Service Center Research Articles

Audit Sistem Informasi Monitoring dan Evaluasi (Monev) Pada Puskesmas Kecamatan Ciracas Menggunakan COBIT 2019

This research starts from the framework of thinking that auditing information technology governance in monitoring and evaluation (monev) information systems using COBIT 2019 is an important thing to do. In the present and future, it is necessary to align information technology investments with the aim of community services in public health centers. The COBIT 2019 framework provides the benefits of implementing information systems, minimizing risks, and optimizing resources according to needs at the Ciracas District Health Center. In implementing monitoring and evaluation (monev), the factor design from COBIT 2019 can determine which domains must be assessed for their maturity level, so that agencies can know what needs to be improved. In this case, the EDM02 domain focuses on the process of optimizing the contribution of business value, services and IT assets resulting from investment at a cost that is acceptable to the company, while MEA03 ensures that the agency has complied with all applicable external requirements. Based on the results of the inspection, EDM02 has a current maturity value of 4.23 with a maturity level of 5-Optimized, which means that the implementation of monitoring and evaluation (monev) at the Ciracas District Health Center has run according to its objectives, while MEA03 has a current maturity value of 3.98 with a maturity level of 4- Manged and Measureable, which means monitoring and evaluation (monev) at the Ciracas District Health Center has been running well, even data or information has been integrated

Integration of Transformational Capabilities in Research Service Center Facilities

Integration of Transformational Capabilities in Research Service Center Facilities

Socioeconomic, Patient, and Hospital Determinants for the Utilization of Peripheral Nerve Blocks in Total Joint Arthroplasty.

While peripheral nerve blocks (PNBs) are associated with various improved outcomes in patients undergoing total hip or knee arthroplasty (THA/TKA), disparities in PNB utilization have been reported. This study assessed the importance of socioeconomic, demographic, clinical, and hospital determinants in explaining PNB utilization using the population-attributable risk (PAR) framework. Subsequently, we examined the association between PNB use and 3 secondary outcomes: Centers for Medicare and Medicaid Services (CMS)-defined complications, 90-day all-cause readmissions, and length of stay >3 days. This retrospective cohort study included 52,926 THA and 94,795 TKA cases from the 5% 2012 to 2021 Medicare dataset. Mixed-effects logistic regression models measured the association between study variables and PNB utilization. Variables of interest were demographic (age, sex), clinical (outpatient setting, diagnosis, prior hospitalizations in the year before surgery, Deyo-Charlson index, obesity, (non)-opioid abuse, smoking), socioeconomic (neighborhood Social Deprivation Index, race and ethnicity) and hospital variables (beds, ownership, region, rurality, resident-to-bed ratio). The model was used for the calculation of variable-specific and variable category-specific PARs (presented in percentages), reflecting the proportion of variation in PNB use explained after eliminating variables (or groups of variables) of interest with all other factors held constant. Subsequently, regression models measured the association between PNB use and secondary outcomes. Associations are presented with odds ratios (ORs) and 95% confidence intervals (95% CIs). Socioeconomic and demographic variables accounted for only a small proportion of variation in PNB use (up to 3% and 7%, respectively). Clinical (THA: 46%; TKA: 34%) and hospital variables (THA: 31%; TKA: 22%) were the primary drivers of variation. In THA, variation by clinical variables was driven by increased PNB use in the inpatient setting (OR, 1.28 [95% CI, 1.07-1.53]) and decreased use in patients with ≥2 prior hospitalizations (OR, 0.72 [95% CI, 0.57-0.90]). Moreover, nonosteoarthritis diagnoses associated with reduced PNB utilization in THA (OR, 0.64 [95% CI, 0.58-0.72]) and TKA (OR, 0.35 [95% CI, 0.34-0.37]).In TKA, PNB use was subsequently associated with fewer complications (OR, 0.82 [95% CI, 0.75-0.90]) and less prolonged length of stay (OR, 0.90 [95% CI, 0.86-0.95]); no association was found for readmissions (OR, 0.98 [95% CI, 0.93-1.03]). In THA, associations did not reach statistical significance. Among THA and TKA patients on Medicare, large variations exist in the utilization of PNBs by clinical and hospital variables, while demographic and socioeconomic variables played a limited role. Given the consistent benefits of PNBs, particularly in TKA patients, more standardized provision may be warranted to mitigate the observed variation.

