Patient Record Information Research Articles

Assessment of Drug Use Pattern Using WHO Core Prescribing Indicators at Outpatient Settings of Governmental Hospitals in Dessie Town.

BackgroundEnhancing the standards of medical treatment at all levels of the healthcare delivery system can improve the quality of life in developing countries. One method to promote rational drug use is an assessment of drug use pattern based on drug use indicators.ObjectiveTo evaluate prescription patterns at the outpatient pharmacy of Dessie Referral Hospital and Boru Meda Hospital at Dessie town.MethodsAn institution-based retrospective cross-sectional study was conducted to assess the prescribing patterns in governmental hospitals of Dessie town from April 1 to May 30, 2019. Six hundred eligible prescriptions were selected from each hospital through a systematic random sampling technique.ResultsThe result of this study showed that both hospitals used standard prescriptions (100%). Age (99.0%) and name (94.7%) of patients were the most commonly recorded patient information while weight, address of patients and diagnosis were recorded only in 1.1%, 39.2% and 61.3% of the studied prescription papers, respectively. A total 2409 drugs were prescribed in the 1200 prescription papers and the percentage of encounters with injection(s) and antibacterial(s) was 9.0% and 42.6%, respectively. At each hospital, all drugs were prescribed from the Ethiopian essential drug list.ConclusionThe present study revealed the use of standard presecription papers at both hospitals. None of the patient-related information was completely written in all prescrptions. For drug-related information, only the name of the drug was written in all prescription papers. There is also a significant deviation from the acceptable WHO standard for prescribing antibiotics.

Cisplatin-Induced Peripheral Neuropathy: An Observational Descriptive Study

Peripheral neurotoxicity is a major adverse effect of cisplatin chemotherapy. A prospective observational study was conducted among 200 cancer patients who received cisplatin between October 2017 and March 2018 to evaluate the occurrence, causality and severity of cisplatin induced peripheral neuropathy. A suitable data collection form was used to record patient information required for the study. Peripheral neuropathy was assessed using the National Cancer Institute- Common Terminology Criteria for Adverse Events (NCI-CTCAE). As per the results, 19 (9.5%) patients developed peripheral neuropathy after receiving cisplatin therapy. Peripheral neuropathy was reported higher in males (84.2%) compared to females (15.7%) and more within the age group of 58-65 years (38.6%). Most of the patients developed Grade I neuropathy (84.2%), followed by Grade II neuropathy (15.7%). The study concluded that the severity of peripheral neuropathy increases with higher cumulative doses of cisplatin.

Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience

IntroductionTwo protocols were developed to guide the use of subdissociative dose ketamine (SDDK) for analgesia and dissociative sedation ketamine for severe agitation/excited delirium in the emergency department (ED). We sought to evaluate the safety of these protocols implemented in 18 EDs within a large health system.MethodsWe conducted a retrospective chart review to evaluate all adult patients who received intravenous (IV) SDDK for analgesia and intramuscular (IM) dissociative sedation ketamine for severe agitation/excited delirium in 12 hospital-based and six freestanding EDs over a one-year period from the protocol implementation. We developed a standardized data collection form and used it to record patient information regarding ketamine use, concomitant medication use, and any comorbidities that could have impacted the incidence of adverse events.ResultsApproximately 570,000 ED visits occurred during the study period. SDDK was used in 210 ED encounters, while dissociative sedation ketamine for severe agitation/excited delirium was used in 37 ED encounters. SDDK was used in 83% (15/18) of sites while dissociative sedation ketamine was used in 50% (9/18) of sites. Endotracheal intubation, non-rebreather mask, and nasal cannula ≥ four liters per minute were identified in one, five, and three patients, respectively. Neuropsychiatric adverse events were identified in 4% (9/210) of patients who received SDDK.ConclusionPatients experienced limited neuropsychiatric adverse events from SDDK. Additionally, dissociative sedation ketamine for severe agitation/excited delirium led to less endotracheal intubation than reported in the prehospital literature. The favorable safety profile of ketamine use in the ED may prompt further increases in usage.

