Search

Background: This study aims to identify trends, research gaps, leading journals, institutions, countries, and authors by examining the top 100 cited Yttrium-90 Radioembolization (Y90) research articles. The insights gained will assist funding and collaboration efforts in Y90 research. The team analyzed 981 articles from 36 peer-reviewed journals, gathering data on authors, publication year, journal, citations, affiliations, keywords, and references. Author affiliations were scrutinized to pinpoint institutions and countries. p values < 0.05 were deemed statistically significant. The most cited paper (703 citations) was authored by Salem et al. (2010), and the journal with the most publications (16) was Journal of Vascular and Interventional Radiology. There was no significant correlation between journal impact factor and citation metrics. A decreasing trend in the number of top 100 articles was observed since the peak period (2008–2013). Most papers were published in high-impact factor (IF > 3, n = 31/35) and SCImago Q1 journals (86/100), with Northwestern University, Clínica Universidad de Navarra, and Ludwig Maximilian University of Munich being the leading institutions. The most prolific authors were Salem, R., Lewandowski, R.J., and Mulcahy, M.F., with Salem, R. as the most influential. A statistically significant positive correlation between collaborative links and published articles was also discovered. Short conclusion: The top 100 cited articles were primarily published in high-impact journals, and Northwestern University and the USA showed greater productivity and collaboration. These findings have crucial implications for researchers, policymakers, and institutions, aiding in the improvement of Y90 application and understanding in clinical practice. [ABSTRACT FROM AUTHOR]

Background: In low-middle income countries, healthcare providers primarily use paper health records for capturing data. Paper health records are utilized predominately due to the prohibitive cost of acquisition and maintenance of automated data capture devices and electronic medical records. Data recorded on paper health records is not easily accessible in a digital format to healthcare providers. The lack of real time accessible digital data limits healthcare providers, researchers, and quality improvement champions to leverage data to improve patient outcomes. In this project, we demonstrate the novel use of computer vision software to digitize handwritten intraoperative data elements from smartphone photographs of paper anesthesia charts from the University Teaching Hospital of Kigali. We specifically report our approach to digitize checkbox data, symbol-denoted systolic and diastolic blood pressure, and physiological data. Methods: We implemented approaches for removing perspective distortions from smartphone photographs, removing shadows, and improving image readability through morphological operations. YOLOv8 models were used to deconstruct the anesthesia paper chart into specific data sections. Handwritten blood pressure symbols and physiological data were identified, and values were assigned using deep neural networks. Our work builds upon the contributions of previous research by improving upon their methods, updating the deep learning models to newer architectures, as well as consolidating them into a single piece of software. Results: The model for extracting the sections of the anesthesia paper chart achieved an average box precision of 0.99, an average box recall of 0.99, and an mAP0.5-95 of 0.97. Our software digitizes checkbox data with greater than 99% accuracy and digitizes blood pressure data with a mean average error of 1.0 and 1.36 mmHg for systolic and diastolic blood pressure respectively. Overall accuracy for physiological data which includes oxygen saturation, inspired oxygen concentration and end tidal carbon dioxide concentration was 85.2%. Conclusions: We demonstrate that under normal photography conditions we can digitize checkbox, blood pressure and physiological data to within human accuracy when provided legible handwriting. Our contributions provide improved access to digital data to healthcare practitioners in low-middle income countries. [ABSTRACT FROM AUTHOR]

My Turn is software used to manage several Covid-19 mass vaccination campaigns in California. The objective of this article is to describe the use of My Turn at two points of dispensing in California and comment on process improvements to reduce manual tasks of six identified processes of vaccination–registration, scheduling, administration, documentation, follow-up, and digital vaccine record–and paper. We reviewed publicly available documents of My Turn and patients vaccinated at George R. Moscone Convention Center in San Francisco and Oakland Coliseum Community Vaccination Clinic. For publicly available documents of My Turn, we examined videos of My Turn on YouTube, and documentation from EZIZ, the website for the California Vaccines for Children Program. For patients, we examined publicly available vaccination record cards on Instagram and Google. At the George R. Moscone Convention Center, 329,608 vaccines doses were given. At the Oakland Coliseum Community Vaccination Clinic, more than 500,000 vaccine doses were administered. The use of My Turn can be used to reduce manual tasks and paper for mass vaccinating patients against Covid-19. [ABSTRACT FROM AUTHOR]