Assessing the Validity of the Centers for Medicare & Medicaid Services Measure in Identifying Potentially Preventable Emergency Department Visits by Patients With Cancer.

The Centers for Medicare & Medicaid Services (CMS) implemented chemotherapy measures (OP-35) to reduce potentially preventable emergency department visits (PPEDVs) and hospitalizations. This study evaluated the validity of the OP-35 measure in identifying PPEDVs among patients with cancer. This is a cross-sectional study, which used data from the 2012-2022 National Hospital Ambulatory Medical Care Survey. ED visits are assessed and compared on the basis of three measures: immediacy using Emergency Severity Index (ESI), disposition (discharge v hospitalization), and OP-35 criteria. Between 2012 and 2022, a weighted sample of 46,723,524 ED visits were made by patients with cancer. Among reported ESI cases, 25.2% (8,346,443) was high urgency. In addition, 30.3% (14,135,496) of ED visits among patients with cancer led to hospitalizations. Using the OP-35 measure, it was found that 20.85% (9,743,977) was PPEDVs. A 21.9% (10,232,102) discrepancy between discharge diagnosis (CMS billing codes) and chief complaints was identified. Further analysis showed that 19.2% (1,872,556) of potentially preventable ED visits (CMS OP-35) were high urgency and 32.6% (3,181,280) resulted in hospitalization. The CMS approach to identifying PPEDVs has limitations. First, it may overcount preventable visits by including high-urgency or hospitalization-requiring cases. Second, relying on final diagnoses for retrospective preventability judgment can be misleading as they may not reflect the initial reason for the visit. In addition, differentiating causes for ED visits in patients with cancer undergoing various treatments is challenging as the approach does not distinguish between chemotherapy-related complications and others. Identification inconsistencies arise because of varying coding practices and chosen preventable conditions, lacking consensus and alignment with specific hospital or patient needs. Finally, the model fails to consider crucial nonclinical factors like social support, economic barriers, and alternative care access, potentially unfairly penalizing hospitals serving underserved populations.

Quality of the digital gp visits and characteristics of the users: retrospective observational study

Objectives This study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting. Design The study adopted a retrospective analysis of patient record data collected in 2019, comparing visits to a digital primary health center with traditional health center visits. Setting Primary health care. Participants The data encompassed patients who utilized the digital clinic and those who visited public health centers for primary health care services. Main Outcome Measures The study assessed demographics, health diagnoses, prescribed medications, sick leave recommendations, re-admission rates, and differences in costs between digital clinic and face-to-face visits. Secondary outcomes included a comparative analysis of medication categories, resolution rates for health problems, and potential impacts on health care utilization. Results Digital clinic users were typically younger, more educated, and predominantly female compared with health centre users. Digital visits were well-suited for uncomplicated infections, while health centre appointments were associated with a higher prevalence of chronic conditions. Medication patterns differed between the two modalities, with digital clinic users receiving generic over-the-counter drugs and antibiotics, whereas health centre visits commonly involved cardiac and antihypertensive medications. Sick leave recommendations were slightly higher in the digital clinic, but the difference was not significant. Approximately 70% of health problems addressed in the digital clinic were successfully resolved, and the cost of digital visits was about 50,3% of face-to-face appointments. Conclusion Digital health care services offer a cost-efficient alternative for specific health problems, appealing to younger, educated individuals, when compared to the users of public health center, and may enable improvement of cost-effectiveness combined with acceptable demand management and patient segmentation practices. The results highlight the potential benefits of digital clinics, particularly for uncomplicated cases, while also emphasizing the importance of suitable referral mechanisms for in-person consultations.

