and the opinions of medical education leaders about such restrictions' impact on medical student education and patient care. Education deans (n = 126) of medical schools in the United States and Canada were surveyed to determine policies regarding placement of medical student notes in the patient record, the value of medical students' documentation in the medical record, and the use of electronic medical records (EMRs) for patient notes. The instrument was a 23-item anonymous Web survey. Seventy-nine deans responded. Over 90% believed student notes belong in medical records, but only 42% had a policy regarding this. Ninety-three percent indicated that without student notes, student education would be negatively affected. Fewer (56%) indicated that patient care would be negatively affected. Most thought limiting students' notes would negatively affect several other issues: feeling a part of the team (96%), preparation for internship (95%), and students' sense of involvement (94%). Half (52%) reported that fourth-year students could place notes in paper charts at "all" affiliated hospitals, and 6% reported that fourth-year students could do so at "no" hospitals. Although students' ability to enter notes in patients' records is believed to be important for student education, only about half of all hospitals allow all students' notes in the EMR. Policies regarding placement of student notes should be implemented to ensure students' competency in note writing and their value as members of the patient care team.
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[Methodology for the development of policy brief in public health].
Felt, Emily; Carrasco, José Miguel; Vives-Cases, Carmen
2018-01-10
A policy brief is a document that summarizes research to inform policy. In a brief and succinct way, it defines a policy problem, presents a synthesis of relevant evidence, identifies possible courses of action and makes recommendations or key points. The objective of this note is to describe the methodology used to produce a policy brief for communicating public health research. This note is based on the model presented by Eugene Bardach in addition to the authors' own experiences. We describe six steps: 1) identifying the audience; 2) defining the problem; 3) gathering information and evidence; 4) consideration of policy alternatives; 5) projecting results and designing recommendations; and 6) telling the story. We make a case for the use of policy briefs as a part of an overall communications strategy for research that aims to bring together research teams and stakeholders. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
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ERIC Educational Resources Information Center
Information Dynamics Corp., Reading, MA.
A study intended to provide the Defense Documentation Center (DDC) with a five-year plan for the development of improved and new microfiche products, services, and production capabilities is summarized in this report. In addition, the major findings, conclusions, and recommendations developed during the study are noted. The results of the research…
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The Use of Model-Driven Methodologies and Processes in Aegis Development
2011-05-17
Jamie.Durbin@lmco.com Christopher.M.Thompson@lmco.com May 17, 2011 Distribution Statement A: Approved for Public Release. Distribution is unlimited...Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per...AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES Presented at the 23rd Systems and Software
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ERIC Educational Resources Information Center
Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.
This document summarizes the Comprehensive Smokeless Tobacco and Health Education Act of 1985 bill. A summary of the impact of the bill is included which notes the following: (1) programs to inform the public of the dangers of smokeless tobacco are to be established; (2) smokeless tobacco products will carry one of three warning statements; and…
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Cross-mapping clinical notes between hospitals: an application of the LOINC Document Ontology.
Li, Li; Morrey, C Paul; Baorto, David
2011-01-01
Standardization of document titles is essential for management as the volume of electronic clinical notes increases. The two campuses of the New York Presbyterian Hospital have over 2,700 distinct document titles. The LOINC Document Ontology (DO) provides a standard for the naming of clinical documents in a multi-axis structure. We have represented the latest LOINC DO structure in the MED, and developed an automated process mapping the clinical documents from both the West (Columbia) and East (Cornell) campuses to the LOINC DO. We find that the LOINC DO can represent the majority of our documents, and about half of the documents map between campuses using the LOINC DO as a reference. We evaluated the possibility of using current LOINC codes in document exchange between different institutions. While there is clear success in the ability of the LOINC DO to represent documents and facilitate exchange we find there are granularity issues.
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Audit of the informed consent process as a part of a clinical research quality assurance program.
Lad, Pramod M; Dahl, Rebecca
2014-06-01
Audits of the informed consent process are a key element of a clinical research quality assurance program. A systematic approach to such audits has not been described in the literature. In this paper we describe two components of the audit. The first is the audit of the informed consent document to verify adherence with federal regulations. The second component is comprised of the audit of the informed consent conference, with emphasis on a real time review of the appropriate communication of the key elements of the informed consent. Quality measures may include preparation of an informed consent history log, notes to accompany the informed consent, the use of an informed consent feedback tool, and the use of institutional surveys to assess comprehension of the informed consent process.
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An audit of inpatient case records and suggestions for improvements.
Arshad, A R; Ganesananthan, S; Ajik, S
2000-09-01
A study was carried out in Kuala Lumpur Hospital to review the adequacy of documentation of bio-data and clinical data including clinical examination, progress review, discharge process and doctor's identification in ten of our clinical departments. Twenty criteria were assessed in a retrospective manner to scrutinize the contents of medical notes and subsequently two prospective evaluations were conducted to see improvement in case notes documentation. Deficiencies were revealed in all the criteria selected. However there was a statistically significant improvement in the eleven clinical data criteria in the subsequent two evaluations. Illegibility of case note entries and an excessive usage of abbreviations were noted during this audit. All clinical departments and hospitals should carry out detailed studies into the contents of their medical notes.
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2011-01-01
Background Over the past ten years there has been an increasing focus on the need for improving the experience of end of life care. A number of policy initiatives have been introduced to develop approaches to discussing and documenting individual preferences for end of life care, in particular preferred place to die. Methods The aim was to investigate practice in relation to discussing and documenting end of life care and preferred place to die in the last 4 weeks of life with patients and their families. The study utilised an audit of 65 case notes, alongside four group interviews with a mix of health care professionals involved in palliative care provision. Results While there was evidence that discussions relating to end of life care and preferred place to die had taken place in around half of the audited case notes, there appeared to be a lack of a systematic approach to the recording of discussions with patients or carers about these kind of issues. Health care staff subsequently highlighted that initiating discussions about end of life care and preferences in relation to place of death was challenging and that the recording and tracking of such preferences was problematic. Conclusions Further work is required to establish how information may be adequately recorded, revised and transferred across services to ensure that patients' preferences in relation to end of life care and place of death are, as far as possible, achieved. PMID:22053810
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Beaulieu, Daphnée; Barkun, Alan; Martel, Myriam
2012-07-21
To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior colorectal neoplasia (CRN) by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional database providing pathological results. Required documentation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a standardized glossary with 10% independent data validation. Sample size calculations determined the number of reports needed. Two hundreds and fifty patients (63.2 ± 10.5 years, female: 42.8%, average risk: 38.5%, personal/family history of CRN: 43.3%/20.2%) were scoped in June 2009 by 8 gastroenterologists and 3 surgeons (mean practice: 17.1 ± 8.5 years). Procedural indication and informed consent were always documented. 14% provided a previous colonoscopy date (past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness). Most procedural indicators were recorded (exam date: 98.4%, medications: 99.2%, difficulty level: 98.8%, prep quality: 99.6%). All reports noted extent of visualization (cecum: 94.4%, with landmarks noted in 78.8% - photodocumentation: 67.2%). No procedural times were recorded. One hundred and eleven had polyps (44.4%) with anatomic location noted in 99.1%, size in 65.8%, morphology in 62.2%; removal was by cold biopsy in 25.2% (cold snare: 18%, snare cautery: 31.5%, unrecorded: 20.7%), 84.7% were retrieved. Adenomas were noted in 24.8% (advanced adenomas: 7.6%, cancer: 0.4%) in this population with varying previous colonic investigations. This audit reveals lacking reported items, justifying additional research to optimize quality of reporting.
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Beaulieu, Daphnée; Barkun, Alan; Martel, Myriam
2012-01-01
AIM: To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. METHODS: Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior colorectal neoplasia (CRN) by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional database providing pathological results. Required documentation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a standardized glossary with 10% independent data validation. Sample size calculations determined the number of reports needed. RESULTS: Two hundreds and fifty patients (63.2 ± 10.5 years, female: 42.8%, average risk: 38.5%, personal/family history of CRN: 43.3%/20.2%) were scoped in June 2009 by 8 gastroenterologists and 3 surgeons (mean practice: 17.1 ± 8.5 years). Procedural indication and informed consent were always documented. 14% provided a previous colonoscopy date (past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness). Most procedural indicators were recorded (exam date: 98.4%, medications: 99.2%, difficulty level: 98.8%, prep quality: 99.6%). All reports noted extent of visualization (cecum: 94.4%, with landmarks noted in 78.8% - photodocumentation: 67.2%). No procedural times were recorded. One hundred and eleven had polyps (44.4%) with anatomic location noted in 99.1%, size in 65.8%, morphology in 62.2%; removal was by cold biopsy in 25.2% (cold snare: 18%, snare cautery: 31.5%, unrecorded: 20.7%), 84.7% were retrieved. Adenomas were noted in 24.8% (advanced adenomas: 7.6%, cancer: 0.4%) in this population with varying previous colonic investigations. CONCLUSION: This audit reveals lacking reported items, justifying additional research to optimize quality of reporting. PMID:22826619
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Organizing Diverse, Distributed Project Information
NASA Technical Reports Server (NTRS)
Keller, Richard M.
2003-01-01
SemanticOrganizer is a software application designed to organize and integrate information generated within a distributed organization or as part of a project that involves multiple, geographically dispersed collaborators. SemanticOrganizer incorporates the capabilities of database storage, document sharing, hypermedia navigation, and semantic-interlinking into a system that can be customized to satisfy the specific information-management needs of different user communities. The program provides a centralized repository of information that is both secure and accessible to project collaborators via the World Wide Web. SemanticOrganizer's repository can be used to collect diverse information (including forms, documents, notes, data, spreadsheets, images, and sounds) from computers at collaborators work sites. The program organizes the information using a unique network-structured conceptual framework, wherein each node represents a data record that contains not only the original information but also metadata (in effect, standardized data that characterize the information). Links among nodes express semantic relationships among the data records. The program features a Web interface through which users enter, interlink, and/or search for information in the repository. By use of this repository, the collaborators have immediate access to the most recent project information, as well as to archived information. A key advantage to SemanticOrganizer is its ability to interlink information together in a natural fashion using customized terminology and concepts that are familiar to a user community.
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Readability Formulas and User Perceptions of Electronic Health Records Difficulty: A Corpus Study
Yu, Hong
2017-01-01
Background Electronic health records (EHRs) are a rich resource for developing applications to engage patients and foster patient activation, thus holding a strong potential to enhance patient-centered care. Studies have shown that providing patients with access to their own EHR notes may improve the understanding of their own clinical conditions and treatments, leading to improved health care outcomes. However, the highly technical language in EHR notes impedes patients’ comprehension. Numerous studies have evaluated the difficulty of health-related text using readability formulas such as Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning-Fog Index (GFI). They conclude that the materials are often written at a grade level higher than common recommendations. Objective The objective of our study was to explore the relationship between the aforementioned readability formulas and the laypeople’s perceived difficulty on 2 genres of text: general health information and EHR notes. We also validated the formulas’ appropriateness and generalizability on predicting difficulty levels of highly complex technical documents. Methods We collected 140 Wikipedia articles on diabetes and 242 EHR notes with diabetes International Classification of Diseases, Ninth Revision code. We recruited 15 Amazon Mechanical Turk (AMT) users to rate difficulty levels of the documents. Correlations between laypeople’s perceived difficulty levels and readability formula scores were measured, and their difference was tested. We also compared word usage and the impact of medical concepts of the 2 genres of text. Results The distributions of both readability formulas’ scores (P<.001) and laypeople’s perceptions (P=.002) on the 2 genres were different. Correlations of readability predictions and laypeople’s perceptions were weak. Furthermore, despite being graded at similar levels, documents of different genres were still perceived with different difficulty (P<.001). Word usage in the 2 related genres still differed significantly (P<.001). Conclusions Our findings suggested that the readability formulas’ predictions did not align with perceived difficulty in either text genre. The widely used readability formulas were highly correlated with each other but did not show adequate correlation with readers’ perceived difficulty. Therefore, they were not appropriate to assess the readability of EHR notes. PMID:28254738
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QNOTE: an instrument for measuring the quality of EHR clinical notes.
Burke, Harry B; Hoang, Albert; Becher, Dorothy; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; Sessums, Laura L; O'Malley, Patrick; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W
2014-01-01
The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole. Retrospective multicenter blinded study of the clinical notes of 100 outpatients with type 2 diabetes mellitus who had been seen in clinic on at least three occasions. The 300 notes were rated by eight general internal medicine and eight family medicine practicing physicians. The QNOTE instrument scored the quality of the note as the sum of a set of 12 note element scores, and its inter-rater agreement was measured by the intraclass correlation coefficient. The Global instrument scored the note in its entirety, and its inter-rater agreement was measured by the Fleiss κ. The overall QNOTE inter-rater agreement was 0.82 (CI 0.80 to 0.84), and its note quality score was 65 (CI 64 to 66). The Global inter-rater agreement was 0.24 (CI 0.19 to 0.29), and its note quality score was 52 (CI 49 to 55). The QNOTE quality scores were consistent, and the overall QNOTE score was significantly higher than the overall Global score (p=0.04). We found the QNOTE to be a valid instrument for evaluating the quality of electronic clinical notes, and its performance was superior to that of the Global instrument. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Exact Test of Independence Using Mutual Information
2014-05-23
1000 × 0.05 = 50. Entropy 2014, 16 2844 Importantly, the permutation test, which does not preserve Markov order, resulted in 489 Type I errors! Using...Block 13 ARO Report Number Block 13: Supplementary Note © 2014 . Published in Entropy , Vol. Ed. 0 16, (7) (2014), (, (7). DoD Components reserve a...official Department of the Army position, policy or decision, unless so designated by other documentation. ... Entropy 2014, 16, 2839-2849; doi:10.3390
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2012-01-01
colleagues Lionel Galway and Louis Miller, who provided thoughtful reviews of this document. - xix - Glossary AEL Army Equipment Loss AEPS...quality ( Galway and Hanks, 1996) noted that a key to better execution of data policies may be ensuring that organizations that generate the data...understand how it will be used. More specifically, Galway and Hanks (1996:15) observed that the persistence of missing, invalid, and inaccurate data
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Motulsky, Aude; Wong, Jenna; Cordeau, Jean-Pierre; Pomalaza, Jorge; Barkun, Jeffrey; Tamblyn, Robyn
2017-04-01
To describe the usage of a novel application (The FLOW) that allows mobile devices to be used for rounding and handoffs. The FLOW provides a view of patient data and the capacity to enter short notes via personal mobile devices. It was deployed using a "bring-your-own-device" model in 4 pilot units. Social network analysis (SNA) was applied to audit trails in order to visualize usage patterns. A questionnaire was used to describe user experience. Overall, 253 health professionals used The FLOW with their personal mobile devices from October 2013 to March 2015. In pediatric and neonatal intensive care units (ICUs), a median of 26-26.5 notes were entered per user per day. Visual network representation of app entries showed that usage patterns were different between the ICUs. In 127 questionnaires (50%), respondents reported using The FLOW most often to enter notes and for handoffs. The FLOW was perceived as having improved patient care by 57% of respondents, compared to usual care. Most respondents (86%) wished to continue using The FLOW. This study shows how a handoff and rounding tool was quickly adopted in pediatric and neonatal ICUs in a hospital setting where patient charts were still paper-based. Originally developed as a tool to support informal documentation using smartphones, it was adapted to local practices and expanded to print sign-out documents and import notes within the medicolegal record with desktop computers. Interestingly, even if not supported by the nursing administrative authorities, the level of use for data entry among nurses and doctors was similar in all units, indicating close collaboration in documentation practices in these ICUs. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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An Audit of Nursing Documentation at Three Public Hospitals in Jamaica.
Lindo, Jascinth; Stennett, Rosain; Stephenson-Wilson, Kayon; Barrett, Kerry Ann; Bunnaman, Donna; Anderson-Johnson, Pauline; Waugh-Brown, Veronica; Wint, Yvonne
2016-09-01
Nursing documentation provides an important indicator of the quality of care provided for hospitalized patients. This study assessed the quality of nursing documentation on medical wards at three hospitals in Jamaica. This cross-sectional study audited a multilevel stratified sample of 245 patient records from three type B hospitals. An audit instrument which assessed nursing documentation of client history, biological data, client assessment, nursing standards, discharge planning, and teaching facilitated data collection. Descriptive statistics were conducted using IBM SPSS, Version 19 (IBM Inc., Armonk, NY, USA). Records from three hospitals (Hospital 1, n = 119, 48.6%; Hospital 2, n = 56, 22.9%; Hospital 3, n = 70, 28.6%) were audited. Documented evidence of the patient's chief complaint (81.6%), history of present illness (78.8%), past health (79.2%), and family health (11.0%) were noted; however, less than a third of the dockets audited recorded adequate assessment data (e.g., occupation or living accommodations of patients). The audit noted 90% of records had a physical assessment completed within 24 hr of admission and entries timed, dated, and signed by a nurse. Less than 5% of dockets had evidence of patient teaching, and 13.5% had documented evidence of discharge planning conducted within 72 hr of admission. This study highlights the weakness in nursing documentation and the need for increased training and continued monitoring of nursing documentation at the hospitals studied. Additional research regarding the factors that affect nursing documentation practice could prove useful. The study provides valuable information for the development of strategic risk management programs geared at improving the quality of care delivered to clients and presents an opportunity for nurse leaders to implement structured interventions geared at improving nursing documentation in Jamaica. In light of Jamaica's epidemiologic transition of chronic diseases, gaps in nurses' documentation of client assessment, patient teaching, and discharge planning should be addressed with urgency. Patient teaching and discharge planning enable the clients to participate more effectively in their health maintenance process. © 2016 Sigma Theta Tau International.
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Best practice in primary care pathology: review 9
Smellie, W S A; Shaw, N; Bowlees, R; Taylor, A; Howell‐Jones, R; McNulty, C A M
2007-01-01
This ninth best‐practice review examines two series of common primary care questions in laboratory medicine: (i) potassium abnormalities and (ii) venous leg ulcer microbiology. The review is presented in question‐and‐answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence‐based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence‐based. They will be updated periodically to take account of new information. PMID:17259298
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Rates of sexual history taking and screening in HIV-positive men who have sex with men.
MacRae, Alasdair; Lord, Emily; Forsythe, Annabel; Sherrard, Jackie
2017-03-01
A case note audit was undertaken of HIV-positive men who have sex with men (MSM) to ascertain whether national guidelines for taking sexual histories, including recreational drug use and sexually transmitted infection (STI) screening were being met. The notes of 142 HIV-positive men seen in 2015 were available, of whom 85 were MSM. Information was collected regarding sexual history, recreational drug use documentation, sexually transmitted infection screen offer and test results. Seventy-seven (91%) of the MSM had a sexual history documented, of whom 60 (78%) were sexually active. STI screens were offered to 58/60 (97%) of those who were sexually active and accepted by 53 (91%). Twelve (23%) of these had an STI. A recreational drug history was taken in 63 (74%) with 17 (27%) reporting use and 3 (5%) chemsex. The high rate of STIs highlights that regular screening in this group is essential. Additionally, the fact that over a quarter reported recreational drug use and given the increasing concern around chemsex, questions about this should be incorporated into the sexual history proforma.
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Ho, Jonhan; Aridor, Orly; Parwani, Anil V.
2012-01-01
Background: For decades anatomic pathology (AP) workflow have been a highly manual process based on the use of an optical microscope and glass slides. Recent innovations in scanning and digitizing of entire glass slides are accelerating a move toward widespread adoption and implementation of a workflow based on digital slides and their supporting information management software. To support the design of digital pathology systems and ensure their adoption into pathology practice, the needs of the main users within the AP workflow, the pathologists, should be identified. Contextual inquiry is a qualitative, user-centered, social method designed to identify and understand users’ needs and is utilized for collecting, interpreting, and aggregating in-detail aspects of work. Objective: Contextual inquiry was utilized to document current AP workflow, identify processes that may benefit from the introduction of digital pathology systems, and establish design requirements for digital pathology systems that will meet pathologists’ needs. Materials and Methods: Pathologists were observed and interviewed at a large academic medical center according to contextual inquiry guidelines established by Holtzblatt et al. 1998. Notes representing user-provided data were documented during observation sessions. An affinity diagram, a hierarchal organization of the notes based on common themes in the data, was created. Five graphical models were developed to help visualize the data including sequence, flow, artifact, physical, and cultural models. Results: A total of six pathologists were observed by a team of two researchers. A total of 254 affinity notes were documented and organized using a system based on topical hierarchy, including 75 third-level, 24 second-level, and five main-level categories, including technology, communication, synthesis/preparation, organization, and workflow. Current AP workflow was labor intensive and lacked scalability. A large number of processes that may possibly improve following the introduction of digital pathology systems were identified. These work processes included case management, case examination and review, and final case reporting. Furthermore, a digital slide system should integrate with the anatomic pathologic laboratory information system. Conclusions: To our knowledge, this is the first study that utilized the contextual inquiry method to document AP workflow. Findings were used to establish key requirements for the design of digital pathology systems. PMID:23243553
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Redundancy-Aware Topic Modeling for Patient Record Notes
Cohen, Raphael; Aviram, Iddo; Elhadad, Michael; Elhadad, Noémie
2014-01-01
The clinical notes in a given patient record contain much redundancy, in large part due to clinicians’ documentation habit of copying from previous notes in the record and pasting into a new note. Previous work has shown that this redundancy has a negative impact on the quality of text mining and topic modeling in particular. In this paper we describe a novel variant of Latent Dirichlet Allocation (LDA) topic modeling, Red-LDA, which takes into account the inherent redundancy of patient records when modeling content of clinical notes. To assess the value of Red-LDA, we experiment with three baselines and our novel redundancy-aware topic modeling method: given a large collection of patient records, (i) apply vanilla LDA to all documents in all input records; (ii) identify and remove all redundancy by chosing a single representative document for each record as input to LDA; (iii) identify and remove all redundant paragraphs in each record, leaving partial, non-redundant documents as input to LDA; and (iv) apply Red-LDA to all documents in all input records. Both quantitative evaluation carried out through log-likelihood on held-out data and topic coherence of produced topics and qualitative assessement of topics carried out by physicians show that Red-LDA produces superior models to all three baseline strategies. This research contributes to the emerging field of understanding the characteristics of the electronic health record and how to account for them in the framework of data mining. The code for the two redundancy-elimination baselines and Red-LDA is made publicly available to the community. PMID:24551060
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Redundancy-aware topic modeling for patient record notes.
Cohen, Raphael; Aviram, Iddo; Elhadad, Michael; Elhadad, Noémie
2014-01-01
The clinical notes in a given patient record contain much redundancy, in large part due to clinicians' documentation habit of copying from previous notes in the record and pasting into a new note. Previous work has shown that this redundancy has a negative impact on the quality of text mining and topic modeling in particular. In this paper we describe a novel variant of Latent Dirichlet Allocation (LDA) topic modeling, Red-LDA, which takes into account the inherent redundancy of patient records when modeling content of clinical notes. To assess the value of Red-LDA, we experiment with three baselines and our novel redundancy-aware topic modeling method: given a large collection of patient records, (i) apply vanilla LDA to all documents in all input records; (ii) identify and remove all redundancy by chosing a single representative document for each record as input to LDA; (iii) identify and remove all redundant paragraphs in each record, leaving partial, non-redundant documents as input to LDA; and (iv) apply Red-LDA to all documents in all input records. Both quantitative evaluation carried out through log-likelihood on held-out data and topic coherence of produced topics and qualitative assessment of topics carried out by physicians show that Red-LDA produces superior models to all three baseline strategies. This research contributes to the emerging field of understanding the characteristics of the electronic health record and how to account for them in the framework of data mining. The code for the two redundancy-elimination baselines and Red-LDA is made publicly available to the community.
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Kimia, Amir A; Savova, Guergana; Landschaft, Assaf; Harper, Marvin B
2015-07-01
Electronically stored clinical documents may contain both structured data and unstructured data. The use of structured clinical data varies by facility, but clinicians are familiar with coded data such as International Classification of Diseases, Ninth Revision, Systematized Nomenclature of Medicine-Clinical Terms codes, and commonly other data including patient chief complaints or laboratory results. Most electronic health records have much more clinical information stored as unstructured data, for example, clinical narrative such as history of present illness, procedure notes, and clinical decision making are stored as unstructured data. Despite the importance of this information, electronic capture or retrieval of unstructured clinical data has been challenging. The field of natural language processing (NLP) is undergoing rapid development, and existing tools can be successfully used for quality improvement, research, healthcare coding, and even billing compliance. In this brief review, we provide examples of successful uses of NLP using emergency medicine physician visit notes for various projects and the challenges of retrieving specific data and finally present practical methods that can run on a standard personal computer as well as high-end state-of-the-art funded processes run by leading NLP informatics researchers.
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Improving Continuity of Care via the Discharge Summary
Sakaguchi, Farrant H.; Lenert, Leslie A.
2015-01-01
Discharge summaries (DCS) frequently fail to improve the continuity of care. A chart review of 188 DCS was performed to identify specific components that could be improved through health information technology. Medication reconciliations were analyzed for completeness and for medical reasoning. Documentation of pending results and follow-up details were analyzed. Patient preferences, patient goals, and the handover tone were noted. Patients were discharged on an average of 9.8 medications, only 3% of medication reconciliations were complete and medical reasoning was frequently absent. There were 358 pending results in 188 hospital discharges though only 14% were mentioned in the DCS. Documentation of clear, timely follow-up was present for less than 50% of patients. Patient preferences, patient goals, and lessons learned were rarely included. A handover tone was in only 17% of the DCS. Evaluating the DCS as a clinical handover is novel but information for safe handovers is frequently missing. PMID:26958250
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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.
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Park, Sun Young; Lee, So Young; Chen, Yunan
2012-03-01
The goal of this study was to examine the effects of medical notes (MD) in an electronic medical records (EMR) system on doctors' work practices at an Emergency Department (ED). We conducted a six-month qualitative study, including in situ field observations and semi-structured interviews, in an ED affiliated with a large teaching hospital during the time periods of before, after, and during the paper-to-electronic transition of the rollout of an EMR system. Data were analyzed using open coding method and various visual representations of workflow diagrams. The use of the EMR in the ED resulted in both direct and indirect effects on ED doctors' work practices. It directly influenced the ED doctors' documentation process: (i) increasing documentation time four to five fold, which in turn significantly increased the number of incomplete charts, (ii) obscuring the distinction between residents' charting inputs and those of attendings, shifting more documentation responsibilities to the residents, and (iii) leading to the use of paper notes as documentation aids to transfer information from the patient bedside to the charting room. EMR use also had indirect consequences: it increased the cognitive burden of doctors, since they had to remember multiple patients' data; it aggravated doctors' multi-tasking due to flexibility in the system use allowing more interruptions; and it caused ED doctors' work to become largely stationary in the charting room, which further contributed to reducing doctors' time with patients and their interaction with nurses. We suggest three guidelines for designing future EMR systems to be used in teaching hospitals. First, the design of documentation tools in EMR needs to take into account what we called "note-intensive tasks" to support the collaborative nature of medical work. Second, it should clearly define roles and responsibilities. Lastly, the system should provide a balance between flexibility and interruption to better manage the complex nature of medical work and to facilitate necessary interactions among ED staff and patients in the work environment. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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Chaplain Documentation and the Electronic Medical Record: A Survey of ACPE Residency Programs.
Tartaglia, Alexander; Dodd-McCue, Diane; Ford, Timothy; Demm, Charles; Hassell, Alma
2016-01-01
This study explores the extent to which chaplaincy departments at ACPE-accredited residency programs make use of the electronic medical record (EMR) for documentation and training. Survey data solicited from 219 programs with a 45% response rate and interview findings from 11 centers demonstrate a high level of usage of the EMR as well as an expectation that CPE residents document each patient/family encounter. Centers provided considerable initial training, but less ongoing monitoring of chaplain documentation. Centers used multiple sources to develop documentation tools for the EMR. One center was verified as having created the spiritual assessment component of the documentation tool from a peer reviewed published model. Interviews found intermittent use of the student chart notes for educational purposes. One center verified a structured manner of monitoring chart notes as a performance improvement activity. Findings suggested potential for the development of a standard documentation tool for chaplain charting and training.
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1981-09-01
ommunication (COM), Document is available to the U.S. Oceanic Air Traffic Systems public through the National Technical Information Service...contact with NAT aircraft. Tourism and Transport Reykjavik Provides VHF and HF radio Iceland but fi- contact with northerly NAT air- nanced partly by...Other Techniques to Civil Aviation, Working Group B, Note presented by the Aviation and Marine Comnunications Service, Department of Tourism and
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Feedback Control and Estimation Applied to Boundary Layers Subject to Free-Stream Turbulence
2006-11-01
technological importance in many applications. Under free-stream turbulence intensities of 1 % or more it is observed experimen- tally [ 1 ] that transition occurs...wider and longer. Note also that lam- inar streaks can be observed downstream of the spots. The turbulent region at the end of the domain is created by...REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour
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Gulf War Air Power Survey. Volume 5. A Statistical Compendium and Chronology
1993-01-01
documentation proved to be a blessing and a curse. While students and analysts of the Gulf War can tap an especially broad spectrum of information collected...to target folders and pre- and post-strike photos. They include interviews and oral history materials, SITREPS from several different Services and...these limits. You will note the first "day" lasted longer than one day and included two nights. Subsequently, the system stabilized according to a
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Glucose Oxidase Catalyzed Self-Assembly of Bioelectroactive Gold Nanostructures
2010-01-01
Electroanalysis 2010, 22, No. 7-8, 784 – 792 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is...Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES Electroanalysis 2010, 22, No. 7-8, 784 - 792 14. ABSTRACT 15...Scientific, Waltham, MA). The data collection was completed using OMNIC 2.1 software. For FT-IR, 5 mL of GOx-Au compo- sites were deposited onto a glass
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Gundlapalli, Adi V; Divita, Guy; Redd, Andrew; Carter, Marjorie E; Ko, Danette; Rubin, Michael; Samore, Matthew; Strymish, Judith; Krein, Sarah; Gupta, Kalpana; Sales, Anne; Trautner, Barbara W
2017-07-01
To develop a natural language processing pipeline to extract positively asserted concepts related to the presence of an indwelling urinary catheter in hospitalized patients from the free text of the electronic medical note. The goal is to assist infection preventionists and other healthcare professionals in determining whether a patient has an indwelling urinary catheter when a catheter-associated urinary tract infection is suspected. Currently, data on indwelling urinary catheters is not consistently captured in the electronic medical record in structured format and thus cannot be reliably extracted for clinical and research purposes. We developed a lexicon of terms related to indwelling urinary catheters and urinary symptoms based on domain knowledge, prior experience in the field, and review of medical notes. A reference standard of 1595 randomly selected documents from inpatient admissions was annotated by human reviewers to identify all positively and negatively asserted concepts related to indwelling urinary catheters. We trained a natural language processing pipeline based on the V3NLP framework using 1050 documents and tested on 545 documents to determine agreement with the human reference standard. Metrics reported are positive predictive value and recall. The lexicon contained 590 terms related to the presence of an indwelling urinary catheter in various categories including insertion, care, change, and removal of urinary catheters and 67 terms for urinary symptoms. Nursing notes were the most frequent inpatient note titles in the reference standard document corpus; these also yielded the highest number of positively asserted concepts with respect to urinary catheters. Comparing the performance of the natural language processing pipeline against the human reference standard, the overall recall was 75% and positive predictive value was 99% on the training set; on the testing set, the recall was 72% and positive predictive value was 98%. The performance on extracting urinary symptoms (including fever) was high with recall and precision greater than 90%. We have shown that it is possible to identify the presence of an indwelling urinary catheter and urinary symptoms from the free text of electronic medical notes from inpatients using natural language processing. These are two key steps in developing automated protocols to assist humans in large-scale review of patient charts for catheter-associated urinary tract infection. The challenges associated with extracting indwelling urinary catheter-related concepts also inform the design of electronic medical record templates to reliably and consistently capture data on indwelling urinary catheters. Published by Elsevier Inc.
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Gaps in patient care practices to prevent hospital-acquired delirium.
Alagiakrishnan, Kannayiram; Marrie, Thomas; Rolfson, Darryl; Coke, William; Camicioli, Richard; Duggan, D'Arcy; Launhardt, Bonnie; Fisher, Bruce; Gordon, Debbie; Hervas-Malo, Marilou; Magee, Bernice; Wiens, Cheryl
2009-10-01
To evaluate the current patient care practices that address the predisposing and precipitating factors contributing to the prevention of hospital-acquired delirium in the elderly. Prospective cohort (observational) study. Patients 65 years of age and older who were admitted to medical teaching units at the University of Alberta Hospital in Edmonton over a period of 7 months and who were at risk of delirium. Medical teaching units at the University of Alberta. Demographic data and information on predisposing factors for hospital-acquired delirium were obtained for all patients. Documented clinical practices that likely prevent common precipitants of delirium were also recorded. Of the 132 patients enrolled, 20 (15.2%) developed hospital-acquired delirium. At the time of admission several predisposing factors were not documented (eg, possible cognitive impairment 16 [12%], visual impairment 52 [39.4%], and functional status of activities of daily living 99 [75.0%]). Recorded precipitating factors included catheter use, screening for dehydration, and medications. Catheters were used in 35 (26.5%) patients, and fluid intake-and-output charting assessed dehydration in 57 (43.2%) patients. At the time of admission there was no documentation of hearing status in 69 (52.3%) patients and aspiration risk in 104 (78.8%) patients. After admission, reorientation measures were documented in only 16 (12.1%) patients. Although all patients had brief mental status evaluations performed once daily, this was not noted to occur twice daily (which would provide important information about fluctuation of mental status) and there was no formal attention span testing. In this study, hospital-acquired delirium was also associated with increased mortality (P < .004), increased length of stay (P < .007), and increased institutionalization (P < .027). Gaps were noted in patient care practices that might contribute to hospital-acquired delirium and also in measures to identify the development of delirium at an earlier stage. Effort should be made to educate health professionals to identify the predisposing and precipitating factors, and to screen for delirium. This might improve the prevention of delirium.
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Meystre, Stéphane M; Ferrández, Óscar; Friedlin, F Jeffrey; South, Brett R; Shen, Shuying; Samore, Matthew H
2014-08-01
As more and more electronic clinical information is becoming easier to access for secondary uses such as clinical research, approaches that enable faster and more collaborative research while protecting patient privacy and confidentiality are becoming more important. Clinical text de-identification offers such advantages but is typically a tedious manual process. Automated Natural Language Processing (NLP) methods can alleviate this process, but their impact on subsequent uses of the automatically de-identified clinical narratives has only barely been investigated. In the context of a larger project to develop and investigate automated text de-identification for Veterans Health Administration (VHA) clinical notes, we studied the impact of automated text de-identification on clinical information in a stepwise manner. Our approach started with a high-level assessment of clinical notes informativeness and formatting, and ended with a detailed study of the overlap of select clinical information types and Protected Health Information (PHI). To investigate the informativeness (i.e., document type information, select clinical data types, and interpretation or conclusion) of VHA clinical notes, we used five different existing text de-identification systems. The informativeness was only minimally altered by these systems while formatting was only modified by one system. To examine the impact of de-identification on clinical information extraction, we compared counts of SNOMED-CT concepts found by an open source information extraction application in the original (i.e., not de-identified) version of a corpus of VHA clinical notes, and in the same corpus after de-identification. Only about 1.2-3% less SNOMED-CT concepts were found in de-identified versions of our corpus, and many of these concepts were PHI that was erroneously identified as clinical information. To study this impact in more details and assess how generalizable our findings were, we examined the overlap between select clinical information annotated in the 2010 i2b2 NLP challenge corpus and automatic PHI annotations from our best-of-breed VHA clinical text de-identification system (nicknamed 'BoB'). Overall, only 0.81% of the clinical information exactly overlapped with PHI, and 1.78% partly overlapped. We conclude that automated text de-identification's impact on clinical information is small, but not negligible, and that improved clinical acronyms and eponyms disambiguation could significantly reduce this impact. Copyright © 2014 Elsevier Inc. All rights reserved.
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Harrod, Molly; Montoya, Ana; Mody, Lona; McGuirk, Helen; Winter, Suzanne; Chopra, Vineet
2016-01-01
Objectives To understand frontline nurses’ (registered nurses and licensed practical nurses), unit nurse managers’ and skilled nursing facility (SNF) administrators’ perceived preparedness in providing care for patients with peripherally inserted central catheters (PICCs) in SNFs. Design An exploratory, qualitative pilot study. Setting Two community based SNFs. Participants Patients, frontline nurses (registered nurses and licensed practical nurses), unit nurse managers and SNF administrators. Methods Over 36-weeks, we observed and conducted informal interviews with 56 patients with PICCs and their nurses focusing on PICC care practices and documentation. In addition, we collected baseline PICC data including placement indication (e.g., antimicrobial administration), placement setting (hospital vs. SNF), and dwell time. We then conducted focus groups with frontline nurses and unit nurse managers and semi-structured interviews with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. Results During weekly informal interviews and observations variations in documentation were observed. Differences between patient-reported PICC concerns (quality-of-life) and those described by frontline nurses were noted. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs and gaps in training and education were highlighted as barriers in improving practice and safety. Conclusion Our study suggests that practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions and increase resource availability in SNFs appear necessary to enhance PICC care and patient safety. PMID:27603747
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Harrod, Molly; Montoya, Ana; Mody, Lona; McGuirk, Helen; Winter, Suzanne; Chopra, Vineet
2016-10-01
To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs. Exploratory, qualitative pilot study. Two community based SNFs. Residents with PICCs, frontline nurses (RNs, LPNs), unit nurse managers, and SNF administrators. Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety. Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
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The Process of Note Taking: Implications for Students with Mild Disabilities
ERIC Educational Resources Information Center
Boyle, Joseph R.
