scholarly journals Evaluation of a Novel Teleradiology Technology for Image-Based Distant Consultations: Applications in Neurosurgery

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1413
Author(s):  
Paulina Cewe ◽  
Gustav Burström ◽  
Ivan Drnasin ◽  
Marcus Ohlsson ◽  
Halldor Skulason ◽  
...  
Keyword(s):  
Decision Making ◽  
Data Storage ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Local Data ◽  
International Consultation ◽  
Telemedicine Technology ◽  
The Mean ◽  
Mean Time ◽  
Fast Access

In emergency settings, fast access to medical imaging for diagnostic is pivotal for clinical decision making. Hence, a need has emerged for solutions that allow rapid access to images on small mobile devices (SMD) without local data storage. Our objective was to evaluate access times to full quality anonymized DICOM datasets, comparing standard access through an authorized hospital computer (AHC) to a zero-footprint teleradiology technology (ZTT) used on a personal computer (PC) or SMD using national and international networks at a regional neurosurgical center. Image datasets were sent to a senior neurosurgeon, outside the hospital network using either an AHC and a VPN connection or a ZTT (Image Over Globe (IOG)), on a PC or an SMD. Time to access DICOM images was measured using both solutions. The mean time using AHC and VPN was 250 ± 10 s (median 249 s (233–274)) while the same procedure using IOG took 50 ± 8 s (median 49 s (42–60)) on a PC and 47 ± 20 s (median 39 (33–88)) on a SMD. Similarly, an international consultation was performed requiring 23 ± 5 s (median 21 (16–33)) and 27 ± 1 s (median 27 (25–29)) for PC and SMD respectively. IOG is a secure, rapid and easy to use telemedicine technology facilitating efficient clinical decision making and remote consultations.

scholarly journals Accuracy of a Point-of Care Hemoglobin A1c Assay - A Community Outreach Project

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A465-A466
Author(s):  
Noura Semreen ◽  
Gene Otuonye ◽  
Angelica Medina Pena ◽  
Natasha Rastogi
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Mean Difference ◽  
Health Clinic ◽  
Sampling Point ◽  
The Mean ◽  
Hba1c Measurement ◽  
Hba1c Levels

Abstract Glycated hemoglobin (HbA1c) is an invaluable tool in diabetes mellitus (DM) management. Conventionally obtained via venous blood sampling, point-of-care (POCT) capillary HbA1c measurement offers an opportunity for immediate treatment modification, reduced cost & increased patient satisfaction. While previous studies using the POCT HbA1c test A1cNow+ have shown accuracy within a 0.5% range from the gold standard venous HbA1c, we noted discrepancy in our community health clinic & sought to evaluate the accuracy of POCT HbA1c levels compared to venous HbA1c levels to guide our clinical decision-making. In this 2-part study, we compared POCT HbA1c levels measured via a single use A1CNow+ HbA1c monitoring device & venous HbA1c samples measured by a standardized lab. Part1: after retrospective chart review, we identified 262 patients with prediabetes, Type1 or Type2 DM based on ADA guidelines who attended our clinic from January 2019-June 2019 & received POCT HbA1c with A1cNow+ testing during their visit. Of those cases, 47 patients also had a venous HbA1c at a standardized laboratory within 1 month of having their POCT HbA1c performed in our clinic. Part2: We noted variability in the temperature storage of A1CNow+ test strips. Storage was standardized to room temperature as per device instructions in June 2019. We subsequently reviewed charts from June 2019-December 2019 & identified 118 patients who had both POCT HbA1c & venous HbA1c measurement within a 1 month period. Patients was categorized into subgroups per ACP guidelines for DM control: prediabetic (HbA1c 5.7–6.4%), controlled DM (HbA1c 6.5 to 8.0%) & uncontrolled DM (HbA1c >8.0%). The average difference between POCT & venous HbA1c tests was calculated & analyzed for statistical significance using paired t test analysis. Part1: For patients in prediabetic, controlled & uncontrolled DM subgroups, the mean difference between A1cNow+ & standardized venous HbA1c testing was 0.68% (p= 0.004), 1.15% (p= <0.0001) and 1.36% (p= 0.0003) respectively. Part2: After standardization of test strip storage, the mean difference between A1cNow+ & venous HbA1c testing for prediabetic, controlled & uncontrolled DM patients was 0.33% (p= 0.002), 0.41% (p= 0.011) and 1.26% (p= <0.0001) respectively. POCT HbA1c provides a unique opportunity to immediately address glycemic control. Its advantages are especially apparent in a patient population with limited resources & poor follow up, as in our clinic. Although standardizing test storage improved overall concordance between A1cNow+ HbA1c testing & venous HbA1c, there was still a statistically significant larger mean difference in uncontrolled DM patients. In prediabetic & controlled DM patients, however, POCT HbA1c was accurate within previously published reports of a 0.5% range when compared to venous HbA1c. An algorithm has since been developed to guide our clinical decision making with these findings.

scholarly journals Vigilance in Iranian Nurses Working in Intensive Care Units

2021 ◽  
Author(s):  
Mojgan Najafi ◽  
Mehdi Ajri ◽  
Mansoureh Karimollahi
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Decision Making ◽  
Essential Element ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Demographic Characteristics ◽  
Cross Sectional ◽  
The Mean

