Accurate Documentation Research Articles

Lost in translation: Unveiling medical students' untold errors of medical history documentation.

The accurate documentation of a medical history interview is an important goal in medical education. As students' documentation of medical history interviews is mostly decentralised on the wards, a systematic assessment of documentation quality is missing. We therefore evaluated the extent of details missed in students' medical history reports in a standardised setting. In this prospective, observational study, 123 of 380 students (32.4%) participated in an Objective Structured Clinical Examination (OSCE) regarding history taking and documentation. Based on the interviews and nine deductively selected main categories, a categorical system was established using a summarising qualitative content analysis. The items in the transcripts (defined as ground truth) and in students' reports were labelled and assigned to the correct subcategory. The ground truth and students' reports were compared to quantify students' documentation completeness. Next to the nine deductively selected main categories, 61 subcategories were defined. A total of 8943 items were labelled in the 123 interview transcripts (ground truth), compared with 5870 items labelled in students' reports (65.6% completeness of students' reports compared with ground truth). The main category personal details overlapped with 94.2% between students' report and ground truth incontrast to the main category with the highest discrepancy, allergy, with 41.1% overlap. Pertinent negative items and non-numerical quantifications were often missed. Medical students show incomplete documentation of medical history interviews. Therefore, accurate documentation should be taught as an important goal in medical education.

Optimizing Neuroscience Mortality: A Collaborative Approach to Documentation Improvement.

Mortality index is the ratio of observed-to-expected mortality. Accurate and thorough documentation of patient comorbidities and conditions is the key determinant of neuroscience expected mortality. In this study, we focused on reviewing neuroscience documentation, as optimizing mortality index provides accurate assessment of the quality of care provided, improves service-line rankings, and affects reimbursement. We assembled an interprofessional team of a neurologist and clinical documentation integrity (CDI) specialists to review clinical documentation of all mortalities from the neuroscience service lines at a tertiary academic medical center over 9 months. We identified common documentation opportunities among high acuity neuroscience patients to improve accuracy of expected mortality. Using the mortality risk adjustment method from Vizient Inc., we compared baseline and postreview expected mortality. We reviewed 70 mortality charts over a 9-month period. Opportunities to improve documentation were present in 60%. Common underreported comorbidities included aspiration pneumonia, shock, encephalopathy, thrombocytopenia, hemorrhagic disorder due to anticoagulation, and nontraumatic subarachnoid hemorrhage. The number of diagnoses identified per patient that affected mortality increased between the first and last quarter from 4.3 to 7.8 (p < 0.0001). Physician-identified additional diagnoses per patient decreased from 1.0 to 0.3 (p = 0.0037), as CDI specialists had increased capture of neuroscience specific diagnoses throughout the intervention. The average expected mortality significantly increased from baseline 0.33 to 0.42 (p < 0.0001). Collaboration between physicians and CDI specialists optimizes expected mortality by identification of common gaps in documentation specific to neuroscience patients. Neurologist engagement is beneficial in CDI and lays the framework for clinical documentation education for neurology physicians.

Towards novel classification of infants’ movement patterns supported by computerized video analysis

BackgroundPositional preferences, asymmetry of body position and movements potentially indicate abnormal clinical conditions in infants. However, a lack of standardized nomenclature hinders accurate assessment and documentation of these preferences over time. Video tools offer a safe and reproducible method to analyze and describe infant movement patterns, aiding in physiotherapy management and goal planning. The study aimed to develop an objective classification system for infant movement patterns with particular emphasis on the specific distribution of muscle tension, using methods of computer analysis of video recordings to enhance accuracy and reproducibility in assessments.MethodsThe study involved the recording of videos of 51 infants between 6 and 15 weeks of age, born at term, with an Apgar score of at least 8 points. Based on observations of a recording of infant spontaneous movements in the supine position, experts identified postural-motor patterns: symmetry and typical asymmetry linked to the asymmetrical tonic neck reflex. Deviations from the typical postural-motor system were indicated, and subcategories of atypical patterns were distinguished. A computer-based inference system was developed to automatically classify individual patterns.ResultsThe following division of motor patterns was used: (1) normal patterns, including (a) typical (symmetrical, asymmetrical: variants 1 and 2); and (b) atypical (variants: 1 to 4), (2) positional preference, and (3) abnormal patterns. The proposed automatic classification method achieved an expert decision mapping accuracy of 84%. For atypical patterns, the high reproducibility of the system’s results was confirmed. Lower reproducibility, not exceeding 70%, was achieved with typical patterns.ConclusionsBased on the observation of infant spontaneous movements, it is possible to identify movement patterns divided into typical and atypical patterns. Computer-based analysis of infant movement patterns makes it possible to objectify and satisfactorily reproduce diagnostic decisions.

