scholarly journals Resurrecting the Hospital Autopsy: Impact of an Office of Decedent Affairs on Consent Rates, Providers, and Next-of-Kin

2020 ◽  
Vol 145 (1) ◽  
pp. 55-65
Author(s):  
Justin E. Juskewitch ◽  
Joan M. Griffin ◽  
Joseph J. Maleszewski ◽  
Gladys B. Asiedu ◽  
Michael A. Paolini ◽  
...  
Keyword(s):  
Clinical Information ◽  
Death Process ◽  
Medical Examiner ◽  
Hospital Death ◽  
Communication Link ◽  
Next Of Kin ◽  
Positive Role ◽  
Before And After ◽  
Bereavement Counseling ◽  
The Impact

Context.— Autopsy rates have decreased dramatically despite providing important clinical information to medical practices and social benefits to decedents' families. Objective.— To assess the impact of an institutional Office of Decedent Affairs (ODA), a direct communication link between pathology and decedents' families, on hospital autopsy consent rates, autopsy-related communication, practitioner views, and next-of-kin experiences. Design.— A before and after study involving all hospital decedents whose deaths did not fall within the jurisdiction of the medical examiner's office from 2013 to 2018. A pathology-run ODA launched in May 2016 to guide next-of-kin through the hospital death process (including autopsy-related decisions) and serve as the next-of-kin's contact for any subsequent autopsy-related communication. Critical care and hematology/oncology practitioners were assessed for their autopsy-related views and decedents' next-of-kin were assessed for their autopsy-related experiences. Autopsy consent rates for non–medical examiner hospital deaths, autopsy-related communication rates, practitioner views on the role and value of autopsy, and next-of-kin autopsy experiences and decisions factors were compared prior to and after ODA launch. Results.— Autopsy consent rates significantly increased from 13.2% to 17.3% (480 of 3647 deaths versus 544 of 3148 deaths; P < .001). There were significant increases in the rate of autopsy-related discussions and bereavement counseling provided to decedents' families. Practitioner views on the positive role of autopsy for any hospital death and those with advanced stage cancer also significantly increased. Next-of-kin indicated more consistent autopsy-related discussions with the potential benefits of autopsy discussed becoming key decision factors. Conclusions.— An ODA improves hospital autopsy consent rates, autopsy-related communication, providers' autopsy-related views, and next-of-kins autopsy experiences.

scholarly journals Better Use of Data to improve parent Satisfaction (BUDS): protocol for a prospective before-and-after pilot study employing mixed methods to improve parent experience of neonatal care

2019 ◽  
Vol 3 (1) ◽  
pp. e000515 ◽  
Author(s):  
Susanna Sakonidou ◽  
Izabela Andrzejewska ◽  
Sophia Kotzamanis ◽  
Wendy Carnegie ◽  
Mable Nakubulwa ◽  
...  
Keyword(s):  
Survey Data ◽  
Clinical Data ◽  
Clinical Information ◽  
Parent Satisfaction ◽  
Neonatal Care ◽  
Data Completeness ◽  
Before And After ◽  
Staff Interactions ◽  
The Impact ◽  
Staff Workload

IntroductionHaving a baby that requires neonatal care is stressful and traumatic. Parents often report dissatisfaction with communication of clinical information. In the UK neonatal care data are recorded daily using electronic patient record systems (EPR), from which deidentified data form the National Neonatal Research Database (NNRD). We aim to evaluate the impact of sharing neonatal EPR data with parents, on parent-reported satisfaction, parent–staff interactions, staff workload and data completeness.MethodsA prospective, before-and-after, mixed-method study. Participants are parents of inpatient babies (maximum 90) and staff in a tertiary neonatal intensive care unit, London, UK. The intervention was developed by former neonatal parents, neonatologists and neonatal nurses: a communication tool for parents comprising individualised, written, daily infant updates for parents, derived from EPR data. The intervention will be provided to parents over 6 weeks. Plan-Do-Study-Act cycles will inform the tool’s iterative development and improvement. The tool’s impact will be measured using a validated parent survey, staff survey, data completeness measures and interviews.AnalysisPrimary outcome: parent satisfaction ‘with communication of clinical information and involvement in care’. Secondary outcomes: parent–staff interactions, staff workload, data completeness. Baseline survey data will be obtained from clinical service evaluation preceding the intervention. Baseline data completeness will be derived from the NNRD. During the intervention, surveys will be administered biweekly and data completeness assessed daily. We will analyse outcomes using run charts and partially paired statistical tests. Parent and staff interviews will explore information exchange and the communication tool’s impact.DiscussionThis study will evaluate the impact of a parent co-designed intervention on communication with parents in neonatal care and the completeness of routinely recorded electronic clinical data. Better use of routinely recorded clinical data provides the opportunity to improve parent satisfaction and increase the research utility of such data, benefiting clinical care.Ethics and disseminationReviewed and approved by the West Midlands—South Birmingham REC (18/WM/0175).Registration numberISRCTN62718241.

