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Leoni FG, Magnano San Lio P, De Molo C, Bakken S, Ferronato M, Dietrich CF, Serra C. Budd-Chiari syndrome (BCS): a challenging diagnosis not to be overlooked-single center report and pictorial essay. J Ultrasound 2023; 26:249-254. [PMID: 36180766 PMCID: PMC10063764 DOI: 10.1007/s40477-022-00723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022] Open
Abstract
Budd-Chiari syndrome (BCS) is a rare disease with a variable clinical presentation and often late diagnosis. Doppler ultrasonography (DUS) permits to determine the site of the obstructed venous tracts, the thrombotic or non-thrombotic nature of the obstruction with its morphologic features and the flow-pattern alterations. Other non-specific findings, which are seen in most of the other liver diseases, include ascites, hepatosplenomegaly and caudate hypertrophy. The aim of this study is to show our experience in BCS reporting retrospectively 15 cases referred to our hepatology center between 2017 and 2021. Four selected cases depict the extreme heterogeneous behaviour of BCS and highlight the importance of DUS as a diagnostic tool when there is a clinical suspicion. In patients, mainly young, who present with ascites and abdominal pain, BCS has to be considered and DUS is the first imaging technique to be performed to rule it out.
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Affiliation(s)
- F. G. Leoni
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - P. Magnano San Lio
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - C. De Molo
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - S. Bakken
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - M. Ferronato
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - C. F. Dietrich
- University Clinic for Visceral Surgery and Medicine, INSELSPITAL, University Hospital of Bern, Bern, Switzerland
| | - C. Serra
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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2
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Chernick LS, Konja A, Gonzalez A, Stockwell MS, Ehrhardt A, Bakken S, Westhoff CL, Dayan PS, Santelli J. Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors. Digit Health 2022; 8:20552076221104660. [PMID: 35707267 PMCID: PMC9189520 DOI: 10.1177/20552076221104660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/14/2022] [Indexed: 12/31/2022] Open
Abstract
Objective Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support. Methods We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14-19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients. Results Females (n = 22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5-12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n = 39) found the images "relatable," "super-realistic," and "educational." Conclusion Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA,Lauren S Chernick, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY, USA.
| | - Alexis Konja
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Ariana Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - Melissa S Stockwell
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center, New York, NY, USA
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, NY, USA
| | - Carolyn L Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - John Santelli
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
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Chernick LS, Santelli J, Stockwell MS, Gonzalez A, Ehrhardt A, Thompson JL, Leu CS, Bakken S, Westhoff CL, Dayan PS. A multi-media digital intervention to improve the sexual and reproductive health of female adolescent emergency department patients. Acad Emerg Med 2022; 29:308-316. [PMID: 34738284 PMCID: PMC8960324 DOI: 10.1111/acem.14411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED. METHODS We conducted a pilot-randomized controlled trial of sexually active female ED patients age 14-19 years. Participants were randomized to the intervention Dr. Erica (Emergency Room Interventions to improve the Care of Adolescents) or usual care. Dr. Erica consists of an ED-based digital intervention along with 3 months of personalized and interactive multimedia messaging. We assessed the feasibility, adoption, and fidelity of Dr. Erica among adolescent female users. Initiation of highly effective contraception was the primary efficacy outcome. RESULTS We enrolled 146 patients; mean (±SD) age was 17.7 (±1.27) years and 87% were Hispanic. Dr. Erica demonstrated feasibility, with high rates of consent (84.4%) and follow-up (82.9%). Intervention participants found Dr. Erica acceptable, liking (98.0%, on Likert scale) and recommending (83.7%) the program. A total of 87.5% adopted the program, responding to at least one text; a total of 289 weblinks were clicked. Dr. Erica demonstrated fidelity; few participants opted out (6.9%) and failed to receive texts (1.4%). Contraception was initiated by 24.6% (14/57) in the intervention and 21.9% (14/64) in the control arms (absolute risk difference [ARD] = 2.7%, 95% confidence interval [CI] = -12.4% to 17.8%). Participants receiving Dr. Erica were more likely to choose a method to start in the future (65.9% [27/41]) than controls (30.0% [15/50]); ARD = 35.9%, 95% CI = 16.6% to 55.1%). CONCLUSIONS A personalized, interactive digital intervention was feasible to implement, acceptable to female ED patients and demonstrated high fidelity and adoption. This ED-based intervention shows potential to improve contraception decision making.
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Affiliation(s)
- Lauren S Chernick
- Department of Emergency Medicine, Columbia University Medical Center
| | - John Santelli
- Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center,Department of Pediatrics, Columbia University Medical Center
| | - Melissa S Stockwell
- Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center,Department of Pediatrics, Columbia University Medical Center
| | - Ariana Gonzalez
- Department of Emergency Medicine, Columbia University Medical Center
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center
| | - John L.P. Thompson
- Department of Biostatistics, Columbia Mailman School of Public Health and Department of Neurology, Columbia University Medical Center
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia Mailman School of Public Health
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center
| | - Carolyn L. Westhoff
- Department of Obstetrics-Gynecology and Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center
| | - Peter S Dayan
- Department of Emergency Medicine, Columbia University Medical Center
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Chernick LS, Stockwell MS, Gonzalez A, Mitchell J, Ehrhardt A, Bakken S, Westhoff CL, Santelli J, Dayan PS. A User-Informed, Theory-Based Pregnancy Prevention Intervention for Adolescents in the Emergency Department: A Prospective Cohort Study. J Adolesc Health 2021; 68:705-712. [PMID: 32948403 PMCID: PMC8527994 DOI: 10.1016/j.jadohealth.2020.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED-based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]). METHODS We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation). RESULTS We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation ± 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35). CONCLUSIONS Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females.