2007-01-01
Students with mild disabilities have a difficult time recording notes from lectures. Accurate note taking is important because it helps students understand the content from lectures and notes serve as a document for later review. In this article, the author describes what teachers can do before, during, and after the lecture to help students…
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Grass buffers for playas in agricultural landscapes: An annotated bibliography
Melcher, Cynthia P.; Skagen, Susan K.
2005-01-01
References on best management practices (BMPs) for agricultural lands were included because certain BMPs are crucial for informing decisions about buffer design/ effectiveness and overall playa ecology. We also included various papers that increase the spectrum of time over which buffer theories and practices have evolved. An unannotated section lists references that we did not prioritize for annotation and references that may be helpful but were beyond the scope of this document. Finally, we provide notes on conversations we had with scientists, land managers, and other buffer experts whom we consulted, and their contact information. We conclude the bibliography with appendices of common and scientific names of birds and plants and acronyms used in both the bibliography. In the annotations, italicized text signifies our own editorial remarks. Readers should also note that much of the work on buffers has been designed using English units of measure rather than metrics; in most cases, their results have been converted to metrics for publication, explaining the seemingly odd or irregular buffer widths and other parameters reported.
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-03-23
...U.S. Customs and Border Protection (CBP) published a document in the Federal Register on March 19, 2012, announcing that it will be holding two trade symposia this year. One trade symposium will be held on the West Coast on May 10, 2012, and the other will be on the East Coast later in the year. This document corrects that March 19 document to note that the theme of this year's symposia has been changed to ``Transforming Trade for a Stronger Economy''; and to inform the public that the fees have changed for both attendance at the Long Beach Convention and Entertainment Center and for access to the live web- casting of the event; that the trade symposium will now be one hour longer, running from 8:30 a.m. until 4 p.m.; and that registration will open to the public on or about March 20, 2012.
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Saifuddin, Aamir; Magee, Lucia; Barrett, Rachael
2015-01-01
Clinical handover has been identified as a "major preventable cause of harm" by the Royal College of Physicians (RCP). Whilst working at a London teaching hospital from August 2013, we noted substandard weekend handover of medical patients. The existing pro forma was filled incompletely by day doctors so it was difficult for weekend colleagues to identify unwell patients, with inherent safety implications. Furthermore, on-call medical staff noted that poor accessibility of vital information in patients' files was affecting acute clinical management. We audited the pro formas over a six week period (n=83) and the Friday ward round (WR) entries for medical inpatients over two weekends (n=84) against the RCP's handover guidance. The results showed poor documentation of several important details on the pro formas, for example, ceiling of care (4%) and past medical history (PMH) (23%). Problem lists were specified on 62% of the WR entries. We designed new handover pro formas and 'Friday WR sheets' to provide prompts for this information and used Medical Meetings and emails to explain the project's aims. Re-audit demonstrated significant improvement in all parameters; for instance, PMH increased to 52% on the pro formas. Only 10% of Friday WR entries used our sheet. However, when used, outcomes were much better, for example, problem list documentation increased to 100%. In conclusion, our interventions improved the provision of crucial information needed to prioritise and manage patients over the weekend. Future work should further highlight the importance of safe handover to all doctors to induce a shift in culture and optimise patient care.
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BoB, a best-of-breed automated text de-identification system for VHA clinical documents.
Ferrández, Oscar; South, Brett R; Shen, Shuying; Friedlin, F Jeffrey; Samore, Matthew H; Meystre, Stéphane M
2013-01-01
De-identification allows faster and more collaborative clinical research while protecting patient confidentiality. Clinical narrative de-identification is a tedious process that can be alleviated by automated natural language processing methods. The goal of this research is the development of an automated text de-identification system for Veterans Health Administration (VHA) clinical documents. We devised a novel stepwise hybrid approach designed to improve the current strategies used for text de-identification. The proposed system is based on a previous study on the best de-identification methods for VHA documents. This best-of-breed automated clinical text de-identification system (aka BoB) tackles the problem as two separate tasks: (1) maximize patient confidentiality by redacting as much protected health information (PHI) as possible; and (2) leave de-identified documents in a usable state preserving as much clinical information as possible. We evaluated BoB with a manually annotated corpus of a variety of VHA clinical notes, as well as with the 2006 i2b2 de-identification challenge corpus. We present evaluations at the instance- and token-level, with detailed results for BoB's main components. Moreover, an existing text de-identification system was also included in our evaluation. BoB's design efficiently takes advantage of the methods implemented in its pipeline, resulting in high sensitivity values (especially for sensitive PHI categories) and a limited number of false positives. Our system successfully addressed VHA clinical document de-identification, and its hybrid stepwise design demonstrates robustness and efficiency, prioritizing patient confidentiality while leaving most clinical information intact.
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Ban, Vin Shen; Madden, Christopher J; Browning, Travis; O'Connell, Ellen; Marple, Bradley F; Moran, Brett
2017-04-01
Monitoring the supervision of residents can be a challenging task. We describe our experience with the implementation of a templated note system for documenting procedures with the aim of enabling automated, discrete, and standardized capture of documentation of supervision of residents performing floor-based procedures, with minimal extra effort from the residents. Procedural note templates were designed using the standard existing template within a commercial electronic health record software. Templates for common procedures were created such that residents could document every procedure performed outside of the formal procedural areas. Automated reports were generated and letters were sent to noncompliers. A total of 27 045 inpatient non-formal procedural area procedures were recorded from August 2012 to June 2014. Compliance with NoteWriter template usage averaged 86% in the first year and increased to 94.6% in the second year ( P = .0055). Initially, only 12.5% of residents documented supervision of any form. By the end of the first year, this was above 80%, with the gains maintained into the second year and beyond. Direct supervision was documented to have occurred where required in 62.8% in the first year and increased to 99.8% in the second year ( P = .0001) after the addition of hard stops. Notification of attendings prior to procedures was documented 100% of the time by September 2013. Letters sent to errant residents decreased from 3.6 to 0.83 per 100 residents per week. The templated procedure note system with hard stops and integrated reporting can successfully be used to improve monitoring of resident supervision. This has potential impact on resident education and patient safety. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Schroeder, P.R.; Gibson, A.C.; Dardeau, E.A.
This technical note has a twofold purpose: to describe a technique for comparing the predicted quality of surface runoff from confined dredged material disposal areas with applicable water quality standards and to document a computer program called RUNQUAL, written for that purpose as a part of the Automated Dredging and Disposal Alternatives Management System (ADDAMS).
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Further results from PIXE analysis of inks in Galileo's notes on motion
NASA Astrophysics Data System (ADS)
Del Carmine, P.; Giuntini, L.; Hooper, W.; Lucarelli, F.; Mandò, P. A.
1996-06-01
We have recently analysed the inks in some of the folios of Vol. 72 of Manoscritti galileiani, kept at the Biblioteca Nazionale Centrale di Firenze, which contains a collection of loose handwritten sheets containing undated notes, data from experiments and propositions on the problems of motion from different periods of Galileo's life. This paper reports specific results obtained from the analysis of some of these propositions, which allowed to make a contribution to their chronological attribution and therefore to the solution of some historical controversies. Even in the case where the "absolute" chronological attributions could not be made on the basis of comparison with dated documents, the PIXE results provided useful information to deny or confirm the hypothesis that different propositions were written in the same or in different periods.
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Best practice in primary care pathology: review 5
Smellie, W S A; Forth, J; Ryder, S; Galloway, M J; Wood, A C; Watson, I D
2006-01-01
This fifth best practice review examines three series of common primary care questions in laboratory medicine: (1) minor liver function test abnormalities; (2) laboratory monitoring of patients receiving lithium; and (3) investigation of possible venous thromboembolism. The review is presented in question–answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence‐based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus‐based rather than evidence‐based. They will be updated periodically to take account of new information. PMID:16644875
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[Information hygiene and regulation of information for vulnerable groups of the population].
Denisov, E I; Eremin, A L; Sivochalova, O V; Kurerov, N N
2014-01-01
Development of information society engenders the problem of hygienic regulation of information load for the population, first of all for vulnerable groups. There are presented international and Russian normative legal documents and experience in this area, there are described the negative effects of information (such as stress, depression, suicidal ideations). There are considered social-psychological characteristics of vulnerable groups that requires their best protection from loads of information, doing harm, particularly in terms of reproductive health, family relationships, children, etc. There was noted the desirability of improvement of sanitary, legislation on the regulation of the information load on the population, especially in vulnerable groups, in terms of optimization of parameters of the signal-carriers on volume, brightness and the adequacy of the volume and content of information in radio and television broadcasting, in an urban environment and at the plant to preserve the health and well-being of the population.
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1988-12-01
Behavioral and Social Sciences Approved for the public release; distrbution is unlimited All, U.S. ARMY RESEARCH INSTITUTE FOR THE BEHAVIORAL AND SOCIAL ...Institute for the Behavioral and Social Sciences. NOTE The views, opinions, and findings in this report are those of the author(s) and should not to be...U.S. Army Research Institute for the Organization I HumRRO Behavioral and Social Sciences 6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City
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ERIC Educational Resources Information Center
Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.
The text of Part 2 of a Senate hearing on the Tobacco Product Education and Health Protection Act of 1990 is reported in this document. It is noted that this act would amend the Public Service Act to establish a center for tobacco products, to inform the public concerning the hazards of tobacco use, to disclose and restrict additives to such…
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ERIC Educational Resources Information Center
Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.
The text of Part 1 of a Senate hearing on the Tobacco Product Education and Health Protection Act of 1990 is reported in this document. It is noted that this act would amend the Public Service Act to establish a center for tobacco products, to inform the public concerning the hazards of tobacco use, to disclose and restrict additives to such…
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A Handbook for Producing Classroom Vugraphs
1988-09-01
UNCLASSIFIED SECURITY CLASSIFICATION OF THIS PAGE Form Approved REPORT DOCUMENTATION PAGE OMB No. 0704-0188 la . REPORT SECURITY CLASSIFICATION lb...or can do with the information. Students try to boil down the informacion presented visually to some compact form, usually by taking notes for later...EtSm firam ta, 1019 DriveSyste Maor era dffrencmpnns fiure1) wr rt shaft asran o ispt ea ul-p Il ~01 4 00 1 J ~~W~ Driv Syte1MjoiCmpnet to tranmft engine
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1980-10-01
Location Flowchart has been drawn up to give guidance as to where to apply for various categories of reports. It also serves as an aid in deciding whether...or further disclosure S.l-. 72 NOTES 1. The flowchart is not intended to cover all possibilities; the following points are made for your guidance. 2...not followed the flowchart correctly - start again from ’BEGIN’. NEI N ’"A. 7-.1 %. 73 REPORT LOCATION BEGIN~ FLOWCHART rreporto aD-P.orriBR6N~I-D ubr
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Nutritional status and interventions in hospice: physician assessment of cancer patients.
Flynn, B; Barrett, M; Sui, J; Halpin, C; Paz, G; Walsh, D
2018-06-07
Cancer cachexia is a multifactorial syndrome characterised by a progressive loss of skeletal muscle mass. It adversely influences quality of life, treatment response and survival. Early identification and multimodal interventions can potentially treat cancer cachexia. However, healthcare professionals demonstrate a lack of understanding and the ability to identify cancer cachexia early. The present study aimed to evaluate the assessment by physicians of nutritional status in cancer patients admitted to hospice. A retrospective medical record review was conducted on all cancer admissions to a specialist in-patient palliative care unit over a 4-month period between October 2016 and January 2017. Charts were reviewed for evidence of documented nutritional assessment by physicians. Data were collected from the referral letter, admission notes, drug kardex and discharge letter. The information extracted included: (i) patient demographics and characteristics; (ii) terms used by physicians to describe nutritional status; (iii) any record of nutritional impact symptoms (NIS) experienced by the patient; and (iv) nutritional interventions prescribed. One hundred and forty admissions were evaluated. Nutritional terminology and NIS were most commonly documented on the admission notes. Only 41% of documents recorded any nutritional term used by physicians to assess nutritional status. Furthermore, 71% of documents recorded at least one NIS experienced by the patient. Fatigue was the most frequent NIS. We identified an inadequate nutritional assessment of cancer patients admitted to hospice. Implementation of a nutritional symptom checklist and nutrition screening tools, along with enhanced physician education and multidisciplinary nutrition care, could improve the identification and management of cancer cachexia in the palliative care setting. © 2018 The British Dietetic Association Ltd.
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Assessment of SOAP note evaluation tools in colleges and schools of pharmacy.
Sando, Karen R; Skoy, Elizabeth; Bradley, Courtney; Frenzel, Jeanne; Kirwin, Jennifer; Urteaga, Elizabeth
2017-07-01
To describe current methods used to assess SOAP notes in colleges and schools of pharmacy. Members of the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group were invited to share assessment tools for SOAP notes. Content of submissions was evaluated to characterize overall qualities and how the tools assessed subjective, objective, assessment, and plan information. Thirty-nine assessment tools from 25 schools were evaluated. Twenty-nine (74%) of the tools were rubrics and ten (26%) were checklists. All rubrics included analytic scoring elements, while two (7%) were mixed with holistic and analytic scoring elements. A majority of the rubrics (35%) used a four-item rating scale. Substantial variability existed in how tools evaluated subjective and objective sections. All tools included problem identification in the assessment section. Other assessment items included goals (82%) and rationale (69%). Seventy-seven percent assessed drug therapy; however, only 33% assessed non-drug therapy. Other plan items included education (59%) and follow-up (90%). There is a great deal of variation in the specific elements used to evaluate SOAP notes in colleges and schools of pharmacy. Improved consistency in assessment methods to evaluate SOAP notes may better prepare students to produce standardized documentation when entering practice. Copyright © 2017 Elsevier Inc. All rights reserved.
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FAPA: Faculty Appointment Policy Archive, 1998. [CD-ROM.
ERIC Educational Resources Information Center
Trower, C. Ann
This CD-ROM presents 220 documents collected in Harvard University's Faculty Appointment Policy Archive (FAPA), the ZyFIND search and retrieval system, and instructions for their use. The FAPA system and ZyFIND allow browsing through documents, inserting bookmarks in documents, attaching notes to documents without modifying them, and selecting…
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Nursing documentation with NANDA and NIC in a comprehensive HIS/EPR system.
Flø, Kåre
2006-01-01
DIPS nursing documentation system facilitates that nurses can write several types of notes into the EPR. Within these notes the nurses can register NANDA diagnoses and NIC interventions with nursing activities. To choose NANDA and NIC the nurse can use a search engine, or she can choose a relevant Care plan guideline and pick the suggested diagnoses and interventions from there. Diagnoses and interventions with nursing activities registered are presented in a Care plan. When a nurse writes a note for a patient she will always be presented the Care plan and she can easy evaluate and update the Care plan.
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Collection of "Clearinghouse Notes," 1997-98.
ERIC Educational Resources Information Center
Education Commission of the States, Denver, CO.
This document is a collection of Education Commission of the States notes that address a wide array of education issues. The notes provide brief overviews of state legislation passed or pending on specific education issues. It analyzes such matters as performance-based accountability systems; state-level policies regarding accreditation in public…
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Readability Formulas and User Perceptions of Electronic Health Records Difficulty: A Corpus Study.
Zheng, Jiaping; Yu, Hong
2017-03-02
Electronic health records (EHRs) are a rich resource for developing applications to engage patients and foster patient activation, thus holding a strong potential to enhance patient-centered care. Studies have shown that providing patients with access to their own EHR notes may improve the understanding of their own clinical conditions and treatments, leading to improved health care outcomes. However, the highly technical language in EHR notes impedes patients' comprehension. Numerous studies have evaluated the difficulty of health-related text using readability formulas such as Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning-Fog Index (GFI). They conclude that the materials are often written at a grade level higher than common recommendations. The objective of our study was to explore the relationship between the aforementioned readability formulas and the laypeople's perceived difficulty on 2 genres of text: general health information and EHR notes. We also validated the formulas' appropriateness and generalizability on predicting difficulty levels of highly complex technical documents. We collected 140 Wikipedia articles on diabetes and 242 EHR notes with diabetes International Classification of Diseases, Ninth Revision code. We recruited 15 Amazon Mechanical Turk (AMT) users to rate difficulty levels of the documents. Correlations between laypeople's perceived difficulty levels and readability formula scores were measured, and their difference was tested. We also compared word usage and the impact of medical concepts of the 2 genres of text. The distributions of both readability formulas' scores (P<.001) and laypeople's perceptions (P=.002) on the 2 genres were different. Correlations of readability predictions and laypeople's perceptions were weak. Furthermore, despite being graded at similar levels, documents of different genres were still perceived with different difficulty (P<.001). Word usage in the 2 related genres still differed significantly (P<.001). Our findings suggested that the readability formulas' predictions did not align with perceived difficulty in either text genre. The widely used readability formulas were highly correlated with each other but did not show adequate correlation with readers' perceived difficulty. Therefore, they were not appropriate to assess the readability of EHR notes. ©Jiaping Zheng, Hong Yu. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.03.2017.
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Comparing two anesthesia information management system user interfaces: a usability evaluation.
Wanderer, Jonathan P; Rao, Anoop V; Rothwell, Sarah H; Ehrenfeld, Jesse M
2012-11-01
Anesthesia information management systems (AIMS) have been developed by multiple vendors and are deployed in thousands of operating rooms around the world, yet not much is known about measuring and improving AIMS usability. We developed a methodology for evaluating AIMS usability in a low-fidelity simulated clinical environment and used it to compare an existing user interface with a revised version. We hypothesized that the revised user interface would be more useable. In a low-fidelity simulated clinical environment, twenty anesthesia providers documented essential anesthetic information for the start of the case using both an existing and a revised user interface. Participants had not used the revised user interface previously and completed a brief training exercise prior to the study task. All participants completed a workload assessment and a satisfaction survey. All sessions were recorded. Multiple usability metrics were measured. The primary outcome was documentation accuracy. Secondary outcomes were perceived workload, number of documentation steps, number of user interactions, and documentation time. The interfaces were compared and design problems were identified by analyzing recorded sessions and survey results. Use of the revised user interface was shown to improve documentation accuracy from 85.1% to 92.4%, a difference of 7.3% (95% confidence interval [CI] for the difference 1.8 to 12.7). The revised user interface decreased the number of user interactions by 6.5 for intravenous documentation (95% CI 2.9 to 10.1) and by 16.1 for airway documentation (95% CI 11.1 to 21.1). The revised user interface required 3.8 fewer documentation steps (95% CI 2.3 to 5.4). Airway documentation time was reduced by 30.5 seconds with the revised workflow (95% CI 8.5 to 52.4). There were no significant time differences noted in intravenous documentation or in total task time. No difference in perceived workload was found between the user interfaces. Two user interface design problems were identified in the revised user interface. The usability of anesthesia information management systems can be evaluated using a low-fidelity simulated clinical environment. User testing of the revised user interface showed improvement in some usability metrics and highlighted areas for further revision. Vendors of AIMS and those who use them should consider adopting methods to evaluate and improve AIMS usability.
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Clinical Information Systems Integration in New York City's First Mobile Stroke Unit.
Kummer, Benjamin R; Lerario, Michael P; Navi, Babak B; Ganzman, Adam C; Ribaudo, Daniel; Mir, Saad A; Pishanidar, Sammy; Lekic, Tim; Williams, Olajide; Kamel, Hooman; Marshall, Randolph S; Hripcsak, George; Elkind, Mitchell S V; Fink, Matthew E
2018-01-01
Mobile stroke units (MSUs) reduce time to thrombolytic therapy in acute ischemic stroke. These units are widely used, but the clinical information systems underlying MSU operations are understudied. The first MSU on the East Coast of the United States was established at New York Presbyterian Hospital (NYP) in October 2016. We describe our program's 7-month pilot, focusing on the integration of our hospital's clinical information systems into our MSU to support patient care and research efforts. NYP's MSU was staffed by two paramedics, one radiology technologist, and a vascular neurologist. The unit was equipped with four laptop computers and networking infrastructure enabling all staff to access the hospital intranet and clinical applications during operating hours. A telephone-based registration procedure registered patients from the field into our admit/discharge/transfer system, which interfaced with the institutional electronic health record (EHR). We developed and implemented a computerized physician order entry set in our EHR with prefilled values to permit quick ordering of medications, imaging, and laboratory testing. We also developed and implemented a structured clinician note to facilitate care documentation and clinical data extraction. Our MSU began operating on October 3, 2016. As of April 27, 2017, the MSU transported 49 patients, of whom 16 received tissue plasminogen activator (t-PA). Zero technical problems impacting patient care were reported around registration, order entry, or intranet access. Two onboard network failures occurred, resulting in computed tomography scanner malfunctions, although no patients became ineligible for time-sensitive treatment as a result. Thirteen (26.5%) clinical notes contained at least one incomplete time field. The main technical challenges encountered during the integration of our hospital's clinical information systems into our MSU were onboard network failures and incomplete clinical documentation. Future studies are necessary to determine whether such integrative efforts improve MSU care quality, and which enhancements to information systems will optimize clinical care and research efforts. Schattauer GmbH Stuttgart.
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Using Inspections to Improve the Quality of Product Documentation and Code.
ERIC Educational Resources Information Center
Zuchero, John
1995-01-01
Describes how, by adapting software inspections to assess documentation and code, technical writers can collaborate with development personnel, editors, and customers to dramatically improve both the quality of documentation and the very process of inspecting that documentation. Notes that the five steps involved in the inspection process are:…
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Solidarity and the Universal Declaration on Bioethics and Human Rights.
Gunson, Darryl
2009-06-01
Recent work has stressed the importance of the concept of solidarity to bioethics and social philosophy generally. But can and should it feature in documents such as the Universal Declaration on Bioethics and Human Rights as anything more than a vague notion with multiple possible interpretations? Although noting the tension between universality and particularity that such documents have to deal with, and also noting that solidarity has a political content, the paper explores the suggestion that solidarity should feature more centrally in international regulations. The paper concludes with the view that when solidarity is seen aright, the UDBHR is an implicitly solidaristic document.
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Code of Federal Regulations, 2014 CFR
2014-01-01
.... Unless otherwise noted, mail also means electronic mail containing PDF copies of pleadings or documents... § 16.1 and any regulation, agreement, or document of conveyance issued or made under that statute... Civil Rights. Complainant means the person submitting a complaint. Complaint means a written document...
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Medical decision making: guide to improved CPT coding.
Holt, Jim; Warsy, Ambreen; Wright, Paula
2010-04-01
The Current Procedural Terminology (CPT) coding system for office visits, which has been in use since 1995, has not been well studied, but it is generally agreed that the system contains much room for error. In fact, the available literature suggests that only slightly more than half of physicians will agree on the same CPT code for a given visit, and only 60% of professional coders will agree on the same code for a particular visit. In addition, the criteria used to assign a code are often related to the amount of written documentation. The goal of this study was to evaluate two novel methods to assess if the most appropriate CPT code is used: the level of medical decision making, or the sum of all problems mentioned by the patient during the visit. The authors-a professional coder, a residency faculty member, and a PGY-3 family medicine resident-reviewed 351 randomly selected visit notes from two residency programs in the Northeast Tennessee region for the level of documentation, the level of medical decision making, and the total number of problems addressed. The authors assigned appropriate CPT codes at each of those three levels. Substantial undercoding occurred at each of the three levels. Approximately 33% of visits were undercoded based on the written documentation. Approximately 50% of the visits were undercoded based on the level of documented medical decision making. Approximately 80% of the visits were undercoded based on the total number of problems which the patient presented during the visit. Interrater agreement was fair, and similar to that noted in other coding studies. Undercoding is not only common in a family medicine residency program but it also occurs at levels that would not be evident from a simple audit of the documentation on the visit note. Undercoding also occurs from not exploring problems mentioned by the patient and not documenting additional work that was performed. Family physicians may benefit from minor alterations in their documentation of office visit notes.
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Mbagwu, Michael; French, Dustin D; Gill, Manjot; Mitchell, Christopher; Jackson, Kathryn; Kho, Abel; Bryar, Paul J
2016-05-04
Visual acuity is the primary measure used in ophthalmology to determine how well a patient can see. Visual acuity for a single eye may be recorded in multiple ways for a single patient visit (eg, Snellen vs. Jäger units vs. font print size), and be recorded for either distance or near vision. Capturing the best documented visual acuity (BDVA) of each eye in an individual patient visit is an important step for making electronic ophthalmology clinical notes useful in research. Currently, there is limited methodology for capturing BDVA in an efficient and accurate manner from electronic health record (EHR) notes. We developed an algorithm to detect BDVA for right and left eyes from defined fields within electronic ophthalmology clinical notes. We designed an algorithm to detect the BDVA from defined fields within 295,218 ophthalmology clinical notes with visual acuity data present. About 5668 unique responses were identified and an algorithm was developed to map all of the unique responses to a structured list of Snellen visual acuities. Visual acuity was captured from a total of 295,218 ophthalmology clinical notes during the study dates. The algorithm identified all visual acuities in the defined visual acuity section for each eye and returned a single BDVA for each eye. A clinician chart review of 100 random patient notes showed a 99% accuracy detecting BDVA from these records and 1% observed error. Our algorithm successfully captures best documented Snellen distance visual acuity from ophthalmology clinical notes and transforms a variety of inputs into a structured Snellen equivalent list. Our work, to the best of our knowledge, represents the first attempt at capturing visual acuity accurately from large numbers of electronic ophthalmology notes. Use of this algorithm can benefit research groups interested in assessing visual acuity for patient centered outcome. All codes used for this study are currently available, and will be made available online at https://phekb.org.
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French, Dustin D; Gill, Manjot; Mitchell, Christopher; Jackson, Kathryn; Kho, Abel; Bryar, Paul J
2016-01-01
Background Visual acuity is the primary measure used in ophthalmology to determine how well a patient can see. Visual acuity for a single eye may be recorded in multiple ways for a single patient visit (eg, Snellen vs. Jäger units vs. font print size), and be recorded for either distance or near vision. Capturing the best documented visual acuity (BDVA) of each eye in an individual patient visit is an important step for making electronic ophthalmology clinical notes useful in research. Objective Currently, there is limited methodology for capturing BDVA in an efficient and accurate manner from electronic health record (EHR) notes. We developed an algorithm to detect BDVA for right and left eyes from defined fields within electronic ophthalmology clinical notes. Methods We designed an algorithm to detect the BDVA from defined fields within 295,218 ophthalmology clinical notes with visual acuity data present. About 5668 unique responses were identified and an algorithm was developed to map all of the unique responses to a structured list of Snellen visual acuities. Results Visual acuity was captured from a total of 295,218 ophthalmology clinical notes during the study dates. The algorithm identified all visual acuities in the defined visual acuity section for each eye and returned a single BDVA for each eye. A clinician chart review of 100 random patient notes showed a 99% accuracy detecting BDVA from these records and 1% observed error. Conclusions Our algorithm successfully captures best documented Snellen distance visual acuity from ophthalmology clinical notes and transforms a variety of inputs into a structured Snellen equivalent list. Our work, to the best of our knowledge, represents the first attempt at capturing visual acuity accurately from large numbers of electronic ophthalmology notes. Use of this algorithm can benefit research groups interested in assessing visual acuity for patient centered outcome. All codes used for this study are currently available, and will be made available online at https://phekb.org. PMID:27146002
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Fulton, James L.
1992-01-01
Spatial data analysis has become an integral component in many surface and sub-surface hydrologic investigations within the U.S. Geological Survey (USGS). Currently, one of the largest costs in applying spatial data analysis is the cost of developing the needed spatial data. Therefore, guidelines and standards are required for the development of spatial data in order to allow for data sharing and reuse; this eliminates costly redevelopment. In order to attain this goal, the USGS is expanding efforts to identify guidelines and standards for the development of spatial data for hydrologic analysis. Because of the variety of project and database needs, the USGS has concentrated on developing standards for documenting spatial sets to aid in the assessment of data set quality and compatibility of different data sets. An interim data set documentation standard (1990) has been developed that provides a mechanism for associating a wide variety of information with a data set, including data about source material, data automation and editing procedures used, projection parameters, data statistics, descriptions of features and feature attributes, information on organizational contacts lists of operations performed on the data, and free-form comments and notes about the data, made at various times in the evolution of the data set. The interim data set documentation standard has been automated using a commercial geographic information system (GIS) and data set documentation software developed by the USGS. Where possible, USGS developed software is used to enter data into the data set documentation file automatically. The GIS software closely associates a data set with its data set documentation file; the documentation file is retained with the data set whenever it is modified, copied, or transferred to another computer system. The Water Resources Division of the USGS is continuing to develop spatial data and data processing standards, with emphasis on standards needed to support hydrologic analysis, hydrologic data processing, and publication of hydrologic thermatic maps. There is a need for the GIS vendor community to develop data set documentation tools similar to those developed by the USGS, or to incorporate USGS developed tools in their software.
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NCAR CSM ocean model by the NCAR oceanography section. Technical note
DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
This technical note documents the ocean component of the NCAR Climate System Model (CSM). The ocean code has been developed from the Modular Ocean Model (version 1.1) which was developed and maintained at the NOAA Geophysical Fluid Dynamics Laboratory in Princeton. As a tribute to Mike Cox, and because the material is still relevant, the first four sections of this technical note are a straight reproduction from the GFDL Technical Report that Mike wrote in 1984. The remaining sections document how the NCAR Oceanography Section members have developed the MOM 1.1 code, and how it is forced, in order tomore » produce the NCAR CSM Ocean Model.« less
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Best practice in primary care pathology: review 7
Smellie, W S A; Forth, J; Smart, S R S; Galloway, M J; Irving, W; Bareford, D; Collinson, P O; Kerr, K G; Summerfield, G; Carey, P J; Minhas, Rubin
2007-01-01
This seventh best‐practice review examines four series of common primary care questions in laboratory medicine: (1) blood count abnormalities 2; (2) cardiac troponins; (3) high‐density lipoprotein cholesterol; and (4) viral diseases 2. The review is presented in a question–answer format, with authorship attributed for each question series. The recommendations are a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence‐based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. The recommendations are not standards, but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information. PMID:17046843
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Is There Value in Having Radiology Provide a Second Reading in Pediatric Orthopaedic Clinic?
Natarajan, Vivek; Bosch, Patrick; Dede, Ozgur; Deeney, Vincent; Mendelson, Stephen; Ward, Timothy; Brooks, Maria; Kenkre, Tanya; Roach, James
2017-06-01
The Joint Commission on Accreditation of Healthcare Organizations specifically mandates the dual interpretation of musculoskeletal radiographs by a radiologist in addition to the orthopaedist in all hospital-based orthopaedic clinics. Previous studies have questioned the utility of this practice. The purpose of this study was to further investigate the clinical significance of having the radiologist provide a second interpretation in a hospital-based pediatric orthopaedic clinic. A retrospective review was performed of all patients who had plain radiographs obtained in the pediatric orthopaedic clinic at an academic children's hospital over a 4-month period. For each radiographic series, the orthopaedist's note and the radiology interpretation were reviewed and a determination was made of whether the radiology read provided new clinically useful information and/or a new diagnosis, whether it recommended further imaging, or if it missed a diagnosis that was reflected in the orthopaedist's note. The hospital charges associated with the radiology read for each study were also quantified. The charts of 1570 consecutive clinic patients who were seen in the pediatric orthopaedic clinic from January to April, 2012 were reviewed. There were 2509 radiographic studies performed, of which 2264 had both a documented orthopaedist's note and radiologist's read. The radiologist's interpretation added new, clinically important information in 1.0% (23/2264) of these studies. In 1.7% (38/2264) of the studies, it was determined that the radiologist missed the diagnosis or clinically important information that could affect treatment. The total amount of the professional fees charged for the radiologists' interpretations was $87,362. On average, the hospital charges for each occurrence in which the radiologist's read provided an additional diagnosis or clinically important information beyond the orthopaedist's note were $3798. The results of this study suggest that eliminating the requirement to have the radiologist interpret radiographs in the pediatric orthopaedic clinic would have few clinical consequences. Level III-This is a diagnostic retrospective cohort study.
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A Visible Ideology: A Document Series in a Women's Clothing Company.
ERIC Educational Resources Information Center
Cronn-Mills, Kirstin
2000-01-01
Notes that corporate documents of a women's clothing company changed in one season from relatively outdated designs to more updated, professional layouts but the content changed very little. Contends that the document redesign indicates a move to a more feminist outlook for the company. Describes how the document design represents a slow change…
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2013-08-15
McCrea, M., Harding, H.P., Jr., Matthews, A., and Cantu, R.C. (2007). Recurrent concussion and risk of depression in retired professional football ... concussion , is often unrecog nized due to the severity of the other injuries occurring in a combat setting, particularly life threatening injuries and...foreign body; light sensitivity Previous blast Documented in SOAP note or EMED Previous combat concussion Combat related, documented in SOAP note or EMED
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Classroom Notes Plus: A Quarterly of Teaching Ideas, 2005-06
ERIC Educational Resources Information Center
National Council of Teachers of English, 2006
2006-01-01
This document is a compilation of the four issues in the 23rd volume of "Classroom Notes Plus." Each issue of "Classroom Notes Plus" contains descriptions of original, unpublished teaching practices, and of adapted ideas. The August 2005 (v23 n1) issue includes: Sharing Responses to Literature via Exit Slips (Barb Wagner); Letting Learners Teach…
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Assessing the Readability of Medical Documents: A Ranking Approach.
Zheng, Jiaping; Yu, Hong
2018-03-23
The use of electronic health record (EHR) systems with patient engagement capabilities, including viewing, downloading, and transmitting health information, has recently grown tremendously. However, using these resources to engage patients in managing their own health remains challenging due to the complex and technical nature of the EHR narratives. Our objective was to develop a machine learning-based system to assess readability levels of complex documents such as EHR notes. We collected difficulty ratings of EHR notes and Wikipedia articles using crowdsourcing from 90 readers. We built a supervised model to assess readability based on relative orders of text difficulty using both surface text features and word embeddings. We evaluated system performance using the Kendall coefficient of concordance against human ratings. Our system achieved significantly higher concordance (.734) with human annotators than did a baseline using the Flesch-Kincaid Grade Level, a widely adopted readability formula (.531). The improvement was also consistent across different disease topics. This method's concordance with an individual human user's ratings was also higher than the concordance between different human annotators (.658). We explored methods to automatically assess the readability levels of clinical narratives. Our ranking-based system using simple textual features and easy-to-learn word embeddings outperformed a widely used readability formula. Our ranking-based method can predict relative difficulties of medical documents. It is not constrained to a predefined set of readability levels, a common design in many machine learning-based systems. Furthermore, the feature set does not rely on complex processing of the documents. One potential application of our readability ranking is personalization, allowing patients to better accommodate their own background knowledge. ©Jiaping Zheng, Hong Yu. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 23.03.2018.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-09-02
...'' and provided four support documents (``Separation Agreement and Release'' related to Louis Reynolds... Reynolds. The ``Separation Agreement and Release'' document established that Louis Reynolds was separated... handwritten note that Louis Reynolds is one of the individuals. The ``Signatures'' document shows that Louis...
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Input Range Testing for the General Mission Analysis Tool (GMAT)
NASA Technical Reports Server (NTRS)
Hughes, Steven P.
2007-01-01
This document contains a test plan for testing input values to the General Mission Analysis Tool (GMAT). The plan includes four primary types of information, which rigorously define all tests that should be performed to validate that GMAT will accept allowable inputs and deny disallowed inputs. The first is a complete list of all allowed object fields in GMAT. The second type of information, is test input to be attempted for each field. The third type of information is allowable input values for all objects fields in GMAT. The final piece of information is how GMAT should respond to both valid and invalid information. It is VERY important to note that the tests below must be performed for both the Graphical User Interface and the script!! The examples are illustrated using a scripting perspective, because it is simpler to write up. However, the test must be performed for both interfaces to GMAT.
