Computer Entry Research Articles

Exploring the human factors of medication errors in community pharmacy: a mixed methods study

Abstract Introduction Medication errors and near misses in the community pharmacy dispensing process have the potential to adversely impact patient safety. The World Health Organisation has identified the importance of Human factors (HF) in the Patient Safety Curriculum guide (1). However, there is a lack of knowledge on how HF principles have or could be applied in the community pharmacy setting. Adopting a HF approach and using qualitative methods can provide in-depth understanding of factors that contribute to these errors, and contribute to intervention development that may improve patient safety. Aim The study aims to investigate the factors contributing to medication dispensing errors and near misses in community pharmacy, and to gather pharmacists’ views of these factors and how these could be mitigated. Methods Three Irish community pharmacies were recruited and provided details of the last ten dispensing errors or near misses which occurred. Each error was mapped to the Hierarchical Task Analysis (HTA) steps developed for this study, and mapped to the Systematic Human Error Reduction and Prediction Approach (SHERPA) framework (2). A detailed report was prepared for each pharmacy outlining the error analysis, with recommendations to prevent the errors in future. A qualitative semi-structured interview was conducted with the three pharmacists in the recruited pharmacies to discuss the report, and analysed by thematic analysis. Results A total of 30 medication errors/near misses were analysed (10 errors reached the patients and were not administered). The HTA developed outlines 185 subtasks potentially involved in dispensing a prescribed medication. On mapping to the SHERPA framework, selection-based errors were the most frequently reported error category (21/30, 70%); this included incorrect product selection from the shelf (17/30, 56.7%) and incorrect product selection at the point of computer entry (4/30, 13.3%). Of the 75 HTA steps involved across the 30 errors, the most frequent point of error was in the gathering medication steps (47/75, 62.7%), followed by the pharmacist accuracy check steps (16/75, 21.3%) and patient mix up errors (5/30, 16.7%). The pharmacist interview themes found that cognitive burden, fatigue, distraction and staffing deficiencies were reported as increasing the risk of error and near miss. Knowledge gaps and inexperience with certain medications were also reported as contributing to errors. Recommendations to prevent errors included changes to the physical environment (e.g. using product shelf alerts), improved checking processes and taking short mental breaks. Conclusion This study found that the most common errors/near misses were at the product selection stage of dispensing, with pharmacy accuracy checks sometimes, but not always, detecting these before they reached the patient. Medication errors occur due to several varying and often interacting factors; cognitive burden and lack of standardised medication checking processes. Despite the small sample size and potential for social desirability bias in the interviews, this study has demonstrated how HF techniques can be applied to the dispensing process as a means of understanding and preventing error occurrence in the community pharmacy. References (1) Vosper H, Hignett S. A UK perspective on human factors and patient safety education in pharmacy Curricula. Am J Pharm Educ. 2017;82:6184. (2) Sutherland A, Ashcroft DM, Phipps DL. Exploring the human factors of prescribing errors in paediatric intensive care units. Arch Dis Child 2019;104:588-595.

PATHWAYS TO COMPUTER SCIENCE AT COMMUNITY COLLEGE: SINGLE MOTHERS AS RETURNING STUDENTS

Focusing on adult women (re-)entering college to study computer science is one avenue to broadening participation in computing, and community college computer science departments are primed to take advantage of this population of overlooked students. One understudied group is single mothers who are studying computer science with the intention of transfer and completion of a bachelor’s degree in preparation for entering a computing career. Social cognitive career theory describes the social cognitive process by which individuals gain interests and make career-based decisions, and we used this framework as a guide in a single case study to answer the research question: How does a returning single mother experience community college as a step on a pathway with a goal of a bachelor’s degree in computer science and entry into a computing job? To answer this question, we analyzed data from an interview and a follow-up message exchange with a 28-year-old white female single parent who was attending a community college in California at the time of the study. Findings from this study demonstrate that women returning to college to study computer science can experience high self-efficacy and outcome expectations. Implications from this work suggest that college departments could trumpet the salaries and availability of computing jobs to attract returning female students, emphasizing those careers that are pro-social. These students may be adopted as leaders, counted upon to ask questions that younger students are too afraid to verbalize and to run college organizations focused on computing majors and careers.

