The impact of a dedicated placenta request form on the provision of clinical information at a tertiary centre

Background: An incompletely filled Radiology Request Form (RRF) is a common problem faced by both radiologists andradiographers. Objective: The study was carried out to objectively evaluate the adequacy of completion of radiology request forms in atertiary care centre. Indoor and outdoor patient departments of POF Hospital Wah Cantonment. Design: Descriptive, retrospective study.Setting: Radiology Department POF Hospital, Wah Cantonment. Period: 01 Jul 2009 to 01 September 2009. Methods: A total of 1500request forms received by the radiology department from 01Jul 2009 to 01Sep 2009 were reviewed. These included requests for a varietyof examinations from different departments within POF Hospital, Wah Cantonment. A database of the collected forms was created, notingwhich of the various fields were adequately completed. Results: Only 270 out of the 1500 forms were completed in full and 1230 were notcompletely filled. The only parameter fulfilled in all the forms was the presence of referring doctor’s signature. The commonest blankfields were as follows: patient location: 62%, clinical notes: 67.26%, doctor's name: 47.33% and date of referral: 14.2%. Conclusions:The inadequate transmission of clinical information observed in this study is typical example of the various problems that radiologistshave to face.

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Improving knowledge and confidence in the acute management of eating disorders and resulting complications

BJPsych Open ◽

10.1192/bjo.2021.503 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S186-S186

Author(s):

Sarah Fynes-Clinton ◽

Clare Price ◽

Louisa Beckford ◽

Maisha Shahjahan ◽

Brendan McKeown

Keyword(s):

Eating Disorders ◽

Clinical Information ◽

Easy Access ◽

Average Score ◽

Junior Doctors ◽

Refeeding Syndrome ◽

Improvement Project ◽

Positive Effects ◽

The Creation ◽

The Impact

AimsThis project aimed to improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call.BackgroundA recent survey found just 1% of doctors have the opportunity for clinical experience on eating disorders. Anecdotally, a number of junior doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts.MethodThis project aimed to ascertain levels of confidence with managing patients with eating disorders, and to collect suggestions to improve this. This was achieved using a survey sent out to 97 doctors working in a Mental Health Trust.We then utilised two of the suggestions to improve the identified areas of concern. The first method involved direct lectures. This was followed up with the creation of a poster highlighting the pertinent information which was displayed in key clinical areas. The second avenue was the creation of an information booklet covering key clinical information that is available to all on call doctors.ResultThe response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Refeeding syndrome was identified as the greatest area of concern by responding doctors.To assess the impact of the lectures, MCQs were given out before and after the presentation. The results were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%.ConclusionBy using multiple methods to improve doctors confidence, (lectures, written information and visual posters), this quality improvement project achieved its aims in improving doctors knowledge, and through having easy access to important information, will have long term positive effects on patient care.

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Data-driven approach to Early Warning Score-based alert management

BMJ Open Quality ◽

10.1136/bmjoq-2017-000088 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000088 ◽

Cited By ~ 5

Author(s):

Muge Capan ◽

Stephen Hoover ◽

Kristen E Miller ◽

Carmen Pal ◽

Justin M Glasgow ◽

...

Keyword(s):

Patient Safety ◽

Early Warning ◽

Early Recognition ◽

Clinical Information ◽

Patient Characteristics ◽

The Elderly ◽

Early Warning Score ◽

The Right ◽

The Impact ◽

Alerting Systems

BackgroundIncreasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals.MethodsWe quantified the impact of an EWS-based clinical alert system on quantity and frequency of alerts using three different alert algorithms consisting of a set of criteria for triggering and muting alerts when certain criteria are satisfied. We used retrospectively collected EHRs data from December 2015 to July 2016 in three units at the study hospitals including general medical, acute care for the elderly and patients with heart failure.ResultsWe compared the alert-generating algorithms by opportunity of early recognition of clinical deterioration while proactively estimating alert burden at a unit and patient level. Results highlighted the dependency of the number and frequency of alerts generated on the care location severity and patient characteristics.ConclusionEWS-based alert algorithms have the potential to facilitate appropriate alert management prior to integration into clinical practice. By comparing different algorithms with regard to the alert frequency and potential early detection of physiological deterioration as key patient safety opportunities, findings from this study highlight the need for alert systems tailored to patient and care location needs, and inform alternative EWS-based alert deployment strategies to enhance patient safety.