Defining the high-risk patient

As the volume of surgery continues to grow worldwide, the identification of high-risk patients is an important goal to guide clinical decision making in the perioperative period. Risk stratification evolved over the last decade from simple risk stratification tools, still used widely in the clinical arena to more sophisticated risk prediction models based on machine learning and latent class analysis, which can be incorporated into a well-developed electronic patient record or critical care clinical information system. As the debate about which patients will benefit most from critical care admission and interventions is still ongoing, the identification of the high-risk patient is a continuing challenge. In this review we will summarise the latest developments in the use of these risk stratification tools and risk prediction models, which can be utilised to identify the high-risk surgical candidate.

Unified electronic traceability and data storage system

Background & Aim In a field that requires complete visibility and traceability, we are still relying on hand written forms and documents that introduce the possibility of fraud, human error, and other complications. I propose that soon, we as an industry will be able to electronically record patient information, sample data, logistics tracking, manufacturing batch records, and patient treatment data with little to no need for manual input. This software will use a series of patient, sample, and product barcodes to maintain complete traceability of the process from start to finish. All equipment used throughout the process will integrate into the software and automatically record values and calculations into the appropriate forms or batch records Methods, Results & Conclusion With this technology physicians and patients will have complete visibility into the treatment or therapy that is being developed and manufacturers will be able to track data trends and monitor incoming and outgoing materials in real time along with receiving updates and notifications related to critical events within the process. Privacy is also a serious concern within the cell therapy industry because all parties need the necessary information to produce a quality product all while respecting the regulations set in place by organizations like the FDA and HIPAA. With this technology only certain participants in the process will be given access to this sensitive information. A system like I am describing will streamline the FDA approval process that previously took years to complete by centralizing all necessary information. This will allow regulatory committees to locate specific pieces of data with a simple search on their computer instead of sifting through pages upon pages of documents allowing the company to get to market much faster. With date and time stamps attached to each piece of recorded information things such as deviation investigations and chain of custody will be expedited and made much easier to complete. This integrated software will also allow for real time communications between collection and manufacturing sites that will decrease the occurrence of miscommunication-based errors. Many collection and infusion sites do not have personnel that are aptly trained on things like cGMP regulations or proper technique to administer your product. In a field that requires complete visibility and traceability, we are still relying on hand written forms and documents that introduce the possibility of fraud, human error, and other complications. I propose that soon, we as an industry will be able to electronically record patient information, sample data, logistics tracking, manufacturing batch records, and patient treatment data with little to no need for manual input. This software will use a series of patient, sample, and product barcodes to maintain complete traceability of the process from start to finish. All equipment used throughout the process will integrate into the software and automatically record values and calculations into the appropriate forms or batch records With this technology physicians and patients will have complete visibility into the treatment or therapy that is being developed and manufacturers will be able to track data trends and monitor incoming and outgoing materials in real time along with receiving updates and notifications related to critical events within the process. Privacy is also a serious concern within the cell therapy industry because all parties need the necessary information to produce a quality product all while respecting the regulations set in place by organizations like the FDA and HIPAA. With this technology only certain participants in the process will be given access to this sensitive information. A system like I am describing will streamline the FDA approval process that previously took years to complete by centralizing all necessary information. This will allow regulatory committees to locate specific pieces of data with a simple search on their computer instead of sifting through pages upon pages of documents allowing the company to get to market much faster. With date and time stamps attached to each piece of recorded information things such as deviation investigations and chain of custody will be expedited and made much easier to complete. This integrated software will also allow for real time communications between collection and manufacturing sites that will decrease the occurrence of miscommunication-based errors. Many collection and infusion sites do not have personnel that are aptly trained on things like cGMP regulations or proper technique to administer your product.

