Patient Data Management System Research Articles

Retrospective analysis of the resuscitation room management of nontraumatic critically ill children in a university emergency department (OBSERvE-DUS-PED study)

The establishment of a resuscitation room management for nontraumatic critically ill children appears to make sense. This study collected data of pediatric patients suffering from nontraumatic critically ill conditions treated in aresuscitation room. The retrospective OBSERvE-DUS-PED study (November 2019-October 2022) recorded pediatric patients (age < 18years) who were admitted to the emergency department (ED) for resuscitation room care. The routinely documented data on treatment were taken from the hospital information system MEDICO® and the patient data management system COPRA® in accordance with the OBSERvE dataset. The study was approved by the Ethics Committee of the Medical Faculty of the Heinrich Heine University (2023-2377). The study included 52pediatric resuscitation room patients. Adolescents aged 14-17years were the most frequent in the cohort representing 37% of the total and neonates/infants (0-1year) were lowest at 8%. The most common symptoms categorized according to ABCDE problems were disturbance of consciousness(D) at 61%, cardiovascular failure(C) at 25%, respiratory insufficiency(B) at 6%, airway obstruction(A) and exposure/environment (E) problems each at 4%. The out-of-hospital and in-hospital emergency procedures were performed with the following frequencies: venous (58%vs. 65%), intraosseous (14%vs. 2%) and central venous access (0%vs. 12%), invasive airway management (35% vs.8%), cardiopulmonary resuscitation (21%vs. 10%), vasopressors (15%vs. 17%), and intra-arterial pressure measurement (0%vs. 17%). The mean duration of resuscitation room management was 70 ± 43 min. The 30-day mortality was 17%. The OBSERvE-DUS-PED study demonstrates the major challenges in the care of critically ill nontraumatic pediatric patients, both in out-of-hospital and in-hospital management. The variety and complexity of the referral diagnoses as well as the immediate vital threat to the patients make it appear sensible to treat such patients primarily in aresuscitation room of the ED due to the available material, infrastructural and personnel resources.

A qualitative, multi-centre approach to the current state of digitalisation and automation of surveillance in infection prevention and control in German hospitals

BackgroundHealthcare associated infections (HAI) pose a major threat to healthcare systems resulting in an increased burden of disease. Surveillance plays a key role in rapidly identifying these infections and preventing further transmissions. Alas, in German hospitals, the majority of surveillance efforts have been heavily relying on labour intensive processes like manual chart review. In order to be able to identify further starting points for future digital tools and interventions to aid the surveillance of HAI we aimed to gain an understanding of the current state of digitalisation in the context of the general surveillance organisation in German clinics across all care-levels. The end user perspective of infection prevention and control (IPC) professionals was chosen to identify digital interventions that have the biggest impact on the daily surveillance work routines of IPC professionals. Perceived impediments in the advancement of surveillance digitalisation should be explored.MethodsFollowing the development of an interview guideline, eight IPC professionals from seven German hospitals of different care levels were questioned in semi- structured interviews between December 2022 and January 2023. These included questions about general surveillance organisation, access to digital data sources, software to aid the surveillance process as well as current issues in the surveillance process and implementation of software systems. Subsequently, after full transcription, the interview sections were categorized in code categories (first deductive then inductive coding) and analysed qualitatively.ResultsResults were characterised by high heterogeneity in terms of general surveillance organisation and access to digital data sources. Software configuration of hospital and laboratory information systems (HIS/LIS) as well as patient data management systems (PDMS) varied not only between hospitals of different care levels but also between hospitals of the same care level. Outside research projects, neither fully automatic software nor solutions utilising artificial intelligence have currently been implemented in clinical routine in any of the hospitals.ConclusionsAccess to digital data sources and software is increasingly available to aid surveillance of HAI. Nevertheless, surveillance processes in hospitals analysed in this study still heavily rely on manual processes. In the analysed hospitals, there is an implementation and funding gap of (semi-) automatic surveillance solutions in clinical practice, especially in healthcare facilities of lower care levels.

Workload reduction through automated documentation in intensive and intermediate care - a monocentric observational study.