The present study was a review of cases of central cystadenocarcinoma over the past 29 years and provides clinical, radiological, and pathological information about these rare lesions. Six cases of central cystadenocarcinoma treated between 1991 and 2019 at Peking University Hospital of Stomatology in Beijing, China, were retrospectively analysed. A comprehensive review of clinical records was summarised and the histological diagnosis was revised using the 2017 World Health Organization criteria. The mean age of patients with central cystadenocarcinoma was 63 (range 51-75) years, and the male:female ratio 1:1. The clinical signs included localised swelling, pain, lower lip numbness, and trismus. There were more cases in the mandible than in the maxilla. All lesions were unilocular or multilocular in radiolucent regions with or without clear margins. The preferred treatment of central cystadenocarcinoma was surgical excision with wide margins, and no local recurrence was found during follow-up. Central cystadenocarcinoma often occurred in middle-aged or elderly patients. Because cystadenocarcinoma is somewhat rare, metastatic tumours of the jaw should be considered when diagnosing cystadenocarcinoma. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study is the analysis of bibliometric studies of the medical most-cited papers. Materials and Methods: This applied and the scientometric study was conducted using retrospective bibliometric analysis methods. AScopus search was conducted and 883 articles were retrieved. After reviewing the titles and abstracts, 432 articles related to the purpose of this research were identified. Items such as year, journal, country, and institution were considered. Medical subject heading and NLM were applied for the subject categorization of articles. Given the dynamics of subject areas over time, only the content of 117 articles published in 2020 and 2021 were analyzed. These 117 articles have been reviewed with 11,700 most-cited articles. By reviewing 117 articles, the most productive journal, country, and institute in producing 11,700 articles were identified. Results: The findings have shown a significant number of these publications review 100 most-cited articles in the field of medicine. Articles pertaining to the Nervous System, Musculoskeletal System, Dentistry, Radiology, and Cardiovascular System are the most numerous among the publications. Conclusion: The results of this study allow readers to know the most productive countries, institutions, and journals of various subject areas, as well as the most influential fields and research trends in that subject area. The results of this study also identify subject areas for which the characteristics of their core articles have not yet been explored to plan future research. [ABSTRACT FROM AUTHOR]

Healthcare policies promote technology use as a means to modernise healthcare and support seamless, person-centred care. However, despite information technology (IT) use being common practice in clinical settings, its use in patients' homes is still developing. This study explored patients' perspectives on the use of IT and electronic health records (EHR) in their home environment. Semi structured interviews were conducted with housebound patients who received regular care from the district nursing team, and thematic data analysis was undertaken. Participants reported variable knowledge and experiences with mobile working and EHR. Most were positive and identified clear benefits for clinicians. However, few participants reported benefits to themselves. Contrary to popular belief, IT use is expected by older patients and, while barriers were identified, the overall opinion was positive. A digital divide was apparent, with some at risk of being disadvantaged by the increasing use of technology. [ABSTRACT FROM AUTHOR]

Objective: The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods: A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results: In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P < 0.001). In the PMR group, 70.0% of discharge summaries were completed and adequately documented, compared with 91.5% of those in the EMR group (P < 0.001). At out-patient review, there was an improvement in documentation of weight-bearing instructions in the EMR compared with PMR group (81.1% vs 76.2% respectively; P = 0.032). Conclusion: The EMR is associated with an improvement in the standard of orthopaedic medical record documentation, but deficiencies remain in key components of the medical record. What is known about the topic?: Medical records are an essential tool in modern medical practice and have significant implications for patient care and management, communication and medicolegal issues. Despite the importance of comprehensive documentation, numerous examples of poor documentation continue to be demonstrated. Recently, significant changes to the medical record in Australia have been implemented with the conversion of some hospitals to an EMR and the implementation of the My Health Record. What does this paper add?: Standards of patient care should be monitored continuously and deficiencies identified in order to implement measures for improvement and to close the quality loop. This study has highlighted that although there has been improvement in medical record keeping with the implementation of an EMR, the standard of orthopaedic medical record keeping continues to be below what is expected, and several key areas of documentation require improvement. What are the implications for practitioners?: The implications of these findings for practitioners are to highlight current deficiencies in documentation and promote change in current practice to improve the quality of medical record documentation among medical staff. Although the EMR has improved documentation, there remain areas for further improvement, and hospital administrators will find these observations useful in implementing ongoing change. [ABSTRACT FROM AUTHOR]

The AUD2IT-algorithm is a tool to structure the data, which is collected during an emergency treatment. The goal is on the one hand to structure the documentation of the data and on the other hand to give a standardised data structure for the report during handover of an emergency patient. AUD2IT-algorithm was developed to provide residents a documentation aid, which helps to structure the medical reports without getting lost in unimportant details or forgetting important information. The sequence of anamnesis, clinical examination, considering a differential diagnosis, technical diagnostics, interpretation and therapy is rather an academic classification than a description of the real workflow. In a real setting, most of these steps take place simultaneously. Therefore, the application of the AUD2IT-algorithm should also be carried out according to the real processes. A big advantage of the AUD2IT-algorithm is that it can be used as a structure for the entire treatment process and also is entirely usable as a handover protocol within this process to make sure, that the existing state of knowledge is ensured at each point of a team-timeout. PR-E-(AUD2IT)-algorithm makes it possible to document a treatment process that, in principle, does not have to be limited to the field of emergency medicine. Also, in the outpatient treatment the PR-E-(AUD2IT)-algorithm could be used and further developed. One example could be the preparation and allocation of needed resources at the general practitioner. The algorithm is a standardised tool that can be used by healthcare professionals of any level of training. It gives the user a sense of security in their daily work. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Forensic examination and dating documents is an important issue in our society, because documents are used throughout our lives to record everything we do. It starts with our birth certificate and ends with our death certificate. Between them there are receipts, leases, deeds, contracts, checks, wills, sales agreements, and medical records. The validity of all of these documents is often questioned during litigation. This study describes the use of nondestructive analysis of paper (Fourier transform infrared [FTIR] spectroscopy using an attenuated total reflectance [ATR] technique, Raman spectroscopy) and destructive analysis of paper (microscopic analysis of fibers, FTIR analysis of paper ash, inductively coupled plasma–mass spectrometry [ICP-MS]). The results are discussed in detail. [ABSTRACT FROM PUBLISHER]

