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Wu KA, Boccaccio K, Buckles D, Hartwig MG, Klapper JA. Efforts to improve the billing accuracy of robotic-assisted thoracic surgery through education, updated procedure cards, and electronic medical record system changes. BMJ Open Qual 2024; 13:e002710. [PMID: 38649198 PMCID: PMC11043709 DOI: 10.1136/bmjoq-2023-002710] [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: 12/08/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
Precise medical billing is essential for decreasing hospital liability, upholding environmental stewardship and ensuring fair costs for patients. We instituted a multifaceted approach to improve the billing accuracy of our robotic-assisted thoracic surgery programme by including an educational component, updating procedure cards and removing the auto-populating function of our electronic medical record. Overall, we saw significant improvements in both the number of inaccurate billing cases and, specifically, the number of cases that overcharged patients.
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Affiliation(s)
- Kevin A Wu
- Duke University School of Medicine, Durham, North Carolina, USA
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kenneth Boccaccio
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Danielle Buckles
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Matthew G Hartwig
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jacob A Klapper
- Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Silva AR, Hoffmann NG, Fernandez-Llimos F, Lima EC. Data quality review of the Brazilian nosocomial infections surveillance system. J Infect Public Health 2024; 17:687-695. [PMID: 38471259 DOI: 10.1016/j.jiph.2024.02.013] [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: 08/07/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Surveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. METHODS Data Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. RESULTS Throughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. CONCLUSIONS While adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.
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Affiliation(s)
- Alice Ramos Silva
- Pharmacy School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit (UCIBIO), Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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Koshimoto BHB, Brandão PRDP, Borges V, Ferraz HB, Schumacher-Schuh AF, Rieder CRDM, Olchik MR, Mata IF, Tumas V, Santos-Lobato BL. Floor and ceiling effects on the Montreal Cognitive Assessment in patients with Parkinson's disease in Brazil. Dement Neuropsychol 2023; 17:e20230022. [PMID: 38053643 PMCID: PMC10695441 DOI: 10.1590/1980-5764-dn-2023-0022] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/10/2023] [Accepted: 07/30/2023] [Indexed: 12/07/2023] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease associated with cognitive impairment. The Montreal Cognitive Assessment (MoCA) has been used as a recommended global cognition scale for patients with PD, but there are some concerns about its application, partially due to the floor and ceiling effects. Objective To explore the floor and ceiling effects on the MoCA in patients with PD in Brazil. Methods Cross-sectional study with data from patients with PD from five Brazilian Movement Disorders Clinics, excluding individuals with a possible diagnosis of dementia. We analyzed the total score of the MoCA, as well as its seven cognitive domains. The floor and ceiling effects were evaluated for the total MoCA score and domains. Multivariate analyses were performed to detect factors associated with floor and ceiling effects. Results We evaluated data from 366 patients with PD and approximately 19% of individuals had less than five years of education. For the total MoCA score, there was no floor or ceiling effect. There was a floor effect in the abstraction and delayed memory recall domains in 20% of our sample. The ceiling effect was demonstrated in all domains (80.8% more common in naming and 89% orientation), except delayed recall. Education was the main factor associated with the floor and ceiling effects, independent of region, sex, age at evaluation, and disease duration. Conclusion The floor and ceiling effects are present in specific domains of the MoCA in Brazil, with a strong impact on education. Further adaptations of the MoCA structure for underrepresented populations may reduce these negative effects.
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Affiliation(s)
| | - Pedro Renato de Paula Brandão
- Universidade de Brasília, Laboratório de Neurociências e Comportamento, Brasília DF, Brazil
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, Brasília DF, Brazil
| | - Vanderci Borges
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Henrique Ballalai Ferraz
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Artur Francisco Schumacher-Schuh
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal do Rio Grande do Sul, Departamento de Farmacologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
| | - Carlos Roberto de Mello Rieder
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Maira Rozenfeld Olchik
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
- Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia e Ortopedia, Porto Alegre RS, Brazil
| | - Ignacio Fernandez Mata
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vitor Tumas
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil
| | - Bruno Lopes Santos-Lobato
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Hospital Ophir Loyola, Serviço de Neurologia, Belém PA, Brazil
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Raja H, Fitzpatrick N. Assessing the readability and quality of online information on Bell's palsy. J Laryngol Otol 2023; 137:1130-1134. [PMID: 36524547 DOI: 10.1017/s0022215122002626] [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] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the readability and quality of current online information on Bell's palsy. METHOD A Google search using the terms 'Bell's palsy' and 'facial palsy' was performed separately. The first three pages of results were analysed. Readability was assessed using Flesch Reading Ease Score, Flesch-Kincaid Grade Level, the Gunning-Fog Index and the Simple Measure of Gobbledygook. Quality was assessed using the Discern tool. Spearman's correlation between quality and readability was calculated. RESULTS A total of 31 websites met the inclusion criteria. The mean Flesch Reading Ease Score, Flesch-Kincaid Grade Level, the Gunning Fox Index and the Simple Measure of Gobbledygook scores were 52.45 (95 per cent confidence interval = 47.01-57.86), 10.50 (95 per cent confidence interval = 9.42-11.58), 12.76 (95 per cent confidence interval = 11.68-13.85) and 9.36 (95 per cent confidence interval = 8.52-10.20), respectively. The average Discern score was 44 (95 per cent confidence interval = 40.88-47.12). A negligible correlation was noted between the Discern and Flesch Reading Ease Score (rs = -0.05, p = 0.80). CONCLUSION Online information on Bell's palsy is generally of fair quality but is written above the recommended reading age guidance in the UK.
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Affiliation(s)
- H Raja
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Fitzpatrick
- Department of Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, UK
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Naberezhneva N, Uleberg O, Dahlhaug M, Giil-Jensen V, Ringdal KG, Røise O. Excellent agreement of Norwegian trauma registry data compared to corresponding data in electronic patient records. Scand J Trauma Resusc Emerg Med 2023; 31:50. [PMID: 37752614 PMCID: PMC10521548 DOI: 10.1186/s13049-023-01118-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The Norwegian Trauma Registry (NTR) is designed to monitor and improve the quality and outcome of trauma care delivered by Norwegian trauma hospitals. Patient care is evaluated through specific quality indicators, which are constructed of variables reported to the registry by certified registrars. Having high-quality data recorded in the registry is essential for the validity, trust and use of data. This study aims to perform a data quality check of a subset of core data elements in the registry by assessing agreement between data in the NTR and corresponding data in electronic patient records (EPRs). METHODS We validated 49 of the 118 variables registered in the NTR by comparing those with the corresponding ones in electronic patient records for 180 patients with a trauma diagnosis admitted in 2019 at eight public hospitals. Agreement was quantified by calculating observed agreement, Cohen's Kappa and Gwet's first agreement coefficient (AC1) with 95% confidence intervals (CIs) for 27 nominal variables, quadratic weighted Cohen's Kappa and Gwet's second agreement coefficient (AC2) for five ordinal variables. For nine continuous, one date and seven time variables, we calculated intraclass correlation coefficient (ICC). RESULTS Almost perfect agreement (AC1 /AC2/ ICC > 0.80) was observed for all examined variables. Nominal and ordinal variables showed Gwet's agreement coefficients ranging from 0.85 (95% CI: 0.79-0.91) to 1.00 (95% CI: 1.00-1.00). For continuous and time variables there were detected high values of intraclass correlation coefficients (ICC) between 0.88 (95% CI: 0.83-0.91) and 1.00 (CI 95%: 1.00-1.00). While missing values in both the NTR and EPRs were in general negligeable, we found a substantial amount of missing registrations for a continuous "Base excess" in the NTR. For some of the time variables missing values both in the NTR and EPRs were high. CONCLUSION All tested variables in the Norwegian Trauma Registry displayed excellent agreement with the corresponding variables in electronic patient records. Variables in the registry that showed missing data need further examination.