The impact of a guideline to prevent inappropriate albumin administration in a hospital in Iran

2020 ◽  
Vol 26 (10) ◽  
pp. 1-7
Author(s):  
Javad Javan-Noughabi ◽  
Elahe Parnian ◽  
Mohammadreza Hajiesmaeili ◽  
Hamid Salehiniya ◽  
Fatemeh Setoodehzadeh
Keyword(s):  
Hospital Setting ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Descriptive Statistics ◽  
Sectional Study ◽  
National Guidelines ◽  
Cross Sectional ◽  
Standard Guideline ◽  
Before And After ◽  
The Impact

Background/Aims In Iran, there are no specific national guidelines for the prescription or administration of albumin. Since March 2017, a standard guideline for albumin prescription has been implemented at a hospital in Tehran, Iran. The objective of this study was to compare the use of albumin and its related costs before and after implementation of this guideline. Methods A cross-sectional study was performed at the hospital in 2018. Data regarding albumin prescription were collected using a census method. Collected data included the demographic and clinical information of patients, duration of hospitalisation and the costs of tests and pharmacotherapy consultations before albumin was prescribed. Albumin consumption costs were also collected before and after the implementation of the guideline. Data were analysed using SPSS 21 software and descriptive statistics. Results Albumin consumption was significantly reduced after the guideline was implemented, decreasing from an average of 28 vials (289g) to an average of 6 vials (67g) per patient. The average cost of albumin use also fell from the equivalent of $1218 before the guideline was implemented, to an average of $281 per patient. Conclusions The implementation of a guideline for albumin prescription and administration in a hospital setting resulted in a significant reduction of inappropriate albumin use and the associated costs.

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.

scholarly journals Usual Interstitial Pneumonia in Contemporary Surgical Pathology Practice: Impact of International Consensus Guidelines for Idiopathic Pulmonary Fibrosis on Pathologists

2020 ◽  
Author(s):  
Jordan M. Eldersveld ◽  
Eunhee S. Yi ◽  
Katie L. Kunze ◽  
Maxwell L. Smith ◽  
Henry D. Tazelaar ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Interstitial Pneumonia ◽  
Usual Interstitial Pneumonia ◽  
Clinical Information ◽  
Clinical Syndrome ◽  
International Consensus ◽  
Before And After ◽  
Lung Biopsies ◽  
The Impact

Context.— Idiopathic pulmonary fibrosis is a clinical syndrome characterized by the presence of usual interstitial pneumonia (UIP) radiologically and pathologically. Per consensus criteria adopted in 2011, diagnosis of idiopathic pulmonary fibrosis no longer requires a biopsy in an appropriate context if UIP is seen on imaging. As a result, lung biopsies are now typically reserved for patients having indeterminate clinical or imaging findings or suspicion for alternative diagnoses, but the impact of updated guidelines on pathology practice remains unclear. Objective.— To determine the frequency of histologic UIP before and after 2011. Design.— Surgical lung biopsies from adults were studied within two 4-year periods: July 1, 2006, through June 30, 2010, and January 1, 2012, through December 31, 2015. Pathology slides were reviewed in a fashion blinded to clinical information and were classified using current guidelines. Results.— Biopsies from 177 and 86 patients (mean [SD] age, 62 [12] and 59 [14] years; 50.3% [89 of 177] and 48.8% [42 of 86] men) before and after 2011, respectively, were reviewed. Probable UIP or UIP was less-frequently encountered after 2011 in all patients with fibrosis (9 of 54 [16.7%] versus 41 of 119 [34.5%] before 2011, P = .02) and also in patients 50 years old and older (8 of 46 [17.4%] versus 39 of 109 [35.8%] before 2011, P = .02), with a concomitant rise in cases indeterminate for UIP or showing alternative diagnoses. Conclusions.— Histology for UIP is less frequently encountered in our contemporary practice compared with the historic era. The pretest probability of a non-UIP diagnosis is now high, even in elderly patients, underscoring the need for pathologists to be familiar with the histologic features of alternative diagnoses.