Background: Paper patching, a method that places cigarette paper over the most mobile quadrants of the tympanic membrane, is one of the treatment options for patulous eustachian tube (PET). Aims/Objectives: The objective of this study was to compare the outcomes of two different treatment strategies for PET. Material and methods: Twenty-three patients underwent paper patching of the tympanic membrane and 16 patients were treated with nasal saline irrigation with or without ipratropium bromide nasal spray. Medical records were reviewed for resolution of PET symptoms as categorical variables (complete remission, partial remission, or no improvement) with a minimum follow-up of 3 months. Results: Immediately after undergoing paper patching, 20 of the 23 patients (87.0%) reported complete remission (CR). The percentage of CR after paper patching was 82.6% at 1 month and 65.2% at 3 months. A greater percentage of patients reported CR of aural symptoms in the paper patching group than in the nasal irrigation group at both 1 and 3 months after treatment (p < .05). Conclusions and significance: Repetitive paper patching resolves aural discomfort in most PET patients for at least 3 months and can be considered as a first-line treatment option for PET in the outpatient setting. [ABSTRACT FROM AUTHOR]

Persons living with human immunodeficiency virus (HIV) and others receiving antiretrovirals are at risk for medication errors during hospitalization and at transitions of care. These errors may result in adverse effects or viral resistance, limiting future treatment options. A range of interventions is described in the literature to decrease the occurrence or duration of medication errors, including review of electronic health records, clinical checklists at care transitions, and daily review of medication lists. To reduce the risk of medication-related errors, antiretroviral stewardship programs (ARVSPs) are needed to enhance patient safety. This call to action, endorsed by the Infectious Diseases Society of America, the HIV Medicine Association, and the American Academy of HIV Medicine, is modeled upon the success of antimicrobial stewardship programs now mandated by the Joint Commission. Herein, we propose definitions of ARVSPs, suggest resources for ARVSP leadership, and provide a summary of published, successful strategies for ARVSP that healthcare facilities may use to develop locally appropriate programs. [ABSTRACT FROM AUTHOR]

Rapid technological evolve brings grate changes. As technology advances it replaces the old way of working or doing things. With the electronic format of paper work, efforts of organizations are greatly reduces. But it give rise to new problems i.e. how to store, access and update the records. As the data is available online, it may affect data's privacy and security. A health care domain greatly advances with new innovations. The documents can be saved easily and access everywhere. A patient and organization can effectively use this system to access his medical records, medical history and currently prescribe medicines. It gives patient as well as his family to easily access the data, sharing of medical reports and use of signed prescription at pharmacy anytime anywhere. The data should be available but need to take care of data security and privacy. The patient must be the owner of data. Using blockchain technology, data will be available in decentralized manner. Using digitize signature the authentication of data can be verified. With the use of cryptography, data will be secure. While consensuses algorithm used for the reliability in a network. The system provides privacy using privacy agreement storage. Only with the permission from the patient or authorized person the data can be used. Owner will be able to see, who is using his data and for what purpose. The system will be efficient to handle the data electronically as well as effective to confidentiality, authenticity and patient-centric. [ABSTRACT FROM AUTHOR]

This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care. [ABSTRACT FROM AUTHOR]

Background: Prehospital emergency care services are one of the vital health services in many countries that provide first and immediate medical care to the patients and injured people at the scene and during transfer to healthcare centers. This study was conducted to investigate and compare the use of prehospital emergency services in urban and road emergency bases of Hamadan University of Medical Sciences. Materials and Methods: In a descriptive-analytic study, all missions (ambulance requests) conducted at urban and road emergency bases were studied and compared over three years. The study tool was a checklist compiled of questions from PCR (Patient Care Report). PCR contains written information about the patient's demographic characteristics, mission time, mission address, mission reasons, emergency base and mission code (ambulance identification code), and so on. Finally, the collected data were analyzed using descriptive (mean and variance) and inferential statistics (t test and Chi-square). Results: The results of the study indicated that every year, urban bases missions increased about 600 and rural bases missions about 450. Road traffic incidents, falls, cardiac emergencies and poisoning were the most common causes for ambulance call at urban and road emergency bases. In addition, urban and road bases missions were significantly different with regard to the cause of missions in all cases (except heat stroke) (P<0.01). Conclusion: Understanding the number and pattern of prehospital emergency services in urban and rural areas plays a significant role in the proper planning of prehospital emergency care. The study showed that the need for emergency prehospital emergency services is increasing and policymakers should be considered this issue. [ABSTRACT FROM AUTHOR]

