Incomplete Documentation Research Articles

On the uncertainty in numerical modeling of wireless communication devices operating at frequencies of 900 MHz, 1800 MHz, and 28 GHz.

Some of the difficulties in numerical modeling of wireless communication devices for dosimetric evaluations arise from, e.g. incomplete documentation available for the numerical model, such as missing information on dielectric materials or the antenna matching circuitry. This study investigates the impact of these difficulties on the dosimetric results, such as the peak spatial average specific absorption rate at 900 and 1800MHz and the peak spatial average power density at 28GHz. The impact of dielectric losses, detuning, and mesh resolution is quantified using different generic and Computer Aided Design (CAD) based models of wireless transmitters. The findings show that the uncertainties of the numerical results due to detuning and mesh resolution can be reduced by normalization to the antenna feedpoint power instead of the feedpoint current. Uncertainties due to variations in dielectric losses can largely be compensated by normalization to the radiated power.

Perbandingan Motivasi Kerja Ruang Rawat Inap dan Ruang Operasi dalam Pelaksanaan Pendokumentasian di RS MTSJ

Based on the results of a preliminary study conducted by researchers in January in the inpatient room and operating room at MTSJ Hospital, it was found that there was still a lot of incomplete documentation. Of the 10 murder documentation, 7 of them are still incomplete, incomplete documentation, starting from not including all the acts committed by the murder, inaccuracy in the signature of informed consent between the witness and the patient, unavailability in the form of a fall risk for pediatric and geriatric patients. Documentation at MTSJ Hospital still receives little attention, so care documents are still found whose contents are incomplete. Some problems with documenting nursing care include: lack of motivation in documenting nursing care, writing documentation is considered time-consuming and focuses on patient care. Incomplete documentation will cause losses to clients because important information related to their care and health conditions is neglected. Inefficient and ineffective documentation due to inadequate quality and accuracy causes communication errors between nurses and other professions. Based on the description above and the results of preliminary research, researchers are interested in researching the comparison of work motivation in inpatient rooms and operating rooms with the implementation of documentation at MTSJ Hospital.

Poster 160: Preoperative MRI Underestimates Shoulder Labral Injuries Compared with Diagnostic Arthroscopy

Objectives: To compare the overall agreement in the magnitude of shoulder labral injuries between preoperative MRI and assessment at the time of diagnostic arthroscopy. Methods: A retrospective chart review was performed of patients undergoing primary arthroscopic labral repair procedures between February 2018 and February 2023. Exclusion criteria included prior ipsilateral shoulder surgery, MRI study performed at outside health system, and incomplete documentation of labral tear location. Age, gender, and dates of injury, imaging, and surgery were recorded. Radiology and operative reports were reviewed to record the location and extent of the labral tear using conventional clock-face coordinates. Tear locations were further classified as either anterior (2-6 o’clock), posterior (6-10 o’clock), or superior (10-2 o’clock). MRI studies were performed by 1.5-Tesla scanner and all radiology reports were performed by fellowship-trained musculoskeletal radiologists at a single health system. Subgroup analysis of labral tear size on radiology interpretation was performed between MRI arthrogram (MRA) and conventional MRI studies. Results: A total of 138 subjects (mean age 25.8 years, 73% male) met criteria for inclusion in this study. Of the included subjects, 105 underwent MRI arthrogram and 33 underwent conventional MRI studies. The average time from initial injury to MRI was 153.4 days and the average time from MRI to surgical intervention was 66.8 days. The average total recorded labral tear size in clock-face coordinates was significantly greater on diagnostic arthroscopy compared with the radiologist MRI interpretation (4.4 vs 3.6, p<0.01). The average labral tear size in the posterior region was also significantly greater on diagnostic arthroscopy (2.4 vs 1.6, p<0.01). The average labral tear size in the anterior (2.5 vs 2.2, p=0.08) and superior (1.6 vs 1.5, p=0.29) regions was greater on diagnostic arthroscopy but did not reach statistical significance. The difference in total and posterior tear size remained significant in both the arthrogram and conventional MRI subgroups. Subjects undergoing MRI arthrogram had a significantly greater reported size of anterior labral tears in clock-face coordinates compared with conventional MRI (2.7 vs 2.0, p=0.03), but did not reach significance for the posterior (p=0.40), superior (p=0.31), and the overall global labrum (p=0.29). Conclusions: MRI significantly underestimate the overall size of labral tears in setting of shoulder instability, particularly in the posterior labrum. Surgeons should account for potential underestimation of true labral injury during preoperative planning for surgical management of shoulder instability.