scholarly journals COVID-19 pandemic is associated with mechanical complications in patients with ST-elevation myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001497
Author(s):  
Satoshi Kitahara ◽  
Masashi Fujino ◽  
Satoshi Honda ◽  
Yasuhide Asaumi ◽  
Yu Kataoka ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Late Presentation ◽  
Medical Attention ◽  
Hospital Death ◽  
Mechanical Complication ◽  
St Segment Elevation ◽  
Mechanical Complications ◽  
Before And After ◽  
The Impact

ObjectiveAlthough there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about the impact of the COVID-19 pandemic on mechanical complications resulting from ST-segment elevation myocardial infarction (STEMI) and mortality.MethodsThis single-centre retrospective cohort study analysed presentations, incidence of mechanical complications, and mortality in patients with STEMI before and after a state of emergency was declared due to the COVID-19 pandemic by the Japanese government on 7 April 2020.ResultsWe analysed 359 patients with STEMI hospitalised before the declaration and 63 patients hospitalised after the declaration. The proportion of patients with late presentation was significantly higher after the declaration than before (25.4% vs 14.2%, p=0.03). The incidence of late presentation was significantly higher during the COVID-19 pandemic than before (incidence rate ratio (IRR), 2.41; 95% CI, 1.37 to 4.05; p=0.001, even after adjusting for month (IRR, 2.61; 95% CI, 1.33 to 5.13; p<0.01). Primary PCI was performed significantly less often after the declaration than before (68.3% vs 82.5%, p=0.009). The mechanical complication resulting from STEMI occurred in 13 of 359 (3.6%) patients before the declaration and 9 of 63 (14.3%) patients after the declaration (p<0.001). However, the incidence of in-hospital death (before, 6.2% vs after, 6.4%, p=0.95) was comparable.ConclusionsFollowing the COVID-19 pandemic, an increased incidence of mechanical complications resulting from STEMI was observed. Instructing people to stay at home, without effectively educating them to immediately seek medical attention when suffering symptoms of a heart attack, may worsen outcomes in patients with STEMI.

Strategic Role of Zakat in Multidimensional Quality of Life in Sijunjung, Indonesia

2018 ◽  
Vol 15 (1) ◽  
pp. 55-72
Author(s):  
Herlin Hamimi ◽  
Abdul Ghafar Ismail ◽  
Muhammad Hasbi Zaenal
Keyword(s):  
Quality Of Life ◽  
Positive Impact ◽  
Wealth Distribution ◽  
Absolute Poverty ◽  
Before And After ◽  
The Status ◽  
Being There ◽  
The Impact

Zakat is one of the five pillars of Islam which has a function of faith, social and economic functions. Muslims who can pay zakat are required to give at least 2.5 per cent of their wealth. The problem of poverty prevalent in disadvantaged regions because of the difficulty of access to information and communication led to a gap that is so high in wealth and resources. The instrument of zakat provides a paradigm in the achievement of equitable wealth distribution and healthy circulation. Zakat potentially offers a better life and improves the quality of human being. There is a human quality improvement not only in economic terms but also in spiritual terms such as improving religiousity. This study aims to examine the role of zakat to alleviate humanitarian issues in disadvantaged regions such as Sijunjung, one of zakat beneficiaries and impoverished areas in Indonesia. The researcher attempted a Cibest method to capture the impact of zakat beneficiaries before and after becoming a member of Zakat Community Development (ZCD) Program in material and spiritual value. The overall analysis shows that zakat has a positive impact on disadvantaged regions development and enhance the quality of life of the community. There is an improvement in the average of mustahik household incomes after becoming a member of ZCD Program. Cibest model demonstrates that material, spiritual, and absolute poverty index decreased by 10, 5, and 6 per cent. Meanwhile, the welfare index is increased by 21 per cent. These findings have significant implications for developing the quality of life in disadvantaged regions in Sijunjung. Therefore, zakat is one of the instruments to change the status of disadvantaged areas to be equivalent to other areas.

ANALISIS PENGARUH PEMBANGUNAN JALAN LAYANG JANTI TERHADAP PERKEMBANGAN TATA RUANG KAWASAN JANTI STUDI KASUS : KAWASAN JANTI, DESA CATURTUNGGAL, KABUPATEN SLEMAN, D. I. YOGYAKARTA

2017 ◽  
Vol 11 (3) ◽  
pp. 255
Author(s):  
Jeky El Boru
Keyword(s):  
Road Network ◽  
Open Space ◽  
Qualitative Description ◽  
Analysis Method ◽  
Open Spaces ◽  
The Road ◽  
Before And After ◽  
Linkage Method ◽  
The Impact ◽  
Parking Place