Use of Lean Healthcare to Improve Hospital Throughput and Reduce LOS.

Following the Pareto principle, we focused on improving the discharge process on the medical-surgical units that received the most patients admitted from the emergency department. Increased demand for medical-surgical beds, renovations, and diminished bed capacity made it imperative to improve efficiency using quality improvement techniques. A core team of frontline staff decreased the time between computer entry of discharge orders and patient's departure from the unit to less than 60 minutes, with 80% compliance. The team developed a daily dashboard that detailed the process and outcome measures to create situational awareness and daily visual management. Additional observations of staff workflow uncovered excessive walking for printer use. Printers were placed at the point of use to reduce transport times. Next, using survey results provided by patients on discharge quality, a Treasure Map that aided with teach-back and Team Discharge were implemented to level the staff's workload. Finally, physicians discharged patients earlier in the day. They standardized their discharge criteria to remove subjectivity from the discharge process and enable better team involvement. After implementing 4 interventions, the average time between computer entry of discharge orders and patient's departure from the unit decreased (94.26 versus 65.98 minutes; P < 0.001), simultaneously reducing our average length of stay from 5.62 to 4.81 days (P < 0.001). In conclusion, hardwiring proven interventions and complementing them with daily visual management led to significant, sustained results.

Data quality comparison between computers and smartphones in different web survey modes and question formats

PurposeLow response rates in web surveys and the use of different devices in entering web survey responses are the two main challenges to response quality of web surveys. The purpose of this study is to compare the effects of using interviewers to recruit participants in computer-assisted self-administered interviews (CASI) vs computer-assisted personal interviews (CAPI) and smartphones vs computers on participation rate and web survey response quality.Design/methodology/approachTwo field experiments using two similar media use studies on US college students were conducted to compare response quality in different survey modes and response devices.FindingsResponse quality of computer entry was better than smartphone entry in both studies for open-ended and closed-ended question formats. Device effect was only significant on overall completion rate when interviewers were present.Practical implicationsSurvey researchers are given guidance how to conduct online surveys using different devices and choice of question format to maximize survey response quality. The benefits and limitations of using an interviewer to recruit participants and smartphones as web survey response devices are discussed.Social implicationsIt shows how computer-assisted self-interviews and smartphones can improve response quality and participation for underprivileged groups.Originality/valueThis is the first study to compare response quality in different question formats between CASI, e-mailed delivered online surveys and CAPI. It demonstrates the importance of human factor in creating sense of obligation to improve response quality.

Workflow Mapping-A Q-Probes Study of Preanalytic Testing Processes: A College of American Pathologists Q-Probes Study of 35 Clinical Laboratories.

Workflow mapping is a tool used to characterize operational processes throughout most industries and to identify non-value-added activities. To develop a set of workflow mapping tools to compare the sequence and timing of activities, including waiting steps, used by clinical laboratories to process specimens during the preanalytic testing phase. Laboratories enrolled in this College of American Pathologists Q-Probes study created workflow maps detailing the steps they used to process specimens from the time of sample arrival in the laboratory to the time of sample delivery to chemistry analyzers. Enrollees recorded the sequence and types of steps involved in specimen processing and the time needed to complete each step. Institution average total specimen processing times (SPTs) and the number of steps required to prepare samples varied widely among institutions. Waiting steps, that is, steps requiring specimens to wait before advancing to the next process step, and specimen centrifugation consumed the greatest amount of processing times for both routine and STAT testing. Routine and STAT testing SPTs were shorter at institutions that used rapid centrifuges to prepare samples. Specimen processes requiring more sample waiting steps and computer entry steps had longer aggregate total process times than those with fewer such steps. Aggregate specimen processing times may be shortened by reducing the number of steps involving sample waiting and computer entry activities. Rapid centrifugation is likely to reduce overall average institutional SPTs.