The global coronavirus pandemic has placed an unprecedented and enormous burden on health systems worldwide. In addition to a shortage of resources, nurses were also confronted with high levels of sick leave and an increasing exodus from the profession. Automating documentation obligations is an effective way of reducing the burden on the workplace. The study was conducted at a tertiary university hospital. The time required for the manual documentation of administered medication and dose changes of syringe and infusion pumps was recorded using the patient data management system (PDMS) representing all intensive and intermediate care wards (n = 6). Subsequently, all medication administration - grouped into five classes - was evaluated from January 1st, 2019, until December 31st, 2022. A total of 1,373,340 drug applications were studied, treating 32,499 patients. Data were obtained from ICUs (68%) and IMC wards (32%). This corresponds to an overall time of 2,901 ± 233 hours per year. Based on publicly known national rates for intensive care nurses, an annual financial expenditure of approximately 83,300 € (~ USD 89,300) per year was estimated. A non-negligible part of the daily working time in the medical sector is spent on documentation duties. This aggravates the high workload, which has increased in recent years. Automated documentation systems can lead to considerable relief and the possibility of focusing primarily on the patient and on other core competencies and activities. This is even more important, as available staff will be a key resource in patient care for the foreseeable future.

Analysis of Blockchain Technology in Patient Data Management System : Security, Privacy, and Efficiency in the Digital Healthcare Context

In the rapidly evolving landscape of digital healthcare, ensuring secure, confidential, and efficient patient data management has become paramount. Blockchain technology has emerged as a promising solution to address these challenges. This study aims to analyze the implementation of blockchain technology within patient data management systems, with a specific focus on security, privacy, and efficiency in the context of digital healthcare. Within this framework, a notable gap arises between technological innovation trends and their practical application within the healthcare sector. This research expands our understanding of how blockchain can be effectively harnessed to tackle security and patient data privacy challenges within the increasingly interconnected digital healthcare environment. Employing a comprehensive methodology that encompasses qualitative and quantitative approaches, including surveys, literature analysis, and case studies, this study delves into how blockchain technology can provide an added layer of security to patient data, enhance privacy through improved access control, and streamline the sharing of health information. The novelty of this research lies in its holistic approach to identifying gaps in blockchain technology application methods within patient data management, while also addressing practical challenges inherent to the digital healthcare context. The anticipated outcomes of this analysis will provide valuable insights for decision-makers aiming to implement blockchain technology to fortify data security, safeguard privacy, and enhance efficiency within patient data management systems. In conclusion, this research contributes to a nuanced comprehension of the potential of blockchain technology to augment security, privacy, and efficiency in patient data management. By shedding light on innovative methods like blockchain integration, this study offers valuable guidance for effectively navigating the dynamic landscape of digital healthcare.

Medical records information system based on prototyping model using automatic identifier NFC card

Radio Frequency Identification is a compact wireless technology that is superior and has been developed in the commercial and educational for example in automatic identification in the hospital patient registration. This research aims to improve patient registration services to be more practical during outpatient registration at hospitals. Currently, hospital outpatient registration is still carried out semi-computerized where patients come to the reception desk and then register by filling in a registration form. Next, the reception staff performs data entry from the registration form that has been filled in by the patient. If a lot of patients come, there will be a queue of patients because it takes quite a long time for the registration process. Based on the problems faced, this research carried out the development of a patient data management system using NFC cards which contain patient medical record number data. When a patient visits the hospital, the patient taps the medical record card and inputs the complaint and the doctor they are going to, then the patient gets a queue number for consultation, until the patient consults with a doctor and gets the medicine prescribed by the doctor through the use of the system. Testing the system by reading and writing data on the NFC card on the card reader/writer unit, the test results showed that the maximum reading distance for the NFC card was 7 cm with a reading angle relative to the NFC reader/writer with 300 can read the NFC card.

Functional requirements of patient data management systems in intensive care medicine

As part of the German government's digitization initiative, the paper-based documentation that is still present in many intensive care units is to be replaced by digital patient data management systems (PDMS). In order to simplify the implementation of such systems, standards for basic functionalities that should be part of basic configurations of PDMS would be of great value. This paper describes functional requirements for PDMS in several categories. Criteria for standardized data documentation were defined by the authors and derived functional requirements were classified into two priority categories. Overall, general technical requirements, functionalities for intensive care patient care, and additional functionalities for PDMS were defined and prioritized. Using this paper as astarting point for adiscussion about basic functionalities of PDMS, it is planned to develop and obtain consensus on definitive standards with representatives from medical societies, medical informatics and PDMS manufacture.

Clinical Value and Operational Risks of MRI in ICU patients - ARetrospective Analysis Performed at a University Medical Center.