Abstract: This research aims to analyze the impact of Janti Flyover Construction toward the growth of layout at Janti Urban Area, including structured space, open space, and linkage. Method used for data collecting are observation, air photograph monitoring, and interview, whereas the analysis method is qualitative description, which is the superimposed method of two layers, that are the layout condition before and after flyover construction. The result shows that the impact of Janti Flyover construction can be seen on building mass (solid), the increasing number of open spaces, including the road network, parking place, and park, whereas the relation between spaces, visually and structurally, can be seen on the growth of buildings which have new shapes and styles, therefore the performance of the overall building does not have a proportional shape. Considering Janti Street at the collective relation, its role is getting stronger as the main frame road network.Keywords: Flyover construction, layout changing, Janti AreaAbstrak: Penelitian ini bertujuan untuk menganalisis pengaruh pembangunan Jalan Layang Janti terhadap perkembangan tata ruang Kawasan Janti, meliputi ruang terbangun, ruang terbuka, serta hubungan antar ruang (“linkage”). Metode pengumpulan data dilakukan melalui observasi, pengamatan foto udara, dan wawancara; sedangkan metode analisis melalui deskripsi secara kualitatif yang berupa “superimposed method” dari dua lapisan kondisi lahan, yakni kondisi tata ruang sebelum dan sesudah pembangunan jalan layang. Hasil penelitian menunjukkan bahwa pengaruh pembangunan Jalan Layang Janti terdapat pada massa bangunan (“solid”), pertambahan ruang terbuka yang berupa jaringan jalan, parkir, dan taman; sedangkan pada hubungan antar ruang ̶ secara visual dan struktural ̶ yakni tumbuhnya bangunan dengan bentuk dan gaya baru, sehingga bentuk tampilan bangunan secara keseluruhan tidak proporsional. Pada hubungan kolektif, Jalan Janti semakin kuat perannya sebagai kerangka utama jaringan jalan.Kata kunci : Pembangunan jalan layang, tata ruang, Kawasan Janti

Impact of merger on efficiency and productivity : a case study of commercial banks in Malaysia

1970 ◽  
Vol 5 (1) ◽  
pp. 77
Author(s):  
Mahadzir Ismail ◽  
Saliza Sulaiman ◽  
Hasni Abdul Rahim ◽  
Nordiana Nordin
Keyword(s):  
Efficiency Score ◽  
Malmquist Productivity Index ◽  
Productivity Index ◽  
Data Envelopment ◽  
Master Plan ◽  
Before And After ◽  
Domestic Banks ◽  
The Impact ◽  
Efficiency And Productivity

The Financial Master Plan (2001- 2010) aims to enhance the capacity of banking industry so that higher effic iency and productivity can be reaped in the future. This study seeks to determine the impact of merger on the efficiency and productivity ofcommercial banks in Malaysia for the period 1995 until 2005. The study uses a non-parametric approach, nam ely DEA (data envelopment analysis?) to estimate the efficiency scores and to construct the Malmquist productivity index. To enable this estimation, three bank inputs and outputs are used. Amongst the findings are those banks exhibit higher efficiency score after the merger and thefo reign banks are more efficient than the local banks. Productivity of the banks is calculated in both periods, before and after the merger: The results show that, it is the local banks that have improved the most after the merger. The main source of productivity is technical change or innovation. The findings support the existing policy of having larger domestic banks in term of size.

THE EFFECT OF METACOGNITIVE INSTRUCTION ON MAXIMIZING EFL LEARNERS’ METACOGNITIVE AWARENESS IN LISTENING

2018 ◽  
Vol 7 (1) ◽  
pp. 8-17
Author(s):  
Mahsa Assadi
Keyword(s):  
Experimental Research ◽  
Listening Comprehension ◽  
Intervention Program ◽  
Metacognitive Awareness ◽  
Listening Test ◽  
Efl Learners ◽  
Metacognitive Instruction ◽  
Before And After ◽  
Comprehension Ability ◽  
The Impact

This study reports a pre-experimental research on the impact of metacognitive instruction on EFL learners’ metacognitive awareness and their listening performance. To obtain the goal of the study, a group of 30 Iranian intermediate EFL learners, including 14 males and 16 females, were selected randomly. Their ages range from 20 to 24. The participants took part in 16 weeks’ intervention program based on metacognitive pedagogical sequence consisted of five stages. The metacognitive awareness listening questionnaire (MALQ), and a listening test were also used to find changes in metacognitive awareness and listening performance before and after the treatment. The results of comparing pre and posttests scores revealed that metacognitive instruction raised the learners’ metacognitive awareness and helped them improve their listening comprehension ability.

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