Pattern of Eye Disorders at the Ophthalmology Clinic of a Tertiary Health Facility in the Niger-delta Region: The Implications for Preventive Ophthalmology

Objective: To determine the pattern of eye disorders among Nigerian Niger Delta region residents as a basis for preventive ophthalmology.&#x0D; Methodology: This study was a retrospective study involving an eleven-year cumulative review of clinical records from the Ophthalmology Clinic of University of Port Harcourt Teaching Hospital. Data on eye disorders were retrieved from the Ophthalmology Clinic records and manually entered into a computer-spread sheet. Double entry check was performed to avoid errors in computer entry. The respective eye disorders from the records were summed to obtain the absolute and relative cumulative frequencies and appropriately presented using horizontal bar chart. Data analyzed with United States Centers for Disease Control and Prevention (CDC) Epi-Info version 7 software.&#x0D; Results: The cumulative total record from the Ophthalmology Clinic was 55,109 from a total of 41 eye disorders. The absolute and relative frequencies of the identified eye disorders from the clinic are presented in horizontal bar chart. The top five ocular disorders were glaucoma (26.97%), refractive error (26.06%), cataract (10.60%), allergic conjunctivitis (9.31%) and bacterial conjunctivitis (5.02%) while the least common cases seen include pan uveitis (0.08%), herpes zoster ophthalmicus (0.07%) pingueculum (0.07%), painful blind eye (0.06%) and orbital cellulitis (0.05%). The anterior segment subspecialty (34.76%) accounted for majority of cases seen followed by glaucoma subspecialty (26.97%), oculoplasty (4.04%), vitreo-retinal (2.4%), paediatric (0.74%), neuro-ophthalmology (0.7%). Cases which cut-across more than one subspecialty group accounted for 28.19%.&#x0D; Conclusion: The commonest eye disorders identified in this study are among the major causes of avoidable blindness in developing countries including Nigeria. To reduce the burden of blindness and visual impairment would involve a concerted effort to tackle these disorders especially by developing the various ophthalmic subspecialties.

Replacing the Lab Manual with a Learning Management System in Physics Investigations for K-4 Pre-service Teachers

The traditional laboratory investigation uses a procedure written on paper; students then record their responses on a supplied data page or laboratory notebook. In an attempt to make this process more efficient, the use of a Learning Management System (in this case D2L) was used to present the material and collect student feedback. Each student had a University supplied laptop, read the procedure from the screen and submitted answers through D2L. As anticipated there was no change in content knowledge. However surprisingly, subjects felt the paper and pencil approach was easier to use than computer entry. In a subsequent study, the same population in the same course completed an on-line only lecture and lab course. We will discuss the student's reaction to this on-line class.

Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery.

