scholarly journals 782. Provider to Provider Electronic Consultation (E-consult): A Tool for the Pediatric Infectious Diseases Specialist to Document Encounters and Quantify Effort.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S347-S347
Author(s):  
Blanca E Gonzalez ◽  
Charles B Foster ◽  
Frank Esper ◽  
Heather Daniels ◽  
Carla Saracusa ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Nurse Practitioners ◽  
Immunocompromised Host ◽  
Cross Sectional Study ◽  
Medical Liability ◽  
Cross Sectional ◽  
Level 3 ◽  
Level 1 ◽  
Clinical Queries ◽  
Level 2

Abstract Background Curbside consultation is a ubiquitous practice within the medical field informally providing advice to community providers. The electronic consult (E-Consult) allows direct provider-to-provider communication between the primary care provider (PCP) and specialists using a secure electronic platform while documenting these interactions within the patient’s medical record (EMR). They offer PCP’s a forum for asking nonurgent questions. For the specialist, it allows review of the EMR, reduces medical liability of the curbside consult and provides a mechanism for generating RVUs. This service was implemented in our healthcare network (of over 300 pediatricians and pediatric specialists who see more than 500,000 pediatric visits each year) in April 2018. Our aim was to review and analyze the E-consults provided by the Pediatric Infectious Diseases (PID) service. Methods Cross-sectional study of E-consults performed by the PID from April 11 -2018-April 22 2019. Clinical queries were categorized by type and tabulated. Consult Billing was as following: Level 1=5 minutes (min); Level 2 =10min; Level 3= 15 minutes; Level 4= 25 minutes. RVU values were institutionally derived and assigned. Results We performed 171 E- consults with an average of 13 per month (range 3–18) generated from 59 providers (52 (88%) physicians and 7 (12%) certified nurse practitioners). Common reasons for the E-consult included: vaccine questions (25.7%), diagnosis questions (21.6%), exposure questions (20.4%) and treatment recommendations (10.5%). Of vaccine questions, 43% related to vaccine schedules /boosters, 13% vaccines for travel and 11.3% vaccines for the immunocompromised host. Consultation in the PID clinic was recommended for 25.7% patients, 9% requiring urgent evaluation. Of the 171 E-consults, 12.2% were evaluated in the PID clinic and 5% by another specialty. Billing was performed for 168 of the E consults= 9 level 1, 35 level 2, 83 level 3 and 41 level 4 generating 161 RVUs (equivalent to 53 level 4 new outpatient visits at our institution). Conclusion E-consults are an alternative to informal curbside consults for nonurgent clinical queries. Encounters are documented in the EMR and professional effort devoted to the task is tracked providing an additional source of RVU generation for the PID physician. Disclosures All authors: No reported disclosures.

scholarly journals A Study on Knowledge Towards Brain Death among Residents in Indonesia

2020 ◽  
Vol 56 (2) ◽  
pp. 140
Author(s):  
Asra Al Fauzi ◽  
Christrijogo Sumartono Waloejo ◽  
Abdulloh Machin ◽  
Muhammad Ja'far Shodiq
Keyword(s):  
Brain Death ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Research Subjects ◽  
Cross Sectional ◽  
Academic Medical ◽  
Center Hospital ◽  
Level 3 ◽  
Level 2

This research was conducted to evaluate the knowledge and diagnosis of brain death among resident in Indonesia. This study used an observational analytic study with a cross-sectional study design using a questionnaire. The research subjects consisted of 132 level 2 (after 2 years of residency) and level 3 (after 4 years of residency) residents, the total sampling for which was taken from the departments of Neurosurgery, Anesthesiology, and Neurology at Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Data were taken from November 2018 to January 2019. A total of 132 residents of Neurosurgery, Neurology, and Anesthesiology participated in this study. From the series of studies, residents’ knowledge of the concept of brain death was in the sufficient category (41.7%), residents’ knowledge of the technical diagnosis of brain death was in the good category (40.2%), residents’ knowledge of brain death examination was in the less category (43.2%), and finally, it was found that the resident's knowledge of brain death was in a good category (35.6%). There were also significant differences in knowledge of brain death between Neurosurgery, Neurology, and Anesthesiologist Resident (P <0.001) and knowledge of brain death between level 2 and level 3 residents (P=0.032). In general, the Indonesian resident doctors’ knowledge of brain death is adequate, but knowledge of the clinical examination of brain death is still lacking. Further research must be carried out to promote knowledge of brain death in residents as well as professional doctors/specialists, so that the number of organ transplants, especially in Indonesia, will increase.

