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At least 325 records · Page 18Linked to original sources
PubMed1994

Role of programmed ventricular stimulation in patients with idiopathic dilated cardiomyopathy and documented sustained ventricular tachyarrhythmias: inducibility and prognostic value in 102 patients.

The role of programmed ventricular stimulation (PVS) in patients at high risk of sudden death related to idiopathic dilated cardiomyopathy (DCM) is still controversial. The possible reason is that most study series have been too small or that only a few patients had documented sustained ventricular tachyarrhythmias. This study therefore, looked at PVS performed in 102 patients with DCM and documented sustained ventricular tachycardia (VT; n = 63) or ventricular fibrillation (VF; n = 39). Sustained VT was induced in 27 of 63 patients (43%) with documented sustained VT and in 14 of 39 patients (36%) with documented VF (ns). VF was induced in nine patients (14%) with a history of sustained VT and in seven (18%) with a history of VF (ns). At a mean follow-up of 32 +/- 15 months, sudden death occurred in 14 (14%) patients, a rate similar in both patients with documented VT and VF (ns). Incidence of sudden death at 36 months was 6% in patients with inducible sustained VT/VF compared to 29% in patients without inducible VT/VF (P < 0.05). A favourable drug regimen (response to drug and no intolerable side effects) was obtained by serial drug testing in 25 of all 102 patients (25%). A cardioverter defibrillator (ICD) was implanted in 32 patients, in 63% of whom discharges were observed during 18 +/- 11 months of follow-up; only one patient (3%) died suddenly. Thus, in patients with DCM, there was no relationship between documented and inducible ventricular tachyarrhythmias, and initiation of sustained VT or VF had little prognostic value for the prediction of subsequent sudden death. Wherever antiarrhythmic drug therapy was of limited value, implantation of an ICD may improve the prognosis of these high risk patients.

Anti-Arrhythmia Agents↗
PubMed1996

Streamlining documentation: an opportunity to reduce costs and increase nurse clinicians' time with patients.

Clinical documentation can take up to 25 percent of a nurse's time in an acute care setting, not to mention the time spent by other clinicians and ancillary caregivers on documentation. Institutions can reduce documentation time by systematically determining what information is crucial to the provision of patient care across all disciplines and then using a redesign process that mirrors work redesign. By following a structured process that challenges the philosophy and function of the documentation system, a hospital's multidisciplinary staff members can use their expertise to design alternatives that achieve documentation's original intent-to document diagnoses and treatment accurately-in a more efficient and useful way.

Cost Control↗
PubMedDate not supplied

Document security: a funny thing happened on the way to the shredder.

In these days of close attention to security of information handled electronically, there is a tendency to overlook the security of hard-copy documents, particularly patient records and employee documentation. Document security is related to growing concerns for individual privacy; guidelines are furnished for protecting employee privacy by separating retention practices for business information from personal information. Sensitive documentation requires rules and procedures for processing, retaining, accessing, storing and eventually destroying. Also, documents that are missing or incomplete sometimes present unique problems for the organization. The article provides simple rules for safeguarding employee and patient documentation.

Confidentiality↗
PubMed2006

Chart documentation of informed consent for operative vaginal delivery: is it adequate?

OBJECTIVES: To determine the documentation frequency of informed consent for women undergoing a trial of nonemergent instrumental delivery. STUDY DESIGN: A retrospective chart review of instrumented vaginal deliveries from 1992 to 2005 was performed. Cases were identified from a Labor and Delivery database and hospital records were reviewed for documentation of associated risks, general consent for the procedure, indication, and option of cesarean delivery (CD). RESULTS: Three hundred forty six charts were reviewed: 246 were excluded for an emergency delivery (19%), misclassification (25%), or lost notes (27%). In the remaining 100 cases, 61% had a general consent for instrumented vaginal delivery. Documentation of any maternal or neonatal risks was found in 3% and 0%, respectively. The option of a cesarean delivery was documented in 22% of the cases. When comparing 5-year time intervals before and after 2000, there was no increased frequency in documentation of maternal or neonatal risks. CONCLUSIONS: Documentation of informed consent for instrumented vaginal delivery is inconsistent and should be improved.

Consent Forms↗
PubMed2005

A scale space approach for automatically segmenting words from historical handwritten documents.

