Electronic Data Management System Research Articles

A novel electronic data collection system for large-scale surveys of neglected tropical diseases.

BackgroundLarge cross-sectional household surveys are common for measuring indicators of neglected tropical disease control programs. As an alternative to standard paper-based data collection, we utilized novel paperless technology to collect data electronically from over 12,000 households in Ethiopia.MethodologyWe conducted a needs assessment to design an Android-based electronic data collection and management system. We then evaluated the system by reporting results of a pilot trial and from comparisons of two, large-scale surveys; one with traditional paper questionnaires and the other with tablet computers, including accuracy, person-time days, and costs incurred.Principle FindingsThe electronic data collection system met core functions in household surveys and overcame constraints identified in the needs assessment. Pilot data recorders took 264 (standard deviation (SD) 152 sec) and 260 sec (SD 122 sec) per person registered to complete household surveys using paper and tablets, respectively (P = 0.77). Data recorders felt a lack of connection with the interviewee during the first days using electronic devices, but preferred to collect data electronically in future surveys. Electronic data collection saved time by giving results immediately, obviating the need for double data entry and cross-correcting. The proportion of identified data entry errors in disease classification did not differ between the two data collection methods. Geographic coordinates collected using the tablets were more accurate than coordinates transcribed on a paper form. Costs of the equipment required for electronic data collection was approximately the same cost incurred for data entry of questionnaires, whereas repeated use of the electronic equipment may increase cost savings.Conclusions/SignificanceConducting a needs assessment and pilot testing allowed the design to specifically match the functionality required for surveys. Electronic data collection using an Android-based technology was suitable for a large-scale health survey, saved time, provided more accurate geo-coordinates, and was preferred by recorders over standard paper-based questionnaires.

A Research on the Enterprises Information Management Based on E-Commerce

The so-called e-commerce refers to the ESD (Electronic System of Distribution) which can be achieved in the areas of enterprises through the modern network and information technology, including the issuance and exchange basic information of the network, enterprises promotion, pre-market advertising, after-sales service and electronic distribution by electronic means, as well as, internal process and the electronic management information system applications of enterprises. In order to accommodate the complex network data of large scale companies, this thesis analyses PMI, strategy and role hierarchical model. On such a basis, the thesis proposes an applicable plan for access control of enterprises information system based on attribute certificate. These new entrants are often backed by advanced technology companies and competitive organizations with funds from Chinese and foreign conglomerates. Therefore, the applications of e-commerce in the field have brought about the information of business operations and internal management, which can provide consumers with a higher quality of services. In this paper, the enterprises information management and organization will be discussed in the e-commerce. Currently the technology of information and network develops rapidly. As a result, e-commerce, e-government and e-office prevail over our society and have become a part of our life. This situation enhances the efficiency of work and changes for the enterprises information management in China.

Cell Phone-Based System (Chaak) for Surveillance of Immatures of Dengue Virus Mosquito Vectors

Capture of surveillance data on mobile devices and rapid transfer of such data from these devices into an electronic database or data management and decision support systems promote timely data analyses and public health response during disease outbreaks. Mobile data capture is used increasingly for malaria surveillance and holds great promise for surveillance of other neglected tropical diseases. We focused on mosquito-borne dengue, with the primary aims of: 1) developing and field-testing a cell phone-based system (called Chaak) for capture of data relating to the surveillance of the mosquito immature stages, and 2) assessing, in the dengue endemic setting of Mérida, Mexico, the cost-effectiveness of this new technology versus paper-based data collection. Chaak includes a desktop component, where a manager selects premises to be surveyed for mosquito immatures, and a cell phone component, where the surveyor receives the assigned tasks and captures the data. Data collected on the cell phone can be transferred to a central database through different modes of transmission, including near-real time where data are transferred immediately (e.g., over the Internet) or by first storing data on the cell phone for future transmission. Spatial data are handled in a novel, semantically driven, geographic information system. Compared with a pen-and-paper-based method, use of Chaak improved the accuracy and increased the speed of data transcription into an electronic database. The cost-effectiveness of using the Chaak system will depend largely on the up-front cost of purchasing cell phones and the recurring cost of data transfer over a cellular network.

