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Pegram C, Diaz-Ordaz K, Brodbelt DC, Chang YM, von Hekkel AF, Wu CH, Church DB, O'Neill DG. Target Trial Emulation: Does surgical versus non-surgical management of cranial cruciate ligament rupture in dogs cause different outcomes? Prev Vet Med 2024; 226:106165. [PMID: 38503655 DOI: 10.1016/j.prevetmed.2024.106165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/07/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Target trial emulation applies design principles from randomised controlled trials to the analysis of observational data for causal inference and is increasingly used within human epidemiology. Using anonymised veterinary clinical data from the VetCompass Programme, this study applied the target trial emulation framework to determine whether surgical (compared to non-surgical) management for cranial cruciate ligament (CCL) rupture in dogs causes improved short- and long-term lameness and analgesia outcomes. The emulated target trial included dogs diagnosed with CCL rupture between January 1, 2019 and December 31, 2019 within the VetCompass database. Inclusion in the emulated trial required dogs aged ≥ 1.5 and < 12 years, first diagnosed with unilateral CCL rupture during 2019 and with no prior history of contralateral ligament rupture or stifle surgery. Dogs were retrospectively observed to have surgical or non-surgical management. Informed from a directed acyclic graph derived from expert opinion, data on the following variables were collected: age, breed, bodyweight, neuter status, insurance status, non-orthopaedic comorbidities, orthopaedic comorbidities and veterinary group. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding, with weights calculated based on a binary logistic regression exposure model. Censored dogs were accounted for in the IPTW analysis using inverse probability of censoring weighting (IPCW). The IPCWs were combined with IPTWs and used to weight each dog's contribution to binary logistic regression outcome models. Standardized mean differences (SMD) examined the balance of covariate distribution between treatment groups. The emulated trial included 615 surgical CCL rupture cases and 200 non-surgical cases. The risk difference for short-term lameness in surgically managed cases (compared with non-surgically managed cases) was -25.7% (95% confidence interval (CI) -36.7% to -15.9%) and the risk difference for long-term lameness -31.7% (95% CI -37.9% to -18.1%). The study demonstrated the application of the target trial framework to veterinary observational data. The findings show that surgical management causes a reduction in short- and long-term lameness compared with non-surgical management in dogs.
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Affiliation(s)
- Camilla Pegram
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK.
| | - Karla Diaz-Ordaz
- University College London, Department of Statistical Science, Gower Street, London WC1E 6BT, UK
| | - Dave C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Yu-Mei Chang
- Research Support Office, The Royal Veterinary College, Hatfield, Herts AL9 7TA, UK
| | - Anna Frykfors von Hekkel
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Chieh-Hsi Wu
- Statistical Sciences Research Institute, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK
| | - David B Church
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
| | - Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
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Katalinic M, Schenk M, Franke S, Katalinic A, Neumuth T, Dietz A, Stoehr M, Gaebel J. Generation of a Realistic Synthetic Laryngeal Cancer Cohort for AI Applications. Cancers (Basel) 2024; 16:639. [PMID: 38339389 PMCID: PMC10854797 DOI: 10.3390/cancers16030639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Obtaining large amounts of real patient data involves great efforts and expenses, and processing this data is fraught with data protection concerns. Consequently, data sharing might not always be possible, particularly when large, open science datasets are needed, as for AI development. For such purposes, the generation of realistic synthetic data may be the solution. Our project aimed to generate realistic cancer data with the use case of laryngeal cancer. METHODS We used the open-source software Synthea and programmed an additional module for development, treatment and follow-up for laryngeal cancer by using external, real-world (RW) evidence from guidelines and cancer registries from Germany. To generate an incidence-based cohort view, we randomly drew laryngeal cancer cases from the simulated population and deceased persons, stratified by the real-world age and sex distributions at diagnosis. RESULTS A module with age- and stage-specific treatment and prognosis for laryngeal cancer was successfully implemented. The synthesized population reflects RW prevalence well, extracting a cohort of 50,000 laryngeal cancer patients. Descriptive data on stage-specific and 5-year overall survival were in accordance with published data. CONCLUSIONS We developed a large cohort of realistic synthetic laryngeal cancer cases with Synthea. Such data can be shared and published open source without data protection issues.
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Affiliation(s)
- Mika Katalinic
- Innovation Center Computer Assisted Surgery, Faculty of Medicine, University Leipzig, 04109 Leipzig, Germany; (M.K.)
| | - Martin Schenk
- Innovation Center Computer Assisted Surgery, Faculty of Medicine, University Leipzig, 04109 Leipzig, Germany; (M.K.)
| | - Stefan Franke
- Innovation Center Computer Assisted Surgery, Faculty of Medicine, University Leipzig, 04109 Leipzig, Germany; (M.K.)
| | - Alexander Katalinic
- Institute of Social Medicine and Epidemiology, University of Luebeck, 23562 Luebeck, Germany;
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, Faculty of Medicine, University Leipzig, 04109 Leipzig, Germany; (M.K.)
| | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Matthaeus Stoehr
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Jan Gaebel
- Innovation Center Computer Assisted Surgery, Faculty of Medicine, University Leipzig, 04109 Leipzig, Germany; (M.K.)
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Kuusisto H, Keränen T, Saranto K. Problems Experienced by Health Care Professionals with Do not Attempt Resuscitation (DNAR) Orders - A Qualitative Study. Stud Health Technol Inform 2023; 309:233-237. [PMID: 37869848 DOI: 10.3233/shti230785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
A 'Do Not Attempt Resuscitation' (DNAR) order is one of the most important yet difficult medical decisions. Despite the recent European guidelines, health care professionals (HCPs) in general perceive challenges in making a DNAR order. We aimed to evaluate the types of problems related to DNAR order making. A link to a web-based multiple-choice questionnaire including open-ended questions was sent by e-mail to all physicians and nurses working in the Tampere University Hospital special responsibility area covering a catchment area of 900,000 Finns. The questionnaire covered issues on DNAR order making, its meaning and documentation. Here we report the analysis of the open-ended questions, examined based on the Ottawa Decision Support Framework with expanded individual decisional needs categories. Qualitative data describing respondents' opinions (N=648) regarding problems related to DNAR order decision making were analysed using Atlas.ti 23.12 software. In total, 599 statements (phrases) dealing with inadequate advice, information, emotional support, and instrumental help were identified. Our results show that HCPs experience lack of support in DNAR decision making on multiple levels. Digital decision-making support integrated into electronic patient records (EPR) to assure timely and clearly visible DNAR orders could be beneficial.
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Affiliation(s)
- Hanna Kuusisto
- University of Eastern Finland, Kuopio, Finland
- Tampere University Hospital, Tampere, Finland
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Bakhiet A, Passmore W, Nath U, Das A, Pillai A. Can a Fully Electronic Patient Record-Based Virtual Fracture Clinic Increase Compliance With British Orthopaedic Association Guidelines for the Assessment of Acute Orthopaedic Trauma Patients? Cureus 2023; 15:e46942. [PMID: 37841983 PMCID: PMC10570870 DOI: 10.7759/cureus.46942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction There is clear guidance for the follow-up of acute orthopaedic trauma patients within 72 hours of presentation as per British Orthopaedic Association (BOA) guidelines. The virtual fracture clinic (VFC) model has been adopted nationwide to increase compliance with these guidelines. Traditionally our VFC was paper-based, but recently it has been made completely electronic with the introduction of Hive which is a comprehensive electronic patient record (EPR). The aim of this audit was to assess the effectiveness of the Hive VFC and to see the impact it has on improving the patient experience. Methods Data was collected retrospectively by looking at referrals to the Hive VFC across a seven-month period from its date of introduction. No patients were excluded and data was collected for 2,158 patients. Patient demographics, referral details, and outcomes were recorded on a Microsoft Excel version 16.0 for Windows spreadsheet (Microsoft Corporation, Washington, United States). Data was analysed using Microsoft Excel. Results Data was collected for 2,158 patients between September 9, 2022, and March 31, 2023, in the Hive VFC. The largest proportion of injuries was found in the foot and ankle region with 32% of referrals (n=688), followed by hand and wrist with 30% (n=651), upper limb with 28% (n=595), and lower limb with 7% (n=142). There was a 50.4% (n=125) increase in the number of patients seen in the VFC across the study period with 248 patients being seen in September 2022, increasing to 373 in March 2023. The number of patients with acute traumatic orthopaedic injuries that were assessed within 72 hours on average was 94.5% per month. There was an increase of 7.3% during the study period from September 2022 to March 2023, 89.9% to 96.5%, respectively. Conclusion We believe that Hive VFC is a clinically sound and effective way of assessing acute traumatic orthopaedic patients and increasing compliance with BOA and NICE guidelines. The number of patients needing acute orthopaedic assessment is rising steadily, and this should alert us to find more convenient, time and cost-saving methods of delivering safe and effective patient care.
