Structured Templates Research Articles

Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research.

BackgroundNearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system–level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs.ObjectiveWe aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation.MethodsA systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research.ResultsIn the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions.ConclusionsCurrent evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies.

Impact of implementing structured note templates on data capture for hernia surgery.

Electronic medical record notes have been determined to be lacking in quality, accessibility and content. Structured note templates could provide a way to improve these aspects, particularly with regard to data availability for research and quality improvement. To determine whether the implementation of a standardised template for hernia documentation can improve data completeness and timeliness. Retrospective review of clinic notes of 30 patients, 15 prior to implementation of a standardised note template and 15 after implementation of the template. The number of the 21 Americas Hernia Society Quality Collaborative (AHSQC) variables which were present in the notes was recorded, as was the time that the consultation ended and the time that the note was submitted. Mean number of variables collected prior to implementation of the template was 5.9 ± 1.6 vs. 20 ± 0.4 after implementation (p < 0.001). In the pre-implementation group, 20% of the notes were completed after the day of the visit, while all of the notes in the post-implementation group were completed on the same day as the visit (p = 0.367). Implementation of a structured note template resulted in significantly improved capture of specific database variables within clinical notes. Structured note templates are an effective tool to improve data capture from the clinical setting for research and quality improvement.

Process of Developing Palliative Care Curriculum for Training Medical Interns in a Tertiary Care Teaching Hospital in Puducherry, India

Objectives:The department of community medicine (DCM) has been training medical interns for palliative care in the hospital and community setting. There was no specific curriculum or course material available for training them. This study aims to develop, implement and evaluate the palliative care curriculum for training medical interns.Materials and Methods:The present program development and evaluation of palliative care curriculum was done in the DCM, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. We followed the Kern’s six steps for curriculum development. It was done during July 2016 and May 2017. We framed expected outcomes from literature review and interviews with experts. The curriculum was delivered through small group sessions followed by hands-on exposure to hospital- and community-based palliative care programs guided by a workbook. Medical interns were given feedback on their field assignments on history taking, followed by reflection using structured template incorporated in the workbook. The reaction to the curriculum was collected from various stakeholders.Results:Medical interns found the curriculum useful for them to acquire basic skills of pain management, communication skills and teamwork. Patients and family felt satisfied with the quality of care provided.Conclusion:The new palliative care curriculum was well received by all the stakeholders involved. This can be adopted in similar context for training medical interns in palliative care.

Knowledge configuration model for fast derivation design of electronic equipment and its implementation

There has contradictions in timeliness and diversity in the design schemes of complex product systems. The traditional solidified knowledge template for the knowledge reuse purpose cannot meet the rapid design needs of complex products. This paper proposes a configurable knowledge ontology model (CKOM) and a corresponding design method for rapid derivation of complex products. Based on the combination of basic knowledge elements (BKE), customized knowledge elements (CKE), and assorted knowledge elements (AKE), a knowledge structural body (KSB) is constructed by unitizing knowledge ontology into units of knowledge. And a dynamic structured knowledge template configuration method based on physical form (Pf) configuration and virtual form (Vf) association is proposed. The knowledge configuration information is transmitted and parsed in XML form, and the virtual form is established to associate and dynamically configure the corresponding physical form knowledge structure. Based on the structured knowledge model configuration template, a rapid derivative design method for electronic equipment is proposed. The rapid derivation design process is divided into three stages: requirement analysis, index demonstration, and scheme formation. By establishing seven knowledge attributes, such as global, local, scope, retrieval, the required product knowledge elements, rule knowledge elements and tools are dynamically configured to realize the dynamic processing of design parameters based on configuration knowledge elements and then form a corresponding design scheme. Finally, a rapid derivation design system is developed and applied to electronic equipment, which verifies the rationality and effectiveness of the proposed model and method.

Preliminary Radiology Report Discordances and Patient Outcomes.

At our institution, resident and fellow radiologists issue preliminary reports for off-hours imaging studies, which are overread by attending radiologists the next day using structured discrepancy templates. In this study, we examined the impact on patient management and outcome of studies with major discordance. For our retrospective observational study, preliminary reports between March and June 2017 that received major discordance were identified through report text search. Electronic medical records were reviewed for patient management change and patient outcome. Of the 199 cases, 52 cases (26%) had management change and 119 cases (60%) did not have management change. In 25 cases (13%), the preliminary report was proven correct on subsequent management. Three cases (2%) were lost to follow-up. In only one case was adverse outcome directly related to the discordant finding. In cases with patient management change, there was higher proportion of perceptual error compared with those without management change (73% versus 59%). In 47 cases (24%), the discordant finding or diagnosis was known to the clinical team, and better history could have avoided the major change. Adverse outcome from the discordant imaging finding was low (0.5%). Major change in preliminary report could be reduced with better clinical history. Patient management change was more frequently seen with perceptual errors, placing greater emphasis on strategies to reduce them.