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Affiliation(s)
- N Naberezhneva
- Biobank and Registry Support Department, Division for medical quality registries for South- Eastern Norway Regional Health Authority, Oslo University Hospital, Oslo, Norway
| | - Oddvar Uleberg
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
- Department of Emergency Medicine and Pre-hospital services, St. Olav`s University Hospital, Trondheim, Norway.
| | - M Dahlhaug
- Norwegian Trauma Registry, Division of Orthopedics, Oslo University Hospital, Oslo, Norway
| | - V Giil-Jensen
- Norwegian Trauma Registry, Division of Orthopedics, Oslo University Hospital, Oslo, Norway
- Western Norway Trauma Center, Haukeland University Hospital, Bergen, Norway
| | - K G Ringdal
- Norwegian Trauma Registry, Division of Orthopedics, Oslo University Hospital, Oslo, Norway
- Department of Anesthesiology, Vestfold Hospital Trust, Tønsberg, Norway
- Division of Prehospital Care, Vestfold Hospital Trust, Tønsberg, Norway
| | - O Røise
- Norwegian Trauma Registry, Division of Orthopedics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Ludley A, Ting A, Malik D, Sivanadarajah N. Observational analysis of documentation burden and data duplication in trauma patient pathways at a major trauma centre. BMJ Open Qual 2023; 12:bmjoq-2022-002084. [PMID: 37185156 PMCID: PMC10151962 DOI: 10.1136/bmjoq-2022-002084] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES Trauma patients require extensive documentation across paper and electronic modalities. The objectives of this study were (1) to assess the documentation burden for trauma patients by contrasting entries against predetermined key information elements, dubbed 'data entry points' (DEPs) of a thorough trauma clerking, and by evaluating completeness of entries; and (2) to assess documentation for repetition using a Likert scale and through identification of copied data elements. METHODS A 1-month retrospective observational pilot study analysing documentation within the first 24 hours of a patient's presentation to a major trauma centre. Documentation was analysed across three platforms: paper notes, electronic health record (EHR) and patient organisation system (POS) entries. Entries were assessed against predetermined DEPs, for completeness, for directly copied elements and for uniqueness (using a Likert scale). RESULTS 30 patients were identified. The mean completeness of a clerking on paper, EHR and POS was 79%, 70% and 62%, respectively. Mean completeness decreased temporally down to 41% by the second ward round. The mean proportion of documented DEPs on paper, EHR and POS entries was 47%, 49% and 35%, respectively. 77% of POS entries contained copied elements, with a low level of uniqueness of 1.3/5. DISCUSSION Our results show evidence of high documentation burden with unnecessary repetition of data entry in the management of trauma patients. CONCLUSION This pilot study of trauma patient documentation demonstrates multiple inefficiencies and a marked administrative burden, further compounded by the need to document across multiple platforms, which may lead to eventual patient safety concerns.
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Affiliation(s)
- Alistair Ludley
- Imperial College School of Medicine, Imperial College London, London, UK
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Andrew Ting
- Imperial College School of Medicine, Imperial College London, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Dean Malik
- Imperial College School of Medicine, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Naveethan Sivanadarajah
- Imperial College School of Medicine, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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FORTES JEFFERSONPACHECOAMARAL, HOTTA GISELEHARUMI, AGUIAR DÉBORAPINHEIRO, OLIVEIRA VICTORBRUNOSOARESDE, OLIVEIRA FRANCISCOCARLOSDEMATTOSBRITO, SANTOS-JÚNIOR FRANCISCOFLEURYUCHOA. RELIABILITY OF THE ISOMETRIC DYNAMOMETER IN CONTROL, PARAPLEGIC, AND AMPUTEE INDIVIDUALS. Acta Ortop Bras 2023; 31:e255829. [PMID: 36844127 PMCID: PMC9949314 DOI: 10.1590/1413-785220233101e255829] [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] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 04/06/2022] [Indexed: 02/22/2023]
Abstract
Objective To determine the Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), Minimum Detectable Change (MDC), and the Minimum Clinically Important Difference (MCID) of the isometric measurements of muscle strength of trunk extension and of flexion and knee extension at maximum contraction in healthy, paraplegic, and amputee individuals, by using an isometric dynamometer with a belt for stabilization. Methods An observational cross-sectional study was carried out to assess the reliability of a portable isometric dynamometer in the trunk extension and flexion and knee extension movements of each group. Results In all measurements, ICC ranged from 0.66 to 0.99, SEM from 0.11 to 3.73 kgf, and MDC from 0.30 to 10.3 kgf. The MCID of the movements ranged from 3.1 to 4.9 kgf in the amputee group and from 2.2 to 3.66 kgf in the paraplegic group. Conclusion The manual dynamometer demonstrated good intra-examiner reliability, presenting moderate and excellent ICC results. Thus, this device is a reliable resource to measure muscle strength in amputees and paraplegics. Level of Evidence II, Cross-Sectional Study.
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Affiliation(s)
| | - GISELE HARUMI HOTTA
- Lead - Dell Research, Development, and Innovation Center, Fortaleza, CE, Brazil.,Universidade de São Paulo, Ribeirão Preto Medical School, Department of Health Sciences, Ribeirão Preto, SP, Brazil
| | | | | | - FRANCISCO CARLOS DE MATTOS BRITO OLIVEIRA
- Lead - Dell Research, Development, and Innovation Center, Fortaleza, CE, Brazil.,Universidade Estadual do Ceará, Department of Computer Science, Fortaleza, CE, Brazil
| | - FRANCISCO FLEURY UCHOA SANTOS-JÚNIOR
- Lead - Dell Research, Development, and Innovation Center, Fortaleza, CE, Brazil.,Instituto Le Santé, Fortaleza, CE, Brazil.,Universidade de São Paulo, Ribeirão Preto Medical School, Department of Health Sciences, Ribeirão Preto, SP, Brazil
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Weiand D, Cullerton C, Oxley R, Plummer CJ. Impact of computerised provider order entry on the quality and quantity of clinical information included with investigation requests: an interrupted time series analysis. BMJ Open Qual 2023; 12:bmjoq-2022-002143. [PMID: 36720495 PMCID: PMC9890764 DOI: 10.1136/bmjoq-2022-002143] [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: 10/04/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Relevant clinical information is vital to inform the analytical and interpretative phases of most investigations. The aim of this study is to evaluate the impact of implementation of computerised provider order entry (CPOE), featuring order-specific electronic order entry forms (eOEFs), on the quality and quantity of clinical information included with investigation requests. METHODS The CPOE module of a commercially available electronic health record (Cerner Millennium) was implemented at a large, tertiary care centre. The laboratory information management system was interrogated to collect data on specimens sent for microbiological culture 1 year before implementation of CPOE (2018), immediately post implementation (2019) and 6 months post implementation (2020). An interrupted time series analysis was performed, using text mining, to evaluate the quality and quantity of free-text clinical information. RESULTS In total, 39 919 specimens were collected from 16 458 patients. eOEFs were used to place 10 071 out of 13 735 orders in 2019 (73.3%), and 9155 out of 12 229 orders in 2020 (74.9%). No clinical details were included with 653 out of 39 919 specimens (1.6%), of which 22 (3.4%) were ordered using eOEFs. The median character count increased from 14 in 2018, to 41 in 2019, and 38 in 2020. An anti-infective agent was specified in 581 out of 13 955 requests (4.2%) in 2018; 5545 out of 13 735 requests (40.4%) in 2019; and 5215 out of 12 229 requests (42.6%) in 2020. Ciprofloxacin or piperacillin-tazobactam (Tazocin) were mentioned in the clinical details included with 421 out of 15 335 urine culture requests (2.7%), of which 406 (96.3%) were ordered using eOEFs. Subsequent detection of in vitro non-susceptibility led to a change in anti-infective therapy for five patients. CONCLUSIONS Implementation of CPOE, featuring order-specific eOEFs, significantly and sustainably improves the quality and quantity of clinical information included with investigation requests, resulting in changes to patient management that would not otherwise have occurred.
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Affiliation(s)
- Daniel Weiand
- Medical Microbiology, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Caroline Cullerton
- Medical Microbiology, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Oxley
- Medical Microbiology, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris J Plummer
- Cardiology, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Albuquerque PMNM, Da Silva EPC, Melo TMDS, Montenegro EJN, de Oliveira DA, Guerino MR, De Siqueira GR. Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques. J Manipulative Physiol Ther 2022; 45:227-234. [PMID: 35879125 DOI: 10.1016/j.jmpt.2022.06.001] [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: 10/01/2019] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation. METHODS Twenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ2 test were used to identify the factors associated with the error and inaccuracy of palpation. RESULTS Accuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = -0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region. CONCLUSION The palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.