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Affiliation(s)
- Lauren S. Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York,Address correspondence to: Lauren S. Chernick, M.D., M.Sc., Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY 10032
| | - Melissa S. Stockwell
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York,Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Ariana Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
| | - Jameson Mitchell
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center, New York, New York
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, New York
| | - Carolyn L. Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York,Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, New York
| | - John Santelli
- Department of Child and Adolescent Health, Columbia University Medical Center, New York, New York,Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Peter S. Dayan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, New York
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Affiliation(s)
- M. Tourani
- Faculty of Environmental Sciences and Natural Resource Management Norwegian University of Life Sciences Ås Norway
| | - E. N. Brøste
- Faculty of Environmental Sciences and Natural Resource Management Norwegian University of Life Sciences Ås Norway
| | - S. Bakken
- Faculty of Environmental Sciences and Natural Resource Management Norwegian University of Life Sciences Ås Norway
| | - J. Odden
- Norwegian Institute for Nature Research Oslo Norway
| | - R. Bischof
- Faculty of Environmental Sciences and Natural Resource Management Norwegian University of Life Sciences Ås Norway
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Hickey KT, Bakken S, Byrne MW, Bailey DCE, Demiris G, Docherty SL, Dorsey SG, Guthrie BJ, Heitkemper MM, Jacelon CS, Kelechi TJ, Moore SM, Redeker NS, Renn CL, Resnick B, Starkweather A, Thompson H, Ward TM, McCloskey DJ, Austin JK, Grady PA. Corrigendum to Precision health: Advancing symptom and self-management science. Nurs Outlook 2020; 68:139-140. [PMID: 32046859 DOI: 10.1016/j.outlook.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- K T Hickey
- Cardiac Electrophysiology, Columbia University School of Nursing, Columbia University Medical Center, New York, NY
| | - S Bakken
- School of Nursing and Department of Biomedical Informatics, Columbia University, New York, NY.
| | - M W Byrne
- Department of Anesthesiology, Columbia University School of Nursing, Columbia University College of Physicians and Surgeons, New York, NY; Center for Children and Families, Columbia University School of Nursing, Columbia University College of Physicians and Surgeons, New York, NY
| | | | - G Demiris
- University of Pennsylvania, School of Nursing, Philadelphia, PA
| | | | - S G Dorsey
- Department of Pain and Translational Symptom Science, School of Medicine, University of Maryland Baltimore, Baltimore, MD; Department of Anesthesiology, School of Medicine, University of Maryland Baltimore, Baltimore, MD
| | - B J Guthrie
- Bouve College of Health Sciences, Northeastern University School of Nursing, Boston, MA
| | - M M Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA
| | - C S Jacelon
- University of Massachusetts Amherst College of Nursing, Amherst, MA
| | - T J Kelechi
- Medical University of South Carolina, College of Nursing, Charleston, SC
| | - S M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - N S Redeker
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT
| | - C L Renn
- Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD
| | - B Resnick
- Organizational Systems and Adult Health Nursing Department, University of Maryland Baltimore, Baltimore, MD
| | | | - H Thompson
- University of Washington School of Nursing, Seattle, WA
| | - T M Ward
- University of Washington School of Nursing, Seattle, WA
| | - D J McCloskey
- National Institute of Nursing Research, Bethesda, MD
| | - J K Austin
- National Institute of Nursing Research, Bethesda, MD; Indiana University School of Nursing, Bloomington, IN
| | - P A Grady
- National Institute of Nursing Research, Bethesda, MD
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Bjarnadottir RI, Millery M, Fleck E, Bakken S. Correlates of online health information-seeking behaviors in a low-income Hispanic community. Inform Health Soc Care 2016; 41:341-9. [PMID: 26837012 DOI: 10.3109/17538157.2015.1064429] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the correlates of online health information-seeking behaviors among Hispanic residents of a low-income urban neighborhood. METHODS Data were collected with a community survey from 1045 unique participants at ambulatory care clinics in a largely Hispanic immigrant community in northern Manhattan, New York. A descriptive correlational analysis was conducted using logistic regression. RESULTS A majority of the participants were born outside the United States (85.7%), and half (50.3%) had completed high school. A logistic regression revealed that five independent variables were significantly correlated with online health information-seeking behaviors: age, education, marital status, primary language, and health literacy. Age and Spanish as preferred language were negatively associated with online health information-seeking (OR = 0.93 and 0.50), whereas education and health literacy were positively associated with online health information-seeking (OR = 4.28 and 1.28). CONCLUSIONS The findings have implications for designing online health information resources and interventions appropriate for the populations they are likely to reach. Furthermore, the findings highlight the need for special efforts to ensure access to reliable health information for immigrant populations and those with low health literacy.
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Affiliation(s)
| | - M Millery
- b Mailman School of Public Health , Columbia University , New York , NY , USA.,d Department of Biomedical Informatics , Columbia University , New York , NY , USA
| | - E Fleck
- c College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - S Bakken
- a School of Nursing , Columbia University , New York , NY , USA.,d Department of Biomedical Informatics , Columbia University , New York , NY , USA
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Sheehan B, Kaufman D, Bakken S, Currie LM. Cognitive analysis of decision support for antibiotic ordering in a neonatal intensive care unit. Appl Clin Inform 2012; 3:105-23. [PMID: 23616903 DOI: 10.4338/aci-2011-10-ra-0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/20/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clinical decision support systems (CDSS) are a method used to support prescribing accuracy when deployed within a computerized provider order entry system (CPOE). Divergence from using CDSS is exemplified by high alert override rates. Excessive cognitive load imposed by the CDSS may help to explain such high rates. OBJECTIVES The aim of this study was to describe the cognitive impact of a CPOE-integrated CDSS by categorizing system use problems according to the type of mental processing required to resolve them. METHODS A qualitative, descriptive design was used employing two methods; a cognitive walkthrough and a think-aloud protocol. Data analysis was guided by Norman's Theory of Action and a theory of cognitive distances which is an extension to Norman's theory. RESULTS The most frequently occurring source of excess cognitive effort was poor information timing. Information presented by the CDSS was often presented after clinicians required the information for decision making. Additional sources of effort included use of language that was not clear to the user, vague icons, and lack of cues to guide users through tasks. CONCLUSIONS Lack of coordination between clinician's task-related thought processes and those presented by a CDSS results in excessive cognitive work required to use the system. This can lead to alert overrides and user errors. Close attention to user's cognitive processes as they carry out clinical tasks prior to CDSS development may provide key information for system design that supports clinical tasks and reduces cognitive effort.
