A Process of Acceptance of Patient Photographs in Electronic Medical Records to Confirm Patient Identification

Appropriate patient identification is a critical component of safe health care delivery. With increasing reliance on electronic medical records (EMRs), errors of test ordering and documentation have become commonplace. Incorporating patients’ photograph in the EMR has considerably decreased error frequency and improved health care delivery by making it easier for physicians to identify a patient. We conducted a survey of all 35 physicians working in the Executive Health Program to determine the importance of having patient photographs in the EMR. Of the 35 physicians who received the survey, 26 (74.3%) responded, 24 (92.3%) of whom agreed that it was important to improve patient identification, care, and safety. Based on these data, we implemented a quality improvement project to increase the percentage of new patients having a photograph included in the EMR. Our goal was to increase photograph inclusion by more than 20% from baseline within 6 months without any unintended consequences (ie, not slowing down any of the workflow during the intake process). The intervention took place between June 1, 2015, and February 8, 2016. Using Define-Measure-Analyze-Improve-Control models, the baseline rate of photographs in the EMR was 49.5% (302 of 607). We initiated 3 Plan-Do-Study-Act cycles targeting awareness and data sharing campaigns. After the Plan-Do-Study-Act cycles, the weekly rate of patient photographs incorporated into the EMR was at 71.4%, which was significantly improved compared with baseline (F test, P<.001). No unintended consequences were identified. Increased inclusion of patient photographs in the EMR aided in patient identification and improved staff satisfaction with minimal interruption to workflow.

Binding of octamer factors to the murine IL-5 CLE0 in primary T-cells and a T-cell line

Interleukin-5 (IL-5) is an inducible T-cell derived cytokine with remarkable specificity for the eosinophil lineage. It is controlled at the level of transcription and regulation of the gene is an obvious target for therapy of eosinophil-dependent allergic disorders such as asthma, eczema and rhinitis. Using a T-cell line and primary T-cells we have shown for the first time that the Oct1 and Oct2 transcription factors combine to form a complex with the functionally critical murine IL-5 cis-regulatory element, conserved lymphokine element 0 (CLE0), and contribute to positive regulation of the gene. These results show the increasingly important role of octamer factors in regulation of the IL-5 gene.

Binding of octamer factors to a novel 3'-positive regulatory element in the mouse interleukin-5 gene

The development of eosinophilia is regulated by interleukin (IL)-5. The biological specificity of eosinophilia suggests a tight and independent regulation of IL-5 expression. A number of regulatory regions in the 5'-end of the IL-5 gene have been described; many of them are involved in the regulation of other genes, and it is not clear how the specific expression of IL-5 is regulated. In this study, we report the finding of a novel 3'-regulatory element. Data base analysis of a 2-kilobase fragment of the 3'-end of the mouse IL-5 gene revealed the presence of a 40-base pair-long repetitive sequence that consists of four direct repeats of ATGAATGA distributed in a symmetrical manner. This sequence, named mouse downstream regulatory element-1 (mDRE1), was shown to be protected in DNase I footprinting assays in vitro. Electrophoretic mobility shift assays using specific antibodies identified the transcription factors Oct-1 and Oct-2 as responsible for the formation of the specific complexes with mDRE1 and nuclear extracts from both EL4 and primary T-cells. Competition electrophoretic mobility shift assays with oligonucleotides containing different numbers of ATGAATGA repeats showed that Oct-1 and Oct-2 bind to different motifs in the mDRE1 sequence. Deletion of mDRE1 from a 9.5-kilobase IL-5 gene construct significantly decreased the expression of the luciferase reporter gene, suggesting that it plays a positive role in the expression of the IL-5 gene.