Living with ‘thin’ documents: a note on identity documents and liminal citizenship in the chars of Assam, India*

ABSTRACT This paper, based on my doctoral ethnographic research amongst the Miya community in one of the chars of Western Assam, shows how a particular category of identity documents shape their subjectivities, experiences, and aspirations. I focus on the identity documents which have errors, like mistakes in names, dates of birth or addresses, and badly angled photos. I refer to them as thin documents. Because of the thin documents, the Miyas find it difficult to assert formal citizenship rights, which they could normally assert based on accurate documentation. For the thin documents to help prove the Miyas’ citizenship, they must be further supported by an additional set of documents. The process questions the Miya’s formal citizenship rights. I present narratives of the Miya people living with thin documents to illustrate how the materiality of the identity document binds the Miya people to a state of liminal citizenship. I ask: what do these errors in the identity document or thin documents tell us about citizenship, particularly liminal citizenship with reference to the Miya community of Assam?

An efficient image classification and segmentation method for crime investigation applications

AbstractThe field of forensic science is experiencing significant growth, largely driven by the increasing integration of holographic and immersive technologies, along with their associated head-mounted displays. These immersive systems have become increasingly vital in resolving critical crimes as they facilitate communication, interaction, and collaboration. Given the sensitive nature of their work, crime investigators require substantial technical support. There is a pressing need for accurate documentation and archiving of crime scenes, which can be addressed by leveraging 3D scanned scenes to accurately represent evidence and expected scenarios. This study aims to develop an enhanced AR. system that can be deployed on hologram facilities such as the Microsoft HoloLens. The proposed system encompasses two main approaches, namely image classification and image segmentation. Image classification utilizes various deep learning models, including lightweight convolutional neural networks (CNNs) and convolutional Long-Short Term Memory (ConvLSTM). Additionally, the image segmentation approach is based on the fuzzy active contour model (FACM). The effectiveness of the proposed system was evaluated for both classification and segmentation tasks, utilizing metrics such as accuracy, sensitivity, precision, and F1 score. The simulation results indicate that the proposed system achieved a 99% accuracy rate in classification and segmentation tasks, positioning it as an effective solution for detecting bloodstain patterns in AR applications.

Inovasi dalam Pengelolaan Stock : Menerapkan Metode FIFO Melalui Prototype Sistem Informasi

This research focuses on stock management at Rumah Qta Mebeul, a company specialising in the sale of household supplies. The main aims and objectives of this research are to understand how the FIFO method can be practically applied and provide benefits to the company and to improve efficiency and effectiveness of stock management through the application of the First In First Out (FIFO) method using a prototype model on the stock management information system. The FIFO method was chosen because of its ability to optimise the use of raw materials and reduce losses due to expired stock. The system development model uses a prototype model that describes the operation of the FIFO method. This approach will make it possible to better visualise how the FIFO method functions in stock management. The main findings of this research include efficiency in stock management, better control, and more accurate documentation. The results of the study show that the prototype model is able to improve the information system for stock management of goods at Rumah Qta Mebeul with the FIFO method is an effective solution to optimize stock management and reduce company losses due to unused stock.