Use of Smartphone Technology for Small-Scale Silviculture: A Test of Low-Cost Technology in Eastern Ontario

This study examined the potential use of low-cost consumer-grade smartphone technology to perform and improve field data collection in support of small-scale forest management. This proof-of-concept exercise for day-to-day forester operations focused on the effectiveness of the smartphone platform (form factor and functionality) rather than any particular smartphone software. An electronic data acquisition system for a smartphone was developed that combined a simple custom timber cruise application and mobile commercial mapping software to record and process forest stand and geospatial information, and transfer these to a small-scale operator’s existing desktop geographic information system. Workflow efficiency and system performance of the smartphone system was then measured and compared with paper-based methods presently being used in the managed forest. The smartphone greatly increased workflow efficiency by reducing data transfer and processing times, and eliminated the need to carry separate global positioning system (GPS) device, map, paper forms and digital camera. The GPS accuracy of the smartphone was more than adequate to meet operational requirements, and provided a capacity to map forest features on an ad hoc basis that is not easily done through the paper-based process. However, initial data entry using the smartphone takes longer than using paper-based notes, there is a greater chance of data entry error through inadvertent keypad touches on the small screen, and there is the potential for a device malfunction. Overall, it is concluded that smartphones offer an opportunity for small-scale operators to create electronic field data management systems that are affordable, operationally robust, compatible with existing management systems, capable of increasing data management efficiency and, in particular, expanding the types of data that can be collected during silvicultural operations.

Controlled rapid sequence induction and intubation – an analysis of 1001 children

Classic rapid sequence induction puts pediatric patients at risk of cardiorespiratory deterioration and traumatic intubation due to their reduced apnea tolerance and related shortened intubation time. A 'controlled' rapid sequence induction and intubation technique (cRSII) with gentle facemask ventilation prior to intubation may be a safer and more appropriate approach in pediatric patients. The aim of this study was to analyze the benefits and complications of cRSII in a large cohort. Retrospective cohort analysis of all patients undergoing cRSII according to a standardized institutional protocol between 2007 and 2011 in a tertiary pediatric hospital. By means of an electronic patient data management system, vital sign data were reviewed for cardiorespiratory parameters, intubation conditions, general adverse respiratory events, and general anesthesia parameters. A total of 1001 patients with cRSII were analyzed. Moderate hypoxemia (SpO2 80-89%) during cRSII occurred in 0.5% (n=5) and severe hypoxemia (SpO2 <80%) in 0.3% of patients (n=3). None of these patients developed bradycardia or hypotension. Overall, one single gastric regurgitation was observed (0.1%), but no pulmonary aspiration could be detected. Intubation was documented as 'difficult' in two patients with expected (0.2%) and in three patients with unexpected difficult intubation (0.3%). The further course of anesthesia as well as respiratory conditions after extubation did not reveal evidence of 'silent aspiration' during cRSII. Controlled RSII with gentle facemask ventilation prior to intubation supports stable cardiorespiratory conditions for securing the airway in children with an expected or suspected full stomach. Pulmonary aspiration does not seem to be significantly increased.

Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia

Hypoxemia caused by difficulties in airway management presents a major cause for perioperative morbidity and mortality. The ability to predict difficult laryngoscopy more accurately would enable anesthesiologists to take specific precautions to reduce airway risks and prevent patient-threatening events. Over a 6-year period of time, all anesthesia records with a documented direct laryngoscopic view were retrieved from the electronic data management system and statistically processed. The Cormack-Lehane four-point scale of grading laryngoscopy was used to assess visibility of the vocal cords. Of 102,306 cases, the overall rate of difficult laryngoscopy was 4.9 %. Male gender (6.5 %), Mallampati score III and IV (17.3 %), obesity with a BMI ≥35 kg/m(2) (6.1 %), as well as physical status ASA III or IV (6.2 %), were identified as risk factors for difficult laryngoscopy. Patients undergoing surgery in the departments of oromaxillofacial (8.9 %), ear nose throat surgery (ENT) (7.4 %), and cardiac surgery (7.0 %) showed the highest rates of difficult laryngoscopy. The results indicate that the risk for difficult airway situations might substantially differ between surgical patient groups. In hospitals with departmental structures and spatially separated operating rooms, the deduction might be increased awareness and particular structural preparation for difficult airway situations in the respective subspecialties.