Copyright of Radiologia Brasileira is the property of Radiologia Brasileira and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Case reports are commonly used to report the health outcomes of mass gatherings (MGs), and many published reports of MGs demonstrate substantial heterogeneity of included descriptors. As such, it is challenging to perform rigorous comparisons of health services and outcomes between similar and dissimilar events. The degree of variation in published reports has not yet been investigated.Objective: Examine patterns of post-event medical reporting in the existing literature and identify inconsistencies in reporting.Methods: A systematic review of case reports was conducted. Included were English studies, published between January 2009 and December 2018, in Prehospital and Disaster Medicine (PDM) or Current Sports Medicine Reports (CSMR). Analysis of each paper was used to develop a list of 27 categories of data.Results: Seventy-five studies were initially reviewed with 54 publications meeting the inclusion criteria. Forty-two were full case reports (78%) and 12 were conference proceedings (22%). Of the 27 categories of data studied, only 13 were consistently reported in more than 50% of publications. Reporting patterns included inconsistent use of terminology/language and variable retrievability of reports. Reporting on event descriptors, hazard and risk analysis, and clinical outcomes were also inconsistent.Discussion: Case reports are essential tools for researchers and event team members such as medical directors and event producers. The authors found that current case reports, in addition to being inconsistent in content, were generally descriptive rather than explanatory; that is, focused on describing the outcomes as opposed to exploring possible connections between context and health outcomes.Conclusion: This paper quantifies and demonstrates the current state of heterogeneity in MG event reporting. This heterogeneity is a significant impediment to the functional use of published reports to further the science of MG planning and to improve health outcomes. Future work based on the insights gained from this analysis will aim to align and standardize reporting to improve the quality and value of event reporting. [ABSTRACT FROM AUTHOR]

The paper hand-held record (PHR) has been used extensively in general practice (GP) shared care management of pregnant women, and recently, the first Mater Shared Electronic Health Record (MSEHR) was introduced. The aim of this qualitative study was to examine women's experiences using the records and the contribution of the records to integrate care. At the 36-week antenatal visit in a maternity tertiary centre clinic, women were identified as a user of either the PHR or the MSEHR and organised into Phase 1 and Phase 2 studies respectively. Fifteen women were interviewed in Phase 1 and 12 women in Phase 2. Semi-structured interviews were used for data collection, and analysed using qualitative content analysis. Four main themes were identified: (1) purpose of the record, (2) perceptions of the record; (3) content of the record, and (4) sharing the record. Findings indicate that the PHR is a well-liked maternity tool. The findings also indicate there is under-usage of the MSEHR due to health-care providers failing to follow up and discuss the option of using the electronic health record option or if a woman has completed the log-in process. This paper adds to an already favourable body of knowledge about the use of the PHR. It is recommended that continued implementation of the MSEHR be undertaken to facilitate its use. [ABSTRACT FROM AUTHOR]

Background: Compulsory submission of a checklist from the relevant reporting guideline is one of the most widespread journal requirements aiming to improve completeness of reporting. However, the current suboptimal levels of adherence to reporting guidelines observed in the literature may indicate that this journal policy is not having a significant effect.Findings: We explored whether authors provided the appropriate CONSORT checklist extension for their study and whether there were inconsistencies between what authors claimed on the submitted checklist and what was actually reported in the published paper. We randomly selected 12 randomized trials from three journals that provide the originally submitted checklist and analyzed six core CONSORT items. Only one paper used the appropriate checklist extension and had no inconsistencies between what was claimed in the submitted checklist and what was reported in the published paper.Conclusion: Journals should take further actions to take full advantage of the requirement for the submission of fulfilled CONSORT checklists, thus ensuring that these checklists reflect what is reported in the manuscript. [ABSTRACT FROM AUTHOR]

Introduction Paper-based documents are subject to problems related to storage, loss, distribution and editing. Many organizations have introduced ICT-based processes to reduce the use of paper as primary documentation. Nevertheless, paper documents are still being used in healthcare. Purpose To better understand this situation, we have studied the use of paper-based patient lists in two wards in a Norwegian hospital that has ‘gone digital’. We seek to answer the question: “Why is it that paper-based patient lists are maintained in the ward of a hospital going digital?” Methods Participant observations and semi-structured interviews with stakeholders. Results Patient lists allow nurses to immediately record, retrieve, and share relevant patient information at the point of care in a way that is not immediately available through the EPR system. Paper-based tools continue to serve purposes beyond and outside what is currently supported by current electronic information systems. [ABSTRACT FROM AUTHOR]