The Relationship Of Workload And Completeness Spiritual Care Documentation In Nurses In Islamic Hospital Mataram

Documentation is an essential element in accountability for the performance of the nursing profession after performing nursing interventions directly to the client. Findings at the hospital showed that nursing documentation forms have been prepared not complete or not complete unfilled. Nurses more does the work of coordination and an abundance of authority. So that we need to know about correlation of nurses workload with nursing documentation. The method used is descriptive correlation with cross sectional approach. The number of samples in this study were as many as 56 people with purposive sampling method. Analysis of data using statistical test of Rank Spearman. The results of this study showed the majority of the workload of nurses in middle category (37.5%) and most of the documentation of nursing care nurses perform incomplete documentation (67.9), while the Spearman Rank test results show the significance value of 0.011 (P <0,05), which shows there is a relationship between the workload of nurses and nursing documentation. Nurses are required to conduct complete care documentation for record of the whole action is given to the patient can be used as evidence of nursing care has been done correctly, precise, and comprehensive.

PPAT's Obligation in Providing Free Services to Indigent People

PPAT Temporarily must provide free services to people who are unable to obtain an Authentic Deed of land rights or property rights to flats, which is strong evidence in the legal process. However, existing regulations governing this matter can lead to multiple interpretations and incomplete documentation requirements, making it difficult for Land Deed Making Officials (PPAT) to fulfill their obligations. Therefore, the application of standardization by PPAT depends on the interpretation of each individual, because it is not regulated in applicable regulations. This study aims to analyze regulations, literature, and interviews with PPAT to find out how they fulfill their responsibilities. This research used normative legal research which reveals that misinterpretation is caused by two factors, namely the absence of criteria to determine a person's incompetence and the imprecise requirements to guarantee its accuracy. The conclusion show better provide services to the community, it is necessary to establish clear criteria and standards for individuals who are unable to carry out legal actions in the field of land and flats.

Effect of Departmental and Physician-Selected Interventions on Point-of-Care Ultrasound Documentation Completion.

Background Point-of-care ultrasound (POCUS) has been disruptive to many experienced emergency physicians as it requires competence in a new physical skill, real-time image interpretation, and navigation of novel software for submission to the electronic health record (EHR). Incomplete documentation of a performed POCUS study used for clinical decision-making represents a potential medicolegal liability, may expose the patient to repetitive or potentially unnecessary imaging, and is a missed opportunity for reimbursement. Identifying effective facilitators of ED POCUS documentation completion requires additional investigation. Methods In the first part of this mixed-methods study, eligible attending physicians were stratified into levels of use ("high"/"low"/"never") based on recent POCUS documentation performance. Semi-structured interviews were conducted with high and low utilizers to explore their perceptions of the POCUS submission workflow and their receptivity to various proposed interventions. Qualitative data were analyzed using a thematic analysis that explored perceived usefulness and usability. The second part of the study consisted of two intervention phases. First, physicians achieving minimum POCUS documentation numbers were rewarded with additional shift scheduling flexibility. In the second phase, the intervention that garnered the most interview support, daily documentation reminder emails, was implemented. The primary outcome was the individual POCUS documentation rates calculated as all studies submitted divided by all studies performed (submitted plus unsubmitted) per month. Provider-level monthly data was aggregated into a departmental rate. Results Interviews were conducted with 12 physicians, six from the highest and six from the lowest documentation quartiles. Both groups supported the same two proposed interventions: reminder emails ranked first, then monetary rewards ranked second. High utilizers emphasized the clinical utility of POCUS, whereas low utilizers expressed concerns over "double billing" and exposure to medicolegal liability with uncertain scan interpretations. For low utilizers, a documentation decision could be dependent on the performing resident physician's displayed confidence. Both groups voiced frustration with the need to use a separate program, Qpath (Telexy Healthcare, Inc, Maple Ridge, British Columbia, Canada), for POCUS documentation. During intervention phase one, the aggregate departmental documentation rate increased from 44.6% to 60.1% with the introduction of the schedule request incentive. This improvement was seen across all documentation quartiles. The departmental rate remained stable and did not improve further following the addition of the daily documentation reminder emails in intervention phase two. When reminder emails ceased yet the day-off request incentive continued, the departmental rate did not drop. Conclusions The implementation of a non-financial shift scheduling incentivecorrelated with the largest increase in departmental POCUS documentation rate. Interviewees incorrectly predicted that email reminders would be the most influential intervention highlighting a mismatch between physician perception and effective drivers of behavior change.Further investigation may focus on determining the size and longevity of the isolated impact of a schedule request incentive, as one might expect diminishing marginal utility.

