Paper Charts Research Articles

Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

BackgroundAntibiotic use in primary care can drive antimicrobial resistance (AMR) in the community. However, our understanding of antibiotic prescribing in low- and middle-income countries (LMICs) stems mostly from hospital-based studies...

Clinical and Immunological Features of 78 Adult Patients with Primary Selective IgG Subclass Deficiencies.

The purpose of this study is to describe both clinical and immunological features in large cohort of adult patients with IgG subclass deficiency, and response to immunoglobulin therapy. This is a retrospective study of data obtained from electronic medical records and paper charts of 78 patients with IgG subclass deficiency seen and followed at our immunology clinics from 2010 to 2016. Both isolated selective IgG subclass deficiency as well as combined (two) subclass deficiencies were observed. IgG3 subclass deficiency, isolated and in combination with other IgG subclass deficiency, is the most frequent of IgG subclass deficiency. A majority of patients presented with upper and lower respiratory tract infections, especially chronic sinusitis. Both allergic and autoimmune manifestations are common; however, there is no subclass preference. The proportions and absolute numbers of CD3+ T cells, CD4+ T and CD8+ T cells, CD19+ B cells, and CD3-CD16+CD56+ NK cells were normal in the majority of patients in all IgG subclass deficiencies. Total serum IgG levels did not correlate with IgG subclass levels across all IgG subclass deficiencies. Anti-pneumococcal polysaccharide antibody responses were impaired in 56% of patients. IgG3 subclass deficiency is the most common IgG subclass deficiency, and anti-polysaccharide antibody responses are distributed among IgG subclasses with modest preference in IgG2 subclass. The majority of patients treated with immunoglobulin responded by reduction in frequency of infections and requirement of antibiotics.

Adding value to ENCs: Land features

Abstract. In the 1990’s, the International Maritime Organization (IMO) adopted the International Hydrographic Office’s (IHO) S-57 performance standards for Electronic Navigation Charts (ENC), which enforce standardized content, structure, and format. The IMO also revised its Safety of Life at Sea (SOLAS) chapter V regulations to require Electronic Chart Display and Information Systems (ECDIS) onboard certain SOLAS class vessels, starting from 2018. These systems allow for navigating with ENC data, which has several advantages over paper charts; however, many mariners still prefer traditional paper or raster charts. Through the feedback of key stakeholders such as local pilot associations, it has become apparent that the preference for raster or paper charts is due to the inclusion of non-critical S-57 land features. These S-57 land features, which are typically not added to ENC products, such as roads and elevation contours, can supplement navigational positioning systems by providing visual references, particularly when other landmarks (e.g., spot elevations on major topographic features) are not present on the ENC. Moreover, charting roads on ENC products can be useful for locating water access points. This paper discusses the addition of roads and land elevation contours to NOAA’s re-schemed ENC suite in an effort to supplement currently charted marine features and land features crossing over water. General cartographic guidelines have also been developed for the representation of these features through ENC scales (i.e., usage bands 3 to 5). Additionally, this paper includes a discussion on the benefits and challenges of incorporating publicly available land transportation data versus traditional sources on ENC products.

Raster charting products in an ENC-first era

Abstract. Nautical charts are an essential tool for marine navigation. Despite the introduction of global positioning systems (GPS) and electronic navigational tools that present navigation data in a vector format on a display, paper charts are still the preferred choice for many mariners. Interestingly, since the introduction of Electronic Navigation Charts (ENCs) more than thirty years ago, the size of commercial vessels has increased more than four-fold, modern navigational systems have become more sophisticated, and recreational boaters have joined professional mariners in using electronic chart displays. Marine and coastal users of all types are expecting higher resolution and more precision in location of the charted features, and shorter update times for data sources to be published on the chart. With NOAA’s new plan to “standardized, consistent gridded framework” that is optimized for digital displays, it leaves the future of paper charts in question. In order to support a raster-based maintenance system, it is now possible to translate encoding attributes of vector objects into standardized chart symbols and labels. Thus, simplifying workflow processes for paper and raster chart production. This paper discusses NOAA Marine Chart Division’s raster workflow in an ENC-first production line. The paper reviews the benefits of the new desktop tools and web-services for providing chart updates in a timely manner for a broader community.

Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis.

The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts. Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions. We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods. We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates. Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

Abstract Objective Electronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation. Design Prospective, manual time-motion observations of ophthalmology trainees in 2018. Participants Eleven ophthalmology residents and fellows observed during 156 patient encounters. Methods Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models. Main Outcome Measures Total time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients. Results Seven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: –2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: –3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011). Conclusion Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.

ECDIS transitional period completion: analyses, observations and findings

During the past three decades, the Electronic Chart Display and Information System (ECDIS) evolved from its initial purpose to a complex navigation support tool. The transition from paper to electronic charts represents a substantial step in navigation, contributing to the reduction of the navigator’s workload, ease of execution of navigational tasks and integrated information and data fusion. In the system handling, Masters and Officers of the Watch (OOWs) are experiencing various issues ranging in their nature. The proposed paper represents a segment of a systematically carried out research among ECDIS stakeholders. The aim of the ECDIS EHO (Experience, Handling and Opinion) research is the development of an educational framework and the improvement of the Maritime Education and Training (MET) processes. This is to be achieved through a specific approach, proper communication and subtle educational, practical and research activities that have developed through time and research segments accomplishment, always striving at the user-centred, often neglected issues and their solving. The research methodology has been described in the respective chapter, together with the questionnaire which represents one of the main research tools. This segment of the research refers to opinions and attitudes of Masters and OOWs towards ECDIS mandatory implementation period completion, as collected from the ECDIS EHO questionnaire. The answers to the questions regarding the system role as a justified replacement of paper charts and the features of the means of navigation when compared with another have been categorised and discussed. Individual knowledge has been examined concerning new technology perception and understanding of the ECDIS system. The analyses and answers processing and accompanying comments have revealed certain illogicalities referring to the acceptance of the system as a mandatory, primary and often only, means of navigation. The level of acceptance and opinions regarding two means of navigation features have differed among respondents, irrespectively of their seagoing experience, navigational rank, ECDIS experience and the level of education. The analyses have revealed the need for the adaptation of ECDIS Education and Training to a particular navigational rank regarding engagement with the system. A new approach of the targeting methodology has been introduced and conducted. Critical groups of respondents have been identified and elaborated further. The research has resulted in the organisation of a new ECDIS MET course at the Faculty of Maritime Studies of the University of Rijeka. Considering the obtained results and the ongoing system development, findings and solutions have been presented in the conclusion chapter, together with the means of their achievements and the further work.

Long-term survival of structurally compromised tooth preserved with crown lengthening procedure and restorative treatment: A pilot retrospective analysis.

Since there is limited study to assist in an evidenced-based decision whether to extract or preserve a structurally compromised tooth, the aim of this retrospective study was to investigate the long-term survival rate of tooth preservation after crown lengthening procedure (CLP) and restorative treatments. Electronic and paper chart of patients received CLP in our graduate clinic from 1990 to 2015 were reviewed. Statistical analysis was done using Cox regression analysis and Kaplan-Meier estimator. A total of 766 coded charts were initially collected. Four hundred and fourteen cases were included in the final analysis. The Kaplan-Meier estimate shows a cumulative survival rate of 88.3% in 5years, 78.4% in 10years and 68.1% in 15years. In terms of reasons for failure, restorative problem such as recurrent decays was the main issue (35.2%), followed by fracture (29.6%), endodontic complications (23.9%) and periodontal breakdown (11.3%). Within the limitation of this study, structurally compromised teeth have a reasonable long-term survival rate close to 80% after 10years in a teaching institute. Patients with high fracture or caries risk may pose a higher chance of failure. Objective information should be presented to the patient to arrive at an evidence-based decision.