Embracing Digital Transformation: A Three-Cycle Audit on Improving Intraoperative Tourniquet Documentation Following BOAST (British Orthopaedic Association Standards for Trauma) Guidelines.

Introduction Tourniquets are vital devices in orthopaedic surgery that aid in creating a bloodless field.While they reduce operative time and outcomes, improper use can lead to severe complications. The British Orthopaedic Association Standards for Trauma (BOAST) offers guidelines for safe intraoperative tourniquet usage, emphasising proper application and accurate documentation. With the push for a paperless National Health Service (NHS), orthopaedic units across the UK are transitioning to electronic patient records (EPR). In this audit, we aim to evaluate the impact of electronic patient records (EPR) implementation on tourniquet documentation and subsequent interventions to enhance guideline adherence. Methods This closed-loop audit evaluated 159 emergency trauma cases at a single UK-based district general hospital across three different cycles. The first cycle (n=50) was collected before the trust-wide adoption of an EPR system (EPIC HIVE). Upon collecting the second cycle (n=59), local intraoperative tourniquet usage results compared to BOAST were presented at a departmental audit meeting. A specialised smart phrase template was subsequently shared with the department and the results were re-audited in the third cycle (n=50). Statistical analyses were performed to compare the cycles. Results Following the introduction of the EPR, compliance with documentation standards (fully and partially adhered to) initially declined from 38.0% to 17.0%. Post-intervention, compliance increased to 62.0% (p=0.0005). Individual aspects of documentation revealed notable improvements, including increases in skin assessment pre- and post-tourniquet application (0% to 56% and 0% to 60%, respectively, p<0.0001), isolation method (0% to 60%, p<0.0001), exsanguination method (2% to 24%, p=0.0003), tourniquet pressure (39% to 76%, p=0.0001) and tourniquet time (59% to 94%, p=0.0001). Lower limb tourniquet pressures significantly decreased between audit cycles (mean: 287.06 vs mean: 265.91, p=0.007)while upper limb pressures remained relatively stable (mean: 236.67 vs mean: 236.56, p=0.993). No tourniquet-related complications were reported across all audit cycles. Conclusion While the introduction of new EPR systems may initially present challenges in upholding accurate operative records, the incorporation of specialised electronic templates and active staff engagement has shown to be instrumental in improving tourniquet safety and enhancing care standards.

Video Documentation in Thyroidectomy and an Evaluation of Operative Notes.

Introduction Accurate and detailed documentation of surgical operation notes is crucial for post-operative care, research and academic purposes, and medico-legal clarity. Several studies have shown their defiency and inaccuracy sometimes, and some methods have been proposed to make them more objective. This study aimed to evaluate the completeness of thyroidectomy operative notes in a tertiary center and to assess the adequacy of video documentation by comparing it to the corresponding operative notes. Methods A retrospective review of thyroidectomy operative notes from 2010 to 2020 at King Abdulaziz University Hospital,Jeddah, Saudi Arabia, was performed to ensure completeness. Subsequently, 15 thyroidectomies were video recorded, and their notes were compared to the corresponding written operative notes. The completeness score was calculated based on an item list that included items that had to be included in an operative note. An independent samples t-test was used to compare the completeness score means between the two groups. One-way analysis of variance was used to compare the completeness score means between two or more groups. Result A total of 385 thyroidectomy-operative notes were retrospectively reviewed. The completeness scores ranged between 6% and 89% for the various items that had to be documented, with a mean of 54.47%. The mean score of the video-documented operative record was 83.86%±12.84%, which was significantly higher than the corresponding written operative notes (47.53%±18.06%) (p <0.001). Conclusion Video documentation showed significant improvement compared to the corresponding written and retrospective operative notes. Video recording can also be a valuable tool when teaching anatomy and surgical skills and conducting research.