Abstract Background and aim: Vigilance is an essential element in intensive care nursing. This study was conducted to determine nursing vigilance in nurses working in the intensive care units of educational and medical centers in Ardabil, IranMethods: This was a cross-sectional descriptive-analytical study with 192 ICU nurses as the participants. The data were obtained through questionnaires regarding demographic characteristics and nursing vigilance. SPSS software version 24 was used for the statistical analysis.Results: The mean total vigilance score was 3.86 ± 0.23 of 5. The mean scores of the timely diagnosis of changes, pattern recognition, and clinical decision-making subscales were 4.07 ± 0.26, 04.04 ± 0.41, and 3.44 ± 0.25, respectively. No significant relationships were observed between the total or subscale vigilance scores and other demographic characteristics.Conclusion: We assessed ICU nurses’ vigilance behaviors and found that their mean vigilance score was higher than the expected average, indicating our participants had a high level of clinical vigilance. These results suggest a need for effective educational interventions to boost clinical decision-making skills in ICU nurses, especially younger nurses.

scholarly journals Cost effective use of free to use apps (FAN) in neurosurgery in developing countries: from clinical decision making to educational courses, strengthening the health care delivery

2016 ◽  
Vol 18 (3) ◽  
pp. 36 ◽  
Author(s):  
Amit Thapa ◽  
Bidur KC ◽  
Bikram Shakya
Keyword(s):  
Decision Making ◽  
Developing Countries ◽  
Data Storage ◽  
Clinical Decision Making ◽  
Care Delivery ◽  
Medical Knowledge ◽  
Cost Effective ◽  
Clinical Decision ◽  
Good Communication ◽  
Related Data

Introduction and Objective: Financial limitations and scarcity of technological knowledge is a major hurdle to good communication platform, data storage and dissemination of medical knowledge in developing countries. Out of necessity we used free to use apps in our practice. We studied the applicability and cost effective aspect of a systematic use of these apps in neurosurgery.Materials and Methods: We designed Free to use apps in neurosurgery (FAN) module in 4 phases at KMCTH over the last 3 years. We used free apps like viber, dropbox, skype and vlc media player on 3G and wifi. Users were trained in ethics and measures to ensure confidentiality and privacy of patient related data. Endpoints studied were feasibility, reliability, cost effectiveness and overall satisfaction of the users.Results: In the FAN module, viber app was used to send pictures of digital imagings (DI) using smartphones within 30 minutes enabling quick decision by the consultants. Dropbox not only helped store images but also helped quick verification of discharge summaries as early as 15 minutes increasing overall efficiency. With Skype, consultants could be contacted even when they were abroad and using FAN they remain updated of their patients. Using skype and vlc, 2 operative live workshops from abroad was transmitted live with good visual and audio reception allowing question answer sessions with the faculties. Users’ satisfaction was more than 90%.Conclusion: FAN module helped in quick reliable decision making, allowing for instantaneous communication and storing data and exchange of knowledge across countries.

Abstract 267: Case-Based CME Improves on Clinical Decision-Making in Non-ST Elevation Myocardial Infarction

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Amy Larkin ◽  
Michael LaCouture ◽  
Caroline Padbury
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
P Values ◽  
St Elevation ◽  
The Mean ◽  
Post Assessment ◽  
Grand Rounds ◽  
Assessment Questions ◽  
Case Based

Introduction: Evolving therapies and guideline recommendations to treat non-ST elevation myocardial infarction (NSTEMI) create clinical confusion. The educational and practice impact of a case-based design of CME were measured on clinical decision-making related to NSTEMI treatment. Methods: The continuing medical education (CME) activity was developed as an online case-based text activity modeled after the interactive grand rounds approach where clinicians make clinical decisions about treatment for a given patient. The activity targeted primary care physicians (PCPs) and cardiologists who manage patients experiencing a NSTEMI and focused on application of guideline recommendations. The effects of education were assessed using a linked pre-assessment/post-assessment study design that separated learners into 3 categories: improved (incorrect pre, correct post), reinforced (correct pre and post), and unaffected (incorrect post). For all questions combined, the McNemar’s chi-squared test was used to assess whether the mean post[[Unable to Display Character: &#8208;]]assessment score differed from the mean pre[[Unable to Display Character: &#8208;]]assessment score. P values are shown as a measure of significance; P values <.05 are statistically significant. Cohen’s D was used to calculate the effect size. The activity launched online on April 16, 2014 and data were collected through July 24, 2014. Results: 533 PCPs and 531 cardiologist completed both the pre- and post-assessment survey with a large overall effect size of 1.836 ( P <0.05) and 1.799 ( P<0 .05), respectively. PCPs Correct responses on post-assessment questions ranged between 62% and 292% higher after CME completion. While only 8 (2%) participants answered all 4 questions correctly on the pre-assessment, 296 (56%) answered them all correctly on the post-assessment. Between 33% and 63% of participants showed improvement post-educational intervention. Cardiologists Correct responses on post-assessment questions ranged between 34% and 249% higher after CME completion. While only 28 (5%) participants answered all 4 questions correctly on the pre-assessment, 430 (81%) answered them all correctly on the post-assessment. Between 26% and 65% of participants showed improvement after the educational intervention. Conclusion: Online case-based CME activities modeled after the interactive grand rounds approach prompted changes in clinical knowledge, showing that when effectively constructed, this methodology is an effective tool to improve clinical application of guidelines and clinical decision-making in NSTEMI. This interactive educational format should be applied to CME for future activities.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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