Using natural language processing to extract structured epilepsy data from unstructured clinic letters: development and validation of the ExECT (extraction of epilepsy clinical text) system

ObjectiveRoutinely collected healthcare data are a powerful research resource but often lack detailed disease-specific information that is collected in clinical free text, for example, clinic letters. We aim to use...

“It’s not just about prostate cancer, it’s about being a gay man”: A qualitative study of gay men’s experiences of healthcare provision in the UK

Following a diagnosis of prostate cancer, men require information and support from healthcare providers which is tailored to their individual needs. Studies reporting on the needs of gay men with prostate cancer, and their experiences of healthcare provision, are lacking. This study highlights the issues affecting this group of men and the implications for healthcare delivery in the United Kingdom. In-depth interviews were conducted with 12 gay men who had been diagnosed with prostate cancer. A phenomenological approach was used to collect and analyse data. Participants wanted, and expected, candid discussions with healthcare professionals, about how prostate cancer could affect their lives, sexual function, and how to access culturally relevant support before and after treatment. Participants perceived that their healthcare team had little knowledge about their needs, and if, or how, their experience differed due to their sexual orientation. Information provided was perceived as being misplaced or informed by heteronormative assumptions. Consideration should be given to requesting sexual orientation when recording patient information, if patients are willing to disclose. Training should be provided for healthcare professionals to enable them to provide information and support that is culturally relevant at all stages of the consultation.

The use of an application to record information on Dentistry patients from the perspective of dental surgeons

Dental records are complex documents and not all dental surgeons have been careful to fill them correctly. On the other hand, a number of apps for professional support has been observed on the market aimed at healthcare. The purpose of this study was to show how dental surgeons have noticed the technology of mobile devices and how it would help in their work routine by analysing an application for recording patient information. This study was exploratory, qualitative, descriptive, and transversal, with data obtained through a semi-structured interview with open-ended questions applied to ten dental surgeons who have downloaded the App ‘OdontoExame’ as study population. The answers were analysed by the content analysis technique. The results showed that this technology could be useful in storing information. Besides, 90% of respondents stated that the application would help in clinical practices, while 10% considered such a technology still limited to this function.

Effect of computer use on physician-patient communication using a validated instrument: Patient perspective

BackgroundPhysician-patient communication is essential in the physician-patient relationship. Concerns were raised about the impact of the computer on this relationship with the increase in use of electronic medical records (EMR). Most studies addressed the physician’s perspective and only few explored the patient’s perspective. AimThis study aims to assess the patient’s perspective of the effect of the physician’s computer use during the clinical encounter on the interpersonal and communication skills of the physician using a validated communication assessment tool (CAT). Design and settingsThis is a cross-sectional survey of three hundred eighty-two patients who visited the family medicine clinics (FMC) at the American University of Beirut Medical Center (AUBMC). Material and methodsAt the end of the visit with the physician, the patients were approached by the clinical assistant to fill a paper-based questionnaire privately in the waiting room to measure communication skills of physicians using CAT. ResultsNearly two-thirds of the patients (62%) did not consider that using the computer by their physician during the visit would negatively affect the patient-doctor communication. Patients rated their physician with a higher communication score when there was an ongoing relationship between the physician and the patient. Higher communication scores were reported for extensive use of the computer by the physician to check results (p<0.001), to retrieve patient record information (p<0.001) and to educate patients (p<0.001) as compared to less use. ConclusionsPhysician-patient communication was not negatively affected by the physician use of the computer as rated by patients. An ongoing relationship with the physician remains a significant predictor of better physician-patient communication even in the presence of the computer.

Risk Factors for Re-Excision Following Breast-Conserving Surgery.

