Medical Record Information Research Articles

Educational Game Application Development on Classification of Diseases and Related Health Problems Treatment in Android Platform

The classification and codification of diseases and related problems is one of the competences of medical recorder as stated in Kepmenkes RI.377 in 2007. The current problem is the lack of reference exercise in learning KKPMT (Klasifikasi dan Kodifikasi Penyakit dan Masalah Terkait) in Program Diploma-III Medical Recorder and Health Information Malang State Health Polytechnics. The purpose of this research is to design android based KKPMT educational application to improve students understanding of KKPMT course. This investigation was using pre-experiment, one group pretest-posttest with waterfall development method. The population in this study was all the students active in year two of Program Diploma-III Medical Record and Health Information Malang State Health Polytechnics. The result of the implementation showed that after the use of KKPMT educational game application with the diagnosis code G the percentage was above minimum, passing value increased from 6% before using the game to 94% after implementation of the game application. Results of the statistical test by paired t-test showed p-value 0,000 <0.05. The conclusion was that android game software help students in understanding the KKPMT subject matter.

Preferred Names, Preferred Pronouns, and Gender Identity in the Electronic Medical Record and Laboratory Information System: Is Pathology Ready?

Background: Electronic medical records (EMRs) and laboratory information systems (LISs) commonly utilize patient identifiers such as legal name, sex, medical record number, and date of birth. There have been recommendations from some EMR working groups (e.g., the World Professional Association for Transgender Health) to include preferred name, pronoun preference, assigned sex at birth, and gender identity in the EMR. These practices are currently uncommon in the United States. There has been little published on the potential impact of these changes on pathology and LISs. Methods: We review the available literature and guidelines on the use of preferred name and gender identity on pathology, including data on changes in laboratory testing following gender transition treatments. We also describe pathology and clinical laboratory challenges in the implementation of preferred name at our institution. Results: Preferred name, pronoun preference, and gender identity have the most immediate impact on the areas of pathology with direct patient contact such as phlebotomy and transfusion medicine, both in terms of interaction with patients and policies for patient identification. Gender identity affects the regulation and policies within transfusion medicine including blood donor risk assessment and eligibility. There are limited studies on the impact of gender transition treatments on laboratory tests, but multiple studies have demonstrated complex changes in chemistry and hematology tests. A broader challenge is that, even as EMRs add functionality, pathology computer systems (e.g., LIS, middleware, reference laboratory, and outreach interfaces) may not have functionality to store or display preferred name and gender identity. Conclusions: Implementation of preferred name, pronoun preference, and gender identity presents multiple challenges and opportunities for pathology.

Rancangan Bridging Sistem Informasi Primary Care (P-Care) pada Dokter Praktik di Kota Semarang

Applications P-Care (primary care) is an information system of patient care participants BPJS computer-based and online via the Internet. There are some problems encountered in the use of p-care applications in clinic. Patients who visit private doctors have not been entirely entered into BPJS participants so that there are two kinds of membership, namely patient based on the patient BPJS and general patients. Difficulties experienced was when combining patient visitation reports BPJS participants and general patients. The purpose of this study was to produce a draft bridging medical record information system that can bridge the gap between the general patient care with patients BPJS. This research was a case study with observational approach. Object of this research were the components of the p-care information systems. Subjects were the operators, doctors, and owners of primary health care facilities. Data collection were interviews and observations to gain condition p-care information system is running and the user’s expectations for efficiency p-care services. Problems on the clinic services was the difficulty in finding the patient’s medical record card, and there were multiple medical record card. Solutions do is arrange medical record card with the number system, making treatment of identity cards, and establish procedures medical record service. To expedite the necessary service bridging primary care information system designed according to the needs of the clinic management information. The database that corresponds to bridging p-care were patient identity, health care visit, health service, and diagnosis. The design of the interface (interface) generated registration menu, service, and reporting. It was necessary to cooperate with BPJS IT to build bridging systems for ease of service and clinical reporting. Keywords: briding, information system, primary care, clinic, design of information system

Framework for the Application of System Techniques (FAST) as Services Supporting Evaluation in Primary Clinic Semarang Health Polytechnic