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Affiliation(s)
- B Sheehan
- School of Nursing, Columbia University , NY NY
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Stetson P, Bakken S, Wrenn J, Siegler E. Assessing Electronic Note Quality Using the Physician Documentation Quality Instrument (PDQI-9). Appl Clin Inform 2012; 3:164-174. [PMID: 22577483 PMCID: PMC3347480 DOI: 10.4338/aci-2011-11-ra-0070] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 03/29/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE: To refine the Physician Documentation Quality Instrument (PDQI) and test the validity and reliability of the 9-item version (PDQI-9). METHODS: Three sets each of admission notes, progress notes and discharge summaries were evaluated by two groups of physicians using the PDQI-9 and an overall general assessment: one gold standard group consisting of program or assistant program directors (n=7), and the other of attending physicians or chief residents (n=24). The main measures were criterion-related validity (correlation coefficients between Total PDQI-9 scores and 1-item General Impression scores for each note), discriminant validity (comparison of PDQI-9 scores on notes rated as best and worst using 1-item General Impression score), internal consistency reliability (Cronbach's alpha), and inter-rater reliability (intraclass correlation coefficient (ICC)). RESULTS: The results were criterion-related validity (r = -.678 to .856), discriminant validity (best versus worst note, t = 9.3, p = .003), internal consistency reliability (Cronbach's alphas = .87-.94), and inter-rater reliability (ICC = .83, CI = .72-.91). CONCLUSION: The results support the criterion-related and discriminant validity, internal consistency reliability, and inter-rater reliability of the PDQI-9 for rating the quality of electronic physician notes. Tools for assessing note redundancy are required to complement use of PDQI-9. Trials of the PDQI-9 at other institutions, of different size, using different EHRs, and incorporating additional physician specialties and notes of other healthcare providers are needed to confirm its generalizability.
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Affiliation(s)
- P.D. Stetson
- Correspondence to: Peter D. Stetson, MD, MA, Columbia University Medical Center, 650 West 168th Street, BB2–239, New York, NY 10032, , Phone: 212.342.0029
| | | | - J.O. Wrenn
- Department of Medical Informatics, Vanderbilt University
| | - E.L. Siegler
- Division of Geriatrics and Gerontology, Weill Cornell Medical College
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10
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Senathirajah Y, Bakken S. Visual clustering analysis of CIS logs to inform creation of a user-configurable Web CIS interface. Methods Inf Med 2011; 50:337-48. [PMID: 21691676 DOI: 10.3414/me09-01-0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 08/23/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND In this paper, we describe a new method for the study of clinical information system (CIS) logfiles joined with information in the clinical data warehouse. This method uses heatmap representations and clustering techniques to examine clinicians' viewing patterns of laboratory test results. The context of our application of these techniques is to inform the creation of a widget-based interface to the CIS. OBJECTIVES We address the rationale, feasibility, and usefulness of our method through examination of three hypotheses: 1) The frequency distribution of laboratory test viewing will follow a 'long tail' pattern, indicating that patterns are highly variable and supporting the rationale for a widget-based configurable system. 2) Patterns of laboratory testing viewing (by clinician, specialty, clinician/patient/day, and ICD-9-CM codes) can be distinguished by our methods. 3) The identified clusters will include more than 80% of the laboratory test elements found in 30 randomly selected patient records for one day. METHODS The data were plotted as heatmaps and clustered using hierarchical clustering software. Various parameters were tested to give the optimal clusters. RESULTS All the hypotheses were supported. For Hypothesis 3, 91.4% of information elements in the records were covered by the generated clusters. CONCLUSIONS Study findings support the rationale, feasibility, and usefulness of our methods to examine patterns of information access among clinicians and to inform the creation of widget-based interfaces. The results also contribute to our general understanding of clinicians' CIS use.
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Affiliation(s)
- Y Senathirajah
- Department of Biomedical Informatics, Columbia University, 622 West 168th St. Floor VC5, New York, NY 10032, USA.
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11
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Collins SA, Bakken S, Vawdrey DK, Coiera E, Currie L. Clinician preferences for verbal communication compared to EHR documentation in the ICU. Appl Clin Inform 2011; 2:190-201. [PMID: 23616870 DOI: 10.4338/aci-2011-02-ra-0011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 04/22/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Effective communication is essential to safe and efficient patient care. Additionally, many health information technology (HIT) developments, innovations, and standards aim to implement processes to improve data quality and integrity of electronic health records (EHR) for the purpose of clinical information exchange and communication. OBJECTIVE We aimed to understand the current patterns and perceptions of communication of common goals in the ICU using the distributed cognition and clinical communication space theoretical frameworks. METHODS We conducted a focus group and 5 interviews with ICU clinicians and observed 59.5 hours of interdisciplinary ICU morning rounds. RESULTS Clinicians used an EHR system, which included electronic documentation and computerized provider order entry (CPOE), and paper artifacts for documentation; yet, preferred the verbal communication space as a method of information exchange because they perceived that the documentation was often not updated or efficient for information retrieval. These perceptions that the EHR is a "shift behind" may lead to a further reliance on verbal information exchange, which is a valuable clinical communication activity, yet, is subject to information loss. CONCLUSIONS Electronic documentation tools that, in real time, capture information that is currently verbally communicated may increase the effectiveness of communication.