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2012-03-01
REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 The public reporting burden for this collection of information is estimated to average 1 hour...currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1 . REPORT DATE (DD-MM-YY) 2. REPORT TYPE 3. DATES COVERED (From...13. SUPPLEMENTARY NOTES Report contains color. PA Case Number: 88ABW-2012-1688; Clearance Date: 23 Mar 2012. See also Volume 1 , AFRL-RZ-WP-TR
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2005-09-01
aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if...it does not display a currently valid OMB control number. 1. REPORT DATE 01 JUN 2005 2. REPORT TYPE N/ A 3. DATES COVERED - 4. TITLE AND...unlimited 13. SUPPLEMENTARY NOTES The original document contains color images. 14. ABSTRACT This report summarizes the results of a Symposium and
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In Brief: Web site for human spaceflight review committee
NASA Astrophysics Data System (ADS)
Showstack, Randy
2009-06-01
As part of an independent review of human spaceflight plans and programs, NASA has established a Web site for the Review of U.S. Human Space Flight Plans Committee (http://hsfnasagov). The Web site provides the committee's charter, relevant documents, information about meetings and members, and ways to contact the committee. “The human spaceflight program belongs to everyone. Our committee would hope to benefit from the views of all who would care to contact us,” noted committee chairman Norman Augustine, retired chair and CEO of Lockheed Martin Corporation.
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European Science Notes Information Bulletin Reports on Current European/ Middle Eastern Science
1990-05-01
London NWI 5TH UNCLASSIFIED SECURITY CLASSIFICATION OF TI,-S PAGE REPORT DOCUMENTATION PAGE la R~EPORT SECLURT7y CLASSIFCATION Ib RESTRICTIVE MARKINGS...PDILEVENTARI NCTA’iON COSA - CODES SBEC’TEM "Continue on reverse if necessary aind identify by block number) rE-D 6ROUP S BGPOUP (I-i ~ ’J E- 5 re~~ Qt...Scientific Director ....... James E. Andrews Editor................ Ms. Connie R. Orendorf This special issue of ESNIB is de -voted to Dr. J.F. Blackburn
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CFL3D Version 6.4-General Usage and Aeroelastic Analysis
NASA Technical Reports Server (NTRS)
Bartels, Robert E.; Rumsey, Christopher L.; Biedron, Robert T.
2006-01-01
This document contains the course notes on the computational fluid dynamics code CFL3D version 6.4. It is intended to provide from basic to advanced users the information necessary to successfully use the code for a broad range of cases. Much of the course covers capability that has been a part of previous versions of the code, with material compiled from a CFL3D v5.0 manual and from the CFL3D v6 web site prior to the current release. This part of the material is presented to users of the code not familiar with computational fluid dynamics. There is new capability in CFL3D version 6.4 presented here that has not previously been published. There are also outdated features no longer used or recommended in recent releases of the code. The information offered here supersedes earlier manuals and updates outdated usage. Where current usage supersedes older versions, notation of that is made. These course notes also provides hints for usage, code installation and examples not found elsewhere.
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Sheehan, Barbara; Stetson, Peter; Bhatt, Ashish R; Field, Adele I; Patel, Chirag; Maisel, James Mark
2016-01-01
Background The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)–enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user’s experience. Objective The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry. Methods This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods (“protocols”) of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes. Results A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard-Standard protocol and 13.8, 21.3, and 18.7 minutes using the Standard-NLP protocol (1 of 2 hybrid methods). Using 8 out of 9 characteristics measured by the PDQI-9 instrument, the NLP-NLP protocol received a median quality score sum of 24.5; the Standard-Standard protocol received a median sum of 29; and the Standard-NLP protocol received a median sum of 29.5. The mean total score of the usability measure was 36.7 when the participants used the NLP-NLP protocol compared with 30.3 when they used the Standard-Standard protocol. Conclusions In this study, the feasibility of an approach to EHR data capture involving the application of NLP to transcribed dictation was demonstrated. This novel dictation-based approach has the potential to reduce the time required for documentation and improve usability while maintaining documentation quality. Future research will evaluate the NLP-based EHR data capture approach in a clinical setting. It is reasonable to assert that EHRs will increasingly use NLP-enabled data entry tools such as MediSapien NLP because they hold promise for enhancing the documentation process and end-user experience. PMID:27793791
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Kaufman, David R; Sheehan, Barbara; Stetson, Peter; Bhatt, Ashish R; Field, Adele I; Patel, Chirag; Maisel, James Mark
2016-10-28
The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)-enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user's experience. The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry. This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods ("protocols") of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes. A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard-Standard protocol and 13.8, 21.3, and 18.7 minutes using the Standard-NLP protocol (1 of 2 hybrid methods). Using 8 out of 9 characteristics measured by the PDQI-9 instrument, the NLP-NLP protocol received a median quality score sum of 24.5; the Standard-Standard protocol received a median sum of 29; and the Standard-NLP protocol received a median sum of 29.5. The mean total score of the usability measure was 36.7 when the participants used the NLP-NLP protocol compared with 30.3 when they used the Standard-Standard protocol. In this study, the feasibility of an approach to EHR data capture involving the application of NLP to transcribed dictation was demonstrated. This novel dictation-based approach has the potential to reduce the time required for documentation and improve usability while maintaining documentation quality. Future research will evaluate the NLP-based EHR data capture approach in a clinical setting. It is reasonable to assert that EHRs will increasingly use NLP-enabled data entry tools such as MediSapien NLP because they hold promise for enhancing the documentation process and end-user experience. ©David R. Kaufman, Barbara Sheehan, Peter Stetson, Ashish R. Bhatt, Adele I. Field, Chirag Patel, James Mark Maisel. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 28.10.2016.
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Chiang, Michael F.; Read-Brown, Sarah; Tu, Daniel C.; Choi, Dongseok; Sanders, David S.; Hwang, Thomas S.; Bailey, Steven; Karr, Daniel J.; Cottle, Elizabeth; Morrison, John C.; Wilson, David J.; Yackel, Thomas R.
2013-01-01
Purpose: To evaluate three measures related to electronic health record (EHR) implementation: clinical volume, time requirements, and nature of clinical documentation. Comparison is made to baseline paper documentation. Methods: An academic ophthalmology department implemented an EHR in 2006. A study population was defined of faculty providers who worked the 5 months before and after implementation. Clinical volumes, as well as time length for each patient encounter, were collected from the EHR reporting system. To directly compare time requirements, two faculty providers who utilized both paper and EHR systems completed time-motion logs to record the number of patients, clinic time, and nonclinic time to complete documentation. Faculty providers and databases were queried to identify patient records containing both paper and EHR notes, from which three cases were identified to illustrate representative documentation differences. Results: Twenty-three faculty providers completed 120,490 clinical encounters during a 3-year study period. Compared to baseline clinical volume from 3 months pre-implementation, the post-implementation volume was 88% in quarter 1, 93% in year 1, 97% in year 2, and 97% in year 3. Among all encounters, 75% were completed within 1.7 days after beginning documentation. The mean total time per patient was 6.8 minutes longer with EHR than paper (P<.01). EHR documentation involved greater reliance on textual interpretation of clinical findings, whereas paper notes used more graphical representations, and EHR notes were longer and included automatically generated text. Conclusion: This EHR implementation was associated with increased documentation time, little or no increase in clinical volume, and changes in the nature of ophthalmic documentation. PMID:24167326
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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.
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Gaps in patient care practices to prevent hospital-acquired delirium
Alagiakrishnan, Kannayiram; Marrie, Thomas; Rolfson, Darryl; Coke, William; Camicioli, Richard; Duggan, D’Arcy; Launhardt, Bonnie; Fisher, Bruce; Gordon, Debbie; Hervas-Malo, Marilou; Magee, Bernice; Wiens, Cheryl
2009-01-01
ABSTRACT OBJECTIVE To evaluate the current patient care practices that address the predisposing and precipitating factors contributing to the prevention of hospital-acquired delirium in the elderly. DESIGN Prospective cohort (observational) study. PARTICIPANTS Patients 65 years of age and older who were admitted to medical teaching units at the University of Alberta Hospital in Edmonton over a period of 7 months and who were at risk of delirium. SETTING Medical teaching units at the University of Alberta. MAIN OUTCOME MEASURES Demographic data and information on predisposing factors for hospital-acquired delirium were obtained for all patients. Documented clinical practices that likely prevent common precipitants of delirium were also recorded. RESULTS Of the 132 patients enrolled, 20 (15.2%) developed hospital-acquired delirium. At the time of admission several predisposing factors were not documented (eg, possible cognitive impairment 16 [12%], visual impairment 52 [39.4%], and functional status of activities of daily living 99 [75.0%]). Recorded precipitating factors included catheter use, screening for dehydration, and medications. Catheters were used in 35 (26.5%) patients, and fluid intake-and-output charting assessed dehydration in 57 (43.2%) patients. At the time of admission there was no documentation of hearing status in 69 (52.3%) patients and aspiration risk in 104 (78.8%) patients. After admission, reorientation measures were documented in only 16 (12.1%) patients. Although all patients had brief mental status evaluations performed once daily, this was not noted to occur twice daily (which would provide important information about fluctuation of mental status) and there was no formal attention span testing. In this study, hospital-acquired delirium was also associated with increased mortality (P < .004), increased length of stay (P < .007), and increased institutionalization (P < .027). CONCLUSION Gaps were noted in patient care practices that might contribute to hospital-acquired delirium and also in measures to identify the development of delirium at an earlier stage. Effort should be made to educate health professionals to identify the predisposing and precipitating factors, and to screen for delirium. This might improve the prevention of delirium. PMID:19826141
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The devil is in the details: maximizing revenue for daily trauma care.
Barnes, Stephen L; Robinson, Bryce R H; Richards, J Taliesin; Zimmerman, Cindy E; Pritts, Tim A; Tsuei, Betty J; Butler, Karyn L; Muskat, Peter C; Davis, Kenneth; Johannigman, Jay A
2008-10-01
Falling reimbursement rates for trauma care demand a concerted effort of charge capture for the fiscal survival of trauma surgeons. We compared current procedure terminology code distribution and billing patterns for Subsequent Hospital Care (SHC) before and after the institution of standardized documentation. Standardized SHC progress notes were created. The note was formulated with an emphasis on efficiency and accuracy. Documentation was completed by residents in conjunction with attendings following standard guidelines of linkage. Year-to-year patient volume, length of stay (LOS), injury severity, bills submitted, coding of service, work relative value units (wRVUs), revenue stream, and collection rate were compared with and without standardized documentation. A 394% average revenue increase was observed with the standardization of SHC documentation. Submitted charges more than doubled in the first year despite a 14% reduction in admissions and no change in length of stay. Significant increases in level II and level III billing and billing volume (P < .05) were sustainable year to year and resulted in an average per patient admission SHC income increase from $91.85 to $362.31. Use of a standardized daily progress note dramatically increases the accuracy of coding and associated billing of subsequent hospital care for trauma services.
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40 CFR Appendix A to Part 67 - Technical Support Document
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Technical Support Document A Appendix A to Part 67 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS...—Technical Support Document Note: EPA will make copies of appendix A available from: Director, Stationary...
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40 CFR Appendix A to Part 66 - Technical Support Document
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Technical Support Document A Appendix A to Part 66 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS...—Technical Support Document Note: For text of appendix A see appendix A to part 67. ...
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Classroom Notes Plus: A Quarterly of Teaching Ideas, 2006-2007
ERIC Educational Resources Information Center
National Council of Teachers of English, 2007
2007-01-01
This document is a compilation of the four issues in the 24th volume of "Classroom Notes Plus." issue of "Classroom Notes Plus" contains descriptions of original, unpublished teaching practices, and of adapted ideas. The August 2006 issue (v24 n1) includes: More Choice Leads to More Reading (Amy Ishee); Book-of-the Month Reports (Patricia Crist);…
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Following the money: copy-paste of lifestyle counseling documentation and provider billing
2013-01-01
Background Evidence suggests that copy-pasted components of electronic notes may not reliably reflect the care delivered. Federal agencies have raised concerns that such components may be used to justify inappropriately inflated claims for reimbursement. It is not known whether copied information is used to justify higher evaluation and management (E&M) charges. Methods This retrospective cohort study aimed to assess the relationship between the level of evaluation and management (E&M) charges and the method of documentation (none, distinct or copied) of lifestyle counseling (diet, exercise and weight loss) for patients with diabetes mellitus. To determine the association, an ordered multinomial logistic regression model that corrected for clustering within individual providers and patients and adjusted for patient and encounter characteristics was utilized. E&M charge level served as the primary outcome variable. Patients were included if they were followed by primary care physicians affiliated with two academic hospitals for a minimum of two years between 01/01/2000 and 12/13/2009. Results Lifestyle counseling was documented in 65.4% of 155,168 primary care encounters of 16,164 patients. Copied counseling was identified in 12,527 encounters. In multivariable analysis higher E&M charges were associated with older patient age, longer notes, treatment with insulin, medication changes and acute complaints. However, copied lifestyle counseling was associated with a decrease of 70.5% in the odds of higher E&M charge levels when time spent on counseling (required to justify higher charges based on counseling) was recorded (p<0.0001). This finding is opposite to what would have been expected if the impetus for copied documentation of lifestyle counseling was an increase in submitted E&M charges. Conclusion There is no evidence that copied documentation of lifestyle counseling is used to justify higher evaluation and management charges. Higher charges were generally associated with indicators of complexity of care. PMID:24225135
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The ANKLe Score: An Audit of Otolaryngology Emergency Clinic Record Keeping
Dexter, Sara C; Hayashi, Daichi; Tysome, James R
2008-01-01
INTRODUCTION Accurate and legible medical records are essential to good quality patient care. Guidelines from The Royal College of Surgeons of England (RCSE) state the content required to form a complete medical record, but do not address legibility. An audit of otolaryngology emergency clinic record keeping was performed using a new scoring system. PATIENTS AND METHODS The Adjusted Note Keeping and Legibility (ANKLe) score was developed as an objective and quantitative method to assess both the content and legibility of case notes, incorporating the RCSE guidelines. Twenty consecutive otolaryngology emergency clinic case notes from each of 7 senior house officers were audited against standards for legibility and content using the ANKLe score. A proforma was introduced to improve documentation and handwriting advice was given. A further set of 140 notes (20 notes for each of the 7 doctors) was audited in the same way to provide feedback. RESULTS The introduction of a proforma and advice on handwriting significantly increased the quality of case note entries in terms of content, legibility and overall ANKLe score. CONCLUSIONS Accurate note keeping can be improved by the use of a proforma. The legibility of handwriting can be improved using simple advice. The ANKLe score is an objective assessment tool of the overall quality of medical note documentation which can be adapted for use in other specialties. PMID:18430339
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22 CFR 92.77 - Recording documents.
Code of Federal Regulations, 2010 CFR
2010-04-01
... first page where the document is recorded, the consular officer should note the following data: (1) By..., Foreign Service of the United States of America (§ 22.1 of this chapter). For purposes of assessment of...
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Paige, Karen Schultz; Gomez, Penelope E.
This document describes the approach Waste and Environmental Services - Environmental Data and Analysis plans to take to resolve the issues presented in a recent audit of the WES-EDA Environmental Database relative to the RACER database. A majority of the issues discovered in the audit will be resolved in May 2011 when the WES-EDA Environmental Database, along with other LANL databases, are integrated and moved to a new vendor providing an Environmental Information Management (EIM) system that allows reporting capabilities for all users directly from the database. The EIM system will reside in a publicly accessible LANL cloud-based software system.more » When this transition occurs, the data quality, completeness, and access will change significantly. In the remainder of this document, this new structure will be referred to as the LANL Cloud System In general, our plan is to address the issues brought up in this audit in three ways: (1) Data quality issues such as units and detection status, which impinge upon data usability, will be resolved as soon possible so that data quality is maintained. (2) Issues requiring data cleanup, such as look up tables, legacy data, locations, codes, and significant data discrepancies, will be addressed as resources permit. (3) Issues associated with data feed problems will be eliminated by the LANL Cloud System, because there will be no data feed. As discussed in the paragraph above, in the future the data will reside in a publicly accessible system. Note that report writers may choose to convert, adapt, or simplify the information they receive officially through our data base, thereby introducing data discrepancies between the data base and the public report. It is not always possible to incorporate and/or correct these errors when they occur. Issues in the audit will be discussed in the order in which they are presented in the audit report. Clarifications will also be noted as the audit report was a draft document, at the time of this response.« less
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Usability Evaluation of an Unstructured Clinical Document Query Tool for Researchers.
Hultman, Gretchen; McEwan, Reed; Pakhomov, Serguei; Lindemann, Elizabeth; Skube, Steven; Melton, Genevieve B
2018-01-01
Natural Language Processing - Patient Information Extraction for Researchers (NLP-PIER) was developed for clinical researchers for self-service Natural Language Processing (NLP) queries with clinical notes. This study was to conduct a user-centered analysis with clinical researchers to gain insight into NLP-PIER's usability and to gain an understanding of the needs of clinical researchers when using an application for searching clinical notes. Clinical researcher participants (n=11) completed tasks using the system's two existing search interfaces and completed a set of surveys and an exit interview. Quantitative data including time on task, task completion rate, and survey responses were collected. Interviews were analyzed qualitatively. Survey scores, time on task and task completion proportions varied widely. Qualitative analysis indicated that participants found the system to be useful and usable in specific projects. This study identified several usability challenges and our findings will guide the improvement of NLP-PIER 's interfaces.
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Hudson, Patrick L.; Lenat, David R.; Caldwell, Broughton A.; Smith, David
1990-01-01
We provide a current listing of the species of midges (Diptera:Chironomidae) in the southeastern United States (Alabama, Florida, Georgia, North Carolina, South Carolina, and Tennessee). This checklist should aid research on this group of insects, which have often proved useful in the assessment of water quality. We document each species' distribution and general habitat and provide the best taxonomic reference to facilitate the identification or description of species in that genus. Changes in nomenclature, unique ecological traits, bibliographic sources, or other items of information are summarized in a paragraph on each genus. Of the 10 sub-families currently recognized in the Chironomidae, 7 occur in the Southeast. The chironomid fauna of the six southeastern States now consist of 164 described genera and 479 described species. In addition we have listed 14 genera and 245 species that are tenatively noted as undescribed.
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Ferrández, Oscar; South, Brett R; Shen, Shuying; Friedlin, F Jeffrey; Samore, Matthew H; Meystre, Stéphane M
2012-07-27
The increased use and adoption of Electronic Health Records (EHR) causes a tremendous growth in digital information useful for clinicians, researchers and many other operational purposes. However, this information is rich in Protected Health Information (PHI), which severely restricts its access and possible uses. A number of investigators have developed methods for automatically de-identifying EHR documents by removing PHI, as specified in the Health Insurance Portability and Accountability Act "Safe Harbor" method.This study focuses on the evaluation of existing automated text de-identification methods and tools, as applied to Veterans Health Administration (VHA) clinical documents, to assess which methods perform better with each category of PHI found in our clinical notes; and when new methods are needed to improve performance. We installed and evaluated five text de-identification systems "out-of-the-box" using a corpus of VHA clinical documents. The systems based on machine learning methods were trained with the 2006 i2b2 de-identification corpora and evaluated with our VHA corpus, and also evaluated with a ten-fold cross-validation experiment using our VHA corpus. We counted exact, partial, and fully contained matches with reference annotations, considering each PHI type separately, or only one unique 'PHI' category. Performance of the systems was assessed using recall (equivalent to sensitivity) and precision (equivalent to positive predictive value) metrics, as well as the F(2)-measure. Overall, systems based on rules and pattern matching achieved better recall, and precision was always better with systems based on machine learning approaches. The highest "out-of-the-box" F(2)-measure was 67% for partial matches; the best precision and recall were 95% and 78%, respectively. Finally, the ten-fold cross validation experiment allowed for an increase of the F(2)-measure to 79% with partial matches. The "out-of-the-box" evaluation of text de-identification systems provided us with compelling insight about the best methods for de-identification of VHA clinical documents. The errors analysis demonstrated an important need for customization to PHI formats specific to VHA documents. This study informed the planning and development of a "best-of-breed" automatic de-identification application for VHA clinical text.
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Assessing written communication during interhospital transfers of emergency general surgery patients
Harl, Felicity N.R.; Saucke, Megan C.; Greenberg, Caprice C.; Ingraham, Angela M.
2017-01-01
Background Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. Methods We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. Results A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; a mong 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants’ notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient’s ED arrival and were not part of the original documentation provided. Conclusions This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers. PMID:28624064
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Best practice in primary care pathology: review 3
Smellie, W S A; Forth, J; Bareford, D; Twomey, P; Galloway, M J; Logan, E C M; Smart, S R S; Reynolds, T M; Waine, C
2006-01-01
This best practice review examines four series of common primary care questions in laboratory medicine: (i) “minor” blood platelet count and haemoglobin abnormalities; (ii) diagnosis and monitoring of anaemia caused by iron deficiency; (iii) secondary hyperlipidaemia and hypertriglyceridaemia; and (iv) glycated haemoglobin and microalbumin use in diabetes. The review is presented in question–answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence‐based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards, but form a guide to be set in the clinical context. Most of the recommendations are based on consensus rather than evidence. They will be updated periodically to take account of new information. PMID:16873560
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Health Information Management System for Elderly Health Sector: A Qualitative Study in Iran
Sadoughi, Farahnaz; Shahi, Mehraban; Ahmadi, Maryam; Davaridolatabadi, Nasrin
2016-01-01
Background: There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision. Objectives: The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran. Materials and Methods: This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them. Results: The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information. Conclusions: It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran. PMID:27186383
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Health Information Management System for Elderly Health Sector: A Qualitative Study in Iran.
Sadoughi, Farahnaz; Shahi, Mehraban; Ahmadi, Maryam; Davaridolatabadi, Nasrin
2016-02-01
There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision. The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran. This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them. The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information. It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran.
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Goenka, Anu; Annamalai, Medeshni; Dhada, Barnesh; Stephen, Cindy R; McKerrow, Neil H; Patrick, Mark E
2014-04-01
We report on the impact of revisions made to an existing pro forma facilitating routine assessment and the management of paediatric HIV and tuberculosis (TB) in KwaZulu-Natal, South Africa. An initial documentation audit in 2010 assessed 25 sets of case notes for the documentation of 16 select indicators based on national HIV and TB guidelines. Using the findings of this initial audit, the existing case note pro forma was revised. The introduction of the revised pro forma was accompanied by training and a similar repeat audit was undertaken in 2012. This demonstrated an overall improvement in documentation. The three indicators that improved most were documentation of maternal HIV status, child's HIV status and child's TB risk assessment (all P < 0.001). This study suggests that tailor-made documentation pro formas may have an important role to play in improving record keeping in low-resource settings.
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Edwards, Dorothy F; Hahn, Michele G; Baum, Carolyn M; Perlmutter, Monica S; Sheedy, Catherine; Dromerick, Alexander W
2006-03-01
The authors assessed patients with acute stroke to determine whether the systematic use of brief screening measures would more efficiently detect cognitive and sensory impairment than standard clinical practice. Fifty-three patients admitted to an acute stroke unit were assessed within 10 days of stroke onset. Performance on the screening measures was compared to information obtained from review of the patient's chart at discharge. Cognition, language, visual acuity, visual-spatial neglect, hearing, and depression were evaluated. Formal screening detected significantly more impairments than were noted in patient charts in every domain. Only 3 patients had no impairments identified on screening; all remaining patients had at least 1 impairment detected by screening that was not documented in the chart. Thirty-five percent had 3 or more undetected impairments. Memory impairment was most likely to be noted in the chart; for all other domains tested, undocumented impairment ranged from 61% (neglect) to 97% (anomia). Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke.
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Continuing Support of Cloud Free Line of Sight Determination Including Whole Sky Imaging of Clouds
2007-11-30
which is documented in Shields et al. 2007a, Technical Note 271, and Contract N00014-01-D- 0043 DO #11, which is reviewed in Section 2 and documented in...Shields et al. 2007b, Technical Note 272. Under DO #13, we finished preparation of two of the WSI units and their software, and fielded them...and b, and 2005b and c). One of the first two units was fielded at the Air Force’s Starfire Optical Range in October 1992. Technical Memo AV06
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Documents, Practices and Policy
ERIC Educational Resources Information Center
Freeman, Richard; Maybin, Jo
2011-01-01
What are the practices of policy making? In this paper, we seek to identify and understand them by attending to one of the principal artefacts--the document--through which they are organised. We review the different ways in which researchers have understood documents and their function in public policy, endorsing a focus on content but noting that…
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Shayah, A; Agada, F O; Gunasekaran, S; Jassar, P; England, R J A
2007-04-01
To assess the quality of operative note keeping and compare the results with the Royal College of Surgeons (RCS) of England guidelines 'Good Surgical Practice' as the gold standard. ENT Department at Hull Royal Infirmary, University Hospital. A hundred consecutive operative notes were selected between November 2005 and January 2006. The documentation of the operative notes in each case was compared with the RCS of England guidelines. All surgeons were made aware of the results of the first cycle and the guidelines were made available in all ENT theatres in the form of a printed aide-memoir. A second audit cycle was then carried out prospectively between April and June 2006. The results demonstrated a change in practice in key areas. The 1st cycle results showed the documentation of patient identification (94%), name of surgeon (98%) and clearly written postoperative instructions (94%). However, surgeons performed suboptimally at recording the name of assistant (82%), operative diagnosis (46%), the incision type (87%) and the type of wound closure (83%). After introducing the aide-memoir, the second cycle demonstrated a change in practice with 100% documentation in most of the assessed parameters except that the time of surgery and the type of surgery (emergency or elective) were not adequately recorded. We recommend that all surgical departments should have the RCS guidelines as an aide-memoir in theatres to enhance the quality and standardise operative note recording.
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ERIC Educational Resources Information Center
Gravett, Emily O.
2018-01-01
The benefits of in-class discussion, a form of active learning, are well-documented; in particular, discussions allow students the opportunity to learn from their peers. Yet students often treat discussions as 'down' or 'free' time. If students are not taking notes during discussion and reviewing those notes later on, they may not be learning much…
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Audit of Endotracheal Tube Suction in a Pediatric Intensive Care Unit.
Davies, Kylie; Bulsara, Max K; Ramelet, Anne-Sylvie; Monterosso, Leanne
2017-02-01
We report outcomes of a clinical audit examining criteria used in clinical practice to rationalize endotracheal tube (ETT) suction, and the extent these matched criteria in the Endotracheal Suction Assessment Tool(ESAT)©. A retrospective audit of patient notes ( N = 292) and analyses of criteria documented by pediatric intensive care nurses to rationalize ETT suction were undertaken. The median number of documented respiratory and ventilation status criteria per ETT suction event that matched the ESAT© criteria was 2 [Interquartile Range (IQR) 1-6]. All criteria listed within the ESAT© were documented within the reviewed notes. A direct link was established between criteria used for current clinical practice of ETT suction and the ESAT©. The ESAT©, therefore, reflects documented clinical decision making and could be used as both a clinical and educational guide for inexperienced pediatric critical care nurses. Modification to the ESAT © requires "preparation for extubation" to be added.
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Notes on Linguistics, Number 41-43, 1988.
ERIC Educational Resources Information Center
Notes on Linguistics, 1988
1988-01-01
This document consists of the three 1988 issues of the normally quarterly journal "Notes on Linguistics." These issues include the following significant articles: "The Role of the Field Linguist" (Bernard Comrie); "Relational Grammar: An Update Report" (Stephen A. Marlett); "Tone and Stress Analysis by…
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McQuade, David J; Aknuri, Srikanth; Dargan, Paul I; Wood, David M
2012-12-01
Paracetamol (acetaminophen) poisoning is the most common toxicological presentation in the UK. Doctors managing patients with paracetamol poisoning need to assess the risk of their patient developing hepatotoxicity before determining appropriate treatment. Patients deemed to be at 'high risk' of hepatotoxicity have lower treatment thresholds than those deemed to be at 'normal risk'. Errors in this process can lead to harmful or potentially fatal under or over treatment. To determine how well treating doctors assess risk factor status and whether a standardised proforma is useful in the risk stratification process. Retrospective 12-month case note review of all patients presenting with paracetamol poisoning to our large inner-city emergency department. Data were collected on the documentation of risk factors, the presence of a local hospital proforma and treatment outcomes. 249 presentations were analysed and only 59 (23.7%) had full documentation of all the risk factors required to make a complete risk assessment. 56 of the 59 (94.9%) had the local hospital proforma included in the notes; the remaining 3 (5.1%) had full documentation of risk factors despite the absence of a proforma. A local hospital proforma was more likely to be included in the emergency department notes in those with 'adequate documentation' (78 out of 120 (65%)) than for those with 'inadequate documentation' (16 out of 129 (12.4%)); X(2), p<0.001. Despite a low overall uptake of the proforma, use of a standardised proforma significantly increased the likelihood of documentation of the risk factors which increase risk for hepatotoxicity following paracetamol poisoning.
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Abboud, Salim E; Soriano, Stephanie; Abboud, Rayan; Patel, Indravadan; Davidson, Jon; Azar, Nami R; Nakamoto, Dean A
Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents. Copyright © 2017 Elsevier Inc. All rights reserved.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
U.S. Bonneville Power Administration
The 2008 Columbia River Estuary Conference was held at the Liberty Theater in Astoria, Oregon, on April 19-20. The conference theme was ecosystem restoration. The purpose of the conference was to exchange data and information among researchers, policy-makers, and the public, i.e., interrelate science with management. Conference organizers invited presentations synthesizing material on Restoration Planning and Implementation (Session 1), Research to Reduce Restoration Uncertainties (Session 2), Wetlands and Flood Management (Session 3), Action Effectiveness Monitoring (Session 4), and Management Perspectives (Session 5). A series of three plenary talks opened the conference. Facilitated speaker and audience discussion periods were held atmore » the end of each session. Contributed posters conveyed additional data and information. These proceedings include abstracts and notes documenting questions from the audience and clarifying answers from the presenter for each talk. The proceedings also document key points from the discussion periods at the end of each session. The conference program is outlined in the agenda section. Speaker biographies are presented in Appendix A. Poster titles and authors are listed in Appendix B. A list of conference attendees is contained in Appendix C.« less
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ERIC Educational Resources Information Center
Maletsky, Evan, Ed.; Yunker, Lee E., Ed.
1986-01-01
Five sets of activities for students are included in this document. Each is designed for use in junior high and secondary school mathematics instruction. The first Note concerns mathematics on postage stamps. Historical procedures and mathematicians, metric conversion, geometric ideas, and formulas are among the topics considered. Successful…
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Maintaining Research Documents with Database Management Software.
ERIC Educational Resources Information Center
Harrington, Stuart A.
1999-01-01
Discusses taking notes for research projects and organizing them into card files; reviews the literature on personal filing systems; introduces the basic process of database management; and offers a plan for managing research notes. Describes field groups and field definitions, data entry, and creating reports. (LRW)
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42 CFR 485.638 - Conditions of participation: Clinical records.
Code of Federal Regulations, 2010 CFR
2010-10-01
... clinical laboratory services, and consultative findings; (iii) All orders of doctors of medicine or osteopathy or other practitioners, reports of treatments and medications, nursing notes and documentation of... graphics, progress notes describing the patient's response to treatment; and (iv) Dated signatures of the...
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ERIC Educational Resources Information Center
Notes on Linguistics, 1990
1990-01-01
This document consists of the four issues of "Notes on Linguistics" published during 1990. Articles in the four issues include: "The Indians Do Say Ugh-Ugh" (Howard W. Law); "Constraints of Relevance, A Key to Particle Typology" (Regina Blass); "Whatever Happened to Me? (An Objective Case Study)" (Aretta…
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Thorley, Craig; Baxter, Rebecca E; Lorek, Joanna
2016-01-01
Jurors forget critical trial information and what they do recall can be inaccurate. Jurors' recall of trial information can be enhanced by permitting them to take notes during a trial onto blank sheets of paper (henceforth called freestyle note taking). A recent innovation is the trial-ordered-notebook (TON) for jurors, which is a notebook containing headings outlining the trial proceedings and which has space beneath each heading for notes. In a direct comparison, TON note takers recalled more trial information than freestyle note takers. This study investigated whether or not note taking improves recall as a result of enhanced encoding or as a result of note access at retrieval. To assess this, mock jurors watched and freely recalled a trial video with one-fifth taking no notes, two-fifths taking freestyle notes and two-fifths using TONs. During retrieval, half of the freestyle and TON note takers could access their notes. Note taking enhanced recall, with the freestyle note takers and TON note takers without note access performing equally as well. Note taking therefore enhances encoding. Recall was greatest for the TON note takers with note access, suggesting a retrieval enhancement unique to this condition. The theoretical and applied implications of these findings are discussed.
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Using Proxy Records to Document Gulf of Mexico Tropical Cyclones from 1820-1915
Rohli, Robert V.; DeLong, Kristine L.; Harley, Grant L.; Trepanier, Jill C.
2016-01-01
Observations of pre-1950 tropical cyclones are sparse due to observational limitations; therefore, the hurricane database HURDAT2 (1851–present) maintained by the National Oceanic and Atmospheric Administration may be incomplete. Here we provide additional documentation for HURDAT2 from historical United States Army fort records (1820–1915) and other archived documents for 28 landfalling tropical cyclones, 20 of which are included in HURDAT2, along the northern Gulf of Mexico coast. One event that occurred in May 1863 is not currently documented in the HURDAT2 database but has been noted in other studies. We identify seven tropical cyclones that occurred before 1851, three of which are potential tropical cyclones. We corroborate the pre-HURDAT2 storms with a tree-ring reconstruction of hurricane impacts from the Florida Keys (1707–2009). Using this information, we suggest landfall locations for the July 1822 hurricane just west of Mobile, Alabama and 1831 hurricane near Last Island, Louisiana on 18 August. Furthermore, we model the probable track of the August 1831 hurricane using the weighted average distance grid method that incorporates historical tropical cyclone tracks to supplement report locations. PMID:27898726
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76 FR 5363 - Intent To Compromise Claim Against the State of Oklahoma Department of Education
Federal Register 2010, 2011, 2012, 2013, 2014
2011-01-31
... must have Adobe Acrobat Reader, which is available free at this site. Note: The official version of this document is the document published in the Federal Register. Free Internet access to the official... Document Format (PDF) on the Internet at the following site: http://frwebgate.access.gpo.gov/cgi-bin...
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19 CFR 125.34 - Countersigning of documents and notation of bad order or discrepancy.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 19 Customs Duties 1 2010-04-01 2010-04-01 false Countersigning of documents and notation of bad... and Receipt § 125.34 Countersigning of documents and notation of bad order or discrepancy. When a... and shall note thereon any bad order or discrepancy. When available, the importing carrier's tally...
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36 CFR 1254.36 - What care must I take when handling documents?
Code of Federal Regulations, 2010 CFR
2010-07-01
... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What care must I take when... Room Rules Rules Relating to Using Original Documents § 1254.36 What care must I take when handling... must not use paper clips, rubber bands, self-stick notes or similar devices to identify documents. (e...
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ERIC Educational Resources Information Center
Suarez, Stephanie Cox; Daniels, Karen J.
2009-01-01
This case study uses documentation as a tool for formative assessment to interpret the learning of twin boys with significantly delayed language skills. Reggio-inspired documentation (the act of collecting, interpreting, and reflecting on traces of learning from video, images, and observation notes) focused on the unfolding of the boys' nonverbal…
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Electronic health records improve clinical note quality.
Burke, Harry B; Sessums, Laura L; Hoang, Albert; Becher, Dorothy A; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; O'Malley, Patrick G; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W
2015-01-01
The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (p<0.0001) and 55% (p<0.0001), respectively. All the element and grand mean quality scores significantly improved over the 5-year time interval. The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.
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Evaluation of Documentation Patterns of Trainees and Supervising Physicians Using Data Mining.
Madhavan, Ramesh; Tang, Chi; Bhattacharya, Pratik; Delly, Fadi; Basha, Maysaa M
2014-09-01
The electronic health record (EHR) includes a rich data set that may offer opportunities for data mining and natural language processing to answer questions about quality of care, key aspects of resident education, or attributes of the residents' learning environment. We used data obtained from the EHR to report on inpatient documentation practices of residents and attending physicians at a large academic medical center. We conducted a retrospective observational study of deidentified patient notes entered over 7 consecutive months by a multispecialty university physician group at an urban hospital. A novel automated data mining technology was used to extract patient note-related variables. A sample of 26 802 consecutive patient notes was analyzed using the data mining and modeling tool Healthcare Smartgrid. Residents entered most of the notes (33%, 8178 of 24 787) between noon and 4 pm and 31% (7718 of 24 787) of notes between 8 am and noon. Attending physicians placed notes about teaching attestations within 24 hours in only 73% (17 843 of 24 443) of the records. Surgical residents were more likely to place notes before noon (P < .001). Nonsurgical faculty were more likely to provide attestation of resident notes within 24 hours (P < .001). Data related to patient note entry was successfully used to objectively measure current work flow of resident physicians and their supervising faculty, and the findings have implications for physician oversight of residents' clinical work. We were able to demonstrate the utility of a data mining model as an assessment tool in graduate medical education.
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Dubler, Nancy Neveloff
2013-01-01
Unlike bioethics mediators who are employed by healthcare organizations as outside consultants, mediators who are embedded in an institution must be authorized to chronicle a clinical ethics consultation (CEC) or a mediation in a patient's medical chart. This is an important privilege, as the chart is a legal document. In this article I discuss this important part of a bioethics mediator's tool kit in my presentation of a case illustrating how bioethics mediation may proceed, and what this approach using both bioethics and mediation may add.
