SP10.2.12 Information Sustainability: The revitalisation and upcycling of 373,342 historic surgical pathology records into the contemporary electronic patient record in one UK NHS Hospital Trust

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Fatima Rahman ◽  
Alan Hales ◽  
David Cable ◽  
Keith Burrill ◽  
Adrian Bateman ◽  
...  
Keyword(s):  
Electronic Patient Record ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Record ◽  
Clinical Use ◽  
Data Resource ◽  
Cancer Data ◽  
Transition Points ◽  
Pathology Reports ◽  
Cellular Pathology

Abstract Aims Surgical and Cellular pathology (‘e-pathology’) record sets are a valuable data resource with which to populate the Electronic Patient Record (EPR). Accessible reports, even decades old, can be of great value in contemporary clinical decision making and as a resource for longitudinal clinical research. They commonly identify the operation, the location and the pathology, even if not to modern reporting standards. Methods Since 2010, we have built and implemented a timeline structured EPR for the ‘whole-of-life’ visualisation of the electronic documents (e-Docs) of 2.5M+ patients on our Master Index. Prior to this project, our earliest e-Docs dated to 1995. We tracked down 373,342 inert e-pathology reports from our legacy Ferranti (1990-1997) and Masterlab (1997-2004) systems. These were uploaded into our active file servers, following appropriate data quality and patient identity reconciliation checks. Results We have progressively restored 373,342 previously inaccessible e-pathology records to clinical use and to immediacy of access, and in the process extending our “addressable EPR” back to 1990 for living and deceased patients. This process has also allowed us to populate and validate an EPR-integral breast cancer data system of 20,000 cases with e-pathology records dating back to 1990. Conclusions The sustainable revitalisation of old e-pathology reports into a timeline structured EPR creates preserves and upcycles the investment in pathology reporting which is otherwise progressively lost to clinical use. E-pathology records provide reliable, life-long evidence of critical transition points in individual lives and disease progression for clinical and research use, when they can be instantly accessed.

scholarly journals New life for old cellular pathology: a transformational approach to the upcycling of historic e-pathology records for contemporary clinical uses

2021 ◽  
pp. jclinpath-2021-207385
Author(s):  
David Anthony Rew ◽  
Alan Arthur Hales ◽  
David Cable ◽  
Keith Burrill ◽  
Adrian C Bateman
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
University Hospital ◽  
Short Paper ◽  
Clinical Use ◽  
Data Resource ◽  
Cancer Data ◽  
Data Framework ◽  
Pathology Reports ◽  
Cellular Pathology

AimsCellular pathology (‘e-pathology’) record sets are a rich data resource with which to populate the electronic patient record (EPR). Accessible reports, even decades old, can be of great value in contemporary clinical decision making and as a resource for longitudinal clinical research. The aim of this short paper is to describe a solution in a major UK University Hospital which gives immediate visibility and clinical utility to 30 years of e-pathology recordsMethodsOver the past decade, we have created a timeline structured and iconographic data framework for the ‘whole-of-life’ visualisation of the entirety of an EPR. We have enhanced this interface with the sequential extraction of 373 342 e-pathology reports from legacy Ferranti (1990–1997) and Masterlab (1997–2004) files. They have been uploaded into our SQL file servers, following appropriate data quality and patient identity reconciliation checks.ResultsWe have restored a large repository of previously inaccessible e-pathology records to clinical use and to immediacy of access as a foundation element of our timeline structured EPR. This process has also allowed us to populate and validate an EPR-integral breast cancer data system of 20 000 cases with e-pathology records dating back to 1990.ConclusionsThe revitalisation of old e-pathology reports into a timeline structured EPR creates preserves and upcycles the investment in pathology reporting which is otherwise progressively lost to clinical use. E-pathology records provide reliable, life-long evidence of critical transition points in individual lives and disease progression for clinical and research use, when they can be instantly accessed.

scholarly journals Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part two

2008 ◽  
Vol 101 (11) ◽  
pp. 536-543 ◽  
Author(s):  
Sadia Malick ◽  
Kausik Das ◽  
Khalid S Khan
Keyword(s):  
Adult Learning ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Adult Learning Theory ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Use ◽  
Evidence Based Healthcare ◽  
Based Medicine ◽  
Oriented Research

Summary Evidence-based medicine (EBM) is the clinical use of current best available evidence from relevant, valid research. Provision of evidence-based healthcare is the most ethical way to practise as it integrates up-to-date patient-oriented research into the clinical decision-making to improve patients' outcomes. This article provides tips for teachers to teach clinical trainees the final two steps of EBM: integrating evidence with clinical judgement and bringing about change.

scholarly journals Clinical Use of Aided Cortical Auditory Evoked Potentials as a Measure of Physiological Detection or Physiological Discrimination

2012 ◽  
Vol 2012 ◽  
pp. 1-14 ◽  
Author(s):  
Curtis J. Billings ◽  
Melissa A. Papesh ◽  
Tina M. Penman ◽  
Lucas S. Baltzell ◽  
Frederick J. Gallun
Keyword(s):  
Evoked Potentials ◽  
Auditory Evoked Potentials ◽  
Clinical Decision Making ◽  
Hearing Aid ◽  
Clinical Decision ◽  
Clinical Use ◽  
Major Contributor ◽  
Wide Range ◽  
Pure Tones ◽  
Cortical Auditory Evoked Potentials