Intensive care unit (ICU) patients have a high risk of developing complications when leaving the ICU for diagnostic procedures or therapeutic interventions. Our study examined the frequency of adverse events associated with magnetic resonance imaging (MRI) of intensive care patients and the extent of changes in therapy due to the MRI scan to weigh the risks associated with the scan against the potential benefits of an MR scan, using a change in therapy as an indicator of benefit. 4434 ICU patients (January to December 2015) were identified by Hospital Information System (SAP-R/3 IS-H, Walldorf, Germany), ICU patient data management system Metavision (iMDsoft, Israel), and Radiology Information System (Nexus.medRIS, Version 8.42, Nexus, Germany). All intensive care and medical records (HIS) and MRI reports (RIS) were matched and further evaluated in a retrospective case-to-case analysis for biometric data, mechanical ventilation, ICU requirements, planned postoperative vs. emergency diagnostic requirements, complications and impact on further diagnosis or therapy. Out of 4434 ICU patients, 322 ICU patients (7.3 %) underwent a total of 385 MRI examinations. 167 patients needed a total of 215 emergency scans, while 155 patients underwent 170 planned postoperative MRI exams. 158 (94.6 %) out of 167 emergency scan patients were ventilated under continuous intravenous medication and monitoring. In the planned postoperative group, only 6 (3.9 %) out of 155 were ventilated, but a total of 38 (24.5 %) were under continuous medication. 111 patients were accompanied by nurses only during MRI. Only one severe adverse event (0.3 %) was noted and was attributed to study preparation (n = 385). In 8MRI examinations (2.1 %), the examination was interrupted or cancelled due to the patients' condition. While all MRI examinations in the planned group were completed (n = 170, 100 %) (e. g., postoperative controls), only 207 out of 215 (96.3 %) could be performed for emergency diagnostic reasons. MRI influenced the clinical course with a change in diagnosis or therapy in 74 (19.2 %) of all 385 MRI examinations performed, and in the emergency diagnostic group it was 31.2 % (n = 67/215). Nearly 20 % of MRI examinations of ICU patients resulted in a change of therapy. With only one potentially life-threatening adverse event (0.3 %) during transport and the MRI examination, the risk seems to be outweighed by the diagnostic benefit. · The risk of adverse events associated with MRI scans in ICU patients is low.. · The rate of premature termination of ICU patients' MRI scans is low.. · Almost 20 % of ICU patients' MRI scans lead to a change of therapy..

Cervical Radiofrequency Ablation Artifact Mimicking an Electrographic Seizure on RNS.

The responsive neurostimulator continuously monitors the electrocorticogram. It delivers short bursts of high-frequency electrical stimulation when personalized patterns are detected. Intracranial EEG recording including electrocorticography is susceptible to artifacts, albeit at a lesser frequency compared with scalp recording. The authors describe a novel case of a patient with focal epilepsy, bitemporal responsive neurostimulation, and seizures without self-awareness manifest as focal impaired awareness seizures adversely affecting memory. At follow-up evaluation, the patient reported being clinically seizure-free although a single long episode was detected using the Patient Data Management System over the course of 3 years. Initial review identified a left-sided rhythmic discharge with a bilateral spatial field of involvement. In response to detection, the responsive neurostimulation delivered a series of five electrical stimulations. On further review, the patient recalled undergoing cervical radiofrequency ablation, which coincided with the appearance of the "electrographic seizure." Extrinsic electrical artifact involving monomorphic nonevolving waveforms confirmed electrical artifact identified and treated by responsive neurostimulation as an epileptic seizure. On rare occasion, implanted electrical devices may lead to misdiagnosis and mistreatment of patients because of intracranial artifact.

Provision of HIV services to psychiatric inpatients in Botswana: Challenges and recommendations.

The high prevalence of HIV among psychiatric inpatients is well-documented, yet little is known about the provision of HIV services for these patients. This qualitative study aimed to explore and understand healthcare providers' challenges with providing HIV services to psychiatric inpatients. This study was conducted at the national psychiatric referral hospital in Botswana. The authors conducted in-depth interviews with 25 healthcare providers serving HIV-positive psychiatric inpatients. Data analysis was performed using a thematic analysis approach. Healthcare providers reported challenges with transporting patients to access off-site HIV services, longer waiting periods for antiretroviral therapy (ART) initiation, patient confidentiality, fragmented services for treatment of comorbidities, and a lack of patient data integration between the national psychiatric referral hospital and other facilities such as the Infectious Diseases Care Clinic (IDCC) at the nearby district hospital. Providers' recommendations for addressing these challenges included the establishment of an IDCC at the national psychiatric referral hospital, connecting the psychiatric facility to the patient data management system to ensure integration of patient data, and provision of HIV-related in-service training to nurses. Psychiatric healthcare providers advocated for on-site integration of care for psychiatric illness and HIV among inpatients to address the challenges of ART provision. The findings suggest the need to improve the provision of HIV services in the psychiatric hospitals in order to ensure better outcomes for this often-overlooked population. These findings are useful in improving clinical practice for HIV in psychiatric settings.