To identify previously unstudied factors predicting re-excision following breast-conserving surgery (BCS) and to assess the feasibility of obtaining data about breast density for predictive modeling. . Retrospective secondary data analysis. . Data were obtained from the cancer registry and electronic health records (EHRs) at Texas Health Harris Methodist Hospital, a large, urban, private, nonprofit hospital in North Texas. . 244 patients choosing BCS from 2011-2012. . Data were subjected to univariate analyses (chi-square) followed by logistic regression. . The primary dependent variable was re-excision following BCS. Predictors of interest included lifestyle factors, time from diagnosis to surgery, surgical approach, patient age, and breast density, and controlled for covariates, such as assay results. . Three factors predicted re-excision with 87% accuracy. Women younger than 60 years whose surgery included placement of a wire for localization of tissue to be removed and who underwent surgery soon after diagnosis are the least likely to require reoperation after BCS. Data integrity is critical to the success of research using EHRs and registry information. . Nurses may improve patient outcomes by helping women considering BCS solve problems that may delay surgery. Nurses can contribute to the success of nursing research by thoroughly and accurately recording patient information in EHRs.

Student life - 21st century nurse training

Many hospitals have switched to recording observations electronically over the past few years, often using programmes that allow them to identify deteriorating patients quickly and prompt interventions.

P044 PEP/PEPSE reaudit - Whose notes are they anyway? – the data protection act restricting clinical audit

Background/introduction Post Exposure Prophylaxis (PEP) is prescribed to patients presenting with a history of occupational or sexual exposure to HIV infection. The British Association for Sexual Health and HIV (BASHH) published new clinical guidelines on PEP following Sexual Exposure (PEPSE) in 2015. Aim(s)/objectives To audit occupational PEP/PEPSE related attendances in a sexual health clinic (SHC) in 2015 and compare to a previous audit (2011–2013). Methods A retrospective case note review of patients attending in 2015 for PEP/PEPSE. Clinical records were unavailable for patients attending prior to April 2015 due to the SHC contract transferring to a new provider. Results A total of 8 patients attended for PEPSE, two were initiated in A&E, 1 in a Sexual Assault Referral Centre (SARC) and 4 in the SHC. All patients attended after sexual exposure, with none attending after needle stick injury. All patients were started on PEPSE within 72 hours, had baseline HIV test and STI screen. All had PEPSE prescribed within the recommended indications compared to 88% previously. Fifty percent finished PEP course whilst 25% had a documented HIV test 4–6 weeks post PEP. Discussion/conclusion Issues around clinical record ownership have been interpreted differently across trusts. Locally, when the provider for the SHC changed, minimal patient record information was transferred to the new trust. This limited access contributed to small audit numbers. Compared to previous audit smaller numbers of patients finished the PEP course and attended for follow up HIV test but clinicians have a greater understanding of recommended indications for PEPSE.

What is the Impact of the Implementation of an Evidence Based Procedural Sedation Protocol in the Emergency Department?

Background: Procedural sedation and analgesia (PSA) enables emergency physicians to provide pain and anxiety relief for many procedures. However, PSA introduces an independent risk factor and requires continuous monitoring. Recently, we applied the principles of knowledge translation (KT) to develop and implement a PSA protocol in our ED. Objectives: To evaluate the impact of a PSA protocol developed and implemented using KT principles on changes in ED physician practices with respect to length of monitoring time in resuscitation area, complication rate, medication types and doses. Methods: Design: Pre- Post retrospective chart review. Setting: Adult tertiary-care academic centre. Participants: Patients who underwent PSA in the ED as per physician billing code from September 2008 to August 2010. The Pre protocol implementation was from Sept 2008 to Aug 2009 and the Post was from Sept 2009 to Aug 2010. One of the authors (NM) reviewed all charts and recorded patient information such as sociodemographics, past medical history, allergies, monitoring time, complications, medication and doses. Pre and post periods information was compared using two-sample T-test and Chi-square test as appropriate. Results: There were 318 billing codes for PSA from September 2008 to August 2010 of which the 150 occurred during the Pre protocol period and 134 during the Post protocol implementation period. Excluded were 34 patients due to lack of documentation. There were no statistical differences in Pre vs. Post for baseline characteristics (mean age+standard deviation (52+20 vs. 53+22 years), male gender (54% vs. 53%), with a past medical history (36% vs. 47%) and allergies (16% vs. 15.7%)). As well no differences in outcomes with respect to complication rate (7.4% vs. 9.9%) and medication types (70% vs. 65% Ketafol, 23% vs. 23% propofol) and doses used. However, monitoring time in minutes recorded from time of first medication given until patient was moved out of resuscitation area was significantly reduced during the Post period (Pre period: mean 49 (95% CI: 42-56) versus Post period: mean 19 (95% CI: 17-21). Conclusion: The implementation of the PSA protocol using KT principles resulted in a significant and important decrease in monitoring time required for PSA thus liberating important resources in busy EDs.

