Electronic Documentation System Research Articles

Surveillance of Antimicrobial Use in Long-Term Care Facilities: An Antimicrobial Mapping Survey

ObjectivesTo explore antimicrobial management processes in Australian residential aged care facilities (RACFs), including antimicrobial prescribing, supply, administration, and documentation to inform surveillance activities. DesignVoluntary, online cross-sectional survey. Setting and ParticipantsThe survey was disseminated to all South Australian RACFs (n = 237) seeking participation from an infection prevention and control lead (preferred respondent), a nurse or senior RACF staff member, or an aged care pharmacist. MethodsThe survey was open during May-June 2023. Questions aimed to understand clinical and medication management systems, sources of antimicrobial prescription and supply, management by external health care providers and documentation of antimicrobial administration. A process map of antimicrobial management in RACFs was developed. ResultsOf the 54 RACFs included in the analysis (29.5% response rate), most used an electronic clinical documentation system (74.1%) or a hybrid electronic paper-based system (22.2%). Medication charts were either electronic (81.0%), hybrid (5.6%), or paper-based (13.0%). Antimicrobials were prescribed by the resident's usual general practitioner, but also by locums, hospital or specialist physicians, nurse practitioners, virtual care physicians, and dentists. Oral, topical, and inhaled antimicrobial formulations were usually supplied by community pharmacies, and intravenous formulations were predominately supplied by hospitals for administration by outreach nurses. Almost all RACFs (96.2%) had imprest stock of antimicrobials that included both oral and intravenous formulations. Antimicrobials were predominately administered by an enrolled nurse or a registered nurse. Conclusions and ImplicationsAntimicrobial management in RACFs is complex, particularly during care transitions. Multiple prescribers and sources of antimicrobials, use of different systems for clinical documentation, particularly by external health care providers, and clinical governance relating to imprest supplies were identified as key areas where medication management could be improved. Addressing these gaps will facilitate comprehensive, real-time antimicrobial surveillance in Australian RACFs.

The vital role of clinical pharmacy services within the hospital at home interdisciplinary team.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Hospital at home (HaH) program development, spurred by hospital congestion during the COVID-19 pandemic, is moving from a novel idea to a standard of inpatient practice. Understanding pharmacy's clinical role in the HaH patient care team is exceedingly important as programs across the country continue to develop, implement, and expand. The purpose of this study is to describe how clinical pharmacy services are currently provided for home hospital patients and to explain the vital role of pharmacists within the HaH care team. A descriptive study was designed to evaluate pharmacy services provided for home hospital patients from January 1, 2023, to February 28, 2023. Prior to the study period, a focused group of pharmacists routinely active in HaH patient care met to define a standard process for documenting pharmacy services using an electronic documentation system (i-Vent) within the EHR. During the study period, a total of 221 patients were admitted to home hospital at either site representing 3,258 inpatient medication orders with 2,997 medication administrations. Pharmacists signed 903 progress notes and documented 561 interventions across all types. The top 3 pharmacy intervention types were Drug Administration Change (37%), Medication Reconciliation (29%), and Antimicrobial Stewardship (15%). Each of the top 3 types were further evaluated by subtype. Documented pharmacy services encompassed a variety of intervention types. The overwhelming majority of patients admitted to the program received pharmacy consultative services, demonstrating how pivotal pharmacists are to the operational success of these programs and clinical care of HaH patients. More research is needed to expose pharmacy potential and facilitate growth for pharmacists practicing in HaH programs.

Statistical Study of the Impact of Digitalization of Organizations on Lending Activity: Regional Level