All Systems Go: How Systems Engineering Can Improve Healthcare Technology

All Systems Go: How Systems Engineering Can Improve Healthcare Technology

Family satisfaction in the intensive care unit: a quantitative and qualitative analysis

To assess family satisfaction in the intensive care unit (ICU) and areas for improvement using quantitative and qualitative analyses. Prospective cohort study performed in four (mixed surgical, neurological, and cardiological) intensive care units of a university hospital in Germany, using a translated and validated version of the Family Satisfaction in the ICU (FS-ICU) questionnaire, with questions answerable on a rating scale and three open-ended questions about strengths and weaknesses. Quantitative analysis was performed to identify items with low performance and high importance. For qualitative analysis, comments were coded and analyzed to identify important themes. Patient-related data were obtained from an electronic patient data management system. Participants were 215 family members visiting adult intensive care patients with length of stay over 48 h. Response rate was 28 %. Respondents were highly satisfied; summary scores were 78.3 ± 14.3 [mean ± standard deviation (SD)] on a scale of 0 (poor) to 100 (excellent). Regression analysis failed to identify association with patient- or family-related factors. The following themes for possible improvement emerged from both quantitative and qualitative analyses: patient agitation-consistency, clarity and completeness of information-emotional support-respect and compassion towards families. Families were also dissatisfied with the waiting room, ICU atmosphere, and amenities for visiting relatives. Families report high satisfaction with intensive care. Nevertheless, there is room for improvement, in particular regarding how ICU staff communicate with families and provide emotional support.

Contemporary Trends in the Diagnosis and Management of Pulmonary Arterial Hypertension: An Initiative to Close the Care Gap

The Pulmonary Arterial Hypertension-Quality Enhancement Research Initiative (PAHQuERI) was created to help clinicians to implement a guidelines-based approach to the diagnosis and management of pulmonary arterial hypertension (PAH). Patients with PAH represent a heterogeneous population, and physician evaluation and treatment paradigms may vary considerably.Using an electronic data management system, participating physicians recorded data on diagnostic workup, disease management, and outcomes of patients with PAH. Queries were generated automatically following each follow-up visit if the tests recommended by the American College of Chest Physicians (ACCP) were not performed at least once.Of 791 patients enrolled in PAH-QuERI, 77% were women; 64% received a diagnosis . 3 months prior to enrollment; 9% were in New York Heart Association functional class I, 39% in II, 48% in III, and 5% in IV; and the median age was 55 years (interquartile range, 45-66 years). At enrollment, all ACCP-recommended tests had been performed in only 6% of patients. The automated program generated 1,530 reminders for 642 patients (81%) with validated enrollment data. The proportion of recommended tests performed was 91% for CBC count, 91% for liver function test, 50% for connective tissue disease screen, 29% for HIV screen, 88% for chest radiograph, 82% for ECG, 97% for two-dimensional echocardiogram, 83% for pulmonary function tests, 41% for oximetry, 57% for ventilation/perfusion scan, 79% for 6-min walk distance, and 90% for right-sided heart catheterization. Regarding management, 78% of patients were on disease specific therapy, and the use of these therapies tended to increase with the functional disability of the patient. One hundred seventy patients were taking calcium channel blockers, 91 specifically for PAH. Only six of 91 patients (7%) who received calcium channel blockers specifically for PAH had met the current guideline for acute vasoreactivity.When comparing reported clinical practice with ACCP guidelines-recommended strategies, a diagnostic care gap is apparent such that certain essential and recommended diagnostic tests may be underused despite the availability of detailed guidelines and reminders.