Objective: Intensive Care Units are one of the areas with the lowest digitization rate. This study aims to measure the effect of digitizing medical records kept in paper forms in ICUs on time-saving and paper consumption. In our study, care forms in ICUs were transferred to digital media. In our research, care forms in ICUs were transferred to digital media. Methods: The time required to fill out the nursing care forms on paper and digital media was measured, the change in paper and printer costs was determined, and the results were compared. Two volunteer nurses working in the ICU of a university hospital in Istanbul measured the time it took to fill out the forms of patients on paper. Then, a future projection was made using digital form data of 5,420 care days of 428 patients hospitalized between October 2017 and September 2018. Only anonymous data of patients hospitalized in the general ICU were used, and other untempered were not included in the study. Results: When the forms were filled in digitally by the nurses, one nurse per patient per day saved 56.82 min (3.95% per day). Discussion: Health care services are provided in hospitals in Turkey with 28,353 adult intensive care beds and an occupancy rate of 68%. Based on the occupancy rate of 68%, the number of full beds is 19,280. When 56.82 min are saved per bed from the forms filled by the nurses, 760.71 care days are dedicated. Considering the salary of 1,428.67 US dollars per nurse, the savings to be achieved are estimated to be 13,040,804.8 US dollars per year. [ABSTRACT FROM AUTHOR]

The management and maintenance of paper-based patient record archives involve high running costs. Therefore, many health care providers choose to digitize their paper records subsequently destroying the originals. By now, this is an established procedure for patient records from routine care. However, at present it is unclear under which circumstances the patient records of patients taking part in clinical trials can be destroyed after digitization. Paper-based original records may only be destroyed if their digital copies are recognized as source documents by both sponsors and authorities. The authors believe that this recognition should be possible, as long as the scanned paper-based records fulfill the requirements for certified copies according to the Note for Guidance CPMP/ICH/135/95 (ICH-GCP). This requires that, based on the applied rules, it can be proven at any time that the existing digitization process is clearly regulated, and the resulting quality is regularly controlled and sufficiently high. The objective of this key issues paper is to present the manner in which the existing regulatory guidelines can be implemented to allow the digitized patient records being recognized as source documents. An English version of this article will be published in “Clinical Investigation” (Future Science) [1]. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: All hospitals in the province of Styria (Austria) are well equipped with sophisticated Information Technology, which provides all-encompassing on-screen patient information. Previous research made on the theoretical properties, advantages and disadvantages, of reading from paper vs. reading from a screen has resulted in the assumption that reading from a screen is slower, less accurate and more tiring. However, recent flat screen technology, especially on the basis of LCD, is of such high quality that obviously this assumption should now be challenged. As the electronic storage and presentation of information has many advantages in addition to a faster transfer and processing of the information, the usage of electronic screens in clinics should outperform the traditional hardcopy in both execution and preference ratings. This study took part in a County hospital Styria, Austria, with 111 medical professionals, working in a real-life setting. They were each asked to read original and authentic diagnosis reports, a gynecological report and an internal medical document, on both screen and paper in a randomly assigned order. Reading comprehension was measured by the Chunked Reading Test, and speed and accuracy of reading performance was quantified. In order to get a full understanding of the clinicians'' preferences, subjective ratings were also collected. Results: Wilcoxon Signed Rank Tests showed no significant differences on reading performance between paper vs. screen. However, medical professionals showed a significant (90%) preference for reading from paper. Despite the high quality and the benefits of electronic media, paper still has some qualities which cannot provided electronically do date. [Copyright &y& Elsevier]

Background: The advantages of patient-held portable health files (PHF) and personal health records (PHR), paper or electronic, are said to include improved health-care provider continuity-of-care and patient empowerment in maintaining health. Top-down approaches are favored by public sector government and health managers. Bottom-up approaches include systems developed directly by health-care providers, consumers and industry, implemented locally on devices carried by patient-consumers or shared via web-based portals. These allow individuals to access, manage and share their health information, and that of others for whom they are authorized, in a private, secure and confidential environment. Few medical record technologies have been evaluated in randomized trials to determine whether there are important clinical benefits of these interventions. The COMMUNICATE trial will assess the acceptability and long-term clinical outcomes of an electronic and paper patient-held PHF. Methods/Design: This is a 48-month, open-label pragmatic, superiority, parallel-group design randomized controlled trial. Subjects (n=792) will be randomized in a 1:1:1 ratio to each of the trial arms: the electronic PHF added to usual care, the paper PHF added to usual care and usual care alone (no PHF). Inclusion criteria include those 60 years or older living independently in the community, but who have two or more chronic medical conditions that require prescription medication and regular care by at least three medical practitioners (general and specialist care). The primary objective is whether use of a PHF compared to usual care reduces a combined endpoint of deaths, overnight hospitalizations and blindly adjudicated serious out-of-hospital events. All primary analyses will be undertaken masked to randomized arm allocation using intention-to-treat principles. Secondary outcomes include quality of life and health literacy improvements. Discussion: Lack of blinding creates potential for bias in trial conduct and ascertainment of clinical outcomes. Mechanisms are provided to reduce bias, including balanced study contact with all participants, a blinded adjudication committee determining which out-of-hospital events are serious and endpoints that are objective (overnight hospitalizations and mortality). The PRECIS tool provides a summary of the trial's design on the Pragmatic-Explanatory Continuum. Trial registration: Registered with Clinicaltrials.gov (identifier: NCT01082978) on 8 March 2010. [ABSTRACT FROM AUTHOR]