Security and Data Privacy of Medical Information in Blockchain Using Lightweight Cryptographic System

In the healthcare system and hospital environment, the data security and the data connectivity are the major factors to consider for patient data management system. For that, there are several techniques are used to preserve and arrange the patient data with enhanced security system. In that, Blockchain structure of data management improves the secure data storage and transmission process. In the data security system, the quality measure can be validate by means of the size of key that are used for the encryption process. Combined with the blockchain, the encryption model is to be improved for the solve the problem in data security system. This also needs to focus on the size reduction of data storage due to the large key size of encrypted data. In the proposed work, Intuitionistic Derivative Symmetrical Encryption (IDSE) Algorithm based security algorithm along with blockchain function was integrated to form the authorized data storage and transmission process. For the key pattern generation, Differential Hashing Pattern (DHP) based key pattern extraction model was used for high speed data transmission and to reduce the size of data that are encrypted. The features that are considered for the appropriate security system are the data transmission pattern with respect to the time and the hashing model of key generation. In the result analysis, the performance of the IDSE-DHP are validated with the parameters of data transmission and loss rate in the Blockchain and with the throughput related features.

Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study

BackgroundMobilisation and exercise intervention in general are safe and feasible in critically ill patients. For patients requiring catecholamines, however, doses of norepinephrine safe for mobilisation in the intensive care unit (ICU) are not defined. This study aimed to describe mobilisation practice in our hospital and identify doses of norepinephrine that allowed a safe mobilisation.MethodsWe conducted a retrospective single-centre cohort study of 16 ICUs at a university hospital in Germany with patients admitted between March 2018 and November 2021. Data were collected from our patient data management system. We analysed the effect of norepinephrine on level (ICU Mobility Scale) and frequency (units per day) of mobilisation, early mobilisation (within 72 h of ICU admission), mortality, and rate of adverse events. Data were extracted from free-text mobilisation entries using supervised machine learning (support vector machine). Statistical analyses were done using (generalised) linear (mixed-effect) models, as well as chi-square tests and ANOVAs.ResultsA total of 12,462 patients were analysed in this study. They received a total of 59,415 mobilisation units. Of these patients, 842 (6.8%) received mobilisation under continuous norepinephrine administration. Norepinephrine administration was negatively associated with the frequency of mobilisation (adjusted difference -0.07 mobilisations per day; 95% CI − 0.09, − 0.05; p ≤ 0.001) and early mobilisation (adjusted OR 0.83; 95% CI 0.76, 0.90; p ≤ 0.001), while a higher norepinephrine dose corresponded to a lower chance to be mobilised out-of-bed (adjusted OR 0.01; 95% CI 0.00, 0.04; p ≤ 0.001). Mobilisation with norepinephrine did not significantly affect mortality (p > 0.1). Higher compared to lower doses of norepinephrine did not lead to a significant increase in adverse events in our practice (p > 0.1). We identified that mobilisation was safe with up to 0.20 µg/kg/min norepinephrine for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0–1) mobilisation.ConclusionsMobilisation with norepinephrine can be done safely when considering the status of the patient and safety guidelines. We demonstrated that safe mobilisation was possible with norepinephrine doses up to 0.20 µg/kg/min for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0–1) mobilisation.

35. The development, testing, and validation of an automatic LIMS import method for NGS myeloid panel results

For oncology genetic testing, there is a critical need for patient results to be readily available and accessible for the ordering pathologist's review. After an initial genetic testing workup, emergency treatment or follow-up testing may be required, thus accessibility of results is a key feature in providing patient-focused laboratory testing. Ideally, genetic testing results would be incorporated into a LIMS data management system in order to have a permanent record of testing and to allow for the results to be easily accessible, searchable, and transferable by the clinical or pathology team working on behalf of the patient. For maximum impact, Next Generation Sequencing (NGS) reports should be electronically integrated into the patient's electronic health record. NGS reports uploaded as PDF attachments constrain health record searches. Additionally, data in PDF reports often are not able to be transferred to a comprehensive pathology report and may require cumbersome manual entry. Our team has recently completed a project to create an automatic import method for our Myeloid Complete NGS Panel report into our electronic patient data management system. Our data management system is interfaced with our client's LIMS platform enabling the direct and automatic transfer of orders coming in as well as delivery of the resultant NGS report into the patients' health records. We will present the steps taken to create, test, troubleshoot, and validate the automatic upload system. We will also detail critical components of the NGS LIMS report and challenges that were addressed during this project.

