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Uzuner, Ozlem, Jonathan Mailoa, Russell Ryan, and Tawanda Sibanda. "Semantic relations for problem-oriented medical records." Artificial Intelligence in Medicine 50, no. 2 (October 2010): 63–73. http://dx.doi.org/10.1016/j.artmed.2010.05.006.
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Savage, P. "A book that changed my practice: Problem oriented medical records." BMJ 322, no. 7281 (February 3, 2001): 275. http://dx.doi.org/10.1136/bmj.322.7281.275.
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Bassøe, C. F., and J. E. Rasmussen. "Semantic Analysis of Medical Records." Methods of Information in Medicine 32, no. 01 (1993): 66–72. http://dx.doi.org/10.1055/s-0038-1634897.
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Abstract:A program (LogStory) is described that was developed for the automatic semantic analysis of clinical narratives, stored in a computerized problem-oriented medical record (PROMED). The diagnoses were written in a free-text format during consultation, and later collected into diagnostic classes, e.g., diseases. A lexical parser automatically created dictionaries from the clinical narrative associated with each disease. Automatic (fuzzy) set operations were performed on the words associated with each class. The manifestations of 16 diseases were automatically extracted by pairwise operations on the word sets. The correlation between diseases and corresponding signs, symptoms and treatment was highly significant (p <0.001). Applying the difference operation on diseases with disjunct sets of clinical findings allowed the recovery of disease-specific knowledge. The evolution of a disease was accounted for, and the system was able to generalize its findings. The PROMED-LogStory concept enables the processing of natural language and may be a powerful tool for knowledge acquisition and clinical research.
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Weed, L. "New Premises and New Tools for Medical Care and Medical Education." Methods of Information in Medicine 28, no. 04 (October 1989): 207–14. http://dx.doi.org/10.1055/s-0038-1636803.
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Abstract:Medical care and medical education can be supported more than in the past by using new tools and new premises for the effective linkage between bodies of knowledge and the use of that knowledge. The medical record can be converted from a source-oriented record to a problem-oriented record, enabling to trace not only what was done, but why it was done. These possiblities reveal new insights in the use of databases, problem lists, problem-oriented plans, and problem-oriented progress notes and flowsheets. It brings about a neW behavior in teaching which replaces memorizing facts, new possibilities for medical care, and new responsibilities both for physicians and patients. We now have knowledge-coupling tools that can be used directly with the patients at the time of problem solving. Patients are becoming active participants in this process, bringing about new roles for experts as well as expert systems.
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Buchanan, Joel. "Accelerating the Benefits of the Problem Oriented Medical Record." Applied Clinical Informatics 26, no. 01 (2017): 180–90. http://dx.doi.org/10.4338/aci-2016-04-ie-0054.
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Rector, A. L., W. A. Nowlan, and S. Kay. "Foundations for an Electronic Medical Record." Methods of Information in Medicine 30, no. 03 (1991): 179–86. http://dx.doi.org/10.1055/s-0038-1634836.
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AbstractGiven the many efforts currently under way to develop standards for electronic medical records, it is important to step back and reexamine the fundamental principles which should underlie a model of the electronic medical record. This paper presents an analysis based on the experience in developing the PEN & PAD prototype clinical workstation. The fundamental contention is that the requirements for a medical record must be grounded in its use for patient care. The basic requirement is that it be a faithful record of what clinicians have heard, seen, thought, and done. The other requirements for a medical record, e.g., that it be attributable and permanent, follow naturally from this view. We use the criteria developed to re-examine Weed’s Problem Oriented Medical Record and also relate the criteria to secondary uses of the medical record for population data, communications and decision support.
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Tange, H. J. "Consultation of Medical Narratives in the Electronic Medical Record." Methods of Information in Medicine 38, no. 04/05 (1999): 289–93. http://dx.doi.org/10.1055/s-0038-1634417.
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AbstractThis article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much detailed segments will delay the consultation of medical narratives. Validation of the results in daily practice is recommended.
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de Lusignan, Simon, Harshana Liyanage, and Philip Scott. "Computerised medical record systems that guide and protect – reflections on the Bawa-Garba case." BMJ Health & Care Informatics 25, no. 1 (January 2018): 57–59. http://dx.doi.org/10.14236/jhi.v25i1.1040.
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Lawrence Weed proposed we develop computerised, problem-oriented medical records that guide and teach. The Bawa-Garba case outcomes might have been different if care had been supported by computerised medical record (CMR) systems. CMR systems can reduce prescribing errors and could be developed to flag gaps in supervision. However, CMR systems are not a panacea and need to be fit for purpose. Our informatics perspective on this case is to call for widespread use of CMR systems – designed to guide and protect.
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Cillessen, Felix HJM, Pieter de Vries Robbé, and Marion Biermans. "A hospital-wide transition from paper to digital problem-oriented clinical notes." Applied Clinical Informatics 08, no. 02 (April 2017): 502–14. http://dx.doi.org/10.4338/aci-2016-08-ra-0137.
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SummaryObjectives: To evaluate the use, usability, and physician satisfaction of a locally developed problem-oriented clinical notes application that replaced paper-based records in a large Dutch university medical center.Methods: Using a clinical notes database and an application event log file and a cross-sectional survey of usability, authors retrospectively analyzed system usage for medical specialties, users, and patients over 4 years. A standardized questionnaire measured usability. Authors analyzed the effects of sex, age, professional experience, training hours, and medical specialty on user satisfaction via univariate analysis of variance. Authors also examined the correlation between user satisfaction in relation to users’ intensity of use of the application.Results: In total 1,793 physicians used the application to record progress notes for 219,755 patients. The overall satisfaction score was 3.2 on a scale from 1 (highly dissatisfied) to 5(highly satisfied). A statistically significant difference occurred in satisfaction by medical specialty, but no statistically significant differences in satisfaction took place by sex, age, professional experience, or training hours. Intensity of system use did not correlate with physician satisfaction.Conclusions: By two years after the start of the implementation, all medical specialties utilized the clinical notes application. User satisfaction was neutral (3.2 on a 1–5 scale). Authors believe that the significant factors facilitating this transition mirrored success factors reported by other groups: a generic, consistent, and transparent design of the application; intensive collaboration; continuous monitoring; and an incremental rollout.Citation: Cillessen FHJM, de Vries Robbé PF, Biermans MCJ. A hospital-wide transition from paper to digital problem-oriented clinical note. Appl Clin Inform 2017; 8: 502–514 https://doi.org/10.4338/ACI-2016-08-RA-0137
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Takabayashi, Katsuhiko. "II. Problem list: POS/POMR, and current patient problem list; 1. Problem-oriented medical record." Nihon Naika Gakkai Zasshi 106, no. 12 (December 10, 2017): 2529–34. http://dx.doi.org/10.2169/naika.106.2529.
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de Vries Robbé, P. F., and F. H. J. M. Cillessen. "Modeling Problem-oriented Clinical Notes." Methods of Information in Medicine 51, no. 06 (2012): 507–15. http://dx.doi.org/10.3414/me11-01-0064.