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Affiliation(s)
- S A Collins
- Department of Biomedical Informatics , Columbia University
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12
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Vawdrey D, Wilcox L, Collins S, Feiner S, Mamykina O, Stein D, Bakken S, Fred M, Stetson P. Awareness of the Care Team in Electronic Health Records. Appl Clin Inform 2011; 2:395-405. [PMID: 22574103 PMCID: PMC3345520 DOI: 10.4338/aci-2011-05-ra-0034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/19/2011] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE: To support collaboration and clinician-targeted decision support, electronic health records (EHRs) must contain accurate information about patients' care providers. The objective of this study was to evaluate two approaches for care provider identification employed within a commercial EHR at a large academic medical center. METHODS: We performed a retrospective review of EHR data for 121 patients in two cardiology wards during a four-week period. System audit logs of chart accesses were analyzed to identify the clinicians who were likely participating in the patients' hospital care. The audit log data were compared with two functions in the EHR for documenting care team membership: 1) a vendor-supplied module called "Care Providers", and 2) a custom "Designate Provider" order that was created primarily to improve accuracy of the attending physician of record documentation. RESULTS: For patients with a 3-5 day hospital stay, an average of 30.8 clinicians accessed the electronic chart, including 10.2 nurses, 1.4 attending physicians, 2.3 residents, and 5.4 physician assistants. The Care Providers module identified 2.7 clinicians/patient (1.8 attending physicians and 0.9 nurses). The Designate Provider order identified 2.1 clinicians/patient (1.1 attending physicians, 0.2 resident physicians, and 0.8 physician assistants). Information about other members of patients' care teams (social workers, dietitians, pharmacists, etc.) was absent. CONCLUSIONS: The two methods for specifying care team information failed to identify numerous individuals involved in patients' care, suggesting that commercial EHRs may not provide adequate tools for care team designation. Improvements to EHR tools could foster greater collaboration among care teams and reduce communication-related risks to patient safety.
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Affiliation(s)
- D.K. Vawdrey
- Department of Biomedical Informatics, Columbia University
| | - L.G. Wilcox
- Department of Computer Science, Columbia University
| | - S. Collins
- Department of Biomedical Informatics, Columbia University
| | - S. Feiner
- Department of Computer Science, Columbia University
| | - O. Mamykina
- Department of Biomedical Informatics, Columbia University
| | - D.M. Stein
- Department of Biomedical Informatics, Columbia University
| | | | - M.R. Fred
- Department of Information Systems, New York-Presbyterian Hospital
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13
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Bakken S, Warren JJ, Lundberg C, Casey A, Correia C, Konicek D, Zingo C. An evaluation of the usefulness of two terminology models for integrating nursing diagnosis concepts into SNOMED Clinical Terms. Int J Med Inform 2002; 68:71-7. [PMID: 12467792 DOI: 10.1016/s1386-5056(02)00066-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We evaluated the usefulness of two models for integrating nursing diagnosis concepts into SNOMED Clinical Terms (CT). METHODS First, we dissected nursing diagnosis term phrases from two source terminologies (North American Nursing Diagnosis Association Taxonomy 1 (NANDA) and Omaha System) into the semantic categories of the European Committee for Standardization (CEN) categorical structure and ISO reference terminology model (RTM). Second, we critically analyzed the similarities between the semantic links in the CEN and ISO models and the semantic links used to formally define diagnostic concepts in SNOMED CT. RESULTS Our findings demonstrated that focus, bearer/subject of information, and judgment were present in 100% of the NANDA and Omaha term phrases. The Omaha term phrases contained no additional descriptors beyond those considered mandatory in the CEN and ISO models. The comparison among the semantic links showed that SNOMED CT currently contains all but one of the semantic links needed to model the two source terminologies for integration. In conclusion, our findings support the potential utility of the CEN and ISO models for integrating nursing diagnostic concepts into SNOMED CT.
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Affiliation(s)
- S Bakken
- Department of Medical Informatics, School of Nursing, Columbia University, 630 West 168th Street, Mailbox 6, New York, NY, USA.
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14
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Bakken S. Focus on a Medical Informatics Odyssey. J Am Med Inform Assoc 2002. [DOI: 10.1197/jamia.m1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Bakken S, Warren J, Lundberg C, Casey A, Correia C, Konicek D, Zingo C. An evaluation of the utility of the CEN categorical structure for nursing diagnoses as a terminology model for integrating nursing diagnosis concepts into SNOMED. Stud Health Technol Inform 2002; 84:151-5. [PMID: 11604723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
We evaluated the utility of the CEN Categorical Structure for Nursing Diagnoses as a terminology model for integrating nursing diagnosis concepts into SNOMED. First, we dissected nursing diagnosis term phrases from two source terminologies (North American Nursing Diagnosis Association (NANDA) Taxonomy 1 and Omaha System) into the semantic categories of the CEN categorical structure. Second, we critically analyzed the similarities between the semantic links in the CEN model and the semantic links used to formally define diagnostic concepts in SNOMED RT and SNOMED CT. Our findings demonstrated that focus, bearer, and judgment were present in 100% of the NANDA and Omaha term phrases. The Omaha term phrases contained no additional descriptors beyond those considered mandatory in the CEN model. In contrast, at least 3% of NANDA diagnoses included a term in each semantic category of the categorical structure. The comparison among the semantic links showed that neither SNOMED RT and SNOMED CT currently contain all the semantic links needed to model the two source terminologies for integration. In conclusion, our findings support the potential utility of the CEN categorical structure as a terminology model for dissecting nursing diagnostic concepts for integration into SNOMED RT and SNOMED CT. However, in order to accomplish this task, appropriate semantic links must be added to SNOMED RT and SNOMED CT.
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Affiliation(s)
- S Bakken
- School of Nursing and Department of Medical Informatics, Columbia University, New York, New York 10032, USA.