In-situ switchable superhydrophobic shape memory microstructure patterns with reversible wettability and adhesion

Recently, more and more attention has been focused on superhydrophobic patterned surfaces with controllable wettability and adhesion. However, almost all present works are based on designing hydrophilic patterns onto the superhydrophobic surfaces. Smart wetting control on microstructure patterned surfaces is still extremely rare since reversible regulating surface microstructure is relatively more difficult. Herein, we report such a strategy for smart surface wetting control. As a demonstration, a superhydrophobic shape memory polymer (SMP) array was prepared, patterns such as dots and lines can be easily obtained through pressing structured templates on the surface, and such patterns can be removed after a further heating process. During the whole process, lots of surface wetting properties including large/small contact angles, high/low adhesions, and isotropic/anisotropic sliding abilities can be reversibly controlled. The smart controllability comes from the excellent shape memory effect (SME) of the material, which can memorize and present diverse microstructure patterns and solid/liquid contact models. Furthermore, some applications including droplet storage, capture/release, directional transportation, and special advantages compared with traditional hydrophilic patterns such as anti-pollution property and excellent stability were also demonstrated. This work not only opens a novel way for controlling surface wetting, but also provides a new superhydrophobic platform for manipulation of microdroplet.

Implementing Structured Clinical Templates at a Single Tertiary Hospital: Survey Study.

BackgroundElectronic health record (EHR) systems have been widely adopted in hospitals. However, since current EHRs mainly focus on lowering the number of paper documents used, they have suffered from poor search function and reusability capabilities. To overcome these drawbacks, structured clinical templates have been proposed; however, they are not widely used owing to the inconvenience of data entry.ObjectiveThis study aims to verify the usability of structured templates by comparing data entry times.MethodsA Korean tertiary hospital has implemented structured clinical templates with the modeling of clinical contents for the last 6 years. As a result, 1238 clinical content models (ie, body measurements, vital signs, and allergies) have been developed and 492 models for 13 clinical templates, including pathology reports, were applied to EHRs for clinical practice. Then, to verify the usability of the structured templates, data entry times from free-texts and four structured pathology report templates were compared using 4391 entries from structured data entry (SDE) log data and 4265 entries from free-text log data. In addition, a paper-based survey and a focus group interview were conducted with 23 participants from three different groups, including EHR developers, pathology transcriptionists, and clinical data extraction team members.ResultsBased on the analysis of time required for data entry, in most cases, beginner users of the structured clinical templates required at most 70.18% more time for data entry. However, as users became accustomed to the templates, they were able to enter data more quickly than via free-text entry: at least 1 minute and 23 seconds (16.8%) up to 5 minutes and 42 seconds (27.6%). Interestingly, well-designed thyroid cancer pathology reports required 14.54% less data entry time from the beginning of the SDE implementation. In the interviews and survey, we confirmed that most of the interviewees agreed on the need for structured templates. However, they were skeptical about structuring all the items included in the templates.ConclusionsThe increase in initial elapsed time led users to hold a negative opinion of SDE, despite its benefits. To overcome these obstacles, it is necessary to structure the clinical templates for optimum use. In addition, user experience in terms of ease of data entry must be considered as an essential aspect in the development of structured clinical templates.

Synthesis of hexagonal boron nitride 2D layers using polymer derived ceramics route and derivatives

Hexagonal boron nitride (h-BN) is nowadays an increasingly attractive material, especially for two-dimensional material applications, due to its intrisic properties. However, its properties are highly dependent on the used synthesis approach. The polymer derived ceramics (PDCs) route allows elaboration of h-BN with tailored textural and structural properties. Here, we demonstrate the interest of the PDCs pathway for the synthesis of h-BN. Growth of h-BN single crystals with crystal sizes of a few microns at relatively low temperature and atmospheric pressure is successfully achieved from borazine precursor using PDCs. The crystallization is improved by additivation of 5 wt% of Li3N to the pre-ceramic polymer. Furthermore, by coupling PDCs with gas pressure sintering, starting from the same pre-ceramic polymer and 25 wt% of Li3N, the crystal size is enlarged up to hundreds of microns. The fabricated single crystals of pure h-BN can then be exfoliated into h-BN nanosheets. Finally, by combining PDCs with atomic layer deposition, functional BN nano-/hetero-structures are successfully synthesized from highly structured sensitive templates, making this ALD process a promising alternative for fabricating functional BN nanostructures.

