Echoes of a Reading: Genre as Social Action as Formative Influence on Genres and Ideology

ERIC Educational Resources Information Center

Schryer, Catherine F.

2015-01-01

The author became aware of the extraordinary influence of the Problem Oriented Veterinary Medical Record (POVMR) system while working on a dissertation of an ethnographic study of literacy at a veterinary college. However, finding literature on advanced literacies in the profession that touched on how a text type could have such an influence was…

The Medical Gopher — A Microcomputer Based Physician Work Station

PubMed Central

McDonald, Clement J.

1984-01-01

We've developed a microcomputer medical work station intended to reduce the physician's “gopher” work of fetching, reviewing, organizing and writing that consumes his day. The system requires extensive physician interaction; so we have developed a fast and consistent menu-oriented user interface. It provides facilities for entering prescriptions, orders, problems and other medical record information and for generating flowsheets, executing reminder rules, providing ad hoc retrievals and reporting facts about drugs, tests and differential diagnoses. Each work station is connected to a central server (currently a VAX 117/80) in a network configuration, but carries all of its own programs, tables and medical records for a few hundred patients, locally. This system is tested but not yet tried. Questions remain about physician's acceptance and the true usefullness of such a work station.

Preliminary investigation into application of problem-based learning in the practical teaching of diagnostics

PubMed Central

Rui, Zeng; Rong-Zheng, Yue; Hong-Yu, Qiu; Jing, Zeng; Xue-Hong, Wan; Chuan, Zuo

2015-01-01

Background Problem-based learning (PBL) is a pedagogical approach based on problems. Specifically, it is a student-centered, problem-oriented teaching method that is conducted through group discussions. The aim of our study is to explore the effects of PBL in diagnostic teaching for Chinese medical students. Methods A prospective, randomized controlled trial was conducted. Eighty junior clinical medical students were randomly divided into two groups. Forty students were allocated to a PBL group and another 40 students were allocated to a control group using the traditional teaching method. Their scores in the practice skills examination, ability to write and analyze medical records, and results on the stage test and behavior observation scale were compared. A questionnaire was administered in the PBL group after class. Results There were no significant differences in scores for writing medical records, content of interviewing, physical examination skills, and stage test between the two groups. However, compared with the control group, the PBL group had significantly higher scores on case analysis, interviewing skills, and behavioral observation scales. Conclusion The questionnaire survey revealed that PBL could improve interest in learning, cultivate an ability to study independently, improve communication and analytical skills, and good team cooperation spirit. However, there were some shortcomings in systematization of imparting knowledge. PBL has an obvious advantage in teaching with regard to diagnostic practice. PMID:25848334

A Problem-Oriented Record System for Counselors.

ERIC Educational Resources Information Center

Law, Joseph; And Others

1981-01-01

Recommends the adoption of Weed's Problem Oriented Records System by practitioners and supervisors. Also discusses the purposes of recordkeeping in counseling and establishes criteria for adopting documentation systems. Case examples illustrate the applicability of Weed's approach in counseling and practicum supervision. (Author)

Benefits of an Object-oriented Database Representation for Controlled Medical Terminologies

PubMed Central

Gu, Huanying; Halper, Michael; Geller, James; Perl, Yehoshua

1999-01-01

Objective: Controlled medical terminologies (CMTs) have been recognized as important tools in a variety of medical informatics applications, ranging from patient-record systems to decision-support systems. Controlled medical terminologies are typically organized in semantic network structures consisting of tens to hundreds of thousands of concepts. This overwhelming size and complexity can be a serious barrier to their maintenance and widespread utilization. The authors propose the use of object-oriented databases to address the problems posed by the extensive scope and high complexity of most CMTs for maintenance personnel and general users alike. Design: The authors present a methodology that allows an existing CMT, modeled as a semantic network, to be represented as an equivalent object-oriented database. Such a representation is called an object-oriented health care terminology repository (OOHTR). Results: The major benefit of an OOHTR is its schema, which provides an important layer of structural abstraction. Using the high-level view of a CMT afforded by the schema, one can gain insight into the CMT's overarching organization and begin to better comprehend it. The authors' methodology is applied to the Medical Entities Dictionary (MED), a large CMT developed at Columbia-Presbyterian Medical Center. Examples of how the OOHTR schema facilitated updating, correcting, and improving the design of the MED are presented. Conclusion: The OOHTR schema can serve as an important abstraction mechanism for enhancing comprehension of a large CMT, and thus promotes its usability. PMID:10428002

Object-orientated DBMS techniques for time-oriented medical record.

PubMed

Pinciroli, F; Combi, C; Pozzi, G

1992-01-01

In implementing time-orientated medical record (TOMR) management systems, use of a relational model played a big role. Many applications have been developed to extend query and data manipulation languages to temporal aspects of information. Our experience in developing TOMR revealed some deficiencies inside the relational model, such as: (a) abstract data type definition; (b) unified view of data, at a programming level; (c) management of temporal data; (d) management of signals and images. We identified some first topics to face by an object-orientated approach to database design. This paper describes the first steps in designing and implementing a TOMR by an object-orientated DBMS.

ARCADIA: a system for the integration of angiocardiographic data and images by an object-oriented DBMS.

PubMed

Pinciroli, F; Combi, C; Pozzi, G

1995-02-01

Use of data base techniques to store medical records has been going on for more than 40 years. Some aspects still remain unresolved, e.g., the management of textual data and image data within a single system. Object-orientation techniques applied to a database management system (DBMS) allow the definition of suitable data structures (e.g., to store digital images): some facilities allow the use of predefined structures when defining new ones. Currently available object-oriented DBMS, however, still need improvements both in the schema update and in the query facilities. This paper describes a prototype of a medical record that includes some multimedia features, managing both textual and image data. The prototype here described considers data from the medical records of patients subjected to percutaneous transluminal coronary artery angioplasty. We developed it on a Sun workstation with a Unix operating system and ONTOS as an object-oriented DBMS.

Curricular trends in Malaysian medical schools: innovations within.

PubMed

Azila, Nor Mohd Adnan; Rogayah, Jaafar; Zabidi-Hussin, Zabidi Azhar Mohd Hussin

2006-09-01

Various curricular innovations were adopted by medical schools worldwide in an attempt to produce medical graduates that could meet future healthcare needs of society locally and globally. This paper presents findings on curricular approaches implemented in Malaysian medical schools, in trying to meet those needs. Information was obtained from published records, responses from various questionnaires, personal communication and involvement with curricular development. Curricular innovations tended to be implemented in new medical schools upon their establishment. Established medical schools seemed to implement these innovations much later. Curricular trends appear to move towards integration, student-centred and problem-based learning as well as community-oriented medical education, with the Student-centred learning, Problem-based learning, Integrated teaching, Community-based education, Electives and Systematic programme (SPICES) model used as a reference. The focus is based on the premise that although the short-term aim of undergraduate medical education in Malaysia is to prepare graduates for the pre-registration house officer year, they must be able to practise and make decisions independently and be sensitive to the needs of the country's multiracial, multi-religious, and often remote communities. In most cases, curricular planning starts with a prescriptive model where planners focus on several intended outcomes. However, as the plan is implemented and evaluated it becomes descriptive as the planners reassess the internal and external factors that affect outcomes. A common trend in community-oriented educational activities is evident, with the introduction of interesting variations, to ensure that the curriculum can be implemented, sustained and the intended outcomes achieved.

Developing the Medication Reminder Mobile Application "Seeb".

PubMed

Saghaeiannejad-Isfahani, Sakineh; Ehteshami, Asghar; Savari, Ebtesam; Samimi, Ali

2017-06-01

Today, the structure of comprehensive health care emphasizes self-care more than therapy. Medication therapy is a strong instrument for therapy received through the health setting, especially in medication area. Error in medication administration has produced different problems and they cost billions of dollars every year. Regarding mobile phone extensions, we developed a local medication reminder mobile application called "Seeb" as a suitable solution for decreasing medication errors for Iranians. We conducted a mixed methods study in three Phases: 1) Comparative study of existing mobile applications; 2) developed its object-oriented model; 3) Developed the initial version of "Seeb" that was approved for production. This application was designed for the appropriate medication administration including time and dosages through: recording patient and medication data; scheduling patients' medication; and reporting medication administration on progress. "Seeb" has been designed in compliance with Iranian health information technologists and pharmacists requirements. It is expected to reduce medication error and improve patient adherence to medical prescriptions.

Psychometric validation of a new measurement instrument for time-oriented patient information in electronic medical records: A questionnaire survey of physicians.

PubMed

Shibuya, Akiko; Misawa, Jimpei; Maeda, Yukihiro; Ichikawa, Rie; Kamata, Michiyo; Inoue, Ryusuke; Morimoto, Tetsuji; Nakayama, Masaharu; Hishiki, Teruyoshi; Kondo, Yoshiaki

2017-12-01

Time is an important element in medical data. Physicians record and store information about patients' disease progress and treatment response in electronic medical records (EMRs). Because EMRs use timestamps, physicians can identify patterns over time regarding a patient's disease and treatment (eg, laboratory values and medications). However, analyses of physicians' use and satisfaction with EMRs have focused on functionality, storage, and system operation rather than the use of time-oriented information. This study aimed to understand physicians' needs regarding time-oriented patient information in EMRs in clinical practice. The reliability and validity of the items in the questionnaire were evaluated in 87 physicians at a national university hospital. Internal consistency was satisfactory (Cronbach alpha coefficient, 0.87). Four dimensions were identified in exploratory factor analysis. Correlations between the 4 dimensions supported the construct validity of the items. Scores of time-oriented patients' medical history in the 4 dimensions showed a significant association with physician age. Based on confirmatory factor analysis, associations were significant and positive (P < .001). In terms of the needs of physicians regarding time-oriented patient information in EMRs, both time-oriented treatment results followed by time-oriented team information had significant positive associations. Our study suggests that 4 specific time-oriented patient information factors in EMRs are needed by physicians. Exploring physicians' needs regarding patient-specific time-oriented information may provide a better understanding of the barriers facing the adoption and use of EMRs (eg, decision-making and practice safety concerns) and lead to better acceptance of EMRs in physicians' clinical practices. © 2017 John Wiley & Sons, Ltd.

A high-level object-oriented model for representing relationships in an electronic medical record.

PubMed Central

Dolin, R. H.

1994-01-01

The importance of electronic medical records to improve the quality and cost-effectiveness of medical care continues to be realized. This growing importance has spawned efforts at defining the structure and content of medical data, which is heterogeneous, highly inter-related, and complex. Computer-assisted data modeling tools have greatly facilitated the process of representing medical data, however the complex inter-relationships of medical information can result in data models that are large and cumbersome to manipulate and view. This report presents a high-level object-oriented model for representing the relationships between objects or entities that might exist in an electronic medical record. By defining the relationship between objects at a high level and providing for inheritance, this model enables relating any medical entity to any other medical entity, even though the relationships were not directly specified or known during data model design. PMID:7949981

TimeBench: a data model and software library for visual analytics of time-oriented data.

PubMed

Rind, Alexander; Lammarsch, Tim; Aigner, Wolfgang; Alsallakh, Bilal; Miksch, Silvia

2013-12-01

Time-oriented data play an essential role in many Visual Analytics scenarios such as extracting medical insights from collections of electronic health records or identifying emerging problems and vulnerabilities in network traffic. However, many software libraries for Visual Analytics treat time as a flat numerical data type and insufficiently tackle the complexity of the time domain such as calendar granularities and intervals. Therefore, developers of advanced Visual Analytics designs need to implement temporal foundations in their application code over and over again. We present TimeBench, a software library that provides foundational data structures and algorithms for time-oriented data in Visual Analytics. Its expressiveness and developer accessibility have been evaluated through application examples demonstrating a variety of challenges with time-oriented data and long-term developer studies conducted in the scope of research and student projects.

A problem-oriented approach to journal selection for hospital libraries.

PubMed Central

Delman, B S

1982-01-01

This paper describes a problem-oriented approach to journal selection (PAJS), including general methodology, theoretical terms, and a brief description of results when the system was applied in three different hospitals. The PAJS system relates the objective information which the MEDLARS data base offers about the universe of biomedical literature to objective, problem-oriented information supplied by the hospital's medical records. The results were manipulated quantitatively to determine (1) the relevance of various journals to each of the hospital's defined significant information problems and (2) the overall utility of each journal to the institution as a whole. The utility information was plotted on a graph to identify the collection of journal titles which would be most useful to the given hospital. Attempts made to verify certain aspects of the whole process are also described. The results suggest that the methodology is generally able to provide an effective library response. The system optimizes resources vis-a-vis information and can be used for both budget allocation and justification. It offers an algorithm to which operations researchers can apply any one of a variety of mathematical programming methods. Although originally intended for librarians in the community hospital environment, the PAJS system is generalizable and has application potential in a variety of special library settings. PMID:6758893

Pharmaceutical orientation at hospital discharge of transplant patients: strategy for patient safety.

PubMed

Lima, Lívia Falcão; Martins, Bruna Cristina Cardoso; Oliveira, Francisco Roberto Pereira de; Cavalcante, Rafaela Michele de Andrade; Magalhães, Vanessa Pinto; Firmino, Paulo Yuri Milen; Adriano, Liana Silveira; Silva, Adriano Monteiro da; Flor, Maria Jose Nascimento; Néri, Eugenie Desirée Rabelo

2016-01-01

To describe and analyze the pharmaceutical orientation given at hospital discharge of transplant patients. This was a cross-sectional, descriptive and retrospective study that used records of orientation given by the clinical pharmacist in the inpatients unit of the Kidney and Liver Transplant Department, at Hospital Universitário Walter Cantídio, in the city of Fortaleza (CE), Brazil, from January to July, 2014. The following variables recorded at the Clinical Pharmacy Database were analyzed according to their significance and clinical outcomes: pharmaceutical orientation at hospital discharge, drug-related problems and negative outcomes associated with medication, and pharmaceutical interventions performed. The first post-transplant hospital discharge involved the entire multidisciplinary team and the pharmacist was responsible for orienting about drug therapy. The mean hospital discharges/month with pharmaceutical orientation during the study period was 10.6±1.3, totaling 74 orientations. The prescribed drug therapy had a mean of 9.1±2.7 medications per patient. Fifty-nine drug-related problems were identified, in which 67.8% were related to non-prescription of medication needed, resulting in 89.8% of risk of negative outcomes associated with medications due to untreated health problems. The request for inclusion of drugs (66.1%) was the main intervention, and 49.2% of the medications had some action in the digestive tract or metabolism. All interventions were classified as appropriate, and 86.4% of them we able to prevent negative outcomes. Upon discharge of a transplanted patient, the orientation given by the clinical pharmacist together with the multidisciplinary team is important to avoid negative outcomes associated with drug therapy, assuring medication reconciliation and patient safety. Descrever e analisar a orientação farmacêutica oferecida na alta de pacientes transplantados. Trata-se de um estudo transversal, descritivo e retrospectivo, que utilizou os registros das orientações realizadas pelo farmacêutico clínico na unidade de internação do Serviço de Transplante Renal e Hepático, Hospital Universitário Walter Cantídio, em Fortaleza (CE), de janeiro a julho de 2014. Foram analisadas, de acordo com sua significância e desfechos clínicos obtidos, as seguintes variáveis registradas no Banco de Dados do Serviço de Farmácia Clínica: orientações farmacêuticas na alta, problemas e resultados negativos relacionados aos medicamentos, e intervenções farmacêuticas realizadas. A primeira alta pós-transplante envolveu toda a equipe multiprofissional, sendo o farmacêutico responsável pela orientação do tratamento medicamentoso. A média de altas/mês com orientação farmacêutica no período do estudo foi de 10,6±1,3, totalizando 74 orientações. O tratamento clínico prescrito teve média de 9,1±2,7 medicamentos por paciente. Foram identificados 59 problemas relacionados aos medicamentos; 67,8% relacionaram-se com a não prescrição do medicamento necessário, acarretando 89,8% de risco de resultados negativos associados aos medicamentos por problema de saúde não tratado. A principal intervenção foi a solicitação de inclusão do medicamento (66,1%), e 49,2% dos medicamentos envolvidos agiam no aparelho digestivo/metabolismo. Todas as intervenções foram classificadas como apropriadas, e 86,4% foram capazes de prevenir o resultado negativo. A orientação do farmacêutico clínico junto à equipe multiprofissional no momento da alta do paciente transplantado é importante, pois previne resultados negativos associados à farmacoterapia, garantindo a conciliação medicamentosa e a segurança do paciente.

A web-based rapid prototyping and clinical conversational system that complements electronic patient record system.

PubMed

Kim, J H; Ferziger, R; Kawaloff, H B; Sands, D Z; Safran, C; Slack, W V

2001-01-01

Even the most extensive hospital information system cannot support all the complex and ever-changing demands associated with a clinical database, such as providing department or personal data forms, and rating scales. Well-designed clinical dialogue programs may facilitate direct interaction of patients with their medical records. Incorporation of extensive and loosely structured clinical data into an existing medical record system is an essential step towards a comprehensive clinical information system, and can best be achieved when the practitioner and the patient directly enter the contents. We have developed a rapid prototyping and clinical conversational system that complements the electronic medical record system, with its generic data structure and standard communication interfaces based on Web technology. We believe our approach can enhance collaboration between consumer-oriented and provider-oriented information systems.

Use of NLM medical subject headings with the MeSH2010 thesaurus in the PORTAL-DOORS system.

PubMed

Taswell, Carl

2010-01-01

The NLM MeSH Thesaurus has been incorporated for use in the PORTAL-DOORS System (PDS) for resource metadata management on the semantic web. All 25588 descriptor records from the NLM 2010 MeSH Thesaurus have been exposed as web accessible resources by the PDS MeSH2010 Thesaurus implemented as a PDS PORTAL Registry operating as a RESTful web service. Examples of records from the PDS MeSH2010 PORTAL are demonstrated along with their use by records in other PDS PORTAL Registries that reference the concepts from the MeSH2010 Thesaurus. Use of this important biomedical terminology will greatly enhance the quality of metadata content of other PDS records thus improving cross-domain searches between different problem oriented domains and amongst different clinical specialty fields.

Health care transformation through collaboration on open-source informatics projects: integrating a medical applications platform, research data repository, and patient summarization.

PubMed

Klann, Jeffrey G; McCoy, Allison B; Wright, Adam; Wattanasin, Nich; Sittig, Dean F; Murphy, Shawn N

2013-05-30

The Strategic Health IT Advanced Research Projects (SHARP) program seeks to conquer well-understood challenges in medical informatics through breakthrough research. Two SHARP centers have found alignment in their methodological needs: (1) members of the National Center for Cognitive Informatics and Decision-making (NCCD) have developed knowledge bases to support problem-oriented summarizations of patient data, and (2) Substitutable Medical Apps, Reusable Technologies (SMART), which is a platform for reusable medical apps that can run on participating platforms connected to various electronic health records (EHR). Combining the work of these two centers will ensure wide dissemination of new methods for synthesized views of patient data. Informatics for Integrating Biology and the Bedside (i2b2) is an NIH-funded clinical research data repository platform in use at over 100 sites worldwide. By also working with a co-occurring initiative to SMART-enabling i2b2, we can confidently write one app that can be used extremely broadly. Our goal was to facilitate development of intuitive, problem-oriented views of the patient record using NCCD knowledge bases that would run in any EHR. To do this, we developed a collaboration between the two SHARPs and an NIH center, i2b2. First, we implemented collaborative tools to connect researchers at three institutions. Next, we developed a patient summarization app using the SMART platform and a previously validated NCCD problem-medication linkage knowledge base derived from the National Drug File-Reference Terminology (NDF-RT). Finally, to SMART-enable i2b2, we implemented two new Web service "cells" that expose the SMART application programming interface (API), and we made changes to the Web interface of i2b2 to host a "carousel" of SMART apps. We deployed our SMART-based, NDF-RT-derived patient summarization app in this SMART-i2b2 container. It displays a problem-oriented view of medications and presents a line-graph display of laboratory results. This summarization app can be run in any EHR environment that either supports SMART or runs SMART-enabled i2b2. This i2b2 "clinical bridge" demonstrates a pathway for reusable app development that does not require EHR vendors to immediately adopt the SMART API. Apps can be developed in SMART and run by clinicians in the i2b2 repository, reusing clinical data extracted from EHRs. This may encourage the adoption of SMART by supporting SMART app development until EHRs adopt the platform. It also allows a new variety of clinical SMART apps, fueled by the broad aggregation of data types available in research repositories. The app (including its knowledge base) and SMART-i2b2 are open-source and freely available for download.

GRAMPS: An Automated Ambulatory Geriatric Record

PubMed Central

Hammond, Kenric W.; King, Carol A.; Date, Vishvanath V.; Prather, Robert J.; Loo, Lawrence; Siddiqui, Khwaja

1988-01-01

GRAMPS (Geriatric Record and Multidisciplinary Planning System) is an interactive MUMPS system developed for VA outpatient use. It allows physicians to effectively document care in problem-oriented format with structured narrative and free text, eliminating handwritten input. We evaluated the system in a one-year controlled cohort study. When the computer, was used, appointment times averaged 8.2 minutes longer (32.6 vs. 24.4 minutes) compared to control visits with the same physicians. Computer use was associated with better quality of care as measured in the management of a common problem, hypertension, as well as decreased overall costs of care. When a faster computer was installed, data entry times improved, suggesting that slower processing had accounted for a substantial portion of the observed difference in appointment lengths. The GRAMPS system was well-accepted by providers. The modular design used in GRAMPS has been extended to medical-care applications in Nursing and Mental Health.

Longitudinal Retention of Anatomical Knowledge in Second-year Medical Students

ERIC Educational Resources Information Center

Doomernik, Denise E.; van Goor, Harry; Kooloos, Jan G. M.; ten Broek, Richard P.

2017-01-01

The Radboud University Medical Center has a problem-based, learner-oriented, horizontally, and vertically integrated medical curriculum. Anatomists and clinicians have noticed students' decreasing anatomical knowledge and the disability to apply knowledge in diagnostic reasoning and problem solving. In a longitudinal cohort, the retention of…

Association Between Anticipatory Grief and Problem Solving Among Family Caregivers of Persons with Cognitive Impairment

PubMed Central

Fowler, Nicole R.; Hansen, Alexandra S.; Barnato, Amber E.; Garand, Linda

2013-01-01

Objective Measure perceived involvement in medical decision making and determine if anticipatory grief is associated with problem solving among family caregivers of older adults with cognitive impairment. Method Retrospective analysis of baseline data from a caregiver intervention (n=73). Multivariable regression models testing the association between caregivers’ anticipatory grief, measured by the Anticipatory Grief Scale (AGS), with problem solving abilities, measured by the Social Problem Solving Inventory – Revised: Short Form (SPSI-R: S). Results 47/73 (64%) of caregivers reported involvement in medical decision making. Mean AGS was 70.1 (± 14.8) and mean SPSI-R:S was 107.2 (± 11.6). Higher AGS scores were associated with lower positive problem orientation (P=0.041) and higher negative problem orientation scores (P=0.001) but not other components of problem solving- rational problem solving, avoidance style, and impulsivity/carelessness style. Discussion Higher anticipatory grief among family caregivers impaired problem solving, which could have negative consequences for their medical decision making responsibilities. PMID:23428394

[Recommendations for overcoming interface problems in medical rehabilitation of federal pension funds and statutory health insurance].

PubMed

Pohontsch, N; Träder, J-M; Scherer, M; Deck, R

2013-10-01

Interface problems in medical rehabilitation are a consequence of problems with communication and cooperation, lack of information and transparency. Different stakeholders are trying to solve these problems since many years or decades respectively. Following a series of deficit-oriented studies we tried to develop recommendations for possible solutions of important interface problems together with affected people based on a qualitative analysis of main problem areas. 10 separate group discussions with rehabilitation patients, general practitioners and specialists in private practices, representatives of the federal pension fund and statutory health insurance as well as clinicians from rehabilitation clinics and 3 mixed group discussions (all before mentioned groups excluding rehabilitation patients) were conducted. These group discussions served to prepare a semidiurnal final conference. All meetings were recorded and content analyzed or summarized in protocols respectively. Results are recommendations on strategies to reduce interface problems in medical rehabilitation. Those are: development of a rehabilitation-information-website for insurees and general practitioners and specialists in private practices; changes in forms, applications, notifications; advanced training for general practitioners and specialists in private practices und support in detecting rehabilitation need. Due to divided structures of care provision and increasing specialization, overcoming interface problems is one of the main challenges in the provision of medical rehabilitation. It can be met if different stakeholder approach each other without prejudices, share instead of demarcate competencies and are willing to strike new paths. Our recommendations represent the first step to reaching this goal. © Georg Thieme Verlag KG Stuttgart · New York.

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

PubMed

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

2012-06-01

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

Agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases

PubMed Central

Fathelrahman, Ahmed I

2009-01-01

Background The main objective of the present study was to evaluate the agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. Methods Cross-sectional sample of 100 poisoning cases consecutively admitted to the Hospital Pulau Pinang, Malaysia during the period from September 2003 to February 2004 were studied. Data on health and socioeconomic problems were collected both by self-administered questionnaire and from medical records. Agreement between the two sets of data was assessed by calculating the concordance rate, Kappa (k) and PABAK. McNemar statistic was used to test differences between categories. Results Data collected by questionnaire and medical records showed excellent agreement on the "marital status"; good agreements on "chronic illness", "psychiatric illness", and "previous history of poisoning"; and fair agreements on "at least one health problem", and "boy-girl friends problem". PABAK values suggest better agreements' measures. Conclusion There were excellent to good agreements between questionnaire and medical records on the marital status and most of the health problems and fair to poor agreements on the majority of socioeconomic problems. The implications of those findings were discussed. PMID:19751526

Long-Term Outcomes of Innovative Curricular Tracks Used in Four Countries.

ERIC Educational Resources Information Center

Suwanwela, Charas; And Others

1993-01-01

Innovative medical school programs discussed include a problem-based, village-centered rural program in the Philippines, a problem-oriented rural program of community medicine in Thailand, a problem-based curriculum in China, and four restructured medical curricula in the United States. Focus is on the results of the changes. (MSE)

Using medication list--problem list mismatches as markers of potential error.

PubMed Central

Carpenter, James D.; Gorman, Paul N.

2002-01-01

The goal of this project was to specify and develop an algorithm that will check for drug and problem list mismatches in an electronic medical record (EMR). The algorithm is based on the premise that a patient's problem list and medication list should agree, and a mismatch may indicate medication error. Successful development of this algorithm could mean detection of some errors, such as medication orders entered into a wrong patient record, or drug therapy omissions, that are not otherwise detected via automated means. Additionally, mismatches may identify opportunities to improve problem list integrity. To assess the concept's feasibility, this study compared medications listed in a pharmacy information system with findings in an online nursing adult admission assessment, serving as a proxy for the problem list. Where drug and problem list mismatches were discovered, examination of the patient record confirmed the mismatch, and identified any potential causes. Evaluation of the algorithm in diabetes treatment indicates that it successfully detects both potential medication error and opportunities to improve problem list completeness. This algorithm, once fully developed and deployed, could prove a valuable way to improve the patient problem list, and could decrease the risk of medication error. PMID:12463796

Tools for the Job: The POMR in Preventive Medicine

PubMed Central

Dixon-Warren, Brian

1977-01-01

There is increasing interest in practical preventive care in the family doctor's office. The concepts underlying the problem oriented medical record (POMR) include the principles of preventive medicine, and it is thus an excellent vehicle for implementation. However, the classical POMR model must be modified to the context of family practice, and priorities defined by each practice. This article describes how elements of the POMR can be used in planning preventive care. An appraisal of one's own practice is a valuable part of the planning; follow up can assess patient compliance and the effectiveness of the program. PMID:21304858

Combination of Didactic Lectures with Problem-Based Learning Sessions in Physiology Teaching in a Developing Medical College in Nepal.

ERIC Educational Resources Information Center

Ghosh, Sarmishtha; Dawka, Violet

2000-01-01

Introduces the SPICES curriculum of the Manipal College of Medical Sciences in Nepal, which is student centered, problem based, integrated, community-based, elective oriented, and systematic. Reports that the majority of students opined that the combination of didactic lectures and problem-based learning sessions were definitely beneficial.…

Healthcare and Guidelines: A Population-Based Survey of Recorded Medical Problems and Health Surveillance for People with Down syndrome

ERIC Educational Resources Information Center

Maatta, Tuomo; Maatta, Joonas; Tervo-Maatta, Tuula; Taanila, Anja; Kaski, Markus; Iivanainen, Matti

2011-01-01

Background: Medical problems are described in a population of persons with Down syndrome. Health surveillance is compared to the recommendations of national guidelines. Method: Case records from the specialised and primary healthcare and disability services were analysed. Results: A wide spectrum of age-specific medical and surgical problems was…

Dose Tracker Application for Monitoring Crew Medication Usage, Symptoms, and Adverse Effects During Missions

NASA Technical Reports Server (NTRS)

Wotring, Virginia; Smith, LaRona

2015-01-01

Medication usage records can be used as a relatively nonintrusive means of monitoring health. This has been attempted previously through crew medical records, but these records are incomplete from the perspective of a research pharmacologist. During the shuttle era, NASA operations did not include routine questioning of crewmembers about their medication use until after missions were complete. The (long!) questionnaire was on paper. Asking crewmembers to recall medication use from weeks before questioning made getting complete and accurate information virtually impossible. This study will document medication usage of crewmembers before and during their missions. It will capture previously unrecorded data regarding medication use during spaceflight, including side effect qualities, frequencies and severities. The research-oriented data will be collected for research purposes, separate from medical records. Dose Tracker employs an iOS application (app) for fast & easy collection of medication usage data from crewmember participants during their missions.

An object-oriented class library for medical software development.

PubMed

O'Kane, K C; McColligan, E E

1996-12-01

The objective of this research is the development of a Medical Object Library (MOL) consisting of reusable, inheritable, portable, extendable C++ classes that facilitate rapid development of medical software at reduced cost and increased functionality. The result of this research is a library of class objects that range in function from string and hierarchical file handling entities to high level, procedural agents that perform increasingly complex, integrated tasks. A system built upon these classes is compatible with any other system similarly constructed with respect to data definitions, semantics, data organization and storage. As new objects are built, they can be added to the class library for subsequent use. The MOL is a toolkit of software objects intended to support a common file access methodology, a unified medical record structure, consistent message processing, standard graphical display facilities and uniform data collection procedures. This work emphasizes the relationship that potentially exists between the structure of a hierarchical medical record and procedural language components by means of a hierarchical class library and tree structured file access facility. In doing so, it attempts to establish interest in and demonstrate the practicality of the hierarchical medical record model in the modern context of object oriented programming.

A Lexical-Ontological Resource for Consumer Healthcare

NASA Astrophysics Data System (ADS)

Cardillo, Elena; Serafini, Luciano; Tamilin, Andrei

In Consumer Healthcare Informatics it is still difficult for laypeople to find, understand and act on health information, due to the persistent communication gap between specialized medical terminology and that used by healthcare consumers. Furthermore, existing clinically-oriented terminologies cannot provide sufficient support when integrated into consumer-oriented applications, so there is a need to create consumer-friendly terminologies reflecting the different ways healthcare consumers express and think about health topics. Following this direction, this work suggests a way to support the design of an ontology-based system that mitigates this gap, using knowledge engineering and semantic web technologies. The system is based on the development of a consumer-oriented medical terminology that will be integrated with other medical domain ontologies and terminologies into a medical ontology repository. This will support consumer-oriented healthcare systems, such as Personal Health Records, by providing many knowledge services to help users in accessing and managing their healthcare data.

Use of Electronic Medication Administration Records to Reduce Perceived Stress and Risk of Medication Errors in Nursing Homes.

PubMed

Alenius, Malin; Graf, Peter

2016-07-01

Concerns have been raised about the effects of current medication administration processes on the safety of many of the aspects of medication administration. Keeping electronic medication administration records could decrease many of these problems. Unfortunately, there has not been much research on this topic, especially in nursing homes. A prospective case-control survey was consequently performed at two nursing homes; the electronic record system was introduced in one, whereas the other continued to use paper records. The personnel were asked to fill in a questionnaire of their perceptions of stress and risk of medication errors at baseline (n = 66) and 20 weeks after the intervention group had started recording medication administration electronically (n = 59). There were statistically significant decreases in the perceived risk of omitting a medication, of medication errors occurring because of communication problems, and of medication errors occurring because of inaccurate medication administration records in the intervention group (all P < .01 vs the control group). The perceived overall daily stress levels were also reduced in the intervention group (P < .05). These results indicate that the utilization of electronic medication administration records will reduce many of the concerns regarding the medication administration process.

[Problem list in computer-based patient records].

PubMed

Ludwig, C A

1997-01-14

Computer-based clinical information systems are capable of effectively processing even large amounts of patient-related data. However, physicians depend on rapid access to summarized, clearly laid out data on the computer screen to inform themselves about a patient's current clinical situation. In introducing a clinical workplace system, we therefore transformed the problem list-which for decades has been successfully used in clinical information management-into an electronic equivalent and integrated it into the medical record. The table contains a concise overview of diagnoses and problems as well as related findings. Graphical information can also be integrated into the table, and an additional space is provided for a summary of planned examinations or interventions. The digital form of the problem list makes it possible to use the entire list or selected text elements for generating medical documents. Diagnostic terms for medical reports are transferred automatically to corresponding documents. Computer technology has an immense potential for the further development of problem list concepts. With multimedia applications sound and images will be included in the problem list. For hyperlink purpose the problem list could become a central information board and table of contents of the medical record, thus serving as the starting point for database searches and supporting the user in navigating through the medical record.

Accuracy of self-reported medical problems in patients with alcohol dependence and co-occurring schizophrenia or schizoaffective disorder.

PubMed

Meszaros, Zsuzsa Szombathyne; Dimmock, Jacqueline A; Ploutz-Snyder, Robert; Chauhan, Sumerendra Vir Singh; Abdul-Malak, Ynesse; Middleton, Frank A; Batki, Steven L

2011-11-01

Schizophrenia and alcohol dependence (AD) are both major risk factors for a variety of medical problems, yet little is known about the medical status of patients in whom both conditions coexist. The objectives of this study are to assess accuracy of self-reported medical problems and to compare the accuracy reports in patients with schizophrenia or schizoaffective disorder and co-occurring AD compared to patients with AD only and to controls. Our hypothesis was that medical problems are under-reported in patients with co-occurring disorders, possibly due to the combination of alcohol use and symptoms of schizophrenia. Self-reported medical diagnoses were recorded and compared to medical records obtained from all area hospitals in 42 patients with schizophrenia and AD, 44 patients with schizoaffective disorder and AD, 41 patients with AD only, and 15 control subjects. Patients underwent medical history, physical examination, and review of medical records. Patients with schizophrenia or schizoaffective disorder and co-occurring AD underreported their medical problems significantly more than patients with AD only and controls. Accuracy of self report was significantly lower in patients with schizophrenia-spectrum disorders plus co-occurring alcohol dependence than in AD alone or in controls. The most commonly underreported diagnoses included coronary artery disease, chronic renal failure, seizure disorder, hyperlipidemia, asthma and hypertension. In order to detect potentially unreported medical conditions in patients with co-occurring schizophrenia/schizoaffective disorder and alcohol dependence, the use of targeted screening questionnaires is recommended in addition to physical examination and thorough review of medical records. Copyright © 2011 Elsevier B.V. All rights reserved.

Gender roles, illness orientation and use of medical services.

PubMed

Hibbard, J H; Pope, C R

1983-01-01

The study investigates illness orientation as a factor which may account for sex differences in the utilization of medical care. First, sex differences in the way symptoms are perceived, evaluated and acted upon (illness orientation) are analyzed. Then gender role factors which may account for sex differences in illness orientation are examined. Finally, the degree to which gender role factors and illness orientation account for sex differences in medical care utilization are assessed. The study population includes 1648 adults between the ages of 18 and 59. Medical record data covering 7 years of outpatient services are linked with survey data on the respondents. The findings show that while females are more likely to perceive symptoms than males, there is no apparent sex difference in a tendency to adopt the sick role when ill. In addition, results indicate that gender role factors such as level and type of role responsibility and concern with health are related to female though not male symptom reports. Illness orientation variables are related to rates of medical utilization for both sexes. However, it is primarily the perception of symptoms and an interest and concern with health which contributes to sex differences in utilization rates. When examining respondents who report either a very low or very high number of symptoms, sex differences in utilization rates fall below statistical significance.

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

PubMed

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

2012-08-01

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

Management Review: Progress and Challenges at the Defense Logistics Agency.

DTIC Science & Technology

1986-04-01

with safety and worklife problems (warehousing schemes, replacement or improvement of equipment, loading dock shelters, and employee orientation systems... balances . Accuracy of DCASR Contingent The contingent liability record is one of the more important records Liability Records maintained by DCASRs because...needed for making management decisions and for certifying to the accu- racy of ULO balances . Problems in Data Reported to Based on our interviews with

Motivational Influences of Using Peer Evaluation in Problem-Based Learning in Medical Education

ERIC Educational Resources Information Center

Abercrombie, Sara; Parkes, Jay; McCarty, Teresita

2015-01-01

This study investigates the ways in which medical students' achievement goal orientations (AGO) affect their perceptions of learning and actual learning from an online problem-based learning environment, Calibrated Peer Review™. First, the tenability of a four-factor model (Elliot & McGregor, 2001) of AGO was tested with data collected from…

Power in telephone-advice nursing.

PubMed

Leppänen, Vesa

2010-03-01

Power is a central aspect of nursing, especially in telephone-advice nursing, where nurses assess callers' medical problems and decide what measures that need to be taken. This article presents a framework for understanding how power operates in social interaction between nurses and callers in telephone-advice nursing in primary care in Sweden. Power is analysed as the result of nurses and callers being oriented to five social structures that are relevant to their actions in this context, namely the organization of telephone-advice nursing, the social stock of medical knowledge, the professional division of labour between nurses and doctors, structures of social interaction and structures of emotions. While structural constraints govern some actions to a high degree, calls take place in an organizational free room that give nurses more leeway for acting more creatively. The discussion focuses on the introduction of new technologies of control, for instance computerized decision support systems and audio recording of calls, and on how they reduce the free room. Empirical data consist of 276 audio-recorded telephone calls to 13 nurses at six primary-care centres and of qualitative interviews with 18 nurses.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs.

PubMed

McCoy, A B; Wright, A; Krousel-Wood, M; Thomas, E J; McCoy, J A; Sittig, D F

2015-01-01

Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs

PubMed Central

Wright, A.; Krousel-Wood, M.; Thomas, E. J.; McCoy, J. A.; Sittig, D. F.

2015-01-01

Summary Background Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. Objective We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. Methods We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. Results The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. Conclusions We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes. PMID:26171079

[Current teaching, learning and examination methods in medical education and potential applications in rehabilitative issues].

PubMed

Schwarzkopf, S R; Morfeld, M; Gülich, M; Lay, W; Horn, K; Mau, W

2007-04-01

With introduction of the new Federal Medical Licensing Regulations (Approbationsordnung) in Germany, integrated teaching in "Rehabilitation, Physical Medicine, Naturopathic Treatment" (Querschnittsbereich Q12) has become obligatory for the first time. Furthermore, the new Regulations require the medical faculties in Germany to realize an innovative didactic orientation in teaching. This paper provides an overview of recent applications of teaching techniques and examination methods in medical education with special consideration of the new integrated course Q12 and further teaching methods related to rehabilitative issues. Problem-oriented learning (POL), problem-based learning (PBL), bedside teaching, eLearning, and the examination methods Objective Structured Clinical Examination (OSCE) and Triple Jump are in the focus. This overview is intended as the basis for subsequent publications of the Commission for Undergraduate and Postgraduate Training of the German Society of Rehabilitation Science (DGRW), which will present examples of innovative teaching material.

Cardiological database management system as a mediator to clinical decision support.

PubMed

Pappas, C; Mavromatis, A; Maglaveras, N; Tsikotis, A; Pangalos, G; Ambrosiadou, V

1996-03-01

An object-oriented medical database management system is presented for a typical cardiologic center, facilitating epidemiological trials. Object-oriented analysis and design were used for the system design, offering advantages for the integrity and extendibility of medical information systems. The system was developed using object-oriented design and programming methodology, the C++ language and the Borland Paradox Relational Data Base Management System on an MS-Windows NT environment. Particular attention was paid to system compatibility, portability, the ease of use, and the suitable design of the patient record so as to support the decisions of medical personnel in cardiovascular centers. The system was designed to accept complex, heterogeneous, distributed data in various formats and from different kinds of examinations such as Holter, Doppler and electrocardiography.

Enhancing Large-Group Problem-Based Learning in Veterinary Medical Education.

ERIC Educational Resources Information Center

Pickrell, John A.

This project for large-group, problem-based learning at Kansas State University College of Veterinary Medicine developed 47 case-based videotapes that are used to model clinical conditions and also involved veterinary practitioners to formulate true practice cases into student learning opportunities. Problem-oriented, computer-assisted diagnostic…

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

PubMed

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

2016-06-01

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

A study on agent-based secure scheme for electronic medical record system.

PubMed

Chen, Tzer-Long; Chung, Yu-Fang; Lin, Frank Y S

2012-06-01

Patient records, including doctors' diagnoses of diseases, trace of treatments and patients' conditions, nursing actions, and examination results from allied health profession departments, are the most important medical records of patients in medical systems. With patient records, medical staff can instantly understand the entire medical information of a patient so that, according to the patient's conditions, more accurate diagnoses and more appropriate in-depth treatments can be provided. Nevertheless, in such a modern society with booming information technologies, traditional paper-based patient records have faced a lot of problems, such as lack of uniform formats, low data mobility, slow data transfer, illegible handwritings, enormous and insufficient storage space, difficulty of conservation, being easily damaged, and low transferability. To improve such drawbacks, reduce medical costs, and advance medical quality, paper-based patient records are modified into electronic medical records and reformed into electronic patient records. However, since electronic patient records used in various hospitals are diverse and different, in consideration of cost, it is rather difficult to establish a compatible and complete integrated electronic patient records system to unify patient records from heterogeneous systems in hospitals. Moreover, as the booming of the Internet, it is no longer necessary to build an integrated system. Instead, doctors can instantly look up patients' complete information through the Internet access to electronic patient records as well as avoid the above difficulties. Nonetheless, the major problem of accessing to electronic patient records cross-hospital systems exists in the security of transmitting and accessing to the records in case of unauthorized medical personnels intercepting or stealing the information. This study applies the Mobile Agent scheme to cope with the problem. Since a Mobile Agent is a program, which can move among hosts and automatically disperse arithmetic processes, and moves from one host to another in heterogeneous network systems with the characteristics of autonomy and mobility, decreasing network traffic, reducing transfer lag, encapsulating protocol, availability on heterogeneous platforms, fault-tolerance, high flexibility, and personalization. However, since a Mobile Agent contacts and exchanges information with other hosts or agents on the Internet for rapid exchange and access to medical information, the security is threatened. In order to solve the problem, this study proposes a key management scheme based on Lagrange interpolation formulas and hierarchical management structure to make Mobile Agents a more secure and efficient access control scheme for electronic patient record systems when applied to the access of patients' personal electronic patient records cross hospitals. Meanwhile, with the comparison of security and efficacy analyses being the feasibility of validation scheme and the basis of better efficiency, the security of Mobile Agents in the process of operation can be guaranteed, key management efficacy can be advanced, and the security of the Mobile Agent system can be protected.

Child Psychotherapy, Child Analysis, and Medication: A Flexible, Integrative Approach.

PubMed

Whitman, Laura

2015-01-01

For children with moderate to severe emotional or behavioral problems, the current approach in child psychiatry is to make an assessment for the use of both psychotherapy and medication. This paper describes integration of antidepressants and stimulants with psychoanalytically oriented techniques.

Clinical care management and workflow by episodes.

PubMed Central

Claus, P. L.; Carpenter, P. C.; Chute, C. G.; Mohr, D. N.; Gibbons, P. S.

1997-01-01

This paper describes the implementation of clinically defined episodes of care and the introduction of an episode-based summary list of patient problems across Mayo Clinic Rochester in 1996 and 1997. Although Mayo's traditional paper-based system has always relied on a type of 'episode of care' (called the "registration") for patient and history management, a new, more clinically relevant definition of episode of care was put into practice in November 1996. This was done to improve care management and operational processes and to provide a basic construct for the electronic medical record. Also since November 1996, a computer-generated summary list of patient problems, the "Master Sheet Summary Report," organized by episode, has been placed in all patient histories. In the third quarter of 1997, the ability to view the episode-based problem summary online was made available to the 3000+ EMR-capable workstations deployed across the Mayo Rochester campus. In addition, the clinically oriented problem summarization process produces an improved basic "package" of clinical information expected to lead to improved analytic decision support, outcomes analysis and epidemiological research. PMID:9357595

The Use of Electronic Medical Records

PubMed Central

Makoul, Gregory; Curry, Raymond H.; Tang, Paul C.

2001-01-01

Objective: To assess physician–patient communication patterns associated with use of an electronic medical record (EMR) system in an outpatient setting and provide an empirical foundation for larger studies. Design: An exploratory, observational study involving analysis of videotaped physician–patient encounters, questionnaires, and medical-record reviews. Setting: General internal medicine practice at an academic medical center. Participants: Three physicians who used an EMR system (EMR physicians) and three who used solely a paper record (control physicians). A total of 204 patient visits were included in the analysis (mean, 34 for each physician). Main Outcome Measures: Content analysis of whether physicians accomplished communication tasks during encounters; qualitative analysis of how EMR physicians used the EMR and how control physicians used the paper chart. Results: Compared with the control physicians, EMR physicians adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit. A trend suggested that EMR physicians might be less active than control physicians in three somewhat more patient-centered areas (outlining the patient's agenda, exploring psychosocial/ emotional issues, discussing how health problems affect a patient's life). Physicians in both groups tended to direct their attention to the patient record during the initial portion of the encounter. The relatively fixed position of the computer limited the extent to which EMR physicians could physically orient themselves toward the patient. Although there was no statistically significant difference between the EMR and control physicians in terms of mean time across all visits, a difference did emerge for initial visits: Initial visits with EMR physicians took an average of 37.5 percent longer than those with control physicians. Summary: An EMR system may enhance the ability of physicians to complete informationintensive tasks but can make it more difficult to focus attention on other aspects of patient communication. Further study involving a controlled, pre-/post-intervention design is justified. PMID:11687567

Urban Alabama Physicians and the Electronic Medical Record: A Qualitative Study

ERIC Educational Resources Information Center

Tiggle, Michele

2012-01-01

The electronic medical record (EMR) is an information technology tool supporting the examination, treatment, and care of a patient. The EMR allows physicians to view a patient's record showing current medications, a history of visits from health care providers with notes from those visits, a problem list, a functional status assessment, a schedule…

A Real Time Interface Between a Computerized Physician Order Entry System and the Computerized ICU Medication Administration Record

PubMed Central

Chen, Jeannie; Shabot, M. Michael; LoBue, Mark

2003-01-01

Prior attempts to interface ICU Clinical Information Systems (CIS) to Pharmacy systems have been less than successful. The major problem is that in ICUs, medications frequently have to be administered and charted in the CIS Medication Administration Record (MAR) before pharmacists can enter them into the Pharmacy system. When the Pharmacy system belatedly sends medication orders to the CIS MAR, this may create duplicate entries for medications that ICU nurses have had to enter manually to chart doses actually given. The authors have implemented a real time interface between a Computerized Physician Order Entry (CPOE) system and a CIS operating in ten ICUs that solves this problem. The interface transfers new medication orders including order details and alerts directly to the CIS Medication Administration Record (MAR), where they are immediately available for nurse charting. PMID:14728315

Information Seeking in Uncertainty Management Theory: Exposure to Information About Medical Uncertainty and Information-Processing Orientation as Predictors of Uncertainty Management Success.

PubMed

Rains, Stephen A; Tukachinsky, Riva

2015-01-01

Uncertainty management theory outlines the processes through which individuals cope with health-related uncertainty. Information seeking has been frequently documented as an important uncertainty management strategy. The reported study investigates exposure to specific types of medical information during a search, and one's information-processing orientation as predictors of successful uncertainty management (i.e., a reduction in the discrepancy between the level of uncertainty one feels and the level one desires). A lab study was conducted in which participants were primed to feel more or less certain about skin cancer and then were allowed to search the World Wide Web for skin cancer information. Participants' search behavior was recorded and content analyzed. The results indicate that exposure to two health communication constructs that pervade medical forms of uncertainty (i.e., severity and susceptibility) and information-processing orientation predicted uncertainty management success.

Patients who leave the hospital against medical advice: the role of the psychiatric consultant.

PubMed

Holden, P; Vogtsberger, K N; Mohl, P C; Fuller, D S

1989-01-01

Previous studies have identified characteristics of patients who threaten to leave non-psychiatric units against medical advice, but few have described the role of the psychiatric consultant in the patient's decision. This study compared the medical records of 31 patients who threatened to leave the hospital against medical advice (AMA) and who were seen in consultation with the records of AMA-discharged patients who were not seen by a psychiatric consultant. Most patients who received consultations remained hospitalized or were discharged in regular fashion. Those seen soon after admission were most likely to stay. Patients were more likely to remain hospitalized if the consultant's recommendations had a practical, rather than a psychological, orientation.

A Learning Research Informed Design and Evaluation of a Web-Enhanced Object Oriented Programming Seminar

ERIC Educational Resources Information Center

Georgantaki, Stavroula C.; Retalis, Symeon D.

2007-01-01

"Object-Oriented Programming" subject is included in the ACM Curriculum Guidelines for Undergraduate and Graduate Degree Programs in Computer Science as well as in Curriculum for K-12 Computer Science. In a few research studies learning problems and difficulties have been recorded, and therefore, specific pedagogical guidelines and…

The multidisciplinary treatment plan: a format for enhancing activity therapy department involvement.

PubMed

Lang, E; Mattson, M

1985-01-01

A structured, goal-oriented format for enhancing the involvement of activity therapy disciplines in the multidisciplinary treatment planning process has been developed in a large private psychiatric teaching hospital. The format, an adaptation of the problem-oriented record, encompasses formal procedures for identifying and recording relevant problems, goals, methods, and objectives for activity therapy treatment. The benefits of this approach include the development of specific, measurable, attainable functional goals; increased accountability in treatment planning and delivery; less time spent in documentation; and education of other staff about the role and function of activities therapy. Patients have a better understanding of their goals and the steps needed to achieve them and show increased participation in the therapy process.

Nutrition in the Curriculum: Medical Experience.

ERIC Educational Resources Information Center

Shils, Maurice E.

1990-01-01

A review of current curricula in United States medical schools indicates a continued need for more adequate instruction of clinical nutrition to physicians in training and in practice. A major problem is failure to provide patient-oriented, case-related teaching in clinical years to all clinical clerks. (Author/MSE)

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

PubMed

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

2016-01-01

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

Validation of an association rule mining-based method to infer associations between medications and problems.

PubMed

Wright, A; McCoy, A; Henkin, S; Flaherty, M; Sittig, D

2013-01-01

In a prior study, we developed methods for automatically identifying associations between medications and problems using association rule mining on a large clinical data warehouse and validated these methods at a single site which used a self-developed electronic health record. To demonstrate the generalizability of these methods by validating them at an external site. We received data on medications and problems for 263,597 patients from the University of Texas Health Science Center at Houston Faculty Practice, an ambulatory practice that uses the Allscripts Enterprise commercial electronic health record product. We then conducted association rule mining to identify associated pairs of medications and problems and characterized these associations with five measures of interestingness: support, confidence, chi-square, interest and conviction and compared the top-ranked pairs to a gold standard. 25,088 medication-problem pairs were identified that exceeded our confidence and support thresholds. An analysis of the top 500 pairs according to each measure of interestingness showed a high degree of accuracy for highly-ranked pairs. The same technique was successfully employed at the University of Texas and accuracy was comparable to our previous results. Top associations included many medications that are highly specific for a particular problem as well as a large number of common, accurate medication-problem pairs that reflect practice patterns.

42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

...— (i) A substantiated diagnosis; (ii) Short-term and long-range goals; (iii) The specific treatment...) Describe attitudes and behavior; (6) Estimate intellectual functioning, memory functioning, and orientation...

Advances and current state of the security and privacy in electronic health records: survey from a social perspective.

PubMed

Tejero, Antonio; de la Torre, Isabel

2012-10-01

E-Health systems are experiencing an impulse in these last years, when many medical agencies began to include digital solutions into their platforms. Electronic Health Records (EHRs) are one of the most important improvements, being in its most part a patient-oriented tool. To achieve a completely operational EHR platform, security and privacy problems have to be resolved, due to the importance of the data included within these records. But given all the different methods to address security and privacy, they still remain in most cases as an open issue. This paper studies existing and proposed solutions included in different scenarios, in order to offer an overview of the current state in EHR systems. Bibliographic material has been obtained mainly from MEDLINE and SCOPUS sources, and over 30 publications have been analyzed. Many EHR platforms are being developed, but most of them present weaknesses when they are opened to the public. These architectures gain significance when they cover all the requisites related to security and privacy.

Orienting Student Using a Case-Based Instructional Approach: A Case Study

ERIC Educational Resources Information Center

Agbor-Baiyee, W.

2009-01-01

Purpose: Orientation facilitates the transition to a new academic program to meet the need of new students to know programmatic items such as academic expectations, courses, policies and procedures. We used a problem based learning (PBL) approach to introduce our students to the expectations of our intensive 10-week Medical College Admission Test…

Current therapeutic techniques and rehabilitation from neurological disorders

NASA Technical Reports Server (NTRS)

Nickel, V. L.; Hsu, J. D.

1974-01-01

Rancho Los Amigos Hospital is a 1100-bed teaching hospital that is primarily oriented toward rehabilitation. The individual services that deal with neuromuscular disorders are categorically disease entity oriented: They are directed toward the major problems, such as spinal cord injuries, amputations, stroke, cerebral palsy, and rheumatoid arthritis. The services at Rancho cross many traditional medical specialty barriers.

Explaining process orientation failure and success in health care--three case studies.

PubMed

Hellman, Stefan; Kastberg, Gustaf; Siverbo, Sven

2015-01-01

In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs. The authors conducted three case studies and applied Actor-Network Theory as an analytic lens. The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities. Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount.

Concept-oriented indexing of video databases: toward semantic sensitive retrieval and browsing.

PubMed

Fan, Jianping; Luo, Hangzai; Elmagarmid, Ahmed K

2004-07-01

Digital video now plays an important role in medical education, health care, telemedicine and other medical applications. Several content-based video retrieval (CBVR) systems have been proposed in the past, but they still suffer from the following challenging problems: semantic gap, semantic video concept modeling, semantic video classification, and concept-oriented video database indexing and access. In this paper, we propose a novel framework to make some advances toward the final goal to solve these problems. Specifically, the framework includes: 1) a semantic-sensitive video content representation framework by using principal video shots to enhance the quality of features; 2) semantic video concept interpretation by using flexible mixture model to bridge the semantic gap; 3) a novel semantic video-classifier training framework by integrating feature selection, parameter estimation, and model selection seamlessly in a single algorithm; and 4) a concept-oriented video database organization technique through a certain domain-dependent concept hierarchy to enable semantic-sensitive video retrieval and browsing.

Entrepreneurs turn problems into opportunities.

PubMed

Hostetler, D

1985-10-01

The need for products and services to accommodate changes in medical record practice and the increasing number of women going into business for themselves are combining to create new opportunities for the medical record professional who wants to start a business. JAMRA interviewed several entrepreneurs in the medical record field to find out about their experiences, where they see today's opportunities, and what advice they have for would-be entrepreneurs.

[Application and case analysis on the problem-based teaching of Jingluo Shuxue Xue (Science of Meridian and Acupoint) in reference to the team oriented learning method].

PubMed

Ma, Ruijie; Lin, Xianming

2015-12-01

The problem based teaching (PBT) has been the main approach to the training in the universities o the world. Combined with the team oriented learning method, PBT will become the method available to the education in medical universities. In the paper, based on the common questions in teaching Jingluo Shuxue Xue (Science of Meridian and Acupoint), the concepts and characters of PBT and the team oriented learning method were analyzed. The implementation steps of PBT were set up in reference to the team oriented learning method. By quoting the original text in Beiji Qianjin Yaofang (Essential recipes for emergent use worth a thousand gold), the case analysis on "the thirteen devil points" was established with PBT.

Using Problem-solving Therapy to Improve Problem-solving Orientation, Problem-solving Skills and Quality of Life in Older Hemodialysis Patients.

PubMed

Erdley-Kass, Shiloh D; Kass, Darrin S; Gellis, Zvi D; Bogner, Hillary A; Berger, Andrea; Perkins, Robert M

2017-08-24

To determine the effectiveness of Problem-Solving Therapy (PST) in older hemodialysis (HD) patients by assessing changes in health-related quality of life and problem-solving skills. 33 HD patients in an outpatient hemodialysis center without active medical and psychiatric illness were enrolled. The intervention group (n = 15) received PST from a licensed social worker for 6 weeks, whereas the control group (n = 18) received usual care treatment. In comparison to the control group, patients receiving PST intervention reported improved perceptions of mental health, were more likely to view their problems with a positive orientation and were more likely to use functional problem-solving methods. Furthermore, this group was also more likely to view their overall health, activity limits, social activities and ability to accomplish desired tasks with a more positive mindset. The results demonstrate that PST may positively impact mental health components of quality of life and problem-solving coping among older HD patients. PST is an effective, efficient, and easy to implement intervention that can benefit problem-solving abilities and mental health-related quality of life in older HD patients. In turn, this will help patients manage their daily living activities related to their medical condition and reduce daily stressors.

A knowledge-based, concept-oriented view generation system for clinical data.

PubMed

Zeng, Q; Cimino, J J

2001-04-01

Information overload is a well-known problem for clinicians who must review large amounts of data in patient records. Concept-oriented views, which organize patient data around clinical concepts such as diagnostic strategies and therapeutic goals, may offer a solution to the problem of information overload. However, although concept-oriented views are desirable, they are difficult to create and maintain. We have developed a general-purpose, knowledge-based approach to the generation of concept-oriented views and have developed a system to test our approach. The system creates concept-oriented views through automated identification of relevant patient data. The knowledge in the system is represented by both a semantic network and rules. The key relevant data identification function is accomplished by a rule-based traversal of the semantic network. This paper focuses on the design and implementation of the system; an evaluation of the system is reported separately.

Impact of Sexual Orientation Identity on Medical Morbidities in Male-to-Female Transgender Patients.

PubMed

Gaither, Thomas W; Awad, Mohannad A; Osterberg, E Charles; Romero, Angelita; Bowers, Marci L; Breyer, Benjamin N

2017-02-01

We aim to describe the relationship between sexual orientation identity and medical morbidities in a large sample of male-to-female (MTF) transgender patients. We reviewed medical records of patients presenting for MTF sex reassignment surgery (SRS) by a single, high-volume surgeon from 2011 to 2015. Sexual attraction to men (heterosexual), women (lesbian), or both (bisexual) was asked of each patient. We examined 16 medical morbidities for this analysis. During the study period, 330 MTF transgender patients presented for SRS. The average age at the time of surgery was 38.9 (range 18-76). One hundred and one patients (32%) reported being heterosexual, 110 patients (34%) reported being lesbian, and 108 patients (34%) reported being bisexual. Lesbian patients presented for SRS at older ages (mean = 43 years old) compared with heterosexual patients (mean = 36 years old) and bisexual patients (mean = 37), P < 0.01. No differences were found in the majority of coexisting medical morbidities by sexual orientation identity. Lesbian patients had greater odds of having a history of depression, age-adjusted odds ratio (aOR) = 2.36, 95% confidence interval (CI) 1.26-4.40, compared with heterosexual patients. Lesbian patients had higher odds of being married or partnered, aOR = 2.31, 95% CI (1.27-4.19), compared with heterosexual patients. Heterosexual patients had higher odds of having human immunodeficiency virus (HIV), aOR = 9.07, 95% CI (1.08-76.5) compared with lesbian patients. Sexual orientation identity in MTF transgender patients is variable. The majority of medical morbidities are not associated with sexual orientation identity. Although HIV and depression are common morbidities among MTF patients seeking SRS, the prevalence of these morbidities differs by sexual orientation identity, but these findings need replication. Counseling and future research initiatives in transgender care should incorporate sexual orientation identity and associated risk behavior.

A standards-based clinical information system for HIV/AIDS.