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SummaryObjectives: To develop a model as a starting-point for developing a problem-oriented clinical notes application as a generic component of an Electronic Health Record (EHR).Methods: We used the generic conceptualization of Weed’s problem-oriented medical record (POMR) to link progress notes to problems, and the Subjective, Objective, Assessment, Plan (SOAP) headings to classify elements of these notes. Health Level 7 (HL7) Version 3 and Unified Modeling Language (UML) were used for modeling. We looked especially at the role of Conditions and Concerns, and how to model these to document clinical reasoning.Results: We developed a generic HL7-based model for progress notes. In this model the specific clinical note has a condition as its reason. An assertion can be made about a condition. Any condition, observation or procedure can be a concern that has to be tracked. Utmost important is the relationship between constituting parts of a progress note and specially between progress notes by linking a progress note to conditions that are part of an earlier progress note. From this model a comprehensive hierarchical condition tree can be built. Several views, such as chronological, SOAP and condition-oriented, are possible. The clinical notes application is used in daily clinical practice. The model meets explicit design criteria and clinical needs.Conclusions: With the comprehensive HL7 standard it is possible to model and map progress notes using SOAP headings and POMR methodology. We have developed a generic, flexible and applicable paradigm by using acts for each assessment that refer to a condition (1), by separating conditions from concerns (2), and by an extensive use of the working list act (3).
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Tange, Huibert, Zsolt Nagykaldi, and Jan De Maeseneer. "Towards an overarching model for electronic medical-record systems, including problem-oriented, goal-oriented, and other approaches." European Journal of General Practice 23, no. 1 (October 2, 2017): 257–60. http://dx.doi.org/10.1080/13814788.2017.1374367.
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Tribble, Curtis G. "Are You Making Yourself Clear? You Can’t Communicate, or Think, Effectively If You Can’t Write Clearly." Heart Surgery Forum 22, no. 3 (June 24, 2019): E271—E276. http://dx.doi.org/10.1532/hsf.2609.
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n the not too distant past, illegible handwriting was considered to be the biggest problem with medical record keeping. Now the primary problem with medical records is that they are disorganized, and usually undigested, data dumps. A solution to at least part of this problem lies in utilizing the principles of the problem-oriented record.
When one contemplates the optimal format for progress notes, it is worth considering the purposes of progress notes. While progress notes do, of course, play a role in billing, the primary purposes of a progress note should be to provide efficient and effective communication with all who are caring for that patient and to facilitate efficient and effective contemplation of the condition of and the plans for that patient. Although it is beyond the scope of this treatise on creating progress notes, it is also worth pointing out that all patient care notes will also occasionally have legal implications and lawyers reading clinical notes will pay far more attention to assessments and plans than they will to data and results recorded in progress notes that are always easily available elsewhere in the patient record. In other words, lawyers reviewing medical records want to know what the clinicians caring for a patient were thinking, in addition to what those clinicians actually did for that patient.
While all of these issues must be kept in mind, we will focus primarily on the role of clinical notes in providing optimal patient care, particularly in the realm of cardiothoracic surgery, though the principles to be enunciated can apply to most disciplines and to most clinical environments.
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Klappe, Eva S., Nicolette F. de Keizer, and Ronald Cornet. "Factors Influencing Problem List Use in Electronic Health Records—Application of the Unified Theory of Acceptance and Use of Technology." Applied Clinical Informatics 11, no. 03 (May 2020): 415–26. http://dx.doi.org/10.1055/s-0040-1712466.
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Abstract Background Problem-oriented electronic health record (EHR) systems can help physicians to track a patient's status and progress, and organize clinical documentation, which could help improving quality of clinical data and enable data reuse. The problem list is central in a problem-oriented medical record. However, current problem lists remain incomplete because of the lack of end-user training and inaccurate content of underlying terminologies. This leads to modifications of diagnosis code descriptions and use of free-text notes, limiting reuse of data. Objectives We aimed to investigate factors that influence acceptance and actual use of the problem list, and used these to propose recommendations, to increase the value of problem lists for (re)use. Methods Semistructured interviews were conducted with physicians, heads of medical departments, and data quality experts, who were invited through snowball sampling. The interviews were transcribed and coded. Comments were fitted in constructs of the validated framework unified theory of acceptance user technology (UTAUT), and were discussed in terms of facilitators and barriers. Results In total, 24 interviews were conducted. We found large variability in attitudes toward problem list use. Barriers included uncertainty about the responsibility for maintaining the problem list and little perceived benefits. Facilitators included the (re)design of policies, improved (peer-to-peer) training to increase motivation, and positive peer feedback and monitoring. Motivation is best increased through sharing benefits relevant in the care process, such as providing overview, timely generation of discharge or referral letters, and reuse of data. Furthermore, content of the underlying terminology should be improved and the problem list should be better presented in the EHR system. Conclusion To let physicians accept and use the problem list, policies and guidelines should be redesigned, and prioritized by supervising staff. Additionally, peer-to-peer training on the benefits of using the problem list is needed.
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Hildebrandt, J., R. Klar, A. Weyland, and J. U. Wieding. "A Computerized Information System for a Pain Clinic." Methods of Information in Medicine 26, no. 02 (April 1987): 97–101. http://dx.doi.org/10.1055/s-0038-1635485.
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SummaryThe concept of the pain clinic constitutes a recent medical development requiring a thorough documentation of patient-related data in order to achieve reasonable standards in diagnosis and treatment, to ensure that the follow-up maintains these standards and to supply necessary data for research on the epidemiology, etiology, and therapy of chronic pain. We, therefore, developed a set of medical questionnaires for pain patients together with a microcomputer system for the storage and analysis of the data obtained. The main features of our approach are the problem-oriented medical records, the multi-user system and the immediate availability of the supplied data to every therapist using the system.
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Verdier, C., and A. Flory. "An Information System for Epidemiology based on a Computer-Based Medical Record." Methods of Information in Medicine 33, no. 05 (1994): 496–501. http://dx.doi.org/10.1055/s-0038-1635052.
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Abstract:A new way is presented to build an information system addressed to problems in epidemiology. Based on our analysis of current and future requirements, a system is proposed which allows for collection, organization and distribution of data within a computer network. In this application, two broad communities of users – physicians and epidemiologists – can be identified, each with their own perspectives and goals. The different requirements of each community lead us to a client-service centered architecture which provides the functionality requirements of the two groups. The resulting physician workstation provides help for recording and querying medical information about patients and from a pharmacological database. All information is classified and coded in order to be retrieved for pharmaco-economic studies. The service center receives information from physician workstations and permits organizations that are in charge of statistical studies to work with “real” data recorded during patient encounters. This leads to a new approach in epidemiology. Studies can be carried out with a more efficient data acquisition. For modelling the information system, we use an object-oriented approach. We have observed that the object-oriented representation, particularly its concepts of generalization, aggregation and encapsulation, are very usable for our problem.
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HO, L., S. MCGHEE, A. HEDLEY, and J. LEONG. "The application of a computerized problem-oriented medical record system and its impact on patient care." International Journal of Medical Informatics 55, no. 1 (July 1999): 47–59. http://dx.doi.org/10.1016/s1386-5056(99)00019-2.
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Wright, Adam, Dean F. Sittig, Julie McGowan, Joan S. Ash, and Lawrence L. Weed. "Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record." Journal of the American Medical Informatics Association 21, no. 6 (November 2014): 964–68. http://dx.doi.org/10.1136/amiajnl-2014-002776.