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USSR Space Life Sciences Digest. Index to issues 1-4
NASA Technical Reports Server (NTRS)
Teeter, R.; Hooke, L. R.
1986-01-01
This document is an index to issues 1 to 4 of the USSR Space Life Sciences Digest and is arranged in three sections. In section 1, abstracts from the first four issues are grouped according to subject; please note the four letter codes in the upper right hand corner of the pages. Section 2 lists the categories according to which digest entries are grouped and cites additional entries relevant to that category by four letter code and entry number in section 1. Refer to section 1 for titles and other pertinent information. Key words are indexed in section 3.
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NPL-PAD (National Priorities List Publication Assistance Database) for Region 7
THIS DATA ASSET NO LONGER ACTIVE: This is metadata documentation for the National Priorities List (NPL) Publication Assistance Databsae (PAD), a Lotus Notes application that holds Region 7's universe of NPL site information such as site description, threats and contaminants, cleanup approach, environmental process, community involvement, site repository, and regional contacts. This database used to be updated annually, at different times for different NPLs, but it is currently no longer being used. This work fell under objectives for EPA's 2003-2008 Strategic Plan (Goal 3) for Land Preservation & Restoration, which are to clean up and reuse contaminated land.
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How measurement science can improve confidence in research results.
Plant, Anne L; Becker, Chandler A; Hanisch, Robert J; Boisvert, Ronald F; Possolo, Antonio M; Elliott, John T
2018-04-01
The current push for rigor and reproducibility is driven by a desire for confidence in research results. Here, we suggest a framework for a systematic process, based on consensus principles of measurement science, to guide researchers and reviewers in assessing, documenting, and mitigating the sources of uncertainty in a study. All study results have associated ambiguities that are not always clarified by simply establishing reproducibility. By explicitly considering sources of uncertainty, noting aspects of the experimental system that are difficult to characterize quantitatively, and proposing alternative interpretations, the researcher provides information that enhances comparability and reproducibility.
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Emergence, Agency, and Interaction-Notes from the Field.
Penny, Simon
2015-01-01
This article describes the development of several interactive installations and robotic artworks developed through the 1990s and the technological, theoretical, and discursive context in which those works arose. The main works discussed are Petit Mal (1989-1995), Sympathetic Sentience (1996-1997), Fugitive I (1996-1997), Traces (1998-1999), and Fugitive II (2001-2004)-full documentation at ( www.simonpenny.net/works ). These works were motivated by a critical analysis of cognitivist computer science, which contrasted with notions of embodied experience arising from the arts. The works address questions of agency and interaction, informed by cybernetics and artificial life.
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DOT National Transportation Integrated Search
2008-06-23
This document presents the notes taken at the USDOT Integrated Corridor Management (ICM) Transit Data Gaps for Rail Transit Systems Initial Planning Workshop. Different scenarios for handling increased demand on rail and bus transit systems are discu...
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Hydrogen embrittlement of structural alloys. A technology survey
NASA Technical Reports Server (NTRS)
Carpenter, J. L., Jr.; Stuhrke, W. F.
1976-01-01
Technical abstracts for about 90 significant documents relating to hydrogen embrittlement of structural metals and alloys are reviewed. Particular note was taken of documents regarding hydrogen effects in rocket propulsion, aircraft propulsion and hydrogen energy systems, including storage and transfer systems.
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Falls From the O.R. or Procedure Table.
Prielipp, Richard C; Weinkauf, Julia L; Esser, Thomas M; Thomas, Brian J; Warner, Mark A
2017-09-01
Patient safety secured by constant vigilance remains a primary responsibility of every anesthesia professional. Although significant attention has been focused on patient falls occurring before and after surgery, a potentially catastrophic complication is when patients fall off an operating room or procedure table during anesthesia care. Because such events are (fortunately) uncommon, and because very little information is published in our literature, we queried 2 independent closed claims databases (the American Society of Anesthesiologists Closed Claims Project and the secure records of a private, anesthesia specialty-specific liability insurer) for information. We acquired documentation of patient events where a fall occurred during anesthesia care, noting the surrounding conditions of the provider, the patient, and the environment at the time of the event. We identified 21 claims (1.2% of cases) from the American Society of Anesthesiologists Closed Claims Project, while information from a private liability insurer identified falls in only 0.07% of cases. The percentage of these patients under general, regional, or monitored anesthesia care anesthesia was 71.5%, 19.5%, and 9.5%, respectively. To educate personnel about these uncommon events, we summarized this cohort with illustrative examples in a series of mini-case reports, noting that both inpatients and outpatients undergoing a broad array of procedures with various anesthetic techniques within and outside operating rooms may be vulnerable to patient falls. Based on detailed reports, we created 2 supplementary videos to further illuminate some of the unique mechanisms by which these events and their resulting injuries occur. When such information was available, we also noted the associated liability costs of defending and settling malpractice claims associated with these events. Our goal is to inform anesthesia and perioperative personnel about the common patient, provider, and environmental risk factors that appear to contribute to these mishaps, and suggest key strategies to mitigate the risks.
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Documenting the use of computers in Swedish Health Care up to 1980.
Peterson, H E; Lundin, P
2011-01-01
This paper describes a documentation project to create, collect and preserve previously unavailable sources on informatics in Sweden (including health care as one of 16 subgroups), and making them available on the Web. Time was critical as the personal documentation and artifacts of early pioneers could be irretrievably lost. The criteria for participation were that a person had developed a system in a clinical environment which was used by others prior to 1980. Participants were interviewed and asked for early documentation such as notes, minutes from meetings, drawings, test results and early models - together with related artifacts. The approach included traditional oral history interviews, collection of autobiographies and new self-structuring and time saving methods, such as witness seminars and an Internet-based repository of their recollections (the Writers' Web). The combination of methods obtained new information on system errors, and challenges in reaching the goals due partly to inadequacies of the early technology, and partly to the insufficient understanding of the complexity of the many problems which needed to be solved before a useful electronic patient record could be realized. A very important result was the development of a method to collect information in an easier, faster and much less expensive way than using the traditional scientific method, and still reach results that are qualitative and quantitative for the purpose of documenting the early period of computer-based health care technology. The witness seminars and the Writers' Web yielded especially large amounts of hitherto-unknown information. With all material in one database available to everyone on the Web, it is accessed very frequently - especially by students, researchers, journalists and teachers. Study of the materials explains and clarifies the reasons behind the delays and difficulties that have been encountered in developing electronic patient records, as described in an article [3] published in the IMIA Yearbook 2006.
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Extreme precipitation in the Polish Carpathians in the 20th century in the context of last 500 years
NASA Astrophysics Data System (ADS)
Limanowka, Danuta; Cebulak, Elzbieta; Pyrc, Robert
2010-05-01
Extreme weather phenomena together with their exceptional course and intensity have always been dangerous for people. In the historical documents such phenomena were marked as basic disasters. First notes about weather phenomena were made in Polish lands in the 10th century. Most information concerns floods caused by intensive rains. Using the data base created within the Millennium project, extreme precipitation cases exceeding 100 mm were analysed. In each case, the intensive precipitation was followed by a summer flood in the Polish Carpathians in the Upper Vistula River basin. Data from the period of instrumental measurements in the 20th century were studied in detail by the analysis of the frequency of occurrence and the spatial and temporal distribution. The results were referred to last 500 years. The information obtained gives approximate image of extreme precipitation in the historical times in Polish lands. All available multi-proxy data were used. Newspapers' notes concerning described phenomena from 1848-1850 published in Kraków were used to complete and verify the quality of data from the early instrumental period and also to complete the data from the period of the Second World War.
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Naval Training Device Center Index of Technical Reports.
ERIC Educational Resources Information Center
Walker, Lemuel E.
Published Naval Training Device Center technical reports and some technical notes (those available through the Defense Documentation Center-DDC) which have resulted from basic research, exploratory development, and advanced development type projects are listed. The reports are indexed by technical note number, by title, and by contractor code. The…
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A Collection of NIDA Notes: Articles That Address Research on Marijuana.
ERIC Educational Resources Information Center
National Inst. on Drug Abuse (DHHS/PHS), Bethesda, MD.
Included in this document are selections of topic-specific articles on marijuana research reprinted from the National Institute on Drug Abuse's (NIDA) research newsletter, NIDA Notes. The collection features articles originally published from 1995 through 2002. Topics include long-term cognitive impairments in heavy marijuana users, evidence that…
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Use of Information--LMC Connection
ERIC Educational Resources Information Center
Darrow, Rob
2005-01-01
Note taking plays an important part in the correct extracting of information from reference sources. The "Cornell Note Taking Method" initially developed as a method of taking notes during a lecture is well suited for taking notes from print sources and is one of the best "Use of Information" methods.
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Glossary of CERCLA, RCRA and TSCA related terms and acronyms. Environmental Guidance
DOE Office of Scientific and Technical Information (OSTI.GOV)
Not Available
1993-10-01
This glossary contains CERCLA, RCRA and TSCA related terms that are most often encountered in the US Department of Energy (DOE) Environmental Restoration and Emergency Preparedness activities. Detailed definitions are included for key terms. The CERCLA definitions included in this glossary are taken from the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), as amended and related federal rulemakings. The RCRA definitions included in this glossary are taken from the Resource Conservation and Recovery Act (RCRA) and related federal rulemakings. The TSCA definitions included in this glossary are taken from the Toxic Substances and Control Act (TSCA) and related federalmore » rulemakings. Definitions related to TSCA are limited to those sections in the statute and regulations concerning PCBs and asbestos.Other sources for definitions include additional federal rulemakings, assorted guidance documents prepared by the US Environmental Protection Agency (EPA), guidance and informational documents prepared by the US Department of Energy (DOE), and DOE Orders. The source of each term is noted beside the term. Terms presented in this document reflect revised and new definitions published before July 1, 1993.« less
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Shatkay, Hagit; Pan, Fengxia; Rzhetsky, Andrey; Wilbur, W. John
2008-01-01
Motivation: Much current research in biomedical text mining is concerned with serving biologists by extracting certain information from scientific text. We note that there is no ‘average biologist’ client; different users have distinct needs. For instance, as noted in past evaluation efforts (BioCreative, TREC, KDD) database curators are often interested in sentences showing experimental evidence and methods. Conversely, lab scientists searching for known information about a protein may seek facts, typically stated with high confidence. Text-mining systems can target specific end-users and become more effective, if the system can first identify text regions rich in the type of scientific content that is of interest to the user, retrieve documents that have many such regions, and focus on fact extraction from these regions. Here, we study the ability to characterize and classify such text automatically. We have recently introduced a multi-dimensional categorization and annotation scheme, developed to be applicable to a wide variety of biomedical documents and scientific statements, while intended to support specific biomedical retrieval and extraction tasks. Results: The annotation scheme was applied to a large corpus in a controlled effort by eight independent annotators, where three individual annotators independently tagged each sentence. We then trained and tested machine learning classifiers to automatically categorize sentence fragments based on the annotation. We discuss here the issues involved in this task, and present an overview of the results. The latter strongly suggest that automatic annotation along most of the dimensions is highly feasible, and that this new framework for scientific sentence categorization is applicable in practice. Contact: shatkay@cs.queensu.ca PMID:18718948
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UFOs, NGOs, or IGOs: Using International Documents for General Reference.
ERIC Educational Resources Information Center
Shreve, Catherine
1997-01-01
Discusses accessing and using documents from international (intergovernmental) organizations. Profiles the United Nations, the European Union and other Intergovernmental Organizations (IGOs). Discusses the librarian as "Web detective," notes questions to focus on, and presents examples to demonstrate navigation of IGO sites. Lists basic…
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Helping Students Analyze Business Documents.
ERIC Educational Resources Information Center
Devet, Bonnie
2001-01-01
Notes that student writers gain greater insight into the importance of audience by analyzing business documents. Discusses how business writing teachers can help students understand the rhetorical refinements of writing to an audience. Presents an assignment designed to lead writers systematically through an analysis of two advertisements. (SG)
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-06-11
...). As noted in that document, the center of this RNA was established to surround an oil wellhead that... you fax, hand deliver or mail your comment, it will be considered as having been received by the Coast.... Viewing Comments and Documents To view comments, as well as documents mentioned in this preamble as being...
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Education in Asia and Oceania: Reviews, Reports and Notes. Number 15, June 1979.
ERIC Educational Resources Information Center
United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand). Regional Office for Education in Asia and Oceania.
This periodical contains special reports, reviews, and notes of recent documents on education in Asia and Oceania. The first section contains special reports on Pakistan's new educational policy and Thailand's new educational system. Pakistan's 1978 policy provides for village workshops for out-of-school youth; a national council on adult…
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Applied Fluid Mechanics. Lecture Notes.
ERIC Educational Resources Information Center
Gregg, Newton D.
This set of lecture notes is used as a supplemental text for the teaching of fluid dynamics, as one component of a thermodynamics course for engineering technologists. The major text for the course covered basic fluids concepts such as pressure, mass flow, and specific weight. The objective of this document was to present additional fluids…
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A Collection of NIDA NOTES. Articles That Address Research on Heroin.
ERIC Educational Resources Information Center
National Inst. on Drug Abuse (DHHS/PHS), Rockville, MD.
Included in this document are selections of topic-specific articles on heroin research reprinted from the National Institute on Drug Abuses (NIDA) research newsletter, NIDA Notes. Titles include: Buprenorphine Taken Three Times Per Week Is as Effective as Daily Doses in Treating Heroin Addiction; 33-Year Study Finds Lifelong, Lethal Consequences…
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A Collection of NIDA Notes: Articles That Address Research on Club Drugs.
ERIC Educational Resources Information Center
National Inst. on Drug Abuse (DHHS/PHS), Bethesda, MD.
Included in this document are selections of topic-specific articles on club drug research reprinted from the National Institute on Drug Abuse's (NIDA) research newsletter, NIDA Notes. The collection features articles originally published from 1996 through 2002. Topics include the effects of ecstasy and methamphetamine on the brain and body,…
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Moderating the Seductive Details Effect in Multimedia Learning with Note-Taking
ERIC Educational Resources Information Center
Wang, Zhe; Sundararajan, Narayankripa; Adesope, Olusola O.; Ardasheva, Yuliya
2017-01-01
Although the seductive details effect, a phenomenon where interesting but irrelevant pictures impede comprehension, is well documented, studies examining ways of moderating its detrimental impact on learning remain few. The present study examined the effect of note-taking on the seductive details effect. Chinese undergraduate participants (N = 91)…
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50 CFR 253.12 - Guaranteed note, U.S. note, and security documents.
Code of Federal Regulations, 2010 CFR
2010-10-01
... substantial pledged assets other than the project property, and all major limited partners. The Division may... credit judgment, be less. (2) Maturity. This may not exceed 25 years, but shall not exceed the project... pledge of all project property (or adequate substitute collateral). The Division will require such other...
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Education in Asia. Reviews, Reports and Notes. Number 5.
ERIC Educational Resources Information Center
United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand). Regional Office for Education in Asia and Oceania.
An occasional, independent publication of the UNESCO Regional Office for Education in Asia contains reviews of recent publications and studies, brief reports on programs and projects, and notes on Asian documents related to education. The first section of Reviews presents reports on adult and out-of-school education in India, educational wastage…
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The Early Years: Documenting Discoveries
ERIC Educational Resources Information Center
Ashbrook, Peggy
2015-01-01
By observing an organism over time, children can identify patterns in their observations, note growth or other changes, learn about the needs of the organism, and see how the organism creates the next generation of its species; all of these skills are science and engineering practices noted in "A Framework for K-12 Science Education"…
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48 CFR 1446.671 - Inspection, receiving and acceptance certification.
Code of Federal Regulations, 2012 CFR
2012-10-01
... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...
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48 CFR 1446.671 - Inspection, receiving and acceptance certification.
Code of Federal Regulations, 2014 CFR
2014-10-01
... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...
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48 CFR 1446.671 - Inspection, receiving and acceptance certification.
Code of Federal Regulations, 2010 CFR
2010-10-01
... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...
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48 CFR 1446.671 - Inspection, receiving and acceptance certification.
Code of Federal Regulations, 2011 CFR
2011-10-01
... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...
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48 CFR 1446.671 - Inspection, receiving and acceptance certification.
Code of Federal Regulations, 2013 CFR
2013-10-01
... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports § 1446.671... documentation shall be completed via manual or electronic means for each delivery of supplies or services in... except as noted below or on attached documents. ______ Signature and typed name of authorized Government...
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Detecting clinically relevant new information in clinical notes across specialties and settings.
Zhang, Rui; Pakhomov, Serguei V S; Arsoniadis, Elliot G; Lee, Janet T; Wang, Yan; Melton, Genevieve B
2017-07-05
Automated methods for identifying clinically relevant new versus redundant information in electronic health record (EHR) clinical notes is useful for clinicians and researchers involved in patient care and clinical research, respectively. We evaluated methods to automatically identify clinically relevant new information in clinical notes, and compared the quantity of redundant information across specialties and clinical settings. Statistical language models augmented with semantic similarity measures were evaluated as a means to detect and quantify clinically relevant new and redundant information over longitudinal clinical notes for a given patient. A corpus of 591 progress notes over 40 inpatient admissions was annotated for new information longitudinally by physicians to generate a reference standard. Note redundancy between various specialties was evaluated on 71,021 outpatient notes and 64,695 inpatient notes from 500 solid organ transplant patients (April 2015 through August 2015). Our best method achieved at best performance of 0.87 recall, 0.62 precision, and 0.72 F-measure. Addition of semantic similarity metrics compared to baseline improved recall but otherwise resulted in similar performance. While outpatient and inpatient notes had relatively similar levels of high redundancy (61% and 68%, respectively), redundancy differed by author specialty with mean redundancy of 75%, 66%, 57%, and 55% observed in pediatric, internal medicine, psychiatry and surgical notes, respectively. Automated techniques with statistical language models for detecting redundant versus clinically relevant new information in clinical notes do not improve with the addition of semantic similarity measures. While levels of redundancy seem relatively similar in the inpatient and ambulatory settings in the Fairview Health Services, clinical note redundancy appears to vary significantly with different medical specialties.
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[Construction of chemical information database based on optical structure recognition technique].
Lv, C Y; Li, M N; Zhang, L R; Liu, Z M
2018-04-18
To create a protocol that could be used to construct chemical information database from scientific literature quickly and automatically. Scientific literature, patents and technical reports from different chemical disciplines were collected and stored in PDF format as fundamental datasets. Chemical structures were transformed from published documents and images to machine-readable data by using the name conversion technology and optical structure recognition tool CLiDE. In the process of molecular structure information extraction, Markush structures were enumerated into well-defined monomer molecules by means of QueryTools in molecule editor ChemDraw. Document management software EndNote X8 was applied to acquire bibliographical references involving title, author, journal and year of publication. Text mining toolkit ChemDataExtractor was adopted to retrieve information that could be used to populate structured chemical database from figures, tables, and textual paragraphs. After this step, detailed manual revision and annotation were conducted in order to ensure the accuracy and completeness of the data. In addition to the literature data, computing simulation platform Pipeline Pilot 7.5 was utilized to calculate the physical and chemical properties and predict molecular attributes. Furthermore, open database ChEMBL was linked to fetch known bioactivities, such as indications and targets. After information extraction and data expansion, five separate metadata files were generated, including molecular structure data file, molecular information, bibliographical references, predictable attributes and known bioactivities. Canonical simplified molecular input line entry specification as primary key, metadata files were associated through common key nodes including molecular number and PDF number to construct an integrated chemical information database. A reasonable construction protocol of chemical information database was created successfully. A total of 174 research articles and 25 reviews published in Marine Drugs from January 2015 to June 2016 collected as essential data source, and an elementary marine natural product database named PKU-MNPD was built in accordance with this protocol, which contained 3 262 molecules and 19 821 records. This data aggregation protocol is of great help for the chemical information database construction in accuracy, comprehensiveness and efficiency based on original documents. The structured chemical information database can facilitate the access to medical intelligence and accelerate the transformation of scientific research achievements.
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Notes on Lithology, Mineralogy, and Production for Lunar Simulants
NASA Technical Reports Server (NTRS)
Rickman, D. L.; Stoeser, D. B.; Benzel, W. M.; Schrader, C. M.; Edmunson, J. E.
2011-01-01
The creation of lunar simulants requires a very broad range of specialized knowledge and information. This document covers several topic areas relevant to lithology, mineralogy, and processing of feedstock materials that are necessary components of the NASA lunar simulant effort. The naming schemes used for both terrestrial and lunar igneous rocks are discussed. The conflict between the International Union of Geological Sciences standard and lunar geology is noted. The rock types known as impactites are introduced. The discussion of lithology is followed by a brief synopsis of pyroxene, plagioclase, and olivine, which are the major mineral constituents of the lunar crust. The remainder of the text addresses processing of materials, particularly the need for separation of feedstock minerals. To illustrate this need, the text includes descriptions of two norite feedstocks for lunar simulants: the Stillwater Complex in Montana, United States, and the Bushveld Complex in South Africa. Magnetic mineral separations, completed by Hazen Research, Inc. and Eriez Manufacturing Co. for the simulant task, are discussed.
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Morrison, Frances P; Li, Li; Lai, Albert M; Hripcsak, George
2009-01-01
Electronic clinical documentation can be useful for activities such as public health surveillance, quality improvement, and research, but existing methods of de-identification may not provide sufficient protection of patient data. The general-purpose natural language processor MedLEE retains medical concepts while excluding the remaining text so, in addition to processing text into structured data, it may be able provide a secondary benefit of de-identification. Without modifying the system, the authors tested the ability of MedLEE to remove protected health information (PHI) by comparing 100 outpatient clinical notes with the corresponding XML-tagged output. Of 809 instances of PHI, 26 (3.2%) were detected in output as a result of processing and identification errors. However, PHI in the output was highly transformed, much appearing as normalized terms for medical concepts, potentially making re-identification more difficult. The MedLEE processor may be a good enhancement to other de-identification systems, both removing PHI and providing coded data from clinical text.
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Zheng, Shuai; Ghasemzadeh, Nima; Hayek, Salim S; Quyyumi, Arshed A
2017-01-01
Background Extracting structured data from narrated medical reports is challenged by the complexity of heterogeneous structures and vocabularies and often requires significant manual effort. Traditional machine-based approaches lack the capability to take user feedbacks for improving the extraction algorithm in real time. Objective Our goal was to provide a generic information extraction framework that can support diverse clinical reports and enables a dynamic interaction between a human and a machine that produces highly accurate results. Methods A clinical information extraction system IDEAL-X has been built on top of online machine learning. It processes one document at a time, and user interactions are recorded as feedbacks to update the learning model in real time. The updated model is used to predict values for extraction in subsequent documents. Once prediction accuracy reaches a user-acceptable threshold, the remaining documents may be batch processed. A customizable controlled vocabulary may be used to support extraction. Results Three datasets were used for experiments based on report styles: 100 cardiac catheterization procedure reports, 100 coronary angiographic reports, and 100 integrated reports—each combines history and physical report, discharge summary, outpatient clinic notes, outpatient clinic letter, and inpatient discharge medication report. Data extraction was performed by 3 methods: online machine learning, controlled vocabularies, and a combination of these. The system delivers results with F1 scores greater than 95%. Conclusions IDEAL-X adopts a unique online machine learning–based approach combined with controlled vocabularies to support data extraction for clinical reports. The system can quickly learn and improve, thus it is highly adaptable. PMID:28487265
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Yudkowsky, Rachel; Park, Yoon Soo; Hyderi, Abbas; Bordage, Georges
2015-11-01
To determine the psychometric characteristics of diagnostic justification scores based on the patient note format of the United States Medical Licensing Examination Step 2 Clinical Skills exam, which requires students to document history and physical findings, differential diagnoses, diagnostic justification, and plan for immediate workup. End-of-third-year medical students at one institution wrote notes for five standardized patient cases in May 2013 (n = 180) and 2014 (n = 177). Each case was scored using a four-point rubric to rate each of the four note components. Descriptive statistics and item analyses were computed and a generalizability study done. Across cases, 10% to 48% provided no diagnostic justification or had several missing or incorrect links between history and physical findings and diagnoses. The average intercase correlation for justification scores ranged from 0.06 to 0.16; internal consistency reliability of justification scores (coefficient alpha across cases) was 0.38. Overall, justification scores had the highest mean item discrimination across cases. The generalizability study showed that person-case interaction (12%) and task-case interaction (13%) had the largest variance components, indicating substantial case specificity. The diagnostic justification task provides unique information about student achievement and curricular gaps. Students struggled to correctly justify their diagnoses; performance was highly case specific. Diagnostic justification was the most discriminating element of the patient note and had the greatest variability in student performance across cases. The curriculum should provide a wide range of clinical cases and emphasize recognition and interpretation of clinically discriminating findings to promote the development of clinical reasoning skills.
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Code of Federal Regulations, 2011 CFR
2011-10-01
..., upon filing notice of the transfer or encumbrance in the proper land office, become entitled to receive... transfer or encumbrance will be noted upon the records of the land office. Thereafter such transferee or... document is transmitted to the party, unless the serving party learns that it did not reach the party to be...
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Code of Federal Regulations, 2014 CFR
2014-10-01
..., upon filing notice of the transfer or encumbrance in the proper land office, become entitled to receive... transfer or encumbrance will be noted upon the records of the land office. Thereafter such transferee or... document is transmitted to the party, unless the serving party learns that it did not reach the party to be...
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Code of Federal Regulations, 2013 CFR
2013-10-01
..., upon filing notice of the transfer or encumbrance in the proper land office, become entitled to receive... transfer or encumbrance will be noted upon the records of the land office. Thereafter such transferee or... document is transmitted to the party, unless the serving party learns that it did not reach the party to be...
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BASIC Language Flow Charting Program (BASCHART). Technical Note 3-82.
ERIC Educational Resources Information Center
Johnson, Charles C.; And Others
This document describes BASCHART, a computer aid designed to decipher and automatically flow chart computer program logic; it also provides the computer code necessary for this process. Developed to reduce the labor intensive manual process of producing a flow chart for an undocumented or inadequately documented program, BASCHART will…
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9 CFR 205.202 - “Effective financing statement” or EFS.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Uniform Commercial Code (or equivalent document under future successor State law), but can be an entirely separate document meeting the definition in (c)(4). Note that (c)(4) contains a comprehensive definition of... State allows electronic filing of financing statements without the signature of the debtor under...
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9 CFR 205.202 - “Effective financing statement” or EFS.
Code of Federal Regulations, 2014 CFR
2014-01-01
... Uniform Commercial Code (or equivalent document under future successor State law), but can be an entirely separate document meeting the definition in (c)(4). Note that (c)(4) contains a comprehensive definition of... State allows electronic filing of financing statements without the signature of the debtor under...
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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.
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Using language models to identify relevant new information in inpatient clinical notes.
Zhang, Rui; Pakhomov, Serguei V; Lee, Janet T; Melton, Genevieve B
2014-01-01
Redundant information in clinical notes within electronic health record (EHR) systems is ubiquitous and may negatively impact the use of these notes by clinicians, and, potentially, the efficiency of patient care delivery. Automated methods to identify redundant versus relevant new information may provide a valuable tool for clinicians to better synthesize patient information and navigate to clinically important details. In this study, we investigated the use of language models for identification of new information in inpatient notes, and evaluated our methods using expert-derived reference standards. The best method achieved precision of 0.743, recall of 0.832 and F1-measure of 0.784. The average proportion of redundant information was similar between inpatient and outpatient progress notes (76.6% (SD=17.3%) and 76.7% (SD=14.0%), respectively). Advanced practice providers tended to have higher rates of redundancy in their notes compared to physicians. Future investigation includes the addition of semantic components and visualization of new information.
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Using Language Models to Identify Relevant New Information in Inpatient Clinical Notes
Zhang, Rui; Pakhomov, Serguei V.; Lee, Janet T.; Melton, Genevieve B.
2014-01-01
Redundant information in clinical notes within electronic health record (EHR) systems is ubiquitous and may negatively impact the use of these notes by clinicians, and, potentially, the efficiency of patient care delivery. Automated methods to identify redundant versus relevant new information may provide a valuable tool for clinicians to better synthesize patient information and navigate to clinically important details. In this study, we investigated the use of language models for identification of new information in inpatient notes, and evaluated our methods using expert-derived reference standards. The best method achieved precision of 0.743, recall of 0.832 and F1-measure of 0.784. The average proportion of redundant information was similar between inpatient and outpatient progress notes (76.6% (SD=17.3%) and 76.7% (SD=14.0%), respectively). Advanced practice providers tended to have higher rates of redundancy in their notes compared to physicians. Future investigation includes the addition of semantic components and visualization of new information. PMID:25954438
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Harl, Felicity N R; Saucke, Megan C; Greenberg, Caprice C; Ingraham, Angela M
2017-06-15
Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; among 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants' notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient's ED arrival and were not part of the original documentation provided. This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers. Copyright © 2017 Elsevier Inc. All rights reserved.
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A classification of errors in lay comprehension of medical documents.
Keselman, Alla; Smith, Catherine Arnott
2012-12-01
Emphasis on participatory medicine requires that patients and consumers participate in tasks traditionally reserved for healthcare providers. This includes reading and comprehending medical documents, often but not necessarily in the context of interacting with Personal Health Records (PHRs). Research suggests that while giving patients access to medical documents has many benefits (e.g., improved patient-provider communication), lay people often have difficulty understanding medical information. Informatics can address the problem by developing tools that support comprehension; this requires in-depth understanding of the nature and causes of errors that lay people make when comprehending clinical documents. The objective of this study was to develop a classification scheme of comprehension errors, based on lay individuals' retellings of two documents containing clinical text: a description of a clinical trial and a typical office visit note. While not comprehensive, the scheme can serve as a foundation of further development of a taxonomy of patients' comprehension errors. Eighty participants, all healthy volunteers, read and retold two medical documents. A data-driven content analysis procedure was used to extract and classify retelling errors. The resulting hierarchical classification scheme contains nine categories and 23 subcategories. The most common error made by the participants involved incorrectly recalling brand names of medications. Other common errors included misunderstanding clinical concepts, misreporting the objective of a clinical research study and physician's findings during a patient's visit, and confusing and misspelling clinical terms. A combination of informatics support and health education is likely to improve the accuracy of lay comprehension of medical documents. Published by Elsevier Inc.
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Sick Note to Fit Note: one trust’s project to improve usage by hospital clinicians
Moran, Amy; Mainwaring, Cathryn; Keane, Oliver; Sanctuary, Thomas; Watson, Kathryn; Lasoye, Tunji
2018-01-01
Introduction In April 2010, the government introduced a new Statement of Fitness to Work or ’Fit Note' for patients requiring time off of work or adaptations to their work due to illness. Responsibility to issue these documents has shifted from primary to secondary care. Hospital clinicians are required to issue for inpatients and for outpatients where clinical responsibility has not been taken over by the general practitioner (GP). However, awareness of this change is lacking. Misdirecting patients to their GP for the sole purpose of receiving a ’Fit Note' is an unnecessary use of appointment time and negatively impacts on patients. King’s College Hospital NHS Trust receives a number of quality alerts from primary care regarding this issue. Methods A trust-wide educational initiative was designed and implemented to increase staff awareness of Fit Notes and their correct usage in order to reduce the number of patients being misdirected to their GP to obtain one. Interventions included direct staff engagement, a trust-wide promotional campaign and creation of an electronic version of the document. Results Uptake of the electronic version of the Fit Note has steadily increased and there has been a fall in the number of quality alerts received by the trust. However, staff awareness on the whole remains low. Conclusions Patients being misdirected to their general practice for Fit Notes is an important issue and one on which the baseline level of awareness among hospital clinicians is low. Challenges during this intervention have been in penetrating a trust of this size and getting the message across to staff. However, digitising the Fit Note can help to increase its use. PMID:29333499
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Shuttle Transportation System Case-Study Development
NASA Technical Reports Server (NTRS)
Ransom, Khadijah
2012-01-01
A case-study collection was developed for NASA's Space Shuttle Program. Using lessons learned and documented by NASA KSC engineers, analysts, and contractors, decades of information related to processing and launching the Space Shuttle was gathered into a single database. The goal was to provide educators with an alternative means to teach real-world engineering processes and to enhance critical thinking, decision making, and problem solving skills. Suggested formats were created to assist both external educators and internal NASA employees to develop and contribute their own case-study reports to share with other educators and students. Via group project, class discussion, or open-ended research format, students will be introduced to the unique decision making process related to Shuttle missions and development. Teaching notes, images, and related documents will be made accessible to the public for presentation of Space Shuttle reports. Lessons investigated included the engine cutoff (ECO) sensor anomaly which occurred during mission STS-114. Students will be presented with general mission infom1ation as well as an explanation of ECO sensors. The project will conclude with the design of a website that allows for distribution of information to the public as well as case-study report submissions from other educators online.
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ERIC Educational Resources Information Center
Mathematical Association of America, Berkeley, CA. Committee on the Undergraduate Program in Mathematics.
This document presents the latest set of recommendations on the mathematical preparation of elementary and secondary school teachers developed by the Committee on the Undergraduate Program in Mathematics (CUPM) of the Mathematical Association of America (MAA). The introduction notes the background for the recommendations, and states that they are…
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Thoughts & Views on the Gulf War. Facilitators Notes and Workbook.
ERIC Educational Resources Information Center
Hollings, Rick; Berghoff, Beth K.
This document presents a workbook and facilitator's notes designed for use with small groups or with individual students in secondary schools to help them cope with troubling events related to the Gulf War. The material contained in the workbook is designed to help students deal with each of seven stages that the mastery model sees individuals…
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Education in Asia and Oceania: Reviews, Reports and Notes. Numbers 13-14, September 1978.
ERIC Educational Resources Information Center
United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand). Regional Office for Education in Asia and Oceania.
This periodical contains special reports, reviews, and notes of recent documents on education in Asia and Oceania. The first special report, "Education in the People's Republic of China," describes that country's task of educating millions of laborers to have a socialist consciousness, to master modern production skills, and to become…
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Classroom Notes Plus: A Quarterly of Teaching Ideas, 2004-2005
ERIC Educational Resources Information Center
National Council of Teachers of English, 2005
2005-01-01
This document is a compilation of the four issues in the 22nd volume of "Classroom Notes Plus." The August 2004 issue includes: Celebrating Our Names (Nitza Agam); Group Resume (Jennifer L. Alex); There's Much to Learn from Listening (Ann McKenna); Roll Call Turns into Brainstorming (John R. Banks); Create Your Own Museum (Jennifer Collison);…
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78 FR 50335 - Sale and Issue of Marketable Book-Entry Treasury Bills, Notes, and Bonds
Federal Register 2010, 2011, 2012, 2013, 2014
2013-08-19
... DEPARTMENT OF THE TREASURY Fiscal Service 31 CFR Part 356 [Docket No. Fiscal-BPD-2013-0001] Sale and Issue of Marketable Book-Entry Treasury Bills, Notes, and Bonds Correction In rule document 2013-18178 appearing on pages 46426-46445 in the issue of July 31, 2013, make the following corrections...
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78 FR 52857 - Sale and Issue of Marketable Book-Entry Treasury Bills, Notes, and Bonds
Federal Register 2010, 2011, 2012, 2013, 2014
2013-08-27
... DEPARTMENT OF THE TREASURY Fiscal Service 31 CFR Part 356 [Docket No. Fiscal-BPD-2013-0001] Sale and Issue of Marketable Book-Entry Treasury Bills, Notes, and Bonds Correction In rule document C1-2013-18178 appearing on page 50335 in the issue of August 19, 2013, make the following correction...
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NASA Technical Reports Server (NTRS)
Van Cleve, Jeffrey (Editor); Jenkins, Jon; Caldwell, Doug; Allen, Christopher L.; Batalha, Natalie; Bryson, Stephen T.; Chandrasekaran, Hema; Clarke, Bruce D.; Cote, Miles T.; Dotson, Jessie L.;
2010-01-01
The Data Analysis Working Group have released long and short cadence materials, including FFIs and Dropped Targets for the Public. The Kepler Science Office considers Data Release 4 to provide "browse quality" data. These notes have been prepared to give Kepler users of the Multimission Archive at STScl (MAST) a summary of how the data were collected and prepared, and how well the data processing pipeline is functioning on flight data. They will be updated for each release of data to the public archive and placed on MAST along with other Kepler documentation, at http://archive.stsci.edu/kepler/documents.html. Data release 3 is meant to give users the opportunity to examine the data for possibly interesting science and to involve the users in improving the pipeline for future data releases. To perform the latter service, users are encouraged to notice and document artifacts, either in the raw or processed data, and report them to the Science Office.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Goldberg, H.J.