MoCab: A framework for the deployment of machine learning models across health information systems

Background and Objective:Machine learning models are vital for enhancing healthcare services. However, integrating them into health information systems (HISs) introduces challenges beyond clinical decision making, such as interoperability and diverse electronic health records (EHR) formats. We proposed Model Cabinet Architecture (MoCab), a framework designed to leverage fast healthcare interoperability resources (FHIR) as the standard for data storage and retrieval when deploying machine learning models across various HISs, addressing the challenges highlighted by platforms such as EPOCH®, ePRISM®, KETOS, and others. Methods:The MoCab architecture is designed to streamline predictive modeling in healthcare through a structured framework incorporating several specialized parts. The Data Service Center manages patient data retrieval from FHIR servers. These data are then processed by the Knowledge Model Center, where they are formatted and fed into predictive models. The Model Retraining Center is crucial in continuously updating these models to maintain accuracy in dynamic clinical environments. The framework further incorporates Clinical Decision Support (CDS) Hooks for issuing clinical alerts. It uses Substitutable Medical Apps Reusable Technologies (SMART) on FHIR to develop applications for displaying alerts, prediction results, and patient records. Results:The MoCab framework was demonstrated using three types of predictive models: a scoring model (qCSI), a machine learning model (NSTI), and a deep learning model (SPC), applied to synthetic data that mimic a major EHR system. The implementations showed how MoCab integrates predictive models with health data for clinical decision support, utilizing CDS Hooks and SMART on FHIR for seamless HIS integration. The demonstration confirmed the practical utility of MoCab in supporting clinical decision making, validated by its application in various healthcare settings. Conclusions:We demonstrate MoCab’s potential in promoting the interoperability of machine learning models and enhancing its utility across various EHRs. Despite facing challenges like FHIR adoption, MoCab addresses key challenges in adapting machine learning models within healthcare settings, paving the way for further enhancements and broader adoption.

Qualitative insights into mental health treatment through telemedicine during the COVID-19 crisis: a natural experiment in community mental health centers

BackgroundThe COVID-19 pandemic exacerbated existing mental health challenges and introduced new ones, particularly among vulnerable populations such as individuals within the criminal justice system, who disproportionately experienced employment, financial, and housing issues. As mandatory lockdowns and social distancing mandates were implemented, the United States saw unprecedented interruptions to treatment. Telemedicine emerged as a transformative tool in alleviating new and existing treatment barriers. Yet, limited empirical research has examined the impact and implications of telemedicine on mental health treatment in criminal justice populations.MethodsThe timing of this study’s data collection overlapped with the spread of COVID-19 in the United States and provided a unique opportunity to examine the impact of telemedicine as part of a natural experiment. Utilizing interviews with 61 community mental health center service providers, this study qualitatively examined service providers’ experiences in treating criminal justice-involved individuals with serious mental illness who were receiving mental health treatment through telemedicine.ResultsService providers expressed satisfaction with telemedicine in addressing client transportation and childcare barriers while increasing engagement. Service providers voiced new concerns regarding clients’ confidentiality, digital literacy, and limitations to gathering non-verbal client information during virtual treatment.ConclusionsMental health treatment offered through telemedicine mitigates barriers to treatment that disproportionately affect criminal justice clients. Despite its benefits, challenges like access to reliable internet and to internet-enabled devices, confidentiality concerns, and information gathering must be addressed to achieve optimal and equitable mental health treatment through telemedicine. The findings support the continued use of telemedicine in mental health treatment delivery for this population.

Application of Mini-CEX combined with DOPS in standardized training of community outpatient residents

ObjectiveTo explore the application effect of mini clinical evaluation exercise (Mini-CEX) combined with direct observation of procedural skills (DOPS) in the standardized training of general practitioners in community clinics.MethodsFrom June 2022 to June 2023,20 general practitioners who received standardized training for residents in the general outpatient department of Changqing Community Health Service Center of Wuhan Fourth Hospital were collected as the research objects. Mini-CEX combined with DOPS was used to evaluate the general practitioners at the time of admission, 2 weeks of training and 4 weeks of training, and the results were fed back.ResultsThe scores of 20 general practitioners at 2 weeks and 4 weeks of training were compared with the scores at the time of admission, and the difference was statistically significant, p < 0.05.ConclusionMini-CEX combined with DOPS can improve the teaching effect of standardized training of residents in community general clinics.