The purpose of research. The increasing rate of Russian economy digitalization has ambiguous proportions by industries and regions. Russian regions are characterized by uneven levels of Internet adoption, as well as organizations applying computer networks, servers and electronic documentation systems. This creates territorial differentiation of opportunities for organizations to use digital services and online platforms created by commercial banks to attract and service loans.Overview and analysis of literary sources have led to the conclusion that quantitative assessment of interplay between digitalization of organizations and their credit activity has not been sufficiently developed at the regional level. The purpose of this study is to develop statistical indexes to assess the impact of digitalization of organizations on their credit activity by Russian regions, and to analyze interdependence of suggested indexes to find out the patterns of such an impact.Methods. The source data array is a set of values of statistical indexes, proposed for the purposes of the study, published by Rosstat. This array is processed by imputation of missing values knn – k nearest neighbors to eliminate missing part of the original data. The tightness of statistical relationship between the analyzed variables was assessed by calculating the paired correlation coefficients. The average and median values of the analyzed effective variables were calculated across several years. The regional distribution by clusters per effective variable values was made using the hierarchical cluster analysis. The impact of factor variables on the effective variables was assessed using the panel regression modelling.Results. Based on the system of regional statistics indexes formed by the author, the territorial peculiarities of the dependence of credit capacity on the factors of digitalization of organizations in groups of Russian regions were analyzed, and the parameters of the “response” of credit capacity indexes to changes in individual technological components of digitalization of organizations in regional clusters were obtained.Conclusion. It was concluded that the results of the study could be used to develop business lending programs for commercial banks and determine the priorities of regional digital development programs by government bodies.

Documentation for Orthopaedic Surgery: An Audit to Ensure Compliance with the Most Recent Guidelines

Background: Consistent and thorough documentation in orthopaedic surgery is critical for ensuring quality patient care and protecting the legal interests of surgeons. Adherence to the Royal College of Surgeons (RCS) guidelines is fundamental to achieving this. However, studies have identified a persistent deficiency in compliance with these guidelines across various surgical specialities. Objective: The audit aimed to evaluate the existing compliance of orthopaedic surgical documentation with RCS guidelines at Dr. Ziauddin Hospital and to implement a tool to improve documentation practices. Methods: A closed-loop, two-cycle audit was conducted. The first cycle retrospectively analysed 200 surgical notes from January to July 2023, using a standardized operation sheet to assess compliance with RCS guidelines. Identified deficiencies were addressed by introducing an aide-memoir in all orthopaedic operating rooms. The second cycle prospectively analysed 100 surgical notes from August to October 2023 to evaluate the impact of the intervention. Results: The initial audit revealed a 0% compliance rate in documenting the date, time, and type of surgery (elective or emergency). Following interventions, the second cycle showed significant improvements, with compliance rates rising to 100% for date and time, and to 87% for identifying the surgery type. Additional documentation parameters such as the recording of the assistant's name and incision details also improved, though exact numerical increases were not specified. Conclusion: Introducing an aide-memoir significantly enhanced compliance with RCS surgical documentation guidelines. This simple, effective tool facilitated a remarkable improvement in the quality of operative notes, underscoring the need for regular audits and potential integration of electronic documentation systems.

Interprofessional collaboration in the home care setting: perspectives of people receiving home care, relatives, nurses, general practitioners, and therapists—results of a qualitative analysis

BackgroundAbout one million people in need of home care in Germany are assisted by 15,400 home care services. Home healthcare is mostly a complex endeavour because interprofessional collaboration is often challenging. This might negatively impact patient safety. The project interprof HOME aims to develop an interprofessional person-centred care concept for people receiving home care in a multistep approach. In one of the work packages we explored how people receiving home care, relatives, nurses, general practitioners, and therapists (physiotherapists, occupational therapists, and speech therapists) perceive collaboration in this setting.MethodsSemi-structured interviews were conducted with 20 people receiving home care and with 21 relatives. Additionally, we worked with nine monoprofessional focus groups involving nurses of home care services (n = 17), general practitioners (n = 14), and therapists (n = 21). The data were analysed by content analysis.ResultsThree main categories evolved: “perception of interprofessional collaboration”, “means of communication”, and “barriers and facilitators”. People receiving home care and relatives often perceive little to no interprofessional collaboration and take over a significant part of the organisational coordination and information exchange. Interprofessional collaboration in steady care situations does exist at times and mostly occurs in coordination tasks. Contact and information exchange are rare, however, interprofessional personal encounters are sporadic, and fixed agreements and permanent contact persons are not standard. These trends increase with the complexity of the healthcare situation. Joint collaborations are often perceived as highly beneficial. Means of communications such as telephone, fax, or e-mail are used differently and are often considered tedious and time-consuming. No interprofessional formal written or electronic documentation system exists. Personal acquaintance and mutual trust are perceived as being beneficial, while a lack of mutual availability, limited time, and inadequate compensation hinder interprofessional collaboration.ConclusionsInterprofessional collaboration in home care occurs irregularly, and coordination often remains with people receiving home care or relatives. While this individual care set-up may work sufficiently well in low complex care situations, it becomes vulnerable to disruptions with increasing complexity. Close interactions, joint collaboration, and fixed means of communication might improve healthcare at home. The findings were integrated into the development of the person-centred interprofessional care concept interprof HOME.Trial registrationThis study is registered on the International Clinical Trails registry platform ClinicalTrials.gov as NCT05149937 on 03/11/2021.

