Systematic analysis of extracting data on advance directives from patient electronic health records in terminal oncology patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24011-e24011
Author(s):  
William Paul Skelton ◽  
Jason Scott Starr ◽  
Kiarash Rahmanian ◽  
Robert Guenther ◽  
William L. Allen ◽  
...  
Keyword(s):  
Advance Directives ◽  
Altered Mental Status ◽  
Systematic Analysis ◽  
Practice Of Medicine ◽  
Data Points ◽  
Clinical Terminology ◽  
Electronic Health ◽  
Critical Components ◽  
Definition Of ◽  
Terminal Diagnosis

e24011 Background: Advanced care planning and living wills are critical components of caring for patients at the end of their lives. Advance directives are designed to be implemented when a patient meets the legal definition of terminal and is deemed incapacitated. By reviewing the electronic health record (EHR) in patients with terminal cancer, we sought to evaluate whether advance directives were appropriately implemented. Methods: A retrospective analysis of the EHR of 500 cancer patients from 1/1/2013 to 12/31/2016 was performed. Data points were manually collected and entered in a central database, and data analysis was completed using SAS. Results: Of the 500 patients, 160 (32%) had an advance directive (AD). The most common clinical terminology used by physicians indicating a terminal diagnosis was “progressive” (36.6%) and “palliative” (31%). The most common clinical terminology indicating incapacity was “altered mental status” (25.6%), and “not oriented” (14%). 34 patients (6.8%) met all criteria of having a terminal diagnosis, a documented AD, and deemed incapacitated. Of these patients who met all of these data points, their ADs were implemented on average 1.7 days (SD: 4.4 days) after which they should have been. This resulted in a total of 58 days of additional care provided to these patients. Conclusions: End-of-life care is a challenging albeit vital part of the practice of medicine. This study provided insight on to how ADs are managed in day to day practice in a hospital. From our analysis, it is clear that physicians are able to identify when a patient is terminal; however, it is typically later than it should have been recognized (and thereby, leading to delays in the implementation of the patient’s AD). Further studies should be performed focusing on harnessing the power of the EHR and providing physicians formative and evaluative feedback of practice patterns to ensure that ADs are honored when appropriate.

Systematic Analysis of Extracting Data on Advance Directives from Patient Electronic Health Records (EHR) in Terminal Oncology Patients

2021 ◽  
pp. 082585972110011
Author(s):  
Jason S. Starr ◽  
William Paul Skelton ◽  
Kiarash P. Rahmanian ◽  
Robert Guenther ◽  
William L. Allen ◽  
...  
Keyword(s):  
Advance Directives ◽  
Altered Mental Status ◽  
Power Of Attorney ◽  
Systematic Analysis ◽  
Data Points ◽  
Clinical Terminology ◽  
Electronic Health ◽  
Critical Components ◽  
Seriously Ill Patients ◽  
Terminal Diagnosis

Background: Advance directives are legal documents that include living wills and durable health care power of attorney documents. They are critical components of care for seriously ill patients which are designed to be implemented when a patient is terminally ill and incapacitated. We sought to evaluate potential reasons for why advance directives were not appropriately implemented, by reviewing the electronic health record (EHR) in patients with terminal cancer. Methods: A retrospective analysis of the EHR of 500 cancer patients from 1/1/2013 to 12/31/2016 was performed. Data points were manually collected and entered in a central database. Results: Of the 500 patients, 160 (32%) had an advance directive (AD). The most common clinical terminology used by physicians indicating a terminal diagnosis was progressive (36.6%) and palliative (31%). The most common clinical terminology indicating incapacity was altered mental status (25.6%), and not oriented (14%). 34 (6.8%) patients met all criteria of having a terminal diagnosis, a documented AD, and were deemed incapacitated. Of these patients who met all of these data points, their ADs were implemented on average 1.7 days (SD: 4.4 days) after which they should have been. This resulted in a total of 58 days of additional care provided. Discussion: This study provided insight on to how ADs are managed in day to day practice in the hospital. From our analysis it appears that physicians are able to identify when a patient is terminal, however, it is typically later than it should have been recognized. Further studies should be performed focusing on harnessing the power of the EHR and providing physicians formative and evaluative feedback of practice patterns to ensure that ADs are honored when appropriate.