Influence of customer contact employees (CCEs) competencies on their service recovery performance: a moderated-mediation approach

Purpose This study aims to explore the influence of customer contact employees (CCEs) competencies (social, emotional and professional) on their service recovery performance (SRP) with mediation effect of internal marketing and moderation effect of industry/sector. Design/methodology/approach This study used survey-based dyads of 210 CCEs and their managers/supervisors in three service sectors (hotel and hospitality, automobile service centers and organized retail stores). Repeated-measures analysis of variance, confirmatory factor analysis and PROCESS macro of Hayes (2013) was used to assess reliability, validity and to test mediation, moderation and moderated-mediation. Findings CCEs competencies influenced SRP. The relationship between CCEs competencies and SRP was mediated by internal marketing. The industry/sector was found to be a significant moderator between the internal marketing and SRP. Additionally, a significant moderated-mediation effect was found between CCEs competencies and SRP. Research limitations/implications Longitudinal studies could be particularly helpful to evaluate the impact of internal marketing on SRP. The future researcher may benefit from replicating and extending the model in different industries or can study other factors as mediators or moderators for further contribution to the SRP literature. Practical implications Firms striving for consumer retention and aiming to extend their consumer life cycle can greatly benefit from the results of this study to provide effective SRP. The study also suggests that policymakers and management should adopt properly designed and well-articulated human resource management practices for excellence in SRP in their organizations. Originality/value To the best of the authors' knowledge, there is no study in the past which has addressed employee and organizational factors with the dyadic sample. In addition, it has used a moderated-mediation model in the context of SRP and also contributes to the extant literature by researching in a non-Western setting like India.

Trends in Emergency Department Exam Medicare Reimbursements Between 2010 and 2018.

As the Medicare population continues to grow, financial pressure is placed upon hospitals, physicians, and other providers as the payer mix has an increasing proportion of Medicare patients. The purpose of this study was to further the understanding of reimbursement trends surrounding the five levels of emergency department (ED) examinations (CPT codes 99281-99285) from 2010 to 2018 and determine how they have changed with respect to each procedure. CPT codes were filtered into the 2010 and 2018 Physician/Supplier Procedure Summaries from the Centers for Medicare and Medicaid Services' website to gather data on emergency physician submissions and Medicare denials and payments. In 2010, 15,669,196 ED examinations were submitted to Medicare for $7,628,693,382 while in 2018, 16,432,184 ED examinations were submitted for $14,522,456,383. Despite an increase of $397/submission made by emergency physicians, Medicare paid 20.5% of the submitted charges in 2010 for ED examinations and 11.9% in 2018. The denial rate in 2018 was highest for level I ED examinations (11.3%), and the lowest for level V examinations (5.1%). The utilization of level V ED examinations increased 22.3% from 2010 to 2018, while the utilization of the others decreased. Of the five levels of ED examinations, only the level I examinationdid not exhibit a decrease. From 2010 to 2018, emergency physicians charged a higher amount for ED examinations, yet Medicare reimbursement accounted for a smaller proportion of these charges, resulting in less payment per submission for the four most common levels. Downward trends in Medicare reimbursement may place financial burdens that could potentially hamper healthcare outcomes.

The Utilization of Outpatient Health Services and the Associated Factors Among the Older Adults Covered by Comprehensive Health Service Centers in Rasht

Background: The increase in the older adult population has resulted in a higher demand for outpatient health services and subsequently increased costs paid by older adults. Objectives: This study conducted in Rasht aimed to determine the utilization of outpatient health services among older adults covered by comprehensive health service centers and the factors associated with it. Methods: This cross-sectional analytical study was conducted on 384 older adults aged 60 years and older covered by comprehensive health service centers. The sampling method was stratified random sampling based on consecutive sampling. The information required was collected through a researcher-made two-part questionnaire, including individual-social characteristics and outpatient services, via interviews. Data were analyzed using SPSS version 21 software. The significance level of the tests was considered to be P &lt; 0.05. Results: The results showed that 82.8% of the older adults required outpatient services and 90.9% of them actually received these services. Out of the total, 65.1% went to private sector facilities, 17% to public facilities, and the remaining 18% visited facilities in both sectors. The main reasons for not utilizing outpatient services were the lack of money and the inability to pay. Factors such as place of residence (P = 0.014, OR = 2.417), the presence of chronic disorders (P = 0.047, OR = 1.689), health status (P = 0.012, OR = 0.619), and education level (P = 0.05, OR = 0.763) were found to be associated with the utilization of outpatient services. Conclusions: Two-thirds of the sample had chronic diseases, most of them received outpatient services from the private sector, and about 75% of those who did not receive the service could not afford the costs. Therefore, it is necessary to improve the quality of outpatient services in the public sector and enhance their accessibility. Some individuals were unaware of health screenings for older adults in the comprehensive health services centers, so informing them about these services can be useful in promoting their utilization by older adults and reducing the costs of outpatient services.