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Realdi, Giuseppe, Lorenzo Previato, and Nicola Vitturi. "Selection of diagnostic tests for clinical decision making and translation to a problem oriented medical record." Clinica Chimica Acta 393, no. 1 (July 2008): 37–43. http://dx.doi.org/10.1016/j.cca.2008.03.024.
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Radhakrishnan, Nila, Carrie Warring, Ankur Jain, Jorge Fuentes, Angela Dolganiuc, Laura Lourdes, John Busigin, Robert Leverence, and Raj Mehta. "The Use of Evidence-Based, Problem-Oriented Templates as a Clinical Decision Support in an Inpatient Electronic Health Record System." Applied Clinical Informatics 07, no. 03 (July 2016): 790–802. http://dx.doi.org/10.4338/aci-2015-11-ra-0164.
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SummaryThe integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied.We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices.This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs. Primary Outcome measurement was note quality, assessed by the 9-item Physician Documentation Quality Instrument (PDQI-9). Secondary Outcome measurement was physician efficiency, assessed by the total charting time per note.Use of POTs increased the quality of note documentation [score 37.5 vs. 39.0, P = 0.0020]. The benefits of POTs scaled with use; the greatest improvement in note quality was found in notes using three or more POTs [score 40.2, P = 0.0262]. There was no significant difference in total charting time [30 minutes vs. 27 minutes, P = 0.42].Use of evidence-based and problem-oriented templates is associated with improved note quality without significant change in total charting time. It can be used as an effective CDS during note documentation. Citation: Mehta R, Radhakrishnan NS, Warring CD, Jain A, Fuentes J, Dolganiuc A, Lourdes LS, Busigin J, Leverence RR. The use of evidence-based, problemoriented templates as a clinical decision support in an inpatient electronic health record system.
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Peterson, Hans. "History of Medical Informatics: From Punched Cards to Computerized Patient Records: A Personal Journey." Yearbook of Medical Informatics 15, no. 01 (August 2006): 180–86. http://dx.doi.org/10.1055/s-0038-1638483.
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SummaryThis paper presents the early history of the development of CPR in Sweden, the importance of international cooperation and standardisation and how this cooperation has been facilitated by IMIA, the European Union and the standards organisations. It ends with the lessons learned after 35 years of experience put together by the Swedish Institute for Health Services Development, SPRI, in a 5 year project initiated by the Swedish Government and with participation of most health care providers in the country.Starting with the first attempts to use punched cards to store and use patient information for clinical use the author describes his troublesome and difficult road to a Computerized Patient Record that could be used both for the work with the patient and as a tool to follow up both the diagnostic and therapeutic processes and for clinical research.The most important results of the efforts to develop a computerized patient record in Sweden are published in many reports, among them three SPRI reports published in the late 1990s, and they are: Standardized information architecture, a common terminology, rules for communication, security and safety, electronic addresses to all units and users and an agreed upon patient and user identification.The future CPR must be problem oriented, capable of only adding new information instead of repeating already-known data and be available in real time regardless of geographic location. It must be possible to present the information in the CPR as “views” where the healthcare provider has stated in advance the information needed for his patients. There can be a number of “views” for different occasions.
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Hölzel, D., K. Überla, and K. Adelhard. "Design Elements for a Computerized Patient Record." Methods of Information in Medicine 38, no. 03 (1999): 187–93. http://dx.doi.org/10.1055/s-0038-1634187.
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AbstractComputerized medical record systems have to present user-and problem-oriented views of a patient record to health-care professionals. Presentation and manipulation of data must be easily adaptable to current and future demands of medical specialties and specific settings. During the definition, development and evaluation of a prototype of a computerized patient record system, design elements were elaborated to support physicians and other health-care professionals. Our approach shows a high degree of flexibility and adaptability to specific needs, problem orientation and connectivity to other systems, via a hospital information network. The explicit description of the contents of a patient record allows to augment the number of items that can be recorded without modifying the data structure. New views on patient data can be added to the system without interfering with the routine use of the system. Application in several medical specialties proved the feasibility of our prototype.
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De Lusignan, Simon, Siaw-Teng Liaw, Daniel Dedman, Kamlesh Khunti, Khaled Sadek, and Simon Jones. "An algorithm to improve diagnostic accuracy in diabetes in computerised problem orientated medical records (POMR) compared with an established algorithm developed in episode orientated records (EOMR)." Journal of Innovation in Health Informatics 22, no. 2 (June 5, 2015): 255–64. http://dx.doi.org/10.14236/jhi.v22i2.79.
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Bossen, Claus. "Evaluation of a computerized problem-oriented medical record in a hospital department: Does it support daily clinical practice?" International Journal of Medical Informatics 76, no. 8 (August 2007): 592–600. http://dx.doi.org/10.1016/j.ijmedinf.2006.04.007.
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Olson, Richard A. "Defining the Process of Medical Care to Include Dual Situation Awareness between Patient and Clinician." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 2, no. 1 (June 2013): 7–12. http://dx.doi.org/10.1177/2327857913021003.
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Directing design of information & communication system in healthcare according to the workflow in the doctor patient relationship might follow established concepts from the field of Human Factors. The Endsley model of Situation Awareness is modified to accommodate both physician and patient, and recalls the Problem Oriented Medical Record of Lawrence Weed. Although the original purpose of computer health applications was documentation, the goal of shared Dual Situation Awareness and improved shared decisions is offered as an alternative to record-keeping. Also, design with these concepts may provide a pathway to enhanced patient engagement in their health care.
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Chizoba Nneka Ezeaku-Ezeme, Nwankwo Ugochukwu Cornelius, Ugwu Ejike C, and Abundance Mbuotidem Akpan. "A medical predictive system for comparative analysis of fetal parameters." GSC Advanced Engineering and Technology 1, no. 2 (July 30, 2021): 021–30. http://dx.doi.org/10.30574/gscaet.2021.1.2.0032.
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A medical predictive system for comparative analysis of fetal parameters” was motivated by the high rate of fetal loss in Nigeria which mostly occurs as a result of wrong medical predictive system. To solve this problem, software that will identify the fetal parameters that predicts the gestational age was developed. The new model will be a hybrid model. It will combine the Nagele’s Rule and Mittendorf Rule to predict the fetal parameter. The new model will take the average of the two models as the predicted date of delivery. In this new system, it is noteworthy to name some ways of determining gestational age based on Last Menstrual Period (LMP). Therefore the proposed model will be a combination of the two model taking average of the number of days to be added to the LMP. This will be used to determine the Expected Date of Delivery in the new system designed. A platform for solving complication problems due to low and excessive birth weights at delivery by accurately estimating fetal parameters (Fetal Weight, Fetal Age, Conception Date, and Delivery Date) was implemented. This was implemented using externally generated data by combining the independent information about fetal size obtained from the three different approaches (i.e. clinical examination, quantitative assessment of maternal characteristics, ultrasonographic fetal biometry). Expert system methodology and Object Oriented Analysis and Design Methodology (OOADM) were adopted in the design of the predictive system. The new system allows the patients to access their antenatal visit records from any internet access point and the software developed helps physicians to accurately estimate the gestational age of the fetus and hence provide a support tool for estimating Gestation Age and to establish accuracy indicators that will provide tolerances for its later use in growth and health evaluation.