The Introduction of Minbenzhuyi and the Return of Its Traditional Chinese Meaning

Cultura ◽  
2019 ◽  
Vol 16 (2) ◽  
pp. 67-88
Author(s):  
Xiaobo LV
Keyword(s):  
Systematic Analysis ◽  
Intellectual Community ◽  
Chinese Context ◽  
Liang Qichao ◽  
Confucian Values ◽  
Chinese Intellectual ◽  
Ancient Literature ◽  
Definition Of ◽  
Chen Duxiu

The concepts of Minben , Minbensixiang , and Minbenzhuyi are rather popular in current Chinese discourse. However, “Minben” was hardly found in Chinese ancient literature as a noun. Around the year of 1916, “Minbenzhuyi” became widely accepted in Japanese intellectual circles, interpreted as one of the Japanese versions of democracy. In 1917, “Minbenzhuyi” was transferred to China as a loanword by Li Dazhao and developed into one of the Chinese definitions of democracy. Nevertheless, Chen Duxiu questioned the meaning of the term in 1919. It was not until 1922 did Liang Qichao bring Minbenzhuyi back into Chinese context and conduct a systematic analysis, which had a lasting impact on Chinese intellectual community. In the following 20 years, Minbenzhuyi was largely accepted in two different senses: 1) interpreted as Chinese definition of democracy; 2) specifically refers to the Confucian idea of “Minshiminting and Minguijunqing (;, ) Gradually, it became evident that Minbenzhuyi in China had grown distant from the meaning of democracy and returned to its traditional Confucian values.

Health, Illness, and Disease

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric J. Cassell ◽  
Abraham Fuks
Keyword(s):  
Medical Education ◽  
Practice Of Medicine ◽  
Definition Of ◽  
Contemporary Practice ◽  
Illness And Disease ◽  
Negative Sense

This introduction discusses traditional meanings of the following concepts: health, sickness, disease, suffering, and healing. The point is made that “disease” is an abstract phenomenon, albeit one that is critically important to the contemporary practice of medicine. Unfortunately, the term disease has often come to occupy the center of physicians’ preoccupations. Currently, health is considered in a negative sense, as an “absence of disease.” This chapter proposes a new and bold definition of sickness, one that revolves around the notion of function. This opens up possibilities for the goals of physicians and for medical education to be truly person centered.

scholarly journals Towards Semantic Interoperability for Electronic Health Records

2007 ◽  
Vol 46 (03) ◽  
pp. 332-343 ◽  
Author(s):  
P. Knaup ◽  
E. J. S. Hovenga ◽  
S. Heard ◽  
S. Garde
Keyword(s):  
Electronic Health Records ◽  
Domain Knowledge ◽  
Semantic Interoperability ◽  
Health Records ◽  
Face To Face ◽  
Telephone Interviews ◽  
Development Organisation ◽  
Knowledge Governance ◽  
Electronic Health ◽  
Definition Of

Summary Objectives: In the field of open electronic health records (EHRs), openEHR as an archetype-based approach is being increasingly recognised. It is the objective of this paper to shortly describe this approach, and to analyse how openEHR archetypes impact on health professionals and semantic interoperability. Methods: Analysis of current approaches to EHR systems, terminology and standards developments. In addition to literature reviews, we organised face-to-face and additional telephone interviews and tele-conferences with members of relevant organisations and committees. Results: The openEHR archetypes approach enables syntactic interoperability and semantic interpretability – both important prerequisites for semantic interoperability. Archetypes enable the formal definition of clinical content by clinicians. To enable comprehensive semantic interoperability, the development and maintenance of archetypes needs to be coordinated internationally and across health professions. Domain knowledge governance comprises a set of processes that enable the creation, development, organisation, sharing, dissemination, use and continuous maintenance of archetypes. It needs to be supported by information technology. Conclusions: To enable EHRs, semantic interoperability is essential. The openEHR archetypes approach enables syntactic interoperability and semantic interpretability. However, without coordinated archetype development and maintenance, ‘rank growth’ of archetypes would jeopardize semantic interoperability. We therefore believe that openEHR archetypes and domain knowledge governance together create the knowledge environment required to adopt EHRs.