Medical record service information system aims to provide information to facilitate management in the service to patients and facilitate leadership in evaluating services. Therefore, it needs ood medical record data management. However, the current medical record management in primary Clinic Poltekkes Kemenkes Semarang was found to be problems, both from the Input, process, and output, so that information needs for the leader to evaluate health service become obstructed. The purpose of this research is to produce medical record information system as supportingservice evaluation in Primary Clinic Poltekkes Semarang. System development is based on FAST steps (Framework for the Application of System Techniques). The research design used pre-experimental one group pre and post test. The research variables are completeness, accuracy, accessibility, conformity, and clarity of information. The method of data processing using descriptive analysis using weighted mean and Sign Test. Descriptive analysis results show the weighted average value of information quality after system development is greater than before system development. Sign Test test results indicate the difference in the Quality of information before and after system development. Conclusion information system developed is better than old information system. Required supports recommended are in supporting facilities and infrastructure to implement new information system as well as Maintenance and evaluation of system reliability after implemented

Association of maternal serum 25-hydroxyvitamin D concentrations in second and third trimester with risk of gestational diabetes and other pregnancy outcomes.

To evaluate the maternal serum 25(OH)D concentrations and its association with gestational diabetes and other pregnancy outcomes.zMethods:In our nested case-control study, 4718 pregnancy women were included, who were attending second- and third-trimester screening in Nanjing, China. Serum 25(OH)D concentrations were tested by enzyme-linked immunoassay, and the pregnancy and birth outcomes were obtained via electronic medical record collection and information extraction. The associations of 25(OH)D concentrations with gestational diabetes and other pregnancy outcomes were assessed by logistic regression analysis. And receiver-operator characteristic curve analysis was also conducted. For the total population, the median (IQR) concentrations of 25(OH)D was 43.7 (35.5-57.9) nmol l-1, and 63.1% of women had concentrations <50.0 nmol l-1. The 25(OH)D concentrations was significantly lower in gestational diabetes patients than in controls. Moreover, after adjustment for confounders, women with low 25(OH)D concentrations had significantly increased risks of gestational diabetes and some adverse pregnancy outcomes (anemia, macrosomia, abnormal amniotic fluid, and miscarriage or stillbirth). We also observed a threshold for 25(OH)D of 50.0 nmol l-1 for gestational diabetes and a nice predictive accuracy of the 25(OH)D concentrations included panel, with an area under the curve of 0.625 for gestational diabetes. Low 25(OH)D concentrations (<50.0 nmol l-1) in pregnancy was significantly associated with gestational diabetes risk, and it may serve as biomarkers for the surveillance of high-risk pregnant women.

Analysis of nurse navigators\u2019 activities for hospital discharge coordination: a mixed method study for the case of cancer patients

BackgroundModern cancer care requires the development of clinical pathways to enhance coordination, but there are few descriptive studies about the content of coordination activities. More specifically, little is known about hospital discharge coordination, although this is seen as a sensitive phase of clinical pathway.PurposeThe purpose of this study was to identify and quantify the categories of activities performed by nurse navigators for hospital discharge coordination.MethodsPatients supported within the Coordinating Outpatient Care department (COC) at Gustave Roussy (Villejuif, France). Study conducted over two consecutive phases (Feb-September 2014): (1) a qualitative phase to identify the categories of coordination activities (interviews with patients plus, focus groups with nurse navigators—NNs); (2) a quantitative phase to quantify the relative share of each category. The calls received through the telephone platform of COC (made by both patients and primary care providers) were systematically reported (caller; reason for the call; procedure performed) and then analyzed.ResultsQualitative phase: 17 interviews with patients, plus 2 focus groups with NNs. Quantitative phase: 543 calls analyzed. The callers were patients or their relatives (38 %), private nurses (35 %), medical device providers (20 %), and other primary care providers (e.g., pharmacists, family physicians) (7 %). Five categories of coordination activities identified: (F1) Patient monitoring (29 %); (F2) Helping to navigate (24 %); (F3) Managing technical problems (17 %); (F4) Explaining care protocols (16 %); (F5) Collecting and transmitting the patient medical record information (14 %).ConclusionsThe majority of requirements are related to organizational issues (e.g., navigation, lack of information, appointments). Nurse navigators’ training and qualification must therefore combine both clinical and managerial skills.

