Common Clinical Tasks Research Articles

Evaluation of the longer-term impacts on working practices of veterinarians in India after attending a canine surgical neutering training programme.

Effective, continuing professional development opportunities provide veterinarians with the necessary skills to uphold animal welfare standards. In India, surgical neutering is integral in successfully managing the large, free-roaming dog population; the delivery of skills-based, training opportunities which result in long-term behavioural changes remains challenging. Indian veterinarians attending a 12-day, practically focused, training programme on canine surgical neutering, completed a questionnaire prior to the commencement of training and 10-12 months afterwards. Questions explored the programme's impact on their attitudes, working practices, and retained knowledge. A total of 207 participants completed both questionnaires. Ten to 12 months after attendance, most participants reported increased confidence undertaking common surgical and clinical tasks; they felt both motivated and able to use their newly acquired knowledge and skills in their workplace, with some peer-to-peer skills transfer opportunities. Many reported high levels of employer engagement resulting in improvements in the workplace, including equipment investment. Evidence for sustained improvements in working practices were noted in four key areas: surgical practices, use of perioperative analgesia, use of perioperative antibiotics, and post-operative wound management. Average knowledge scores in four areas (surgical skills, peri-operative analgesia, post-operative antibiotics and post-operative care) increased significantly 10-12 months after the training programme as compared to before, after accounting for other participants' characteristics. These findings provide evidence for sustained improvements in workplace practices and patient care after attending a skills-based training opportunity, with a concomitant positive impact on standards of animal welfare. Furthermore, it may inform the development and implementation of future, educational, outcomes-focused training initiatives.

Effects of machine learning-based clinical decision support systems on decision-making, care delivery, and patient outcomes: a scoping review.

Effects of machine learning-based clinical decision support systems on decision-making, care delivery, and patient outcomes: a scoping review.

Federated and distributed learning applications for electronic health records and structured medical data: a scoping review.

Federated and distributed learning applications for electronic health records and structured medical data: a scoping review.

Establishing national diagnostic reference levels in radiography, mammography, and dual-energy x-ray absorptiometry services in Ireland and comparing these with European diagnostic reference levels.

The aim of this work was to establish national diagnostic reference levels (DRLs) in Ireland and compare these to existing European DRLs where available. This work surveyed all radiological facilities providing radiography, mammography, and dual-energy x-ray absorptiometry (DXA) services in Ireland. A list of common procedures and clinical tasks was established. A national database of service providers was used to identify the appropriate medical radiological facilities providing these services. These facilities were issued with an online survey. National DRLs were set as the 75th percentile of the distribution of median values obtained. A national median dose was also established. The broad categorisation of equipment type was also considered. Where differences between DRLs established using different detector types were deemed statistically significant, equipment-specific national DRLs were established. National DRLs were established for 12 adult radiography projections. Equipment-specific (computed radiography and digital radiography) adult DRLs were established for four radiography projections. Paediatric DRLs were established for 11 radiography projections, including two based on clinical indications, for a range of paediatric weight categories. National DRLs were established for unilateral two-view mammography and breast tomosynthesis as well as for four DXA clinical indications and projections. All but one Irish DRL figure was found to be below or equal to European data. This work provided a unique opportunity to establish national DRLs based on census data for a range of procedures and clinical tasks across radiography, mammography and DXA and compare these with European levels. This work established national diagnostic reference levels (DRLs) based on census data for a range of procedures and clinical tasks across radiography, mammography and dual-energy x-ray absorptiometry. The establishment of national DRLs is an essential component in the optimisation of patient radiation dose. • Diagnostic reference levels are easily measured quantities intended for use as an aid to optimise patient dose and to identify when levels of patient dose are unusually high. • Data from all medical radiological facilities in Ireland was obtained to establish national diagnostic reference level (DRL) values and national median dose values in radiography, x-ray breast imaging and dual-energy x-ray absorptiometry (DXA) scanning and these were compared to existing European DRLs where available. • National DRL values were established for the first time in breast tomosynthesis, DXA scanning, and paediatric radiography.

Implementing Large-Scale Electronic Health Records: Experiences from implementations of Epic in Denmark and Finland

Implementing Large-Scale Electronic Health Records: Experiences from implementations of Epic in Denmark and Finland

Implementing Lean Quality Improvement in Primary Care: Impact on Efficiency in Performing Common Clinical Tasks.

