PP14 The feasibility and acceptability of a novel low tech intervention to improve pre-hospital data recording for pre-alert and handover to the emergency department

2019 ◽  
Vol 36 (1) ◽  
pp. e6.1-e6
Author(s):  
David Fitzpatrick ◽  
Douglas Maxwell ◽  
Alan Craigie
Keyword(s):  
Information Exchange ◽  
Significant Proportion ◽  
Data Entry ◽  
Clinical Information ◽  
Data Recording ◽  
Hospital Data ◽  
Clinical Variables ◽  
Exchange Processes ◽  
Post Test ◽  
The Impact

BackgroundPoor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality.AimsTo measure the feasibility and acceptability of a novel, low-tech intervention introduced to support clinical information recording and delivery during pre-alert and handover. The intervention consisted of a reusable card with pre-alert/handover mnemonic and corresponding text boxes for data entry via pen.MethodsA pre and post-test design was used. Paramedics (n=69) based at one city ambulance Station received the intervention. Pre-and post-test measures (12 weeks post-introduction) focussed on paramedic acceptability and utility of intervention, ED staff (n=99) perceptions of handover quality, and proportions of clinical variables documented by ED staff during pre-alert.ResultsTwenty-five (36%) paramedics responded to an intervention acceptability questionnaire. Most felt both the pre-alert (n=23 [92%]) and handover (n=18 [72%]) components of the card were ‘useful’ or ‘very useful’. Nineteen (76%) used the card to record clinical information, almost all (n=23 [92%]) felt it ‘useful’ to ‘very useful’ in supporting pre-alert. Similarly, 65% (n=16) stated they ‘often’ or ‘always’ used the card during handover. For pre-alert information there were improvements in the provision of 8/11 (72.7%) clinical variables measured. Results from the post-test survey evaluating ED staff (n=37 [37%]) perceptions of handover demonstrated perceived improvements in 3/5 domains measured (p<0.05).ConclusionThis novel low-tech intervention was highly acceptable to paramedic participants, improving their data recording and information exchange processes. Further, well conducted studies are required to test the impact of this intervention on information exchange processes.

scholarly journals Improving Access to Longitudinal Patient Health Information within an Emergency Department

2012 ◽  
Vol 03 (03) ◽  
pp. 290-300 ◽  
Author(s):  
S. Shen ◽  
D.A. Dorr ◽  
G. Hripcsak ◽  
L. Heermann ◽  
S.P. Narus ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
User Authentication ◽  
Tracking System ◽  
Clinical Information ◽  
Before And After ◽  
Patient Health ◽  
The Impact

SummaryWe designed and implemented an electronic patient tracking system with improved user authentication and patient selection. We then measured access to clinical information from previous clinical encounters before and after implementation of the system. Clinicians accessed longitudinal information for 16% of patient encounters before, and 40% of patient encounters after the intervention, indicating such a system can improve clinician access to information. We also attempted to evaluate the impact of providing this access on inpatient admissions from the emergency department, by comparing the odds of inpatient admission from an emergency department before and after the improved access was made available. Patients were 24% less likely to be admitted after the implementation of improved access. However, there were many potential confounders, based on the inherent pre-post design of the evaluation. Our experience has strong implications for current health information exchange initiatives.

Cerner Millennium™: The Innsbruck Experience

2003 ◽  
Vol 42 (01) ◽  
pp. 08-15 ◽  
Author(s):  
K.-P. Pfeiffer ◽  
I. Wilhelmy ◽  
M. Ball ◽  
G. Lechleitner
Keyword(s):  
Information System ◽  
Information Exchange ◽  
Security Policy ◽  
Clinical Information System ◽  
Data Entry ◽  
Clinical Information ◽  
Discharge Summary ◽  
University Hospital ◽  
Free Text ◽  
European Healthcare

Summary Objectives: A Clinical Information System, serving more than 2,000 users was to be implemented at three hospitals of TILAK (Tiroler Landeskrankenanstalten GmbH), including the University Hospital of Innsbruck. The system was intended to integrate data from radiology, laboratory, and pathology subsystems with patient data. Methods: Using Cerner Millennium™ software and Health Level 7 standards, the first stage of an Electronic Patient Record (EPR) was built. Direct data entry was facilitated using either a Microsoft Word text processor (with subsequent authentication workflow) or structured forms. An enterprise-wide scheduling module allows coordination and storage of patient appointments directly in the EPR. As required by security policy, the Cerner software regulates the varying degrees of information exchange among organizations and departments within the enterprise. Results: First experiences indicate satisfactory acceptance of system functionalities. The introduction of Cerner Millennium at TILAK has achieved essential goals defined at the beginning of the project. Basic functionalities – free text documentation, standardized documentation, scheduling, and some parts of order entry – are offered in a user friendly manner. Integration with existing systems to complete the EPR has been successful using standard interfaces (HL7). Conclusion: TILAK concluded that it was possible to successfully implement a Clinical Information System (CIS) developed mainly for the American market in a European healthcare environment. Some adaptations and functional extensions were necessary (e.g., the discharge summary “Arztbrief”). The system had enough flexibility to meet the requirements and specifications of European healthcare processes. A key factor of success was the establishment of a basic level of understanding and communication between the software vendor and the TILAK user community.