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Affiliation(s)
- Abdelwakeel Bakhiet
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR
| | - William Passmore
- Trauma and Orthopaedics, University of Manchester, Manchester, GBR
| | - Upamanyu Nath
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR
| | - Abhirun Das
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR
| | - Anand Pillai
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR
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Wac M, Craddock I, Chantziara S, Campbell T, Santos-Rodriguez R, Davidson B, McWilliams C. Design and Evaluation of an Intensive Care Unit Dashboard Built in Response to the COVID-19 Pandemic: Semistructured Interview Study. JMIR Hum Factors 2023; 10:e49438. [PMID: 37751239 PMCID: PMC10565627 DOI: 10.2196/49438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Dashboards and interactive displays are becoming increasingly prevalent in most health care settings and have the potential to streamline access to information, consolidate disparate data sources and deliver new insights. Our research focuses on intensive care units (ICUs) which are heavily instrumented, critical care environments that generate vast amounts of data and frequently require individualized support for each patient. Consequently, clinicians experience a high cognitive load, which can translate to suboptimal performance. The global COVID-19 pandemic exacerbated this problem by generating a large number of additional hospitalizations, which necessitated a new tool that would help manage ICUs' census. In a previous study, we interviewed clinicians at the University Hospitals Bristol and Weston National Health Service Foundation Trust to capture the requirements for bespoke dashboards that would alleviate this problem. OBJECTIVE This study aims to design, implement, and evaluate an ICU dashboard to allow for monitoring of the high volume of patients in need of critical care, particularly tailored to high-demand situations, such as those seen during the COVID-19 pandemic. METHODS Building upon the previously gathered requirements, we developed a dashboard, integrated it within the ICU of a National Health Service trust, and allowed all staff to access our tool. For evaluation purposes, participants were recruited and interviewed following a 25-day period during which they were able to use the dashboard clinically. The semistructured interviews followed a topic guide aimed at capturing the usability of the dashboard, supplemented with additional questions asked post hoc to probe themes established during the interview. Interview transcripts were analyzed using a thematic analysis framework that combined inductive and deductive approaches and integrated the Technology Acceptance Model. RESULTS A total of 10 participants with 4 different roles in the ICU (6 consultants, 2 junior doctors, 1 nurse, and 1 advanced clinical practitioner) participated in the interviews. Our analysis generated 4 key topics that prevailed across the data: our dashboard met the usability requirements of the participants and was found useful and intuitive; participants perceived that it impacted their delivery of patient care by improving the access to the information and better equipping them to do their job; the tool was used in a variety of ways and for different reasons and tasks; and there were barriers to integration of our dashboard into practice, including familiarity with existing systems, which stifled the adoption of our tool. CONCLUSIONS Our findings show that the perceived utility of the dashboard had a positive impact on the clinicians' workflows in the ICU. Improving access to information translated into more efficient patient care and transformed some of the existing processes. The introduction of our tool was met with positive reception, but its integration during the COVID-19 pandemic limited its adoption into practice.
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Affiliation(s)
- Marceli Wac
- Faculty of Engineering, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Ian Craddock
- Faculty of Engineering, University of Bristol, Bristol, United Kingdom
| | - Sofia Chantziara
- Faculty of Engineering, University of Bristol, Bristol, United Kingdom
| | - Tabitha Campbell
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | | | - Brittany Davidson
- Faculty of Engineering, University of Bristol, Bristol, United Kingdom
| | - Chris McWilliams
- Faculty of Engineering, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Wolf U. A Drug Safety Concept (I) to Avoid Polypharmacy Risks in Transplantation by Individual Pharmacotherapy Management in Therapeutic Drug Monitoring of Immunosuppressants. Pharmaceutics 2023; 15:2300. [PMID: 37765269 PMCID: PMC10535417 DOI: 10.3390/pharmaceutics15092300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
For several, also vital medications, such as immunosuppressants in solid organ and hematopoietic stem cell transplantation, therapeutic drug monitoring (TDM) remains the only strategy for fine-tuning the dosage to the individual patient. Especially in severe clinical complications, the intraindividual condition of the patient changes abruptly, and in addition, drug-drug interactions (DDIs) can significantly impact exposure, due to concomitant medication alterations. Therefore, a single TDM value can hardly be the sole basis for optimal timely dose adjustment. Moreover, every intraindividually varying situation that affects the drug exposure needs synoptic consideration for the earliest adjustment. To place the TDM value in the context of the patient's most detailed current condition and concomitant medications, the Individual Pharmacotherapy Management (IPM) was implemented in the posttransplant TDM of calcineurin inhibitors assessed by the in-house laboratory. The first strategic pillar are the defined patient scores from the electronic patient record. In this synopsis, the Summaries of Product Characteristics (SmPCs) of each drug from the updated medication list are reconciled for contraindication, dosing, adverse drug reactions (ADRs), and DDIs, accounting for defined medication scores as a second pillar. In parallel, IPM documents the resulting review of each TDM value chronologically in a separate electronic Excel file throughout each patient's transplant course. This longitudinal overview provides a further source of information at a glance. Thus, the applied two-arm concept of TDM and IPM ensures an individually tailored immunosuppression in the severely susceptible early phase of transplantation through digital interdisciplinary networking, with instructive and educative recommendations to the attending physicians in real-time. This concept of contextualizing a TDM value to the precise patient's condition and comedication was established at Halle University Hospital to ensure patient, graft, and drug safety.
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Affiliation(s)
- Ursula Wolf
- Pharmacotherapy Management, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
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O'Neill DG, Blenkarn A, Brodbelt DC, Church DB, Freeman A. Periodontal disease in cats under primary veterinary care in the UK: frequency and risk factors. J Feline Med Surg 2023; 25:1098612X231158154. [PMID: 36912667 DOI: 10.1177/1098612x231158154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Periodontal disease is a multifactorial inflammatory disease that can have major welfare implications in cats. This study aimed to report the frequency and demographic risk factors of periodontal disease and to explore associations with common comorbid disorders in cats in the UK. METHODS The study included a random sample of 18,249 cats obtained from 1,255,130 cats under primary care during 2019 from clinics participating in the VetCompass programme. All disorders recorded during 2019 were extracted and reported. Risk factor and comorbid disorder analysis used multivariable logistic regression modelling. RESULTS Periodontal disease had a 1-year period prevalence of 15.2% (95% confidence interval [CI] 14.72-15.76). Breeds with the highest prevalence included Siamese (18.7%, 95% CI 12.24-26.72) and Maine Coon (16.7%, 95% CI 11.37-23.18). The median age of cats with periodontal disease (9.47 years, interquartile range [IQR] 5.96-12.97) was higher than for cats without periodontal disease (4.94 years, IQR 1.95-9.51; P <0.001). Increasing adult body weight, increasing age and sex-neuter status were significantly associated with rising odds of periodontal disease. Cats with periodontal disease had a higher median count of comorbid disorders per individual cat (3, IQR 2-4, range 1-14) than cats without periodontal disease (1, IQR 0-2, range 0-15; P <0.001). Cats with periodontal disease had 1.79 times the odds (95% CI 1.62-1.99, P <0.001) of diagnosis with at least one comorbid disorder disease than cats without periodontal disease. CONCLUSIONS AND RELEVANCE Periodontal disease is the most common specific diagnosis in cats and is confirmed as a leading health issue in cats. Ageing is identified as the strongest predictor of periodontal disease risk in cats, suggesting the potential for increasing health gains from emphasis on dental care and health in cats as they age. The study offers evidence on a close link between periodontal disease and reduced overall health in cats.