1998-06-18
UO{sub 3} powder is stored at the T-hopper storage area associated with the 2714-U building in the 200 west area. The T-hopper containers and 13 drums containing this material are used to store the powder on pads immediately north of the building. An interim safety basis document (WHC,1996) was issued in 1996 for the UO{sub 3} powder storage area. In this document the isotope {sup 99}Tc was not included in the source term used to calculate the radiological consequences of a postulated release of the powder. A calculations note (HNF, 1998) was issued to remedy that deficiency. The present documentmore » is a revision to that document to reflect updated data concerning the solubility of UO{sub 3} in simulated lung fluid and to utilize more realistic powder release fractions.« less
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The STAR score: a method for auditing clinical records
Tuffaha, H
2012-01-01
INTRODUCTION Adequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes. METHODS An initial ‘path finding’ study was performed to evaluate the quality of note keeping using the CRABEL scoring tool. The findings prompted the development of the Surgical Tool for Auditing Records (STAR) as an alternative. STAR was validated using inter-rater reliability analysis. An audit cycle of surgical notes using STAR was performed. The results were analysed and a structured form for the completion of surgical notes was introduced to see if the quality improved in the next audit cycle using STAR. An education exercise was conducted and all participants said the exercise would change their practice, with 25% implementing major changes. RESULTS Statistical analysis of STAR showed that it is reliable (Cronbach’s a = 0.959). On completing the audit cycle, there was an overall increase in the STAR score from 83.344% to 97.675% (p<0.001) with significant improvements in the documentation of the initial clerking from 59.0% to 96.5% (p<0.001) and subsequent entries from 78.4% to 96.1% (p<0.001). CONCLUSIONS The authors believe in the value of STAR as an effective, reliable and reproducible tool. Coupled with the application of structured forms to note keeping, it can significantly improve the quality of surgical documentation and can be implemented universally. PMID:22613300
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Open Notes in Swedish Psychiatric Care (Part 2): Survey Among Psychiatric Care Professionals.
Petersson, Lena; Erlingsdóttir, Gudbjörg
2018-06-21
This is the second of two papers presenting the results from a study of the implementation of patient online access to their electronic health records (here referred to as Open Notes) in adult psychiatric care in Sweden. The study contributes an important understanding of both the expectations and concerns that existed among health care professionals before the introduction of the Open Notes Service in psychiatry and the perceived impact of the technology on their own work and patient behavior after the implementation. The results from the previously published baseline survey showed that psychiatric health care professionals generally thought that Open Notes would influence both the patients and their own practice negatively. The objective of this study was to describe and discuss how health care professionals in adult psychiatric care in Region Skåne in southern Sweden experienced the influence of Open Notes on their patients and their own practice, and to compare the results with those of the baseline study. We distributed a full population Web-based questionnaire to psychiatric care professionals in Region Skåne in the spring of 2017, which was one and a half years after the implementation of the service. The response rate was 27.73% (699/2521). Analyses showed that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between health professional groups and attitudes to the Open Notes Service. A total of 41.5% (285/687) of the health care professionals reported that none of their patients stated that they had read their Open Notes. Few health care professionals agreed with the statements about the potential benefits for patients from Open Notes. Slightly more of the health care professionals agreed with the statements about the potential risks. In addition, the results indicate that there was little impact on practice in terms of longer appointments or health care professionals having to address patients' questions outside of appointments. However, the results also indicate that changes had taken place in clinical documentation. Psychologists (39/63, 62%) and doctors (36/94, 38%) in particular stated that they were less candid in their documentation after the implementation of Open Notes. Nearly 40% of the health care professionals (239/650, 36.8%) reported that the Open Notes Service in psychiatry was a good idea. Most health care professionals who responded to the postimplementation survey did not experience that patients in adult psychiatric care had become more involved in their care after the implementation of Open Notes. The results also indicate that the clinical documentation had changed after the implementation of Open Notes. Finally, the results indicate that it is important to prepare health care professionals before an implementation of Open Notes, especially in medical areas where the service is considered sensitive. ©Lena Petersson, Gudbjörg Erlingsdóttir. Originally published in JMIR Mental Health (http://mental.jmir.org), 21.06.2018.
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Determining Primary Care Physician Information Needs to Inform Ambulatory Visit Note Display
Clarke, M.A.; Steege, L.M.; Moore, J.L.; Koopman, R.J.; Belden, J.L.; Kim, M.S.
2014-01-01
Summary Background With the increase in the adoption of electronic health records (EHR) across the US, primary care physicians are experiencing information overload. The purpose of this pilot study was to determine the information needs of primary care physicians (PCPs) as they review clinic visit notes to inform EHR display. Method Data collection was conducted with 15 primary care physicians during semi-structured interviews, including a third party observer to control bias. Physicians reviewed major sections of an artificial but typical acute and chronic care visit note to identify the note sections that were relevant to their information needs. Statistical methods used were McNemar-Mosteller’s and Cochran Q. Results Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. There was also a statistical difference in physicians’ highlighting among all seven major note sections in acute (p = 0.00) and chronic (p = 0.00) care visit notes. Conclusion A&P and HPI sections were most frequently identified as important which suggests that physicians may have to identify a few key sections out of a long, unnecessarily verbose visit note. ROS is viewed by doctors as mostly “not needed,” but can have relevant information. The ROS can contain information needed for patient care when other sections of the Visit note, such as the HPI, lack the relevant information. Future studies should include producing a display that provides only relevant information to increase physician efficiency at the point of care. Also, research on moving A&P to the top of visit notes instead of having A&P at the bottom of the page is needed, since those are usually the first sections physicians refer to and reviewing from top to bottom may cause cognitive load. PMID:24734131
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Bilsland, D J; Rhodes, L E; Zaki, I; Wilkinson, S M; McKenna, K E; Handfield-Jones, S E; Williams, R E
1994-08-01
Following publication of treatment guidelines for patients with psoriasis, a six-centre audit was undertaken to assess current therapeutic practice for two second-line treatments, PUVA and methotrexate. The audit consisted of random sampling of casenotes by external auditors from a paired dermatology department, and assessment by questionnaire. One hundred and eight PUVA and 118 methotrexate casenotes were audited. The commonest indications for treatment were: (a) failure of tropical therapy--PUVA (mean 81% of casenotes), methotrexate (84%); (b) repeated hospital admissions--PUVA (16%), methotrexate (25%). For both PUVA and methotrexate, some aspects of treatment were well documented: PUVA--psoralen dosage (91%), response to PUVA (89%), cumulative lifetime UVA dosage (81%); methotrexate--pretreatment assessment of full blood count (91%), urea and electrolytes (85%), liver function tests (84%). For other aspects documentation was less complete: PUVA--no documentation of presence/absence of skin cancer history (66%), note of photoactive drugs (32%); methotrexate--concurrent medication (69%), history of presence/absence of liver disease (36%). Another aspect which was poorly documented in both PUVA and methotrexate notes was whether advice on contraception/fertility had been given. There was no indication in 29 of 32 casenotes of females of child-bearing age receiving PUVA, and 52 of 63 case notes of relevant patients on methotrexate. This project has demonstrated that formal, multicentre audit based on published guidelines is a practical proposition.
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NASA Astrophysics Data System (ADS)
Hoffman, Kenneth J.; Keithley, Hudson
1994-12-01
There are few systems which aggregate standardized pertinent clinical observations of discrete patient problems and resolutions. The systematic information supplied by clinicians is generally provided to justify reimbursement from insurers. Insurers, by their nature, and expert in modeling health care costs by diagnosis, procedures, and population risk groups. Medically, they rely on clinician generated diagnostic and coded procedure information. Clinicians will document a patient's status at a discrete point in time through narrative. Clinical notes do not support aggregate and systematic analysis of outcome. A methodology exists and has been used by the US Army Drug and Alcohol Program to model the clinical activities, associated costs, and data requirements of an outpatient clinic. This has broad applicability for a comprehensive health care system to which patient costs and data requirements can be established.
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State Requirements for High School Graduation: Communication Skills. Technical Note.
ERIC Educational Resources Information Center
Lawlor, Joseph
This paper contains descriptions of documents setting forth the minimum communications skills competencies required for high school graduation in seven states: Florida, Louisiana, Maryland, Massachusetts, New Mexico, and Utah. It then describes the procedures used to compile a synthesized list from those documents for use in a project to assess…
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32 CFR 651.35 - Decision process.
Code of Federal Regulations, 2011 CFR
2011-07-01
... as soon as possible. (b) The FNSI is a document (40 CFR 1508.13) that briefly states why an action... be prepared. It summarizes the EA, noting any NEPA documents that are related to, but are not part of... two typewritten pages in length. (e) The draft FNSI will be made available to the public prior to...
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The M68HC11 gripper controller electronics
NASA Technical Reports Server (NTRS)
Kelley, Robert B.; Bethel, Jeffrey
1991-01-01
This document describes the instrumentation, operational theory, circuit implementation, calibration procedures, and general notes for the CIRSSE general purpose pneumatic hand. The mechanical design and the control software are discussed. The circuit design, PCB layout, hand instrumentation, and controller construction described in detail in this document are the result of a senior project.
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Improving the Quality of Nursing Documentation in Home Health Care Setting
ERIC Educational Resources Information Center
Obioma, Chidiadi
2017-01-01
Poor nursing documentation of patient care was identified in daily nurse visit notes in a health care setting. This problem affects effective communication of patient status with other clinicians, thereby jeopardizing clinical decision-making. The purpose of this evidence-based project was to determine the impact of a retraining program on the…
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NASA Technical Reports Server (NTRS)
Hall, Forrest G. (Editor); Nelson, Elizabeth; Newcomer, Jeffrey A.
2000-01-01
Boreal Ecosystem-Atmospheric Study (BOREAS) hardcopy maps are a collection of approximately 1,000 hardcopy maps representing the physical, climatological, and historical attributes of areas covering primarily the Manitoba and Saskatchewan provinces of Canada. These maps were collected by BOREAS Information System (BORIS) and Canada for Remote Sensing (CCRS) staff to provide basic information about site positions, manmade features, topography, geology, hydrology, land cover types, fire history, climate, and soils of the BOREAS study region. These maps are not available for distribution through the BOREAS project but may be used as an on-site resource. Information is provided within this document for individuals who want to order copies of these maps from the original map source. Note that the maps are not contained on the BOREAS CD-ROM set. An inventory listing file is supplied on the CD-ROM to inform users of the maps that are available. This inventory listing is available from the Earth Observing System Data and Information System (EOSDIS) Oak Ridge National Laboratory (ORNL) Distributed Active Archive Center (DAAC). For hardcopies of the individual maps, contact the sources provided.
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Zheng, Kai; Mei, Qiaozhu; Yang, Lei; Manion, Frank J.; Balis, Ulysses J.; Hanauer, David A.
2011-01-01
In this study, we comparatively examined the linguistic properties of narrative clinician notes created through voice dictation versus those directly entered by clinicians via a computer keyboard. Intuitively, the nature of voice-dictated notes would resemble that of natural language, while typed-in notes may demonstrate distinctive language features for reasons such as intensive usage of acronyms. The study analyses were based on an empirical dataset retrieved from our institutional electronic health records system. The dataset contains 30,000 voice-dictated notes and 30,000 notes that were entered manually; both were encounter notes generated in ambulatory care settings. The results suggest that between the narrative clinician notes created via these two different methods, there exists a considerable amount of lexical and distributional differences. Such differences could have a significant impact on the performance of natural language processing tools, necessitating these two different types of documents being differentially treated. PMID:22195229
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Allotey, Pascale; Reidpath, Daniel D.; Devarajan, Nirmala; Rajagobal, Kanason; Yasin, Shajahan; Arunachalam, Dharmalingam; Imelda, Johanna Debora; Soyiri, Ireneous; Davey, Tamzyn; Jahan, Nowrozy
2014-01-01
Background Community engagement is an increasingly important requirement of public health research and plays an important role in the informed consent and recruitment process. However, there is very little guidance about how it should be done, the indicators for assessing effectiveness of the community engagement process and the impact it has on recruitment, retention, and ultimately on the quality of the data collected as part of longitudinal cohort studies. Methods An instrumental case study approach, with data from field notes, policy documents, unstructured interviews, and focus group discussions with key community stakeholders and informants, was used to explore systematically the implementation and outcomes of the community engagement strategy for recruitment of an entire community into a demographic and health surveillance site in Malaysia. Results For a dynamic cohort, community engagement needs to be an ongoing process. The community engagement process has likely helped to facilitate the current response rate of 85% in the research communities. The case study highlights the importance of systematic documentation of the community engagement process to ensure an understanding of the effects of the research on recruitment and the community. Conclusions A critical lesson from the case study data is the importance of relationships in the recruitment process for large population-based studies, and the need for ongoing documentation and analysis of the impact of cumulative interactions between research and community engagement. PMID:24804983
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Bayley, K Bruce; Belnap, Tom; Savitz, Lucy; Masica, Andrew L; Shah, Nilay; Fleming, Neil S
2013-08-01
To document the strengths and challenges of using electronic health records (EHRs) for comparative effectiveness research (CER). A replicated case study of comparative effectiveness in hypertension treatment was conducted across 4 health systems, with instructions to extract data and document problems encountered using a specified list of required data elements. Researchers at each health system documented successes and challenges, and suggested solutions for addressing challenges. Data challenges fell into 5 categories: missing data, erroneous data, uninterpretable data, inconsistencies among providers and over time, and data stored in noncoded text notes. Suggested strategies to address these issues include data validation steps, use of surrogate markers, natural language processing, and statistical techniques. A number of EHR issues can hamper the extraction of valid data for cross-health system comparative effectiveness studies. Our case example cautions against a blind reliance on EHR data as a single definitive data source. Nevertheless, EHR data are superior to administrative or claims data alone, and are cheaper and timelier than clinical trials or manual chart reviews. All 4 participating health systems are pursuing pathways to more effectively use EHR data for CER.A partnership between clinicians, researchers, and information technology specialists is encouraged as a way to capitalize on the wealth of information contained in the EHR. Future developments in both technology and care delivery hold promise for improvement in the ability to use EHR data for CER.
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Completion of Launch Director Console Project and Other Support Work
NASA Technical Reports Server (NTRS)
Steinrock, Joshua G.
2018-01-01
There were four projects that I was a part of working on during the spring semester of 2018. This included the completion of the Launch Director Console (LDC) project and the completion and submission of a Concept of Operations (ConOps) document for the Record and Playback System (RPS) at the Launch Control Center (LCC), as well as supporting the implementation of a unit in RPS known as the CDP (Communication Data Processor). Also included was my support and mentorship of a High School robotics team that is sponsored by Kennedy Space Center. The LDC project is an innovative workstation to be used by the launch director for the future Space Launch System program. I worked on the fabrication and assembly of the final console. The ConOps on RPS is a technical document for which I produced supporting information and notes. All of this was done in the support of the IT Project Management Office (IT-F). The CDP is a subsystem that will eventually be installed in and operated by RPS.
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The influence of geopolitical change on the well-being of a population: the Berlin Wall.
Héon-Klin, V; Sieber, E; Huebner, J; Fullilove, M T
2001-03-01
Social cohesion is recognized as a fundamental condition for healthy populations, but social cohesion itself arises from political unity. The history of the Berlin Wall provides a unique opportunity to examine the effects of partition on social cohesion and, by inference, on health. This ethnographic study consisted of examination of the territory formerly occupied by the Wall, formal and informal interviews with Berlin residents, and collection of cultural documents related to the Wall. Transcripts, field notes, and documents were examined by means of a keyword-in-context analysis. The separation of Berlin into 2 parts was a traumatic experience for the city's residents. After partition, East and West Germany had divergent social, cultural, and political experiences and gradually grew apart. The demolition of the Wall--the symbol and the instrument of partition--makes possible but does not ensure the reintegration of 2 populations that were separated for 40 years. The evolution of a new common culture might be accelerated by active attempts at cultural and social exchange.
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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
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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.
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Identification of misspelled words without a comprehensive dictionary using prevalence analysis.
Turchin, Alexander; Chu, Julia T; Shubina, Maria; Einbinder, Jonathan S
2007-10-11
Misspellings are common in medical documents and can be an obstacle to information retrieval. We evaluated an algorithm to identify misspelled words through analysis of their prevalence in a representative body of text. We evaluated the algorithm's accuracy of identifying misspellings of 200 anti-hypertensive medication names on 2,000 potentially misspelled words randomly selected from narrative medical documents. Prevalence ratios (the frequency of the potentially misspelled word divided by the frequency of the non-misspelled word) in physician notes were computed by the software for each of the words. The software results were compared to the manual assessment by an independent reviewer. Area under the ROC curve for identification of misspelled words was 0.96. Sensitivity, specificity, and positive predictive value were 99.25%, 89.72% and 82.9% for the prevalence ratio threshold (0.32768) with the highest F-measure (0.903). Prevalence analysis can be used to identify and correct misspellings with high accuracy.
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Bock, Meredith; Moore, Dan; Hwang, Jimmy; Shumay, Dianne; Lawson, Laurell; Hamolsky, Deborah; Esserman, Laura; Rugo, Hope; Chien, A Jo; Park, John; Munster, Pamela; Melisko, Michelle
2012-08-01
Breast cancer (BC) patients experience multiple symptoms as a result of diagnosis and treatment. While surveillance for detecting cancer recurrence is fundamental to follow-up care, managing symptoms, and promoting health behaviors are equally important. UCSF has implemented a secure online health questionnaire enabling BC patients to provide updates of their health history and symptoms. We randomly selected a sample of stage I-III BC patients (n = 106) who completed a questionnaire before a medical oncology visit between August 2010 and January 2011 and consented to have data used for research. We conducted a chart review calculating the number of symptoms reported in the questionnaire, the clinic note only, and both questionnaire and clinic note, excluding chronic symptoms addressed previously. Self-reported data on exercise and alcohol consumption was compared to documentation of these lifestyle factors in clinic notes. Patients reported significantly more symptoms using the online questionnaire (mean = 3.8, range 0-13) than were documented by the provider in clinic notes (mean = 1.8, range 0-7; p < 0.001 for the difference). A regression plot comparing the percentage of symptoms agreed upon by the patient and provider and the percentage of symptoms addressed yields a slope of 0.56 (95 % CI 0.41-0.71). The number of self-reported symptoms correlates with self-reported Karnofsky scale such that the number of symptoms reported by the patient increases linearly with this score until a threshold and it then plateaus (p < 0.001). Exercise behavior and alcohol consumption were reported in 100 % of the online questionnaires, but was documented in only 30/106 (28 %) and 75/106 (70 %) of charts reviewed. In 19/75 (25 %) charts with alcohol consumption documented, there was substantial discordance between patient and clinician reporting. Electronic data collection of BC patient-reported outcomes has a positive effect on symptom management and identification of opportunities for risk-reducing behavior change.
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Lampert, Markus L; Kraehenbuehl, Stephan; Hug, Balthasar L
2008-12-01
To evaluate the Pharmaceutical Care Network Europe (PCNE) classification system as a tool for documenting the impact of a hospital clinical pharmacology service. Two medical wards comprising totally 85 beds in a university hospital. Number of events classified with the PCNE-system, their acceptance by the medical staff and cost implications. Clinical pharmacy review of pharmacotherapy on ward rounds and from case notes were documented, and identified drug-related problems (DRPs) were classified using the PCNE system version 5.00. During 70 observation days 216 interventions were registered of which 213 (98.6%) could be classified: 128 (60.1%) were detected by reviewing the case notes, 33 (15.5%) on ward rounds, 32 (15.0%) by direct reporting to the clinical pharmacist (CP), and 20 (9.4%) on non-formulary prescriptions. Of 148 suggested interventions by the CP 123 (83.0%) were approved by the responsible physician, 12 ADR reports (8.1%) were submitted to the local pharmacovigilance centre and 31 (20.9%) specific information given without further need for action. An evaluation of the DRPs showed that direct drug costs of
2,058 within the study period or 10,731 per year could be avoided. We consider the PCNE system to be a practical tool in the hospital setting, which demonstrates the values of a clinical pharmacy service in terms of identifying and reducing DRPs and also has the potential to reduce prescribing costs. -
Gerntke, Carina Isabel; Kersten, Jan Felix; Schön, Gerhard; Mann, Oliver; Stark, Michael; Benhidjeb, Tahar
2016-04-01
Over the past 8 years, natural orifice transluminal endoscopic surgery (NOTES) has developed from preclinical to routine clinical practice. However, there are still concerns regarding the transvaginal approach. In our survey, we were interested in females with a professional medical background, thus having at least a basic medical understanding, which might discriminate between objective and subjective concerns. A questionnaire with 14 items was distributed among 1895 female physicians and nursing and administration staff of the University Medical Center Hamburg-Eppendorf. In addition, a qualitative literature review was performed. Data analysis was carried out using statistical package R version 2.15.0. The questionnaire was answered anonymously by 553 employees (29%). Fifty-seven percent were nurses, 18.6% belonged to administration, and 17% were physicians. A total of 63.1% of our respondents would choose the transvaginal NOTES technique for an assumed ovariectomy, while only 30.4% would choose this access for cholecystectomy. Doubts regarding transvaginal NOTES were related to sexual dysfunction (44.8%), its experimental nature (43.8%), future pregnancies (36.8%), and ethical reasons (30.3%). The literature review showed that women's perception of the transvaginal access is documented very heterogeneously and therefore difficult to compare. Despite the good reported results of NOTES and the medical background of the surveyed female employees, our study and the literature review clearly shows that there are fears regarding the transvaginal access, which might be a result of limited information. More accurate explanation of the available methods by the attending surgeon can lead to a better choice of the patient's preferred method. © The Author(s) 2015.
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Zheng, Shuai; Lu, James J; Ghasemzadeh, Nima; Hayek, Salim S; Quyyumi, Arshed A; Wang, Fusheng
2017-05-09
Extracting structured data from narrated medical reports is challenged by the complexity of heterogeneous structures and vocabularies and often requires significant manual effort. Traditional machine-based approaches lack the capability to take user feedbacks for improving the extraction algorithm in real time. Our goal was to provide a generic information extraction framework that can support diverse clinical reports and enables a dynamic interaction between a human and a machine that produces highly accurate results. A clinical information extraction system IDEAL-X has been built on top of online machine learning. It processes one document at a time, and user interactions are recorded as feedbacks to update the learning model in real time. The updated model is used to predict values for extraction in subsequent documents. Once prediction accuracy reaches a user-acceptable threshold, the remaining documents may be batch processed. A customizable controlled vocabulary may be used to support extraction. Three datasets were used for experiments based on report styles: 100 cardiac catheterization procedure reports, 100 coronary angiographic reports, and 100 integrated reports-each combines history and physical report, discharge summary, outpatient clinic notes, outpatient clinic letter, and inpatient discharge medication report. Data extraction was performed by 3 methods: online machine learning, controlled vocabularies, and a combination of these. The system delivers results with F1 scores greater than 95%. IDEAL-X adopts a unique online machine learning-based approach combined with controlled vocabularies to support data extraction for clinical reports. The system can quickly learn and improve, thus it is highly adaptable. ©Shuai Zheng, James J Lu, Nima Ghasemzadeh, Salim S Hayek, Arshed A Quyyumi, Fusheng Wang. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 09.05.2017.
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Fletcher, Sophie; Hughes, Rachel; Pickstock, Sarah; Auret, Kirsten
2018-02-01
Adolescents and young adults (AYA) with cancer are a cohort requiring specialized healthcare models to address unique cognitive and physical challenges. Advance care planning (ACP) discussions likely warrant age-appropriate adaptation, yet, there is little Australian research data available to inform best practice for this group. The goal of this work is to inform future models of ACP discussions for AYA. Retrospective medical record audit of AYA patients and an adult comparison group, diagnosed with a malignancy and referred to a community hospice service, in Western Australia, in the period between January 1, 2012 and December 1, 2015. Information was collected regarding end-of-life care discussions, documentation of agreed plan of care, and care received. Twenty-seven AYA and 37 adult medical records were reviewed. Eighteen (66.7%) AYA patients died at home, compared with 19 (51.4%) adults (p = 0.028). Desire to pursue all available oncological therapies, including clinical trials, was documented for 14 (51.9%) AYA patients compared with 9 (24.3%) of the adult group (p = 0.02). Eleven AYA patients (40.7%) received chemotherapy during the last month of life compared with two (5.4%) adults (p = 0.001). The results indicate that end-of-life care preferences for this unique cohort may differ from those of the adult population and need to be captured and understood. An ACP document incorporating a discussion regarding goals of care, preferred location of care, preference for place of death, and consent to future intervention, including cardiopulmonary resuscitation and prompts for review, could assist in pursuing this objective.
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2007-11-01
of embassy weapons caches. A summary of a related document folder (ISGP-2003- 00010399, 3 October 2000) includes inventories of weapons within the...senior Iraqis noted that after OPERATIO DESERT Fox (December 1998), Saddam became much more concerned for his personal security. Saddam isolated...of a 114-page report concerning IIS operations in the northern area of Iraq, 13 October 1995. Harmony document folder ISGP-2003-000 10399 - Inventories
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Longitudinal Analysis of New Information Types in Clinical Notes
Zhang, Rui; Pakhomov, Serguei; Melton, Genevieve B.
2014-01-01
It is increasingly recognized that redundant information in clinical notes within electronic health record (EHR) systems is ubiquitous, significant, and may negatively impact the secondary use of these notes for research and patient care. We investigated several automated methods to identify redundant versus relevant new information in clinical reports. These methods may provide a valuable approach to extract clinically pertinent information and further improve the accuracy of clinical information extraction systems. In this study, we used UMLS semantic types to extract several types of new information, including problems, medications, and laboratory information. Automatically identified new information highly correlated with manual reference standard annotations. Methods to identify different types of new information can potentially help to build up more robust information extraction systems for clinical researchers as well as aid clinicians and researchers in navigating clinical notes more effectively and quickly identify information pertaining to changes in health states. PMID:25717418
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EPA has developed several technical notes that provide in depth information on a specific function in BASINS. Technical notes can be used to answer questions users may have, or to provide additional information on the application of features in BASINS.
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Race, Reification, and Responsibility.
ERIC Educational Resources Information Center
Cancro, Robert
Noting that many of the attacks on individual scientists as well as some of the attacks on the field of behavior genetics are more than intemperate--they are non-rational--the author discusses his experience as a signatory to a document drawn up by Ellis B. Page during the winter of 1971-1972. The intent of this controversial document was to…
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ERIC Educational Resources Information Center
Giordano, Richard
1994-01-01
Describes the Text Encoding Initiative (TEI) project and the TEI header, which documents electronic text in a standard interchange format understandable to both librarian catalogers and nonlibrarian text encoders. The form and function of the TEI header is introduced, and its relationship to the MARC record is explained. (10 references) (KRN)
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Review of the National Research Council's Framework for K-12 Science Education
ERIC Educational Resources Information Center
Gross, Paul R.
2011-01-01
The new "Framework for K-12 Science Education: Practices, Crosscutting Concepts, and Core Ideas" is a big, comprehensive volume, carefully organized and heavily documented. It is the long-awaited product of the Committee on a Conceptual Framework for New K-12 Science Education Standards. As noted, it is a weighty document (more than 300…
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Education in Asia: Reviews, Reports, and Notes. Number 9.
ERIC Educational Resources Information Center
United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand). Regional Office for Education in Asia and Oceania.
A report on the educational system of Iran along with reviews and reports of recent documents selected from the collection of the Unesco Regional Office for Education in Asia comprise this document. The article on the new Iranian educational system describes changes at the secondary level as a result of rapid socioeconomic development and new…
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Conlin, Jeremy
2017-03-15
This software is code related to reading/writing/manipulating nuclear data in the Generalized Nuclear Data (GND) format, a new format for sharing nuclear data among institutions. In addition to the software and its documentation, notes and documentation from the WPEC Subgroup 43 will be included. WPEC Subgroup 43 is an international committee charged with creating the API for the GND format.
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Patient Activities Planning and Progress Noting a Humanistic Integrated-Team Approach.
ERIC Educational Resources Information Center
Muilenburg, Ted
This document outlines a system for planning recreation therapy, documenting progress, and relating the entire process to a team approach which includes patient assessment and involvement. The recreation program is seen as therapeutic, closely related to the total medical treatment program. The model is designed so that it can be adapted to almost…
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Young, Kenneth J.
2014-01-01
Objective The purpose of this study was to evaluate publicly available information of chiropractic technique systems that advocate radiography for subluxation detection to identify links between chiropractic technique systems and to describe claims made of the health effects of the osseous misalignment component of the chiropractic subluxation and radiographic paradigms. Methods The Internet and publicly available documents were searched for information representing chiropractic technique systems that advocate radiography for subluxation detection. Key phrases including chiropractic, x-ray, radiography, and technique were identified from a Google search between April 2013 and March 2014. Phrases in Web sites and public documents were examined for any information about origins and potential links between these techniques, including the type of connection to BJ Palmer, who was the first chiropractor to advocate radiography for subluxation detection. Quotes were gathered to identify claims of health effects from osseous misalignment (subluxation) and paradigms of radiography. Techniques were grouped by region of the spine and how they could be traced back to B.J Palmer. A genealogy model and summary table of information on each technique were created. Patterns in year of origination and radiographic paradigms were noted, and percentages were calculated on elements of the techniques’ characteristics in comparison to the entire group. Results Twenty-three techniques were identified on the Internet: 6 full spine, 17 upper cervical, and 2 techniques generating other lineage. Most of the upper cervical techniques (14/16) traced their origins to a time when the Palmer School was teaching upper cervical technique, and all the full spine techniques (6/6) originated before or after this phase. All the technique systems’ documents attributed broad health effects to their methods. Many (21/23) of the techniques used spinal realignment on radiographs as one of their outcome measures. Conclusion Chiropractic technique systems in this study (ie, those that advocate for radiography for subluxation misalignment detection) seem to be closely related by descent, their claims of a variety of health effects associated with chiropractic subluxation, and their radiographic paradigms. PMID:25431540
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Young, Kenneth J
2014-12-01
The purpose of this study was to evaluate publicly available information of chiropractic technique systems that advocate radiography for subluxation detection to identify links between chiropractic technique systems and to describe claims made of the health effects of the osseous misalignment component of the chiropractic subluxation and radiographic paradigms. The Internet and publicly available documents were searched for information representing chiropractic technique systems that advocate radiography for subluxation detection. Key phrases including chiropractic, x-ray, radiography, and technique were identified from a Google search between April 2013 and March 2014. Phrases in Web sites and public documents were examined for any information about origins and potential links between these techniques, including the type of connection to BJ Palmer, who was the first chiropractor to advocate radiography for subluxation detection. Quotes were gathered to identify claims of health effects from osseous misalignment (subluxation) and paradigms of radiography. Techniques were grouped by region of the spine and how they could be traced back to B.J Palmer. A genealogy model and summary table of information on each technique were created. Patterns in year of origination and radiographic paradigms were noted, and percentages were calculated on elements of the techniques' characteristics in comparison to the entire group. Twenty-three techniques were identified on the Internet: 6 full spine, 17 upper cervical, and 2 techniques generating other lineage. Most of the upper cervical techniques (14/16) traced their origins to a time when the Palmer School was teaching upper cervical technique, and all the full spine techniques (6/6) originated before or after this phase. All the technique systems' documents attributed broad health effects to their methods. Many (21/23) of the techniques used spinal realignment on radiographs as one of their outcome measures. Chiropractic technique systems in this study (ie, those that advocate for radiography for subluxation misalignment detection) seem to be closely related by descent, their claims of a variety of health effects associated with chiropractic subluxation, and their radiographic paradigms.
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Pilot-Induced Oscillation Research: Status at the End of the Century. Volume 2
NASA Technical Reports Server (NTRS)
Shafer, Mary F. (Compiler); Steinmetz, Paul (Compiler)
2001-01-01
The workshop "Pilot-Induced Oscillation Research: The Status at the End of the Century," was held at NASA Dryden Flight Research Center on 6-8 April 1999. The presentations at this conference addressed the most current information available, addressing regulatory issues, flight test, safety, modeling, prediction, simulation, mitigation or prevention, and areas that require further research. All presentations were approved for publication as unclassified documents with no limits on their distribution. This proceedings includes the viewgraphs (some with author's notes) used for thirty presentations that were actually given and two presentations that were not given because of time limitations. Four technical papers on this subject are also included.
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Pilot-Induced Oscillation Research: Status at the End of the Century. Volume 3
NASA Technical Reports Server (NTRS)
Shafer, Mary F. (Compiler); Steinmetz, Paul (Compiler)
2001-01-01
The workshop "Pilot-Induced Oscillation Research: The Status at the End of the Century," was held at NASA Dryden Flight Research Center on 6-8 April 1999. The presentations at this conference addressed the most current information available, addressing regulatory issues, flight test, safety, modeling, prediction, simulation, mitigation or prevention, and areas that require further research. All presentations were approved for publication as unclassified documents with no limits on their distribution. This proceedings includes the viewgraphs (some with author's notes) used for thirty presentations that were actually given and two presentations that were not given because of time limitations. Four technical papers on this subject are also included.
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Scientific and Technical Information Output of the Langley Research Center, for calendar year 1976
NASA Technical Reports Server (NTRS)
1976-01-01
Documents listed include NASA Technical Reports, Technical Notes, Technical Memorandums, Special Publications, Contractor Reports, journal articles, and technical presentations made at Society meetings. NASA formal reports listed are those that were mailed and distributed to the ultimate user. The material presented here is listed first by Division and then under the following headings: (a) Formal Reports, (b) Contractor Reports, (c) Articles and Meeting Presentations, and (d) High Number Technical Memorandums (High TMX's). Under each heading, the material cited authors in alphabetical order. If a report has more than one author and these authors are from different Divisions, the report is listed only once, under the senior author's name.
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Incidence and predictors of onset of injection drug use in a San Francisco cohort of homeless youth.
Parriott, Andrea M; Auerswald, Colette L
2009-01-01
Few studies document incidence of injection drug use among homeless youth. We followed a cohort of 70 street-recruited homeless youth in San Francisco, California who had never injected drugs for six months in 2004-5. We examined initiation of injection drug use and its predictors, informed by prior ethnographic findings. Data were analyzed using exact logistic regression. 11.4% of youth initiated injection drug use. Having no high school education, being over 21 years old, and being in disequilibrium predicted initiation. Limitations, implications and suggestions for future research are noted. Funding was provided by the National Institute for Child Health and Development.
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Pilot-Induced Oscillation Research: The Status at the End of the Century. Volume 1
NASA Technical Reports Server (NTRS)
Shafer, Mary F. (Compiler); Steinmetz, Paul (Compiler)
2001-01-01
The workshop "Pilot-Induced Oscillation Research: The Status at the End of the Century," was held at NASA Dryden Flight Research Center on 6-8 April 1999. The presentations at this conference addressed the most current information available, addressing regulatory issues, flight test, safety, modeling, prediction, simulation, mitigation or prevention, and areas that require further research. All presentations were approved for publication as unclassified documents with no limits on their distribution. This proceedings includes the viewgraphs (some with author's notes) used for thirty presentations that were actually given and two presentations that were not given because of time limitations. Four technical papers on this subject are also included.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
McCormack, K.E.; Gallaher, R.B.
1982-03-01
This document presents a bibliography that contains 100-word abstracts of event reports submitted to the US Nuclear Regulatory Commission concerning operational events that occurred at boiling-water-reactor nuclear power plants in 1980. The 1547 abstracts included on microfiche in this bibliography describe incidents, failures, and design or construction deficiencies that were experienced at the facilities. These abstracts are arranged alphabetically by reactor name and then chronologically for each reactor. Full-size keyword and permuted-title indexes to facilitate location of individual abstracts are provided following the text. Tables that summarize the information contained in the bibliography are also provided. The information in themore » tables includes a listing of the equipment items involved in the reported events and the associated number of reports for each item. Similar information is given for the various kinds of instrumentation and systems, causes of failures, deficiencies noted, and the time of occurrence (i.e., during refueling, operation, testing, or construction).« less
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Moorthy, A; Alkadhimi, A F; Stassen, Leo F; Duncan, H F
2016-01-01
Concerns were expressed that postoperative written instructions following endodontic treatment are not available in the Dublin Dental University Hospital. Data was collected in three phases: retrospective analysis of clinical notes for evidence of the delivery of postoperative instructions; a randomly distributed questionnaire to patients undergoing root canal treatment prior to the introduction of a written postoperative advice sheet; and, another survey following introduction of the advice sheet. Some 56% of patients' charts documented that postoperative advice was given. Analysis of phase two revealed that patients were not consistently informed of any key postoperative messages. In phase 3 analysis, the proposed benchmarks were met in four out of six categories. Postoperative advice after root canal treatment in the DDUH is both poorly recorded and inconsistently delivered. A combination of oral postoperative instructions and written postoperative advice provided the most effective delivery of patient information.
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Exploring patients' perceptions of accessing electronic health records: Innovation in healthcare.
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.
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Hearing gestures, seeing music: vision influences perceived tone duration.