Elevated levels of β2-microglobulin in cerebrospinal fluid in adult patients with viral encephalitis/meningitis

BackgroundIncreased cerebrospinal fluid (CSF) β2-microglobulin (β2-MG) values are attributed to immune activation, lymphoid cell turnover and release of tissue destruction in the central nervous system (CNS). We investigated plasma and CSF β2-MG levels in adult patients with viral encephalitis/meningitis and their correlations with clinical parameters. MethodCSF samples from 26 patients with viral encephalitis/meningitis were collected. Moreover, 24 CSF samples from patients with non-inflammatory neurological disorders (NIND) as controls were collected. Plasma samples from 22 enrolled patients and 20 healthy individuals were collected. The β2-MG levels were measured by immunoturbidimetry on an automatic biochemical analyzer. Clinical data were extracted from an electronic patient documentation system. ResultCSF levels of β2-MG, adenosine deaminase (ADA), white blood cell (WBC), lactate dehydrogenase (LDH), protein and lactate were significantly increased in patients with viral encephalitis/meningitis respectively (p < 0.001, p < 0.001, p < 0.001, p = 0.001, p < 0.001, p = 0.013). In contrast, no statistically significant difference was found in plasma levels of β2-MG. Furthermore, CSF levels of β2-MG were weakly correlated with WBC (r = 0.426, p = 0.030), lymphocyte percentage (r = 0.599, p = 0.018), ADA (r = 0.545, p = 0.004) and LDH (r = 0.414, p = 0.036), but not with lactate (r = 0.381, p = 0.055), protein (r = 0.179, p = 0.381) and plasma levels of β2-MG (r = -0.156, p = 0.537) in viral encephalitis/meningitis patients. ConclusionCSF β2-MG may be a potential inflammatory marker for viral encephalitis/meningitis in adult patients diagnosed with viral encephalitis/meningitis.

Perbandingan Penggunaan Bahasa Inggris dalam Dokumentasi Elektronik dan Manual dalam Praktek Keperawatan

This research aims to evaluate the differences in the use of the English language in electronic and manual documentation in nursing practice. Documentation is a crucial element in patient care, and with technological advancements, many healthcare institutions are transitioning from manual records to electronic documentation systems. The focus of this study is to identify variations in clarity, accuracy, and efficiency of nurse communication using both documentation methods.The research methodology involves surveys and document analysis on a sample of nurses engaged in both types of documentation. Surveys will assess nurses' perceptions regarding the clarity of documented information, the accuracy of information, and the efficiency of usage. The analyzed documents will include patient records, care plans, and incident reports.The research outcomes are expected to provide insights into the strengths and weaknesses of each documentation method, aiding healthcare organizations in decision-making regarding the implementation or development of documentation systems. The practical implications of this research can enhance nurse communication effectiveness and the quality of patient care, especially in the continually evolving healthcare information technology era.&#x0D; &#x0D;

Nursing Diagnosis Accuracy in Nursing Education: Clinical Decision Support System Compared With Paper-Based Documentation-A Before and After Study.

Computer-based technologies have been widely used in nursing education, although the best educational modality to improve documentation and nursing diagnostic accuracy using electronic health records is still under investigation. It is important to address this gap and seek an effective way to address increased accuracy around nursing diagnoses identification. Nursing diagnoses are judgments that represent a synthesis of data collected by the nurse and used to guide interventions and to achieve desirable patients' outcomes. This current investigation is aimed at comparing the nursing diagnostic accuracy, satisfaction, and usability of a computerized system versus a traditional paper-based approach. A total of 66 nursing students solved three validated clinical scenarios using the NANDA-International terminologies traditional paper-based approach and then the computer-based Clinical Decision Support System. Study findings indicated a significantly higher nursing diagnostic accuracy ( P < .001) in solving cancer and stroke clinical scenarios, whereas there was no significant difference in acute myocardial infarction scenario. The use of the electronic system increased the number of correct diagnostic indicators ( P < .05); however, the level of students' satisfaction was similar. The usability scores highlighted the need to make the electronic documentation systems more user-friendly.