PubMed

Stitt, F W

1995-01-01

To create a clinical data repository to interface the Veteran's Administration (VA) Decentralized Hospital Computer Program (DHCP) and a departmental clinical information system for the management of HIV patients. This system supports record-keeping, decision-making, reporting, and analysis. The database development was designed to overcome two impediments to successful implementations of clinical databases: (i) lack of a standard reference data model, and; (ii) lack of a universal standard for medical concept representation. Health Level Seven (HL7) is a standard protocol that specifies the implementation of interfaces between two computer applications (sender and receiver) from different vendors or sources of electronic data exchange in the health care environment. This eliminates or substantially reduces the custom interface programming and program maintenance that would otherwise be required. HL7 defines the data to be exchanged, the timing of the interchange, and the communication of errors to the application. The formats are generic in nature and must be configured to meet the needs of the two applications involved. The standard conceptually operates at the seventh level of the ISO model for Open Systems Interconnection (OSI). The OSI simply defines the data elements that are exchanged as abstract messages, and does not prescribe the exact bit stream of the messages that flow over the network. Lower level network software developed according to the OSI model may be used to encode and decode the actual bit stream. The OSI protocols are not universally implemented and, therefore, a set of encoding rules for defining the exact representation of a message must be specified. The VA has created an HL7 module to assist DHCP applications in exchanging health care information with other applications using the HL7 protocol. The DHCP HL7 module consists of a set of utility routines and files that provide a generic interface to the HL7 protocol for all DHCP applications. The VA's DHCP core modules are in standard use at 169 hospitals, and the role of the VA system in health care delivery has been discussed elsewhere. This development was performed at the Miami VA Medical Center Special Immunology Unit, where a database was created for an HIV patient registry in 1987. Over 2,300 patient have been entered into a database that supports a problem-oriented summary of the patient's clinical record. The interface to the VA DHCP was designed and implemented to capture information from the patient treatment file, pharmacy, laboratory, radiology, and other modules. We obtained a suite of programs for implementing the HL7 encoding rules from Columbia-Presbyterian Medical Center in New York, written in ANSI C. This toolkit isolates our application programs from the details of the HL7 encoding rules, and allows them to deal with abstract messages and the programming level. While HL7 has become a standard for healthcare message exchange, SQL (Structured Query Language) is the standard for database definition, data manipulation, and query. The target database (Stitt F.W. The Problem-Oriented Medical Synopsis: a patient-centered clinical information system. Proc 17 SCAMC. 1993:88-93) provides clinical workstation functionality. Medical concepts are encoded using a preferred terminology derived from over 15 sources that include the Unified Medical Language System and SNOMed International ( Stitt F.W. The Problem-Oriented Medical Synopsis: coding, indexing, and classification sub-model. Proc 18 SCAMC, 1994: in press). The databases were modeled using the Information Engineering CASE tools, and were written using relational database utilities, including embedded SQL in C (ESQL/C). We linked ESQL/C programs to the HL7 toolkit to allow data to be inserted, deleted, or updated, under transaction control. A graphical format will be used to display the entity-rel

Incorporating client-server database architecture and graphical user interface into outpatient medical records.

PubMed Central

Fiacco, P. A.; Rice, W. H.

1991-01-01

Computerized medical record systems require structured database architectures for information processing. However, the data must be able to be transferred across heterogeneous platform and software systems. Client-Server architecture allows for distributive processing of information among networked computers and provides the flexibility needed to link diverse systems together effectively. We have incorporated this client-server model with a graphical user interface into an outpatient medical record system, known as SuperChart, for the Department of Family Medicine at SUNY Health Science Center at Syracuse. SuperChart was developed using SuperCard and Oracle SuperCard uses modern object-oriented programming to support a hypermedia environment. Oracle is a powerful relational database management system that incorporates a client-server architecture. This provides both a distributed database and distributed processing which improves performance. PMID:1807732

An object-oriented mobile health system with usability features.

PubMed

Escarfullet, Krystle; Moore, Cantera; Tucker, Shari; Wei, June

2012-01-01

Mobile health (m-health) comprises the concept of utilising mobile devices to carry out the task of viewing electronic medical records, reserving medical appointments with a patient's medical provider and electronically refilling prescriptions. This paper aims at developing a m-health system to improve usability from a user's perspective. Specifically, it first developed a m-health model by logically linking characteristics of the m-health system together based on information flows. Then, the system requirements were collected by using a developed questionnaire. These requirements were structured and further in-depth analysis was conducted by using an object-oriented approach based on unified modelling language, such as use-case, sequence and analysis class diagrams. This research will be beneficial to decision makers and developers in the mobile healthcare industry.

Self-medication.

PubMed

Lottier, W I

1978-10-01

Self-medication and drug interaction have been a problem in recent years. Pharmacists in ethical pharmacies and neighborhood establishments can best monitor these problems through use of patient profile records and consultations. The pharmacist should advise the public on over-the-counter (OTC) purchases. Auxiliary labels are recommended for use on containers to prevent drug interactions. Members of the black community have some specific problems with respect to self medications. These are addressed in this article. Self-medication, under supervision, is proper and can be controlled.

Decision Support System for Medical Care Quality Assessment Based on Health Records Analysis in Russia.

PubMed

Taranik, Maksim; Kopanitsa, Georgy

2017-01-01

The paper presents developed decision system, oriented for healthcare providers. The system allows healthcare providers to detect and decrease nonconformities in health records and forecast the sum of insurance payments taking into account nonconformities. The components are ISO13606, fuzzy logic and case-based reasoning concept. The result of system implementation allowed to 10% increase insurance payments for healthcare provider.

A Systems Form of School Health Records

ERIC Educational Resources Information Center

Gaskins, John R.

1973-01-01

Discusses the way in which one Connecticut school district is improving its student health recordkeeping through use of a problem-oriented systems approach introduced about five years ago in clinics and hospitals. (DN)

[Problem areas and examples of best practice in intersectoral medication treatment--a literature review].

PubMed

Mehrmann, Lena; Ollenschläger, Günter

2014-01-01

Transitions between the outpatient and inpatient sector are a critical phase in medication treatment. This article provides an overview of published problem areas and examples of best practice in the intersectoral medication treatment. Data with regard to related problem areas and examples of best practice was collected in August 2011 by a systematic literature research. The relevant literature was identified using the following databases and search engines: MEDLINE, The Cochrane Library, EMBASE, Google, and Google Scholar. Additionally, a hand search was done on the websites of SpringerLink and Thieme Connect. The initial search yielded a total of 4,409 records which were further selected in two screening steps and analysed according to their relevance. Of the remaining 63 records, 3 exclusively described problem areas, 11 of them examples of best practice, and 49 provided information on both problem areas and examples of best practice with regard to intersectoral medication treatment. Among other things, problem areas include varying legal regulations in inpatient and outpatient medication treatment, drug therapy interruptions after hospital discharge, or deficits in communication and continuity of care. Examples of best practice are projects, programmes, initiatives, recommendations, and points to consider with respect to medication reconciliation, pharmaceutical support, or transitions of care. Problem areas as well as examples of best practice are mainly focused on the transition from inpatient to outpatient care. Copyright © 2013. Published by Elsevier GmbH.

Options for diabetes management in sub-Saharan Africa with an electronic medical record system.

PubMed

Kouematchoua Tchuitcheu, G; Rienhoff, O

2011-01-01

An increase of diabetes prevalence of up to 80% is predicted in sub-Saharan Africa (SSA) by 2025 exceeding the worldwide 55%. Mortality rates of diabetes and HIV/AIDS are similar. Diabetes shares several common factors with HIV/AIDS and multidrug-resistant tuberculosis (MDR-TB). The latter two health problems have been efficiently managed by an open source electronic medical record system (EMRS) in Latin America. Therefore a similar solution for diabetes in SSA could be extremely helpful. The aim was to design and validate a conceptual model for an EMRS to improve diabetes management in SSA making use of the HIV and TB experience. A review of the literature addressed diabetes care and management in SSA as well as existing examples of information and communication technology (ICT) use in SSA. Based on a need assessment conducted in SSA a conceptual model based on the traditionally structured healthcare system in SSA was mapped into a three-layer structure. Application modules were derived and a demonstrator programmed based on an open source EMRS. Then the approach was validated by SSA experts. A conceptual model could be specified and validated which enhances a problem-oriented approach to diabetes management processes. The prototyp EMRS demonstrates options for a patient portal and simulation tools for education of health professional and patients in SSA. It is possible to find IT solutions for diabetes care in SSA which follow the same efficiency concepts as HIV or TB modules in Latin America. The local efficiency and sustainability of the solution will, however, depend on training and changes in work behavior.

Understanding catastrophizing from a misdirected problem-solving perspective.

PubMed

Flink, Ida K; Boersma, Katja; MacDonald, Shane; Linton, Steven J

2012-05-01

The aim is to explore pain catastrophizing from a problem-solving perspective. The links between catastrophizing, problem framing, and problem-solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model (Eccleston & Crombez, 2007) and the fear-anxiety-avoidance model (Asmundson, Norton, & Vlaeyen, 2004). In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later. Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation. The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear-anxiety-avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem-solving behaviour. These findings provide support for viewing catastrophizing from a problem-solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients. ©2011 The British Psychological Society.

Molar-incisor-hypomineralisation (MIH). A retrospective clinical study in Greek children. II. Possible medical aetiological factors.

PubMed

Lygidakis, N A; Dimou, G; Marinou, D

2008-12-01

This was to examine the potential medical aetiological factors involved in the development of MIH. During the years 2003--2005, all MIH cases diagnosed according to set criteria were selected from the new patients clinic of a Community Dental Centre for Children (Athens). The age, gender and teeth involved were recorded. A control group of socio-demographically matched controls was also identified. The potential aetiological factors were retrieved through personal interview with the parents and from each child and mother's medical book. Only verified aetiological factors were recorded. Evaluation of the correlation of affected teeth and the timing of the insult was performed in a separate group of 225 affected children aged 8-12 with their entire 12 'index' teeth erupted. From the 3,518, 5.5 to 12 years old children examined, 360 (10.2%) had MIH. Aetiology of MIH: 44 children (12.2%), presented without any relevant medical history, the remaining 316 (87.8%) recorded various medical problems associated with MIH, compared with 18.9% for controls. Perinatal (163, 33.6%) and postnatal (162, 33.9%) problems were the most frequently found and prenatal the least (33, 8.6%). For 42 children (11.7%) problems occurred in more than one chronological period, mainly during both the perinatal and postnatal period (11.1%). The most common prenatal problem was repeated episodes of high fever (12/33), in the perinatal period birth by Caesarean section (92/163) and other birth complications (34/163). Various respiratory conditions (88/162), repeated episodes of high fever (31/162) and neonatal illness (28/162) were the commonly reported problems in the postnatal period. Many MIH cases presented with more than one medical problem during the peri-and postnatal period. Children with MIH recorded 68.9% more frequent medical problems than controls (p<0.0001). A positive correlation (p<0.001) between the total number and type of affected teeth with the timing of the insult was observed in the 225 MIH children with all their 'index' teeth erupted. Children with MIH present with more medical problems than controls during their prenatal, perinatal and postnatal period. The majority of these illnesses may produce hypocalcaemia, hypoxia and pyrexia to the child or the mother. The number of affected teeth was associated with the timing of the possible insult; children with prenatal, perinatal and postnatal problems present more affected teeth in increasing order.

Patients' and physicians' understanding of health and biomedical concepts: relationship to the design of EMR systems.

PubMed

Patel, Vimla L; Arocha, José F; Kushniruk, André W

2002-02-01

The aim of this paper is to examine knowledge organization and reasoning strategies involved in physician-patient communication and to consider how these are affected by the use of computer tools, in particular, electronic medical record (EMR) systems. In the first part of the paper, we summarize results from a study in which patients were interviewed before their interactions with physicians and where physician-patient interactions were recorded and analyzed to evaluate patients' and physicians' understanding of the patient problem. We give a detailed presentation of one of such interaction, with characterizations of physician and patient models. In a second set of studies, the contents of both paper and EMRs were compared and in addition, physician-patient interactions (involving the use of EMR technology) were video recorded and analyzed to assess physicians' information gathering and knowledge organization for medical decision-making. Physicians explained the patient problems in terms of causal pathophysiological knowledge underlying the disease (disease model), whereas patients explained them in terms of narrative structures of illness (illness model). The data-driven nature of the traditional physician-patient interaction allows physicians to capture the temporal flow of events and to document key aspects of the patients' narratives. Use of electronic medical records was found to influence the way patient data were gathered, resulting in information loss and disruption of temporal sequence of events in assessing patient problem. The physician-patient interview allows physicians to capture crucial aspects of the patient's illness model, which are necessary for understanding the problem from the patients' perspective. Use of computer-based patient record technology may lead to a loss of this relevant information. As a consequence, designers of such systems should take into account information relevant to the patient comprehension of medical problems, which will influence their compliance.

MedlinePlus Connect: Linking Patient Portals and Electronic Health Records to Health Information

MedlinePlus

... Patient portals, patient health record (PHR) systems, and electronic health record (EHR) systems can use MedlinePlus Connect ... patient portal, patient health record (PHR) system, or electronic health record (EHR) system sends a problem, medication, ...

An inventory of publications on electronic medical records revisited.

PubMed

Moorman, P W; Schuemie, M J; van der Lei, J

2009-01-01

In this short review we provide an update of our earlier inventories of publications indexed in MedLine with the MeSH term 'Medical Records Systems, Computerized'. We retrieved and analyzed all references to English articles published before January 1, 2008, and indexed in PubMed with the MeSH term 'Medical Records Systems, Computerized'. We retrieved a total of 11,924 publications, of which 3937 (33%) appeared in a journal with an impact factor. Since 2002 the number of yearly publications, and the number of journals in which those publications appeared, increased. A cluster analysis revealed three clusters: an organizational issues cluster, a technically oriented cluster and a cluster about order-entry and research. Although our previous inventory in 2003 suggested a constant yearly production of publications on electronic medical records since 1998, the current inventory shows another rise in production since 2002. In addition, many new journals and countries have shown interest during the last five years. In the last 15 years, interest in organizational issues remained fairly constant, order entry and research with systems gained attention, while interest in technical issues relatively decreased.

A virtual intranet and data-warehousing for healthcare co-operation.

PubMed

Kerkri, E M; Quantin, C; Grison, T; Allaert, F A; Tchounikine, A; Yétongnon, K

2001-01-01

As patient's medical data is disseminated in different health structures, developing a medical or epidemiological patient-oriented data warehouse has some specific requirements compared to intra healthcare structure data-warehousing projects. The difference is that the healthcare structures implicated in a patient-oriented data warehouse project require some considerations about the confidentiality of the patient data and of the activities of healthcare structures. Building a data-warehousing system at a regional level, for example in cancerology, requires the participation of all concerned health structures, as well as different health professionals. The heterogeneity of sources medical data of has to be taken into account for choosing between several organizational configurations of the data warehousing system. In top of data warehousing, we propose a concept of Virtual Intranet, which provides a solution to the problem of medical information security arising from heterogeneous sources.

Elementary systems of medicine.

PubMed

Fabrega, H

1979-06-01

The beliefs about causes of disease, orientations to medical problems, and the treatment practices of relatively small and elementary societies are reviewed and analyzed. Selected published reports of this problem area of ethnomedicine serve as source material. An attempt is made to induce generalizations which will serve as a possible baseline for studies dealing with related material pertaining to more advanced societies.

A comparative study of six European databases of medically oriented Web resources.

PubMed

Abad García, Francisca; González Teruel, Aurora; Bayo Calduch, Patricia; de Ramón Frias, Rosa; Castillo Blasco, Lourdes

2005-10-01

The paper describes six European medically oriented databases of Web resources, pertaining to five quality-controlled subject gateways, and compares their performance. The characteristics, coverage, procedure for selecting Web resources, record structure, searching possibilities, and existence of user assistance were described for each database. Performance indicators for each database were obtained by means of searches carried out using the key words, "myocardial infarction." Most of the databases originated in the 1990s in an academic or library context and include all types of Web resources of an international nature. Five databases use Medical Subject Headings. The number of fields per record varies between three and nineteen. The language of the search interfaces is mostly English, and some of them allow searches in other languages. In some databases, the search can be extended to Pubmed. Organizing Medical Networked Information, Catalogue et Index des Sites Médicaux Francophones, and Diseases, Disorders and Related Topics produced the best results. The usefulness of these databases as quick reference resources is clear. In addition, their lack of content overlap means that, for the user, they complement each other. Their continued survival faces three challenges: the instability of the Internet, maintenance costs, and lack of use in spite of their potential usefulness.

Phosphodiesterase Inhibition Increases CREB Phosphorylation and Restores Orientation Selectivity in a Model of Fetal Alcohol Spectrum Disorders

PubMed Central

Krahe, Thomas E.; Wang, Weili; Medina, Alexandre E.

2009-01-01

Background Fetal alcohol spectrum disorders (FASD) are the leading cause of mental retardation in the western world and children with FASD present altered somatosensory, auditory and visual processing. There is growing evidence that some of these sensory processing problems may be related to altered cortical maps caused by impaired developmental neuronal plasticity. Methodology/Principal Findings Here we show that the primary visual cortex of ferrets exposed to alcohol during the third trimester equivalent of human gestation have decreased CREB phosphorylation and poor orientation selectivity revealed by western blotting, optical imaging of intrinsic signals and single-unit extracellular recording techniques. Treating animals several days after the period of alcohol exposure with a phosphodiesterase type 1 inhibitor (Vinpocetine) increased CREB phosphorylation and restored orientation selectivity columns and neuronal orientation tuning. Conclusions/Significance These findings suggest that CREB function is important for the maturation of orientation selectivity and that plasticity enhancement by vinpocetine may play a role in the treatment of sensory problems in FASD. PMID:19680548

Group psychotherapy with older adults.

PubMed

Saiger, G M

2001-01-01

This article describes a psychodynamically oriented psychotherapy group for older adults conducted in an agency setting, highlighting the problems specific to such groups. The literature on such groups for older adults is reviewed. The issues discussed are the psychology of late life, diagnostic considerations, medical illness and dementia as complicating factors, the issue of caretaking, and the centrality of shame. A systems-oriented approach to understanding the group's success is suggested.

A preliminary study on travel health issues of medical students undertaking electives.

PubMed

Goldsmid, John M; Bettiol, Silvana S; Sharples, Nadine

2003-01-01

With the inclusion of elective programs, often overseas, in many medical courses, it was decided that a preliminary retrospective analysis of health problems associated with these programs in medical students from the University of Tasmania would be desirable. A questionnaire covering general travel health issues was distributed to all medical students in the University of Tasmania, on return from their elective. They were asked to complete the questionnaire and return it on an anonymous and voluntary basis. In addition, student elective submissions were consulted for information relating to their chosen destination. Results of the study indicate that general practitioners were the most common source of pretravel advice for Tasmanian medical students. Overall, 64% of students experienced some sort of health problem of which travelers' diarrhea was the most common. Most problems were mild and self-limiting, but a number of serious infections were recorded, including acute leptospirosis, paratyphoid, and Staphylococcus aureus cellulitis. Of particular concern were the reports of assault and sexual harassment recorded by several students. Elective programs are an important part of many medical courses. With the widespread destinations chosen by students, it is important that they be given adequate pretravel health advice. Most of the health problems encountered by students from the University of Tasmania were mild, but exposure to serious infections was recorded. It is thus imperative that students take out travel health insurance and that they are counseled on how to avoid dangerous situations while abroad.

Health Recommender Systems: Concepts, Requirements, Technical Basics and Challenges

PubMed Central

Wiesner, Martin; Pfeifer, Daniel

2014-01-01

During the last decades huge amounts of data have been collected in clinical databases representing patients' health states (e.g., as laboratory results, treatment plans, medical reports). Hence, digital information available for patient-oriented decision making has increased drastically but is often scattered across different sites. As as solution, personal health record systems (PHRS) are meant to centralize an individual's health data and to allow access for the owner as well as for authorized health professionals. Yet, expert-oriented language, complex interrelations of medical facts and information overload in general pose major obstacles for patients to understand their own record and to draw adequate conclusions. In this context, recommender systems may supply patients with additional laymen-friendly information helping to better comprehend their health status as represented by their record. However, such systems must be adapted to cope with the specific requirements in the health domain in order to deliver highly relevant information for patients. They are referred to as health recommender systems (HRS). In this article we give an introduction to health recommender systems and explain why they are a useful enhancement to PHR solutions. Basic concepts and scenarios are discussed and a first implementation is presented. In addition, we outline an evaluation approach for such a system, which is supported by medical experts. The construction of a test collection for case-related recommendations is described. Finally, challenges and open issues are discussed. PMID:24595212

Information Technology: A Tool to Cut Health Care Costs

NASA Technical Reports Server (NTRS)

Mukkamala, Ravi; Maly, K. J.; Overstreet, C. M.; Foudriat, E. C.

1996-01-01

Old Dominion University embarked on a project to see how current computer technology could be applied to reduce the cost and or to improve the efficiency of health care services. We designed and built a prototype for an integrated medical record system (MRS). The MRS is written in Tool control language/Tool kit (Tcl/Tk). While the initial version of the prototype had patient information hard coded into the system, later versions used an INGRES database for storing patient information. Currently, we have proposed an object-oriented model for implementing MRS. These projects involve developing information systems for physicians and medical researchers to enhance their ability for improved treatment at reduced costs. The move to computerized patient records is well underway, several standards exist for laboratory records, and several groups are working on standards for other portions of the patient record.

Evaluation of a BCMA’s Electronic Medication Administration Record

PubMed Central

Staggers, Nancy; Iribarren, Sarah; Guo, Jia-Wen; Weir, Charlene

2015-01-01

Barcode medication administration (BCMA) systems can reduce medication errors, but sociotechnical issues are quite common. Although crucial to nurses’ work, few usability evaluations are available for electronic medication administration record screens (eMARs). The purpose of this research was to identify current usability problems in the VA’s eMAR/BCMA system and explore how these might impact nurses’ situation awareness. Three expert evaluators used 10 tasks/elements, heuristic evaluation techniques and explored potential impacts using a situation awareness perspective. The results yielded 99 usability problems categorized into 440 heuristic violations with the largest volume in the category of Match with the Real World. Fifteen usability issues were rated as catastrophic with the Administer/Chart medications task having the most. Situational awareness was impacted at all levels, especially at Level 2, Comprehension. Usability problems point to important areas for improvement because these issues have the potential to impact nurses’ situation awareness, “at a glance” information, nurse productivity and patient safety. PMID:25601936

Building Structured Personal Health Records from Photographs of Printed Medical Records.

PubMed

Li, Xiang; Hu, Gang; Teng, Xiaofei; Xie, Guotong

2015-01-01

Personal health records (PHRs) provide patient-centric healthcare by making health records accessible to patients. In China, it is very difficult for individuals to access electronic health records. Instead, individuals can easily obtain the printed copies of their own medical records, such as prescriptions and lab test reports, from hospitals. In this paper, we propose a practical approach to extract structured data from printed medical records photographed by mobile phones. An optical character recognition (OCR) pipeline is performed to recognize text in a document photo, which addresses the problems of low image quality and content complexity by image pre-processing and multiple OCR engine synthesis. A series of annotation algorithms that support flexible layouts are then used to identify the document type, entities of interest, and entity correlations, from which a structured PHR document is built. The proposed approach was applied to real world medical records to demonstrate the effectiveness and applicability.

Building Structured Personal Health Records from Photographs of Printed Medical Records

PubMed Central

Li, Xiang; Hu, Gang; Teng, Xiaofei; Xie, Guotong

2015-01-01

Personal health records (PHRs) provide patient-centric healthcare by making health records accessible to patients. In China, it is very difficult for individuals to access electronic health records. Instead, individuals can easily obtain the printed copies of their own medical records, such as prescriptions and lab test reports, from hospitals. In this paper, we propose a practical approach to extract structured data from printed medical records photographed by mobile phones. An optical character recognition (OCR) pipeline is performed to recognize text in a document photo, which addresses the problems of low image quality and content complexity by image pre-processing and multiple OCR engine synthesis. A series of annotation algorithms that support flexible layouts are then used to identify the document type, entities of interest, and entity correlations, from which a structured PHR document is built. The proposed approach was applied to real world medical records to demonstrate the effectiveness and applicability. PMID:26958219

Longitudinal retention of anatomical knowledge in second-year medical students.

PubMed

Doomernik, Denise E; van Goor, Harry; Kooloos, Jan G M; Ten Broek, Richard P

2017-06-01

The Radboud University Medical Center has a problem-based, learner-oriented, horizontally, and vertically integrated medical curriculum. Anatomists and clinicians have noticed students' decreasing anatomical knowledge and the disability to apply knowledge in diagnostic reasoning and problem solving. In a longitudinal cohort, the retention of anatomical knowledge gained during the first year of medical school among second-year medical students was assessed. In May 2011, 346 medical students applied for the second-year gastro-intestinal (GI) tract course. The students were asked to participate in a reexamination of a selection of anatomical questions of an examination from October 2009. The examination consisted of a clinical anatomy case scenario and two computed tomography (CT) images of thorax and abdomen in an extended matching format. A total of 165 students were included for analysis. In 2011, students scored significantly lower for the anatomy examination compared to 2009 with a decline in overall examination score of 14.7% (±11.7%). Decrease in knowledge was higher in the radiological questions, compared to the clinical anatomy cases 17.5% (±13.6%) vs. 7.9% (±10.0%), respectively, d = 5.17. In both years, male students scored slightly better compared to female students, and decline of knowledge seems somewhat lower in male students (13.1% (±11.1%) vs. 15.5% (±12.0%), respectively), d = -0.21. Anatomical knowledge in the problem-oriented horizontal and vertical integrated medical curriculum, declined by approximately 15% 1.5 year after the initial anatomy course. The loss of knowledge in the present study is relative small compared to previous studies. Anat Sci Educ 10: 242-248. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

Toward an integrated computerized patient record.

PubMed

Dole, T R; Luberti, A A

2000-04-01

Developing a comprehensive electronic medical record system to serve ambulatory care providers in a large health care enterprise requires significant time and resources. One approach to achieving this system is to devise a series of short-term, workable solutions until a complete system is designed and implemented. The initial solution introduced a basic (mini) medical record system that provided an automated problem/summary sheet and decentralization of ambulatory-based medical records. The next step was to partner with an information system vendor committed to continued development of the long-term system capable of supporting the health care organization well into the future.

Securing the communication of medical information using local biometric authentication and commercial wireless links.

PubMed

Ivanov, Vladimir I; Yu, Paul L; Baras, John S

2010-09-01

Medical information is extremely sensitive in nature - a compromise, such as eavesdropping or tampering by a malicious third party, may result in identity theft, incorrect diagnosis and treatment, and even death. Therefore, it is important to secure the transfer of medical information from the patient to the recording system. We consider a portable, wireless device transferring medical information to a remote server. We decompose this problem into two sub-problems and propose security solutions to each of them: (1) to secure the link between the patient and the portable device, and (2) to secure the link between the portable device and the network. Thus we push the limits of the network security to the edge by authenticating the user using their biometric information; authenticating the device to the network at the physical layer; and strengthening the security of the wireless link with a key exchange mechanism. The proposed authentication methods can be used for recording the readings of medical data in a central database and for accessing medical records in various settings.

A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States.

PubMed

Zullig, Leah L; Granger, Bradi B; Bosworth, Hayden B

2016-01-01

Nonadherence to prescription medications is a common and costly problem with multiple contributing factors, spanning the dimensions of individual behavior change, psychology, medicine, and health policy, among others. Addressing the problem of medication nonadherence requires strategic input from key experts in a number of fields. The Medication Adherence Alliance is a group of key experts, predominately from the US, in the field of medication nonadherence. Members include representatives from consumer advocacy groups, community health providers, nonprofit groups, the academic community, decision-making government officials, and industry. In 2015, the Medication Adherence Alliance convened to review the current landscape of medication adherence. The group then established three working groups that will develop recommendations for shifting toward solutions-oriented science. From the perspective of the Medication Adherence Alliance, the objective of this commentary is to describe changes in the US landscape of medication adherence, framing the evolving field in the context of a recent think tank meeting of experts in the field of medication adherence.

Self-reported difficulty in conceiving as a measure of infertility.

PubMed

Dick, M-L B; Bain, C J; Purdie, D M; Siskind, V; Molloy, D; Green, A C

2003-12-01

This study aimed to explore the meaning and potential use of women's self-reported difficulties in conceiving as a measure of infertility in epidemiological studies, and to compare women's stated reasons for infertility with information in their medical records. Data were available from a population-based case-control study of ovarian cancer involving 1638 women. The sensitivity and specificity of women's self-reported infertility were calculated against their estimated fertility status based on detailed reproductive histories. Self-reported reasons for infertility were compared with diagnoses documented in women's medical records. The sensitivity of women's self-reported difficulty in conceiving was 66 and 69% respectively when compared with calendar-derived and self-reported times taken trying to conceive; its specificity was 95%. Forty-one (23%) of the 179 women for whom medical records were available had their self-reported fertility problem confirmed. Self-reported infertility causes could be compared with diagnoses in medical records for only 22 of these women. Self-reported difficulty conceiving is a useful measure of infertility for quantifying the burden of fertility problems experienced in the community. Validation of reasons for infertility is unlikely to be feasible through examination of medical records. Improved education of the public regarding the availability and success rates of infertility treatments is proposed.

New Advanced Technologies to Provide Decentralised and Secure Access to Medical Records: Case Studies in Oncology

PubMed Central

Quantin, Catherine; Coatrieux, Gouenou; Allaert, François André; Fassa, Maniane; Bourquard, Karima; Boire, Jean-Yves; de Vlieger, Paul; Maigne, Lydia; Breton, Vincent

2009-01-01

The main problem for health professionals and patients in accessing information is that this information is very often distributed over many medical records and locations. This problem is particularly acute in cancerology because patients may be treated for many years and undergo a variety of examinations. Recent advances in technology make it feasible to gain access to medical records anywhere and anytime, allowing the physician or the patient to gather information from an “ephemeral electronic patient record”. However, this easy access to data is accompanied by the requirement for improved security (confidentiality, traceability, integrity, ...) and this issue needs to be addressed. In this paper we propose and discuss a decentralised approach based on recent advances in information sharing and protection: Grid technologies and watermarking methodologies. The potential impact of these technologies for oncology is illustrated by the examples of two experimental cases: a cancer surveillance network and a radiotherapy treatment plan. It is expected that the proposed approach will constitute the basis of a future secure “google-like” access to medical records. PMID:19718446

[Security specifications for electronic medical records on the Internet].

PubMed

Mocanu, Mihai; Mocanu, Carmen

2007-01-01

The extension for the Web applications of the Electronic Medical Record seems both interesting and promising. Correlated with the expansion of Internet in our country, it allows the interconnection of physicians of different specialties and their collaboration for better treatment of patients. In this respect, the ophthalmologic medical applications consider the increased possibilities for monitoring chronic ocular diseases and for the identification of some elements for early diagnosis and risk factors supervision. We emphasize in this survey some possible solutions to the problems of interconnecting medical information systems to the Internet: the achievement of interoperability within medical organizations through the use of open standards, the automated input and processing for ocular imaging, the use of data reduction techniques in order to increase the speed of image retrieval in large databases, and, last but not least, the resolution of security and confidentiality problems in medical databases.

A method and knowledge base for automated inference of patient problems from structured data in an electronic medical record.

PubMed

Wright, Adam; Pang, Justine; Feblowitz, Joshua C; Maloney, Francine L; Wilcox, Allison R; Ramelson, Harley Z; Schneider, Louise I; Bates, David W

2011-01-01

Accurate knowledge of a patient's medical problems is critical for clinical decision making, quality measurement, research, billing and clinical decision support. Common structured sources of problem information include the patient problem list and billing data; however, these sources are often inaccurate or incomplete. To develop and validate methods of automatically inferring patient problems from clinical and billing data, and to provide a knowledge base for inferring problems. We identified 17 target conditions and designed and validated a set of rules for identifying patient problems based on medications, laboratory results, billing codes, and vital signs. A panel of physicians provided input on a preliminary set of rules. Based on this input, we tested candidate rules on a sample of 100,000 patient records to assess their performance compared to gold standard manual chart review. The physician panel selected a final rule for each condition, which was validated on an independent sample of 100,000 records to assess its accuracy. Seventeen rules were developed for inferring patient problems. Analysis using a validation set of 100,000 randomly selected patients showed high sensitivity (range: 62.8-100.0%) and positive predictive value (range: 79.8-99.6%) for most rules. Overall, the inference rules performed better than using either the problem list or billing data alone. We developed and validated a set of rules for inferring patient problems. These rules have a variety of applications, including clinical decision support, care improvement, augmentation of the problem list, and identification of patients for research cohorts.

Toward Medical Documentation That Enhances Situational Awareness Learning

PubMed Central

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

Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit.

PubMed

Weiss, Barry D; Brega, Angela G; LeBlanc, William G; Mabachi, Natabhona M; Barnard, Juliana; Albright, Karen; Cifuentes, Maribel; Brach, Cindy; West, David R

2016-01-01

Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices. The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation. Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised. Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems. © Copyright 2016 by the American Board of Family Medicine.

[Problems in organization of medical criminological registration and personality identification for subjects occupationally exposed to life risk].

PubMed

Shcherbakov, V V

2000-01-01

The paper discusses problems in organization of identification studies under conditions of mass deaths as exemplified by forensic medical records of medical criminological identification studies of subjects killed during war conflict in Chechnya. The evolution of the organization model of identification studies is shown transformation of organization philosophy, formation of expert algorithms, formalization and technologic realization of expert solutions.

Protecting Patient Records from Unwarranted Access

NASA Astrophysics Data System (ADS)

Gardner, Ryan; Garera, Sujata; Rubin, Aviel D.; Rajan, Anand; Rozas, Carlos V.; Sastry, Manoj

Securing access to medical information is vital to protecting patient privacy. However, Electronic Patient Record (EPR) systems are vulnerable to a number of inside and outside threats. Adversaries can compromise EPR client machines to obtain a variety of highly sensitive information including valid EPR login credentials, without detection. Furthermore, medical staff can covertly view records of their choosing for personal interest or more malicious purposes. In particular, we observe that the lack of integrity measurement and auditability in these systems creates a potential threat to the privacy of patient information. We explore the use of virtualization and trusted computing hardware to address these problems. We identify open problems and encourage further research in the area.

Technology Implementation and Workarounds in the Nursing Home

PubMed Central

Vogelsmeier, Amy A.; Halbesleben, Jonathon R.B.; Scott-Cawiezell, Jill R.

2008-01-01

Objective This study sought to explore the relationship of workarounds related to the implementation of an electronic medication administration record and medication safety practices in five Midwestern nursing homes. Design As a part of a larger study, this qualitative evaluation was conducted to identify workarounds associated with the implementation of an electronic medication administration record. Data were collected using multimethods including direct observation, process mapping, key informant interviews, and review of field notes from medication safety team meetings. Measurements Open and axial coding techniques were used to identify and categorize types of workarounds in relation to work flow blocks. Results Workarounds presented in two distinct patterns, those related to work flow blocks introduced by technology and those related to organizational processes not reengineered to effectively integrate with the technology. Workarounds such as safety alert overrides and shortcuts to documentation resulted from first-order problem solving of immediate blocks. Nursing home staff as individuals frequently used first-order problem solving instead of the more sophisticated second-order problem solving approach used by the medication safety team. Conclusion This study provides important practical examples of how nursing home staff work around work flow blocks encountered during the implementation of technology. Understanding these workarounds as a means of first-order problem solving is an important consideration to understanding risk to medication safety. PMID:17947626

A novel web-enabled healthcare solution on health vault system.

PubMed

Liao, Lingxia; Chen, Min; Rodrigues, Joel J P C; Lai, Xiaorong; Vuong, Son

2012-06-01

Complicated Electronic Medical Records (EMR) systems have created problems in systems regarding an easy implementation and interoperability for a Web-enabled Healthcare Solution, which is normally provided by an independent healthcare giver with limited IT knowledge and interests. An EMR system with well-designed and user-friendly interface, such as Microsoft HealthVault System used as the back-end platform of a Web-enabled healthcare application will be an approach to deal with these problems. This paper analyzes the patient oriented Web-enabled healthcare service application as the new trend to delivery healthcare from hospital/clinic-centric to patient-centric, the current e-healthcare applications, and the main backend EMR systems. Then, we present a novel web-enabled healthcare solution based on Microsoft HealthVault EMR system to meet customers' needs, such as, low total cost, easily development and maintenance, and good interoperability. A sample system is given to show how the solution can be fulfilled, evaluated, and validated. We expect that this paper will provide a deep understanding of the available EMR systems, leading to insights for new solutions and approaches driven to next generation EMR systems.

Do Children with Multiple Patterns of Problem Behavior Improve? The Effectiveness of an Intensive Bio-Behaviorally Oriented School-Based Behavioral Health Program

ERIC Educational Resources Information Center

Cautilli, Joseph; Harrington, Nadine; Gillam, Emma Vila; Denning, Jamie; Helwig, Ileana; Ettingoff, Andrea; Valdes, Antonio; Angert, Ashley

2004-01-01

Over the last thirty years, children's behavioral health services in the school have witnessed drastic progress. Over this time, medications for mental health problems have improved. In addition, empirically validated treatments, most of which have come from behavioral psychology, have made their way into Best Practice guidelines for the treatment…

Discrimination and externalizing problems among Moroccan- and Romanian-origin early adolescents in Italy: Moderating role of cultural orientations and impulse control.

PubMed

Miconi, Diana; Altoè, Gianmarco; Salcuni, Silvia; Di Riso, Daniela; Schiff, Sami; Moscardino, Ughetta

2018-05-24

Although discrimination is a common stressor in the everyday life of immigrant youth, individuals are not equally susceptible to its adverse effects. This cross-sectional study aimed to examine whether cultural orientation preferences and impulse control (IC) moderate the association between perceived discrimination and externalizing problems among Moroccan- and Romanian-origin early adolescents in Italy. The sample included 126 Moroccan and 126 Romanian youths (46% girls, 42% first-generation) aged 11-13 years and their parents. Perceived discrimination and cultural orientations were assessed using self-report questionnaires, while IC was evaluated via a computerized version of the Iowa Gambling Task. Externalizing behaviors were assessed via parental report. Cluster analysis identified separated, assimilated, and integrated early adolescents. Regression analyses revealed that when facing discrimination, youths who endorsed separation and exhibited low levels of IC were more vulnerable to externalizing problems. In contrast, among assimilated adolescents the discrimination-externalizing difficulties link was significant at high levels of IC. Furthermore, low levels of IC were associated with more externalizing problems for Romanian, but not for Moroccan early adolescents. Findings underscore the need to consider both cultural orientation processes and early adolescents' ability to control their impulses when developing interventions aimed to reduce discrimination-related problem behaviors in immigrant youth. Implications for theory and practice are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Well-child visits

MedlinePlus

... to find or prevent problems. The provider will record your child's height, weight, and other important information. ... This chart remains part of the child's medical record. Talking about your child's growth is a good ...

Processing medical data: a systematic review

PubMed Central

2013-01-01

Background Medical data recording is one of the basic clinical tools. Electronic Health Record (EHR) is important for data processing, communication, efficiency and effectiveness of patients’ information access, confidentiality, ethical and/or legal issues. Clinical record promote and support communication among service providers and hence upscale quality of healthcare. Qualities of records are reflections of the quality of care patients offered. Methods Qualitative analysis was undertaken for this systematic review. We reviewed 40 materials Published from 1999 to 2013. We searched these materials from databases including ovidMEDLINE and ovidEMBASE. Two reviewers independently screened materials on medical data recording, documentation and information processing and communication. Finally, all selected references were summarized, reconciled and compiled as one compatible document. Result Patients were dying and/or getting much suffering as the result of poor quality medical records. Electronic health record minimizes errors, saves unnecessary time, and money wasted on processing medical data. Conclusion Many countries have been complaining for incompleteness, inappropriateness and illegibility of records. Therefore creating awareness on the magnitude of the problem has paramount importance. Hence available correct patient information has lots of potential in reducing errors and support roles. PMID:24107106

Data-driven approach for creating synthetic electronic medical records.

PubMed

Buczak, Anna L; Babin, Steven; Moniz, Linda

2010-10-14

New algorithms for disease outbreak detection are being developed to take advantage of full electronic medical records (EMRs) that contain a wealth of patient information. However, due to privacy concerns, even anonymized EMRs cannot be shared among researchers, resulting in great difficulty in comparing the effectiveness of these algorithms. To bridge the gap between novel bio-surveillance algorithms operating on full EMRs and the lack of non-identifiable EMR data, a method for generating complete and synthetic EMRs was developed. This paper describes a novel methodology for generating complete synthetic EMRs both for an outbreak illness of interest (tularemia) and for background records. The method developed has three major steps: 1) synthetic patient identity and basic information generation; 2) identification of care patterns that the synthetic patients would receive based on the information present in real EMR data for similar health problems; 3) adaptation of these care patterns to the synthetic patient population. We generated EMRs, including visit records, clinical activity, laboratory orders/results and radiology orders/results for 203 synthetic tularemia outbreak patients. Validation of the records by a medical expert revealed problems in 19% of the records; these were subsequently corrected. We also generated background EMRs for over 3000 patients in the 4-11 yr age group. Validation of those records by a medical expert revealed problems in fewer than 3% of these background patient EMRs and the errors were subsequently rectified. A data-driven method was developed for generating fully synthetic EMRs. The method is general and can be applied to any data set that has similar data elements (such as laboratory and radiology orders and results, clinical activity, prescription orders). The pilot synthetic outbreak records were for tularemia but our approach may be adapted to other infectious diseases. The pilot synthetic background records were in the 4-11 year old age group. The adaptations that must be made to the algorithms to produce synthetic background EMRs for other age groups are indicated.

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

PubMed

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

2001-01-01

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

Mosquito Records from Mexico: The Mosquitoes (Diptera: Culicidae) of Tamaulipas State.

PubMed

Ortega-Morales, Aldo I; Zavortink, Thomas J; Huerta-Jiménez, Herón; Sánchez-Rámos, Francisco J; Valdés-Perezgasga, Ma Teresa; Reyes-Villanueva, Filiberto; Siller-Rodríguez, Quetzaly K; Fernandez-Salas, Ildefonso

2015-03-01

To document the diversity and distribution of mosquito species inhabiting the Mexican state of Tamaulipas, collection trips were conducted to all physiographic regions (Grand Northamerican Plains, Coastal Plain of North Gulf, and Sierra Madre Oriental) and subregions across the state. Additionally, we re-examined mosquito specimens in two Mexican entomological collections: the Collection of Insects and Mites of Medical Importance and the Collection of Arthropods of Medical Importance. In total, 3,931 specimens were collected. These represent the two Culicidae subfamilies Anophelinae and Culicinae, 10 tribes, 17 genera, 27 subgenera, 80 named species, and 2 undescribed species. Of these, 3 tribes, 6 genera, 7 subgenera, and 20 species are new records for the mosquito fauna of Tamaulipas. Fourteen species recorded in the historical records were not found in collections made for this study. Taxonomic notes, new distribution limits, and comments about the medical importance of some of the species collected are reported. © The Author 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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

PubMed

Wynia, Matthew K

2007-08-01

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

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

PubMed Central

Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

2017-01-01

Background Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. PMID:28057607

Medical Issues among Children and Teenagers with Down Syndrome in Hong Kong

ERIC Educational Resources Information Center

Yam, Winnie Ka-Ling; Tse, Philomena Wan Ting; Yu, Chak Man; Chow, Chun Bong; But, Wai Man; Li, Kit Yu; Lee, Lai Ping; Fung, Eva Lai Wah; Mak, Pauline Pui Yee; Lau, Joseph Tak Fai

2008-01-01

We examined the prevalence of medical problems in children and teenagers with Down syndrome in Hong Kong. Methods: Children with Down syndrome receiving care from seven regional hospitals were included and their hospital records were reviewed. A total of 407 patients, aged between 0.06 and 17.16 years were included. Cardiovascular problems were…

A method and knowledge base for automated inference of patient problems from structured data in an electronic medical record

PubMed Central

Pang, Justine; Feblowitz, Joshua C; Maloney, Francine L; Wilcox, Allison R; Ramelson, Harley Z; Schneider, Louise I; Bates, David W

2011-01-01

Background Accurate knowledge of a patient's medical problems is critical for clinical decision making, quality measurement, research, billing and clinical decision support. Common structured sources of problem information include the patient problem list and billing data; however, these sources are often inaccurate or incomplete. Objective To develop and validate methods of automatically inferring patient problems from clinical and billing data, and to provide a knowledge base for inferring problems. Study design and methods We identified 17 target conditions and designed and validated a set of rules for identifying patient problems based on medications, laboratory results, billing codes, and vital signs. A panel of physicians provided input on a preliminary set of rules. Based on this input, we tested candidate rules on a sample of 100 000 patient records to assess their performance compared to gold standard manual chart review. The physician panel selected a final rule for each condition, which was validated on an independent sample of 100 000 records to assess its accuracy. Results Seventeen rules were developed for inferring patient problems. Analysis using a validation set of 100 000 randomly selected patients showed high sensitivity (range: 62.8–100.0%) and positive predictive value (range: 79.8–99.6%) for most rules. Overall, the inference rules performed better than using either the problem list or billing data alone. Conclusion We developed and validated a set of rules for inferring patient problems. These rules have a variety of applications, including clinical decision support, care improvement, augmentation of the problem list, and identification of patients for research cohorts. PMID:21613643

Information technology and medication safety: what is the benefit?

PubMed Central

Kaushal, R; Bates, D

2002-01-01



 Medication errors occur frequently and have significant clinical and financial consequences. Several types of information technologies can be used to decrease rates of medication errors. Computerized physician order entry with decision support significantly reduces serious inpatient medication error rates in adults. Other available information technologies that may prove effective for inpatients include computerized medication administration records, robots, automated pharmacy systems, bar coding, "smart" intravenous devices, and computerized discharge prescriptions and instructions. In outpatients, computerization of prescribing and patient oriented approaches such as personalized web pages and delivery of web based information may be important. Public and private mandates for information technology interventions are growing, but further development, application, evaluation, and dissemination are required. PMID:12486992

Student manual, Book 2: Orientation to occupational safety compliance in DOE

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

Colley, D.L.

1993-10-01

This is a student hand-book an Occupational Safety Compliance in DOE. Topics include the following: Electrical; materials handling & storage; inspection responsibilities & procedures; general environmental controls; confined space entry; lockout/tagout; office safety, ergonomics & human factors; medical & first aid, access to records; construction safety; injury/illness reporting system; and accident investigation procedures.

Health disparity in black women: lack of pharmaceutical advertising in black vs. white-oriented magazines.

PubMed Central

Omonuwa, S. C.

2001-01-01

CONTEXT: Racial disparities in health care between black women and white women may be attributed in part to socioeconomic status and lack of insurance, but also may be due to lack of the dissemination of health information in black communities via black popular magazines. OBJECTIVE: Comparison of the number and type of pharmaceutical advertisements between black-oriented magazines and white-oriented magazines. DESIGN: Descriptive study. SETTING: Morehouse School of Medicine. MAIN OUTCOME MEASURES: Recording of the type and number of over-the-counter and prescription drug advertisements. RESULTS: Five black-oriented magazines (Black Woman, Black Elegance, Essence, Ebony, and Upscale) and 5 white-oriented magazines (Family Circle, Working Mother, Good Housekeeping, Ladies' Home Journal, Women's Day) were evaluated for 3 months from June-August, 2000. White-oriented magazines had four to eight times more pharmaceutical ads than black-oriented magazines. Types of medications advertised in the white-oriented magazines and not the black-oriented magazines were, for example, cholinesterase inhibitors, calcium supplements, COX II-inhibitors, intranasal steroids, anorexiants, proton pump inhibitors, and smoking deterrent agents. Conversely, medications advertised in the black-oriented magazines and not the white-oriented magazines were antiviral agents and oral contraceptives. Pharmaceutical companies gave several reasons for the disparity, including the explanation that their particular company was advertising about HIV in the black community. CONCLUSIONS: A barrier to equitable health care for black women may be a low prioritization for health prevention and health management. This low prioritization or disinterest may be a reflection of the black magazine that she is reading due to the lack of pharmaceutical advertisements in black-oriented magazines. The result of this disinterest of black females may be seen in the increased morbidity and mortality for selected diseases. PMID:11491276

Health disparity in black women: lack of pharmaceutical advertising in black vs. white-oriented magazines.

PubMed

Omonuwa, S C

2001-01-01

Racial disparities in health care between black women and white women may be attributed in part to socioeconomic status and lack of insurance, but also may be due to lack of the dissemination of health information in black communities via black popular magazines. Comparison of the number and type of pharmaceutical advertisements between black-oriented magazines and white-oriented magazines. Descriptive study. Morehouse School of Medicine. Recording of the type and number of over-the-counter and prescription drug advertisements. Five black-oriented magazines (Black Woman, Black Elegance, Essence, Ebony, and Upscale) and 5 white-oriented magazines (Family Circle, Working Mother, Good Housekeeping, Ladies' Home Journal, Women's Day) were evaluated for 3 months from June-August, 2000. White-oriented magazines had four to eight times more pharmaceutical ads than black-oriented magazines. Types of medications advertised in the white-oriented magazines and not the black-oriented magazines were, for example, cholinesterase inhibitors, calcium supplements, COX II-inhibitors, intranasal steroids, anorexiants, proton pump inhibitors, and smoking deterrent agents. Conversely, medications advertised in the black-oriented magazines and not the white-oriented magazines were antiviral agents and oral contraceptives. Pharmaceutical companies gave several reasons for the disparity, including the explanation that their particular company was advertising about HIV in the black community. A barrier to equitable health care for black women may be a low prioritization for health prevention and health management. This low prioritization or disinterest may be a reflection of the black magazine that she is reading due to the lack of pharmaceutical advertisements in black-oriented magazines. The result of this disinterest of black females may be seen in the increased morbidity and mortality for selected diseases.

Computing disease incidence, prevalence and comorbidity from electronic medical records.

PubMed

Bagley, Steven C; Altman, Russ B

2016-10-01

Electronic medical records (EMR) represent a convenient source of coded medical data, but disease patterns found in EMRs may be biased when compared to surveys based on sampling. In this communication we draw attention to complications that arise when using EMR data to calculate disease prevalence, incidence, age of onset, and disease comorbidity. We review known solutions to these problems and identify challenges for future work. Copyright © 2016 Elsevier Inc. All rights reserved.

[Effects of work-related medical rehabilitation in patients with musculoskeletal disorders].

PubMed

Streibelt, M; Hansmeier, T; Müller-Fahrnow, W

2006-06-01

A work-related orientation within medical rehabilitation represents concepts with a stronger focus on the patient's individual vocational requirements and is based on different vocationally-orientated strategies of treatment. "Medical Occupational Orientation" ("Medizinisch-berufliche Orientierung", MBO), the model of Klinik Niedersachsen in Bad Nenndorf, places Functional Capacity Evaluation according to Susan Isernhagen (EFL) at the centre of rehabilitation diagnostics and therapy. This study investigates the effects of the MBO model relative to activities and vocational participation of patients with musculoskeletal disorders faced with vocational problems and on management at the interface between medical and vocational rehabilitation. Presented are findings of a randomized follow-up study aimed at evaluating the MBO model. A total of 494 patients of LVA Westfalen, a regional insurance agency, took part. A need for MBO was diagnosed for 222 patients. These patients were randomly assigned either to the MBO model of treatment (experimental group --> U[+]) or to the conventional medical treatment (control group --> K[+]). Patients without a need for MBO (U[-], K[-]) were treated likewise. The written questionings took place at the beginning (t (1)) and end of rehabilitation (t (2)), as well as six (t (3)) and twelve months (t (4)) after the patients' discharge. Currently, the results are based on the 6-month follow-up. Concerning the activities, an MBO-related effect in the experimental group (U[+]) has been found for the Pain Disability Index (PDI), effect sizes being d (u+) = 0.82; d (k+) = 0.17. The risk of unemployment six months after rehabilitation is decreased for MBO(+) patients who participated in the MBO model. In addition, the clinic can make effective prognosis concerning subsequent participation in vocational rehabilitation for both experimental groups (U[+], U[-]). Established for the first time in a randomized controlled trial, the findings presented show that patients with musculoskeletal disorders who are faced with particular vocational problems will achieve significantly better results concerning activities and vocational reintegration if their medical rehabilitation had been based upon an EFL-centred MBO approach.

EMR management system for patient pulse data.

PubMed

Lee, Junyoung

2012-10-01

The purpose of this study is to build an integrated medical information system for effective database management of clinical information and to improve the existing Electronic Medical Record (EMR)-based system that is currently being used in hospitals. The integrated medical information system of hospitals consists of an Order Communication System (OCS), Picture Archiving Communication System (PACS), and Laboratory Information System (LIS), as well as Electronic Medical Record (EMR). It is designed so that remote health screening and patient data search can be accessed through a high speed network-even in remote areas-in order to effectively manage data on medical treatment that patients received at their respective hospitals. The existing oriental treatment system is one in which the doctor requires the patient to visit the hospital in person, so as to be able to check the patient's pulse and measure it with his hand for proper diagnosis and treatment. However, due to the recent development of digitalized medical measurement equipment, not only can doctors now check a patient's pulse without touching it directly, but the measured data are computerized and stored into the database as the electronic obligation record. Thus, even if a patient cannot visit the hospital, proper medical treatment is available by analyzing the patient's medical history and diagnosis process in the remote area. Furthermore, when a comprehensive medical testing center system including the people medical examination and diverse physical examination is established, the quality of medical service is expected to be improved than now.

Software engineering risk factors in the implementation of a small electronic medical record system: the problem of scalability.

PubMed

Chiang, Michael F; Starren, Justin B

2002-01-01

The successful implementation of clinical information systems is difficult. In examining the reasons and potential solutions for this problem, the medical informatics community may benefit from the lessons of a rich body of software engineering and management literature about the failure of software projects. Based on previous studies, we present a conceptual framework for understanding the risk factors associated with large-scale projects. However, the vast majority of existing literature is based on large, enterprise-wide systems, and it unclear whether those results may be scaled down and applied to smaller projects such as departmental medical information systems. To examine this issue, we discuss the case study of a delayed electronic medical record implementation project in a small specialty practice at Columbia-Presbyterian Medical Center. While the factors contributing to the delay of this small project share some attributes with those found in larger organizations, there are important differences. The significance of these differences for groups implementing small medical information systems is discussed.

Using the computer to optimize human performance in health care delivery. The pathologist as medical information specialist.

PubMed

Korpman, R A

1987-07-01

The demands for information retrieval, processing, and synthesis placed on all providers of health care have increased dramatically in the last several decades. Although systems have been developed to capture charge-related data in support of cost reimbursement, there has been a conspicuous lack of attention paid to information tools to directly enhance the delivery of patient care. The termination of cost reimbursement, together with an increasing recognition of the problems inherent in current manual record-keeping systems, is creating a significant new focus on medical information. This change in focus requires a shift in systems orientation away from financial and departmentally centered systems and toward patient-centered approaches. There is thus increasing recognition of the need for a physician-level medical information specialist to serve as an institution's chief information officer, assuming responsibility for the collection, manipulation, and availability of all patient care-related data. By virtue of training, typical experience, hospital presence, and a noncompetitive position with the hospital's medical staff, the pathologist is uniquely suited for this position. To effectively perform this role, a variety of new specialized data management tools are becoming available. Integrated information systems, patient care management by exception, decision support tools, and, in the future, "artificial intelligence" assists can all be expected to become staples of pathology practice, especially impacting those pathologists who choose to be responsive to the new practice milieu of medical information science.

[From planning to realization of an electronic patient record].

PubMed

Krämer, T; Rapp, R; Krämer, K L

1999-03-01

The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the necessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occurred during this process.

From planning to realisation of an electronic patient record.

PubMed

Krämer, T; Rapp, R; Krämer, K-L

1999-03-01

The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the neccessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occured during this process.

Medical Considerations for Multiple-Handicapped Children in the Public Schools

ERIC Educational Resources Information Center

Bryan, Elizabeth; And Others

1978-01-01

The authors discuss concerns and practical suggestions involved in the education of multiply handicapped children in the following problem areas: first aid, emergency care and disaster planning; sanitation; environment; safety in routine and supplemental activities; therapy procedures; and staff protection, training, orientation, and special…

Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

PubMed Central

Wilkinson, G

1986-01-01

I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

Geological Mapping of the North Polar Region of Venus (V-1 Snegurochka Planitia): Significant Problems and Comparisons to the Earth's Archean

NASA Technical Reports Server (NTRS)

Head, James W.; Hurwitz, D. M.; Ivanov, M. A.; Basilevsky, A. T.; Kumar, P. Senthil

2008-01-01

The geological features, structures, thermal conditions, interpreted processes, and outstanding questions related to both the Earth's Archean and Venus share many similarities and we are using a problem-oriented approach to Venus mapping, guided by perspectives from the Archean record of the Earth, to gain new insight into both. The Earth's preserved and well-documented Archean record provides important insight into high heat-flux tectonic and magmatic environments and structures and Venus reveals the current configuration and recent geological record of analogous high-temperature environments unmodified by subsequent several billion years of segmentation and overprinting, as on Earth. We have problems on which progress might be made through comparison. Here we present the major goals of the geological mapping of the V-1 Snegurochka Planitia Quadrangle, and themes that could provide important insights into both planets:

Problems in Recording the Electrocardiogram.

ERIC Educational Resources Information Center

Webster, John G.

The unwanted signals that arise in electrocardiography are discussed. A technical background of electrocardiography is given, along with teaching techniques that educate students of medical instrumentation to solve the problems caused by these signals. (MJH)

Biomedical engineering - A means to add new dimension to medicine and research

NASA Technical Reports Server (NTRS)

Doerr, D. F.

1992-01-01

Biomedical engineering is an evolving science that seeks to insert technically oriented and trained personnel to assist medical professionals in solving technological problems in the pursuit of innovations in the delivery of health care. Consequently, engineering solutions are brought to bear on problems that previously were outside the training of physicians and beyond the understanding or appreciation of the conventionally educated electrical or mechanical engineers. This physician/scientist/engineer team has a capability to extend medicine and research far beyond the capability of a single entity operating alone. How biomedical engineering has added a new dimension to medical science at the Kennedy Space Center is described.

[Role of medical information processing for quality assurance in obstetrics].

PubMed

Selbmann, H K

1983-06-01

The paradigma of problem-orientated assuring of the professional quality of medical case is a kind of "control loop system" consisting of the following 5 steps: routine observation, identification of the problem, analysis of the problem, translation of problem solutions into daily practice and control as to whether the problem has been solved or eliminated. Medical data processing, which involves documentation, electronic data processing and statistics, can make substantial contributions especially to the steps of observation, identification of the problem, and follow-up control. Perinatal data collection, which has already been introduced in 6 Länder of the Federal Republic of Germany, has supplied ample proof of this. These operations were conducted under the heading "internal clinical assuring of quality with external aid". Those clinics who participated in this programme, were given the necessary aid in self-observation (questionnaires, clinical statistics), and they were also given comparative informative data to help them in identifying the problems (clinical profiles, etc.). It is entirely left to the responsibility of the clinics themselves--voluntary cooperation and guarantee of remaining anonymous being a matter of course -- to draw their own consequences from the collected data and to translate these into clinical everyday practice.

Weighty Problems: Predictors of Family Physicians Documenting Overweight and Obesity.

PubMed

Cyr, Peggy R; Haskins, Amy E; Holt, Christina; Hanifi, Jasmine

2016-03-01

Documenting obesity on the problem list has been shown to promote action about obesity and overweight, yet a majority of primary care providers do not record obesity on the medical problem list. With this in mind, our objectives were to determine the proportion of physicians' documentation of overweight (OW) or obesity on the problem list in our primary care teaching practice and to identify predictors of physician documentation of OW/obesity. De-identified health records of 6,195 adult patients with BMI ? 25 kg/m2 seen by a family physician over a 2-year period were included. Using multivariate logistic regression, patient age, BMI, gender, race, insurance, comorbidities, number of visits, physician gender or role, and practice site (suburban versus urban) were examined in relation to inclusion of OW/obesity on the medical problem list. Few (21.1%) patients had OW/obesity on their problem list. In the multivariate model, female PCPs were significantly more likely to document OW/obesity (OR=1.39, 95% CI=1.18--1.63) compared to male PCPs, and faculty were 26% more likely to document obesity (95% CI=1.07--1.48) compared to residents. Female patients, those with hypertension, diabetes, hyperlipidemia, and those with six or more visits were significantly more likely to have obesity on their problem lists, while patients with Medicaid were less likely to have obesity recorded. No significant difference was seen by race. Nearly 80% of OW and obese patients were not identified on the problem list. Patient gender, comorbidity, and number of visits were associated with documentation. Future research should examine automatic documentation of OW/obesity on the medical problem list.