A Hybrid Reporting Platform for Extended RadLex Coding Combining Structured Reporting Templates and Natural Language Processing.

Structured reporting is a favorable and sustainable form of reporting in radiology. Among its advantages are better presentation, clearer nomenclature, and higher quality. By using MRRT-compliant templates, the content of the categorized items (e.g., select fields) can be automatically stored in a database, which allows further research and quality analytics based on established ontologies like RadLex® linked to the items. Additionally, it is relevant to provide free-text input for descriptions of findings and impressions in complex imaging studies or for the information included with the clinical referral. So far, however, this unstructured content cannot be categorized. We developed a solution to analyze and code these free-text parts of the templates in our MRRT-compliant reporting platform, using natural language processing (NLP) with RadLex® terms in addition to the already categorized items. The established hybrid reporting concept is working successfully. The NLP tool provides RadLex® codes with modifiers (affirmed, speculated, negated). Radiologists can confirm or reject codes provided by NLP before finalizing the structured report. Furthermore, users can suggest RadLex® codes from free text that is not correctly coded with NLP or can suggest to change the modifier. Analyzing free-text fields took 1.23s on average. Hybrid reporting enables coding of free-text information in our MRRT-compliant templates and thus increases the amount of categorized data that can be stored in the database. This enhances the possibilities for further analyses, such as correlating clinical information with radiological findings or storing high-quality structured information for machine-learning approaches.

Proteomic Analysis of DNA Synthesis on a Structured DNA Template in Human Cellular Extracts: Interplay Between NHEJ and Replication-Associated Proteins.

It is established that short inverted repeats trigger base substitution mutagenesis in human cells. However, how the replication machinery deals with structured DNA is unknown. It has been previously reported that in human cell-free extracts, DNA primer extension using a structured single-stranded template is transiently blocked at DNA hairpins. Here, the proteomic analysis of proteins bound to the DNA template is reported and evidence that the DNA-PK complex (DNA-PKcs and the Ku heterodimer) recognizes, and is activated by, structured single-stranded DNA is provided. Hijacking the DNA-PK complex by double-stranded oligonucleotides results in a large removal of the pausing sites and an elevated DNA extension efficiency. Conversely, DNA-PKcs inhibition results in its stabilization on the template, along with other proteins acting downstream in the Non-Homologous End-Joining (NHEJ) pathway, especially the XRCC4-DNA ligase 4 complex and the cofactor PAXX. Retention of NHEJ factors to the DNA in the absence of DNA-PKcs activity correlates with additional halts of primer extension, suggesting that these proteins hinder the progression of the DNA synthesis at these sites. Overall these results raise the possibility that, upon binding to hairpins formed onto ssDNA during fork progression, the DNA-PK complex interferes with replication fork dynamics in vivo.

Improving Billing Accuracy Through Enterprise-Wide Standardized Structured Reporting With Cross-Divisional Shared Templates

ObjectiveWe describe our experience in implementing enterprise-wide standardized structured reporting for chest radiographs (CXRs) via change management strategies and assess the economic impact of structured template adoption. MethodsEnterprise-wide standardized structured CXR reporting was implemented in a large urban health care enterprise in two phases from September 2016 to March 2019: initial implementation of division-specific structured templates followed by introduction of auto launching cross-divisional consensus structured templates. Usage was tracked over time, and potential radiologist time savings were estimated. Correct-to-bill (CTB) rates were collected between January 2018 and May 2019 for radiography. ResultsCXR structured template adoption increased from 46% to 92% in phase 1 and to 96.2% in phase 2, resulting in an estimated 8.5 hours per month of radiologist time saved. CTB rates for both radiographs and all radiology reports showed a linearly increasing trend postintervention with radiography CTB rate showing greater absolute values with an average difference of 20% throughout the sampling period. The CTB rate for all modalities increased by 12%, and the rate for radiography increased by 8%. DiscussionChange management strategies prompted adoption of division-specific structured templates, and exposure via auto launching enforced widespread adoption of consensus templates. Standardized structured reporting resulted in both economic gains and projected radiologist time saved.

Creating high-quality radiology reports in foreign languages through multilingual structured reporting.