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Affiliation(s)
| | | | - Thania M de S Melo
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Eduardo J N Montenegro
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Daniella A de Oliveira
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Marcelo R Guerino
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Gisela R De Siqueira
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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Spotnitz M, Patterson J, Huser V, Weng C, Natarajan K. Harmonization of Measurement Codes for Concept-Oriented Lab Data Retrieval. Stud Health Technol Inform 2022; 290:12-16. [PMID: 35672961 DOI: 10.3233/shti220022] [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] [Indexed: 06/15/2023]
Abstract
Measurement concepts are essential to observational healthcare research; however, a lack of concept harmonization limits the quality of research that can be done on multisite research networks. We developed five methods that used a combination of automated, semi-automated and manual approaches for generating measurement concept sets. We validated our concept sets by calculating their frequencies in cohorts from the Columbia University Irving Medical Center (CUIMC) database. For heart transplant patients, the preoperative frequencies of basic metabolic panel concept sets, which we generated by a semi-automated approach, were greater than 99%. We also made concept sets for lumbar puncture and coagulation panels, by automated and manual methods respectively.
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Affiliation(s)
- Matthew Spotnitz
- Columbia University Medical Center Department of Biomedical Informatics
| | - Jason Patterson
- Columbia University Medical Center Department of Biomedical Informatics
| | | | - Chunhua Weng
- Columbia University Medical Center Department of Biomedical Informatics
| | - Karthik Natarajan
- Columbia University Medical Center Department of Biomedical Informatics
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Assis EG, Lima ACL, Nobre CN. How Is the Quality of Information in a Cancer Hospital Regarding the Completeness and Consistency? A Case Study of the Hospital Cancer Registry of the Brazilian Hospital Bom Pastor. Stud Health Technol Inform 2022; 290:989-990. [PMID: 35673170 DOI: 10.3233/shti220232] [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] [Indexed: 06/15/2023]
Abstract
This study aimed to analyze the measurement of information quality in the Information System of the Brazilian Hospital in terms of data completeness and consistency. The quality of information is a fundamental factor in evaluating the performance of information systems. Its use is a reasonable condition in the management of the health service and attention to the care of patients. The research had a retrospective, descriptive character exploratory with quantitative analysis of the data. The study had some limitations, we observed incomplete information regarding some studied variables; this is because the primary source of information in the cancer registry is the patient's medical record. Therefore, the patient's medical records are relevant and should contain the entire health history, from birth to death. In addition, they support research, the management of health services.
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Affiliation(s)
- Erika G Assis
- Graduate Program in Informatics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Cristiane Neri Nobre
- Graduate Program in Informatics, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Vass A, Reinecke I, Boeker M, Prokosch HU, Gulden C. Availability of Structured Data Elements in Electronic Health Records for Supporting Patient Recruitment in Clinical Trials. Stud Health Technol Inform 2022; 290:130-134. [PMID: 35672985 DOI: 10.3233/shti220046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Automated identification of eligible patients for clinical trials is an evident secondary use for electronic health records (EHR) data accumulated during routine care. This task requires relevant data elements to be both available in the EHR and in a structured form. This work analyzes these data quality dimensions of EHR data elements corresponding to a selection of frequent eligibility criteria over a total of 436 patient records at 10 university hospitals within the MIRACUM consortium. Data elements from demographics, diagnosis and laboratory findings are typically structured with a completeness of 73 % to 88 % while medication as well as procedures are rather untructured with a completeness of only 44 %. The results can be used to derive suggestions for data quality improvement measures with respect to patient recruitment as well as to serve as a baseline to quantify future developments.
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Affiliation(s)
- Albert Vass
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,Data Integration Center, University Medicine Greifswald, Greifswald, Germany
| | - Ines Reinecke
- Carl Gustav Carus Faculty of Medicine, Center for Medical Informatics, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Martin Boeker
- Institute of Medical Informatics, Statistics and Epidemiology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg. Erlangen, Germany
| | - Christian Gulden
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg. Erlangen, Germany
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13
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Triefenbach L, Otto R, Bienzeisler J, Kombeiz A, Ehrentreich S, Röhrig R, Majeed RW. Establishing a Data Quality Baseline in the AKTIN Emergency Department Data Registry - A Secondary Use Perspective. Stud Health Technol Inform 2022; 294:209-213. [PMID: 35612058 DOI: 10.3233/shti220439] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Secondary use of clinical data is an increasing application that is affected by the data quality (DQ) of its source systems. Techniques such as audits and risk-based monitoring for controlling DQ often rely on source data verification (SDV). SDV requires access to data generating systems. We present an approach to a targeted SDV based on manual input and synthetic data that is applicable in low resource settings with restricted system access. We deployed the protocol in the DQ management of the AKTIN Emergency Department Data Registry. Our targeted approach has shown to be feasible to form a DQ baseline that can be used for different DQ monitoring processes such as the identification of different error sources.
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Affiliation(s)
- Lucas Triefenbach
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ronny Otto
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Jonas Bienzeisler
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Alexander Kombeiz
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Saskia Ehrentreich
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Raphael W Majeed
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
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14
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Bazyar J, Farrokhi M, Salari A, Safarpour H, Khankeh HR. Accuracy of Triage Systems in Disasters and Mass Casualty Incidents; a Systematic Review. Arch Acad Emerg Med 2022; 10:e32. [PMID: 35573710 PMCID: PMC9078064 DOI: 10.22037/aaem.v10i1.1526] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction To prioritize patients to provide them with proper services and also manage the scarce resources in emergencies, the use of triage systems seems to be essential. The aim of this study was to evaluate the accuracy of the existing triage systems in disasters and mass casualty incidents. Methods The present study is a systematic review of the accuracy of all triage systems worldwide. The results of this study were based on the articles published in English language journals. In this research, all papers published from the beginning of 2000 to the end of 2021 were sought through different databases. Finally, a total of 13 articles was ultimately selected from 89 articles. Results 13 studies on the accuracy of triage systems were reviewed. The START, mSTART, SALT, Smart, Care Flight, ASAV, MPTT, Sieve and ESI triage systems, had an accuracy, sensitivity, and specificity of less than 90%. Only the Smart triage system had an overall accuracy of more than 90%. Conclusion According to the findings of the current systematic review, the performance of the existing triage systems in terms of accuracy of prioritizing the injured people and other performance indexes is not desirable. Therefore, to improve the performance and increase the precision of triage systems, the world nations are recommended to change or revise the indexes used in triage models and also identify other influential factors affecting the accuracy of triage systems.
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Affiliation(s)
- Jafar Bazyar
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran.,Pre-hospital Medical Emergency organization, Ilam university of Medical Sciences, Ilam, Iran
| | - Mehrdad Farrokhi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amir Salari
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Safarpour
- Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran.,Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Corresponding Author: Hamid Reza Khankeh; Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. , Tel: +98 021 2218 0160, ORCID: https://orcid.org/0000-0002-9532-5646
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15
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Gullberg J, Al-Okshi A, Homar Asan D, Zainea A, Sundh D, Lorentzon M, Lindh C. The challenge of applying digital image processing software on intraoral radiographs for osteoporosis risk assessment. Dentomaxillofac Radiol 2022; 51:20210175. [PMID: 34324394 PMCID: PMC8693323 DOI: 10.1259/dmfr.20210175] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate rater agreement and the accuracy of a semi-automated software and its fully automated tool for osteoporosis risk assessment in intraoral radiographs. METHODS A total of 567 intraoral radiographs was selected retrospectively from women aged 75-80 years participating in a large population-based study (SUPERB) based in Gothenburg, Sweden. Five raters assessed participants' risk of osteoporosis in the intraoral radiographs using a semi-automated software. Assessments were repeated after 4 weeks on 121 radiographs (20%) randomly selected from the original 567. Radiographs were also assessed by the softwares' fully automated tool for analysis. RESULTS Overall interrater agreement for the five raters was 0.37 (95% CI 0.32-0.41), and for the five raters with the fully automated tool included as 'sixth rater' the overall Kappa was 0.34 (0.30-0.38). Intrarater agreement varied from moderate to substantial according to the Landis and Koch interpretation scale. Diagnostic accuracy was calculated in relation to reference standard for osteoporosis diagnosis which is T-score values for spine, total hip and femoral neck and presented in form of sensitivities, specificities, predictive values, likelihood ratios and odds ratios. All raters' mean sensitivity, including the fully automated tool, was 40,4% (range 14,3%-57,6%). Corresponding values for specificity was 69,5% (range 59,7%-90,4%). The diagnostic odds ratios ranged between 1 and 2.7. CONCLUSION The low diagnostic odds ratio and agreement between raters in osteoporosis risk assessment using the software for analysis of the trabecular pattern in intraoral radiographs shows that more work needs to be done to optimise the automation of trabecular pattern analysis in intraoral radiographs.