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study.

PubMed

Riahi, Sanaz; Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

2017-01-05

Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. ©Sanaz Riahi, Ilan Fischler, Melanie I Stuckey, Philip E Klassen, John Chen. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 05.01.2017.

The problem with outcomes-based curricula in medical education: insights from educational theory.

PubMed

Rees, Charlotte E

2004-06-01

Educators across the world are charged with the responsibility of producing core learning outcomes for medical curricula. However, much educational theory exists which deliberates the value of learning outcomes in education. This paper aims to discuss the problems surrounding outcomes-based curricula in medical education, using insights from educational theory. The paper begins with a discussion of the traditions, values and ideologies of medical curricula. It continues by analysing the issue of control within the curriculum and argues that curriculum designers and teachers control product-orientated curricula, leading to student disempowerment. The paper debates outcomes-based curricula from an ideological perspective and argues that learning outcomes cannot specify exactly what is to be achieved as a result of learning. The paper argues that medical schools should adopt a model for co-operative control of the curriculum, thus empowering learners. The paper also suggests that medical educators should determine the value of precise learning outcomes before blindly adopting an outcomes-based model.

Sexual Orientation and College Students' Reasons for Nonmedical Use of Prescription Drugs.

PubMed

Dagirmanjian, Faedra R; McDaniel, Anne E; Shadick, Richard

2017-07-03

Nonmedical use of prescription pain medications, sedatives, and stimulants is a well-documented problem among college students. Research has indicated that students who identify as lesbian, gay, or bisexual are at elevated risk. However, little is known about students' reasons for use. (1) To replicate findings that sexual minority students report higher nonmedical use than heterosexual students, moving from a campus-specific to a multicampus sample and (2) to test for an association between sexual orientation and reasons for use. The 2015 College Prescription Drug Study surveyed 3389 students from nine 4-year public and private colleges and universities across the United States using an anonymous online survey. Measures assessed demographic information, prevalence of nonmedical use, frequency of use, where the drugs were obtained, reasons for use, and consequences of use. Stepwise logistic regression models were used to determine if sexual orientation predicted use. Chi-square tests of independence were also used to analyze prevalence of use by demographics as well as to assess differences in reasons for use by sexual orientation. Sexual minority students were significantly more likely than heterosexual students to nonmedically use any prescription drug, pain medications, and sedatives. Sexual minority students were also more likely to select that they used pain medications to relieve anxiety, enhance social interactions, and to feel better. Conclusions/Importance: Although sexual minority students are more likely to report nonmedical use, students overall use prescription medications for similar reasons, with the exception of painkillers. Implications and areas for future research are discussed.

[Diabetes type 1 in young adults: The relationship between psycho-social variables, glycemic control, depression and anxiety].

PubMed

Steinsdottir, Fjola Katrin; Halldorsdottir, Hildur; Gudmundsdottir, Arna; Arnardottir, Steinunn; Smari, Jakop; Arnarson, Eirikur Orn

2008-12-01

The aim of the present study was to investigate whether psycho-social variables, for example social support and task- and emotion-oriented coping would predict psychological and physical well being among young adults with diabetes. Participants were 56 individuals in their twenties suffering from type 1 diabetes. Response rate was 78%. The participants came from the whole of Iceland, 64.3% from the Greater Reykjavík area and 33.9% from rural areas. One participant did not indicate his place of residence. Self-assessment scales were used to assess depression, anxiety, task-, avoidance- and emotion-oriented coping, social support and problems relating to diabetes. Additional information was obtained from patients' records concerning the results of blood glucose measurements (HbA1c). Good social support was related to less anxiety and depression and to less self-reported problems related to having diabetes. Emotion-oriented coping was related to not feeling well and task- oriented coping to feeling better. No relationship was found between psychosocial variables and blood glucose measurements and a limited relationship between self-reported problems related to having diabetes and these measurements. Social support and coping are strongly related to measurements of depression, anxiety and problems related to having diabetes in the present age group. The results indicate that it is very important to teach and strengthen usage, as possible, of task-oriented coping instead of emotion-oriented coping. The results also indicate that social support is highly important for young adults with diabetes type 1. It is clear that friends and family have to be more involved in the treatment and also more educated about the disease and the importance of giving the right kind of support.

A survey aimed at general citizens of the US and Japan about their attitudes toward electronic medical data handling.

PubMed

Kimura, Michio; Nakaya, Jun; Watanabe, Hiroshi; Shimizu, Toshiro; Nakayasu, Kazuyuki

2014-04-25

To clarify the views of the general population of two countries (US and Japan), concerning the handling of their medical records electronically. We contacted people nationwide in the United States at random via Random Digit Dialing (RDD) to obtain 200 eligible responders. The questionnaire was for obtaining the information on their attitudes towards handling of their medical records, disclosure of the name of disease, secondary usage of information, compiling their records into a lifelong medical record, and access to their medical records on the Internet. We had also surveyed people of Shizuoka prefecture in Japan using same questionnaires sent by mail, for which we obtained 457 valid answers. Even in an unidentifiable manner, US people feel profit-oriented usage of medical data without specific consent is not acceptable. There is a significant difference between usage of unidentifiable medical data for profit (about 50% feel negatively) and for official/research purposes (about 30% feel negatively). About 60% of the US responders have a negative view on the proposal that unidentifiable medical information be utilized for profit by private companies to attain healthcare cost savings. As regards compiling a lifelong medical record, positive answers and negative answers are almost equally divided in the US (46% vs. 38%) while more positive attitudes are seen in Japan (74% vs. 12%). However, any incentive measures aimed at changing attitudes to such a compiling including the discount of healthcare costs or insurance fees are unwelcomed by people regardless of their age or health condition in both surveys. Regarding the access to their own medical record via the Internet, 38% of the US responders feel this is unacceptable while 50.5% were willing to accept it. Participants from the US think that the extent of the sharing their identifiable medical records should be limited to the doctors-in-charge and specified doctors referred to by their own doctors. On the other hand, Japanese people find it acceptable for doctors of the same hospital to share their medical records. Even in unidentifiable manner, people in both countries think the profits resulting from the secondary use of medical records should be returned to the public or patients. With regard to compiling a lifelong medical record, participants from the US provided both positive answers and negative answers, while more positive attitudes were observed in Japan. However, any incentives or measures aimed at changing attitudes towards such a compilation, including provision of a discount on healthcare costs or insurance fees, were not welcomed by participants from US as well as those from Japan, regardless of their age or health condition.

The Self-Adapting Focused Review System. Probability sampling of medical records to monitor utilization and quality of care.

PubMed

Ash, A; Schwartz, M; Payne, S M; Restuccia, J D

1990-11-01

Medical record review is increasing in importance as the need to identify and monitor utilization and quality of care problems grow. To conserve resources, reviews are usually performed on a subset of cases. If judgment is used to identify subgroups for review, this raises the following questions: How should subgroups be determined, particularly since the locus of problems can change over time? What standard of comparison should be used in interpreting rates of problems found in subgroups? How can population problem rates be estimated from observed subgroup rates? How can the bias be avoided that arises because reviewers know that selected cases are suspected of having problems? How can changes in problem rates over time be interpreted when evaluating intervention programs? Simple random sampling, an alternative to subgroup review, overcomes the problems implied by these questions but is inefficient. The Self-Adapting Focused Review System (SAFRS), introduced and described here, provides an adaptive approach to record selection that is based upon model-weighted probability sampling. It retains the desirable inferential properties of random sampling while allowing reviews to be concentrated on cases currently thought most likely to be problematic. Model development and evaluation are illustrated using hospital data to predict inappropriate admissions.

Efficient Privacy-Enhancing Techniques for Medical Databases

NASA Astrophysics Data System (ADS)

Schartner, Peter; Schaffer, Martin

In this paper, we introduce an alternative for using linkable unique health identifiers: locally generated system-wide unique digital pseudonyms. The presented techniques are based on a novel technique called collision-free number generation which is discussed in the introductory part of the article. Afterwards, attention is payed onto two specific variants of collision-free number generation: one based on the RSA-Problem and the other one based on the Elliptic Curve Discrete Logarithm Problem. Finally, two applications are sketched: centralized medical records and anonymous medical databases.

Horizontal and vertical integration of academic disciplines in the medical school curriculum.

PubMed

Vidic, Branislav; Weitlauf, Harry M

2002-05-01

A rapid expansion of new scientific information and the introduction of new technology in operative and diagnostic medicine has marked the last several decades. Medical educators, because of and parallel to these developments, initiated a search for a more effective system of presenting core material to medical students. The new educational trends, although varying somewhat from one institution to another, concentrated on the following pedagogical shifts: 1) expansion of conceptual presentation of material at the expense of detail-oriented education; 2) amplification of an integrated approach, as opposed to subject-oriented instruction; 3) scheduling of elective courses to compliment required courses in the curriculum; and 4) institution of small group instruction (i.e., problem-based learning) to actively involve students in the educational process and to develop deductive reasoning based on clinical cases. The future pedagogical system in medical schools will most likely be a combination of "classical" presentation of material combined with concept-oriented, subject-integrated and small group instruction based on either hypothetical or real clinical cases. It is imperative for the success of the new curriculum, however, that certain criteria are satisfied: 1) reorganize basic science departments to determine course ownership; 2) establish a reward system for teaching faculty; and 3) establish new course objectives. Copyright 2002 Wiley-Liss, Inc.

Electronic medical records in diabetes consultations: participants' gaze as an interactional resource.

PubMed

Rhodes, Penny; Small, Neil; Rowley, Emma; Langdon, Mark; Ariss, Steven; Wright, John

2008-09-01

Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

Aligning institutional priorities: engaging house staff in a quality improvement and safety initiative to fulfill Clinical Learning Environment Review objectives and electronic medical record Meaningful Use requirements.

PubMed

Flanagan, Meghan R; Foster, Carolyn C; Schleyer, Anneliese; Peterson, Gene N; Mandell, Samuel P; Rudd, Kristina E; Joyner, Byron D; Payne, Thomas H

2016-02-01

House staff quality improvement projects are often not aligned with training institution priorities. House staff are the primary users of inpatient problem lists in academic medical centers, and list maintenance has significant patient safety and financial implications. Improvement of the problem list is an important objective for hospitals with electronic health records under the Meaningful Use program. House staff surveys were used to create an electronic problem list manager (PLM) tool enabling efficient problem list updating. Number of new problems added and house staff perceptions of the problem list were compared before and after PLM intervention. The PLM was used by 654 house staff after release. Surveys demonstrated increased problem list updating (P = .002; response rate 47%). Mean new problems added per day increased from 64 pre-PLM to 125 post-PLM (P < .001). This innovative project serves as a model for successful engagement of house staff in institutional quality and safety initiatives with tangible institutional benefits. Copyright © 2016 Elsevier Inc. All rights reserved.

Selective attention to emotional pictures as a function of gambling motives in problem and nonproblem gamblers.

PubMed

Hudson, Amanda; Jacques, Sophie; Stewart, Sherry H

2013-12-01

Problem gambling may reflect a maladaptive means of fulfilling specific affect-regulation motives, such as enhancing positive affect or coping with negative affect. Research with clinical populations indicates that disorders with prominent affective symptoms are characterized by attentional biases for symptom-congruent information. Thus, we assessed whether problem gamblers with enhancement motives for gambling would demonstrate attentional biases for positive emotional information, relative to other types of emotional information, and problem gamblers with coping motives for gambling would demonstrate attentional biases for negative emotional information, compared with other types of emotional information. In addition, we expected motive-congruent biases to be stronger in problem gamblers than nonproblem gamblers. To test these hypotheses, problem and nonproblem gamblers received an emotional orienting task in which neutral, negative, and positive pictorial cues appeared to one side of the computer screen, followed by target words in cued or uncued locations. In a look-away condition, participants had to shift attention away from pictures to respond to predominantly uncued targets, whereas in a look-toward condition, they had to orient to pictures to categorize predominantly cued targets. The results revealed motive-congruent orienting biases and disengagement lags for emotional pictures in problem gamblers. The link between motives and affective biases was less apparent in nonproblem gamblers. Results suggest that attentional measures may provide a useful complement to the subjective methodologies that are typically employed in studying problem gamblers. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Feasibility of mHealth and Near Field Communication technology based medication adherence monitoring.

PubMed

Morak, Juergen; Schwarz, Mark; Hayn, Dieter; Schreier, Guenter

2012-01-01

Poor patients' adherence to intake of prescribed medication has been identified as a serious problem in the treatment of chronically ill patients. Technical solutions are needed to measure and - if necessary - to increase the patients' adherence. A telemonitoring solution was developed to record a patient's medication intake based on smart blisters and mobile phones with NFC functionality. The components allowed recording of drug type, timestamp, and dosage of pills taken. The system's usability and technical feasibility was evaluated in the course of an application study. Over a period of 13 months 59 patients suffering from diabetes were monitored. 1,760 blisters were handed out to these patients and 14,843 takeout events were recorded and transmitted via mobile phone. Results indicate the feasibility of this concept to monitor adherence. Although the system still needs to be optimized for routine use it shows the potential for targeting the problem of poor patient adherence by NFC enabled devices.

Organ Procurement Organizations and the Electronic Health Record.

PubMed

Howard, R J; Cochran, L D; Cornell, D L

2015-10-01

The adoption of electronic health records (EHRs) has adversely affected the ability of organ procurement organizations (OPOs) to perform their federally mandated function of honoring the donation decisions of families and donors who have signed the registry. The difficulties gaining access to potential donor medical record has meant that assessment, evaluation, and management of brain dead organ donors has become much more difficult. Delays can occur that can lead to potential recipients not receiving life-saving organs. For over 40 years, OPO personnel have had ready access to paper medical records. But the widespread adoption of EHRs has greatly limited the ability of OPO coordinators to readily gain access to patient medical records and to manage brain dead donors. Proposed solutions include the following: (1) hospitals could provide limited access to OPO personnel so that they could see only the potential donor's medical record; (2) OPOs could join with other transplant organizations to inform regulators of the problem; and (3) hospital organizations could be approached to work with Center for Medicare and Medicaid Services (CMS) to revise the Hospital Conditions of Participation to require OPOs be given access to donor medical records. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Sixteen years of ICPC use in Norwegian primary care: looking through the facts

PubMed Central

2010-01-01

Background The International Classification for Primary Care (ICPC) standard aims to facilitate simultaneous and longitudinal comparisons of clinical primary care practice within and across country borders; it is also used for administrative purposes. This study evaluates the use of the original ICPC-1 and the more complete ICPC-2 Norwegian versions in electronic patient records. Methods We performed a retrospective study of approximately 1.5 million ICPC codes and diagnoses that were collected over a 16-year period at 12 primary care sites in Norway. In the first phase of this period (transition phase, 1992-1999) physicians were allowed to not use an ICPC code in their practice while in the second phase (regular phase, 2000-2008) the use of an ICPC code was mandatory. The ICPC codes and diagnoses defined a problem event for each patient in the PROblem-oriented electronic MEDical record (PROMED). The main outcome measure of our analysis was the percentage of problem events in PROMEDs with inappropriate (or missing) ICPC codes and of diagnoses that did not map the latest ICPC-2 classification. Specific problem areas (pneumonia, anaemia, tonsillitis and diabetes) were examined in the same context. Results Codes were missing in 6.2% of the problem events; incorrect codes were observed in 4.0% of the problem events and text mismatch between the diagnoses and the expected ICPC-2 diagnoses text in 53.8% of the problem events. Missing codes were observed only during the transition phase while incorrect and inappropriate codes were used all over the 16-year period. The physicians created diagnoses that did not exist in ICPC. These 'new' diagnoses were used with varying frequency; many of them were used only once. Inappropriate ICPC-2 codes were also observed in the selected problem areas and for both phases. Conclusions Our results strongly suggest that physicians did not adhere to the ICPC standard due to its incompleteness, i.e. lack of many clinically important diagnoses. This indicates that ICPC is inappropriate for the classification of problem events and the clinical practice in primary care. PMID:20181271

Medical Device Plug-and-Play Interoperability Standards and Technology Leadership

DTIC Science & Technology

2010-10-01

Philips Medical Systems Impact of ARRA/HITECH on Device Connectivity: Safe? Effective? Say what?! Todd Cooper President Breakthrough Solutions...that could notify the physician when, say , one of the devices comes discon- nected in the high-vibration environment of the plane. There is no way at...Electronic record-keeping promises to be an improvement over previous methods (eliminating problems such as illeg- ible handwriting and records

Agency problems of global budget system in Taiwan's National Health Insurance.

PubMed

Yan, Yu-Hua; Yang, Chen-Wei; Fang, Shih-Chieh

2014-05-01

The main purpose of this study was to investigate the agency problem presented by the global budget system followed by hospitals in Taiwan. In this study, we examine empirically the interaction between the principal: Bureau of National Health Insurance (BNHI) and agency: medical service providers (hospitals); we also describe actual medical service provider and hospital governance conditions from a agency theory perspective. This study identified a positive correlation between aversion to agency hazard (self-interest behavior, asymmetric information, and risk hedging) and agency problem risks (disregard of medical ethics, pursuit of extra-contract profit, disregard of professionalism, and cost orientation). Agency costs refer to BNHI auditing and monitoring expenditures used to prevent hospitals from deviating from NHI policy goals. This study also found agency costs negatively moderate the relationship between agency hazards and agency problems The main contribution of this study is its use of agency theory to clarify agency problems and several potential factors caused by the NHI system. This study also contributes to the field of health policy study by clarifying the nature and importance of agency problems in the health care sector. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[A survey about client orientation and wayfinding in Chilean hospitals].

PubMed

Mora, Rodrigo; Oats, Amalia; Marziano, Pía

2014-10-01

Sense of orientation in hospitals can be tricky considering the large extension of buildings and the inadequate signage. To report some of the findings of a larger research project on wayfinding and patient navigation in Chilean hospitals. Five hundred nine hospital users waiting for attention in three hospitals were contacted and asked to answer a survey that lasted 10 minutes, about wayfinding and sense of orientation within the hospital. Users declared to have a good opinion of existing signage in the three hospitals analyzed as well as their architectural organization in terms of their capacity to orient people. However, the vast majority of users asked for directions to navigate within the hospital to staff and medical personnel. Patient navigation problems are imposing a great "hidden" cost to hospitals management due to missed appointments.

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

PubMed

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

2008-01-01

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

Usability Evaluation of An Electronic Medication Administration Record (eMAR) Application

PubMed Central

Guo, J.; Iribarren, S.; Kapsandoy, S.; Perri, S.; Staggers, N.

2011-01-01

Background Electronic medication administration records (eMARs) have been widely used in recent years. However, formal usability evaluations are not yet available for these vendor applications, especially from the perspective of nurses, the largest group of eMAR users. Objective To conduct a formal usability evaluation of an implemented eMAR. Methods Four evaluators examined a commercial vendor eMAR using heuristic evaluation techniques. The evaluators defined seven tasks typical of eMAR use and independently evaluated the application. Consensus techniques were used to obtain 100% agreement of identified usability problems and severity ratings. Findings were reviewed with 5 clinical staff nurses and the Director of Clinical Informatics who verified findings with a small group of clinical nurses. Results Evaluators found 60 usability problems categorized into 233 heuristic violations. Match, Error, and Visibility heuristics were the most frequently violated. Administer Medication and Order and Modify Medications tasks had the highest number of heuristic violations and usability problems rated as major or catastrophic. Conclusion The high number of usability problems could impact the effectiveness, efficiency and satisfaction of nurses’ medication administration activities and may include concerns about patient safety. Usability is a joint responsibility between sites and vendors. We offer a call to action for usability evaluations at all sites and eMAR application redesign as necessary to improve the user experience and promote patient safety. PMID:23616871

[Conduct of survey four months after the start of EMR for home visits to promote cooperation between hospitals and clinics].

PubMed

Nakagawa, Yumiko; Sawada, Sachiko; Tomiyama, Takashi; Ueda, Yuki; Fujii, Kou; Takeshita, Kiyotaka; Kobayashi, Mitsuru; Isono, Osamu

2014-12-01

Electronic medical records(EMR)for home visits were introduced in October 2013 at our institution in order to ensure smooth cooperation between the hospital and clinic by sharing the details of a patient's medical record. A system was developed for remote desktop connections to the EMR terminal server(virtual server)with the use of an SSL-VPN. Mobile terminals and mobile printers were used. Four months after the start of this system, a survey was conducted for 41 home care professionals and other staff(physicians, nurses, and office staff). Home care staff indicated that they had problems with the system, including bad connections and operating conditions, and difficulties responding to problems when they arose. Other staff indicated that they were able to acquire patient information faster than with paper-based records. Future issues include improvements to the user-friendliness of the terminals and improved responses to problems when they occur.

Design of the SGML-based electronic patient record system with the use of object-oriented analysis methods.

PubMed

Kuikka, E; Eerola, A; Porrasmaa, J; Miettinen, A; Komulainen, J

1999-01-01

Since a patient record is typically a document updated by many users, required to be represented in many different layouts, and transferred from place to place, it is a good candidate to be represented structured and coded using the SGML document standard. The use of the SGML requires that the structure of the document is defined in advance by a Document Type Definition (DTD) and the document follows it. This paper represents a method which derives an SGML DTD by starting from the description of the usage of the patient record in medical care and nursing.

Large scale database scrubbing using object oriented software components.

PubMed

Herting, R L; Barnes, M R

1998-01-01

Now that case managers, quality improvement teams, and researchers use medical databases extensively, the ability to share and disseminate such databases while maintaining patient confidentiality is paramount. A process called scrubbing addresses this problem by removing personally identifying information while keeping the integrity of the medical information intact. Scrubbing entire databases, containing multiple tables, requires that the implicit relationships between data elements in different tables of the database be maintained. To address this issue we developed DBScrub, a Java program that interfaces with any JDBC compliant database and scrubs the database while maintaining the implicit relationships within it. DBScrub uses a small number of highly configurable object-oriented software components to carry out the scrubbing. We describe the structure of these software components and how they maintain the implicit relationships within the database.

The effects of physicians' training and personality on test ordering for ambulatory patients.

PubMed Central

Epstein, A M; Begg, C B; McNeil, B J

1984-01-01

We studied records of 351 hypertensive patients cared for by 30 internists in private office practice. We correlated the use of outpatient diagnostic tests with personal characteristics of the prescribing physicians. Doctors trained in medical schools with academic orientations used more tests than other physicians. Patterns of use were not strongly related to the number of years since medical school graduation, or physicians "intolerance of ambiguity" as measured by a standard psychological instrument. These findings suggest that certain types of training may predispose physicians to be high testers. PMID:6496824

[Work-Anxieties and their Treatment in Medical Rehabilitation - Hand Tools for Capacity Training and Psychotherapy].

PubMed

Muschalla, B

2017-02-01

Work-anxieties are often going along with workplace problems and long-term sick leave. Psychopathologically, different qualities of work anxiety can be distinguished: worrying, phobic anxiety, health-related anxiety, anxiety of insufficiency. An evaluation of a work-anxiety treatment showed that confronting patients with the topic work during medical rehabilitation leads to a better course. In work-oriented capacity trainings or behavior therapy groups, coping with everyday phenomena at work may be trained (self-presentation, social rules, work organization and problem solving, coping with chronic illness and impairment conditions). Active coping and communication (explaining impairment to the supervisor and occupational physician for making problem solving possible) are helpful. In some cases, correction of expectations must be done, and normalizing everyday work problems (conflicts and achievement requirements are normal at work, work does not make happy all the time). © Georg Thieme Verlag KG Stuttgart · New York.

[Quality assurance of hospital medical records as a risk management tool].

PubMed

Terranova, Giuseppina; Cortesi, Elisabetta; Briani, Silvia; Giannini, Raffaella

2006-01-01

A retrospective analysis of hospital medical records was performed jointly by the Medicolegal department of the Pistoia Local Health Unit N. 3 and by the management of the SS. Cosma and Damiano di Pescia Hospital. Evaluation was based on ANDEM criteria, JCAHO standards, and the 1992 discharge abstract guidelines of the Italian Health Ministry. In the first phase of the study, data were collected and processed for each hospital ward and then discussed with clinicians and audited. After auditing, appropriate actions were agreed upon for correcting identified problems. Approximately one year later a second smaller sample of medical records was evaluated and a higher compliance rate with the established corrective actions was found in all wards for all data categories. In this study the evaluation of medical records can be considered in the wider context of risk management, a multidisciplinary process directed towards identifying and monitoring risk through the use of appropriate quality indicators.

The potential of the inventory of learning styles to study students' learning patterns in three types of medical curricula.

PubMed

Van der Veken, J; Valcke, M; Muijtjens, A; De Maeseneer, J; Derese, A

2008-01-01

Introducing innovative curricular designs can be evaluating by scrutinizing the learning patterns students use. Studying the potential of Vermunt's Inventory of Learning Styles (ILS) in detecting differences in student learning patterns in different medical curricula. Cross-sectional between-subjects comparison of ILS-scores in third-year medical students in a conventional, an integrated contextual and a PBL-curriculum using one-way post hoc ANOVA. Response rate was 85%: 197 conventional, 130 integrated contextual and 301 PBL students. The results show a differential impact from the three curricula. In relation to processing strategies, the students in the problem-based curriculum showed less rote learning and rehearsing, greater variety in sources of knowledge used and less ability to express study content in a personal manner than did the students in the conventional curriculum. The students of the integrated contextual curriculum showed more structuring of subject matter by integrating different aspects into a whole. In relation to regulation strategies, the students in the problem-based curriculum showed significantly more self-regulation of learning content and the students in the integrated contextual curriculum showed lower levels of regulation. As to learning orientations, the students in the problem-based curriculum showed less ambivalence and the students of the conventional curriculum were less vocationally oriented. The study provides empirical support for expected effects of traditional and innovative curricula which thus far were not well supported by empirical studies.

A cross-sectional assessment of the prevalence of multiple chronic conditions and medication use in a sample of community-dwelling adults with fibromyalgia in Olmsted County, Minnesota

PubMed Central

Vincent, Ann; Whipple, Mary O; McAllister, Samantha J; Aleman, Katherine M; St Sauver, Jennifer L

2015-01-01

Objectives The objective of this study was to evaluate the problem of multiple chronic conditions and polypharmacy in patients with fibromyalgia. Design Retrospective medical record review. Setting Olmsted County, Minnesota. Participants 1111 adults with fibromyalgia. Primary and secondary outcome measures Number and type of chronic medical and psychiatric conditions, medication use. Results Medical record review demonstrated that greater than 50% of the sample had seven or more chronic conditions. Chronic joint pain/degenerative arthritis was the most frequent comorbidity (88.7%), followed by depression (75.1%), migraines/chronic headaches (62.4%) and anxiety (56.5%). Approximately, 40% of patients were taking three or more medications for symptoms of fibromyalgia. Sleep aids were the most commonly prescribed medications in our sample (33.3%) followed by selective serotonin reuptake inhibitors (28.7%), opioids (22.4%) and serotonin norepinephrine reuptake inhibitors (21.0%). Conclusions The results of our study highlight the problem of multiple chronic conditions and high prevalence of polypharmacy in fibromyalgia. Clinicians who care for patients with fibromyalgia should take into consideration the presence of multiple chronic conditions when recommending medications. PMID:25735301

[Therapeutic itineraries of users of medication in a unit of the Family Heatlh Strategy].

PubMed

Guerin, Giliane Dorneles; Rossoni, Eloá; Bueno, Denise

2012-11-01

Therapeutic itineraries represent the trajectories taken by individuals in an attempt to resolve their health problems. The objective of this study was to analyze the trajectory when user prescription medication needs were not met in a Family Health Strategy Unit of the city of Porto Alegre. A database of users whose prescription needs were not fully met and the application of a questionnaire during home visits was performed. Users interviewed were between 53 and 85 years of age. The main problems reported were lack of money, physical difficulty in locomotion, side effects, illegible prescriptions, unavailability of medication in the local pharmacies of the city, fear of effects attributed to the medication, and "bureaucracy." When the medication is not available at the health unit, most users (60%) reported buying it. With respect to the communication of the family health team in the orientation of ways that the user can gain access to the medication, 25% of the respondents reported that the team did not provide necessary information about the alternate location for the acquisition of the medication that was lacking.

New Optical Card for Sneaker’s Network in Place of Electronic Clinical Record

NASA Astrophysics Data System (ADS)

Goto, Kenya; Satsukawa, Takatoshi; Chiba, Seisho; Ohmori, Takaaki

2006-02-01

In order to solve problems in electronic medical records, a new optical card of the digital versatile disk (DVD) type with higher capacity and lower cost than conventional compact disc recording (CD-R)-type cards has been developed, which is thinner, stronger and wearable like a credit card.

[Problems of study designs with randomization, blinding and placebos].

PubMed

Heusser, P

1999-04-01

As randomised double-blind trials are not rarely demanded as a prerequisite for the scientific acceptance of complementary medicine, the author has analysed the soundness of this demand on the basis of the international literature. As a result there appeared a number of methodological, practical and ethical problems which question the theoretically deduced primal value of this study design relative to the needs of medical practice and of health insurance issues. The experimental instruments of randomisation, blinding and placebo deliberately exclude essential therapeutic factors which are integral elements of complementary medical concepts; therefore, it is suggested to supplement quantitatively and collectively oriented experimental research by non-experimental procedures, which adequately reflect the context- and practice-related individual reality.

The problem of seeing hospital staff without G.P. referral--the otolaryngological experience.

PubMed

Walshe, P; McGrain, S; Colgan, G; McShane, D

2001-01-01

Over a three month period, a record was kept of the number of hospital staff who approached the E.N.T. team requesting help for a medical problem. Staff members included doctors, nurses, clerical staff, paramedical staff and porters. The total number of employees in the hospital was recorded. The average General practitioner public patient list (General medical Service cardholders) for South Dublin was recorded (our hospital is in south west Dublin). The total number of hospital staff seen by E.N.T. in 3 months was seventy seven. The total number of hospital staff seen by other surgical specialties was approximately one hundred and sixty seven. Extrapolation of numbers seen by E.N.T. service in three months to numbers seen over a one year period is 308 patients. The numbers seen by the E.N.T. service in three months corresponds to 11.7% of the average South Dublin General Practitioner Medical card list. It has been estimated that approximately 20% of all problems the average General practitioner sees in a week are E.N.T. related. Those practices with a smaller paediatric population would have approximately 15% of the total practice concearned with E.N.T. problems. Therefore as 15% of 2,400 (total hospital staff) = 360, there is potentially a small General Practice which is 'hidden' within the hospital.

Impact of 5 years of lean six sigma in a University Medical Center.

PubMed

Niemeijer, Gerard C; Trip, Albert; de Jong, Laura J; Wendt, Klaus W; Does, Ronald J M M

2012-01-01

Lean Six Sigma (LSS) is an originally industry-based methodology for cost reduction and quality improvement. In more recent years, LSS was introduced in health care as well. This article describes the experiences of the University Medical Center Groningen, the second largest hospital in the Netherlands, with LSS. It was introduced in 2007 to create the financial possibility to develop innovations. In this article, we describe how LSS was introduced, and how it developed in the following years. We zoom in at the traumatology department, where all main processes have been analyzed and improved. An evaluation after 5 years shows that LSS helped indeed reducing cost and improving quality. Moreover, it aided the transition of the organization from purely problem oriented to more process oriented, which in turn is helpful in eliminating waste and finding solutions for difficult problems. A major benefit of the program is that own employees are trained to become project leaders for improvement. Several people from the primary process were thus stimulated and equipped to become role models for continuous improvement.

Consideration of learning orientations as an application of achievement goals in evaluating life science majors in introductory physics

NASA Astrophysics Data System (ADS)

Mason, Andrew J.; Bertram, Charles A.

2018-06-01

When considering performing an Introductory Physics for Life Sciences course transformation for one's own institution, life science majors' achievement goals are a necessary consideration to ensure the pedagogical transformation will be effective. However, achievement goals are rarely an explicit consideration in physics education research topics such as metacognition. We investigate a sample population of 218 students in a first-semester introductory algebra-based physics course, drawn from 14 laboratory sections within six semesters of course sections, to determine the influence of achievement goals on life science majors' attitudes towards physics. Learning orientations that, respectively, pertain to mastery goals and performance goals, in addition to a learning orientation that does not report a performance goal, were recorded from students in the specific context of learning a problem-solving framework during an in-class exercise. Students' learning orientations, defined within the context of students' self-reported statements in the specific context of a problem-solving-related research-based course implementation, are compared to pre-post results on physics problem-solving items in a well-established attitudinal survey instrument, in order to establish the categories' validity. In addition, mastery-related and performance-related orientations appear to extend to overall pre-post attitudinal shifts, but not to force and motion concepts or to overall course grade, within the scope of an introductory physics course. There also appears to be differentiation regarding overall course performance within health science majors, but not within biology majors, in terms of learning orientations; however, health science majors generally appear to fare less well on all measurements in the study than do biology majors, regardless of learning orientations.

Biological and Medical Experiments on the Space Shuttle, 1981 - 1985

NASA Technical Reports Server (NTRS)

Halstead, Thora W. (Editor); Dufour, Patricia A. (Editor)

1986-01-01

This volume is the first in a planned series of reports intended to provide a comprehensive record of all the biological and medical experiments and samples flown on the Space Shuttle. Experiments described have been conducted over a five-year period, beginning with the first plant studies conducted on STS-2 in November 1981, and extending through STS 61-C, the last mission to fly before the tragic Challenger accident of January 1986. Experiments were sponsored within NASA not only by the Life Sciences Division of the Office of Space Science and Applications, but also by the Shuttle Student Involvement Program (SSIP) and the Get Away Special (GAS) Program. Independent medical studies were conducted as well on the Shuttle crew under the auspices of the Space Biomedical Research Institute at Johnson Space Center. In addition, cooperative agreements between NASA and foreign government agencies led to a number of independent experiments and also paved the way for the joint US/ESA Spacelab 1 mission and the German (DFVLR) Spacelab D-1. Experiments included: (1) medically oriented studies of the crew aimed at identifying, preventing, or treating health problems due to space travel; (2) projects to study morphological, physiological, or behavioral effects of microgravity on animals and plants; (3) studies of the effects of microgravity on cells and tissues; and (4) radiation experiments monitoring the spacecraft environment with chemical or biological dosimeters or testing radiation effects on simple organisms and seeds.

Electronic hand-drafting and picture management system.

PubMed

Yang, Tsung-Han; Ku, Cheng-Yuan; Yen, David C; Hsieh, Wen-Huai

2012-08-01

The Department of Health of Executive Yuan in Taiwan (R.O.C.) is implementing a five-stage project entitled Electronic Medical Record (EMR) converting all health records from written to electronic form. Traditionally, physicians record patients' symptoms, related examinations, and suggested treatments on paper medical records. Currently when implementing the EMR, all text files and image files in the Hospital Information System (HIS) and Picture Archiving and Communication Systems (PACS) are kept separate. The current medical system environment is unable to combine text files, hand-drafted files, and photographs in the same system, so it is difficult to support physicians with the recording of medical data. Furthermore, in surgical and other related departments, physicians need immediate access to medical records in order to understand the details of a patient's condition. In order to address these problems, the Department of Health has implemented an EMR project, with the primary goal of building an electronic hand-drafting and picture management system (HDP system) that can be used by medical personnel to record medical information in a convenient way. This system can simultaneously edit text files, hand-drafted files, and image files and then integrate these data into Portable Document Format (PDF) files. In addition, the output is designed to fit a variety of formats in order to meet various laws and regulations. By combining the HDP system with HIS and PACS, the applicability can be enhanced to fit various scenarios and can assist the medical industry in moving into the final phase of EMR.

Mothers' power assertion; children's negative, adversarial orientation; and future behavior problems in low-income families: early maternal responsiveness as a moderator of the developmental cascade.

PubMed

Kim, Sanghag; Kochanska, Grazyna

2015-02-01

Parental power assertion, a key dimension of family environment, generally sets in motion detrimental developmental cascades; however, evidence suggests that other qualities of parenting, such as responsiveness, can significantly moderate those processes. Mechanisms that account for such moderating effects are not fully understood. We propose a conceptual model of processes linking parental power assertion, parental responsiveness, children's negative, adversarial, rejecting orientation toward the parent, and behavior problems. We test that model in a short-term longitudinal design involving 186 low-income, ethnically diverse mothers and their toddlers. When children were 30 months, the dyads were observed in multiple, lengthy, naturalistic laboratory interactions to assess behaviorally mothers' responsiveness and their power-assertive control style. At 33 months, we observed behavioral indicators of children's negative, adversarial, rejecting orientation toward the mothers in several naturalistic and standardized paradigms. At 40 months, mothers rated children's behavior problems. The proposed moderated mediation sequence, tested using a new approach, PROCESS (Hayes, 2013), was supported. The indirect effect from maternal power assertion to children's negative, adversarial orientation to future behavior problems was present when mothers' responsiveness was either low or average but absent when mothers were highly responsive. This study elucidates a potential process that may link parental power assertion with behavior problems and highlights how positive aspects of parenting can moderate this process and defuse maladaptive developmental cascades. It also suggests possible targets for parenting intervention and prevention efforts. PsycINFO Database Record (c) 2015 APA, all rights reserved.

The case against showing patients their records.

PubMed

Ross, A P

1986-03-01

The author, a British consultant surgeon, expresses his reservations about patients' having access to their medical records. The nature of communication between doctors may change if it is known that patients will see the material; potentially helpful yet tentative diagnoses may be excluded while other information is watered down. Physicians will have additional, perhaps burdensome, demands placed on them to explain the records--including parts written by deceased or otherwise unavailable doctors, medical students, or nonphysicians. Persons other than patients may see the records, further complicating the issue. Ross asserts that, while patients do have the right to see records, full access could be more harmful than beneficial to patients and could be fraught with problems for physicians.

School Attendance Revisited: A Study of Urban African American Students' GPA and Coping Strategies.

ERIC Educational Resources Information Center

Steward, Robbie J.; Steward, Astin Devine; Blair, Jonathan

This study investigated the degree to which at-risk, urban, African American high school students' coping strategies and grade point average (GPA) would predict attendance. Data were collected from 100 high school freshmen using the Adolescent Coping Orientation for Problem Experiences. Students' GPAs were identified through school records.…

Description of Exemplar Cases in the Intensive Mental Health Program: Illustrations of Application of the Therapeutic Model

ERIC Educational Resources Information Center

Nelson, Timothy D.; Mashunkashey, Joanna O.; Mitchell, Montserrat C.; Benson, Eric R.; Vernberg, Eric M.; Roberts, Michael C.

2008-01-01

We describe cases from the clinical records in the Intensive Mental Health Program to illustrate the diverse presenting problems, intervention strategies, therapeutic process, and outcomes for children receiving services in this school-based, community-oriented treatment model. Cases reflect varying degrees of treatment response and potential…

Secure Dynamic access control scheme of PHR in cloud computing.

PubMed

Chen, Tzer-Shyong; Liu, Chia-Hui; Chen, Tzer-Long; Chen, Chin-Sheng; Bau, Jian-Guo; Lin, Tzu-Ching

2012-12-01

With the development of information technology and medical technology, medical information has been developed from traditional paper records into electronic medical records, which have now been widely applied. The new-style medical information exchange system "personal health records (PHR)" is gradually developed. PHR is a kind of health records maintained and recorded by individuals. An ideal personal health record could integrate personal medical information from different sources and provide complete and correct personal health and medical summary through the Internet or portable media under the requirements of security and privacy. A lot of personal health records are being utilized. The patient-centered PHR information exchange system allows the public autonomously maintain and manage personal health records. Such management is convenient for storing, accessing, and sharing personal medical records. With the emergence of Cloud computing, PHR service has been transferred to storing data into Cloud servers that the resources could be flexibly utilized and the operation cost can be reduced. Nevertheless, patients would face privacy problem when storing PHR data into Cloud. Besides, it requires a secure protection scheme to encrypt the medical records of each patient for storing PHR into Cloud server. In the encryption process, it would be a challenge to achieve accurately accessing to medical records and corresponding to flexibility and efficiency. A new PHR access control scheme under Cloud computing environments is proposed in this study. With Lagrange interpolation polynomial to establish a secure and effective PHR information access scheme, it allows to accurately access to PHR with security and is suitable for enormous multi-users. Moreover, this scheme also dynamically supports multi-users in Cloud computing environments with personal privacy and offers legal authorities to access to PHR. From security and effectiveness analyses, the proposed PHR access scheme in Cloud computing environments is proven flexible and secure and could effectively correspond to real-time appending and deleting user access authorization and appending and revising PHR records.

User-oriented views in health care information systems.

PubMed

Portoni, Luisa; Combi, Carlo; Pinciroli, Francesco

2002-12-01

In this paper, we present the methodology we adopted in designing and developing an object-oriented database system for the management of medical records. The designed system provides technical solutions to important requirements of most clinical information systems, such as 1) the support of tools to create and manage views on data and view schemas, offering to different users specific perspectives on data tailored to their needs; 2) the capability to handle in a suitable way the temporal aspects related to clinical information; and 3) the effective integration of multimedia data. Remote data access for authorized users is also considered. As clinical application, we describe here the prototype of a user-oriented clinical information system for the archiving and the management of multimedia and temporally oriented clinical data related to percutaneous transluminal coronary angioplasty (PTCA) patients. Suitable view schemas for various user roles (cath-lab physician, ward nurse, general practitioner) have been modeled and implemented on the basis of a detailed analysis of the considered clinical environment, carried out by an object-oriented approach.

Electronic medical records for otolaryngology office-based practice.

PubMed

Chernobilsky, Boris; Boruk, Marina

2008-02-01

Pressure is mounting on physicians to adopt electronic medical records. The field of health information technology is evolving rapidly with innovations and policies often outpacing science. We sought to review research and discussions about electronic medical records from the past year to keep abreast of these changes. Original scientific research, especially from otolaryngologists, is lacking in this field. Adoption rates are slowly increasing, but more of the burden is shouldered by physicians despite policy efforts and the clear benefits to third-party payers. Scientific research from the past year suggests lack of improvements and even decreasing quality of healthcare with electronic medical record adoption in the ambulatory care setting. The increasing prevalence and standardization of electronic medical record systems results in a new set of problems including rising costs, audits, difficulties in transition and public concerns about security of information. As major players in healthcare continue to push for adoption, increased effort must be made to demonstrate actual improvements in patient care in the ambulatory care setting. More scientific studies are needed to demonstrate what features of electronic medical records actually improve patient care. Otolaryngologists should help each other by disseminating research about improvement in patient outcomes with their systems since current adoption and outcomes policies do not apply to specialists.

Issues in the Medication Management Process in People Who Have Intellectual and Developmental Disabilities: A Qualitative Study of the Caregivers' Perspective.

PubMed

Erickson, Steven R; Salgado, Teresa M; Tan, Xi

2016-12-01

People who have intellectual and developmental disabilities (IDD) often rely on caregivers to assist in the medication management process. The aim of this study was to learn from caregivers, who are either family or support staff, what major issues arise throughout the process of managing medication and how these might be addressed. Problems identified by caregivers include (a) prescribers understanding of insurance and agency policies regarding medication utilization; (b) lack of continuity of care and accuracy of the medication record as well as clinical records; (c) poor communication among patients, caregivers, and clinicians; (d) patient willingness to take medication; (e) caregiver understanding and training of medication-related topics; and (f) the health system being unprepared to work with people who have IDD.

Medical education in Saudi Arabia: a review of recent developments and future challenges.

PubMed

Telmesani, A; Zaini, R G; Ghazi, H O

2011-08-01

Medical education has been changing rapidly in Saudi Arabia. Within a decade, the number of medical colleges increased from 5 medical schools with traditional disciplined-based curricula to 21 medical colleges with varied curricula ranging from the traditional to more innovative, problem-based, community-oriented programmes. The private sector has started investing in higher education generally and medical education in particular. Also other government sectors that provide advanced health services have started established new medical colleges. The expansion of quantity in medical education has been associated with a drive for greater quality assurance. Accreditation of higher education institutes began with the establishment of the National Commission for Academic Assessment and Accreditation in 2005. This review focuses on documenting developments in Saudi medical education up to 2008 and discussing the future potential and challenges facing the sector.

Design and evaluation of a service oriented architecture for paperless ICU tarification.

PubMed

Steurbaut, Kristof; Colpaert, Kirsten; Van Hoecke, Sofie; Steurbaut, Sabrina; Danneels, Chris; Decruyenaere, Johan; De Turck, Filip

2012-06-01

The computerization of Intensive Care Units provides an overwhelming amount of electronic data for both medical and financial analysis. However, the current tarification, which is the process to tick and count patients' procedures, is still a repetitive, time-consuming process on paper. Nurses and secretaries keep track manually of the patients' medical procedures. This paper describes the design methodology and implementation of automated tarification services. In this study we investigate if the tarification can be modeled in service oriented architecture as a composition of interacting services. Services are responsible for data collection, automatic assignment of records to physicians and application of rules. Performance is evaluated in terms of execution time, cost evaluation and return on investment based on tracking of real procedures. The services provide high flexibility in terms of maintenance, integration and rules support. It is shown that services offer a more accurate, less time-consuming and cost-effective tarification.

RBAC-Matrix-based EMR right management system to improve HIPAA compliance.

PubMed

Lee, Hung-Chang; Chang, Shih-Hsin

2012-10-01

Security control of Electronic Medical Record (EMR) is a mechanism used to manage electronic medical records files and protect sensitive medical records document from information leakage. Researches proposed the Role-Based Access Control(RBAC). However, with the increasing scale of medical institutions, the access control behavior is difficult to have a detailed declaration among roles in RBAC. Furthermore, with the stringent specifications such as the U.S. HIPAA and Canada PIPEDA etc., patients are encouraged to have the right in regulating the access control of his EMR. In response to these problems, we propose an EMR digital rights management system, which is a RBAC-based extension to a matrix organization of medical institutions, known as RBAC-Matrix. With the aim of authorizing the EMR among roles in the organization, RBAC-Matrix also allow patients to be involved in defining access rights of his records. RBAC-Matrix authorizes access control declaration among matrix organizations of medical institutions by using XrML file in association with each EMR. It processes XrML rights declaration file-based authorization of behavior in the two-stage design, called master & servant stage, thus makes the associated EMR to be better protected. RBAC-Matrix will also make medical record file and its associated XrML declaration to two different EMRA(EMR Authorization)roles, namely, the medical records Document Creator (DC) and the medical records Document Right Setting (DRS). Access right setting, determined by the DRS, is cosigned by the patient, thus make the declaration of rights and the use of EMR to comply with HIPAA specifications.

Medical record management systems: criticisms and new perspectives.

PubMed

Frénot, S; Laforest, F

1999-06-01

The first generation of computerized medical records stored the data as text, but these records did not bring any improvement in information manipulation. The use of a relational database management system (DBMS) has largely solved this problem as it allows for data requests by using SQL. However, this requires data structuring which is not very appropriate to medicine. Moreover, the use of templates and icon user interfaces has introduced a deviation from the paper-based record (still existing). The arrival of hypertext user interfaces has proven to be of interest to fill the gap between the paper-based medical record and its electronic version. We think that further improvement can be accomplished by using a fully document-based system. We present the architecture, advantages and disadvantages of classical DBMS-based and Web/DBMS-based solutions. We also present a document-based solution and explain its advantages, which include communication, security, flexibility and genericity.

Medication discrepancy: a concordance problem between dialysis patients and caregivers.

PubMed

Lindberg, Magnus; Lindberg, Per; Wikström, Björn

2007-01-01

Extensive drug utilization, and non-concordance between the patient and the caregiver about prescriptions and actual medicine intake, are associated with the risk of non-adherence to medication as well as medication-related illness. To achieve reliable estimates of drug use, it is important to consider the patient's self-reported drug utilization as well as to consult his/her medical record. The present multicentre study was conducted with the aim of examining the self-reported drug consumption of dialysis patients and its congruence with medical records. Consumption of pharmaceutical agents was recorded by 204 patients undergoing haemo- or peritoneal dialysis at 10 Swedish clinics. Drug record discrepancies were identified by comparing the self-reported use of prescribed medicines with the subsequently obtained medication lists. The median drug intake was 11 prescribed medicines and by including on-demand drugs this increased to 12. Discrepancies between the self-reported use of prescribed drugs and the medical record were prevalent in 80.4% of cases, with a median of three discrepancies per patient. Dialysis patients have an extensive need for medication but there is an undesirable deviation between consumption and prescription. A single medication list, accessible for the patient and for all prescribers, is a possible solution to achieve concordance but other measures, such as analysis of the reasons for discrepancy and tailored measures, would also benefit concordant medicine-taking.

Nurses' perceptions and problems in the usability of a medication safety app.

PubMed

Ankem, Kalyani; Cho, Sookyung; Simpson, Diana

2017-10-16

The majority of medication apps support medication adherence. Equally, if not more important, is medication safety. Few apps report on medication safety, and fewer studies have been conducted with these apps. The usability of a medication safety app was tested with nurses to reveal their perceptions of the graphical user interface and to discover problems they encountered in using the app. Usability testing of the app was conducted with RN-BSN students and informatics students (n = 18). Perceptions of the graphical components were gathered in pretest and posttest questionnaires, and video recordings of the usability testing were transcribed. The significance of the difference in mean performance time for 8 tasks was tested, and qualitative analysis was deployed to identify problems encountered and to rate the severity of each problem. While all participants perceived the graphical user interface as easy to understand, nurses took significantly more time to complete certain tasks. More nurses found the medication app to be lacking in intuitiveness of user interface design, in capability to match real-world data, and in providing optimal information architecture. To successfully integrate mobile devices in healthcare, developers must address the problems that nurses encountered in use of the app.

HEDEA: A Python Tool for Extracting and Analysing Semi-structured Information from Medical Records

PubMed Central

Aggarwal, Anshul; Garhwal, Sunita

2018-01-01

Objectives One of the most important functions for a medical practitioner while treating a patient is to study the patient's complete medical history by going through all records, from test results to doctor's notes. With the increasing use of technology in medicine, these records are mostly digital, alleviating the problem of looking through a stack of papers, which are easily misplaced, but some of these are in an unstructured form. Large parts of clinical reports are in written text form and are tedious to use directly without appropriate pre-processing. In medical research, such health records may be a good, convenient source of medical data; however, lack of structure means that the data is unfit for statistical evaluation. In this paper, we introduce a system to extract, store, retrieve, and analyse information from health records, with a focus on the Indian healthcare scene. Methods A Python-based tool, Healthcare Data Extraction and Analysis (HEDEA), has been designed to extract structured information from various medical records using a regular expression-based approach. Results The HEDEA system is working, covering a large set of formats, to extract and analyse health information. Conclusions This tool can be used to generate analysis report and charts using the central database. This information is only provided after prior approval has been received from the patient for medical research purposes. PMID:29770248

HEDEA: A Python Tool for Extracting and Analysing Semi-structured Information from Medical Records.

PubMed

Aggarwal, Anshul; Garhwal, Sunita; Kumar, Ajay

2018-04-01

One of the most important functions for a medical practitioner while treating a patient is to study the patient's complete medical history by going through all records, from test results to doctor's notes. With the increasing use of technology in medicine, these records are mostly digital, alleviating the problem of looking through a stack of papers, which are easily misplaced, but some of these are in an unstructured form. Large parts of clinical reports are in written text form and are tedious to use directly without appropriate pre-processing. In medical research, such health records may be a good, convenient source of medical data; however, lack of structure means that the data is unfit for statistical evaluation. In this paper, we introduce a system to extract, store, retrieve, and analyse information from health records, with a focus on the Indian healthcare scene. A Python-based tool, Healthcare Data Extraction and Analysis (HEDEA), has been designed to extract structured information from various medical records using a regular expression-based approach. The HEDEA system is working, covering a large set of formats, to extract and analyse health information. This tool can be used to generate analysis report and charts using the central database. This information is only provided after prior approval has been received from the patient for medical research purposes.

Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission.

PubMed

Lea, Marianne; Barstad, Ingeborg; Mathiesen, Liv; Mowe, Morten; Molden, Espen

2016-02-01

Medication discrepancies at hospital admission is an extensive problem and knowledge is limited regarding improvement strategies. To investigate the effect of teaching and checklist implementation on accuracy of medication history recording during hospitalization. Patients admitted to an internal medicine ward were prospectively included in two consecutive periods. Between the periods, non-mandatory teaching lessons were provided and a checklist assisting medication history recording implemented. Discrepancies between the recorded medications at admission and the patient's actual drug use, as revealed by pharmacist-conducted medication reconciliation, were compared between the periods. The primary endpoint was difference between the periods in proportion of patients with minimum one discrepancy. Difference in median number of discrepancies was included as a secondary endpoint. 56 and 119 patients were included in period 1 (P1) and period 2 (P2), respectively. There was no significant difference in proportion of patients with minimum one discrepancy in P2 (68.9 %) versus P1 (76.8 %, p = 0.36), but a tendency of lower median number of discrepancies was observed in P2 than P1, i.e. 1 and 2, respectively (p = 0.087). More powerful strategies than non-mandatory teaching activities and checklist implementation are required to achieve sufficient improvements in medication history recording during hospitalization.

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

PubMed

Willeboordse, Floor; Grundeken, Lucienne H; van den Eijkel, Lisanne P; Schellevis, François G; Elders, Petra J M; Hugtenburg, Jacqueline G

2016-04-01

Information on medication use and drug-related problems is important in the preparation of clinical medication reviews. Critical information can only be provided by patients themselves, but interviewing patients is time-consuming. Alternatively, patient information could be obtained with a questionnaire. In this study the agreement between patient information on medication use and drug-related problems in older patients obtained with a questionnaire was compared with information obtained during an interview. General practice in The Netherlands. A questionnaire was developed to obtain information on actual medication use and drug-related problems. Two patient groups ≥65 years were selected based on general practitioner electronic medical records in nine practices; I. polypharmacy and II. ≥1 predefined general geriatric problems. Eligible patients were asked to complete the questionnaire and were interviewed afterwards. Agreement on information on medication use and drug-related problems collected with the questionnaire and interview was calculated. Ninety-seven patients participated. Of all medications used, 87.6 % (95 % CI 84.7-90.5) was reported identically in the questionnaire and interview. Agreement for the complete medication list was found for 45.4 % (95 % CI 35.8-55.3) of the patients. On drug-related problem level, agreement between questionnaire and interview was 75 %. Agreement tended to be lower in vulnerable patients characterized by ≥4 chronic diseases, ≥10 medications used and low health literacy. Information from a questionnaire showed reasonable agreement compared with interviewing. The patients reported more medications and drug-related problems in the interview than the questionnaire. Taking the limitations into account, a questionnaire seems a suitable tool for medication reviews that may replace an interview for most patients.

My Family Health Portrait, A tool from the Surgeon General | NIH MedlinePlus the Magazine

MedlinePlus

... is it important to know my family medical history? Your family medical history is a record of health information about you and three generations of close relatives. Family history can be an important risk factor for problems ...

Is medical students' moral orientation changeable after preclinical medical education?

PubMed

Lin, Chaou-Shune; Tsou, Kuo-Inn; Cho, Shu-Ling; Hsieh, Ming-Shium; Wu, Hsi-Chin; Lin, Chyi-Her

2012-03-01

Moral orientation can affect ethical decision-making. Very few studies have focused on whether medical education can change the moral orientation of the students. The purpose of the present study was to document the types of moral orientation exhibited by medical students, and to study if their moral orientation was changed after preclinical education. From 2007 to 2009, the Mojac scale was used to measure the moral orientation of Taiwan medical students. The students included 271 first-year and 109 third-year students. They were rated as a communitarian, dual, or libertarian group and followed for 2 years to monitor the changes in their Mojac scores. In both first and third-year students, the dual group after 2 years of preclinical medical education did not show any significant change. In the libertarian group, first and third-year students showed a statistically significant increase from a score of 99.4 and 101.3 to 103.0 and 105.7, respectively. In the communitarian group, first and third-year students showed a significant decline from 122.8 and 126.1 to 116.0 and 121.5, respectively. During the preclinical medical education years, students with communitarian orientation and libertarian orientation had changed in their moral orientation to become closer to dual orientation. These findings provide valuable hints to medical educators regarding bioethics education and the selection criteria of medical students for admission.

Extracting Information from Electronic Medical Records to Identify the Obesity Status of a Patient Based on Comorbidities and Bodyweight Measures.

PubMed

Figueroa, Rosa L; Flores, Christopher A

2016-08-01

Obesity is a chronic disease with an increasing impact on the world's population. In this work, we present a method of identifying obesity automatically using text mining techniques and information related to body weight measures and obesity comorbidities. We used a dataset of 3015 de-identified medical records that contain labels for two classification problems. The first classification problem distinguishes between obesity, overweight, normal weight, and underweight. The second classification problem differentiates between obesity types: super obesity, morbid obesity, severe obesity and moderate obesity. We used a Bag of Words approach to represent the records together with unigram and bigram representations of the features. We implemented two approaches: a hierarchical method and a nonhierarchical one. We used Support Vector Machine and Naïve Bayes together with ten-fold cross validation to evaluate and compare performances. Our results indicate that the hierarchical approach does not work as well as the nonhierarchical one. In general, our results show that Support Vector Machine obtains better performances than Naïve Bayes for both classification problems. We also observed that bigram representation improves performance compared with unigram representation.

Health-oriented electronic oral health record: development and evaluation.

PubMed

Wongsapai, Mansuang; Suebnukarn, Siriwan; Rajchagool, Sunsanee; Beach, Daryl; Kawaguchi, Sachiko

2014-06-01

This study aims to develop and evaluate a new Health-oriented Electronic Oral Health Record that implements the health-oriented status and intervention index. The index takes the principles of holistic oral healthcare and applies them to the design and implementation of the Health-oriented Electronic Oral Health Record. We designed an experiment using focus groups and a consensus (Delphi process) method to develop a new health-oriented status and intervention index and graphical user interface. A comparative intervention study with qualitative and quantitative methods was used to compare an existing Electronic Oral Health Record to the Health-oriented Electronic Oral Health Record, focusing on dentist satisfaction, accuracy, and completeness of oral health status recording. The study was conducted by the dental staff of the Inter-country Center for Oral Health collaborative hospitals in Thailand. Overall, the user satisfaction questionnaire had a positive response to the Health-oriented Electronic Oral Health Record. The dentists found it easy to use and were generally satisfied with the impact on their work, oral health services, and surveillance. The dentists were significantly satisfied with the Health-oriented Electronic Oral Health Record compared to the existing Electronic Oral Health Record (p < 0.001). The accuracy and completeness values of the oral health information recorded using the Health-oriented Electronic Oral Health Record were 97.15 and 93.74 percent, respectively. This research concludes that the Health-oriented Electronic Oral Health Record satisfied many dentists, provided benefits to holistic oral healthcare, and facilitated the planning, managing, and evaluation of the healthcare delivery system.

A Review of "Intended for Pleasure: Sex Technique and Sexual Fulfillment in Christian Marriage"

ERIC Educational Resources Information Center

Huff, Scott C.

2012-01-01

"Intended for Pleasure" presents information regarding sex and sexuality oriented towards Christian couples. Written by a medical doctor with his wife, the book is particularly strong in describing common sexual problems with an additional strength of focusing not only sexual intercourse but also on the whole relationship as being important to…

Medical students' learning orientation regarding interracial interactions affects preparedness to care for minority patients: a report from Medical Student CHANGES.

