Abstract P147: Telestroke Software Offers Improved and Novel Methods of Studying Physician Decision Making

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Julian P Yang ◽  
Andre Grujovski ◽  
Tim Wright ◽  
Tzu-Ching Wu ◽  
DaiWai M Olson ◽  
...  
Keyword(s):  
Decision Making ◽  
Data Collection ◽  
Acute Stroke ◽  
Data Entry ◽  
Quality Of Data ◽  
Treatment Optimization ◽  
Acute Stroke Care ◽  
Web Based ◽  
Stroke Treatment ◽  
Physician Decision Making

Introduction: Data quality in stroke registries is typically dependent upon some form of chart review and manual data abstraction. The retrospective nature of this process is inherently prone to incomplete and inaccurate data collection with limited insight into the process of physician decision making. Hypothesis: New software packages accompanying telestroke systems will dramatically improve the quality of data by automating the abstraction process and providing real-time access to electronic databases. Methods: Telestroke systems provide web-based programs that record various levels of data. InTouch Technologies, Inc. currently provides StrokeRESPOND v3.0, a web-based program that facilitates telestroke consultation by organizing elements of the physician-patient encounter, including history, vitals, physical exam, laboratory results, and radiographs, and by generating a consultation note. Many data elements captured in the user interface mirror traditional metrics of acute stroke care research and can be de-identified and then directly transferred into an electronic database. The “forced choice” (aka hard-stop) design of data entry and elimination of secondhand abstraction can minimize data corruption and loss. Further, because each point of data entry and manipulation is time-stamped, powerful metadata_“data about data”_can be explored. By analyzing the sequence and patterns of clinical information entry and utilization, the actual thought process of the physician user can be investigated and provide new insights into stroke treatment. Optimization of acute stroke management, a complicated protocol, can be driven by identification of physician decision making patterns associated with multiple outcomes, including higher rates of treatment and faster treatment times. Conclusions: Specialized software programs will improve registry data collection, completeness and accuracy. The generation of metadata offers exciting, new avenues of research. Prospective stroke research using this methodology will require the collaboration of multiple academic institutions and industry partners.

scholarly journals Improving Specimen Labelling and Data Collection in Bio-science Research using Mobile and Web Applications

2020 ◽  
Vol 10 (1) ◽  
pp. 1-16
Author(s):  
Isaac Nyabisa Oteyo ◽  
Mary Esther Muyoka Toili
Keyword(s):  
Data Collection ◽  
Web Applications ◽  
Data Entry ◽  
Science Research ◽  
Quality Data ◽  
Quality Of Data ◽  
Data Entry Form ◽  
Research Activities ◽  
Daunting Task

AbstractResearchers in bio-sciences are increasingly harnessing technology to improve processes that were traditionally pegged on pen-and-paper and highly manual. The pen-and-paper approach is used mainly to record and capture data from experiment sites. This method is typically slow and prone to errors. Also, bio-science research activities are often undertaken in remote and distributed locations. Timeliness and quality of data collected are essential. The manual method is slow to collect quality data and relay it in a timely manner. Capturing data manually and relaying it in real time is a daunting task. The data collected has to be associated to respective specimens (objects or plants). In this paper, we seek to improve specimen labelling and data collection guided by the following questions; (1) How can data collection in bio-science research be improved? (2) How can specimen labelling be improved in bio-science research activities? We present WebLog, an application that we prototyped to aid researchers generate specimen labels and collect data from experiment sites. We use the application to convert the object (specimen) identifiers into quick response (QR) codes and use them to label the specimens. Once a specimen label is successfully scanned, the application automatically invokes the data entry form. The collected data is immediately sent to the server in electronic form for analysis.

scholarly journals Idea Management Systems as a Tool for Goals’ Setting & Achieving and Decision Making: Global Research Results