North West Hutton Decommissioning - Major Challenge Turns to Major Success

This article, written by Editorial Manager Adam Wilson, contains highlights of paper SPE 156827, ’North West Hutton Decommissioning - A Major Challenge, a Major Success,’ by Caroline White and Ged Adams, BP Exploration Operating Company, prepared for the 2012 SPE/APPEA International Conference on Health, Safety, and Environment in Oil and Gas Exploration and Production, Perth, Australia, 11-13 September. The paper has not been peer reviewed. Excellent health, safety, and environment (HSE) performance was maintained throughout the decommissioning and removal of the first major offshore UK installation of the North Sea, the North West Hutton (NWH) installation. The NWH installation was composed of an 18 000-t steel jacket support structure and 20 000 t of topside modules. The total offshore removal program was executed with approximately 900,000 man-hours, with no days-away-from-work cases or high-potential-safety incidents. Introduction The NWH installation (Fig. 1) was a large steel jacket installation 130 km north-east of the Shetland Islands in a water depth of 144 m. It was composed of a 18 000-t steel jacket support structure and 22 000 t of topside modules. At its peak, NWH produced a maximum of 86,500 BOPD. Following cessation of production in January 2003, the NWH installation went into a phase of engineering down, which involved vessel cleaning and module separation in preparation for removal. The installation then went into a normally unmanned installation (NUI) mode for 4 years, during which time a decommissioning program was developed. The decommissioning program was based on a comparative assessment of all decommissioning options, including some 50 external studies, a wide stake-holder consultation process, and review by an independent review group. Knowledge Management In order to capture existing information to support safe engineering design and removal, the following key activities were initiated: A review was made of all incidents from previous North Sea decommissioning projects. The project sought to retain key NWH operations personnel to support the installation in its NUI status and through the engineering design and offshore execution. Access to installation data was challenging. The installation was installed in 1983, when there were no electronic data management systems. Installation as-built data were available, however, because engineering and ownership changes over its lifetime required comprehensive and accurate data. The data were critical for understanding the structural integrity and for development of the module weight reports. Where gaps in knowledge were identified, a detailed offshore survey program was initiated.

High-Dose Norepinephrine Treatment: Determinants of Mortality and Futility in Critically Ill Patients

Critically ill patients with circulatory shock sometimes need rescue treatment with high doses of norepinephrine, a treatment that may be associated with a poor outcome because of excessive vasoconstriction. To evaluate the outcome of treatment and its determinants in patients with circulatory shock who received high doses of norepinephrine in the intensive care unit and to identify indicators of futility for the treatment. A retrospective study was done on 113 consecutive patients with circulatory shock who received 0.9 μg/kg per minute or greater of norepinephrine during at least 1 hour at any time in the intensive care unit. Data were extracted from the electronic patient data management system according to a predefined checklist. A total of 39 patients survived for 28 days after admission to the intensive care unit. The variables independently associated with 28-day mortality in multivariable models included low urine flow, high lactate levels, high organ failure score, high prothrombin time, and need for epinephrine cotreatment. The reason, dose, and duration of norepinephrine administration did not have prognostic significance. Scores greater than 40 on the Acute Physiology and Chronic Health Evaluation II, bicarbonate levels less than 9.0 mEq/L, or receipt of an epinephrine dose of 0.25 μg/kg per minute or greater were associated with 100% mortality. Although the cause of shock and treatment with norepinephrine were not predictive of death when high doses of the drug were deemed necessary, rescue treatment with high-dose norepinephrine is futile in patients with severe disease and metabolic acidemia.

