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* Context.--Acquiring objective, timely, and comprehensive feedback on resident diagnostic performance is notoriously difficult. Objective.--To implement a custom software application (Resident Case Tracker) to improve evaluative diagnostic analysis for residency programs. Design.--Residents and faculty use a graphical user interface with restricted access to their own cases and evaluations. For each sign-out, residents enter their diagnoses and comments for each case. Faculty are provided a sign-out queue to review the resident diagnosis and select their level of agreement alongside optional comments. After sign-out, residents can review the agreement level and comments for each case, overall sign-out statistics, and organ-specific performance, and they have the option of opening and reviewing groups of cases by agreement status. A sign-out evaluation is automatically generated and stored alongside additional reports. Administrative access allows privileged users to readily review data analytics at both an individual and residency-wide global level. Results.--A marked increase in completed evaluations and feedback was noted in the initial 36 months of implementation. During a 3-year academic period, faculty completed individual feedback on 33 685 cases and 1073 overall sign-out evaluations. Conclusions.--Resident Case Tracker is an invaluable tool for our residency program and has provided unparalleled feedback and data analytics. Throughout residency, trainees have access to each completed sign-out, with the ability to learn from discrepant cases while also monitoring improvements in diagnostic acumen over time. Faculty are able to assess resident milestones much more effectively while more readily identifying residents who would benefit from targeted study., For nearly a decade, pathology residency programs have used the Accreditation for Graduate Medical Education milestones with the intent to provide trainees with objective documentation on their progression through key [...]

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Purpose To determine the effect of electronic prescribing (EP) with a clinical information system (Intellivue Clinical Information Portfolio, Philips, UK) on prescribing errors and omitted doses in a paediatric intensive care unit (PICU). Methods Prospective audit of prescribing errors and omitted doses for 96 h periods in three epochs: (1) before implementation of EP, (2) 1 week and (3) 6 months later. Results There was a non-significant reduction in prescribing errors: 8.8% (95% CI 4.4-13.2) pre-implementation of EP versus 8.1% (4.4-11.8) 1 week after implementation and 4.6% (2.0-7.2) 6 months later. The prevalence of omitted doses decreased significantly 6 months following implementation, changing from 8.1% (5.8-10.4) pre-implementation to 10.6% (6.5-14.7) 1 week after implementation and 1.4% (CI 0-2.8%) 6 months after implementation (P < 0.05). Conclusion EP within a clinical information system increases medication safety in a PICU., Author(s): Catherine Warrick [sup.1], Hetal Naik [sup.2], Susan Avis [sup.1], Penny Fletcher [sup.3], Bryony Dean Franklin [sup.2] [sup.4], David Inwald [sup.5] Author Affiliations: (1) grid.417895.6, 0000000106932181, Paediatric Intensive Care Unit, [...]

Background. Existing self-report measures of mobility ignore important contextual features of movement and require respondents to make complex judgments about specific tasks. Thus, we describe the development and validation of a short form (sf) video-animated tool for assessing mobility, the Mobility Assessment Tool--MAT-sf. Methods. This study involves cross-sectional and longitudinal analyses examining the measurement properties of the MAT-sf. The MAT-sf consists of 10 animated video clips that assess respondents' level of proficiency in performing each task. The main outcome measures used for validation included the Pepper Assessment Tool for Disability (PAT-D), the Short Physical Performance Battery (SPPB), and 400-m walk test. Results. Participants (n = 234), 166 women and 68 men, had an average age of 81.9 years and a variety of comorbidities with 65.4% having high blood pressure. An average SPPB score of 8.6 (range 2-12) suggests that the study sample had evidence of compromised physical function but was quite heterogeneous. The MAT-sf had good content validity, excellent tes--retest reliability (r = .93), and criterion-related validity with the PAT-D. Moreover, the MAT-sf added considerable variance to the prediction of both SPPB scores and 400-m gait speed over and above the PAT-D mobility subscale. The MAT-sf also discriminated between older adults who completed or failed the 400-m walk test. Conclusion. The MAT-sf is an innovative psychometrically sound measure of mobility. It has utility in epidemiological studies, translational science, and clinical practice. Key Words: Mobility--Aging--Measurement--Disability. doi: 10.1093/gerona/glq055