2021 ◽  
Vol 129 ◽  
pp. 05008
Author(s):  
Elina Mikelsone ◽  
Tatjana Volkova ◽  
Aivars Spilbergs ◽  
Elita Liela
Keyword(s):  
Decision Making ◽  
Data Analysis ◽  
Data Collection ◽  
Idea Generation ◽  
Value Added ◽  
Scientific Data ◽  
Web Based ◽  
Ongoing Research ◽  
Research Results ◽  
Idea Management

Research background: the authors have explored that there are different idea management system (IMS) application types that could be used both locally and globally for diverse reasons and expected outcomes. There is ongoing research on how IMS could be applied for manageable idea management process. But there is a question – how do these IMS types help to set and achieve goals, and improve decision making? Purpose of the article: The article aims to clarify how an external and mixed web-based IMS could be used during COVID19 time for distance idea generation sessions, as well as, to solve complex issues such as decision making, goals’ setting and reaching them based on different idea generation sources and critical reflection on those ideas of evaluators. Methods: Literature review (data collection: systematic data collection from scientific data bases; data analysis: content analysis). The survey of n>400 enterprises with web-based IMS experience globally (data collection: a survey; data analysis: statistics). Findings & Value added: this paper explores how different types of web-based IMS could be applied as a tool and support system for decision making processes in general, decisions towards goal setting and its outreach. The research results provide also a practical contribution - it could help to choose the most appropriate IMS application type to reach estimated goals and to empower decision making.

Challenges of Outcome Prediction for Acute Stroke Treatment Decisions

Stroke ◽  
2021 ◽  
Author(s):  
Mayank Goyal ◽  
Johanna Maria Ospel ◽  
Manon Kappelhof ◽  
Aravind Ganesh
Keyword(s):  
Decision Making ◽  
Acute Stroke ◽  
Acute Treatment ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Clinical Laboratory ◽  
Clinical Perspective ◽  
Stroke Treatment ◽  
Patient Will ◽  
Acute Stroke Treatment

Physicians often base their decisions to offer acute stroke therapies to patients around the question of whether the patient will benefit from treatment. This has led to a plethora of attempts at accurate outcome prediction for acute ischemic stroke treatment, which have evolved in complexity over the years. In theory, physicians could eventually use such models to make a prediction about the treatment outcome for a given patient by plugging in a combination of demographic, clinical, laboratory, and imaging variables. In this article, we highlight the importance of considering the limits and nuances of outcome prediction models and their applicability in the clinical setting. From the clinical perspective of decision-making about acute treatment, we argue that it is important to consider 4 main questions about a given prediction model: (1) what outcome is being predicted, (2) what patients contributed to the model, (3) what variables are in the model (considering their quantifiability, knowability at the time of decision-making, and modifiability), and (4) what is the intended purpose of the model? We discuss relevant aspects of these questions, accompanied by clinically relevant examples. By acknowledging the limits of outcome prediction for acute stroke therapies, we can incorporate them into our decision-making more meaningfully, critically examining their contents, outcomes, and intentions before heeding their predictions. By rigorously identifying and optimizing modifiable variables in such models, we can be empowered rather than paralyzed by them.