Electronic Data Collection and Management System for Global Adult Tobacco Survey

Introduction:Portable handheld computers and electronic data management systems have been used for national surveys in many high-income countries, however their use in developing countries has been challenging due to varying geographical, economic, climatic, political and cultural environments. In order to monitor and measure global adult tobacco use, the World Health Organization and the US Centers for Disease Control and Prevention initiated the Global Adult Tobacco Survey, a nationally representative household survey of adults, 15 years of age or older, using a standard core questionnaire, sample design, and data collection and management procedures. The Survey has been conducted in 14 low- and middle-income countries, using an electronic data collection and management system. This paper describes implementation of the electronic data collection system and associated findings.Methods:The Survey was based on a comprehensive data management protocol, to enable standardized, globally comparable high quality data collection and management. It included adaptation to specific country needs, selection of appropriate handheld hardware devices, use of open source software, and building country capacity and provide technical support.Results:In its first phase, the Global Adult Tobacco Survey was successfully conducted between 2008 and 2010, using an electronic data collection and management system for interviews in 302,800 households in 14 countries. More than 2,644 handheld computers were fielded and over 2,634 fieldworkers, supervisors and monitors were trained to use them. Questionnaires were developed and programmed in 38 languages and scripts. The global hardware failure rate was < 1% and data loss was almost 0%.Conclusion:Electronic data collection and management systems can be used effectively for conducting nationally representative surveys, particularly in low- and middle-income countries, irrespective of geographical, climatic, political and cultural environments, and capacity-building at the country level is an important vehicle for Health System Strengthening.

New technologies in pediatric anesthesia

This article reviews potential pediatric applications of 3 new technologies. (1) Pulse oximetry-based hemoglobin determination: Hemoglobin determination using spectrophotometric methods recently has been introduced in adults with varied success. This non-invasive and continuous technology may avoid venipuncture and unnecessary transfusion in children undergoing surgery with major blood loss, premature infants undergoing unexpected and complicated emergency surgery, and children with chronic illness. (2) Continuous cardiac output monitoring: In adults, advanced hemodynamic monitoring such as continuous cardiac output monitoring has been associated with better surgical outcomes. Although it remains unknown whether similar results are applicable to children, current technology enables the monitoring of cardiac output non-invasively and continuously in pediatric patients. It may be important to integrate the data about cardiac output with other information to facilitate therapeutic interventions. (3) Anesthesia information management systems: Although perioperative electronic anesthesia information management systems are gaining popularity in operating rooms, their potential functions may not be fully appreciated. With advances in information technology, anesthesia information management systems may facilitate bedside clinical decisions, administrative needs, and research in the perioperative setting.

Improving Documentation of a Beta-Blocker Quality Measure Through an Anesthesia Information Management System and Real-Time Notification of Documentation Errors

Continuation of perioperative beta-blockers for surgical patients who are receiving beta-blockers prior to arrival for surgery is an important quality measure (SCIP-Card-2). For this measure to be considered successful, name, date, and time of the perioperative beta-blocker must be documented. Alternately, if the beta-blocker is not given, the medical reason for not administering must be documented. Before the study was conducted, the institution lacked a highly reliable process to document the date and time of self-administration of beta-blockers prior to hospital admission. Because of this, compliance with the beta-blocker quality measure was poor (-65%). To improve this measure, the anesthesia care team was made responsible for documenting perioperative beta-blockade. Clear documentation guidelines were outlined, and an electronic Anesthesia Information Management System (AIMS) was configured to facilitate complete documentation of the beta-blocker quality measure. In addition, real-time electronic alerts were generated using Smart Anesthesia Messenger (SAM), an internally developed decision-support system, to notify users concerning incomplete beta-blocker documentation. Weekly compliance for perioperative beta-blocker documentation before the study was 65.8 +/- 16.6%, which served as the baseline value. When the anesthesia care team started documenting perioperative beta-blocker in AIMS, compliance was 60.5 +/- 8.6% (p = .677 as compared with baseline). Electronic alerts with SAM improved documentation compliance to 94.6 +/- 3.5% (p < .001 as compared with baseline). To achieve high compliance for the beta-blocker measure, it is essential to (1) clearly assign a medical team to perform beta-blocker documentation and (2) enhance features in the electronic medical systems to alert the user concerning incomplete documentation.

Continuing Medical Education for Sonographers

The requirement for continuing medical education in health care originated in the early 1900s when several investigators in the United States determined that the training physicians were receiving was woefully inadequate. The Flexner Report, which was based on an extensive analysis of how the early medical schools were educating physicians, proposed several radical changes in physician instruction, including a recommendation for postgraduate training. Now known as continuing medical education (CME), this obligation is practically universal in the medical and allied health fields including sonography. Although there are many options for the diagnostic medical sonographer to earn CME credits, the Society of Diagnostic Medical Sonography (SDMS) instituted a unique program for sonographers to earn credits by providing clinical instruction to sonography students. By using electronic data collection and management systems, it is now easy for sonography program directors to submit their clinical instructors for CME credits through the SDMS.