PubMed

Burgess, Diana J; Burke, Sara E; Cunningham, Brooke A; Dovidio, John F; Hardeman, Rachel R; Hou, Yuefeng; Nelson, David B; Perry, Sylvia P; Phelan, Sean M; Yeazel, Mark W; van Ryn, Michelle

2016-09-29

There is a paucity of evidence on how to train medical students to provide equitable, high quality care to racial and ethnic minority patients. We test the hypothesis that medical schools' ability to foster a learning orientation toward interracial interactions (i.e., that students can improve their ability to successfully interact with people of another race and learn from their mistakes), will contribute to white medical students' readiness to care for racial minority patients. We then test the hypothesis that white medical students who perceive their medical school environment as supporting a learning orientation will benefit more from disparities training. Prospective observational study involving web-based questionnaires administered during first (2010) and last (2014) semesters of medical school to 2394 white medical students from a stratified, random sample of 49 U.S. medical schools. Analysis used data from students' last semester to build mixed effects hierarchical models in order to assess the effects of medical school interracial learning orientation, calculated at both the school and individual (student) level, on key dependent measures. School differences in learning orientation explained part of the school difference in readiness to care for minority patients. However, individual differences in learning orientation accounted for individual differences in readiness, even after controlling for school-level learning orientation. Individual differences in learning orientation significantly moderated the effect of disparities training on white students' readiness to care for minority patients. Specifically, white medical students who perceived a high level of learning orientation in their medical schools regarding interracial interactions benefited more from training to address disparities. Coursework aimed at reducing healthcare disparities and improving the care of racial minority patients was only effective when white medical students perceived their school as having a learning orientation toward interracial interactions. Results suggest that medical school faculty should present interracial encounters as opportunities to practice skills shown to reduce bias, and faculty and students should be encouraged to learn from one another about mistakes in interracial encounters. Future research should explore aspects of the medical school environment that contribute to an interracial learning orientation.

Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda.

PubMed

Kaye, Dan K; Mwanika, Andrew; Sekimpi, Patrick; Tugumisirize, Joshua; Sewankambo, Nelson

2010-06-23

Uganda has an acute problem of inadequate human resources partly due to health professionals' unwillingness to work in a rural environment. One strategy to address this problem is to arrange health professional training in rural environments through community placements. Makerere University College of Health Sciences changed training of medical students from the traditional curriculum to a problem-based learning (PBL) curriculum in 2003. This curriculum is based on the SPICES model (student-centered, problem-based, integrated, community-based and services oriented). During their first academic year, students undergo orientation on key areas of community-based education, after which they are sent in interdisciplinary teams for community placements. The objective was to assess first year students' perceptions on experiential training through community placements and factors that might influence their willingness to work in rural health facilities after completion of their training. The survey was conducted among 107 newly admitted first year students on the medical, nursing, pharmacy and medical radiography program students, using in-depth interview and open-ended self-administered questionnaires on their first day at the college, from October 28-30, 2008. Data was collected on socio-demographic characteristics, motivation for choosing a medical career, prior exposure to rural health facilities, willingness to have part of their training in rural areas and factors that would influence the decision to work in rural areas. Over 75% completed their high school from urban areas. The majority had minimal exposure to rural health facilities, yet this is where most of them will eventually have to work. Over 75% of the newly admitted students were willing to have their training from a rural area. Perceived factors that might influence retention in rural areas include the local context of work environment, support from family and friends, availability of continuing professional training for career development and support of co-workers and the community. Many first year students at Makerere University have limited exposure to health facilities in rural areas and have concerns about eventually working there.

Ambulatory EHR functionality: a comparison of functionality lists.

PubMed

Drury, Barbara M

2006-01-01

There is a proliferation of lists intended to define and clarify the functionality of an ambulatory electronic health record system. These lists come from both private and public entities and vary in terminology, granularity, usability, and comprehensiveness. For example, functionality regarding a problem list includes the following possible definitions: * "Create and maintain patient-specific problem lists," from the HL7 Electronic Health Record Draft Standard for Trial Use. * "Provide a flexible mechanism for retrieval of encounter information that can be organized by diagnosis, problem, problem type," from the Bureau of Primary Health Care. * "The system shall associate encounters, orders, medications and notes with one or more problems," from the Certification Commission on Health Information Technology. * "Displays dates of problems on problem list," from COPIC Insurance Co. * "Shall automatically close acute problems using an automated algorithm," from the Physicians Foundations HIT Subcommittee. This article will compare the attributes of these five electronic health record functionality lists and their usefulness to different audiences-clinicians, application developers and payers.

Discourses of student orientation to medical education programs

PubMed Central

Ellaway, Rachel H.; Cooper, Gerry; Al-Idrissi, Tracy; Dubé, Tim; Graves, Lisa

2014-01-01

Background Although medical students’ initial orientation is an important point of transition in medical education, there is a paucity of literature on the subject and major variations in the ways that different institutions orient incoming medical students to their programs. Methods We conducted a discourse analysis of medical education orientation in the literature and on data from a survey of peer institutions’ approaches to orientation. Results These two discourses of orientation had clear similarities, in particular, the critical role of ceremony and symbols, and the focus on developing professionalism and physician identities. There were also differences between them, in particular, in the way that the discourse in the literature focused on the symbolic and professional aspects of orientation; something we have called ‘cultural orientation’. Meanwhile, those who were responsible for orientation in their own institutions tended to focus on the practical and social dimensions. Conclusion By examining how orientation has been described and discussed, we identify three domains of orientation: cultural, social, and practical. These domains are relatively distinct in terms of the activities associated with them, and in terms of who is involved in organizing and running these activities. We also describe orientation as a liminal activity system on the threshold of medical school where incoming students initially cross into the profession. Interestingly, this state of ambiguity also extends to the scholarship of orientation with only some of its aspects attracting formal enquiry, even though there is a growing interest in transitions in medical education as a whole. We hope, therefore, that this study can help to legitimize enquiry into orientation in all its forms and that it can begin to situate the role of orientation more firmly within the firmament of medical education practice and research. PMID:24646440

The prevalence of obesity documentation in Primary Care Electronic Medical Records. Are we acknowledging the problem?

PubMed

Mattar, Ahmed; Carlston, David; Sariol, Glen; Yu, Tongle; Almustafa, Ahmad; Melton, Genevieve B; Ahmed, Adil

2017-01-25

Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient's problem list for patients with eligible body mass indexes (BMI) as contained in the patients' electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese.

Development of a clinician reputation metric to identify appropriate problem-medication pairs in a crowdsourced knowledge base.

PubMed

McCoy, Allison B; Wright, Adam; Rogith, Deevakar; Fathiamini, Safa; Ottenbacher, Allison J; Sittig, Dean F

2014-04-01

Correlation of data within electronic health records is necessary for implementation of various clinical decision support functions, including patient summarization. A key type of correlation is linking medications to clinical problems; while some databases of problem-medication links are available, they are not robust and depend on problems and medications being encoded in particular terminologies. Crowdsourcing represents one approach to generating robust knowledge bases across a variety of terminologies, but more sophisticated approaches are necessary to improve accuracy and reduce manual data review requirements. We sought to develop and evaluate a clinician reputation metric to facilitate the identification of appropriate problem-medication pairs through crowdsourcing without requiring extensive manual review. We retrieved medications from our clinical data warehouse that had been prescribed and manually linked to one or more problems by clinicians during e-prescribing between June 1, 2010 and May 31, 2011. We identified measures likely to be associated with the percentage of accurate problem-medication links made by clinicians. Using logistic regression, we created a metric for identifying clinicians who had made greater than or equal to 95% appropriate links. We evaluated the accuracy of the approach by comparing links made by those physicians identified as having appropriate links to a previously manually validated subset of problem-medication pairs. Of 867 clinicians who asserted a total of 237,748 problem-medication links during the study period, 125 had a reputation metric that predicted the percentage of appropriate links greater than or equal to 95%. These clinicians asserted a total of 2464 linked problem-medication pairs (983 distinct pairs). Compared to a previously validated set of problem-medication pairs, the reputation metric achieved a specificity of 99.5% and marginally improved the sensitivity of previously described knowledge bases. A reputation metric may be a valuable measure for identifying high quality clinician-entered, crowdsourced data. Copyright © 2013 Elsevier Inc. All rights reserved.

Development of a clinician reputation metric to identify appropriate problem-medication pairs in a crowdsourced knowledge base

PubMed Central

McCoy, Allison B.; Wright, Adam; Rogith, Deevakar; Fathiamini, Safa; Ottenbacher, Allison J.; Sittig, Dean F.

2014-01-01

Background Correlation of data within electronic health records is necessary for implementation of various clinical decision support functions, including patient summarization. A key type of correlation is linking medications to clinical problems; while some databases of problem-medication links are available, they are not robust and depend on problems and medications being encoded in particular terminologies. Crowdsourcing represents one approach to generating robust knowledge bases across a variety of terminologies, but more sophisticated approaches are necessary to improve accuracy and reduce manual data review requirements. Objective We sought to develop and evaluate a clinician reputation metric to facilitate the identification of appropriate problem-medication pairs through crowdsourcing without requiring extensive manual review. Approach We retrieved medications from our clinical data warehouse that had been prescribed and manually linked to one or more problems by clinicians during e-prescribing between June 1, 2010 and May 31, 2011. We identified measures likely to be associated with the percentage of accurate problem-medication links made by clinicians. Using logistic regression, we created a metric for identifying clinicians who had made greater than or equal to 95% appropriate links. We evaluated the accuracy of the approach by comparing links made by those physicians identified as having appropriate links to a previously manually validated subset of problem-medication pairs. Results Of 867 clinicians who asserted a total of 237,748 problem-medication links during the study period, 125 had a reputation metric that predicted the percentage of appropriate links greater than or equal to 95%. These clinicians asserted a total of 2464 linked problem-medication pairs (983 distinct pairs). Compared to a previously validated set of problem-medication pairs, the reputation metric achieved a specificity of 99.5% and marginally improved the sensitivity of previously described knowledge bases. Conclusion A reputation metric may be a valuable measure for identifying high quality clinician-entered, crowdsourced data. PMID:24321170

Medical care at the Sweetwaters Music Festival.

PubMed

Yates, K M; Hazell, W C; Schweder, L

2001-04-13

To describe medical cover and medical presentations at the four-day 1999 Sweetwaters Music Festival, and make comparisons with other festivals. All medical contacts were counted, and patients presenting to the medical tent were included in the study. Case records were studied to determine demographic data, nature of complaint, treatment and disposition. A Medline literature search was performed to obtain information on other festivals. There were 2,231 medical contacts overall (8.9% of estimated attendees) and 217 presentations to the medical tent (0.9% of estimated attendees). 53% of patients presenting to the medical tent were men and the mean patient age was 25 years. Lacerations (16%), intoxication (13%), local infections (12%) and soft tissue injuries (9%) were the most common problems. There were no deaths or cardiac arrests. Problems encountered were similar to other music festivals, with minor injuries predominant.

Troubled meditations on psychosexual differentiation: reply to Hegarty (2009).

PubMed

Zucker, Kenneth J; Drummond, Kelley D; Bradley, Susan J; Peterson-Badali, Michele

2009-07-01

P. Hegarty (see record 2009-09998-015) offered several critiques of the articles by G. Rieger, J. A. W. Linsenmeier, L. Gygax, and J. M. Bailey (see record 2007-19851-006) and K. D. Drummond, S. J. Bradley, M. Peterson-Badali, and K. J. Zucker (see record 2007-19851-005) that were published in a Developmental Psychology special section entitled "Sexual Orientation Across the Lifespan," guest-edited by C. J. Patterson and R. C. Savin-Williams (2008): (a) reliance on a "disease paradigm" (i.e., the use of "medicalizing" language) of lesbian-gay-bisexual-transgender issues at the expense of a "stigma paradigm," (b) endorsement of a developmental linkage between childhood sex-typed behavior and later gender identity-sexual orientation, and (c) various sociophilosophical and applied matters pertaining to the diagnosis of gender identity disorder in children. In this reply, we address these 3 criticisms and argue that an interdisciplinary approach, informed by multiple paradigms, will most certainly facilitate, not impede, the discovery of answers to many questions about psychosexual development for which data are currently lacking.

Predictors of patient communication in psychiatric medication encounters among veterans with serious mental illnesses.

PubMed

Hack, Samantha M; Medoff, Deborah R; Brown, Clayton H; Fang, Lijuan; Dixon, Lisa B; Klingaman, Elizabeth A; Park, Stephanie G; Kreyenbuhl, Julie A

2016-06-01

Person-centered psychiatric services rely on consumers actively sharing personal information, opinions, and preferences with their providers. This research examined predictors of consumer communication during appointments for psychiatric medication prescriptions. The Roter Interaction Analysis System was used to code recorded Veterans Affairs psychiatric appointments with 175 consumers and 21 psychiatric medication prescribers and categorize communication by purpose: biomedical, psychosocial, facilitation, or rapport-building. Regression analyses found that greater provider communication, symptomology, orientation to psychiatric recovery, and functioning on the Repeatable Battery for the Assessment of Neuropsychological Status Attention and Language indices, as well as consumer diagnostic label, were positive predictors of consumer communication, though the types of communication impacted varied. Provider communication is the easiest variable to intervene on to create changes in consumer communication. Future research should also consider how cognitive and symptom factors may impact specific types of consumer communication in order to identify subgroups for targeted interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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

PubMed Central

2004-01-01

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

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

PubMed

Laerum, Hallvard; Faxvaag, Arild

2004-02-09

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

Reliance on high technology among senior medical students.

PubMed

Merrill, J M; Lorimor, R J; Thornby, J I; Vallbona, C

1998-01-01

To gain a better understanding of senior medical students who perceive high-technology medicine as the desirable form of medical practice, we developed and evaluated a structural equation model. Intolerance to clinical uncertainty, Machiavellianism, and authoritarianism characterized students who scored higher on reliance on high-technology medicine. High scorers also tended to have a negative orientation toward patients' psychological problems and were unlikely to choose careers in primary care medicine. Students who perceive high technology as a panacea in clinical medicine share personal traits and attitudes toward patients that are not conducive to achieving the national goal of a 50:50 ratio between primary and non-primary care physicians.

Approach Towards an Evidence-Oriented Knowledge and Data Acquisition for the Optimization of Interdisciplinary Care in Dentistry and General Medicine.

PubMed

Seitz, Max W; Haux, Christian; Knaup, Petra; Schubert, Ingrid; Listl, Stefan

2018-01-01

Associations between dental and chronic-systemic diseases were observed frequently in medical research, however the findings of this research have so far found little relevance in everyday clinical treatment. Major problems are the assessment of evidence for correlations between such diseases and how to integrate current medical knowledge into the intersectoral care of dentists and general practitioners. On the example of dental and chronic-systemic diseases, the Dent@Prevent project develops an interdisciplinary decision support system (DSS), which provides the specialists with information relevant for the treatment of such cases. To provide the physicians with relevant medical knowledge, a mixed-methods approach is developed to acquire the knowledge in an evidence-oriented way. This procedure includes a literature review, routine data analyses, focus groups of dentists and general practitioners as well as the identification and integration of applicable guidelines and Patient Reported Measures (PRMs) into the treatment process. The developed mixed methods approach for an evidence-oriented knowledge acquisition indicates to be applicable and supportable for interdisciplinary projects. It can raise the systematic quality of the knowledge-acquisition process and can be applicable for an evidence-based system development. Further research is necessary to assess the impact on patient care and to evaluate possible applicability in other interdisciplinary areas.

Development and evaluation of a crowdsourcing methodology for knowledge base construction: identifying relationships between clinical problems and medications

PubMed Central

Wright, Adam; Laxmisan, Archana; Ottosen, Madelene J; McCoy, Jacob A; Butten, David; Sittig, Dean F

2012-01-01

Objective We describe a novel, crowdsourcing method for generating a knowledge base of problem–medication pairs that takes advantage of manually asserted links between medications and problems. Methods Through iterative review, we developed metrics to estimate the appropriateness of manually entered problem–medication links for inclusion in a knowledge base that can be used to infer previously unasserted links between problems and medications. Results Clinicians manually linked 231 223 medications (55.30% of prescribed medications) to problems within the electronic health record, generating 41 203 distinct problem–medication pairs, although not all were accurate. We developed methods to evaluate the accuracy of the pairs, and after limiting the pairs to those meeting an estimated 95% appropriateness threshold, 11 166 pairs remained. The pairs in the knowledge base accounted for 183 127 total links asserted (76.47% of all links). Retrospective application of the knowledge base linked 68 316 medications not previously linked by a clinician to an indicated problem (36.53% of unlinked medications). Expert review of the combined knowledge base, including inferred and manually linked problem–medication pairs, found a sensitivity of 65.8% and a specificity of 97.9%. Conclusion Crowdsourcing is an effective, inexpensive method for generating a knowledge base of problem–medication pairs that is automatically mapped to local terminologies, up-to-date, and reflective of local prescribing practices and trends. PMID:22582202

[Development of electronic medical recording system for clinics using the internet based on patient participation in pursuit of NBM].

PubMed

Omatsu, Masahiko; Tachibana, Hidenobu; Umeda, Tokuo

2004-06-01

The current medical system does not allow sufficient time for medical interviews, a situation that can create problems in patient-doctor relationships and result in a variety of problems. The importance of narrative based medicine (NBM) has been raised as a result of the overemphasis on evidence based medicine (EBM) in recent years. From this point of view, we have developed an electronic medical recording (EMR) system for clinics that uses the Internet and is based on patient participation, in pursuit of NBM. This system enables the patient to report information prior to the face-to-face interview with his or her doctor. In this way, the patient has more time to summarize and explain physical conditions and concerns. These reports from patients are automatically saved to the EMR database, without any additional workload. Therefore, this system will provide more effective communication between patient and doctor. In addition, the doctor is able to receive the results of medical treatment directly, in addition to the patient's other records. These sets of records will contribute to more efficient operation of the clinic. At this time, we have improved this system on the assumption that outsourcing the server will avoid the burden of maintenance. This prototype system uses a personal identification number (PIN) and an encode/decode algorithm for security. The secure PIN enables us to use conventional e-mail. Through experimental clinical testing, the effects on mutual understanding in medical examinations were studied. We are confident that this system based on patient narratives will contribute greatly to the spread of EMR systems for clinics operated by family physicians.

Medical and Mental Health Needs of Adolescent Indochinese Refugees.

ERIC Educational Resources Information Center

Johnson, Jennifer; And Others

1986-01-01

Presents results of a study analyzing the health records of 181 adolescent Indochinese refugees in San Diego, CA. Focuses on the medical problems known to be prevalent among adult Indochinese refugees: tuberculosis infection, intestinal parasites, and hepatitis B antigenemia. Reports that Indochinese adolescents may have a high rate of mental…

Direct medical cost and utility analysis of diabetics outpatient at Karanganyar public hospital

NASA Astrophysics Data System (ADS)

Eristina; Andayani, T. M.; Oetari, R. A.

2017-11-01

Diabetes Mellitus is a high cost disease, especially in long-term complication treatment. Long-term complication treatment cost was a problem for the patient, it can affect patients quality of life stated with utility value. The purpose of this study was to determine the medical cost, utility value and leverage factors of diabetics outpatient. This study was cross sectional design, data collected from retrospective medical record of the financial and pharmacy department to obtain direct medical cost, utility value taken from EQ-5D-5L questionnaire. Data analyzed by Mann-Whitney and Kruskal-Wallis test. Results of this study were IDR 433,728.00 for the direct medical cost and pharmacy as the biggest cost. EQ-5D-5L questionnaire showed the biggest proportion on each dimension were 61% no problem on mobility dimension, 89% no problems on self-care dimension, 54% slight problems on usual activities dimension, 41% moderate problems on pain/discomfort dimension and 48% moderate problems on anxiety/depresion dimension. Build upon Thailand value set, utility value was 0.833. Direct medical cost was IDR 433,728.00 with leverage factors were pattern therapy, blood glucose level and complication. Utility value was 0.833 with leverage factors were patients characteristic, therapy pattern, blood glucose level and complication.

Dyspareunia

PubMed Central

Shaul, David L.

1985-01-01

Painful coitus is a distressing symptom for both sexes. Often, physician and patient avoid this issue because of their own inability to deal with such problems. Dyspareunia may be caused by a variety of conditions, mainly related to the reproductive system. However, even where medical or surgical treatment is contemplated, therapy will usually require some form of sex counselling. A sex-oriented history which resembles the usual medical format is used in the assessment. The PLISSIT model of therapy allows the practitioner to begin treatment, and to make a referral when his or her “comfort index” may be exceeded. PMID:21274068

[Ethic rounds in intensive care. Possible instrument for a clinical-ethical assessment in intensive care units].

PubMed

Scheffold, N; Paoli, A; Gross, J; Riemann, U; Hennersdorf, M

2012-10-01

Ethical problems, such as medical end-of-life decisions or withdrawing life-sustaining treatment are viewed as an essential task in intensive care units. This article presents the ethics rounds as an instrument for evaluation of ethical problems in intensive care medicine units. The benchmarks of ethical reflection during the ethics rounds are considerations of ethical theory of principle-oriented medical ethics. Besides organizational aspects and the institutional framework, the role of the ethicist is described. The essential evaluation steps, as a basis of the ethics rounds are presented. In contrast to the clinical ethics consultation, the ethicist in the ethics rounds model is integrated as a member of the ward round team. Therefore ethical problems may be identified and analyzed very early before the conflict escalates. This preventive strategy makes the ethics rounds a helpful instrument in intensive care units.

Pharmacy practice simulations: performance of senior pharmacy students at a University in southern Brazil

PubMed Central

Galato, Dayani; Alano, Graziela M.; Trauthman, Silvana C.; França, Tainã F.

Objective A simulation process known as objective structured clinical examination (OSCE) was applied to assess pharmacy practice performed by senior pharmacy students. Methods A cross-sectional study was conducted based on documentary analysis of performance evaluation records of pharmacy practice simulations that occurred between 2005 and 2009. These simulations were related to the process of self-medication and dispensing, and were performed with the use of patients simulated. The simulations were filmed to facilitate the evaluation process. It presents the OSCE educational experience performed by pharmacy trainees of the University of Southern Santa Catarina and experienced by two evaluators. The student general performance was analyzed, and the criteria for pharmacy practice assessment often identified trainees in difficulty. Results The results of 291 simulations showed that students have an average yield performance of 70.0%. Several difficulties were encountered, such as the lack of information about the selected/prescribed treatment regimen (65.1%); inadequate communication style (21.9%); lack of identification of patients’ needs (7.7%) and inappropriate drug selection for self-medication (5.3%). Conclusions These data show that there is a need for reorientation of clinical pharmacy students because they need to improve their communication skills, and have a deeper knowledge of medicines and health problems in order to properly orient their patients. PMID:24367467

Therapist qualities preferred by sexual-minority individuals.

PubMed

Burckell, Lisa A; Goldfried, Marvin R

2006-01-01

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Object-oriented design and programming in medical decision support.

PubMed

Heathfield, H; Armstrong, J; Kirkham, N

1991-12-01

The concept of object-oriented design and programming has recently received a great deal of attention from the software engineering community. This paper highlights the realisable benefits of using the object-oriented approach in the design and development of clinical decision support systems. These systems seek to build a computational model of some problem domain and therefore tend to be exploratory in nature. Conventional procedural design techniques do not support either the process of model building or rapid prototyping. The central concepts of the object-oriented paradigm are introduced, namely encapsulation, inheritance and polymorphism, and their use illustrated in a case study, taken from the domain of breast histopathology. In particular, the dual roles of inheritance in object-oriented programming are examined, i.e., inheritance as a conceptual modelling tool and inheritance as a code reuse mechanism. It is argued that the use of the former is not entirely intuitive and may be difficult to incorporate into the design process. However, inheritance as a means of optimising code reuse offers substantial technical benefits.

The Effect of Sequence of Instruction on Students' Cognitive Preferences and Recall in the Context of a Problem-Oriented Method of Teaching.

ERIC Educational Resources Information Center

Boreham, N. C.; And Others

1985-01-01

This study investigated the effects of two sequences of instruction--theory-to-application and application-to-theory--on medical students' cognitive preferences in preclinical science teaching. Results indicate that presenting an example of the clinical application of biochemical theory before presenting the theory itself increased students'…

The VA Computerized Patient Record — A First Look

PubMed Central

Anderson, Curtis L.; Meldrum, Kevin C.

1994-01-01

In support of its in-house DHCP Physician Order Entry/Results Reporting application, the VA is developing the first edition of a Computerized Patient Record. The system will feature a physician-oriented interface with real time, expert system-based order checking, a controlled vocabulary, a longitudinal repository of patient data, HL7 messaging support, a clinical reminder and warning system, and full integration with existing VA applications including lab, pharmacy, A/D/T, radiology, dietetics, surgery, vitals, allergy tracking, discharge summary, problem list, progress notes, consults, and online physician order entry. PMID:7949886

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

PubMed

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

[Disagreement between physicians' medication records and information given by patients].

PubMed

Rabøl, Rasmus; Arrøe, Gry Rosenkjaer; Folke, Fredrik; Madsen, Kristian Rørbaek; Langergaard, Michael Thøger; Larsen, Annette Højmann; Budek, Tommy; Andersen, Jens Rikardt

2006-03-27

A survey was conducted to evaluate the level of disagreement between the drug records of family doctors and information provided by patients at the time of hospitalisation. One hundred patients acutely admitted to a hospital department of medicine were consecutively included if the patient ingested more than two non-OTC drugs. A second drug interview was performed shortly after admission, and the patient's current medication was recorded. If no written medical record from the referring family doctor was available at the time of admission, the doctor was contacted by phone for supplementary information. Discrepancies between the information given by the patient and the medical records of family doctors were recorded. The results were analysed blindly by two of the authors (one senior and one junior doctor) to determine if the discrepancies were clinically relevant for the patient. We found at least one clinically relevant and potentially dangerous discrepancy in the medical records of 40% (95% CI 30%-50%) of the patients. In all, discrepancies were found in the drug lists of 63% of the patients. The patients with discrepancies were similar in age, sex, way of hospitalization and number of drugs ingested, compared to those without discrepancies. Afterwards the family doctors were invited to a meeting in which these problems were evaluated. We conclude that there is an urgent need for improvement in the communication between the primary and secondary health care sectors concerning medication being prescribed for patients with chronic diseases. The large number of discrepancies in the drug records of patients in this study is discouraging.

Efficient hemodynamic event detection utilizing relational databases and wavelet analysis

NASA Technical Reports Server (NTRS)

Saeed, M.; Mark, R. G.

2001-01-01

Development of a temporal query framework for time-oriented medical databases has hitherto been a challenging problem. We describe a novel method for the detection of hemodynamic events in multiparameter trends utilizing wavelet coefficients in a MySQL relational database. Storage of the wavelet coefficients allowed for a compact representation of the trends, and provided robust descriptors for the dynamics of the parameter time series. A data model was developed to allow for simplified queries along several dimensions and time scales. Of particular importance, the data model and wavelet framework allowed for queries to be processed with minimal table-join operations. A web-based search engine was developed to allow for user-defined queries. Typical queries required between 0.01 and 0.02 seconds, with at least two orders of magnitude improvement in speed over conventional queries. This powerful and innovative structure will facilitate research on large-scale time-oriented medical databases.

Future orientation, school contexts, and problem behaviors: a multilevel study.

PubMed

Chen, Pan; Vazsonyi, Alexander T

2013-01-01

The association between future orientation and problem behaviors has received extensive empirical attention; however, previous work has not considered school contextual influences on this link. Using a sample of N = 9,163 9th to 12th graders (51.0 % females) from N = 85 high schools of the National Longitudinal Study of Adolescent Health, the present study examined the independent and interactive effects of adolescent future orientation and school contexts (school size, school location, school SES, school future orientation climate) on problem behaviors. Results provided evidence that adolescent future orientation was associated independently and negatively with problem behaviors. In addition, adolescents from large-size schools reported higher levels of problem behaviors than their age mates from small-size schools, controlling for individual-level covariates. Furthermore, an interaction effect between adolescent future orientation and school future orientation climate was found, suggesting influences of school future orientation climate on the link between adolescent future orientation and problem behaviors as well as variations in effects of school future orientation climate across different levels of adolescent future orientation. Specifically, the negative association between adolescent future orientation and problem behaviors was stronger at schools with a more positive climate of future orientation, whereas school future orientation climate had a significant and unexpectedly positive relationship with problem behaviors for adolescents with low levels of future orientation. Findings implicate the importance of comparing how the future orientation-problem behaviors link varies across different ecological contexts and the need to understand influences of school climate on problem behaviors in light of differences in psychological processes among adolescents.

Exposure to Environmental Air Manganese and Medication ...

EPA Pesticide Factsheets

Manganese (Mn) is an essential element with natural low levels found in water, food, and air, but due to industrialized processes, both workplace and the environmental exposures to Mn have increased. Recently, environmental studies have reported physical and mental health problems associated with air-Mn exposure, but medical record reviews for exposed residents are rare in the literature. When medical records and clinical testing are unavailable, examination of residents’ prescribed medication use may be used as a surrogate of health effects associated with Mn. We examined medication use among adult Ohio residents in two towns with elevated air-Mn (n=185) and one unexposed control town (n=90). Study participants recorded medication use in a health questionnaire and brought their currently prescribed medication, over-the-counter and supplement lists to their interview. Two physicians (family and psychiatric medicine) reviewed the provided medication list and developed medical categories associated with the medications used. The exposed (E) and control (C) groups were compared on the established 12 medication and 1 supplement categories using chi-square tests. The significant medication categories were further analyzed using hierarchical binomial logistic regression adjusting for education, personal income, and years of residency. The two groups were primarily white (E:94.6%; C:96.7%) but differed on education (E:13.8; C:15.2 years), residence length in their re

[Differentiation of coding quality in orthopaedics by special, illustration-oriented case group analysis in the G-DRG System 2005].

PubMed

Schütz, U; Reichel, H; Dreinhöfer, K

2007-01-01

We introduce a grouping system for clinical practice which allows the separation of DRG coding in specific orthopaedic groups based on anatomic regions, operative procedures, therapeutic interventions and morbidity equivalent diagnosis groups. With this, a differentiated aim-oriented analysis of illustrated internal DRG data becomes possible. The group-specific difference of the coding quality between the DRG groups following primary coding by the orthopaedic surgeon and final coding by the medical controlling is analysed. In a consecutive series of 1600 patients parallel documentation and group-specific comparison of the relevant DRG parameters were carried out in every case after primary and final coding. Analysing the group-specific share in the additional CaseMix coding, the group "spine surgery" dominated, closely followed by the groups "arthroplasty" and "surgery due to infection, tumours, diabetes". Altogether, additional cost-weight-relevant coding was necessary most frequently in the latter group (84%), followed by group "spine surgery" (65%). In DRGs representing conservative orthopaedic treatment documented procedures had nearly no influence on the cost weight. The introduced system of case group analysis in internal DRG documentation can lead to the detection of specific problems in primary coding and cost-weight relevant changes of the case mix. As an instrument for internal process control in the orthopaedic field, it can serve as a communicative interface between an economically oriented classification of the hospital performance and a specific problem solution of the medical staff involved in the department management.

Efficient Queries of Stand-off Annotations for Natural Language Processing on Electronic Medical Records.

PubMed

Luo, Yuan; Szolovits, Peter

2016-01-01

In natural language processing, stand-off annotation uses the starting and ending positions of an annotation to anchor it to the text and stores the annotation content separately from the text. We address the fundamental problem of efficiently storing stand-off annotations when applying natural language processing on narrative clinical notes in electronic medical records (EMRs) and efficiently retrieving such annotations that satisfy position constraints. Efficient storage and retrieval of stand-off annotations can facilitate tasks such as mapping unstructured text to electronic medical record ontologies. We first formulate this problem into the interval query problem, for which optimal query/update time is in general logarithm. We next perform a tight time complexity analysis on the basic interval tree query algorithm and show its nonoptimality when being applied to a collection of 13 query types from Allen's interval algebra. We then study two closely related state-of-the-art interval query algorithms, proposed query reformulations, and augmentations to the second algorithm. Our proposed algorithm achieves logarithmic time stabbing-max query time complexity and solves the stabbing-interval query tasks on all of Allen's relations in logarithmic time, attaining the theoretic lower bound. Updating time is kept logarithmic and the space requirement is kept linear at the same time. We also discuss interval management in external memory models and higher dimensions.

Efficient Queries of Stand-off Annotations for Natural Language Processing on Electronic Medical Records

PubMed Central

Luo, Yuan; Szolovits, Peter

2016-01-01

In natural language processing, stand-off annotation uses the starting and ending positions of an annotation to anchor it to the text and stores the annotation content separately from the text. We address the fundamental problem of efficiently storing stand-off annotations when applying natural language processing on narrative clinical notes in electronic medical records (EMRs) and efficiently retrieving such annotations that satisfy position constraints. Efficient storage and retrieval of stand-off annotations can facilitate tasks such as mapping unstructured text to electronic medical record ontologies. We first formulate this problem into the interval query problem, for which optimal query/update time is in general logarithm. We next perform a tight time complexity analysis on the basic interval tree query algorithm and show its nonoptimality when being applied to a collection of 13 query types from Allen’s interval algebra. We then study two closely related state-of-the-art interval query algorithms, proposed query reformulations, and augmentations to the second algorithm. Our proposed algorithm achieves logarithmic time stabbing-max query time complexity and solves the stabbing-interval query tasks on all of Allen’s relations in logarithmic time, attaining the theoretic lower bound. Updating time is kept logarithmic and the space requirement is kept linear at the same time. We also discuss interval management in external memory models and higher dimensions. PMID:27478379

Electronic medical archives: a different approach to applying re-signing mechanisms to digital signatures.

PubMed

Chen, Tzer-Long; Lin, Frank Y S

2011-08-01

Electronic medical records can be defined as a digital format of the traditionally paper-based anamneses, which contains the history of a patient such as his somewhat illness, current health problems, and his chronic treatments. An electronic anamnesis is meant to make the patient's health information more conveniently accessible and transferable between different medical institutions and also easier to be kept quite a long time. Because of such transferability and accessibility of electronic anamneses, we can use less resource than before on storing the patients' medical information. This also means that medical care providers could save more funds on record-keeping and access a patient's medical background directly since shown on the computer screen more quickly and easily. Overall, the service quality has seemingly improved greatly. However, the usage of electronic anamneses involves in some concerned issues such as its related law declaration, and the security of the patient's confidential information. Because of these concerns, a secure medical networking scheme is taking into consideration. Nowadays, the administrators at the medical institutions are facing more challenges on monitoring computers and network systems, because of dramatic advances in this field. For instance, a trusted third party is authorized to access some medical records for a certain period of time. In regard to the security purpose, all the electronic medical records are embedded with both of the public-key infrastructure (PKI) cryptography and the digital signature technique so as to ensure the records well-protected. Since the signatures will be invalid due to the revocation or time expiration, the security of records under this premise would turn into vulnerable. Hence, we propose a re-signing scheme, whose purpose is to make a going-expired digital signature been resigned in time, in keeping with the premise of not conflicting with the laws, morals, and privacy while maintaining the security of the electronic medical records.

An analytic approach to resolving problems in medical ethics.

PubMed Central

Candee, D; Puka, B

1984-01-01

Education in ethics among practising professionals should provide a systematic procedure for resolving moral problems. A method for such decision-making is outlined using the two classical orientations in moral philosophy, teleology and deontology. Teleological views such as utilitarianism resolve moral dilemmas by calculating the excess of good over harm expected to be produced by each feasible alternative for action. The deontological view focuses on rights, duties, and principles of justice. Both methods are used to resolve the 1971 Johns Hopkins case of a baby born with Down's syndrome and duodenal atresia. PMID:6234395

Adapting current Arden Syntax knowledge for an object oriented event monitor.

PubMed

Choi, Jeeyae; Lussier, Yves A; Mendoça, Eneida A

2003-01-01

Arden Syntax for Medical Logic Module (MLM)1 was designed for writing and sharing task-specific health knowledge in 1989. Several researchers have developed frameworks to improve the sharability and adaptability of Arden Syntax MLMs, an issue known as "curly braces" problem. Karadimas et al proposed an Arden Syntax MLM-based decision support system that uses an object oriented model and the dynamic linking features of the Java platform.2 Peleg et al proposed creating a Guideline Expression Language (GEL) based on Arden Syntax's logic grammar.3 The New York Presbyterian Hospital (NYPH) has a collection of about 200 MLMs. In a process of adapting the current MLMs for an object-oriented event monitor, we identified two problems that may influence the "curly braces" one: (1) the query expressions within the curly braces of Arden Syntax used in our institution are cryptic to the physicians, institutional dependent and written ineffectively (unpublished results), and (2) the events are coded individually within a curly braces, resulting sometimes in a large number of events - up to 200.

The Utility of Continuous Temperature Monitoring of Refrigerators in a Long-Term Care Facility.

PubMed

Worz, Chad; Postolski, Josh; Williams, Kevin

2017-04-01

It is the current practice in most long-term care facilities to use manual logs when documenting refrigerator temperatures. This process is commonly associated with poor or fabricated compliance, little oversight, and documentation errors, both because of overt omissions and unsubstantiated values. It is also well-established that medication storage requirements are mandated by the Centers for Medicare & Medicaid Services (CMS). This analysis demonstrates the potential risk of poor cold-chain management of medications and establishes the possible utility of digitally recorded continuous temperature monitoring over manual logs. This small case-oriented review of a large nursing facility's storage process attempts to expose the risk associated with improper medication storage. The primary outcome of the study was to determine if a difference existed between temperature logs completed manually compared with those done with a continuous monitor. American Thermal Instruments (ATI) thermometers were placed into each of the existing refrigerators in a 147-bed nursing facility. Through a mobile app, the data recorded in each refrigerator were compiled into daily reports. Data were collected from a total of 12 refrigerators, 3 of which were medication refrigerators. Logging intervals were done over a 263-minute period and compiled the lowest recorded temperature, highest recorded temperature, and the average temperature for each refrigerator. In addition, reports showing the real-time results were compiled using the ATI DataNow service. All of the refrigerators analyzed had highest temperature recorded readings exceeding the maximum allowable temperature (50°F for refrigerator). All of the refrigerators had lowest temperature recorded readings below the minimum allowable temperature (32°F for refrigerators). All of the refrigerators also reported average temperatures outside of the allowable temperature range. The results necessitated the replacement of a refrigerator and the evaluation of a dairy refrigerator in the food service area. This resulted in consistent measurements within the allowable range. Following this analysis, it can be concluded that the common assumptions about the effectiveness of manual temperature logs should be verified. It can also be concluded that continuous temperature monitoring improves temperature-reporting accuracy. Proper medication storage is mandated by CMS; risk does exist that an improperly stored vaccine, biologic, or medication could lose effectiveness. While it has not been proven, improved medication storage offered from continuous monitoring could result in improved medication viability and hence improved patient outcomes associated with those medications.

28 CFR 552.26 - Medical attention in use of force and application of restraints incidents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... upon gaining physical control of the inmate. When possible, staff shall seek such assistance at the... seek the guidance of qualified health personnel (based upon a review of the inmate's medical record) to identify physical or mental problems. When mental health staff or qualified health personnel determine that...

28 CFR 552.26 - Medical attention in use of force and application of restraints incidents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of force situations, staff shall seek the assistance of mental health or qualified health personnel... seek the guidance of qualified health personnel (based upon a review of the inmate's medical record) to identify physical or mental problems. When mental health staff or qualified health personnel determine that...

28 CFR 552.26 - Medical attention in use of force and application of restraints incidents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of force situations, staff shall seek the assistance of mental health or qualified health personnel... seek the guidance of qualified health personnel (based upon a review of the inmate's medical record) to identify physical or mental problems. When mental health staff or qualified health personnel determine that...

28 CFR 552.26 - Medical attention in use of force and application of restraints incidents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of force situations, staff shall seek the assistance of mental health or qualified health personnel... seek the guidance of qualified health personnel (based upon a review of the inmate's medical record) to identify physical or mental problems. When mental health staff or qualified health personnel determine that...

28 CFR 552.26 - Medical attention in use of force and application of restraints incidents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of force situations, staff shall seek the assistance of mental health or qualified health personnel... seek the guidance of qualified health personnel (based upon a review of the inmate's medical record) to identify physical or mental problems. When mental health staff or qualified health personnel determine that...

Sex of the GP--20 years on.

PubMed

Harrison, Christopher M; Britt, Helena C; Charles, Janice

2011-08-15

Previous research with the Australian Morbidity and Treatment Survey (1990-1991) showed significant differences in general practitioner characteristics and patient mix of male and female GPs. Even after adjusting for these, it was seen that male and female GPs managed different types of medical conditions. The proportion of female GPs increased from 19.6% in 1990-1991 to 37.1% in 2009-2010. This study investigates whether differences remain two decades later. Analysis of 2009-2010 Bettering the Evaluation and Care of Health (BEACH) data examining GP characteristics, patient encounter characteristics, patient reasons for encounter (RFE), problem types managed and management methods used, by GP sex. Whether GP sex was an independent predictor of problem types being managed, or management methods used, was tested using multiple logistic regressions and Poisson regression. 988 GPs recorded 98 800 GP-patient encounters. Adjusted differences in clinical activity of male and female GPs. After adjustment, compared with male GPs, females recorded more RFEs about general and unspecified issues and endocrine, female genital, pregnancy and family planning problems; and fewer concerning the musculoskeletal, respiratory, skin and male genital systems. Female GPs managed more general and unspecified, digestive, circulatory, psychological, endocrine, female genital and social problems; recorded nearly 20% more clinical treatments and referrals; recorded nearly 10% more imaging and pathology tests; and 4.3% fewer medications. After two decades, even with increased numbers of female GPs, the differences in problems managed by male and female GPs remain, and will probably continue. Female GPs use more resources per encounter, but may not use more resources in terms of annual patient care.

[Adoption in China of children with special needs: the "green passage"].

PubMed

Oliván Gonzalvo, G

2007-10-01

Requests of international adoption in China can be processed by the ordinary way and by the so-called way "green passage" (GP). All the children for adoption by the GP have special needs because to suffer from congenital malformations, chronic diseases or development disabilities that will need medical or surgical treatment and a specialized monitoring in the adoptive country. The medical literature warns that the preadoptive medical records from China do not offer absolute guarantee of veracity. This problem has been observed in adoptions by the ordinary way of children diagnosed like healthy, but also it can happen in children for adoption by the GP. The clinical cases of three children with special needs recently assigned to Spanish families are presented. We think that in all the assignations of children with special needs from China, the Adoption Organizations must offer to the families the complete medical records, the certified results of the laboratory tests and the pictures so that, of exclusive and absolutely confidential manner, they consult with specialized doctors in order to obtain the highest information of the health problems and to value the medical prognosis before taking a decision on the acceptance of the adoption.

Java and its future in biomedical computing.

PubMed Central

Rodgers, R P

1996-01-01

Java, a new object-oriented computing language related to C++, is receiving considerable attention due to its use in creating network-sharable, platform-independent software modules (known as "applets") that can be used with the World Wide Web. The Web has rapidly become the most commonly used information-retrieval tool associated with the global computer network known as the Internet, and Java has the potential to further accelerate the Web's application to medical problems. Java's potentially wide acceptance due to its Web association and its own technical merits also suggests that it may become a popular language for non-Web-based, object-oriented computing. PMID:8880677

A light on medical practice in 19th-century Canada: the medical manuscripts of Dr. John Mackieson of Charlottetown

PubMed Central

Shephard, D A

1998-01-01

During his long career as a physician in Charlottetown, Dr. John Mackieson (1795-1885) compiled 4 medical manuscripts: 2 sets of case records, a synopsis of the medical conditions that were common in his day and a formulary. As primary sources, these documents provide information about medicine in 19th-century Canada and augment our knowledge of the problems of medical practice in that era. They illustrate aspects of the work of Dr. Mackieson, a generalist with interests in surgery and obstetrics, and they facilitate an understanding of the rationale underlying the treatments that he and his contemporaries used. Although 150 years old, the case records can be appreciated for their relevance to the art of medicine. Two excerpts from the case records, presented in this article, provide a sense of Dr. Mackieson's writings and introduce a discussion on the significance of these manuscripts in relation to the ideas on disease and treatment that governed medical practice, both in Prince Edward Island and elsewhere in Canada, in the 19th century. PMID:9724982

Written feedback and continuity of learning in a geographically distributed medical education program.

PubMed

Harvey, Pam; Radomski, Natalie; O'Connor, Dennis

2013-12-01

The provision of effective feedback on clinical performance for medical students is important for their continued learning. Written feedback is an underutilised medium for linking clinical performances over time. The aim of this study is to investigate how clinical supervisors construct performance orientated written feedback and learning goals for medical students in a geographically distributed medical education (GDME) programme. This qualitative study uses textual analysis to examine the structure and content of written feedback statements in 1000 mini-CEX records from 33 Australian undergraduate medical students during their 36 week GDME programme. The students were in their second clinical year. Forty percent of mini-CEX records contained written feedback statements. Within these statements, 80% included comments relating to student clinical performance. The way in which written feedback statements were recorded varied in structure and content. Only 16% of the statements contained student learning goals focused on improving a student's clinical performance over time. Very few of the written feedback statements identified forward-focused learning goals. Training clinical supervisors in understanding how their feedback contributes to a student's continuity of learning across their GDME clinical placements will enable more focused learning experiences based on student need. To enhance student learning over time and place, effective written feedback should contain focused, coherent phrases that help reflection on current and future clinical performance. It also needs to provide enough detail for other GDME clinical supervisors to understand current student performance and plan future directions for their teaching.

Analysis of the Status Quo of Humanistic Quality-Oriented Education in Medical Colleges and Universities

ERIC Educational Resources Information Center

Liu, Shulei; Li, Yamin

2012-01-01

With transformation of contemporary modern medical educational modes and improvement of requirement upon doctors' humanistic quality, it seems quite important to strengthen humanistic quality-oriented education in medical colleges and universities. Medical humanistic quality-oriented education in China started late, which determines that there are…

What kind of motivation drives medical students' learning quests?

PubMed

Sobral, Dejano T

2004-09-01

To describe the patterns of medical students' motivation early in the undergraduate programme and to examine their relationships with learning features and motivational outcomes. The Academic Motivation Scale (AMS) was administered after the first medical year to 297 students of both sexes from consecutive classes within a 4-year timeframe. Measures of learner orientation and reflection in learning were also obtained. Academic achievement and peer tutoring experience were recorded during a 2-year follow-up. Quantitative approaches included analysis of variance, correlational and classificatory analyses of the data. The profile of the students' responses revealed higher levels of autonomous motivation than of controlled motivation although such measures were positively related. Correlation analysis showed significant association of autonomous motivation with higher levels of meaning orientation, reflection in learning, academic achievement, cross-year peer-tutoring experience, and intention to continue with studies. Classificatory analysis identified 4 student groups with distinct patterns of motivation. Analysis of variance revealed significant and consistent differences in learning features and outcomes among such groups. The findings indicate that medical students portray distinct patterns of autonomous and controlled motivation that seem to relate to the learners' frame of mind towards learning as well as the educational environment. Autonomous motivation had closer relationships than controlled motivation with measures of self-regulation of learning and academic success in the context of a demanding medical programme.

Effective chronic disease management: patients' perspectives on medication-related problems.

PubMed

Gordon, Karen; Smith, Felicity; Dhillon, Soraya

2007-03-01

To examine medication-related problems from the perspective of patients with a chronic condition and to identify how they may be supported in managing their medication. Patients prescribed medication for cardiovascular disease were recruited through five general medical surgeries and four community pharmacies in south London. Data were collected in 98 face-to-face interviews in participants' own homes. Interviews were designed to enable a detailed and holistic exploration of medication-related problems from participants' perspectives. Data were audio-recorded and transcribed verbatim to allow qualitative analysis. Five broad categories of medication-related problem emerged which were examined in the context of patients' perspectives on, and experiences of, the use of medicines and health services. These were concerns about and management of side effects; differing views regarding the use of medicines; cognitive, practical and sensory problems; lack of information or understanding; and problems with access to, and organisation of, services. All categories of problem had potential implications for the success of therapy in that they created barriers to adherence, access to medication or informed decision-making. The study demonstrated how patients actively engage in decision-making about their medicines in the home, if not in the consultation. The five categories of problem provide a focus for interventions by health professionals to support patients in achieving optimal theory outcomes. They demonstrate the need for a comprehensive approach, spanning patient education to the systems of delivery of care. Within the NHS in Britain, policy and practice initiatives are being designed to achieve this end. Further research should focus on the evaluation of professional practices and service developments in supporting patients in the self-management of their medicines.

Service-Oriented Security Framework for Remote Medical Services in the Internet of Things Environment

PubMed Central

Lee, Jae Dong; Yoon, Tae Sik; Chung, Seung Hyun

2015-01-01

Objectives Remote medical services have been expanding globally, and this is expansion is steadily increasing. It has had many positive effects, including medical access convenience, timeliness of service, and cost reduction. The speed of research and development in remote medical technology has been gradually accelerating. Therefore, it is expected to expand to enable various high-tech information and communications technology (ICT)-based remote medical services. However, the current state lacks an appropriate security framework that can resolve security issues centered on the Internet of things (IoT) environment that will be utilized significantly in telemedicine. Methods This study developed a medical service-oriented frame work for secure remote medical services, possessing flexibility regarding new service and security elements through its service-oriented structure. First, the common architecture of remote medical services is defined. Next medical-oriented secu rity threats and requirements within the IoT environment are identified. Finally, we propose a "service-oriented security frame work for remote medical services" based on previous work and requirements for secure remote medical services in the IoT. Results The proposed framework is a secure framework based on service-oriented cases in the medical environment. A com parative analysis focusing on the security elements (confidentiality, integrity, availability, privacy) was conducted, and the analysis results demonstrate the security of the proposed framework for remote medical services with IoT. Conclusions The proposed framework is service-oriented structure. It can support dynamic security elements in accordance with demands related to new remote medical services which will be diversely generated in the IoT environment. We anticipate that it will enable secure services to be provided that can guarantee confidentiality, integrity, and availability for all, including patients, non-patients, and medical staff. PMID:26618034

Service-Oriented Security Framework for Remote Medical Services in the Internet of Things Environment.

PubMed

Lee, Jae Dong; Yoon, Tae Sik; Chung, Seung Hyun; Cha, Hyo Soung

2015-10-01

Remote medical services have been expanding globally, and this is expansion is steadily increasing. It has had many positive effects, including medical access convenience, timeliness of service, and cost reduction. The speed of research and development in remote medical technology has been gradually accelerating. Therefore, it is expected to expand to enable various high-tech information and communications technology (ICT)-based remote medical services. However, the current state lacks an appropriate security framework that can resolve security issues centered on the Internet of things (IoT) environment that will be utilized significantly in telemedicine. This study developed a medical service-oriented frame work for secure remote medical services, possessing flexibility regarding new service and security elements through its service-oriented structure. First, the common architecture of remote medical services is defined. Next medical-oriented secu rity threats and requirements within the IoT environment are identified. Finally, we propose a "service-oriented security frame work for remote medical services" based on previous work and requirements for secure remote medical services in the IoT. The proposed framework is a secure framework based on service-oriented cases in the medical environment. A com parative analysis focusing on the security elements (confidentiality, integrity, availability, privacy) was conducted, and the analysis results demonstrate the security of the proposed framework for remote medical services with IoT. The proposed framework is service-oriented structure. It can support dynamic security elements in accordance with demands related to new remote medical services which will be diversely generated in the IoT environment. We anticipate that it will enable secure services to be provided that can guarantee confidentiality, integrity, and availability for all, including patients, non-patients, and medical staff.

Problem-based learning at the receiving end: a 'mixed methods' study of junior medical students' perspectives.

PubMed

Maudsley, Gillian; Williams, Evelyn M I; Taylor, David C M

2008-11-01

Qualitative insights about students' personal experience of inconsistencies in implementation of problem-based learning (PBL) might help refocus expert discourse about good practice. This study explored how junior medical students conceptualize: PBL; good tutoring; and less effective sessions. Participants comprised junior medical students in Liverpool 5-year problem-based, community-orientated curriculum. Data collection and analysis were mostly cross-sectional, using inductive analysis of qualitative data from four brief questionnaires and a 'mixed' qualitative/quantitative approach to data handling. The 1999 cohort (end-Year 1) explored PBL, generated 'good tutor' themes, and identified PBL (dis)advantages (end-Year 1 then mid-Year 3). The 2001 cohort (start-Year 1) described critical incidents, and subsequently (end-Year 1) factors in less effective sessions. These factors were coded using coding-frames generated from the answers about critical incidents and 'good tutoring'. Overall, 61.2% (137), 77.9% (159), 71.0% (201), and 71.0% (198) responded to the four surveys, respectively. Responders perceived PBL as essentially process-orientated, focused on small-groupwork/dynamics and testing understanding through discussion. They described 'good tutors' as knowing when and how to intervene without dominating (51.1%). In longitudinal data (end-Year 1 to mid-Year 3), the main perceived disadvantage remained lack of 'syllabus' (and related uncertainty). For less effective sessions (end-Year 1), tutor transgressions reflected unfulfilled expectations of good tutors, mostly intervening poorly (42.6% of responders). Student transgressions reflected the critical incident themes, mostly students' own lack of work/preparation (54.8%) and other students participating poorly (33.7%) or dominating/being self-centred (31.6%). Compelling individual accounts of uncomfortable PBL experiences should inform improvements in implementation.

Bigdata Oriented Multimedia Mobile Health Applications.

PubMed

Lv, Zhihan; Chirivella, Javier; Gagliardo, Pablo

2016-05-01

In this paper, two mHealth applications are introduced, which can be employed as the terminals of bigdata based health service to collect information for electronic medical records (EMRs). The first one is a hybrid system for improving the user experience in the hyperbaric oxygen chamber by 3D stereoscopic virtual reality glasses and immersive perception. Several HMDs have been tested and compared. The second application is a voice interactive serious game as a likely solution for providing assistive rehabilitation tool for therapists. The recorder of the voice of patients could be analysed to evaluate the long-time rehabilitation results and further to predict the rehabilitation process.

A National Medical Information System for Senegal: Architecture and Services.

PubMed

Camara, Gaoussou; Diallo, Al Hassim; Lo, Moussa; Tendeng, Jacques-Noël; Lo, Seynabou

2016-01-01

In Senegal, great amounts of data are daily generated by medical activities such as consultation, hospitalization, blood test, x-ray, birth, death, etc. These data are still recorded in register, printed images, audios and movies which are manually processed. However, some medical organizations have their own software for non-standardized patient record management, appointment, wages, etc. without any possibility of sharing these data or communicating with other medical structures. This leads to lots of limitations in reusing or sharing these data because of their possible structural and semantic heterogeneity. To overcome these problems we have proposed a National Medical Information System for Senegal (SIMENS). As an integrated platform, SIMENS provides an EHR system that supports healthcare activities, a mobile version and a web portal. The SIMENS architecture proposes also a data and application integration services for supporting interoperability and decision making.

Identifying collaborative care teams through electronic medical record utilization patterns.

PubMed

Chen, You; Lorenzi, Nancy M; Sandberg, Warren S; Wolgast, Kelly; Malin, Bradley A

2017-04-01

The goal of this investigation was to determine whether automated approaches can learn patient-oriented care teams via utilization of an electronic medical record (EMR) system. To perform this investigation, we designed a data-mining framework that relies on a combination of latent topic modeling and network analysis to infer patterns of collaborative teams. We applied the framework to the EMR utilization records of over 10 000 employees and 17 000 inpatients at a large academic medical center during a 4-month window in 2010. Next, we conducted an extrinsic evaluation of the patterns to determine the plausibility of the inferred care teams via surveys with knowledgeable experts. Finally, we conducted an intrinsic evaluation to contextualize each team in terms of collaboration strength (via a cluster coefficient) and clinical credibility (via associations between teams and patient comorbidities). The framework discovered 34 collaborative care teams, 27 (79.4%) of which were confirmed as administratively plausible. Of those, 26 teams depicted strong collaborations, with a cluster coefficient > 0.5. There were 119 diagnostic conditions associated with 34 care teams. Additionally, to provide clarity on how the survey respondents arrived at their determinations, we worked with several oncologists to develop an illustrative example of how a certain team functions in cancer care. Inferred collaborative teams are plausible; translating such patterns into optimized collaborative care will require administrative review and integration with management practices. EMR utilization records can be mined for collaborative care patterns in large complex medical centers. © 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

Medical student communication skills and specialty choice.

PubMed

Ping Tsao, Carol I; Simpson, Deborah; Treat, Robert

2015-06-01

The aim of this study was to determine if communication skills differ for medical students entering person or technique-oriented specialties. Communication ratings by clerkship preceptors on an institutionally required end of clerkship medical student performance evaluation (SPE) form were compiled for 2011/2012 academic year (Class of 2013). M3 clerkships and the Class of 2013 match appointments were categorized as person or technique-oriented clerkships/specialties. Mean differences in SPE communication scores were determined by analyses of variance (ANOVA) and independent t tests. Score associations were determined by Pearson correlations. Inter-item reliability was reported with Cronbach alpha. The Class of 2013 match appointments were as follows: person-oriented (N = 91) and technique-oriented (N = 91) residency specialties. There was no significant difference in mean communication scores for medical students who entered person-oriented (mean 7.8, SD 0.4) versus technique-oriented (mean 7.9, SD 0.4) specialties (p = 0.258) or for person-oriented clerkship (mean 7.8, SD 0.4) versus technique-oriented clerkship (mean 7.9, SD 0.6) ratings for medical students who matched into person-oriented specialties (p = 0.124). Medical students who matched into technique-oriented specialties (mean 8.1, SD 0.5) received significantly higher (p = 0.001) communication ratings as compared with those matching into person-oriented specialties (mean 7.8, SD 0.5) from technique-oriented clerkships. Communication with patients and families is a complex constellation of specific abilities that appear to be influenced by the rater's specialty. Further study is needed to determine if technique-oriented specialties communication skill rating criteria differ from those used by raters from person-oriented specialties.

Simple solution to the medical instrumentation software problem

NASA Astrophysics Data System (ADS)

Leif, Robert C.; Leif, Suzanne B.; Leif, Stephanie H.; Bingue, E.

1995-04-01

Medical devices now include a substantial software component, which is both difficult and expensive to produce and maintain. Medical software must be developed according to `Good Manufacturing Practices', GMP. Good Manufacturing Practices as specified by the FDA and ISO requires the definition and compliance to a software processes which ensures quality products by specifying a detailed method of software construction. The software process should be based on accepted standards. US Department of Defense software standards and technology can both facilitate the development and improve the quality of medical systems. We describe the advantages of employing Mil-Std-498, Software Development and Documentation, and the Ada programming language. Ada provides the very broad range of functionalities, from embedded real-time to management information systems required by many medical devices. It also includes advanced facilities for object oriented programming and software engineering.

Supporting ontology-based keyword search over medical databases.

PubMed

Kementsietsidis, Anastasios; Lim, Lipyeow; Wang, Min

2008-11-06

The proliferation of medical terms poses a number of challenges in the sharing of medical information among different stakeholders. Ontologies are commonly used to establish relationships between different terms, yet their role in querying has not been investigated in detail. In this paper, we study the problem of supporting ontology-based keyword search queries on a database of electronic medical records. We present several approaches to support this type of queries, study the advantages and limitations of each approach, and summarize the lessons learned as best practices.

Female boxing in Italy: 2002-2007 report.

PubMed

Bianco, Massimiliano; Massimiliano, Bianco; Sanna, Nicola; Nicola, Sanna; Bucari, Sante; Sante, Bucari; Fabiano, Carmela; Carmela, Fabiano; Palmieri, Vincenzo; Palmieri, V; Zeppilli, Paolo; Paolo, Zeppilli

2011-06-01

To collect medical data on women's boxing. Cross-sectional and longitudinal study. Medical examinations requested by Italian laws. A retrospective study was conducted on all female boxing competitions in Italy from April 2001 to December 2007. Sixty-one amateur female boxers were evaluated longitudinally. (1) Retrospective study: All pre-/postmatch medical reports were analysed. (2) Prospective study: Breast, gynaecologic, brain, eyes, ear, nose and throat examinations were carried out. (1) Retrospective study: Any injury assessed before/after the match. (2) Prospective study: Health problems which could be related to boxing activity. (1) Retrospective study: Data from 5600 examinations were collected. Precompetition, a medical problem was recorded in three athletes (one conjunctiva hyperemia, one zygomatic bruise, one eyelid haematoma). Post competition, 51/2800 medical checks showed mild common injuries, such as soft tissue facial lesions, epistaxis and hand-wrist problems. Only one concussion was recorded with hospitalisation (for a thorough evaluation). Another athlete was hospitalised for a nasal fracture. (2) Prospective study: Two fibroadenomas, three ovarian cysts and one intramural uterine myoma were diagnosed. In four boxers, non-specific electroencephalographic abnormalities were detected, however, with a normal brain MRI in three (the fourth is still waiting for the radiologic procedure). Nasal septum deviation was common (42.6%) and a transmissive hypoacusia was observed in two athletes. No major eye injuries were reported. Female boxing seems to be a safe sport with a very low incidence of events requiring hospitalisation. No specific diseases in female boxers could be observed, in particular regarding the breast and reproductive system.