Abstract TMP86: Telestroke Improves Guideline-Based Comprehensive Stroke Care: The TELECAST Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christopher D Streib ◽  
Oladi Bentho ◽  
Kathryn Bard ◽  
Eric Jaton ◽  
Sarah Engkjer ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Composite Score ◽  
Stroke Recurrence ◽  
Acute Stroke Care ◽  
Specialist Service ◽  
Stroke Treatment ◽  
Chi Squared ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Limited access to stroke specialist expertise produces disparities in inpatient stroke treatment. The impact of telestroke on the remote delivery of guideline-based inpatient stroke care is yet to be comprehensively studied. The TELECAST trial (NCT03672890) prospectively examined the impact of a 24-7 telestroke specialist service dedicated to inpatient acute stroke care spanning admission to discharge. Methods: AHA stroke guidelines were used to derive outcome metrics in the following acute stroke inpatient care categories: diagnostic stroke evaluation (DSE), secondary stroke prevention (SSP), health screening and evaluation (HSE), and stroke education (SE). Adherence to AHA guidelines for stroke inpatients pre-telestroke (July 1, 2016-June 30, 2018) and post-telestroke intervention (July 1, 2018-June 30, 2019) were studied. The primary outcome was a composite score of all guideline-based stroke care. Secondary outcomes consisted of subcategory composite scores in DSE, SSP, HSE, and SE. Chi-squared tests were utilized to assess primary and secondary outcomes. Statistical analysis was performed using STATA 15.0. Results: Following institution of a comprehensive inpatient telestroke service, overall adherence to guideline-based metrics improved (composite score: 85% vs 94%, p<0.01) as did adherence to DSE guidelines (subgroup score: 90 vs 95%, p<0.01). SSP, HSE, and SE subgroup scores were not significantly different. See Table 1. Conclusion: The implementation of a 24-7 inpatient telestroke service improved adherence to AHA guidelines for inpatient acute stroke care. Dedicated inpatient telestroke specialist coverage may improve inpatient stroke care and reduce stroke recurrence in hospitals without access to stroke specialists.

Ten Years of Improving Acute Stroke Management in a Metropolitan Area: A Population-Based Quantification of Quality Indicators

2021 ◽  
pp. 1-11
Author(s):  
Anna Alegiani ◽  
Michael Rosenkranz ◽  
Leonie Schmitz ◽  
Susanne Lezius ◽  
Günter Seidel ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Quality Indicators ◽  
Metropolitan Area ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Stroke Units ◽  
Stroke Treatment ◽  
Acute Stroke Treatment ◽  
Over Time

<b><i>Background and Purpose:</i></b> Rapid access to acute stroke treatment improves clinical outcomes in patients with ischemic stroke. We aimed to shorten the time to admission and to acute stroke treatment for patients with acute stroke in the Hamburg metropolitan area by collaborative multilevel measures involving all hospitals with stroke units, the Emergency Medical Services (EMS), and health-care authorities. <b><i>Methods:</i></b> In 2007, an area-wide stroke care quality project was initiated. The project included mandatory admission of all stroke patients in Hamburg exclusively to hospitals with stroke units, harmonized acute treatment algorithms among all hospitals, repeated training of the EMS staff, a multimedia educational campaign, and a mandatory stroke care quality monitoring system based on structured data assessment and quality indicators for procedural measures. We analyzed data of all patients with acute stroke who received inhospital treatment in the city of Hamburg during the evaluation period from the quality assurance database data and evaluated trends of key quality indicators over time. <b><i>Results:</i></b> From 2007 to 2016, a total of 83,395 patients with acute stroke were registered. During this period, the proportion of patients admitted within ≤3 h from symptom onset increased over time from 27.8% in 2007 to 35.2% in 2016 (<i>p</i> &#x3c; 0.001). The proportion of patients who received rapid thrombolysis (within ≤30 min after admission) increased from 7.7 to 54.1% (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Collaborative stroke care quality projects are suitable and effective to improve acute stroke care.

Abstract 352: Early Data From an Implementation Science Study Suggests the Need for Identification and Adoption of Best Practices to Improve the Timeliness of Stroke Treatment

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Lisa M Monk
Keyword(s):  
Best Practices ◽  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Early Data ◽  
Screening Tools ◽  
Stroke Severity ◽  
Ct Scanner ◽  
Acute Stroke Care ◽  
Stroke Treatment