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Affiliation(s)
- Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
| | - Alyx Blenkarn
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
| | - Dave C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
| | - David B Church
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
| | - Alix Freeman
- Department of Dentistry, Oral and Maxillofacial Surgery, Eastcott Referrals, Swindon, UK
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O'Neill DG, Gunn-Moore D, Sorrell S, McAuslan H, Church DB, Pegram C, Brodbelt DC. Commonly diagnosed disorders in domestic cats in the UK and their associations with sex and age. J Feline Med Surg 2023; 25:1098612X231155016. [PMID: 36852509 DOI: 10.1177/1098612x231155016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVES The objectives of this study were to generate a robust evidence base on the prevalence of common disorders in cats and develop a deeper understanding of disorder associations with sex and age that could offer important opportunities for targeted veterinary care to improve feline health and welfare. METHODS A random sample of 18,249 cats was obtained from 1,255,130 cats under primary care during 2019 within VetCompass, an epidemiological research programme based on anonymised primary care veterinary clinical records. All disorders recorded during 2019 were extracted and reported, and associations with sex and age were examined. RESULTS The most prevalent disorders were periodontal disease (n = 2780 [15.2%], 95% confidence interval [CI] 14.72-15.76), obesity (n = 2114 [11.6%], 95% CI 11.12-12.06) and dental disease (n = 1502 [8.2%], 95% CI 7.84-8.64). Compared with male cats, females had an increased prevalence of poor quality of life, postoperative complications and hyperthyroidism, among others. Male cats had a higher prevalence of periodontal disease, road traffic accident (RTA) and obesity. Younger cats (<8 years) had an increased prevalence of cat bite abscess, flea infestation and RTA, while older cats (⩾8 years) had increased prevalence of lameness, cystitis and dental disease, among others. CONCLUSIONS AND RELEVANCE These findings suggest that the veterinary profession needs to engage more effectively in informing owners on common preventable disorders (ie, obesity and dental disease). This new information can contribute to more targeted health surveillance and more effective veterinary interventions to promote improved health and welfare in pet cats. Large-scale collection and analysis of anonymised veterinary clinical records offer an important clinical resource for research.
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Affiliation(s)
- Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
| | - Danièlle Gunn-Moore
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian, UK
| | | | - Harriet McAuslan
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
| | - David B Church
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
| | - Camilla Pegram
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
| | - Dave C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, UK
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Leicester L, Reid A, Gilbert S, Marshall R, O'Neill DG. Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary-care emergency practice. Vet Rec 2023:e2485. [PMID: 36628550 DOI: 10.1002/vetr.2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The paucity of published veterinary clinical audits suggests that clinical audit is an under-used tool for quality improvement (QI) in the veterinary profession. Therefore, a continuous QI process was designed and implemented at a UK multisite small animal emergency practice, focusing on audit of clinical management of canine dystocia. METHODS Data collection phases were undertaken in 2014, 2019 and 2021, with intervening knowledge dissemination activities. Nine variables relating to clinical management of canine dystocia were selected as audit criteria in the initial dataset, and 21 variables were measured in each subsequent phase. RESULTS Between 2014 and 2021, statistically significant increases (p < 0.05) were demonstrated in recording of bodyweight, use of diagnostic imaging, use of ultrasonography, recording of fetal heart rates, use of calcium gluconate, and use during caesarean section of intravenous fluid therapy, multimodal analgesia, full agonist opioids, paracetamol and local anaesthesia. Statistically significant decreases were demonstrated in median first quantity and median first dose of oxytocin, and in the use of NSAIDs during caesarean section. A clinical audit planning template was created for future audits. LIMITATIONS Typical case presentation and management of canine dystocia cases may vary between dedicated emergency and non-emergency primary-care settings. CONCLUSION This study demonstrates the feasibility of large-scale veterinary clinical audit and suggests that the application of the clinical audit process promotes learning within the veterinary team and improved clinical outcomes.
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Affiliation(s)
| | | | | | | | - Dan G O'Neill
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
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Zenner D, Méndez AR, Schillinger S, Val E, Wickramage K. Health and illness in migrants and refugees arriving in Europe: analysis of the electronic Personal Health Record system. J Travel Med 2022; 29:6541145. [PMID: 35238944 PMCID: PMC9635060 DOI: 10.1093/jtm/taac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/10/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The electronic Personal Health Record (ePHR) is a health information system that registers health data on newly arriving migrants and was implemented in eight European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Romania, Serbia and Slovenia). This is a cross-sectional study aimed to describe the health problems and health status of all migrants attended at health clinics as part of the health assessment programme established in the reception centres (2016-2019). METHODS Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on pre-specified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings or review of medical records. Crude proportions were calculated and odds ratios (OR) estimated using logistic regression modelling. RESULTS The ePHR dataset contained a total of 19 564 clinical episodes in 14 436 individuals, recorded between January 2016 and October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. There were 2531/19 564 (12.9%) infectious diseases episodes reported during the study period, being 1283/2531 (50.7%) of them pharyngo-tonsillitis, 529 (20.9%) scabies, 158 (6.2%) viral hepatitis and 156(6.1%) lower respiratory infections. There were 2462 (17.1%) individuals with non-communicable diseases reported; including 821 (5.7%) cardiovascular diseases, 1183 (8.2%) neurological condition, 644 (4.5%) Diabetes mellitus and 212 (1.5%) kidney disease cases. Having Diabetes Mellitus (adjusted OR, aOR 3.3, [95% confidence interval, CI 2.7-4.1], P < 0.001), and neurological disorders (aOR 1.8, [95% CI 1.4-2.2], P < 0.001) were associated with cardiovascular disorders in the multivariable logistic regression model.Mental health problems were reported in 641/14 436 (4.4%) individuals and were associated with increasing age. Furthermore, 610 episodes of acute injuries were reported among 585/14 436 (4.1%) people, 517 (88.4%) of them in men (P < 0.001). CONCLUSIONS The ePHR is a valuable tool to efficiently collect health-related data to better address migrant health issues. We described a mostly healthy population with many acute infectious disease episodes particularly in children, but also with significant number of chronic conditions and less frequent injuries or mental health problems.
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Affiliation(s)
- Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, 58 Turner St, London E1 2AB, UK
| | - Ana Requena Méndez
- Department of Medicine-Solna, Karolinska Institutet, 171 65 Solna, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Barcelona Institute for Global Health (ISGlobal Campus Clinic), Barcelona 08036, Spain
| | - Steffen Schillinger
- Migration Health Division, International Organization for Migration, 1226. Manila, Philippines
| | - Elena Val
- Migrant Health Division, International Organization for Migration, Regional Office for the EU/EAA and NATO B-1000 Brussels, Belgium
| | - Kolitha Wickramage
- Migration Health Division, International Organization for Migration, 1226. Manila, Philippines
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Floch YL. [Deployment of the white plan with healthcare and paramedical teams]. Soins 2021; 66:34-36. [PMID: 34187652 DOI: 10.1016/s0038-0814(21)00161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the context of a crisis situation or exceptional healthcare situation, and the activation of the white plan, the director of nursing and the paramedical teams are at the heart of the action in order to organise the continuity of care for patients and residents, notably in the case of a computer system failure resulting from a power outage.
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Affiliation(s)
- Yann Le Floch
- Centre hospitalier Moulins-Yzeure, 10 avenue du Général-de-Gaule, 03006 Moulins, France.
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12
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Rodríguez Hermosa JL, Fuster Gomila A, Puente Maestu L, Amado Diago CA, Callejas González FJ, Malo De Molina Ruiz R, Fuentes Ferrer ME, Alvarez-Sala JL, Calle Rubio M. Assessing the Usefulness of the Prevexair Smartphone Application in the Follow-Up High-Risk Patients with COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:53-65. [PMID: 33447026 PMCID: PMC7802911 DOI: 10.2147/copd.s279394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/11/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction This manuscript analyzes the exacerbations recorded by the Prevexair application through the daily analysis of symptoms in high-risk patients with COPD and explores its usefulness in assessing clinical stability with respect to that reported in visits. Patients and Methods This study is a multi-centre cohort of COPD patients with the exacerbator phenotype who were monitored over 6 months. The Prevexair application was installed on the patients' smartphones. Patients used the app to record symptom changes, use of medication and use of healthcare resources. It is not established a recommended action plan when worsening of symptoms. At their clinical visit during the follow-up period, patients were asked about exacerbations suffered during these 6 months of monitoring. The investigators who conducted the visit were blinded about the Prevexair app records. Results The patients experienced a total of 185 exacerbations according to daily records in the app whereas only 64 exacerbations were recalled during medical visits. Perception became more accurate for severe exacerbations (kappa 0.6577), although we found no factors that predicted poor recall. The proportion of 72.5% patients were classified as unstable if the exacerbations captured by Prevexair were used to define stability, versus 47.8% if the exacerbations recall in visit was used. Two-thirds of the exacerbations recorded in the Prevexair application were not reported to doctors during their clinical visits. Almost half were treated with oral corticosteroids and/or antibiotics and more than one-quarter of the exacerbations treated did not seek medical attention. Conclusion The findings of this cohort study confirm that patients do not always remember the exacerbations suffered during their medical visit. The prevexair application is useful in monitoring COPD patients at high risk, in order to a better assessment of exacerbations of COPD during medical visits. Further research must be carried out to evaluate this strategy in clinical practice.