No privacy for all? Serious failings in the HHS medical records regulations.

PubMed

Sobel, Richard

2002-01-01

The Bush administration surprised many by the approval without major revisions of the Clinton administration's HHS medical records regulations, despite heavy lobbying from the health industry. Though these "privacy rules" are supposed to protect patient confidentiality, what has gone unmentioned are the regulations' major lapses that breach informed consent and confidentiality. Recently issued "clarifications" of the regulations reveal that they do not prevent unconsented access to sensitive medical information by marketers, health plans, health care clearinghouses, and law enforcement. These problems with the regulations constitute a serious breach of patient privacy, endangering the doctor-patient relationship and potentially driving up health care costs, and need to be addressed.

[History of Japanese Committee for Anatomical Nomenclature].

PubMed

Kimura, Kunihiko

2008-12-01

This paper records a history of the Japanese Committee of Anatomical Nomenclature since 1990, as a supplement to the previous report (1991), explains a progressing of the edition of Japanese medical terms by the Japanese Association of Medical Sciences and the Ministry of Education, Sciences and Culture, and points out of some problems on terms in Japanese.

Residents' Ratings of Their Clinical Supervision and Their Self-Reported Medical Errors: Analysis of Data From 2009.

PubMed

Baldwin, DeWitt C; Daugherty, Steven R; Ryan, Patrick M; Yaghmour, Nicholas A; Philibert, Ingrid

2018-04-01

Medical errors and patient safety are major concerns for the medical and medical education communities. Improving clinical supervision for residents is important in avoiding errors, yet little is known about how residents perceive the adequacy of their supervision and how this relates to medical errors and other education outcomes, such as learning and satisfaction. We analyzed data from a 2009 survey of residents in 4 large specialties regarding the adequacy and quality of supervision they receive as well as associations with self-reported data on medical errors and residents' perceptions of their learning environment. Residents' reports of working without adequate supervision were lower than data from a 1999 survey for all 4 specialties, and residents were least likely to rate "lack of supervision" as a problem. While few residents reported that they received inadequate supervision, problems with supervision were negatively correlated with sufficient time for clinical activities, overall ratings of the residency experience, and attending physicians as a source of learning. Problems with supervision were positively correlated with resident reports that they had made a significant medical error, had been belittled or humiliated, or had observed others falsifying medical records. Although working without supervision was not a pervasive problem in 2009, when it happened, it appeared to have negative consequences. The association between inadequate supervision and medical errors is of particular concern.

Information system for diagnosis of respiratory system diseases

NASA Astrophysics Data System (ADS)

Abramov, G. V.; Korobova, L. A.; Ivashin, A. L.; Matytsina, I. A.

2018-05-01

An information system is for the diagnosis of patients with lung diseases. The main problem solved by this system is the definition of the parameters of cough fragments in the monitoring recordings using a voice recorder. The authors give the recognition criteria of recorded cough moments, audio records analysis. The results of the research are systematized. The cough recognition system can be used by the medical specialists to diagnose the condition of the patients and to monitor the process of their treatment.

From application to implication in medical anthropology: political, historical and narrative interpretations of the world of sickness and health.

PubMed

Nunes, Mônica de Oliveira

2014-01-01

This article reviews some of the current writing on medical anthropology, and is guided by political orientation/implication in the choice of its study targets, its analysis and its construction of solutions for the problems investigated. Starting from the narratives of anthropologists, it goes on to show the historical and socio-political bases characteristic of the subject in their countries of origin or migration. Within a general overview of the three principal contemporary trends - critical medical anthropology, the anthropology of suffering and the anthropology of biopower - the focus is on theoretical and thematic choices to meet the demand for "politicization" of the anthropological debate in the field of health, on the basis of which an "implied" medical anthropology is advocated.

Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates.

PubMed

Goldzweig, Caroline Lubick; Parkerton, Patricia H; Washington, Donna L; Lanto, Andrew B; Yano, Elizabeth M

2004-04-01

Despite the importance of early cancer detection, variation in screening rates among physicians is high. Insights into factors influencing variation can guide efforts to decrease variation and increase screening rates. To explore the association of primary care practice features and a facility's quality orientation with breast and cervical cancer screening rates. Cross-sectional study of screening rates among 144 Department of Veterans Affairs (VA) medical centers and for a national sample of women. We linked practice structure and quality improvement characteristics of individual VA medical centers from 2 national surveys (1 to primary care directors and 1 to a stratified random sample of employees) to breast and cervical cancer screening rates determined from a review of random medical records. We conducted bivariate analyses and multivariate logistic regression of primary care practice and facility features on cancer screening rates, above and below the median. While the national screening rates were high for breast (87%) and cervical cancer (90%), higher screening rates were more likely when primary care providers were consistently notified of specialty visits and when staff perceived a greater organizational commitment to quality and anticipated rewards and recognition for better performance. Organization and quality orientation of the primary care practice and its facility can enhance breast and cervical cancer screening rates. Internal recognition of quality performance and an overall commitment to quality improvement may foster improved prevention performance, with impact varying by clinical service.

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

PubMed

Tweya, Hannock; Feldacker, Caryl; Gadabu, Oliver Jintha; Ng'ambi, Wingston; Mumba, Soyapi L; Phiri, Dave; Kamvazina, Luke; Mwakilama, Shawo; Kanyerere, Henry; Keiser, Olivia; Mwafilaso, Johnbosco; Kamba, Chancy; Egger, Matthias; Jahn, Andreas; Simwaka, Bertha; Phiri, Sam

2016-03-05

Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

[Problems in the transmission of information during within-hospital medical consultations and referrals].

PubMed

Montero Ruiz, E; Rebollar Merino, Á; Melgar Molero, V; Barbero Allende, J M; Culebras López, A; López Álvarez, J

2014-01-01

Within-hospital medical consultations and referrals (MCR) have many problems, among them are those related to the oral and written transmission of information. Our aim is to analyze problems in the transmission of information related to MCR, and possible differences between medical (MS) and surgical (SS) services. A prospective, observational study was conducted on the MCR requested to Internal Medicine Service over an 8 month period. The following variables were collected: age, sex, the requester, MCR type, type of admission, comorbidity, hospital stay and mortality, length of MCR, the number of physicians responsible for the patient requesting service during the MCR, MCR repeats, information on the request, available medical records, verbal contact, conflict between doctors, and medical information in the discharge summary. Of the total 215 MCR received, 66 (30.7%) were requested by MS, and 149 (69.3%) per SS. MCR duration was 3 days (standard deviation [SD] 4.8. The number of doctors responsible was 1.7 (SD 1.1), with, Repeats 43 (20%) and Urgent 14 (6.5%). Minimum information on the request, 6 (9.1%) MS and 21 (27.5%) SS. Low availability of medical record, 2 (3%) MS and 50 (33.6%) SS. No verbal contact, 33 (15.4%). Conflict between doctors 13 (6%). Information acceptably good in MCR urgent request 100% MS, and 80% SS. Two out of three MCR were without reference to the discharge report. There are significant losses in the transmission of information during the process of the MCR, which is higher in surgical than in medical departments. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Justice and care: the implications of the Kohlberg-Gilligan debate for medical ethics.

PubMed

Sharpe, V A

1992-12-01

Carol Gilligan has identified two orientations to moral understanding; the dominant 'justice orientation' and the under-valued 'care orientation'. Based on her discernment of a 'voice of care', Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.

Real time coarse orientation detection in MR scans using multi-planar deep convolutional neural networks

NASA Astrophysics Data System (ADS)

Bhatia, Parmeet S.; Reda, Fitsum; Harder, Martin; Zhan, Yiqiang; Zhou, Xiang Sean

2017-02-01

Automatically detecting anatomy orientation is an important task in medical image analysis. Specifically, the ability to automatically detect coarse orientation of structures is useful to minimize the effort of fine/accurate orientation detection algorithms, to initialize non-rigid deformable registration algorithms or to align models to target structures in model-based segmentation algorithms. In this work, we present a deep convolution neural network (DCNN)-based method for fast and robust detection of the coarse structure orientation, i.e., the hemi-sphere where the principal axis of a structure lies. That is, our algorithm predicts whether the principal orientation of a structure is in the northern hemisphere or southern hemisphere, which we will refer to as UP and DOWN, respectively, in the remainder of this manuscript. The only assumption of our method is that the entire structure is located within the scan's field-of-view (FOV). To efficiently solve the problem in 3D space, we formulated it as a multi-planar 2D deep learning problem. In the training stage, a large number coronal-sagittal slice pairs are constructed as 2-channel images to train a DCNN to classify whether a scan is UP or DOWN. During testing, we randomly sample a small number of coronal-sagittal 2-channel images and pass them through our trained network. Finally, coarse structure orientation is determined using majority voting. We tested our method on 114 Elbow MR Scans. Experimental results suggest that only five 2-channel images are sufficient to achieve a high success rate of 97.39%. Our method is also extremely fast and takes approximately 50 milliseconds per 3D MR scan. Our method is insensitive to the location of the structure in the FOV.

An implementation of wireless medical image transmission system on mobile devices.

PubMed

Lee, SangBock; Lee, Taesoo; Jin, Gyehwan; Hong, Juhyun

2008-12-01

The advanced technology of computing system was followed by the rapid improvement of medical instrumentation and patient record management system. The typical examples are hospital information system (HIS) and picture archiving and communication system (PACS), which computerized the management procedure of medical records and images in hospital. Because these systems were built and used in hospitals, doctors out of hospital have problems to access them immediately on emergent cases. To solve these problems, this paper addressed the realization of system that could transmit the images acquired by medical imaging systems in hospital to the remote doctors' handheld PDA's using CDMA cellular phone network. The system consists of server and PDA. The server was developed to manage the accounts of doctors and patients and allocate the patient images to each doctor. The PDA was developed to display patient images through remote server connection. To authenticate the personal user, remote data access (RDA) method was used in PDA accessing the server database and file transfer protocol (FTP) was used to download patient images from the remove server. In laboratory experiments, it was calculated to take ninety seconds to transmit thirty images with 832 x 488 resolution and 24 bit depth and 0.37 Mb size. This result showed that the developed system has no problems for remote doctors to receive and review the patient images immediately on emergent cases.

A practical guideline for identifying research intent with projects that collect private, identifiable health information.

PubMed

Amdur, Robert J; Speers, Marjorie A

2003-06-01

Radiation oncologists frequently engage in activities that involve the collection and analysis of data from medical records. Access to health information is an ethical issue because, if not done according to appropriate guidelines, it constitutes an invasion of privacy or breach in confidentiality. To protect patients for the social harm that may result from medical record review, our society has established laws and regulations that apply to projects that require medical record review. A major branch point in the guidelines for such projects is whether private information will be collected for research or nonresearch purposes. However, a problem with discussing privacy protection in terms of a research versus nonresearch model is that it is difficult to make this distinction for many kinds of projects. The purpose of this paper is to establish a practical guideline that can be used to decide if a project that involves analysis of private, identifiable medical information should be considered research from the regulatory standpoint.

[Preliminary study on the time of first appearance of "lanhousha" (scarlet fever)].

PubMed

Yu, X

2001-04-01

There are controversies about the problem of the source of "lanhousha" (scarlet fever) in the field of modern medical history, whether it is an epidemic appeared from the ancient time in our country or imported from other countries. Now, almost all researches were carried out around the classic medical books, especially "Medical Records of Ye Tianshi", and hardly dealing it in a historical context at that time. Through contrastive analysis between the records in medical books and historical facts, it is concluded that Ye Tianshi's records of scarlet fever have nothing to do with Ye Tianshi himself, and is by author of allonym. It perhaps was exogenous cold diseases spread when a severe epidemic diseases happened at Southern Jiangsu in the 11th year of Yongzheng reign. Even though there was some scarlet fever, it was not the first spread of scarlet fever in fact. Actually, in late Kangxi reign, scarlet fever was regarded as an epidemic disease seldom seen at Southern Jiangsu.

The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards

PubMed Central

Lau, Hong Sang; Florax, Christa; Porsius, Arijan J; de Boer, Anthonius

2000-01-01

Aims Accurate recording of medication histories in hospital medical records (HMR) is important when patients are admitted to the hospital. Lack of registration of drugs can lead to unintended discontinuation of drugs and failure to detect drug related problems. We investigated the comprehensiveness of medication histories in HMR with regard to prescription drugs by comparing the registration of drugs in HMR with computerized pharmacy records obtained from the community pharmacy. Methods Patients admitted to the general ward of two acute care hospitals were included in the study after obtaining informed consent. We conducted an interview on drugs used just prior to hospitalization and extracted the medication history from the HMR. Pharmacy records were collected from the community pharmacists over a 1 year period before the admission. Drugs in the pharmacy records were defined as possibly used (PU-drugs) when they were dispensed before the admission date and had a theoretical enddate of 7 days before the admission date or later. If any PU-drug was not recorded in the HMR, we asked the patient whether they were using that drug or not. Results Data were obtained from 304 patients who had an average age of 71 (range 40–92) years. The total number of drugs according to the HMR was 1239, 43 of which were not used. When compared with the pharmacy records we found an extra 518 drugs that were not recorded in the HMR but were possibly in use. After verification with the patients, 410 of these were indeed in use bringing the total number of drugs in use to 1606. The type of drugs in use but not recorded in the HMR covered a broad spectrum and included many drugs considered to be important such as cardiovascular drugs (n = 67) and NSAIDs (n = 31). The percentages of patients with 0, 1, 2, 3, 4, 5–11 drugs not recorded in the HMR were 39, 28, 16, 8, 3.6 and 5.5, respectively. Of the 1606 drugs in use according to information from all sources, only 38 (2.4%) were not retrievable in the pharmacy records when the complete year prior to hospitalization was evaluated. Conclusions The medication history in the hospital medical record is often incomplete, as 25% of the prescription drugs in use is not recorded and 61% of all patients has one of more drugs not registered. Pharmacy records from the community pharmacist can be used to obtain more complete information on the medication history of patients admitted to the hospital. PMID:10848724

Cross-sectional investigation of drug-related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud.

PubMed

Wang, Hue-Yu; Yeh, Ming-Kung; Ho, Chung-Han; Hu, Ming-Kuan; Huang, Yaw-Bin

2017-01-01

To analyze and characterize data regarding the prevalence and types of outpatient drug-related problems (DRPs) found by clinical pharmacists after implementation of the Virtual Medicine Record in Cloud System (VMRCS). A cross-sectional study regarding outpatient pharmaceutical care was conducted at a medical center in Taiwan. Patients aged >20 years old with multiple chronic diseases and polypharmacy were enrolled. In Stage I (1 October-31 December 2014), patients received pharmaceutical care according to prescription data accessed online in the VMRCS. In Stage II (1 June-31 August 2015), the VMRCS were pre-download and arranged to the institute's required format, facilitated DRP detection. Clinical pharmacists then reviewed and evaluated the prescription data through pre-downloaded VMRCS. Overall, 1539 and 1600 prescriptions were evaluated in these two stages, respectively. DRPs were recorded using the Pharmaceutical Care Network Europe (PCNE)-DRP. DRPs were found for 50.2% of patients in Stage I and 55.2% in Stage II (p < 0.05) and were most frequently encountered for "Drugs for the cardiovascular system" and caused by "Inappropriate duplication of therapeutic group or active ingredient." In terms of problems, incidence of "Unnecessary drug treatment" was highest. Duplicate medications were most frequently seen for "Drugs for acid-related disorders." The efficiency to identify DRPs was at least 2.4 times higher with pre-downloaded prescription data than with real-time online queries. With VMRCS, DRPs were more easily identified whether patients received medical care in the same hospital or not. DRPs could be efficiently prevented through the use of pre-downloaded patient prescription data. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Patient safety and patient assessment in pre-hospital care: a study protocol.

PubMed

Hagiwara, Magnus Andersson; Nilsson, Lena; Strömsöe, Anneli; Axelsson, Christer; Kängström, Anna; Herlitz, Johan

2016-02-12

Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden. The study is a retro-perspective structured medical record review based on the use of 11 screening criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for pre-hospital care and a newly development instrument designed to compare the pre-hospital assessment with the final hospital assessment. Three different ambulance organisations are participating in the study. Every month, one rater in each organisation randomly collects 30 medical records for review. With guidance from the review instrument, he/she independently reviews the record. Every month, the review team meet for a discussion of problematic reviews. The results will be analysed with descriptive statistics and logistic regression. The findings will make an important contribution to knowledge about patient safety issues in pre-hospital care.

The prevalence of obesity documentation in Primary Care Electronic Medical Records

PubMed Central

Mattar, Ahmed; Carlston, David; Sariol, Glen; Yu, Tongle; Almustafa, Ahmad; Melton, Genevieve B.

2017-01-01

Summary Background Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient’s problem list for patients with eligible body mass indexes (BMI) as contained in the patients’ electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. Method This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Results Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Conclusion Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese. PMID:28119990

Personality and Medical Specialty Choice: Technique Orientation versus People Orientation.

ERIC Educational Resources Information Center

Borges, Nicole J.; Osmon, William R.

2001-01-01

Results of the 16 Personality Factor Questionnaire completed by 161 physicians indicated that role consciousness, abstractedness, and tough mindedness differentiated medical specialties (surgeons, anesthesiologists, family practitioners). Results correlated with the use of differences between person orientation and technique orientation to…

Prevalence of physical health problems among youth entering residential treatment.

PubMed

Nelson, Timothy D; Smith, Tori R; Thompson, Ronald W; Epstein, Michael H; Griffith, Annette K; Hurley, Kristin Duppong; Tonniges, Thomas F

2011-11-01

To examine the prevalence of physical health problems among youth entering residential treatment. The sample included 1744 youth (mean age: 14.6 ± 1.8 years) entering a large residential treatment program between 2000 and 2010. Youth received an intake medical evaluation, including a review of available records, detailed medical history, and physical examination. Medical conditions present at the time of the evaluation were recorded by the examining physician and later coded by the research team. Only diagnoses recognized by the International Classification of Diseases, 10th Revision, were included in the analyses. To maintain the focus on physical health problems, behavioral and emotional disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were excluded. Obesity, acne, and allergies were also excluded. Approximately one-third (33.7%) of youth had a physical health diagnosis at the time of intake. Asthma was the most prevalent condition diagnosed (15.3% of the sample). Girls were significantly more likely to have a diagnosis than were boys (37.1% vs 31.5%). Age was not associated with diagnostic status. Rates of physical health conditions differed significantly by ethnicity: black (36.4%) and white (35.4%) youth had the highest rates, and Hispanic youth (23.2%) had the lowest. Youth who enter residential treatment have high rates of physical health conditions. These problems could complicate mental health treatment and should be considered in multidisciplinary treatment planning.

[Improvement of medical processes with Six Sigma - practicable zero-defect quality in preparation for surgery].

PubMed

Sobottka, Stephan B; Töpfer, Armin; Eberlein-Gonska, Maria; Schackert, Gabriele; Albrecht, D Michael

2010-01-01

Six Sigma is an innovative management- approach to reach practicable zero- defect quality in medical service processes. The Six Sigma principle utilizes strategies, which are based on quantitative measurements and which seek to optimize processes, limit deviations or dispersion from the target process. Hence, Six Sigma aims to eliminate errors or quality problems of all kinds. A pilot project to optimize the preparation for neurosurgery could now show that the Six Sigma method enhanced patient safety in medical care, while at the same time disturbances in the hospital processes and failure costs could be avoided. All six defined safety relevant quality indicators were significantly improved by changes in the workflow by using a standardized process- and patient- oriented approach. Certain defined quality standards such as a 100% complete surgical preparation at start of surgery and the required initial contact of the surgeon with the patient/ surgical record on the eve of surgery could be fulfilled within the range of practical zero- defect quality. Likewise, the degree of completion of the surgical record by 4 p.m. on the eve of surgery and their quality could be improved by a factor of 170 and 16, respectively, at sigma values of 4.43 and 4.38. The other two safety quality indicators "non-communicated changes in the OR- schedule" and the "completeness of the OR- schedule by 12:30 a.m. on the day before surgery" also show an impressive improvement by a factor of 2.8 and 7.7, respectively, corresponding with sigma values of 3.34 and 3.51. The results of this pilot project demonstrate that the Six Sigma method is eminently suitable for improving quality of medical processes. In our experience this methodology is suitable, even for complex clinical processes with a variety of stakeholders. In particular, in processes in which patient safety plays a key role, the objective of achieving a zero- defect quality is reasonable and should definitely be aspirated. Copyright © 2010. Published by Elsevier GmbH.

Facilitating Positive Psychosocial Adaptation in Children with Cystic Fibrosis by Increasing Family Communication and Problem-Solving Skills. A Research Report to the Cystic Fibrosis Foundation.

ERIC Educational Resources Information Center

Stabler, Brian; And Others

This study tested the effects of two group-oriented supportive and educational approaches on the parents of children with cystic fibrosis (CF). Thirteen families were randomly assigned either to a group which received information on medical and technical aspects of CF or to a group which received instruction in communication skills in addition to…

Optimizing medication safety in the home.

PubMed

LeBlanc, Raeanne Genevieve; Choi, Jeungok

2015-06-01

Medication safety among community-dwelling older adults in the United States is an ongoing health issue impacting health outcomes, chronic disease management, and aging in place at home. This article describes a medication safety improvement project that aimed to: (1) Increase the ability of participants to manage medications, (2) Identify and make necessary medication changes, (3) Create an accurate up-to-date medication list to be available in the home, and (4) Provide communication between the primary care provider, participant, and case manager. An in-home medication assessment was completed for 25 participants using an evidence-based medication management software system. This process was used to review medications; identify medication-related problems; create a shared medication list; and convey this information to the primary care provider, case manager, and client while addressing needed medication changes. Educational interventions on management and understanding of medications were provided to participants to emphasize the correct use of medications and use of a personal medication record. Outcome improvements included provision of an accurate medication list, early identification of medication-related problems, identification of drug duplication, and identification of medication self-management challenges that can be useful for optimizing medication safety-related home healthcare and inform future interventions.

Towards case-based medical learning in radiological decision making using content-based image retrieval

PubMed Central

2011-01-01

Background Radiologists' training is based on intensive practice and can be improved with the use of diagnostic training systems. However, existing systems typically require laboriously prepared training cases and lack integration into the clinical environment with a proper learning scenario. Consequently, diagnostic training systems advancing decision-making skills are not well established in radiological education. Methods We investigated didactic concepts and appraised methods appropriate to the radiology domain, as follows: (i) Adult learning theories stress the importance of work-related practice gained in a team of problem-solvers; (ii) Case-based reasoning (CBR) parallels the human problem-solving process; (iii) Content-based image retrieval (CBIR) can be useful for computer-aided diagnosis (CAD). To overcome the known drawbacks of existing learning systems, we developed the concept of image-based case retrieval for radiological education (IBCR-RE). The IBCR-RE diagnostic training is embedded into a didactic framework based on the Seven Jump approach, which is well established in problem-based learning (PBL). In order to provide a learning environment that is as similar as possible to radiological practice, we have analysed the radiological workflow and environment. Results We mapped the IBCR-RE diagnostic training approach into the Image Retrieval in Medical Applications (IRMA) framework, resulting in the proposed concept of the IRMAdiag training application. IRMAdiag makes use of the modular structure of IRMA and comprises (i) the IRMA core, i.e., the IRMA CBIR engine; and (ii) the IRMAcon viewer. We propose embedding IRMAdiag into hospital information technology (IT) infrastructure using the standard protocols Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven (HL7). Furthermore, we present a case description and a scheme of planned evaluations to comprehensively assess the system. Conclusions The IBCR-RE paradigm incorporates a novel combination of essential aspects of diagnostic learning in radiology: (i) Provision of work-relevant experiences in a training environment integrated into the radiologist's working context; (ii) Up-to-date training cases that do not require cumbersome preparation because they are provided by routinely generated electronic medical records; (iii) Support of the way adults learn while remaining suitable for the patient- and problem-oriented nature of medicine. Future work will address unanswered questions to complete the implementation of the IRMAdiag trainer. PMID:22032775

Towards case-based medical learning in radiological decision making using content-based image retrieval.

PubMed

Welter, Petra; Deserno, Thomas M; Fischer, Benedikt; Günther, Rolf W; Spreckelsen, Cord

2011-10-27

Radiologists' training is based on intensive practice and can be improved with the use of diagnostic training systems. However, existing systems typically require laboriously prepared training cases and lack integration into the clinical environment with a proper learning scenario. Consequently, diagnostic training systems advancing decision-making skills are not well established in radiological education. We investigated didactic concepts and appraised methods appropriate to the radiology domain, as follows: (i) Adult learning theories stress the importance of work-related practice gained in a team of problem-solvers; (ii) Case-based reasoning (CBR) parallels the human problem-solving process; (iii) Content-based image retrieval (CBIR) can be useful for computer-aided diagnosis (CAD). To overcome the known drawbacks of existing learning systems, we developed the concept of image-based case retrieval for radiological education (IBCR-RE). The IBCR-RE diagnostic training is embedded into a didactic framework based on the Seven Jump approach, which is well established in problem-based learning (PBL). In order to provide a learning environment that is as similar as possible to radiological practice, we have analysed the radiological workflow and environment. We mapped the IBCR-RE diagnostic training approach into the Image Retrieval in Medical Applications (IRMA) framework, resulting in the proposed concept of the IRMAdiag training application. IRMAdiag makes use of the modular structure of IRMA and comprises (i) the IRMA core, i.e., the IRMA CBIR engine; and (ii) the IRMAcon viewer. We propose embedding IRMAdiag into hospital information technology (IT) infrastructure using the standard protocols Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven (HL7). Furthermore, we present a case description and a scheme of planned evaluations to comprehensively assess the system. The IBCR-RE paradigm incorporates a novel combination of essential aspects of diagnostic learning in radiology: (i) Provision of work-relevant experiences in a training environment integrated into the radiologist's working context; (ii) Up-to-date training cases that do not require cumbersome preparation because they are provided by routinely generated electronic medical records; (iii) Support of the way adults learn while remaining suitable for the patient- and problem-oriented nature of medicine. Future work will address unanswered questions to complete the implementation of the IRMAdiag trainer.

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

PubMed

Mjaaland, Trond A; Finset, Arnstein

2009-07-01

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

Strain System for the Motion Base Shuttle Mission Simulator

NASA Technical Reports Server (NTRS)

Huber, David C.; Van Vossen, Karl G.; Kunkel, Glenn W.; Wells, Larry W.

2010-01-01

The Motion Base Shuttle Mission Simulator (MBSMS) Strain System is an innovative engineering tool used to monitor the stresses applied to the MBSMS motion platform tilt pivot frames during motion simulations in real time. The Strain System comprises hardware and software produced by several different companies. The system utilizes a series of strain gages, accelerometers, orientation sensor, rotational meter, scanners, computer, and software packages working in unison. By monitoring and recording the inputs applied to the simulator, data can be analyzed if weld cracks or other problems are found during routine simulator inspections. This will help engineers diagnose problems as well as aid in repair solutions for both current as well as potential problems.

Improving the human readability of Arden Syntax medical logic modules using a concept-oriented terminology and object-oriented programming expressions.

PubMed

Choi, Jeeyae; Bakken, Suzanne; Lussier, Yves A; Mendonça, Eneida A

2006-01-01

Medical logic modules are a procedural representation for sharing task-specific knowledge for decision support systems. Based on the premise that clinicians may perceive object-oriented expressions as easier to read than procedural rules in Arden Syntax-based medical logic modules, we developed a method for improving the readability of medical logic modules. Two approaches were applied: exploiting the concept-oriented features of the Medical Entities Dictionary and building an executable Java program to replace Arden Syntax procedural expressions. The usability evaluation showed that 66% of participants successfully mapped all Arden Syntax rules to Java methods. These findings suggest that these approaches can play an essential role in the creation of human readable medical logic modules and can potentially increase the number of clinical experts who are able to participate in the creation of medical logic modules. Although our approaches are broadly applicable, we specifically discuss the relevance to concept-oriented nursing terminologies and automated processing of task-specific nursing knowledge.

Demographics of the gay and lesbian population in the United States: evidence from available systematic data sources.

PubMed

Black, D; Gates, G; Sanders, S; Taylor, L

2000-05-01

This work provides an overview of standard social science data sources that now allow some systematic study of the gay and lesbian population in the United States. For each data source, we consider how sexual orientation can be defined, and we note the potential sample sizes. We give special attention to the important problem of measurement error, especially the extent to which individuals recorded as gay and lesbian are indeed recorded correctly. Our concern is that because gays and lesbians constitute a relatively small fraction of the population, modest measurement problems could lead to serious errors in inference. In examining gays and lesbians in multiple data sets we also achieve a second objective: We provide a set of statistics about this population that is relevant to several current policy debates.

Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department.

PubMed

Zhabenko, Olena; Austic, Elizabeth; Conroy, Deirdre A; Ehrlich, Peter; Singh, Vijay; Epstein-Ngo, Quyen; Cunningham, Rebecca M; Walton, Maureen A

2016-01-01

To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers). A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011-2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit. 23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school. These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.

Integrating clinical communication with clinical reasoning and the broader medical curriculum.

PubMed

Cary, Julie; Kurtz, Suzanne

2013-09-01

The objectives of this paper are to discuss the results of a workshop conducted at EACH 2012. Specifically, we will (1) examine the link between communication, clinical reasoning, and medical problem solving, (2) explore strategies for (a) integrating clinical reasoning, medical problem solving, and content from the broader curriculum into clinical communication teaching and (b) integrating communication into the broader curriculum, and (3) discuss benefits gained from such integration. Salient features from the workshop were recorded and will be presented here, as well as a case example to illustrate important connections between clinical communication and clinical reasoning. Potential links between clinical communication, clinical reasoning, and medical problem solving as well as strategies to integrate clinical communication teaching and the broader curricula in human and veterinary medicine are enumerated. Participants expressed enthusiasm and keen interest in integration of clinical communication teaching and clinical reasoning during this workshop, came to the idea of the interdependence of these skills easily, and embraced the rationale immediately. Valuing the importance of communication as clinical skill and embracing the interdependence between communication and thought processes related to clinical reasoning and medical problem solving will be beneficial in teaching programs. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Holland's Theory Applied to Medical Specialty Choice

ERIC Educational Resources Information Center

Borges, Nicole J.; Savickas, Mark L.; Jones, Bonnie J.

2004-01-01

The present study tested the hypothesis that medical specialties classified as technique oriented or patient oriented would be distinguished by RIASEC code, with technique-oriented specialists resembling Investigative-Realistic types and patient-oriented specialists resembling Investigative-Social types. Using longitudinal data obtained from 447…

Epidemiological profile of snake-bite cases from Haryana: A five year (2011-2015) retrospective study.

PubMed

Bhargava, Saurabh; Kaur, Ramanjeet; Singh, Rajvinder

2018-02-01

Varieties of venomous snakes inhabit in the world which accidentally take thousands of human lives every year. This severe medical emergency constantly persuades national and international health agencies to look at efficient epidemiological profiling of snake-bite cases for the proper management of this sympathetic problem. Establishing the accurate database of snake-bite in humans from different localities of India may perhaps lack certainty due to few inevitable reasons such as consideration of this problem as less emergent problem in disparity to pesticide poisoning, difficulty in the accessibility to rural and tribal areas where chances of snake-bite remain ceiling, lack of inspiring models of snake-bite management training, reduced reporting system, and pitiable maintenance of hospital data in India. Therefore, the present modest study was carried out to explore valuable information regarding snake-bite problem in Haryana. Factual data on snake-bite incidences happened from 2011 to 2015 were collected from government hospitals and medical institutes of Haryana. This retrospective study disclosed a few characteristic points related to the frequency of snake-bite cases, gender involved, anti-snake venom (ASV) treatment, and numbers of deaths with snake-bite. Records revealed a total of 6555 cases of snake-bite including 130 deaths reported in Haryana during the study period. A significant variation in the occurrence of snake-bite cases was also recorded in different areas of Haryana. There was a huge database of recorded snake-bite cases from government medical institute but district wise survey disclosed the maximum number of snake-bite incidences, especially amongst males from Panchkula. The present study has provided a more updated and comprehensive record of snake-bite from Haryana during 2011-2015. A huge burden of snake-bite amongst human was found in Haryana; hence, the findings of this study purposely enlighten people about the size of this problem in the selected region. However, this study also remained limited due to lack of information on a few important parameters and availability of homogeneous data. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

[Risks and control of complete market-oriented reforms of medical institutions].

PubMed

Ding, Jiannong; Tian, Yongquan

2014-04-01

Marketization has become the mainstream since the new public management emerges globally in second half of the 20th century. Some countries infuse private capital into medical institutions which used to be managed by the government originally, and cause the medical industry reforms to be market-oriented. Market-oriented reforms of medical institutions may have risks in the following aspects: the risk of uneven distribution of medical resources, the risk of market failure, the moral risk of government renting-seeking and corruption and the decay of social justice values. Measures of controlling these risks include defining the function orientation of the government, completing the institution-building of healthcare system, improving primary medical system and strengthening social consciousness of hospitals.

Recalling the Doctor to Action--Two Requesting Formats Employed by a Nurse for Making Relevant the Doctor's Intervention

ERIC Educational Resources Information Center

Sterie, Anca Cristina

2015-01-01

At the hospital, nurses' telephone calls to doctors mostly revolve around obtaining doctors' intervention in a medical case. To achieve this, nurses need to make the doctor's intervention relevant, by explicitly requesting it or, more indirectly, by reporting a medical problem. Two recorded telephone conversations have been selected for analysis…

New Tools for Learning: A Case of Organizational Problem Analysis Derived from Debriefing Records in a Medical Center

ERIC Educational Resources Information Center

Holzmann, Vered; Mischari, Shoshana; Goldberg, Shoshana; Ziv, Amitai

2012-01-01

Purpose: This article aims to present a unique systematic and validated method for creating a linkage between past experiences and management of future occurrences in an organization. Design/methodology/approach: The study is based on actual data accumulated in a series of projects performed in a major medical center. Qualitative and quantitative…

Contingency Management of Hospitalized Character and Behavior Disordered Soldiers

DTIC Science & Technology

1977-09-01

staff who administered the educational program. In addition to traditional forms such as lectures and group discussions, programmed texts, role...medical discharges. The disastrous effects of too ready identification of social and motivational problems as medical illnesses has been amply recorded...postulates that behavior is increased in rate, shaped, suppressed, or extinguished depending on its consequences or effects on the environment. It

Integration of radiographic images with an electronic medical record.

PubMed Central

Overhage, J. M.; Aisen, A.; Barnes, M.; Tucker, M.; McDonald, C. J.

2001-01-01

Radiographic images are important and expensive diagnostic tests. However, the provider caring for the patient often does not review the images directly due to time constraints. Institutions can use picture archiving and communications systems to make images more available to the provider, but this may not be the best solution. We integrated radiographic image review into the Regenstrief Medical Record System in order to address this problem. To achieve adequate performance, we store JPEG compressed images directly in the RMRS. Currently, physicians review about 5% of all radiographic studies using the RMRS image review function. PMID:11825241

Utilizing Health Records to Characterize Obesity, Comorbidities, and Health-Care Services in One Human Service Agency in the United States

ERIC Educational Resources Information Center

Fisher, Kathleen; Hardie, Thomas L.; Ranjan, Sobhana; Peterson, Justin

2017-01-01

US surveys report higher prevalence of obesity in adults with intellectual disability. Health records of 40 adults with intellectual disability were retrospectively reviewed for data on health status, problem lists with International Classification of Diseases, Ninth Revision codes, medication lists, and health encounters over 18 months. Mean age…

Use of patients' mobile phones to store and share personal health information: results of a questionnaire survey.

PubMed

Tawara, Satoru; Yonemochi, Yasuhiro; Kosaka, Takayuki; Kouzaki, Yanosuke; Takita, Tomohiro; Tsuruta, Toshihisa

2013-01-01

To explore the opinions of outpatients concerning a new communication method: the self-management of assessed personal problems in health information records (SAPPHIRE) using patients' mobile phones to store and share medical content (medical SAPPHIRE, or m-SAPPHIRE). A cross-sectional questionnaire survey. Patients Outpatients who visited us from March 1 to May 30, 2012, were asked to complete a questionnaire survey regarding SAPPHIRE and m-SAPPHIRE. The m-SAPPHIRE data consisted of a problem list, height, weight, waist size and active medication list. Ten questions were asked regarding the usefulness of m-SAPPHIRE, the sharing of m-SAPPHIRE and the use of mobile phones to store m-SAPPHIRE data. One hundred and ninety-three patients (male/female, 79/114; mean age, 57±21 years) were registered: 95.9% answered that m-SAPPHIRE would be useful, 98% agreed to manage their personal health records by themselves, and 95.8%, 93.8%, and 92.8% of the patients responded that they would allow m-SAPPHIRE information to be shared with family members, medical workers, and health care providers, respectively. Of the patients, 75.1% responded that they owned a mobile phone, and 43.5% answered that they could enter m-SAPPHIRE information into a mobile phone by themselves, while 27.5% responded that they could do so with someone's help. Patients believe that m-SAPPHIRE would be useful for retrieving their health records during emergency situations or for sharing with family members and medical and health care providers. SAPPHIRE using mobile phones could be an inexpensive and legal method for sharing medical data.

The MEDIGATE graphical user interface for entry of physical findings: design principles and implementation. Medical Examination Direct Iconic and Graphic Augmented Text Entry System.

PubMed

Yoder, J W; Schultz, D F; Williams, B T

1998-10-01

The solution to many of the problems of the computer-based recording of the medical record has been elusive, largely due to difficulties in the capture of those data elements that comprise the records of the Present Illness and of the Physical Findings. Reliable input of data has proven to be more complex than originally envisioned by early work in the field. This has led to more research and development into better data collection protocols and easy to use human-computer interfaces as support tools. The Medical Examination Direct Iconic and Graphic Augmented Text Entry System (MEDIGATE System) is a computer enhanced interactive graphic and textual record of the findings from physical examinations designed to provide ease of user input and to support organization and processing of the data characterizing these findings. The primary design objective of the MEDIGATE System is to develop and evaluate different interface designs for recording observations from the physical examination in an attempt to overcome some of the deficiencies in this major component of the individual record of health and illness.

An observation tool for instructor and student behaviors to measure in-class learner engagement: a validation study

PubMed Central

Alimoglu, Mustafa K.; Sarac, Didar B.; Alparslan, Derya; Karakas, Ayse A.; Altintas, Levent

2014-01-01

Background Efforts are made to enhance in-class learner engagement because it stimulates and enhances learning. However, it is not easy to quantify learner engagement. This study aimed to develop and validate an observation tool for instructor and student behaviors to determine and compare in-class learner engagement levels in four different class types delivered by the same instructor. Methods Observer pairs observed instructor and student behaviors during lectures in large class (LLC, n=2) with third-year medical students, lectures in small class (LSC, n=6) and case-based teaching sessions (CBT, n=4) with fifth-year students, and problem-based learning (PBL) sessions (~7 hours) with second-year students. The observation tool was a revised form of STROBE, an instrument for recording behaviors of an instructor and four randomly selected students as snapshots for 5-min cycles. Instructor and student behaviors were scored 1–5 on this tool named ‘in-class engagement measure (IEM)’. The IEM scores were parallel to the degree of behavior's contribution to active student engagement, so higher scores were associated with more in-class learner engagement. Additionally, the number of questions asked by the instructor and students were recorded. A total of 203 5-min observations were performed (LLC 20, LSC 85, CBT 50, and PBL 48). Results Interobserver agreement on instructor and student behaviors was 93.7% (κ=0.87) and 80.6% (κ=0.71), respectively. Higher median IEM scores were found in student-centered and problem-oriented methods such as CBT and PBL. A moderate correlation was found between instructor and student behaviors (r=0.689). Conclusions This study provides some evidence for validity of the IEM scores as a measure of student engagement in different class types. PMID:25308966

Musculoskeletal Injuries and Training Patterns in Junior Elite Orienteering Athletes

PubMed Central

Taube, Wolfgang; Zuest, Peter; Clénin, German; Wyss, Thomas

2015-01-01

Findings about the relation between musculoskeletal injuries and training patterns in orienteering athletes are sparse. Therefore, the musculoskeletal injuries and training patterns of 31 Swiss elite orienteering athletes aged 18-19 years were analyzed in a retrospective study. Individual training diaries and medical records were used to assess training data and injury history, respectively. Group comparisons and a multiple linear regression (MLR) were performed for statistical analysis. The junior elite orienteering athletes performed 7.38 ± 2.00 training sessions weekly, with a total duration of 455.75 ± 98.22 minutes. An injury incidence rate (IIR) of 2.18 ± 2.13 injuries per 1000 hours of training was observed. The lower extremity was affected in 93% of all injuries, and the knee (33%) was the most commonly injured location. The MLR revealed that gender and six training variables explained 60% of the variance in the injury severity index in this study. Supported by the low IIR in the observed age group, the training protocol of the junior elite orienteering athletes was generally adequate. In comparison to elite track, marathon, and orienteering athletes, the junior elite athletes performed less high-intensity interval training (HIIT). However, more frequent HIIT seems to be a protective factor against injuries. PMID:26258134

Can we still stop the migration of physicians from Austria? : An evaluation of clinical internships by students of the Medical University of Vienna.

PubMed

Seitz, Tamara; Turk, Bela R; Löffler-Stastka, Henriette

2017-01-01

The increasing emigration of graduates of the Medical University of Vienna presents a serious problem. This study examined students' evaluation of clinical rotations, their self-rated performance, and where they felt the most deficits exist. Medical students answered an online questionnaire surveying the following aspects: an evaluation of their internship; supervision; integration in the team and improvement of field-specific knowledge; the qualities of taking a patient's medical history by empathy; patient-centeredness; structure; target orientation; and the ability to integrate field-specific knowledge into anamnesis. The data collected indicate that rotations in Austria, especially in Vienna, were evaluated significantly worse than those abroad. Particularly the lack of supervision and integration in the team were criticized. These data stress a dire need for the reform of curricular structures during clinical rotation in the latter years of medical education.

Orienting to Medicine: Scripting Professionalism, Hierarchy, and Social Difference at the Start of Medical School.

PubMed

Craig, Sienna R; Scott, Rebekah; Blackwood, Kristy

2018-04-23

Nascent medical students' first view into medical school orients them toward what is considered important in medicine. Based on ethnography conducted over 18 months at a New England medical school, this article explores themes which emerged during a first-year student orientation and examines how these scripts resurface across a four-year curriculum, revealing dynamics of enculturation into an institution and the broader profession. We analyze orientation activities as discursive and embodied fields which serve "practical" purposes of making new social geographies familiar, but which also frame institutional values surrounding "soft" aspects of medicine: professionalism; dynamics of hierarchy and vulnerability; and social difference. By examining orientation and connecting these insights to later, discerning educational moments, we argue that orientation reveals tensions between the overt and hidden curricula within medical education, including what being a good doctor means. Our findings are based on data from semi-structured interviews, focus groups, and participant-observation in didactic and clinical settings. This article answers calls within medical anthropology and medical education literature to recognize implicit values at play in producing physicians, unearthing ethnographically how these values are learned longitudinally via persisting gaps between formal and hidden curricula. Assumptions hidden in plain sight call for ongoing medical education reform.

The standard data model approach to patient record transfer.

PubMed Central

Canfield, K.; Silva, M.; Petrucci, K.

1994-01-01

This paper develops an approach to electronic data exchange of patient records from Ambulatory Encounter Systems (AESs). This approach assumes that the AES is based upon a standard data model. The data modeling standard used here is IDEFIX for Entity/Relationship (E/R) modeling. Each site that uses a relational database implementation of this standard data model (or a subset of it) can exchange very detailed patient data with other such sites using industry standard tools and without excessive programming efforts. This design is detailed below for a demonstration project between the research-oriented geriatric clinic at the Baltimore Veterans Affairs Medical Center (BVAMC) and the Laboratory for Healthcare Informatics (LHI) at the University of Maryland. PMID:7949973

Adverse events attributed to traditional Korean medical practices: 1999–2010

PubMed Central

Shin, Hyeun-Kyoo; Jeong, Soo-Jin; Ernst, Edzard

2013-01-01

Abstract Objective To investigate adverse events attributed to traditional medical treatments in the Republic of Korea. Methods Adverse events recorded in the Republic of Korea between 1999 and 2010 – by the Food and Drug Administration, the Consumer Agency or the Association of Traditional Korean Medicine – were reviewed. Records of adverse events attributed to the use of traditional medical practices, including reports of medicinal accidents and consumers’ complaints, were investigated. Findings Overall, 9624 records of adverse events attributed to traditional medical practices – including 522 linked to herbal treatments – were identified. Liver problems were the most frequently reported adverse events. Only eight of the adverse events were recorded by the pharmacovigilance system run by the Food and Drug Administration. Of the 9624 events, 1389 – mostly infections, cases of pneumothorax and burns – were linked to physical therapy (n = 285) or acupuncture/moxibustion (n = 1104). Conclusion In the Republic of Korea, traditional medical practices often appear to have adverse effects, yet almost all of the adverse events attributed to such practices between 1999 and 2010 were missed by the national pharmacovigilance system. The Consumer Agency and the Association of Traditional Korean Medicine should be included in the national pharmacovigilance system. PMID:23940404

User-oriented evaluation of a medical image retrieval system for radiologists.

PubMed

Markonis, Dimitrios; Holzer, Markus; Baroz, Frederic; De Castaneda, Rafael Luis Ruiz; Boyer, Célia; Langs, Georg; Müller, Henning

2015-10-01

This article reports the user-oriented evaluation of a text- and content-based medical image retrieval system. User tests with radiologists using a search system for images in the medical literature are presented. The goal of the tests is to assess the usability of the system, identify system and interface aspects that need improvement and useful additions. Another objective is to investigate the system's added value to radiology information retrieval. The study provides an insight into required specifications and potential shortcomings of medical image retrieval systems through a concrete methodology for conducting user tests. User tests with a working image retrieval system of images from the biomedical literature were performed in an iterative manner, where each iteration had the participants perform radiology information seeking tasks and then refining the system as well as the user study design itself. During these tasks the interaction of the users with the system was monitored, usability aspects were measured, retrieval success rates recorded and feedback was collected through survey forms. In total, 16 radiologists participated in the user tests. The success rates in finding relevant information were on average 87% and 78% for image and case retrieval tasks, respectively. The average time for a successful search was below 3 min in both cases. Users felt quickly comfortable with the novel techniques and tools (after 5 to 15 min), such as content-based image retrieval and relevance feedback. User satisfaction measures show a very positive attitude toward the system's functionalities while the user feedback helped identifying the system's weak points. The participants proposed several potentially useful new functionalities, such as filtering by imaging modality and search for articles using image examples. The iterative character of the evaluation helped to obtain diverse and detailed feedback on all system aspects. Radiologists are quickly familiar with the functionalities but have several comments on desired functionalities. The analysis of the results can potentially assist system refinement for future medical information retrieval systems. Moreover, the methodology presented as well as the discussion on the limitations and challenges of such studies can be useful for user-oriented medical image retrieval evaluation, as user-oriented evaluation of interactive system is still only rarely performed. Such interactive evaluations can be limited in effort if done iteratively and can give many insights for developing better systems. Copyright © 2015. Published by Elsevier Ireland Ltd.

Which students will choose a career in psychiatry?

PubMed

Gowans, Margot C; Wright, Bruce J; Brenneis, Fraser R; Scott, Ian M

2011-10-01

In Canada, availability of and access to mental health professionals is limited. Only 6.6% of practising physicians are psychiatrists, a situation unlikely to improve in the foreseeable future. Identifying student characteristics present at medical school entry that predict a subsequent psychiatry residency choice could allow targeted recruiting or support to students early on in their careers, in turn creating a supply of psychiatry-oriented residency applicants. Between 2002 and 2004, data were collected from students in 15 Canadian medical school classes within 2 weeks of commencement of their medical studies. Surveys included questions on career preferences, attitudes, and demographics. Students were followed through to graduation and entry data linked anonymously with residency choice data. Logistic regression was used to identify early predictors of a psychiatry residency choice. Students (n = 1502) (77.4% of those eligible) contributed to the final analysis, with 5.3% naming psychiatry as their preferred residency career. When stated career interest in psychiatry at medical school entry was not included in a regression model, an exit career choice in psychiatry was predicted by a student's desire for prestige, lesser interest in medical compared with social problems, low hospital orientation, and not volunteering in sports. When an entry career interest in psychiatry was included in the model, this variable became the only predictor of an exit career choice in psychiatry. While experience and attitudes at medical school entry can predict whether students will chose a psychiatry career, the strongest predictor is an early career interest in psychiatry.

Problem-Oriented Learning in Geography Education: Construction of Motivating Problems

ERIC Educational Resources Information Center

Weiss, Günther

2017-01-01

This article reports on the possibilities and challenges of starting problem-oriented learning in geography lessons. The article focuses on the features of motivating problems, because one of the essential functions of the problem to start with is to animate learners to solve it. The analysis of various introductions to problem-oriented learning…

Optical monitoring of scoliosis by 3D medical laser scanner

NASA Astrophysics Data System (ADS)

Rodríguez-Quiñonez, Julio C.; Sergiyenko, Oleg Yu.; Preciado, Luis C. Basaca; Tyrsa, Vera V.; Gurko, Alexander G.; Podrygalo, Mikhail A.; Lopez, Moises Rivas; Balbuena, Daniel Hernandez

2014-03-01

Three dimensional recording of the human body surface or anatomical areas have gained importance in many medical applications. In this paper, our 3D Medical Laser Scanner is presented. It is based on the novel principle of dynamic triangulation. We analyze the method of operation, medical applications, orthopedically diseases as Scoliosis and the most common types of skin to employ the system the most proper way. It is analyzed a group of medical problems related to the application of optical scanning in optimal way. Finally, experiments are conducted to verify the performance of the proposed system and its method uncertainty.

[Medicine and orientalism in the late nineteenth century Korea].

PubMed

Lee, Jong-Chan

2002-06-01

The paper investigates medical missionaries that exerted a significant role in establishing Western medicine in the late nineteenth century Chosun, in relation to orientalism, an academically popularized concept introduced by Edward Said. Historical analysis is focused on several important medical missionaries such as Horace N. Allen, William B. Scranton, John W. Heron, C. C. Vinton, and Oliver R. Avison to explain how their activism as medical missionary contributed to the formation of medical orientalism in which Western medicine was 'taught, studied, administered, and judged' in that period. In addition, I explore into how medical orientalism was in service of Japanese imperialism by showing that medical missionaries had to be under imperial surveillance by Japanese colonizers. The article explores the medical system of the Koryo Dynasty period and its social characteristics. First, the structure of medical system and roles of medical institutions during the Koryo Dynasty period will be summarized. Then the characteristics of the medical system will be identified through exploring the principles of its formation in a view of social recognition of medical care and a view of social recognition of medical care and a view of public policy.

Designing an algorithm to preserve privacy for medical record linkage with error-prone data.

PubMed

Pal, Doyel; Chen, Tingting; Zhong, Sheng; Khethavath, Praveen

2014-01-20

Linking medical records across different medical service providers is important to the enhancement of health care quality and public health surveillance. In records linkage, protecting the patients' privacy is a primary requirement. In real-world health care databases, records may well contain errors due to various reasons such as typos. Linking the error-prone data and preserving data privacy at the same time are very difficult. Existing privacy preserving solutions for this problem are only restricted to textual data. To enable different medical service providers to link their error-prone data in a private way, our aim was to provide a holistic solution by designing and developing a medical record linkage system for medical service providers. To initiate a record linkage, one provider selects one of its collaborators in the Connection Management Module, chooses some attributes of the database to be matched, and establishes the connection with the collaborator after the negotiation. In the Data Matching Module, for error-free data, our solution offered two different choices for cryptographic schemes. For error-prone numerical data, we proposed a newly designed privacy preserving linking algorithm named the Error-Tolerant Linking Algorithm, that allows the error-prone data to be correctly matched if the distance between the two records is below a threshold. We designed and developed a comprehensive and user-friendly software system that provides privacy preserving record linkage functions for medical service providers, which meets the regulation of Health Insurance Portability and Accountability Act. It does not require a third party and it is secure in that neither entity can learn the records in the other's database. Moreover, our novel Error-Tolerant Linking Algorithm implemented in this software can work well with error-prone numerical data. We theoretically proved the correctness and security of our Error-Tolerant Linking Algorithm. We have also fully implemented the software. The experimental results showed that it is reliable and efficient. The design of our software is open so that the existing textual matching methods can be easily integrated into the system. Designing algorithms to enable medical records linkage for error-prone numerical data and protect data privacy at the same time is difficult. Our proposed solution does not need a trusted third party and is secure in that in the linking process, neither entity can learn the records in the other's database.

Mental health problems of undocumented migrants in the Netherlands: A qualitative exploration of recognition, recording, and treatment by general practitioners.

PubMed

Teunissen, Erik; Van Bavel, Eric; Van Den Driessen Mareeuw, Francine; Macfarlane, Anne; Van Weel-Baumgarten, Evelyn; Van Den Muijsenbergh, Maria; Van Weel, Chris

2015-06-01

To explore the views and experiences of general practitioners (GPs) in relation to recognition, recording, and treatment of mental health problems of undocumented migrants (UMs), and to gain insight in the reasons for under-registration of mental health problems in the electronic medical records. Qualitative study design with semi-structured interviews using a topic guide. Sixteen GPs in the Netherlands with clinical expertise in the care of UMs. GPs recognized many mental health problems in UMs. Barriers that prevented them from recording these problems and from delivering appropriate care were their low consultation rates, physical presentation of mental health problems, high number of other problems, the UM's lack of trust towards health care professionals, and cultural differences in health beliefs and language barriers. Referrals to mental health care organizations were often seen as problematic by GPs. To overcome these barriers, GPs provided personalized care as far as possible, referred to other primary care professionals such as social workers or mental health care nurses in their practice, and were a little less restrictive in prescribing psychotropics than guidelines recommended. GPs experienced a variety of barriers in engaging with UMs when identifying or suspecting mental health problems. This explains why there is a gap between the high recognition of mental health problems and the low recording of these problems in general practice files. It is recommended that GPs address mental health problems more actively, strive for continuity of care in order to gain trust of the UMs, and look for opportunities to provide mental care that is accessible and acceptable for UMs.

Physicians who keep lax records put careers in danger, college course warns.

PubMed Central

Kramer, D

1996-01-01

During a recent workshop sponsored by the College of Physicians and Surgeons of Ontario, Dr. Paul Caulford identified the most common problems with medical records: they are much too brief, don't tell the patient's story and are missing important details. He warned that physicians must pay more attention to their records because "the way things are moving, the scrutiny of records in the past in nothing in comparison to what it will be like in the future." Images p1470-a PMID:8943936

Ambulatory cardiology network in Greece: Clinical and therapeutic implications in the outpatient setting. The TEVE-SSF study.

PubMed

Panagiotopoulos, Konstantinos E; Panagiotopoulou, Eleni E; Katsaros, Konstantinos; Noikokirakis, Georgios; Mpouziou, Maria; Stamelou, Angeliki; Toumanidis, Savvas

2016-11-15

Community based registries are particularly valuable tools to Preventive Cardiology as they summarize epidemiological data of ischemic heart disease risk factors, medications and lifestyle characteristics. We enrolled 1191 patients, from an outpatient community based cardiology network, dedicated to cover medically, office based professionals. We recorded demographic and lifestyle characteristics, risk factors for ischemic heart disease, all clinical entities diagnosed and therapies which were prescribed for hypertension and lipid disorders specifically. Our population consisted of 659 males (55%) and 532 females (45%), (mean age 46±14). A sedentary lifestyle was almost universal (92%), followed by smoking (44%) and overweight body composition (38%). Unhealthy lifestyle increased significantly during the third decade of life, while multimorbidity ascended during the fifth. Cardiovascular morbidity was present in 611 patients (51%), while 289 patients (24%) were found negative for cardiovascular disease and positive for a different system diagnosis. Lipid disorders (32%) and hypertension (31%) were the most frequent cardiovascular entities. β-Blockers and statins were the most frequently prescribed medications for hypertension and lipid disorders respectively. Cardiovascular morbidity was frequent in this ambulatory middle aged population, whereas multimorbidity (mainly from gastrointestinal and endocrine system) was a significant coexisting problem, even for a cardiology oriented outpatient population. Unhealthy lifestyle is of major importance because it was present in the majority of our patients early in their life and because it was statistically related to hyperlipidemia and hypertension. Preventive Cardiology must introduce special interventions to deescalate the presence of unhealthy lifestyle in young populations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The evolution of medical informatics in China: A retrospective study and lessons learned.

PubMed

Lei, Jianbo; Meng, Qun; Li, Yuefeng; Liang, Minghui; Zheng, Kai

2016-08-01

In contrast to China's giant health information technology (HIT) market and tremendous investments in hospital information systems the contributions of Chinese scholars in medical informatics to the global community are very limited. China would like to have a more important position in the global medical informatics community. A better understanding of the differences between medical informatics research and education in China and the discipline that emerged abroad will better inform Chinese scholars to develop right strategies to advance the field in China and help identify an appropriate means to collaborate more closely with medical informatics scholars globally. For the first time, this paper divides the evolution of medical informatics in China into four stages based on changes in the core content of research, the educational orientation and other developmental characteristics. The four stages are infancy, incubation, primary establishment and formal establishment. This paper summarizes and reviews major supporting journals and publications, as well as major organizations. Finally, we analyze the main problems that exist in the current disciplinary development in China related to medical informatics research and education and offer suggestions for future improvement. The evolution of medical informatics shows a strong and traditional concentration on medical library/bibliographic information rather than medical (hospital information or patient information) information. Misdirected-concentration, a lack of formal medical informatics trained teaching staff and mistakenly positioning medical informatics as an undergraduate discipline are some of the problems inhibiting the development of medical informatics in China. These lessons should be shared and learned for the global community. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Future orientation, impulsivity, and problem behaviors: a longitudinal moderation model.

PubMed

Chen, Pan; Vazsonyi, Alexander T

2011-11-01

In the current study, based on a sample of 1,873 adolescents between 11.4 and 20.9 years of age from the first 3 waves of the National Longitudinal Study of Adolescent Health, we investigated the longitudinal effects of future orientation on levels of and developmental changes in problem behaviors, while controlling for the effects by impulsivity; we also tested the moderating effects by future orientation on the impulsivity-problem behaviors link over time. Additionally, we examined future orientation operationalized by items measuring education, marriage, and life domains. Findings based on growth curve analyses provided evidence of longitudinal effects by education and life future orientation on both levels of and developmental changes in problem behaviors; the effect of marriage future orientation was not significant for either test. In addition, only life future orientation moderated the effect by impulsivity on levels of problem behaviors over time. More specifically, impulsivity had a weaker effect on levels of problem behaviors over time for adolescents who reported higher levels of life future orientation.

'What is not written does not exist': the importance of proper documentation of medication use history.

PubMed

Silvestre, Carina Carvalho; Santos, Lincoln Marques Cavalcante; de Oliveira-Filho, Alfredo Dias; de Lyra, Divaldo Pereira

2017-10-01

Medications are perceived as health risk factors, because they might cause damage if used improperly. In this context, an adequate assessment of medication use history should be encouraged, especially in transitions of care to avoid unintended medication discrepancies (UMDs). In a case-controlled study, we investigated potential risk factors for UMDs at hospital admission and found that 150 (42%) of the 358 patients evaluated had one or more UMDs. We were surprised to find that there was no record of a patient and/or relative interview on previous use of medication in 117 medical charts of adult patients (44.8%). Similarly, in the medical charts of 52 (53.6%) paediatric patients, there was no record of parents and/or relatives interviews about prior use of medications. One hundred thirty-seven medical charts of adult patients (52.4%) and seventy-two medical charts of paediatric patients (74.2%) had no record about medication allergies and intolerances. In other words, there was a lack of basic documentation regarding the patient's medication use history. As patients move between settings in care, there is insufficient tracking of verbal and written information related to medication changes, which results in a progressive and cumulative loss of information, as evidenced by problems associated with clinical transfers and medication orders. Proper documentation of medication information during transfer is a key step in the procedure; hence, it should be rightly performed. It remains unclear whether interviews, and other investigations about medication use history have been performed but have not been recorded as health-care data. Therefore, it is crucial to the improvement of medication use safety that documentation of all drug-related information-even if not directly related to the actual event-become routine practice in health-care organizations, since 'what is not written does not exist'.