The Impact of Real-Time Documentation of In-Hospital Medication Changes on Preventing Undocumented Discrepancies at Discharge and Improving Physician-Pharmacist Communication: A Retrospective Cohort Study and Survey.

Transitional medication safety is crucial, as miscommunication about medication changes can lead to significant risks. Unclear or incomplete documentation during care transitions can result in outdated or incorrect medication lists at discharge, potentially causing medication errors, adverse drug events, and inadequate patient education. These issues are exacerbated by extended hospital stays and multiple care events, making accurate medication recall challenging at discharge. Thus, we aimed to investigate how real-time documentation of in-hospital medication changes prevents undocumented medication changes at discharge and improves physician-pharmacist communication. We conducted a retrospective cohort study in a tertiary hospital. Two pharmacists reviewed medical records of patients admitted to the acute medical unit from April to June 2020. In-hospital medication discrepancies were determined by comparing preadmission and hospitalization medication lists and it was verified whether the physician's intent of medication changes was clarified by documentation. By a documentation rate of medication changes of 100% and <100%, respectively, fully documented (FD) and partially documented (PD) groups were defined. Any undocumented medication changes at discharge were considered a "documentation error at discharge". Pharmacists' survey was conducted to assess the impact of appropriate documentation on the pharmacists. After reviewing 400 medication records, patients were categorized into FD (61.3%) and PD (38.8%) groups. Documentation errors at discharge were significantly higher in the PD than in the FD group. Factors associated with documentation errors at discharge included belonging to the PD group, discharge from a non-hospitalist-managed ward, and having three or more intentional discrepancies. Pharmacists showed favorable attitudes towards physician's documentation. Appropriate documentation of in-hospital medication changes, facilitated by free-text communication, significantly decreased documentation errors at discharge. This analysis underlines the importance of communication between pharmacists and hospitalists in improving patient safety during transitions of care.

TRENDS OF ASPHYXIAL DEATHS AND ITS ASSOCIATION WITH VARIOUS DEMOGRAPHIC FACTORS REPORTED TO FORENSIC MEDICINE DEPARTMENT PESHAWAR; AN AUTOPSY-BASED RETROSPECTIVE STUDY

Objectives: To find the frequency of reported asphyxial deaths to gender and pattern of injury reported. This study also intended to identify the causes and the association between age, area, and gender of the deceased with sexual assault-related asphyxial deaths. Methods: A retrospective chart review was conducted at the Department of Forensic Medicine and Toxicology Khyber Medical College Peshawar from 1st July 2018 to 30th June 2023 (5 years data). All the subjects who died due to asphyxia and were presented for autopsy at the department were included in the study. Cases with incomplete documentation and those referred from other districts were excluded from the study. Results: Of the total 187 subjects, 66.8% (n=125) were males and 33.2% (n=62) were females with male to female ratio of 2:1. In the data, 57.2% (n=107) belonged to urban areas and 42.8% (n=80) were of rural areas. In total subjects, 88.8% (n=166) had immediate deaths, 6.4% (n=12) had delayed ones, and 4.8% (n=9) were undetermined. The most prevalent type of asphyxia was mechanical 113 (60.4%). The most common cause of asphyxia death was found to be hanging at 34.22%. However, of the 187 subjects, 5.3% (n=10) had intoxications, of which 1.6% (n=3) had tetrahydrocannabinol (THC), carbon monoxide (CO) and morphine poisoning each and 0.5% (n=1) had methamphetamine poisoning. Conclusion: Our study concluded that asphyxial deaths were more prevalent in males in the middle-aged group. Asphyxial deaths were found more in urban areas than in rural areas. Mechanical asphyxia was the most common type of asphyxia while hanging was the most common pattern. Key words: asphyxia, tetrahydrocannabinol, mechanical, traumatic, sexual, iatrogenic, and chemical asphyxia.