Relationship between neonatal respiratory distress syndrome pulmonary ultrasonography and respiratory distress score, oxygenation index, and chest radiography grading.

Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome (RDS), but current assessment methods for RDS pose a cumulative risk of harm to neonates. Thus, a less harmful method for assessing the health of neonates with RDS is needed. To analyze the relationships between pulmonary ultrasonography and respiratory distress scores, oxygenation index, and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity. This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022. The pulmonary ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray grade of each newborn before and after treatment were collected. Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity. The pulmonary ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment (P < 0.05). Spearman correlation analysis showed that before and after treatment, the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score, oxygenation index, and chest X-ray grade (ρ = 0.429-0.859, P < 0.05). Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS (area under the curve = 0.805-1.000, P < 0.05). The pulmonary ultrasonography score was significantly associated with the neonatal RDS score, oxygenation index, and chest X-ray grade. The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.

دور الحكومة الرقمية في دعم النمو الاقتصادي للدول - دراسة حالة: دولة الإمارات العربية المتحدة

The study aimed to identify the reality and future of implementing digital government in the United Arab Emirates, and its role in supporting the country’s economic growth. This is done by learning about the concept of digital government, its elements, and its importance, and then learning about the foundations of implementing digital government in the United Arab Emirates. The role of the digital government in enhancing the position of the United Arab Emirates regionally and internationally as a center for technical progress and e-commerce, and knowing the position of the United Arab Emirates in the relevant global competitiveness indicators through the use of the descriptive analytical approach and the case study approach. The study reached a set of results, the most important of which are: The contribution of the United Arab Emirates’ adoption of modern technology and its application to digital government in achieving the concept of leadership and innovation, and developing distinguished infrastructure, as the country has allocated large investments to support the information technology sector; This led it to become a regional center for information and communication technology services and industry, and created an attractive investment environment in the information technology sector, which enhanced the diversification of sources of income and increased the size of the gross domestic product and its dependence on non-oil sectors, as the percentage of increase in the gross domestic product reached 7.9%. Year 2022, these sectors, of all types, relied on a qualified infrastructure of technical development, which highlights the importance of the state adopting technical progress through digital government in supporting economic growth. Digital transformation in the United Arab Emirates also contributed to enhancing its competitiveness in the international system by occupying first place globally in 23 indicators in 2020 in multiple sectors, including communications, health, work, and residence, all of which fall within the digital transformation in the United Arab Emirates. The study recommended a set of recommendations, including the need to generalize the success of the United Arab Emirates’ experience in implementing the digital government project to Arab countries; this is due to the success of its application in the UAE and its role in facilitating and simplifying all procedures and services provided to customers. Its impact on reducing time and costs, and its role in attracting investments and promoting economic growth. In addition to continuing to build and strengthen the education system using modern technical means, which contributes to spreading the culture of information technology and preparing technically qualified educational personnel to deal with the requirements of technical development.