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16
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Ozbolt J, Androwich I, Bakken S, Button P, Hardiker N, Mead C, Warren J, Zingo C. The nursing terminology summit: collaboration for progress. Stud Health Technol Inform 2002; 84:236-40. [PMID: 11604740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The Nursing Terminology Summit has used collaborative processes to bring about significant changes in the development of terminology standards for nursing. This paper draws on agendas, reports, notes, and other documents from the Summit, in addition to the authors' own experience as Organizer, Steering Committee, and participants, to provide a brief history of the Summit process. The analysis identifies factors that increased the risk of failure as well as factors that fostered success. The paper concludes with lessons learned that can be applied in other arenas to promote change in medical informatics.
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Affiliation(s)
- J Ozbolt
- Vanderbilt University, Nashville, Tennessee 37240-0008, USA.
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17
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Abstract
In recent years shared decision making between patients and their health care providers and the inclusion of patient preferences in patient care have been, in theory, embraced as models for good clinical practice. Patients' experiences, values, and preferences are increasingly acknowledged as important pieces of evidence for appropriate health care decision making. To effectively use information about patient preferences in patient care, this information, which is gathered through a process of preference elicitation, needs to be integrated with other types of information, e.g., diagnoses, treatments, and patient status indicators within the context of a longitudinal electronic health record. This integration requires that patient preference-related concepts be represented nonambiguously and in a manner that renders them suitable for computer rather than human processing. In this article, the authors describe important patient preference-related concepts and illustrate the use of the LOINC semantic structure as a terminology model to create fully specified names for a sample of 15 preference elicitations from 8 published research articles.
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Affiliation(s)
- C M Ruland
- Department of Medical Informatics, School of Nursing, Columbia University, Vanderbilt Clinic, 5th Floor, 622 W. 168th Street, New York, New York 10032, USA.
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18
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Coenen A, McNeil B, Bakken S, Bickford C, Warren JJ. Toward comparable nursing data: American Nurses Association criteria for data sets, classification systems, and nomenclatures. Comput Nurs 2001; 19:240-6; quiz 246-8. [PMID: 11764715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The American Nurses Association has long recognized the need for nursing to participate in the development of national healthcare data sets and standardized terminologies suitable for implementation in computer-based systems. In 1989, the American Nurses Association Steering Committee on Databases to Support Clinical Nursing Practice was established to make policy recommendations related to nursing data needs. A primary function of the committee was the development of criteria for "recognition" of nursing language systems toward the goal of a Unified Nursing Language System. The committee has evolved and, in 1998, was renamed the Committee on Nursing Practice Information Infrastructure. In this article the revisions in the American Nurses Association recognition criteria and the role of professional associations in standards development are discussed. Distinct criteria for nursing data sets, classification systems, and nomenclatures are reflective of the evolution in the healthcare environment toward concept-oriented terminologic systems that facilitate data re-use.
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Affiliation(s)
- A Coenen
- Marquette University, PO Box 1881, Milwaukee, WI 53201, USA.
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19
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Abstract
Symptom management for persons living with HIV/AIDS is recognized as an extremely important component of care management. This article reports on the continuing validation of the revised Sign and Symptom Check-List for Persons With HIV Disease (SSC-HIVrev). The initial validation study used a combined sample of 933 HIV-positive persons and concluded that the validity and reliability of the instrument were adequate to measure patients' self-report of HIV-related signs and symptoms. The revised scale includes items to measure gynecological-related symptoms and the impact of lipodystrophy (body fat redistribution) due to antiretroviral therapy on patients' symptom experience. The scale structure (factor analysis) and reliability estimates were recalculated in a new sample of 372 HIV-positive persons. Based on reviewing the clusters of items, factor loadings, reliability estimates, and clinical interpretability, an 11-factor solution was determined that explained 73.3% of the variance. Of the retained factors, 4 had eigenvalues less than 1, yet they explained significant amounts of variance in the rotated sums of squares loading (5.0%, 4.3%, 4.3%, and 3.6%, respectively), the reliability estimates were good, and the factors had clinical meaning. The revised scale (SSC-HIVrev) has three parts: Part 1 consists of 45 items that clustered into 11 factor scores along with a total score, with reliability estimates ranging from .76 to .91; Part 2 consists of 19 HIV-related symptoms that do not cluster into factor scores but may be of interest from a clinical perspective; and Part 3 consists of 8 items related to gynecological symptoms for women. These 8 items were submitted to a principal components factor analysis with varimax rotation (n = 118 HIV-positive women), and a 1-factor solution explained 71.8% of the variance, with a reliability estimate of .94. The psychometric properties of the SSC-HIVrev are presented.
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Affiliation(s)
- W L Holzemer
- School of Nursing, University of California, San Francisco, USA
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20
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Affiliation(s)
- S Bakken
- Nursing and Medical Informatics, Columbia University, New York, NY 10032, USA
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21
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Coenen A, Marin HF, Park HA, Bakken S. Collaborative efforts for representing nursing concepts in computer-based systems: international perspectives. J Am Med Inform Assoc 2001; 8:202-11. [PMID: 11320065 PMCID: PMC131028 DOI: 10.1136/jamia.2001.0080202] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2000] [Accepted: 01/15/2001] [Indexed: 11/04/2022] Open
Abstract
Current nursing terminology efforts have converged toward meeting the demand for a reference terminology for nursing concepts by building on the foundation of existing interface and administrative terminologies and by collaborating with terminology efforts across the spectrum of health care. In this article, the authors illustrate how collaboration is promoting convergence toward a reference terminology for nursing by briefly summarizing a wide range of exemplary activities. These include: 1) the International Classification of Nursing Practice (ICNP) activities of the International Council of Nurses (ICN), 2) work in Brazil and Korea that has contributed to, and been stimulated by, ICNP developments, 3) efforts in the United States to improve understanding of the different types of terminologies needed in nursing and to promote harmonization and linking among them, and 4) current nursing participation in major multi-disciplinary standards initiatives. Although early nursing terminology work occurred primarily in isolation and resulted in some duplicative efforts, the activities summarized in this article demonstrate a tremendous level of collaboration and convergence not only in the discipline of nursing but in multi-disciplinary standards initiatives. These efforts are an important prerequisite for ensuring that nursing concepts are represented in computer-based systems in a manner that facilitates multi-purpose use at local, national, regional, and international levels.