The clinical usefulness of aided cortical auditory evoked potentials (CAEPs) remains unclear despite several decades of research. One major contributor to this ambiguity is the wide range of variability across published studies and across individuals within a given study; some results demonstrate expected amplification effects, while others demonstrate limited or no amplification effects. Recent evidence indicates that some of the variability in amplification effects may be explained by distinguishing between experiments that focused on physiological detection of a stimulus versus those that differentiate responses to two audible signals, or physiological discrimination. Herein, we ask if either of these approaches is clinically feasible given the inherent challenges with aided CAEPs. N1 and P2 waves were elicited from 12 noise-masked normal-hearing individuals using hearing-aid-processed 1000-Hz pure tones. Stimulus levels were varied to study the effect of hearing-aid-signal/hearing-aid-noise audibility relative to the noise-masked thresholds. Results demonstrate that clinical use of aided CAEPs may be justified when determining whether audible stimuli are physiologically detectable relative to inaudible signals. However, differentiating aided CAEPs elicited from two suprathreshold stimuli (i.e., physiological discrimination) is problematic and should not be used for clinical decision making until a better understanding of the interaction between hearing-aid-processed stimuli and CAEPs can be established.

scholarly journals Recommendations of the Russian Gastroenterological Association on Clinical Use of High-Resolution Manometry in Diagnosis of Esophageal Disorders

2020 ◽  
Vol 30 (3) ◽  
pp. 61-88 ◽  
Author(s):  
V. T. Ivashkin ◽  
I. V. Mayev ◽  
A. S. Trukhmanov ◽  
O. A. Storonova ◽  
S. A. Abdulkhakov ◽  
...  
Keyword(s):  
High Resolution ◽  
Motor Function ◽  
Clinical Data ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Upper Esophageal Sphincter ◽  
Motor Disorders ◽  
Clinical Use ◽  
High Resolution Manometry ◽  
Esophageal Sphincter

Aim. Current recommendations of the Russian Gastroenterological Association on clinical use of high-resolution manometry in diagnosis of esophageal disorders are intended to assist in clinical decision making, terminology standardisation and interpretation of clinical data.Key points. In 2018, a joint meeting of the Russian Gastroenterological Association and Russian Neurogastroenterology and Motility Group approved unified terminology and classification of esophageal motor function disorders for high-resolution manometry diagnosis.Gastrointestinal patient complaints typically concern esophageal disorders such as dysphagia, regurgitation, heart-burn, chest pain or belching. To exclude erosive and ulcerative lesions, eosinophilic esophagitis and organic changes, esophagogastroduodenoscopy and biopsy are recommended in pre-treatment. Upon excluding mucosal lesions and esophageal lumen obstruction as causal for symptoms, use of high-resolution manometry is recommended. This method of esophageal examination has become the “gold standard” in diagnosis of motor disorders.High-resolution manometry enables detailed investigation of integral quantitative and qualitative characteristics of esophagus motor function and specific related disorders, analysis of esophageal contractile propagation and strictly coordinated synchronous peristalsis of upper esophageal sphincter, esophagus and lower esophageal sphincter, which malfunction may provoke development of achalasia, esophagospasm, hiatal hernia, ineffective eso pha geal motility and other motor disorders.Conclusion. High-resolution manometry is a relatively new method for study of esophagus motor function gaining increasingly wide application in clinical practice. It enables a medical professional to obtain evidence that may critically affect the choice of optimal patient care strategy and effective treatment. Current recommendations are based on an extensive review of up-to-date information and will be updated with new corpus of clinical data and assessment emerging in evidential medicine to provide gastroenterologists country-wide with latest scientific and practical guidelines.

Accuracy and comprehensiveness of pathology reportage after lung cancer resection

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6523-6523 ◽  
Author(s):  
A. Farooq ◽  
R. U. Osarogiagbon ◽  
J. W. Allen ◽  
T. F. O'Brien ◽  
D. Spencer ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Operative Management ◽  
Tnm Staging ◽  
Careful Examination ◽  
Chi Square ◽  
Cancer Resection ◽  
Pn Stage ◽  
Pathology Reports

6523 Background: Decisions about prognosis, adjuvant chemo/radiation therapy and clinical trial eligibility require careful examination of the surgical resection specimen. In January 2004, the College of American Pathologists (CAP) and the American College of Surgeons Committee on Cancer mandated reportage of specific items after resection of lung cancer. The extent of compliance is unknown. Methods: We examined final pathology reports for all lung cancer resections in the Memphis Metropolitan Area from January 2004 to December 2007. End-points were the percentage of reports with each CAP item and the 6 most vital determinants of post-operative management and accuracy of TNM staging. Chi-square test was used for year to year comparisons. Results: Table 1 shows frequency of reportage of CAP items. Of those with reported pT stage, it was accurate in 242 of 263 (92.02%) identified as T1; 193 of 208 (92.79%) T2; 21 of 24 (87.5%) T3; 11 of 11 (100%) T4. The most common T-staging error, understaging of satellite nodules (T4), occurred in 12 of 21 (57%) mis-staged as T1, 11 of 15 (73%) T2, 3 of 3 (100%) T3. Overall, 62.6% of reports accurately identified pT-stage. Of those with reported pN-stage, 351 of 352 (99.7%) accurately identified N0; 69 of 81 (85.2%) accurately identified N1, 12 of 81 (14.81%) N1 designations were actually N2; 27 of 27 (100%) N2 designations were accurate; 31 of 34 (91.2%) identified as Nx (no lymph nodes in the specimen) were accurate, 3 (8.8%) were truly N0. Overall, 64.08% of reports accurately identified pN-stage. 4 of 503 identified as pMx (0.8%) had pM1. There was no change in proportion of incomplete and/or inaccurate pathology reports over the 4 years of analysis. Conclusions: Pathology evaluation of lung cancer resection specimens is frequently incomplete or inaccurate, potentially impairing clinical decision-making. Satellite nodules are often understaged. Simple corrective interventions such as enforcement of mandatory institutional utilization of the CAP checklist and AJCC staging manual need to be investigated. [Table: see text] [Table: see text]

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