Many libraries, museums, and other organizations contain large collections of handwritten historical documents, for example, the papers of early presidents like George Washington at the Library of Congress. The first step in providing recognition/ retrieval tools is to automatically segment handwritten pages into words. State of the art segmentation techniques like the gap metrics algorithm have been mostly developed and tested on highly constrained documents like bank checks and postal addresses. There has been little work on full handwritten pages and this work has usually involved testing on clean artificial documents created for the purpose of research. Historical manuscript images, on the other hand, contain a great deal of noise and are much more challenging. Here, a novel scale space algorithm for automatically segmenting handwritten (historical) documents into words is described. First, the page is cleaned to remove margins. This is followed by a gray-level projection profile algorithm for finding lines in images. Each line image is then filtered with an anisotropic Laplacian at several scales. This procedure produces blobs which correspond to portions of characters at small scales and to words at larger scales. Crucial to the algorithm is scale selection, that is, finding the optimum scale at which blobs correspond to words. This is done by finding the maximum over scale of the extent or area of the blobs. This scale maximum is estimated using three different approaches. The blobs recovered at the optimum scale are then bounded with a rectangular box to recover the words. A postprocessing filtering step is performed to eliminate boxes of unusual size which are unlikely to correspond to words. The approach is tested on a number of different data sets and it is shown that, on 100 sampled documents from the George Washington corpus of handwritten document images, a total error rate of 17 percent is observed. The technique outperforms a state-of-the-art gap metrics word-segmentation algorithm on this collection.

Abstracting and Indexing↗
PubMed1996

Development of nursing documentation for use in the outpatient oncology setting.

In response to the particular demands upon patients and nursing staff in the outpatient setting, and the identification of a need for nursing orientated documentation, a new nursing documentation system has been developed and implemented within an oncology day unit. The documentation is used by the nursing team engaged in the care of patients receiving outpatient chemotherapy treatment. The system consists of documents for the initial and ongoing assessment, planning, implementation and evaluation of nursing care. These include pretreatment patient self-assessment forms, flowsheets for the documentation of chemotherapy treatment and administration and a record for information and teaching given to patients and significant others. Referrals to other services and health care professionals are also documented. This tool is designed to ensure a high standard of nursing intervention and maximize quality of life in this group of patients. An audit is planned to evaluate the effectiveness of this tool and highlight any areas requiring improvement or modification. There are also plans to further develop this system for use in the inpatient and community setting.

Ambulatory Care↗
PubMed1996

Nursing documentation in patient records.

The correct documentation of nursing care is a very important prerequisite for safe care. An extensive survey (n = 380 records), was conducted, using the NoGa protocol for a review of the nurses' documentation. The documentation revealed considerable deficiencies in most of the wards, and the nursing history, status and planned interventions were inadequate in two-thirds of the records. Furthermore, the nursing diagnosis, goals and discharge notes were especially poorly documented. The NoGa protocol was easy to use as an audit tool, useful for screening the nurses' documentation and useful for evaluation of the outcomes of educational programmes in nursing documentation.

Clinical Protocols↗
PubMed1999

Polysomnography and home documented monitoring of cardiorespiratory pattern.

Polysomnographic findings were compared with data obtained subsequently from home documented monitoring in order to study the diagnostic value of both techniques. Polysomnography was performed in 1274 infants born prematurely and in 422 patients admitted because of apparent life threatening events (ALTEs). In 72 of the infants, home documented monitoring of the cardiorespiratory pattern, including QRS complexes, was performed. Subsequent documented episodes of heart rate < 50 beats/min were considered as "serious life threatening events". It was confirmed that polysomnographic findings correlated well with subsequent events as registered by home documented monitoring. Especially in the ALTE group where both infants with and without abnormal polysomnography were home monitored, the single polysomnography significantly predicted subsequent life threatening events. Home documented monitoring of the cardiorespiratory pattern has a distinctive advantage over simple cardiorespiratory monitoring as a means to identify and document life threatening events, in addition to its value as a rescue device.

Apnea↗
PubMedDate not supplied

A model for enhancing Internet medical document retrieval with "medical core metadata".

OBJECTIVE: Finding documents on the World Wide Web relevant to a specific medical information need can be difficult. The goal of this work is to define a set of document content description tags, or metadata encodings, that can be used to promote disciplined search access to Internet medical documents. DESIGN: The authors based their approach on a proposed metadata standard, the Dublin Core Metadata Element Set, which has recently been submitted to the Internet Engineering Task Force. Their model also incorporates the National Library of Medicine's Medical Subject Headings (MeSH) vocabulary and MEDLINE-type content descriptions. RESULTS: The model defines a medical core metadata set that can be used to describe the metadata for a wide variety of Internet documents. CONCLUSIONS: The authors propose that their medical core metadata set be used to assign metadata to medical documents to facilitate document retrieval by Internet search engines.

Abstracting and Indexing↗
PubMed2000

Using quality improvement teams to improve documentation in records at a community mental health center.