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Affiliation(s)
- Juan Luis Rodríguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonia Fuster Gomila
- Pulmonology Department, Hospital U. Son Llátzer, Palma De Mallorca, Balearic Islands, Spain
| | | | - Carlos Antonio Amado Diago
- Pulmonology Department, Hospital U. Marqués de Valdecilla, Santander, Cantabria, Spain.,Department of Medicine, Universidad de Cantabria, Santander, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Department of Medicine Preventive, San Carlos Health Research Institute (IdISSC), Madrid, Spain.,Department of Medicine, Universidad Alfonso X El Sabio, Madrid, Spain
| | - Jose Luis Alvarez-Sala
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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13
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Hansen S, Hilberg O, Ulrik CS, Bodtger U, M. Rasmussen L, D. Assing K, Wimmer-Aune A, B. Rasmussen K, Bjerring N, Christiansen A, Schmid J, Krogh NS, Porsbjerg C. The Danish severe asthma register: an electronic platform for severe asthma management and research. Eur Clin Respir J 2020; 8:1842117. [PMID: 33209214 PMCID: PMC7646603 DOI: 10.1080/20018525.2020.1842117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 10/22/2020] [Indexed: 12/27/2022] Open
Abstract
The evaluation and management of severe asthma patients require collection of comprehensive information, which is often a challenge in a busy outpatient clinic. The Danish Severe Asthma Register (DSAR) was designed as an electronic patient record form that captures operational clinical data and provides a clinical overview of the severe asthma patient. DSAR is a nationwide register; all patients in Denmark who are treated with biologics for severe asthma are included, and data are as a minimum entered at start of biological treatment, after four and 12 months of treatment, and hereafter annually. Currently, there are data from 621 treatment courses with biologics included in DSAR, with 71% of patients treated with anti-IL-5 drugs and 29% with an anti-IgE drug. Patients enter Patient Reported Outcome Measures electronically on tablets when they arrive in the outpatient clinic and their answers are immediately available to the clinician during the consultation. Nurses and doctors enter clinical data into DSAR during the consultation. DSAR offers immediate access to well-presented longitudinal overview and automatically creates a journal output that can be copy-pasted into the hospital's existing health record form. DSAR is also currently expanding with an app, to be used for monitoring of home-treatment. In addition to serving as an electronic patient record form, DSAR will also provide opportunities to monitor the real-life efficacy of biological treatment for severe asthma in Denmark, and it will be a valuable research platform that will aid in answering important research questions on severe asthma in the future.
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Affiliation(s)
- Susanne Hansen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
| | - Ole Hilberg
- Department of Respiratory Medicine, Vejle Hospital, Vejle, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Linda M. Rasmussen
- Allergy Clinic, Department of Dermato-Allergology, Gentofte Hospital, Copenhagen, Denmark
| | - Karin D. Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Kirsten B. Rasmussen
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Niels Bjerring
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Anders Christiansen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Johannes Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Niels Steen Krogh
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
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14
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Schofield I, Brodbelt DC, Niessen SJM, Church DB, Geddes RF, Kennedy N, O'Neill DG. Development and internal validation of a prediction tool to aid the diagnosis of Cushing's syndrome in dogs attending primary-care practice. J Vet Intern Med 2020; 34:2306-2318. [PMID: 32935905 PMCID: PMC7694798 DOI: 10.1111/jvim.15851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Novel methods to aid identification of dogs with spontaneous Cushing's syndrome are warranted to optimize case selection for diagnostics, avoid unnecessary testing, and ultimately aid decision-making for veterinarians. HYPOTHESIS/OBJECTIVES To develop and internally validate a prediction tool for dogs receiving a diagnosis of Cushing's syndrome using primary-care electronic health records. ANIMALS Three hundred and ninety-eight dogs diagnosed with Cushing's syndrome and 541 noncase dogs, tested for but not diagnosed with Cushing's syndrome, from a cohort of 905 544 dogs attending VetCompass participating practices. METHODS A cross-sectional study design was performed. A prediction model was developed using multivariable binary logistic regression taking the demography, presenting clinical signs and some routine laboratory results into consideration. Predictive performance of each model was assessed and internally validated through bootstrap resampling. A novel clinical prediction tool was developed from the final model. RESULTS The final model included predictor variables sex, age, breed, polydipsia, vomiting, potbelly/hepatomegaly, alopecia, pruritus, alkaline phosphatase, and urine specific gravity. The model demonstrated good discrimination (area under the receiver operating curve [AUROC] = 0.78 [95% CI = 0.75-0.81]; optimism-adjusted AUROC = 0.76) and calibration (C-slope = 0.86). A tool was developed from the model which calculates the predicted likelihood of a dog having Cushing's syndrome from 0% (score = -13) to 96% (score = 10). CONCLUSIONS AND CLINICAL IMPORTANCE A tool to predict a diagnosis of Cushing's syndrome at the point of first suspicion in dogs was developed, with good predictive performance. This tool can be used in practice to support decision-making and increase confidence in diagnosis.
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Affiliation(s)
- Imogen Schofield
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - David C Brodbelt
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - Stijn J M Niessen
- Clinical Science and Services, The Royal Veterinary College, Hatfield, UK.,The VetCT Telemedicine Hospital, St John's Innovation Centre, Cambridge, UK
| | - David B Church
- Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Rebecca F Geddes
- Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Noel Kennedy
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
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15
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Martens FK, Huntjens DW, Rigter T, Bartels M, Bet PM, Cornel MC. DPD Testing Before Treatment With Fluoropyrimidines in the Amsterdam UMCs: An Evaluation of Current Pharmacogenetic Practice. Front Pharmacol 2020; 10:1609. [PMID: 32047438 PMCID: PMC6997151 DOI: 10.3389/fphar.2019.01609] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/10/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction The fluoropyrimidines (FP) (5-Fluorouracil, capecitabine, and tegafur) are commonly used anti-cancer drugs, but lead to moderate to severe toxicity in about 10-40% of patients. DPD testing [either the enzyme activity of dihydropyrimidine dehydrogenase (DPD) or the DPYD genotype] identifies patients at higher risk for toxicity who may be treated more safely with a lower drug dose. The Netherland's National guideline for colon carcinoma was updated in 2017 to recommend DPYD genotyping before treatment with FP. Pretreatment DPYD genotyping identifies approximately 50% of the patients that will develop severe FP toxicity. The aim of the study was to assess the uptake of DPD testing in the Amsterdam University Medical Centers over time and to evaluate stakeholder experiences to indicate barriers and facilitators of implementation in routine clinical care. Materials and Methods We used a mixed-method approach involving electronic patient records of 753 unique patients and pharmacy information systems analyses and fifteen semi-structured interviews with oncologists, pharmacists, and patients. The constellation perspective was used to identify barriers and facilitators at the level of practice, culture and structure. The proportion of FP users who were DPD tested pretreatment showed an increase from 1% (1/86) in Q2-2017 up to 87% (73/84) in Q4-2018. Unlike a landmark paper published in 2015, the National guideline for colorectal carcinoma followed by meetings to achieve local consensus led to this steep increase in the proportion of patients tested. Results Facilitating factors for stakeholders to implement testing included the existence of clear protocols, (anecdotal) evidence of the utility, being aware that peers are adhering to standard practice and clear and simple procedures for ordering and reporting. Main barriers included the lack of clear divisions of responsibilities, the lack of consensus on a test approach, long turn-around times and non-user-friendly IT-infrastructures. More professional education on the utility and limitations of pharmacogenetic testing was desired by most stakeholders. Conclusion While the evidence for DPD testing was sufficient, only after the update of a National guideline and local consensus meetings the proportion of FP users that were DPD tested pretreatment rose to 87%. The implementation of personalized medicine requires stakeholders involved to attune practice, culture and structure.