The surgical stress response plays an important role on the pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic agonists attenuate this response and may help prevent postoperative cardiac complications. To determine the efficacy and safety of α-2 adrenergic agonists for reducing mortality and cardiac complications in adults undergoing cardiac surgery and non-cardiac surgery. We searched CENTRAL (2017, Issue 4), MEDLINE (1950 to April Week 4, 2017), Embase (1980 to May 2017), the Science Citation Index, clinical trial registries, and reference lists of included articles. We included randomized controlled trials that compared α-2 adrenergic agonists (i.e. clonidine, dexmedetomidine or mivazerol) against placebo or non-α-2 adrenergic agonists. Included trials had to evaluate the efficacy and safety of α-2 adrenergic agonists for preventing perioperative mortality or cardiac complications (or both), or measure one or more relevant outcomes (i.e. death, myocardial infarction, heart failure, acute stroke, supraventricular tachyarrhythmia and myocardial ischaemia). Two authors independently assessed trial quality, extracted data and independently performed computer entry of abstracted data. We contacted study authors for additional information. Adverse event data were gathered from the trials. We evaluated included studies using the Cochrane 'Risk of bias' tool, and the quality of the evidence underlying pooled treatment effects using GRADE methodology. Given the clinical heterogeneity between cardiac and non-cardiac surgery, we analysed these subgroups separately. We expressed treatment effects as pooled risk ratios (RR) with 95% confidence intervals (CI). We included 47 trials with 17,039 participants. Of these studies, 24 trials only included participants undergoing cardiac surgery, 23 only included participants undergoing non-cardiac surgery and eight only included participants undergoing vascular surgery. The α-2 adrenergic agonist studied was clonidine in 21 trials, dexmedetomidine in 24 trials and mivazerol in two trials.In non-cardiac surgery, there was high quality evidence that α-2 adrenergic agonists led to a similar risk of all-cause mortality compared with control groups (1.3% with α-2 adrenergic agonists versus 1.7% with control; RR 0.80, 95% CI 0.61 to 1.04; participants = 14,081; studies = 16). Additionally, the risk of cardiac mortality was similar between treatment groups (0.8% with α-2 adrenergic agonists versus 1.0% with control; RR 0.86, 95% CI 0.60 to 1.23; participants = 12,525; studies = 5, high quality evidence). The risk of myocardial infarction was probably similar between treatment groups (RR 0.94, 95% CI 0.69 to 1.27; participants = 13,907; studies = 12, moderate quality evidence). There was no associated effect on the risk of stroke (RR 0.93, 95% CI 0.55 to 1.56; participants = 11,542; studies = 7; high quality evidence). Conversely, α-2 adrenergic agonists probably increase the risks of clinically significant bradycardia (RR 1.59, 95% CI 1.18 to 2.13; participants = 14,035; studies = 16) and hypotension (RR 1.24, 95% CI 1.03 to 1.48; participants = 13,738; studies = 15), based on moderate quality evidence.There was insufficient evidence to determine the effect of α-2 adrenergic agonists on all-cause mortality in cardiac surgery (RR 0.52, 95% CI 0.26 to 1.04; participants = 1947; studies = 16) and myocardial infarction (RR 1.01, 95% CI 0.43 to 2.40; participants = 782; studies = 8), based on moderate quality evidence. There was one cardiac death in the clonidine arm of a study of 22 participants. Based on very limited data, α-2 adrenergic agonists may have reduced the risk of stroke (RR 0.37, 95% CI 0.15 to 0.93; participants = 1175; studies = 7; outcome events = 18; low quality evidence). Conversely, α-2 adrenergic agonists increased the risk of bradycardia from 6.4% to 12.0% (RR 1.88, 95% CI 1.35 to 2.62; participants = 1477; studies = 10; moderate quality evidence), but their effect on hypotension was uncertain (RR 1.19, 95% CI 0.87 to 1.64; participants = 1413; studies = 9; low quality evidence).These results were qualitatively unchanged in subgroup analyses and sensitivity analyses. Our review concludes that prophylactic α-2 adrenergic agonists generally do not prevent perioperative death or major cardiac complications. For non-cardiac surgery, there is moderate-to-high quality evidence that these agents do not prevent death, myocardial infarction or stroke. Conversely, there is moderate quality evidence that these agents have important adverse effects, namely increased risks of hypotension and bradycardia. For cardiac surgery, there is moderate quality evidence that α-2 adrenergic agonists have no effect on the risk of mortality or myocardial infarction, and that they increase the risk of bradycardia. The quality of evidence was inadequate to draw conclusions regarding the effects of alpha-2 agonists on stroke or hypotension during cardiac surgery.

Breastfeeding and infant growth outcomes in the context of intensive peer counselling support in two communities in Bangladesh.