Improving the quality of newborn feeding documentation in an EHR using a mixed methods approach

IntroductionNewborn feeding is key to infant growth and survival. Accurate feeding documentation can inform care decisions and planning of care. A nutritional dashboard is available within the Electronic Health Record (EHR) which accumulates feeding data in a graphical display. PurposeTo improve the quality of newborn feeding documentation for post-natal ward babies and babies in the Neonatal Intensive Care Unit (NICU). Designand Methods: A multidisciplinary end user expert group (n = 38) was established. Qualitative thematic analyses from this group were used to design new feeding data entry and review elements. Quantitative pre-post design was used to assess feeding documentation for both post-natal ward baby charts (n = 134) and NICU baby charts (n = 188). Descriptive statistics and Pearson's chi-square were used to assess pre-post differences and statistical significance. The use of a nutritional dashboard was assessed using system audit logs and analyzed using Poisson regression testing. ResultsPost-natal ward babies had improvements in structured feeding documentation by 91.6% (from 17.9% to 34.3%) (p = 0.031). NICU data feeding documentation improved by 25% (from 72.3% to 90.4%) (p = 0.001). Use of the nutritional dashboard however reduced in the post period. ConclusionThis study has positively demonstrated improvements in the quality of newborn feeding documentation within the patient's EHR can be achieved through a collaborative multidisciplinary approach optimising EHR design. Practice implicationsThe benefit of a multidisciplinary approach to EHR design is paramount to promoting superior quality data entry compliant with individual workflows.

Quality of hydroxychloroquine retinopathy screening at a Canadian teaching hospital.

To assess the quality of hydroxychloroquine (HCQ)-induced retinopathy screening at a Canadian tertiary center, we concentrate on risk factor documentation within the electronic health record, in accordance with the 2016 AAO guidelines. We performed a retrospective quality assessment study based on chart review of patients who underwent screening for HCQ-induced retinopathy at the Centre Hospitalier de l'Université de Montréal (CHUM) from 2016 to 2019. We evaluated four key risk factors for HCQ-induced retinopathy: daily dose, duration of use, renal disease, and tamoxifen use, using a three-tier grading system (ideal, adequate, inadequate) for documentation assessment. Pareto and root cause analyses were conducted to identify potential improvement solutions. Documentation quality varied in our study: daily dosage was 33% ideal, 31% appropriate, and 36% inappropriate. Duration of use documentation was 75% ideal, 2% adequate, and 24% inadequate. Renal disease documentation was only 6% ideal, with 62% adequate and 32% of charts lacking any past medical history. Among women's charts, tamoxifen use wasn't documented at all, with 65% adequately documenting medication lists. Pareto analysis indicated that improving renal disease and tamoxifen documentation could reduce 64% of non-ideal records, and enhancing daily dose documentation could decrease this by up to 90%. Accurate documentation of key risk factors is critical for HCQ-induced retinopathy screening, impacting both exam initiation and frequency. Our study identifies potential improvements in the screening process at the hospital, referring physician, and ophthalmologist levels. Implementing integrated pathways could enhance patient experience and screening effectiveness.

Antibiotic allergy prevalence and documentation quality in Massachusetts long-term care facilities: A cross-sectional survey

BackgroundAntimicrobial resistance poses a significant global health challenge, particularly affecting older adults who are more susceptible to infections and their complications. Accurate diagnosis and documentation of antibiotic allergies are essential for effective antimicrobial stewardship. Despite the recognized overdiagnosis of antibiotic allergies, comprehensive studies on this subject in long-term care (LTC) settings are limited. ObjectiveTo determine the point prevalence of antibiotic allergies and documentation quality in Massachusetts LTC facilities. MethodsWe conducted a cross-sectional, 1-day point prevalence survey from July 1, 2023, to March 31, 2024, across 20 participating LTC facilities in Massachusetts in partnership with the Massachusetts Department of Public Health. The survey assessed the prevalence and documentation of antibiotic allergies among 2345 residents. Multivariable logistic regression was used to explore associations between documented penicillin allergy and demographic factors, including non-penicillin antibiotic allergies. ResultsThe overall point prevalence of documented antibiotic allergies was 39.1%, with the most frequently reported classes being penicillins at 23.1%, sulfonamides at 15.4%, and cephalosporins at 5.2%. Significant documentation gaps were identified, with up to 92.8% of the allergy records found to be incomplete. Factors associated with documented penicillin allergies included female sex (adjusted odds ratio [aOR], 1.50; 95% CI, 1.16-1.94), White race (aOR, 1.92; 95% CI, 1.25-2.94), having allergies to non-penicillin antibiotics (aOR, 2.89; 95% CI, 2.33-3.59), and receipt of antibiotic (aOR, 2.13; 95% CI, 1.68-2.71). ConclusionThe high prevalence of documented antibiotic allergies and the notable deficiencies in their documentation underscore the urgent need for enhanced antibiotic evaluation, documentation practices, and penicillin delabeling in LTC facilities.