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Affiliation(s)
- Forike K Martens
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Daan W Huntjens
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Tessel Rigter
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Meike Bartels
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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16
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Abstract
Abstract.Background: Child abuse and suicide among the young population
is a serious and prevalent problem. Many studies have demonstrated that people with adverse
childhood experiences, such as child abuse, are likely to develop suicidal behavior. This
study evaluates the connection between child abuse and suicidal behavior in the Hong Kong
community where incidents of child abuse have been on the rise over the past decade. Aims:
To determine the association between child abuse and attempted suicide in the child
population of Hong Kong using hospital electronic medical records system. Method: From
January 1, 1995 to July 31, 2016, patients with admission age < 18 years with the
diagnosis of child abuse or influenza infection (comparison group) were included in this
study (n = 54,256). In secondary data analysis, an association was found between children
who had experienced child abuse and the outcome measure of hospital admission for attempted
suicide compared with influenza infection. Results: The adjusted hazard ratio of attempting
suicide in children who experienced sexual abuse and physical abuse compared with the
influenza-infected group was 6.48 (95% CI [4.56, 9.19]) and 4.83 (95% CI [3.67, 6.34]). The
age at onset of adverse incidents was negatively associated with the attempted suicide
timing. Female patients had a 1.64 higher risk of repeating attempted suicide. In addition,
nearly 5% of children who had experienced child abuse attempted suicide in the 10 years
after their admission, and more than 36% of patients had a record of repeated suicide
attempt in the 20 years after the initial admission. Limitations: The accuracy of the
diagnosis, selection bias, insufficiency of study period, Berkson's bias, incomplete
socioeconomic status, as well as the absence of psychiatric diagnosis are the limitations.
Conclusion: Our results indicate that there is a significant association between child abuse
and suicide attempts in Hong Kong. If confirmed, the study (a) demonstrates that hospital
admission records are a critical source for identifying children with a high risk for
suicidal behavior; (b) may inform policy makers that additional and long-term intervention
programs should be provided to children so as to reduce subsequent suicide attempts.
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Affiliation(s)
- Wilfred Hing-Sang Wong
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China.,Department of Public Health Science, Walden University, Minneapolis, MN, USA
| | - Wen-Hung Kuo
- Department of Public Health Science, Walden University, Minneapolis, MN, USA
| | - Curt Sobolewski
- Department of Public Health Science, Walden University, Minneapolis, MN, USA
| | - Inderjeet Bhatia
- Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China
| | - Patrick Ip
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China
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17
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Malycha J, Redfern OC, Ludbrook G, Young D, Watkinson PJ. Testing a digital system that ranks the risk of unplanned intensive care unit admission in all ward patients: protocol for a prospective observational cohort study. BMJ Open 2019; 9:e032429. [PMID: 31511294 PMCID: PMC6747664 DOI: 10.1136/bmjopen-2019-032429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Traditional early warning scores (EWSs) use vital sign derangements to detect clinical deterioration in patients treated on hospital wards. Combining vital signs with demographics and laboratory results improves EWS performance. We have developed the Hospital Alerting Via Electronic Noticeboard (HAVEN) system. HAVEN uses vital signs, as well as demographic, comorbidity and laboratory data from the electronic patient record, to quantify and rank the risk of unplanned admission to an intensive care unit (ICU) within 24 hours for all ward patients. The primary aim of this study is to find additional variables, potentially missed during development, which may improve HAVEN performance. These variables will be sought in the medical record of patients misclassified by the HAVEN risk score during testing. METHODS This will be a prospective, observational, cohort study conducted at the John Radcliffe Hospital, part of the Oxford University Hospitals NHS Foundation Trust in the UK. Each day during the study periods, we will document all highly ranked patients (ie, those with the highest risk for unplanned ICU admission) identified by the HAVEN system. After 48 hours, we will review the progress of the identified patients. Patients who were subsequently admitted to the ICU will be removed from the study (as they will have been correctly classified by HAVEN). Highly ranked patients not admitted to ICU will undergo a structured medical notes review. Additionally, at the end of the study periods, all patients who had an unplanned ICU admission but whom HAVEN failed to rank highly will have a structured medical notes review. The review will identify candidate variables, likely associated with unplanned ICU admission, not included in the HAVEN risk score. ETHICS AND DISSEMINATION Approval has been granted for gathering the data used in this study from the South Central Oxford C Research Ethics Committee (16/SC/0264, 13 June 2016) and the Confidentiality Advisory Group (16/CAG/0066). DISCUSSION Our study will use a clinical expert conducting a structured medical notes review to identify variables, associated with unplanned ICU admission, not included in the development of the HAVEN risk score. These variables will then be added to the risk score and evaluated for potential performance gain. To the best of our knowledge, this is the first study of this type. We anticipate that documenting the HAVEN development methods will assist other research groups developing similar technology. TRIAL REGISTRATION NUMBER ISRCTN12518261.
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Affiliation(s)
- James Malycha
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Oliver C Redfern
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Guy Ludbrook
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Duncan Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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18
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Mohammed S, Peter E, Gastaldo D, Howell D. The medicalisation of the dying self: The search for life extension in advanced cancer. Nurs Inq 2019; 27:e12316. [PMID: 31398774 DOI: 10.1111/nin.12316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022]
Abstract
Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late-stage cancer and their healthcare providers enacted the process of medicalisation through engaging in the search for oncological treatments, such as experimental drug trials, despite the incurability of their disease. The seven cases included 20 interviews with patients, family, physicians and nurses, the analysis of 30 documents and 5 hr of field observation. A poststructural perspective informed our study. We propose that searching for life extension enacts medicalisation by shaping the dying person afflicted with terminal cancer into new medical subjectivities that are knowledgeable, active, entrepreneurial and curative. Participants initially took up medical thinking from the formal oncology system, but then began to apply and internalise medical rationalities to alter their personhood, thereby generating new curative possibilities for themselves. For people seeking life extension, the embodied and day-to-day experiences of suffering and being close to death became expressed and moderated in fundamentally medicalised terms.
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Affiliation(s)
- Shan Mohammed
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Peter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Centre for Critical Qualitative Health Research (CQ), Toronto, ON, Canada.,Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Denise Gastaldo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Centre for Critical Qualitative Health Research (CQ), Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Doris Howell
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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19
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Priestman W, Collins R, Vigne H, Sridharan S, Seamer L, Bowen D, Sebire NJ. Lessons learned from a comprehensive electronic patient record procurement process-implications for healthcare organisations. BMJ Health Care Inform 2019; 26:bmjhci-2019-000020. [PMID: 31072821 PMCID: PMC7062322 DOI: 10.1136/bmjhci-2019-000020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 11/21/2022] Open
Abstract
Background This study describes learning from procurement of a comprehensive electronic patient record (EPR/electronic health record (EHR)), system for a specialist clinical academic institution. Method Retrospective review of procurement process in addition to evaluation of peer-reviewed literature in the field. Results Main lessons learned include the importance of detailed preparation of organisational requirements/specifications and organisational ‘readiness’. Early staff involvement, resulting in ownership of the selected system by the organisation was a key achievement. The scoring process used required significant resource commitment but, despite being extensive in scope, provided relatively poor distinction between suppliers, despite significant variation in supplier self-scoring. Other elements, such as demonstrations and site visits, provided superior evaluation of functional abilities, and specification requirements should be regarded as threshold evaluation. Conclusion While principles should be followed, the procurement process must be modified to meet the needs of the specific organisation, in terms of its clinical activities, digital maturity, existing infrastructure and budget.
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Affiliation(s)
| | | | | | | | | | | | - N J Sebire
- Histopathology Department, Level 3 Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
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20
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Shiells K, Holmerova I, Steffl M, Stepankova O. Electronic patient records as a tool to facilitate care provision in nursing homes: an integrative review. Inform Health Soc Care 2018; 44:262-277. [PMID: 30125140 DOI: 10.1080/17538157.2018.1496091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: The electronic patient record (EPR) has been introduced into nursing homes with the aim of reducing time spent on documentation, improving documentation quality and increasing transferability of information, all of which should facilitate care provision. However, previous research has shown that EPR may be creating new burdens for staff. The purpose of this literature review is to explore how EPR is facilitating or hindering care provision in nursing homes. Methods: An integrative literature review was carried out using four electronic databases to search for relevant articles. After screening, 22 articles were included for thematic synthesis. Results: Thematic synthesis resulted in six analytical themes linked to care provision: time for direct care; accountability; assessment and care planning; exchange of information; risk awareness; and person-centered care. Conclusion: For EPR to facilitate care provision in nursing homes, consideration should be given to the type of device used for documentation, as well as the types of applications, the functionality, content, and structure of EPR. Further research exploring the experiences of end users is required to identify the optimal characteristics of an EPR system specifically for use in nursing homes.