Many primary care practices have adopted Lean techniques to reduce the amount of time spent completing routine tasks. Few studies have evaluated both immediate and sustained impacts of Lean to improve this aspect of primary care work efficiency. To examine 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. Non-randomized stepped wedge with segmented regression and interrupted time series analysis (January 2011-December 2016). A total of 317 physician-led teams in 46 primary care departments in a large ambulatory care delivery system. Lean redesign was initiated in one pilot site followed by system-wide spread across all primary care departments. Redesigns included standardization of exam room equipment and supplies, streamlining of call management processes, care team co-location, and team management of the electronic inbox. Time-stamped EHR tracking of physicians' completion time for 4 common tasks: (1) office visit documentation and closure of patient charts; (2) telephone call resolution; (3) prescription refill renewal; and (4) response to electronic patient messages. After Lean implementation, we found decreases in the amount of time to complete: office visit documentation (- 29.2% [95% CI: - 44.2, - 10.1]), telephone resolution (- 22.2% [95% CI: - 38.1, - 2.27]), and renewal of prescription refills (- 2.96% per month [95% CI: - 4.21, - 1.78]). These decreases were sustained over several years. Response time to electronic patient messages did not change significantly. Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks. Our findings support the use of Lean techniques to engage teams in routine aspects of patient care. More research is warranted to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.

Flattening the Learning Curve: A Case-Based Video Orientation for a Subspeciality Residency Rotation.

Flattening the Learning Curve: A Case-Based Video Orientation for a Subspeciality Residency Rotation.

Using the PARAFAC2 tensor factorization on EHR audit data to understand PCP desktop work.

Using the PARAFAC2 tensor factorization on EHR audit data to understand PCP desktop work.

Application of cognitive screening guidelines by health care providers in diabetes care: A cross-sectional descriptive study.

The risk of cognitive dysfunction is higher in people with diabetes than in the general population, and approximately 50% of those with diabetes will develop cognitive impairments as they age. Screening for cognitive dysfunction in people with diabetes can help identify both pathology and those who are at risk for higher health care utilization, but we do not know how health care providers implement cognitive screening recommendations in this population. In this study, we examined health care providers' knowledge of those recommendations and their application of them, as well as factors associated with guideline use. This study used a cross-sectional, descriptive correlational design with a convenience sample. All data were collected with a 20-question online survey sent to advanced practice nurses (APNs), medical doctors/doctor of osteopathic medicines (MDs/DOs), and physician assistants (PAs) in Central Texas. One-hundred eighty-one health care providers responded. Participants most frequently said they were "moderately familiar" with guidelines for cognitive impairment screening (60.9%). Twenty-three per cent of physicians, 37.4% of APNs, and 8.3% of PAs indicated that they incorporated routine screening into daily practice. However, 64% did not use standardized tools to assess cognitive function. The most common clinical tasks related to cognitive screening were referral for more in-depth cognitive screening (44%) and education of families regarding cognitive problems (29%). Lack of time was the most common barrier to screening (57.7%). Most respondents believed that there was a good rationale for assessing cognitive function in people with diabetes. However, despite some familiarity with guidelines for cognitive function screening, most respondents did not use standardized assessment tools. The results indicate variability in clinical practice regarding assessment and practices, such that there may be some variability in outcomes for patients.

Task-oriented search for evidence-based medicine

Research on how clinicians search shows that they pose queries according to three common clinical tasks: searching for diagnoses, searching for treatments and searching for tests. We hypothesise, therefore, that structuring an information retrieval system around these three tasks would be beneficial when searching for evidence-based medicine (EBM) resources in medical digital libraries. Task-oriented (diagnosis, test and treatment) information was extracted from free-text medical articles using a natural language processing pipeline. This information was integrated into a retrieval and visualisation system for EBM search that allowed searchers to interact with the system via task-oriented filters. The effectiveness of the system was empirically evaluated using TREC CDS—a gold standard of medical articles and queries designed for EBM search. Task-oriented information was successfully extracted from 733,138 articles taken from a medical digital library. Task-oriented search led to improvements in the quality of search results and savings in searcher workload. An analysis of how different tasks affected retrieval showed that searching for treatments was the most challenging and that the task-oriented approach improved search for treatments. The most savings in terms of workload were observed when searching for treatments and tests. Overall, taking into account different clinical tasks can improve search according to these tasks. Each task displayed different results, making systems that are more adaptive to the clinical task type desirable. A future user study would help quantify the actual cost-saving estimates.

Blood Pressure Targets in CKD: Lessons Learned from SPRINT and Previous Observational Studies.