BackgroundExclusive breastfeeding and growth faltering during infancy remain challenges in Bangladesh. The Training & Assistance for Health & Nutrition Foundation has been working to address this gap through community-based peer counsellors since 2000. In this paper, we assessed the programme’s progress, particularly with respect to early initiation of breastfeeding and exclusive breastfeeding for normal birth weight, as well as for low birth weight (LBW) infants.MethodsThe peer counselling programme is continuing in rural and urban areas of Bangladesh, but only data collected between January 2013 and June 2015 is presented in this descriptive study. Intensive breastfeeding counselling was provided to women during the third trimester of pregnancy and 6 months postpartum by well-trained peer counsellors. They recorded data on infants’ birth weight, feeding practices and body weight every month and submitted these for computer entry. Weight measurements were converted to weight-for-age Z-scores (WAZ) and growth patterns assessed by comparing attained body weights with the World Health Organization (WHO) 2006 Child Growth Standards.ResultsA total of 994 infants were born during the study period; 94 % were normal birth weight and 6 % were LBW (<2.5 kg). Initiation of breastfeeding within one hour of birth was reported by 94 % of counselled mothers in both groups. The prevalence of exclusive breastfeeding at 6 months was 94 % in the normal birth weight infants and 92 % in the LBW infants, and their mean body weights were 7.5 ± 0.8 kg and 6.6 ± 0.7 kg respectively. There was no growth faltering in these infants during 6 months. Underweight rates in normal birth weight infants remained similar (2.2 % at 1 month and 2.5 % at 6 months), whereas underweight rates in LBW infants decreased from 42.1 % at 1 month to 21.1 % at 6 months.ConclusionsIn the context of a well-structured programme setting, and under the described circumstances, it seems likely that the well-trained and supervised community-based peer counsellors could assist in encouraging and helping mothers of both normal birth weight and LBW infants to initiate breastfeeding within one hour and to continue exclusive breastfeeding until 6 months of age. Our data suggest that they may also have contributed towards prevention of growth faltering in these infants.

Assistive computer input device for muscular atrophy patients

This article is aimed at people who suffer from muscular dystrophy or amyotrophic lateral sclerosis. A webcam captures images of the user’s head, and the computer then processes these images to calculate and transform the swinging direction and distance of the user’s head into the position of the mouse cursor and into the action of clicking the mouse. To accurately and quickly recognize these features, this article used a round sticker with a diameter of 1 cm as an identification label, which is stuck on the user’s forehead. After the webcam captures the images, the program can recognize the positions of the identification label and move the mouse cursor. Through Windows API, this article determined the user’s intention and action of clicking the mouse on the basis of a series of movements to control the mouse cursor. As confirmed by the experimental results, the proposed assisted computer entry device for muscular atrophy patients is applicable and gives good results for the e-book reading program, use of the web browser, and the execution of the application software and mini-games developed by this system structure.

Analysis of Lost Sonographer Productivity in a University Hospital Vascular Laboratory

Introduction Improved efficiency is necessary to deliver cost effective services in today's healthcare environment. Details of how a vascular sonographer's (SG) time is allocated during an average working day have not been adequately described previously. Our objective was to provide insight into the SG average day, and therefore investigate ways at becoming more efficient. This improved efficiency may not only result in cost savings, but better patient and SG satisfaction. Methods SG at two hospitals affiliated with our university (Hospital A and B) tracked their activities daily during five consecutive weekdays. Scan time, delays in patient arrival, preparation for the test, computer entry, lunch breaks, and administrative time (patient and nonpatient related) were logged. Results Eleven SG performed 113 tests at Hospital A and 60 at Hospital B. On average, there were 5.4 full time equivalent (FTE) and 1.8 FTE SG working daily at Hospitals A and B respectively. Hospital A performed 62 portable studies, Hospital B performed none. Each SG performed between 14 and 32 tests (mean 21.4) in the study period. This was equivalent to 6.35 tests per FTE per day. Excluding portable studies, actual scan time occupied only 38.8% of the SG day. Nonpatient related but essential activities (23.7%) and nonscan nonessential activities (27.9%) took up the rest of the SG time. Conclusion In order to maximize efficiency in the vascular lab, nonpatient related activities, which occupy about a quarter of the daily workday, must be eliminated. Off-loading of these responsibilities to ancillary staff may improve SG efficiency. Portable studies consume a significant amount of time, and thus are a drag on efficiency as well.