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Affiliation(s)
| | - Ayman Al-Okshi
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Sebha University, Sebha, Libya
| | | | - Anita Zainea
- Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Daniel Sundh
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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16
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Neves Duarte Lisboa I, Dantas De Sá Tinôco J, Dias Fernandes MIDC, Da Silva RR, Barbosa Da Silva J, Freire Delgado M, Oliveira Lopes MV, Brandão De Carvalho Lira AL. Constipation in Chemotherapy Patients: A Diagnostic Accuracy Study. Asian Pac J Cancer Prev 2021; 22:3017-3021. [PMID: 34582674 PMCID: PMC8850898 DOI: 10.31557/apjcp.2021.22.9.3017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 11/28/2022] Open
Abstract
Objective: To analyze the accuracy of clinical indicators of constipation in cancer patients undergoing chemotherapy. Methods: A diagnostic accuracy study was conducted from February to September 2018, with 240 cancer patients undergoing chemotherapy. The data collection instrument was a form with sociodemographic and clinical variables, and clinical indicators of constipation. The sensitivity and specificity of the clinical indicators of interest were calculated using a latent class analysis approach. Result: The prevalence of constipation in the sample was 86.6%. The most sensitive clinical indicators were straining with defecation (100.0%), and hypoactive bowel sounds (75.0%), while headache (99.9%), abdominal pain (75.0%), pain with defecation (75.0%), straining with defecation (99.9%) and liquid stool (78.1%) were indicators with high specificity. Conclusion: A set of six clinical indicators was significantly associated with the occurrence of constipation in cancer patients undergoing chemotherapy, especially straining with defecation. These indicators can be used by nurses to identify constipation and propose prompt and effective interventions.
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Abstract
OBJECTIVE There is limited understanding amongst patients and parents of paediatric patients regarding adenoidectomy. Most patients access health-related information online. The aim of this study was to assess the suitability of online information on adenoidectomy. METHOD The term 'adenoid' was used to search Google, and the first 50 websites identified were screened. For each website, the readability and quality were assessed. RESULTS Of the 41 websites that met the inclusion criteria, the mean readability scores corresponded to 'difficult to read' and university-level reading categories. For the quality of the websites, the mean score corresponded to 'fair' with 39 per cent of the websites containing either 'poor' or 'very poor' quality data. The ENT UK information is one of the most readable and reliable online resources. CONCLUSION The online information on adenoidectomy is largely set at an inappropriate readability level and of variable quality. Surgeons should consider assisting their patients with online searches regarding adenoidectomy.
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18
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Camacho P, Dutra-Medeiros M, Salgueiro L, Sadio S, Rosa PC. Manual Segmentation of 12 Layers of the Retina and Choroid through SD-OCT in Intermediate AMD: Repeatability and Reproducibility. J Ophthalmic Vis Res 2021; 16:384-392. [PMID: 34394867 PMCID: PMC8358755 DOI: 10.18502/jovr.v16i3.9435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/07/2019] [Accepted: 12/11/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the repeatability and reproducibility of the segmentation of 12 layers of the retina and the choroid, performed manually by SD-OCT, along the horizontal meridian at three different temporal moments, and to evaluate its concordance with the same measurements performed by two other operators in intermediate AMD. Methods A cross-sectional study of 40 eyes from 40 subjects with intermediate AMD was conducted. The segmentation was performed manually, using SD-OCT. The 169 measurements per eye were repeated at three time points to study the intra-operator variability. The same process was repeated a single time by two different trained operators for the inter-operator variability. Results Forty participants (28 women and 12 men) were enrolled in this study, with an average age of 76.4 ± 8.2 (range, 55–92 years). Overall, the maximum values of the various structures were found in the 3 mm of the macula. Intra-operator variability: the highest ICC values turned out to be discovered in thicker locations. Inter-operator variability: except correlation values of 0.826 (0.727; 0.898) obtained in the OPL (T2.5) and 0.634 (0.469; 0.771) obtained in the IPL (N2), all other correlation values were >0.92, in most cases approaching higher values like 0.98. Conclusion The measurements of several layers of the retina and the choroid achieved at 13 locations presented a good repeatability and reproducibility. Manual quantification is still an alternative for the weaknesses of automatic segmentation. Locations of greatest concordance should be those used for the clinical control and monitoring.
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Affiliation(s)
- Pedro Camacho
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal.,Ophtalmology Institute Dr. Gama Pinto, Lisbon, Portugal.,NOVA Medical School, Lisbon, Portugal
| | - Marco Dutra-Medeiros
- Retina Institute of Lisbon, Lisbon, Portugal.,NOVA Medical School, Lisbon, Portugal
| | | | - Sílvia Sadio
- Ophtalmology Institute Dr. Gama Pinto, Lisbon, Portugal.,Retina Institute of Lisbon, Lisbon, Portugal
| | - Paulo C Rosa
- Ophtalmology Institute Dr. Gama Pinto, Lisbon, Portugal.,Retina Institute of Lisbon, Lisbon, Portugal
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Eshagh Hoseini SJ, Vahedian M, Sharifi A. Comparing the Accuracy of Ohmann and Alvarado Scoring Systems in Detection of Acute Appendicitis; a Cross-Sectional Study. Arch Acad Emerg Med 2021; 9:e37. [PMID: 34223182 PMCID: PMC8221549 DOI: 10.22037/aaem.v9i1.1187] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Alvarado Scoring System (ASS) and Ohmann Scoring System (OSS) are two scoring systems for diagnosing acute appendicitis (AA). This study was designed to compare the diagnostic accuracy of the two mentioned scores in detection of acute abdominal cases at risk for AA. Methods: In this prospective cross-sectional study, patients admitted to the emergency departments of two academic hospitals in Qom, Iran, with right lower quadrant (RLQ) abdominal pain suspected to AA were evaluated. All cases were scored using ASS and OSS, and screening performance characteristics of the two scores were calculated and reported considering the pathologic findings as a gold standard. Results: 174 patients with a preliminary AA diagnosis and the mean age of 38.1 ± 10.63 years (11- 73) were included in this study (62.07% male). At the optimal cutoff point of ≥7 for the ASS, the sensitivity and the specificity were 46.43% (95% CI: 37.97%-55.07%), 97.05% (95% CI: 84.67%-92.93%), respectively. At the optimal cutoff point of ≥11 for the OSS, the sensitivity and the specificity were 74.29% (95% CI: 66.22%-81.29%), and 55.88% (95% CI: 37.89% - 72.82%), respectively. Conclusion: Based on the finding of this study, the ASS ≥ 7 was more accurate than the OSS ≥ 11 for detection of AA. But it should be considered that the overall accuracy of Alvarado and Ohmann scores in this regard were fair (0.83) and poor (0.67), respectively.
