Abstract 234: The Variability of Visual Assessment of Traditional Capillary Refill Measurement

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Koichiro Shinozaki ◽  
Kota Saeki ◽  
Lee Jacobson ◽  
Julianne Falotico ◽  
Timmy Li ◽  
...  
Keyword(s):  
Patient Information ◽  
Healthcare Providers ◽  
Visual Assessment ◽  
Video Camera ◽  
Clinical Situation ◽  
Capillary Refill ◽  
Video Assessment ◽  
Software Analysis ◽  
Observer Reliability ◽  
Acceptable Method

Objective: Capillary refill time (CRT) measured at the bedside is widely promulgated as an acceptable method to identify patients in shock. However, inter-observer reliability of CRT visual assessments is questionable. To investigate the variability that occurs when healthcare providers (HCP) visually assess CRT, we conducted a study in the emergency department (ED) that simultaneously measured CRT while recording the change in the patients’ fingertip color by video. Methods: Three HCPs were selected to perform manual CRT assessments at the bedside to classified patients as having either normal (≤2 seconds) or abnormal (>2 seconds) CRT. An attending ED physician, blinded from the HCP classification, quantitatively measured CRT using a chronograph ( visual CRT ). A video camera was mounted on top of the hand tool in order to obtain a digital recording of the change in color, as the fingertip was compressed. The videos were thereafter used to calculate CRT via image software analysis ( image CRT ). Additionally, nine HCPs, including the ED physician, reviewed the videos in a separate setting to visually assess CRT while blinded from any patient information ( video assessment CRT ). Results: Thirty ER patients were enrolled in the ED. The ED physician identified 10 patients with abnormal CRT (> 2.0 seconds), while only two patients were identified by HCPs. Mean visual CRT was 2.0±0.9 (range: 1.2-4.4) seconds; mean image CRT, 2.4±2.1 (range: 0.5-8.0); mean video assessment CRT by the ED physician, 1.8±0.6 (range: 1.0-2.7). The correlation between visual CRT and image CRT was strong (r=0.648, p=0.002), while it was weak between visual and video assessment CRT (r=0.312, p=0.18). Inter-observer reliability of video assessment CRT among HCPs was low (intra correlation coefficient: 0.15, 95% CI 0.05-0.33). Conclusions: Inter-observer reliability of visual CRT assessment is low. The reliability of skilled physician in a real clinical situation increases and it infers that a reliable CRT test may only be capable if other patient information is available at the bedside, such as patient’s background, distressed appearance, cold peripheral temperature etc.

scholarly journals The Value of Library and Information Services in Patient Care: Canadian Results From an International Multisite Study

2013 ◽  
Vol 34 (3) ◽  
pp. 138 ◽  
Author(s):  
Joan C. Bartlett ◽  
Joanne Gard Marshall
Keyword(s):  
Patient Care ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Study ◽  
Clinical Situation ◽  
Information Services ◽  
Information Resources ◽  
Sources Of Information ◽  
Choice Of Treatment ◽  
Recent Patient

Introduction: This paper presents the Canadian results from a larger, international study with the objective of assessing the value of health library and information services and their impact on patient care. Methods: Data were collected using a web-based survey of healthcare providers in 13 Canadian hospitals collectively served by four libraries, and data were analyzed statistically using SPSS. The survey centred on a specific, recent, patient care incident for which the respondent had sought information. Follow-up semi-structured phone interviews with librarians at the participating sites provided supplemental data. Results: Twelve hundred and thirty-one people from the Canadian sites responded to the survey. Over 70% indicated that their management of the clinical situation changed as a result of the information. Positive changes included advice given to patient or family (48%), choice of drugs (31%), and choice of treatment (30%); adverse events that were avoided included patient misunderstanding of disease (23%), additional tests or procedures (18%), and patient mortality (5%). Results also showed which information resources were used and from where they were accessed. The information resources were valued as much, if not more, than other sources of information such as laboratory reports or medical records. Discussion: The results showed that participants perceive health library and information services to be highly valued and reported that their use has a positive impact on a range of patient care outcomes. They also highlighted the preferred information resources and access points among different groups of health professionals.

scholarly journals Special aspects of explosive loosening with minimal rock displacement

2020 ◽  
Vol 192 ◽  
pp. 01003
Author(s):  
Evgeny Shevkun ◽  
Aleksander Leshchinsky ◽  
Andrey Plotnikov
Keyword(s):  
Development Time ◽  
Video Recording ◽  
Visual Assessment ◽  
Video Camera ◽  
Stress Waves ◽  
Original Position ◽  
Multiple Impacts ◽  
Bottom Hole ◽  
The Difference ◽  
Interval Velocities