Enhancing Clinical Documentation with Synthetic Data: Leveraging Generative Models for Improved Accuracy

Accurate and comprehensive clinical documentation is crucial for delivering high-quality healthcare, facilitating effective communication among providers, and ensuring compliance with regulatory requirements. However, manual transcription and data entry processes can be time-consuming, error-prone, and susceptible to inconsistencies, leading to incomplete or inaccurate medical records. This paper proposes a novel approach to augment clinical documentation by leveraging synthetic data generation techniques to generate realistic and diverse clinical transcripts. We present a methodology that combines state-of- the-art generative models, such as Generative Adversarial Networks (GANs) and Variational Autoencoders (VAEs), with real-world clinical transcript and other forms of clinical data to generate synthetic transcripts. These synthetic transcripts can then be used to supplement existing documentation workflows, providing additional training data for natural language processing models and enabling more accurate and efficient transcription processes. Through extensive experiments on a large dataset of anonymized clinical transcripts, we demonstrate the effectiveness of our approach in generating high- quality synthetic transcripts that closely resemble real- world data. Quantitative evaluation metrics, including perplexity scores and BLEU scores, as well as qualitative assessments by domain experts, validate the fidelity and utility of the generated synthetic transcripts. Our findings highlight synthetic data generation's potential to address clinical documentation challenges, improving patient care, reducing administrative burdens, and enhancing healthcare system efficiency.

The impact of end-of-life quality metrics on date of death and hospice documentation over time.

e23009 Background: Patient experience and quality of care at the end of life (EOL) have become increasingly important for Oncology providers with the shift to value-based care (VBC). Medicare VBC programs such as the Oncology Care Model (OCM) and Enhancing Oncology Model (EOM) encourage care transformation and use quality measurement to drive EOL quality improvements. Timely and accurate documentation allows practices to evaluate their own performance and continuously improve care transformation efforts. We studied documentation trends in the electronic health record (EHR) and compared them with Medicare claims to evaluate the impact quality metrics had on ensuring accurate practice documentation. Methods: Best practices were established, and continuous education was provided to enable capture and recording of key EOL data in the EHR beginning in July 2016. Patient level date of death (DOD) and hospice enrollment (HSP) data were provided by CMS during the OCM (July 2016 - June 2022) for 14 participating practices in The US Oncology Network (The Network). We obtained corresponding DOD and HSP data from the EHR and compared documentation trends between systems. Statistical analysis was performed for increasing/decreasing trends using the Mann Kendall test. Results: There were statistically significant increases in EHR DOD (19.37% increase, p value 0.02) and HSP (18.93% increase, p value 0.002) documentation from 2016 -2022. All practices had an average year over year increase of 16.40% in HSP documentation (range 11.94% - 18.93.%) and 16.24% increase in DOD documentation (range 6.49% - 19.37%). The median increase from 2016 to 2022 in documentation of DOD was 68% (range 37% - 92%) and HSP was 48% (range 12% - 83%) for all practices. Conclusions: As an epitome of the Hawthorne effect, EOL quality metrics drive clinical documentation improvements with DOD and HSP, further accelerated by continuous education and the establishment of best practices. Improved clinical documentation aids care transformation and quality improvement, creating a positive feedback loop. The impact of quality measurement on other structured and unstructured documentation in the EHR is apt for further exploration. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. [Table: see text]

Improving the Quality and Standardization of Operative Notes in a Tertiary Regional ENT Department: A Closed-Loop Audit.