Unified Patient Information System for Iraqi Hospitals

Because of the health conditions experienced by the country, especially in the last three decades in Iraq Caused by various conditions, including the difficult political crises that have passed represented and pass the country's and other economic conditions and environmental and the absence of quality control, especially in the period following the year 2003, Which invited us to think in an attempt to reduce the incidence of certain diseases by facilitating the linking causes their causes That's where recording patient information in a unified database After comparing it with the circumstances that accompanied the emergence of those conditions, Researchers can identify the problem clearly linked through the circumstances that have occurred in these specific dates periods. In this system, using program visual .Net as a front for entering of data that will be stored in the database for the purpose of retrieval through a program that works on the web site when you need to retrieve it. The proposed system overcomes the problems related to retrieve and find particular information, waste of effort and time, inoculation details of patient is difficult to make as input costs requirements and paperwork burdens is involved and to collect from various registers, probability of error in manual calculations, and provides the support the researchers to take a decision.

Construction of Dynamic Medical Information System for Digital Hospital Environments

The distribution of healthcare information via cloud-based hospital information systems has been increasing in recent years. Because these systems can disseminate sensitive healthcare information to various smart devices, their security approaches must be carefully studied. In addition, research is required to ensure that patients are being properly notified about changes in their medical treatments. Therefore, in this paper, we propose a dynamic medical information system for digital hospital environments. For this purpose, we design a system that can securely distribute existing digital hospital data, including medical images and patient record information. In order to classify the providing services, we divide them into two types--synchronization and security. We suggest a dynamic authentication method to access medical information. Moreover, the proposed system provides Digital Imaging and Communications in Medicine (DICOM) file synchronization between system environments. We confirm the usefulness of the application based on experimental results.

Abstract IA35: Sustainabity of patient navigation programs: Lessons learned from a Medicare innovation project

Abstract IA35: Sustainabity of patient navigation programs: Lessons learned from a Medicare innovation project

Concurrent Chemoradiation for Cancer of the Cervix: Results of a Multi-Institutional Study From the Setting of a Developing Country (India).

PurposeThe primary output of hospital-based cancer registries is data on cancer stage and treatment-based survival that can be used to evaluate patient care, but because there are many challenges in obtaining follow-up details, a separate study on patterns of care and patterns of survival for patients at selected sites was initiated under the National Cancer Registry Programme of India. This article presents the results for cervical cancer.Patients and MethodsA standardized patient information form was used to record patient information, and data were entered into a central repository—the National Centre for Disease Informatics and Research. The study patients were from 12 institutions and were diagnosed between January 1, 2006, and December 31, 2008. Patterns of treatment were assessed for 7,336 patients, and patterns of survival were determined for 2,669 patients from six institutions, at least 70% of whom had data regarding follow-up as of December 31, 2012.ResultsOf 7,336 patients, 55.5% received optimal radiotherapy (RT). In all, 80.9% of patients had locally advanced cancers (stage IIB to IVA), 51.1% received RT alone, and 44.4% received concurrent chemoradiation (RTCT). In 1,753 patients with locally advanced cancers, significantly better survival was observed with RTCT than with RT alone (5-year cumulative survival, 70.2% v 47.3%; hazard ratio, 0.48; 95% CI, 0.41 to 0.56).ConclusionA conservative estimate indicates that, on an annual basis, 38,771 patients with cervical cancers in India alone do not get the benefit of RTCT and thus they have poorer survival. There is a need to reiterate the National Cancer Institute's alert that advised supplementing chemotherapy to radiation for locally advanced cancer of the cervix in the context of the developing world, where 84.3% of cancers of the cervix occur.