There is a disconnect from discovery of best treatment options and application into clinical practice in a timely manner. The I M plementation of best Pr actices f O r acute stroke care-de v eloping and optimizing regional systems of Stroke Care (IMPROVE Stroke Care) goal is to develop a regional integrated stroke system that identifies, classifies, and treats patients with acute ischemic stroke more rapidly and effectively with reperfusion therapy. These improvements in acute stroke care delivery are expected to result in lower mortality, fewer recurrent strokes, and improved long term functional outcomes. Recent discoveries in stroke care and advancement in technology extends the window for both TPA administration and mechanical thombectomy. The challenge of implementing these latest advances are difficult considering the ability of hospitals to implement the original American Heart Association (AHA) Systems of Stroke Care recommendations. Early data from this project shows that the challenges continue to exist in recommendations that have been in place as early as 2005. EMS is not utilizing pre-hospital stroke screening tools, only 5% of the time, stroke severity tools, only 7% of the time, lytic checklists, 0% of the time, destination decision changed due to severity score, 0% of the time, and pre-notifying emergency rooms, only 63% of the time. Emergency departments door to CT <45 minutes, only 55% of the time, Lytic given in CT scanner, only 35% of the time, Door to lytic therapy< 45 minutes, 77% of the time, Door to Groin puncture, 81% of the time, and Door to TICI Flow 2c/3 flow <90 minutes, 39% of the time. The Systems of Stroke Care have recommendations that will improve time to treatment and outcomes for patients. This project is working to provide tools, guidance, data, and feedback to improve application of these recommendations and identify best practices and solutions to barriers.

Informatics Applications in Neonatology

2011 ◽  
pp. 1215-1234
Author(s):  
Malcolm Battin ◽  
David Knight ◽  
Carl Kuschel
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Clinical Practice ◽  
Data Collection ◽  
Information Sources ◽  
Physiological Monitoring ◽  
Multiple Sources ◽  
Web Based ◽  
Data Intensive ◽  
Information Tools

Neonatal care is an extremely data-intensive activity. Physiological monitoring equipment is used extensively along with web-based information tools and knowledge sources. Merging data from multiple sources adds value to this data collection. Neonatal databases assist with collecting, displaying, and analyzing data from a number of sources. Although the construction of such databases can be difficult, it can provide helpful support to clinical practice including surveillance of infectious diseases and even medical error. Along with recording outcomes, such systems are extremely useful for the support of audit and quality improvement as well as research. Electronic information sources are often helpful in education and communication with parents and others, both within the unit and at a distance. Systems are beginning to be used to help with decision making – for example in the case of weaning neonates from ventilators, and this work is likely to become more important in the future.

INTEGRATING SCAT DATA AND GEOGRAPHICAL INFORMATION SYSTEMS TO SUPPORT SHORELINE CLEANUP OPERATIONS

1997 ◽  
Vol 1997 (1) ◽  
pp. 499-506 ◽  
Author(s):  
Alain Lamarche ◽  
Edward H. Owens
Keyword(s):  
Decision Making ◽  
Information System ◽  
Data Analysis ◽  
Data Collection ◽  
Software Package ◽  
Geographical Information Systems ◽  
Data Entry ◽  
Decision Makers ◽  
Geographical Information ◽  
Gis Technology

ABSTRACT An analysis of the work performed by the various teams involved in shoreline cleanup operations has been applied to the design of an approach for the integration of data collected by the SCAT process with electronic maps produced by geographical information system (GIS) technology. This has led to the implementation of a PC-based system that incorporates a database of SCAT information, a knowledge base on oil behavior and shoreline cleanup, and a GIS. The system provides support to data collection using the SCAT approach for field teams and to map-based data analysis for planners and managers. In the course of this work, a set of the maps that are considered the most useful for summarizing information about shoreline conditions was designed and evaluated. This evaluation initially involved consultation with individuals experienced in shoreline cleanup. The applicability of the map representation for decision making was further tested during spill drills. SCAT surveys generate a large volume of data that need to be captured and integrated. There is a risk that this large amount of information might overwhelm decision makers involved in the management of shoreline cleanup operations. The paper describes the various modifications that were made to the SHORECLEAN software package to provide some solutions to these problems. These include providing specialized SCAT data entry forms, automating the links between a SCAT database and a GIS, and producing map representations that provide clear, useful, and nonmisleading information for decision makers.