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Chizoba Nneka Ezeaku-Ezeme, Nwankwo Ugochukwu Cornelius, Ugwu Ejike C, and Abundance Mbuotidem Akpan. "A medical predictive system for comparative analysis of fetal parameters." GSC Advanced Engineering and Technology 1, no. 2 (July 30, 2021): 021–30. http://dx.doi.org/10.30574/gscarr.2021.1.2.0032.
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A medical predictive system for comparative analysis of fetal parameters” was motivated by the high rate of fetal loss in Nigeria which mostly occurs as a result of wrong medical predictive system. To solve this problem, software that will identify the fetal parameters that predicts the gestational age was developed. The new model will be a hybrid model. It will combine the Nagele’s Rule and Mittendorf Rule to predict the fetal parameter. The new model will take the average of the two models as the predicted date of delivery. In this new system, it is noteworthy to name some ways of determining gestational age based on Last Menstrual Period (LMP). Therefore the proposed model will be a combination of the two model taking average of the number of days to be added to the LMP. This will be used to determine the Expected Date of Delivery in the new system designed. A platform for solving complication problems due to low and excessive birth weights at delivery by accurately estimating fetal parameters (Fetal Weight, Fetal Age, Conception Date, and Delivery Date) was implemented. This was implemented using externally generated data by combining the independent information about fetal size obtained from the three different approaches (i.e. clinical examination, quantitative assessment of maternal characteristics, ultrasonographic fetal biometry). Expert system methodology and Object Oriented Analysis and Design Methodology (OOADM) were adopted in the design of the predictive system. The new system allows the patients to access their antenatal visit records from any internet access point and the software developed helps physicians to accurately estimate the gestational age of the fetus and hence provide a support tool for estimating Gestation Age and to establish accuracy indicators that will provide tolerances for its later use in growth and health evaluation.
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Bayer-Garner, Ilene B., Louis M. Fink, and Laura W. Lamps. "Pathologists in a Teaching Institution Assess the Value of the Autopsy." Archives of Pathology & Laboratory Medicine 126, no. 4 (April 1, 2002): 442–47. http://dx.doi.org/10.5858/2002-126-0442-piatia.
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Abstract Context.—With the advent of modern diagnostic technology, use of the autopsy as a means of assessing diagnostic accuracy has declined precipitously. Interestingly, during the same period, the rate of misdiagnosis found at autopsy has not changed. Objectives.—To ascertain why an autopsy was requested, whether or not questions asked by clinicians were specifically addressed, and what types of misdiagnoses were found. Design.—One hundred forty-two consecutive autopsy records from the University of Arkansas for Medical Sciences Hospital were reviewed. In the same period, 715 deaths occurred, giving an overall autopsy rate of 20.14%. Results.—Of the 125 autopsies in which the problem-oriented autopsy request was available for review, a reason for the autopsy was given in only 69 cases (55%). One hundred three clinical questions were asked, and of these, 81 were specifically addressed in the final anatomic diagnosis, 10 were addressed in some part of the autopsy report but not in the final anatomic diagnosis, 10 were not addressed at all, and 2 could not be answered by the autopsy. Sixty-one autopsies revealed 81 misdiagnoses: 47 class I (missed major diagnosis that, if detected before death, could have led to a change in management that might have resulted in cure or prolonged survival) and 34 class II misdiagnoses (missed major diagnosis in which antemortem detection would have not led to a change in management). Conclusions.—The autopsy continues to be a vital part of medical education and quality assurance. It is important for the clinician to provide a clinical summary and specific clinical questions to be addressed or to speak directly with the pathologist and for the pathologist to provide answers that are easily accessible within the autopsy report. In this way, a problem-oriented autopsy can be performed based on questions raised by the clinician and the pathologist as a result of the gross dissection and microscopic evaluation.
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Rienhoff, O., and G. Kouematchoua Tchuitcheu. "Options for Diabetes Management in Sub-Saharan Africa with an Electronic Medical Record System." Methods of Information in Medicine 50, no. 01 (2011): 11–22. http://dx.doi.org/10.3414/me09-01-0021.
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Summary Background: An increase of diabetes prevalence of up to 80% is predicted in subSaharan Africa (SSA) by 2025 exceeding the worldwide 55%. Mortality rates of diabetes and HIV/AIDS are similar. Diabetes shares several common factors with HIV/AIDS and multidrug-resistant tuberculosis (MDR-TB). The latter two health problems have been efficiently managed by an open source electronic medical record system (EMRS) in Latin America. Therefore a similar solution for diabetes in SSA could be extremely helpful. Objectives: The aim was to design and validate a conceptual model for an EMRS to improve diabetes management in SSA making use of the HIV and TB experience. Methods: A review of the literature addressed diabetes care and management in SSA as well as existing examples of information and communication technology (ICT) use in SSA. Based on a need assessment conducted in SSA a conceptual model based on the traditionally structured healthcare system in SSA was mapped into a three-layer structure. Application modules were derived and a demonstrator programmed based on an open source EMRS. Then the approach was validated by SSA experts. Results: A conceptual model could be specified and validated which enhances a problem-oriented approach to diabetes management processes. The prototyp EMRS demonstrates options for a patient portal and simulation tools for education of health professional and patients in SSA. Conclusion: It is possible to find IT solutions for diabetes care in SSA which follow the same efficiency concepts as HIV or TB modules in Latin America. The local efficiency and sustainability of the solution will, however, depend on training and changes in work behavior.
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ALTER, GEORGE C., and ANN G. CARMICHAEL. "Reflections on the classification of causes of death." Continuity and Change 12, no. 2 (August 1997): 169–73. http://dx.doi.org/10.1017/s0268416097002889.
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On November 11–14 1993, Indiana University hosted a conference on the ‘History of Registration of Causes of Death’, with funding from the US National Institute on Aging and the National Institute of Child Health and Human Development. The conference brought together historians of medicine and historically-oriented demographers and epidemiologists to discuss the origins of the recording of causes of death and the possible uses of these documents in demographic and epidemiological research. Demographers and epidemiologists would like to use long-run series of causes of death to examine the effects of social and economic conditions, the availability of health care, and specific risk factors on mortality. Many important questions (such as the effects of early health experiences on old-age morbidity and mortality) are best studied with data on changes over long periods of time. However, it is very difficult to construct a consistent series of deaths by cause over time because advances in medical theory and practice have led to significant changes in the classification of diseases. For example, it is unclear whether the prevalence of heart disease was increasing, decreasing, or constant before 1940, because heart disease was often classified under other categories.The essays in this special number of Continuity and Change offer a range of insights on the historical circumstances in which cause-of-death registration emerged. They help us to see the ways in which medical theory, medical practitioners, and their increasingly influential professional organizations shaped the conceptualization of reporting of causes of death. Günter Risse's ‘Causes of death as a historical problem’ serves as an overview of the problems that social historians of medicine find underlying any continuous history of mortality experience. Above all, he argues, medical historians react as historians, wary of Whiggish confidence in state records without attention to the ideologies governing their creation.
