Trust in pathways? Professionals’ sensemaking of care pathways in the Norwegian mental health services system

Background In January 2019, care pathways within specialist mental health and substance abuse treatment services were officially launched in Norway. The care pathway introduced timeframes for assessment and treatment, allowing a maximum of 6 weeks to finish assessment and provide the patient with a diagnosis, in addition to allowing a maximum of 6 weeks from diagnosis to the first evaluation. The different action points required coding. The system was based on goals to improve services by focusing on user participation, coordinated patient flow, avoidance of unnecessary waiting time, improvement of equal access to services regardless of geographic location, and increased emphasis on physical health and lifestyle. The purpose of our study was to examine how mental health professionals made sense of care pathways and furthermore, how issues of trust affected the process of implementation. Methods Our multiple case study included four outpatient clinics for adults in four community mental health centres (CMHCs) in different parts of Norway. Qualitative data were collected through in-depth individual and focus group interviews and analysed using systematic text condensation. The informants were treatment personnel and leaders in four different outpatient clinics for adults. Results The results indicated four distinct themes or reactions to the care pathway and its implementation: 1) lack of clarity regarding the overall goals and content of the care pathway; 2) the increased burden of coding, registration and administrative work, which professionals experienced as a stressor; 3) an IT and medical record system that did not correspond to the coding of the care pathway; and 4) an unrealistic distinction between assessment and treatment. These themes/reactions increased the health professionals’ distrust towards the care pathway, and a process of sensemaking encouraged them to reduce the importance of the care pathway system and its implementation. Conclusion Theories of trust help in understanding how mental health professionals interpret care pathway implementation. Distrust and resistance towards the care pathways overshadow some of the overall quality goals of the care pathway, a view that was indeed shared by mental health professionals.

Use of a Deprescribing Tool in an Interdisciplinary Primary-Care Patient-Aligned Care Team

Objective: To pilot the VIONE approach in a single Primary Care Patient Aligned Care Team (PACT). The authors aim for the Clinical Pharmacy Specialist (CPS) to perform 20 comprehensive medication reviews (CMRs) and the pilot PACT physician (PCP) to complete 200 VIONE discontinuations. Cost avoidance and CPS recommendations will also be analyzed. Polypharmacy is associated with increased risk of adverse drug events, falls, hospitalizations, and death. VIONE is a deprescribing tool that assists providers in identifying inappropriate medications. Design: Quality Improvement Setting: Single VA Health Care System (VAHCS) Participants: High-risk veterans in pilot PACT Interventions: The CPS educated the PCP regarding VIONE methodology and assisted with CMRs. When deprescribing was warranted, VIONE discontinuation reasons were selected in the Computerized Patient Record System (CPRS). Data were electronically stored in a national dashboard. Results: The authors identified 231 veterans at risk for polypharmacy-related adverse events. The PCP and CPS were able to reach 99 veterans and make 136 medication discontinuations between September 1, 2019, and March 1, 2020. The CPS performed 20 CMRs, resulting in 90 deprescribing recommendations. Thirty-eight CPS recommendations were accepted and contributed $18,835.95 to the sum annualized cost avoidance of $21,904.80. Conclusion: The VIONE methodology was successfully implemented in the pilot PACT. The utilization of the CPS was associated with an increased average number of medication discontinuations per veteran and contributed to cost avoidance.

Leishmaniasis in the United States military veterinary patient population

OBJECTIVE To describe the presence of Leishmania infection within the animal population receiving care from US Army Veterinary Services. ANIMALS 629 canine, feline, and equine patients of US Army Veterinary Services from 2014 to 2017. PROCEDURES Personnel at the US Army Public Health Center ran a query within the Remote Online Veterinary Record system using previously validated search terms (eg, liesh, leish, and lesh) and returned data on any patient for which the master problem list included those terms. Next, a query was run to identify all leishmaniasis testing. Records identified by queries were reviewed manually, and data were collected on patient signalment, indication for and type of testing, location of testing, and previous locations or country of the patient. RESULTS Only dogs (n = 378), not cats or horses, had been tested for leishmaniasis, 54 (14.3%) of which tested positive for Leishmania infection. More specifically, 39 of 104 (37.5%) privately owned dogs tested positive, compared with 15 of 274 (5.6%) government-owned dogs. Overall, 186 dogs had no clinical signs, 12 (6.5%) of which tested positive. Forty-four of the 54 (81%) test-positive dogs were located in or had traveled to an endemic area. CLINICAL RELEVANCE The prevalence of leishmaniasis in the various subpopulations of dogs suggested the need for additional prevalence studies. Many animals travel in and out of the US, and repeated introduction of Leishmania spp could lead to this vector-borne disease becoming endemic in the US animal and human populations. Consequently, US veterinarians need to ensure proper testing and follow-up to protect one health.