Telaah Faktor Risiko dan Pemeriksaan Osteoartritis terhadap Kualitas Hidup Masyarakat Desa Kendalpayak Malang

Osteoarthritis is a degenerative disease characterized by loss of synovial fluid and articular cartilage in the joints, causing pain and difficulty moving which harms people's quality of life. This community service activity aims to examine the risk factors and results of osteoarthritis examinations on the quality of life of the community. The activity was carried out by collecting data on risk factors and quality of life of the community from 10 elderly integrated health service centers in Kendalpayak. Osteoarthritis examination is carried out based on a clinical examination by a Bone Specialist at Saiful Anwar Hospital. The results obtained were 94 women and 19 men, aged 40-45 years 12 people, 46-60 years 43 people, and 54 people aged &gt;60 years. The Body Mass Index categories of underweight, normal, overweight, and obesity were 4.4%; 45.1%; 30.1%; and 20.4%, respectively. Menopause status ≤10 and &gt;10 years were 22.3% and 29.9%. The data collection on light, moderate, and heavy exercise patterns were 68.2%; 27.4%; 4.4%. The physical activity data collected from light, moderate, and heavy respectively were as follows: 39%; 52.2%; 8.8%. There were 5.3% who had a history of bone trauma. Based on clinical examination, 7.2% were positive for osteoarthritis. Measuring quality of life using the EQ-5D questionnaire in osteoarthritis sufferers shows the severity of the dimensions Mobility (56.1%), Self-Care (24.2%), Usual Activities (41.5%), Pain/Discomfort (92.7%), and Anxiety/Depression (61%). In conclusion, risk factors that influence the quality of life of osteoarthritis sufferers in Kendalpayak Village, Malang include being elderly, female, and menopausal.

Sistem Tata Kelola Tagihan Pembayaran Klaim Jaminan Kecelakaan Kerja Pada BPJS Ketenagakerjaan Cabang Surabaya Karimunjawa

BPJS Employment cooperates with many employer companies and Work Accident Service Centers in managing Work Accident Insurance. In its management, of course, the company must have an effective and efficient governance system. The research entitled "Governance System for Payment Bills for Work Accident Guarantee Claims at Bpjs Ketenagakerjaan Surabaya Karimunjawa Branch" has the aim of conducting an ongoing analysis of the governance of bills for payment of work accident guarantee claims. The results obtained in this study are that researchers know the benefits of Work Accident Insurance and the procedures and Management System for JKK Payment Bills which are carried out very well by the BPJS Employment Surabaya Karimunjawa.

Synergistic effects of social determinants of health and race-ethnicity on 30-day all-cause readmission disparities: a retrospective cohort study

ObjectiveThe objective of this study is to assess the effects of social determinants of health (SDOH) and race-ethnicity on readmission and to investigate the potential for geospatial clustering of patients...

Regional variability of cardiovascular magnetic resonance access and utilization in the United States

Clinical guidelines and scientific data increasingly support the appropriate use of cardiovascular magnetic resonance (CMR) . The extent of CMR adoption across the United States (US) remains unclear. This observational analysis aims to capture CMR practice patterns in the US. Commissioned reports from the Society for Cardiovascular Magnetic Resonance (SCMR), pre-existing survey data from CMR centers, and socioeconomic and coronary heart disease data from the Centers for Disease Control and Prevention were used. The location of imaging centers performing CMR was based on 2018 Medicare claims. Secondary analysis was performed on center-specific survey data from 2017-2019, which were collected by members of the SCMR US Advocacy Subcommittee for quality improvement purposes. The correlation between the number of imaging centers billing for CMR services per million persons, socioeconomic determinants, and coronary heart disease epidemiology was determined. A total of 591 imaging centers billed the Center for Medicare & Medicaid Services for CMR services in 2018 and 112 (of 155) unique CMR centers responded to the survey. In 2018, CMR services were available in almost all 50 states. Minnesota was the state with the highest number of CMR centers per million Medicare beneficiaries (52.6 centers per million), and Maine had the lowest (4.4 per million). The total density of CMR centers was 16 per million for US Medicare beneficiaries. Sixty-eight percent (83 of 112) of survey responders were cardiologists, and 28% (31/112) were radiologists. In 72% (71/112) of centers, academic health care systems performed 81%-100% of CMR exams. The number of high-volume centers (>500 scans per year) increased by seven between 2017 and 2019. In 2019, 53% (59/112) of centers were considered high-volume centers and had an average of 19years of experience. Centers performing <50 scans had on average 3.5years of experience. Approximate patient wait time for a CMR exam was 2weeks to 1month. Despite increasing volume and availability in almost all 50 states, CMR access remains geographically variable. Advocacy efforts to improve access and innovations that reduce imaging time and exam complexity have the potential to increase the adoption of CMR technology.