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Combi, C., G. Pozzi, R. Rossi, and F. Pinciroli. "MS2/Cardio: Towards a Multi-Service Medical Software for Cardiology." Methods of Information in Medicine 31, no. 01 (1992): 18–28. http://dx.doi.org/10.1055/s-0038-1634856.
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Abstract:Many clinics are interested to use software packages in daily practice, but lack of integration of such packages seriously limits their scope. In practice this often entails switching between programs and interrupting the run of an individual program. A multi-task approach would not solve this problem as it would not eliminate the need to input the same data many times, as often occurs when using separate packages. The construction of a Multi-Service Medical Software package (MSx2) is described, which was also developed as an example of practical integration of some clinically relevant functions. The package runs on a personal computer in an MS-DOS environment and integrates a time-oriented medical record management unit (TOMRU) for data of ambulatory patients, and a drug information management unit (DIMU) concerning posology, content, effects, and possible interactions. Of the possible database configurations allowed by MSx2, the cardiology patient database (MSx2/C) and hypertensive patient database (MSx2/H) were developed and described here. Clinical information to be included in the configurations was obtained after discussion and consensus of clinical practitioners. MSx2/C was distributed to several hundred clinical centers during computerized courses to train future users. MSx2 can easily transfer patient data to statistical processing packages.
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Clercq, De. "The Index as a New Concept towards an Integrated Framework for the Electronic Patient Record." Methods of Information in Medicine 41, no. 04 (2002): 313–20. http://dx.doi.org/10.1055/s-0038-1634388.
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Summary Objective: To overcome some classical limitations of the POMR (Problem-Oriented Medical Record), including the management of divergent opinions between health professionals, in order to construct a common patient record across multiple disciplines in hospital settings and professional networks. Methods: Using a complex clinical case, we improved a POMR model previously used by GPs in order to translate it into a hospital setting. The enhanced model has been assessed through use in various ongoing clinical cases and through extended discussion with professional end-users (physicians, nurses, general practitioners, and social workers). Results: The Index concept (flexible structural link) is proposed as a major improvement in the construction of a POMR in a shared care environment. Conclusions: The Index introduces interesting new perspectives. Following its implementation in the Belgian pilot site in the CORINES project, further studies remain to be carried out in order to develop a cost/benefit assessment.
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Cooper, James W., William E. Wade, Christopher L. Cook, and Allison H. Burfield. "Consultant Pharmacist Drug Therapy Recommendations Acceptance and Rejection from Monthly Drug Regimen Reviews in a Geriatric Nursing Facility: Fourth Year Results and Cost Analysis." Hospital Pharmacy 42, no. 8 (August 2007): 729–36. http://dx.doi.org/10.1310/hpj4208-729.
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Purpose To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data. Method A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse outcomes were calculated from billing records or prior studies of the outcome. These results were compared with prior 1- and 2-year studies of outcomes within the same setting. Carryover effects of recommendations implemented in prior periods were also calculated. Results There were 178 recommendations made in 2,004 DRR reports (8.9%). A low acceptance rate, 27 of 178 recommendations (15.2%), resulted and was combined with carryover of prior acceptance in a cost savings of $113,962. The 151 recommendations that were rejected resulted in $226,503 of presumed unnecessary costs to the health care system. A prior 2-year study of recommendations with an acceptance rate of 89% showed costs savings of $111,609 per year with acceptance and $112,297 added costs per year with 11% rejection. The first-year study had a 93% acceptance rate at a projected cost savings of $43,854 and costs increased by $60,825 with a 7% rejection. The costs of recommendation rejection in the fourth year were substantially higher, with a higher rejection rate than was seen in the prior 3 years of observation. Conclusion Documentation of the costs from CP intervention should factor in costs of rejection that may increase with the percentage rejection of recommendations, length of observation period, and may vary between facilities.
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NAKAO, Terutoshi, and Yoshitaka TSUKAMOTO. "Disclosure of a Problem Oriented Type of Medical Record Supported the Mental Care of the Bereaved Family Members of a Suddenly Died Patient with the Advanced Esophageal Carcinoma." Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 31, no. 1 (2006): 100–104. http://dx.doi.org/10.4030/jjcs1979.31.1_100.
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Pentith, Rebecca, Samantha Louise Moss, Kevin Lamb, and Carmel Edwards. "Perfectionism Among Young Female Competitive Irish Dancers - Prevalence and Relationship with Injury Responses." Journal of Dance Medicine & Science 25, no. 2 (June 15, 2021): 152–58. http://dx.doi.org/10.12678/1089-313x.061521k.
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This study investigated the prevalence of perfectionism among young female competitive Irish dancers and examined the relationships between perfectionistic tendencies and coping strategies used when experiencing injury. Sixty-eight female dancers (Mean age: 14 ± 2.3 years) completed the Child-Adolescent Perfectionism Scale and the Ways of Coping Questionnaire and provided a record of injuries incurred during their championship careers. Participants reported 189 injuries, mostly involving the lower extremities. Seventy-nine percent of dancers reported perfectionistic tendencies (mixed perfectionism 40%, pure self-oriented perfectionism 29%, pure socially prescribed perfectionism 10%), and most frequently adopted "planful problem-solving," "seeking social support," "distancing," and "self-controlling" strategies to cope with injury. Perfectionism and two coping strategies were found to be significantly related (p = 0.03); "planful problem-solving" was typically used "quite a bit or a great deal" by the mixed perfectionism group, but only "somewhat" by the non-perfectionism group, whereas "confrontive coping" was typically not used by the non-perfectionism group but was used "somewhat" by the mixed perfectionism group. Given the presence of such a large degree of perfectionism and the simultaneous employment of problem- and emotion-focused strategies when coping with injuries, it is suggested that medical practitioners acknowledge such tendencies when supporting their dancers in order to reduce the likelihood of negative psychological impact.
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Thews, O., C. Rohrbach, M. Sergl, K. Pommerening, and R. Müller. "A Graph-Grammar Approach to Represent Causal, Temporal and Other Contexts in an Oncological Patient Record." Methods of Information in Medicine 35, no. 02 (April 1996): 127–41. http://dx.doi.org/10.1055/s-0038-1634641.
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AbstractThe data of a patient undergoing complex diagnostic and therapeutic procedures do not only form a simple chronology of events, but are closely related in many ways. Such data contexts include causal or temporal relationships, they express inconsistencies and revision processes, or describe patient-specific heuristics. The knowledge of data contexts supports the retrospective understanding of the medical decision-making process and is a valuable base for further treatment. Conventional data models usually neglect the problem of context knowledge, or simply use free text which is not processed by the program. In connection with the development of the knowledge-based system THEMPO (Therapy Management in Pediatric Oncology), which supports therapy and monitoring in pediatric oncology, a graph-grammar approach has been used to design and implement a graph-oriented patient model which allows the representation of non-trivial (causal, temporal, etc.) clinical contexts. For context acquisition a mouse-based tool has been developed allowing the physician to specify contexts in a comfortable graphical manner. Furthermore, the retrieval of contexts is realized with graphical tools as well.
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Ghimire, Neeta, B. Kayastha, and P. Nepal. "The First Dental Visit." Journal of Chitwan Medical College 3, no. 4 (January 11, 2014): 30–33. http://dx.doi.org/10.3126/jcmc.v3i4.9551.