The dynamics of the development of an industrial mass explosion at deceleration intervals of 150x200 ms on a frame-by-frame video recording on a consumer video camera with a shooting frequency of 25 frames per second is studied. Possibilities of visual assessment of the explosion site of individual borehole charges are evaluated. The main difficulties in recording processing are caused by the difference in the intervals between frames (40 ms) and decelerations between charges (50 ms). A significant deviation of the actual deceleration intervals from the nominal value was revealed, which significantly changes the actual picture of the development of a mass explosion, including an increase in the actual development time of a mass explosion against the calculated one. The passage through the zones of the location of individual borehole charges up to 40 stress waves was established. Such multiple impacts of stress waves are expressed in a decrease in the magnitude of the interval velocities of dust and gas emissions as the number of impacts of stress waves increases. Due to the multiple effects of stress waves in the extension stage, the fracturing of the rock mass increases. This is expressed in a decrease in the dynamics, and then in the termination of the outburst of bottom hole material as the disturbance of rocks in the prefracture zone increases. There is no breakdown of rocks; the “ore-rock” contacts have retained their original position, which makes it possible to reduce the dilution of ore to a minimum.

scholarly journals Recent Advancement of Clinical Information Systems: Opportunities and Challenges

2018 ◽  
Vol 27 (01) ◽  
pp. 083-090 ◽  
Author(s):  
Md. Mohaimenul Islam ◽  
Tahmina Nasrin Poly ◽  
Yu-Chuan Li
Keyword(s):  
Information Systems ◽  
Patient Information ◽  
Data Exchange ◽  
Healthcare Providers ◽  
Diagnostic Errors ◽  
Clinical Information ◽  
Organizational Factors ◽  
Field Studies ◽  
Quality Of Healthcare ◽  
Clinical Information Systems

Objectives: Clinical information systems (CISs) have generated opportunities for meaningful improvements both in patient care and workflow but there is still a long way to perfection. Healthcare providers are still facing challenges of data exchange, management, and integration due to lack of functionality among these systems. Our objective here is to systematically review, synthesize, and summarize the literature that describes the current stage of clinical information systems, so as to assess the current state of knowledge, and identify benefits and challenges. Methods: PubMed, EMBASE, and the bibliographies of articles were searched for studies published until September 1, 2017, which reported on significant advancement of clinical information systems, as well as problems and opportunities in this field. Studies providing the most detailed information were included and the others were kept only as references. Results: We selected 23 papers out of 1,026 unique abstracts for full-text review using our selection criteria, and 20 out of these 23 studies met all of our inclusion criteria. We focused on three major areas: 1) Ambulatory and inpatients clinical information systems; 2) Specialty information systems; and 3) Ancillary information systems. As CIS can support evidence-based practices that, in turn, improve patient's safety, quality and efficacy of care, advancement, acceptability, and adaptability of CIS have increased worldwide. Although, the demand for CIS functionality is rising fast, current CISs still have data integration challenges and lack of functionality to exchange patient information from all or some parts of the healthcare system. These limitations can be attributed to technical, human, and organizational factors Conclusion: Clinical information systems provide tremendous opportunities to reduce clinical errors such as medication errors and diagnostic errors and to support healthcare professionals by offering up-to-date patient information. They promise to improve workflow and efficiency of care, thus boosting the overall quality of healthcare.

scholarly journals Search Functionality Within the Electronic Health Record and Health Information Exchange Databases

2020 ◽  
Vol 3 ◽  
Author(s):  
Brandon Gregory ◽  
Jordan Hill ◽  
Titus Schleyer
Keyword(s):  
Electronic Health Record ◽  
Health Information ◽  
Patient Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Health Record ◽  
Search Function ◽  
Electronic Health

Background and Hypothesis:  In the US today, over 95% of healthcare institutions operate using the electronic health record (EHR). While proven to be a substantial improvement to medical practice, the substantial amount of retained information within those records has made searching the EHR for relevant material difficult and too time consuming. We hypothesize that by providing a search function within the EHR with added capability of collaborative filtration, physicians will be better able to retrieve important patient information and thus provide more efficient care.     Project Methods:   Emergency Department physicians of Sidney & Lois Eskenazi Hospital and Indiana University Health Hospital were recruited to partake in this study based on their use and familiarity of the EHR Cerner and/or Health Information Exchange (HIE) CareWeb Search function. Participants filled out a pre-interview, Likert-scale questionnaire to determine their general impressions of search functions and the frequency with which they were used. Additional insight was obtained during an interview focusing on participants’ previous experiences searching within the EHR/HIE. Participants were then shown a mock-up of potential collaborative filtering integration into CareWeb in order to collect opinions regarding the feature’s usability/practicality, display/format, and a number of suggested terms.    Results:   From the pilot study, current challenges that limit clinician search function use include limited time in clinician workflow, information overload, and inaccurate results. Clinicians are more likely to conduct searches when treating patients who have limited medical history, complex histories, known recent visitations, and/or who have been seen at other institutions. Participants demonstrated interest in a collaborative filtration search feature; they expressed a preference to have the feature recommend five related search terms.    Potential Impact:   The data from this study aims to refine the way healthcare providers search within the EHR/HIE. This will allow healthcare providers to more efficiently extract relevant patient information for improved healthcare delivery and proficient clinician workflow. 