The safe and effective treatment of patients accessing multiple NHS services relies upon efficient communication between primary care, secondary care, and out of hours providers. There is a theoretical risk to patient safety from delays in these processes, to which paper communications are particularly vulnerable. When letters are received they must be reviewed and prioritised in order of clinical importance, a process that requires both time and clinical resources. This is relevant to the challenge of resource allocation to maximise patient benefit. This retrospective study investigated the impact on patient safety of 249 clinical letters reporting routine clinical encounters in secondary care and out of hours services that were delayed by an average of 18-24 months to a suburban London general practice. No clinical harm could be attributed to the delay. This small study did not suggest delays in routine communications pose a significant risk to patient safety. Conversely, it questions the efficiency and benefit to patients of prioritising clinical time to reviewing routine letters. The adoption of fully integrated, shared electronic patient records with the function to highlight clinically urgent or important communications might ease clinician workload, to the ultimate benefit of patient care. [ABSTRACT FROM AUTHOR]

The article presents a study on the survival of bacterial pathogens on regular office paper and to quantify the proportion of pathogens transferred from hand to paper and back to another hand. Findings reveal that bacteria can be transferred on paper by contaminated hands of healthcare workers, deemed the most important route of pathogenic bacteria transmission. It stresses that the best way to minimize the pathogen spread is proper hand hygiene as paper is hard to disinfect once contaminated.

Although the potential benefits of computer-based records have been identified in different areas of the healthcare environment, in many settings paper-based records and computer-based records are still used in parallel. In this article, emergency department (ED) staff perspectives about the use of paper- or computer-based records are presented. This was a qualitative study in which data were collected using in-depth semi-structured interviews with the ED staff. The interviews were transcribed verbatim and data were analysed using framework analysis. In total, 34 interviews were undertaken. The study identified a number of factors which might encourage or discourage the use of paper-based and computer-based records in the ED. Users also expressed their concerns and expectations. Although there is a tendency towards computerizing healthcare settings, user acceptance of technology should not be underestimated. To improve user acceptance, users' concerns should be investigated and addressed appropriately. [ABSTRACT FROM AUTHOR]

This white paper explores the considerations of standards-based interoperability of medical images between organizations, patients, and providers. In this paper, we will look at three different standards-based image exchange implementations that have been deployed to facilitate exchange of images between provider organizations. The paper will describe how each implementation uses applicable technology and standards; the image types that are included; and the governance policies that define participation, access, and trust. Limitations of the solution or non-standard approaches to solve challenges will also be identified. Much can be learned from successes elsewhere, and those learnings will point to recommendations of best practices to facilitate the adoption of image exchange. [ABSTRACT FROM AUTHOR]

Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia. The completeness of medication information, and whether medication changes during the admission were explained, were assessed. Further, the likelihood of any incomplete information having an impact on continuity of care was assessed. There were 1352 and 1771 medication orders assessed in paper and electronic discharge summaries, respectively. Of these, 90.9% and 93.4% were complete in paper and electronic discharge summaries, respectively. The dose (OR 25.24, 95%CI: 3.41-186.9) and route (OR 8.65, 95%CI: 3.46-21.59) fields of medication orders, were more likely to be complete in electronic as compared with paper discharge summaries. There was no difference for drug frequency (OR 1.09, 95%CI: 0.77-1.55). There was no significant improvement in the proportion of incomplete medication orders rated as unclear and likely to impede continuity of care in paper compared with electronic discharge summaries (7.3% vs. 6.5%). Of changes to medication regimen, only medication additions were more likely to be explained in the electronic (n=253, 37.2%) compared to paper (n=104, 14.3%) discharge summaries (OR 3.14; 95%CI: 2.20-4.18). In summary, electronic discharge summaries offer some improvements over paper discharge summaries in terms of the quality of medication information documented. However, explanations of changes to medication regimens remained low, despite this being crucial information. Future efforts should focus on including the rationale for changes to medication regimens in discharge summaries. [ABSTRACT FROM AUTHOR]

Abstract: There is little doubt surrounding the benefits of the Nutrition Care Process and International Dietetics and Nutrition Terminology (IDNT) to dietetics practice; however, evidence to support the most efficient method of incorporating these into practice is lacking. The main objective of our study was to compare the efficiency and effectiveness of an electronic and a manual paper-based system for capturing the Nutrition Care Process and IDNT in a single in-center hemodialysis unit. A cohort of 56 adult patients receiving maintenance hemodialysis were followed for 12 months. During the first 6 months, patients received the usual standard care, with documentation via a manual paper-based system. During the following 6-month period (Months 7 to 12), nutrition care was documented by an electronic system. Workload efficiency, number of IDNT codes used related to nutrition-related diagnoses, interventions, monitoring and evaluation using IDNT, nutritional status using the scored Patient-Generated Subjective Global Assessment Tool of Quality of Life were the main outcome measures. Compared with paper-based documentation of nutrition care, our study demonstrated that an electronic system improved the efficiency of total time spent by the dietitian by 13 minutes per consultation. There were also a greater number of nutrition-related diagnoses resolved using the electronic system compared with the paper-based documentation (P<0.001). In conclusion, the implementation of an electronic system compared with a paper-based system in a population receiving hemodialysis resulted in significant improvements in the efficiency of nutrition care and effectiveness related to patient outcomes. [Copyright &y& Elsevier]