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Oral health is a vital part of overall infant health. An early dental visit is important in rendering prevention oriented intervention and parental counselling regarding the oral health. To assess the age and common chief complaint of the children in their first dental visit. This was a retrospective study done using case records of 842 children, who reported to the Department of Pedodontics and Preventive Dentistry, chitwan medical college. The age groups were divided into four categories; less than 3 years, 3-6years, 7-11 years and 12-14 years. The various chief complaints of patient were categorized as follows; routine check up, dental caries, dental pain, deposits/bad breath, malocclusion, unerupted ,missing or extra tooth, oral habits, trauma, orientation to prevention and others (cleft lip, palate, natal/neonatal teeth, mobile teeth, soft tissue lesions and others). The age group and the most common complaint at the first dental visit were assessed. Majority of children who visited the dentist were of age 7-11 years with the most common reason for their visit being pain followed by dental caries. None of the children visited for regular check up within 6 months of eruption of first tooth, though few children of that age group visited the dentist for other reasons like cleft lip/palate, natal/ neonatal tooth etc. The reason behind the first dental visit is when there is a problem. The most common age group to visit dentist was 7-11years with the commonest reason for their visit being pain and dental caries. It can be concluded that awareness and knowledge regarding the first dental visit is almost nil among the parents of this region. Journal of Chitwan Medical College 2013; 3(4); 30-33 DOI: http://dx.doi.org/10.3126/jcmc.v3i4.9551
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Tribble, Curt G. "Gimme 3 Steps (With a Nod to an American Rock Song from the 1970s)." Heart Surgery Forum 19, no. 2 (April 6, 2016): 080. http://dx.doi.org/10.1532/hsf.1565.
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The message that patients are frequently dissatisfied with their interactions with their physicians is a common one. And, articles about physician burnout are plentiful [Shanafelt 2015]. Indeed, a recent national survey showed a nearly 9 percent increase in burnout rates over just the last 3 years [Peckham 2015]. Many factors contribute to this problem, not the least of which is the push to use electronic medical records systems, as evidenced by the recent comment from the acting administrator of the Centers for Medicare and Medicaid, Mr. Andy Slavitt, who said “we have to get the hearts and minds of physicians back. I think we’ve lost them” [McKnight 2016]. <br />While many of the factors contributing to physician dissatisfaction are, and will be, difficult to control, there is at least one source of satisfaction that is within the relatively easy purview of virtually all practicing physicians, and that source is the patients for whom all physicians care. Fortunately, there are some straightforward, simple, and efficient ways to improve the view patients have of their physicians and the satisfaction that physicians can derive from caring for their patients. Three simple steps that can make both physicians and their patients more satisfied with the interactions between patients and physicians are outlined here. These suggestions are primarily oriented toward physicians in training caring for hospitalized patients, though they are most certainly applicable to all physicians. These suggestions are based on what younger physicians can say to, ask of, or do for a patient under their care, all of which can be easily and efficiently accomplished.
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Maksikova, Tatyana, Aleksey Kalyagin, Dmitriy Piven, and Galina Sinkova. "Prevention of Chronic Non-Communicable Diseases in Russia: Analytical Review of General Institutional Issues." Bangladesh Journal of Medical Science 18, no. 2 (March 25, 2019): 353–67. http://dx.doi.org/10.3329/bjms.v18i2.40709.
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Objective: The purpose of this research is to assess regulatory, organizational and methodological documents, as well as Russian and international recommendations, to use infromation from them to identify and systematize problems in prevention of chronic non-communicable diseases, and tooffer solutions.
Materials and Methods: Analysis encompasees the key Federal Laws of the Russian Federation; orders, records, and reports provided by various ministries and departments of the Russian Federation,as well as by the leading research institutes; guides, manuals, and federal recommendations; the latest Russian and foreign guidelines and recommendations on prevention of chronic non-communicable diseases.
Results and Discussion: Analysis was faced with a number of problems:poor correlation between changes in regulatory documents governing the prevention of chronic non-communicable diseases; incomplete allowance for international experience and guidelines on prevention of chronic non-communicable diseases, incomplete epidemiological data; poor coordination and uneven assignment of responsibilities in structures involved in prevention; shift in emphasis from population-oriented prevention and high-risk groups towards secondary prevention; below-satisfactory efficiency of tuberculosis screening in clinical examination.
Conclusions: Their resolutionmay significantly increase the effectiveness of measures intendedfor prevention of chronic non-communicable diseases and their risk factors from occurence in Russia.
Bangladesh Journal of Medical Science Vol.18(2) 2019 p.353-367
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Ljuhar, Kenan, Adem Zalihić, Aida Gavranović, Basri Lenjani, Premtim Rashiti, and Nuhi Arslani. "Out of Hospital Cardiac Arrest: A Case Report." Albanian Journal of Trauma and Emergency Surgery 5, no. 1 (January 20, 2021): 807–11. http://dx.doi.org/10.32391/ajtes.v5i1.162.
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Introduction: Sudden OHCA (Out of hospital cardiac arrest) is the third leading cause of death in industrialized nations. With more than 60% of cardiovascular deaths resulting from cardiac arrest, it remains the leading cause of death worldwide. Heart rhythms associated with cardiac arrest are divided into two groups: shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) and non-shockable rhythms (asystole and pulseless electrical activity (PEA)). VF is the most commonly identified arrhythmia in cardiac arrest patients. Urgent medical treatment includes cardiopulmonary resuscitation and early defibrillation.
Material and Methods: Materials for this case report are data collected from the medical records of the Emergency Medical Center of Sarajevo protocol of patients.
Case report: Our case report is presented with 59 years old man who had OHCA in his apartment. The initial rhythm was VF, and cardiopulmonary resuscitation was provided due to the Advanced life support guidelines to shockable rhythms. It was delivered 3 DC Shock-s (200J, 300J, 360 J) with the biphasic defibrillator, it was administered 1mg Adrenalin and performed endotracheal intubation. After the third DC shock, we got the return of spontaneous circulation ROSC. The patient was transferred to the University hospital, were he was stabile, and PCI of the LAD was performed as per the standard protocol. Echocardiography performed in the CCU revealed hypokinesia of RV, with preserved systolic function. On hospital day 7 he had a full neurological recovery. He was conscious, oriented, with normal breathing, blood pressure 125/79mmHg, sPO2 99, ECG: sinus rhythm, fr 87/min, without pathological signs. Echocardiography revealed the reduced systolic function of the left ventricle, with mitral regurgitation MR+2.
Discussion: Out-of-hospital cardiac arrest (OHCA) is a major health problem in Europe and in the United States. The numbers of patients who have OHCA annually in these two parts of the world have traditionally been reported to be 275,000 and 420,000 respectively. The success of resuscitation depends on many factors: well-organized health care, organization of outpatient emergency services, but primarily when it comes to OHCA, education of the population on Basic life support, and early Cardiopulmonary resuscitation and use of AED (automated external defibrillator).
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Ziminski, Timoteus B., Steven A. Demurjian, Eugene Sanzi, Mohammed Baihan, and Thomas Agresta. "An Architectural Solution for Health Information Exchange." International Journal of User-Driven Healthcare 6, no. 1 (January 2016): 65–103. http://dx.doi.org/10.4018/ijudh.2016010104.