Proficiency in identifying, managing and communicating medical errors: feasibility and validity study assessing two core competencies.

BackgroundCommunication skills and professionalism are two competencies in graduate medical education that are challenging to evaluate. We aimed to develop, test and validate a de novo instrument to evaluate these two competencies.MethodsUsing an Objective Standardized Clinical Examination (OSCE) based on a medication error scenario, we developed an assessment instrument that focuses on distinctive domains [context of discussion, communication and detection of error, management of error, empathy, use of electronic medical record (EMR) and electronic medical information resources (EMIR), and global rating]. The aim was to test feasibility, acceptability, and reliability of the method.ResultsFaculty and standardized patients (SPs) evaluated 56 trainees using the instrument. The inter-rater reliability of agreement between faculty was substantial (Fleiss k = 0.71) and intraclass correlation efficient was excellent (ICC = 0.80). The measured agreement between faculty and SPs evaluation of resident was lower (Fleiss k = 0.36). The instrument showed good conformity (ICC = 0.74). The majority of the trainees (75 %) had satisfactory or higher performance in all six assessed domains and 86 % found the OSCE to be realistic. Sixty percent reported not receiving feedback on EMR use and asked for subsequent training.ConclusionAn OSCE-based instrument using a medical error scenario can be used to assess competency in professionalism, communication, using EMRs and managing medical errors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0755-5) contains supplementary material, which is available to authorized users.

Analysis of the efficacy of laparoscopic Toupet fundoplication treatment of hiatal hernia combined with gastroesophageal reflux disease

Objective To explore the efficacy of laparoscopic Toupet fundoplication treatment of hiatal hernia combined with gastroesophageal reflux disease. Methods Forty one patients' medical record information of hiatal hernia combined with gastroesophageal reflux disease that underwent laparoscopic Toupet fundoplication were collected in Xinjiang Uygur Autonomous Region People's Hospital from October 2012 to October 2015. Thirty six cases were adopted pure hiatal hernia suture, 2 cases were used biological patch repair, 1 case used Johnson PHY patch repair, 1 case used Bade patch repair, and 1 case used Tyco hiatal hernia dedicated anti-blocking patch repair. These patients were carried out 24 hours esophageal pH monitoring, esophageal manometry, gastroesophageal reflux disease questionnaire (GERDQ) score and postoperative complications before surgery and 6 months postoperative. The clinical efficacy of laparoscopic Floppy Nissen fundoplication treatment of hiatal hernia combined with gastroesophageal reflux disease was retrospectively analyzed. Results There was no perioperative deaths and serious complications during perioperation. The reflux symptoms were significantly improved postoperative. There was significantly lower in reflux time , the number of reflux (29.83±19.71), acid reflux time percentage , and DeMeester score (7.28±7.38) than the preoperative . GERD Q scale score (7.18±1.33) was significantly lower than preoperative (10.91±2.02) with statistically significant difference (P<0.05). lower esophagealsphincter (LES) pressure was significantly increased than preoperative . Residual pressure was significantly increased than preoperative . Relaxation rate was significantly reduced than preoperative . However, swallowing invalid was increased than preoperative , with statistically significant difference (P<0.05). The median follow-up was 10 months, and there was no recurrence during follow-up. Conclusions Laparoscopic Toupet fundoplication can effectively inhibit reflux symptoms, and increase LES pressure, which is worthy of promotion. However, there is slightly higher incidence of postoperative dysphagia. Key words: Laparoscopy; Fundoplication; Hernia, hiatal/CO/SU; Gastroesophageal reflux/CO/SU

Long-Term Retrospective Analysis of Gene Therapy with Alipogene Tiparvovec and Its Effect on Lipoprotein Lipase Deficiency-Induced Pancreatitis.