scholarly journals Functional Status of the Children with Cerebral PalsyAnd Their Mothers’ Psychological Status: A Cross-sectional Study

2022 ◽  
Vol 6 (1) ◽  
pp. 17
Author(s):  
Esma Demırhan ◽  
Esma Ocal Eriman ◽  
Afitap Icagasıoglu
Keyword(s):  
Chronic Disease ◽  
Functional Status ◽  
Cross Sectional Study ◽  
Psychological Status ◽  
Obsessive Compulsive ◽  
Paranoid Ideation ◽  
Cross Sectional ◽  
Level 3 ◽  
Sleeping Disorder ◽  
Level 2

Objective: The aims of this study were to assess the demographic characteristics and functional status of children with cerebral palsy (CP) and to evaluate the psychological status of their mothers.Results: A total of 101 patients were included in the study (%57,4% boys, %42,6% girls). Their mean age was 6,79±4,48 (1,5-18) years. Mothers’ mean age was 33,31±7,72 (20-53) years. The neurologic classification were as follows: diplegia 27,7%, tetraplegia 45,5%, hemiplegia 19,8%, dyskinetic or ataxic 6,9%. The GMFCS levels were as follows: level 1 11,9%, level 2 14,9%, level 3 17,8%, level 4 25.7%, level 5 29,7%. SCL-90-R outcomes were as follows: 38,6% somatization, 18,8% anxiety, 37,6% obsessive-compulsive, 36,6% depression, 32,7% interpersonal-sensitivity, 21,8% eating-sleeping disorder. We didn’t detect any significant correlation between the GMFCS levels of children and mothers’ physicological status. Childrens’ low WeeFIM scores were related with anxiety, obsessive-compulsive, depression, interpersonalsensitivity, paranoid ideation and eating-sleeping disorder. (p=0,009, p=0,017, p=0,009, P=0,0001, p=0,021, p=0,001 respectively). The presence of chronic disease was related with somatization, anxiety and depression (p=0,001, p=0,024, p=0,008 respectively). The presence of pain was related with somatization (p=0,0001).Conclusion: Lower WeeFIM scores of children with CP and chronic disease and pain presence in their mothers were detected as the factors that negatively affect psychological status of mothers.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 17-23

Conducting Three-Level Longitudinal Analyses

2016 ◽  
Vol 37 (1) ◽  
pp. 7-58 ◽  
Author(s):  
James L. Peugh ◽  
Ronald H. Heck
Keyword(s):  
Repeated Measures ◽  
Cluster Sampling ◽  
Longitudinal Analyses ◽  
Cross Sectional ◽  
Data Analyses ◽  
Level Data ◽  
Level 3 ◽  
Level 1 ◽  
Data Analytic ◽  
Level 2

Researchers in the field of early adolescence interested in quantifying the environmental influences on a response variable of interest over time would use cluster sampling (i.e., obtaining repeated measures from students nested within classrooms and/or schools) to obtain the needed sample size. The resulting longitudinal data would be nested at three levels (e.g., repeated measures [Level 1], collected across participants [Level 2], and nested within different schools [Level 3]). A previous publication addressed statistical analysis issues specific to cross-sectional three-level data analytic designs. This article expands upon the previous cross-sectional three-level publication to address topics specific to longitudinal three-level data analyses efforts. Although all analysis examples are demonstrated using SAS, the equivalent SPSS and Mplus syntax scripts, as well as the generated example data and additional supplemental materials, are available online.

scholarly journals Perbedaan Gender pada Kejadian Sindrom Metabolik pada Penduduk Perkotaan di Indonesia

2012 ◽  
Vol 7 (5) ◽  
pp. 219
Author(s):  
Krisnawaty Bantas ◽  
Hari Koesnanto Yoseph ◽  
Budi Moelyono
Keyword(s):  
Gender Differences ◽  
Marital Status ◽  
Activity Level ◽  
Cross Sectional ◽  
Main Independent Variable ◽  
Fiber Consumption ◽  
Level 3 ◽  
Level 1 ◽  
And Gender ◽  
Level 2