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Affiliation(s)
- Seyed Jalal Eshagh Hoseini
- Department of Surgery, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Mostafa Vahedian
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Sharifi
- Student research committee, Qom University of Medical Sciences, Qom, Iran
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20
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Karimi S, Heydari F, Mirbaha S, Elfil M, Baratloo A. Accuracy of prehospital ambulance stroke test in terms of diagnosis of patients with acute ischemic stroke: A multi-center study. Curr J Neurol 2020; 19:196-199. [PMID: 38011376 PMCID: PMC8236426 DOI: 10.18502/cjn.v19i4.5547] [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] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
Background: Andsberg et al. have recently introduced a novel scoring system entitled "PreHospital Ambulance Stroke Test (PreHAST)", which helps to early identification of patients with acute ischemic stroke (AIS) even in prehospital setting. Its validity has not been assessed in a study yet, and the purpose of this study was to assess this scoring system on a larger scale to provide further evidence in this regard. Methods: This was a cross-sectional multi-center accuracy study, in which, sampling was performed prospectively. All patients over 18 years of age admitted to the emergency department (ED) and suspected as AIS cases were included. All required data were recorded in a form consisting of 3 parts: baseline characteristics, neurological examination findings required for calculating PreHAST score, and the ultimate diagnosis made from interpretation of their brain magnetic resonance imaging (MRI). Results: Data from 805 patients (57.5% men) with the mean age of 67.1 ± 13.6 years were analyzed. Of all the patients presenting with suspected AIS, 562 (69.8%) had AIS based on their MRI findings. At the suggested cut-off point (score ≥ 1), PreHAST had a specificity of 46.5% [95% confidence interval (CI): 40.1%-53.0%) and a sensitivity of 93.2% (95% CI: 90.8%-95.2%). Conclusion: According to the findings of our study, at the suggested cut-off point (score ≥ 1), PreHAST had 93.2% sensitivity and 46.5% specificity in detection of patients with AIS, which were somewhat different from those reported in the original study, where 100% sensitivity and 40% specificity were reported for this scoring system.
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Affiliation(s)
- Somayeh Karimi
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Heydari
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Mirbaha
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alireza Baratloo
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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21
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Lefebvre A. Quality Improvement Teams: Moving from the Passionate Few to the Mandated Many. J Am Board Fam Med 2020; 33:S42-5. [PMID: 32928949 DOI: 10.3122/jabfm.2020.S1.200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/08/2022] Open
Abstract
Quality Improvement has gone from practice by practice piecework to an industry driven by expertise that lies within corporate offices rather than within patient care. Using for her 20 years of experience leading and teaching quality improvement as a lens, the author makes the case for quality improvement teams to ensure a key role for clinicians and direct care staff who are closest to the patients and the improvements that need to be made.
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22
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Carter SA, Gutman T, Logeman C, Cattran D, Lightstone L, Bagga A, Barbour SJ, Barratt J, Boletis J, Caster D, Coppo R, Fervenza FC, Floege J, Hladunewich M, Hogan JJ, Kitching AR, Lafayette RA, Malvar A, Radhakrishnan J, Rovin BH, Scholes-Robertson N, Trimarchi H, Zhang H, Azukaitis K, Cho Y, Viecelli AK, Dunn L, Harris D, Johnson DW, Kerr PG, Laboi P, Ryan J, Shen JI, Ruiz L, Wang AYM, Lee AHK, Fung S, Tong MKH, Teixeira-Pinto A, Wilkie M, Alexander SI, Craig JC, Tong A. Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers. Clin J Am Soc Nephrol 2020; 15:673-684. [PMID: 32354728 PMCID: PMC7269216 DOI: 10.2215/cjn.13101019] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 10/25/2019] [Accepted: 03/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Shared decision making in patients with glomerular disease remains challenging because outcomes important to patients remain largely unknown. We aimed to identify and prioritize outcomes important to patients and caregivers and to describe reasons for their choices. DESIGN , setting, participants, & measurementsWe purposively sampled adult patients with glomerular disease and their caregivers from Australia, Hong Kong, the United Kingdom, and the United States. Participants identified, discussed, and ranked outcomes in focus groups using the nominal group technique; a relative importance score (between zero and one) was calculated. Qualitative data were analyzed thematically. RESULTS Across 16 focus groups, 134 participants (range, 19-85 years old; 51% women), including 101 patients and 33 caregivers, identified 58 outcomes. The ten highest-ranked outcomes were kidney function (importance score of 0.42), mortality (0.29), need for dialysis or transplant (0.22), life participation (0.18), fatigue (0.17), anxiety (0.13), family impact (0.12), infection and immunity (0.12), ability to work (0.11), and BP (0.11). Three themes explained the reasons for these rankings: constraining day-to-day experience, impaired agency and control over health, and threats to future health and family. CONCLUSIONS Patients with glomerular disease and their caregivers highly prioritize kidney health and survival, but they also prioritize life participation, fatigue, anxiety, and family impact.
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Affiliation(s)
- Simon A Carter
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia .,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Charlotte Logeman
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Dan Cattran
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto General Research Institute, Toronto, Ontario, Canada
| | - Liz Lightstone
- Centre for Inflammatory Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Arvind Bagga
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sean J Barbour
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Barratt
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom.,John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom
| | - John Boletis
- Nephrology Department and Renal Transplantation Unit, Medical School, University of Athens, Laiko Hospital, Athens, Greece
| | - Dawn Caster
- Division of Nephrology, University of Louisville, Kentucky, Louisville
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany
| | - Michelle Hladunewich
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jonathan J Hogan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Richard Kitching
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Richard A Lafayette
- Stanford University Medical Center, Stanford, California.,Division of Nephrology, Department of Medicine, Stanford University, Stanford, California
| | - Ana Malvar
- Nephrology, Hospital Fernández, Buenos Aires, Argentina
| | | | - Brad H Rovin
- Division of Nephrology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Hérnan Trimarchi
- Nephrology Service and Kidney Transplantation Unit, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - David Harris
- Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Peter G Kerr
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Paul Laboi
- Department of Nephrology, York Hospital, York, United Kingdom
| | - Jessica Ryan
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jenny I Shen
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles Medical Center, Torrance, California
| | - Lorena Ruiz
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles Medical Center, Torrance, California
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | - Samuel Fung
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | | | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Martin Wilkie
- Department of Nephrology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Yang YS, Ryu GW, Choi M. Factors Associated with Daily Completion Rates in a Smartphone-Based Ecological Momentary Assessment Study. Healthc Inform Res 2019; 25:332-337. [PMID: 31777677 PMCID: PMC6859272 DOI: 10.4258/hir.2019.25.4.332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/16/2019] [Revised: 10/19/2019] [Accepted: 10/19/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives Ecological momentary assessment (EMA) methods are known to have validity for capturing momentary changes in variables over time. However, data quality relies on the completion rates, which are influenced by both participants' characteristics and study designs. This study applied an EMA method using a mobile application to assess momentary moods and stress levels in patients with Moyamoya disease to examine variables associated with EMA completion rates. Methods Adults with Moyamoya disease were recruited from a tertiary hospital in Seoul. Patients with cognitive impairment were excluded. The EMA survey was loaded as a mobile application onto the participants' personal smartphones. Notifications were sent at semi-random intervals four times a day for seven consecutive days. Daily completion rates were calculated as the percentage of completed responses per day; overall completion rates were calculated as the proportion of completed responses per total of the 28 scheduled measures in the study and assessed through a descriptive analysis, t-test, ANOVA, and regression analysis, with mixed modeling to identify the point at which the daily completion rate significantly decreased. Results A total of 98 participants responded (mean age, 41.00 ± 10.30 years; 69.4% female; 75.5% married). The overall completion rate was 70.66%, with no gender or age differences found. The daily completion rate decreased significantly after day 5 (p = 0.029). Conclusions Obtaining a good completion rate is essential for quality data in EMA methods. Strategic approaches to a study design should be established to encourage participants throughout a study to improve completion rates.
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Affiliation(s)
- Yong Sook Yang
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Gi Wook Ryu
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
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Abstract
Secondary analysis of electronic health records for clinical research faces significant challenges due to known data quality issues in health data observationally collected for clinical care and the data biases caused by standard healthcare processes. In this manuscript, we contribute methodology for data quality assessment by plotting domain-level (conditions (diagnoses), drugs, and procedures) aggregate statistics and concept-level temporal frequencies (i.e., annual prevalence rates of clinical concepts). We detect common temporal patterns in concept frequencies by normalizing and clustering annual concept frequencies using K-means clustering. We apply these methods to the Columbia University Irving Medical Center Observational Medical Outcomes Partnership database. The resulting domain-aggregate and cluster plots show a variety of patterns. We review the patterns found in the condition domain and investigate the processes that shape them. We find that these patterns suggest data quality issues influenced by system-wide factors that affect individual concept frequencies.
