scholarly journals P26 Pharmacy discharge service to facilitate early discharges and to improve the quality of electronic discharge letters (EDL’s)

2020 ◽  
Vol 105 (9) ◽  
pp. e19.2-e20
Author(s):  
Sonal Ladani ◽  
Mohammed AbouDaya ◽  
William Thornhill ◽  
Nanna Christiansen
Keyword(s):  
Electronic Patient Record ◽  
Electronic System ◽  
Discharge Process ◽  
Medical Team ◽  
Related Information ◽  
Written Information ◽  
Complex Patients ◽  
Medical Teams ◽  
Discharge Prescription

AimThe current discharge process on the paediatric wards involves transcribing medications from one electronic system to another, this has led to errors and compromises patient safety. Discharges are also sometimes delayed due to patients waiting for their medications. The newly implemented discharge service involves pharmacists working closely with the medical team to identify patients for discharge as early as possible and to accurately transcribe medications onto the electronic patient record (EPR).MethodThe pharmacist would attend the consultant-led morning handover or would liaise with the nurse in charge on the ward to establish discharges and transfers for that day or over the weekend if on a Friday. The most urgent discharges and any complex patients were prioritised. The EPR system would be used to generate the EDL’s, transcribe the medicines for discharge and add any other relevant written information. Any medication related issues would be clarified with the medical team. The prescription would be handed over to the medical team to be reviewed and signed. This would then be dispensed and checked by the pharmacy team. The patient/parent or carer would be counselled on their medications. Data was collected from November 2018 – March 2019, this included time informed about discharge, time EDL started, time EDL printed and time EDL completed. Other data collected included if any additional written information was provided to the GP and if any amendments were required after the doctor had reviewed the prescription. The data was inputted into an Excel spreadsheet and was compared against August – October 2018.Results152 discharge prescriptions were included in the service. The data was compared to the data from August – October 2018 which showed more than double of the prescriptions were completed in the morning between 9am-12noon (compared to 12noon-5.30pm) since the service started. Less prescription needed amendments at the point of screening and more prescriptions included additional medication related information. The quality of the prescriptions had improved and completing prescriptions earlier meant timely discharges, improved bed utilisation and improved patient quality. Positive feedback was given by patients, doctors and nurses as well as the rest of the ward teams.ConclusionCommunication has improved between the hospital and community care, as well as patient satisfaction and bed availability. A future development would be to introduce prescribing pharmacists within medical teams to streamline the discharge prescription process further, freeing up medical time and increasing the focus on medicines optimisation for all patients.

Mass-Casualty Training Exercise Using High-Fidelity Computerized Simulators and Involving Time and Resource Limitation

2021 ◽  
Vol 36 (3) ◽  
pp. 313-320
Author(s):  
Phillip A. Jacobson ◽  
Paul N. Severin ◽  
Dino P. Rumoro ◽  
Shital Shah
Keyword(s):  
Health Care ◽  
Resource Limitation ◽  
Mass Casualty ◽  
Health Care Personnel ◽  
High Fidelity ◽  
Medical Team ◽  
Training Exercise ◽  
The Mean ◽  
Medical Teams

AbstractPurpose:Training emergency department (ED) personnel in the care of victims of mass-casualty incidents (MCIs) is a highly challenging task requiring unique and innovative approaches. The purpose of this study was to retrospectively explore the value of high-fidelity simulators in an exercise that incorporates time and resource limitation as an optimal method of training health care personnel in mass-casualty care.Methods:Mass-casualty injury patterns from an explosive blast event were simulated for 12 victims using high-fidelity computerized simulators (HFCS). Programmed outcomes, based on the nature of injuries and conduct of participants, ranged from successful resuscitation and survival to death. The training exercise was conducted five times with different teams of health care personnel (n = 42). The exercise involved limited time and resources such as blood, ventilators, and imaging capability. Medical team performance was observed and recorded. Following the exercise, participants completed a survey regarding their training satisfaction, quality of the exercise, and their prior experiences with MCI simulations. The Likert scale responses from the survey were evaluated using mean with 95% confidence interval, as well as median and inter-quartile range. For the categorical responses, the frequency, proportions, and associated 95% confidence interval were calculated.Results:The mean rating on the quality of experiences related trainee survey questions (n = 42) was between 4.1 and 4.6 on a scale of 5.0. The mean ratings on a scale of 10.0 for quality, usefulness, and pertinence of the program were 9.2, 9.5, and 9.5, respectfully. One hundred percent of respondents believed that this type of exercise should be required for MCI training and would recommend this exercise to colleagues. The five medical team (n = 5) performances resulted in the number of deaths ranging from two (including the expectant victims) to six. Eighty percent of medical teams attempted to resuscitate the “expectant” infant and exhausted the O- blood supply. Sixty percent of medical teams depleted the supply of ventilators. Forty percent of medical teams treated “delayed” victims too early.Conclusion:A training exercise using HFCS for mass casualties and employing limited time and resources is described. This exercise is a preferred method of training among participating health care personnel.