Sindrom Metabolik (SM) merupakan faktor risiko penting penyakit kardiovaskuler yang merupakan penyebab utama kematian di Indonesia. Perbedaan gender pada SM berkontribusi terhadap perbedaan gender pada penyakit kardiovaskuler. Penelitian ini bertujuan mengetahui prevalensi dan risiko SM berdasarkan gender di perkotaan Indonesia menggunakan data Riset Kesehatan Dasar 2007 dan menggunakan rancangan penelitian potong lintang. Populasi penelitian terdiri dari 13.262 orang pria dan wanita yang tidak hamil berusia lebih dari 15 tahun yang bermukim di daerah perkotaan. Variabel penelitian meliputi variabel dependen sindrom metabolik. Variabel independen utama adalah gender dan variabel kovariat yang lain adalah level 1 (umur, statusperkawinan, pendidikan, stres, merokok, dan aktivitas fisik), level 2 (pendapatan keluarga, konsumsi energi rumah tangga, konsumsi protein rumah tangga, konsumsi serat rumah tangga, anggota rumah tangga, dan balita dalam rumah tangga), dan level 3 (provinsi, status urban, dan Indeks Pembangunan Manusia (IPM)). Analisis dilakukan dengan multilevel regresi logistik. Hasil penelitian menyebutkan bahwa prevalensi SM adalah 17,5 %, prevalensi pada wanita (21,3%) lebih tinggi daripada pria (12,9%). Risiko sindrom metabolikberdasarkan gender bergantung pada status umur, pendidikan, dan perkawinan dari individu. Variasi kejadian SM berdasarkan pendapatan keluarga kecil (nilai MOR 1,21) dan variasi kejadian SM berdasarkan provinsi juga kecil (nilai MOR1,18).Kata kunci: analisis multilevel, gender, sindrom metabolikAbstractMetabolic Syndrome (MS) is an important factor for Cardiovascular Disease (CVD). One of the main causes of death in Indonesia is CVD. Gender differences in MS may contribute the gender differences in CVD. This study aimed to examine the prevalence and MS risk by gender in the urban population of Indonesia using Riskesdas 2007 data and cross-sectional design study. Population of study consisted of 13,262 men and non pregnant women over 15 years old lived in urban area. Variables included in this study are MS as the dependentvariable and gender as the main independent variable. The covariate variables consisted of: level 1 variables (age, marital status, education, stress, smoking, and physical activity), level 2 (family outcome, household energy consumption, protein consumption, fiber consumption, members, and toddler under5 years), level 3 (province, urban status, and human development index). Multilevel logistic regression used in data analysis. Result showed that prevalence of MS was 17,5%, on women (21.3%) was higher than men (12.9%). The risk of MS by gender was depent on age, educational level, and marital status of individual. The variation of MS occurrence among the family incomes was small (MOR 1.21), and the variation of MS occurrence among the provinces was also small (MOR 1.18).Keywords: multilevel analysis, gender, metabolic syndrome

scholarly journals The association between chiropractors’ view of practice and patient encounter-level characteristics in Ontario, Canada: a cross-sectional study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jessica J. Wong ◽  
Sheilah Hogg-Johnson ◽  
André E. Bussières ◽  
Simon D. French ◽  
Silvano A. Mior
Keyword(s):  
Well Being ◽  
Cross Sectional Study ◽  
Patient Encounter ◽  
Sectional Study ◽  
Cross Sectional ◽  
Reason For Encounter ◽  
Patient Health ◽  
Level 1 ◽  
The Impact ◽  
Level 2