Impact of genetic reclassification on ARVC diagnosis based on the 2010 task force criteria

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Costa ◽  
A Gasperetti ◽  
D Akdis ◽  
G Suna ◽  
A Medeiros Domingo ◽  
...  
Keyword(s):  
Genetic Variants ◽  
Genetic Variant ◽  
Task Force ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Significant Proportion ◽  
Clinical Information ◽  
University Hospital ◽  
Funding Source ◽  
Cascade Screening ◽  
The Impact

Abstract Introduction Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is an inherited condition, which is associated with potentially life-threatening ventricular arrhythmias in the young. Approximately 60% of patients carry a possibly disease-causing genetic variant. Purpose The aim of this study was to investigate the impact of the 2015 American College of Medical Genetics (ACMG) Criteria on ARVC diagnosis based on the 2010 Modified Task Force Criteria (TFC). Methods The study included 79 patients from the Swiss ARVC Registry who harbored a genetic variant deemed to be associated with the disease at initial screening, and classified them as definite, borderline or possible ARVC. Every variant found was re-classified on Varsome Genetics, based on the 2015 ACMG Criteria. Clinical information was then assessed at last available follow-up of every patient and ARVC diagnosis was reclassified based on the newest genetic evidence available. Results In 42 out of 79 patients (53.2%), genetic variants were reclassified. Out of these, 33 variants (41.8%) were downgraded from pathogenic (P) / likely pathogenic (LP) to either variants of unknown significance (VUS) or benign (B) / likely benign (LB). Three patients (3.8%) were upgraded from VUS / LP to P. Out of the 12 variants initially classified as VUS, 9 (75%) were reclassified as B or LB. Overall, 13 patients (16.5%) were downgraded from their initial diagnosis (11 from definite to borderline and 2 from borderline to possible). Conclusion A significant proportion of patients with ARVC diagnosed based on the 2010 TFC were reclassified when the 2015 ACMG Criteria were taken into consideration. These findings may have clinical consequences, particularly for genetic cascade screening of family members of ARVC patients and necessitate reassessment of genetic variants of index patients who were previously diagnosed with ARVC. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University Hospital Zurich

Implicit and explicit corrective feedback and feedback exposure conditions

2020 ◽  
Vol 4 (1) ◽  
pp. 3-48
Author(s):  
Takehiro Iizuka ◽  
Kimi Nakatsukasa
Keyword(s):  
Explicit Knowledge ◽  
Corrective Feedback ◽  
Significant Difference ◽  
Oral Corrective Feedback ◽  
Post Test ◽  
Picture Description ◽  
Potential Factors ◽  
Implicit And Explicit ◽  
Instructional Settings ◽  
The Impact

This exploratory study examined the impact of implicit and explicit oral corrective feedback (CF) on the development of implicit and explicit knowledge of Japanese locative particles (activity de, movement ni and location ni) for those who directly received CF and those who observed CF in the classroom. Thirty-six college students in a beginning Japanese language course received either recast (implicit), metalinguistic (explicit) or no feedback during an information-gap picture description activity, and completed a timed picture description test (implicit knowledge) and an untimed grammaticality judgement test (explicit knowledge) in a pre-test, immediate post-test and delayed post-test. The results showed that overall there was no significant difference between CF types, and that CF benefited direct and indirect recipients similarly. Potential factors that might influence the effectiveness of CF, such as instructional settings, complexity of target structures and pedagogy styles, are discussed.