Arrangement of Archives of Cloud Computing Based and Utilization of Microsoft Access

2018 ◽  
Vol 1 ◽  
pp. 198
Author(s):  
Lusy Tunik Muharlisiani ◽  
Henny Sukrisno ◽  
Emmy Wahyuningtyas ◽  
Shofiya Syidada ◽  
Dina Chamidah
Keyword(s):  
Cloud Computing ◽  
Public Service ◽  
Human Life ◽  
Electronic System ◽  
Main Function ◽  
Scientific Publications ◽  
Data Manipulation ◽  
Administrative Management ◽  
Microsoft Access

Service at the “Kelurahan” is a very important part in determining the success of development, especially in public service. The problem faced is the lack of skill level of the “Kelurahan” apparatus with the more dynamic demands of the community and the archive management system is still conventional and manual that is writing the identity of the archive into the book agenda, expedition, control card, and borrowed archive card, so it takes a more practical electronic system, effective and efficient so required to develop themselves in order to improve public services. Conventional administration and archive management must be transformed into cloud-based computing (digital), for which archiving managers should always be responsive and follow these developments and wherever possible in order to utilize for archival activities, with greater access expected archives are evidence at once able to talk about historical facts and events and be able to give meaning and benefit to human life, so archives that were only visible and readable at archival centers can now be accessed online, and even their services have led to automated service systems. Using Microsoft Access which its main function is to handle the process of data manipulation and manufacture of a system, this system is built so that the bias runs on Cloud which means Cloud itself is a paradigm in which information is permanently stored on servers on the internet and stored. The purpose of this program is the implementation of administrative management that has been based cloud computing (digital) and is expected to be a solution in managing the archive so that if it has been designed and programmed, it can be stored in the computer and benefi- cial to the “Kelurahan” apparatus and add in the field of management archives in the form of improving the quality of service to the community, can facilitate and scientific publications.

Training Package for Emergency Medical Teams Deployed to Disaster Stricken Areas: Has ‘TEAMS’ Achieved its Goals?

2021 ◽  
pp. 1-7
Author(s):  
Moran Bodas ◽  
Kobi Peleg ◽  
Bruria Adini ◽  
Luca Ragazzoni
Keyword(s):  
Self Efficacy ◽  
Training Programs ◽  
Team Work ◽  
Pilot Training ◽  
Perceived Needs ◽  
Training Package ◽  
Emergency Medical ◽  
Field Team ◽  
Medical Teams

Abstract In spite of their good intentions, Emergency Medical Teams (EMTs) were relatively disorganized for many years. To enhance the efficient provision of EMT’s field team work, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established. The purpose of this study was to assess the effectiveness and quality of the TEAMS training package in 2 pilot training programs in Germany and Turkey. A total of 19 German and 29 Turkish participants completed the TEAMS training package. Participants were asked to complete a set of questionnaires designed to assess self-efficacy, team work, and quality of training. The results suggest an improvement for both teams’ self-efficacy and team work. The self-efficacy scale improved from 3.912 (± 0.655 SD) prior to training to 4.580 (± 0.369 SD) after training (out of 5). Team work improved from 3.085 (± 0.591 SD) to 3.556 (± 0.339 SD) (out of 4). The overall mean score of the quality of the training scale was 4.443 (± 0.671 SD) (out of 5). In conclusion, The TEAMS Training Package for Emergency Medical Teams has been demonstrated to be effective in promoting EMT team work capacities, and it is considered by its users to be a useful and appropriate tool for addressing their perceived needs.