Alipogene tiparvovec (Glybera) is a gene therapy product approved in Europe under the "exceptional circumstances" pathway as a treatment for lipoprotein lipase deficiency (LPLD), a rare genetic disease resulting in chylomicronemia and a concomitantly increased risk of acute and recurrent pancreatitis, with potentially lethal outcome. This retrospective study analyzed the frequency and severity of pancreatitis in 19 patients with LPLD up to 6 years after a single treatment with alipogene tiparvovec. An independent adjudication board of three pancreas experts, blinded to patient identification and to pre- or post-gene therapy period, performed a retrospective review of data extracted from the patients' medical records and categorized LPLD-related acute abdominal pain events requiring hospital visits and/or hospitalizations based on the adapted 2012 Atlanta diagnostic criteria for pancreatitis. Both entire disease time period data and data from an equal time period before and after gene therapy were analyzed. Events with available medical record information meeting the Atlanta diagnostic criteria were categorized as definite pancreatitis; events treated as pancreatitis but with variable levels of laboratory and imaging data were categorized as probable pancreatitis or acute abdominal pain events. A reduction of approximately 50% was observed in all three categories of the adjudicated post-gene therapy events. Notably, no severe pancreatitis and only one intensive care unit admission was observed in the post-alipogene tiparvovec period. However, important inter- and intraindividual variations in the pre- and post-gene therapy incidence of events were observed. There was no relationship between the posttreatment incidence of events and the number of LPL gene copies injected, the administration of immunosuppressive regimen or the percent triglyceride decrease achieved at 12 weeks (primary end point in the prospective clinical studies). Although a causal relationship cannot be established and despite the limited number of individuals evaluated, results from this long-term analysis suggest that alipogene tiparvovec was associated with a lower frequency and severity of pancreatitis events, and a consequent overall reduction in health care resource use up to 6 years posttreatment.

Ultrasound-guided Intralesional Bleomycin Injection (IBI) for Treatment of Cutaneous Hemangiomas and Vascular Malformations

Purpose: To report the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin in the treatment of cutaneous hemangiomas and vascular malformations. Material & Methods: The medical records of patients with cutaneous hemangiomas and vascular malformations treated with the intralesional injection of bleomycin under ultrasound guidance between August 2009 and June 2013 at the Indus Hospital, Karachi were reviewed retrospectively using a computerized medical record information management system. Data were extracted using a pre-coded performa that included patient demographics, type and location of lesion, number of treatments, presenting/pre- and post-treatment clinical symptoms (pain, swelling, heaviness, size, discoloration), ultrasound appearance and vascularity, and post-treatment side effects. The dose range of bleomycin was 0.5-1.0 mg/kg, but not exceeding 15 mg in a single session. A maximum of four treatments were given in any given patient except for one, who presented with recurrence after a year of complete resolution. Therapeutic outcome was determined using review of ultrasound images and recorded clinical assessment. Treatment response was categorized as: (i) complete resolution [more than 90% reduction]; (ii) substantial reduction [more than 50% reduction]; (iii) mild reduction [25% reduction]; or, (iv) no improvement [ < 10% reduction]. Results: A total of 30 patients (16 female, 14 male), ranging in age from 8 months to 48 years (mean age 10.2 years), were treated from 2009 to 2013. There were 23 hemangiomas. Seven were vascular malformations, of which five were lymphatic malformations and two were venous malformations. Twenty-eight lesions were located in the head and neck region, and two were peripheral.. In 24 of the 30 patients (76%), treatment had been completed. In six patients (21%) treatment was ongoing at the time of this report. Seventeen of the 23 hemangiomas (74%) were completely resolved clinically and on ultrasound, five (22%) showed substantial improvement and one (4%) showed mild improvement. In five of the seven vascular malformations (71%) lymphatic malformations resolved completely, and two (29%) venous malformations showed substantial improvement. Of the 13 patients presenting with discoloration, there was complete resolution in one (7.7%), marked reduction in 11 (84.6%) and mild reduction in one (7.7%). Of seven patients presenting with pain, there was complete resolution in two (28.6%), marked reduction in two (28.6%), mild reduction in two (28.6%), and no improvement in one (14.3%). There were no pulmonary complications. Conclusion: Ultrasound-guided intralesional injection of bleomycin is an option to consider for the treatment of certain types of cutaneous hemangiomas and vascular malformations. Prospective studies should be undertaken to understand the various factors contributing to therapeutic success.