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Affiliation(s)
- Kate Shiells
- a Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University , Prague , Czech Republic
| | - Iva Holmerova
- a Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University , Prague , Czech Republic
| | - Michal Steffl
- b Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, Charles University , Prague , Czech Republic
| | - Olga Stepankova
- c Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague , Prague , Czech Republic
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21
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McGreevy P, Thomson P, Dhand NK, Raubenheimer D, Masters S, Mansfield CS, Baldwin T, Soares Magalhaes RJ, Rand J, Hill P, Peaston A, Gilkerson J, Combs M, Raidal S, Irwin P, Irons P, Squires R, Brodbelt D, Hammond J. VetCompass Australia: A National Big Data Collection System for Veterinary Science. Animals (Basel) 2017; 7:ani7100074. [PMID: 28954419 PMCID: PMC5664033 DOI: 10.3390/ani7100074] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 01/08/2023] Open
Abstract
Simple Summary The VetCompass Australia program collects real-time clinical records from veterinary practices and aggregates them for researchers to interrogate. It delivers Australian researchers sustainable and cost-effective access to authoritative data from hundreds of veterinary practitioners, across Australia and opens up major international collaborative opportunities with related projects in the United Kingdom and elsewhere. Abstract VetCompass Australia is veterinary medical records-based research coordinated with the global VetCompass endeavor to maximize its quality and effectiveness for Australian companion animals (cats, dogs, and horses). Bringing together all seven Australian veterinary schools, it is the first nationwide surveillance system collating clinical records on companion-animal diseases and treatments. VetCompass data service collects and aggregates real-time, clinical records for researchers to interrogate, delivering sustainable and cost-effective access to data from hundreds of veterinary practitioners nationwide. Analysis of these clinical records will reveal geographical and temporal trends in the prevalence of inherited and acquired diseases, identify frequently prescribed treatments, revolutionize clinical auditing, help the veterinary profession to rank research priorities, and assure evidence-based companion-animal curricula in veterinary schools. VetCompass Australia will progress in three phases: (1) roll-out of the VetCompass platform to harvest Australian veterinary clinical record data; (2) development and enrichment of the coding (data-presentation) platform; and (3) creation of a world-first, real-time surveillance interface with natural language processing (NLP) technology. The first of these three phases is described in the current article. Advances in the collection and sharing of records from numerous practices will enable veterinary professionals to deliver a vastly improved level of care for companion animals that will improve their quality of life.
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Affiliation(s)
- Paul McGreevy
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW 2006, Australia.
| | - Peter Thomson
- School of Life and Environmental Sciences, Faculty of Science, University of Sydney, Sydney, NSW 2006, Australia.
| | - Navneet K Dhand
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW 2006, Australia.
| | - David Raubenheimer
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia.
| | - Sophie Masters
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW 2006, Australia.
| | - Caroline S Mansfield
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, VIC 3030, Australia.
| | - Timothy Baldwin
- School of Computing and Information Systems, University of Melbourne, Parkville, VIC 3010, Australia.
| | - Ricardo J Soares Magalhaes
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia.
- Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia.
| | - Jacquie Rand
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia.
| | - Peter Hill
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy, SA 5371, Australia.
| | - Anne Peaston
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy, SA 5371, Australia.
| | - James Gilkerson
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC 3010, Australia.
| | - Martin Combs
- School of Animal and Veterinary Science, Faculty of Science, Charles Sturt University, Wagga, NSW 2650, Australia.
| | - Shane Raidal
- School of Animal and Veterinary Science, Faculty of Science, Charles Sturt University, Wagga, NSW 2650, Australia.
| | - Peter Irwin
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA 6150, Australia.
| | - Peter Irons
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA 6150, Australia.
| | - Richard Squires
- College of Public Health, Medical and Veterinary Science, James Cook University, Townsville, QLD 4811, Australia.
| | - David Brodbelt
- Pathobiology and Population Services, Royal Veterinary College, University of London, Hertfordshire AL9 7TA, UK.
| | - Jeremy Hammond
- Information and Communications Technology, University of Sydney, NSW 2006, Australia.
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Sheaff R, Halliday J, Byng R, Øvretveit J, Exworthy M, Peckham S, Asthana S. Bridging the discursive gap between lay and medical discourse in care coordination. Sociol Health Illn 2017; 39:1019-1034. [PMID: 28349619 DOI: 10.1111/1467-9566.12553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
For older people with multiple chronic co-morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information-sharing difficulties arising from differences between patients' oral narratives and medical sense-making; and whether a modified form of 'narrative medicine' might mitigate them. We systematically compared 66 general practice patients' own narratives of their health problems and care with the contents of their clinical records. Data were collected in England during 2012-13. Patients' narratives differed from the accounts in their medical record, especially the summary, regarding mobility, falls, mental health, physical frailty and its consequences for accessing care. Parts of patients' viewpoints were never formally encoded, parts were lost when clinicians de-coded it, parts supplemented, and sometimes the whole narrative was re-framed. These discrepancies appeared to restrict the patient record's utility even for GPs for the purposes of risk stratification, case management, knowing what other care-givers were doing, and coordinating care. The findings suggest combining the encoding/decoding theory of communication with inter-subjectivity and intentionality theories as sequential, complementary elements of an explanation of how patients communicate with clinicians. A revised form of narrative medicine might mitigate the discursive gap and its consequences for care coordination.
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Affiliation(s)
- Rod Sheaff
- School of Government, Plymouth University, UK
| | | | - Richard Byng
- School of Medicine and Dentistry, Plymouth University, UK
| | | | - Mark Exworthy
- Health Services Management Centre, University of Birmingham, UK
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Pafitanis G, Hadjiandreou M, Withers L, Dent H. Medicons: toward clinical examination diagrams standardization in medical documentation. Adv Med Educ Pract 2017; 8:347-351. [PMID: 28579872 PMCID: PMC5446968 DOI: 10.2147/amep.s133681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Electronic patient records (EPRs) allow efficient and accurate medical documentation. Diagrams have traditionally been used to document clinical signs in patient notes. The interpretation of these diagrams may vary among doctors across a range of specialties, but this has never been tested previously. This study investigated how common diagrams were interpreted and explored the use of digitalized diagrams - Medicons in creating a common language to be used in digital clinical examination proformas. MATERIALS AND METHODS A cross-sectional survey utilizing a multiple-choice questionnaire was carried out across London hospitals. Seventeen digitalized examination diagrams were included in a multiple-choice questionnaire to test doctors' perception and explore their opinions of diagram usage. The questionnaire was sent to junior doctors in training. RESULTS A total of 206 responses were received from 31 foundation year 1 trainees, 45 foundation year 2 trainees, 94 core surgical trainees and 36 core medical trainees. Diagrams were interpreted correctly, on average, 75% of the time. The majority of doctors (94%) felt that diagrams facilitated the understanding of clinical examination, documentation of pathologic site (98%) and improved the efficiency of documentation (89.8%). All doctors felt that diagrams may benefit overall medical care provision. CONCLUSION Digitalizing signs and symptoms in EPR will enhance clinical documentation and may contribute to better patient care. New initiatives need to be employed to increase the use of diagrams - Medicons, as young doctors perceived these to improve clinical documentation. Standardized electronic proformas should be included into EPR to improve the efficiency and accuracy of clinical examination documentation.
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Affiliation(s)
| | | | - Leo Withers
- The Royal London Hospital, Barts Health NHS Trust, London, UK
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Drinkwater J, Stanley N, Szilassy E, Larkins C, Hester M, Feder G. Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children. Br J Gen Pract 2017; 67:e437-44. [PMID: 28137783 DOI: 10.3399/bjgp17X689353] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/19/2016] [Indexed: 11/24/2022] Open
Abstract
Background Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family. Aim To explore how and why general practice clinicians document DVA in families with children. Design and setting A qualitative interview study using vignettes with GPs and practice nurses (PNs) in England. Method Semi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes. Results Most clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians. Conclusion Managing DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access.