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.tips.2009.07.003 Byline: Matthew D. Hall, Misty D. Handley, Michael M. Gottesman Abstract: When cancer cells develop resistance to chemotherapeutics, it is frequently conferred by the ATP-dependent efflux pump P-glycoprotein (MDR1, P-gp, ABCB1). P-gp can efflux a wide range of cancer drugs; its expression confers cross-resistance, termed 'multidrug resistance' (MDR), to a wide range of drugs. Strategies to overcome this resistance have been actively sought for more than 30 years, yet clinical solutions do not exist. A less understood aspect of MDR is the hypersensitivity of resistant cancer cells to other drugs, a phenomenon known as 'collateral sensitivity' (CS). This review highlights the extent of this effect for the first time, and discusses hypotheses (e.g. generation of reactive oxygen species) to account for the underlying generality of this phenomenon, and proposes exploitation of CS as a strategy to improve response to chemotherapy. Author Affiliation: Laboratory of Cell Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA

Byline: Minna Niskanen (1), Matti Reinikainen (2), Ville Pettila (3) Keywords: Intensive care unit; Resource utilization; Length of stay; Outcome assessment; Benchmarking Abstract: Objectives To create a tool for benchmarking intensive care units (ICUs) with respect to case-mix adjusted length of stay (LOS) and to study the association between clinical and economic measures of ICU performance. Design Observational cohort study. Setting Twenty-three ICUs in Finland. Patients A total of 80,854 consecutive ICU admissions during 2000--2005, of which 63,304 met the inclusion criteria. Interventions None. Measurements and results Linear regression was used to create a model that predicted ICU LOS. Simplified Acute Physiology Score (SAPS) II, age, disease categories according to Acute Physiology and Chronic Health Evaluation III, single highest Therapeutic Intervention Scoring System score collected during the ICU stay and presence of other ICUs in the hospital were included in the model. Probabilities of hospital death were calculated using SAPS II, age, and disease categories as covariates. In the validation sample, the created model accounted for 28% of variation in ICU LOS across individual admissions and 64% across ICUs. The expected ICU LOS was 2.53 +- 2.24 days and the observed ICU LOS was 3.29 +- 5.37 days, P < 0.001. There was no association between the mean observed - mean expected ICU LOS and standardized mortality ratios of the ICUs (Spearman correlation 0.091, P = 0.680). Conclusions We developed a tool for the assessment of resource use in a large nationwide ICU database. It seems that there is no association between clinical and economic quality indicators. Author Affiliation: (1) Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland (2) Department of Intensive Care, North Carelia Central Hospital, Joensuu, Finland (3) Department of Anesthesiology and Intensive Care, Meilahti Hospital, Helsinki University Central Hospital, Helsinki, Finland Article History: Registration Date: 15/12/2008 Received Date: 19/12/2007 Accepted Date: 08/12/2008 Online Date: 06/01/2009 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1377-0) contains supplementary material, which is available to authorized users.

The considerable emphasis in the development and implementation of clinical information systems in hospitals internationally seems to have had a limited effect. In particular, the implementation of electronic patient record (EPR) systems has been slower and more difficult than anticipated and with little change in efficiency and security. This paper suggests why this might be the case. Well established research findings within the field of computer supported cooperative work (CSCW--an interdisciplinary research field between informatics and the social sciences) are cited to construct a case for greater awareness of (1) inter- and intra-professional interests, and (2) broader social and health policy contexts. We draw on Gouldner's work [(1957). Cosmopolitans and locals: toward an analysis of latent social roles - I. Administrative Science Quarterly, 2(3), 281-306; (1958). Cosmopolitans and locals: toward an analysis of latent social roles--II. Administrative Science Quarterly, 2 (4), 444-480] on organisational roles to develop a discussion of professional awareness; a pivotal notion is also the interactionist one of the hospital as a 'negotiated order'. Drawing for illustrative purposes on the Norwegian experience (that is, reviewing research on hospital information systems in Norway), we contend that enhanced awareness of the hospital itself as a social system may be a precondition of cost-effective hospital information and communication technologies. Keywords: Norway Hospital Information and communication technologies (ICT) Implementation Computer supported cooperative work (CSCW) Awareness Negotiated order Health systems