Do we achieve the Montgomery standard for consent in orthopaedic surgery?

2021 ◽  
pp. 1-7
Author(s):  
Xenia N Tonge ◽  
Henry Crouch-Smith ◽  
Vijay Bhalaik ◽  
William D Harrison
Keyword(s):  
Treatment Options ◽  
Information Provision ◽  
Common Source ◽  
Health Board ◽  
Improvement Project ◽  
Specific Patient ◽  
Written Information ◽  
Orthopaedic Patients ◽  
Recorded Data

Aims/Background The Montgomery v Lanarkshire Health Board (2015) case set a precedent that has driven the modernisation of consenting practice. Failure to demonstrate informed consent is a common source of litigation. This quality improvement project aimed to provide pragmatic guidance for surgeons on consent and to improve the patient experience during decision making. Methods Elective orthopaedic patients were assessed and the quality of documented consent was recorded. Data were collected over two discrete cycles, with cycle 1 used as a baseline in practice. The following criteria were reviewed: grade of consenting clinician, alternative treatment options, description of specific risks, place and timing of consent and whether the patient received written information or a copied clinic letter. Cycle 1 results were presented to clinicians; a teaching session was provided for clinicians on the standard of consent expected and implementation of a change in practice was established with a re-audit in cycle 2. Results There were 111 patients included in cycle 1, and 96 patients in cycle 2. Consent was undertaken mostly by consultants (54%). Specific patient risks were documented in 50% of patients in cycle 1 and 60% in cycle 2. Risks associated with a specific procedure were documented in 42% in cycle 1 and 76% in cycle 2, alternative options in 48% (cycle 1) and 66% (cycle 2). A total of 14% of patients in cycle 1 and 8% in cycle 2 had documented written information provision. Copied letters to patients was only seen in 12% of all cycles. Documentation from dedicated consenting clinics outperformed standard clinics. Conclusions Highlighting poor documentation habits and refining departmental education can lead to improvements in practice. The use of consenting clinics should be considered and clinicians should individually reflect on how to address their own shortcomings. Other units should strongly consider a similar audit. This article provides stepwise advice to improve consent and specifics from which to audit.

Assessment of high school textbooks addressing radiations

2021 ◽  
Author(s):  
S. Economides ◽  
K. Karfopoulos ◽  
E. Mestousi ◽  
P. Founta ◽  
E. Carinou ◽  
...  
Keyword(s):  
High School ◽  
High School Teachers ◽  
Safety Culture ◽  
Online Survey ◽  
Early Age ◽  
School Teachers ◽  
Quality Of Information ◽  
Related Information ◽  
Different Types

Exposure to different types of radiation is an integral part of everyday life (e.g. cosmic radiation, radon, medical applications, cell phones, etc.). Therefore, the general public should adequately be informed on the issue from an early age in order to develop a realistic understanding of the associated risks and the necessary safety culture. In this respect, the quality of the related information provided in the school textbooks is of great importance. The present work demonstrates a quantified assessment of high school textbooks regarding the information on different radiation-related topics provided to students. The assessment was carried out based on an anonymous online survey with the participation of a total of 347 high school teachers. According to the results of the survey, the high school textbooks address radiation issues in a sparse, occasional, and fragmentary manner. Moreover, the results indicate that the quality of information they provide was judged as unsatisfactory in terms of scientific correctness, completeness, clarity-comprehensiveness and objectivity. Radiation protection and applications of non-ionizing radiation are the topics that are covered to a lesser extent in the textbooks and curricula evaluated.

Challenges of Telemonitoring Programs for Complex Chronic Conditions: A Randomized Controlled Trial with an Embedded Qualitative Study (Preprint)

2021 ◽  
Author(s):  
Patrick Ware ◽  
Amika Shah ◽  
Heather Joan Ross ◽  
Alexander Gordon Logan ◽  
Phillip Segal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Decision Support ◽  
Chronic Conditions ◽  
Controlled Trial ◽  
Self Care ◽  
Randomized Controlled ◽  
Complex Patients ◽  
Secondary Outcomes