The association of statin therapy with the risk of recurrent venous thrombosis

Essentials A lowered risk of recurrent venous thrombosis (VT) with statin treatment is controversial. Among observational inception cohort of 2,798 adults with incident VT, 457 had recurrent VT. Time-to-event models with time-varying statin use and adjustment for potential confounders was used for analysis. Compared to nonuse, current statin use was associated with 26% lower risk of recurrent VT. Click to hear Prof. Büller's perspective on Anticoagulant Therapy in the Treatment of Venous Thromboembolism Background Meta-analyses of randomized controlled trials suggest that treatment with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) lowers the risk of incident venous thrombosis (VT), particularly among those without prevalent clinical cardiovascular disease (CVD). Whether this is true for the prevention of recurrent VT is debated. We used an observational inception cohort to estimate the association of current statin use with the risk of recurrent VT. Methods and Results The study setting was a large healthcare organization with detailed medical record and pharmacy information at cohort entry and throughout follow-up. We followed 2798 subjects 18-89 years of age who experienced a validated incident VT between January 1, 2002, and December 31, 2010, for a first recurrent VT, validated by medical record review. During follow-up, 457 (16%) developed a first recurrent VT. In time-to-event models incorporating time-varying statin use and adjusting for potential confounders, current statin use was associated with a 26% lower risk of recurrent VT: hazard ratio 0.74, 95% confidence interval 0.59-0.94. Among cohort members free of CVD (n = 2134), current statin use was also associated with a lower risk (38%) of recurrent VT: hazard ratio 0.62, 95% confidence interval 0.45-0.85. We found similar results when restricting to new users of statins and in subgroups of different statin types and doses. Conclusions In a population-based cohort of subjects who had experienced an incident VT, statin use, compared with nonuse, was associated with a clinically relevant lower risk of recurrent VT. These findings suggest a potential secondary benefit of statins among patients who have experienced an incident VT.

NEED ANALYSIS FOR IDENTIFYING ESP MATERIALS FOR MEDICAL RECORD STUDENTS IN APIKES CITRA MEDIKA SURAKARTA

Identifying teaching material is the process of selecting, adapting and evaluating of teaching based on specific necessities of the students. Need Analysisis really needed to identify teaching materials for English for Specific Purpose. The researchobjective is toidentify the ESP materials for teaching 3rd semestermedical record students at Academy of Medical Record and Health information Citra Medika (APIKES CITRA MEDIKA) Surakarta. The work used qualitativeand quantitative methods. The outcomesof this study showed the real necessities of students in learning English to prepare their future at the field of medical record and health information. Findings of the need analysis demonstrate that all four of the language skills were necessary for their academic studies and their target career. There are certain topics related to English for medical record such as medical record staff’ duties, ethical and legal issues in medical record, Hospital statistics, Medical record filling system, Health information system, and so on. Accordingly, this study proposes new ESP materials based on the stakeholders’ needs.It is suggested that textbook or handout of English for Medical Record will be made based on the Need Analysis by ESP designers and ESP lecturers involve actively recognizing the progressive needs of medical record students.

Emergency Physicians' Experience with Advance Care Planning Documentation in the Electronic Medical Record: Useful, Needed, and Elusive.

For patients' preferences to be honored, emergency department (ED) physicians must be able to find and use advance care planning (ACP) information in the electronic medical record (EMR). ED physicians' experiences with ACP EMR documentation and their documentation needs are unknown. We surveyed 70 ED physicians (81% response rate) from a tertiary and county ED. Our primary outcome was confidence finding and using ACP EMR documentation (percentage reporting very/extremely on a five-point Likert scale). Secondary outcomes included frequency of use and perceived usefulness of types of ACP documentation. Suggestions for improvement were analyzed using thematic content analysis. Participants' mean age was 36 years (± 9) and 54% were women. Thirty-one percent reported being very/extremely confident they could find ACP EMR documentation, and 55% felt very/extremely confident they could use it to care for patients. Yet 74% needed it ≥1 time/week and 43% ≥5 times/week. Participants reported code status orders (90%), Physician Orders for Life Sustaining Treatment (POLST) (86%), and durable power of attorney for health care (78%) as very/extremely useful, followed by values statements (31%), oral directives (34%), and living wills (37%). ED physicians wanted highly visible ACP information, "on the main screen." EMR systems are not optimized to provide critical ACP information to ED physicians who lack confidence finding or using ACP EMR documentation to care for patients. Dedicated ACP information on the EMR home screen and tailored training may be needed to help ED providers find, use, and discuss ACP documentation to provide care aligned with patients' goals.