AIM: With the background knowledge that auditing of Medical Records (MR) for adequacy and completeness is necessary if it is to be useful and reliable in continuing patient care; protection of the legal interest of the patient, physicians, and the Hospital; and meeting requirements for researches, we scrutinized theatre records of our hospital to identify routine omissions or deficiencies, and correctable errors in our MR system. METHOD: Obstetrics and Gynaecological post operation theatre records between January 2006 and December 2008 were quantitatively and qualitatively analyzed for details that included: hospital number; Patients age; diagnosis; surgery performed; types and modes of anesthesia; date of surgery; patients' ward; Anesthetists names; surgeons and attending nurses names, and abbreviations used with SPSS 15.0 for Windows. RESULTS: Hardly were any of the 1270 surgeries during the study period documented without an omission or an abbreviation. Hospital numbers and patients' age were not documented in 21.8% (n=277) and 59.1% (n=750) respectively. Diagnoses and surgeries were recorded with varying abbreviations in about 96% of instances. Surgical team names were mostly abbreviated or initials only given. CONCLUSION: To improve the quality of Paper-based Medical Record, regular auditing, training and good orientation of medical personnel for good record practices, and discouraging large volume record book to reduce paper damages and sheet loss from handling are necessary else what we record toady may neither be useful nor available tomorrow. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Healthcare organizations are increasingly implementing electronic health records (EHRs) and other related health information technology (IT). Even in institutions which have long adopted these computerized systems, employees continue to rely on paper to complete their work. The objective of this study was to explore and understand human-technology integration factors that may be causing employees to rely on paper alternatives to the EHR. Methods: We conducted semi-structured interviews with 20 key-informants in a large Veterans Affairs Medical Center (VAMC), with a fully implemented EHR, to understand the use of paper-based alternatives. Participants included clinicians, administrators, and IT specialists across several service areas in the medical center. Results: We found 11 distinct categories of paper-based workarounds to the use of the EHR. Paper use related to the following: (1) efficiency; (2) knowledge/skill/ease of use; (3) memory; (4) sensorimotor preferences; (5) awareness; (6) task specificity; (7) task complexity; (8) data organization; (9) longitudinal data processes; (10) trust; and (11) security. We define each of these and provide examples that demonstrate how these categories promoted paper use in spite of a fully implemented EHR. Conclusions: In several cases, paper served as an important tool and assisted healthcare employees in their work. In other cases, paper use circumvented the intended EHR design, introduced potential gaps in documentation, and generated possible paths to medical error. We discuss implications of these findings for EHR design and implementation. [Copyright &y& Elsevier]

What role do texts play in LGBTQ (lesbian, gay, bisexual, transgender, and queer) parents’ experiences of disability service systems? In interviews with 15 LGBTQ parents of disabled children in Toronto, Canada, participants selected documents to be used as a focus for discussion. Parents considered how LGBTQ identity and other intersectional identities influenced their experiences of institutional texts including adoption certificates, intake forms, and assessments. Findings suggest that documentation practices can operate as forms of systemic gatekeeping. LGBTQ identity was sometimes very significant in parents’ accounts, and sometimes less central than other aspects of their families' identities and experiences. [ABSTRACT FROM PUBLISHER]

Introduction: Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients’ clinical problems more effectively and risk stratify the patient. Method: The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms. Results: There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings. Discussion: Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician’s decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The consultation request process between primary care and specialty services often contains paper-based components that may be inefficient and difficult to track. Other barriers may include workarounds and communication breakdowns with the potential to adversely impact delivery of quality medical care. We investigated current challenges to the electronic outpatient consult management process in the United States Veterans Health Administration (VHA). Design: We conducted ethnographic observation and semi-structured interviews in nine different specialty clinics and three primary care clinics in a large, tertiary Veterans Affairs Medical Center (VAMC). We also performed a national-level query of ‘electronic error and enhancement requests’ (E3Rs) related to the consult package in the VA''s electronic health record (EHR) submitted over a 5-year period (2005–2009). Measurements: Two researchers recorded the observable interactions and interview responses of 16 healthcare workers related to their work with consultations. Two separate coding schemes were applied to both the observational and the interview data. E3Rs from the national query were reviewed and categorized based on the nature of the enhancement requests. Results: We identified several examples of paper persistence, as well as workarounds, communication breakdowns, and redundancies in computerized consult management. An analysis of enhancement requests for the consults also revealed three broad needs related to reporting, configuration or customization, and user interface enhancements. Conclusion: Understanding these challenges to the current consult management process is important to help design enhanced informatics tools integrated into workflow to support coordination of care and tracking of consults requests. [Copyright &y& Elsevier]