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Health information technology (HIT) systems including electronic health records (EHRs) have a market saturation nearing 92% at individual institutions but are still unsuited for cross-institutional collaboration of stakeholders (e.g., medical providers such as physicians, hospitals, clinics, labs, etc.) in support of health information exchange (HIE) of different HIT systems in geographically separate locations. In the computer science field, software architectures such as service-oriented architecture, grid computing, publish/subscribe paradigm, and data warehousing are well-established approaches for interoperation. However, the application of these software architectures to support HIE has not been significantly explored. To address this issue, this paper proposes an architectural solution for HIE that leverages established software architectural styles in conjunction with the emergent HL7 standard Fast Healthcare Interoperability Resources (FHIR). FHIR models healthcare data with XML or JSON schemas using a set of 93 resources to track a patient's clinical findings, problems, allergies, adverse events, history, suggested physician orders, care planning, etc. For each resource, a FHIR CRUD RESTful Application Program Interface (API) is defined to share data in a common format for each of the HITs that can then be easily accessible by mobile applications. This paper details an architectural solution for HIE using software architectural styles in conjunction with FHIR to allow HIT systems of stakeholders to be integrated to facilitate collaboration among medical providers. To demonstrate the feasibility and utility of HHIEA, a realistic regional healthcare scenario is introduced that illustrates the interactions of stakeholders across an integrated collection of HIT systems.
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DE WEERDT, W. J. G., and M. A. HARRISON. "Problem List of Stroke Patients as Identified in the Problem Orientated Medical Record." Australian Journal of Physiotherapy 31, no. 4 (1985): 146–50. http://dx.doi.org/10.1016/s0004-9514(14)60631-0.
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Brondfield, Samuel Craig, Hala Borno, Claire Mulvey, Li-Wen Huang, and Pelin Cinar. "Implementation of a fellow-initiated financial toxicity screening tool in medical oncology clinics." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 64. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.64.
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64 Background: Financial toxicity is an increasingly recognized problem for patients receiving cancer treatment, particularly in the high-cost precision medicine era. Financial toxicity is linked to asset depletion, debt, and bankruptcy. To address this imminent concern, we designed, implemented, and evaluated a fellow-initiated financial toxicity screening tool for use in medical oncology clinics. Methods: An interprofessional team of University of California San Francisco (UCSF) social workers and physicians selected three highly rated items from the COST measure, a published financial toxicity tool with validity evidence. We oriented all UCSF hematology/oncology fellows to the tool and the concept of financial toxicity. We instructed fellows to screen all patients other than second-opinion visits and to offer a social work referral to high-scoring patients. Implementation was from August 2017 to March 2018. While screening was initially documented in the progress note, in October 2017 we built a navigator into the electronic medical record to facilitate screening. We randomly selected one half-day per week for each fellow and reviewed charts for screening scores. The cumulative goal was to screen 30% of eligible patients during implementation. Results: Fellows (n = 8) rotated in five disease-specific medical oncology clinics. Prior to implementation, fellows did not document financial toxicity (0%). At the mid-point of implementation, fellows had screened 32% of patients. By the end, the cumulative screening rate decreased to 18%. The screening tool will be presented. Qualitative fellow feedback identified lack of provider familiarity with financial toxicity, packed clinic visits, and difficulty remembering to screen as barriers. Fellows suggested that screening performed by clinic staff prior to the encounter might better inform the visit. Conclusions: Fellow-initiated financial toxicity screening was initially successful but decreased over time. Future iterations could include screening prior to the encounter, augmenting provider financial toxicity training, and continual reminders. Future work is needed to improve screening and mitigate the impact of financial toxicity.
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Winman, Thomas. "Artifacts at Work." International Journal of Sociotechnology and Knowledge Development 6, no. 2 (April 2014): 53–66. http://dx.doi.org/10.4018/ijskd.2014040104.
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This study focuses on nursing students' internships and how the students are handling the tension created by expectations and dilemmas when using medical records (MRs) in practice. The overall aim of this study is to develop knowledge about what is required by nursing students in order to coordinate and sustain knowledge through the use of MRs. The theoretical approach to learning that has been adopted implies that learning takes place in social activities, and empirically this means that the study of learning and professional knowledge is a matter of studying activities where, for example, technologies are put into practical use, where experience and knowledge are brought to life. The data consists of observations of five nursing students during their second year in nursing school, interviews and ten video-recordings from shift reports. The result shows that nursing students regularly use MRs as a source of information and that they are struggling with transforming that information into action-oriented knowledge. The conclusion is that information systems such as MRs need to be understood and defined by teachers as materials and devices created or adapted to solving practical problems, and should be treated thereafter. Providers of education need to take into account the different types of intellectual or practical knowledge that professionals like nurses are expected to have, where the use of technology cannot be separated from, but need to be integrated into other aspects of knowledge.
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Jose, James H., Saul M. Adler, William G. Keyes, and James M. Bradford. "Clinical Information Systems for Intensive Care, Pediatric Critical Care, and Neonatology." Journal of Intensive Care Medicine 12, no. 2 (March 1997): 79–92. http://dx.doi.org/10.1177/088506669701200203.
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Computer information systems are expected to soon take the place of current paper charting practices, and they offer great promise to assist management of the considerable amounts of data encountered in the information-rich environment of intensive care units (ICUs). Efforts to create an electronic medical record (EMR) have been underway for more than two decades, and major national organizations, such as the Institute of Medicine, have issued recommendations on standards. Benefits of an EMR include a legible patient record, enhanced communication, provision of timely reminders and alerts to clinicians, reduction of calculation errors, access to data bases for quality assurance and research, reduced healthcare costs, and improved patient outcomes. Despite these benefits, successful EMR implementations have been confined to a few committed institutions, and expensive failures have occurred. Practitioners of neonatology and pediatric intensive care are likely to have substantial difficulty implementing an EMR to fit their specialized needs because most experience in this area has been gained through care of adult patients, and systems being developed are oriented toward nonpediatric patients. It is therefore important to examine experience thus far with the functional components of an EMR so practitioners will be able to evaluate systems better as they become available. System components discussed include nursing charting facilities, lab reporting, physician order entry, physician progress notes, structured reports, decision support systems, and problem list management. Other concerns discussed include research and quality assurance functions, data access and confidentiality issues, and electronic mail. Maximizing the “structured data” content, as opposed to narrative content of an EMR, is an important priority, and progress on developing a uniform medical language is discussed. An approach to evaluating clinical information systems for use in the ICU is presented; it should assist practitioners of pediatric critical care and neonatology in identifying computer-based charting solutions that are optimal for infants and children, while cooperating with medical center-wide needs for compatibility and a common data base.
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Lopez, Rafael, Antonio Anton, Enrique Aranda, Alfredo Carrato, Manuel Constenla, Juan Jesús Cruz, Eduardo Diaz-Rubio, et al. "Implementation of the quality training program in Spain." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 11. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.11.