BACKGROUND Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on the use of telemonitoring in this population, particularly those with multiple chronic conditions (MCCs). OBJECTIVE This randomized controlled trial (RCT) and embedded qualitative study aimed to evaluate the impact and experiences of patients and healthcare providers (HCPs) using a telemonitoring system with decision support to manage complex patients, including those with MCCs, compared to the standard of care. METHODS A pragmatic 6-month RCT sought to recruit 146 patients with a diagnosis of heart failure (HF), uncontrolled hypertension (HT), and/or insulin requiring diabetes (DM) from outpatient specialty settings in Toronto, Canada. Participants were randomized into the control and telemonitoring groups with the latter being instructed to take readings relevant to their condition(s). The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status as measured by the SF-36. Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported healthcare utilization. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group were interviewed about their experiences RESULTS A total of 96 patients were recruited and randomized. Recruitment was terminated early due to implementation challenges and the onset of COVID-19. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of HF patients found improvements in self-care maintenance (P=.036) and physical quality of life (P= .046). Opinions expressed by the 5 HCPs and 13 patients interviewed differed based on the condition(s) monitored. Although HF patients reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care, and the design of the decision support whereby it was indicated that fluctuations in HT and DM patient status typically required less urgent intervention compared to HF. CONCLUSIONS Consistent with previous studies, we recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary, but not sufficient components of such programs for complex patients with lower acuity. We conclude that a multidisciplinary model of care that includes care coordination must accompany telemonitoring systems which may best be operationalized through novel models of care, such as nurse-led models. CLINICALTRIAL ClinicalTrials.gov NCT03127852, ISRCTN (41238563) INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.8367

Blockchain for Governance of Sustainability Transparency in the Global Energy Value Chain: Part 2, Reconciling the Technology/Regulation Mismatch

2021 ◽  
Vol 2 (1) ◽  
pp. 22-50
Author(s):  
Lauren Downes ◽  
Chris Reed
Keyword(s):  
Value Chain ◽  
Regulatory Change ◽  
The European Union ◽  
Regulatory Requirements ◽  
Global Energy ◽  
Energy Value ◽  
Related Information ◽  
Governance Model ◽  
Regulatory Frameworks

In this second part of a two-part article we continue our consideration of how global energy value chains could be managed more sustainably through blockchain by greatly increasing transparency. The aim is to use this transparency to incentivise more sustainable behaviour on the part both of energy producers and suppliers and of consumers. Incentives of this kind are market based, and so we have concentrated on market-based instruments in the energy sector, emphasising those that decrease the CO2 footprint of energy consumption, such as emissions trading schemes and renewable energy certificates. Blockchain can enhance transparency by improving the quality of, and access to, sustainability-related information. However, existing laws and regulatory frameworks that govern market-based instruments may prevent these benefits from becoming fully realised. We review the governance frameworks of market-based instruments in several international jurisdictions (Brazil, India, Kazakhstan, Mexico, South Africa and Ukraine, as well as the European Union with particular reference to the Netherlands and United Kingdom (which was a member of the EU at the time of this writing), to ascertain how laws, rules and regulations may limit transparency of sustainability information. We also consider jurisdictional differences to identify difficulties in the creation of a global framework for managing sustainability information from market-based instruments. Jurisdictional differences mean that a one-size fits all solution may not be possible. To overcome this, we propose a blockchain governance model, using aggregated blockchains and peering agreements. It allows flexibility when disclosing information, through layering of permissions, and this means that it should be possible to construct a transparency system which complies with existing domestic legal and regulatory requirements, rather than requiring major legal and regulatory change.

scholarly journals A Review: Mealtime Difficulties following Frontotemporal Lobar Degeneration

2018 ◽  
Vol 46 (5-6) ◽  
pp. 285-297 ◽  
Author(s):  
Courtney Lewis ◽  
Mark Walterfang ◽  
Dennis Velakoulis ◽  
Adam P. Vogel
Keyword(s):  
Eating Behavior ◽  
Frontotemporal Lobar Degeneration ◽  
Eating Behaviors ◽  
Behavioral Changes ◽  
Individual Care ◽  
Swallowing Difficulties ◽  
Potential Impact ◽  
Medical Teams ◽  
Late Stages