Socioeconomic disparities among uninsured cancer patients: A free clinic study.

e18110 Background: Cancer is the second leading cause of death in the United States and approximately 38.4% of Americans will be diagnosed with cancer during their lifetime. Cancer treatment and follow-up care is expensive and uninsured individuals may face barriers to receiving necessary treatments. Minorities may encounter additional barriers to accessing healthcare. There is limited research about socioeconomic disparities in uninsured cancer patients seen at free clinics in the United States. Methods: A retrospective chart review was conducted to collect chronic disease parameters from electronic medical records and paper charts at nine free clinics in the Tampa Bay area in Florida. Demographics were compared between cancer patients and the non-cancer population via chi-square test or independent samples t-test. Results: Between January 2016 and December 2017, 9127 uninsured patients were seen at nine free clinics. 2137 patients were excluded from the study because there was no cancer data in their charts. Of the patients included in the study, 221 (3.2%) had a current or past diagnoses of cancer. Cancer patients were more likely to be female (n = 145, 65.9), p = 0.048, compared to non-cancer patients. Cancer patients were more likely to be Caucasian (n = 106, 89.1%), p < 0.001 compared to non-cancer patients (n = 2489, 69.3%). Cancer patients were less likely to be African American compared to non-cancer patients (n = 6, 5.0% vs. n = 754, 21%), p < 0.001. Cancer patients were significantly older than non-cancer patients (M = 54.1, SD = 12.0) vs. (M = 41.0, SD = 16.7), p < 0.001. Patients who had cancer were more likely to be unemployed compared to non-cancer patients (n = 78, 54.9% vs. n = 1685, 46.6%), p = 0.050. Conclusions: The study revealed that uninsured cancer patients are more likely to be unemployed, female, of older age, and Caucasian compared to non-cancer patients. It appears that uninsured African Americans are not utilizing free clinics for their healthcare and may be lost to follow-up. A variety of factors may have contributed to these disparities in this vulnerable population including lack of transportation, lack of awareness of free resources in the area, and more. This study increases awareness of disparities in uninsured, cancer patients.

P093: Quality assurance programs for tests pending at discharge from emergency departments: a systematic review

Introduction: Emergency department (ED) care allows for the rapid assessment of patient concerns, but often leads to tests being performed that are not finalized or reviewed prior to patients leaving the ED. The follow-up for these tests pending at discharge (TPADs), most commonly final diagnostic imaging (DI) reports and microbiology cultures, is a major medico-legal concern for ED providers and significant safety concern for patients. We therefore performed a systematic review of the literature to identify existing ED quality assurance (QA) processes to address TPADs relating to final DI reports and microbiology cultures. Methods: Comprehensive literature searches were developed with a medical librarian and conducted in Ovid Medline, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL from inception through May 8, 2018. Studies were included if they described an intervention or program designed to follow-up relevant ED TPADs, and excluded if they pertained to communication between departments or clinicians only rather than with patients. Study selection was performed independently by two reviewers in two steps (title and abstract review, then full-text review), with all discrepancies resolved by consensus with a senior reviewer. The primary outcome was the description of any QA process to follow-up on TPADs and secondary outcomes included quantifiable results of successful interventions or programs. Results: From the 11,685 articles identified, 58 were selected for full-text review, and 12 met eligibility criteria. In the included studies, the responsibility for following up on TPADs was owned by different members of the care team (e.g., ED physicians, nurses or radiologists) and recorded in a variety of ways (e.g., electronic medical record, paper chart, system designed for TPADs). Follow-up pathways with variable standardization were described, ranging from dedicated assignment for TPAD duties with protected/remunerated time to do so, to follow-up completion done by the first clinician to receive the TPAD result. Studies that evaluated their QA process implementation found that more patients were notified of abnormal test results, follow-up times decreased, and fewer unnecessary antibiotics were used. Conclusion: A variety of QA processes have been implemented to follow up on ED TPADs in terms of personnel involved, charting and logistics, and when evaluated, they have improved patient care.