Building a national electronic medical record exchange system - experiences in Taiwan.

PubMed

Li, Yu-Chuan Jack; Yen, Ju-Chuan; Chiu, Wen-Ta; Jian, Wen-Shan; Syed-Abdul, Shabbir; Hsu, Min-Huei

2015-08-01

There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care. In November 2009, Taiwan's Executive Yuan passed the 'Plan for accelerating the implementation of electronic medical record systems in medical institutions' (2010-2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document Architecture (CDA) standards to generate clinical documents and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS) profile for the communication infrastructure. By December of 2014, the number of hospitals that provide an inter-institution EMR exchange service had reached 321. Hospitals that had not joined the service were all smaller ones with less than 100 beds. Inter-institution EMR exchange can make it much easier for people to access their own medical records, reduce the waste of medical resources, and improve the quality of medical care. The implementation of an inter-institution EMR exchange system faces many challenges. This article provides Taiwan's experiences as a reference. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Quality improvement in breast cancer project: compliance with antiresorptive agents and changing patterns of drug use.

PubMed

Borden, Charles P; Shapiro, Charles L; Ramirez, Maria Teresa; Kotur, Linda; Farrar, William

2014-02-01

The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute participated in NCCN's Quality Improvement in Breast Cancer initiative. The Opportunities for Improvement (OFI) team elected to improve concordance with the NCCN Clinical Practice Guidelines in Oncology for Breast Cancer recommendation that all patients diagnosed with skeletal metastases receive bisphosphonates. Assembling a multidisciplinary team of clinicians, researchers, and administrative stakeholders, the OFI team followed Six Sigma's approach to problem-solving known as DMAIC (define, measure, analyze, improve, and control). Baseline concordance was 79%, which was below the recommended target range. Initial analysis quickly revealed that 5 cases were concordant, resulting in a new baseline of 89%. The key root cause identified for the remaining gap was lack of documentation. The solution included education regarding documentation for existing staff, in addition to hard-wiring the material into new physician orientation, discussion of all patients with bone disease at tumor board meetings, and improved consistency with use of the new electronic medical record system. After implementation, the reported concordance was 92%, and the lack of documentation problem decreased from 11% in the baseline study to 6%. The team concluded that use of the NCCN Oncology Outcomes Database as an opportunity for clinical quality improvement initiatives not only is possible but also should be an essential element of any clinical program looking to continuously improve.

Illness, the problem of evil, and the analogical structure of healing: on the difference Christianity makes in bioethics.

PubMed

Khushf, George

1995-03-01

A Christian bioethic needs to place the medical approach to sickness, suffering, and death within the context of redemption and the renewal of humanity in the image of God. This can be done by accounting for the way in which the disruptions of the human life-world that attend the illness experience manifest the structure of the problem of evil and point toward an answer that transcends the individual and the medical community. Further, the disease-oriented approach to medicine, when understood in the context of the analogia entis, can be taken as an analogy for a deeper spiritual healing, and can thus become a vehicle through which one can minister to the disruptions of a patient's life-world. An appreciation of the analogical structure of healing provides the basis for a Christian ethic of care.

Individualizing the Orientation Process for Newly Hired CRNAs in a Large Academic Medical Center

ERIC Educational Resources Information Center

Gorman, Katherine

2017-01-01

Purpose: The purpose of this scholarly project was to investigate whether an individualized clinical orientation would result in a shortened time to orient and integrate Certified Registered Nurse Anesthetists (CRNAs) into practice in a large academic medical center. By individualizing the orientation process, this project seeks to determine if…

Methods for Cataloguing, Storing, and Retrieving Large Volumes of Tape-Recorded Conversations. Working Papers in Sociolinguistics, No. 32.

ERIC Educational Resources Information Center

Skopek, Lucienne; And Others

A major problem in doing linguistic research from tape-recorded material is finding specific tape content for later, detailed analysis of data. A project on use of language in medicine being carried out at the Cornell University Medical College has developed a method of cataloguing taped material that eliminates the need for transcriptions and…

Approach to Anemia in Hospitalized Patients with Infectious Diseases; Is it Appropriate?

PubMed

Entezari-Maleki, Taher; Khalili, Hossein; Karimzadeh, Iman; Jafari, Sirous

2015-01-01

Anemia of chronic diseases (ACD) is a common problem in patients with infectious diseases and can influence the quality of life and patients' survival. Despite the clinical importance of ACD, data are still lacking regarding this problem in the infectious diseases. This study aimed to evaluate the prevalence, related factors, outcome and approaches to anemia in the infectious diseases ward. This retrospective study was performed to review the medical records of patients admitted to the infectious diseases department of Imam Khomeini hospital during a two-year period between 2009 and 2011. A standard protocol was developed to evaluate anemia. Patients' demographic data approaches to manage anemia and routine laboratory tests were recorded and compared with the protocol. Totally, 1,120 medical records were reviewed. ACD was recognized in 705 patients (63%). Only 5.1% of diagnostic and 8.7% of treatment approaches was based on the protocol. The majority of patients (89.4%) were received inappropriate treatment regarding. Mortality rate of patients with ACD was 3.4%. Moreover, a significant correlation between anemia and mortality was detected (r = 0.131; p = 0.026). A statistically significant correlation was also identified between patients' Hgb and ESR, CRP, reasons of admission, number of medications, and underlying diseases. In conclusion, results of this study suggested that ACD is a common problem in infectious diseases patients and significantly associated with patients' mortality. Moreover, the majority of studied patients were not received an appropriate diagnostic and treatment approach which arises more concerns regarding the management of ACD in infectious diseases setting.

Development and implementation of a 'Mental Health Finder' software tool within an electronic medical record system.

PubMed

Swan, D; Hannigan, A; Higgins, S; McDonnell, R; Meagher, D; Cullen, W

2017-02-01

In Ireland, as in many other healthcare systems, mental health service provision is being reconfigured with a move toward more care in the community, and particularly primary care. Recording and surveillance systems for mental health information and activities in primary care are needed for service planning and quality improvement. We describe the development and initial implementation of a software tool ('mental health finder') within a widely used primary care electronic medical record system (EMR) in Ireland to enable large-scale data collection on the epidemiology and management of mental health and substance use problems among patients attending general practice. In collaboration with the Irish Primary Care Research Network (IPCRN), we developed the 'Mental Health Finder' as a software plug-in to a commonly used primary care EMR system to facilitate data collection on mental health diagnoses and pharmacological treatments among patients. The finder searches for and identifies patients based on diagnostic coding and/or prescribed medicines. It was initially implemented among a convenience sample of six GP practices. Prevalence of mental health and substance use problems across the six practices, as identified by the finder, was 9.4% (range 6.9-12.7%). 61.9% of identified patients were female; 25.8% were private patients. One-third (33.4%) of identified patients were prescribed more than one class of psychotropic medication. Of the patients identified by the finder, 89.9% were identifiable via prescribing data, 23.7% via diagnostic coding. The finder is a feasible and promising methodology for large-scale data collection on mental health problems in primary care.

Creating a palliative and end-of-life program in a cure-oriented pediatric setting: the zig-zag method.

PubMed

Harper, Joann; Hinds, Pamela S; Baker, Justin N; Hicks, Judy; Spunt, Sheri L; Razzouk, Bassem I

2007-01-01

Children living with and dying of advanced-stage cancer suffer physically, emotionally, and spiritually. Relief of their suffering requires comprehensive, compassionate palliative and end-of-life (EoL) care.However, an EoL care program might appear inconsistent with the mission of a pediatric oncology research center committed to seeking cures. Here the authors describe the methods used to achieve full institutional commitment to their EoL care program and those used to build the program's philosophical, research, and educational foundations after they received approval. The authors convened 10 focus groups to solicit staff perceptions of the hospital's current palliative and EoL care. They also completed baseline medical record reviews of 145 patient records to identify key EoL characteristics. The authors then crafted a vision statement and a strategic plan, implemented new research protocols,and established publication and funding trajectories. They conclude that establishing a state-of-the-art palliative and EoL program in a cure-oriented pediatric setting is achievable via consensus building and recruitment of diverse institutional resources.

Striking trends in the incidence of health problems in The Netherlands (2002-05). Findings from a new strategy for surveillance in general practice.

PubMed

Biermans, Marion C J; Spreeuwenberg, Peter; Verheij, Robert A; de Bakker, Dinny H; de Vries Robbé, Pieter F; Zielhuis, Gerhard A

2009-06-01

This study aimed to detect striking trends based on a new strategy for monitoring public health. We used data over 4 years from electronic medical records of a large, nationally representative network of general practices. Episodes were either directly recorded by general practitioners (GPs) or were constructed using a new record linkage method (EPICON). The episodes were used to estimate raw morbidity rates for all codes of the International Classification of Primary Care (ICPC). Multilevel Poisson regression models were used to analyse the trend over time for 15 health problems that showed an obvious change over time. Based on these models, we calculated adjusted incidence rates corrected for clustering, sex and age. During 2002-05, both men and women increasingly consulted the GP because of concern about a drug reaction, a change in faeces/bowel movements and urination problems. Men showed an increase in consultations for prostate problems and venereal diseases. The incidence of chronic internal knee derangement decreased for both sexes. Women consulted their GP less frequently about sterilization and fear of being pregnant. The strategy developed proved to be useful to detect trends across a short period of time. Changes in the health care market, such as the increasing availability of over-the-counter drugs and various large advertising campaigns for medications may explain some of the findings. The increasing incidence of health problems in the urogenital area deserves attention as it could reflect increases in the incidence of sexually transmitted diseases (STDs) and urinary tract infections.

Semantic retrieval and navigation in clinical document collections.

PubMed

Kreuzthaler, Markus; Daumke, Philipp; Schulz, Stefan

2015-01-01

Patients with chronic diseases undergo numerous in- and outpatient treatment periods, and therefore many documents accumulate in their electronic records. We report on an on-going project focussing on the semantic enrichment of medical texts, in order to support recall-oriented navigation across a patient's complete documentation. A document pool of 1,696 de-identified discharge summaries was used for prototyping. A natural language processing toolset for document annotation (based on the text-mining framework UIMA) and indexing (Solr) was used to support a browser-based platform for document import, search and navigation. The integrated search engine combines free text and concept-based querying, supported by dynamically generated facets (diagnoses, procedures, medications, lab values, and body parts). The prototype demonstrates the feasibility of semantic document enrichment within document collections of a single patient. Originally conceived as an add-on for the clinical workplace, this technology could also be adapted to support personalised health record platforms, as well as cross-patient search for cohort building and other secondary use scenarios.

Patient-oriented education and medication management intervention for people with decompensated cirrhosis: study protocol for a randomized controlled trial.

PubMed

Hayward, Kelly L; Martin, Jennifer H; Cottrell, W Neil; Karmakar, Antara; Horsfall, Leigh U; Patel, Preya J; Smith, David D; Irvine, Katharine M; Powell, Elizabeth E; Valery, Patricia C

2017-07-20

People with decompensated cirrhosis require complex medical care and are often prescribed an intricate and frequently changing medication and lifestyle regimen. However, many patients mismanage their medications or have poor comprehension of their disease and self-management tasks. This can lead to harm, hospitalization, and death. A patient-oriented education and medication management intervention has been developed for implementation at a tertiary hospital hepatology outpatient center in Queensland, Australia. Consenting patients with decompensated cirrhosis will be randomly allocated to education intervention or usual care treatment arms when they attend routine follow-up appointments. In the usual care arm, participants will be reviewed by their hepatologist according to the current model of care in the hepatology clinic. In the intervention arm, participants will be reviewed by a clinical pharmacist to receive the education and medication management intervention at baseline in addition to review by their hepatologist. Intervention participants will also receive three further educational contacts from the clinical pharmacist within the following 6-month period, in addition to routine hepatologist review that is scheduled within this time frame. All participants will be surveyed at baseline and follow-up (approximately 6 months post-enrollment). Validated questionnaire tools will be used to determine participant adherence, medication beliefs, illness perceptions, and quality of life. Patients' knowledge of dietary and lifestyle modifications, their current medications, and other clinical data will be obtained from the survey, patient interview, and medical records. Patient outcome data will be collected at 52 weeks. The intervention described within this protocol is ready to adapt and implement in hepatology ambulatory care centers globally. Investigation of potentially modifiable variables that may impact medication management, in addition to the effect of a clinical pharmacist-driven education and medication management intervention on modifying these variables, will provide valuable information for future management of these patients. Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616000780459 . Registered on 15 June 2016.

The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members: Database Development and De-Identification.

PubMed

Erich, Roger; Eaton, Melinda; Mayes, Ryan; Pierce, Lamar; Knight, Andrew; Genovesi, Paul; Escobar, James; Mychalczuk, George; Selent, Monica

2016-08-01

Preparing data for medical research can be challenging, detail oriented, and time consuming. Transcription errors, missing or nonsensical data, and records not applicable to the study population may hamper progress and, if unaddressed, can lead to erroneous conclusions. In addition, study data may be housed in multiple disparate databases and complex formats. Merging methods may be incomplete to obtain temporally synchronized data elements. We created a comprehensive database to explore the general hypothesis that environmental and occupational factors influence health outcomes and risk-taking behavior among active duty Air Force personnel. Several databases containing demographics, medical records, health survey responses, and safety incident reports were cleaned, validated, and linked to form a comprehensive, relational database. The final step involved removing and transforming personally identifiable information to form a Health Insurance Portability and Accountability Act compliant limited database. Initial data consisted of over 62.8 million records containing 221 variables. When completed, approximately 23.9 million clean and valid records with 214 variables remained. With a clean, robust database, future analysis aims to identify high-risk career fields for targeted interventions or uncover potential protective factors in low-risk career fields. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Selection of medical students according to their moral orientation.

PubMed

Bore, Miles; Munro, Don; Kerridge, Ian; Powis, David

2005-03-01

Consideration has been given to the use of tests of moral reasoning in the selection procedure for medical students. We argue that moral orientation, rather than moral reasoning, might be more efficacious in minimising the likelihood of inappropriate ethical behaviour in medicine. A conceptualisation and measure of moral orientation are presented, together with findings from 11 samples of medical school applicants and students. To provide empirical evidence for the reliability and validity of a measure of moral orientation and to explore gender, age, cultural and educational influences on moral orientation. A questionnaire designed to measure a libertarian-dual-communitarian dimension of moral orientation was completed by 7864 medical school applicants and students in Australia, Israel, Fiji, New Zealand, Scotland and England and by 84 Australian psychology students between 1997 and 2001. Older respondents produced marginally higher (more communitarian) moral orientation scores, as did women compared to men. Minor but significant (P <0.05) cultural differences were found. The Israeli samples produced higher mean moral orientation scores, while the Australian psychology student sample produced a lower (more libertarian) mean score relative to all other samples. No significant change in moral orientation score was observed after 1 year in a sample of Australian medical school students (n=59), although some differences observed between 5 cohorts of Australian medical students (Years 1-5; n=234) did reach significance. Moral orientation scores were found to be significantly correlated with a number of personality measures, providing evidence of construct validity. In all samples moral orientation significantly predicted the moral decisions made in response to the hypothetical dilemmas embedded in the measurement instrument. Discussion The results provide support for the conceptualisation of a libertarian-dual-communitarian dimension of moral orientation and demonstrate the psychometric properties of the measurement instrument. A number of questions concerning the use of such tests in selection procedures are considered.

Max-margin weight learning for medical knowledge network.

PubMed

Jiang, Jingchi; Xie, Jing; Zhao, Chao; Su, Jia; Guan, Yi; Yu, Qiubin

2018-03-01

The application of medical knowledge strongly affects the performance of intelligent diagnosis, and method of learning the weights of medical knowledge plays a substantial role in probabilistic graphical models (PGMs). The purpose of this study is to investigate a discriminative weight-learning method based on a medical knowledge network (MKN). We propose a training model called the maximum margin medical knowledge network (M 3 KN), which is strictly derived for calculating the weight of medical knowledge. Using the definition of a reasonable margin, the weight learning can be transformed into a margin optimization problem. To solve the optimization problem, we adopt a sequential minimal optimization (SMO) algorithm and the clique property of a Markov network. Ultimately, M 3 KN not only incorporates the inference ability of PGMs but also deals with high-dimensional logic knowledge. The experimental results indicate that M 3 KN obtains a higher F-measure score than the maximum likelihood learning algorithm of MKN for both Chinese Electronic Medical Records (CEMRs) and Blood Examination Records (BERs). Furthermore, the proposed approach is obviously superior to some classical machine learning algorithms for medical diagnosis. To adequately manifest the importance of domain knowledge, we numerically verify that the diagnostic accuracy of M 3 KN is gradually improved as the number of learned CEMRs increase, which contain important medical knowledge. Our experimental results show that the proposed method performs reliably for learning the weights of medical knowledge. M 3 KN outperforms other existing methods by achieving an F-measure of 0.731 for CEMRs and 0.4538 for BERs. This further illustrates that M 3 KN can facilitate the investigations of intelligent healthcare. Copyright © 2018 Elsevier B.V. All rights reserved.

Open-source software platform for medical image segmentation applications

NASA Astrophysics Data System (ADS)

Namías, R.; D'Amato, J. P.; del Fresno, M.

2017-11-01

Segmenting 2D and 3D images is a crucial and challenging problem in medical image analysis. Although several image segmentation algorithms have been proposed for different applications, no universal method currently exists. Moreover, their use is usually limited when detection of complex and multiple adjacent objects of interest is needed. In addition, the continually increasing volumes of medical imaging scans require more efficient segmentation software design and highly usable applications. In this context, we present an extension of our previous segmentation framework which allows the combination of existing explicit deformable models in an efficient and transparent way, handling simultaneously different segmentation strategies and interacting with a graphic user interface (GUI). We present the object-oriented design and the general architecture which consist of two layers: the GUI at the top layer, and the processing core filters at the bottom layer. We apply the framework for segmenting different real-case medical image scenarios on public available datasets including bladder and prostate segmentation from 2D MRI, and heart segmentation in 3D CT. Our experiments on these concrete problems show that this framework facilitates complex and multi-object segmentation goals while providing a fast prototyping open-source segmentation tool.

Apollo experience report: Lunar module environmental control subsystem

NASA Technical Reports Server (NTRS)

Gillen, R. J.; Brady, J. C.; Collier, F.

1972-01-01

A functional description of the environmental control subsystem is presented. Development, tests, checkout, and flight experiences of the subsystem are discussed; and the design fabrication, and operational difficulties associated with the various components and subassemblies are recorded. Detailed information is related concerning design changes made to, and problems encountered with, the various elements of the subsystem, such as the thermal control water sublimator, the carbon dioxide sensing and control units, and the water section. The problems associated with water sterilization, water/glycol formulation, and materials compatibility are discussed. The corrective actions taken are described with the expection that this information may be of value for future subsystems. Although the main experiences described are problem oriented, the subsystem has generally performed satisfactorily in flight.

Recognition and treatment of psychological disorders during military service in the UK armed forces: a study of war pensioners.

PubMed

Brewin, Chris R; Andrews, Bernice; Hejdenberg, Jennie

2012-12-01

Little is known about the detection and treatment of psychological disorders arising during military service. We investigated whether personnel who developed disorders while serving in the UK armed forces came to the attention of medical services for these problems, received corresponding diagnoses, and were treated. For this retrospective record-based study 132 veterans in receipt of a war pension for psychological or physical problems received a lifetime diagnostic interview. Those with onsets of PTSD, depression, or alcohol abuse while in service were compared with those who never developed any condition or only developed it after discharge. Their medical records were inspected for contemporaneous contacts, diagnoses, and treatment. PTSD and depression, but not alcohol abuse, were independently associated with mental health contacts while in service. The median time from PTSD onset to first contact was 1 month. Under half of personnel meeting criteria for these disorders received a corresponding diagnosis, and alcohol abuse was more likely to be recognised in the context of comorbid PTSD. PTSD was as well recognised in earlier as in later years covered by the study. Most personnel with disorders received treatment, and those treated were more likely to be medically downgraded or discharged. War pensioners are more likely than not to have had their psychological problems acknowledged and treated while in service. The fact that these problems are still largely present 10 years later raises questions over the continuity of care associated with the transition to civilian life.

Framing effects in medical situations: distinctions of attribute, goal and risky choice frames.

PubMed

Peng, Jiaxi; Jiang, Yuan; Miao, Danmin; Li, Rui; Xiao, Wei

2013-06-01

To verify whether three different framing effects (risky choice, attribute and goal) exist in simulated medical situations and to analyse any differences. Medical decision-making problems were established, relating to medical skill evaluation, patient compliance and a selection of treatment options. All problems were described in positive and negative frame conditions. Significantly more positive evaluations were made if the doctor's medical records were described as 'of 100 patients, 70 patients became better' compared with those described as 'of 100 patients, 30 patients didn't become better'. Doctor's advice described in a negative frame resulted in significantly more decisions to comply, compared with advice described in a positive frame. Treatment options described in terms of survival rates resulted in significantly more adventurous choices compared with options described in terms of mortality rates. Decision-making reversal appeared in the risky choice and attribute frames, but not the goal frame. Framing effects were shown to exist in simulated medical situations, but there were significant differences among the three kinds of such effects.

A case for safety leadership team training of hospital managers.

PubMed

Singer, Sara J; Hayes, Jennifer; Cooper, Jeffrey B; Vogt, Jay W; Sales, Michael; Aristidou, Angela; Gray, Garry C; Kiang, Mathew V; Meyer, Gregg S

2011-01-01

Delivering safe patient care remains an elusive goal. Resolving problems in complex organizations like hospitals requires managers to work together. Safety leadership training that encourages managers to exercise learning-oriented, team-based leadership behaviors could promote systemic problem solving and enhance patient safety. Despite the need for such training, few programs teach multidisciplinary groups of managers about specific behaviors that can enhance their role as leadership teams in the realm of patient safety. The aims of this study were to describe a learning-oriented, team-based, safety leadership training program composed of reinforcing exercises and to provide evidence confirming the need for such training and demonstrating behavior change among management groups after training. Twelve groups of managers from an academic medical center based in the Northeast United States were randomly selected to participate in the program and exposed to its customized, experience-based, integrated, multimodal curriculum. We extracted data from transcripts of four training sessions over 15 months with groups of managers about the need for the training in these groups and change in participants' awareness, professional behaviors, and group activity. Training transcripts confirmed the need for safety leadership team training and provided evidence of the potential for training to increase targeted behaviors. The training increased awareness and use of leadership behaviors among many managers and led to new routines and coordinated effort among most management groups. Enhanced learning-oriented leadership often helped promote a learning orientation in managers' work areas. Team-based training that promotes specific learning-oriented leader behaviors can promote behavioral change among multidisciplinary groups of hospital managers.

The Role Of The Family Physician In Hospital

PubMed Central

Shea, P. E.; Johnston, M. A.; Premi, J. N.; Tweedie, T.

1980-01-01

Five family doctors at St. Joseph's Hospital in Hamilton, Ontario, completed a comprehensive survey of 88 active, associate and senior members of the Department of Family Medicine, detailing their activities in hospital, their attitudes toward the hospital, their actual and desired roles and their Department of Family Medicine. The study illustrates the changing role in hospital from procedure-orientation to patient advocate, and the resulting problems. These problems were mainly lack of communication skills and feeling impotent in dealing with the hospital power structure. Implications for family medicine training programs, continuing medical education programs and teaching and community hospitals are discussed in a series of four papers. PMID:21297840

A Neuro-Oncology Workstation for Structuring, Modeling, and Visualizing Patient Records

PubMed Central

Hsu, William; Arnold, Corey W.; Taira, Ricky K.

2016-01-01

The patient medical record contains a wealth of information consisting of prior observations, interpretations, and interventions that need to be interpreted and applied towards decisions regarding current patient care. Given the time constraints and the large—often extraneous—amount of data available, clinicians are tasked with the challenge of performing a comprehensive review of how a disease progresses in individual patients. To facilitate this process, we demonstrate a neuro-oncology workstation that assists in structuring and visualizing medical data to promote an evidence-based approach for understanding a patient’s record. The workstation consists of three components: 1) a structuring tool that incorporates natural language processing to assist with the extraction of problems, findings, and attributes for structuring observations, events, and inferences stated within medical reports; 2) a data modeling tool that provides a comprehensive and consistent representation of concepts for the disease-specific domain; and 3) a visual workbench for visualizing, navigating, and querying the structured data to enable retrieval of relevant portions of the patient record. We discuss this workstation in the context of reviewing cases of glioblastoma multiforme patients. PMID:27583308

A Neuro-Oncology Workstation for Structuring, Modeling, and Visualizing Patient Records.

PubMed

Hsu, William; Arnold, Corey W; Taira, Ricky K

2010-11-01

The patient medical record contains a wealth of information consisting of prior observations, interpretations, and interventions that need to be interpreted and applied towards decisions regarding current patient care. Given the time constraints and the large-often extraneous-amount of data available, clinicians are tasked with the challenge of performing a comprehensive review of how a disease progresses in individual patients. To facilitate this process, we demonstrate a neuro-oncology workstation that assists in structuring and visualizing medical data to promote an evidence-based approach for understanding a patient's record. The workstation consists of three components: 1) a structuring tool that incorporates natural language processing to assist with the extraction of problems, findings, and attributes for structuring observations, events, and inferences stated within medical reports; 2) a data modeling tool that provides a comprehensive and consistent representation of concepts for the disease-specific domain; and 3) a visual workbench for visualizing, navigating, and querying the structured data to enable retrieval of relevant portions of the patient record. We discuss this workstation in the context of reviewing cases of glioblastoma multiforme patients.

[Lower respiratory tract infections among the elderly in Finnøy municipality. A retrospective study of the incidence, treatment and outcome].

PubMed

Bråtveit, A; Malterud, K

1992-09-10

Based on a retrospective study of the case records of the primary health care services in a small Norwegian coastal community (Finnøy), we found an incidence of 13% for lower respiratory infections in persons aged 70 years or more. Most often the initial medication was penicillin. In 23% of recorded episodes, medication was changed, owing to unsatisfactory response. Overall mortality in the group was 9%. Three out of five deaths occurred in patients terminally ill from other diseases at the time the respiratory infection started. Problems related to diagnosis, management and prevention are discussed.

Task-based learning versus problem-oriented lecture in neurology continuing medical education.

PubMed

Vakani, Farhan; Jafri, Wasim; Ahmad, Amina; Sonawalla, Aziz; Sheerani, Mughis

2014-01-01

To determine whether general practitioners learned better with task-based learning or problem-oriented lecture in a Continuing Medical Education (CME) set-up. Quasi-experimental study. The Aga Khan University, Karachi campus, from April to June 2012. Fifty-nine physicians were given a choice to opt for either Task-based Learning (TBL) or Problem Oriented Lecture (PBL) in a continuing medical education set-up about headaches. The TBL group had 30 participants divided into 10 small groups, and were assigned case-based tasks. The lecture group had 29 participants. Both groups were given a pre and a post-test. Pre/post assessment was done using one-best MCQs. The reliability coefficient of scores for both the groups was estimated through Cronbach's alpha. An item analysis for difficulty and discriminatory indices was calculated for both the groups. Paired t-test was used to determine the difference between pre- and post-test scores of both groups. Independent t-test was used to compare the impact of the two teaching methods in terms of learning through scores produced by MCQ test. Cronbach's alpha was 0.672 for the lecture group and 0.881 for TBL group. Item analysis for difficulty (p) and discriminatory indexes (d) was obtained for both groups. The results for the lecture group showed pre-test (p) = 42% vs. post-test (p) = 43%; pre- test (d) = 0.60 vs. post-test (d) = 0.40. The TBL group showed pre -test (p) = 48% vs. post-test (p) = 70%; pre-test (d) = 0.69 vs. post-test (d) = 0.73. Lecture group pre-/post-test mean scores were (8.52 ± 2.95 vs. 12.41 ± 2.65; p < 0.001), where TBL group showed (9.70 ± 3.65 vs. 14 ± 3.99; p < 0.001). Independent t-test exhibited an insignificant difference at baseline (lecture 8.52 ± 2.95 vs. TBL 9.70 ± 3.65; p = 0.177). The post-scores were not statistically different lecture 12.41 ± 2.65 vs. TBL 14 ± 3.99; p = 0.07). Both delivery methods were found to be equally effective, showing statistically insignificant differences. However, TBL groups' post-test higher mean scores and radical increase in the post-test difficulty index demonstrated improved learning through TBL delivery and calls for further exploration of longitudinal studies in the context of CME.

Settings for learning: the community beyond.

PubMed

Okasha, A

1995-01-01

The primary objective of medical education to medical students should not be the recruitment of specialists or to provide instructions about highly sophisticated clinic medicine. Our responsibility towards them is rather to enable them to learn about medical practice in its most prevalent context, which is the community medical practice, and to contribute to their general medical education and the health welfare of their community. The health needed by the nation cannot possibly be provided by specialists. It is a task for all doctors. If we agree that the ultimate goal of medical education is to secure health and proper care (whether primary, secondary or tertiary) for the population, medical curricula and learning settings should be open for any modifications that ensure a proper approach to our patients' practicalities, resources and needs. A major modification involved in that process would be for the educational setting to move from the hospital into the community and doctors to acquire the skills and conviction of working as part of a health team, in which they are not necessarily the leaders. The main social target of the World Health Organization and its member states, and in fact the main goal of humanity, is 'Health for All by the year 2000' through primary health care (HFA/PHC). Health systems of countries will have to be reoriented, so that they are based on the PHC approach. Health personnel are needed to service those health systems which are relevant to the needs of HFA/PHC, and hence whose education should be relevant to this major goal. This does not mean that by the year 2000 doctors and nurses will provide medical care for everybody or that sickness and disability will be eradicated. It does mean, however, that health begins at home, in schools and in factories, and that health care services should be available in those places and should respond to the needs expressed in those places. It is there, where people live and work, that health is made or broken. It does mean that essential health should be accessible to all individuals and families in an acceptable and affordable way, and with their full involvement. Health personnel should be trained according to the plans of integrated health services and health manpower development (HSMD), with a view of placing at the disposal of the system the right kind of manpower, in the right numbers, at the right time, in the right place (WHO 1979, 1985, 1987). Graduates of programmes based on problem-based, community-oriented tracks as opposed to the traditional track should certainly be able to: respond to the health needs and expressed demands of the community, work with the community, stimulate healthy lifestyles and self-care, educate the community as well as their co-workers, solve and stimulate the resolve of both individual and community health problems, orient their own as well as community efforts to health promotion, prevent disease, unnecessary suffering, disability and death, work in and with health teams, if necessary provide leadership to such teams, continue learning lifelong so as to keep competence up to date, and improve this competence as much as possible (Fülöp 1990). A limited literature is available comparing innovative and conventional medical curricula, where the innovative one is based on problem-solving learning with a community-oriented track geared towards community needs (Schmidt 1983). This approach showed that the outcome is better, if directed towards the health needs of the community.

Improving Image Matching by Reducing Surface Reflections Using Polarising Filter Techniques

NASA Astrophysics Data System (ADS)

Conen, N.; Hastedt, H.; Kahmen, O.; Luhmann, T.

2018-05-01

In dense stereo matching applications surface reflections may lead to incorrect measurements and blunders in the resulting point cloud. To overcome the problem of disturbing reflexions polarising filters can be mounted on the camera lens and light source. Reflections in the images can be suppressed by crossing the polarising direction of the filters leading to homogeneous illuminated images and better matching results. However, the filter may influence the camera's orientation parameters as well as the measuring accuracy. To quantify these effects, a calibration and an accuracy analysis is conducted within a spatial test arrangement according to the German guideline VDI/VDE 2634.1 (2002) using a DSLR with and without polarising filter. In a second test, the interior orientation is analysed in more detail. The results do not show significant changes of the measuring accuracy in object space and only very small changes of the interior orientation (Δc ≤ 4 μm) with the polarising filter in use. Since in medical applications many tiny reflections are present and impede robust surface measurements, a prototypic trinocular endoscope is equipped with polarising technique. The interior and relative orientation is determined and analysed. The advantage of the polarising technique for medical image matching is shown in an experiment with a moistened pig kidney. The accuracy and completeness of the resulting point cloud can be improved clearly when using polarising filters. Furthermore, an accuracy analysis using a laser triangulation system is performed and the special reflection properties of metallic surfaces are presented.

Electronic Medical Records (EMRs), Epidemiology, and Epistemology: Reflections on EMRs and Future Pediatric Clinical Research

PubMed Central

Wasserman, Richard C.

2011-01-01

Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research. PMID:21622040

Occupational medical prophylaxis for the musculoskeletal system: A function-oriented system for physical examination of the locomotor system in occupational medicine (fokus(C)).

PubMed

Spallek, Michael; Kuhn, Walter; Schwarze, Sieglinde; Hartmann, Bernd

2007-10-29

Occupational physicians are very often confronted with questions as to the fitness of the postural and locomotor systems, especially the spinal column. Occupational medical assessment and advice can be required by patients with acute symptoms, at routine check-ups, by persons who have problems doing certain jobs, and for expert medical reports as to the fitness of persons with chronic disorders or after operations. Therefore, for occupational medical purposes a physical examination must aim primarily to investigate functions and not structures or radiologic evidence. The physical examination should be structured systematically and according to regions of the body and, together with a specific (pain) anamnesis should provide a basis for the medical assessment.This paper presents a function-oriented system for physical examination of the locomotor system, named fokus(C) (Funktionsorientierte Koerperliche Untersuchungssystematik, also available on DVD). fokus(C) has been developed with a view to its relevance for occupational medical practice and does not aim primarily to provide a precise diagnosis. Decisive for an occupational medical assessment of disorders of the musculoskeletal system is rather information about functional disorders and any impairment of performance or mobility which they can cause. The division of the physical examination into a rapid screening phase and a subsequent more intensive functional diagnostic phase has proved its practicability in many years of day-to-day use. Here, in contrast to the very extensive measures recommended for orthopaedic and manual diagnosis, for reasons of efficiency and usability of the system in routine occupational medical examinations the examination is structured according to the findings. So it is reduced to that which is most necessary and feasible.

A content analysis of parents' written communication of needs and expectations for emergency care of their children.

PubMed

Hoppa, Eric Christopher; Porter, Stephen C

2011-06-01

We investigated the potential value of information shared by parents on a written form designed to capture needs and expectations for care to an emergency department (ED) system that values patient-centeredness. We conducted a retrospective content analysis of parent-completed written forms collected during an improvement project focused on parent-provider communication in a pediatric ED. The primary outcome was potential value of the completed forms to a patient-centered ED system, defined as a form that was legible, included observations that mapped to medical problems, and included reasonable parental requests. We analyzed variation in potential value and other form attributes across a priori-defined visit type and acuity. Visit type was validated by a separate, blinded medical record review. A random stratified sample of 1008 forms was established from 6937 parent-completed forms collected during the 6-month improvement project; 995 of 1008 forms had matching medical records; 922 (92.7%) of 995 forms demonstrated potential value; 990 (99.5%) of 995 forms were legible; 948 (95.3%) of 995 forms included observations that mapped to a medical problem, and 599 (93.3%) of 642 forms contained reasonable parental requests. There was good agreement between the form and medical record for visit type (κ = 0.62). The potential value of forms did not vary significantly across visit type (88.2%-92.8%) or acuity (88.9%-93.4%). Information shared by parents on written forms designed to capture needs and expectations provides potential value to a patient-centered ED system. The high level of informational value is consistent across patient type and acuity level.

Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports.

PubMed

Magrabi, Farah; Liaw, Siaw Teng; Arachi, Diana; Runciman, William; Coiera, Enrico; Kidd, Michael R

2016-11-01

To identify the categories of problems with information technology (IT), which affect patient safety in general practice. General practitioners (GPs) reported incidents online or by telephone between May 2012 and November 2013. Incidents were reviewed against an existing classification for problems associated with IT and the clinical process impacted. 87 GPs across Australia. Types of problems, consequences and clinical processes. GPs reported 90 incidents involving IT which had an observable impact on the delivery of care, including actual patient harm as well as near miss events. Practice systems and medications were the most affected clinical processes. Problems with IT disrupted clinical workflow, wasted time and caused frustration. Issues with user interfaces, routine updates to software packages and drug databases, and the migration of records from one package to another generated clinical errors that were unique to IT; some could affect many patients at once. Human factors issues gave rise to some errors that have always existed with paper records but are more likely to occur and cause harm with IT. Such errors were linked to slips in concentration, multitasking, distractions and interruptions. Problems with patient identification and hybrid records generated errors that were in principle no different to paper records. Problems associated with IT include perennial risks with paper records, but additional disruptions in workflow and hazards for patients unique to IT, occasionally affecting multiple patients. Surveillance for such hazards may have general utility, but particularly in the context of migrating historical records to new systems and software updates to existing systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse.

PubMed

Cha, Myeong-Il; Kim, Gi Woon; Kim, Chu Hyun; Choa, Minhong; Choi, Dai Hai; Kim, Inbyung; Wang, Soon Joo; Yoo, In Sool; Yoon, Han Deok; Lee, Kang Hyun; Cho, Suck Ju; Heo, Tag; Hong, Eun Seog

2016-09-01

To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.

Prediction task guided representation learning of medical codes in EHR.

PubMed

Cui, Liwen; Xie, Xiaolei; Shen, Zuojun

2018-06-18

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

A fuzzy-ontology-oriented case-based reasoning framework for semantic diabetes diagnosis.

PubMed

El-Sappagh, Shaker; Elmogy, Mohammed; Riad, A M

2015-11-01

Case-based reasoning (CBR) is a problem-solving paradigm that uses past knowledge to interpret or solve new problems. It is suitable for experience-based and theory-less problems. Building a semantically intelligent CBR that mimic the expert thinking can solve many problems especially medical ones. Knowledge-intensive CBR using formal ontologies is an evolvement of this paradigm. Ontologies can be used for case representation and storage, and it can be used as a background knowledge. Using standard medical ontologies, such as SNOMED CT, enhances the interoperability and integration with the health care systems. Moreover, utilizing vague or imprecise knowledge further improves the CBR semantic effectiveness. This paper proposes a fuzzy ontology-based CBR framework. It proposes a fuzzy case-base OWL2 ontology, and a fuzzy semantic retrieval algorithm that handles many feature types. This framework is implemented and tested on the diabetes diagnosis problem. The fuzzy ontology is populated with 60 real diabetic cases. The effectiveness of the proposed approach is illustrated with a set of experiments and case studies. The resulting system can answer complex medical queries related to semantic understanding of medical concepts and handling of vague terms. The resulting fuzzy case-base ontology has 63 concepts, 54 (fuzzy) object properties, 138 (fuzzy) datatype properties, 105 fuzzy datatypes, and 2640 instances. The system achieves an accuracy of 97.67%. We compare our framework with existing CBR systems and a set of five machine-learning classifiers; our system outperforms all of these systems. Building an integrated CBR system can improve its performance. Representing CBR knowledge using the fuzzy ontology and building a case retrieval algorithm that treats different features differently improves the accuracy of the resulting systems. Copyright © 2015 Elsevier B.V. All rights reserved.

Preparing faculty to teach in a problem-based learning curriculum: the Sherbrooke experience.

PubMed

Grand'Maison, P; Des Marchais, J E

1991-03-01

Over the last 6 years Sherbrooke Medical School has undertaken a major reform of its undergraduate curriculum. A new student-centred, community-oriented curriculum was implemented in September 1987. Problem-based learning (PBL) is now the main educational method. To adequately prepare teachers for the curriculum a series of faculty development programs in pedagogy were offered: first, a 2-day introductory workshop to initiate teachers into educational principles and their application in the new program; second, a 1-year basic training program in medical pedagogy; third, a 1-day workshop on PBL; and fourth, a comprehensive 3-day training program in PBL tutoring. Over 60% of all full-time teachers attended the introductory program and 80% the tutor training program. The 1-year basic training program was completed by 33% of the faculty members. The implementation of these programs, coupled with a high participation rate, resulted in a more student-centred educational philosophy and a greater interest in medical education. This had a significant impact when the new curriculum was instituted. Lessons learned from the experience are discussed.

An HL7/CDA Framework for the Design and Deployment of Telemedicine Services

DTIC Science & Technology

2001-10-25

schemes and prescription databases. Furthermore, interoperability with the Electronic Health Re- cord ( EHR ) facilitates automatic retrieval of relevant...local EHR system or the integrated electronic health record (I- EHR ) [9], which indexes all medical contacts of a patient in the regional net- work...suspected medical problem. Interoperability with middleware services of the HII and other data sources such as the local EHR sys- tem affects

Individual and hospital-related determinants of potentially inappropriate admissions emerging from administrative records.

PubMed

Fusco, Marco; Buja, Alessandra; Piergentili, Paolo; Golfetto, Maria Teresa; Serafin, Gianni; Gallo, Silvia; Dalla Barba, Livio; Baldo, Vincenzo

2016-11-01

The appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. Medical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients' medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. Inappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards' specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients' higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. Some individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate inexpensive real-time data for identifying what determines potentially inappropriate hospital resource usage, and thus orient auditing activities and health care policy-making. Copyright © 2016. Published by Elsevier Ireland Ltd.

[Learning during the early clinical years takes more than good study habits: Perceptions of students and teachers].

PubMed

Zúñiga, Denisse; Leiva, Isabel; Calderón, Maribel; Tomicic, Alemka; Padilla, Oslando; Riquelme, Arnoldo; Bitran, Marcela

2015-11-01

Teaching methods of the undergraduate medical curriculum change considerably from the first years to clinical training. Clinical learning occurs in complex and varied scenarios while caring for patients. Students have to adapt their learning approaches and strategies to be able to integrate theory and clinical practice and become experiential learners. To identify the strategies used by medical students to learn during the initial clinical years, as reported by students themselves and by their clinical tutors. We performed eight focus group discussions with 54 students enrolled in years three to six and we interviewed eight clinical tutors. Both focus group discussions and interviews were audio recorded, transcribed and analyzed according to Grounded Theory. Four main themes were identified in the discourse of both students and tutors: Strategies oriented to theoretical learning, strategies oriented to experiential learning, strategies for integrating theory and practice and strategies oriented to evaluation. The mentioning of individual differences was present across the reports of both students and tutors. Students use a rich variety of strategies to face the challenges of clinical learning. Both students and tutors recognize that the learning approaches and strategies vary according the nature of the task and individual differences. The responses of students bring particular knowledge of the approaches used for the theoretical and practical integration and delve into the social dimension of learning.

Bringing the Flipped Classroom to Day 1: A Novel Didactic Curriculum for Emergency Medicine Intern Orientation

PubMed Central

Barrie, Michael G.; Amick, Christopher; Mitzman, Jennifer; Way, David P.; King, Andrew M.

2018-01-01

Most emergency medicine (EM) residency programs provide an orientation program for their incoming interns, with the lecture being the most common education activity during this period. Our orientation program is designed to bridge the gap between undergraduate and graduate medical education by ensuring that all learners demonstrate competency on Level 1 Milestones, including medical knowledge (MK). To teach interns core medical knowledge in EM, we reformulated orientation using the flipped-classroom model by replacing lectures with small group, case-based discussions. Interns demonstrated improvement in medical knowledge through higher scores on a posttest. Evaluation survey results were also favorable for the flipped-classroom teaching format. PMID:29383072

Bringing the Flipped Classroom to Day 1: A Novel Didactic Curriculum for Emergency Medicine Intern Orientation.

PubMed

Barrie, Michael G; Amick, Christopher; Mitzman, Jennifer; Way, David P; King, Andrew M

2018-01-01

Most emergency medicine (EM) residency programs provide an orientation program for their incoming interns, with the lecture being the most common education activity during this period. Our orientation program is designed to bridge the gap between undergraduate and graduate medical education by ensuring that all learners demonstrate competency on Level 1 Milestones, including medical knowledge (MK). To teach interns core medical knowledge in EM, we reformulated orientation using the flipped-classroom model by replacing lectures with small group, case-based discussions. Interns demonstrated improvement in medical knowledge through higher scores on a posttest. Evaluation survey results were also favorable for the flipped-classroom teaching format.

[Quality of information analysis on basic causes of neonatal deaths recorded in the Mortality Information System: a study in Maceió, Alagoas State, Brazil, 2001-2002].

PubMed

Pedrosa, Linda Délia C O; Sarinho, Silvia W; Ordonha, Manoelina R

2007-10-01

Analysis of the quality of information on basic causes of neonatal deaths in Brazil is crucially important, since it allows one to estimate how many deaths are avoidable and provide support for policies to decrease neonatal mortality. The current study aimed to evaluate the reliability and validity of the Mortality Information System (MIS) for discriminating between basic causes of neonatal deaths and defining percentages of reducible causes. The basic causes of early neonatal deaths in hospitals in Maceió, Alagoas State, were analyzed, and the causes recorded in medical records were compared to the MIS data in order to measure reliability and validity. The modified SEADE Foundation and Wigglesworth classifications were compared to analyze the capacity for reduction of neonatal mortality. Maternal causes predominated in the medical records, as compared to respiratory disorders on the death certificates and in the MIS. The percentage of avoidable deaths may be much higher than observed from the MIS, due to imprecision in completing death certificates. Based on the MIS, the greatest problems are in early diagnosis and treatment of neonatal causes. However, the results show that the most pressing problems relate to failures in prenatal care and lack of control of diseases.

Cloud based emergency health care information service in India.

PubMed

Karthikeyan, N; Sukanesh, R

2012-12-01

A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the past years. We have developed two services for health care. 1. Cloud based Palm vein recognition system 2. Distributed Medical image processing tools for medical practitioners.

Ultra Low Power Signal Oriented Approach for Wireless Health Monitoring

PubMed Central

Marinkovic, Stevan; Popovici, Emanuel

2012-01-01

In recent years there is growing pressure on the medical sector to reduce costs while maintaining or even improving the quality of care. A potential solution to this problem is real time and/or remote patient monitoring by using mobile devices. To achieve this, medical sensors with wireless communication, computational and energy harvesting capabilities are networked on, or in, the human body forming what is commonly called a Wireless Body Area Network (WBAN). We present the implementation of a novel Wake Up Receiver (WUR) in the context of standardised wireless protocols, in a signal-oriented WBAN environment and present a novel protocol intended for wireless health monitoring (WhMAC). WhMAC is a TDMA-based protocol with very low power consumption. It utilises WBAN-specific features and a novel ultra low power wake up receiver technology, to achieve flexible and at the same time very low power wireless data transfer of physiological signals. As the main application is in the medical domain, or personal health monitoring, the protocol caters for different types of medical sensors. We define four sensor modes, in which the sensors can transmit data, depending on the sensor type and emergency level. A full power dissipation model is provided for the protocol, with individual hardware and application parameters. Finally, an example application shows the reduction in the power consumption for different data monitoring scenarios. PMID:22969379

Ultra low power signal oriented approach for wireless health monitoring.

PubMed

Marinkovic, Stevan; Popovici, Emanuel

2012-01-01

In recent years there is growing pressure on the medical sector to reduce costs while maintaining or even improving the quality of care. A potential solution to this problem is real time and/or remote patient monitoring by using mobile devices. To achieve this, medical sensors with wireless communication, computational and energy harvesting capabilities are networked on, or in, the human body forming what is commonly called a Wireless Body Area Network (WBAN). We present the implementation of a novel Wake Up Receiver (WUR) in the context of standardised wireless protocols, in a signal-oriented WBAN environment and present a novel protocol intended for wireless health monitoring (WhMAC). WhMAC is a TDMA-based protocol with very low power consumption. It utilises WBAN-specific features and a novel ultra low power wake up receiver technology, to achieve flexible and at the same time very low power wireless data transfer of physiological signals. As the main application is in the medical domain, or personal health monitoring, the protocol caters for different types of medical sensors. We define four sensor modes, in which the sensors can transmit data, depending on the sensor type and emergency level. A full power dissipation model is provided for the protocol, with individual hardware and application parameters. Finally, an example application shows the reduction in the power consumption for different data monitoring scenarios.

Comparison of two heuristic evaluation methods for evaluating the usability of health information systems.

PubMed

Khajouei, Reza; Hajesmaeel Gohari, Sadrieh; Mirzaee, Moghaddameh

2018-04-01

In addition to following the usual Heuristic Evaluation (HE) method, the usability of health information systems can also be evaluated using a checklist. The objective of this study is to compare the performance of these two methods in identifying usability problems of health information systems. Eight evaluators independently evaluated different parts of a Medical Records Information System using two methods of HE (usual and with a checklist). The two methods were compared in terms of the number of problems identified, problem type, and the severity of identified problems. In all, 192 usability problems were identified by two methods in the Medical Records Information System. This was significantly higher than the number of usability problems identified by the checklist and usual method (148 and 92, respectively) (p < 0.0001). After removing the duplicates, the difference between the number of unique usability problems identified by the checklist method (n = 100) and usual method (n = 44) was significant (p < 0.0001). Differences between the mean severity of the real usability problems (1.83) and those identified by only one of the methods (usual = 2.05, checklist = 1.74) were significant (p = 0.001). This study revealed the potential of the two HE methods for identifying usability problems of health information systems. The results demonstrated that the checklist method had significantly better performance in terms of the number of identified usability problems; however, the performance of the usual method for identifying problems of higher severity was significantly better. Although the checklist method can be more efficient for less experienced evaluators, wherever usability is critical, the checklist should be used with caution in usability evaluations. Copyright © 2018 Elsevier Inc. All rights reserved.

The Impact of A "Brief ECT Orientation Module" on The Knowledge and Attitudes of Medical Students Towards ECT in India.

PubMed

Balhara, Yps; Yadav, T; Mathur, S; Kataria, Dk

2012-07-01

Electroconvulsive therapy (ECT) continues to be an intervention that attracts controversy in spite of its proven efficacy. There is limited literature on attitude and knowledge of medical students towards ECT from Asian and African countries. The current study assesses the impact of a "Brief ECT Orientation Module" on the knowledge of and attitudes of Indian medical students towards modified ECT. The study was conducted at a tertiary care multi-specialty hospital associated with a government medical college. The students were administered the study questionnaire on Day 1 of Psychiatry clerkship. Following this, they were administered the Brief ECT Orientation Module. Assessment was made using a questionnaire with items related to knowledge and attitude towards ECT before and after "Brief ECT Orientation Module." Fifty-nine students completed the study. There was a significant improvement in knowledge of medical students on all the three domains of the questionnaire for assessment of knowledge about ECT-related facts. A change in attitudes towards ECT was also observed following Brief ECT Orientation Module, especially among those who witnessed ECT administration. The findings of the current study suggest that the Brief ECT Orientation Module is effective in improving the knowledge and attitude of medical students towards ECT.

Identifying individuals with physician-diagnosed chronic obstructive pulmonary disease in primary care electronic medical records: a retrospective chart abstraction study.

PubMed

Lee, Theresa M; Tu, Karen; Wing, Laura L; Gershon, Andrea S

2017-05-15

Little is known about using electronic medical records to identify patients with chronic obstructive pulmonary disease to improve quality of care. Our objective was to develop electronic medical record algorithms that can accurately identify patients with obstructive pulmonary disease. A retrospective chart abstraction study was conducted on data from the Electronic Medical Record Administrative data Linked Database (EMRALD ® ) housed at the Institute for Clinical Evaluative Sciences. Abstracted charts provided the reference standard based on available physician-diagnoses, chronic obstructive pulmonary disease-specific medications, smoking history and pulmonary function testing. Chronic obstructive pulmonary disease electronic medical record algorithms using combinations of terminology in the cumulative patient profile (CPP; problem list/past medical history), physician billing codes (chronic bronchitis/emphysema/other chronic obstructive pulmonary disease), and prescriptions, were tested against the reference standard. Sensitivity, specificity, and positive/negative predictive values (PPV/NPV) were calculated. There were 364 patients with chronic obstructive pulmonary disease identified in a 5889 randomly sampled cohort aged ≥ 35 years (prevalence = 6.2%). The electronic medical record algorithm consisting of ≥ 3 physician billing codes for chronic obstructive pulmonary disease per year; documentation in the CPP; tiotropium prescription; or ipratropium (or its formulations) prescription and a chronic obstructive pulmonary disease billing code had sensitivity of 76.9% (95% CI:72.2-81.2), specificity of 99.7% (99.5-99.8), PPV of 93.6% (90.3-96.1), and NPV of 98.5% (98.1-98.8). Electronic medical record algorithms can accurately identify patients with chronic obstructive pulmonary disease in primary care records. They can be used to enable further studies in practice patterns and chronic obstructive pulmonary disease management in primary care. NOVEL ALGORITHM SEARCH TECHNIQUE: Researchers develop an algorithm that can accurately search through electronic health records to find patients with chronic lung disease. Mining population-wide data for information on patients diagnosed and treated with chronic obstructive pulmonary disease (COPD) in primary care could help inform future healthcare and spending practices. Theresa Lee at the University of Toronto, Canada, and colleagues used an algorithm to search electronic medical records and identify patients with COPD from doctors' notes, prescriptions and symptom histories. They carefully adjusted the algorithm to improve sensitivity and predictive value by adding details such as specific medications, physician codes related to COPD, and different combinations of terminology in doctors' notes. The team accurately identified 364 patients with COPD in a randomly-selected cohort of 5889 people. Their results suggest opportunities for broader, informative studies of COPD in wider populations.

Natural Language Processing Based Instrument for Classification of Free Text Medical Records

PubMed Central

2016-01-01

According to the Ministry of Labor, Health and Social Affairs of Georgia a new health management system has to be introduced in the nearest future. In this context arises the problem of structuring and classifying documents containing all the history of medical services provided. The present work introduces the instrument for classification of medical records based on the Georgian language. It is the first attempt of such classification of the Georgian language based medical records. On the whole 24.855 examination records have been studied. The documents were classified into three main groups (ultrasonography, endoscopy, and X-ray) and 13 subgroups using two well-known methods: Support Vector Machine (SVM) and K-Nearest Neighbor (KNN). The results obtained demonstrated that both machine learning methods performed successfully, with a little supremacy of SVM. In the process of classification a “shrink” method, based on features selection, was introduced and applied. At the first stage of classification the results of the “shrink” case were better; however, on the second stage of classification into subclasses 23% of all documents could not be linked to only one definite individual subclass (liver or binary system) due to common features characterizing these subclasses. The overall results of the study were successful. PMID:27668260

A clinically useful diabetes electronic medical record: lessons from the past; pointers toward the future.

PubMed

Gorman, C; Looker, J; Fisk, T; Oelke, W; Erickson, D; Smith, S; Zimmerman, B

1996-01-01

We have analysed the deficiencies of paper medical records in facilitating the care of patients with diabetes and have developed an electronic medical record that corrects some of them. The diabetes electronic medical record (DEMR) is designed to facilitate the work of a busy diabetes clinic. Design principles include heavy reliance on graphic displays of laboratory and clinical data, consistent color coding and aggregation of data needed to facilitate the different types of clinical encounter (initial consultation, continuing care visit, insulin adjustment visit, dietitian encounter, nurse educator encounter, obstetric patient, transplant patient, visits for problems unrelated to diabetes). Data input is by autoflow from the institutional laboratories, by desk attendants or on-line by all users. Careful attention has been paid to making data entry a point and click process wherever possible. Opportunity for free text comment is provided on every screen. On completion of the encounter a narrative text summary of the visit is generated by the computer and is annotated by the care giver. Currently there are about 7800 patients in the system. Remaining challenges include the adaptation of the system to accommodate the occasional user, development of portable laptop derivatives that remain compatible with the parent system and improvements in the screen structure and graphic display formats.

Sexual orientation and functional pain in U.S. young adults: the mediating role of childhood abuse.

PubMed

Roberts, Andrea L; Rosario, Margaret; Corliss, Heather L; Wypij, David; Lightdale, Jenifer R; Austin, S Bryn

2013-01-01

Pain without known pathology, termed "functional pain," causes much school absenteeism, medication usage, and medical visits. Yet which adolescents are at risk is not well understood. Functional pain has been linked to childhood abuse, and sexual orientation minority youth (gay, lesbian, bisexual, "mostly heterosexual," and heterosexual with same-sex sexual contact) are more likely to be victims of childhood abuse than heterosexuals, thus may be at greater risk of functional pain. We examined sexual orientation differences in past-year prevalence of functional headache, pelvic, and abdominal pain and multiple sites of pain in 9,864 young adults (mean age = 23 years) from a large U.S. cohort. We examined whether childhood abuse accounted for possible increased risk of functional pain in sexual minority youth. Sexual minority youth, except for gays and lesbians, were at higher risk of functional pelvic and abdominal pain and multiple sites of pain than heterosexuals. Gay and lesbian youth had elevated prevalence only of abdominal pain. Childhood abuse accounted for 14% to 33% of increased experience of multiple sites of pain in minority youth. Youth who identify as "mostly heterosexual" or bisexual or who identify as heterosexual and have had same-sex partners comprised 18% of our sample. Clinicians should be aware that patients with these orientations are at elevated risk of functional pain and may be in need of treatment for sequelae of childhood abuse. Conventional categorization of sexual orientation as heterosexual or homosexual may fail to distinguish a large number of youth who do not wholly identify with either group and may be at elevated risk of health problems.

Clinical orientation program for new medical registrars--a qualitative evaluation.

PubMed

Rosemergy, Ian; Bell, Damon A; Jayathissa, Sisira K

2009-02-01

We present a qualitative evaluation of a clinical orientation program for medical registrars within the Wellington region in New Zealand, designed and implemented by current advanced registrars. This program was intended to improve the transition from house officer to medical registrar. The program was qualitatively evaluated using focus groups comprising participants, presenters and senior nursing staff. Purposive samples were drawn from each of these groups. The most significant finding was the perception of enhanced professional collegiality among medical staff. There were benefits to participants and presenters with improved communication between medical registrars. We believe there are individual, institutional and patient care benefits with a region-specific, clinical orientation for new medical registrars.

Designing an Algorithm to Preserve Privacy for Medical Record Linkage With Error-Prone Data

PubMed Central

Pal, Doyel; Chen, Tingting; Khethavath, Praveen

2014-01-01

Background Linking medical records across different medical service providers is important to the enhancement of health care quality and public health surveillance. In records linkage, protecting the patients’ privacy is a primary requirement. In real-world health care databases, records may well contain errors due to various reasons such as typos. Linking the error-prone data and preserving data privacy at the same time are very difficult. Existing privacy preserving solutions for this problem are only restricted to textual data. Objective To enable different medical service providers to link their error-prone data in a private way, our aim was to provide a holistic solution by designing and developing a medical record linkage system for medical service providers. Methods To initiate a record linkage, one provider selects one of its collaborators in the Connection Management Module, chooses some attributes of the database to be matched, and establishes the connection with the collaborator after the negotiation. In the Data Matching Module, for error-free data, our solution offered two different choices for cryptographic schemes. For error-prone numerical data, we proposed a newly designed privacy preserving linking algorithm named the Error-Tolerant Linking Algorithm, that allows the error-prone data to be correctly matched if the distance between the two records is below a threshold. Results We designed and developed a comprehensive and user-friendly software system that provides privacy preserving record linkage functions for medical service providers, which meets the regulation of Health Insurance Portability and Accountability Act. It does not require a third party and it is secure in that neither entity can learn the records in the other’s database. Moreover, our novel Error-Tolerant Linking Algorithm implemented in this software can work well with error-prone numerical data. We theoretically proved the correctness and security of our Error-Tolerant Linking Algorithm. We have also fully implemented the software. The experimental results showed that it is reliable and efficient. The design of our software is open so that the existing textual matching methods can be easily integrated into the system. Conclusions Designing algorithms to enable medical records linkage for error-prone numerical data and protect data privacy at the same time is difficult. Our proposed solution does not need a trusted third party and is secure in that in the linking process, neither entity can learn the records in the other’s database. PMID:25600786

Utilization of Dental General Anaesthesia for Children

PubMed Central

Karim, Zarina Abdul; Musa, Normaizura; Noor, Siti Noor Fazliah Mohd

2008-01-01

Dental treatment under general anaesthesia may be needed for some children and adolescents due to medical or behaviour problem. The objective of the study is to identify the type of treatment that has been carried out under GA in Hospital Universiti Sains Malaysia (HUSM). A retrospective record review study from hospital records of dental patients (under 18 years old) receiving dental treatment under GA from 2003 until 2007 were retrieved from the database. Information such as the reason for GA, and the type of treatment provided was recorded in data sheet. The data were analyzed using SPSS 12.0.1 for Windows. It was checked and verified for errors. A total of 349 cases were treated of which 43.6% had medical problems. Patients were mostly diagnosed to have rampant caries (77.1%) and some of them have behavioural problems (34.4%). Treatment pattern in deciduous dentition revealed more extraction (97.8%) as compared to restoration (75.7%) whereas in permanent dentition more restoration was done (24.3%) as compared to extraction (2.2%). Majority of the restorations were done using Glass Ionomer Cements (47.5%). Biopsy (4.3%) contributed mainly to the surgery (24.1%) done during GA. General anesthesia is necessary when dental disease is interfering with health and general well-being of patient and it can facilitated dental treatment allowing dentists to benefit from improved treatment conditions and provide a higher quality of care. PMID:22570587

Medication challenges for patients with severe mental illness: experience and views of patients, caregivers and mental health care workers in Dar es Salaam, Tanzania.