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Abstract 16084: Relationship Between Diastolic Interventricular Septal Flattening and Prognosis in Patients With Severe Tricuspid Regurgitation

Circulation ◽

10.1161/circ.142.suppl_3.16084 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Omori Taku ◽

Goki Uno ◽

Shunsuke Shimada ◽

Takahiro Shiota

Keyword(s):

Tricuspid Regurgitation ◽

Cardiac Death ◽

Surrogate Marker ◽

Clinical Information ◽

Right Atrial ◽

Cardiac Events ◽

Severe Tricuspid Regurgitation ◽

Kaplan Meier ◽

Advanced Therapy ◽

The Impact

Introduction: Diastolic interventricular septal flattening is one of the major findings in patients with severe tricuspid regurgitation (TR). However, the relationship between diastolic interventricular septal flattening and outcome in patients with severe TR is not fully understood. This study aimed to investigate the impact of diastolic interventricular septal flattening on cardiac events in patients with severe TR. Methods: We retrospectively reviewed patients who underwent 2 dimensional echocardiography and were diagnosed as severe TR in 2014. Eccentricity index in end-diastole (EI-ED) was measured as septal wall configuration (Figure). Cardiac events investigated as endpoints were cardiac death and heart failure (HF) admission. Results: 376 patients were diagnosed as severe TR. We excluded 15 patients on mechanical respiratory support during echocardiography and 20 with missing data of clinical information. Remaining 341 severe TR patients (75 ± 16 years, 191 (56%) female) were investigated in this study.232 (68%) patients showed abnormal EI-ED (defined as over 1.0). During a follow-up period (median, 183 days; range. 40 to 983 days), 119 (34%) patients experienced cardiac events (29 cardiac death and 90 HF admission). By the Cox proportional hazard model, the presence of abnormal EI-ED and right atrial pressure (RAP) elevation on echocardiography (defined as more than 8mmHg) were independent predictors for cardiac events with a hazard ratio of 2.71 (95% Confidential interval (CI), 1.25 to 5.86; p=0.011) and of 3.02 (95%CI, 1.08 to 8,47; p=0.036) respectively. The Kaplan-Meier curves showed that severe TR patients with abnormal EI-ED and RAP elevation were at higher risk for cardiac event (Figure). Conclusions: The presence of abnormal EI-ED is an important predictor for cardiac events in patients with severe TR. The presence of abnormal EI-ED and RAP elevation can be a potential surrogate marker of advanced therapy for severe TR.

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The Impact of Preoperative Breast Magnetic Resonance Imaging on Surgical Management in Symptomatic Patients With Invasive Lobular Carcinoma

Breast Cancer Basic and Clinical Research ◽

10.1177/1178223420948477 ◽

2020 ◽

Vol 14 ◽

pp. 117822342094847

Author(s):

Brian M Moloney ◽

Peter F McAnena ◽

Éanna J Ryan ◽

Ellen O Beirn ◽

Ronan M Waldron ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Lobular Carcinoma ◽

Multivariable Analysis ◽

Breast Mri ◽

Breast Conserving Surgery ◽

Conventional Imaging ◽

Resonance Imaging ◽

Tertiary Centre ◽

The Impact

Objective: Due to an insidious proliferative pattern, invasive lobular breast cancer (ILC) often fails to form a defined radiological or palpable lesion and accurate diagnosis remains challenging. This study aimed to determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes. Methods: Consecutive symptomatic patients diagnosed with ILC in a tertiary centre over a 9-year period were reviewed. The time from diagnosis until surgery, initial type of surgery/index operation (breast-conserving surgery [BCS]/mastectomy) and the rates of reoperation (re-excision/completion mastectomy) were recorded. Patients were grouped into those who received conventional imaging and preoperative MRI (MR+) and those who received conventional imaging alone (MR–). Results: There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR– group (32.5 vs 21.1 days, P < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR– group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; χ2 = 5.63; P = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR– group (50.0%, n = 35 vs 37.8%, n = 56; χ2 = 2.89; P = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; χ2 = 0.076, P = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period. Conclusion: While MRI was associated with minor delays in treatment and did not reduce overall rates of margin re-excision or completion mastectomy, it altered the choice of surgical procedure in almost a quarter of MR+ cases. The benefit of preoperative breast MRI appears to be confined to select (younger, dense breast, borderline conservable) cases in symptomatic ILC.