Epidemiology of Traumatic Posterior Hip Instability in the National Football League

Background: There is a paucity of literature regarding injury incidence, mechanism, and return to play in National Football League (NFL) players who have sustained traumatic posterior hip instability. Purpose: To describe the incidence of traumatic posterior hip instability and the rate of return to play in NFL players across 18 seasons. Study Design: Descriptive epidemiology study. Methods: We retrospectively assessed all traumatic posterior hip dislocations/subluxations that occurred during football-related activities in the NFL seasons from 2000 through 2017. Player demographics and injury data (injury mechanism, season of injury, treatment, days missed, and return to play time) were collected from all 32 NFL teams prospectively through a leaguewide electronic health record system. Descriptive statistics are presented. Results: Across the 18 NFL seasons, 16 posterior hip instability injuries in 14 players were reported, with a maximum incidence of 4 (25%) in 2013. Posterior hip instability was predominantly sustained by offensive players (64.3%), with tight ends being the most affected (31.3%). Half of the injuries occurred during the regular season, 43.8% in the preseason, and 6.2% in the offseason. Of all injuries, 37.5% were noncontact, while 56.3% involved contact (direct or indirect), and 6.2% were of unknown mechanism. Among noncontact injuries, 66.7% occurred during cutting and change of direction while sprinting. The time of return to full participation was documented for 11 of the 16 reported injuries (68.8%); among them, the mean time loss was 136.7 ± 83.8 days—143.3 ± 99.6 days if the player underwent surgery (n = 4) and 116.7 ± 76.2 days missed by players without surgery (n = 6)—the treatment modality was unknown in 1 player. Conclusion: Although the incidence of traumatic posterior hip instability during the study period was low, all injured athletes missed time from football activities and competitions. Injuries that required surgery led to more missed time than those that did not. Ongoing research to understand risk factors and mechanisms of this injury, in conjunction with improvements to prevention and rehabilitation protocols, is necessary to ensure the safety of professional American football players.

Analyzing Health Information Technology and Electronic Medical Record System-Related Patient Safety Incidents Using Data from the Korea Patient Safety Reporting and Learning System

Purpose: At present, there are a variety of serious patient safety incidents related to problems in health information technology (HIT), specifically involving electronic medical records (EMRs). This emphasizes the need for an enhanced electronic medical record system (EMRS). As such, this study analyzed both the nature of and potential to prevent incidents associated with HIT/EMRS based on data from the Korea Patient Safety Reporting and Learning System (KOPS).Methods: This study analyzed patient safety incidents submitted to KOPS between August 2016 and December 2019. HIT keywords were used to extract HIT/EMRS incidents. Each case was reviewed to confirm whether the contributing factors were related to HIT/EMRS (HIT/EMRS-related incidents) and if the incident could have been prevented (HIT/EMRS-preventable incidents). The selected reports were summarized for general clarity (e.g., incident type, and degree of harm).Results: Of the 25,515 obtained reports, 2,664 incidents (10.4%) were HIT-related, while 2,525 (9.9%) were EMRS-related. HIT/EMRS-related incidents were the third largest type of incident followed by 'fall' and 'medication incidents.' More than 80% of HIT/EMRS-related incidents were medication-related, accounting for approximately one-third of the total number of medication incidents. Approximately 10% of HIT/EMRS-related incidents resulted in patient harm, with more than 94% of these deemed as preventable; further, sentinel events were wholly preventable.Conclusion: This study provides basic data for improving EMR use/safety standards based on real-world patient safety incidents. Such improvements entail the establishment of long-term plans, research, and incident analysis, thus ensuring a safe healthcare environment for patients and healthcare providers.