Hypertension management is one of the most common clinical tasks in the care of patients with chronic kidney disease (CKD). Elevated blood pressure (BP) is associated with greater risk of all-cause mortality, cardiovascular (CV) disease, and CKD progression in this population. However, it is still debated, to what target(s) BP should be lowered in patients with signs of kidney damage. The Systolic Blood Pressure Intervention Trial (SPRINT) provided new and important information about the effects of lowering systolic BP to a target of <120mmHg, which is lower than the levels currently recommended by the most guidelines (<140/90mmHg). The SPRINT results were not only exciting but also surprising for many clinicians because evidence from well-conducted observational studies in CKD patient showed increased mortality in patients with CKD whose office systolic BP levels were <120mmHg, as compared with systolic BP in 120-139mmHg range. In the present review, we will discuss whether a systolic BP goal of <120mmHg that was found to be beneficial for CV and all-cause mortality outcomes in the SPRINT can be generalized to the entire CKD population.

How Do Clinical Information Systems Affect the Cognitive Demands of General Practitioners?: Usability Study with a Focus on Cognitive Workload

Clinical information systems in the National Health Service do not need to conform to any explicit usability requirements. Poor usability can increase the mental workload experienced by clinicians and cause fatigue, increase error rates and impact the overall patient safety. Mental workload can be used as a measure of usability. To assess the subjective cognitive workload experienced by general practitioners (GPs) with their systems. To raise awareness of the importance of usability in system design among users, designers, developers and policymakers. We used a modified version of the NASA Task Load Index, adapted for web. We developed a set of common clinical scenarios and computer tasks on an online survey. We emailed the study link to 199 clinical commissioning groups and 1,646 GP practices in England. Sixty-seven responders completed the survey. The respondents had spent an average of 17 years in general practice, had experience of using a mean of 1.5 GP computer systems and had used their current system for a mean time of 6.7 years. The mental workload score was not different among systems. There were significant differences among the task scores, but these differences were not specific to particular systems. The overall score and task scores were related to the length of experience with their present system. Four tasks imposed a higher mental workload on GPs: 'repeat prescribing', 'find episode', 'drug management' and 'overview records'. Further usability studies on GP systems should focus on these tasks. Users, policymakers, designers and developers should remain aware of the importance of usability in system design.What does this study add?• Current GP systems in England do not need to conform to explicit usability requirements. Poor usability can increase the mental workload of clinicians and lead to errors.• Some clinical computer tasks incur more cognitive workload than others and should be considered carefully during the design of a system.• GPs did not report overall very high levels of subjective cognitive workload when undertaking common clinical tasks with their systems.• Further usability studies on GP systems should focus on the tasks incurring higher cognitive workload.• Users, policymakers, and designers and developers should remain aware of the importance of usability in system design.

A Comparison of Examination Equipment Used During Common Clinical Ophthalmologic Tasks

OCCUPATIONAL APPLICATIONS Ophthalmologists and other eye-care physicians frequently use clinical examination equipment that restricts access to patients and requires the adoption of sustained, non-neutral working postures of the neck and shoulders. The use of ergonomic principles in the design of examination equipment could help reduce these physical demands, which may be partly responsible for the high prevalence of neck and shoulder pain among ophthalmologists. This study compared the effects of a set of this alternative “ergonomic” equipment to a set of conventional equipment on measures of neck and shoulder muscle activity and upper arm posture during simulations of common clinical ophthalmologic tasks. Results suggested that some aspects of the alternative equipment may help reduce exposures to sustained, non-neutral working postures of the neck and shoulder among ophthalmologists. Ophthalmologists and other eye-care physicians may consider implementing similar alternative equipment interventions into their practices.TECHNICAL ABSTRACT Background: Ophthalmologists report a high prevalence of work-related musculoskeletal symptoms, particularly of the neck and shoulders. Improving the design of equipment used in the clinical environment may reduce exposures to physical risk factors (e.g., sustained muscular exertions and non-neutral postures) associated with neck and shoulder pain among ophthalmologists. Purpose: This study compares estimates of neck and shoulder muscle activity and upper arm posture during use of conventional and alternative examination equipment common in clinical ophthalmologic practice. Methods: Fifteen ophthalmologists performed one mock clinical examination using conventional equipment and one mock clinical examination using alternative equipment with the potential to reduce exposure to sustained muscular exertions and non-neutral upper arm postures. The alternative equipment included a slit lamp biomicroscope with inclined viewing oculars, adjustable elbow supports, and a wider tabletop with more room for supporting the arms in comparison to the conventional slit lamp biomicroscope. A wireless binocular indirect ophthalmoscope was also evaluated that had a more even weight distribution than the conventional design. Measurements of upper trapezius and anterior deltoid muscle activity, upper arm posture, and perceived usability were used to compare the conventional and alternative equipment. Results: In comparison to the conventional slit lamp biomicroscope, the alternative slit lamp biomicroscope led to (i) 12% to 13% reductions in upper trapezius muscle activity levels, (ii) a 9% reduction in left anterior deltoid muscle activity levels, and (iii) a 15% reduction in the percentage of work time spent with the left upper arm elevated in positions greater than 60º. In addition, participants rated the comfort and adjustability of both the alternative slit lamp biomicroscope and binocular indirect ophthalmoscope more favorably than the conventional equipment. Conclusions: The results suggest that the alternative slit lamp biomicroscope may help to reduce overall muscular demands and non-neutral postures of the neck and shoulder region among ophthalmologists.