Globalization and migration are increasing the demand for reports in different languages. We aimed to examine if structured reports created by non-German-speaking radiologists with multilingual templates show significant differences in quality to structured reports and free-text reports by German native speakers. We used structured templates that allow radiologists to report in their mother tongue and then switch the report language to German or English automatically using proprietary software. German- and English-speaking radiology residents created structured reports in both German and English with these templates. Reports for three different exam types were created (intensive care chest x-ray, shoulder x-ray specifically for degenerative processes, and CT pulmonary angiogram for pulmonary embolism). The report quality of automatically translated German structured reports by English-speaking radiologists and German structured reports by German radiologists was then evaluated by German clinicians with a standardized questionnaire. The questionnaire was designed to assess attributes including content, comprehensibility, clinical consequences, and overall quality. Structured reports by English-speaking radiologists that were automatically translated into German and Germanstructured reports by German radiologists both received very high or high overall quality ratings in the majority of cases, showing no significant differences in quality. Likewise, no significant differences were observed between the two report types regarding comprehensibility and clinical consequences. Structured reports by German radiologists received significantly better ratings for overall quality and comprehensibility compared to free-text reports by German radiologists. Multilingual structured reporting templates may serve as a feasible tool for creating high-quality radiology reports in foreign languages. • Multilingualism in structured reporting templates can be a useful tool for creating high-quality radiology reports in foreign languages. • German reports created with multilingual structured reporting templates by English-speaking radiologists and German structured reports by German radiologists exhibit no significant differences in overall report quality. • Multilingual structured reporting templates can help radiologists overcome communication barriers and facilitate teleradiology.

Molecular Recognition of Structures Is Key in the Polymerization of Patterned Barnacle Adhesive Sequences.

The permanent adhesive produced by adult barnacles is held together by tightly folded proteins that form amyloid-like materials distinct among marine foulants. In this work, we link stretches of alternating charged and noncharged linear sequences from a family of adhesive proteins to their role in forming fibrillar nanomaterials. Using recombinant proteins and short barnacle cement derived peptides (BCPs), we find a central sequence with charged motifs of the pattern [Gly/Ser/Val/Thr/Ala-X], where X are charged amino acids, to exert specific control over timing, structure, and morphology of fibril formation. While most BCPs remain dormant, the core segment demonstrates rapid polymerization as well as an ability to template other peptides with no propensity for self-assembly. Patterned charge domains assemble dormant peptides through a specific antiparallel β-sheet structure as measured by FTIR. While charged domains favor an antiparallel structure, BCPs without charged domains switch fibril assembly to favor simpler parallel β-sheet aggregates. In addition to activation, charged domains direct nanofibers to grow into discrete microns long fibrils similar to the natural adhesive, while segments without such domains only form short branched aggregates. The assembly of adhesive sequences through recognition of structured templates outlines a strategy used by barnacles to control physical mechanisms of underwater adhesive delivery, activation, and curing based on molecular recognition between proteins.

Standardized report template for indeterminate renal masses at CT and MRI: a collaborative product of the SAR Disease-Focused Panel on Renal Cell Carcinoma.

To create a succinct yet comprehensive evidence-based structured report template for indeterminate renal masses characterized at CT and MRI. This IRB-exempt, iterative, multi-institutional quality improvement project was informed by published data derived from a multi-institutional survey and a multi-institutional review of CT and MRI radiology reports. A two-stage blinded Delphi process by the 16-member 12-institution Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma was conducted to create a structured report template for indeterminate renal masses evaluated at CT and MRI. Individual reporting characteristics were scored by members as 'core,' 'optional,' or 'exclude.' Threshold for inclusion was ≥ 80% support. If < 80% members considered a characteristic a 'core' feature, but ≥ 80% considered it either 'core' or 'optional,' it was considered an 'optional' feature. If neither was the case, the characteristic was excluded. Free-text comments were permitted. Characteristics considered 'core' by 50-99% of respondents in Round 1 (i.e., nonunanimous support) and uninvestigated free-text comments were assessed in Round 2. Core and optional structured reporting templates were derived. The response rate was 100% in Round 1 (16/16) and Round 2 (16/16). In Round 1, 5 characteristics had unanimous support as 'core' features. Following Round 2, 13 characteristics had ≥ 80% support as 'core' features, and 10 characteristics had ≥ 80% support as 'optional' features. Structured report templates were derived. Structured 'core' and 'optional' templates for indeterminate renal masses at CT and MRI were derived, which may improve compliance with reporting preferred and essential imaging characteristics.

