Biomedical subjects
H Prins
Publications and source records attributed to H Prins.
Availability and usability of data for medical practice assessment.
OBJECTIVE: We analyzed availability and usability of the electronic patient data required for assessment of medical practice for a specific patient group. DESIGN: Case study in which physicians defined performance indicators and additional exploratory information. Data availability in the hospital information system was determined. Data usability was evaluated based on reason for recording, administrative procedures, and comparison with paper data. SETTING: A 155 bed pediatric department in a public academic medical center. STUDY PARTICIPANTS: Pediatricians and children with suspected meningitis. MAIN OUTCOME MEASURES: Availability and usability of electronic patient data. Usability criteria were standardization, completeness, and accuracy. RESULTS: A total of 14 performance indicators were defined. Of 39 data items required for indicator quantification, 29 were available, and 19 were usable without manual handling. Completeness and accuracy of the registration of reason for admission and discharge diagnoses were insufficient, leading to problematic patient selection and complication detection. Time-points of patient events were inaccurate or not available. Data regarding outpatient diagnosis, signs and symptoms, indications for test ordering, and medication administration were missing. Test result reports were not adequately standardized. Based on electronic patient data, five out of 14 performance indicators could be quantified reliably, but only after patient selection problems were overcome. For exploratory information, 16 out of 25 required data items were available and 13 were usable. CONCLUSIONS: Availability and usability of electronic patient data are insufficient for physician-led and detailed assessment of medical practice for specific patient groups. Extended registration of the reason for admission will improve patient selection and assessment of diagnostic process.
Recruitment of psychiatrists.
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Software engineering in medical informatics: the academic hospital as learning environment.
In 2001, the revised course Software Engineering has been implemented in the Medical Informatics curriculum at the Academic Medical Center, Amsterdam. This 13 weeks, full-time course consists of three parts: internship, theory and project. All parts are provided in problem-oriented manner with special attention for relevant skills such as project management, documentation and presentation. During the internship, students observe how health care professionals at several hospital wards work and how information supply is organized. In the theory part, students study concepts and methods of software engineering by means of case descriptions and self-directed learning. During the project, they apply their acquired knowledge to an observed, clinical information problem and complete several stages of the software engineering process. Evaluation by inquiry showed that, compared to other courses, students spent more time, and distributed their time more evenly, during the whole period of the course. In conjunction with theory, a combination of internship and project in a hospital seems to provide a surplus value compared to a practical in a computer laboratory. The integration of software theory, clinical practice and problem-based approach, contributed to the enthusiastic, intensive and realistic way students learned in this important topic that might be chosen as a future profession.
Did Lady Macbeth have a mind diseas'd'? ( a medico-legal enigma).
The character of Lady Macbeth has often been presented as evil and demonic. In this contribution, an attempt is made to show her in a somewhat different light; in doing so, some implications for forensic-psychiatric practice are suggested. 'Cann'st thou not minister to a mind diseas'd ..?' (Macbeth, to his wife's physician: V:i: 40)1
Whither mental health legislation? (Locking up the disturbed and the deviant).
The publication of the Government's two-part White Paper - Reforming The Mental Health Act - provides the opportunity to review and comment upon some of its main proposals against a background of current concerns with issues of public protection in mental health and criminal justice.
Effect of discharge letter-linked diagnosis registration on data quality.
OBJECTIVE: Diagnostic data are essential for the assessment of medical practice: they are needed for retrieval of clinical cases and describing co-morbidity and complications. In most Western countries, diagnosis registration in hospital information systems is based mainly on completing forms after patient discharge. As this registration plays no role in patient care, data quality is usually unsatisfactory. To improve data quality, we redesigned the process of diagnosis registration at a paediatric department, and now paediatricians provide diagnoses with codes in a separate registration heading of the discharge letter. We compared the quality of this discharge letter-linked diagnosis registration with the quality of the previous form based registration. DESIGN: Retrospective study with blinded before and after measurement. Re-abstracted diagnosis descriptions of the text of discharge letters were taken as gold standard. SETTING: A paediatric department in an academic medical centre. STUDY PARTICIPANTS: From each registration period, 60 admissions were selected randomly. Mean age of the patients was 4.5 (SD +/- 5.5) and 5.2 (SD +/- 5.2) years for the old and new situation respectively. Mean length of stay was 8.8 (SD +/- 11.0) and 7.2 (SD +/- 12.4) days. INTERVENTION: Discharge letter-linked diagnosis registration. MAIN OUTCOME MEASURES: Completeness and accuracy, both at three-digit level of ICD-9-CM. RESULTS: Completeness of form-based diagnosis registration was 51% (95% CI, 44-58%) and of discharge letter-linked diagnosis registration 54% (95% CI, 47-60%). Accuracy was 65% (95% CI, 58-72%) and 67% (95% CI, 60-74%) respectively. CONCLUSIONS: The discharge letter-linked diagnosis registration does not provide a better basis for assessment of medical practice than the form based diagnosis registration.
Availability and accuracy of electronic patient data for medical practice assessment.
UNLABELLED: We analyzed availability and accuracy of electronic patient data needed to assess medical practice. A case study was performed in which pediatricians formulated 14 performance indicators that cover aspects of care for children with suspected meningitis. Data items needed to quantify these indicators were listed. Required patient data were gathered from hospital information system and paper medical records. Accuracy of electronically available data was based on comparison with paper data and, when paper data were not available, on how data were recorded at the source, administrative procedures and original goal for which data were recorded. CONCLUSION: Registration of reason for admission and diagnoses gives no reliable basis to select patients with 'suspicion on a disease' as selection criterion. Besides, many performance indicators cannot be reliably quantified because data are not recorded electronically (indication, medication, outpatient diagnosis), are not recorded specific enough (intervention time), are not standardized (radiology report), or cannot be obtained from other hospitals.
'A scandalous and corrupt hospital'--reflections on the Fallon report.
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A change of direction in the disposal of mentally disordered offenders: the impact of the Crime (Sentences) Act 1977.
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Inquiries after homicide in England and Wales.
Recent instruction from the Department of Health requires the institution of an independent inquiry into all cases of homicide committed by those who have been in contact with the psychiatric services. The background to this instruction is explored briefly within the context of more general concerns about violence and homicide, and the advantages and disadvantages of such inquiries are discussed.
Personal liberties versus public safety: some issues for mental health review tribunals (MHRTs)
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The Mental Health Act and professional hostage taking.
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Can the law serve as the solution to social ills? The case of the Mental Health (Patients in the Community) Act, 1995.
The background to the Mental Health (Patients in the Community) Act, 1995 is reviewed briefly. Some problems concerning the Act's provisions for 'supervised discharge' are then discussed. Some more general extrapolations follow concerning the problems of legislating for social and personal 'ills'.
'I've got a little list' (Koko: Mikado). But is it any use? Comments on the forensic aspects of 'supervision registers' for the mentally ill.
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What price the concept of psychopathic disorder?
The current concept of psychopathic disorder is reviewed against a short historical background. Aetiology is commented upon briefly and key characteristics described. Support is provided for the view that the concept has a degree of usefulness in clinical management provided it is viewed in a focused and restricted fashion.
Classification of fire-setters.
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Research design for the project information for analysis of clinical care in the Academic Medical Center, Amsterdam.
The medical staff at the Department of Pediatrics in the Academic Medical Center, Amsterdam, are strongly involved in the analysis of the effectiveness and efficiency of the clinical care provided. One method to increase effectiveness and efficiency is to provide clinicians with a comprehensive summary of their medical activities.