Prevalence of Parasitic Infections in a Tertiary Hospital in China: A 12-Year Retrospective Study

BackgroundParasitic infections represent a worldwide public health issue in many developing countries. Few epidemiological studies regarding parasitic infections and the evolution of infection spectrum in China have been reported up to date. It is necessary to investigate the epidemiological feature of parasitic infection during recent years.MethodsThree hundred and thirty-six cases of parasitic infections were retrospectively enrolled and analyzed. Electronic medical records of the enrolled parasitic patients from January 1, 2010 to May 31, 2021 were retrieved from the Electronic Medical Record System of a tertiary hospital in China. Demographic characteristics and data of laboratory tests were exported in Excel and analysis were performed using Graphpad Prism 5.ResultsOverall, seventeen species of parasites were detected in 336 admissions with a total number of infected individuals reached the peak in 2018. Moreover, the regions of patients distributed mainly included: Shanghai (40.48%), Zhejiang (18.45%), Anhui (6.85%), Jiangsu (6.25%) and Jiangxi (4.76%). Two hundred and eighty-eight cases were diagnosed with single species of parasitic infection and 47 cases were found mixed species infection. Foodborne parasites (FBPs) were the primary species of parasites and the top 4 were clonorchis sinensis (24.70%), sparganum mansoni (16.07%), paragonimus westermani (20.83%) and cysticercus (17.86%). Obvious eosinophil elevation was found in 56.54% enrolled patients. Patients with periods of infection before the time of diagnosis lasted longer than 6 months includes four parasites: sparganum mansoni (28.30%, 15/53), paragonimus westermani (38.57%, 27/70), cysticercus (25.00%, 15/60).ConclusionsOur study demonstrated the prevalence of parasitic infection over the latest 12 years in a single center of China. The trend of parasitic infection rate reached the peak in 2018 with the dominating parasitic species changed from soil origin to foodborne. Furthermore, with the emergence of various dietary habits and the development of living conditions, unclean diets especially eating raw meat had become the main route of transmission for parasites, which alarmed that food safety education for public should be strengthened and enlarged. Although eosinophil elevation and IgE is reliable indicators for initiating screening of parasitic infection but enough for diagnosis, novel diagnostic kits for parasites should be devepoled.

Decreasing drug waste, reducing drug costs, and improving workflow efficiency through the implementation of automated chemotherapy dose rounding rules in the electronic health record system

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To decrease drug waste and cost by implementing automated chemotherapy dose rounding rules in the electronic health record (EHR). Dose rounding of chemotherapy is a recognized method for reducing drug waste, and professional organizations have published guidelines recommending dose rounding when possible. Summary On the basis of current literature and guideline recommendations, Mayo Clinic developed system-wide consensus to allow dose rounding for biologic and chemotherapy agents to the nearest vial size if rounding resulted in the dose being within 10% of the originally calculated dose or to a convenient measurable volume, based on concentration of the drug, if rounding to the nearest vial size resulted in the dose being outside the 10% range. Oncology pharmacists reviewed and analyzed all drugs listed in the EHR used in injectable form for the treatment of cancer and developed dose rounding rules. The rules were implemented and applied at the dose calculation stage before provider signature. From January to June 2019, approximately 40,000 cancer treatment doses were administered. The rounding rules saved a total of 9,814 vials of drug, of which 5,329 were for biologic agents and 4,485 were for oncolytic drugs. This resulted in a total 6-month cost savings of $7,284,796 (in 2019 dollars; biologics, $5,727,402; oncolytics, $1,557,394). Conclusion Systematic implementation of dose rounding rules utilizing the EHR can result in significant reduction of drug waste and realization of savings.

Biometric personal data and their use in the investigation of criminal offences

The article is devoted to the analysis of biometric personal data, which is proposed to be considered as a source of information about a person and used during pre-trial investigation of criminal offences. The relevance of the research topic lies in the need to develop an optimal mechanism for using biometric personal data in the activities of pre-trial investigation bodies. The purpose of the research is to analyse the current international and national legislation on determining the place of biometric personal data in the criminal record system, implement their classification and provide recommendations for use by state bodies and individuals. To achieve this goal, the work used dialectical, historical-legal, formal-logical, dogmatic, structural-system and comparative-legal methods. It is proved that various types of biometric personal data accumulated in the criminal record system can be successfully used in the process of investigating criminal offences, and in some cases by individuals within the limits of their statutory powers. It was noted that along with the positive results of such activities, there are certain risks, namely, the presence of a threat of leakage and access to biometric data by unauthorized persons, as evidenced by the negative judicial practice of individual countries regarding unsatisfactory collection, processing, storage and use of biometric personal data. Taking into account the above, it is stated that the collection, processing and use of biometric personal data for the purpose of their use in the investigation of criminal offences must meet certain requirements, namely: the owner of the database of biometric personal data should only be the state represented by a special state body. Accordingly, the state should ensure the storage and protection of biometric personal data