The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence.

BackgroundWeb-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website’s benefits can identify barriers to user engagement and maximize future use.ObjectiveWe developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial.MethodsWe recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants’ favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP.ResultsEnrolled participants (N=32) were an average of 51.7 ± 11.8 years old, 66% (21/32) female, 60% (19/32) non-Hispanic White, 88% (28/32) had more than 12 years of education, half had household incomes over $50,000, and 78% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 ± 6.3 years, average A1c was 7.4 ± 2.0, and 38% (12/32) were prescribed insulin. Of enrolled participants, 91% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an unspecified format). Participants also reported difficulty accessing the site and, once accessed, using all of its features. Participants recommended improving the site’s user interface to facilitate quick, efficient access to all features and content.ConclusionsAdults with T2DM rated the Diabetes MAP website favorably on surveys, but focus groups gave more in-depth feedback on the user experience (eg, difficulty accessing the site, maximizing all of the site’s features and content, and recovering from errors). Appropriate usability testing methods ensure Web-delivered interventions work as intended and any benefits are not diminished by usability challenges.

Natural Language Processing and Technical Challenges of Influenza-Like Illness Surveillance

Processing free-text clinical information in an electronic medical record may enhance surveillance systems for early identification of influenza-like illness outbreaks. However, processing clinical text using natural language processing (NLP) poses a challenge in preserving the semantics of the original information recorded. In this study, we discuss several NLP and technical issues as well as potential solutions for implementation in syndromic surveillance systems.

Physician and Parent Perspectives on Psychosocial and Emotional Data Entry in the Electronic Medical Record in a Pediatric Setting.

Objective:This pilot study was conducted to evaluate physician and patient preferences for documentation of emotional and psychosocial information in the electronic medical record (EMR).Methods:Pediatricians from an academic medical center and parents of patients in an academic pediatric rheumatology practice were surveyed on 10 different elements using Likert-type scale items (1 = not at all important, 10 = extremely important). The importance of the proposed categories was evaluated by means testing and pairwise comparisons of the responses.Results:Responses were obtained from 45 physicians and 35 parents. The overall mean scores for physicians and parents were 7.70 and 7.44, respectively. Scores on personality, friends, and school differed between physicians and parents, but those differences were not significant after adjustment for multiple comparisons (P = .13, .17, and .26, respectively). Fears, special requests, and special needs were in the high-score group for both physicians and parents.Conclusion:Physicians and parents reported that the incorporation of emotional and psychosocial information into the EMR added value to the health care of children.

Initial Benchmarking of the Quality of Medical Care in Childhood-Onset Systemic Lupus Erythematosus.

To assess the quality of medical care in childhood-onset systemic lupus erythematosus (SLE) at tertiary pediatric rheumatology centers as measured by observance of SLE quality indicators (SLE-QIs). International consensus has been achieved for childhood-onset SLE-QIs capturing medical care provision in 9 domains: diagnostic testing, education of cardiovascular (CV) risk and lifestyles, lupus nephritis (LN), medication management, bone health, ophthalmologic surveillance, transition, pregnancy, and vaccination. Using medical record information, the level of performance of these childhood-onset SLE-QIs was assessed in childhood-onset SLE populations treated at 4 tertiary pediatric rheumatology centers in the US, 2 in Brazil, and 1 center in India. A total of 483 childhood-onset SLE patients were assessed. Care for the 310 US patients differed markedly for childhood-onset SLE-QIs addressing LN, bone health, vaccinations, education on CV risk, and transition planning. Performance of safety blood testing for medications was high at all centers. Despite often similar performance on the childhood-onset SLE-QI, access to kidney biopsies was lower in Brazil than in the US. Irrespective of the country of practice, larger centers tended to meet the childhood-onset SLE-QIs more often than smaller centers. The childhood-onset SLE-QIs, evidence-based minimum standards of medical care, are not consistently met in the US or some other countries outside the US. This has the potential to contribute to suboptimal childhood-onset SLE outcomes.