Implication of Medical Treatment for Surgical Strategies in IBD

2019 ◽  
Vol 20 (13) ◽  
pp. 1363-1368
Author(s):  
Krisztina B. Gecse ◽  
Christianne J. Buskens
Keyword(s):  
Nutritional Status ◽  
Medical Treatment ◽  
Significant Proportion ◽  
Timing Of Surgery ◽  
Multidisciplinary Management ◽  
Key Factors ◽  
Surgical Strategies ◽  
Immunosuppressive Medications ◽  
Medical Paradigm ◽  
The Impact

Despite changing medical paradigm, still a significant proportion of patients with IBD require surgery. The patient&#039;s general condition, including nutritional status and the use of immunosuppressive medications is of great importance with regard to surgical complications, as well as the choice of optimal surgical strategy. The indication and the timing of surgery are key factors for the multidisciplinary management of IBD patients. The purpose of this review is to provide an overview on the impact of medical treatment on surgical strategies in IBD.

The impact of algorithmic decision-making processes on young people’s well-being (Preprint)

2019 ◽  
Author(s):  
Elvira Perez Vallejos ◽  
Liz Dowthwaite ◽  
Helen Creswich ◽  
Virginia Portillo ◽  
Ansgar Koene ◽  
...  
Keyword(s):  
Young People ◽  
Significant Proportion ◽  
Well Being ◽  
Early Years ◽  
Negative Experiences ◽  
Children And Young People ◽  
Online Platforms ◽  
Internet Users ◽  
Decision Making Processes ◽  
The Impact

BACKGROUND Algorithms rule the online environments and are essential for performing data processing, filtering, personalisation and other tasks. Research has shown that children and young people make up a significant proportion of Internet users, however little attention has been given to their experiences of algorithmically-mediated online platforms, or the impact of them on their mental health and well-being. The algorithms that govern online platforms are often obfuscated by a lack of transparency in their online Terms and Conditions and user agreements. This lack of transparency speaks to the need for protecting the most vulnerable users from potential online harms. OBJECTIVE To capture young people's experiences when being online and perceived impact on their well-being. METHODS In this paper, we draw on qualitative and quantitative data from a total of 260 children and young people who took part in a ‘Youth Jury’ to bring their opinions to the forefront, elicit discussion of their experiences of using online platforms, and perceived psychosocial impact on users. RESULTS The results of the study revealed the young people’s positive as well as negative experiences of using online platforms. Benefits such as being convenient and providing entertainment and personalised search results were identified. However, the data also reveals participants’ concerns for their privacy, safety and trust when online, which can have a significant impact on their well-being. CONCLUSIONS We conclude by making recommendations that online platforms acknowledge and enact on their responsibility to protect the privacy of their young users, recognising the significant developmental milestones that this group experience during these early years, and the impact that technology may have on them. We argue that governments need to incorporate policies that require technologists and others to embed the safeguarding of users’ well-being within the core of the design of Internet products and services to improve the user experiences and psychological well-being of all, but especially those of children and young people. CLINICALTRIAL N/A

The Relationship Between Highly Visual Social Media and Young People’s Mental Health: A Scoping Review (Preprint)

2020 ◽  
Author(s):  
Alanna McCrory
Keyword(s):  
Mental Health ◽  
Social Media ◽  
Young People ◽  
Scoping Review ◽  
Quantitative Methods ◽  
Grey Literature ◽  
Significant Proportion ◽  
Mental Wellbeing ◽  
Published Evidence ◽  
The Impact

UNSTRUCTURED Users of highly visual social media (HVSM), such as Snapchat and Instagram, share their messages through images, rather than relying on words. A significant proportion of people that use these platforms are adolescents. Previous research reveals mixed evidence regarding the impact of online social technologies on this age group’s mental wellbeing, but it is uncertain whether the psychological effects of visual content alone differ from text-driven social media. This scoping review maps existing literature that has published evidence about highly visual social media, specifically its psychological impact on young people. Nine electronic databases and grey literature from 2010 until March 2019 were reviewed for articles describing any aspect of visual social media, young people and their mental health. The screening process retrieved 239 articles. With the application of eligibility criteria, this figure was reduced to 25 articles for analysis. Results indicate a paucity of data that exclusively examines HVSM. The predominance of literature relies on quantitative methods to achieve its objectives. Many findings are inconsistent and lack the richness that qualitative data may provide to explore the reasons for theses mixed findings.

scholarly journals Relative contributions of family history and a polygenic risk score on COPD and related outcomes: COPDGene and ECLIPSE studies

2020 ◽  
Vol 7 (1) ◽  
pp. e000755
Author(s):  
Matthew Moll ◽  
Sharon M. Lutz ◽  
Auyon J. Ghosh ◽  
Phuwanat Sakornsakolpat ◽  
Craig P. Hersh ◽  
...  
Keyword(s):  
Family History ◽  
Risk Score ◽  
Characteristic Curve ◽  
Significant Proportion ◽  
Chronic Obstructive ◽  
Polygenic Risk Score ◽  
Positive Interaction ◽  
Polygenic Risk ◽  
Mediation Analyses ◽  
The Impact