Citizen Science in Archaeology

Copyright © 2014 by the Society for American Archaeology. Citizen science, as a process of volunteer participation through crowdsourcing, facilitates the creation of mass data sets needed to address subtle and large-scale patterns in complex phenomena. Citizen science efforts in other field disciplines such as biology, geography, and astronomy indicate how new web-based interfaces can enhance and expand upon archaeologists' existing platforms of volunteer engagement such as field schools, community archaeology, site stewardship, and professional-avocational partnerships. Archaeological research can benefit from the citizen science paradigm in four ways: fieldwork that makes use of widely available technologies such as mobile applications for photography and data upload; searches of large satellite image collections for site identification and monitoring; crowdfunding; and crowdsourced computer entry of heritage data.

Citizen Science in Archaeology

Abstract Citizen science, as a process of volunteer participation through crowdsourcing, facilitates the creation of mass data sets needed to address subtle and large-scale patterns in complex phenomena. Citizen science efforts in other field disciplines such as biology, geography, and astronomy indicate how new web-based interfaces can enhance and expand upon archaeologists’ existing platforms of volunteer engagement such as field schools, community archaeology, site stewardship, and professional–avocational partnerships. Archaeological research can benefit from the citizen science paradigm in four ways: fieldwork that makes use of widely available technologies such as mobile applications for photography and data upload; searches of large satellite image collections for site identification and monitoring; crowdfunding; and crowdsourced computer entry of heritage data.

제조 및 유통산업을 위한 RFID 기반 자동 검수 시스템의 설계 및 구현

현재 제조, 유통산업에서는 입출고 운영결과를 수기 작성, 전산 입력 또는 엑셀파일에 의존하는 물류를 운영하고 있다. 이에 수기 입력 오류, 전산 입력 오류, 실시간 데이터 처리 불가, 수량 부족/초과 문제 발생과 같이 물류를 운영하는데 문제가 발생하고 있다. 이에 본 논문은 RFID 기술을 활용하여 입출고 데이터 처리를 통한 입고 자동 검수 시스템을 제안한다. 또한 실시간 데이터 처리 및 자동 검수를 통해 기존 물류 운영 대비 RFID를 적용한 시스템의 비용 절감효과를 제안한다. RFID 기술을 적용하여 입출고 데이터를 현장에서 실시간으로 처리할 수 있으며 수량 부족/초과 문제도 현장에서 바로 조치할 수 있게 된다. 그럼으로써 현재 운영 시스템 대비 RFID 시스템을 통해 물류비를 절감할 수 있다. Current manufacturing and distribution industries work with handwritten shipping information or receive operation results in excel files and have to go through computer processing for their logistics. Thus, hand writing error or computer entry error, non-real-time data processing, quantity shortage and excess operating problems have been frequently occurring in many logistics points. In this paper, we will be proposing a RFID based automatic inspection system that will ensure more accurate data for inbound and outbound. Real-time data processing and automatic inspection system will show cost saving effect compared to the existing system.