SUN-526 Prevalence of Hyperparathyroidism in X-Linked Hypophosphatemia

X-linked hypophosphatemia, due to PHEX mutations results in elevated fibroblast growth factor 23, hypophosphatemia and rickets/osteomalacia. Conventional therapy requires high doses of phosphate salts combined with active vitamin D analogues. Known complications of this regimen include nephrocalcinosis and secondary and tertiary hyperparathyroidism. The prevalence of hyperparathyroidism and treatment with parathyroidectomy in XLH is uncertain. The goal of this study was to estimate the prevalence of hyperparathyroidism and parathyroidectomy among XLH patients. We also characterized the outcome of parathyroidectomy for XLH patients. We conducted a retrospective chart review study from 1/1/2010 to 12/31/2017 using data from electronic records and paper charts. All XLH patients attending our center were eligible for analysis if they had at least one concurrent measurement of parathyroid hormone (PTH) and serum calcium. Categorization was based on the highest PTH and calcium values, persistence of hypercalcemia and a history of parathyroidectomy. Of the 104 patients having a diagnosis of XLH, 84 had concurrent measurements available of calcium and PTH. Data were available from 46 patients as adults and 43 as children (5 as both). Of these, 71/84 (84.52%), had evidence of secondary or tertiary hyperparathyroidism at any time point. Secondary hyperparathyroidism (defined as any PTH value ≥65pg/mL and not hypercalcemic) occurred in 35/43 (81.4%) children and 41/46 (89.1%) adults at any time point. Resolution of secondary hyperparathyroidism was observed in all children, except two with parathyroidectomies at ages 15 and 18 for tertiary hyperparathyroidism. Resolution of secondary hyperparathyroidism was observed in 27/41 adults. Tertiary (or hypercalcemic) hyperparathyroidism had an overall prevalence of 14/84 (16.67%) patients or 14/46 (30.4%) of adults (n=10 with PTH ≥65 pg/mL plus Calcium ≥10.5 mg/dl; n=1 with PTH ≥65 pg/mL plus Calcium 10.2-10.4 mg/dl; n=2 with PTH ≥50 pg/mL plus Calcium ≥10.5 mg/dL; n=1 with parathyroidectomy prior to presentation to our center). Parathyroidectomy was documented in 8/84 (9.5%) of the total population, or 8/46 (17.4%) of adults with XLH. After parathyroidectomy, residual or recurrent tertiary hyperparathyroidism was detected in 6/8 patients at a median of 6 years (ranging from 0 to 29 years). One patient had chronic postoperative hypoparathyroidism, and one patient remains normocalcemic 4 years after surgery. The majority of patients with XLH develop hyperparathyroidism during treatment with phosphate and active vitamin D. A significant proportion develop hypercalcemic hyperparathyroidism and most had recurrence of parathyroid autonomy after surgery. Careful monitoring and dose adjustment to minimize elevations of PTH are recommended.

The potential impact of an electronic medication management system on safety‐critical prescribing errors in an emergency department

AbstractBackgroundMedication errors in hospitals are common. Although electronic medication management systems (eMMS) have the potential to reduce errors during inpatient care, little is known about their effect in emergency departments (ED).AimThe aims of this study were to report on the types of prescribing errors in an ED prior to implementation of an eMMS, to assess the risk the errors pose to patient safety and to evaluate whether safety‐critical errors were potentially preventable with a newly implemented eMMS.MethodsMedication orders on paper charts were assessed for prescribing errors by a clinical hospital pharmacist. Error severity was rated using a five‐point scale. Errors of moderate or higher severity, and all errors involving defined high‐risk medicines were considered safety‐critical errors. The potential for safety‐critical errors to be prevented by the eMMS was rated (likely, possibly or unlikely).ResultsAcross 239 medication orders, 208 errors (27 clinical, 181 legal or procedural) were identified. The overall prescribing error rate was 0.87 errors/order. There were 67 safety‐critical errors (53 legal or procedural, 14 clinical). Overall, 82.1% of errors were likely preventable by eMMS. However, of the clinical safety‐critical errors, only 2 (14.3%) were considered likely preventable.ConclusionAlthough eMMS has the capacity to prevent a high proportion of safety‐critical legal or procedural errors in the ED, clinical prescribing errors in this category were unlikely to be prevented by using eMMS. Further investigation of these more severe error types could guide the design of eMMS decision support to improve system effectiveness.

Epidemiology of traumatic injuries presenting to an ED in Central Haiti: a retrospective cohort study

BackgroundIn Haiti, like many low-income countries, traumatic injuries are leading causes of morbidity and mortality. Yet, little is known about the epidemiology of traumatic injuries in Haitian EDs. Improved understanding...