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Affiliation(s)
- A Coenen
- International Council of Nurses, Geneva, Switzerland
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22
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Abstract
OBJECTIVES To describe the importance of standardized nursing vocabularies as a foundation for quality in health care decision-making. DATA SOURCES Literature, online sources, and committee documents. CONCLUSIONS Several standardized vocabularies are recognized by the American Nurses Association Committee for Nursing Practice Information Infrastructure. Vendors also have integrated the vocabularies into their information systems. Future efforts include developing an international nursing reference terminology. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses face quality of care issues that impact decision-making at the point of care. To describe their practice, oncology nurses must strive to use nursing data that are standardized, documented, and made visible by inclusion in computer-based systems.
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23
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McKnight L, Stetson PD, Bakken S, Curran C, Cimino JJ. Perceived information needs and communication difficulties of inpatient physicians and nurses. Proc AMIA Symp 2001:453-7. [PMID: 11825229 PMCID: PMC2243385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
In order to understand the differing perceptions of information needs and communication patterns of healthcare professionals as they relate to medical errors, we conducted a survey and 5 focus group sessions of inpatient physicians and nurses. Although nurses and physicians stated differing information needs, both groups expressed significant problems with obtaining patient, domain and institution-specific information in a timely manner. Identification of appropriate providers and establishing contact with those people was perceived as the most pressing communication need. All focus group participants felt that communication difficulties were common and could give examples in which such difficulties led to adverse events. Our studies suggest that information needs and communication difficulties are common and can lead to medical errors or near misses. Many of these problems may be amenable to information technology solutions.
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Affiliation(s)
- L McKnight
- Department of Medical Informatics and School of Nursing, Columbia University, New York, NY, USA
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24
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Stetson PD, McKnight LK, Bakken S, Curran C, Kubose TT, Cimino JJ. Development of an ontology to model medical errors, information needs, and the clinical communication space. Proc AMIA Symp 2001:672-6. [PMID: 11825270 PMCID: PMC2243576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Medical errors are common, costly and often preventable. Work in understanding the proximal causes of medical errors demonstrates that systems failures predispose to adverse clinical events. Most of these systems failures are due to lack of appropriate information at the appropriate time during the course of clinical care. Problems with clinical communication are common proximal causes of medical errors. We have begun a project designed to measure the impact of wireless computing on medical errors. We report here on our efforts to develop an ontology representing the intersection of medical errors, information needs and the communication space. We will use this ontology to support the collection, storage and interpretation of project data. The ontology's formal representation of the concepts in this novel domain will help guide the rational deployment of our informatics interventions. A real-life scenario is evaluated using the ontology in order to demonstrate its utility.
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Affiliation(s)
- P D Stetson
- Medical Informatics, Columbia University, New York, NY, USA
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25
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Abstract
The contention of the author is that an informatics infrastructure is essential for evidenced-based practice. Five building blocks of an informatics infrastructure for evidence-based practice are proposed: 1) standardized terminologies and structures, 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Selected examples illustrate how each of these building blocks supports the application of evidence to practice and the building of evidence from practice. Although a number of major challenges remain, medical informatics can provide solutions that have the potential to decrease unintended variation in practice and health care errors.
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Affiliation(s)
- S Bakken
- Columbia University, New York, New York, USA.
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Cieslowski BJ, Wajngurt D, Cimino JJ, Bakken S. Integration of nursing assessment concepts into the medical entities dictionary using the LOINC semantic structure as a terminology model. Proc AMIA Symp 2001:115-9. [PMID: 11825165 PMCID: PMC2243408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Recent investigations have tested the applicability of various terminology models for the representing nursing concepts including those related to nursing diagnoses, nursing interventions, and standardized nursing assessments as a prerequisite for building a reference terminology that supports the nursing domain. We used the semantic structure of Clinical LOINC (Logical Observations, Identifiers, Names, and Codes) as a reference terminology model to support the integration of standardized assessment terms from two nursing terminologies into the Medical Entities Dictionary (MED), the concept-oriented, metadata dictionary at New York Presbyterian Hospital. Although the LOINC semantic structure was used previously to represent laboratory terms in the MED, selected hierarchies and semantic slots required revisions in order to incorporate the nursing assessment concepts. This project was an initial step in integrating nursing assessment concepts into the MED in a manner consistent with evolving standards for reference terminology models. Moreover, the revisions provide the foundation for adding other types of standardized assessments to the MED.
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Affiliation(s)
- B J Cieslowski
- Department of Medical Informatics and School of Nursing, Columbia University, New York, NY, USA
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27
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Bakken S, Campbell KE, Cimino JJ, Huff SM, Hammond WE. Toward vocabulary domain specifications for health level 7-coded data elements. J Am Med Inform Assoc 2000; 7:333-42. [PMID: 10887162 PMCID: PMC61438 DOI: 10.1136/jamia.2000.0070333] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/1999] [Accepted: 12/28/1999] [Indexed: 11/03/2022] Open
Abstract
The "vocabulary problem" has long plagued the developers, implementers, and users of computer-based systems. The authors review selected activities of the Health Level 7 (HL7) Vocabulary Technical Committee that are related to vocabulary domain specification for HL7 coded data elements. These activities include: 1) the development of two sets of principles to provide guidance to terminology stakeholders, including organizations seeking to deploy HL7-compliant systems, terminology developers, and terminology integrators; 2) the completion of a survey of terminology developers; 3) the development of a process for HL7 registration of terminologies; and 4) the maintenance of vocabulary domain specification tables. As background, vocabulary domain specification is defined and the relationship between the HL7 Reference Information Model and vocabulary domain specification is described. The activities of the Vocabulary Technical Committee complement the efforts of terminology developers and other stakeholders. These activities are aimed at realizing semantic interoperability in the context of the HL7 Message Development Framework, so that information exchange and use among disparate systems can occur for the delivery and management of direct clinical care as well as for purposes such as clinical research, outcome research, and population health management.