A Chance to Cut

A Chance to Cut Bruce H. Campbell My gloved hand reaches for progressively sharper surgical instruments. The prior radiation therapy and recurrent cancer [End Page E3] have made his neck tissues as stiff and hard as an old block of wood; everything appears too dull and feels too dry under the bright operating room lights. I push, dissect, urge, divide, prod, and spread with little effect. The nursing staff keeps to its routine—completing computer entries, retrieving supplies, counting sponges—only intermittently aware that things are not going well at the point of attack. Nondescript music plays softly and the anesthesia machine continues to emit its gentle sounds. The junior resident—assisting me with the first of many neck dissections she will see during her five years of training—grips the retractor as she has been told and dabs the wound periodically to clear any blood or fluid. I glance up to recheck the CT scan. It confirms that this man’s recurrent cancer is just below the next layer of neck muscles. There are also some large blood vessels and major nerves nearby. I am confident, though, that I will be able to expose the mass, protect all of the critical structures, and safely remove the cancer. Curing cancer with surgery is no small feat, mind you. Cancer is, after all, a molecular disease not easily confined to an obvious lump, even though we sometimes refer to a malignant mass being “like a walnut” or “as hard and round as a marble.” The actual disease rests deep inside each cancer cell where the genetic code—the DNA—makes mistake–after–mistake. If cancer is to be cured with a surgical procedure, the surgeon must remove every last cell that is capable of making the same nonsensical, life–threatening error. Given Science’s rudimentary knowledge of cancer cell dynamics and signaling, it’s a miracle that surgery ever works. Yet, we continue to try. And we succeed just often enough to keep on trying. I rearrange the retractors and alter my approach. My mentors would have known what to do next, I imagine. My training included time well–spent with brilliant and technically–gifted surgeons. How would they have approached this case? Their experience and instincts might have told them to open the wound more widely, work the lateral and deep margins first, or position the instruments differently. Perhaps, one of my mentors would have attacked this man’s tumor using the same approach I am attempting but would have known exactly where to exploit some area of weakness that I cannot locate. A few swift, confident moves and he would have held the mass in his hands. “That’s it. We’re done,” he would have said. I met this patient several months ago when his cancer was first discovered and have seen him throughout his course of treatment. Recently, his daughter had accompanied him to the office to review his options. “Treatment has been rugged, Doc,” he reminded me. “The cancer’s still there and they said I can’t get any more radiation. Chemo would only prolong things. I don’t really want surgery, but what choice do I have if I want to be cured?” “Supportive care is an option, but the only curative approach is surgery.” “Well, I’m not ready to quit yet, Doc. I got grand-kids, y’know. I want to watch them grow up.” He nodded to his daughter. “I’m in charge of spoiling her little boys.” The daughter smiled. We crowded around the computer screen to look at the scans. I showed them how the tumor was invading and destroying surrounding structures. I described the surgery and the risks. “There are many things I will not know about your tumor until we are actually in the operating room,” I explained. Surgery in the setting of recurrent disease involves a series of on–the–spot decisions and course corrections. The odds of success are unknowable. “Sometimes, the only way to find out if we can remove the cancer is simply to try.” He took a deep breath and looked at his daughter. “Well then, Doc, if surgery is the only...

The impact of computerised physician order entry with integrated clinical decision support on pharmacist–physician communication in the hospital setting: a systematic review of the literature

ObjectiveTo document the issues and impact that computerised physician order entry (CPOE) with clinical decision support (CDS) can have on pharmacist–physician communication in the hospital setting.HypothesisNovel processes introduced by CPOE...

Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery

The surgical stress response plays an important role on the pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic agonists attenuate this response and may thereby prevent cardiac complications. This review assessed the efficacy and safety of preoperative (within 24 hours), intraoperative, and postoperative (first 48 hours) alpha-2 adrenergic agonists for preventing mortality and cardiac complications after surgery performed under either general or neuraxial anaesthesia, or both. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to August week 4 2008), EMBASE (1980 to week 36 2008), the Science Citation Index, and reference lists of articles. We included randomized controlled trials that compared alpha-2 adrenergic agonists (clonidine, dexmedetomidine, or mivazerol) against placebo or non-alpha-2 adrenergic agonists. Included studies had to report on mortality, myocardial infarction, myocardial ischaemia, or supraventricular tachyarrhythmia. Three authors independently assessed trial quality and extracted data. Two authors independently performed computer entry of abstracted data. We contacted study authors for additional information. Adverse event data were gathered from the trials. We included 31 studies (4578 participants). Study quality was generally inadequate, with only six studies clearly reporting methods for blinding and allocation concealment. Overall, alpha-2 adrenergic agonists reduced mortality (relative risk (RR) 0.66; 95% CI 0.44 to 0.98; P = 0.04) and myocardial ischaemia (RR 0.68; 95% CI 0.57 to 0.81; P < 0.0001). However, their effects appeared to vary with the surgical procedure. The most encouraging data pertained to vascular surgery, where they reduced mortality (RR 0.47; 95% CI 0.25 to 0.90; P = 0.02), cardiac mortality (RR 0.36; 95% CI 0.16 to 0.79; P = 0.01), and myocardial infarction (RR 0.66; 95% CI 0.46 to 0.94; P = 0.02). With regard to adverse effects, alpha-2 adrenergic agonists significantly increased perioperative hypotension (RR 1.32; 95% CI 1.07 to 1.62; P = 0.009) and bradycardia (RR 1.66; 95% CI 1.14 to 2.41; P = 0.008). Our study provides encouraging evidence that alpha-2 adrenergic agonists may reduce cardiac risk, especially during vascular surgery. Nonetheless, these data remain insufficient to make firm conclusions about their efficacy and safety. A large randomized trial of alpha-2 adrenergic agonists is therefore warranted. Additionally, future research must determine which specific alpha-2 adrenergic agonist should be used, and whether it is safe to combine them with other perioperative interventions (for example beta-adrenergic blockade).