Controle estatístico de processo paramétrico e não paramétrico em uma indústria de laticínios

O Brasil é um dos maiores produtores mundiais de leite bovino, sendo que grande parte é destinada para fabricação de queijos. Para que a indústria queijei ra se mantenha, o leite, sua principal matéria-prima, deve ser de qualidade. Sendo a qualidade do leite avaliada por diversas variáveis em fluxo contínuo, o controle estatístico de processo (CEP) pode ser uma ferramenta para monitorá-la. Neste trabalho foram utilizadas cartas de controle paramétricas e não paramétricas para verificar se o processo de recebimento de leite em uma queijaria da cidade de São Luís de Montes Belos, Goiás, estava sob controle estatístico. Foram verificadas normalidade e simetria dos dados, e como esperado, o CEP paramétrico se mostrou aparentemente mais poderoso. Os autores sugerem a utilização de CEP como ferramenta para assegurar a qualidade de laticínios, mas sempre verificando se as pressuposições de cada metodologia são atendidas. Em específico, se verificada normalidade, as cartas paramétricas são mais poderosas e por isso, são aconselhadas.

Application of Information Technologies and Algorithms in Ship Passage Planning

Abstract With the continuous increase of international oil prices, more and more shipping companies look for new solutions to the ever present question: How to reduce operational fuel consumption and decrease air pollution. Ship route planning is an indispensable part of the ship navigation process. In the modern world, the passage planning aspect of navigation is shifting. No longer do we see mariners drawing course lines on a paper chart. No longer do they calculate distances with compasses. Elaborate algorithms on various digital devices perform all these tasks. Algorithms plot the optimum tracks on digital charts and algorithms can decide how to avoid collision situations. Nowadays charter companies do not rely solely on the experienced navigators on board their vessels to decide the best route. Instead, this task is outsourced ashore to routing and weather-routing enterprises. The algorithms used by those enterprises are continuously evolving and getting better and better. They are coming popular because of another reason – more and more the shipping society support the newly idea for using crewless ships. However, are they up to the task to eliminate the human element in passage planning? In this article, we are going to review some of the weak points of the algorithms in use.

The Updating of the Nautical Chart Number 69 on Java Sea Area for Safety Navigation of Sailing

Indonesia is the largest archipelagic country in the world that has become one of the main routes in international marine trade by contributing 40% of all international marine trade routes. The importance of waterways in international trading demands the existence of nautical chart for navigation. Time after time, the sea changes, therefore nautical chart needs to be update especially on the area that has a high marine traffic density such as Java Sea which currently has developed an electronic map for navigation, however paper charts are still needed for planning shipping line, the navigation on small boats and backup of charts on large ships. The aim to be achieved from this research is the availability of the latest paper chart which is appropriate with IHO standard S-4, INT1 (symbols, abbreviations and terms used on charts), INT2 (the boundary lines, gradient, grid and linear scale) and Chart Number 1. Updating chart number 69 was created by using data Electronic Navigation Chart (ENC) Northen part of Central Java region, data raster paper chart number 69 the ninth edition of the second expenditure, survey data 2017 in Cirebon and the Eastern part of Java Sea and Indonesian Notice to Mariners number 11-29 year 2017. Data obtained from the Pusat Hidrografi dan Oseanografi TNI-AL. The software used in production of nautical chart is Paper Chart Composer (PCC). Then it was added the updated data and information to the chart. The result of production a chart were corrected using digital and manual quality control analysis to eliminate errors in the process of production chart. As a result of updating nautical chart number 69 is that some of the objects that had been corrected have errors so it needs to be repaired until no more errors occur. The updating paper chart was already matched to standard IHO S-4 and INT1. The visualization of paper chart in accordance with the standard IHO INT2 and Chart number 1. The avaibility of paper chart number 69 with the update of data on the area of the Java Sea has been accomplished and can be used by mariner to navigation.

Analysis of Systems Ensuring the Acquisition of Real-Time Cartographic Navigation Information

Abstract Electronic Chart Display and Information Systems (ECDIS), which are used on vessels and can replace paper charts, allow to obtain and display on electronic charts information from basic and additional data sources. For the certified use of ECDIS instead of paper charts, it is necessary to ensure constant updating of Electronic Navigation Chart (ENC) data provided to vessels for use. The known visual and satellite observation systems intended for cartographic information update are costly, have low accuracy and do not allow to quickly update navigational charts in real-time mode. The stand-alone use of remotely piloted aircraft (RPA) will make it possible not only to substantially reduce costs and increase the accuracy of monitoring, but also to provide information in real-time mode.