Evaluation of Blood Transfusion Request form: The Experience in a Tertiary Health Facility in Jos, Nigeria

Background: There is a thin line between a safe blood transfusion and transfusion-related fatality hence the need to be diligent in every aspect of the blood transfusion process. Appropriate and complete documentation on a blood transfusion request form is one of the most important preanalytic activities serving as a communication tool between the clinician and the blood transfusion laboratory personnel. Aims: To evaluate compliance with appropriate and complete documentation of information on our blood transfusion request forms for a reliable preanalytic process towards an efficient blood transfusion service. Study Design: It is a retrospective study. Place and Duration of Study: Blood Bank of the Jos University Teaching Hospital between January to December 2023. Methodology: Six thousand, three hundred and sixty (6360) blood transfusion request forms from the Jos University Teaching Hospital Blood bank were evaluated for complete or incomplete documentation retrospectively and results were presented in frequencies and percentages. Results: There was 100% compliance in filling in the patients' surnames and other names as well as the laboratory number and blood groups of the patients while only 4779 (75.14%) filled in the patients' ages with 1416(22.26%) using the prefix of adult(ad) while 165(2.59%) fail to document the patients' age. There were 2829 (44.48%) males with 3522 (55.38%) females while no sex was indicated in 9 of the reviewed forms. Obstetrics history has the least cumulated documented response of 0.38% while a significant 1008 (15.85%) did not indicate either blood grouping or blood grouping with cross-match request. Conclusion: Appropriate and complete documentation of information on blood transfusion request forms is a problem among clinicians and will require continuous education on its importance, periodic auditing, provision of electronic data system and attitudinal change for a better blood transfusion compatibility service.

Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care

BackgroundEmergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records.MethodsThe ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers.ResultsFrom the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions.ConclusionThis study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety.

A Descriptive Analysis of Nasal Polyposis in HIV Positive Versus HIV Negative Patients

Nasal polyposis (NP) represents a benign proliferation of soft tissue tumors within the nasal cavity and paranasal sinuses, characterized by chronic inflammation of the sinonasal mucosa. This phenomenon, attributed to various environmental and physiological factors, presents clinically as semi-transparent masses with variable morphology, often obstructing nasal passages and causing respiratory compromise, olfactory dysfunction, and recurrent infections. Predominantly associated with chronic rhinosinusitis (CRS), NP poses significant challenges in diagnosis and management, particularly in the context of comorbid conditions such as human immunodeficiency virus (HIV) infection. HIV infection, known for its debilitating effects on the immune system, is theorized to exacerbate NP development and manifestation through mechanisms involving CD4 cell depletion and dysregulation of immune responses. Despite extensive research, elucidating potential pathways linking HIV infection to NP, comprehensive understanding remains elusive. This study aims to address this knowledge gap by conducting a retrospective chart review of patients presenting with NP at Charlotte Maxeke Johannesburg Academic Hospital between January 2016 and December 2020. The primary objective is to investigate the influence of HIV status on the clinical, radiological, and histological features of NP. Data collection, encompassing patient demographics, HIV status, clinical presentations, radiological findings, and histopathological characteristics, will be conducted between March 2021 and August 2022. Preliminary analysis of collected data reveals a cohort of 41 patients meeting inclusion criteria, with notable exclusions based on undisclosed HIV status and incomplete documentation. Initial findings suggest a nuanced interplay between genetic predisposition, environmental factors, and HIV status in NP pathogenesis, underscoring the need for further research to validate these observations. In conclusion, this study underscores the importance of elucidating the complex relationship between HIV infection and NP to optimize diagnostic and therapeutic approaches, particularly in regions with a high HIV prevalence such as South Africa. By comprehensively assessing the clinical, radiological, and histological features of NP in HIV-positive and HIV-negative populations, this research endeavours to enhance our understanding of NP pathophysiology and improve patient outcomes.

Do goals of care documentation reflect the conversation?: Evaluating conversation-documentation accuracy.