Medication errors resulting from computer entry by nonprescribers

The characteristics of medication errors associated with the use of computer order-entry systems by nonprescribers are discussed. A retrospective analysis of records submitted to MEDMARX was conducted for the period from July 1, 2001, to December 31, 2005, to identify all computer-related medication errors made by nonprescribers. Quantitative analysis of the records included the severity of each error, the origin within the medication-use process, the type of error, principal causes, the location within the facility where the error was made, and the therapeutic drug classes frequently involved. Similar data from the University of Pittsburgh Medical Center (UPMC) were also analyzed and compared with the national data set. During the 4.5 years, 693 unique facilities submitted 90,001 medication error records that were the result of computer entry by nonprescribers. The national data set and the UPMC data had similar findings for error severity, error origin, and type of error but showed some differences in the rank ordering of error causes, location where the error occurred, and drug classes frequently associated with such errors. The percentage of harm associated with computer-entry errors was small for both the national data set and UPMC data (0.99% and 0.80%, respectively). Both data sets cited performance deficit as the leading cause of computer-entry errors, but large percentage differences were seen with other causes, including inaccurate or omitted transcription (30% versus 12.6%, respectively), documentation (19.5% versus 10.6%, respectively), and procedure or protocol not followed (21.7% versus 30.3%, respectively). Both data sets implicated the inpatient pharmacy department as the location where most computer-entry errors occurred (49.3% versus 69.0%, respectively). Analysis of the characteristics of medication errors associated with the use of computer-entry systems by non-prescribers from both MEDMARX and an individual health system database demonstrated that computer systems create new opportunities for errors to occur. Working closely with information technology personnel dedicated to assisting pharmacy departments and vendors, adequate training of pharmacy staff, and development of national standards for drug information displays in computer order-entry systems may help minimize such errors.

Hardiness vs Alienation Personality Construct Essentially Explains Burnout Proclivity and Erroneous Computer Entry Problems in Rural Hellenic Hospital Labs

Hardiness vs Alienation Personality Construct Essentially Explains Burnout Proclivity and Erroneous Computer Entry Problems in Rural Hellenic Hospital Labs

SURVEY RUMAH TANGGA PHBS DI KOTA BUKITTINGGI TAHUN 2006

Clean and health life behaviour is a mainproblem in Indonesia and beeing a serious problem in Bukittinggi. In 2005 we found only 18,2% Families in Bukittinggi which have clean and health life behaviour, and we found the clean and health life behaviour was increase up to 34,6% in 2006. The purpose of this survey is how to know the description of the Clean and health life behaviour programs were done in Bukittinggi's Family. The method in this survey is analitical descriptive with cross sectional design, and use the fast survey technic. The Population in this survey is all of Bukittinggi's Family Sample design use stepping cluster design and amount of samples are 210 Families (30 cluster x 7 Families, because 1 cluster have 7 families). The method of data collecting are interview and field obeservation with questioners. Data are processed by SPSS Computer Programfrom editing, coding, entry and cleaning.