scholarly journals The Postencounter Form System: Viewpoint on Efficient Data Collection Within Electronic Health Records (Preprint)

2019 ◽  
Author(s):  
Philip Held ◽  
Randy A Boley ◽  
Walter G Faig ◽  
John A O'Toole ◽  
Imran Desai ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Medical Center ◽  
Health Records ◽  
Clinical Notes ◽  
The Road ◽  
Clinical Encounters ◽  
Efficient Data ◽  
Data Points ◽  
Electronic Health ◽  
Using Data

UNSTRUCTURED Electronic health records (EHRs) offer opportunities for research and improvements in patient care. However, challenges exist in using data from EHRs due to the volume of information existing within clinical notes, which can be labor intensive and costly to transform into usable data with existing strategies. This case report details the collaborative development and implementation of the postencounter form (PEF) system into the EHR at the Road Home Program at Rush University Medical Center in Chicago, IL to address these concerns with limited burden to clinical workflows. The PEF system proved to be an effective tool with over 98% of all clinical encounters including a completed PEF within 5 months of implementation. In addition, the system has generated over 325,188 unique, readily-accessible data points in under 4 years of use. The PEF system has since been deployed to other settings demonstrating that the system may have broader clinical utility.

scholarly journals Systemic approach to the choice of optical methods of forensic examination of micro-objects

2021 ◽  
Vol 39 (69) ◽  
pp. 564-580
Author(s):  
Liudmyla Havryliuk ◽  
Valentyna Drozd ◽  
Olena Nenia ◽  
Anatolii Kyslyi ◽  
Andrii Niebytov
Keyword(s):  
Systematic Approach ◽  
Systemic Approach ◽  
Optical Methods ◽  
Structural Method ◽  
Systematic Analysis ◽  
Holistic View ◽  
Legal Method ◽  
Logical Method ◽  
Examination Methods ◽  
Definition Of

The aim of the article is to analyze theoretical and methodological provisions related to the definition of directions and principles of implementation of a systematic approach to the use of optical research methods, in particular micro-objects. Subject of research is substantiation and formulation of the classification characteristics of such systematic approach, considering the requirements of forensic techniques. Methodology: The study applies such methods of scientific knowledge as dialectical method, system and structural method, logic and legal method, methods of systematic analysis, logical method. Research results: The article studies the problematic issues of a systematic approach to the choice of scientific and technical methods and means for micro-object examination. Practical consequences: The authors argue that optical methods of the micro-object examination require classifying and systematizing to provide a holistic view of their potentials, as well as the nature of the information that can be obtained about the object being examined. Value / originality: The analysis of clarified classification characteristics and requirements for examination methods in forensic science enables to propose the algorithm of the systemic approach to the creation of the open system classification of methods of micro-object examination and to make justified conclusions.

scholarly journals LIMITER – CONSTRUCTIVE COMPONENT, NECESSARY FOR DETERMINING A SUBJECT SHORT-POINTED WEAPONS

2020 ◽  
pp. 350-360
Author(s):  
V. Bolshakov ◽  
Yu. Maznichenko ◽  
Yu. Holub ◽  
M. Molyboha ◽  
I. Samoilenko
Keyword(s):  
Current Method ◽  
Special Forces ◽  
Technical Standards ◽  
Systematic Analysis ◽  
Physical Strength ◽  
Technical Requirements ◽  
Current State ◽  
The Us ◽  
The Difference ◽  
Definition Of