OBJECTIVE: A community mental health center sought a system for qualitative review of patients' records to improve the quality of documentation through the engagement of clinical staff in the review process. METHODS: The center developed a quality improvement system in which treatment team clinicians use a scored 30-item protocol to measure the quality of record documentation by peers. Questions address whether the record documents the full range of the psychiatric treatment process, including assessment and diagnosis, treatment planning, and provision of clinical services. Other questions address specific contractual or regulatory requirements, such as whether procedure codes are correct, and evaluate the physician's record of medication management. Each treatment team at the mental health center's six clinics has a quality improvement work group, composed of the team psychiatrist and at least one other team clinician. Each month the work group meets to review two randomly selected medical records from another treatment team at the same clinic and arrive at a consensus score. An administrative oversight team meets regularly with clinician-reviewers to foster uniform scoring of the protocol throughout the center. RESULTS: An analysis of the trend in protocol scores over a 21-month period suggests that the procedure improves the quality of the documentation in patients' records. CONCLUSIONS: A team-based quality review process appears to have a positive impact on the quality of medical record documentation. Improved documentation may improve continuity of care and improve the accuracy of record information used for other quality measurement systems.

Community Mental Health Centers↗
PubMed2002

Critical elements of documentation for data-based research.

Scientific integrity and progress are enhanced by precise documentation of the conceptual development and information management aspects of research. Careful and complete documentation of the research process supports accurate reporting. The exercise of documenting data management activities provides an opportunity for nurse researchers to reflect on a study to guide current work and inform and enhance future research. The literature includes many references to the need for data management but contains little advice regarding the nuts and bolts of documenting data management activities. This article describes specific steps for documenting data-based research beginning with the study design and ending with data analysis. The documentation framework and examples presented are sufficient to guide the comprehensive record keeping required for complex studies and can be modified to meet the simpler needs of smaller research projects.

Clinical Nursing Research↗
PubMed2006

Automatic document classification of biological literature.

BACKGROUND: Document classification is a wide-spread problem with many applications, from organizing search engine snippets to spam filtering. We previously described Textpresso, a text-mining system for biological literature, which marks up full text according to a shallow ontology that includes terms of biological interest. This project investigates document classification in the context of biological literature, making use of the Textpresso markup of a corpus of Caenorhabditis elegans literature. RESULTS: We present a two-step text categorization algorithm to classify a corpus of C. elegans papers. Our classification method first uses a support vector machine-trained classifier, followed by a novel, phrase-based clustering algorithm. This clustering step autonomously creates cluster labels that are descriptive and understandable by humans. This clustering engine performed better on a standard test-set (Reuters 21578) compared to previously published results (F-value of 0.55 vs. 0.49), while producing cluster descriptions that appear more useful. A web interface allows researchers to quickly navigate through the hierarchy and look for documents that belong to a specific concept. CONCLUSION: We have demonstrated a simple method to classify biological documents that embodies an improvement over current methods. While the classification results are currently optimized for Caenorhabditis elegans papers by human-created rules, the classification engine can be adapted to different types of documents. We have demonstrated this by presenting a web interface that allows researchers to quickly navigate through the hierarchy and look for documents that belong to a specific concept.

Abstracting and Indexing↗
PubMed2004

Items of concern associated with source document verification of clinical trials for new drugs.

In the present study, we analyzed concerns of the sponsors of clinical trials regarding source document verification (SDV) procedures performed at the University of Tokyo Hospital during April 1999 and March 2001, with special focus on the differences in description between the source document and case report form (CRF). Of 132 SDV procedures (78 protocols, 496 cases), the sponsors had problematic concerns with 348 cases (70.2%) totalling 693 items, which consisted of description inconsistencies between the source documents and the CRF (41.4%), lack of description in the CRF (39.8%), and lack of description in the source documents (8.8%). The most frequently found inconsistencies between the source documents and CRF were concerning items regarding observations, laboratory examinations, and compliance, which were associated with misdescription of clinical data and/or items for evaluation in the CRF. It was also revealed that the frequent lack of description in the CRF was associated with patient history and/or complications, adverse events, and concomitant drugs and/or therapy. In contrast, the frequent lack of description in the source documents was associated with items concerning patient background, observations, and informed consent. Further, we found that submission of a report of deviation from the protocols was required for 4.0% of the claims. These results suggest the necessity of better data management during the practice of clinical trials for the purpose of maintaining the quality of clinical trials.

Clinical Trials Data Monitoring Committees↗
PubMed2006

Narrative review: the promotion of gabapentin: an analysis of internal industry documents.