Patient information strategies for decision-making and management of osteoarthritis

2016 ◽  
Author(s):  
Gillian Hawker ◽  
Anne Lyddiatt ◽  
Linda Li ◽  
Dawn Stacey ◽  
Susan Jaglal ◽  
...  
Keyword(s):  
Decision Making ◽  
Chronic Disease ◽  
Disease Management ◽  
Patient Information ◽  
Chronic Disease Management ◽  
Decision Aids ◽  
Healthcare Providers ◽  
Information Strategies ◽  
Shared Goal ◽  
The Individual

Osteoarthritis (OA) is a chronic, disabling disease that warrants care that aligns with the principles of ‘chronic disease management’. Central to the success of chronic disease management is the ‘informed, activated patient’. Patient information strategies, including the use of patient decision aids, are essential to enabling patients with OA to self-manage their disease and engage in informed, shared decision-making. Such strategies are best delivered by a multidisciplinary team of healthcare providers and adapted to the characteristics, preferences, and values of the individual OA patient. Patients actively involved in their own disease management, that is, ‘self-management’, including shared goal-setting and decision-making about treatment interventions, are, on average, more adherent to treatment recommendations, have enhanced self-efficacy and, ultimately, experience better health outcomes.

scholarly journals P038: Does the pediatric emergency department have a role in pediatric palliative care?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S90-S91
Author(s):  
A. Côté ◽  
N. Gaucher ◽  
A. Payot
Keyword(s):  
Emergency Medicine ◽  
Palliative Care ◽  
Continuity Of Care ◽  
Health Care Professionals ◽  
Moral Distress ◽  
Healthcare Providers ◽  
Clinical Situation ◽  
Pediatric Emergency ◽  
Pediatric Palliative Care ◽  
Pediatric Emergency Medicine

Introduction: Very little is known regarding the emergency department’s (ED) role in the care of paediatric patients with complex chronic and life-limiting illnesses. In fact, the provision of paediatric palliative care (PPC) in the paediatric ED has, of yet, never been explored. This study aims to explore pediatric emergency medicine healthcare professionals’ perspectives regarding their role in PPC and to compare these to other health care professionals’ understandings of the ED’s role in PPC. Methods: Interdisciplinary semi-structured focus groups were held with healthcare providers from pediatric emergency medicine, pediatric palliative care, pediatric complex care and pediatric intensive care. Exploratory open-ended questions introduced naturally occurring discussions and interactions. Data was transcribed in full and analysed using NVivo© software. Data analysis was performed by thematic analysis and theoretical sampling. Results: From January to October 2016, 58 participants were interviewed; most were female nurses and physicians. ED providers seek to maintain continuity of care and uphold pre-established wishes throughout PPC patients’ ED visits by listening and supporting the patient and family, evaluating the clinical situation, communicating with primary care teams and organising rapid admissions to wards. Some ED providers recognized having no choice to provide palliative care approach under certain circumstances despite thinking it might not be part of their culture and role. Each interdisciplinary team demonstrated particular values and cultures, influencing their understandings of the ED’s role in PPC; continuity of care is complicated by these distinct philosophies. Limitations to providing PPC in the ED are related to unsuitable physical environments, lack of uninterrupted time, efficiency expectations, unknown patients, provider lack of knowledge and moral distress. Solutions were directed at improving communication between teams and humanizing care to develop a sensibility to quality PPC in the ED. Conclusion: Although the perspective of pediatric ED’s role in caring for PPC patients is heterogeneous, several barriers to providing high quality emergency PPC can be overcome. Future studies will explore the experiences of PPC families presenting to the ED.

scholarly journals Does training level affect the accuracy of visual assessment of capillary refill time?