The systematic analysis of the world experience of civilian use of knives not as cold weapons showed that at present the knife did not become the main attribute of equipping tourists, fish men and even hunters. In particular, today there are very few types of hunting, during which the knife is used to finish off the beast or to protect against it. At the same time, as the practice of hunting management proves, during hunting there are many uses for the knife, even without considering it as a means for cooking. This, in particular, sharpening various stakes (for a tent, a hut, a campfire), skinning a game, preparing chips for a fire, scraping ice from skis or marsh mud from shoes. To do this, in accordance with current state technical standards, any folding knife must have a lock, and the blades of all knives must be of sufficient thickness so as not to break from the load. Handles of hunting knives should be comfortable to hold so that your hand will not get tired during long-term work. For all knives, according to the technical requirements, the length and thickness of the blade must be consistent, as well as the angle of inclination of the tip relative to the axis of the blade. With regard to the above, an interesting example is the collection of knives by the Swedish company Eriksson, consisting of four models, made in the configuration of the Swedish finca. The knives have a handle and a blade of a classic Finnish knife, but with a one-sided stopper. Their blades, depending on the color of the handle, are made of different types of steel. Knives with blue plastic handles have stainless steel blades, and knives with red handles are made of carbon steel. It is believed that in Sweden almost every construction worker walks with such a knife in his pocket. It should be noted that according to the current method of forensic investigation of cold weapons and structurally similar products in it, these knives can be attributed to cold weapons by the size of the blade. It is also interesting an urban-type knife, which is not a cold weapon of the Worden Tactical Medium Company. Renowned wizard Kelly Warden, an instructor for American Rangers, designs this knife. Since 2001, Kelly Warden has been the main consultant on impact and blade weapons of Detachment 1 of the US Special Forces. He trains Special Forces hand-to-hand combat with the use of a knife, machete, baton, sticks, as well as the method of forceful detention. The blade length of the knife described is 74 mm, thickness – 3.8 mm; the handle has a sub-finger protrusion to prevent the arm from slipping on the blade. The knife does not have a standard stopper, which, in addition to protecting it from slipping the hand on the blade, must prevent the hand from sinking into the victim’s body. By all measures, this knife is not a cold weapon in accordance with the requirements of the criminal law of Ukraine. Kelly Warden believes that the knife as a means of self-defense levels the difference in weight, height and physical strength, but its main drawback is its damaging ability. The proposed article is devoted to this circumstance, the definition of the role of the restrictor in classifying a knife as a cold weapon.

scholarly journals Contemporary forms and methods of counteracting narcotization of the youth

2020 ◽  
Vol 9 (28) ◽  
pp. 377-385
Author(s):  
Anatoliy Trokhymovych Komziuk ◽  
Ruslan Semenovych Orlovskyi ◽  
Bohdan Mykhailovich Orlovskyi ◽  
Taisa Vasylivna Rodionova
Keyword(s):  
Law Enforcement ◽  
Developed Countries ◽  
Law Enforcement Agencies ◽  
Lower Efficiency ◽  
Systematic Analysis ◽  
Legal Method ◽  
The Developed Countries ◽  
Definition Of ◽  
Major Factors ◽  
Preventive Methods

The purpose of the paper is to examine the most efficient forms and methods of counteracting narcotization in society, especially of the youth, and also to characterize the most important factors of the proliferation of narcotization. The authors used the following methods in the research: dialectical, dogmatic, method of systematic analysis and comparative-legal method. The paper analyses forms and methods of counteracting narcotization of the youth in Ukraine and worldwide. It elaborates the definition of the following terms: “narcotization”, “counteracting narcotization”, “forms of counteracting narcotization” and “methods of counteracting narcotization”. It ascertains that emerging and proliferation of narcotization has a direct correlation with the complex of social factors, each one of them obtained a specific characteristic. Besides analyzing the major factors of emergence and proliferation of narcotization of the youth, the paper gives particular attention to defining forms, methods and means of counteracting this socially harmful phenomenon. The paper studies positive experience in regard to activities of law enforcement agencies of the developed countries in the sphere of counteracting narcotization, including narcotization of the youth. It emphasizes that coercive methods of reducing narcotization have much lower efficiency compared to preventive methods that are generally more humane and economically efficient. The paper formulates the conclusion about the necessity of ongoing engagement of the community in counteracting narcotization of society, especially of the youth.

scholarly journals The Banff Working Group Classification of Definitive Polyomavirus Nephropathy: Morphologic Definitions and Clinical Correlations

2017 ◽  
Vol 29 (2) ◽  
pp. 680-693 ◽  
Author(s):  
Volker Nickeleit ◽  
Harsharan K. Singh ◽  
Parmjeet Randhawa ◽  
Cinthia B. Drachenberg ◽  
Ramneesh Bhatnagar ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Working Group ◽  
Classification Scheme ◽  
Clinical Presentation ◽  
Interstitial Fibrosis ◽  
The United States ◽  
Systematic Analysis ◽  
Definition Of ◽  
Morphologic Classification