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11 Background: The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Since 2015, ECO has been collaborating with ASCO (American Society of Clinical Oncology) in quality initiatives in cancer care, like the QOPI (Quality Oncology Practice Initiative) program and the QOPI Certification Program (QCP). The Quality Training Program (QTP) is a 6-month course with 3 in-person learning sessions that prepares oncology teams to design, implement and lead successful quality improvement activities in their practices. In 2018, ECO reached a new agreement with ASCO to implement this program in Spain. Methods: The QTP was developed in Spain by ECO in collaboration with ASCO, following the same methodology and contents of ASCO’s program. The first session was carried out in October 2018, with 12 Spanish teams participating with diverse quality improvement projects. The program counted with ASCO and ECO faculty, constituted by experts in the quality and oncology field. Results: Each QTP Spanish team counted with 2-3 representatives from their hospitals and developed an improvement project, following the methodology of the course, including a problem statement, process map, cause and effect diagram, diagnostic data, aim statement, measures, baseline data, priority/pay-off matrix of possible changes/interventions, change data, next steps/plan for sustainability, among others. The projects were mainly focused on the waiting time reduction in the Emergency Area and from the patient’s visit to the oncologist until treatment administration, burnout reduction on oncology professionals, improvement of the identification and management of complications for cancer patients receiving immunotherapy, improvement of the uniformity in the medical records registry, among others. QTP participants presented their projects’ results on the third and last session of the program in April 2019 with positive outcomes. Conclusions: The QTP’s quality improvement approach allows Spanish teams and the ECO Foundation to enhance the goal of a quality-oriented health care system. ECO will continue pursuing excellence and quality with further initiatives like the QOPI program, the QCP and the QTP.
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Grossman, Lisa V., Sung W. Choi, Sarah Collins, Patricia C. Dykes, Kevin J. O’Leary, Milisa Rizer, Philip Strong, Po-Yin Yen, and David K. Vawdrey. "Implementation of acute care patient portals: recommendations on utility and use from six early adopters." Journal of the American Medical Informatics Association 25, no. 4 (September 4, 2017): 370–79. http://dx.doi.org/10.1093/jamia/ocx074.
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Abstract Objective To provide recommendations on how to most effectively implement advanced features of acute care patient portals, including: (1) patient-provider communication, (2) care plan information, (3) clinical data viewing, (4) patient education, (5) patient safety, (6) caregiver access, and (7) hospital amenities. Recommendations We summarize the experiences of 6 organizations that have implemented acute care portals, representing a variety of settings and technologies. We discuss the considerations for and challenges of incorporating various features into an acute care patient portal, and extract the lessons learned from each institution’s experience. We recommend that stakeholders in acute care patient portals should: (1) consider the benefits and challenges of generic and structured electronic care team messaging; (2) examine strategies to provide rich care plan information, such as daily schedule, problem list, care goals, discharge criteria, and post-hospitalization care plan; (3) offer increasingly comprehensive access to clinical data and medical record information; (4) develop alternative strategies for patient education that go beyond infobuttons; (5) focus on improving patient safety through explicit safety-oriented features; (6) consider strategies to engage patient caregivers through portals while remaining cognizant of potential Health Insurance Portability and Accountability Act (HIPAA) violations; (7) consider offering amenities to patients through acute care portals, such as information about navigating the hospital or electronic food ordering.
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Nagykaldi, Zsolt J., Huibert Tange, and Jan De Maeseneer. "Moving From Problem-Oriented to Goal-Directed Health Records." Annals of Family Medicine 16, no. 2 (March 2018): 155–59. http://dx.doi.org/10.1370/afm.2180.
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Narkevich, I. A., O. D. Nemyatykh, K. A. Kovaleva, L. G. Ratova, I. O. Trushnikova, E. N. Parizhskaya, and A. O. Konradi. "LIFE QUALITY ASSESSMENT OF PATIENTS WITH STABLE CORONARY ARTERY DISEASE AFTER MYOCARDIAL REVASCULARIZATION." Pharmacy & Pharmacology 8, no. 6 (May 17, 2021): 465–75. http://dx.doi.org/10.19163/2307-9266-2020-8-6-465-475.
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The aim of this study is to assess the life quality of patients with stable coronary artery disease after angioplasty and stenting of coronary arteries at the post-hospital stage.Materials and methods. Methods of the sociological analysis (questionnaire surveys) and methods of mathematical statistics (descriptive statistics, time series method, factor and variance analyses) were used at different stages of the prospective observational study. The research materials were as follows:1458 electronic patient records with a stable coronary heart disease (SCHD) after angioplasty and stenting of coronary arteries (ASCA); 620 questionnaires filled in by patients before the surgery, 1, 6, 12 months after discharge. The statistical analysis was performed using the IBM SPSS Statistics software.Results. The results of a comprehensive survey make it possible for us to assert that during the studied period, stable good healths of cardiac surgery patients with ASCA were maintained. Within the framework of the EQ-5D-5L questionnaire, it was revealed that more than 50% of patients have no physiological problems. The results of the SAQ analysis demonstrate that 58% of the patients feel better, and more than 34% of the patients do not have shortness of breath 1 year after the surgery. A statistically significant improvement in their healths was established according to a visual analogue scale relatively to the annual observation mark (62.82 ± 20.95), which corresponds to the high results assessment of the medical technology use. At the same time, 53% of the patients notify that the treatment results meet their own expectations.Conclusion. The proposed calculation of the integrated index of patients’ treatment efficiency demonstrated by the patients with stable coronary heart disease after angioplasty and stenting of the coronary arteries is based on the results of the factor analysis. This calculation can be used to assess the efficiency of pharmacotherapy in the framework of a value-oriented approach to the treatment of a number of other pathologies.
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Aguiar, Maria Cecília Azevedo de, Natália Cristina Garcia Pinheiro, Karolina Pires Marcelino, and Kenio Costa de Lima. "Halitosis and associated factors in institutionalized elderly persons." Revista Brasileira de Geriatria e Gerontologia 20, no. 6 (December 2017): 856–68. http://dx.doi.org/10.1590/1981-22562017020.170160.
Full textAbstract:
Abstract Objective: to evaluate the prevalence of halitosis and associated factors in institutionalized elderly persons. Methods: a sectional study was performed with 268 elderly persons from 11 long-term care institutions in Natal in the northeast of Brazil. Data collection included an oral epidemiologic examination and questions about self-perception of oral health, as well as a consultation of medical records and the application of a questionnaire to the directors of the institutions. Halitosis was measured using the organoleptic test. The independent variables were oral, sociodemographic, institutional, general health and functional conditions. Bivariate analysis was performed using the Pearson chi-square test and Fisher's exact test, and the magnitude of effect was verified by the prevalence ratio for the independent variables in relation to the outcome, with a 95% confidence level. Results: the prevalence of halitosis was 26.1%, which was exhaled by the mouth in 98.57% of cases and by the nose in 10% of cases. Prevalence was 43% higher among non-white individuals (p=0.006); 65% higher among those living in non-profit institutions (p=0.039); 52% higher in elderly persons with oriented cognitive status (p=0.047); 41% higher in elderly persons with root caries (p=0.029); 62% higher in those who did not use dentures (p=0.046); 57% lower in edentulous persons (p<0.001); and 73% higher in elderly individuals with tongue biofilm (p=0.001). Conclusion: The occurrence of halitosis in institutionalized elderly persons was similar to other studies, but there was an expressive number of extrabuccal cases and an association with oral health problems, as well as sociodemographic, institutional and functional factors.