Development of a web-based application to improve data collection for antimicrobial point prevalence surveys in the public health care system in South Africa; findings and implications (Preprint)

2019 ◽  
Author(s):  
Natalie Schellack ◽  
Danie Kruger ◽  
Nokuthula N Dlamini ◽  
Johanna C Meyer ◽  
Brian Godman ◽  
...  
Keyword(s):  
South Africa ◽  
Data Collection ◽  
Resource Constraints ◽  
Data Entry ◽  
Ease Of Use ◽  
Point Prevalence ◽  
Public Health Care ◽  
Time Saving ◽  
Prevalence Survey ◽  
Web Based

BACKGROUND Determining antimicrobial utilization patterns in hospitals can be a challenge given personnel and resource constraints with paper based systems. A web–based application (APP) was developed in South Africa to address this, building on a recent pilot point prevalence survey (PPS) using a paper-based system. OBJECTIVE The study aim was to test and refine the develop app as well as to evaluate its ease of use and potential time saving versus paper based methods. METHODS The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection phase, the app was evaluated for functionality on all 35 variables and subsequently refined. After the data collection, the app was evaluated in terms of its time saving potential and ease of use. RESULTS 181 patient’s files were surveyed across 13 wards in the hospital, with the findings similar to the paper-based study. The median age for males was 45.5 years and the median age for females was 42 years. Overall 80 out of 181 (44%) patients received antibiotics. Whilst 38% (12 out of 31) of patients in the adult surgical ward received antimicrobials, the prevalence was the highest (78%) in the paediatric medical wards. All the data collectors were confident in using the app after training and found the tool not complex at all. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spending is important for instigating quality improvement programmes in resource limited settings. CONCLUSIONS All data collectors would recommend the app for future PPS surveys. Several concerns with data entry were identified, which have now been addressed in both the refined app as well as in future training. The app development has been successful and is now being deployed across South Africa as part of a national PPS.

Abstract WP248: Methods to Achieving a 9-minute Door to TPA Time

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Deepak S Nair ◽  
Arun Talkad ◽  
Clayton McNeil ◽  
Jan Jahnel ◽  
Teresa Swanson-Devlin ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Time Of Day ◽  
National Average ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
The Past ◽  
Stroke Center

Introduction Despite guidelines recommending “door to needle times” (DTN) of ≤60 minutes and the Target: Stroke program, the national average for stroke treatment is 79 minutes. We present the factors that have reduced DTN in our Stroke Center. Methods We retrospectively identified all patients who received IV rt-PA using our acute stroke code database, from 2007 to 2012. The patients were organized by their DTN into four groups: <20min, 20-39min, 40-59min, and ≥60min. Median NIHSS scores were calculated, along with median DTN per group and annually. We also specified median lab times, the source of the stroke code (EMS or ED), and time of day for the code. Results There were 180 patients that received IV rt-PA: 7 patients in <20min, 49 in 20-39min, 52 in 40-59min, and 72 in ≥60min. Median DTN was 14min, 30min, 46.5min, and 76min, respectively, with the overall fastest DTN being 9 minutes. Median NIHSS scores were 7, 12, 13, and 8, respectively. EMS initiated the code in 100% of the <20min cases, 45% in 20-39min, 44% in 40-59min, and 40% in ≥60min. Eighty-six percent of the <20min cases arrived during the day, as did 84% of the 20-39min, 65% of the 40-59min, and 42% of the ≥60min cases. When rt-PA was given before labs were resulted, the median DTN was 30min; otherwise, the median DTN was 54min. All cases with <20min DTN presented after May 2011, when the first such case occurred. The median DTN was 65.5min in 2007, 51min in 2008, 61min in 2009, 59.5min in 2010, 47min in 2011, and 35min in 2012. Conclusions Our experience suggests that the “Target: Stroke” strategies (EMS initiation of stroke codes, rapid triage, rt-PA before labs) can significantly reduce the time to thrombolysis. However, our significant improvement over the past two years followed a singular 13-minute DTN, which demonstrated that teamwork and passion for acute stroke care can catalyze the consistent delivery of efficient stroke treatment.

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