Schutz, Michael; Lipscomb, Scott
2007-01-01
Percussionists inadvertently use visual information to strategically manipulate audience perception of note duration. Videos of long (L) and short (S) notes performed by a world-renowned percussionist were separated into visual (Lv, Sv) and auditory (La, Sa) components. Visual components contained only the gesture used to perform the note, auditory components the acoustic note itself. Audio and visual components were then crossed to create realistic musical stimuli. Participants were informed of the mismatch, and asked to rate note duration of these audio-visual pairs based on sound alone. Ratings varied based on visual (Lv versus Sv), but not auditory (La versus Sa) components. Therefore while longer gestures do not make longer notes, longer gestures make longer sounding notes through the integration of sensory information. This finding contradicts previous research showing that audition dominates temporal tasks such as duration judgment.
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Allred, Sharon K; Smith, Kevin F; Flowers, Laura
2004-01-01
With the increased interest in evidence-based medicine, Internet access and the growing emphasis on national standards, there is an increased challenge for teaching institutions and nursing services to teach and implement standards. At the same time, electronic clinical documentation tools have started to become a common format for recording nursing notes. The major aim of this paper is to ascertain and assess the availability of clinical nursing tools based on the NANDA, NOC and NIC standards. Faculty at 20 large nursing schools and directors of nursing at 20 hospitals were interviewed regarding the use of nursing standards in clinical documentation packages, not only for teaching purposes but also for use in hospital-based systems to ensure patient safety. A survey tool was utilized that covered questions regarding what nursing standards are being taught in the nursing schools, what standards are encouraged by the hospitals, and teaching initiatives that include clinical documentation tools. Information was collected on how utilizing these standards in a clinical or hospital setting can improve the overall quality of care. Analysis included univariate and bivariate analysis. The consensus between both groups was that the NANDA, NOC and NIC national standards are the most widely taught and utilized. In addition, a training initiative was identified within a large university where a clinical documentation system based on these standards was developed utilizing handheld devices.
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Göransson, Katarina; Lundberg, Johan; Ljungqvist, Olle; Ohlsson, Elisabet; Sandblom, Gabriel
2015-09-01
Poor communication between surgical and anesthesia unit personnel may jeopardize patient safety. Review reports from a national survey on patient safety performed at 17 units 2011-2013 were analyzed in order to identify strategies to reduce risks related to the interaction between surgery and anesthesia. The reports were reviewed in this study by an independent group in order to extract findings related to communication between anesthesia and surgical unit personnel. Suggested strategies to improve patient safety included: uniform national health declaration forms; consistent use of admission notes; uniform systems for documenting medical information; multidisciplinary forum for evaluation of high-risk patients; weekly and daily scheduling of surgical programs; application of the WHO check list; open dialog during surgery; oral and written reports from the surgeon to the postoperative unit; and combined mortality and morbidity conferences.
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THE CHALLENGING ROLE OF A READING COACH, A CAUTIONARY TALE.
Al Otaiba, Stephanie; Hosp, John L; Smartt, Susan; Dole, Janice A
2008-04-01
The purpose of this case study is to describe the challenges one coach faced during the initial implementation of a coaching initiative involving 33 teachers in an urban, high-poverty elementary school. Reading coaches are increasingly expected to play a key role in the professional development efforts to improve reading instruction in order to improve reading achievement for struggling readers. Data sources included initial reading scores for kindergarten and first-graders, pretest and posttest scores of teachers' knowledge, a teacher survey, focus group interviews, project documents, and field notes. Data were analyzed using a mixed methods approach. Findings revealed several challenges that have important implications for research and practice: that teachers encountered new information about teaching early reading that conflicted with their current knowledge, this new information conflicted with their core reading program, teachers had differing perceptions of the role of the reading coach that affected their feelings about the project, and reform efforts are time-intensive.
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Developmental rate and behavior of early life stages of bighead carp and silver carp
Chapman, Duane C.; George, Amy E.
2011-01-01
The early life stages of Asian carp are well described by Yi and others (1988), but since these descriptions are represented by line drawings based only on live individuals and lacked temperature controls, further information on developmental time and stages is of use to expand understanding of early life stages of these species. Bighead carp and silver carp were cultured under two different temperature treatments to the one-chamber gas bladder stage, and a photographic guide is provided for bighead carp and silver carp embryonic and larval development, including notes about egg morphology and larval swimming behavior. Preliminary information on developmental time and hourly thermal units for each stage is also provided. Both carp species developed faster under warmer conditions. Developmental stages and behaviors are generally consistent with earlier works with the exception that strong vertical swimming immediately after hatching was documented in this report.
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Origin of the northern Atlantic`s Heinrich events
DOE Office of Scientific and Technical Information (OSTI.GOV)
Broecker, W.; Bond, G.; Klas, M.
1992-01-01
As first noted by Heinrich, 1988, glacial age sediments in the eastern part of the northern Atlantic contain layers with unusually high ratios of ice-rafted lithic fragments of foraminifera shells. He estimated that these layers are spaced at intervals of roughly 10000 years. In this paper we present detailed information documenting the existence of the upper five of these layers in ODP core 609 from 50{degrees}N and 24{degrees}W. Their ages are respectively 15000 radiocarbon years, 20000 radiocarbon years, 27000 radiocarbon years, about 40000 years, and about 50000 years. We also note that the high lithic fragment to foram ratio ismore » the result of a near absence of shells in these layers. Although we are not of one mind regarding the origin of these layers, we lean toward an explanation that the Heinrich layers are debris released during the melting of massive influxes of icebergs into the northern Atlantic. These sudden inputs may be the result of surges along the eastern margin of the Laurentide ice sheet. 7 refs., 3 figs., 2 tabs.« less
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Reid, Gavin; Deponio, Pamela; Davidson Petch, Louise
2005-08-01
This article reports on research commissioned by the Scottish Executive Education Department (SEED). It aimed to establish the range and extent of policy and provision in the area of specific learning difficulties (SpLD) and dyslexia throughout Scotland. The research was conducted between January and June 2004 by a team from the University of Edinburgh. The information was gathered from a questionnaire sent to all education authorities (100% response rate was achieved). Additional information was also obtained from supplementary interviews and additional materials provided by education authorities. The results indicated that nine education authorities in Scotland (out of 32) have explicit policies on dyslexia and eight authorities have policies on SpLD. It was noted however that most authorities catered for dyslexia and SpLD within a more generic policy framework covering aspects of Special Educational Needs or within documentation on 'effective learning'. In relation to identification thirty-six specific tests, or procedures, were mentioned. Classroom observation, as a procedure was rated high by most authorities. Eleven authorities operated a formal staged process combining identification and intervention. Generally, authorities supported a broader understanding of the role of identification and assessment and the use of standardized tests was only part of a wider assessment process. It was however noted that good practice in identification and intervention was not necessarily dependent on the existence of a dedicated policy on SpLD/dyslexia. Over fifty different intervention strategies/programmes were noted in the responses. Twenty-four authorities indicated that they had developed examples of good practice. The results have implications for teachers and parents as well as those involved in staff development. Pointers are provided for effective practice and the results reflect some of the issues on the current debate on dyslexia particularly relating to early identification.
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ERIC/RCS Report: Animals in Literature.
ERIC Educational Resources Information Center
O'Donnell, Holly
1980-01-01
Notes children's continuing interest in animal stories, examines some characteristics of animal stories as discussed in ERIC documents, and suggests booklists that include listings of animal stories. (ET)
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The $$ Game: A Guidebook on the Funding of Law-Related Educational Programs. Working Notes, No. 7.
ERIC Educational Resources Information Center
White, Charles J., III, Ed.
This document addresses itself to the securing of funds necessary to maintain or fund law-related education projects. Drawing on the expertise of project directors who have been successful in securing funds, this document was put together as a guide to the funding process. Essays provide guidance to locating funding sources, writing proposals,…
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Defense Industrial Base Assessment: U.S. Space Industry
2007-08-31
Approved for public release; distribution is unlimited. Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection...DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release, distribution unlimited 13. SUPPLEMENTARY NOTES The original document contains color...profitability and a refusal of some foreign customers to procure equipment that requires U.S. ITAR licensing.” The BIS survey addressed
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The Pedagogy of Teaching Educational Vision: A Vision Coach's Field Notes about Leaders as Learners
ERIC Educational Resources Information Center
Schein, Jeffrey
2009-01-01
The emerging field of educational visioning is full of challenges and phenomena worthy of careful analysis and documentation. A relatively neglected phenomenon is the learning curve of the leaders (often lay leaders) involved in the visioning process. This article documents a range of experiences of the author serving as a vision coach to five…
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ERIC Educational Resources Information Center
van der Heide, D. C.; van der Putten, A. A. J.; van den Berg, P. B.; Taxis, K.; Vlaskamp, C.
2009-01-01
Background: Persons with profound intellectual and multiple disabilities (PIMD) suffer from a wide range of health problems and use a wide range of different drugs. This study investigated for frequently used medication whether there was a health problem documented in the medical notes for the drug prescribed. Method: Persons with PIMD with an…
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"Records of Rights": A New Exhibit at the National Archives in Washington, D.C.
ERIC Educational Resources Information Center
Hussey, Michael
2014-01-01
America's founding documents--the Declaration of Independence, the Constitution, and the Bill of Rights--are icons of human liberty. But the ideals enshrined in those documents did not initially apply to all Americans. They were, in the words of Martin Luther King, Jr., "a promissory note to which every American was to fall heir."…
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-10-01
... list of guidance documents the Center for Devices and Radiological Health (CDRH) is considering for... annually posting a list of guidance documents that CDRH is considering for development and providing... CDRH is intending to work over the next Fiscal Year (FY). We note that the agency is not required to...
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ERIC Educational Resources Information Center
Seefeldt, Steve, Comp.
Provided in this document are descriptions of reforestation projects and techniques presented by Peace Corps volunteers from Chad, Ivory Coast, Upper Volta, and Niger. The purpose of the document is to aid individuals in trying to find solutions to the problems facing forestry in the Sahel. These projects include: (1) reforestation of Ronier palm…
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Gilgenkrantz, Simone
2011-05-01
Gathering archival documents to trace the history of the Zeiss company presents no difficulty : they are abundant… except for a period from 1932 to 1945, systematically ignored, and that corresponds to the Nazi period. On the website Zeiss Historica, among the outstanding personalities of the Zeiss company, we note that, for Professor Emanuel Goldberg, the web page « is still under development but an early picture of the professor is available. ». But fortunately, Mickael Buckland, a Professor at the UC Berkeley School of Information brought the life and the work of Emanuel Goldberg to light. Thanks to him, his works and innovations, who had disappeared from our cultural and scientific heritage, return to light after being erased during fifty years. Goldberg had published dozens of articles, obtained patents, developed cameras, microdots, movie cameras, and he designed what he called a "Statistical Machine ", the first electronic document retrieval machine. In France, if this rediscovery was made known to the world of information science, it has not had the impact it deserved in the scientific world. Therefore it is time to reconstruct his career and his work, and to analyse the reasons why some attempted to erase definitively his name and memory. © 2011 médecine/sciences - Inserm / SRMS.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Johnson, Gary E.; Sutherland, G. Bruce
The 2008 Columbia River Estuary Conference was held at the Liberty Theater in Astoria, Oregon, on April 19-20. The conference theme was ecosystem restoration. The purpose of the conference was to exchange data and information among researchers, policy-makers, and the public, i.e., interrelate science with management. Conference organizers invited presentations synthesizing material on Restoration Planning and Implementation (Session 1), Research to Reduce Restoration Uncertainties (Session 2), Wetlands and Flood Management (Session 3), Action Effectiveness Monitoring (Session 4), and Management Perspectives (Session 5). A series of three plenary talks opened the conference. Facilitated speaker and audience discussion periods were held atmore » the end of each session. Contributed posters conveyed additional data and information. These proceedings include abstracts and notes documenting questions from the audience and clarifying answers from the presenter for each talk. The proceedings also document key points from the discussion periods at the end of each session. The conference program is outlined in the agenda section. Speaker biographies are presented in Appendix A. Poster titles and authors are listed in Appendix B. A list of conference attendees is contained in Appendix C. A compact disk, attached to the back cover, contains material in hypertext-markup-language from the conference website (http://cerc.labworks.org/) and the individual presentations.« less
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EMP-002a Phase Shift through the Ionosphere
DOE Office of Scientific and Technical Information (OSTI.GOV)
Soltz, R.; Simons, D.; Fenimore, E.
2015-10-20
In this note we review the derivation and use of the Ionospheric Transfer Function (ITF) in the DIO- RAMA model to calculate the propagation of a broad band ElectroMagnetic Pulse (EMP) through the Ionosphere in the limit of geometric optics. This note is intended to resolve a misunderstanding between the NDS VVA and EMP modeling teams regarding the appropriate use of the phase and group velocities in DIORAMA. The di erent approaches are documented in EMP-002 note, \\Phase vs. Group" [1], generated by the LLNL DIORAMA VVA team, and the subsequent response from the DIORAMA EMP modeling team' [2].
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Powell-Bowns, M; Wilson, M S J; Mustafa, A
2015-12-01
To determine whether pregnancy status, gynaecological history, date of last menstrual period and contraceptive use are documented in emergency female admissions of reproductive age admitted to general surgery. This is a retrospective study. This study was conducted in the United Kingdom. Females of reproductive age (12-50 years) admitted as an emergency to general surgery with abdominal pain were considered in this study. Retrospective analysis of medical notes of emergency female admissions with abdominal pain between January and September 2012. We recorded whether a pregnancy test result was documented (cycle 1). Results were analysed and a prompt added to the medical clerk-in document. We re-audited (cycle 2) between January and June 2013 looking for improvement. Documented pregnancy status within 24 h of admission and prior to any surgical intervention. 100 case notes were reviewed in stage 1. 30 patients (30 %) had a documented pregnancy status. 32 (32 %), 25 (25 %) and 29 (29 %) had a documented gynaecology history, contraceptive use and date of last menstrual period (LMP), respectively. 24 patients underwent emergency surgery, 6 (25 %) had a documented pregnancy status prior to surgery. Of 50 patients reviewed in stage 2, 37 (75.0 %) had a documented pregnancy status (p < 0.001), with 41 (82 %) having both gynaecological history (p < 0.0001) and contraceptive use (p < 0.0001) documented. 40 patients (80 % had a documented LMP (p < 0.0001). 7 patients required surgery, of whom 6 (85.7 %) had a documented pregnancy test prior to surgery (p = 0.001). All pregnancy tests were negative. A simple prompt in the surgical admission document has significantly improved the documentation of pregnancy status and gynaecological history in our female patients, particularly in those who require surgical intervention. A number of patient safety concerns were addressed locally, but require a coordinated, interdisciplinary discussion and a national guideline. A minimum standard of care, in females of reproductive age, should include mandatory objective documentation of pregnancy status, whether or not they require surgical intervention.
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Preliminary surficial geologic map of the Newberry Springs 30' x 60' quadrangle, California
Phelps, G.A.; Bedford, D.R.; Lidke, D.J.; Miller, D.M.; Schmidt, K.M.
2012-01-01
The Newberry Springs 30' x 60' quadrangle is located in the central Mojave Desert of southern California. It is split approximately into northern and southern halves by I-40, with the city of Barstow at its western edge and the town of Ludlow near its eastern edge. The map area spans lat 34°30 to 35° N. to long -116 °to -117° W. and covers over 1,000 km2. We integrate the results of surficial geologic mapping conducted during 2002-2005 with compilations of previous surficial mapping and bedrock geologic mapping. Quaternary units are subdivided in detail on the map to distinguish variations in age, process of formation, pedogenesis, lithology, and spatial interdependency, whereas pre-Quaternary bedrock units are grouped into generalized assemblages that emphasize their attributes as hillslope-forming materials and sources of parent material for the Quaternary units. The spatial information in this publication is presented in two forms: a spatial database and a geologic map. The geologic map is a view (the display of an extracted subset of the database at a given time) of the spatial database; it highlights key aspects of the database and necessarily does not show all of the data contained therein. The database contains detailed information about Quaternary geologic unit composition, authorship, and notes regarding geologic units, faults, contacts, and local vegetation. The amount of information contained in the database is too large to show on a single map, so a restricted subset of the information was chosen to summarize the overall nature of the geology. Refer to the database for additional information. Accompanying the spatial data are the map documentation and spatial metadata. The map documentation (this document) describes the geologic setting and history of the Newberry Springs map sheet, summarizes the age and physical character of each map unit, and describes principal faults and folds. The Federal Geographic Data Committee (FGDC) compliant metadata provides detailed information about the digital files and file structure of the spatial data.
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ERIC Educational Resources Information Center
Haggart, S. A.; Furry, W. S.
This Working Note documents the first year's events and outcomes in developing the budgeting system and resource allocation rules to support the Education Voucher Demonstration. The district now has systems for per pupil resource allocation and school/minischool cost center accounting. The basic voucher of $1,041 for grades 7-8, and $788 for…
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Buck, Deborah; Gamble, Carrol; Dudley, Louise; Preston, Jennifer; Hanley, Bec; Williamson, Paula R; Young, Bridget
2014-01-01
Patient and public involvement (PPI) in research is increasingly required, although evidence to inform its implementation is limited. Objective Inform the evidence base by describing how plans for PPI were implemented within clinical trials and identifying the challenges and lessons learnt by research teams. Methods We compared PPI plans extracted from clinical trial grant applications (funded by the National Institute for Health Research Health Technology Assessment Programme between 2006 and 2010) with researchers’ and PPI contributors’ interview accounts of PPI implementation. Analysis of PPI plans and transcribed qualitative interviews drew on the Framework technique. Results Of 28 trials, 25 documented plans for PPI in funding applications and half described implementing PPI before applying for funding. Plans varied from minimal to extensive, although almost all anticipated multiple modes of PPI. Interview accounts indicated that PPI plans had been fully implemented in 20/25 trials and even expanded in some. Nevertheless, some researchers described PPI within their trials as tokenistic. Researchers and contributors noted that late or minimal PPI engagement diminished its value. Both groups perceived uncertainty about roles in relation to PPI, and noted contributors’ lack of confidence and difficulties attending meetings. PPI contributors experienced problems in interacting with researchers and understanding technical language. Researchers reported difficulties finding ‘the right’ PPI contributors, and advised caution when involving investigators’ current patients. Conclusions Engaging PPI contributors early and ensuring ongoing clarity about their activities, roles and goals, is crucial to PPI's success. Funders, reviewers and regulators should recognise the value of preapplication PPI and allocate further resources to it. They should also consider whether PPI plans in grant applications match a trial's distinct needs. Monitoring and reporting PPI before, during and after trials will help the research community to optimise PPI, although the need for ongoing flexibility in implementing PPI should also be recognised. PMID:25475243
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Feasibility and Acceptability of a Best Supportive Care Checklist among Clinicians.
Boucher, Nathan A; Nicolla, Jonathan; Ogunseitan, Adeboye; Kessler, Elizabeth R; Ritchie, Christine S; Zafar, Yousuf Y
2018-04-23
Best supportive care (BSC) is often not standardized across sites, consistent with best evidence, or sufficiently described. We developed a consensus-based checklist to document BSC delivery, including symptom management, decision making, and care planning. We hypothesized that BSC can be feasibly documented with this checklist consistent with consolidated standards of reporting trials. To determine feasibility/acceptability of a BSC checklist among clinicians. To test feasibility of a BSC checklist in standard care, we enrolled a sample of clinicians treating patients with advanced cancer at four centers. Clinicians were asked to complete the checklist at eligible patient encounters. We surveyed enrollees regarding checklist use generating descriptive statistics and frequencies. We surveyed 15 clinicians and 9 advanced practice providers. Mean age was 41 (SD = 7.9). Mean years since fellowship for physicians was 7.2 (SD = 4.5). Represented specialties are medical oncology (n = 8), gynecologic oncology (n = 4), palliative care (n = 2), and other (n = 1). For "overall impact on your delivery of supportive/palliative care," 40% noted improved impact with using BSC. For "overall impact on your documentation of supportive/palliative care," 46% noted improvement. Impact on "frequency of comprehensive symptom assessment" was noted to be "increased" by 33% of providers. None noted decreased frequency or worsening impact on any measure with use of BSC. Regarding feasibility of integrating the checklist into workflow, 73% agreed/strongly agreed that checklists could be easily integrated, 73% saw value in integration, and 80% found it easy to use. Clinicians viewed the BSC checklist favorably illustrating proof of concept, minor workflow impact, and potential of benefit to patients.
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Semantic Document Library: A Virtual Research Environment for Documents, Data and Workflows Sharing
NASA Astrophysics Data System (ADS)
Kotwani, K.; Liu, Y.; Myers, J.; Futrelle, J.
2008-12-01
The Semantic Document Library (SDL) was driven by use cases from the environmental observatory communities and is designed to provide conventional document repository features of uploading, downloading, editing and versioning of documents as well as value adding features of tagging, querying, sharing, annotating, ranking, provenance, social networking and geo-spatial mapping services. It allows users to organize a catalogue of watershed observation data, model output, workflows, as well publications and documents related to the same watershed study through the tagging capability. Users can tag all relevant materials using the same watershed name and find all of them easily later using this tag. The underpinning semantic content repository can store materials from other cyberenvironments such as workflow or simulation tools and SDL provides an effective interface to query and organize materials from various sources. Advanced features of the SDL allow users to visualize the provenance of the materials such as the source and how the output data is derived. Other novel features include visualizing all geo-referenced materials on a geospatial map. SDL as a component of a cyberenvironment portal (the NCSA Cybercollaboratory) has goal of efficient management of information and relationships between published artifacts (Validated models, vetted data, workflows, annotations, best practices, reviews and papers) produced from raw research artifacts (data, notes, plans etc.) through agents (people, sensors etc.). Tremendous scientific potential of artifacts is achieved through mechanisms of sharing, reuse and collaboration - empowering scientists to spread their knowledge and protocols and to benefit from the knowledge of others. SDL successfully implements web 2.0 technologies and design patterns along with semantic content management approach that enables use of multiple ontologies and dynamic evolution (e.g. folksonomies) of terminology. Scientific documents involved with many interconnected entities (artifacts or agents) are represented as RDF triples using semantic content repository middleware Tupelo in one or many data/metadata RDF stores. Queries to the RDF enables discovery of relations among data, process and people, digging out valuable aspects, making recommendations to users, such as what tools are typically used to answer certain kinds of questions or with certain types of dataset. This innovative concept brings out coherent information about entities from four different perspectives of the social context (Who-human relations and interactions), the casual context (Why - provenance and history), the geo-spatial context (Where - location or spatially referenced information) and the conceptual context (What - domain specific relations, ontologies etc.).
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Isoardi, Jonathon; Spencer, Lyndall; Sinnott, Michael; Nicholls, Kim; O'Connor, Angela; Jones, Fleur
2013-08-01
The primary objective of the present study was to learn the factors that influence the documentation practices of ED interns. A second objective was to identify the expectations of emergency physicians (EPs) towards the medical record documentation of ED interns. A qualitative design was adopted using semi-structured interviews in convenience samples drawn from both groups. Eighteen interviews were conducted with intern volunteers and 10 with EP volunteers. One (5%) intern and two (20%) EPs had received medical documentation training. Factors that encouraged interns' documentation included: patient acuity (the more critical the condition, the more comprehensive the documentation) and the support of senior colleagues. Inhibiting factors included uncertainty about how much to write, and the shift being worked (interns indicated they wrote less at night). Factors of consequence to senior personnel included the apparent reluctance of interns to document management plans. They noted that interns frequently confine their notes to assessment, investigations and treatments, whereas EPs preferred records that demonstrated intern thought processes and included such matters as future actions to follow immediate treatment. A positive theme that emerged included the high level of support interns received from their senior colleagues. Another theme, the influence of patient acuity, held both positive and negative implications for intern writing practices. The lack of formal training is an impediment to the production of useful medical records by ED interns. One solution proposed by both interns and senior personnel was the introduction of the subject into intern education programmes. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
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Köhler, Marie; Rosvall, Maria; Emmelin, Maria
2016-08-15
Knowledge about social determinants of health has influenced global health strategies, including early childhood interventions. Some psychosocial circumstances - such as poverty, parental mental health problems, abuse and partner violence - increase the risk of child maltreatment and neglect. Healthcare professionals' awareness of psychosocial issues is of special interest, since they both have the possibility and the obligation to identify vulnerable children. Child Health Services health records of 100 children in Malmö, Sweden, who had been placed in, or were to be placed in family foster care, were compared with health records of a matched comparison group of 100 children who were not placed in care. A mixed-method approach integrating quantitative and qualitative analysis was applied. The documentation about the foster care group was more voluminous than for the comparison group. The content was problem-oriented and dominated by severe parental health and social problems, while the child's own experiences were neglected. The professionals documented interaction with healthcare and social functions, but very few reports to the Social Services were noted. For both groups, notes about social structures were almost absent. Child Health Service professionals facing vulnerable children document parental health issues and interaction with healthcare, but they fail to document living conditions thereby making social structures invisible in the health records. The child perspective is insufficiently integrated in the documentation and serious child protection needs remain unmet, if professionals avoid reporting to Social Services.
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Standards for hospital libraries 2002
Gluck, Jeannine Cyr; Hassig, Robin Ackley; Balogh, Leeni; Bandy, Margaret; Doyle, Jacqueline Donaldson; Kronenfeld, Michael R.; Lindner, Katherine Lois; Murray, Kathleen; Petersen, JoAn; Rand, Debra C.
2002-01-01
The Medical Library Association's “Standards for Hospital Libraries 2002” have been developed as a guide for hospital administrators, librarians, and accrediting bodies to ensure that hospitals have the resources and services to effectively meet their needs for knowledge-based information. Specific requirements for knowledge-based information include that the library be a separate department with its own budget. Knowledge-based information in the library should be directed by a qualified librarian who functions as a department head and is a member of the Academy of Health Information Professionals. The standards define the role of the medical librarian and the links between knowledge-based information and other functions such as patient care, patient education, performance improvement, and education. In addition, the standards address the development and implementation of the knowledge-based information needs assessment and plans, the promotion and publicity of the knowledge-based information services, and the physical space and staffing requirements. The role, qualifications, and functions of a hospital library consultant are outlined. The health sciences library is positioned to play a key role in the hospital. The increasing use of the Internet and new information technologies by medical, nursing, and allied health staffs; patients; and the community require new strategies, strategic planning, allocation of adequate resources, and selection and evaluation of appropriate information resources and technologies. The Hospital Library Standards Committee has developed this document as a guideline to be used in facing these challenges. Editor's Note: The “Standards for Hospital Libraries 2002” were approved by the members of the Hospital Library Section during MLA '02 in Dallas, Texas. They were subsequently approved by Section Council and received final approval from the MLA Board of Directors in June 2002. They succeed the Standards for Hospital Libraries published in 1994 and the Minimum Standards for Health Sciences Libraries in Hospitals from 1983. A Frequently Asked Questions document discussing the development of the new standards can be found on the Hospital Library Section Website at http://www.hls.mlanet.org. PMID:12398254
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Technical Assistance for the Conservation of Built Heritage at Bagan, Myanmar
NASA Astrophysics Data System (ADS)
Mezzino, D.; Santana Quintero, M.; Ma Pwint, P.; Tin Htut Latt, W.; Rellensmann, C.
2016-06-01
Presenting the outcomes of a capacity building activity, this contribution illustrates a replicable recording methodology to obtain timely, relevant and accurate information about conditions, materials and transformations of heritage structures. The purpose of the presented training activity consisted in developing local capabilities for the documentation of the built heritage at Bagan, Myanmar, employing different IT-supported techniques. Under the Director of UNESCO, the direct supervision of the chief of the culture unit, and in close consultation and cooperation with the Association of Myanmar Architects, the Department of Archaeology National Museum and Library (DoA) a documentation strategy has been developed in order to set up a recording methodology for the over three thousand Bagan monuments. The site, located in central Myanmar, in South East Asia, was developed between the IX and the XIII century as capital of the Myanmar kingdom. In the last years, this outstanding site has been exposed to an increasing number of natural hazards including earthquakes and flooding that strongly affected its built structures. Therefore, a documentation strategy to quickly capture shape, color, geometry and conditions of the monuments, in order to develop proper conservation projects, was needed. The scope of the training activity consisted in setting up a recording strategy updating the existing Bagan inventory, using three Buddhist temples as pilot cases study. The three documented temples were different in size, construction period, conditions and shape. The documentation included several IT-supported techniques including: Electronic Distance Measurements (EDM), SFM Photogrammetry, Laser Scanning, Record Photography as well as hand measurement and field notes. The monuments' surveying has been developed in accordance with the guidelines and standards established by the ICOMOS International Committee for Documentation of Cultural Heritage (CIPA). Recommendations on how to extend the adopted methodology to the other Bagan monuments have been also elaborated.
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Newman, Eric D; Lerch, Virginia; Billet, Jon; Berger, Andrea; Kirchner, H Lester
2015-04-01
Electronic health records (EHRs) are not optimized for chronic disease management. To improve the quality of care for patients with rheumatic disease, we developed electronic data capture, aggregation, display, and documentation software. The software integrated and reassembled information from the patient (via a touchscreen questionnaire), nurse, physician, and EHR into a series of actionable views. Core functions included trends over time, rheumatology-related demographics, and documentation for patient and provider. Quality measures collected included patient-reported outcomes, disease activity, and function. The software was tested and implemented in 3 rheumatology departments, and integrated into routine care delivery. Post-implementation evaluation measured adoption, efficiency, productivity, and patient perception. Over 2 years, 6,725 patients completed 19,786 touchscreen questionnaires. The software was adopted for use by 86% of patients and rheumatologists. Chart review and documentation time trended downward, and productivity increased by 26%. Patient satisfaction, activation, and adherence remained unchanged, although pre-implementation values were high. A strong correlation was seen between use of the software and disease control (weighted Pearson's correlation coefficient 0.5927, P = 0.0095), and a relative increase in patients with low disease activity of 3% per quarter was noted. We describe innovative software that aggregates, stores, and displays information vital to improving the quality of care for patients with chronic rheumatic disease. The software was well-adopted by patients and providers. Post-implementation, significant improvements in quality of care, efficiency of care, and productivity were demonstrated. Copyright © 2015 by the American College of Rheumatology.
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NASA Astrophysics Data System (ADS)
Caballero, L. B.; Castillo, M. M.; Van Balen, K.
2017-08-01
Recent policies adopted in Cuba are producing a significant turn into the country's socioeconomic dynamics. Past shifting circumstances have demonstrated the positive and negative implications on heritage sites. In this regard, this paper presents a first stage of a research project aimed at monitoring the impact of socioeconomic dynamics on local heritage sites. The research partial results focus on the documentation of the evolution of a case study: Vista Alegre District in the city of Santiago de Cuba. Scholars have noted that the District's urban design and historic building stock represent its most significant heritage values. Such qualities are under permanent threat due to transformations and deterioration. In order to analyse current site condition, and to understand transformations as a result of socioeconomic dynamics, a Geographic Information System (GIS) was implemented as a monitoring and documenting tool. The GIS allowed integrating data related to the evolution of the urban layout, and the heritage buildings. Data was sourced from heritage management and urban planning offices, as well as from previous studies on the site. In addition, the analysis of remote sensing imagery, and a field survey helped to update the existing records, and to include new information with the purpose of assessing the integrity of heritage values. At this stage, maps that describe the site evolution, the significant changes over time, and the alterations to character defining elements served to identify sectors of different scenic qualities. Results are essential to contribute to draft management strategies as part of decision making.
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ERIC Educational Resources Information Center
Peyrefitte, Magali; Lazar, Gillian
2018-01-01
This teaching note describes the design and implementation of an activity in a 90-minute teaching session that was developed to introduce a diverse cohort of first-year criminology and sociology students to the use of documents as sources of data. This approach was contextualized in real-world research through scaffolded, student-centered tasks…
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Spectral Characterization of RDX, ETN, PETN, TATP, HMTD, HMX, and C-4 in the Mid-Infrared Region
2014-04-01
Samuels Joseph A. Domanico Joseph May Ronald W. Miles, Jr. Augustus W. Fountain III RESEARCH AND TECHNOLOGY DIRECTORATE April 2014 Approved for public ...position unless so designated by other authorizing documents. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting...AVAILABILITY STATEMENT Approved for public release; distribution is unlimited. 13. SUPPLEMENTARY NOTES *Science Applications International Corporation
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Code of Federal Regulations, 2011 CFR
2011-10-01
... officer shall perform market research and document why a small business set-aside is inappropriate when an... market price. [48 FR 42240, Sept. 19, 1983] Editorial Note: For Federal Register citations affecting...
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Sampling and analyses plan for tank 103 at the 219-S waste handling facility
DOE Office of Scientific and Technical Information (OSTI.GOV)
FOWLER, K.D.
1999-06-23
This document describes the sampling and analysis activities associated with taking a Resource Conservation and Recovery Act (RCRA) protocol sample of the waste from Tank 103 at the 21 9-S Waste Handling Facility treatment storage, andlor disposal (TSD) unit at the 2224 Laboratory complex. This sampling and analyses is required based on negotiations between the State of Washington Department of Ecology (Ecology) and the Department of Energy, Richland Operations, (RL) in letters concerning the TPA Change Form M-32-98-01. In a letter from George H. Sanders, RL to Moses N. Jaraysi, Ecology, dated January 28,1999, it was noted that ''Prior tomore » the Tank 103 waste inventory transfer, a RCRA protocol sample of the waste will be obtained and tested for the constituents contained on the Part A, Form 3 Permit Application for the 219-S Waste Handling Facility.'' In the April 2, 1999 letter, from Brenda L. Becher-Khaleel, Ecology to James, E. Rasmussen, RL, and William O. Adair, FDH, Ecology states that the purpose of these analyses is to provide information and justification for leaving Tank 103 in an isolated condition in the 2194 TSD unit until facility closure. The data may also be used at some future date in making decisions regarding closure methodology for Tank 103. Ecology also notes that As Low As Reasonably Achievable (ALARA) concerns may force deviations from some SW-846 protocol. Every effort will be made to accommodate requirements as specified. Deviations from SW-846 will be documented in accordance with HASQARD.« less
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Process and implementation of participatory ergonomic interventions: a systematic review.
van Eerd, Dwayne; Cole, Donald; Irvin, Emma; Mahood, Quenby; Keown, Kiera; Theberge, Nancy; Village, Judy; St Vincent, Marie; Cullen, Kim
2010-10-01
Participatory ergonomic (PE) interventions may vary in implementation. A systematic review was done to determine the evidence regarding context, barriers and facilitators to the implementation of participatory ergonomic interventions in workplaces. In total, 17 electronic databases were searched. Data on PE process and implementation were extracted from documents meeting content and quality criteria and synthesised. The search yielded 2151 references. Of these, 190 documents were relevant and 52 met content and quality criteria. Different ergonomic teams were described in the documents as were the type, duration and content of ergonomic training. PE interventions tended to focus on physical and work process changes and report positive impacts. Resources, programme support, ergonomic training, organisational training and communication were the most often noted facilitators or barriers. Successful PE interventions require the right people to be involved, appropriate ergonomic training and clear responsibilities. Addressing key facilitators and barriers such as programme support, resources, and communication is paramount. STATEMENT OF RELEVANCE: A recent systematic review has suggested that PE has some effect on reducing symptoms, lost days of work and claims. Systematic reviews of effectiveness provide practitioners with the desire to implement but do not provide clear information about how. This article reviews the literature on process and implementation of PE.
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Kleczka, Bernadette; Musiega, Anita; Rabut, Grace; Wekesa, Phoebe; Mwaniki, Paul; Marx, Michael; Kumar, Pratap
2018-06-01
The United Nations' Sustainable Development Goal #3.8 targets 'access to quality essential healthcare services'. Clinical practice guidelines are an important tool for ensuring quality of clinical care, but many challenges prevent their use in low-resource settings. Monitoring the use of guidelines relies on cumbersome clinical audits of paper records, and electronic systems face financial and other limitations. Here we describe a unique approach to generating digital data from paper using guideline-based templates, rubber stamps and mobile phones. The Guidelines Adherence in Slums Project targeted ten private sector primary healthcare clinics serving informal settlements in Nairobi, Kenya. Each clinic was provided with rubber stamp templates to support documentation and management of commonly encountered outpatient conditions. Participatory design methods were used to customize templates to the workflows and infrastructure of each clinic. Rubber stamps were used to print templates into paper charts, providing clinicians with checklists for use during consultations. Templates used bubble format data entry, which could be digitized from images taken on mobile phones. Besides rubber stamp templates, the intervention included booklets of guideline compilations, one Android phone for digitizing images of templates, and one data feedback/continuing medical education session per clinic each month. In this paper we focus on the effect of the intervention on documentation of three non-communicable diseases in one clinic. Seventy charts of patients enrolled in the chronic disease program (hypertension/diabetes, n=867; chronic respiratory diseases, n=223) at one of the ten intervention clinics were sampled. Documentation of each individual patient encounter in the pre-intervention (January-March 2016) and post-intervention period (May-July) was scored for information in four dimensions - general data, patient assessment, testing, and management. Control criteria included information with no counterparts in templates (e.g. notes on presenting complaints, vital signs). Documentation scores for each patient were compared between both pre- and post-intervention periods and between encounters documented with and without templates (post-intervention only). The total number of patient encounters in the pre-intervention (282) and post-intervention periods (264) did not differ. Mean documentation scores increased significantly in the post-intervention period on average by 21%, 24% and 17% for hypertension, diabetes and chronic respiratory diseases, respectively. Differences were greater (47%, 43% and 27%, respectively) when documentation with and without templates was compared. Changes between pre- vs.post-intervention, and with vs.without template, varied between individual dimensions of documentation. Overall, documentation improved more for general data and patient assessment than in testing or management. The use of templates improves paper-based documentation of patient care, a first step towards improving the quality of care. Rubber stamps provide a simple and low-cost method to print templates on demand. In combination with ubiquitously available mobile phones, information entered on paper can be easily and rapidly digitized. This 'frugal innovation' in m-Health can empower small, private sector facilities, where large numbers of urban patients seek healthcare, to generate digital data on routine outpatient care. These data can form the basis for evidence-based quality improvement efforts at large scale, and help deliver on the SDG promise of quality essential healthcare services for all. Copyright © 2017 Elsevier B.V. All rights reserved.