UScale: a digital device for automatic urine volume measurement and frequency volume charting.

Background:Health issues relating to the lower urinary tract are an increasing burden on the health economy. Measurement of urination frequency/volume using diaries to evaluate symptoms and assess severity is established in the management of these health problems. In current practice, these frequency volume diaries are completed by voiding into a measuring jug and the completion of paper or digital charts. Despite being shown useful to diagnosis, this can be a cumbersome method of data collection, leading to issues with patient compliance. In this paper we describe the established benefits of providing clinicians accurate micturition data followed by an analysis of the problems with the current data collection method.Methods:We introduce our prototype electronic device and accompanying method, which is designed to improve data accuracy and patient compliance, while reducing patient training requirements and clinician workload.Results:The device hardware calibration and testing procedure is described, and two sets of initial data from assumed healthy volunteers are presented, allowing us to demonstrate the advantages of digital data in the fast calculation of diary summary statistics and their potential use to clinicians.Conclusions:We discuss the design improvements to the UScale device, collection bag, and electronic medical records integration undertaken while validating our described method.

Towards Paperless Vessels: A Master’s Perspective

The transitional period of implementation of the Electronic Chart Display and Information System (ECDIS) expired on July 1st, 2018. As for this date onward, vessels of 3000 GT or more subject to the Safety of Life at Sea (SOLAS) Convention and engaged in international voyages, must be fitted with an official ECDIS system. The Convention furthermore requires mandatory possession of navigational equipment as an adequate back-up. In case that independent system is used for this purpose, there is no further obligation for a vessel to possess traditional paper navigational charts and it can be considered as paperless. Beside paper charts, this term also implies digital nautical publications and probably an electronic ship’s log in the foreseeable future. The interpretation of ECDIS differs considering particular rank of an Officer of the Watch (OOW) and its engagement towards the system. The system should be accepted by OOWs as true end-users. The proposed paper elaborates opinions and standpoints of decisive end-users towards the system, its role as a primary navigational means, and the fact that traditional navigation conduct is replaced by digital means. For this purpose a survey between OOWs was conducted focusing on their answers to respective questions. The sample size allowed for the observation of opinions over several years and the definition of the ECDIS acceptance level. Results are presented and discussed together with proposals of new activities which have to be carried out to improve the safety of navigation by the ECDIS system and its further development.

Predictors of sling revision after mid-urethral sling procedures: a case-control study.

To identify patient characteristics and surgical factors predictive of complications requiring mid-urethral sling (MUS) revision/removal. Case-control study. Tertiary academic centre in Canada. One hundred and seven women undergoing MUS revision/removal between 2005 and 2016 were matched with 214 controls by date of index MUS procedure (2:1 ratio). Data on patient and surgical factors were obtained via manual electronic and paper chart review. Three sets of pre-specified simple and multivariable logistic regression models were fitted to: (1) examine previously reported risk factors for MUS revision after primary surgical treatment; (2) identify preoperative predictors of MUS complications requiring revision/removal; and (3) identify surgical factors associated with this outcome after adjusting for potential confounding factors. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for patient and surgical factors. The median time to MUS revision was 153 days (interquartile range, IQR 49-432 days). Active smoking status (OR 2.29, 95% CI 1.13-4.63, P = 0.03), having had a previous hysterectomy (OR 3.88, 95% CI 2.02-7.46, P < 0.01), and undergoing concomitant pelvic organ prolapse surgery at the time of the index MUS procedure (OR 2.63, 95% CI 1.32-5.52, P < 0.01) were independently associated with the need for MUS revision/removal. Sling type (obturator versus retropubic), method of tensioning (to cough versus over instrument), anaesthetic type, and estimated blood loss were not associated with this outcome in the analysis presented here. Active smoking status, having had a previous hysterectomy, and undergoing concomitant surgery for pelvic organ prolapse are risk factors for requiring subsequent MUS revision/removal. Risk factors for sling revision include smoking, previous hysterectomy, and concomitant prolapse surgery.