IntroductionFamily history is a risk factor for chronic obstructive pulmonary disease (COPD). We previously developed a COPD risk score from genome-wide genetic markers (Polygenic Risk Score, PRS). Whether the PRS and family history provide complementary or redundant information for predicting COPD and related outcomes is unknown.MethodsWe assessed the predictive capacity of family history and PRS on COPD and COPD-related outcomes in non-Hispanic white (NHW) and African American (AA) subjects from COPDGene and ECLIPSE studies. We also performed interaction and mediation analyses.ResultsIn COPDGene, family history and PRS were significantly associated with COPD in a single model (PFamHx <0.0001; PPRS<0.0001). Similar trends were seen in ECLIPSE. The area under the receiver operator characteristic curve for a model containing family history and PRS was significantly higher than a model with PRS (p=0.00035) in NHWs and a model with family history (p<0.0001) alone in NHWs and AAs. Both family history and PRS were significantly associated with measures of quantitative emphysema and airway thickness. There was a weakly positive interaction between family history and the PRS under the additive, but not multiplicative scale in NHWs (relative excess risk due to interaction=0.48, p=0.04). Mediation analyses found that a significant proportion of the effect of family history on COPD was mediated through PRS in NHWs (16.5%, 95% CI 9.4% to 24.3%), but not AAs.ConclusionFamily history and the PRS provide complementary information for predicting COPD and related outcomes. Future studies can address the impact of obtaining both measures in clinical practice.

Improvement in psychological wellbeing among adolescents with a substance use disorder attending an outpatient treatment programme

2021 ◽  
pp. 1-8
Author(s):  
N.M. Gamage ◽  
C. Darker ◽  
B.P. Smyth
Keyword(s):  
Substance Use ◽  
Psychological Symptoms ◽  
Significant Proportion ◽  
Cannabis Use ◽  
Psychological Wellbeing ◽  
Substance Use Treatment ◽  
Disruptive Behaviour ◽  
Treatment Programme ◽  
The Impact

Objectives: Adolescents with substance use disorders (SUDs) exhibit high rates of comorbid psychological problems. This study aimed to examine the impact of an outpatient substance use treatment programme upon the psychological wellbeing of adolescents. Methods: A prospective study was carried out examining psychological symptoms in a group of adolescents attending the Youth Drug and Alcohol (YoDA) Addiction Service in Dublin. Participants were treated with evidenced based psychological models such as cognitive behavioural therapy, motivational interviewing and systemic family therapy. The Becks Youth Inventory was utilised to assess psychological symptoms at treatment entry and repeated three months later at follow up. Results: Among 36 adolescents who were included in this study, poly-substance misuse was the norm. Almost three-quarter had a cannabis use disorder (CUD). There were significant reductions in mean subscale scores of depression (56.0 to 50.8, p = 0.003), anger (55.2 to 49.5, p < 0.001) and disruptive behaviour (61.6 to 56.5, p = 0.002) at follow up. Although there wasn’t a statistically significant reduction in mean scores for anxiety, we observed a significant proportion of participants (p = 0.008) improving and moving out of a moderate to severe symptom range when examined by category. This was also the case for self-concept (p = 0.04). Furthermore this study revealed a positive correlation between the reduction in days of cannabis use and reduction in depressive scores (Pearson correlation 0.49, p = 0.01) among those with a CUD. Conclusion: The findings indicate that substance use treatment for adolescents is associated with important psychological and behavioural improvements.

scholarly journals Prostate cancer and the human papilloma virus: causative association, role of vaccines, and the impact of the COVID-19 pandemic

2021 ◽  
Author(s):  
Naomi Morka ◽  
Joseph M. Norris ◽  
Mark Emberton ◽  
Daniel Kelly
Keyword(s):  
Prostate Cancer ◽  
Human Papilloma Virus ◽  
Hpv Vaccination ◽  
Significant Proportion ◽  
Vaccine Uptake ◽  
Papilloma Virus ◽  
Vaccination Campaigns ◽  
The Impact ◽  
Hpv Vaccine Uptake

AbstractProstate cancer affects a significant proportion of men worldwide. Evidence from genetic and clinical studies suggests that there may be a causal association between prostate cancer and the human papilloma virus (HPV). As HPV is a vaccine-preventable pathogen, the possibility of a role in prostate cancer causation may reinforce the importance of effective HPV vaccination campaigns. This is of particular relevance in light of the COVID-19 pandemic, which may have considerable effects on HPV vaccine uptake and distribution.

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