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Marathon of eponyms: 7 Gorlin-Goltz syndrome (Naevoid basal-cell carcinoma syndrome).
Scully, C; Langdon, J; Evans, J
2010-01-01
The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital-centred practitioners. This series has selected some of the more recognized relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarizes data about Gorlin-Goltz syndrome.
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Marathon of eponyms: 17 Quincke oedema (Angioedema).
Scully, C; Langdon, J; Evans, J
2011-04-01
The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital-centred practitioners. This series has selected some of the more recognized relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarizes data about Quincke's oedema. © 2011 John Wiley & Sons A/S.
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Marathon of eponyms: 2 Bell palsy (idiopathic facial palsy).
Scully, C; Langdon, J; Evans, J
2009-05-01
The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185-186). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital-centred practitioners. This series has selected some of the more recognised relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarises data about Bell paralysis.
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Coteaching in physical education: a strategy for inclusive practice.
Grenier, Michelle A
2011-04-01
Qualitative research methods were used to explore the factors that informed general and adapted physical education teachers' coteaching practices within an inclusive high school physical education program. Two physical education teachers and one adapted physical education teacher were observed over a 16-week period. Interviews, field notes, and documents were collected and a constant comparative approach was used in the analysis that adopted a social model framework. Primary themes included community as the cornerstone for student learning, core values of trust and respect, and creating a natural support structure. Coteaching practices existed because of the shared values of teaching, learning, and the belief that all students should be included. Recommendations include shifting orientations within professional preparation programs to account for the social model of disability.
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Muggli, Monique E; LeGresley, Eric M; Hurt, Richard D
2004-05-29
The 1998 State of Minnesota legal settlement with the tobacco industry required British American Tobacco (BAT) to provide public access to the 8 million pages housed in its document depository located near Guildford, UK, and to any company documents sent to the Minnesota depository. While the Minnesota depository is managed by an independent third party, BAT's Guildford depository is run by the company itself. Starkly different from the Minnesota depository, at the Guildford depository it is extraordinarily more difficult to access, search, and obtain requested documents. BAT's approach to running the Guildford depository, in our view, amounts to concealing what is supposed to be public information. Newly produced BAT documents from subsequent litigation, dating from 1996 to 2001 disclose the company's efforts to gather intelligence on visitors and their work. We believe that BAT has acted to make access to information more difficult by delaying document production requested by public visitors and refusing to supply requested documents in an electronic format despite, in the company's own words, the establishment of "big time imaging" capabilities at the Guildford depository. During testimony in 2000, then BAT Chairman, Martin Broughton stated to the UK House of Commons Health Select Committee that the scanning and subsequent placement of the Guildford collection online "would be an extreme effort for absolutely no purpose whatsoever", stating that "there is no indication to me that serious researchers are showing any interest in the papers em leader ". New documents show that not only did the company recognise the importance of research undertaken by visitors, but also invested substantial resources and undertook numerous scanning projects during that time. The vulnerability of this important resource is demonstrated by the decreased number of files listed on the electronic database and the inadvertent deletion of an audio tape housed at the depository. With regard to intelligence gathering, BAT's law firm reported to BAT on the daily activities of depository visitors. Despite assurances to the contrary, these depository visitor reports show that BAT apparently tracked the database searches of a visitor. The company also tracked the physical movement of visitors and, in at least one instance, observed and noted the personal mobile phone use of a visitor. These activities raise ethical issues about BAT and/or its solicitors observing the work of lawyers and researchers representing health and government bodies. Given this new evidence, we assert that BAT is incapable of operating its depository in the spirit of the Minnesota settlement and should, therefore, be divorced from its operation. Accordingly, we recommend that the company provide its entire document collection electronically to interested parties thus allowing greater access to the public-health community as has been done in the USA.
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The Composer's Program Note for Newly Written Classical Music: Content and Intentions.
Blom, Diana M; Bennett, Dawn; Stevenson, Ian
2016-01-01
In concerts of western classical music the provision of a program note is a widespread practice dating back to the 18th century and still commonly in use. Program notes tend to inform listeners and performers about historical context, composer biographical details, and compositional thinking. However, the scant program note research conducted to date reveals that program notes may not foster understanding or enhance listener enjoyment as previously assumed. In the case of canonic works, performers and listeners may already be familiar with much of the program note information. This is not so in the case of newly composed works, which formed the basis of the exploratory study reported here. This article reports the views of 17 living contemporary composers on their writing of program notes for their own works. In particular, the study sought to understand the intended recipient, role and the content of composer-written program notes. Participating composers identified three main roles for their program notes: to shape a performer's interpretation of the work; to guide, engage or direct the listener and/or performer; and as collaborative mode of communication between the composer, performer, and listener. For some composers, this collaboration was intended to result in "performative listening" in which listeners were actively engaged in bringing each composition to life. This was also described as a form of empathy that results in the co-construction of the musical experience. Overall, composers avoided giving too much personal information and they provided performers with more structural information. However, composers did not agree on whether the same information should be provided to both performers and listeners. Composers' responses problematize the view of a program note as a simple statement from writer to recipient, indicating instead a more complex set of relations at play between composer, performer, listener, and the work itself. These relations are illustrated in a model. There are implications for program note writers and readers, and for educators. Future research might seek to enhance understanding of program notes, including whether the written program note is the most effective format for communications about music.
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The Composer’s Program Note for Newly Written Classical Music: Content and Intentions
Blom, Diana M.; Bennett, Dawn; Stevenson, Ian
2016-01-01
In concerts of western classical music the provision of a program note is a widespread practice dating back to the 18th century and still commonly in use. Program notes tend to inform listeners and performers about historical context, composer biographical details, and compositional thinking. However, the scant program note research conducted to date reveals that program notes may not foster understanding or enhance listener enjoyment as previously assumed. In the case of canonic works, performers and listeners may already be familiar with much of the program note information. This is not so in the case of newly composed works, which formed the basis of the exploratory study reported here. This article reports the views of 17 living contemporary composers on their writing of program notes for their own works. In particular, the study sought to understand the intended recipient, role and the content of composer-written program notes. Participating composers identified three main roles for their program notes: to shape a performer’s interpretation of the work; to guide, engage or direct the listener and/or performer; and as collaborative mode of communication between the composer, performer, and listener. For some composers, this collaboration was intended to result in “performative listening” in which listeners were actively engaged in bringing each composition to life. This was also described as a form of empathy that results in the co-construction of the musical experience. Overall, composers avoided giving too much personal information and they provided performers with more structural information. However, composers did not agree on whether the same information should be provided to both performers and listeners. Composers’ responses problematize the view of a program note as a simple statement from writer to recipient, indicating instead a more complex set of relations at play between composer, performer, listener, and the work itself. These relations are illustrated in a model. There are implications for program note writers and readers, and for educators. Future research might seek to enhance understanding of program notes, including whether the written program note is the most effective format for communications about music. PMID:27881967
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36 CFR 1193.33 - Information, documentation, and training.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Information, documentation... Accessibility and Usability § 1193.33 Information, documentation, and training. (a) Manufacturers shall ensure access to information and documentation it provides to its customers. Such information and documentation...
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Predicate Argument Structure Frames for Modeling Information in Operative Notes
Wang, Yan; Pakhomov, Serguei; Melton, Genevieve B.
2015-01-01
The rich information about surgical procedures contained in operative notes is a valuable data source for improving the clinical evidence base and clinical research. In this study, we propose a set of Predicate Argument Structure (PAS) frames for surgical action verbs to assist in the creation of an information extraction (IE) system to automatically extract details about the techniques, equipment, and operative steps from operative notes. We created PropBank style PAS frames for the 30 top surgical action verbs based on examination of randomly selected sample sentences from 3,000 Laparoscopic Cholecystectomy notes. To assess completeness of the PAS frames to represent usage of same action verbs, we evaluated the PAS frames created on sample sentences from operative notes of 6 other gastrointestinal surgical procedures. Our results showed that the PAS frames created with one type of surgery can successfully denote the usage of the same verbs in operative notes of broader surgical categories. PMID:23920664
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Intentional forgetting: note-taking as a naturalistic example.
Eskritt, Michelle; Ma, Sierra
2014-02-01
In the present study, we examined whether note-taking as a memory aid may provide a naturalistic example of intentional forgetting. In the first experiment, participants played Concentration, a memory card game in which the identity and location of pairs of cards need to be remembered. Before the game started, half of the participants were allowed to study the cards, and the other half made notes that were then unexpectedly taken away. No significant differences emerged between the two groups for remembering identity information, but the study group remembered significantly more location information than did the note-taking group. In a second experiment, we examined whether note-takers would show signs of proactive interference while playing Concentration repeatedly. The results indicated that they did not. The findings suggest that participants adopted an intentional-forgetting strategy when using notes to store certain types of information.
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A Note About HARP's State Trimming Method
NASA Technical Reports Server (NTRS)
Butler, Ricky W.; Hayhurst, Kelly J.; Johnson, Sally C.
1998-01-01
This short note provides some additional insight into how the HARP program works. In some cases, it is possible for HARP to tdm away too many states and obtain an optimistic result. The HARP Version 7.0 manual warns the user that 'Unlike the ALL model, the SAME model can automatically drop failure modes for certain system models. The user is cautioned to insure that no important failure modes are dropped; otherwise, a non-conservative result can be given.' This note provides an example of where this occurs and a pointer to further documentation that gives a means of bounding the error associated with trimming these states.
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Wang, Hui; Zhang, Weide; Zeng, Qiang; Li, Zuofeng; Feng, Kaiyan; Liu, Lei
2014-04-01
Extracting information from unstructured clinical narratives is valuable for many clinical applications. Although natural Language Processing (NLP) methods have been profoundly studied in electronic medical records (EMR), few studies have explored NLP in extracting information from Chinese clinical narratives. In this study, we report the development and evaluation of extracting tumor-related information from operation notes of hepatic carcinomas which were written in Chinese. Using 86 operation notes manually annotated by physicians as the training set, we explored both rule-based and supervised machine-learning approaches. Evaluating on unseen 29 operation notes, our best approach yielded 69.6% in precision, 58.3% in recall and 63.5% F-score. Copyright © 2014 Elsevier Inc. All rights reserved.
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Haglin, Jack M; Zeller, John L; Egol, Kenneth A; Phillips, Donna P
2017-12-01
The Accreditation Council for Graduate Medical Education (ACGME) guidelines requires residency programs to teach and evaluate residents in six overarching "core competencies" and document progress through educational milestones. To assess the progress of orthopedic interns' skills in performing a history, physical examination, and documentation of the encounter for a standardized patient with spinal stenosis, an objective structured clinical examination (OSCE) was conducted for 13 orthopedic intern residents, following a 1-month boot camp that included communications skills and curriculum in history and physical examination. Interns were objectively scored based on their performance of the physical examination, communication skills, completeness and accuracy of their electronic medical record (EMR), and their diagnostic conclusions gleaned from the patient encounter. The purpose of this study was to meaningfully assess the clinical skills of orthopedic post-graduate year (PGY)-1 interns. The findings can be used to develop a standardized curriculum for documenting patient encounters and highlight common areas of weakness among orthopedic interns with regard to the spine history and physical examination and conducting complete and accurate clinical documentation. A major orthopedic specialty hospital and academic medical center. Thirteen PGY-1 orthopedic residents participated in the OSCE with the same standardized patient presenting with symptoms and radiographs consistent with spinal stenosis. Videos of the encounters were independently viewed and objectively evaluated by one investigator in the study. This evaluation focused on the completeness of the history and the performance and completion of the physical examination. The standardized patient evaluated the communication skills of each intern with a separate objective evaluation. Interns completed these same scoring guides to evaluate their own performance in history, physical examination, and communications skills. The interns' documentation in the EMR was then scored for completeness, internal consistency, and inaccuracies. The independent review revealed objective deficits in both the orthopedic interns' history and the physical examination, as well as highlighted trends of inaccurate and incomplete documentation in the corresponding medical record. Communication skills with the patient did not meet expectations. Further, interns tended to overscore themselves, especially with regard to their performance on the physical examination (p<.0005). Inconsistencies, omissions, and inaccuracies were common in the corresponding medical notes when compared with the events of the patient encounter. Nine of the 13 interns (69.2%) documented at least one finding that was not assessed or tested in the clinical encounter, and four of the 13 interns (30.8%) included inaccuracies in the medical record, which contradicted the information collected at the time of the encounter. The results of this study highlighted significant shortcomings in the completeness of the interns' spine history and physical examination, and the accuracy and completeness oftheir EMR note. The study provides a valuable exercise for evaluating residents in a multifaceted, multi-milestone manner that more accurately documents residents' clinical strengths and weaknesses. The study demonstrates that orthopedic residents require further instruction on the complexities of the spinal examination. It validates a need for increased systemic support for improving resident documentation through comprehensive education and evaluation modules. Copyright © 2017 Elsevier Inc. All rights reserved.
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[Health, hospitality sector and tobacco industry].
Abella Pons, Francesc; Córdoba Garcia, Rodrigo; Suárez Bonel, Maria Pilar
2012-11-01
To present the strategies used by the tobacco industry to meet government regulatory measures of its products. To demonstrate the relationship between tobacco industry and the hospitality sector. Note that the arguments and strategies used routinely by the hospitality industry have been previously provided by the tobacco industry. Location of key documents by meta-search, links to declassified documents, specific websites of the tobacco and hospitality industry, news sources and published articles in health journals. This review reveals the close relationship between tobacco industry and hospitality sector. It highlights the strategies carried out by the tobacco industry, including strategic hoarding of information, public relations, lobbying, consultation program, smoker defence groups, building partnerships, intimidation and patronage. The arguments and strategies used by the hospitality industry to match point by point that used by the tobacco industry. These arguments are refutable from the point of view of public health as it is scientifically proven that totally smoke-free environments are the only way to protect non-smokers from tobacco smoke exposure and its harmful effects on health. Copyright © 2011 Elsevier España, S.L. All rights reserved.
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The influence of geopolitical change on the well-being of a population: the Berlin Wall.
Héon-Klin, V; Sieber, E; Huebner, J; Fullilove, M T
2001-01-01
OBJECTIVES: Social cohesion is recognized as a fundamental condition for healthy populations, but social cohesion itself arises from political unity. The history of the Berlin Wall provides a unique opportunity to examine the effects of partition on social cohesion and, by inference, on health. METHODS: This ethnographic study consisted of examination of the territory formerly occupied by the Wall, formal and informal interviews with Berlin residents, and collection of cultural documents related to the Wall. Transcripts, field notes, and documents were examined by means of a keyword-in-context analysis. RESULTS: The separation of Berlin into 2 parts was a traumatic experience for the city's residents. After partition, East and West Germany had divergent social, cultural, and political experiences and gradually grew apart. CONCLUSIONS: The demolition of the Wall--the symbol and the instrument of partition--makes possible but does not ensure the reintegration of 2 populations that were separated for 40 years. The evolution of a new common culture might be accelerated by active attempts at cultural and social exchange. PMID:11236400
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A five-year review of burn injuries in Irrua
Dongo, Andrew E; Irekpita, Eshobo E; Oseghale, Lilian O; Ogbebor, Charles E; Iyamu, Christopher E; Onuminya, John E
2007-01-01
Background The management of burns remains a challenge in developing countries. Few data exist to document the extent of the problem. This study provides data from a suburban setting by documenting the epidemiology of burn injury and ascertaining outcome of management. This will help in planning strategies for prevention of burns and reducing severity of complications. Methods A total of 72 patients admitted for burns between January 1st, 2002 and December 31st, 2006 at the Irrua specialist teaching hospital were studied retrospectively. Sources of information were the case notes and operation registers. Data extracted included demographics as well as treatment methods and outcome Results The results revealed male to female ratio of 2.1:1. Over 50% of the injuries occurred at home. There was a seasonal variation with over 40% of injuries occurring between November and January. The commonest etiologic agent was flame burn from kerosene explosion. There were 7 deaths in the series. Conclusion Burns are preventable. We recommend adequate supply of unadulterated petroleum products and establishment of burn centers. PMID:17956614
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Minnesota Department of Human Services audit of medication therapy management programs.
Smith, Stephanie; Cell, Penny; Anderson, Lowell; Larson, Tom
2013-01-01
To inform medication therapy management (MTM) providers of findings of the Minnesota Department of Human Services review of claims submitted to Minnesota Health Care Programs (MHCP) for patients receiving MTM services and to discuss the impact of the audit on widespread MTM services and future audits. A retrospective review was completed on MTM claims submitted to MHCP from 2008 to 2010. The auditor verified that the Current Procedural Terminology codes billed matched the actual number of medications, conditions, and drug therapy problems assessed during an encounter. 190 claims were reviewed for 57 distinct pharmacies that billed for MTM services from 2008 to 2010, representing 4.5% of all claims submitted. The auditor reported that generally, the documentation within the electronic medical record had the least "up-coding" of all documentation systems. A total of 18 claims were coded at a higher level than appropriate, but only 10 notices were sent out to recover money because the others did not meet the minimum $50 threshold. The auditor expressed concerns that a number of claims billed at the highest complexity level were only 15 minutes long. Providers will need to be cautious of the conditions that they bill as complex and of how they define drug therapy problems. Everything for which is being billed must be clearly assessed or rationalized in the documentation note. The auditor expressed that overall, documentation was well done; however, many MTM providers are now asking how to internally prepare for future audits.
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Text-interpreter language for flexible generation of patient notes and instructions.
Forker, T S
1992-01-01
An interpreted computer language has been developed along with a windowed user interface and multi-printer-support formatter to allow preparation of documentation of patient visits, including progress notes, prescriptions, excuses for work/school, outpatient laboratory requisitions, and patient instructions. Input is by trackball or mouse with little or no keyboard skill required. For clinical problems with specific protocols, the clinician can be prompted with problem-specific items of history, exam, and lab data to be gathered and documented. The language implements a number of text-related commands as well as branching logic and arithmetic commands. In addition to generating text, it is simple to implement arithmetic calculations such as weight-specific drug dosages; multiple branching decision-support protocols for paramedical personnel (or physicians); and calculation of clinical scores (e.g., coma or trauma scores) while simultaneously documenting the status of each component of the score. ASCII text files produced by the interpreter are available for computerized quality audit. Interpreter instructions are contained in text files users can customize with any text editor.
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Education in medical billing benefits both neurology trainees and academic departments.
Waugh, Jeff L
2014-11-11
The objective of residency training is to produce physicians who can function independently within their chosen subspecialty and practice environment. Skills in the business of medicine, such as clinical billing, are widely applicable in academic and private practices but are not commonly addressed during formal medical education. Residency and fellowship training include limited exposure to medical billing, but our academic department's performance of these skills was inadequate: in 56% of trainee-generated outpatient notes, documentation was insufficient to sustain the chosen billing level. We developed a curriculum to improve the accuracy of documentation and coding and introduced practice changes to address our largest sources of error. In parallel, we developed tools that increased the speed and efficiency of documentation. Over 15 months, we progressively eliminated note devaluation, increased the mean level billed by trainees to nearly match that of attending physicians, and increased outpatient revenue by $34,313/trainee/year. Our experience suggests that inclusion of billing education topics into the formal medical curriculum benefits both academic medical centers and trainees. © 2014 American Academy of Neurology.
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Therapeutic Sleep for Traumatic Brain Injury
2017-06-01
policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting...patients develop sleep disorders, a correlation that is extremely prevalent in military personnel. Here, we have developed a paradigm to induce TBI in...lower while on day 7, the number of genes that are up- and down-regulated is increased again. Contrary to our experimental design we noted that we also
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FES-Rowing versus Zoledronic Acid to Improve BoneHealth in SCI
2016-12-01
SUPPLEMENTARY NOTES 14. ABSTRACT There is no established treatment to prevent bone loss or to induce new bone formation following SCI, although the... no established treatment to prevent bone loss or to induce new bone formation following SCI. The goal of this clinical trial -- FES-Rowing versus...Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No . 0704-0188 Public
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ERIC Educational Resources Information Center
Molgaard, Virginia
These two documents address the issue of dealing with blame for farm families in crisis. The first document, for the adult student, discusses how and why people blame each other, with emphasis on the current farm financial crisis. It is noted that blaming occurs primarily at the anger and depression stages of the loss cycle and that, when losing…
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Enhancing Quality of Life for Breast Cancer Patients with Bone Metastases
2008-04-01
Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188...Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT See Next Page . 15. SUBJECT TERMS Breast...CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON USAMRMC a. REPORT U b. ABSTRACT U c. THIS PAGE U
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NASA Technical Reports Server (NTRS)
Zelkin, Natalie; Henriksen, Stephen
2011-01-01
This document is being provided as part of ITT's NASA Glenn Research Center Aerospace Communication Systems Technical Support (ACSTS) contract NNC05CA85C, Task 7: "New ATM Requirements--Future Communications, C-Band and L-Band Communications Standard Development." ITT has completed a safety hazard analysis providing a preliminary safety assessment for the proposed L-band (960 to 1164 MHz) terrestrial en route communications system. The assessment was performed following the guidelines outlined in the Federal Aviation Administration Safety Risk Management Guidance for System Acquisitions document. The safety analysis did not identify any hazards with an unacceptable risk, though a number of hazards with a medium risk were documented. This effort represents a preliminary safety hazard analysis and notes the triggers for risk reassessment. A detailed safety hazards analysis is recommended as a follow-on activity to assess particular components of the L-band communication system after the technology is chosen and system rollout timing is determined. The security risk analysis resulted in identifying main security threats to the proposed system as well as noting additional threats recommended for a future security analysis conducted at a later stage in the system development process. The document discusses various security controls, including those suggested in the COCR Version 2.0.
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Thiessen, Kellie; Heaman, Maureen; Mignone, Javier; Martens, Patricia; Robinson, Kristine
2016-03-15
In 2000, midwifery was regulated in the Canadian Province of Manitoba. Since the establishment of the midwifery program, little formal research has analyzed the utilization of regulated midwifery services. In Manitoba, the demand for midwifery services has exceeded the number of midwives in practice. The specific objective of this study was to explore factors influencing the implementation and utilization of regulated midwifery services in Manitoba. The case study design incorporated qualitative exploratory descriptive methods, using data derived from two sources: interviews and public documents. Twenty-four key informants were purposefully selected to participate in semi-structured in-depth interviews. All documents analyzed were in the public domain. Content analysis was employed to analyze the documents and transcripts of the interviews. The results of the study were informed by the Behavioral Model of Health Services Use. Three main topic areas were explored: facilitators, barriers, and future strategies and recommendations. The most common themes arising under facilitators were funding of midwifery services and strategies to integrate the profession. Power and conflict, and lack of a productive education program emerged as the most prominent themes under barriers. Finally, future strategies for sustaining the midwifery profession focused on ensuring avenues for registration and education, improving management strategies and accountability frameworks within the employment model, enhancing the work environment, and evaluating both the practice and employment models. Results of the document analysis supported the themes arising from the interviews. These findings on factors that influenced the implementation and integration of midwifery in Manitoba may provide useful information to key stakeholders in Manitoba, as well as other provinces as they work toward successful implementation of regulated midwifery practice. Funding for new positions and programs was consistently noted as a successful strategy. While barriers such as structures of power within Regional Health Authorities and inter and intra-professional conflict were identified, the lack of a productive midwifery education program emerged as the most prominent barrier. This new knowledge highlights issues that impact the ongoing growth and capacity of the midwifery profession and suggests directions for ensuring its sustainability.
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Research notes : September 1995.
DOT National Transportation Integrated Search
1995-09-01
The Repair of Rutting Caused by Studded Tires Literature Review was prepared to document the alternatives available for Oregon pavements. Other study objectives included determining the viability of the alternatives with regard to material costs (inc...
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The Impact of Novice Counselors' Note-Taking Behavior on Recall and Judgment
ERIC Educational Resources Information Center
Lo, Chu-Ling; Wadsworth, John
2014-01-01
Purpose: To examine the effect of note-taking on novice counselors' recall and judgment of interview information in four situations: no notes, taking notes, taking notes and reviewing these notes, and reviewing notes taken by others. Method: The sample included 13 counselors-in-training recruited from a master's level training program in…
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Clarke, Martina A; Moore, Joi L; Steege, Linsey M; Koopman, Richelle J; Belden, Jeffery L; Canfield, Shannon M; Kim, Min S
2018-09-01
The purpose of this study was to determine the information needs of primary care patients as they review clinic visit notes to inform information that should be contained in an after-visit summary (AVS). We collected data from 15 patients with an acute illness and 14 patients with a chronic disease using semi-structured interviews. The acute patients reviewed seven major sections, and chronic patients reviewed eight major sections of a simulated, but realistic visit note to identify relevant information needs for their AVS. Patients in the acute illness group identified the Plan, Assessment and History of Present Illness the most as important note sections, while patients in the chronic care group identified Significant Lab Data, Plan, and Assessment the most as important note sections. This study was able to identify primary care patients' information needs after clinic visit. Primary care patients have information needs pertaining to diagnosis and treatment, which may be the reason why both patient groups identified Plan and Assessment as important note sections. Future research should also develop and assess an AVS based on the information gathered in this study and evaluate its usefulness among primary care patients. The results of this study can be used to inform the development of an after-visit summary that assists patients to fully understand their treatment plan, which may improve treatment adherence.
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ten Broek, R P G; van den Beukel, B A W; van Goor, H
2013-02-01
The operative report contains critical information for patient care, serves an educational purpose and is an important source for surgical research. Recent studies demonstrate that operative reports are unstructured and lack vital components. The accuracy of the operative notes has never been assessed. The aim of this study was to analyse the accuracy of operative reports by comparing notes with intraoperative observer-derived findings regarding adhesions and adhesiolysis-related complications. The incidence of adhesions and adhesiolysis-induced injury were scored from the reports by a researcher blinded to operative findings obtained prospectively by direct observation. In addition, factors influencing correct reporting were analysed, including sex, surgical experience, delay in dictation, and the gradual introduction of a new report template with a focus on describing operative findings rather than actions taken. A total of 755 consecutive operative reports were analysed. Sensitivity and specificity for the incidence of adhesions was 85·1 and 72·4 per cent respectively. Six of 43 inadvertent enterotomies, and 17 of 48 other organ injuries, had not been reported. All missed bowel injuries were found in reports written in the old template. A median delay in dictating of 3 (range 1-226) working days was found for 56 reports (7·4 per cent). Documentation of inadvertent enterotomies was missing more often in delayed reports (2 of 3 versus 4 of 40 reports dictated with no delay; P = 0·022). The sensitivity and specificity of operative reports noting adhesions and adhesiolysis were low. One in seven enterotomies was not reported. Effort should be put into teaching timely, meaningful, structured and accurate reporting of surgical procedures. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Initial Steps toward Validating and Measuring the Quality of Computerized Provider Documentation
Hammond, Kenric W.; Efthimiadis, Efthimis N.; Weir, Charlene R.; Embi, Peter J.; Thielke, Stephen M.; Laundry, Ryan M.; Hedeen, Ashley
2010-01-01
Background: Concerns exist about the quality of electronic health care documentation. Prior studies have focused on physicians. This investigation studied document quality perceptions of practitioners (including physicians), nurses and administrative staff. Methods: An instrument developed from staff interviews and literature sources was administered to 110 practitioners, nurses and administrative staff. Short, long and original versions of records were rated. Results: Length transformation did not affect quality ratings. On several scales practitioners rated notes less favorably than administrators or nurses. The original source document was associated with the quality rating, as was tf·idf, a relevance statistic computed from document text. Tf·idf was strongly associated with practitioner quality ratings. Conclusion: Document quality estimates were not sensitive to modifying redundancy in documents. Some perceptions of quality differ by role. Intrinsic document properties are associated with staff judgments of document quality. For practitioners, the tf·idf statistic was strongly associated with the quality dimensions evaluated. PMID:21346983
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Higgs, Ashlea; Diwersy, Mario
2014-02-01
About 25 years ago, one of our colleagues joined the Wellcome Trust, the world's second largest private biomedical funder. At the time, computers and the Internet were not a regular part of everyday work routines. Today, a quarter of a century later, the Wellcome Trust and other forward thinking funders are leading the way in integrating software, systems, and information technology into their funding processes. While not all research funders have been technologically proactive--some have only recently switched to electronic applications and others still operate with largely document-based processes-almost all funders experience some level of difficulty when it comes to translating technological advances into operational efficiencies and strategic insights. Also, although there are exceptions, funders generally do not share notes. That is scary. It is a rich and perhaps troubling irony that even while they invest billions of dollars in groundbreaking research to solve some of the world's greatest challenges, many funders struggle to find effective solutions to what can seem like pedestrian information challenges:
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36 CFR 1194.41 - Information, documentation, and support.
Code of Federal Regulations, 2010 CFR
2010-07-01
... TRANSPORTATION BARRIERS COMPLIANCE BOARD ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY STANDARDS Information, Documentation, and Support § 1194.41 Information, documentation, and support. (a) Product support... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Information, documentation...
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22 CFR 92.60 - Examination procedures.
Code of Federal Regulations, 2010 CFR
2010-04-01
... memory by reference to written records. A witness may be permitted to refresh his memory by referring to... notes, papers or other documents to refresh his memory or for the sake of testifying to matters not then...
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DigiMemo: Facilitating the Note Taking Process
ERIC Educational Resources Information Center
Kurt, Serhat
2009-01-01
Everyone takes notes daily for various reasons. Note taking is very popular in school settings and generally recognized as an effective learning strategy. Further, note taking is a complex process because it requires understanding, selection of information and writing. Some new technological tools may facilitate the note taking process. Among such…
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Sweet, K; Sturm, A C; Schmidlen, T; Hovick, S; Peng, J; Manickam, K; Salikhova, A; McElroy, J; Scheinfeldt, L; Toland, A E; Roberts, J S; Christman, M
2017-04-01
Genomic risk information for potentially actionable complex diseases and pharmacogenomics communicated through genomic counseling (GC) may motivate physicians and patients to take preventive actions. The Ohio State University-Coriell Personalized Medicine Collaborative is a randomized trial to measure the effects of in-person GC on chronic disease patients provided with multiplex results. Nine personalized genomic risk reports were provided to patients through a web portal, and to physicians via electronic medical record (EMR). Active arm participants (98, 39% female) received GC within 1 month of report viewing; control arm subjects (101, 54% female) could access counseling 3-months post-report viewing. We examined whether GC affected documentation of physician-patient communication by reviewing the first clinical note following the patient's GC visit or report upload to the EMR. Multivariable logistic regression modeling estimated the independent effect of GC on physician-patient communication, as intention to treat (ITT) and per protocol (PP), adjusted for physician educational intervention. Counselees in the active arm had more physician-patient communications than control subjects [ITT, odds ratio (OR): 3.76 (95% confidence interval (CI): 1.38-10.22, p < 0.0094); PP, OR: 5.53 (95% CI: 2.20-13.90, p = 0.0017). In conclusion, GC appreciably affected physician-patient communication following receipt of potentially actionable genomic risk information. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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WASTE TREATMENT PLANT (WTP) LIQUID EFFLUENT TREATABILITY EVALUATION
DOE Office of Scientific and Technical Information (OSTI.GOV)
LUECK, K.J.
2004-10-18
A forecast of the radioactive, dangerous liquid effluents expected to be produced by the Waste Treatment Plant (WTP) was provided by Bechtel National, Inc. (BNI 2004). The forecast represents the liquid effluents generated from the processing of Tank Farm waste through the end-of-mission for the WTP. The WTP forecast is provided in the Appendices. The WTP liquid effluents will be stored, treated, and disposed of in the Liquid Effluent Retention Facility (LERF) and the Effluent Treatment Facility (ETF). Both facilities are located in the 200 East Area and are operated by Fluor Hanford, Inc. (FH) for the US. Department ofmore » Energy (DOE). The treatability of the WTP liquid effluents in the LERF/ETF was evaluated. The evaluation was conducted by comparing the forecast to the LERF/ETF treatability envelope (Aromi 1997), which provides information on the items which determine if a liquid effluent is acceptable for receipt and treatment at the LERF/ETF. The format of the evaluation corresponds directly to the outline of the treatability envelope document. Except where noted, the maximum annual average concentrations over the range of the 27 year forecast was evaluated against the treatability envelope. This is an acceptable approach because the volume capacity in the LERF Basin will equalize the minimum and maximum peaks. Background information on the LERF/ETF design basis is provided in the treatability envelope document.« less
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NASA Technical Reports Server (NTRS)
Horowitz, Richard; King, Joseph H.
1993-01-01
This document identifies, in a highly summarized way, all the data held at the NSSDC. These data cover astrophysics and astronomy, solar and space physics, planetary and lunar, and Earth science disciplines. They are primarily, but not exclusively, from past and ongoing NASA spaceflight missions. We first identify all the data electronically available through NSSDC's principal online (magnetic disk-based) and nearline (robotics jukebox-based) systems, and then those data available on CDROM's. Finally, we identify all NSSDC-held data, the majority of which are still offline on magnetic tape, film, etc., but including the electronically accessible and CD-ROM resident data of earlier sections. These comprehensive identifications are in the form of two listings, one for the majority of NSSDC-held data sets resulting from individual instruments flown on individual spacecraft, and the other listing for the remainder of NSSDC-held data sets which do not adhere to this spacecraft/experiment/dataset hierarchy. The latter listing is presented in two parts, one for the numerous source catalogs of the NSSDC-operated Astronomical Data Center, and the other for the remainder. Access paths to all these data, and to further information about each, are also given in the related sections of this Data Listing. Note that this document is a companion to the electronically accessible information files (in particular, the NASA Master Directory) at NSSDC which also identify NSSDC-resident (and other) data.
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The role of handouts, note-taking and overhead transparencies in veterinary science lectures.
McLennan, M W; Isaacs, G
2002-10-01
To study student and staff views of the role and use of handouts, note-taking and overhead transparencies in veterinary science lectures at the University of Queensland The Nominal Group Technique was used to help develop a questionnaire, which was completed by 351 students (a response rate of 84%) and 35 staff (76%) from the 5 years of the veterinary course. The data were analysed using the SAS statistical computer package. Staff and students held different views as to the frequency with which handouts should be used, their educational value, and whether they should be complete or partial. Fewer students than staff agreed that handouts discourage further reading in a subject. Almost all staff and students saw the central functions of note-taking to be provision of notes for subsequent revision and encoding information given by the lecturer. More students than staff however, considered that note-taking in lectures interferes with understanding. Staff and students held similar views as to the uses of overheads in lectures. Interestingly however, more staff than students agreed that overheads often contain too much information. Both students and staff saw the central role of note-taking as providing a set of good notes for revision. Generally students preferred that this information be provided in the form of partial or complete handouts, while staff preferred students to take notes and to read outside lectures. Surprisingly, more staff than students felt that overhead transparencies often contained too much information. Note-taking, handouts and overhead transparencies need to be linked in a coherent educational strategy to promote effective learning.
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Evaluation of a user guidance reminder to improve the quality of electronic prescription messages.
Dhavle, A A; Corley, S T; Rupp, M T; Ruiz, J; Smith, J; Gill, R; Sow, M
2014-01-01
Prescribers' inappropriate use of the free-text Notes field in new electronic prescriptions can create confusion and workflow disruptions at receiving pharmacies that often necessitates contact with prescribers for clarification. The inclusion of inappropriate patient direction (Sig) information in the Notes field is particularly problematic. We evaluated the effect of a targeted watermark, an embedded overlay, reminder statement in the Notes field of an EHR-based e-prescribing application on the incidence of inappropriate patient directions (Sig) in the Notes field. E-prescriptions issued by the same exact cohort of 97 prescribers were collected over three time periods: baseline, three months after implementation of the reminder, and 15 months post implementation. Three certified and experienced pharmacy technicians independently reviewed all e-prescriptions for inappropriate Sig-related information in the Notes field. A physician reviewer served as the final adjudicator for e-prescriptions where the three reviewers could not reach a consensus. ANOVA and post hoc Tukey HSD tests were performed on group comparisons where statistical significance was evaluated at p<0.05. The incidence of inappropriate Sig-related information in the Notes field decreased from a baseline of 2.8% to 1.8% three months post-implementation and remained stable after 15 months. In addition, prescribers' use of the Notes decreased by 22% after 3 months and had stabilized at 18.7% below baseline after 15 months. Insertion of a targeted watermark reminder statement in the Notes field of an e-prescribing application significantly reduced the incidence of inappropriate Sig-related information in Notes and decreased prescribers' use of this field.