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Affiliation(s)
- Casey N Ta
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
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Parciak M, Bauer C, Bender T, Lodahl R, Schreiweis B, Tute E, Sax U. Provenance Solutions for Medical Research in Heterogeneous IT-Infrastructure: An Implementation Roadmap. Stud Health Technol Inform 2019; 264:298-302. [PMID: 31437933 DOI: 10.3233/shti190231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research data generated in large projects raise challenges about not only data analytics but also data quality assessments and data governance. The provenance of a data set - that is the history of data sets - holds information relevant to technicians and non-technicians and is able to answer questions regarding data quality, transparency, and more. We propose an implementation roadmap to extract, store, and utilize provenance records in order to make provenance available to data analysts, research subjects, privacy officers, and machines (machine readability). Each aspect is tackled separately, resulting in the implementation of a provenance toolbox. We aim to do so within the context of HiGHmed, a research consortium established within the medical informatics initiative in Germany. In this testbed of federated IT-infrastructures, the toolbox shall assist each stakeholder in answering domain-specific and domain-agnostic questions regarding the provenance of data sets. This way, we will improve data re-use, transparency, and reproducibility.
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Affiliation(s)
- Marcel Parciak
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
| | - Christian Bauer
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
| | - Theresa Bender
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
| | - Robert Lodahl
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
| | - Björn Schreiweis
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Erik Tute
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Ulrich Sax
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
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Kamdje-Wabo G, Gradinger T, Löbe M, Lodahl R, Seuchter SA, Sax U, Ganslandt T. Towards Structured Data Quality Assessment in the German Medical Informatics Initiative: Initial Approach in the MII Demonstrator Study. Stud Health Technol Inform 2019; 264:1508-1509. [PMID: 31438205 DOI: 10.3233/shti190508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Demonstrator study aims to analyse comorbidities and rare diseases among patients from German university hospitals within the German Medical Informatics Initiative. This work aimed to design and determine the feasibility of a model to assess the quality of the claims data used in the study. Several data quality issues were identified affecting small amounts of cases in one of the participating sites. As a next step an extension to all participating sites is planned.
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Affiliation(s)
- Gaetan Kamdje-Wabo
- Department of Biomedical Informatics of the Heinrich-Lanz-Center, Mannheim University Medicine, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Tobias Gradinger
- Department of Biomedical Informatics of the Heinrich-Lanz-Center, Mannheim University Medicine, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Matthias Löbe
- Institute of Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Germany
| | - Robert Lodahl
- Department of Medical Informatics, University Medical Center Goettingen, Goettingen, Germany
| | - Susanne Andrea Seuchter
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Ulrich Sax
- Department of Medical Informatics, University Medical Center Goettingen, Goettingen, Germany
| | - Thomas Ganslandt
- Department of Biomedical Informatics of the Heinrich-Lanz-Center, Mannheim University Medicine, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
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Yook IH, Park SJ, Choi MJ, Kim DJ, Choi IY. Factors Affecting Smartphone Usage Self-Report Levels. Stud Health Technol Inform 2019; 264:1937-1938. [PMID: 31438416 DOI: 10.3233/shti190722] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
For the treatment of smartphone addiction, it is important to understand users' smartphone usage patterns. Most of the studies are based on self-report surveys. However, there are differences between self-reported usage and real usage. For a better understanding of usage patterns, this study identified demographic and social factors that affect smartphone usage self-report levels. Also, it was confirmed that the influencing factors differ depending on the smartphone usage content by application category.
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Affiliation(s)
- In Hye Yook
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So Jin Park
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mun Joo Choi
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Jin Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Young Choi
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Schmidt EE, Eichelser C, Ahlborn B, Keune D, Castaños-Vélez E, Juárez D, Lablans M. Automated Reports for Monitoring and Improving Data Quality in a Translational Research Network. Stud Health Technol Inform 2019; 264:1458-1459. [PMID: 31438180 DOI: 10.3233/shti190483] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Standardised, automated quality reports were generated at three pilot locations of the decentralized translational research network DKTK with separated local data warehouses (LDW), for assessing syntactic conformity against common data element definitions deposited in a central metadata repository (MDR). Deviations in the LDW were categorised, and locally corrected. Comparisons of reports from two time points confirm a major improvement in data quality in terms of syntactic conformity, an essential prerequisite for network-wide data integration.
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Affiliation(s)
- Esther E Schmidt
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Corinna Eichelser
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine III, Klinikum der Universität München (KUM), Germany.,Department of Medicine III, Klinikum rechts der Isar (MRI), TUM, Germany
| | - Bernd Ahlborn
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute for Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität München (LMU), München, Germany
| | - Dietmar Keune
- Clinical Cancer Registry,Charité Comprehensive Cancer Center, Berlin, Germany
| | | | - David Juárez
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Lablans
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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Masic I, Jankovic SM, Begic E. PhD Students and the Most Frequent Mistakes During Data Interpretation by Statistical Analysis Software. Stud Health Technol Inform 2019; 262:105-109. [PMID: 31349277 DOI: 10.3233/shti190028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Correct choice and administration of a statistical test are absolutely essential for meaningful interpretation of research data, yet mistakes are still frequent and could be easily found in published scientific papers or PhD theses. The aim of this study was to analyze mistakes made by PhD students in statistical analysis of data collected during research within the framework of their thesis. PhD students frequently use Excel and SPSS for data processing, while SAS, Stata and R are also available. The study was designed as cross-sectional analysis of random sample (n=15) of PhD theses in pre-approval stage at Faculty of Medical Sciences, University of Kragujevac, Serbia. In total 14 (93%) theses had at least one mistake. The most frequent mistakes were as the following: insufficient statistical power due to small sample size, inappropriate presentation of results at tables and graphs, andinappropriate choice of statistical tests. In order to improve the situation, training courses in statistics during PhD studies should be re-evaluated and improved in regard to relevance, delivery methods and motivating potential, and mentors should invest more effort to review the data and guide students through statistical analysis.
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Affiliation(s)
- Izet Masic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Slobodan M Jankovic
- Department of Pharmacology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
| | - Edin Begic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
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Nascimento DP, Costa LOP, Gonzalez GZ, Maher CG, Moseley AM. Abstracts of low back pain trials are poorly reported, contain spin of information and are inconsistent with the full text: An overview study. Arch Phys Med Rehabil 2019; 100:1976-1985.e18. [PMID: 31207219 DOI: 10.1016/j.apmr.2019.03.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/31/2018] [Revised: 03/09/2019] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate trials abstracts evaluating treatments for low back pain with regards to completeness of reporting, spin (i.e., interpretation of study results that overemphasizes the beneficial effects of the intervention), and inconsistencies in data with the full text. DATA SOURCES The search was performed on Physiotherapy Evidence Database (PEDro) in February 2016. STUDY SELECTION This is an overview study of a random sample of 200 low back pain trials published between 2010 and 2015. The languages of publication were restricted to English, Spanish and Portuguese. DATA EXTRACTION Completeness of reporting was assessed using the CONSORT for Abstracts checklist (CONSORT-A). Spin was assessed using a SPIN-checklist. Consistency between abstract and full text were assessed by applying the assessment tools to both the abstract and full text of each trial and calculating inconsistencies in the summary score (paired t test) and agreement in the classification of each item (Kappa statistics). Methodological quality was analyzed using the total PEDro score. DATA SYNTHESIS The mean number of fully reported items for abstracts using the CONSORT-A was 5.1 (SD 2.4) out of 15 points and the mean number of items with spin was 4.9 (SD 2.6) out of 7 points. Abstract and full text scores were statistically inconsistent (P=0.01). There was slight to moderate agreement between items of the CONSORT-A in the abstracts and full text (mean Kappa 0.20 SD 0.13) and fair to moderate agreement for items of the SPIN-checklist (mean Kappa 0.47 SD 0.09). CONCLUSIONS The abstracts were incomplete, with spin and inconsistent with the full text. We advise health care professionals to avoid making clinical decisions based solely upon abstracts. Journal editors, reviewers and authors are jointly responsible for improving abstracts, which could be guided by amended editorial policies.