Comprehensive and accurate documentation is paramount in ensuring patient safety, and continuity of care, and casts the foundation for auditing practice and creating research. Unfortunately, a lack of documentation has been reported globally. This study aims to challenge current practices and ensure high-quality documentation. The study appraised 100 operation notes completed within a tertiary, regional ENT department against the published guidance. Following an inquiry into the findings, the operative note proformas were modified in alignment with the Royal College of Surgeons (RCS) published standards for the quality of operative notes. A further 100 operation notes were audited. Rates of compliance before and post implementing the intervention were compared. Non-parametric data were analyzed using Fischer's exact test, with P< 0.05 considered to be statistically significant. Upon auditing of operative note completeness against the set criteria, the use of a comprehensive operative note proforma significantly refined the quality of documentation and adherence to the published standards (P< 0.00001). This study displayed the lack of adherence to the RCS standards about the quality of operative notes within our center. The adoption of a modified proforma which incorporates the 18 criteria defined by the RCS resulted in improved conformance to published standards and a higher quality of documentation. This study corroborates the RCS framework as an effective tool in recognizing deficient practices and areas of improvement. Through compliance with published standards, a higher quality of documentation is attained, contributing to patient safety, clear continued communication, and support of clinical governance.

Digitalization in the Emergency Department-An Interview Study of Nurses' Experiences in Norway.

Emergency departments (EDs) are overcrowded and linked to an increased risk of mortality and morbidity. Digitalization in EDs has been shown to increase effectiveness, reduce wait times, and improve performance and patient experience. The purpose of this study was to explore ED nurses' experiences with digitalization in the ED. Interviews were conducted with eight ED nurses in a Norwegian hospital. Data were analyzed using Braun and Clarke's six-step thematic analysis. Through analysis, three themes were identified, namely (1) consequences for patient safety, (2) influencing communication in the ED, and (3) impacting acute nursing. ED nurses experienced that the digital tools had increased patient safety through accurate documentation and providing a quick overview of the patient. However, digital tools were also seen as a threat to patient safety due to taking focus away from the patient. Digital tools were experienced to have negatively changed the communication both between personnel and between personnel and patients. Also, digital tools impacted the ED nurses' professional role to a more digitalization-focused approach rather than a patient-oriented approach. These aspects must be included when planning the implementation of new digital tools in EDs in the future.

Enhancing Procedure Documentation in Neonatal Intensive Care Unit (NICU): A Quality Improvement Initiative at a Tertiary Neonatal Hospital.

Background Accurate and comprehensive procedure documentation in Electronic Medical Records (EMR) is crucial for high-quality patient care, especially in high-acuity settings like Neonatal Intensive Care Units (NICU). Gaps in documentation at Corniche Hospital's NICU that were affecting patient safety and continuity of care were identified and addressed by following a pre and post-intervention design in the research. The process involved the initial audit, educational sessions with healthcare providers, and follow-up audits to measure improvements.Results post-intervention showed a significant increase in compliance with documentation standards, pointing out the effectiveness of educational interventions in improving EMR documentation practices. The local problem is demonstrated through the observation ofincomplete and inconsistent procedure documentation in the NICU,hindering effective patient management and multi-disciplinary team communication. Methods A Quality Improvement Project (QIP) was implemented, including a baseline audit, educational interventions targeting healthcare providers, and subsequent re-audits to assess improvement. The project involved tailored educational sessions focused on correct EMR usage, adherence to documentation standards, and practical aspects of documenting procedures. Results Post-intervention, there was a significant increase in documentation compliance. The percentage of compliance in procedure encounter placement in EMR increased from 81% to 100%, and nursing documentation compliance improved from 11 (52.4%) to 18 (85.7%). However, a slight decrease in the completeness of physician documentation was noted. Conclusions The QIP effectively improved procedure documentation in the NICU. Continuous education and periodic review are essential for maintaining and further enhancing documentation standards. This initiative underscores the importance of targeted training and consistent audits in improving clinical documentation in healthcare settings.