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Affiliation(s)
- S Bakken
- Columbia University, New York, New York 10032, USA.
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28
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Corless IB, Bakken S, Nicholas PK, Holzemer WL, McGibbon CA, Inouye J, Nokes KM, Turner JG, Powell-Cope GM, Brown MA, Portillo CJ. Predictors of perception of cognitive functioning in HIV/AIDS. J Assoc Nurses AIDS Care 2000; 11:19-26. [PMID: 10826301 DOI: 10.1016/s1055-3290(06)60273-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This is a descriptive, correlational study of the predictors of perceived cognitive functioning. The convenience sample of 728 nonhospitalized persons receiving health care for HIV/AIDS was recruited from seven sites in the United States. All measures were self-reported. Self-perception of cognitive functioning, the dependent variable, was composed of three items from the Medical Outcomes Study HIV scale: thinking, attention, and forgetfulness. Data related to age, gender, ethnicity, education, injection drug use, CD4 count, and length of time known to be HIV-positive were collected on a demographic questionnaire. The scale from the Sign and Symptom Checklist for Persons with HIV Disease was used to measure self-reported symptoms. Data were analyzed using hierarchical multiple regression analysis. Predictors of perception of cognitive functioning explained a total of 36.3% of the variance. Four blocks--person variables (1.5%) (age, gender, education, history of injection drug use), disease status (2.3%), symptom status (26.5%), and functional status (5.4%)--significantly contributed statistically to the total variance. Among those individuals who completed the questions related to depression (n = 450), 28% of the variance in cognitive functioning was explained by this variable. The findings in this multi-site study indicate that symptom status explained the largest amount of variance in perceived cognitive functioning. Early identification of cognitive impairment can result in appropriate clinical interventions in remediable conditions and in the improvement of quality of life.
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Affiliation(s)
- I B Corless
- MGH Institute of Health Professions, Boston, USA
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Bakken S, Holzemer WL, Brown MA, Powell-Cope GM, Turner JG, Inouye J, Nokes KM, Corless IB. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDS 2000; 14:189-97. [PMID: 10806637 DOI: 10.1089/108729100317795] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The purpose of this descriptive, correlational study was to examine the relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. The convenience sample of 707 non-hospitalized persons receiving health care for HIV/AIDS was recruited from seven U.S. sites. All measures were self-report. Perception of engagement with health care provider was measured by the newly developed Engagement with Health Care Provider scale. Adherence to therapeutic regimen included adherence to medications, provider advice, and appointments. Health status was measured by the Medical Outcomes Study Short Form 36 (MOS SF-36), Living with HIV scale, CD4 count, and length of time known to be HIV-positive. There were no significant relationships between engagement with health care provider and age, gender, ethnicity, and type of health care provider. Subscales of the MOS SF-36 and Living with HIV explained a significant, but modest amount of the variance in engagement. Clients who were more engaged with their health care provider reported greater adherence to medication regimen and provider advice. Clients who missed at least one appointment in the last month or who reported current or past injection drug use were significantly less engaged.
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Affiliation(s)
- S Bakken
- University of California, San Francisco, USA
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30
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Bakken S, Cimino JJ, Haskell R, Kukafka R, Matsumoto C, Chan GK, Huff SM. Evaluation of the clinical LOINC (Logical Observation Identifiers, Names, and Codes) semantic structure as a terminology model for standardized assessment measures. J Am Med Inform Assoc 2000; 7:529-38. [PMID: 11062226 PMCID: PMC129661 DOI: 10.1136/jamia.2000.0070529] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The purpose of this study was to test the adequacy of the Clinical LOINC (Logical Observation Identifiers, Names, and Codes) semantic structure as a terminology model for standardized assessment measures. METHODS After extension of the definitions, 1, 096 items from 35 standardized assessment instruments were dissected into the elements of the Clinical LOINC semantic structure. An additional coder dissected at least one randomly selected item from each instrument. When multiple scale types occurred in a single instrument, a second coder dissected one randomly selected item representative of each scale type. RESULTS The results support the adequacy of the Clinical LOINC semantic structure as a terminology model for standardized assessments. Using the revised definitions, the coders were able to dissect into the elements of Clinical LOINC all the standardized assessment items in the sample instruments. Percentage agreement for each element was as follows: component, 100 percent; property, 87.8 percent; timing, 82.9 percent; system/sample, 100 percent; scale, 92.6 percent; and method, 97.6 percent. DISCUSSION This evaluation was an initial step toward the representation of standardized assessment items in a manner that facilitates data sharing and re-use. Further clarification of the definitions, especially those related to time and property, is required to improve inter-rater reliability and to harmonize the representations with similar items already in LOINC.
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Affiliation(s)
- S Bakken
- Columbia University, New York, New York 10032, USA.
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Bakken S, Parker J, Konicek D, Campbell KE. An evaluation of ICNP intervention axes as terminology model components. Proc AMIA Symp 2000:42-6. [PMID: 11079841 PMCID: PMC2244103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
In this paper we evaluate selected axes of the International Classification of Nursing Practice (ICNP) as terminology model components for nursing actions by dissecting and categorizing two data sets of term phrases (Patient Care Data Set and Home Health Care Classification). Second, we critically analyze the relationships between the ICNP axes and terminology model components used to formally define procedures (including nursing actions) in SNOMED RT. Our findings demonstrate that the semantic categories represented by the ICNP intervention axes are relevant sources for terminology model components for nursing actions. In addition, our findings suggest that only minimal additions or extensions to the current semantic links of SNOMED RT are needed to support the formal definition of nursing actions such as those contained in PCDS and HHCC.