Pressure and oxygen debt on bypass – potential quality markers of perfusion?

No markers of quality of perfusion pressure and oxygen delivery during cardiopulmonary bypass (CPB), to complement rewarming rate, maximum temperature on rewarming, lowest haematocrit, and blood glucose, exist. Using the electronic acquisition of blood pressure on bypass (JOCAP system), the percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, median, mode, standard deviation, variance, and average, maximum and cumulative oxygen debt were calculated. Numerous different readouts of achievement of maintenance of constant pressure on bypass and oxygen debt are now easily achievable with perfusion electronic data management systems. Mean, median, and mode offer poor discrimination of pressure control during CPB. Percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, and standard deviation all have discriminatory power, but need clinical correlation for their significance. A composite score involving non-pressure readouts (e.g. oxygen delivery, arterial and venous saturations, and flow rates) may need to be integrated into any perfusion quality marker. Assessment of adequacy of constant perfusion pressure and oxygen delivery may allow the scientific evaluation of pressure and oxygen delivery on bypass for patients to be compared accurately. Currently, in studies involving CPB, blood pressure targets are stated with no quantitative assessment of adequacy of achievement of these targets. Electronic data monitoring during cardiopulmonary bypass, when correlated with clinical outcome, may help to provide a marker of quality of perfusion pressure during CPB and may, indeed, allow patient-specific perfusion pressure strategies to be developed.

Evaluating acceptance of an electronic data management system at a tertiary care institution

This research reports on satisfaction with the introduction of an electronic document management system in a tertiary hospital environment. A buffet of training and familiarization options were offered: one-on-one training, open house, drop-in, e-learning, classroom training, and self-study. It was found that professions differ in their pattern of satisfaction with training and they also differ in their satisfaction with both the usefulness and the ease of use of the system. Satisfaction among administrators was highest and that among nurses lowest. There was an association between attendance at the open house event and satisfaction with the system.

Neonatal Bloodstream Infection Surveillance in the UK using Nationally Agreed Definitions

Background and aims: Various definitions of bloodstream infection (BSI) and catheter-associated BSI (CABSI) are used internationally. Until recently there have been no nationally accepted definitions in the UK. We aimed to collect data on BSI and CABSI using these new standardised definitions.Methods: Information about all late-onset bacteraemias in preterm infants < 30 weeks' gestation and/or < 1500g was collected prospectively over a 12 month period from a microbiology database based in a level 3 UK NICU. Information about clinical presentation at the time when the infection screen was performed was entered prospectively into an electronic patient data management system. The diagnosis of BSI was made either when the blood culture yielded, 1)a pure growth of a recognised pathogen;2)a skin commensal or mixed growth plus 3 or more clinical signs.CABSI was diagnosed when a central vascular catheter was in place within 48 hours of the blood culture being taken. figure Graph 1 The median (range) rate of BSI and CABSI was 5.8 (1.7-7.8) and 4.2 (0-7.4) per 1000 patient days, respectively. Approximately three-quarters of all late-onset BSI were CABSIs.Conclusions: This study demonstrates the feasibility of a system designed to collect BSI data for surveillance purposes using nationally agreed definitions. These definitions will be used to provide information about late-onset BSI for national surveillance in the UK.

239-P Implementation of an electronic data management system in the transplant immunology and immunogenetics laboratory at the University of Chicago

239-P Implementation of an electronic data management system in the transplant immunology and immunogenetics laboratory at the University of Chicago

Increasing early protein intake is associated with a reduction in insulin-treated hyperglycaemia in very preterm infants

IntroductionA standardised, concentrated neonatal parenteral nutrition (scNPN1) regimen can increase very preterm protein intake.1 Our aim was to compare macronutrient intake and metabolic tolerance using a modified regimen (scNPN2) designed...