BACKGROUND: Internal documents from the pharmaceutical industry provide a unique window for understanding the structure and methods of pharmaceutical promotion. Such documents have become available through litigation concerning the promotion of gabapentin (Neurontin, Pfizer, Inc., New York, New York) for off-label uses. PURPOSE: To describe how gabapentin was promoted, focusing on the use of medical education, research, and publication. DATA SOURCES: Court documents available to the public from United States ex. rel David Franklin vs. Pfizer, Inc., and Parke-Davis, Division of Warner-Lambert Company, mostly from 1994-1998. DATA EXTRACTION: All documents were reviewed by 1 author, with selected review by coauthors. Marketing strategies and tactics were identified by using an iterative process of review, discussion, and re-review of selected documents. DATA SYNTHESIS: The promotion of gabapentin was a comprehensive and multifaceted process. Advisory boards, consultants meetings, and accredited continuing medical education events organized by third-party vendors were used to deliver promotional messages. These tactics were augmented by the recruitment of local champions and engagement of thought leaders, who could be used to communicate favorable messages about gabapentin to their physician colleagues. Research and scholarship were also used for marketing by encouraging "key customers" to participate in research, using a large study to advance promotional themes and build market share, paying medical communication companies to develop and publish articles about gabapentin for the medical literature, and planning to suppress unfavorable study results. LIMITATIONS: Most available documents were submitted by the plaintiff and may not represent a complete picture of marketing practices. CONCLUSION: Activities traditionally considered independent of promotional intent, including continuing medical education and research, were extensively used to promote gabapentin. New strategies are needed to ensure a clear separation between scientific and commercial activity.

Advisory Committees↗
PubMed1999

[Quality control of medical documentation of in-patients at the St. Stephen Municipal Hospital in Budapest].

Within the frame of hospital quality control programme, the authors have investigated since 1997 the medical documentation concerning in-patients of St. Stephen Hospital Budapest. An assessment form of 26 items related to main elements of medical documentation has been created for the study. Choosing of both order of departments' succession and cases to be investigated took place at random. Evaluation was performed at a scala of 0-3 points, by a five-membered work-group; all members first carried out the qualifications independently of each other, and then they formed the final opinion together at common sessions. Investigation of 204 "first round" cases proved the feasibility of the applied method. As it turned out from the results, the quality of documentation showed statistically significant differences between departments of the hospital and the average standard of documentation could not be declared as satisfying at the period of basic survey. Deficiencies of documentation especially in respect of case history, disease course, personal data and informed consent have been found. On the other hand, registration of status on admission and final report got a relatively high average score-number. The authors call attention to the importance of ordinary control of medical documentation.

Analysis of Variance↗
PubMed1999

Chart documentation of clinical preventive services at 9 Texas clinics.

Documentation of clinical preventive services at 9 Texas family practice residency programs, community health centers, and public health regional clinics was examined. Assessment of 11 risks, counseling on those risks, and timeliness of 8 screening tests and immunizations were abstracted. Documentation of clinicians' risk assessment focused on tobacco use (56.4%), alcohol/drug abuse (45.8%), and excess weight (21.6%). Counseling was documented most often for nutrition (20.5%), family planning (11.6%), and physical activity (10.3%). Of the sites studied, public health regional clinics had the highest documentation of assessment and counseling. Community health centers were most up-to-date for diabetes and cholesterol screening. Family practice residencies documented the highest rate of counseling for obesity risk. Clinicians do not document risk assessment, counseling, or up-to-date screening tests and immunizations for most of their adult patients. Texas practitioners may need support or assistance to provide universal access to clinical preventive services.

Adult↗
PubMedDate not supplied

Measurement of the effects of an integrated, point-of-care computer system on quality of nursing documentation and patient satisfaction.

This quasi-experimental, modified time series study measured the effects of the nursing module of a point of care clinical information system on nursing documentation and patient satisfaction. Measurements were taken before implementation of the module and at 6-, 12-, and 18-month intervals postimplementation. Quality of nursing documentation was measured by compliance to items applicable to nursing documentation selected from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Closed Medical Review Tool. Patient satisfaction was measured by using the Risser Patient Satisfaction Scale. The study data showed a statistically significant increase in the quality of nursing documentation after implementation of the computerized nursing documentation system, as well as a decrease in variability in charting, as evidenced by a decrease in standard deviations. A significant increase in charting compliance was still occurring between the 12- and the 18-month time points after initiation of automated documentation. The point of care computer system did not seem to affect patient satisfaction with the nurse-patient relationship.

Humans↗
PubMed2000

[Significance of product documents (tenpubunsho) cited in judicial precedents in the field of anesthesiology].

The significance of the product documents (Tempubunsho) was mentioned in 21 out of 94 medical malpractice cases published in several laws reports 1963-97. The number of such cases has been increasing in recent years. Among the items described in the product documents, the precautions for use were most frequently mentioned (12 cases) followed by the instructions for administration and dosage (3 cases). In most cases, the judgment was against the medical institution involved due to the violation of legal obligations with respect to the contents of the product documents. Product documents will be taken much more seriously in future lawsuits. Attention should be focused on the contents of the product documents, especially when revised. When the administration of a drug deviates from the contents of the product document, medical evidence is required to support this deviation.

Anesthesiology↗