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Koichiro Shinozaki ◽  
Lee S. Jacobson ◽  
Kota Saeki ◽  
Naoki Kobayashi ◽  
Steve Weisner ◽  
...  
Keyword(s):  
Visual Assessment ◽  
Training Level ◽  
Capillary Refill Time ◽  
Capillary Refill

Identification of Minerals by Electron Diffraction

1976 ◽  
Vol 34 ◽  
pp. 608-609
Author(s):  
J. S. Lally ◽  
R. J. Lee ◽  
A. Szirmae
Keyword(s):  
Electron Diffraction ◽  
Diffraction Pattern ◽  
Visual Assessment ◽  
Environmental Research ◽  
Specimen Preparation ◽  
Computer Search ◽  
Mineral Phases ◽  
Large Numbers ◽  
Acceptable Method ◽  
Identification Procedures

The employment of electron microscopy to monitor the concentration of particles in air and water samples is now an established method in environmental research. A large amount of effort has been expended on improving methods of specimen preparation and particle counting techniques; however, identification procedures using electron diffraction have not been developed to the same extent. Often, identifications are based on visual assessment of what is loosely called "a characteristic diffraction pattern." This may be an acceptable method when the mineral phases to be identified come from a known source (such as a chrysotile asbestos operation) but are not generally useful when minerals in air and water might come from a variety of sources. The methods to be described here have evolved from the normal identification procedures using standard stereograms of minerals (which is perfectly adequate provided not more than 3 or 4 possible structures are to be tested) into a systematic computer search of large numbers of different crystal structures as possible solutions to a given diffraction pattern.

The Rights of the Dying Child and the Duties of Healthcare Providers: The “Trieste Charter”

2016 ◽  
Vol 103 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Franca Benini ◽  
Roberta Vecchi ◽  
Pierina Lazzarin ◽  
Momcilo Jankovic ◽  
Luciano Orsi ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Healthcare Providers ◽  
Clinical Situation ◽  
Fundamental Rights ◽  
Extensive Discussion ◽  
Rights Of The Child ◽  
Incurable Illness ◽  
Tragic Event ◽  
Fourth Step ◽  
The City

Purpose The death of a child is a devastating and tragic event for all those involved. This charter aims to help healthcare workers and people assisting terminally ill children to recognize some important rights of the child, with some related suggestions. We consider it important to have a trace of this process, based on the skillfulness of long-lasting experts. Methods In September 2012, a group of professionals working with children affected by incurable illness in Italy launched a project to formulate the charter. Trieste is the city where the group of professionals first met to start the project. The first step was a detailed literature search on the topic, the second step was an extensive discussion among the professionals (writing committee) to prepare a first draft; later (third step) the draft was revised by 38 experts in different areas, including patient and family representatives, and lastly (fourth step) the final version of the charter was prepared. Results We developed a document containing 10 rights and corresponding duties that could be applied to any clinical situation or circumstances and used as a guide by professionals and families caring for children in the terminal stages of an illness. Conclusions The Trieste Charter proposes fundamental rights for children who are approaching the end of their lives. The charter will have achieved its purpose when every person caring for a dying child is capable of staying near the child until the last moments of his or her life, prepared to accept his or her death, ensuring both respect and dignity.

scholarly journals Development of a Scoring System to Assess Feather Damage in Canadian Laying Hen Flocks

Animals ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. 436 ◽  
Author(s):  
Caitlin Decina ◽  
Olaf Berke ◽  
Nienke van Staaveren ◽  
Christine F. Baes ◽  
Alexandra Harlander-Matauscheck
Keyword(s):  
Scoring System ◽  
Management Strategies ◽  
Scoring Systems ◽  
Weighted Kappa ◽  
Visual Assessment ◽  
Egg Laying ◽  
Ease Of Use ◽  
The Body ◽  
Small Scale ◽  
Observer Reliability

Feather damage (FD) due to feather pecking behavior is an ongoing welfare concern among commercial egg-laying hens. Canada’s current transition from conventional cage housing to alternative housing systems, where FD can spread easily within large flocks, underlines the need for frequent and accurate assessment of plumage condition. A standardized methodology for assessing FD in Canada does not yet exist. To improve FD assessment on commercial farms, a FD scoring system and visual scoring guide for farmers were developed. Two existing plumage scoring systems, LayWel and AssureWel, which differ in level of detail and bird handling, were assessed for ease of use, and intra- and inter-observer reliability. Practical application of the AssureWel scoring system was greatest, with strong intra- and inter-observer reliability for the back region of the body (weighted kappa = 0.88 for both measures) in small-scale flocks. This informed the creation of a modified version of the AssureWel system, which included three scoring levels and the visual assessment of 50 birds per flock. An accompanying guide was developed including sampling instructions and depictions of the scoring scheme, both written and visual. This simplified scoring system can serve as a benchmarking tool for FD prevalence, and can allow for future effectiveness assessments of management strategies to prevent and control FD; however, farmers should be trained to apply this system under commercial conditions.

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