Documenting goals of care in the electronic health record is meant to relay patient preferences to other clinicians. Evaluating the content and documentation of nurse and social worker led goals of care conversations can inform future goals of care initiative efforts. As part of the ADvancing symptom Alleviation with Palliative Treatment trial, this study analyzed goals of care conversations led by nurses and social workers and documented in the electronic health record. Informed by a goals of care communication guide, we identified five goals of care components: illness understanding, goals and values, end of life planning, surrogate, and advance directives. Forty conversation transcripts underwent content analysis. Through an iterative team process, we defined documentation accuracy as four categories: (1) Complete-comprehensive accurate documentation of the conversation, (2) Incomplete-partial documentation of the conversation, (3) Missing-discussed and not documented, and (4) Incorrect-misrepresented in documentation. We also defined-Not Discussed-for communication guide questions that were not discussed nor documented. A constant comparative approach was used to determine the presence or absence of conversation content in the documentation. All five goals of care components were discussed in 67% (27/40) of conversation transcripts. Compared to the transcripts, surrogate (37/40, 93%) and advance directives (36/40, 90%) were often documented completely. Almost 40% of goals and values (15/40, 38%) and half of end of life planning (19/40, 48%) were incomplete. Illness understanding was missing (13/40, 33%), not discussed (13/40, 33%), or incorrect (2/40, 5%). Nurse and social worker led goals of care conversations discussed and documented most components of the goals of care communication guide. Further research may guide how best to determine the relative importance of accuracy, especially in the broad setting of incomplete, missing, and incorrect EHR documentation.

Enhancing Collaboration and Efficiency through Automated Documentation of GCP Stored Procedures with genAI

Abstract: In the realm of cloud-based data management on the Google Cloud Platform (GCP), effective documentation of work processes is essential for streamlined operations. However, existing practices often rely on manual efforts, leading to incomplete and time-consuming documentation. To overcome this challenge, we propose a Lab Week project leveraging genAI's natural language processing capabilities. Our objective is to develop a Python script that automates the generation of comprehensive documentation for GCP Stored Procedures. This innovative solution aims to extract crucial details such as Common Table Expressions (CTEs), temporary tables, end tables, and associated columns, resulting in a structured Word document. By harnessing genAI's power, our automated documentation system not only saves time but also ensures consistency and depth in GCP Design Details. This initiative fosters collaboration and knowledge transfer among team members, with the generated Word documents seamlessly integrating into Confluence pages as valuable resources for our development teams

The design of the Inpatient Care Monitoring and Evaluation System for the Executive Report at X Hospital

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;One of the information systems needed in a hospital to support services is the inpatient information system. Several field constraints that often occur and can impede patient services include: limited bed space, hindered coordination between units or rooms, sudden changes in bed space requirements, the lack of integration of information systems, incomplete and inaccurate documentation of patient mobilization, the length of the patient discharge process, unavailable facilities in rooms, and the existence of hospital service indicators that must be achieved. Based on the above, a real-time and integrated information system is required, starting from the registration of inpatients to their discharge, in order to improve the quality of service and patient satisfaction. The design of the Inpatient Monitoring and Evaluation System for the Executive Report is an enhancement of the hospital information system that integrates all inpatient patient service activities, including supporting facilities, to generate useful information for monitoring and developing inpatient care services. This information can be used as a basis for decision-making by the leaders. The design of the Inpatient Monitoring and Evaluation System for the Executive Report utilizes the Systems Development Life Cycle (SDLC) method in the form of a prototype, with the drafting phase starting from design to development. The final result of this information system design consists of comprehensive, integrated, and real-time information related to patient activities from admission to discharge, presented in a dashboard that is useful for monitoring and evaluating inpatient care services. It can also serve as a basis for decision-making by hospital leaders and achieving hospital indicators.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords: Bed management, dashboard, information, inpatient, integration&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Studiu istoric al unei case urbane stil „Arta 1900”

This paper aims to answer a series of questions resulting from the presence of incomplete and superficial documentation gathered over time in the context of rehabilitation and restoration of historic houses in Turda, some of which are classified as monuments. Therefore, the following questions are considered: What is the value of a historical study in the context of an intervention? What is the structure of a historical study of a building? Who is in a position to carry out such a study and to impose permissions and restrictions? How can the research results be used? Does the history of one building illustrate wider policies of the Austro-Hungarian authorities to urbanise and modernise smaller towns in the realm? Although, this study is dedicated to a single building, located in the historical centre of the town, its detailed study and the reconstruction of its historical and architectural path can provide clues concerning the implementation of urban policies of the Austro-Hungarian Monarchy in provincial context. The building was classified as a historical monument, but its aspect today reflects its complicated history and the many unfortunate and misguided interventions it has undergone. It has also been neglected by existing research, and thus, its position within the „Art 1900” [Art Nouveau] has not been explored. Consequently, the present research attempts to make the most of the data recorded sporadically in various sources covering the history of Turda. On the other hand, the lack of conservation strategies for this type of heritage, reflected in a coherent legislative framework, has led until recently to a lax and confusing approach at the local administration level as well, as evidenced by the series of renovations and rehabilitation inappropriate to the original style, carried out by the local authority, owners or tenants over time. Good documentation forwarded to the authorities and current owners can, therefore, help these buildings and act as a method of educating the public, providing guidance concerning the value, functionality, and capacity of heritage to create more value for local communities.