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2008.11.005 Byline: Aksel Hagen Tjora (a)(b), Graham Scambler (c) Abstract: The considerable emphasis in the development and implementation of clinical information systems in hospitals internationally seems to have had a limited effect. In particular, the implementation of electronic patient record (EPR) systems has been slower and more difficult than anticipated and with little change in efficiency and security. This paper suggests why this might be the case. Well established research findings within the field of computer supported cooperative work (CSCW - an interdisciplinary research field between informatics and the social sciences) are cited to construct a case for greater awareness of (1) inter- and intra-professional interests, and (2) broader social and health policy contexts. We draw on Gouldner's work [(1957). Cosmopolitans and locals: toward an analysis of latent social roles - I. Administrative Science Quarterly, 2(3), 281-306; (1958). Cosmopolitans and locals: toward an analysis of latent social roles - II. Administrative Science Quarterly, 2 (4), 444-480] on organisational roles to develop a discussion of professional awareness; a pivotal notion is also the interactionist one of the hospital as a 'negotiated order'. Drawing for illustrative purposes on the Norwegian experience (that is, reviewing research on hospital information systems in Norway), we contend that enhanced awareness of the hospital itself as a social system may be a precondition of cost-effective hospital information and communication technologies. Author Affiliation: (a) Department of Sociology and Political Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway (b) Norwegian Centre for Telemedicine, 9038 TromsA[cedilla], Norway (c) Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK

Byline: Mathijs Vogelzang (1), Bert G. Loef (1), Joost G. Regtien (1), Iwan C. C. Horst (2), Hein Assen (1), Felix Zijlstra (2), Maarten W. N. Nijsten (1) Keywords: Insulin; Glucose; Critically ill; Computer decision support Abstract: Objective Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients. Design and setting Observational cohort study in three intensive care units (32 beds) in a 1,300-bed university teaching hospital. Patients All 2,800 patients admitted to the surgical, neurosurgical, and cardiothoracic units the study period started at each ICU after implementation of Glucose Regulation for Intensive Care Patients (GRIP), a freely available computer-assisted glucose control protocol. Measurements and results We analysed compliance in relation to recommended insulin pump rates and glucose measurement frequency. Patients were on GRIP-ordered pump rates 97% of time. Median measurement time was 5a-min late (IQR 20a-min early to 34a-min late). Hypoglycemia was uncommon (7% of patients for mild hypoglycemia, Conclusions Our computer-assisted glucose control protocol provides safe and efficient glucose regulation in routine intensive care practice. A low rate of hypoglycemic episodes was achieved with a considerably lower number of glucose measurements than used in most other schemes. Author Affiliation: (1) Department of Critical Care, University Medical Center, University of Groningen, 9700 RB, Groningen, The Netherlands (2) Department of Cardiology, University Medical Center, University of Groningen, 9700 RB, Groningen, The Netherlands Article History: Registration Date: 11/03/2008 Received Date: 21/12/2007 Accepted Date: 10/03/2008 Online Date: 04/04/2008 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1091-y) contains supplementary material, which is available to authorized users.

Objective: Imperfect patient-ventilator interaction is common during assisted ventilation, and the detection of clinically relevant mismatching requires visual monitoring of the ventilator screen. We have assessed the feasibility, sensitivity and specificity of an algorithm embedded in a ventilator system that is able to automatically detect the occurrence of ineffective triggering and double triggering in real time. Design: Prospective study. Setting: Respiratory intensive care unit. Methods: Twenty patients undergoing pressure-support ventilation, either non-invasively (NIV, n = 10) or conventionally ventilated (n = 10), were studied. Measurements: The detection of ineffective triggering and double triggering from the algorithm was compared by two operators with the 'real' occurrence of the phenomena as assessed using the transdiaphragmatic pressure (Pdi). Results: Seven of the 20 patients exhibited gross mismatching, while in the remaining patients patient-ventilator mismatching was artificially induced using a pressure control, with a low respiratory rate. Ineffective triggering and double triggering were identified by the operators in 507 and 19 of the 3343 analyzed breaths, respectively. False positives were significantly more frequent in the NIV group than with conventional ventilation. The algorithm had an overall sensitivity of 91% and specificity of 97%. Specificity was statistically higher in the conventional ventilated group than with NIV (99% vs. 95%, p < 0.05). Conclusions: We have demonstrated the feasibility and efficacy of a new algorithm to detect the occurrence of impaired patient-ventilator interaction during mechanical ventilation in real time. This software may help the clinician in the identification of this problem, which has been shown to have important clinical consequences. Keywords Patient-ventilator interaction * Pressure-support ventilation * Non-invasive ventilation * Ineffective efforts * COPD, Introduction It has been shown that poor interaction between the patient and the ventilator, particularly during the inspiratory triggering phase, is associated with an inferior clinical outcome [1, 2]. Theoretically [...]

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WE ARE writing in to the article "Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System" by Han et al. (1) The authors are to [...]

Mental health problems are common in primary care, representing 30%-50% of visits. Family physicians are often frustrated by their lack of training and by the difficulties of obtaining a timely [...]

More and more insurers and hospitals are using software to 'profile' practitioners and exclude those who don't measure up. But is it all just a fancy form of economic credentialing? [...]