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Allan PA, Newman MJ, Oehmen R, English WA. The use of daily electronic prompts to help improve antimicrobial stewardship in a critical care unit. J Infect Prev 2016; 17:179-184. [PMID: 28989477 DOI: 10.1177/1757177416645346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/26/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) represents a growing threat to public health, with the potential to reverse many of the gains made in modern medicine. AMR is contributed to by both inappropriate choice of antibiotics and inappropriate antibiotic course durations. OBJECTIVES The objective of this audit was to determine if the introduction of antimicrobial prescribing electronic prompts in an electronic patient record had a positive impact on antimicrobial stewardship. METHODS The audit examined the proportion of antibiotic prescriptions within a critical care unit in which both a valid stop date and indication were recorded. The audit was repeated on two occasions: first, after an education programme, and second, after the introduction of an electronic prompt within the patients' electronic patient record. RESULTS Chi-square analyses indicated that significant improvements in both the recording of indications (χ²(4) = 39.69, P <0.0001) and stop-dates (χ²(4) = 42.10, P <0.0001) occurred across the three audits. CONCLUSION We conclude that the novel use of daily electronic prompts has a positive impact on antimicrobial stewardship.
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Affiliation(s)
- P A Allan
- Critical Care Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - M J Newman
- Critical Care Department, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - R Oehmen
- University of Notre Dame, School of Medicine, Freemantle, Perth, Western Australia, Australia
| | - W A English
- Critical Care Department, Royal Cornwall Hospital, Truro, Cornwall, UK
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Elbers PW, Girbes A, Malbrain ML, Bosman R. Right dose, right now: using big data to optimize antibiotic dosing in the critically ill. Anaesthesiol Intensive Ther 2015; 47:457-63. [PMID: 26459228 DOI: 10.5603/AIT.a2015.0061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 11/25/2022] Open
Abstract
Antibiotics save lives and are essential for the practice of intensive care medicine. Adequate antibiotic treatment is closely related to outcome. However this is challenging in the critically ill, as their pharmacokinetic profile is markedly altered. Therefore, it is surprising that critical care physicians continue to rely on standard dosing regimens for every patient, regardless of the actual clinical situation. This review outlines the pharmacokinetic and pharmacodynamic principles that underlie the need for individualized and personalized drug dosing. At present, therapeutic drug monitoring may be of help, but has major disadvantages, remains unavailable for most antibiotics and has produced mixed results. We therefore propose the AutoKinetics concept, taking decision support for antibiotic dosing back to the bedside. By direct interaction with electronic patient records, this opens the way for the use of big data for providing the right dose at the right time in each patient.
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Sniatecki JJ, Styles C, Boyle N, Sanders R. Cataract surgery: factors influencing decision to treat and implications for training (south-east Scotland 2008-2014). Clin Ophthalmol 2015; 9:1821-7. [PMID: 26491242 PMCID: PMC4599148 DOI: 10.2147/opth.s92803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the population referred for cataract surgery, identify factors that influenced decision to treat, and patients suitable for ophthalmic training. Patients and methods A total of 2,693 consecutive referrals over 6 years were interrogated using Business Objects software on cataract electronic patient records. Results A total of 2,693 patients were referred for cataract surgery (group A). Of these patients 2,132 (79%) had surgery (group B) and 561 (21%) did not (group C). Age for group B vs group C: 672 (32%) vs 115 (20%) ≤69 years, P<0.001; 803 (38%) vs 225 (40%) 70–79 years, P=0.48; 586 (27%) vs 203 (36%) 80–89 years, P<0.05; 71 (3%) vs 18 (3%) ≥90 years, P=1.0. Visual acuity, group B vs group C: 556 (26%) vs 664 (59%) 6/12 or better; 1,275 (60%) vs 367 (33%) 6/18–6/60; 266 (12%) vs 64 (6%) counting fingers or worse, P<0.05. Medical history for group B vs C: cognitive impairment: 55 (2.6%) vs 29 (5.2%), P<0.05; cardiovascular accident: 158 (7.4%) vs 60 (10.7%), P<0.05; diabetes: 372 (17.4%) vs 96 (17.1%), P=0.87; COPD/asthma: 382 (17.9%) vs 93 (16.6%), P=0.53; heart disease: 535 (25.1%) vs 155 (27.6%), P=0.35; hypertension: 971 (45.5%) vs 263 (46.9%), P=0.73. Ocular history for group B vs C was significant (P<0.05) for age-related macular degeneration 255 (12.0%) vs 93 (16.6%), other macular pathology 38 (1.8%) vs 25 (4.5%), corneal pathology 92 (4.3%) vs 36 (6.4%), amblyopia 37 (1.7%) vs 22 (3.9%). Detailed data on presenting complaint, ophthalmic history, and social status is discussed. Conclusion We observed that surgery at a younger age with good levels of visual acuity was a factor in deferring cataract surgery. Cognitive impairment, cardiovascular accident, amblyopia, corneal and macular pathology significantly affected decision not to operate. We estimate that 80% of patients would be suitable for ophthalmic training.
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Affiliation(s)
- Jan J Sniatecki
- Cataract Unit, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Caroline Styles
- Cataract Unit, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Natalie Boyle
- Cataract Unit, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Roshini Sanders
- Cataract Unit, Queen Margaret Hospital, Dunfermline, Fife, UK
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Soler JK, Corrigan D, Kazienko P, Kajdanowicz T, Danger R, Kulisiewicz M, Delaney B. Evidence-based rules from family practice to inform family practice; the learning healthcare system case study on urinary tract infections. BMC Fam Pract 2015; 16:63. [PMID: 25980623 PMCID: PMC4438341 DOI: 10.1186/s12875-015-0271-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/27/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70). METHODS Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project. RESULTS The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection" . The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis" . The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis. CONCLUSIONS We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data.
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Affiliation(s)
- Jean K Soler
- Mediterranean Institute of Primary Care 19, Triq ir-Rand, Attard, Malta.
| | - Derek Corrigan
- Department of General Practice, HRB Centre for Primary Care Research, Beaux Lane House, Lower Mercer Street, Dublin, Ireland.
| | - Przemyslaw Kazienko
- Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland.
| | - Tomasz Kajdanowicz
- Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland.
| | | | - Marcin Kulisiewicz
- Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland.
| | - Brendan Delaney
- Wolfson Chair of General Practice, King's College London, Capital House, Guy's Hospital, London, England.
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Spallek H, Johnson L, Kerr J, Rankin D. Costs of health IT: beginning to understand the financial impact of a dental school EHR. J Dent Educ 2014; 78:1542-1551. [PMID: 25362696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Health Information Technology (Health IT) constitutes an integral component of the operations of most academic dental institutions nowadays. However, the expenses associated with the acquisition and the ongoing maintenance of these complex systems have often been buried among costs for other electronic infrastructure systems, distributed across various cost centers including unmeasured central campus support, covered centrally and therefore difficult to quantify, and spread over years, denying school administrators a clear understanding of the resources that have been dedicated to Health IT. The aim of this study was to understand the financial impact of Health IT at four similar U.S. dental schools: two schools using a purchased Electronic Health Record (EHR), and two schools that developed their own EHR. For these schools, the costs of creating ($2.5 million) and sustaining ($174,000) custom EHR software were significantly higher than acquiring ($500,000) and sustaining ($121,000) purchased software. These results are based on historical data and should not be regarded as a gold standard for what a complete Health IT suite should cost. The presented data are intended to inform school administrators about the myriad of costs associated with Health IT and give them a point of reference when comparing costs or making estimates for implementation projects.
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Affiliation(s)
- Heiko Spallek
- Dr. Spallek is Associate Professor, Dental Public Health, Center for Informatics in Oral Health Translational Research and Associate Dean, Office of Faculty Affairs, School of Dental Medicine, University of Pittsburgh; Dr. Johnson is Professor of Dentistry, School of Dentistry, Associate Dean for Faculty Affairs and Institutional Effectiveness, and Clinical Professor, School of Information, University of Michigan; Mr. Kerr is Associate Dean for Administration, School of Dental Medicine, University at Buffalo; and Mr. Rankin is Director, Office of Computing and Information Systems, School of Dentistry, University of North Carolina at Chapel Hill.