A parametric morphing method for generating structured meshes for marine free surface flow applications with plane symmetry

Abstract This article introduces a method for morphing a parametric, rectangular and structured 3D template mesh such that it embodies: (1) a given (half) hull surface properly aligned with a pre-defined air-water interface zone, (2) a high-quality boundary layer region near the hull, and (3) a smooth transition of the mesh to the template mesh structure away from the hull. The performance of the proposed method is successfully validated on three widely studied benchmark cases, namely the parabolic Wigley hull, the Series 60 hull and the DTMB 5415 combatant hull. The proposed automated mesh generation method is useful in shape optimization for computational fluid dynamics, among others. Highlights A new method for creating structured meshes for marine CFD applications is presented. The proposed method is parametric and thus fully programmable. The method includes an automatic resolution of CAD geometry errors. The resulting meshes are strictly orthogonal near the inter-phase zone and the hull. The main application of the proposed method is in CFD-based shape optimization.

Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study.

BackgroundThe referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake.ObjectiveThe aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries.MethodsA total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors.ResultsThe users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings.ConclusionsWe found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words.

GPs' opinions of discharge summaries generated by advanced nurse practitioners in emergency care settings.

Clinical handover at the point of discharge is critically important. It generally occurs through a written document, usually in the form of a discharge summary. Hospital discharge summaries contribute to continuity of care for patients who leave hospital and who may require care in the community provided by their GP. They must be accurate, valid, reliable, timely, legible and complete. The aim of this study was to investigate GPs' perceptions of the content of discharge summaries generated by emergency advanced nurse practitioners (EANPs). A cross-sectional descriptive survey design was used and a questionnaire was distributed to 120 GPs. Raw statistical data were analysed using SPSS v22 while the qualitative data from the open-ended questions were manually analysed. Most GPs were satisfied with the EANPs' discharge summary letters. However, this study supports previous papers that identified deficits in communication between secondary care and GPs. There is a need to refine discharge summaries to create an enhanced structured discharge summary template that can be used by all disciplines.

Strategies for Implementing a Standardized Structured Radiology Reporting Program.

Radiology practices are increasingly implementing standardized report templates to overcome the drawbacks of individual templates. However, implementing a standardized structured reporting program is not necessarily straightforward. This article provides practical guidance for radiologists who wish to implement standardized structured reporting in their practice. Challenges that radiology groups encounter tend to fall into two categories: technical and organizational. Defining and carrying out technical work can be tedious but tends to be relatively straightforward, whereas overcoming organizational challenges often requires changes in individuals' strongly held values, beliefs, roles, and relationships. Established organizational change models can help frame the organizational strategy to implement a standardized structured reporting program. Once leadership support is secured, a standardized structured reporting committee can be convened to establish report priorities, standards, design principles, and guidelines. Report standards help to establish the common framework upon which all report templates are constructed, helping to ensure report consistency. By using these standards, committee members can create reports relevant to their subspecialties, which can then be edited for formatting and content. Once report templates have been developed, edited, and published, an abbreviated form of the same process can be used to maintain the reports, which can be accomplished with much less effort than that initially required to create the templates. After standardized structured report templates are implemented and become embedded in practice, most radiologists eventually appreciate the merits of the program. ©RSNA, 2018.

Documentation of psychotropic pro re nata medication administration: An evaluation of electronic health records compared with paper charts and verbal reports.

To describe the documentation of pro re nata (PRN) medication for anxiety and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, Nursing process and critical thinking, Saddle River, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., Marinis etal., 2010, J Clin Nurs, 19, 1544-1552) and considerable information missing (e.g., Marinis etal., 2010, J Clin Nurs, 19, 1544-1552). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker etal., 2008, J Clin Nurs, 17, 1122-1131). The project was a mixed-method, two-phase study that collected data from two sites. In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be made through training, using structured report templates and by switching to electronic databases.

Structured reporting of x-rays for atraumatic shoulder pain: advantages over free text?

BackgroundTo analyse structured and free text reports of shoulder X-ray examinations evaluating the quality of reports and potential contributions to clinical decision-making.MethodsWe acquired both standard free text and structured reports of 31 patients with a painful shoulder without history of previous trauma who received X-ray exams. A template was created for the structured report based on the template ID 0000154 (Shoulder X-ray) from radreport.org using online software with clickable decision trees with concomitant generation of structured semantic reports. All reports were evaluated regarding overall quality and key features: content, information extraction and clinical relevance.ResultsTwo experienced orthopaedic surgeons reviewed and rated structured and free text reports of 31 patients independently. The structured reports achieved significantly higher median ratings in all key features evaluated (P < 0.001), including facilitation of information extraction (P < 0.001) and better contribution to subsequent clinical decision-making (P < 0.001). The overall quality of structured reports was significantly higher than in free text report (P < 0.001).ConclusionsA comprehensive structured template may be a useful tool to assist in clinical decision-making and is, thus, recommended for the reporting of degenerative changes regarding X-ray examinations of the shoulder.