A Hash Based Remote User Authentication and Authenticated Key Agreement Scheme for the Integrated EPR Information System.

To protect patient privacy and ensure authorized access to remote medical services, many remote user authentication schemes for the integrated electronic patient record (EPR) information system have been proposed in the literature. In a recent paper, Das proposed a hash based remote user authentication scheme using passwords and smart cards for the integrated EPR information system, and claimed that the proposed scheme could resist various passive and active attacks. However, in this paper, we found that Das's authentication scheme is still vulnerable to modification and user duplication attacks. Thereafter we propose a secure and efficient authentication scheme for the integrated EPR information system based on lightweight hash function and bitwise exclusive-or (XOR) operations. The security proof and performance analysis show our new scheme is well-suited to adoption in remote medical healthcare services.

Security Analysis and Improvement of 'a More Secure Anonymous User Authentication Scheme for the Integrated EPR Information System'.

Over the past few years, secure and privacy-preserving user authentication scheme has become an integral part of the applications of the healthcare systems. Recently, Wen has designed an improved user authentication system over the Lee et al.’s scheme for integrated electronic patient record (EPR) information system, which has been analyzed in this study. We have found that Wen’s scheme still has the following inefficiencies: (1) the correctness of identity and password are not verified during the login and password change phases; (2) it is vulnerable to impersonation attack and privileged-insider attack; (3) it is designed without the revocation of lost/stolen smart card; (4) the explicit key confirmation and the no key control properties are absent, and (5) user cannot update his/her password without the help of server and secure channel. Then we aimed to propose an enhanced two-factor user authentication system based on the intractable assumption of the quadratic residue problem (QRP) in the multiplicative group. Our scheme bears more securities and functionalities than other schemes found in the literature.

The GOLD ReGISTry: a Global, Prospective, Observational Registry Collecting Longitudinal Data on Patients with Advanced and Localised Gastrointestinal Stromal Tumours

BackgroundGastrointestinal stromal tumours (GISTs) are the most common gastrointestinal sarcomas. This global, prospective registry followed patients with advanced or localised GIST (2007–2011). MethodsCurrent and evolving diagnostics, treatments and outcome measures in patients with GIST were assessed. Eligible patients were diagnosed with advanced or localised GIST within 15months of registry entry. No treatment plan was prescribed, and no visit schedule was mandated. Treating physicians recorded patient information, including tumour response, diagnostic methods, medications, surgeries performed, mutation status and adverse events leading to dose/medication changes. Survival outcomes were estimated using the Kaplan–Meier method. Other data were analysed using descriptive statistics. ResultsThe registry included 1663 patients (advanced GIST, n=1095; localised GIST, n=537). Medications (e.g. tyrosine kinase inhibitor use and dosing), disease progression or recurrence and physician assessment of response to treatment in registry patients were consistent with controlled trials and prevailing clinical recommendations. In advanced GIST, estimated 30-month progression-free survival (PFS) (59.8%) and overall survival (OS) (82.7%) were higher than results from previously reported trials (≈40% and ≈70%, respectively). Consistent with treatment guidelines, the most common initial treatments were imatinib for advanced GIST, and complete surgical resection for localised GIST. Computed tomography scans were the most common imaging technique used at diagnosis and follow-up. Mutation analysis was performed at diagnosis in only 15.3% and 14.5% of patients with advanced and localised GIST, respectively. ConclusionsIn this real-world GIST registry, patients with advanced GIST were treated with imatinib and patients with localised GIST received surgical resection, in accordance with prevailing clinical recommendations.