Visual acuity prediction on real-life patient data using a machine learning based multistage system

In ophthalmology, intravitreal operative medication therapy (IVOM) is a widespread treatment for diseases related to the age-related macular degeneration (AMD), the diabetic macular edema, as well as the retinal vein occlusion. However, in real-world settings, patients often suffer from loss of vision on time scales of years despite therapy, whereas the prediction of the visual acuity (VA) and the earliest possible detection of deterioration under real-life conditions is challenging due to heterogeneous and incomplete data. In this contribution, we present a workflow for the development of a research-compatible data corpus fusing different IT systems of the department of ophthalmology of a German maximum care hospital. The extensive data corpus allows predictive statements of the expected progression of a patient and his or her VA in each of the three diseases. For the disease AMD, we found out a significant deterioration of the visual acuity over time. Within our proposed multistage system, we subsequently classify the VA progression into the three groups of therapy “winners”, “stabilizers”, and “losers” (WSL classification scheme). Our OCT biomarker classification using an ensemble of deep neural networks results in a classification accuracy (F1-score) of over 98%, enabling us to complete incomplete OCT documentations while allowing us to exploit them for a more precise VA modelling process. Our VA prediction requires at least four VA examinations and optionally OCT biomarkers from the same time period to predict the VA progression within a forecasted time frame, whereas our prediction is currently restricted to IVOM/no therapy. We achieve a final prediction accuracy of 69% in macro average F1-score, while being in the same range as the ophthalmologists with 57.8 and 50±10.7\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$50 \\pm 10.7$$\\end{document}% F1-score.

Relationship between long-acting reversible contraception and acne in a cohort of adolescents and young adults.

The use of progestin-only long-acting reversible contraception (LARC) may be a risk factor for acne. Few studies have focused primarily on the effects of hormonal LARC on the development or exacerbation of acne in adolescents and young adults. We sought to understand the incidence and management of acne following hormonal LARC insertion in this adolescent/young adult population. A secondary data analysis was conducted of prospectively collected quality improvement (QI) data from the Adolescent Medicine LARC Collaborative. Subjects were evaluated by clinicians in adolescent medicine clinics at participating study sites, and acne severity was documented using a standardized recording instrument and scale. Descriptive statistics were reported as frequencies and percentages for categorical variables or mean and standard deviation (SD) for continuous variables. We compared demographic and clinical characteristics by those who had worsening acne, accounting for site inter-correlation using Cochran-Mantel-Haenszel chi-square tests for categorical variables and linear generalized estimating equation (GEE) regression for continuous variables. Of 1319 subjects who completed LARC insertion, 28.5% (376/1319) experienced worsening acne following use of progestin-only LARC. Acne was a contributing factor to LARC removal in only 3% (40/1319), and the sole reason for removal in 0.4% (5/1319) of all subjects. As this was a secondary analysis of prospectively collected QI data, limitations of this study include incomplete or inaccurate documentation of acne severity. Moreover, LARC insertions without follow-up/removal visits or with only follow-up/removal within 8 weeks of insertion were excluded from our study, which may also bias results. Adolescents and young adults seeking progestin-only LARC should be counseled about the potential for developing acne or experiencing a worsening of existing acne during LARC use. However, acne was not a common reason for LARC discontinuation.