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Affiliation(s)
- Dafne P Nascimento
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.
| | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Gabrielle Z Gonzalez
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Christopher G Maher
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne M Moseley
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, Australia
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Zuil-Escobar JC, Martínez-Cepa CB, Martín-Urrialde JA, Gómez-Conesa A. Medial Longitudinal Arch: Accuracy, Reliability, and Correlation Between Navicular Drop Test and Footprint Parameters. J Manipulative Physiol Ther 2018; 41:672-679. [PMID: 30573198 DOI: 10.1016/j.jmpt.2018.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/30/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the correlation among the navicular drop test, the arch angle, the Staheli index and the Chippaux-Smirak index. The reliability and the correlation among the footprint parameters were also estimated. METHODS A cross-sectional study (n = 86; 59.3% women; 27.8 years, standard deviation: 4.8 years) was carried out. The navicular drop test was evaluated and footprint parameters using a plantar pressure platform were recorded in the dominant foot. Pearson correlation coefficients, intraclass correlation coefficient, standard error of measurement, and minimum detectable change were calculated. RESULTS Both intrarater and interrater reliability were excellent for all the parameters evaluated (intraclass correlation coefficients > 0.880). Statistically significant correlations existed between the navicular drop test and footprints parameters (arch angle = 0,643; Staheli index = 0.633; Chippaux-Smirak index = 0.614). The footprint parameters had excellent correlation with each other (0.838-0.881). The navicular drop test and the footprint parameters studied were reproducible and thus had excellent reliability. CONCLUSION The correlations obtained between the navicular drop test and the footprint parameters evaluated were good. The navicular drop test appears to be a reproducible, valid, and simple test for evaluating medial longitudinal arch height, having fewer disadvantages than using footprint parameters.
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Abstract
OBJECTIVE In order to achieve a faster and more reliable anterior rhinomanometric evaluation, nasal skin was prepared using benzoin tincture solution, which provides simpler and better adhesion of the foam tape to the nasal skin. METHOD Two consecutive anterior rhinomanometry measurements were made, one with and one without benzoin tincture application. RESULTS The average time taken to perform classic foam tape anterior rhinomanometry without benzoin tincture application was 281.32 seconds, and the average coefficients of variation for the right and left passages were 7.48 and 7.59 per cent, respectively. When benzoin tincture was used, the average time taken for completion of the tests was 121.24 seconds, and the average coefficients of variation for the right and left passages were 2.17 and 2.32 per cent. CONCLUSION The use of benzoin tincture to clean the nasal skin before placing foam tape shortens the procedure duration and significantly increases test reliability.
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Shokri A, Eskandarloo A, Norouzi M, Poorolajal J, Majidi G, Aliyaly A. Diagnostic accuracy of cone-beam computed tomography scans with high- and low-resolution modes for the detection of root perforations. Imaging Sci Dent 2018; 48:11-19. [PMID: 29581945 PMCID: PMC5863015 DOI: 10.5624/isd.2018.48.1.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/24/2017] [Revised: 11/04/2017] [Accepted: 11/17/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose This study compared the diagnostic accuracy of cone-beam computed tomography (CBCT) scans obtained with 2 CBCT systems with high- and low-resolution modes for the detection of root perforations in endodontically treated mandibular molars. Materials and Methods The root canals of 72 mandibular molars were cleaned and shaped. Perforations measuring 0.2, 0.3, and 0.4 mm in diameter were created at the furcation area of 48 roots, simulating strip perforations, or on the external surfaces of 48 roots, simulating root perforations. Forty-eight roots remained intact (control group). The roots were filled using gutta-percha (Gapadent, Tianjin, China) and AH26 sealer (Dentsply Maillefer, Ballaigues, Switzerland). The CBCT scans were obtained using the NewTom 3G (QR srl, Verona, Italy) and Cranex 3D (Soredex, Helsinki, Finland) CBCT systems in high- and low-resolution modes, and were evaluated by 2 observers. The chi-square test was used to assess the nominal variables. Results In strip perforations, the accuracies of low- and high-resolution modes were 75% and 83% for NewTom 3G and 67% and 69% for Cranex 3D. In root perforations, the accuracies of low- and high-resolution modes were 79% and 83% for NewTom 3G and was 56% and 73% for Cranex 3D. Conclusion The accuracy of the 2 CBCT systems was different for the detection of strip and root perforations. The Cranex 3D had non-significantly higher accuracy than the NewTom 3G. In both scanners, the high-resolution mode yielded significantly higher accuracy than the low-resolution mode. The diagnostic accuracy of CBCT scans was not affected by the perforation diameter.
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Affiliation(s)
- Abbas Shokri
- Dental Implant Research Center, Department of Oral and Maxillofacial Radiology, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Eskandarloo
- Dental Implant Research Center, Department of Oral and Maxillofacial Radiology, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marouf Norouzi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Urmia University of Medical Sciences, Urmia, Iran
| | - Jalal Poorolajal
- Department of Epidemiology and Noncommunicable Disease Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Gelareh Majidi
- Department of Radiology, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Alireza Aliyaly
- Dental Implant Research Center, Department of Oral and Maxillofacial Radiology, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
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Modjarrad K, Vermund SH. Ensuring HIV Data Availability, Transparency and Integrity in the MENA Region Comment on "Improving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward". Int J Health Policy Manag 2017; 6:729-732. [PMID: 29172382 PMCID: PMC5726325 DOI: 10.15171/ijhpm.2017.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/24/2017] [Indexed: 12/18/2022] Open
Abstract
In this commentary, we elaborate on the main points that Karamouzian and colleagues have made about HIVdata scarcity in Middle Eastern and North African (MENA) countries. Without accessible and reliable data, no epidemic can be managed effectively or efficiently. Clearly, increased investments are needed to bolster capabilities to capture and interpret HIV surveillance data. We believe that this enhanced capacity can be achieved, in part, by leveraging and repurposing existing data platforms, technologies and patient cohorts. An immediate modest investment that capitalizes on available infrastructure can generate data on the HIV burden and spread that can be persuasive for MENA policy-makers to intensify efforts to track and contain the growing HIV epidemic in this region. A focus on key populations will yield the most valuable data, including among men who have sex with men (MSM), transgender women and men, persons who inject drugs (PWIDs), female partners of high risk men and female sex workers.
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Affiliation(s)
- Kayvon Modjarrad
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Sten H. Vermund
- Yale School of Public Health, Yale University, New Haven, CT, USA
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Li L, McCaughey E, Iles-Mann J, Sargeant A, Dahm MR, Mumford V, Westbrook JI, Georgiou A. Assessing Data Integration and Quality for the Evaluation of Point-of-Care Testing Across Rural and Remote Emergency Departments in Australia. Stud Health Technol Inform 2017; 245:471-475. [PMID: 29295139] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In Australia, New South Wales Health Pathology's implementation of managed Point-of-Care Testing (PoCT) services across rural and remote emergency departments (EDs) has the potential to significantly improve access to results for certain types of pathology laboratory tests and help to deliver timely patient care. The aim of this study was to assess the quality of the datasets, including the integration of PoCT results into clinical systems, as a precursor to the application of an evaluation framework for monitoring the delivery of PoCT services and their impact on patient care. Three datasets, including laboratory, ED presentations and hospital admissions data were extracted from the relevant clinical information systems. Each dataset was assessed on six dimensions: completeness, uniqueness, timeliness, validity, accuracy, and consistency. Data incompleteness was the largest problem. Assessing the PoCT data integration and data quality is a precondition for the evaluation of PoCT and for monitoring and improving service delivery.