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Confidentiality and security of clinical information in mental health practice

Advances in Psychiatric Treatment ◽

10.1192/apt.8.4.291 ◽

2002 ◽

Vol 8 (4) ◽

pp. 291-296 ◽

Cited By ~ 13

Author(s):

Roy McClelland ◽

Victoria Thomas

Keyword(s):

Mental Health ◽

Social Services ◽

Information And Communication Technologies ◽

New Technologies ◽

Personal Information ◽

Health Sector ◽

Clinical Information ◽

Health Care Organisation ◽

Good Communication ◽

The Impact

‘Security holds the key’ was the title of a newspaper article concerned with e-commerce (D. Sumner-Smith, The Sunday Times, 6 February, 2000, p. 3.13). However, it applies just as readily to the health sector. The need to safeguard the confidentiality of information that patients share with clinicians is as fundamental as the principle of consent. This issue has come to the fore in the context of the rapid developments and applications of information and communication technologies within society in general and within the health sector in particular. There are also changing societal expectations regarding access to information, confidentiality and disclosure. The emerging scenarios present significant challenges in relation to the traditional methods used to deal with the privacy and confidentiality of personal information (Anderson, 1995). In addition to the impact of new technologies, consideration also needs to be given to the impact of changes in health care organisation and practice, for example multidisciplinary and multi-agency working. Mental health services are in many respects at the vanguard of these changes, where the ideals of community care, shared care and seamless care depend fundamentally on good communication and information sharing. Failures in communicating information, particularly across sectoral boundaries, have led to significant problems in patient care, as revealed in several recent enquiries into homicides (Northamptonshire Health Authority & Northamptonshire Social Services, 1999)

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Jugular valve function and petrosal sinuses pressure: a computational model applied to sudden sensorineural hearing loss

Veins and Lymphatics ◽

10.4081/vl.2017.6707 ◽

2017 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Mirko Tessari ◽

Andrea Ciorba ◽

Lucas Omar Mueller ◽

Qinghui Zhang ◽

Mariapaola Cristini ◽

...

Keyword(s):

Mathematical Model ◽

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Clinical Information ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Mean Flow ◽

Venous Outflow ◽

Valve Function ◽

The Impact

Reports of extra-cranial venous outflow disturbances have recently been linked to sudden sensorineural hearing loss (SSNHL). Aims of the present study are: i) to quantify, with mathematical model, the impact of jugular valve function on the pressure of the superior and inferior petrosal sinuses (SPS, IPS) and the main auricolar veins; ii) to verify the feasibility of the application of mathematical model in the clinical setting in terms of consistency respect to the usual measures of SSNHL outcome. Extra-cranial venous outflow and post analysis were respectively blindly assessed by echo colour-Doppler (ECD) and a validated mathematical model for the human circulation. The pilot study was conducted on 1 healthy control and in a group of 4 patients with different outcome of SSNHL. The main finding was the significant increased pressure calculated in the SPS and IPS of patients with ipsilateral jugular obstruction due to not mobile valve leaflets (6.55 mmHg), respect to the other subjects without extracranial complete obstruction (6.01 mmHg), P=0.0006. Moreover, we demonstrated an inverted correlation between the extrapolated pressure values in the SPS/IPS and the mean flow measured in the correspondent internal jugular vein (r= –0.87773; r-squared= 0.7697; P=0.0009). The proposed mathematical model can be applied to venous extra-cranial ECD investigation in order to derive novel clinical information on the drainage of the inner ear. Such clinical information seems to provide coherent parameters potentially capable to drive the prognosis. This innovative approach was proven to be feasible by the present pilot investigation and warrants further studies with an increased sample of patients.

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The critical care environment

10.1093/med/9780199696260.003.0002 ◽

2017 ◽

Author(s):

Sheila Adam ◽

Sue Osborne ◽

John Welch

Keyword(s):

Critical Care ◽

Clinical Information ◽

Electronic Patient Records ◽

Care Environment ◽

Team Working ◽

Use Of Technology ◽

Design Structure ◽

Key Factor ◽

The Impact ◽

Location Design

This chapter details the optimal location, design, structure, staffing, and equipment required to support high quality critical care. The chapter covers the impact of the critical care environment on patients, family, and staff themselves. The use of technology, including clinical information systems and electronic patient records, is described. Staffing numbers and roles and the importance of team working and collaboration as a key factor in the effectiveness of the critical care environment are also covered. The impact of cleanliness and infection control features as part of the design. The role that the environment has in mitigating the impact on patients in critical care as well as improving outcomes is described as well as other aspects of safety within critical care.

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