Introduction: The electronic health record (EHR) is a computerized health information system where provider record detailed encounter information such as patient demographics, encounter summaries, medical history allergies, intolerances, and lab test histories [9]. The EHR will be used in future diagnostic and treatment decision making. The decision is always taken by a physician or dentist. Medical documentation contains information about treatment, communication with insurance service system and statistical data evaluation. The EHR may support and improve future diagnostics and therapy in general. The data can be used in statistics and other scientific purposes. Aim: The aim of study is to verify the simplicity of data process implementation and time of data storing for modification of classical paper WHO dental card, lifetime dental EHR controlled by keyboard and lifetime dental EHR controlled by voice. Methods: All three methods were applied on 126 patients. The dental status of patients was examined and the data recorded in classical way into the paper WHO dental card. The same person recorded all data to lifetime dental EHR using keyboard and using voice. Then we compared the time, which was needed for recording the data using these three methods. Using Friedaman test we found very significant differences in time of recording among three methods (p<0.001). We can see that the paper WHO dental card was recorded quickly, but its reuse due to missing electronic form is difficult. Times for recording data using keyboard or voice in lifetime dental EHR were not significantly different (Wilcoxon pair test for statistical comparison reached the value p=0.09). Conclusion: The clinical practice demanded to find ways to eliminate the need to touch peripherals like keyboard, mouse and touch screen. Therefore the automatic speech recognition was added to enable dentist to use the software without a single touch. This way we eliminated the need for computer operator and unnecessary hygienic procedures (washing hands, changing gloves etc.). [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The adoption of electronic medical record (EMR) system is gradually increasing. However, various time–motion studies reveal conflicting data regarding time effectiveness on workflow due to computerization. One of the major issues for physicians is their uncertainty with EMRs’ potential impact of time on workflow. A tertiary eye hospital in south India was in the process of implementing an EMR system in their ambulatory care unit. Many of the staff did not have previous computing experience and there were conflicting views on the time effectiveness of the computerized system after implementation. The management was thus interested to know the real time effectiveness of EMR in their hospital. The study compliments existing studies of this type by comparing the time efficiency of documentation time using EMR system with paper documentation in a hospital in a developing country where a transition between paper and EMR documentation was currently in progress. Methods: Ten randomly selected optometrists documented the time they spent during consultation with both paper and EMR documentation. The time spent was documented for a total of 200 records (100 EMR and 100 paper records). The independent-samples t-test and analysis of variance were used to compare the means of the consultation time and calculated documentation time spent between the electronic and paper records. Results: There was no statistically significant difference in the time spent for documentation between electronic and paper records. The mean time spent in documenting electronic records was 0.92min (95% CI −3.06 to 1.14) longer than in paper records. Conclusion: EMR systems can be adopted in eye hospitals without having significant negative impact on duration of consultation and documentation for optometrists. More time–motion studies that include ophthalmologists are however needed in order to get a more complete picture of time impact of the EMR system on clinical workflow in eye hospitals. [Copyright &y& Elsevier]

The article reports on the plan to convert the medical paper documents to electronic forms. Topics discussed include the importance of putting the paper documents into electronic forms to prevent the missing patient information and identification and illegible or incomplete surgery scheduling forms, the management of patient scheduling process, and the patients medical care management.

We used medical record abstraction to conduct research in a psychiatric hospital with paper-based medical records. The challenges we encountered included: the difficulty in retrieving files; the extensive effort and time needed to extract clinical information; the lack of a standardised documentation system of medical records; and the need for advanced computer literacy. To promote future research using electronic medical records, potential solutions include creating a registry of all patients receiving treatment, as well as equipping busy clinicians with computer skills. [ABSTRACT FROM AUTHOR]

Abstract: The present study was performed to explore a new approach to systematization of the management of paper-based clinical pathways by developing a new system requiring little capital investment. A new system was developed and incorporated into an existing network at a hospital with a paper-based clinical pathway management system. The effectiveness of this new system was examined by comparing the management efficiency of clinical pathways before and after its introduction, and by comparison of the new system with other such systems currently in place at other medical institutions with regard to efficiency. In addition, the acceptability of the system for other medical institutions was examined by providing free access to the software on the Internet. The development costs of the new system were low. Although the new system has been in place for more than 3 years, no problems have yet been encountered in either the existing network system or in the management system itself. The new system allows the processing of statistics and analysis of circulation or variance automatically, neither of which were possible in the original paper-based system. We provided open access to the system as free software on the Internet, and it has since been downloaded by many medical institutions and enterprises in Japan. This system is very useful for institutions where it is difficult to introduce expensive new systems for systematic management of clinical pathways, such as electronic medical records, because of problems regarding capital or system management, and it may also be useful in other countries. [Copyright &y& Elsevier]

Summary: Objectives: In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person''s medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record. Methods: In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care. Results: After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome. Discussion: The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established. [Copyright &y& Elsevier]

A temporary computer mishap, of all things, has confirmed the value of electronic medical records to FP Allen Wenner in West Columbia, SC. In 1998, Wenner's practice adopted an EMR [...]

Background: Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. Methods: We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. Results: The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Conclusions: Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS. [ABSTRACT FROM AUTHOR]