Polyomavirus nephropathy (PVN) is a common viral infection of renal allografts, with biopsy-proven incidence of approximately 5%. A generally accepted morphologic classification of definitive PVN that groups histologic changes, reflects clinical presentation, and facilitates comparative outcome analyses is lacking. Here, we report a morphologic classification scheme for definitive PVN from the Banff Working Group on Polyomavirus Nephropathy, comprising nine transplant centers in the United States and Europe. This study represents the largest systematic analysis of definitive PVN undertaken thus far. In a retrospective fashion, clinical data were collected from 192 patients and correlated with morphologic findings from index biopsies at the time of initial PVN diagnosis. Histologic features were centrally scored according to Banff guidelines, including additional semiquantitative histologic assessment of intrarenal polyomavirus replication/load levels. In-depth statistical analyses, including mixed effects repeated measures models and logistic regression, revealed two independent histologic variables to be most significantly associated with clinical presentation: intrarenal polyomavirus load levels and Banff interstitial fibrosis ci scores. These two statistically determined histologic variables formed the basis for the definition of three PVN classes that correlated strongest with three clinical parameters: presentation at time of index biopsy, serum creatinine levels/renal function over 24 months of follow-up, and graft failure. The PVN classes 1–3 as described here can easily be recognized in routine renal biopsy specimens. We recommend using this morphologic PVN classification scheme for diagnostic communication, especially at the time of index diagnosis, and in scientific studies to improve comparative data analysis.

scholarly journals P007: A comparative analysis of qSOFA, SIRS and Early Warning Scores Criteria to identify sepsis in the prehospital setting

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S79-S80 ◽  
Author(s):  
S. AlQahtani ◽  
P. Menzies ◽  
B. Bigham ◽  
M. Welsford
Keyword(s):  
Severe Sepsis ◽  
Screening Tool ◽  
Early Recognition ◽  
Capture Rate ◽  
Data Capture ◽  
Prehospital Setting ◽  
Life Saving ◽  
Data Points ◽  
And Performance ◽  
Definition Of

Introduction: Early recognition of sepsis is key in delivering timely life-saving interventions. The role of paramedics in recognition of these patients is understudied. It is not known if the usual prehospital information gathered is sufficient for severe sepsis recognition. We sought to: 1) evaluate the paramedic medical records (PMRs) of severe sepsis patients to describe epidemiologic characteristics; 2) determine which severe sepsis recognition and prediction scores are routinely captured by paramedics; and 3) determine how these scores perform in the prehospital setting. Methods: We performed a retrospective review of patients ≥18 years who met the definition of severe sepsis in one of two urban Emergency Departments (ED) and had arrived by ambulance over an eighteen-month period. PMRs were evaluated for demographic, physiologic and clinical variables. The information was entered into a database, which auto-filled a tool that determined SIRS criteria, shock index, prehospital critical illness score, NEWS, MEWS, HEWS, MEDS and qSOFA. Descriptive statistics were calculated. Results: We enrolled 298 eligible sepsis patients: male 50.3%, mean age 73 years, and mean prehospital transportation time 30 minutes. Hospital mortality was 37.5%. PMRs captured initial: respiratory rate 88.6%, heart rate 90%, systolic blood pressure 83.2%, oxygen saturation 59%, temperature 18.7%, and Glasgow Coma Scale 89%. Although complete MEWS and HEWS data capture rate was <17%, 98% and 68% patients met the cut-point defining “critically-unwell” (MEWS ≥3) and “trigger score” (HEWS ≥5), respectively. The qSOFA criteria were completely captured in 82% of patients; however, it was positive in only 36%. It performed similarly to SIRS, which was positive in only 34% of patients. The other scores were interim in having complete data captured and performance for sepsis recognition. Conclusion: Patients transported by ambulance with severe sepsis have high mortality. Despite the variable rate of data capture, PMRs include sufficient data points to recognize prehospital severe sepsis. A validated screening tool that can be applied by paramedics is still lacking. qSOFA does not appear to be sensitive enough to be used as a prehospital screening tool for deadly sepsis, however, MEWS or HEWS may be appropriate to evaluate in a large prospective study.

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