PubMed

Iseselo, Masunga K; Ambikile, Joel Seme

2017-01-01

Management of patients with mental disorders is inadequate in the majority of low and middle income countries. The main treatment modality for patients with severe mental disorders in these countries is mainly pharmacological approach. Patients face many challenges in meeting medication needs. In this context, high percentages of individuals who have severe mental disorders are not treated. Regular and adequate supplies of appropriate, safe and affordable medications are some of the important aspects required for provision of quality mental health services. Psychotropic medications are an important component of holistic care that provides treatment options for those suffering from mental illnesses. In Tanzania, mental health services face many challenges including inadequate mental health care providers, infrastructure, and medication supply. Relapse is a common problem among patients attending mental health facilities. This study is aimed at exploring views and experiences of patients, caregivers and mental health care providers on the psychotropic medication in Dar es Salaam, Tanzania. A qualitative study was conducted, involving two focus group discussions with seven and nine caregivers in each group. Eleven in-depth interviews with four patients and seven mental health care providers at Temeke Municipality, Dar es Salaam, were conducted. Convenient sampling procedure was used to select participants for the study. Discussion and interview guides were used during data collection. Interviews were audio-recorded in Kiswahili with all study participants. The recorded interviews were transcribed and qualitative content thematic analysis was used to analyze data after translation. Four themes were identified. These include attitudes of patients towards psychotropic medication, availability of psychotropic medications, financial concerns towards psychotropic medications, and coverage of free treatment policy. The availability and affordability of psychotropic medications to patients are big problems. This was partly attributed to insufficient funds to support the budget of health facilities and technical challenges contributed by both the health facilities and other stakeholders. To improve mental health services in the country, it is important to ensure adequate supply of psychotropic medications in the health facilities. Access to psychotropic medications is essential in addressing the public health problem of untreated mental illnesses. These findings call for the government and other stakeholders to increase funding for essential psychotropic medications.

Geological Mapping of Fortuna Tessera (V-2): Venus and Earth's Archean Process Comparisons

NASA Technical Reports Server (NTRS)

Head, James W.; Hurwitz,D. M.; Ivanov, M. A.; Basilevsky, A. T.; Kumar, P. Senthil

2008-01-01

The geological features, structures, thermal conditions, interpreted processes, and outstanding questions related to both the Earth's Archean and Venus share many similarities and we are using a problem-oriented approach to Venus mapping, guided by insight from the Archean record of the Earth, to gain new insight into the evolution of Venus and Earth's Archean. The Earth's preserved and well-documented Archean record provides important insight into high heat-flux tectonic and magmatic environments and structures and the surface of Venus reveals the current configuration and recent geological record of analogous high-temperature environments unmodified by subsequent several billion years of segmentation and overprinting, as on Earth. Elsewhere we have addressed the nature of the Earth's Archean, the similarities to and differences from Venus, and the specific Venus and Earth-Archean problems on which progress might be made through comparison. Here we present the major goals of the Venus-Archean comparison and show how preliminary mapping of the geology of the V-2 Fortuna Tessera quadrangle is providing insight on these problems. We have identified five key themes and questions common to both the Archean and Venus, the assessment of which could provide important new insights into the history and processes of both planets.

On necessity and sufficiency in counseling and psychotherapy (revisited).

PubMed

Lazarus, Arnold A

2007-09-01

It seems to me that Carl Rogers (see record 2007-14639-002) was far too ambitious in trying to specify general conditions of necessity and sufficiency that would be relevant to the entire spectrum of problems and the diverse expectancies and personalities of the people who seek our help. Rogers' position and orientation almost totally overlook the array of problems under the rubric of "response deficits" that stem from misinformation and missing information and call for active correction, training, and retraining. Rogers also paid scant attention to problems with significant biological determinants. Nevertheless, as exemplified by his seminal 1957 article and many other articles and books, Rogers made major contributions within the domain of the therapeutic alliance. Today, the scientific emphasis looks at accountability, the need to establish various treatments of choice, and the need to understand their presumed mechanisms. Treatment efficacy and generalizability across different methodologies are now considered key issues. The efficacy narrowing and clinically self-limiting consequences of adhering to one particular school of thought are now self-evident to most. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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

PubMed

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

2014-01-01

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

Assessment of clinical co-morbidities

PubMed Central

Basu, Debasish; Basu, Aniruddha; Ghosh, Abhishek

2018-01-01

A large proportion of patients with substance use disorders have clinical comorbidities, either medical or psychiatric. An initial assessment is necessary initially for prompt identification and management of any psychiatric or medical emergency, and thereafter a more detailed assessment for the comprehensive understanding of the individual. This should be done keeping in mind the goals of both immediate and long term assessment so that a comprehensive but individualized, context and culture sensitive, reality based, recovery-oriented management plan can be formulated. Assessment should consist of not only history-taking, physical and mental status examination but also laboratory and instrument based assessment as needed. During assessment, collateral reports and past medical records are valuable additions along with self-report. Since substance use disorders influence various aspects of daily life, hence medical, social, occupational, religious, spiritual, financial and legal aspects should be evaluated. Overall, the assessment needs to be diagnosis and management focused, covering the various bio-psycho-social domains relevant to the individual. PMID:29540914

Issues of medical necessity: a medical director's guide to good faith adjudication.

PubMed

Quinn, C

1997-06-01

The term medical necessity is difficult to define, a problem for insurers who need to clearly describe what is and is not covered in their contracts with subscribers. An unclear, vague definition of medical necessity leaves insurers vulnerable to litigation by subscribers denied care deemed medically unnecessary. To avoid lawsuits, insurers must make every effort to educate their subscribers about their medical coverage, going beyond merely providing a lengthy subscriber handbook. In decisions on medical necessity, medical directors at insurance companies play a key role. They can bolster the insurer's position in denial-of-care cases in numerous ways, including keeping meticulous records, eliminating unreasonable financial incentives, maintaining a claims denial database, and consulting with other insurers to achieve a consensus on medical necessity.

Medical errors in primary care clinics – a cross sectional study

PubMed Central

2012-01-01

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

Patients with cardiac disease: considerations for the dental practitioner.

PubMed

Jowett, N I; Cabot, L B

2000-09-23

The provision of dental treatment under both local anaesthesia and sedation has an excellent safety record, although medical problems may occur. The high prevalence of cardiac disease in the population, particularly ischaemic heart disease, makes it the most common medical problem encountered in dental practice. Additionally, the increasing survival of children with congenital heart disease makes them a significant proportion of those attending for dental treatment. While most dental practitioners feel confident in performing cardio-pulmonary resuscitation, treating patients with co-existent cardio-vascular disease often causes concern over potential problems during treatment. This article aims to allay many of these fears by describing the commoner cardiac conditions and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care.

Work disability resulting from chronic health conditions.

PubMed

Lerner, Debra; Allaire, Saralynn H; Reisine, Susan T

2005-03-01

To describe current programs and policies for addressing work disability among adults with chronic health conditions, and to identify opportunities for new research aimed at reducing the problem. The authors conducted secondary data analysis and a literature review. Millions of Americans with a chronic health condition have a work disability or are at risk of developing one. This public health problem is costing hundreds of billions of dollars a year nationally in lost productivity and diminishing the quality of life of millions of Americans. The medical care system, employers, and government--three traditional sources of help for adults with chronic health problems--are not sufficiently oriented toward the primary or secondary prevention of work disability. New research is urgently needed to reduce the burden of work disability on individuals and society.

Coping methods to stress among patients on hemodialysis and peritoneal dialysis.

PubMed

Parvan, Kobra; Ahangar, Ronak; Hosseini, Fahimeh Alsadat; Abdollahzadeh, Farahnaz; Ghojazadeh, Morteza; Jasemi, Madineh

2015-03-01

Dialysis patients need to deal and cope with various aspects of their disease. Identifying the adaptation methods provides valuable information for planning specific treatment and medical care delivery and improving the performance of medical teams. The present study aims to evaluate the coping strategies to stress among patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) at the Imam Reza Educational-Medical Hospital, Tabriz, West Azarbaijan, Iran. This descriptive and analytical study was conducted on 70 patients in the year 2012. The subjects were selected through census method and simple random sampling method. Data were collected using a customized questionnaire and consisted of demographic information and the Jalowiec Coping Scale (JCS) through a structured interview. Descriptive and inferential statistics were used to analyze the data in SPSS (version 13). The mean score of frequency of use of the coping strategy as "sometimes used" for the HD patients was 70.94 ± 18.91 and also for PD patients as "seldom used" was 58.70 ± 12.66. The mean score of helpfulness of coping strategies in the HD group was 49.57 ± 19.42 as "slightly helpful", whereas in the PD group it was 37.21 ± 14.38 as "slightly helpful" Furthermore, both groups used the emotion-oriented coping styles more frequently than the problem-oriented methods. HD patients used coping methods more frequently than the PD patients. The majority of patients used emotion-oriented coping strategies to deal with stress factors. Use of educational, counseling and supportive programs to assist in coping techniques can facilitate the coping process with stress factors in dialysis patients.

Hospital dental practice in special patients

PubMed Central

Silvestre-Rangil, Javier; Espín-Gálvez, Fernando

2014-01-01

Dental patients with special needs are people with different systemic diseases, multiple disorders or severe physical and/or mental disabilities. A Medline search was made, yielding a total of 29 articles that served as the basis for this study, which offers a brief description of the dental intervention protocols in medically compromised patients. Dental treatment in patients with special needs, whether presenting medical problems or disabilities, is sometimes complex. For this reason the hospital should be regarded as the ideal setting for the care of these individuals. Before starting any dental intervention, a correct patient evaluation is needed, based on a correct anamnesis, medical records and interconsultation reports, and with due assessment of the medical risks involved. The hospital setting offers the advantage of access to electronic medical records and to data referred to any complementary tests that may have been made, and we moreover have the possibility of performing treatments under general anesthesia. In this context, ambulatory major surgery is the best approach when considering general anesthesia in patients of this kind. Key words:Hospital dentistry, special patients, medically compromised patients. PMID:24121921

Worldwide telemedicine services based on distributed multimedia electronic patient records by using the second generation Web server hyperwave.

PubMed

Quade, G; Novotny, J; Burde, B; May, F; Beck, L E; Goldschmidt, A

1999-01-01

A distributed multimedia electronic patient record (EPR) is a central component of a medicine-telematics application that supports physicians working in rural areas of South America, and offers medical services to scientists in Antarctica. A Hyperwave server is used to maintain the patient record. As opposed to common web servers--and as a second generation web server--Hyperwave provides the capability of holding documents in a distributed web space without the problem of broken links. This enables physicians to browse through a patient's record by using a standard browser even if the patient's record is distributed over several servers. The patient record is basically implemented on the "Good European Health Record" (GEHR) architecture.

Association between regression and self injury among children with autism.

PubMed

Lance, Eboni I; York, Janet M; Lee, Li-Ching; Zimmerman, Andrew W

2014-02-01

Self injurious behaviors (SIBs) are challenging clinical problems in individuals with autism spectrum disorders (ASDs). This study is one of the first and largest to utilize inpatient data to examine the associations between autism, developmental regression, and SIBs. Medical records of 125 neurobehavioral hospitalized patients with diagnoses of ASDs and SIBs between 4 and 17 years of age were reviewed. Data were collected from medical records on the type and frequency of SIBs and a history of language, social, or behavioral regression during development. The children with a history of any type of developmental regression (social, behavioral, or language) were more likely to have a diagnosis of autistic disorder than other ASD diagnoses. There were no significant differences in the occurrence of self injurious or other problem behaviors (such as aggression or disruption) between children with and without regression. Regression may influence the diagnostic considerations in ASDs but does not seem to influence the clinical phenotype with regard to behavioral issues. Additional data analyses explored the frequencies and subtypes of SIBs and other medical diagnoses in ASDs, with intellectual disability and disruptive behavior disorder found most commonly. Copyright © 2013 Elsevier Ltd. All rights reserved.

Visual function in patients followed at a Veterans Affairs polytrauma network site: an electronic medical record review.

PubMed

Stelmack, Joan A; Frith, Theresa; Van Koevering, Denise; Rinne, Stephen; Stelmack, Thomas R

2009-08-01

This observational study describes the "Polytrauma System of Care" used by the Veterans Health Administration to guide medical care and rehabilitation of injured military personnel serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) and reports the visual function of patients with polytrauma and/or traumatic brain injury (TBI) at the Hines, Illinois, Polytrauma Network Site (PNS). A retrospective medical record review was performed for 103 patients with polytrauma seen at the Hines PNS from October 2005 through March 2008 and 88 patients with TBI seen in the Hines TBI Clinic from December 2007 through March 2008. Visual symptoms were self-reported by 76% of patients with polytrauma and 75% of the patients with TBI. Problems with reading (polytrauma 60% and TBI 50%) and accommodation (polytrauma 30% and TBI 47%) were frequently found on eye examinations. Spectacles were the treatment most frequently prescribed (polytrauma 62% and TBI 78%). It is important for optometrists to be aware of the high rates of self-reported symptoms and visual problems in military personnel returning from deployment to the wars in Iraq and Afghanistan. Post-traumatic stress disorder and depression may complicate optometric evaluation and management.

Why Patient Matching Is a Challenge: Research on Master Patient Index (MPI) Data Discrepancies in Key Identifying Fields

PubMed Central

Just, Beth Haenke; Marc, David; Munns, Megan; Sandefer, Ryan

2016-01-01

Patient identification matching problems are a major contributor to data integrity issues within electronic health records. These issues impede the improvement of healthcare quality through health information exchange and care coordination, and contribute to deaths resulting from medical errors. Despite best practices in the area of patient access and medical record management to avoid duplicating patient records, duplicate records continue to be a significant problem in healthcare. This study examined the underlying causes of duplicate records using a multisite data set of 398,939 patient records with confirmed duplicates and analyzed multiple reasons for data discrepancies between those record matches. The field that had the greatest proportion of mismatches (nondefault values) was the middle name, accounting for 58.30 percent of mismatches. The Social Security number was the second most frequent mismatch, occurring in 53.54 percent of the duplicate pairs. The majority of the mismatches in the name fields were the result of misspellings (53.14 percent in first name and 33.62 percent in last name) or swapped last name/first name, first name/middle name, or last name/middle name pairs. The use of more sophisticated technologies is critical to improving patient matching. However, no amount of advanced technology or increased data capture will completely eliminate human errors. Thus, the establishment of policies and procedures (such as standard naming conventions or search routines) for front-end and back-end staff to follow is foundational for the overall data integrity process. Training staff on standard policies and procedures will result in fewer duplicates created on the front end and more accurate duplicate record matching and merging on the back end. Furthermore, monitoring, analyzing trends, and identifying errors that occur are proactive ways to identify data integrity issues. PMID:27134610

Progress integrating medical humanities into medical education: a global overview.

PubMed

Pfeiffer, Stefani; Chen, Yuchia; Tsai, Duujian

2016-09-01

The article reviews the most recent developments in integrating humanities into medical education. Global implications and future trends are illustrated. The main concern of medical humanities education is teaching professionalism; one important aspect that has emerged is the goal of nurturing emotion through reflexivity. Relating effectively to all stakeholders and being sensitive to inequitable power dynamics are essential for professional social accountability in modern medical contexts. Mediating doctors' understanding of the clinical encounter through creative arts and narrative is part of most recent pedagogic innovations aimed at motivating learners to become empowered, engaged and caring clinicians. Scenario-based and discursive-oriented evaluations of such activities should be aligned with the medical humanities' problem-based learning curriculum. Medical humanities education fosters professional reflexivity that is important for achieving patient-centered care. Countering insufficient empathy with reflective professionalism is an urgent challenge in medical education; to answer this need, creative arts and narrative understanding have emerged as crucial tools of medical humanities education. To ensure competent professional identity formation in the era of translational medicine, medical humanities programs have adopted scenario-based assessments through inclusion of different voices and emphasizing personal reflection and social critique.

Completeness of patient records in community pharmacies post-discharge after in-patient medication reconciliation: a before-after study.

PubMed

Karapinar-Çarkıt, Fatma; van Breukelen, Ben R L; Borgsteede, Sander D; Janssen, Marjo J A; Egberts, Antoine C G; van den Bemt, Patricia M L A

2014-08-01

Transfer of discharge medication related information to community pharmacies could improve continuity of care. This requires for community pharmacies to accurately update their patient records when new information is transferred. An instruction manual that specifies how to document information regarding medication changes and clinical information (i.e. allergies/contraindications) could support community pharmacies. To explore the effect of instruction manuals sent to community pharmacies on completeness of their patient records. A before-after study was performed (July 2009-August 2010) in the St Lucas Andreas Hospital, a general teaching hospital in Amsterdam, The Netherlands. Patients discharged from the cardiology and respiratory ward were included consecutively. The intervention consisted of a training session for community pharmacies regarding documentation problems and faxing an instruction manual to community pharmacies specifying how to document discharge information in their information system. Usual care consisted of faxing a discharge medication overview to community pharmacies without additional instructions. Two weeks after discharge the medication records of community pharmacies were collected by fax. These were compared with the initial discharge overviews regarding completeness of medication changes (i.e. explicit explanation that medication had been changed) and clinical information documentation. MAIN OUTCOME MEASURE OUTCOMES: were the number and percentage of completely documented medication changes (either needing to be dispensed or not) and clinical information items. The sample size was calculated at 107 patients per measurement period. Multivariable logistic regression was used for analysis. Two hundred and eighteen patients (112 before-106 after) were included. Completeness of medication changes documentation increased marginally after the intervention (46.6 vs 56.3 %, adjusted Odds Ratio 1.4 [95 % confidence interval 1.07-1.83]). Documentation increased when medication was actually dispensed by the community pharmacy. No significant improvements were seen for allergy and contraindication documentation. The intervention is insufficient to increase the completeness of documentation by community pharmacies as marginal improvements were achieved. Future studies should evaluate whether electronic infrastructures may help in achieving updated medication records to improve continuity of pharmaceutical care.

An Observational Study of Antibiotic Prescribing Behavior and the Hawthorne Effect

PubMed Central

Mangione-Smith, Rita; Elliott, Marc N; McDonald, Laurie; McGlynn, Elizabeth A

2002-01-01

Objectives To assess whether prospective, observational study procedures, including questionnaires and audio recording, are associated with different patterns of physician diagnostic decision making and antibiotic prescribing. Data Sources/Setting (1) Survey data from a prospective observational study of treatment patterns for children with acute upper respiratory illnesses (10/96–3/97) and (2) retrospective medical record abstraction data of nonobserved encounters for the same problems occurring during (10/96–3/97) and one year after (10/97–3/98) the observational study period. Ten pediatricians in two community practices were studied. Study Design Patterns of diagnoses recorded in the medical record and antibiotics ordered for visits occurring outside of the observational study (same time period and one year later) were compared with the pattern of diagnoses and antibiotics ordered during the observational study. Data Collection/Extraction Methods For the observational study (10/96–2/97), diagnosis and treatment choices were obtained from questionnaires completed by physicians immediately following the visit. For the nonstudy encounters (10/96–3/97 and 10/97–3/98), data were abstracted from medical records one year after the observational study was completed. Principal Findings The proportion of viral cases in which an antibiotic was prescribed was 29 percentage points lower for the observational study compared to the retrospective analysis (p <.05). In one of two study sites, the proportion of cases assigned a bacterial diagnosis was 29 percentage points lower in the observational study period compared to the retrospective study (p <.05). Conclusions Observational study procedures including questionnaires and audio recording can affect antibiotic prescribing behavior. Future observational studies aimed at examining the frequency of inappropriate antibiotic prescribing should measure and adjust for the Hawthorne effect; without such adjustments, the results will likely underestimate the true degree of the problem. Future interventions aimed at decreasing inappropriate antibiotic prescribing should consider “harnessing” the Hawthorne effect through performance feedback to participating physicians. PMID:12546288

Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings.

PubMed

Chua, Siew Siang; Kok, Li Ching; Yusof, Faridah Aryani Md; Tang, Guang Hui; Lee, Shaun Wen Huey; Efendie, Benny; Paraidathathu, Thomas

2012-11-12

The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%), insufficient awareness and knowledge about disease condition and medication (20.4%), adverse drug reactions (15.6%), therapeutic failure (13.9%), drug-choice problems (9.5%) and dosing problems (3.4%). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52%) were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2%) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. This study demonstrates the importance of pharmacists working in collaboration with other healthcare providers especially the medical doctors in identifying and resolving pharmaceutical care issues to provide optimal care for patients with chronic diseases.

Use of Cognitive Behavioral Therapy and Token Economy to Alleviate Dysfunctional Behavior in Children with Attention-Deficit Hyperactivity Disorder.

PubMed

Coelho, Luzia Flavia; Barbosa, Deise Lima Fernandes; Rizzutti, Sueli; Muszkat, Mauro; Bueno, Orlando Francisco Amodeo; Miranda, Monica Carolina

2015-01-01

Medication has proved highly efficacious as a means of alleviating general symptoms of attention-deficit hyperactivity disorder (ADHD). However, many patients remain functionally impaired by inappropriate behavior. The present study analyzed the use of cognitive behavioral therapy (CBT) with the Token-Economy (TE) technique to alleviate problem behavior for 25 participants with ADHD, all children (19 boys, mean age 10.11) on long-term methylphenidate medication, who were given 20 CBT sessions with 10 weeks of TE introduced as of session 5. Their ten most acute problem behaviors were selected and written records kept. On weekdays, parents recorded each inappropriate behavior and provided a suitable model for their actions. At weekly sessions, problem behaviors were counted and incident-free participants rewarded with a token. To analyze improvement (less frequent problem behavior), a list of 11 behavioral categories was rated: inattention, impulsivity, hyperactivity, disorganization, disobeying rules and routines, poor self-care, verbal/physical aggression, low frustration tolerance, compulsive behavior, antisocial behavior, lacking in initiative and distraction. Two CBT specialists categorized behaviors and an ADHD specialist ruled on discrepancies. Statistical analyses used were Generalized Estimating Equations with Poisson distribution and autoregressive order correlation structure. In the course of the sessions, problematic behaviors decreased significantly in seven categories: impulsiveness, hyperactivity, disorganization, disobeying rules and routine, poor self-care, low frustration tolerance, compulsive behaviors, and antisocial behaviors. Caregiver attitudes to children's inappropriate behavior were discussed and reshaped. As functional improvement was observed on applying TE for 10 weeks, this type of intervention may be useful as an auxiliary strategy combined with medication.

[The effect of gender on the physician's role. Attitudes and expectations of medical students examined by a questionnaire at the start of their studies].

PubMed

Odborg, M H; Eriksen, T R; Petersson, B H

1995-09-04

A questionnaire was given to 254 medical students matriculated in 1992/93 concerning their motivation for wanting to become a doctor, attitudes towards which qualities a doctor should have and their potential choice of medical specialty. The analysis focuses on whether answers are relation-orientated (i.e. directed towards relations to others) or autonomy-orientated (i.e. directed towards rationality and independence). The results show that motivations for becoming a doctor are both relation- and autonomy-orientated. Most students expect the doctor to both be able to relate to the patient and be professionally competent. No gender differences could be demonstrated concerning motivations for becoming a doctor or which qualities a good doctor should possess. Significant gender differences were displayed concerning choice of specialty, most women aiming towards relation-orientated specialties and most men aiming towards autonomy-orientated specialties. It is concluded that the growing proportion of women doctors could change the medical profession towards becoming more patient- and relation-orientated, however their choice of relation-orientated and lower prestige specialties could result in less overall influence than one might otherwise expect.

[Significance of expert-guided groups for relatives in psychiatry].

PubMed

Plessen, U; Postzich, M; Wilkmann, M

1985-03-01

Psychiatric interest in relatives of patients was concentrated in the past on their pathogenetic and etiological influence on mental illness. The medical paradigma of mental illness did not account for relatives affliction in psychic disturbance of their family member. Against this a community care oriented approach involves relatives into psychiatric care, particularly under the aspects of coping strategies and rehabilitative sources. Practicability and effects of this approach were explored in expert-guided relative groups at the Psychiatric Hospital Gütersloh (FRG). Results indicated that relatives are concerned with a series of problems. Participating in relative groups facilitates coping with these problems. Expert-guided and relative centered groups were found helpful, discharging and encouraging for relatives.

The Impact of A “Brief ECT Orientation Module” on The Knowledge and Attitudes of Medical Students Towards ECT in India

PubMed Central

Balhara, YPS; Yadav, T; Mathur, S; Kataria, DK

2012-01-01

Background: Electroconvulsive therapy (ECT) continues to be an intervention that attracts controversy in spite of its proven efficacy. There is limited literature on attitude and knowledge of medical students towards ECT from Asian and African countries. Aim: The current study assesses the impact of a “Brief ECT Orientation Module” on the knowledge of and attitudes of Indian medical students towards modified ECT. Subjects and Methods: The study was conducted at a tertiary care multi-specialty hospital associated with a government medical college. The students were administered the study questionnaire on Day 1 of Psychiatry clerkship. Following this, they were administered the Brief ECT Orientation Module. Assessment was made using a questionnaire with items related to knowledge and attitude towards ECT before and after “Brief ECT Orientation Module.” Results: Fifty-nine students completed the study. There was a significant improvement in knowledge of medical students on all the three domains of the questionnaire for assessment of knowledge about ECT-related facts. A change in attitudes towards ECT was also observed following Brief ECT Orientation Module, especially among those who witnessed ECT administration. Conclusion: The findings of the current study suggest that the Brief ECT Orientation Module is effective in improving the knowledge and attitude of medical students towards ECT. PMID:23440565

An adaptive semantic based mediation system for data interoperability among Health Information Systems.

PubMed

Khan, Wajahat Ali; Khattak, Asad Masood; Hussain, Maqbool; Amin, Muhammad Bilal; Afzal, Muhammad; Nugent, Christopher; Lee, Sungyoung

2014-08-01

Heterogeneity in the management of the complex medical data, obstructs the attainment of data level interoperability among Health Information Systems (HIS). This diversity is dependent on the compliance of HISs with different healthcare standards. Its solution demands a mediation system for the accurate interpretation of data in different heterogeneous formats for achieving data interoperability. We propose an adaptive AdapteR Interoperability ENgine mediation system called ARIEN, that arbitrates between HISs compliant to different healthcare standards for accurate and seamless information exchange to achieve data interoperability. ARIEN stores the semantic mapping information between different standards in the Mediation Bridge Ontology (MBO) using ontology matching techniques. These mappings are provided by our System for Parallel Heterogeneity (SPHeRe) matching system and Personalized-Detailed Clinical Model (P-DCM) approach to guarantee accuracy of mappings. The realization of the effectiveness of the mappings stored in the MBO is evaluation of the accuracy in transformation process among different standard formats. We evaluated our proposed system with the transformation process of medical records between Clinical Document Architecture (CDA) and Virtual Medical Record (vMR) standards. The transformation process achieved over 90 % of accuracy level in conversion process between CDA and vMR standards using pattern oriented approach from the MBO. The proposed mediation system improves the overall communication process between HISs. It provides an accurate and seamless medical information exchange to ensure data interoperability and timely healthcare services to patients.

A Physician-based Voluntary Reporting System for Adverse Events and Medical Errors

PubMed Central

Weingart, Saul N; Callanan, Lawrence D; Ship, Amy N; Aronson, Mark D

2001-01-01

OBJECTIVE To create a voluntary reporting method for identifying adverse events (AEs) and potential adverse events (PAEs) among medical inpatients. DESIGN Medical house officers asked their peers about obstacles to care, injuries or extended hospitalizations, and problems with medications that affected their patients. Two independent reviewers coded event narratives for adverse outcomes, responsible parties, preventability, and process problems. We corroborated house officers' reports with hospital incident reports and conducted a retrospective chart review. SETTING The cardiac step-down, oncology, and medical intensive care units of an urban teaching hospital. INTERVENTION Structured confidential interviews by postgraduate year-2 and -3 medical residents of interns during work rounds. MEASUREMENTS AND MAIN RESULTS Respondents reported 88 events over 3 months. AEs occurred among 5 patients (0.5% of admissions) and PAEs among 48 patients (4.9% of admissions). Delayed diagnoses and treatments figured prominently among PAEs (54%). Clinicians were responsible for the greatest number of incidents (55%), followed by workers in the laboratory (11%), radiology (15%), and pharmacy (3%). Respondents identified a variety of problematic processes of care, including problems with diagnosis (16%), therapy (26%), and failure to provide clinical and support services (29%). We corroborated 84% of reported events in the medical record. Participants found voluntary peer reporting of medical errors unobtrusive and agreed that it could be implemented on a regular basis. CONCLUSIONS A physician-based voluntary reporting system for medical errors is feasible and acceptable to front-line clinicians. PMID:11903759

A continuous usability evaluation of an electronic medication administration record application.

PubMed

Vicente Oliveros, Noelia; Gramage Caro, Teresa; Pérez Menéndez-Conde, Covadonga; Álvarez-Diaz, Ana María; Martín-Aragón Álvarez, Sagrario; Bermejo Vicedo, Teresa; Delgado Silveira, Eva

2017-12-01

The complexity of an electronic medication administration record (eMAR) has been underestimated by most designers in the past. Usability issues, such as poorly designed user application flow in eMAR, are therefore of vital importance, since they can have a negative impact on nursing activities and result in poor outcomes. The purpose of this study was to evaluate the usability of an eMAR application during its development. A usability evaluation was conducted during the development of the eMAR application. Two usability methods were used: a heuristic evaluation complemented by usability testing. Each eMAR application version provided by the vendor was evaluated by 2 hospital pharmacists, who applied the heuristic method. They reviewed the eMAR tasks, detected usability problems and their heuristic violations, and rated the severity of the usability problems. Usability testing was used to assess the final application version by observing how 3 nurses interacted with the application. Thirty-four versions were assessed before the eMAR application was considered usable. During the heuristic evaluation, the usability problems decreased from 46 unique usability problems in version 1 (V1) to 9 in version 34 (V34). In V1, usability problems were categorized into 154 heuristic violations, which decreased to 27 in V34. The average severity rating also decreased from major usability problem (2.96) to no problem (0.23). During usability testing, the 3 nurses did not encounter new usability problems. A thorough heuristic evaluation is a good method for obtaining a usable eMAR application. This evaluation points key areas for improvement and decreases usability problems and their severity. © 2017 John Wiley & Sons, Ltd.

Scalable Decision Support at the Point of Care: A Substitutable Electronic Health Record App for Monitoring Medication Adherence

PubMed Central

Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D

2013-01-01

Background Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. Objective The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as “iPhone like platforms” by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. Methods The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients’ prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction of future adherence on a clinician-facing Web interface. Results The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns. The MPR Monitor app is installed in the SMART reference container as the “MPR Monitor”, where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. Conclusions The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality. PMID:23876796

Scalable decision support at the point of care: a substitutable electronic health record app for monitoring medication adherence.

PubMed

Bosl, William; Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D

2013-07-22

Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as "iPhone like platforms" by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients' prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction of future adherence on a clinician-facing Web interface. The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns. The MPR Monitor app is installed in the SMART reference container as the "MPR Monitor", where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality.

Using video to introduce clinical materials.

PubMed

Kommalage, Mahinda; Senadheera, Chandanie

2012-08-01

The early introduction of clinical material is a recognised strategy in medical education. The University of Ruhana Medical School, where a traditional curriculum is followed, offers students pre-clinical subjects without clinical exposure during their first and second years. Clinical materials in the form of videos were introduced to first-year students. In the videos, patients and their relatives described the diseases and related problems. Students were instructed to identify the problems encountered by patients and relatives. Each video was followed by a discussion of the problems identified by the students. The medical, social and economic problems encountered by patients and relatives were emphasised during post-video discussions. A lecture was conducted linking the contents of the videos to subsequent lectures. The aim of this study is to investigate whether combining teaching preclinical material with a video presentation of relevant clinical cases facilitates the interest and understanding of students. Quantitative data were collected using a questionnaire, whereas qualitative data were collected using focus group discussions. Quantitative data showed that students appreciated the video, had 'better' knowledge acquisition and a 'better' understanding of problems encountered by patients. Qualitative analysis highlighted the following themes: increased interest; enhanced understanding; relevance of basic knowledge to clinical practice; orientation to profession; and personalising theories. The introduction of patients in the form of videos helped students to understand the relevance of subject material for clinical practice, increased their interest and facilitated a better understanding of the subject material. Therefore, it seems video is a feasible medium to introduce clinical materials to first-year students who follow a traditional curriculum in a resource-limited environment. © Blackwell Publishing Ltd 2012.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women

PubMed Central

Everett, Bethany G.; Mollborn, Stefanie

2013-01-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women. PMID:25382887

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women.

PubMed

Everett, Bethany G; Mollborn, Stefanie

2014-08-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen's health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen's model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.

Delinquent-oriented attitudes mediate the relation between parental inconsistent discipline and early adolescent behavior.

PubMed

Halgunseth, Linda C; Perkins, Daniel F; Lippold, Melissa A; Nix, Robert L

2013-04-01

Although substantial research supports the association between parental inconsistent discipline and early adolescent behaviors, less is understood on mechanisms underlying this relation. This study examined the mediating influence of delinquent-oriented attitudes in early adolescence. Using a longitudinal sample of 324 rural adolescents and their parents, findings revealed that inconsistent discipline in sixth grade predicted an increase in adolescent delinquent-oriented attitudes by seventh grade which, in turn, predicted both an increase in early adolescent antisocial behaviors and a decrease in socially competent behaviors by eighth grade. Therefore, it appears that accepting attitudes toward delinquency may in part develop from experiencing inconsistent discipline at home and may offer a possible explanation as to why early adolescents later engage in more antisocial and less socially competent behaviors. Findings may inform family-based preventive intervention programs that seek to decrease behavior problems and promote social competence in early adolescents. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Usage experience with the document archiving and communication system for the storage and retrieval of medical records.

PubMed

Takeda, Toshihiro; Ueda, Kanayo; Manabe, Shiro; Teramoto, Kei; Mihara, Naoki; Matsumura, Yasushi

2013-01-01

Standard Japanese electronic medical record (EMR) systems are associated with major shortcomings. For example, they do not assure lifelong readability of records because each document requires its own viewing software program, a system that is difficult to maintain over long periods of time. It can also be difficult for users to comprehend a patient's clinical history because different classes of documents can only be accessed from their own window. To address these problems, we developed a document-based electronic medical record that aggregates all documents for a patient in a PDF or DocuWorks format. We call this system the Document Archiving and Communication System (DACS). There are two types of viewers in the DACS: the Matrix View, which provides a time line of a patient's history, and the Tree View, which stores the documents in hierarchical document classes. We placed 2,734 document classes into 11 categories. A total of 22,3972 documents were entered per month. The frequency of use of the DACS viewer was 268,644 instances per month. The DACS viewer was used to assess a patient's clinical history.

Quality of care for people with multimorbidity - a case series.

PubMed

Schiøtz, Michaela L; Høst, Dorte; Christensen, Mikkel B; Domínguez, Helena; Hamid, Yasmin; Almind, Merete; Sørensen, Kim L; Saxild, Thomas; Holm, Rikke Høgsbro; Frølich, Anne

2017-11-18

Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark. To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups. Before each focus group, clinicians were asked to review patients' medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients. Further, two clinical pharmacologists reviewed the appropriateness of medications listed in patient records. The review of the patients' records conducted by three groups of clinicians revealed that around half of the patients received adequate care for the single condition which prompted the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review of the medication lists revealed that the majority of the medication lists contained inappropriate medications and that there were incongruity in medication listed in the primary and secondary care sector. Several barriers for providing high quality care were identified. These included relative short consultation times in general practice and outpatient clinics, lack of care coordinators, and lack of shared IT-system proving an overview of the treatment. Our findings reveal quality of care deficiencies for people with multimorbidity. Suggestions for care improvement for people with multimorbidity includes formally assigned responsibility for care coordination, a change in the financial incentive structure towards a system rewarding high quality care and care focusing on prevention of disease exacerbation, as well as implementing shared medical record systems.

The More Things Change the More They Stay the Same

NASA Astrophysics Data System (ADS)

Moore, John W.

1998-01-01

In what year would you guess that these statements appeared in this Journal? Students can be classified as problem oriented or answer oriented. The answer-oriented student ... does little or no reflective thinking. ...To simply work a problem for a student may not be educational at all. The student should be taught the process used in the solution. ...My experience indicates that an answer-oriented attitude can be changed. ...But one can't do much teaching of problem-solving techniques and at the same time get on with the day's lecture. ...Problem-solving technique is a tool of learning. ...To teach it well should be about the most rewarding academic activity. ...A year of stressing methods of problem solving would alter the orientation and motivation of many students we now call poor.

Others' anger makes people work harder not smarter: the effect of observing anger and sarcasm on creative and analytic thinking.

PubMed

Miron-Spektor, Ella; Efrat-Treister, Dorit; Rafaeli, Anat; Schwarz-Cohen, Orit

2011-09-01

The authors examine whether and how observing anger influences thinking processes and problem-solving ability. In 3 studies, the authors show that participants who listened to an angry customer were more successful in solving analytic problems, but less successful in solving creative problems compared with participants who listened to an emotionally neutral customer. In Studies 2 and 3, the authors further show that observing anger communicated through sarcasm enhances complex thinking and solving of creative problems. Prevention orientation is argued to be the latent variable that mediated the effect of observing anger on complex thinking. The present findings help reconcile inconsistent findings in previous research, promote theory about the effects of observing anger and sarcasm, and contribute to understanding the effects of anger in the workplace. PsycINFO Database Record (c) 2011 APA, all rights reserved

"All is well": professionals' documentation of social determinants of health in Swedish Child Health Services health records concerning maltreated children - a mixed method approach.

PubMed

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.

Psychiatric emergencies in children and adolescents: an Emergency Department audit.

PubMed

Starling, Jean; Bridgland, Kim; Rose, Donna

2006-12-01

To describe a cohort of children presenting to a paediatric emergency department with mental health problems. An Emergency Department (ED) computerized record system and hospital records were used to obtain data on children who presented to a paediatric ED with mental health problems. There were 291 presentations of 231 children in a 10-month period, about one per day. They were a small (0.8%) but complicated part of the ED workload. Most were first presentations and came voluntarily to ED. There were a wide variety of presenting symptoms including self-harm, suicide attempts, behavioural disorders and medical disorders with associated psychological problems. Acute psychosis was rare. Many children with mental health problems were seen for the first time in ED. With the growing awareness of mental health problems in this age group, it is likely that such presentations will increase. Paediatric and psychiatry services have an opportunity to work together to provide early intervention services for what is potentially a very accessible population.

Prenatal Depressive Symptoms and Toddler Behavior Problems: The Role of Maternal Sensitivity and Child Sex.

PubMed

Edwards, Renee C; Hans, Sydney L

2016-10-01

Increasing evidence suggests that maternal depression during pregnancy is associated with child behavioral outcomes even after accounting for later maternal depression. The purpose of this study was to examine various mechanisms, including maternal sensitivity, neonatal problems, and concurrent maternal depression, that might explain the association between prenatal maternal depressive symptoms and toddler behavior problems. Young, low income, African American mothers (n = 196) were interviewed during pregnancy and at 24-months postpartum, medical records were collected at the birth, and mother-child interactions were video-recorded at 24 months. Path analyses revealed that the association between prenatal depression and toddler behavior problems was mediated by maternal sensitivity and maternal depressive symptoms at 24 months. No evidence was found for a mediating effect of neonatal problems. Path models examining sex differences suggested that different mediating factors may be important for boys and girls, with boys being particularly susceptible to the effects of maternal sensitivity.

Community-oriented medical education and clinical training: comparison by medical students in hospitals.

PubMed

Ali, Azizi

2012-10-01

To determine the students' comparison of their one month educational trainings in Community-Oriented Medical Education with hospitals clinical education. Observational study. Kermanshah Community-Oriented Medical Education Field, Kermanshah University of Medical Sciences, Kermanshah, Iran, from April 2000 to February 2009. As of 2000, medical interns of Kermanshah University of Medical Sciences spend one month in the field of community-oriented medical education. At the end of the one-month period, the interns filled a questionnaire of 11 questions (based on the Likert scale) to assess the level of education in the field compared to hospital clinics. Data of questionnaires collected and completed from 2000 through 2009 (948 questionnaires) were analyzed on SPSS 18 using descriptive statistics (percentage) and analytic statistics (Chi-square test). The 948 students consisted of 66.4% males (n = 666) and 33.6% females (n = 282). All 11 variables of comparison were rated improved in the field education compared to the hospital training. The greatest difference pertained referring patients to the relevant health units (82% vs. 23.3%); patience in education (84.6% vs. 37.1%); consideration given to the three levels of prevention (77.2% vs. 33.6%) and the attention paid to the presence of students (91.7% vs. 51.8%), all of which were statistically significant (p < 0.0001). According to the interns, the educational status of specialized clinics of the field was superior to the specific clinics of hospitals (p < 0.0001). From the standpoint of medical students, training in community-oriented medical education in the field was better than training in the hospitals' clinics.

A novel key management solution for reinforcing compliance with HIPAA privacy/security regulations.

PubMed

Lee, Chien-Ding; Ho, Kevin I-J; Lee, Wei-Bin

2011-07-01

Digitizing medical records facilitates the healthcare process. However, it can also cause serious security and privacy problems, which are the major concern in the Health Insurance Portability and Accountability Act (HIPAA). While various conventional encryption mechanisms can solve some aspects of these problems, they cannot address the illegal distribution of decrypted medical images, which violates the regulations defined in the HIPAA. To protect decrypted medical images from being illegally distributed by an authorized staff member, the model proposed in this paper provides a way to integrate several cryptographic mechanisms. In this model, the malicious staff member can be tracked by a watermarked clue. By combining several well-designed cryptographic mechanisms and developing a key management scheme to facilitate the interoperation among these mechanisms, the risk of illegal distribution can be reduced.

Digital photo documentation of forensically relevant injuries as part of the clinical first response protocol.

PubMed

Verhoff, Marcel A; Kettner, Mattias; Lászik, András; Ramsthaler, Frank

2012-09-01

A problem encountered by medical examiners is that they have to assess injuries that have already been medically treated. Thus, they have to base their reports on clinical forensic examinations performed hours or days after an injury was sustained, or even base their assessment solely on information gleaned from medical files. In both scenarios, the forensic examiner has to rely heavily on the first responder's documentation of the original injury pattern. Medical priority will be to immediately treat a patient's injuries, and the first responder may, in addition, initially be unaware of a possibly criminal origin of an injury. As a result, the documentation of injuries is frequently of limited value for forensic purposes. This situation could be improved if photographic records were briefly made of injuries before they were treated. German-language medicolegal, criminal, and photography journals and books were selectively searched with the help of PubMed and other databases. In addition, the authors' experiences in creating and evaluating photographic records for clinical forensic use were assessed. This paper is an aid to creating photographic records of sufficient quality for forensic purposes. The options provided by digital photography in particular make this endeavor feasible even in a clinical setting. In addition, our paper illuminates some technical aspects of creating and archiving photographic records for forensic use, and addresses possible error sources. With the requisite technical background knowledge, injuries can be photographically recorded to forensic standards during patient care.

[Information technology in medical education].

PubMed

Ramić, A

1999-01-01

The role of information technology in educational models of under-graduate and post-graduate medical education is growing in 1980's influenced by PC's break-in in medical practice and creating relevant data basis, and, particularly, in 1990's by integration of information technology on international level, development of international network, Internet, Telemedicin, etc. The development of new educational information technology is evident, proving that information in transfer of medical knowledge, medical informatics and communication systems represent the base of medical practice, medical education and research in medical sciences. In relation to the traditional approaches in concept, contents and techniques of medical education, new models of education in training of health professionals, using new information technology, offer a number of benefits, such as: decentralization and access to relevant data sources, collecting and updating of data, multidisciplinary approach in solving problems and effective decision-making, and affirmation of team work within medical and non-medical disciplines. Without regard to the dynamics of change and progressive reform orientation within health sector, the development of modern medical education is inevitable for all systems a in which information technology and available data basis, as a base of effective and scientifically based medical education of health care providers, give guarantees for efficient health care and improvement of health of population.

Correlation between academic achievement goal orientation and the performance of Malaysian students in an Indian medical school.

PubMed

Barkur, Rajashekar Rao; Govindan, Sreejith; Kamath, Asha

2013-01-01

According to goal orientation theory, achievement goals are defined as the terminal point towards which one's efforts are directed. The four academic achievement goal orientations commonly recognised are mastery, performance approach, performance avoidance and work avoidance. The objective of this study was to understand the goal orientation of second year undergraduate medical students and how this correlates with their academic performance. The study population consisted of 244 second year Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Melaka Manipal Medical College, Manipal campus, Manipal University, India. Students were categorised as high performers and low performers based on their first year university examination marks. Their goal orientations were assessed through a validated questionnaire developed by Was et al. These components were analysed by independent sample t-test and correlated to their first year university examination marks. Confirmatory component factor analysis extracted four factors, which accounted for 40.8% of the total variance in goal orientation. The performance approach goal orientation alone explained 16.7% of the variance followed by mastery (10.8%), performance avoidance (7.7%) and work avoidance (5.7%). The Cronbach's alpha for 19 items, which contributed to internal consistency of the tool, was observed to be 0.635. A strong positive correlation was shown between performance approach, performance avoidance and work avoidance orientations. Of the four goal orientations, only the mean scores in work avoidance orientation differed for low performers and high performers (5.0 vs. 4.3; P = 0.0003). Work avoidance type of goal orientation among the low performer group may account for their lower performance compared with high performer group. This indicates that academic achievement goal orientation may play a role in the performance of undergraduate medical students.

Joint Curriculum Development of the Training Program for Five-Year, Rural-Oriented, Tuition-Waived Medical Students

ERIC Educational Resources Information Center

Che, Xiang-Xin; Niu, Li; Xia, Xiu-Long; Wang, Xin

2014-01-01

To alleviate the shortage of competent undergraduate-level medical professionals in the central and western rural regions of China, from 2010 to 2012, the Chinese government mandated 100 medical colleges to recruit 30,000 rural-oriented, tuition-waived medical students (RTMS) for the township and village hospitals. But no educational curriculum is…

A data model that captures clinical reasoning about patient problems.

PubMed Central

Barrows, R. C.; Johnson, S. B.

1995-01-01

We describe a data model that has been implemented for the CPMC Ambulatory Care System, and exemplify its function for patient problems. The model captures some nuances of clinical thinking about patients that are not accommodated in most other models, such as an evolution of clinical understanding about patient problems. A record of this understanding has clinical utility, and serves research interests as well as medical audit concerns. The model is described with an example, and advantages and limitations in the current implementation are discussed. PMID:8563311

Recovery outcomes of schizophrenia patients treated with paliperidone palmitate in a community setting: patient and provider perspectives on recovery.

PubMed

Williams, Wesley; McKinney, Christopher; Martinez, Larry; Benson, Carmela

2016-01-01

This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders. Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider's (Recovery Markers Inventory [RMI]) and patient's (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI. A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p < 0.05), an overall increase (p < 0.01), and an increased rate of change (p < 0.05) in RMI scores during the paliperidone palmitate LAI treatment period vs the pre-treatment period. This study contained a retrospective, non-comparative design, and did not adjust for multiplicity Conclusions: The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug's use as schizophrenia treatment from a recovery-oriented perspective.

Empathic orientation among medical students from three universities in Barranquilla, Colombia and one university in the Dominican Republic.

PubMed

Díaz Narváez, Víctor Patricio; Alonso Palacio, Luz Marina; Caro, Sara Elvira; Silva, María Guadalupe; Castillo, Joel Arboleda; Bilbao, Jorge Luis; Acosta, Jesús Iglesias

2014-02-01

To compare empathic orientation among medical students from three schools of medicine in Colombia and one in the Dominican Republic. Empathic orientation of medical students was measured using the Jefferson Scale of Physician Empathy (JSPE), Spanish version for students (the "S" version) validated in Mexico and Chile, and culturally adapted to Colombia and the Dominican Republic. Data were compared using a three-factor analysis of variance (model III) and a discriminant analysis. No differences in empathic orientation were observed among courses and between sexes, but differences were found in schools of medicine considered as a unit in each studied country. Empathic orientation levels tend to reduce as courses advance. This was observed in both male and female students and in all schools analyzed.

[The social role of the faculties of medicine: physicians' perception of the dominant orientation of their medical studies and social involvement].

PubMed

Dopelt, Keren; Yahav, Zehava; Urkin, Jacob; Bachner, Yaacov; Davidovitch, Nadav

2014-02-01

Medical education, based on the principles of social medicine, has the ability to contribute to reducing health disparities through the "creation" of doctors who are more involved in community programs. To compare the social and community orientation of graduates from the various medical schools. An online cross-sectional survey among 12,000 physicians who are graduates of Israeli medical schools was conducted in May 2011. The study encompassed 1,050 physicians, Israeli medical school graduates living in Israel and practicing medicine: 36% were Hebrew University graduates, 26% were Tel Aviv University graduates, 22% were Technion graduates and 16% were Ben-Gurion University (BGU) graduates. Higher rates of physicians who studied at the Technion and BGU are working or have worked in the periphery (approximately 50% vs. approximately 30% average of Hebrew and Tel-Aviv University schools). Among BGU graduates, 47% are active in community programs vs. 34-38% in other schools. Among physicians active in community programs, 32% of BGU alumni estimated that their medical education greatly influenced their community involvement vs. 8-15% in other schools. Hebrew University alumni graded their studies as having a higher research orientation. In contrast, BGU graduates graded their studies as having a higher social orientation, and had more positive attitudes on the role of the physician in reducing health disparities. Medical education with a social orientation will induce a socialization process that reinforces human values regarding the doctor-patient relationship and produce positive attitudes among future doctors regarding their social involvement. The findings emphasize the need to develop educational programs with a social orientation and to strengthen medical schools in the periphery.

Realization of a universal patient identifier for electronic medical records through biometric technology.

PubMed

Leonard, D C; Pons, Alexander P; Asfour, Shihab S

2009-07-01

The technology exists for the migration of healthcare data from its archaic paper-based system to an electronic one, and, once in digital form, to be transported anywhere in the world in a matter of seconds. The advent of universally accessible healthcare data has benefited all participants, but one of the outstanding problems that must be addressed is how the creation of a standardized nationwide electronic healthcare record system in the United States would uniquely identify and match a composite of an individual's recorded healthcare information to an identified individual patients out of approximately 300 million people to a 1:1 match. To date, a few solutions to this problem have been proposed that are limited in their effectiveness. We propose the use of biometric technology within our fingerprint, iris, retina scan, and DNA (FIRD) framework, which is a multiphase system whose primary phase is a multilayer consisting of these four types of biometric identifiers: 1) fingerprint; 2) iris; 3) retina scan; and 4) DNA. In addition, it also consists of additional phases of integration, consolidation, and data discrepancy functions to solve the unique association of a patient to their medical data distinctively. This would allow a patient to have real-time access to all of their recorded healthcare information electronically whenever it is necessary, securely with minimal effort, greater effectiveness, and ease.

Measuring hospital medical staff organizational structure.

PubMed Central

Shortell, S M; Getzen, T E

1979-01-01

Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively independent dimensions supporting a multidimensional view of medical staff organization structure. The six dimensions include 1) Resource Capability, 2) Generalist Physician Contractual Orientation, 3) Communication/Control, 4) Local Staff Orientation, 5) Participation in Decision Making, and 6) Hospital-Based Physician Contractual Orientation. It is suggested that these dimensions can be used to develop an empirical typology of hospital medical staff organization structure and to investigate the relationship between medical staff organization and public policy issues related to cost containment and quality assurance. PMID:511580

Assessment of health seeking behaviour and self-medication among general public in the state of Penang, Malaysia.

PubMed

Dawood, Omar T; Hassali, Mohamed A; Saleem, Fahad; Ibrahim, Inas R; Abdulameer, Aseel H; Jasim, Hanan H

2017-01-01

Patients' behaviour in making decisions regarding health is currently changing from passive recipients to recipients who play an active role in taking action to control their health and taking self-care initiatives. This study was conducted to evaluate the health seeking behaviour among general public and its associated factors; and to evaluate the medicine taking behaviour in public and the practice of self-medication. A cross-sectional study was undertaken among general public in Penang Island, Malaysia. A convenience sampling of 888 participants successfully completed the survey. Self-administered questionnaires were distributed among the residents in the north east of Penang Island. This study showed that most of the participants chose to consult the physician when they experience any health problems (66.7%), followed by self-medication (20.9%). The first action for consulting the physician was significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI 1.04-8.89). The prevalence of self-medication was 54%. The practice of self-medication was significantly associated with Chinese participants, educated people, people with alone living status and people with more self-care orientation. Increasing the awareness of the public about the rational choice of getting medical assistance is a very important issue to control their health. A health education program is needed to increase the awareness about the use of medicines among the general public and to enable them to make the right decisions relating to health problems.

[Medical ethics in residency training].

PubMed

Civaner, Murat; Sarikaya, Ozlem; Balcioğlu, Harun

2009-04-01

Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.

Perspective: the revolution is upon us.

PubMed

Sierles, Frederick S

2010-05-01

Profound socioeconomic pressures on medical student education have been catalogued extensively. These pressures include teaching patient shortages, teacher shortages, conflicting systems, and financial problems. Many of these problems have been caused by an unregulated free market affecting medicine overall, with market values sometimes overshadowing the academic values of education, research, and patient care. This has caused profound changes in the conduct of medical student education. Particularly important has been a reduction in the "gold standard" of teaching: direct student-teacher and supervised student-patient interaction, replaced by a potpourri of online and simulated modules. The aggregate of these changes constitutes a revolution that challenges whether medical schools, school buildings, classes, and dedicated faculty are even necessary. The author posits several recommendations in response to this revolution: (1) recognize the revolution as such, and carefully guide or abort it, lest its outcome be inadequate, inauthentic, or corrupt, (2) prioritize academic rather than business values, (3) ensure that funds allotted for education are used for education, (4) insist that medical schools, not industry, teach students, (5) value authentic education more than simulation, (6) adopt learner-centered teaching without misusing it, (7) maintain acceptable class attendance without requiring it, (8) provide, from the first school day, authentic, patient-centered medical education characterized by vertical integration, humanism, early patient exposure, biopsychosocial orientation, and physician role modeling, (9) ensure that third- and fourth-year students have rich patient-care responsibility, and 10) keep tenure. These actions would permit the preservation of an educational gold standard that justifies medical education's cost.

Improving practice using action research: resolving the problem of kinking with non-metal cannulae.

PubMed

Griffith, Sue

2011-11-01

In one UK hospice, inpatient unit records showed that over 8 years 12 needlestick injuries related to continuous subcutaneous infusion of medication occurred. Following a change-over to Teflon cannulae no further incidents were reported. However, when the more sensitive and accurate McKinley T34 syringe drivers were introduced in 2007 a new problem of recurrent occlusion alarm sounding manifested. Investigation revealed that the Teflon cannulae were often kinking, delaying medication delivery and necessitating re-siting of the cannula. The action research approach was used to find an alternative device to improve practice and ensure that both staff and patients were safeguarded. This paper explains how that process was followed until a satisfactory alternative was sourced and evidenced, including an account of the problems that were experienced along the way.

An 'Honest Broker' mechanism to maintain privacy for patient care and academic medical research.

PubMed

Boyd, Andrew D; Hosner, Charlie; Hunscher, Dale A; Athey, Brian D; Clauw, Daniel J; Green, Lee A

2007-01-01

From the Hippocratic Oath to the World Medical Association's Declaration of Geneva, physicians have sworn to protect patients' privacy. However, as systems move to more integrated architectures, protecting this medical data becomes more of a challenge. The increase in complexity of IT environments, the aggregation of data, and the desire of other entities to access this data, often 24 h/day x 7 day/week x 365 day/year, is putting serious strains on our ability to maintain its security. This problem cuts across all electronic record sources from patient care records to academic medical research records. In order to address this issue, we are rethinking the way we store, transmit, process, access, and federate patient data from clinical and research applications. Our groups at the University of Michigan are developing a system called the "Honest Broker" to help manage this problem. The Honest Broker will offload the burden of housing identifiable data elements of protected health information (PHI) (e.g., name and address) as well as manage data transfer between clinical and research systems. Lab results and other non-identifiable data will be stored in separate systems with either a research study ID or clinical ID number. This two-component architecture increases the burden on attackers who now need to compromise two systems, one of which is seriously hardened, in order to match health data with a patient's actual identity. While no security system is truly intrusion-proof, this architecture provides a high security choke point reducing the likelihood of a breach. By redesigning the method of integrating clinical care and research, we have enabled projects that would be cost prohibitive to conduct otherwise. The scalability of this mechanism is dependant on nature of the heterogenous nature of the clinical systems serving patients.

A pilot study exploring the relationship between lifelong learning and factors associated with evidence-based medicine.

PubMed

Mi, Misa; Halalau, Alexandra

2016-07-03

To explore possible relationships between residents' lifelong learning orientation, skills in practicing evidence-based medicine (EBM), and perceptions of the environment for learning and practicing EBM. This was a pilot study with a cross-sectional survey design. Out of 60 residents in a medical residency program, 29 participated in the study. Data were collected using a survey that comprised three sections: the JeffSPLL Scale, EBM Environment Scale, and an EBM skill questionnaire. Data were analyzed using SPSS and were reported with descriptive and inferential statistics (mean, standard deviation, Pearson's correlation, and a two-sample t-test). Mean scores on the JeffSPLL Scale were significantly correlated with perceptions of the EBM Scale and use of EBM resources to keep up to date or solve a specific patient care problem. There was a significant correlation between mean scores on the EBM Scale and hours per week spent in reading medical literature to solve a patient care problem. Two-sample t-tests show that residents with previous training in research methods had significantly higher scores on the JeffSPLL Scale (p=0.04), EBM Scale (p=0.006), and self-efficacy scale (p =0.024). Given the fact that physicians are expected to be lifelong learners over the course of their professional career, developing residents' EBM skills and creating interventions to improve specific areas in the EBM environment would likely foster residents' lifelong learning orientation.

Quality of doctor-patient communication through the eyes of the patient: variation according to the patient's educational level.

PubMed

Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam

2015-10-01

Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In this study we describe patients' perspective in doctor-patient communication according to their educational level, and to what extent these perspectives lean towards the expert opinion on doctor-patient communication. In a multi-center study (Belgium, The Netherlands, UK and Italy), focus group discussions were organised using videotaped medical consultations. A mixed methods approach was used to analyse the data. Firstly, a difference in perspective in communication style was found between the lower educated participants versus the middle and higher educated participants. Secondly, lower educated participants referred positively most to aspects related to the affective/emotional area of the medical consultation, followed by the task-oriented/problem-focused area. Middle and higher educated participants positively referred most to the task-oriented/problem-focused area. The competency of the physician was an important category of communication for all participants, independent of social background. The results indicate that the preferences of lower educated participants lean more towards the expert opinion in doctor-patient communication than the middle and higher educated participants. Patients' educational level seems to influence their perspective on communication style and should be taken into account by physicians. Further quantitative research is needed to confirm these results.

[Medical record management and risk management processes. State of the art and new normative guidelines about the organization and the management of the sanitary documentation in the National Health System or Hospital Trusts].

PubMed

Spolaore, P; Murolo, G; Sommavilla, M

2003-01-01

Recent health care reforms, the start of accreditation processes of health institutions, and the introduction also in the health system of risk management concepts and instruments, borrowed from the enterprise culture and the emphasis put on the protection of privacy, render evident the need and the urgency to define and to implement improvement processes of the organization and management of the medical documentation in the hospital with the aim of facilitation in fulfilment of regional and local health authorities policies about protection of the safety and improvement of quality of care. Currently the normative context that disciplines the management of medical records inside the hospital appears somewhat fragmentary, incomplete and however not able to clearly orientate health operators with the aim of a correct application of the enforced norms in the respect of the interests of the user and of local health authority. In this job we individuate the critical steps in the various phases of management process of the clinical folder and propose a new model of regulations, with the purpose to improve and to simplify the management processes and the modalities of compilation, conservation and release to entitled people of all clinical documentation.