Idiopathic Canine Laryngeal Paralysis as One Sign of a Diffuse Polyneuropathy: An Observational Study of 90 Cases (2007-2013).

To determine survival and incidence of complications in dogs with idiopathic laryngeal paralysis (ILP) and concurrent neurologic signs. Observational study. Dogs (n = 90) with ILP. Medical records (January 2007-June 2013) of dogs with ILP were reviewed. Neurologic comorbidities, including pelvic limb neurologic abnormalities and esophageal abnormalities were identified. Using medical record information and client interviews, the relationship between these comorbidities and postoperative survival (primary outcome measure) and postoperative complications (secondary outcome measure) was identified. Dogs that had surgical correction of ILP had a 2.6-fold reduction in the hazard of death throughout the study period (HR = 2.6; 95% CI: 1.34-4.84, P = .006). Owner assessed patient quality of life (10-point scale) increased by an average of 4.1 ± 1.4 units immediately postoperatively, and 4.9 ± 0.9 units until death or followup compared with preoperative values. Thirty-five of 72 dogs available for followup had evidence of diffuse neurologic comorbidities. Overall complication rate for dogs with neurologic comorbidities was 74%, compared with 32% for dogs without neurologic comorbidities. Presence of any neurologic comorbidity was associated with a significantly greater odds of any complication (OR = 4.04; 95% CI: 1.25-13.90, P = .019) as well as recurring complications (OR = 8.00; 95% CI: 1.49-54.38; P = .015). Surgical correction of ILP was positively associated with survival, and dogs with neurologic comorbidities were at greater risk for developing postoperative complications.

EXCLUSIVE BREASTFEEDING AND MATERNAL SELF-EFFICACY AMONG WOMEN OF INTIMATE PARTNER VIOLENCE SITUATIONS

ABSTRACT This study aims to evaluate the practice of breastfeeding among women in intimate partner violence situation during the current pregnancy for the duration of exclusive breastfeeding, the level of self-efficacy in breastfeeding, related factors from the beginning, the establishment of breastfeeding and early weaning. Cross-sectional study. 63 women in intimate partner violence situation in the current pregnancy participated, identified by survey in antenatal service. Data collection was performed in the prenatal and postpartum period. We used a questionnaire to identify the intimate partner violence, the Breastfeeding Self-Efficacy Scale and medical record information. The average days of exclusive breastfeeding was 19.08. There was no statistically significant association between the duration of exclusive breastfeeding at 30 and 70 days postpartum and intimate partner violence and care practices with level of self-efficacy to breastfeed. We found association between the type of breastfeeding at 30 and 70 days postpartum and better conditions vital of newborns with level of self-efficacy to breastfeed.

Prevalence and Risk Factors for Pressure Ulcer in Hospitalized Adults

BACKGROUND: Pressure ulcers represent a serious public health problem, serving as a quality indicator (negative) the assistance provided by the health services. The aim of this study was to identify the prevalence of pressure ulcers in the Intensive Care Unit of a University Hospital in Joao Pessoa-PB and check the associations between socio-demographic and clinical data of customers and risk factors for the development of these. METHODS: The study of the sectional, quantitative, carried out with 78 patients in the Intensive Care Unit of a University Hospital in Joao Pessoa. Data were collected from medical record information from January to December 2014. RESULTS: Ten patients had pressure ulcers, and 6 already admitted with injuries and the 4 developed during hospitalization in the studied sector. The prevalence of these lesions in the sample was 12.8%. Has been identified as risk factors associated with pressure ulcer (p <0.05) the reason for hospitalization, pre-existing conditions, level of consciousness, ventilation, peripheral perfusion, hydration and the use of antidepressant/anti-inflammatory drugs. CONCLUSION: The results underscore the importance of this study for academic and professional environment, with regard to the promotion of knowledge of some risk variables for ulcers, being able to influence behavior and thus expand excellence in care. The involvement of the whole multidisciplinary team regarding the prevention, improves the quality of life of individuals, decreases the rescue professionals, the burden of treatment and hospitalization time.