| | - Lynn Johnson
- Dr. Spallek is Associate Professor, Dental Public Health, Center for Informatics in Oral Health Translational Research and Associate Dean, Office of Faculty Affairs, School of Dental Medicine, University of Pittsburgh; Dr. Johnson is Professor of Dentistry, School of Dentistry, Associate Dean for Faculty Affairs and Institutional Effectiveness, and Clinical Professor, School of Information, University of Michigan; Mr. Kerr is Associate Dean for Administration, School of Dental Medicine, University at Buffalo; and Mr. Rankin is Director, Office of Computing and Information Systems, School of Dentistry, University of North Carolina at Chapel Hill
| | - Joseph Kerr
- Dr. Spallek is Associate Professor, Dental Public Health, Center for Informatics in Oral Health Translational Research and Associate Dean, Office of Faculty Affairs, School of Dental Medicine, University of Pittsburgh; Dr. Johnson is Professor of Dentistry, School of Dentistry, Associate Dean for Faculty Affairs and Institutional Effectiveness, and Clinical Professor, School of Information, University of Michigan; Mr. Kerr is Associate Dean for Administration, School of Dental Medicine, University at Buffalo; and Mr. Rankin is Director, Office of Computing and Information Systems, School of Dentistry, University of North Carolina at Chapel Hill
| | - David Rankin
- Dr. Spallek is Associate Professor, Dental Public Health, Center for Informatics in Oral Health Translational Research and Associate Dean, Office of Faculty Affairs, School of Dental Medicine, University of Pittsburgh; Dr. Johnson is Professor of Dentistry, School of Dentistry, Associate Dean for Faculty Affairs and Institutional Effectiveness, and Clinical Professor, School of Information, University of Michigan; Mr. Kerr is Associate Dean for Administration, School of Dental Medicine, University at Buffalo; and Mr. Rankin is Director, Office of Computing and Information Systems, School of Dentistry, University of North Carolina at Chapel Hill
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Borycki E, Sangster-Gormley E, Schreiber R, Swamy M, Feddema A, Griffith J. Electronic Record Adoption and Use among Nurse Practitioners in British Columbia. Can J Nurs Res 2014; 46:44-65. [PMID: 29509464 DOI: 10.1177/084456211404600105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There has been a research focus on physician adoption of electronic medical records (EMRs). However, there has been less research into nurse practitioner (NP) use of EMRs. The authors present findings on the adoption and use of EMRs by NPs arising from a survey of the patterns of NP practices in the Canadian province of British Columbia. The research reveals a high rate of NP adoption of EMRs, with 82% of respondents indicating that they were using the technology. However, only 19% of NPs were using fully electronic records while 63% were using hybrid records, with only components of the electronic record being available. Respondents were found to be using several EMR features and functions, namely patient demographics, clinical notes, medication lists, laboratory results, and patient problems. NPs' high rate of EMR adoption suggests that there is much to be learned regarding the effect of eHealth strategies on EMR adoption.
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Affiliation(s)
- Elizabeth Borycki
- School of Health Information Science, University of Victoria, British Columbia, Canada
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Floor-Schreudering A, Heringa M, Buurma H, Bouvy ML, De Smet PAGM. Missed drug therapy alerts as a consequence of incomplete electronic patient records in Dutch community pharmacies. Ann Pharmacother 2013; 47:1272-9. [PMID: 24259691 DOI: 10.1177/1060028013501992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Complete and up-to-date medical and pharmaceutical information in the electronic patient record (EPR) is a prerequisite for risk management in community pharmacy. OBJECTIVES To analyze which information is missing in the EPR and which drug therapy alerts, therefore, fail to appear. METHODS Pharmacy students selected patients who were dispensed a prescription drug and enlisted for >3 months in the participating pharmacies. Patients received a questionnaire in which they were asked to verify their medication history, and to provide additional patient information. For each enrolled patient, the students collected all relevant information from the EPR. Self-reported data from the patient were compared with data retrieved from the EPR. Missed information in the EPR was evaluated based on national professional guidelines. RESULTS Questionnaires were received from 67% of the selected patients (442/660). Prescription drugs were missing in the EPR of 14% of the 442 patients, nonprescription drugs in 44%, diseases in 83%, and intolerabilities in 16%. In 38% of the patients (166/442), drug therapy alerts failed to appear because of missing information: drug-disease interactions in 34% of the patients, duplicate medications in 4%, drug-drug interactions (DDIs) in 4%, and drug intolerabilities in 2%. Among the (non-)prescription drugs missing, NSAIDs were most frequently responsible for the missed alerts. Diseases most frequently associated with missed alerts were gastroesophageal reflux disease, renal insufficiency, asthma/chronic obstructive pulmonary disease, and heart failure. CONCLUSIONS Relevant patient information was frequently missing in the EPRs. The nonappearance of drug therapy alerts may have had clinical consequences for patients.
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Michel-Verkerke MB, Spil TAM. The USE IT-adoption-model to predict and evaluate adoption of information and communication technology in healthcare. Methods Inf Med 2013; 52:475-83. [PMID: 23907265 DOI: 10.3414/me12-01-0107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 04/21/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE The USE IT-model integrates theories about adoption and diffusion of innovations and is suitable to predict and evaluate the success of an information system from a user's perspective. The USE IT-model consists of four determinants: relevance, requirements, resources and resistance, which are measured at the macro-level (organizational), and at the micro-level (individual). After applying the USE IT approach in several researches we evaluated and updated the USE IT-model. METHODS We used the USE IT-model in ten case studies in healthcare and compared the results of the studies with the determinants and dimensions of the USE IT-model. RESULTS The quality of the implementation process is part of the innovation process-dimension and therefore relocated as a dimension of macro-resistance. The improvements and value in the relevance determinant are made more concrete by quality, efficiency, effectiveness, and task support. The dimensions of micro-resistance are reduced, and the dimension negative consequences is added. Also the dimensions of macro- and micro-requirements are made more specific to express the importance of information quality, availability and accessibility. DISCUSSION AND CONCLUSION The research resulted in the updated USE IT-adoption-model to predict and evaluate the adoption of information systems in healthcare. The structure and determinants of the original USE IT-model with a distinction between the macro- and micro-level remained unchanged.
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Affiliation(s)
- M B Michel-Verkerke
- Margreet B. Michel-Verkerke, Saxion University of Applied Sciences, Research Center Health, Social Work and Technology, M. H. Tromplaan 28, 7513 AB Enschede, The Netherlands, E-mail:
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Clarke E, Bhatt S, Patel R, Samraj S. Audit of the effect of electronic patient records on uptake of HIV testing in a level 3 genitourinary medicine service. Int J STD AIDS 2013; 24:661-5. [PMID: 23970576 DOI: 10.1177/0956462413478877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This audit aimed to measure the impact of introducing and then modifying an electronic patient record (EPR) system on the uptake of HIV testing at a level 3 genitourinary medicine service. It was a retrospective case note review of all new and rebook patients attending our service in 2007 (paper records) and 2010 (EPR), and a prospective review in 2012 (following modification of the EPR). The uptake of HIV testing increased significantly from 72.8% to 78.1% following introduction of the EPR (p = 0.009), and increased further to 86.6% (p < 0.0001) following modification of the EPR. Clinics using paper notes should consider switching to EPR as a means of increasing HIV testing uptake.
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Affiliation(s)
- Emily Clarke
- Department of Genitourinary Medicine, Royal South Hants Hospital, Southampton, UK
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Klinis S, Markaki A, Kounalakis D, Symvoulakis EK. Monitoring reasons for encounter via an electronic patient record system: the case of a rural practice initiative. Int J Med Sci 2012; 9:704-7. [PMID: 23091407 PMCID: PMC3477679 DOI: 10.7150/ijms.4999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/17/2012] [Indexed: 11/29/2022] Open
Abstract
The objective of this brief communication was to tabulate common reasons for encounter in a Greek rural general practice, as result of a recently adopted electronic patient record (EPR) application. Twenty encounter reasons accounted for 3,797 visits (61% of all patient encounters), whereas 565 other reasons accounted for the remaining 2,429 visits (39%). Number one reason for encounter was health maintenance or disease prevention seeking services, including screening examinations for malignancies, immunization and provision of medical opinion reports. Hypertension, lipid disorder and ischemic heart disease without angina were among the most common reasons for seeking care. A strengths/weaknesses/opportunities/threats (SWOT) analysis on the key role of an EPR system in collecting data from rural and remote primary health care settings is also presented.
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Affiliation(s)
| | - Adelais Markaki
- 2. Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
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Abstract
Current health information initiatives and targets set by the UK government have brought about a flurry of activity in the National Health Service to try to reach those targets. One target is to implement an electronic patient record system as a replacement for the present paper-based system of record keeping. However, this will not be an easy task; simply introducing information technology into an already chaotic system will only compound existing problems. This article highlights the gaps that must be filled before an electronic record system can be effectively implemented. The two major elements that are missing are mandatory clinical recording standards and a profession that is responsible for monitoring and enforcing those standards. Some examples of relevant standards for clinical recording are provided and the role of a health information management profession is described.
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