Diagnosis of spatial neglect and rehabilitation access for stroke survivors.

Spatial neglect in stroke survivors is associated with a decrease in quality of life. This disorder occurs in 20-80% of stroke survivors and up to 1/3 of stroke survivors will continue to experience chronic impairment. Occupational therapists are uniquely qualified to treat stroke survivors with spatial neglect due to their holistic approach but access to therapy is limited. Diagnostic coding is used to help determine appropriate reimbursement and continuation of care including rehabilitation services. The objectives of this study were to 1) identify the prevalence of diagnostic coding for spatial neglect in stroke survivors, and 2) identify the prevalence and types of rehabilitation for patients with diagnostic coding for spatial neglect. We completed a retrospective cohort analysis using 2018 and 2019 5% Medicare Limited Data Sets from the Centers for Medicare and Medicaid Services. We extracted all ischemic stroke survivors and stratified them by the presence of a secondary diagnostic code indicating spatial neglect. Rehabilitation Current Procedural Terminology codes were used to identify stroke survivors who received rehabilitation. Despite recommendations from clinical practice, only 4.9% had a diagnostic code for spatial neglect. Of those formally diagnosed, only 2.3% received outpatient occupational therapy after being discharged from acute care.

Disciplining a Rubidium Atomic Clock Based on Adaptive Kalman Filter.

Rubidium atomic clocks have been used extensively in various fields, with applications such as a core component of Global Navigation Satellite Systems (GNSS). However, they exhibit inherently poor long-term stability. This paper presents the development of a control system for rubidium atomic clocks. It introduces an adaptive Kalman filtering algorithm for the disciplining of a rubidium atomic clock, utilizing autocovariance least squares (ALS) to estimate the clock's noise parameters. The experimental results demonstrate that the proposed algorithm achieves a high estimation accuracy. The standard deviation of the clock error between the steered rubidium atomic clock 1 Pulse Per Second (1PPS) and Coordinated Universal Time (UTC) provided by the National Time Service Center (NTSC) is better than 2.568 nanoseconds(ns), with peak-to-peak values improving to within 11.358 ns. Notably, its frequency stability is reduced to 3.06 × 10-13 @100,000 s. The results for the rubidium atomic clock demonstrate that the adaptive Kalman filtering algorithm proposed herein constitutes an accurate and effective control strategy for the rubidium atomic clock discipline.

Effectiveness of a Community-Based Ostomy Nursing Technique to Enhance the Delivery of Patient Care and Quality of Life

ABSTRACT This study aimed to develop and validate a community-based ostomy care training program for nursing staff, with the goal of enhancing their ostomy nursing competencies and improving patient satisfaction. Between March 2021 and October 2021, 20 registered nurses and 50 patients with enterostomy surgery who took part in the promotion of a new nursing technique in five community health service centers in the Wuxing District, Huzhou City, were enrolled in this study (forming the intervention group). In addition, 15 registered nurses and 40 patients with enterostomy surgery from four community health service centers with similar economic and health conditions in the same area were randomly selected as the control group. All community health service centers were independent institutions. The indexes before and after the promotion of the technique were compared, and the effectiveness of the training was evaluated by observing the improvement in nursing skills and changes in patient quality of life after the training. The “quality-of-life scale” was used to analyze the quality of life of patients who had undergone colostomy surgery. The new approach to ostomy care delivered in a community setting was found to improve staff knowledge and skill in ostomy care (p < 0.001), improve the quality-of-life scores of patients and reduce patient travel time and medical expenses. The promotion of ostomy nursing techniques in community health service centers has several benefits. It improves the ostomy nursing skill levels of community medical staff. This reduces the occurrence of ostomy complications. Additionally, it establishes an effective connection between tertiary hospitals and community health service centers. This connection is conducive to better nursing care for patients who have undergone ostomy surgery. The hospital – community – family nursing model can improve self-management abilities and reduce the incidence of complications of enterostomies.