Medical student self-reported confidence in obstetrics and gynaecology: development of a core clinical competencies document

BackgroundClinical competencies in obstetrics and gynaecology have not been clearly defined for Australian medical students, the growing numbers of which may impact clinical teaching. Our aim was to administer and validate a competencies list, for self-evaluation by medical students of their confidence to manage common clinical tasks in obstetrics and gynaecology; to evaluate students’ views on course changes that may result from increasing class sizes.MethodsA draft list of competencies was peer-reviewed, and discussed at two student focus groups. The resultant list was administered as part of an 81 item online survey.ResultsSixty-eight percent (N = 172) of those eligible completed the survey. Most respondents (75.8%) agreed or strongly agreed that they felt confident and well equipped to recognise and manage most common and important obstetric and gynaecological conditions. Confidence was greater for women, and for those who received a higher assessment grade. Free-text data highlight reasons for lack of clinical experience that may impact perceived confidence.ConclusionsThe document listing competencies for medical students and educators is useful for discussions around a national curriculum in obstetrics and gynaecology in medical schools, including the best methods of delivery, particularly in the context of increasing student numbers.

Implications of our developing understanding of risk and protective factors in the treatment of adult male sexual offenders.

This paper summarizes our developing knowledge of factors that contribute added risk of sexual recidivism (risk factors) and factors that are associated with a reduced risk of sexual recidivism (protective factors). Specific im plications for the design of future treatment programs are drawn. This information is contrasted with the common foci of sexual offender treatment programs that were designed before these research findings emerged, and suggestions made about how common clinical tasks might be re-revisited and revised in the light of this new knowledge.

Phase retrieval from one single phase contrast x-ray image

Phase retrieval is required for achieving artifact-free x-ray phase-sensitive 3D imaging. A phase-retrieval approach based on the phase-attenuation duality with high energy x-rays can greatly facilitate for phase sensitive imaging by allowing phase retrieval from only one single projection image. The previously derived phase retrieval formula is valid only for small Fresnel propagator phases corresponding to common clinical imaging tasks. In this work we presented a new duality-based phase retrieval formula that can be applied for cases with large Fresnel propagator phases corresponding to high spatial resolution imaging. The computer simulation demonstrated superiority of this new formula over the previous phase retrieval formula in reconstructing the high frequency components of imaged objects. A modified Tikhonov regularization technique has been devised for phase retrieval in cases of very high resolution and large object-detector distance such that some Fresnel propagator phases may be close or greater than pi. This new phase retrieval formula lays the foundation for implementing high-resolution phase-sensitive 3D imaging of soft tissue objects.

What factors affect the use of electronic patient records by Irish GPs?

What factors affect the use of electronic patient records by Irish GPs?

Recommendations for a Physician Assistant Medical Genetics Curriculum

Recognizing that genetics is playing a larger role in clinical practice, the challenge for physician assistant (PA) educators is to prepare our students with an appropriate foundation of knowledge, skills, and attitudes. A knowledge base of fundamental genetic principles and approaches is essential, as are the skills that will allow students to apply these principles in the clinic and to exhibit professional attitudes related to genetic information and diagnosis. Such knowledge, skills, and attitudes will be required for common clinical tasks, for example, when assessing familial risk for common diseases as well as ordering, interpreting, and explaining genetic test results to a patient. PA programs need to develop appropriate curricula to meet this dynamic challenge. As a companion piece to recently proposed genetics competencies, a concise outline of recommendations for a PA medical genetics curriculum is offered. The recommendations are designed to assist in teaching PA students the knowledge, skills, and attitudes they require to meet the demands of genomic medicine. A wide variety of teaching and evaluation methods, including didactic lectures, Web-assisted learning, and clinical experience, are proposed. In addition, specific valid genetics Web resources are presented for teaching, genetic education, primary care clinicians, and students. Teaching should be related to clinical cases and/or experiences whenever possible.

Heuristic evaluation of clinical functions in four practice management systems: A pilot study

Heuristic evaluation of clinical functions in four practice management systems: A pilot study

Comparison of LCD and CRT Displays Based on Efficacy for Digital Mammography

Comparison of LCD and CRT Displays Based on Efficacy for Digital Mammography