Documenting the decision structure in software development

NASA Technical Reports Server (NTRS)

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

1990-01-01

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

Medical ethics and education for social responsibility.

PubMed

Roemer, M I

1980-01-01

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

Medical ethics and education for social responsibility.

PubMed Central

Roemer, M. I.

1980-01-01

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

Psychotherapeutic and work-oriented interventions: employment outcomes among young adults with work disability due to a mental disorder.

PubMed

Mattila-Holappa, Pauliina; Joensuu, Matti; Ahola, Kirsi; Koskinen, Aki; Tuisku, Katinka; Ervasti, Jenni; Virtanen, Marianna

2016-01-01

We examined the extent to which psychotherapeutic and work-oriented interventions were included in a medical treatment and rehabilitation plan and whether they predicted future employment among young adults with work disability due to a mental disorder. Data were obtained from the treatment and rehabilitation plans of 1163 young adults aged 18‒34 years, who in 2008 were granted fixed-term work disability compensation due to a mental disorder and were followed for 5 years. Forty-six percent had no proposal for psychotherapy or a work-oriented intervention in their treatment and rehabilitation plan, 22 % had a plan for only a psychotherapeutic intervention, 23 % had a plan for only a work-oriented intervention, and 10 % had both types of interventions planned. Having a planned psychotherapeutic intervention (HR = 1.35, 95 % CI 1.07-1.69) and of the work-oriented interventions, planned rehabilitative courses and training (HR = 1.34, 95 % CI 1.03-1.70) predicted quicker entry into competitive employment. Having a plan for both a psychotherapeutic and work-oriented intervention was associated with being employed at the end of the follow-up (OR = 1.77, 95 % CI 1.07-2.95). Young adults with a long-term psychiatric work disability episode rarely have a recorded plan for rehabilitation in their treatment and rehabilitation plan although psychotherapeutic interventions and a combination of a psychotherapeutic and work-oriented intervention might help them gain employment.

Electronic medical record features and seven quality of care measures in physician offices.

PubMed

Hsiao, Chun-Ju; Marsteller, Jill A; Simon, Alan E

2014-01-01

The effect of electronic medical records (EMRs) on quality of care in physicians' offices is uncertain. This study used the 2008-2009 National Ambulatory Medical Care Survey to examine the relationship between EMRs features and quality in physician offices. The relationship between selected EMRs features and 7 quality measures was evaluated by testing 25 associations in multivariate models. Significant relationships include reminders for guideline-based interventions or screening tests associated with lower odds of inappropriate urinalysis and prescription of antibiotics for upper respiratory infection (URI), prescription order entry associated with lower odds of prescription of antibiotics for URI, and patient problem list associated with higher odds of inappropriate prescribing for elderly patients. EMRs system level was associated with lower odds of blood pressure check, inappropriate urinalysis, and prescription of antibiotics for URI compared with no EMRs. The results show both positive and inverse relationships between EMRs features and quality of care.

[Who decides what data should be recorded in the medical history in relation to the biological origin?

PubMed

Gallego Riestra, Sergio; Riaño Galán, Isolina

2018-02-01

There is an increasing request by patients or their representatives not to have some data registered in their clinical history or if such data exists to be deleted. Without doubt, this is so because such clinical data is accessed by various professionals who in most cases are not directly involved in caring for such patients. On the other hand, such data is copied and iteratively and unnecessary reproduced in various discharge reports and others forms. The problem arises when such controversial data refer to particularly sensitive clinical aspects such as assisted reproduction techniques, which invades personal and family privacy. Therefore, the question is who determines what data should be recorded in the medical records and according to what criteria should be taken that decision? Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

[Computer-assisted multimedia interactive learning program "Primary Open-Angle Glaucoma"].

PubMed

Dick, V B; Zenz, H; Eisenmann, D; Tekaat, C J; Wagner, R; Jacobi, K W

1996-05-01

Advances in the area of information technology have opened up new possibilities for the use of interactive media in the training of medical students. Classical instructional technologies, such as video, slides, audio cassettes and computer programs with a textbook orientation, have been merged into one multimedia computer system. The medical profession has been increasingly integrating computer-based applications which can be used, for example, for record keeping within a medical practice. The goal of this development is to provide access to all modes of information storage and retrieval as well as documentation and training systems within a specific context. Since the beginning of the winter semester 1995, the Department of Ophthalmology in Giessen has used the learning program "Primary Open Angle Glaucoma" in student instruction. One factor that contributed to the implementation of this project was that actual training using patients within the clinic is difficult to conduct. Media-supported training that can provide a simulation of actual practice offers a suitable substitute. The learning program has been installed on Power PCs (Apple MacIntosh), which make up the technical foundation of our system. The program was developed using Hypercard software, which provides userfriendly graphical work environment. This controls the input and retrieval of data, direct editing of documents, immediate simulation, the creation of on-screen documents and the integration of slides that have been scanned in as well as QuickTime films. All of this can be accomplished without any special knowledge of programming language or operating systems on the part of the user. The glaucoma learning program is structured along the lines of anatomy, including an explanation of the circulation of the aqueous humor, pathology, clinical symptoms and findings, diagnosis and treatment. This structure along with the possibility for creating a list of personal files for the user with a collection of illustrations and text allows for quick access to learning content. The program is designed in such a way that working with and through it is done in a manner conducive to learning. Student response to the learning program as an accompaniment to instruction has been positive. Independent, supplemental student learning by means of an interactive learning program has raised the quality of study within the sciences. The use of a pedagogically sound multimedia program, that is oriented toward problem solving and based on actual cases offers students the opportunity to actively work ophthalmological material. An additional benefit is the development of competence in working with computer-support information systems, something that is playing an ever-increasing role within the medical profession.

Computers in medical education 1: evaluation of a problem-orientated learning package.

PubMed

Devitt, P; Palmer, E

1998-04-01

A computer-based learning package has been developed, aimed at expanding students' knowledge base, as well as improving data-handling abilities and clinical problem-solving skills. The program was evaluated by monitoring its use by students, canvassing users' opinions and measuring its effectiveness as a learning tool compared to tutorials on the same material. Evaluation was undertaken using three methods: initially, by a questionnaire on computers as a learning tool and the applicability of the content: second, through monitoring by the computer of student use, decisions and performance; finally, through pre- and post-test assessment of fifth-year students who either used a computer package or attended a tutorial on equivalent material. Most students provided positive comments on the learning material and expressed a willingness to see computer-aided learning (CAL) introduced into the curriculum. Over a 3-month period, 26 modules in the program were used on 1246 occasions. Objective measurement showed a significant gain in knowledge, data handling and problem-solving skills. Computer-aided learning is a valuable learning resource that deserves better attention in medical education. When used appropriately, the computer can be an effective learning resource, not only for the delivery of knowledge. but also to help students develop their problem-solving skills.

Problems for biomedical research at the academia-industrial interface.

PubMed

Weatherall, David

2003-01-01

Throughout much of the world, universities have driven towards industrial partnerships. This collaboration, which, in the biochemical field at least, has to continue if potential benefits for patients are to be realised, has brought with it a number of problems. These include the neglect of long-term research in favour of short-term projects, the curtailing of free dissemination of research information within university departments and the biasing of results of clinical trials by the financial interests of the investigators. It is very important that governments, universities, and industry itself address these problems. Universities should monitor the amount of basic, curiosity-driven research that is being carried on, compared with that which is more short-term goal orientated. PhD students and post-doctoral fellows should be exposed to the principles of bioethics early on in their careers. Further work is necessary on the terms of research contracts to protect, on the one hand, the rights of individual scientists and, on the other, industry from rogue scientists. Where problems arise, procedures should be in place for independent reviews to be conducted by bodies such as the Medical Research Council in the UK or the National Institutes of Health in the USA. The conflict-of-interest rules recently introduced for publication in medical journals should be extended to all branches of science.

Measuring Actual eHealth Literacy Among Patients With Rheumatic Diseases: a Qualitative Analysis of Problems Encountered Using Health 1.0 and Health 2.0 Applications

PubMed Central

Drossaert, Constance HC; de Heus, Miriam; Taal, Erik; van de Laar, Mart AFJ

2013-01-01

Background The Internet offers diverse opportunities for disease management, through information websites (Health 1.0) and interactive applications such as peer support forums, online consults, and insight into electronic medical records (Health 2.0). However, various skills are required to benefit from Health 1.0 and Health 2.0 applications for one’s own health, known as eHealth literacy. Objective To study the eHealth literacy of patients with rheumatic diseases and the types of problems they encounter when using the Internet in relation to their disease. Methods In two studies, patients were asked about their current disease-related Internet use and their eHealth literacy was observed during performance tests. In study 1, 15 patients (aged 39-74) performed 6 information-retrieval tasks on the Internet (Health 1.0). In study 2, 16 patients (aged 24-72) performed 3 Health 2.0 tasks on a hospital-based online Web portal and 2 Health 2.0 tasks on interactive websites. Participants were asked to think aloud while performing the assignments, and screen activities were recorded. Types and frequency of problems were identified by 2 independent researchers and coded into categories using inductive analysis. Results Almost all patients in our studies had searched the Internet for information about rheumatic diseases in the past. Fewer patients had used Health 2.0 applications, but many were nevertheless enthusiastic about the possibilities from Health 2.0 applications after finishing the assignments. However, nearly all participants experienced difficulties, and a substantial number of participants were not able to complete all of the assignments. Encountered problems could be divided into 6 sequential categories: (1) operating the computer and Internet browser, (2) navigating and orientating on the Web, (3) utilizing search strategies, (4) evaluating relevance and reliability, (5) adding content to the Web, and (6) protecting and respecting privacy. Most severe difficulties occurred in levels 3 and 4—in formulating a search query, evaluating the source of the information, and in scanning a website for relevant information. Conclusions Many patients have insufficient skills to properly use Health 1.0 and Health 2.0. Formulating proper search strategies and evaluating the found information caused problems among the majority of patients. Concerning Health 2.0, use and awareness of these applications is low and patients should be guided in the use of them. Our findings may contribute to the awareness of patients’ eHealth literacy problems among health professionals, and stress the importance of usability guidelines in Web design. PMID:23399720

Product-line administration: a framework for redefining medical record department services.

PubMed

Postal, S N

1990-06-01

Product-line administration is a viable approach for managing medical records services in an environment that demands high quantity and quality service levels. Product-line administration directs medical record department team members to look outside of the department and seek input from the customers it is intended to serve. The feedback received may be alarming at first, as the current state of products usually reveals a true lack of customer input. As the planning, defining, managing, and marketing phases are implemented, the road will not be easy and rewards will be slow to come. Product-line administration does not provide quick fixes, but it does provide long-term problem resolution as products are refined and new products developed to meet customer needs and expectations. In addition to better meeting the needs of the department's external customers, the department's internal customers' needs and expectations will be addressed. The participative management approach will help nurture each team member's creativity. The team members will have the opportunity to reach their full potential while reaping the rewards and benefits of providing products and services that meet the needs and expectations of all department customers. The future of the health care industry promises more changes as the country moves toward some form of prospective payment in the ambulatory setting. Reactive management and the constant struggle to catch up can no longer be accepted as a management approach. It is imperative that the medical record department be viewed as a business with product lines composed of quality products. The planning, defining, managing, and marketing components of product-line administration afford responsiveness to the current situation and the development of quality products that will ensure that medical record departments are prepared for the future.

The influence of cultural and religious orientations on social support and its potential impact on medication adherence

PubMed Central

Hatah, Ernieda; Lim, Kien Ping; Ali, Adliah Mohd; Mohamed Shah, Noraida; Islahudin, Farida

2015-01-01

Purpose Social support can positively influence patients’ health outcomes through a number of mechanisms, such as increases in patients’ adherence to medication. Although there have been studies on the influence of social support on medication adherence, these studies were conducted in Western settings, not in Asian settings where cultural and religious orientations may be different. The objective of this study was to assess the effects of cultural orientation and religiosity on social support and its relation to patients’ medication adherence. Methods This was a cross-sectional study of patients with chronic diseases in two tertiary hospitals in Selangor, Malaysia. Patients who agreed to participate in the study were asked to answer questions in the following areas: 1) perceived group and higher authority cultural orientations; 2) religiosity: organizational and non-organizational religious activities, and intrinsic religiosity; 3) perceived social support; and 4) self-reported medication adherence. Patients’ medication adherence was modeled using multiple logistic regressions, and only variables with a P-value of <0.25 were included in the analysis. Results A total of 300 patients completed the questionnaire, with the exception of 40 participants who did not complete the cultural orientation question. The mean age of the patients was 57.6±13.5. Group cultural orientation, organizational religious activity, non-organizational religious activity, and intrinsic religiosity demonstrated significant associations with patients’ perceived social support (r=0.181, P=0.003; r=0.230, P<0.001; r=0.135, P=0.019; and r=0.156, P=0.007, respectively). In the medication adherence model, only age, duration of treatment, organizational religious activity, and disease type (human immunodeficiency virus) were found to significantly influence patients’ adherence to medications (adjusted odds ratio [OR] 1.05, P=0.002; OR 0.99, P=0.025; OR 1.19, P=0.038; and OR 9.08, P<0.05, respectively). Conclusion When examining religious practice and cultural orientation, social support was not found to have significant influence on patients’ medication adherence. Only age, duration of treatment, organizational religious activity, and disease type (human immunodeficiency virus) had significant influence on patients’ adherence. PMID:25960641

Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study.

PubMed

Sellappans, Renukha; Lai, Pauline Siew Mei; Ng, Chirk Jenn

2015-08-27

The aim of this study was to identify the challenges faced by primary care physicians (PCPs) when prescribing medications for patients with chronic diseases in a teaching hospital in Malaysia. 3 focus group discussions were conducted between July and August 2012 in a teaching primary care clinic in Malaysia. A topic guide was used to facilitate the discussions which were audio-recorded, transcribed verbatim and analysed using a thematic approach. PCPs affiliated to the primary care clinic were purposively sampled to include a range of clinical experience. Sample size was determined by thematic saturation of the data. 14 family medicine trainees and 5 service medical officers participated in this study. PCPs faced difficulties in prescribing for patients with chronic diseases due to a lack of communication among different healthcare providers. Medication changes made by hospital specialists, for example, were often not communicated to the PCPs leading to drug duplications and interactions. The use of paper-based medical records and electronic prescribing created a dual record system for patients' medications and became a problem when the 2 records did not tally. Patients sometimes visited different doctors and pharmacies for their medications and this resulted in the lack of continuity of care. PCPs also faced difficulties in addressing patients' concerns, and dealing with patients' medication requests and adherence issues. Some PCPs lacked time and knowledge to advise patients about their medications and faced difficulties in managing side effects caused by the patients' complex medication regimen. PCPs faced prescribing challenges related to patients, their own practice and the local health system when prescribing for patients with chronic diseases. These challenges must be addressed in order to improve chronic disease management in primary care and, more importantly, patient safety. 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.

Examining Medical Student Specialty Choice Through a Gender Lens: An Orientational Qualitative Study.

PubMed

Smith, Victoria; Bethune, Cheri; Hurley, Katrina F

2018-01-01

Phenomenon: A growing number of women are entering the medical workforce, yet their distribution across medical specialties remains nonuniform. We sought to describe how culture, bias, and socialization shape gendered thinking regarding specialty choice at a Canadian undergraduate medical institution. We analyzed transcripts from the Career Choices Project: 16 semistructured focus group discussions with 70 students graduating from Memorial University of Newfoundland in 2003, 2006, 2007, and 2008. The questions and prompts were designed to explore factors influencing specialty choice and did not specifically probe gender-based experiences. Focus groups were audio-recorded, transcribed, and deidentified before analysis. Analysis was inductive and guided by principles of orientational qualitative inquiry using a gender-specific lens. The pursuits of personal and professional goals, as well as contextual factors, were the major themes that influenced decision-making for women and men. Composition of these major themes varied between genders. Influence of a partner, consideration of familial commitments (both present and future), feeling a sense of connectedness with the field in question, and social accountability were described by women as important. Both genders hoped to pursue careers that would afford "flexibility" in order to balance work with their personal lives, though the construct of work-life balance differed between genders. Women did not explicitly identify gender bias or sexism as influencing factors, but their narratives suggest that these elements were at play. Insights: Our findings suggest that unlike men, women's decision-making is informed by tension between personal and professional goals, likely related to the context of gendered personal and societal expectations.

Leveraging Social Networking Sites for an Autoimmune Hepatitis Genetic Repository: Pilot Study to Evaluate Feasibility.

PubMed

Comerford, Megan; Fogel, Rachel; Bailey, James Robert; Chilukuri, Prianka; Chalasani, Naga; Lammert, Craig Steven

2018-01-18

Conventional approaches to participant recruitment are often inadequate in rare disease investigation. Social networking sites such as Facebook may provide a vehicle to circumvent common research limitations and pitfalls. We report our preliminary experience with Facebook-based methodology for participant recruitment and participation into an ongoing study of autoimmune hepatitis (AIH). The goal of our research was to conduct a pilot study to assess whether a Facebook-based methodology is capable of recruiting geographically widespread participants into AIH patient-oriented research and obtaining quality phenotypic data. We established a Facebook community, the Autoimmune Hepatitis Research Network (AHRN), in 2014 to provide a secure and reputable distillation of current literature and AIH research opportunities. Quarterly advertisements for our ongoing observational AIH study were posted on the AHRN over 2 years. Interested and self-reported AIH participants were subsequently enrolled after review of study materials and completion of an informed consent by our study coordinator. Participants returned completed study materials, including epidemiologic questionnaires and genetic material, to our facility via mail. Outside medical records were obtained and reviewed by a study physician. We successfully obtained all study materials from 29 participants with self-reported AIH within 2 years from 20 different states. Liver biopsy results were available for 90% (26/29) of participants, of which 81% (21/29) had findings consistent with AIH, 15% (4/29) were suggestive of AIH with features of primary biliary cholangitis (PBC), and 4% (1/29) had PBC alone. A total of 83% (24/29) had at least 2 of 3 proposed criteria: positive autoimmune markers, consistent histologic findings of AIH on liver biopsy, and reported treatment with immunosuppressant medications. Self-reported and physician records were discrepant for immunosuppressant medications or for AIH/PBC diagnoses in 4 patients. Facebook can be an effective ancillary tool for facilitating patient-oriented research in rare diseases. A social media-based approach transcends established limitations in rare disease research and can further develop research communities. ©Megan Comerford, Rachel Fogel, James Robert Bailey, Prianka Chilukuri, Naga Chalasani, Craig Steven Lammert. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.01.2018.

Review of the Burden of Esophageal Cancer in Malaysia.

PubMed

Siti-Azrin, Ab Hamid; Wan-Nor-Asyikeen, Wan Adnan; Norsa'adah, Bachok

2016-01-01

Esophageal cancer is one of the top leading causes of cancer-related deaths in Malaysia. To date, neither the prevalence nor incidence of esophageal cancer nationally have been recorded. Esophageal cancer remains a major and lethal health problem even if it is not common in Malaysia. The late presentation of esophageal cancer makes it a difficult and challenging medical problem. Therefore, more governmental and non-governmental organizations of Malaysia should emphasize primary and secondary prevention strategies.

CLARUS as a Cloud Security Framework: e-Health Use Case.

PubMed

Vidal, David; Iriso, Santiago; Mulero, Rafael

2017-01-01

Maintaining Passive Medical Health Records (PMHR) is an increasing cost and resource consumption problem. Moving to the cloud is the clearest solution to solve the problem as it offers a high amount of space and computation power. But the cloud is not safe enough when dealing with this kind of information because it can be easily accessed by attackers. The European Commission funded research project CLARUS contributes to protect healthcare-sensitive information in a secure way.

Building health information technology capacity: they may come but will they use it?

PubMed

Burke-Bebee, Suzie; Wilson, Marisa; Buckley, Kathleen M

2012-10-01

Medical errors remain a major safety problem more than a decade after the Institute of Medicine reported 98 000 related deaths occur yearly in US hospitals. Medication errors account for one-third of these errors. Although medication reconciliation is an accepted care standard for patient safety, little evidence is available to make practice recommendations for primary care. The purpose of this study was to evaluate the effectiveness of using secure e-mail alerts within the reconciliation process on patient medication safety in clinics where electronic and personal health records are used. A nonexperimental, descriptive design with a convenience sample of 62 patients from two Veterans Health Administration clinics was used. Patients received secure e-mail instructing them to review their online medication list, update it based on home medications, and bring it to the appointment for discussion with their provider. A retrospective chart review was conducted examining changes made to medication lists in the electronic record after reconciliation. Data revealed the organization's adoption of secure e-mail did not guarantee its meaningful use by providers and patients, a clear barrier to implementing technology as an adjunct to care in context of complex clinical processes such as medication reconciliation. Lessons learned from the project's implementation are discussed.

Dispositional optimism, self-framing and medical decision-making.

PubMed

Zhao, Xu; Huang, Chunlei; Li, Xuesong; Zhao, Xin; Peng, Jiaxi

2015-03-01

Self-framing is an important but underinvestigated area in risk communication and behavioural decision-making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self-frame and decision-making. Participants (N = 500) responded to the Life Orientation Test-Revised and self-framing test of medical decision-making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self-frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5-year survival rate. Based on the current findings, it can be concluded that self-framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision-making. © 2014 International Union of Psychological Science.

Heaps of health, metaphysical fitness: Ayurveda and the ontology of good health in medical anthropology.

PubMed

Alter, J S

1999-02-01

Because most scholars take it for granted that medicine is concerned with healing and problems of ill health, the way in which various medical systems define good health has not been adequately studied. Moreover, good health as such is usually regarded as a natural, normative state of being even by most medical anthropologists, who otherwise take a critical, relativist perspective on the subject of illness, pain, and disease. Using the case of Ayurvedic medicine, this article shows that there is a very different way of looking at the question of how health is embodied. This perspective is proactive and concerned with overall fitness rather than reactive and primarily concerned with either illness or disease. The argument presented here therefore seeks to go beyond the limiting--although extremely useful--orientation of remedial health care and suggest a radical challenge to some of the most basic ontological assumptions in the cross-cultural comparative study of medical systems.

Data warehouse for detection of occupational diseases in OHS data.

PubMed

Godderis, L; Mylle, G; Coene, M; Verbeek, C; Viaene, B; Bulterys, S; Schouteden, M

2015-11-01

Occupational health and safety (OHS) services collect a wide range of data during health surveillance. To build a 'data warehouse' to make OHS data available for research and to investigate sector-specific health problems. Medical data were extracted, transformed and loaded into the data warehouse. After validation, data on lifestyle, categorized medication use, ICD-9-CM encoded sickness absences and health complaints, collected between 2010 and 2014, were analysed with logistic regression to compare proportions between employment sectors, taking into account age, gender, body mass index (BMI) and year of examination. The data set comprised 585000 employees. Average age and employment seniority were 39 ± 12 and 8 ± 9 years, respectively. BMI was 26 ± 5 kg/m(2). Health complaints, medication use and sickness absence significantly increased with BMI and age. The proportion of employees with health problems was highest in health care (64%), government (61%) and manufacturing (60%) and lowest in the service sector. In all sectors, 10% of workers reported locomotor health problems, apart from the service sector (8%) with similar results for medication consumption. Neuropsychological drugs were more frequently used by health care workers (8%). The transport sector contained the highest proportion of cardiological medication users (12%). Finally, 30-59% of employees reported at least one sickness absence episode. Sickness absence due to locomotor issues was highest in manufacturing (11%) and health care (10%), followed by government (9%) and construction (9%). Significant differences in indices of workers' health were observed between sectors. This information is now being used in the implementation of a sector-oriented health surveillance programme. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Focus on Problems of National Interest in the College General Chemistry Laboratory: The Effects of the Problem-Oriented Method Compared with Those of the Traditional Approach.

ERIC Educational Resources Information Center

Neman, Robert Lynn

This study was designed to assess the effects of the problem-oriented method compared to those of the traditional approach in general chemistry at the college level. The problem-oriented course included topics such as air and water pollution, drug addiction and analysis, tetraethyl-lead additives, insecticides in the environment, and recycling of…

Oral impacts on quality of life and problem-oriented attendance among South East London adults.

PubMed

Gaewkhiew, Piyada; Bernabé, Eduardo; Gallagher, Jennifer E; Klass, Charlotte; Delgado-Angulo, Elsa K

2017-04-26

Dental care seeking behaviour is often driven by symptoms. The value of oral health related quality of life (OHRQoL) measures to predict utilisation of dental services is unknown. This study aims to explore the association between OHRQoL and problem-oriented dental attendance among adults. We analysed cross-sectional data for 705 adults, aged 16 years and above, living in three boroughs of Inner South East London. Data were collected during structured interviews at home. The short form of the Oral Health Impact Profile (OHIP-14) was used to assess the frequency of oral impacts on daily life in the last year. Problem-oriented attendance was defined based on time elapsed since last visit (last 6 months) and reason for that visit (trouble with teeth). The association between OHIP-14 (total and domain) scores and problem-oriented attendance was tested in logistic regression models adjusting for participants' sociodemographic characteristics. Problem-oriented attenders had a higher OHIP-14 total score than regular attenders (6.73 and 3.73, respectively). In regression models, there was a positive association between OHIP-14 total score and problem-oriented attendance. The odds of visiting the dentist for trouble with teeth were 1.07 greater (95% Confidence Interval: 1.04-1.10) per unit increase in the OHIP-14 total score, after adjustment for participants' sociodemographic characteristics. In subsequent analysis by OHIP-14 domains, greater scores in all domains but handicap were significantly associated with problem-oriented attendance. This study shows that oral impacts on quality of life are associated with recent problem-oriented dental attendance among London adults. Six of the seven domains in the OHIP-14 questionnaire were also associated with dental visits for trouble with teeth.

Y2K: prepare, don't panic.

PubMed

Russo, R

1999-04-01

Y2K issues could affect anyone, so it is important for HIV-positive people to make preparations to ensure their health and security. There are wide-ranging opinions about the effects of the so-called Millennium Bug, but some planning will make any changes more manageable. Patients should have adequate supplies of food, water, and medications at home in case of shortages or production problems. Other prudent steps include keeping extra cash on hand and obtaining copies of medical records and benefit plans. Internet resources are listed.

Best practice in unbilled account management: one medical center's story.

PubMed

Menaker, Debra; Miller, Joshua

2016-02-01

After implementing its new electronic health record, a large metropolitan academic medical center (AMC) decided to optimize its supporting business systems, beginning with billing. By identifying problems and taking the following corrective actions immediately, the AMC significantly reduced the number and average age of its unbilled accounts: Realigning system automation to improve routing efficiency. Facilitating interdisciplinary collaboration to better identify and correct the root causes of issues. Ensuring transparent data reporting by setting up different ways of viewing the underlying information.

The cost of family-oriented communication before air medical interfacility transport.

PubMed

Macnab, A J; Gagnon, F; George, S; Sun, C

2001-01-01

Family-oriented communication with parents by transport teams eases the stress associated with transferring children to tertiary care. This study was conducted to determine the duration of family-oriented visits and whether the visit contributed significant cost to the mission. Data collection was prospective and double-blind; questions were incorporated into another study. Subjects were infants or children requiring assisted ventilation and air transport to tertiary care. Time from completion of stabilization to departure and reasons for any delay were recorded. Cost of contact time longer than 20 minutes (total acceptable time for family visit and transfer to vehicle) was calculated at paramedic overtime at $0.82/minute and aircraft wait time at $200/hour if incurred. Forty-six patients were enrolled. In 16 cases (35%), time between completing stabilization and hospital departure exceeded 20 minutes, with "family visit" listed as the explanation. Nine of these visits incurred overtime, and two incurred aircraft wait costs. Total costs for providing communication visits more than 10 minutes long were $607 or approximately $13 per patient. The costs for visit time longer than 10 minutes are small compared with the documented benefits of family-oriented communication. However, transport personnel must be mindful of the potential to incur additional cost through overtime, aircraft wait time, or pilot replacement.

Personal health records in the preclinical medical curriculum: modeling student responses in a simple educational environment utilizing Google Health

PubMed Central

2012-01-01

Background Various problems concerning the introduction of personal health records in everyday healthcare practice are reported to be associated with physicians’ unfamiliarity with systematic means of electronically collecting health information about their patients (e.g. electronic health records - EHRs). Such barriers may further prevent the role physicians have in their patient encounters and the influence they can have in accelerating and diffusing personal health records (PHRs) to the patient community. One way to address these problems is through medical education on PHRs in the context of EHR activities within the undergraduate medical curriculum and the medical informatics courses in specific. In this paper, the development of an educational PHR activity based on Google Health is reported. Moreover, student responses on PHR’s use and utility are collected and presented. The collected responses are then modelled to relate the satisfaction level of students in such a setting to the estimation about their attitude towards PHRs in the future. Methods The study was conducted by designing an educational scenario about PHRs, which consisted of student instruction on Google Health as a model PHR and followed the guidelines of a protocol that was constructed for this purpose. This scenario was applied to a sample of 338 first-year undergraduate medical students. A questionnaire was distributed to each one of them in order to obtain Likert-like scale data on the sample’s response with respect to the PHR that was used; the data were then further analysed descriptively and in terms of a regression analysis to model hypothesised correlations. Results Students displayed, in general, satisfaction about the core PHR functions they used and they were optimistic about using them in the future, as they evaluated quite high up the level of their utility. The aspect they valued most in the PHR was its main role as a record-keeping tool, while their main concern was related to the negative effect their own opinion might have on the use of PHRs by patients. Finally, the estimate of their future attitudes towards PHR integration was found positively dependent of the level of PHR satisfaction that they gained through their experience (rho = 0.524, p <0.001). Conclusions The results indicate that students support PHRs as medical record keeping helpers and perceive them as beneficial to healthcare. They also underline the importance of achieving good educational experiences in improving PHR perspectives inside such educational activities. Further research is obviously needed to establish the relative long-term effect of education to other methods of exposing future physicians to PHRs. PMID:23009713

[Medical support of Russian Armed Forces: the results and perspectives].

PubMed

Shappo, V V

2008-01-01

The results of work of the Russian Federation Armed Forces medical service obtained in 2007 were summarized and the main problems of its activities in the current year and the very near future were determined. So the work at defining medical support as a type of Army and Navy support was began. The most important task of medical service in 2008 is realization of the Armed Forces medical support conception and goal-oriented program "The improvement of Russian Federation Armed Forces medical support in 2008-2012", the formation of two-level system of personnel's medical support. During the task realization the medical units and institutions are reorganized into federal state institutions. The RF DM Main Military Medical Headquarters works at significant improvement of war and military service veterans' medical attendance. The departmental program "Development of material and technical basis of military medical institutions for 2001-2010" is successfully realized. The measures to optimize the assignment of graduates from military medical higher schools are carried out. The tasks to improve the research work were outlined. The new principles of organization of military medical service control and work will be based on centralization of planning and decentralization of decision implementation, the possibility of military medical units to carry it out taking into account the common intention, safe feedback in order to make the work of army and navy medical specialists more effective in any conditions.

Cognitive problem solving patterns of medical students correlate with success in diagnostic case solutions.

PubMed

Kiesewetter, Jan; Ebersbach, René; Görlitz, Anja; Holzer, Matthias; Fischer, Martin R; Schmidmaier, Ralf

2013-01-01

Problem-solving in terms of clinical reasoning is regarded as a key competence of medical doctors. Little is known about the general cognitive actions underlying the strategies of problem-solving among medical students. In this study, a theory-based model was used and adapted in order to investigate the cognitive actions in which medical students are engaged when dealing with a case and how patterns of these actions are related to the correct solution. Twenty-three medical students worked on three cases on clinical nephrology using the think-aloud method. The transcribed recordings were coded using a theory-based model consisting of eight different cognitive actions. The coded data was analysed using time sequences in a graphical representation software. Furthermore the relationship between the coded data and accuracy of diagnosis was investigated with inferential statistical methods. The observation of all main actions in a case elaboration, including evaluation, representation and integration, was considered a complete model and was found in the majority of cases (56%). This pattern significantly related to the accuracy of the case solution (φ = 0.55; p<.001). Extent of prior knowledge was neither related to the complete model nor to the correct solution. The proposed model is suitable to empirically verify the cognitive actions of problem-solving of medical students. The cognitive actions evaluation, representation and integration are crucial for the complete model and therefore for the accuracy of the solution. The educational implication which may be drawn from this study is to foster students reasoning by focusing on higher level reasoning.

[Customer orientation in ambulant medicine].

PubMed

Heinrich, M

2014-07-01

Due to developments of the health market, economic aspects of the health system are more relevant. In this upcoming market the patient is regarded as customer and the doctor as provider of medical services. Studies on customer orientation in the ambulant medicine lag behind this dynamic. An aim of the study is to comprehend the attitudes of the doctors referring to the customer orientation. In a second step the findings are discussed according to statements of health-care paticipants. Developments in role comprehension of doctor and patient are focused to gain results in scientific and practical applications. Guideline-supported, partly narrative interviews with n=9 gynaecologists and n=11 general practitioners in Freiburg/Germany are recorded, transcribed and reviewed in a qualitative analysis. The statements of the doctors show patient satisfaction has an incremental meaning sspecially regarding the sequence of patient relationship and economic management of the doctor's workplace. The doctor's role comprehension meets with a refusal of the role of salesman and the patient as customer. The method of interviews is suitable to gather empirical impressions of the doctors. The control sample is adequate, however a bias due to inhomogeneous thematic affinitiy and local social-demographics might be possible. The customer orientation has become an important factor in doctor-patient relationtships. The relevance of the doctor-patient conversation and the risk of misuse of the patient confidence are mentioned by the doctors. The doctor as paternalistic care provider gives way to the customer-focused service provider. The doctor's necessity of autonomyssss and dependency on patient satisfaction have potential for conflict. Intensive mention of customer orientation in medicine in the media emphasises its importance. Rational handling with the possibilities of individual health markets is a prospective challange. Further research could be established in all aspects of customer orientation, especially the changing relevance of ethical responsibility. An enlargement or comparison with other control samples (n>20, other medical subfields, structurally weak areas) could be illuminating. The results of this qualitative study can be used to develop quantitative inquiries. © Georg Thieme Verlag KG Stuttgart · New York.

Role of non-government organizations in engaging medical students in research.

PubMed

Manoranjan, Branavan; Dey, Ayan K; Wang, Xin; Kuzyk, Alexandra; Petticrew, Karen; Carruthers, Chris; Arnold, Ian

2017-03-01

The continued decline in medical trainees entering the workforce as clinician-scientists has elevated the need to engage medical students in research. While past studies have shown early exposure to generate interest among medical students for research and academic careers, financial constraints have limited the number of such formal research training programs. In light of recent government budget cuts to support research training for medical students, non-government organizations (NGOs) may play a progressively larger role in supporting the development of clinician-scientists. Since 2005, the Mach-Gaensslen Foundation has sponsored 621 Canadian medical student research projects, which represents the largest longitudinal data set of Canadian medical students engaged in research. We present the results of the pre- and post-research studentship questionnaires, program evaluation survey and the 5-year and 10-year follow-up questionnaires of past recipients. This paper provides insight into the role of NGOs as stakeholders in the training of clinician-scientists and evaluates the impact of such programs on the attitudes and career trajectory of medical students. While the problem of too few physicians entering academic and research-oriented careers continues to grow, alternative-funding strategies from NGOs may prove to be an effective approach in developing and maintaining medical student interest in research. Copyright © 2017 American Federation for Medical Research.

Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

PubMed

Christensen, Leif; Karle, Hans; Nystrup, Jørgen

2007-09-01

An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

Trends in Biophysical Research and Their Implications for Medical Libraries

PubMed Central

Chen, Ching-chih

1973-01-01

This is a statistical survey of the trends in biophysical research as reflected by papers presented at four Biophysical Society (BPS) annual meetings between 1958 and 1972 and by the funding sources of the reported projects. The study reveals that biophysical research has grown quite substantially, particularly since 1968. Although biophysics is truly interdisciplinary, since 1968 there has been more pronounced emphasis on biomedically oriented problems and a tendency toward more specific and more highly specialized problems. Between 1958 and 1972, most biophysicists were academic researchers, 50% of whom were biomedical scientists. Over three quarters of the ongoing biophysical research projects during this period were supported by governmental agencies, and among them, the National Institutes of Health was the largest single funding source. PMID:4573970

Environmental geology of Bath, England

NASA Astrophysics Data System (ADS)

Kellaway, G. A.

1995-10-01

The hot springs of Bath, England, have been of importance to man for hundreds of years. It was a famous spa in Roman times. Subsequently, the springs were used during the 17th through the 20th centuries and extensive urban and commercial properties were developed at Bath using the water for medical and tourist-oriented activities. With urban and commercial development in the area, man's impact on the environment was substantial and typical environmental problems included pollution, land subsidence, or stability that effected construction, drainage, highways, and canals. During the growth of Bath in the 18th and 19th centuries these environmental problems were described by geologist William Smith and Joseph Townsend. Bath and vicinity provides a unique example of environmental geoscience.

Navigation interface for recommending home medical products.

PubMed

Luo, Gang

2012-04-01

Based on users' health issues, an intelligent personal health record (iPHR) system can automatically recommend home medical products (HMPs) and display them in a sequential order. However, the sequential output interface does not categorize search results and is not easy for users to quickly navigate to their desired HMPs. To address this problem, we developed a navigation interface for retrieved HMPs. Our idea is to use medical knowledge and nursing knowledge to construct a navigation hierarchy based on product categories. This hierarchy is added to the left side of each search result Web page to help users move through retrieved HMPs. We demonstrate the effectiveness of our techniques using USMLE medical exam cases.

A novel approach for incremental uncertainty rule generation from databases with missing values handling: application to dynamic medical databases.

PubMed

Konias, Sokratis; Chouvarda, Ioanna; Vlahavas, Ioannis; Maglaveras, Nicos

2005-09-01

Current approaches for mining association rules usually assume that the mining is performed in a static database, where the problem of missing attribute values does not practically exist. However, these assumptions are not preserved in some medical databases, like in a home care system. In this paper, a novel uncertainty rule algorithm is illustrated, namely URG-2 (Uncertainty Rule Generator), which addresses the problem of mining dynamic databases containing missing values. This algorithm requires only one pass from the initial dataset in order to generate the item set, while new metrics corresponding to the notion of Support and Confidence are used. URG-2 was evaluated over two medical databases, introducing randomly multiple missing values for each record's attribute (rate: 5-20% by 5% increments) in the initial dataset. Compared with the classical approach (records with missing values are ignored), the proposed algorithm was more robust in mining rules from datasets containing missing values. In all cases, the difference in preserving the initial rules ranged between 30% and 60% in favour of URG-2. Moreover, due to its incremental nature, URG-2 saved over 90% of the time required for thorough re-mining. Thus, the proposed algorithm can offer a preferable solution for mining in dynamic relational databases.

Alcohol Demand, Future Orientation, and Craving Mediate the Relation Between Depressive and Stress Symptoms and Alcohol Problems

PubMed Central

Soltis, Kathryn E.; McDevitt-Murphy, Meghan; Murphy, James G.

2017-01-01

Background Elevated depression and stress have been linked to greater levels of alcohol problems among young adults even after taking into account drinking level. The current study attempts to elucidate variables that might mediate the relation between symptoms of depression and stress and alcohol problems, including alcohol demand, future time orientation, and craving. Methods Participants were 393 undergraduates (60.8% female, 78.9% White/Caucasian) who reported at least 2 binge drinking episodes (4/5+ drinks for women/men, respectively) in the previous month. Participants completed self-report measures of stress and depression, alcohol demand, future time orientation, craving, and alcohol problems. Results In separate mediation models that accounted for gender, race, and weekly alcohol consumption, future orientation and craving significantly mediated the relation between depressive symptoms and alcohol problems. Alcohol demand, future orientation, and craving significantly mediated the relation between stress symptoms and alcohol problems. Conclusions Heavy drinking young adults who experience stress or depression are likely to experience alcohol problems and this is due in part to elevations in craving and alcohol demand, and less sensitivity to future outcomes. Interventions targeting alcohol misuse in young adults with elevated levels of depression and stress should attempt to increase future orientation and decrease craving and alcohol reward value. PMID:28401985

Alcohol Demand, Future Orientation, and Craving Mediate the Relation Between Depressive and Stress Symptoms and Alcohol Problems.

PubMed

Soltis, Kathryn E; McDevitt-Murphy, Meghan E; Murphy, James G

2017-06-01

Elevated depression and stress have been linked to greater levels of alcohol problems among young adults even after taking into account drinking level. This study attempts to elucidate variables that might mediate the relation between symptoms of depression and stress and alcohol problems, including alcohol demand, future time orientation, and craving. Participants were 393 undergraduates (60.8% female, 78.9% White/Caucasian) who reported at least 2 binge-drinking episodes (4/5+ drinks for women/men, respectively) in the previous month. Participants completed self-report measures of stress and depression, alcohol demand, future time orientation, craving, and alcohol problems. In separate mediation models that accounted for gender, race, and weekly alcohol consumption, future orientation and craving significantly mediated the relation between depressive symptoms and alcohol problems. Alcohol demand, future orientation, and craving significantly mediated the relation between stress symptoms and alcohol problems. Heavy-drinking young adults who experience stress or depression are likely to experience alcohol problems, and this is due in part to elevations in craving and alcohol demand, and less sensitivity to future outcomes. Interventions targeting alcohol misuse in young adults with elevated levels of depression and stress should attempt to increase future orientation and decrease craving and alcohol reward value. Copyright © 2017 by the Research Society on Alcoholism.

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

PubMed

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

2001-01-01

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

Links between alcohol and other drug problems and maltreatment among adolescent girls: Perceived discrimination, ethnic identity, and ethnic orientation as moderators

PubMed Central

Gray, Calonie M. K.; Montgomery, Marilyn J.

2012-01-01

Objectives This study examined the links between maltreatment, posttraumatic stress symptoms, ethnicity-specific factors (i.e., perceived discrimination, ethnic identity, and ethnic orientation), and alcohol and/or other drug (AOD) problems among adolescent girls. Methods These relations were examined using archived data from a community sample of 168 Black and Hispanic adolescent girls who participated in a school-based substance use intervention. Results The results revealed that maltreatment was linked to AOD problems, but only through its relation with posttraumatic stress symptoms; maltreatment was positively related to posttraumatic stress symptoms, which were positively related to AOD problems. Both perceived discrimination and ethnic orientation were significant moderators. Specifically, greater perceived discrimination was associated with an increased effect of maltreatment on posttraumatic stress symptoms. Ethnic orientation demonstrated protective properties in the relation between maltreatment and AOD problem severity, such that the effect of maltreatment on AOD problem severity was less for girls with average to high ethnic orientation compared to girls with low ethnic orientation. Conclusions The findings of this study underscore the importance of developing interventions for Black and Hispanic girls that target maltreatment and AOD use concurrently and address ethnicity-specific factors. PMID:22608406

Conversational pursuit of medication compliance in a Therapeutic Community for persons diagnosed with mental disorders*

PubMed Central

Mortari, Luigina

2014-01-01

Purpose In this article, we contribute to the debate on medication compliance by exploring the conversational “technologies” entailed in the process of promoting clients’ adherence to psychopharmacological prescriptions. Using a case study approach, we explore how medication-related problems are dealt with in conversational interaction between the staff members and the clients of a mental health Therapeutic Community (TC) in Italy. Method Four meetings between two staff members (Barbara and Massimo) and the clients of the TC were audio-recorded. The data were transcribed and analyzed using the method of Conversation Analysis. Results Barbara and Massimo recur to practices of topic articulation to promote talk that references the clients’ failure to take the medications. Through these practices they deal with the practical problem of mobilizing the clients’ cooperation in courses of action that fit into the institutional agenda of fostering medication adherence. Conclusions Barbara and Massimo’s conversational practices appear to reflect the assumption that medication-related problems can be reduced to compliance problems. This assumption works to make the clients accountable for their failure to take the medications while shaping a conversational environment that is unreceptive to their complaints about side effects. Implications for the understanding of mental health rehabilitation practice in TCs are discussed. Implications of RehabilitationTherapeutic community staff members should be aware of the challenges and blocks in communicating with their clients.Therapeutic communities can promote staff members’ awareness of communication challenges through reflective workshops in which they can jointly view and comment on interaction with their clients.Reflective workshops can be used to raise awareness of the presuppositions underlying therapeutic community staff members’ communication practices. PMID:24053481

Digital radiography and electronic data storage from the perspective of legal requirements for record keeping.

PubMed

Figgener, L; Runte, C

2003-12-01

In some countries physicians and dentists are required by law to keep medical and dental records. These records not only serve as personal notes and memory aids but have to be in accordance with the necessary standard of care and may be used as evidence in litigation. Inadequate, incomplete or even missing records can lead to reversal of the burden of proof, resulting in a dramatically reduced chance of successful defence in litigation. The introduction of digital radiography and electronic data storage presents a new problem with respect to legal evidence, since digital data can easily be manipulated and industry is now required to provide adequate measures to prevent manipulations and forgery.

Family planning: pitting the private sector against a public problem.

PubMed

Harvey, P D

1975-01-01

A most promising recent international development has been the harnessing of commercial marketing techniques to promote family planning. Although most projects of this type are government approved and subsidized by international funding organizations, they are a striking departure from traditional government-operated, medically oriented programs. Results have often been dramatic because of certain attributes of the commercial sector, such as 1) marketing, management, finance, distribution, and logistics skills; 2) awareness of and sensitivity to consumers' needs; and 3) the consistent and self-sustaining motivation of profit.

PSYCHE: An Object-Oriented Approach to Simulating Medical Education

PubMed Central

Mullen, Jamie A.

1990-01-01

Traditional approaches to computer-assisted instruction (CAI) do not provide realistic simulations of medical education, in part because they do not utilize heterogeneous knowledge bases for their source of domain knowledge. PSYCHE, a CAI program designed to teach hypothetico-deductive psychiatric decision-making to medical students, uses an object-oriented implementation of an intelligent tutoring system (ITS) to model the student, domain expert, and tutor. It models the transactions between the participants in complex transaction chains, and uses heterogeneous knowledge bases to represent both domain and procedural knowledge in clinical medicine. This object-oriented approach is a flexible and dynamic approach to modeling, and represents a potentially valuable tool for the investigation of medical education and decision-making.

Why do family doctors prescribe potentially inappropriate medication to elderly patients?

PubMed

Voigt, Karen; Gottschall, Mandy; Köberlein-Neu, Juliane; Schübel, Jeannine; Quint, Nadine; Bergmann, Antje

2016-07-22

Based on changes in pharmacokinetics and -dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited. This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients' records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs' medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed. Content analysis of 1846 patients' records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics. It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs' experiences in daily practice, FPs' knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs' daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs' advanced training.

Electronic medical records and efficiency and productivity during office visits.

PubMed

Furukawa, Michael F

2011-04-01

To estimate the relationship between electronic medical record (EMR) use and efficiency of utilization and provider productivity during visits to US office-based physicians. Cross-sectional analysis of the 2006-2007 National Ambulatory Medical Care Survey. The sample included 62,710 patient visits to 2625 physicians. EMR systems included demographics, clinical notes, prescription orders, and laboratory and imaging results. Efficiency was measured as utilization of examinations, laboratory tests, radiology procedures, health education, nonmedication treatments, and medications. Productivity was measured as total services provided per 20-minute period. Survey-weighted regressions estimated association of EMR use with services provided, visit intensity/duration, and productivity. Marginal effects were estimated by averaging across all visits and by major reason for visit. EMR use was associated with higher probability of any examination (7.7%, 95% confidence interval [CI] = 2.4%, 13.1%); any laboratory test (5.7%, 95% CI = 2.6%, 8.8%); any health education (4.9%, 95% CI = 0.2%, 9.6%); and fewer laboratory tests (-7.1%, 95% CI = -14.2%, -0.1%). During pre/post surgery visits, EMR use was associated with 7.3% (95% CI= -12.9%, -1.8%) fewer radiology procedures. EMR use was not associated with utilization of nonmedication treatments and medications, or visit duration. During routine visits for a chronic problem, EMR use was associated with 11.2% (95% CI = 5.7%, 16.8%) more diagnostic/screening services provided per 20-minute period. EMR use had a mixed association with efficiency and productivity during office visits. EMRs may improve provider productivity, especially during visits for a new problem and routine chronic care.

Determination of optimal self-drive tourism route using the orienteering problem method

NASA Astrophysics Data System (ADS)

Hashim, Zakiah; Ismail, Wan Rosmanira; Ahmad, Norfaieqah

2013-04-01

This paper was conducted to determine the optimal travel routes for self-drive tourism based on the allocation of time and expense by maximizing the amount of attraction scores assigned to each city involved. Self-drive tourism represents a type of tourism where tourists hire or travel by their own vehicle. It only involves a tourist destination which can be linked with a network of roads. Normally, the traveling salesman problem (TSP) and multiple traveling salesman problems (MTSP) method were used in the minimization problem such as determination the shortest time or distance traveled. This paper involved an alternative approach for maximization method which is maximize the attraction scores and tested on tourism data for ten cities in Kedah. A set of priority scores are used to set the attraction score at each city. The classical approach of the orienteering problem was used to determine the optimal travel route. This approach is extended to the team orienteering problem and the two methods were compared. These two models have been solved by using LINGO12.0 software. The results indicate that the model involving the team orienteering problem provides a more appropriate solution compared to the orienteering problem model.

Incidence of sleep pattern disturbance (SPD) in a hemodialysis sample.

PubMed

Strangio, D; Locking-Cusolito, H

1999-01-01

Personal experience suggests that sleep pattern disturbance (SPD) is a serious problem for the patients we serve. The purpose of this study was to identify the scope of sleep problems among all willing patients in a medium-sized hemodialysis unit in a university teaching centre. This descriptive study examined SPD through the use of a sleep diary that subjects were asked to complete each morning for a week. Subjects were asked to describe sleep latency, sleep quantity, number of arousals, whether they awoke feeling rested, factors that interfered with sleep the night before, and sleep inducers employed the night before. They were also asked to record their dialysis schedule. Each subject's chart was reviewed with respect to medications and evidence of other medical problems that interfered with sleep. Findings were benchmarked with results from the literature. Information regarding facilitators and barriers to sleep has provided some basis for an interdisciplinary plan of care to address this distressing problem.

Profile and professional expectations of medical students in Mozambique: a longitudinal study.

PubMed

Ferrinho, Paulo; Fronteira, Inês; Sidat, Mohsin; da Sousa, Fernando; Dussault, Gilles

2010-09-21

This paper compares the socioeconomic profile of medical students registered at the Faculty of Medicine of Universidade Eduardo Mondlane (FM-UEM), Maputo, for the years 1998/99 and 2007/08. The objective is to describe the medical students' social and geographical origins, expectations and perceived difficulties regarding their education and professional future. Data were collected through questionnaires administered to all medical students. The response rate in 1998/99 was 51% (227/441) and 50% in 2007/08 (484/968).The main results reflect a doubling of the number of students enrolled for medical studies at the FM-UEM, associated with improved student performance (as reflected by failure rates). Nevertheless, satisfaction with the training received remains low and, now as before, students still identify lack of access to books or learning technology and inadequate teacher preparedness as major problems. There is a high level of commitment to public sector service. However, students, as future doctors, have very high salary expectations that will not be met by current public sector salary scales. This is reflected in an increasing degree of orientation to double sector employment after graduation.

X-ray compass for determining device orientation

DOEpatents

Da Silva, Luiz B.; Matthews, Dennis L.; Fitch, Joseph P.; Everett, Matthew J.; Colston, Billy W.; Stone, Gary F.

1999-01-01

An apparatus and method for determining the orientation of a device with respect to an x-ray source. In one embodiment, the present invention is coupled to a medical device in order to determine the rotational orientation of the medical device with respect to the x-ray source. In such an embodiment, the present invention is comprised of a scintillator portion which is adapted to emit photons upon the absorption of x-rays emitted from the x-ray source. An x-ray blocking portion is coupled to the scintillator portion. The x-ray blocking portion is disposed so as to vary the quantity of x-rays which penetrate the scintillator portion based upon the particular rotational orientation of the medical device with respect to the x-ray source. A photon transport mechanism is also coupled to the scintillator portion. The photon transport mechanism is adapted to pass the photons emitted from the scintillator portion to an electronics portion. By analyzing the quantity of the photons, the electronics portion determines the rotational orientation of the medical device with respect to the x-ray source.

X-ray compass for determining device orientation

DOEpatents

Da Silva, L.B.; Matthews, D.L.; Fitch, J.P.; Everett, M.J.; Colston, B.W.; Stone, G.F.

1999-06-15

An apparatus and method for determining the orientation of a device with respect to an x-ray source are disclosed. In one embodiment, the present invention is coupled to a medical device in order to determine the rotational orientation of the medical device with respect to the x-ray source. In such an embodiment, the present invention is comprised of a scintillator portion which is adapted to emit photons upon the absorption of x-rays emitted from the x-ray source. An x-ray blocking portion is coupled to the scintillator portion. The x-ray blocking portion is disposed so as to vary the quantity of x-rays which penetrate the scintillator portion based upon the particular rotational orientation of the medical device with respect to the x-ray source. A photon transport mechanism is also coupled to the scintillator portion. The photon transport mechanism is adapted to pass the photons emitted from the scintillator portion to an electronics portion. By analyzing the quantity of the photons, the electronics portion determines the rotational orientation of the medical device with respect to the x-ray source. 25 figs.

The place of SGML and HTML in building electronic patient records.

PubMed

Pitty, D; Gordon, C; Reeves, P; Capey, A; Vieyra, P; Rickards, T

1997-01-01

The authors are concerned that, although popular, SGML (Standard Generalized Markup Language) is only one approach to capturing, storing, viewing and exchanging healthcare information and does not provide a suitable paradigm for solving most of the problems associated with paper based patient record systems. Although a discussion of the relative merits of SGML, HTML (HyperText Markup Language) may be interesting, we feel such a discussion is avoiding the real issues associated with the most appropriate way to model, represent, and store electronic patient information in order to solve healthcare problems, and therefore the medical informatics community should firstly concern itself with these issues. The paper substantiates this viewpoint and concludes with some suggestions of how progress can be made.

MessageSpace: a messaging system for health research

NASA Astrophysics Data System (ADS)

Escobar, Rodrigo D.; Akopian, David; Parra-Medina, Deborah; Esparza, Laura

2013-03-01

Mobile Health (mHealth) has emerged as a promising direction for delivery of healthcare services via mobile communication devices such as cell phones. Examples include texting-based interventions for chronic disease monitoring, diabetes management, control of hypertension, smoking cessation, monitoring medication adherence, appointment keeping and medical test result delivery; as well as improving patient-provider communication, health information communication, data collection and access to health records. While existing messaging systems very well support bulk messaging and some polling applications, they are not designed for data collection and processing of health research oriented studies. For that reason known studies based on text-messaging campaigns have been constrained in participant numbers. In order to empower healthcare promotion and education research, this paper presents a system dedicated for healthcare research. It is designed for convenient communication with various study groups, feedback collection and automated processing.

A Java-based electronic healthcare record software for beta-thalassaemia.

PubMed

Deftereos, S; Lambrinoudakis, C; Andriopoulos, P; Farmakis, D; Aessopos, A

2001-01-01

Beta-thalassaemia is a hereditary disease, the prevalence of which is high in persons of Mediterranean, African, and Southeast Asian ancestry. In Greece it constitutes an important public health problem. Beta-thalassaemia necessitates continuous and complicated health care procedures such as daily chelation; biweekly transfusions; and periodic cardiology, endocrinology, and hepatology evaluations. Typically, different care items are offered in different, often-distant, health care units, which leads to increased patient mobility. This is especially true in rural areas. Medical records of patients suffering from beta-thalassaemia are inevitably complex and grow in size very fast. They are currently paper-based, scattered over all units involved in the care process. This hinders communication of information between health care professionals and makes processing of the medical records difficult, thus impeding medical research. Our objective is to provide an electronic means for recording, communicating, and processing all data produced in the context of the care process of patients suffering from beta-thalassaemia. We have developed - and we present in this paper - Java-based Electronic Healthcare Record (EHCR) software, called JAnaemia. JAnaemia is a general-purpose EHCR application, which can be customized for use in all medical specialties. Customization for beta-thalassaemia has been performed in collaboration with 4 Greek hospitals. To be capable of coping with patient record diversity, JAnaemia has been based on the EHCR architecture proposed in the ENV 13606:1999 standard, published by the CEN/TC251 committee. Compliance with the CEN architecture also ensures that several additional requirements are fulfilled in relation to clinical comprehensiveness; to record sharing and communication; and to ethical, medico-legal, and computational issues. Special care has been taken to provide a user-friendly, form-based interface for data entry and processing. The experience gained through the use of JAnaemia in 4 Greek hospitals reveals a significant contribution towards (1) improvement of the quality of the data being recorded, since data entry is guided by appropriate forms, (2) easier cooperation between physicians, who share a common information repository, and (3) increased processing capabilities, which facilitate medical research. JAnaemia appears to be a useful tool, which can improve the quality of care offered to beta-thalassaemic patients in Greece.

The continuing problem of missed test results in an integrated health system with an advanced electronic medical record.

PubMed

Wahls, Terry; Haugen, Thomas; Cram, Peter

2007-08-01

Missed results can cause needless treatment delays. However, there is little data about the magnitude of this problem and the systems that clinics use to manage test results. Surveys about potential problems related to test results management were developed and administered to clinical staff in a regional Veterans Administration (VA) health care network. The provider survey, conducted four times between May 2005 and October 2006, sampling VA staff physicians, physician assistants, nurse practitioners, and internal medicine trainees, asked questions about the frequency of missed results and diagnosis or treatment delays seen in the antecedent two weeks in their clinics, or if a trainee, the antecedent month. Clinical staff survey response rate was 39% (143 of 370), with 40% using standard operating procedures to manage test results. Forty-four percent routinely reported all results to patients. The provider survey response rate was 50% (441 of 884) overall, with responses often (37% overall; range 29% to 46%) indicating they had seen patients with diagnosis or treatment delays attributed to a missed result; 15% reported two or more such encounters. Even in an integrated health system with an advanced electronic medical record, missed test results and associated diagnosis or treatment delays are common. Additional study and measures of missed results and associated treatment delays are needed.

[Oganization of sanitary care organization in the 1st Infantry Battalion of the 7th Puma Brigade during offensive attacks at the Dinara Mountain in the Winter 94 operation].

PubMed

Pigac, Biserka; Kretić, Marijan; Vuković, Jurica

2006-09-01

The aim of this paper is to show sanitary care organization in the 1st infantry battalion of 7th Puma Brigade during attacks at the Dinara mountain in the Winter 94 operation, and to compare it with the general pattern described. The problems encountered and mistakes made in the medical care organization that were caused either by the lack of coordination between the command and military personnel or the lack of equipment, inadequate equipment, geographical characteristics of the area, communication problems, weather conditions or any other reason influencing sanitary care are presented. Based on the analysis of two cases, it is concluded that sanitary care was organizaed according to the echelon principles. During the war, medical care was satisfactory in spite of all the problems and shortcomings, mainly owing to the young, brave and enthusiastic command and medical personnel. Medical care in the Croatian Army during the war was an integral part of the military-civilian health care system. Despite rather common problems and deficiencies, the achievements in taking care of the wounded and sick persons were satisfactory, all the wounded men were properly managed, functionally and cosmetically recovered, and capable of normal living and work. These results were especially gratifying since they were, in general, recorded in young men.

Sex differences in interpersonal problems: does sexual orientation moderate?

PubMed

Lee, Debbiesiu L; Harkless, Lynn E; Sheridan, Daniel J; Winakur, Emily; Fowers, Blaine J

2013-01-01

Sexual orientation was examined as a moderator in the relation between biological sex and interpersonal problems. Participants were 60 lesbians, 45 heterosexual women, 37 gay men, and 39 heterosexual men, who completed the Inventory of Interpersonal Problems-Circumplex. Sexual orientation was found to moderate one of the eight interpersonal problems under study. Heterosexual women scored significantly higher than lesbian women in Non-assertive. Although hypothesized, gay men did not differ from heterosexual men along the Dominant-Cold quadrant. Implications of these results are discussed.