Curriculum for diagnostic endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in diagnostic endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in diagnostic EUS. This curriculum is set out in terms of the prerequisites prior to training; the recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should have achieved competence in upper gastrointestinal endoscopy before training in diagnostic EUS. 2: The development of diagnostic EUS skills by methods that do not involve patients is advisable, but not mandatory, prior to commencing formal training in diagnostic EUS. 3: A trainee's principal trainer should be performing adequate volumes of diagnostic EUSs to demonstrate maintenance of their own competence. 4: Training centers for diagnostic EUS should offer expertise, as well as a high volume of procedures per year, to ensure an optimal level of quality for training. Under these conditions, training centers should be able to provide trainees with a sufficient wealth of experience in diagnostic EUS for at least 12 months. 5: Trainees should engage in formal training and supplement this with a range of learning resources for diagnostic EUS, including EUS-guided fine-needle aspiration and biopsy (FNA/FNB). 6: EUS training should follow a structured syllabus to guide the learning program. 7: A minimum procedure volume should be offered to trainees during diagnostic EUS training to ensure that they have the opportunity to achieve competence in the technique. To evaluate competence in diagnostic EUS, trainees should have completed a minimum of 250 supervised EUS procedures: 80 for luminal tumors, 20 for subepithelial lesions, and 150 for pancreaticobiliary lesions. At least 75 EUS-FNA/FNBs should be performed, including mostly pancreaticobiliary lesions. 8: Competence assessment in diagnostic EUS should take into consideration not only technical skills, but also cognitive and integrative skills. A reliable valid assessment tool should be used regularly during diagnostic EUS training to track the acquisition of competence and to support trainee feedback. 9: A period of supervised practice should follow the start of independent activity. Supervision can be delivered either on site if other colleagues are already practicing EUS or by maintaining contacts with the training center and/or other EUS experts. 10: Key performance measures including the annual number of procedures, frequency of obtaining a diagnostic sample during EUS-FNA/FNB, and adverse events should be recorded within an electronic documentation system and evaluated.

ADVANCED CARE PLANNING: LEVERAGING PARTNERSHIPS TO IMPROVE STATE-WIDE DISSEMINATION

Abstract Rowan-Virtua School of Osteopathic Medicine, The New Jersey Institute for Successful Aging (NJISA), in collaboration with the New Jersey Division of Aging Services (DoAS) and Respecting Choices, implemented a state-wide project training workforce professionals in Advanced Care Planning (ACP) conversations with older adults. The concept: proactively leverage the long-term care management relationships in community-based, high-touch programs. NJISA identified Respecting Choices, an evidenced-based program approved by the Administration for Community Living. Respecting Choices offers standardized certification for ACP facilitators and instructors, paving a pathway for workforce sustainability. To achieve state-wide penetration, NJISA partnered with NJ DoAS to target staff and professionals serving the state aging network. NJ DoAS provided access to county-level case managers serving the Jersey Assistance for Community Caregiving (JACC) program, Program of All-Inclusive Care for the Elderly (PACE) nurses and social workers, and NJ DoAS staff. Also included in training efforts were staff from select senior affordable housing sites. With funding support through the New Jersey Health Foundation, NJISA and Respecting Choices offered virtual, live training course for certification of First Steps ACP facilitators and instructors and Design and Implementation for state aging networks, and ACP Instructors. NJ DoAS modified the electronic documentation system utilized by JACC staff to capture on-going ACP conversations and outcomes. Despite barriers and mid-course corrections, training totals include (30) certified ACP Facilitators, (3) leaders for Design and Implementation, and (5) certified ACP Instructors. Response to curriculum was positive; participants indicating greater confidence navigating ACP conversations. Future plans to continue dissemination have been discussed.