Epidemiology, management, and outcome of infection, sepsis, and septic shock in a German emergency department (EpiSEP study).

The adjacent conditions infection, sepsis, and septic shock are among the most common causes of treatment in the emergency department (ED). Most available data come from intensive care units (ICU) and include nosocomial infections acquired during hospitalization. Epidemiological data from German EDs are not yet available, although the ED is one of the first points of contact for patients. The aim of this study was to investigate the epidemiology, causes, diagnosis, mortality, and treatment of patients with infections in the ED. In this retrospective, single-center observational study, routinely collected data from the patient data management system and from the hospital information system were analyzed. All adult patients who presented to the ED in connection with an infection during the study period from 01/01 to 28/02/2019 were included. Exclusion criteria were age ≤ 17 years and incomplete records. Three groups (I. Infection, II. Sepsis, and III. Septic shock) were defined according to SEPSIS-3 definitions. During the study period, a total of 6,607 patients were treated in the ED. Of these patients, 19.3% (n = 1,278) had an infection (mean age 56 ± 23 years, 50% female). The sites of infection were distributed as follows: Respiratory tract 35%, genitourinary tract 18%, maxillofacial/ears/nose/throat 14%, intraabdominal 13%, soft tissues 10%, central nervous system 1%, other cause 3%, or unknown cause 6%. Infection only, sepsis and septic shock were present in 86, 10, and 3%, respectively. There were significant differences in vital signs as well as in the various emergency sepsis scores across the predefined groups [I vs. II vs. III: SOFA (pts.): 1 ± 1 vs. 4 ± 2 vs. 7 ± 3 (p < 0.0001), systolic blood pressure (mmHg): 137 ± 25 vs. 128 ± 32 vs. 107 ± 34 (p < 0.05), heart rate (bpm): 92 ± 18 vs. 99 ± 23 vs. 113 ± 30 (p < 0.05), respiratory rate (min-1): 18 ± 4 vs. 20 ± 7 vs. 24 ± 10 (p < 0.05)]. In the three groups, blood cultures were obtained in 34, 81, and 86%, of cases, respectively and antibiotics were administered in the ED in 50, 89, and 86%, of cases respectively. The 30-day mortality rate in the three groups was 1.6, 12.0, and 38.1%, respectively. This study is the first to show the incidence, management, and outcome of patients classified as infection, sepsis, and septic shock in a German ED. The findings of our real-world data are important for quality management and enable the optimization of treatment pathways for patients with infectious diseases.

Exploring the ability of child and adolescent mental health services (CAMHS) to respond to new valuable knowledge: the influence of professionals and internal organisational processes

PurposeHealth policies in England highlight the need for child and adolescent mental health services (CAMHS) to embed new knowledge in practice, yet evidence remains scarce about the services’ ability to learn from the external environment. This paper aims to present a critical analysis of the CAMHS’ ability to implement new knowledge through the lens of absorptive capacity, an organisation’s ability to identify, assimilate and use new valuable knowledge.Design/methodology/approachSixteen semi-structured interviews were conducted with staff from the CAMHS department of a mental health organisation in England to explore the services’ absorptive capacity.FindingsProfessionals were identified having an impact on the main absorptive capacity components in the following ways: professional background and perceived reliability of knowledge sources appeared to affect knowledge identification; informal communication was found to facilitate knowledge assimilation and exploitation; trust was found to enable knowledge exploitation, particularly between senior management and frontline professionals. At an organisational level, team meetings and internal reporting were identified as enablers to knowledge assimilation and exploitation, while organisational hierarchy and patient data management systems were identified as barriers to knowledge assimilation. No organisational processes were found regarding knowledge identification, indicating an imbalanced investment in the main components of absorptive capacity.Practical implicationsInvesting in these underpinning factors of absorptive capacity can assist CAMHS with capitalising on new knowledge that is valuable to service provision.Originality/valueThis study offers novel insights into the learning ability of CAMHS through the lens of absorptive capacity.