Long-Term Outcomes Associated With β-Lactam Allergies

β-lactam (BL) allergies are the most common drug allergy worldwide, but most are reported in error. BL allergies are also well-established risk factors for adverse drug events and antibiotic-resistant infections during inpatient health care encounters, but the understanding of the long-term outcomes of patients with BL allergies remains limited. To evaluate the long-term clinical outcomes of patients with BL allergies. This longitudinal retrospective cohort study was conducted at a single regional health care system in western Pennsylvania. Electronic health records were analyzed for patients who had an index encounter with a diagnosis of sepsis, pneumonia, or urinary tract infection between 2007 and 2008. Patients were followed-up until death or the end of 2018. Data analysis was performed from January 2022 to January 2024. The presence of any BL class antibiotic in the allergy section of a patient's electronic health record, evaluated at the earliest occurring observed health care encounter. The primary outcome was all-cause mortality, derived from the Social Security Death Index. Secondary outcomes were defined using laboratory and microbiology results and included infection with methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, or vancomycin-resistant Enterococcus (VRE) and severity and occurrence of acute kidney injury (AKI). Generalized estimating equations with a patient-level panel variable and time exposure offset were used to evaluate the odds of occurrence of each outcome between allergy groups. A total of 20 092 patients (mean [SD] age, 62.9 [19.7] years; 12 231 female [60.9%]), of whom 4211 (21.0%) had BL documented allergy and 15 881 (79.0%) did not, met the inclusion criteria. A total of 3513 patients (17.5%) were Black, 15 358 (76.4%) were White, and 1221 (6.0%) were another race. Using generalized estimating equations, documented BL allergies were not significantly associated with the odds of mortality (odds ratio [OR], 1.02; 95% CI, 0.96-1.09). BL allergies were associated with increased odds of MRSA infection (OR, 1.44; 95% CI, 1.36-1.53), VRE infection (OR, 1.18; 95% CI, 1.05-1.32), and the pooled rate of the 3 evaluated antibiotic-resistant infections (OR, 1.33; 95% CI, 1.30-1.36) but were not associated with C difficile infection (OR, 1.04; 95% CI, 0.94-1.16), stage 2 and 3 AKI (OR, 1.02; 95% CI, 0.96-1.10), or stage 3 AKI (OR, 1.06; 95% CI, 0.98-1.14). Documented BL allergies were not associated with the long-term odds of mortality but were associated with antibiotic-resistant infections. Health systems should emphasize accurate allergy documentation and reduce unnecessary BL avoidance.

Introducing a standardised register for strengthening the inpatient management of newborns and sick children: Implementation research in selected health facilities of Bangladesh.

It is imperative to maintain accurate documentation of clinical interventions aimed at enhancing the quality of care for newborns and sick children. The National Newborn Health and IMCI programme of Bangladesh led the development of a standardised register for managing newborns and sick children under five years of age during inpatient care through stakeholder engagement. We aimed to assess the implementation outcomes of the standardised register in the inpatient department. We conducted implementation research in two district hospitals and two sub-district hospitals of Kushtia and Dinajpur districts from November 2022 to January 2023 to assess the implementation outcomes of the standardised register. We assessed the following World Health Organization implementation outcome variables: usability, acceptability, adoption (actual use), fidelity (completeness and accuracy), and utility (quality of care) of the register against preset benchmarks. We collected data through structured interviews with health care providers; participant enrolment; and data extraction from inpatient registers and case record forms. The average usability and acceptability scores among health care providers were 73 (standard deviation (SD) = 14) and 82 (SD = 14) out of 100, respectively. The inpatient register recorded 96% (95% confidence interval (CI) = 95-97) of under-five children who were admitted to the inpatient department (adoption - actual use). The proportions of completed data elements in the inpatient register were above the preset benchmark of 70% for all the assessed data elements except 'investigation done' (24%; 95% CI = 23-26) (fidelity - completeness). The percentage agreements between government-appointed nurses posted and study-appointed nurses were above the preset benchmark of 70% for all the reported variables (fidelity - accuracy). The kappa coefficient for the overall level of agreement between these two groups regarding reported variables indicated moderate to substantial agreement. The proportion of newborns with sepsis receiving injectable antibiotics was 62% (95% CI = 47-75) (utility - quality of care). We observed some variability in the completeness and accuracy of the inpatient register by district and facility type. The inpatient register was positively received by health care providers, with evaluations of implementation outcome variables showing encouraging results. Our findings could inform evidence-based decision-making on the implementation and scale-up of the inpatient register in Bangladesh, as well as other low- and middle-income countries.