Abstract Background Chiropractors have diverse views of practice, but the impact on their patient profiles and treatment approaches remains unclear. We assessed the association between chiropractors’ view of practice (unorthodox versus orthodox) and patient encounter-level characteristics among chiropractors who practice in Ontario, Canada. Methods We conducted a cross-sectional study using Ontario Chiropractic Observation and Analysis STudy (O-COAST) data. In O-COAST, Ontario chiropractors were randomly recruited from a list of registered chiropractors in 2015 and recorded up to 100 consecutive patient encounters. We classified chiropractors’ response regarding their views of practice as unorthodox when viewing “vertebral subluxation as an encumbrance to health that is corrected to benefit overall well-being”; other views were considered orthodox. Patient encounter-level characteristics included: (1) non-musculoskeletal reason-for-encounter; (2) subluxation as diagnosis; (3) duration of encounter (log-transformed for modeling); (4) unimodal manipulative treatment; and (5) patient health characteristics (good health status, some activity limitations). We conducted multilevel logistic regression to assess the association between view of practice and aforementioned characteristics, accounting for potential confounders and clustering of encounters within chiropractors. The multilevel models had two levels (level 1—patient encounter level; level 2—chiropractor level), with level 1 patient encounters nested within level 2 chiropractors. Results We included 40 chiropractors (mean age = 43.4 years, SD = 11.5) and 3,378 chiropractor-patient encounters. The 2,332 unique patients identified had a mean age of 48.5 years (SD = 18.5). Chiropractors with unorthodox views had higher odds of having patients with a non-musculoskeletal reason-for-encounter (adjusted odds ratio (aOR) 16.5, 95% CI 3.2–84.0) and subluxation as diagnosis (aOR 63.0, 95% CI 4.2–949.1). Encounters of chiropractors with unorthodox views were 0.6 times shorter than those with orthodox views (95% CI 0.4–0.9). Chiropractor level explained 32%, 75%, and 49% of the variability in non-musculoskeletal reason-for-encounter, subluxation as diagnosis, and encounter duration, respectively. We observed no association between unorthodox view and unimodal manipulative treatment or patient health characteristics. Conclusions Chiropractors’ unorthodox view of practice was associated with treating non-musculoskeletal conditions, subluxation as diagnosis, and shorter duration of encounter. Chiropractor level explained a high proportion of variability in these outcomes. Findings have implications for understanding chiropractic practice and informing interprofessional collaboration.

scholarly journals SITUATION OF HYPERTENSION IN PEOPLE FORM 25 AGO OR MORE IN THAI BINH PROVINCE, 2017

2021 ◽  
Vol 62 (4) ◽  
Author(s):  
Hoang Van Binh ◽  
Tran Thi Nhu Quynh
Keyword(s):  
Blood Pressure Level ◽  
Cross Sectional Study ◽  
Pressure Level ◽  
Cluster Sampling ◽  
Age Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
High Blood Pressure Level ◽  
Level 1 ◽  
Level 2

 A cross-sectional study was carried out in 2017, with the method of cluster sampling (PPS) to select30 communes/wards in 8 districts/cities in Thai Binh province. A total of 1450 adults from 25 ago ormore the results showed that:The prevalence rate of hypertension was 29.8%, of which men account for 36.5%, 22.0% higherthan that of women (p<0.05), mainly high blood pressure level 1 (42.3%), level 2 (35.4%) and level3 (22.3%).The rate of hypertension tends to increase gradually by age group, the group aged 70 and overaccounts for the highest proportion (36.4%), the age group 60-69 was 34.8%, the age group 40-59was 31.5% and the lowest of 25-39 age group (16.1%) (p<0.05).

EVALUASI PELATIHAN DI PT. PUPUK KUJANG CIKAMPEK

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Lania Muharsih ◽  
Ratih Saraswati
Keyword(s):  
Training Evaluation ◽  
Work Productivity ◽  
Learning Behavior ◽  
Level 3 ◽  
Level 1 ◽  
Four Levels ◽  
A Company ◽  
Level 2 ◽  
Evaluation Sheet ◽  
Assessment Factor

This study aims to determine the training evaluation at PT. Kujang Fertilizer. PT. Pupuk Kujang is a company engaged in the field of petrochemicals. Evaluation sheet of PT. Fertilizer Kujang is made based on Kirkpatrick's theory which consists of four levels of evaluation, namely reaction, learning, behavior, and results. At level 1, namely reaction, in the evaluation sheet is in accordance with the theory of Kirkpatrick, at level 2 that is learning should be held pretest and posttest but only made scale. At level 3, behavior, according to theory, but on assessment factor number 3, quantity and work productivity should not need to be included because they are included in level 4. At level 4, that is the result, here is still lacking to get a picture of the results of the training that has been carried out because only based on answers from superiors without evidence of any documents.   Keywords: Training Evaluation, Kirkpatrick Theory.    Penelitian ini bertujuan mengetahui evaluasi training di PT. Pupuk Kujang. PT. Pupuk Kujang merupakan perusahaan yang bergerak di bidang petrokimia. Lembar evaluasi PT. Pupuk Kujang dibuat berdasarkan teori Kirkpatrick yang terdiri dari empat level evaluasi, yaitu reaksi, learning, behavior, dan hasil. Pada level 1 yaitu reaksi, di lembar evaluasi tersebut sudah sesuai dengan teori dari Kirkpatrick, pada level 2 yaitu learning seharusnya diadakan pretest dan posttest namun hanya dibuatkan skala. Pada level 3 yaitu behavior, sudah sesuai teori namun pada faktor penilaian nomor 3 kuantitas dan produktivitas kerja semestinya tidak perlu dimasukkan karena sudah termasuk ke dalam level 4. Pada level 4 yaitu hasil, disini masih sangat kurang untuk mendapatkan gambaran hasil dari pelatihan yang sudah dilaksanakan karena hanya berdasarkan dari jawaban atasan tanpa bukti dokumen apapun.   Kata kunci: Evaluasi Pelatihan, Teori Kirkpatrick.