Improving Quality Metrics in Neurosurgery: A Spinal Surgery 3-Year Case Review

BACKGROUND AND OBJECTIVES: Despite the known importance of accurate clinical documentation as a companion to quality patient care, this is not often prioritized in practice and leads to a variety of downstream consequences. Inaccurate documentation leads to missed opportunities in full, accurate coding. In turn, it also negatively influences hospital and physician quality ranking, medical center profiling, and revenue captured. The aim of this study is to highlight the opportunity for continuous improvement in clinical documentation and the significance accurate clinical documentation has on outcome measures, such as expected length of stay (eLOS). METHODS: A single-center retrospective chart review took place for patients undergoing spinal surgery from 2019 to 2021. Based on Vizient's diagnosis-related group risk model for eLOS, 192 charts spanning 10 unique diagnosis-related groups were reviewed to identify ICD-10 diagnosis and procedure codes that were not coded or not clearly documented by a physician. A new eLOS for each patient was recalculated with the addition of the newly identified variables and then compared with the original eLOS. RESULTS: Overall, there was a significant difference between the original eLOS and new eLOS when the newly identified variables were added (P &lt; .001). Of 192 patient charts, 89.5% had at least one new variable contributing to eLOS, with an average of 2.60 (0, 12) new variables. This resulted in an average increase in eLOS of 2.869 days (−0.160, 35.129). Compared with the observed LOS, the new eLOS was significantly different (P &lt; .001), whereas the original LOS was not (P = .5661). CONCLUSION: Incomplete documentation and coding can misrepresent the quality of patient care provided and the complexity of their cases. This represents an opportunity for improvement for both the clinicians, clinical documentation improvement specialists, and coders to improve quality metrics and hospital rankings.

Fasciotomy done for vascular trauma at a tertiary care centre in Sri Lanka

Introduction Compartment syndrome is a major factor contributing to limb loss and poor outcome following lower limb vascular injuries. Method This is a retrospective study done on patients with vascular injuries and undergone fasciotomy at the accident service operation theatre (ASOT) at the national hospital of Sri Lanka (NHSL), during a period of one year. Cases with Incomplete documentation were excluded. Data on patient demographics, time of injury, and time of fasciotomy, associated fractures, muscle viability and outcome were collected. Results A total of 30 cases were included. 26 (86%) were males. Nine (30%) were upper limb and 21(70%) were lower limb fasciotomy. The cause for limb injuries were road traffic accidents (RTA) in 18 (58.1%), trap gun injury in five (16.1%). All the fasciotomy were done prior to revascularization. 19 (63.3%) had fractures (12 (63%) were open and seven (36%) closed). six (20%) fasciotomy were done for compartment syndrome, 24 (80%) were done prophylactically. Three patients with compartment syndrome had open fractures (50%) and three had closed fractures (50%). On fasciotomy, in four cases all four leg compartment muscles were non-viable, two had non-viable three compartments and one patient had non-viable two compartments. The mean delay in patients who had all compartments viable was 3.7 hours (2-6.5) and the mean delay in patients with three or four non-viable compartments was 12.2hours (7-24). This difference was statistically significant (p-0.0001). The fasciotomy delay was also significant (p-0.0001) between the patients who had an amputation and limb salvage. Overall amputation rate was 20% in this series. Mean time of delay from admission to NHSL to the time of fasciotomy was 1.8 hours (1-3.5). Mean time of injury to time of fasciotomy was 5.42 hours (2-24). Discussion Number of non-viable compartments is significantly associated with the duration between time of injury to time of fasciotomy(P-0.0001). Therefore we suggest early fasciotomy before transfer

Kinerja Perawat Ruang Rawat Inap RSUD Tengku Sulung

The largest proportion of health workers in the hospital is nurses which is 50.79%. One of the performance indicators is seen from the provision of nursing care in the hospital, seen from the nursing care documentation for the last 3 years in 2020 by 30%, in 2021 by 40.3% and in 2022 by 50.8%. The purpose of this research was to analyse nurses performance in the aspects of quality, quantity, used of working time, teamwork and incentives. This research used a qualitative research approach method with a case study design. interviews, observation and documentation were conducted on 5 informants to produce accurate and complete data. Data analysis in this research was carried out by triangulation. The results of this research found that nurses' knowledge of SOPs was good. Incomplete documentation of the initial study on medical history was 40% and physical examination was 60%. Nurses’ activity time were still classified as low direct activities by 19.5%, indirect activities by 32.6%, personal activities by 28.9% and non-productive activities by 19.5%. Providing financial incentives in the form of Eid Mubarak THR, while non-financial incentives in the form of awards and praise have not been implemented. Teamwork is less effective due to the lack of pharmacists and nutritionists in collaboration. The performance of nurses in inpatient rooms are less effective because in the implementation of nursing SOPs there are still nurses who are not in accordance with SOPs, incompleteness in filling out the initial nursing review documentation, nursing activity time are still low, financial and non-financial incentives are not implemented and teamwork is less effective due to the lack of involvement between pharmacists and nutrition professionals in collaboration.