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Affiliation(s)
- Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Euan McCaughey
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Juliana Iles-Mann
- Pathology West, New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Andrew Sargeant
- New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Hanmer L, Nicola E, Bradshaw D. Development of a Data Collection Tool for MbHIS-QUAL: Evaluation of the Quality of Morbidity Data in Routine Health Information Systems (RHISs) in Hospitals. Stud Health Technol Inform 2017; 245:1300. [PMID: 29295383] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The quality of morbidity data in multiple routine inpatient records in a sample of South African hospitals is being assessed in terms of data accuracy and completeness. Extensive modification of available data collection tools was required to make it possible to collect the required data for the study.
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Affiliation(s)
- Lyn Hanmer
- South African Medical Research Council, Cape Town, South Africa
| | - Edward Nicola
- South African Medical Research Council, Cape Town, South Africa
| | - Debbie Bradshaw
- South African Medical Research Council, Cape Town, South Africa
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Naziyok TP, Feeken C, Zeleke AA, Dörks M, Röhrig R. Data Collection of Medication - Impact of Autocompletion in eCRFs on Efficiency and Data Quality. Stud Health Technol Inform 2017; 243:70-74. [PMID: 28883173] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Openclinica Input Completion (OIC) was developed to increase the efficiency to enter drugs in eCRF in OpenClinica®. The aim of the study was to evaluate the impact on efficiency and data quality as well as usability. METHODS 20 participants were asked to input 15 drugs with the new tool and by hand. RESULTS The mean input time got decreased from 16:12m to 3:59m. 31 of 300 (10%) of manual entered medication data sets had one or more errors versus 10 of 300 (3,3%) data sets entered with OIC. CONCLUSION OIC was able to increase efficiency and data quality. We conclude that new additions to the graphical user interface in electronical Case-Report-Form (eCRF) systems should be validated before usage in research projects.
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Affiliation(s)
- Tolga P Naziyok
- Dep. Medical Informatics, Carl von Ossietzky University Oldenburg, Germany
| | - Corinna Feeken
- Dep. Medical Informatics, Carl von Ossietzky University Oldenburg, Germany
| | - Atinkut A Zeleke
- Dep. Medical Informatics, Carl von Ossietzky University Oldenburg, Germany
| | - Michael Dörks
- Dep. Outpatient care and Pharmacoepidemiology, Carl von Ossietzky University Oldenburg, Germany
| | - Rainer Röhrig
- Dep. Medical Informatics, Carl von Ossietzky University Oldenburg, Germany
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Jung B, Seo KS, Kwon SJ, Lee K, Hong S, Seo H, Kim GY, Park GM, Jeong J, Seo S. Efficacy evaluation of syringe pump developed for continuous drug infusion. J Dent Anesth Pain Med 2016; 16:303-307. [PMID: 28879319 PMCID: PMC5564196 DOI: 10.17245/jdapm.2016.16.4.303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/15/2016] [Revised: 12/30/2016] [Accepted: 12/31/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In dental intravenous sedation, continuous intravenous infusion of a low-dose drug requires an infusion pump such as a syringe pump. To develop a new syringe pump for clinical use, the functions of the pump must meet certain international standards. Various safety and efficacy tests must be performed on the syringe pump, as stipulated by these standards, and an approval must be received from the approving agency based on such test results. METHODS The authors of the present study developed a novel syringe pump and performed efficacy evaluation by testing its infusion speed at 1 and 25 ml/h, and infusion performance testing at 2 and 24 h. Moreover, performance evaluation was conducted by comparing the novel pump to an existing pump with the infusion speed varied from 1 to 5 ml/h. RESULTS In the efficacy testing on the newly developed syringe pump, infusion with the infusion speed initially set to 1 ml/h resulted in infusion speeds of 1.00 and 0.99 ml/h in the 2- and 24-h assessment, respectively. Changing the infusion speed setting to 25 ml/h resulted in an infusion speed of 25.09 and 23.92 ml/h in the 2- and 24-h assessment, respectively. These results show no significant differences when compared with other commercially available pumps. CONCLUSIONS The efficacy testing of the newly developed syringe pump showed the accuracy to be within tolerance. Based on these findings, we believe that the newly developed syringe pump is suitable for clinical use.
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Affiliation(s)
- Bongsu Jung
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Suk Jin Kwon
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | | | | | | | - Gi-Young Kim
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Geun-Mook Park
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Juhee Jeong
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Soowon Seo
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
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Zuil-Escobar JC, Martínez-Cepa CB, Martín-Urrialde JA, Gómez-Conesa A. Reliability and Accuracy of Static Parameters Obtained From Ink and Pressure Platform Footprints. J Manipulative Physiol Ther 2016; 39:510-517. [PMID: 27581795 DOI: 10.1016/j.jmpt.2016.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 01/15/2015] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the accuracy and the intrarater reliability of arch angle (AA), Staheli Index (SI), and Chippaux-Smirak Index (CSI) obtained from ink and pressure platform footprints. METHODS We obtained AA, SI, and CSI measurements from ink pedigraph footprints and pressure platform footprints in 40 healthy participants (aged 25.65 ± 5.187 years). Intrarater reliability was calculated for all parameters obtained using the 2 methods. Standard error of measurement and minimal detectable change were also calculated. A repeated-measure analysis of variance was used to identify differences between ink and pressure platform footprints. Intraclass correlation coefficient and Bland and Altman plots were used to assess similar parameters obtained using different methods. RESULTS Intrarater reliability was >0.9 for all parameters and was slightly higher for the ink footprints. No statistical difference was reported in repeated-measure analysis of variance for any of the parameters. Intraclass correlation coefficient values from AA, SI, and CSI that were obtained using ink footprints and pressure platform footprints were excellent, ranging from 0.797 to 0.829. However, pressure platform overestimated AA and underestimated SI and CSI. CONCLUSIONS Our study revealed that AA, SI, and CSI were similar regardless of whether the ink or pressure platform method was used. In addition, the parameters indicated high intrarater reliability and were reproducible.
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Al-Abri R, Al-Balushi M, Kolethekkat A, Bhargava D, Al-Alwi A, Al-Bahlani H, Al-Garadi M. The Accuracy of IOS Device-based uHear as a Screening Tool for Hearing Loss: A Preliminary Study From the Middle East. Oman Med J 2016; 31:142-5. [PMID: 27168926 DOI: 10.5001/omj.2016.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/03/2022] Open
Abstract
OBJECTIVES To determine and explore the potential use of uHear as a screening test for determining hearing disability by evaluating its accuracy in a clinical setting and a soundproof booth when compared to the gold standard conventional audiometry. . METHODS Seventy Sultan Qaboos University students above the age of 17 years who had normal hearing were recruited for the study. They underwent a hearing test using conventional audiometry in a soundproof room, a self-administered uHear evaluation in a side room resembling a clinic setting, and a self-administered uHear test in a soundproof booth. The mean pure tone average (PTA) of thresholds at 500, 1000, 2000 and 4000 Hz for all the three test modalities was calculated, compared, and analyzed statistically. . RESULTS There were 36 male and 34 female students in the study. The PTA with conventional audiometry ranged from 1 to 21 dB across left and right ears. The PTA using uHear in the side room for the same participants was 25 dB in the right ear and 28 dB in the left ear (3-54 dB across all ears). The PTA for uHear in the soundproof booth was 18 dB and 17 dB (1-43 dB) in the right and left ears, respectively. Twenty-three percent of participants were reported to have a mild hearing impairment (PTA > 25 dB) using the soundproof uHear test, and this number was 64% for the same test in the side room. For the same group, only 3% of participants were reported to have a moderate hearing impairment (PTA > 40 dB) using the uHear test in a soundproof booth, and 13% in the side room. . CONCLUSION uHear in any setting lacks specificity in the range of normal hearing and is highly unreliable in giving the exact hearing threshold in clinical settings. However, there is a potential for the use of uHear if it is used to rule out moderate hearing loss, even in a clinical setting, as exemplified by our study. This method needs standardization through further research.
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Affiliation(s)
- Rashid Al-Abri
- ENT Division, Surgery Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mustafa Al-Balushi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Arif Kolethekkat
- ENT Division, Surgery Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Deepa Bhargava
- ENT Division, Surgery Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Amna Al-Alwi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Hana Al-Bahlani
- Clinical Physiology Department, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Manal Al-Garadi
- Clinical Physiology Department, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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