Electronic nursing documentation interventions to promote or improve patient safety and/or quality care in an acute setting

Research has demonstrated that the implementation of electronic nursing documentation interventions can enhance the precision and comprehensiveness of records, thereby providing a significant benefit. Electronic documentation systems help to reduce errors resulting from factors such as indecipherable handwriting, incomplete or absent documentation, and transcription errors. ‎In May 2022, a comprehensive research was conducted in CINAHL, MEDLINE, Cochrane, and Web of Science to identify relevant literature for their study. The study focuses on the use of electronic health systems in nursing, specifically in the documentation of care plans, records, reports, and charts. Individuals utilizing any given database employ the tools at their disposal to conduct searches for document abstracts and titles. This rapid review comprised one cross-sectional, one randomised control trial, two quasi-experimental, one qualitative, and one cohort study. The US, Taiwan, and Jordan each held two tests. The six trials included a medical-surgical and telemetry hospital with 446 beds, an acute care hospital with 1037 beds, a medical-surgical unit, and an urgent care clinic. The results revealed that electronic nursing documentation has improved quality of nursing.

Digital support for quality assurance in 24-hour caregiving at home: a randomized controlled trial investigating the effects on quality of life and professional skills of paid 24h-caregivers

BackgroundRegarding the care of older adults, 24-h home-care represents a cornerstone, with > 32,000 service users in Austria. Our research project 24hQuAALity aimed to develop and evaluate a distributed client-server software solution for the support and quality assurance of this home-care service. In this trial, we investigated the effects of this intervention on the quality of life and professional skills of paid 24h-caregivers in Austria.MethodsThe application used in our study comprises an e-learning platform, an integrated emergency management, networking opportunities, and an electronic care documentation system in the native language of the 24h-caregivers. The trial was conducted using a parallel three-arm study design to evaluate (i) a control group, which performed usual home care, (ii) a partial intervention group, which used the e-learning and networking platforms, and (iii) a full intervention group, which used the entire intervention (e-learning platform, networking platform, and digital care documentation). Primary self-reported outcomes were the standardized ASCOT for Carers score and a score based on responses to project-specific efficacy questions.ResultsAmong the 110 24h-caregivers who were randomly classified into the three groups, ASCOT for Carers score data were available for 57 and 35 24h-caregivers at 5- and 9-month follow-up examinations, respectively. At 9 months, 24h-caregivers receiving any intervention rated the ASCOT for Carers score (not significantly) better than the controls (p = 0.05, ηp2 = 0.15), mainly in the domain “feeling encouraged and supported”. At 9 months, 24h-caregivers receiving any intervention rated the project-specific Efficacy score significantly better than the controls (p = 0.02, ηp2 = 0.20), mainly due to better ratings in the subitems “satisfaction with current docu”, “docu supports doing my job”, “ I’m well prepared for emergencies”, “my professional skills are adequate for doing my job”, and “communication with contacts”.ConclusionsProviding e-learning and e-documentation devices to 24h-caregivers improved their care-related quality of life, mainly because they felt more encouraged and supported. Moreover, these interventions improved their self-perceived professional skills. As an extrapolation of findings, we found that these interventions could empower 24h-caregivers and improve the quality of home-care services provided by them.Trial registrationDigital Support for Quality Assurance in 24-h Caregiving at Home was registered and posted on the ClinicalTrials.gov public website (ClinicalTrials.gov Identifier: NCT04581538).

Diagnostic concordance among nursing clinical decision support system users: a pilot study.

To analyze the nursing diagnostic concordance among users of a clinical decision support system (CDSS), The Electronic Documentation System of the Nursing Process of the University of São Paulo (PROCEnf-USP®), structured according to the Nanda International, Nursing Intervention Classification and Nursing Outcome Classification (NNN) Taxonomy. This pilot, exploratory-descriptive study was conducted from September 2017 to January 2018. Participants were nurses, nurse residents, and nursing undergraduates. Two previously validated written clinical case studies provided participants with comprehensive initial assessment clinical data to be registered in PROCEnf-USP®. After having registered the clinical data in PROCEnf-USP®, participants could either select diagnostic hypotheses offered by the system or add diagnoses not suggested by the system. A list of nursing diagnoses documented by the participants was extracted from the system. The concordance was analyzed by Light's Kappa (K). The research study included 37 participants, which were 14 nurses, 10 nurse residents, and 13 nursing undergraduates. Of the 43 documented nursing diagnoses, there was poor concordance (K = 0.224) for the diagnosis "Ineffective airway clearance" (00031), moderate (K = 0.591) for "Chronic pain" (00133), and elevated (K = 0.655) for "Risk for unstable blood glucose level" (00179). The other nursing diagnoses had poor or no concordance. Clinical reasoning skills are essential for the meaningful use of the CDSS. There was concordance for only 3 nursing diagnoses related to biological needs. The low level of concordance might be related to the clinical judgment skills of the participants, the written cases, and the sample size.