Background: Frontotemporal lobar degeneration (FTLD) can result in a decline in behavior, language, and motor function. Mealtime disturbances are a common and significant outcome of FTLD. Disturbances during mealtimes can arise from dysphagia or may occur secondary to behavioral changes such as rapid eating, mealtime rigidity, and altered diet preferences. Summary: Few studies have comprehensively evaluated eating behavior or dysphagia in individuals presenting with FTLD pathology despite the potential impact on medical safety and individual quality of life. Dysphagia is reported in the late stages of frontotemporal dementia and early in the motor subtypes of FTLD. The identification of dysphagia can alert individuals and medical teams to disease progression and provide insight into the nature and spread of the underlying neuropathology. Improved understanding of eating behaviors can improve individual care and may enhance diagnostic accuracy. Key Message: Aberrant eating behavior and swallowing difficulties are reported in the conditions associated with FTLD neuropathology. The consequences of mealtime disturbances include health risks associated with an increased BMI and aspiration, reduction of an individual’s independence, and an increase in caregiver stress and burden. Here we review and summarize the literature on eating behavior and swallow impairments (dysphagia) in each of the syndromes caused by FTLD.

scholarly journals Pulmonary Embolism Response Teams: A Novel Approach for the Care of Complex Patients With Pulmonary Embolism

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 48S-55S ◽  
Author(s):  
Mateo Porres–Aguilar ◽  
Javier E. Anaya-Ayala ◽  
Gustavo A. Heresi ◽  
Belinda N. Rivera-Lebron
Keyword(s):  
Pulmonary Embolism ◽  
The United States ◽  
Cardiovascular Death ◽  
Pulmonary Embolectomy ◽  
Systemic Thrombolysis ◽  
Cardiopulmonary Support ◽  
Novel Approach ◽  
Adoption And Implementation ◽  
Complex Patients

Pulmonary embolism represents the third most common cause of cardiovascular death in the United States. Reperfusion therapeutic strategies such as systemic thrombolysis, catheter directed therapies, surgical pulmonary embolectomy, and cardiopulmonary support devices are currently available for patients with high- and intermediate-high–risk pulmonary embolism. However, deciding on optimal therapy may be challenging. Pulmonary embolism response teams have been designed to facilitate multidisciplinary decision-making with the goal to improve quality of care for complex cases with pulmonary embolism. Herein, we discuss the current role and strategies on how to leverage the strengths from pulmonary embolism response teams, its possible worldwide adoption, and implementation to improve survival and change the paradigm in the care of a potentially deadly disease.

scholarly journals Does the packaging of health information affect the assessment of its reliability? A randomized controlled trial protocol

2021 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Leela Raj ◽  
Denise Smith ◽  
James Heilman
Keyword(s):  
Health Information ◽  
Controlled Trial ◽  
Online Health Information ◽  
Plain Language ◽  
Double Blind ◽  
University Campuses ◽  
University Of Oxford ◽  
Written Information ◽  
Significant Difference

Background Wikipedia is frequently used as a source of health information. However, the quality of its content varies widely across articles. The DISCERN tool is a brief questionnaire developed in 1996 by the Division of Public Health and Primary Health Care of the Institute of Health Sciences of the University of Oxford. They claim it provides users with a valid and reliable way of assessing the quality of written information. However, the DISCERN instrument’s reliability in measuring the quality of online health information, particularly whether or not its scores are affected by reader biases about specific publication sources, has not yet been explored. Methods This study is a double-blind randomized assessment of a Wikipedia article versus a BMJ literature review using a modified version of the DISCERN tool. Participants will include physicians and medical residents from four university campuses in Ontario and British Columbia and will be randomized into one of four study arms. Inferential statistics tests (paired t-test, multi-level ordinal regression, and one-way ANOVA) will be conducted with the data collected from the study. Outcomes The primary outcome of this study will be to determine whether a statistically significant difference in DISCERN scores exists, which could suggest whether or not how health information is packaged influences how it is assessed for quality. Plain Language Summary The internet, and in particular Wikipedia, is an important way for professionals, students and the public to obtain health information. For this reason, the DISCERN tool was developed in 1996 to help users assess the quality of the health information they find. The ability of DISCERN to measure the quality of online health information has been supported with research, but the role of bias has not necessarily been accounted for. Does how the information is packaged influence how the information itself is evaluated? This study will compare the scores assigned to articles in their original format to the same articles in a modified format in order to determine whether the DISCERN tool is able to overcome bias. A significant difference in ratings between original and inverted articles will suggest that the DISCERN tool lacks the ability to overcome bias related to how health information is packaged.

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