Design And Development of Help Patient Data Management Information System at Sinergi Atap Negeri Foundation Web-Based Using Codeigniter

The Sinergi Atap Negeri Foundation is a legal and independent non-profit social foundation with the goal of becoming a halfway house facilitator for needy patients and families. The purpose of this study is to create a data management information system for assisted patients to aid in data management, patient submissions, and data transactions at the Sinergi Atap Negeri Foundation, thereby making work more effective and efficient. The waterfall method is used in software development to collect data from previous studies through observations, interviews, and literature studies. The Sinergi Atap Negeri Foundation's patient data management system, according to the analysis, is still manual, whereas previously data management could only be managed by one foundation administrator and accessed by anyone. Given these concerns, researchers are encouraged to develop a web-based application using PHP, the Codeigniter 3 framework, and Mysql as a database. It is hoped that this information system will improve the performance of foundation employees by making data entry easier and faster, as well as avoiding data loss errors from a security standpoint.

Towards an Ontology-Based Phenotypic Query Model

Clinical research based on data from patient or study data management systems plays an important role in transferring basic findings into the daily practices of physicians. To support study recruitment, diagnostic processes, and risk factor evaluation, search queries for such management systems can be used. Typically, the query syntax as well as the underlying data structure vary greatly between different data management systems. This makes it difficult for domain experts (e.g., clinicians) to build and execute search queries. In this work, the Core Ontology of Phenotypes is used as a general model for phenotypic knowledge. This knowledge is required to create search queries that determine and classify individuals (e.g., patients or study participants) whose morphology, function, behaviour, or biochemical and physiological properties meet specific phenotype classes. A specific model describing a set of particular phenotype classes is called a Phenotype Specification Ontology. Such an ontology can be automatically converted to search queries on data management systems. The methods described have already been used successfully in several projects. Using ontologies to model phenotypic knowledge on patient or study data management systems is a viable approach. It allows clinicians to model from a domain perspective without knowing the actual data structure or query language.

TELEDerm: Implementing store-and-forward teledermatology consultations in general practice: Results of a cluster randomized trial.

Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices. Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices. The primary analysis revealed no significant difference in referral rates (relative risk = 1.02; 95% confidence interval = 0.911-1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates. While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.

Responsive neurostimulation of the thalamus improves seizure control in idiopathic generalised epilepsy: initial case series

ObjectivesUp to 40% of patients with idiopathic generalised epilepsy (IGE) are drug resistant and potentially could benefit from intracranial neuromodulation of the seizure circuit. We present outcomes following 2 years...

Capturing of intracranial pressure treatment during neurointensive care in patients with acute brain injury using a novel tablet-based method

Critical care is complex and stressful. It is difficult to register in real time data not recorded by automatic systems. Time-specific knowledge of manual measures is important for understanding pathophysiology and for analyzing treatment and quality of care. Therefore, a novel iPad-based method for registration of manual measures was developed, which many can build themselves. Using a configuration for intracranial pressure (ICP) management, the methodology was validated, ICP treatment captured, and the quality of ICP management evaluated. Twenty-two patients with acute brain injuries were studied. The iPad-system was totally used for 2538 h. Thirteen-hundred-five manual measures were entered. Thirty-nine episodes of predefined ICP insults were identified. During 16/39 episodes, ICP treatments were registered. For 4/39 episodes treatments were registered within 90 s before or after the episode. For 3/39 episodes it was registered that treatment was intentionally refrained. In 15/16 episodes without registered treatment, the insult was mild or reasonable explanations were found when medical records and the Patient data management system were reviewed. In one situation without particular circumstances, morphine and clonidine were given to decrease ICP but not registered. No episodes of downtime or loss of data occurred. The developed methodology appears to be stable and robust as well as feasible and user-friendly. It was possible to capture the treatment of ICP insults with high temporal resolution, and to evaluate the quality of ICP management. An own developed novel tablet-based system like our system may be a promising potential tool useful in various future intensive care applications.

Evaluation of volatile sedation in the postoperative intensive care of patients recovering from heart valve surgery: protocol for a randomised, controlled, monocentre trial

IntroductionPatients undergoing heart valve surgery are predominantly transferred postoperatively to the intensive care unit (ICU) under continuous sedation. Volatile anaesthetics are an increasingly used treatment alternative to intravenous substances in...