Documenting Pharmacist Intervention: A Technology-Driven Solution to Overcome Challenges

Clinical pharmacist conducts multiple activities governed by the best evidence for disease management and safe medication practices. The ASHP highlighted the importance of documenting and recording clinical pharmacy interventions to prevent adverse drug events and reduce hospital length of stay. Our institution utilizes an in-house electronic documentation system (e-DS) to document clinical interventions. We aim to study the impact of enhancing the e-DS. This study is a retrospective single-center descriptive review post-implementation of in-house e-DS enhancements. Data were collected between September 2017 and December 2019 for documented interventions by clinical pharmacists for admitted patients. Fields for analysis include clinical interventions, expected outcomes of interventions, cycle time for documentation, and drug cost. Outcomes measures include several documented interventions, preventing medication errors/adverse drug events, time-saving and cost avoidance. Descriptive analysis will be performed for categorical variables. The study showed an increased number of documented interventions for preventing medication errors/adverse drug events, time-saving, and cost avoidance, with an average time-saving of 20 minutes per 10 interventions and estimated cost avoidance of 20 000 SAR per month. Study limitations include a lack of interface with EHR and non-feasibility to estimate indirect cost. Investment in documentation system optimization to reduce medication errors/adverse drug events, time-saving and cost avoidance.

Development of Electronic Documentation System for Final Project with Gamification to Improve the Effectiveness of Final Project Creation

The final project is very important for every student in their educational program. This is a final project that requires in-depth research and thought, helping students put into practice the knowledge they learn and apply it in the form of real work. In several educational programs, the results of the final assignment can also be used as a determining factor for a student's final grade. The process of preparing the final assignment involves several stages, including determining the topic, selecting a supervisor, conducting guidance, conducting a plagiarism test, final assignment exam, and uploading the results of the assignment. end to the existing system. However, in such a long process, if it is not supported by a good system, the process of compiling the Final Project can be a troublesome thing. Therefore, there is a need for a gamification process in the existing system to improve the quality of the system and re-encourage students in doing their final assignments. Gamification uses game design and has several important components such as feature points, badges, levels, leaderboards, challenges and prizes. The gamification process can increase student involvement and the achievements given.

Implementasi of technology acceptance model (TAM) in electronic documentation of nursing care: phenomenology explorative

Incomplete medical record documentation affects the quality of service in hospitals. The migration of SIMRS is intended to allow hospital services to be integrated. The use of electronic medical records as a nursing care documentation tool needs to be evaluated in terms of the acceptance of technology through three constructs: the effect of benefits, the effect of ease of use of the system, and self-confidence in computing ability. The study aims to explore the nurses’ experiences of the influence of the benefits of using technology, the ease of use of technology, and nurses' self-confidence when using technology. This study used qualitative methodology with an exploratory phenomenological approach. Data were collected through FGDs with 12 participants selected by purposive sampling technique and consultation with information technology and nursing management experts. Data analysis used the Collaizi Model. The results obtained from this study indicate that the electronic care documentation system must consider the security system of the medical record and that obstacles to operating the system must be anticipated. Guidelines should be made for the application of 3S nursing care in EMR. Adapting to technology influences self-confidence in computing ability, the belief that technology can complete tasks, the usefulness of technology, and the ease of use of electronic documentation technology. It can be concluded that the evaluation of technology acceptance as early as possible is very important to support the successful use of information systems and provide input for management and policymakers in understanding the process of adaptation to new technologies and the creation of practical guidelines for the successful implementation of information systems.

The Efficiency of Document and Border Procedures for International Trade

In many countries, document and border procedures create trading barriers, thereby impairing economic growth. These can range from insufficient transshipment facilities to unsupportive institutional arrangements. To address this, countries have taken reforms to improve their procedures by introducing electronic documentation systems, strengthening border infrastructure, and enhancing customs procedures. However, the efficiency of the document and border procedures in each country remains unclear, as well as how new reforms can affect these. This study investigated the efficiency of document and border procedures in each country, defined as the trade volume and value per required cost, time, and documents in the trading procedures. The efficiencies were calculated through a data envelopment analysis with cross-sectional data from 2019 and a window analysis with panel data from 2014 to 2019. The study found a positive change in export procedure efficiency after all three types of reforms were instituted in a country, but a positive change in import efficiency only after the introduction of electronic documentation. All countries were classified according to their document and border procedure strengths and weaknesses.