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Uhlmann, Wendy R; Schwalm, Katie; Raymond, Victoria M
2017-08-01
Obtaining genetic testing insurance authorizations for patients is a complex, time-involved process often requiring genetic counselor (GC) and physician involvement. In an effort to mitigate this complexity and meet the increasing number of genetic testing insurance authorization requests, GCs formed a novel partnership with an industrial engineer (IE) and a patient services associate (PSA) to develop a streamlined work flow. Eight genetics clinics and five specialty clinics at the University of Michigan were surveyed to obtain benchmarking data. Tasks needed for genetic testing insurance authorization were outlined and time-saving work flow changes were introduced including 1) creation of an Excel password-protected shared database between GCs and PSAs, used for initiating insurance authorization requests, tracking and follow-up 2) instituting the PSAs sending GCs a pre-clinic email noting each patients' genetic testing insurance coverage 3) inclusion of test medical necessity documentation in the clinic visit summary note instead of writing a separate insurance letter and 4) PSAs development of a manual with insurance providers and genetic testing laboratories information. These work flow changes made it more efficient to request and track genetic testing insurance authorizations for patients, enhanced GCs and PSAs communication, and reduced tasks done by clinicians.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Drell, D.W.; Metting, F.B. Jr.; Wuy, L.D.
1996-11-01
This document summarizes the proceedings of a workshop on Bioremediation and Its Societal Implications and Concerns (BASIC) held July 18-19, 1996 at the Airlie Center near Warrenton, Virginia. The workshop was sponsored by the Office of Health and Environmental Research (OHER), U.S. Department of Energy (DOE), as part of its fundamental research program in Natural and Accelerated Bioremediation Research (NABIR). The information summarized in these proceedings represents the general conclusions of the workshop participants, and not the opinions of workshop organizers or sponsors. Neither are they consensus opinions, as opinions differed among participants on a number of points. The generalmore » conclusions presented below were reached through a review, synthesis, and condensation of notes taken by NABIR Program Office staff and OHER program managers throughout the workshop. Specific contributions by participants during breakout sessions are recorded in bullet form in the appropriate sections, without attribution to the contributors. These contributions were transcribed as faithfully as possible from notes about the original discussions. They were edited only to make them grammatically correct, parallel in structure, and understandable to someone not familiar with the NABIR Program or BASIC element.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
This large document provides a catalog of the location of large numbers of reports pertaining to the charge of the Presidential Advisory Committee on Human Radiation Research and is arranged as a series of appendices. Titles of the appendices are Appendix A- Records at the Washington National Records Center Reviewed in Whole or Part by DoD Personnel or Advisory Committee Staff; Appendix B- Brief Descriptions of Records Accessions in the Advisory Committee on Human Radiation Experiments (ACHRE) Research Document Collection; Appendix C- Bibliography of Secondary Sources Used by ACHRE; Appendix D- Brief Descriptions of Human Radiation Experiments Identified by ACHRE,more » and Indexes; Appendix E- Documents Cited in the ACHRE Final Report and other Separately Described Materials from the ACHRE Document Collection; Appendix F- Schedule of Advisory Committee Meetings and Meeting Documentation; and Appendix G- Technology Note.« less
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Follow-up Evaluation of Air Force Blood Donors Screening Positive for Chagas Disease
2017-08-27
abstract, paper. poster and other supporting documentation. 5. Save and forward. via email. the processing form and all supporting documentation to...letter of approval or disapproval. 9. Once your manuscript, poster or presentation has been approved for a one-time public release. you may proceed with...legal reviews. please contact the legal office at (210) 671-5795/3365. DSN 473. NOTE: All abstracts, papers, posters . etc .. should contain the
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De Groot-de Laat, Lotte E; Ren, Ben; McGhie, Jackie; Oei, Frans B S; Raap, Goris Bol; Bogers, J J C; Geleijnse, Marcel L
2014-11-01
Mitral regurgitation (MR) is a common disorder for which mitral valve surgery is an established therapy. Although surgical indications are clearly defined for the management of valvular heart disease, a gap exists between current guidelines and their effective application. The study aim was to provide an insight into the diagnostic information provided for cardiac surgeons before performing mitral valve surgery. The source documents and echocardiographic studies of 100 patients, referred by nine hospitals, were screened for arguments for MR severity justifying referral for surgery. Details of the documented MR mechanism, mitral annulus (MA) size, tricuspid regurgitation (TR) severity and annulus size were also noted. According to the referring physician, MR was severe in 83% and moderate-to-severe in 17%. In the great majority of patients (98%) the MR mechanism was mentioned, although specific information on the prolapsing scallops was available in only 17% of cases. The recommended primary determinants of MR severity, vena contracta and proximal isovelocity surface area (PISA) were measured in only 22% and 31% of patients, respectively. In 94% of patients with available PISA information this was described only qualitatively. Correct image expansion using the zoom mode was performed in only 25% of these patients, and a correct adaptation of the Nyquist limit in only 6%. Tricuspid annulus measurements guiding the need for concomitant tricuspid valvuloplasty in patients with less than severe TR were reported in only 6% of patients. These data demonstrate a clear and important gap between current guidelines and real-world practice with regards to the echocardiographic diagnostic information provided to the surgeon before performing mitral valve surgery.
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Using Payroll Deduction to Shelter Individual Health Insurance from Income Tax
Hall, Mark A; Hager, Christie L; Orentlicher, David
2011-01-01
Objective To assess the impact of state laws requiring or encouraging employers to establish “section 125” cafeteria plans that shelter employees' premium contributions from tax. Data Sources Available descriptive statistics, 65 key-informant interviews, and relevant documents in study states and nationally, 2008–2009. Study Design Case studies were conducted in Indiana, Massachusetts, and Missouri—three states adopting laws in 2007. Descriptive quantitative information came from insurers, regulators, and surveys of employers. In each state, 15–17 semistructured but open-ended interviews were conducted with insurance agents, insurers, government officials, and third-party administration firms, and 29 informed sources were interviewed from a national perspective or other states. Key informants were selected based on their known or reported experience, in a “snowball” fashion until saturation was reached. Interview notes were coded for systematic analysis. Finally, relevant rulings, brochures, instructions, marketing materials, and other documents were collected and analyzed. Findings Despite the potential for substantial cost savings, use of section 125 plans to purchase individual insurance remained low in these states after 1 or 2 years. Absent a mandate, few employers were strongly motivated to offer these plans in order to retain an adequate workforce, and uncertainty about federal legality deterred doing so. For smaller employers, benefits to owners did not outweigh administrative complexities. Nevertheless, few downsides were found to states mandating or encouraging these plans. In particular, there is little evidence that many employers dropped group coverage as a result. Conclusions Section 125 plans remain a limited tool for states to reduce the inequitable tax treatment of individually purchased insurance, but a complete remedy requires reform of federal tax law. PMID:21054377
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Using payroll deduction to shelter individual health insurance from income tax.
Hall, Mark A; Hager, Christie L; Orentlicher, David
2011-02-01
To assess the impact of state laws requiring or encouraging employers to establish "section 125" cafeteria plans that shelter employees' premium contributions from tax. Available descriptive statistics, 65 key-informant interviews, and relevant documents in study states and nationally, 2008-2009. Case studies were conducted in Indiana, Massachusetts, and Missouri--three states adopting laws in 2007. Descriptive quantitative information came from insurers, regulators, and surveys of employers. In each state, 15-17 semistructured but open-ended interviews were conducted with insurance agents, insurers, government officials, and third-party administration firms, and 29 informed sources were interviewed from a national perspective or other states. Key informants were selected based on their known or reported experience, in a "snowball" fashion until saturation was reached. Interview notes were coded for systematic analysis. Finally, relevant rulings, brochures, instructions, marketing materials, and other documents were collected and analyzed. Despite the potential for substantial cost savings, use of section 125 plans to purchase individual insurance remained low in these states after 1 or 2 years. Absent a mandate, few employers were strongly motivated to offer these plans in order to retain an adequate workforce, and uncertainty about federal legality deterred doing so. For smaller employers, benefits to owners did not outweigh administrative complexities. Nevertheless, few downsides were found to states mandating or encouraging these plans. In particular, there is little evidence that many employers dropped group coverage as a result. Section 125 plans remain a limited tool for states to reduce the inequitable tax treatment of individually purchased insurance, but a complete remedy requires reform of federal tax law. © Health Research and Educational Trust.
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AASG Wells Data for the EGS Test Site Planning and Analysis Task
Augustine, Chad
2013-10-09
AASG Wells Data for the EGS Test Site Planning and Analysis Task Temperature measurement data obtained from boreholes for the Association of American State Geologists (AASG) geothermal data project. Typically bottomhole temperatures are recorded from log headers, and this information is provided through a borehole temperature observation service for each state. Service includes header records, well logs, temperature measurements, and other information for each borehole. Information presented in Geothermal Prospector was derived from data aggregated from the borehole temperature observations for all states. For each observation, the given well location was recorded and the best available well identified (name), temperature and depth were chosen. The “Well Name Source,” “Temp. Type” and “Depth Type” attributes indicate the field used from the original service. This data was then cleaned and converted to consistent units. The accuracy of the observation’s location, name, temperature or depth was note assessed beyond that originally provided by the service. - AASG bottom hole temperature datasets were downloaded from repository.usgin.org between the dates of May 16th and May 24th, 2013. - Datasets were cleaned to remove “null” and non-real entries, and data converted into consistent units across all datasets - Methodology for selecting ”best” temperature and depth attributes from column headers in AASG BHT Data sets: • Temperature: • CorrectedTemperature – best • MeasuredTemperature – next best • Depth: • DepthOfMeasurement – best • TrueVerticalDepth – next best • DrillerTotalDepth – last option • Well Name/Identifier • APINo – best • WellName – next best • ObservationURI - last option. The column headers are as follows: • gid = internal unique ID • src_state = the state from which the well was downloaded (note: the low temperature wells in Idaho are coded as “ID_LowTemp”, while all other wells are simply the two character state abbreviation) • source_url = the url for the source WFS service or Excel file • temp_c = “best” temperature in Celsius • temp_type = indicates whether temp_c comes from the corrected or measured temperature header column in the source document • depth_m = “best” depth in meters • depth_type = indicates whether depth_m comes from the measured, true vertical, or driller total depth header column in the source document • well_name = “best” well name or ID • name_src = indicates whether well_name came from apino, wellname, or observationuri header column in the source document • lat_wgs84 = latitude in wgs84 • lon_wgs84 = longitude in wgs84 • state = state in which the point is located • county = county in which the point is located
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Description of the TCERT Vetting Reports for Data Release 25
NASA Technical Reports Server (NTRS)
Van Cleve, Jeffrey E.; Caldwell, Douglas A.
2016-01-01
This document, the Kepler Instrument Handbook (KIH), is for Kepler and K2 observers, which includes the Kepler Science Team, Guest Observers (GOs), and astronomers doing archival research on Kepler and K2 data in NASAs Astrophysics Data Analysis Program (ADAP). The KIH provides information about the design, performance, and operational constraints of the Kepler flight hardware and software, and an overview of the pixel data sets available. The KIH is meant to be read with these companion documents:1. Kepler Data Processing Handbook (KSCI-19081) or KDPH (Jenkins et al., 2016). The KDPH describes how pixels downlinked from the spacecraft are converted by the Kepler Data Processing Pipeline (henceforth just the pipeline) into the data products delivered to the MAST archive. 2. Kepler Archive Manual (KDMC-10008) or KAM (Thompson et al., 2016). The KAM describes the format and content of the data products, and how to search for them.3. Kepler Data Characteristics Handbook (KSCI-19040) or KDCH (Christiansen et al., 2016). The KDCH describes recurring non-astrophysical features of the Kepler data due to instrument signatures, spacecraft events, or solar activity, and explains how these characteristics are handled by the pipeline.4. Kepler Data Release Notes 25 (KSCI-19065) or DRN 25 (Thompson et al., 2015). DRN 25 describes signatures and events peculiar to individual quarters, and the pipeline software changes between a data release and the one preceding it.Together, these documents supply the information necessary for obtaining and understanding Kepler results, given the real properties of the hardware and the data analysis methods used, and for an independent evaluation of the methods used if so desired.
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Safe Practices for Copy and Paste in the EHR
Lehmann, Christoph U.; Michel, Jeremy; Solomon, Ronni; Possanza, Lorraine; Gandhi, Tejal
2017-01-01
Summary Background Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The Partnership for Health IT Patient Safety was formed to gather data, conduct analysis, educate, and disseminate safe practices for safer care using health information technology (IT). Objective To characterize copy and paste events in clinical care, identify safety risks, describe existing evidence, and develop implementable practice recommendations for safe reuse of information via copy and paste. Methods The Partnership 1) reviewed 12 reported safety events, 2) solicited expert input, and 3) performed a systematic literature review (2010 to January 2015) to identify publications addressing frequency, perceptions/attitudes, patient safety risks, existing guidance, and potential interventions and mitigation practices. Results The literature review identified 51 publications that were included. Overall, 66% to 90% of clinicians routinely use copy and paste. One study of diagnostic errors found that copy and paste led to 2.6% of errors in which a missed diagnosis required patients to seek additional unplanned care. Copy and paste can promote note bloat, internal inconsistencies, error propagation, and documentation in the wrong patient chart. Existing guidance identified specific responsibilities for authors, organizations, and electronic health record (EHR) developers. Analysis of 12 reported copy and paste safety events was congruent with problems identified from the literature review. Conclusion Despite regular copy and paste use, evidence regarding direct risk to patient safety remains sparse, with significant study limitations. Drawing on existing evidence, the Partnership developed four safe practice recommendations: 1) Provide a mechanism to make copy and paste material easily identifiable; 2) Ensure the provenance of copy and paste material is readily available; 3) Ensure adequate staff training and education; 4) Ensure copy and paste practices are regularly monitored, measured, and assessed. PMID:28074211
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Tsou, Amy Y; Lehmann, Christoph U; Michel, Jeremy; Solomon, Ronni; Possanza, Lorraine; Gandhi, Tejal
2017-01-11
Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The Partnership for Health IT Patient Safety was formed to gather data, conduct analysis, educate, and disseminate safe practices for safer care using health information technology (IT). To characterize copy and paste events in clinical care, identify safety risks, describe existing evidence, and develop implementable practice recommendations for safe reuse of information via copy and paste. The Partnership 1) reviewed 12 reported safety events, 2) solicited expert input, and 3) performed a systematic literature review (2010 to January 2015) to identify publications addressing frequency, perceptions/attitudes, patient safety risks, existing guidance, and potential interventions and mitigation practices. The literature review identified 51 publications that were included. Overall, 66% to 90% of clinicians routinely use copy and paste. One study of diagnostic errors found that copy and paste led to 2.6% of errors in which a missed diagnosis required patients to seek additional unplanned care. Copy and paste can promote note bloat, internal inconsistencies, error propagation, and documentation in the wrong patient chart. Existing guidance identified specific responsibilities for authors, organizations, and electronic health record (EHR) developers. Analysis of 12 reported copy and paste safety events was congruent with problems identified from the literature review. Despite regular copy and paste use, evidence regarding direct risk to patient safety remains sparse, with significant study limitations. Drawing on existing evidence, the Partnership developed four safe practice recommendations: 1) Provide a mechanism to make copy and paste material easily identifiable; 2) Ensure the provenance of copy and paste material is readily available; 3) Ensure adequate staff training and education; 4) Ensure copy and paste practices are regularly monitored, measured, and assessed.
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Using natural language processing to identify problem usage of prescription opioids.
Carrell, David S; Cronkite, David; Palmer, Roy E; Saunders, Kathleen; Gross, David E; Masters, Elizabeth T; Hylan, Timothy R; Von Korff, Michael
2015-12-01
Accurate and scalable surveillance methods are critical to understand widespread problems associated with misuse and abuse of prescription opioids and for implementing effective prevention and control measures. Traditional diagnostic coding incompletely documents problem use. Relevant information for each patient is often obscured in vast amounts of clinical text. We developed and evaluated a method that combines natural language processing (NLP) and computer-assisted manual review of clinical notes to identify evidence of problem opioid use in electronic health records (EHRs). We used the EHR data and text of 22,142 patients receiving chronic opioid therapy (≥70 days' supply of opioids per calendar quarter) during 2006-2012 to develop and evaluate an NLP-based surveillance method and compare it to traditional methods based on International Classification of Disease, Ninth Edition (ICD-9) codes. We developed a 1288-term dictionary for clinician mentions of opioid addiction, abuse, misuse or overuse, and an NLP system to identify these mentions in unstructured text. The system distinguished affirmative mentions from those that were negated or otherwise qualified. We applied this system to 7336,445 electronic chart notes of the 22,142 patients. Trained abstractors using a custom computer-assisted software interface manually reviewed 7751 chart notes (from 3156 patients) selected by the NLP system and classified each note as to whether or not it contained textual evidence of problem opioid use. Traditional diagnostic codes for problem opioid use were found for 2240 (10.1%) patients. NLP-assisted manual review identified an additional 728 (3.1%) patients with evidence of clinically diagnosed problem opioid use in clinical notes. Inter-rater reliability among pairs of abstractors reviewing notes was high, with kappa=0.86 and 97% agreement for one pair, and kappa=0.71 and 88% agreement for another pair. Scalable, semi-automated NLP methods can efficiently and accurately identify evidence of problem opioid use in vast amounts of EHR text. Incorporating such methods into surveillance efforts may increase prevalence estimates by as much as one-third relative to traditional methods. Copyright © 2015. Published by Elsevier Ireland Ltd.
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Information system life-cycle and documentation standards, volume 1
NASA Technical Reports Server (NTRS)
Callender, E. David; Steinbacher, Jody
1989-01-01
The Software Management and Assurance Program (SMAP) Information System Life-Cycle and Documentation Standards Document describes the Version 4 standard information system life-cycle in terms of processes, products, and reviews. The description of the products includes detailed documentation standards. The standards in this document set can be applied to the life-cycle, i.e., to each phase in the system's development, and to the documentation of all NASA information systems. This provides consistency across the agency as well as visibility into the completeness of the information recorded. An information system is software-intensive, but consists of any combination of software, hardware, and operational procedures required to process, store, or transmit data. This document defines a standard life-cycle model and content for associated documentation.
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THE CHALLENGING ROLE OF A READING COACH, A CAUTIONARY TALE
AL OTAIBA, STEPHANIE; HOSP, JOHN L.; SMARTT, SUSAN; DOLE, JANICE A.
2011-01-01
The purpose of this case study is to describe the challenges one coach faced during the initial implementation of a coaching initiative involving 33 teachers in an urban, high-poverty elementary school. Reading coaches are increasingly expected to play a key role in the professional development efforts to improve reading instruction in order to improve reading achievement for struggling readers. Data sources included initial reading scores for kindergarten and first-graders, pretest and posttest scores of teachers’ knowledge, a teacher survey, focus group interviews, project documents, and field notes. Data were analyzed using a mixed methods approach. Findings revealed several challenges that have important implications for research and practice: that teachers encountered new information about teaching early reading that conflicted with their current knowledge, this new information conflicted with their core reading program, teachers had differing perceptions of the role of the reading coach that affected their feelings about the project, and reform efforts are time-intensive. PMID:23794791
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Cornford, Tony; Barber, Nicholas; Avery, Anthony; Takian, Amirhossein; Lichtner, Valentina; Petrakaki, Dimitra; Crowe, Sarah; Marsden, Kate; Robertson, Ann; Morrison, Zoe; Klecun, Ela; Prescott, Robin; Quinn, Casey; Jani, Yogini; Ficociello, Maryam; Voutsina, Katerina; Paton, James; Fernando, Bernard; Jacklin, Ann; Cresswell, Kathrin
2011-01-01
Objectives To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England. Design Theoretically informed, longitudinal qualitative evaluation based on case studies. Setting 12 “early adopter” NHS acute hospitals and specialist care settings studied over two and a half years. Data sources Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researchers’ field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents. Results Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS providers. There was early evidence that deploying systems resulted in important learning within and between organisations and the development of relevant competencies within NHS hospitals. Conclusions Implementation of the NHS Care Records Service in “early adopter” sites proved time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients. Although our results might not be directly transferable to later adopting sites because the functionalities we evaluated were new and untried in the English context, they shed light on the processes involved in implementing major new systems. The move to increased local decision making that we advocated based on our interim analysis has been pursued and welcomed by the NHS, but it is important that policymakers do not lose sight of the overall goal of an integrated interoperable solution. PMID:22006942
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A retrospective review of performance and utility of routine clinical pelvimetry.
Blackadar, Charles S; Viera, Anthony J
2004-01-01
Some authorities have questioned the utility of performing clinical pelvimetry as part of routine prenatal care. This study determined the frequency with which clinical pelvimetry is still performed at two military hospitals and whether the results of pelvimetry influence the management of labor and delivery. We conducted a retrospective review of prenatal records at two military hospitals. One was an overseas hospital, and one was a family medicine teaching hospital in the United States. The records of 660 pregnant women were reviewed to identify documentation that pelvimetry was performed during prenatal care and whether there was evidence that the physician managing labor and delivery altered management based on pelvimetry results. Seventy percent (461) of the 660 records reviewed had all pelvimetry measurements documented as normal, or the provider had written "good for TOL (trial of labor)," "proven to XX pounds," or similar annotation that pelvimetry was normal. Nine percent (58 records) had no documentation of pelvimetry (pelvimetry section left blank). The remaining 21% (141 charts) had at least one pelvimetry measurement listed as abnormal on the initial prenatal exam. No admission note, progress note, or operative note recorded during labor and delivery made reference to clinical pelvimetry results. No abnormal pelvimetry result was referenced in follow-up visits or appeared to make any difference in mode of delivery or treatment in labor. Two women (one at each institution) had initial visit notes indicating the need to consider radiographic pelvimetry based on the results of clinical exam, but this test was not done in either case, and both women delivered vaginally. Our study indicates that clinical pelvimetry does not change management of pregnant patients. Current practice is to allow all women a trial of labor regardless of pelvimetry results. This makes the routine performance and recording of clinical pelvimetry a waste of time, a potential liability, and an unnecessary discomfort for patients.
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ARL Arabic Dependency Treebank
2016-02-10
This technical note describes the US Army Research Laboratory (ARL) Arabic Dependency Treebank (AADT) for the purpose of documenting its release. The...AADT was derived from existing Arabic treebanks distributed by the Linguistic Data Consortium using constituent-to- dependency conversion software
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... use among the nation’s youth. View Online Dirty Money and Cocaine Published: December 18, 2014 Dirty money: find out just how much of your cash ... June 27, 2018 NOTE: PDF documents require the free Adobe Reader . Flash content requires the free Adobe ...
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Previous MOVES Versions and Documentation
Find all software, user guides, and download and installation instructions for MOVES2010a and MOVES2010. Note that these version are not valid for SIP and transportation conformity purposes: MOVES2014 and MOVES2014a are the latest versions.
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47 CFR 80.605 - U.S. Coast Guard coordination.
Code of Federal Regulations, 2013 CFR
2013-10-01
... documentation as to this fact. Note: Surveillance radar coast stations do not require U.S. Coast Guard approval. (b) Coast station transponders (i.e., radar beacons, or racons) operating in the band 2900-3100 or...
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47 CFR 80.605 - U.S. Coast Guard coordination.
Code of Federal Regulations, 2012 CFR
2012-10-01
... documentation as to this fact. Note: Surveillance radar coast stations do not require U.S. Coast Guard approval. (b) Coast station transponders (i.e., radar beacons, or racons) operating in the band 2900-3100 or...
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47 CFR 80.605 - U.S. Coast Guard coordination.
Code of Federal Regulations, 2014 CFR
2014-10-01
... documentation as to this fact. Note: Surveillance radar coast stations do not require U.S. Coast Guard approval. (b) Coast station transponders (i.e., radar beacons, or racons) operating in the band 2900-3100 or...
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ERIC Educational Resources Information Center
Kumaran, Maha; Geary, Joe
2011-01-01
Technology has transformed libraries. There are digital libraries, electronic collections, online databases and catalogs, ebooks, downloadable books, and much more. With free technology such as social websites, newspaper collections, downloadable online calendars, clocks and sticky notes, online scheduling, online document sharing, and online…
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16 CFR 4.9 - The public record.
Code of Federal Regulations, 2010 CFR
2010-01-01
... to § 305.8 of this chapter; (xiii) Annual filings by professional boxing sanctioning organizations as required by the Muhammed Ali Boxing Reform Act, 15 U.S.C. 6301 note, 6307a-6307h; (xiv) Other documents...
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15 CFR Supplement No. 2 to Part 774 - General Technology and Software Notes
Code of Federal Regulations, 2013 CFR
2013-01-01
... 15 Commerce and Foreign Trade 2 2013-01-01 2013-01-01 false General Technology and Software Notes... Software Notes 1. General Technology Note. The export of “technology” that is “required” for the... necessary” information. 2. General Software Note. License Exception TSU (“mass market” software) is...
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15 CFR Supplement No. 2 to Part 774 - General Technology and Software Notes
Code of Federal Regulations, 2011 CFR
2011-01-01
... 15 Commerce and Foreign Trade 2 2011-01-01 2011-01-01 false General Technology and Software Notes... Software Notes 1. General Technology Note. The export of “technology” that is “required” for the... necessary” information. 2. General Software Note. License Exception TSU (“mass market” software) is...
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15 CFR Supplement No. 2 to Part 774 - General Technology and Software Notes
Code of Federal Regulations, 2012 CFR
2012-01-01
... 15 Commerce and Foreign Trade 2 2012-01-01 2012-01-01 false General Technology and Software Notes... Software Notes 1. General Technology Note. The export of “technology” that is “required” for the... necessary” information. 2. General Software Note. License Exception TSU (“mass market” software) is...
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NASA Technical Reports Server (NTRS)
Thompson, Susan E.; Fraquelli, Dorothy; Van Cleve, Jeffrey E.; Caldwell, Douglas A.
2016-01-01
A description of Kepler, its design, performance and operational constraints may be found in the Kepler Instrument Handbook (KIH, Van Cleve Caldwell 2016). A description of Kepler calibration and data processing is described in the Kepler Data Processing Handbook (KDPH, Jenkins et al. 2016; Fanelli et al. 2011). Science users should also consult the special ApJ Letters devoted to early Kepler results and mission design (April 2010, ApJL, Vol. 713 L79-L207). Additional technical details regarding the data processing and data qualities can be found in the Kepler Data Characteristics Handbook (KDCH, Christiansen et al. 2013) and the Data Release Notes (DRN). This archive manual specifically documents the file formats, as they exist for the last data release of Kepler, Data Release 25(KSCI-19065-002). The earlier versions of the archive manual and data release notes act as documentation for the earlier versions of the data files.
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Huettig, Matthias; Buscher, Georg; Menzel, Thomas; Scheppach, Wolfgang; Puppe, Frank; Buscher, Hans-Peter
2004-03-15
The quality of medical reports on diagnostic procedures has a considerable impact on the quality of medical care. Handwritten or otherwise unstructured reports tend to be incomplete, whereas structured questionnaires are of limited flexibility and not considered case-adequate. Thus, medical reports of this kind may promote an incomplete and misleading documentation and, therefore, be problematic with respect to their reliability. SonoConsult (SC), an expert system for structured and case-adequate documentation of sonographic findings with an additional diagnostic component, was evaluated with respect to user acceptance and suitability for enhancing the quality of reports and supporting sonographic beginners. The expectations and the attitudes of the users toward the program were evaluated by anonymous questionnaires. The documentation of findings and the diagnostic conclusions in 103 free text reports made by experienced examiners were evaluated by subjecting their information to a subsequent input into SC. Free text reports were checked for information that was asked by SC but not mentioned in the reports. In a series of 150 cases, the system diagnoses were blinded during input of findings into SC-questionnaires and the examiners' diagnostic conclusions were compared with the uncovered SC-diagnoses with respect to forgotten diagnoses. The structured and data-driven acquisition of information by the program was well accepted by the users. However, only a medium interest in the system-delivered diagnoses was noted. The program-generated reports were characterized by a more detailed description of the findings and a higher number of diagnoses in comparison to the unstructured reports before introduction of SC as the only documentation system. When unaware of the system diagnoses, information was entered into the questionnaires, and SC generated some diagnoses which were not mentioned by the examiners in their conclusions. The possibility to inspect the system diagnoses led to an enhancement of the number of diagnoses the examiners mentioned in their conclusions. By contrast, the examiners meant that the influence of the program on their conclusions was minimal or dispensable. Beginners in sonography acknowledged that the program led them to perform a complete examination in an adequate sequence. An expert system for the data-driven, case-adequate information acquisition of abdominal ultrasound examinations may enhance the quality of the reports and, potentially, of the examinations at the same time. In addition, it may help beginners to learn a structured problem- and finding-adequate examination sequence.
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Topaz, Maxim; Lai, Kenneth; Dowding, Dawn; Lei, Victor J; Zisberg, Anna; Bowles, Kathryn H; Zhou, Li
2016-12-01
Electronic health records are being increasingly used by nurses with up to 80% of the health data recorded as free text. However, only a few studies have developed nursing-relevant tools that help busy clinicians to identify information they need at the point of care. This study developed and validated one of the first automated natural language processing applications to extract wound information (wound type, pressure ulcer stage, wound size, anatomic location, and wound treatment) from free text clinical notes. First, two human annotators manually reviewed a purposeful training sample (n=360) and random test sample (n=1100) of clinical notes (including 50% discharge summaries and 50% outpatient notes), identified wound cases, and created a gold standard dataset. We then trained and tested our natural language processing system (known as MTERMS) to process the wound information. Finally, we assessed our automated approach by comparing system-generated findings against the gold standard. We also compared the prevalence of wound cases identified from free-text data with coded diagnoses in the structured data. The testing dataset included 101 notes (9.2%) with wound information. The overall system performance was good (F-measure is a compiled measure of system's accuracy=92.7%), with best results for wound treatment (F-measure=95.7%) and poorest results for wound size (F-measure=81.9%). Only 46.5% of wound notes had a structured code for a wound diagnosis. The natural language processing system achieved good performance on a subset of randomly selected discharge summaries and outpatient notes. In more than half of the wound notes, there were no coded wound diagnoses, which highlight the significance of using natural language processing to enrich clinical decision making. Our future steps will include expansion of the application's information coverage to other relevant wound factors and validation of the model with external data. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Strupp, J; Groebe, B; Knies, A; Mai, M; Voltz, R; Golla, H
2017-12-01
Palliative and hospice care (PHC) still mainly focuses on patients with cancer. In order to connect patients severely affected by multiple sclerosis (MS) and caregivers to PHC, a nationwide hotline was implemented to facilitate access to PHC. The hotline was designed in cooperation with the German Multiple Sclerosis Society. Self-disclosed information given by callers was documented using case-report forms supplemented by personal notes. Data were analysed descriptively. A total of 222 calls were documented in 27 months. The patients' mean age was 51.12 years (range 27-84 years) and mean illness duration was 18 years (range 1 month to 50 years). Inquiries included information on PHC (28.8%) and access to PHC (due to previous refusal of PHC, 5.4%), general care for MS (36.1%), adequate housing (9.0%) and emotional support in crisis (4.5%). A total of 31.1% of callers reported 'typical' palliative symptoms (e.g. pain, 88.4%), 50.5% reported symptoms evolving from MS and 35.6% reported psychosocial problems. For 67 callers (30.2%), PHC services were recommended as indicated. The hotline provided insight into the needs and problems of patients severely affected by MS and their caregivers, some of which may be met by PHC. Future follow-up calls will demonstrate if the hotline helped to improve access to PHC beyond providing information. Overall, the hotline seemed to be easily accessible for patients severely affected by MS whose mobility is limited. © 2017 EAN.
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Shine, Daniel; Jessen, Laurie; Bajaj, Jasmeet; Pencak, Dorothy; Panush, Richard
2002-01-01
CONTEXT The impact of residents on hospital finance has been studied; there are no data describing the economic effect of residents on attending physicians. OBJECTIVE In a community teaching hospital, we compared allowable inpatient visit codes and payments (based on documentation in the daily progress notes) between a general medicine teaching unit and nonteaching general medicine units. DESIGN Retrospective chart review, matched cohort study. SETTING Six hundred fifty–bed community teaching hospital. PATIENTS Patients were discharged July 1998 through February 1999 from Saint Barnabas Medical Center. We randomly selected 200 patients in quartets. Each quartet consisted of a pair of patients cared for by residents and a pair cared for only by an attending physician. In each pair, 1 of the patients was under the care of an attending physician who usually admitted to the teaching service, and 1 was under the care of a usually nonteaching attending. Within each quartet, patients were matched for diagnosis-related group, length of stay, and discharge date. MAIN OUTCOME MEASURES We assigned the highest daily visit code justifiable by resident and attending chart documentation, determining relative value units (RVUs) and reimbursements allowed by each patient's insurance company. RESULTS Although more seriously ill, teaching-unit patients generated a mean 1.75 RVUs daily, compared with 1.84 among patients discharged from nonteaching units (P = .3). Median reimbursement, daily and per hospitalization, was similar on teaching and nonteaching units. Nonteaching attendings documented higher mean daily RVUs than teaching attendings (1.83 vs 1.76, P = .2). Median allowable reimbursements were $267 per case ($53 daily) among teaching attendings compared with $294 per case ($58 daily) among nonteaching attendings (Z = 1.54, P = .1). When only the resident note was considered, mean daily RVUs increased 39% and median allowable dollars per day 27% (Z = 4.21, P < .001). CONCLUSIONS Nonteaching attendings appear to document their visits more carefully from a billing perspective than do teaching attendings. Properly counter-documented, resident notes could substantially increase payments to attending physicians. PMID:12133156
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-09-12
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2012-12-12
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Enhancements to the NASA Astrophysics Science Information and Abstract Service
NASA Astrophysics Data System (ADS)
Kurtz, M. J.; Eichhorn, G.; Accomazzi, A.; Grant, C. S.; Murray, S. S.
1995-05-01
The NASA Astrophysics Data System Astrophysics Science Information and Abstract Service, the extension of the ADS Abstract Service continues rapidly to expand in both use and capabilities. Each month the service is used by about 4,000 different people, and returns about 1,000,000 pieces of bibliographic information. Among the recent additions to the system are: 1. Whole Text Access. In addition to the ApJ Letters we now have whole text for the ApJ on-line, soon we will have AJ and Rev. Mexicana. Discussions with other publishers are in progress. 2. Space Instrumentation Database. We now provide a second abstract service, covering papers related to space instruments. This is larger than the astronomy and astrophysics database in terms of total abstracts. 3. Reference Books and Historical Journals. We have begun putting the SAO Annals and the HCO Annals on-line. We have put the Handbook of Space Astronomy and Astrophysics by M.V. Zombeck (Cambridge U.P.) on-line. 4. Author Abstracts. We can now include original abstracts in addition to those we get from the NASA STI Abstracts Database. We have included abstracts for A&A in collaboration with the CDS in Strasbourg, and are collaborating with the AAS and the ASP on others. We invite publishers and editors of journals and conference proceedings to include their original abstracts in our service; send inquiries via e-mail to ads@cfa.harvard.edu. 5. Author Notes. We now accept notes and comments from authors of articles in our database. These are arbitrary html files and may contain pointers to other WWW documents, they are listed along with the abstracts, whole text, and data available in the index listing for every reference. The ASIAS is available at: http://adswww.harvard.edu/
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Improving government regulations: a guidebook for conservation and renewable energy
DOE Office of Scientific and Technical Information (OSTI.GOV)
Neese, R. J.; Scheer, R. M.; Marasco, A. L.
1981-04-01
An integrated view of the Office of Conservation and Solar Energy (CS) policy making encompassing both administrative procedures and policy analysis is presented. Chapter One very briefly sketches each step in the development of a significant regulation, noting important requirements and participants. Chapter Two expands upon the Overview, providing the details of the process, the rationale and source of requirements, concurrence procedures, and advice on the timing and synchronization of steps. Chapter Three explains the types of analysis documents that may be required for a program. Regulatory Analyses, Environmental Impact Statements, Urban and Community Impact Analyses, and Regulatory Flexibility Analysesmore » are all discussed. Specific information to be included in the documents and the circumstances under which the documents need to be prepared are explained. Chapter Four is a step-by-step discussion of how to do good analysis. Use of models and data bases is discussed. Policy objectives, alternatives, and decision making are explained. In Chapter five guidance is provided on identifying the public that would most likely be interested in the regulation, involving its constituents in a dialogue with CS, evaluating and handling comments, and engineering the final response. Chapter Six provides direction on planning the evaluation, monitoring the regulation's success once it has been promulgated, and allowing for constructive support or criticism from outside DOE. (MCW)« less