Affordable Sensors for Speditive and Accurate Documentation of Built Heritage: First Tests and Preliminary Results

Abstract. When facing unregulated human interventions, the tumultuous backdrop of wars, and the relentless impact of climate change, a significant effect is held on those structures that stand as custodians of our cultural identity and historical legacy. The need to document their status is an essential first step toward preservation and restoration. This contribution will analyze and compare diverse datasets acquired through three distinct methods: Terrestrial Laser Scanner, Apple’s iPhone 15 Pro with no additional tool, and iPhone 15 Pro using Pix4D viDoc RTK Rover to assess the quality and accuracy of point clouds, as well as to determine the feasibility of each technique for the expeditious documentation of endangered built heritage. The use of mass-distributed low-cost sensors provides a rapid and cost-effective means to capture detailed 3D models of built heritage while, at the same time, democratizing the process of documentation. Low-cost sensors not only facilitate documentation but also enhance the efficiency of conservation efforts. The precision of LiDAR sensors helps identify structural vulnerabilities, allowing conservationists to prioritize interventions and allocate resources wisely. Furthermore, detailed imagery will enable conservationists to monitor subtle structural changes over time, acting as an early warning system against potential threats. As an additional aid, the RTK Rover enables centimeter-level positioning accuracy while maintaining a compact and fast deployable design, and the direct measurement of Ground Control Points (GCPs) significantly streamlines the surveying process and equipment footprint.

Analysis of Production Cost Calculation Using Job Order Costing Method at PT Secma Energy Cell

Production Cost Calculation is very important for companies as support in financial reporting. Recording production costs encourages business managers to create accurate and fast administrative documentation, so that companies can predict selling price and profit and loss in accordance with expectations. This study aims to examine whether PT Secma Energy Cell, situated in Gresik Regency, East Java, to the principles of cost accounting in implementing the Job Order Costing method for determining production costs. Utilizing a descriptive qualitative approach with a case study methodology, the study aims to evaluate the application of cost calculations for plastic bags and rolls of varying sizes. Data gathering techniques encompass observation, interviews, and documentation of total and variable cost calculations. The study spanned around six months, from December 2022 to May 2023, whereas the data recorded dates back to October 2021. Findings revealed that PT Secma Energy Cell employs a total of 62 individuals, with 34 engaged directly in production activities, while the remainder are non-production staff. Over the course of one month, the company utilized 115,400 kilograms of raw materials, amounting to IDR 2,311,471,500.00, the production of ready-to-sell goods for 1 month was 42,775,005 kg, plastic roll production was 105,020.00 kg, and plastic bag production was 147,795 kg. Up to this point, the company has established the product price per kilogram with an approximately markup of 70%, so that each order received has been calculated in advance regarding the selling price of each product. The analysis revealed that using the Job Order Costing method, the production cost amounted to IDR16,559.48 per kilogram for plastic bags and IDR20,118.81 for plastic rolls. This indicates that PT Secma Energy Cell effectively implements the job order costing method by accurately accounting for expenses associated with raw materials, direct labor, and factory overhead costs. This is intended to enhance the accuracy of the set selling price and potentially boost the company’s future profitability.