scholarly journals An Atmospheric Visibility Grading Method Based on Ensemble Learning and Stochastic Weight Average

Atmosphere ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 869
Author(s):  
Xiuguo Zou ◽  
Jiahong Wu ◽  
Zhibin Cao ◽  
Yan Qian ◽  
Shixiu Zhang ◽  
...  
Keyword(s):  
Ensemble Learning ◽  
Traffic Accidents ◽  
Feature Sets ◽  
Atmospheric Visibility ◽  
Average Accuracy ◽  
Level 3 ◽  
Visual Characteristics ◽  
Level 1 ◽  
Grading Model ◽  
Level 2

In order to adequately characterize the visual characteristics of atmospheric visibility and overcome the disadvantages of the traditional atmospheric visibility measurement method with significant dependence on preset reference objects, high cost, and complicated steps, this paper proposed an ensemble learning method for atmospheric visibility grading based on deep neural network and stochastic weight averaging. An experiment was conducted using the scene of an expressway, and three visibility levels were set, i.e., Level 1, Level 2, and Level 3. Firstly, the EfficientNet was transferred to extract the abstract features of the images. Then, training and grading were performed on the feature sets through the SoftMax regression model. Subsequently, the feature sets were ensembled using the method of stochastic weight averaging to obtain the atmospheric visibility grading model. The obtained datasets were input into the grading model and tested. The grading model classified the results into three categories, with the grading accuracy being 95.00%, 89.45%, and 90.91%, respectively, and the average accuracy of 91.79%. The results obtained by the proposed method were compared with those obtained by the existing methods, and the proposed method showed better performance than those of other methods. This method can be used to classify the atmospheric visibility of traffic and reduce the incidence of traffic accidents caused by atmospheric visibility.

scholarly journals Discharge against medical advice from the emergency department in a university hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feras H. Abuzeyad ◽  
Moonis Farooq ◽  
Salah Farhat Alam ◽  
Mudhaffar Ismael Ibrahim ◽  
Luma Bashmi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Small Sample ◽  
Medical Advice ◽  
University Hospital ◽  
High Risk Population ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Level 3 ◽  
Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

scholarly journals Effect of the COVID-19 pandemic on the ability of level 1 trauma centers to meet American College of Surgeons research requirements

2021 ◽  
Vol 6 (1) ◽  
pp. e000692
Author(s):  
Robert M Madayag ◽  
Erica Sercy ◽  
Gina M Berg ◽  
Kaysie L Banton ◽  
Matthew Carrick ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
American College Of Surgeons ◽  
The Usa ◽  
Virus Exposure ◽  
Level 1 ◽  
Verification Process ◽  
Question Survey

IntroductionThe COVID-19 pandemic has had major effects on hospitals’ ability to perform scientific research while providing patient care and minimizing virus exposure and spread. Many non-COVID-19 research has been halted, and funding has been diverted to COVID-19 research and away from other areas.MethodsA 28-question survey was administered to all level 1 trauma centers in the USA that included questions about how the pandemic affected the trauma centers’ ability to fulfill the volume and research requirements of level 1 verification by the American College of Surgeons (ACS).ResultsThe survey had a 29% response rate (40/137 successful invitations). Over half of respondents (52%) reported reduced trauma admissions during the pandemic, and 7% reported that their admissions dropped below the volume required for level 1 verification. Many centers diverted resources from research during the pandemic (44%), halted ongoing consenting studies (33%), and had difficulty fulfilling research requirements because of competing clinical priorities (40%).DiscussionResults of this study show a need for flexibility in the ACS verification process during the COVID-19 pandemic, potentially including reduction of the required admissions and/or research publication volumes.Level of evidenceLevel IV, cross-sectional study.

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