Health Monitoring System with Ventilator Using Arduino

This paper refers to the problems faced of shortage of ventilators and comes with a reliable and homemade ventilator which is easy to use. During the pandemic year’s like covid 2019 diseases arrived and during this we were out of oxygen ventilators and we lost many lives. To overcome this situation, we built homemade electronic machine using Arduino which works like oxygen ventilator. The ventilator develop here is somehow similar to the ventilator used today at various hospital’s ICU, but comes with low cost and are made for only emergency purposes. But several features will clearly separate them from the current generation of ventilators as things changes with time. There will be integration with other bedside technology and developed according to new era. After some decades, all ICUs will have electronic charting may be integrated with several sensors and can be monitored or controlled with several types of microprocessors, where data from all sensors will be transmitted to electronic documentation systems or may use cloud computing sort technologies for further references. As a result, we developed ventilators that are able to be integrated electronically with mechanical actuation. And to avoid overall problems faced by users or patients.

Acceptance of electronic and paper-based standardized Nursing Care Plans Documentation System among nurses in a Tertiary Health Facility in North-Central Nigeria

Acceptance is important for successful adoption of new technology. This study assessed the level of acceptability of electronic and paper-based Standardized Nursing Care Plans templates among nurses in a tertiary health facility in North Central Nigeria. Adopting a comparative design, data were collected from 32 nurses working in two medical units of a tertiary health facility who had earlier been introduced to an electronic and Paper-based Standardized Nursing Care plan (SNCPs) templates. A structured questionnaire was used to collect data from the nurses. Data was computed using Statistical Package for Social Sciences (SPSS) version 20 and analyzed using frequency distribution, independent t-test, and Multiple Regression. The result showed that the electronic SNCPs were accepted by all nurses working in the electronic ward while only 2(12.5%) of nurses in the paper word did not accept the paper SNCPs. There was no significant difference in the level of nurses’ acceptability of SNCPs (t-value = 1.400, p = 0.172). Also, only nurses’ years of experience had a statistically significant relationship with acceptance. Providing adequate training would enhance nurses use SNCPs in either electronic or paper formats.

Integrating patient- and caregiver-reported outcome measures into the daily care routines of specialised outpatient palliative care: a qualitative study (ELSAH) on feasibility, acceptability and appropriateness

BackgroundThe use of patient-reported outcome measures (PROM) and caregiver-reported outcome measures can raise the patient centeredness of treatment and improve the quality of palliative care. Nevertheless, the everyday implementation of self-report in patients and caregivers is complex, and should be adapted for use in specific settings. We aimed to implement a set of outcome measures that included patient and caregiver self- and proxy-reported outcome measures in specialised outpatient palliative care (SOPC). In this study, we explore how the Integrated Palliative Outcome Scale (IPOS), IPOS Views on Care (IPOS VoC) and the Short-form Zarit Caregiver Burden Interview (ZBI-7) can be feasibly, acceptably and appropriately implemented in the daily care routines of SOPC.MethodsFive SOPC teams were trained, and used the outcome measures in daily practice. Team members were mainly nurses and physicians. To investigate their feedback, we used a multi-method qualitative design consisting of focus groups with SOPC-team members (n = 14), field notes of meetings and conversations with the SOPC teams. In an iterative process, we analysed the findings using qualitative content analysis and refined use of the outcome measures.ResultsWe found that integrating patient and caregiver outcome measures into daily care routines in SOPC is feasible. To improve feasibility, acceptability and appropriateness, the resulting burden on patients and relatives should be kept to a minimum, the usefulness of the measures must be understood, they should be used considerately, and administration must be manageable. We removed ZBI-7 from the set of measures as a result of feedback on its content and wording.ConclusionsSOPC-team members have reservations about the implementation of PROM in SOPC, but with appropriate adjustments, its application in daily care is feasible, accepted and perceived as appropriate. Previous to use, SOPC-team members should be trained in how to apply the measures, in the design of manageable processes that include integration into electronic documentation systems, and in ongoing evaluation and support. They should also be taught how useful the measures can be.Trial registrationMay 19th, 2017, German Clinical Trials Register DRKS-ID: DRKS00012421.