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Affiliation(s)
- S Bakken
- School of Nursing and Department of Medical Informatics, Columbia University, New York, New York, USA
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Bakken S, Cashen MS, Mendonca EA, O'Brien A, Zieniewicz J. Representing nursing activities within a concept-oriented terminological system: evaluation of a type definition. J Am Med Inform Assoc 2000; 7:81-90. [PMID: 10641965 PMCID: PMC61457 DOI: 10.1136/jamia.2000.0070081] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/1999] [Accepted: 09/16/1999] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE A type definition, as a component of the categorical structures of a concept-oriented terminology, must support nonambiguous concept representations and, consequently, comparisons of data that are represented using different terminologies. The purpose of the study was to evaluate the adequacy and utility of a proposed type definition for nursing activity concepts. DESIGN Nursing activity terms (n = 1039) from patient charts and intervention terms from two nursing terminologies (Home Health Care Classification and Omaha System) were decomposed into the attributes of the proposed type definition-Delivery Mode, Activity Focus, and Recipient. MEASUREMENTS Attributes of the type definition were coded as present or absent for each term by multiple raters. In addition, Delivery Mode was rated as Explicit or Implicit and Recipient was rated as Explicit, Implicit, or Ambiguous. The data were summarized using descriptive statistics. Inter-rater reliabilities were calculated for each attribute of the type definition. RESULTS All attributes of the type definition were present in 73.9 percent of the chart terms, 91.3 percent of Home Health Care Classification intervention terms, and 63.5 percent of Omaha System intervention terms. While Delivery Mode and Activity Focus were almost universally present, Recipient was problematic. It was rated as ambiguous in 4.8 percent of the chart terms, 8.7 percent of Home Health Care Classification intervention terms, and 36.5 percent of Omaha System intervention terms. CONCLUSIONS The study findings supported the adequacy and utility of the type definition. Further research is needed to refine the type definition and its use for representing nursing activity concepts within a concept-oriented terminological system.
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Affiliation(s)
- S Bakken
- University of California-San Francisco, USA.
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Bakken S, Dolter KJ, Holzemer WL. A comparison of three strategies for risk-adjustment of outcomes for AIDS patients hospitalized for Pneumocystis carinii pneumonia. J Adv Nurs 1999; 30:1424-31. [PMID: 10583654 DOI: 10.1046/j.1365-2648.1999.01229.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The need for risk-adjustment of patient outcomes has been driven by the competitive health care market and the subsequent increase in comparative outcome reporting among health care institutions, among managed care plans, and among individual providers for some procedures (e.g. coronary artery bypass graft surgery). However, if the outcomes reported do not take into account patient characteristics that can be considered dimensions of risk for poor clinical outcomes or increased utilization of services, there is the possibility that inaccurate conclusions will be drawn about the quality of care provided. OBJECTIVE The specific purpose of this study was to examine the ability of four measures, APACHE III - acute physiology scale, Quality Audit Marker - ambulation score, Quality Audit Marker - self-care ability score, and Nursing Severity Index, to predict mortality and hospital length of stay in a convenience sample of 140 males with Pneumocystis carinii pneumonia. METHODS The study utilized a descriptive, longitudinal design. RESULTS APACHE III - acute physiology scale (P = 0.006, odds ratio = 1.40), and Quality Audit Marker - ambulation (P = 0.037, odds ratio = 0.50), were significant predictors of hospital mortality and the APACHE III - acute physiology scale was also a predictor of mortality within 3 (P = 0.004, odds ratio = 1.13) and 6 months (P = 0.009, odds ratio = 1.10) following hospitalization. Only Quality Audit Marker - ambulation (P = 0.0001) was a significant predictor of length of stay. CONCLUSIONS The findings of this study confirm the findings of other investigators that measures of acute clinical stability and functional status have utility as risk-adjustment approaches for the outcomes of mortality and length of stay. Further research is needed that compares the utility of generic vs. disease-specific measures for prediction of outcomes in HIV/AIDS.
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Affiliation(s)
- S Bakken
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, USA.
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Bakken S, Cashen MS, O'Brien A. Evaluation of a type definition for representing nursing activities within a concept-based terminologic system. Proc AMIA Symp 1999:17-21. [PMID: 10566312 PMCID: PMC2232843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
A terminology model is a conceptual representation that is optimized for the management of terminologic definitions. The purpose of this study was to evaluate one component of a terminology model, a type definition for nursing activity concepts. Two research questions were examined: 1) What percentage of nursing activity terms includes the three essential properties of the type definition (Delivery Mode, Activity Focus, and Recipient)? and 2) Can the nursing activity terms be reliably decomposed into the three elements of the type definition? The sample comprised 1039 non-redundant nursing activity terms collected from the health records of patients hospitalized for an AIDS-related condition. Each nursing activity term was decomposed into the three elements of the type definition by three raters. Percent agreement among the raters ranged from 91.5% to 96.2%. All terms included either an Explicit (82.0%) or Implicit (18.0%) Delivery Mode. Activity Focus was present in 95.1% of the terms in the sample. Recipient was coded as Explicit in 19.2%, Implicit in 75.9%, and Ambiguous in 4.8% of the nursing activity terms in the data set. Mapping among nursing terminologies and convergence of nursing terms within large concept-based health care terminologies has been hindered by the lack of a robust concept representation. A type definition is an essential component of such a representation. Further research is needed to refine the type definition and to incorporate it within a terminology model for nursing concepts.
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Affiliation(s)
- S Bakken
- University of California, San Francisco, USA
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