In 2002, when he began to make the transition from basic cell biology to research into Alzheimer's disease, Virgil Muresan found himself all but overwhelmed by the sheer volume of [...]

When Gil M. Holland opened a solo practice in Chandler, AZ, in late 2004, he decided to start out with an electronic health record system right off the bat. Relying [...]

Most of us don't think twice about depositing our money in a bank. We are certain the bank will safeguard our money and that it will be there if we [...]

Context.--The mechanics of the practice of medicine in general and of pathology in particular is evolving rapidly with the rise in the use of electronic information systems for managing the care of individual patients, including the ordering and reporting of laboratory tests, maintaining the health of served populations, and documenting the full range of health care activities. Pathologists currently in practice and those in training need to acquire additional skills in informatics to be prepared to maintain a central role in patient care. Objective.--To summarize the evolving landscape of pathology informatics, with particular attention to the preparation of pathologists for this discipline and to the possible influence of the new subspecialty certification in clinical informatics. Data Sources.--Most of the information discussed is drawn from the authors' direct experience with informatics, resident and fellow education, and the organizations supporting these activities in pathology. Conclusions.--The increasing reliance of medical practice on electronic health records and other clinical information systems is creating a greater need for physicians skilled in the use and management of these tools. The establishment of clinical informatics as a formal subspecialty in medicine will likely help secure a role for physicians within information management structures at health care institutions. Pathologists must actively engage in informatics to assure that our specialty is appropriately recognized and represented in this growing discipline. (Arch Pathol Lab Med. 2014; 138:505-511; doi: 10.5858/arpa.2013-0328-RA), Informatics is a term that means different things to different people. While most will accept the generic definition of 'the science of information management,' how that definition manifests itself in [...]

In keeping with the need for us, as pathologists, to engage in transformation and to reinvent ourselves as a profession, (1) Flach et al (2) at the University of Bern's [...]

A PC-based system for the simulation of the vertebroplasty procedure, which focuses on the provision of a near-realistic haptic feel in bone needle insertion and manual polymethylmethacrylate (PMMA) injection, is described. It is shown with virtual reality gaming technique that the surgical simulator can become a virtual trainer for a potentially risky spinal interventional procedure.

Can't afford electronic records? Here's a less costly alternative--and the pros and cons of various systems. Albany, GA, internist Brian T. Keefe used to spend $1,400 a month on transcription [...]

Author(s): Krish Thiru [sup.1], Stuart Rowe [sup.2], Nicola Shaw [sup.3], Andrew Durward [sup.4], David P. Inwald [sup.5], Padmanabhan Ramnarayan [sup.6] Author Affiliations: (1) grid.420468.c, Great Ormond Street Hospital, , Great [...]

The size of the organization in which you work affects your view of all aspects of the behavioral healthcare community, including the rapid changes occurring in the industry. Your organization's [...]

Admitting a mistake, whether personal or professional, is difficult. The 'blame and shame' environment that has long existed in healthcare frequently makes caregivers fearful of admitting errors. Mistakes can occur [...]

Microsoft has finally released the new PC computer operating system that they have talked about since 2004. This article discusses how this new software will affect physicians using PC computers [...]

If you're making New Year's resolutions to exercise more and eat less, why not transfer that spirit of self-improvement to your life as a computer user? Make 2005 the year [...]

Abstract Electronic prescribing has been gaining momentum with the passage of recent federal legislation. This article attempts to present the current status of e-prescribing. 'Electronic communications between physicians and pharmacists [...]

To paraphrase Benjamin Franklin, nothing in life is certain except death, taxes, and software salespeople who constantly say, "Yes, our program can do that." That's why anyone shopping for a [...]

Shopping for electronic medical record software? The wide range of choices can make you dizzy. According to a survey by Healthcare Informatics magazine, almost 400 companies offer an EMR product. [...]

Clearwave Corporation's Patient Self Service Kiosk and Real-time Eligibility Verification solution has joined Greenway Medical Technologies' online Marketplace as a certified API solution for users of Greenway's PrimeSUITE platform, an [...]

A problem faced by patients seeking medical attention is often getting a clinic appointment at a time convenient to them. Conversely, cancellations and more crucially 'no-shows' by patients can disrupt [...]

A NEW online tool will make it possible for physicians to gain detailed information about community health trends. The 2013 County Health Rankings, published online by the Robert Wood Johnson [...]

An estimated 40,000 medical apps currently are available, and the number is growing. Medical Economics is taking a closer look at some of your favorites. Send your best and worst [...]