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At least 1,045 records · Page 58Linked to original sources
PubMed1995

Influence of applied brachial recording forces on pulse wave velocity and transmission in the brachio-radial arterial segment.

Arterial stiffness in hypertension and heart failure may increase afterload on the left ventricle. Pulse wave velocity and transmission ratio measurements are noninvasive methods to assess arterial stiffness. Since noninvasive pressure pulse recording requires sufficient applied force to distort the vessel wall, we hypothesized that the pulse wave velocity, transmission ratios, and distal pulse amplitudes and contours may be altered by the recording technique. Brachial and radial arterial pressure pulses were recorded simultaneously using a piezoelectric pulse transducer in 14 young, normal, male subjects using 10 brachial artery recording forces (0.35-3.58N, approximately equal to 0.36N increments) applied in a random order and a constant radial force (2.35N). Pulses were Fourier analyzed. One subject was excluded from analysis because of improper transducer positioning over the brachial artery. In 8 subjects, no significant changes occurred in any variable over all brachial recording forces. In the remaining 5 subjects, the measured variables remained constant until brachial artery recording forces exceeded 2.42 +/- 0.03N. The pulse wave velocity (p < 0.04), transmission ratios (harmonics 2-5, p < 0.0001), radial pulse amplitude (p < 0.0003), and relative powers (harmonics 2-5, p < 0.02) then decreased. In these subjects, brachial artery depths were less than the other subjects (5.9 +/- 0.4 vs. 7.7 +/- 0.4 mm, p < 0.05). The brachial and radial artery recording forces normally used during clinical measurements by 2 investigators were 1.43 +/- 0.01N (95% confidence intervals (CI) = 1.23N, 1.62N) and 1.88 +/- 0.11N (95% CI = 1.65N, 2.10N), respectively. Therefore, at forces normally used by clinical investigators, the pulse wave velocity, harmonic transmission ratios, and pulse amplitudes and contours obtained at the brachial and radial artery are not significantly influenced by forces applied at the brachial artery. However, these variables may be decreased in subjects with more superficial arteries when higher recording forces are used.

Adult↗
PubMed1996

Epilepsy monitoring and advice recorded: general practitioners' views, current practice and patients' preferences.

BACKGROUND: Epilepsy is a common condition that is managed at the interface between primary and secondary care. AIM: A study aimed to describe general practitioners' criteria for aspects of optimal epilepsy care and their estimates of current levels of care achieved; to compare these estimates with clinical data extracted from their patients' medical records; and to compare general practitioners' estimates and recorded data with information provided by the patients themselves. METHOD: Thirty seven general practitioners from six practices in the south Thames region were sent a questionnaire enquiring about current practice with regard to general practitioner and specialist monitoring of patients with epilepsy and provision of advice, and about their criteria for the optimum levels of aspects of epilepsy care. Of patients aged over 15 years in the study practices, 0.6% were found to have active epilepsy; 283 of these 326 patients were sent a questionnaire enquiring about their epilepsy, the service and advice provided, and whether they required more information. Responses to the general practitioners' questionnaire and to the patients' questionnaire were compared and also compared with information extracted from the patients' medical records. RESULTS: Ninety five per cent of the general practitioners responded. Of 255 patient questionnaires (90%) returned, 251 could be analysed. Of 247 patients, 168 (68%) reported having had no seizure in the previous six months. Forty of 241 patients (17%) had a regular arrangement to see their general practitioner regarding their epilepsy. Of 191 patients who expressed a preference, 116 (61%) reported preferring to receive their epilepsy care mainly from their general practitioner. General practitioners reported that ideally patients should be monitored in primary care every six months (the median recorded frequency was 14 months) and that there should be a record of advice given to all patients on driving, adverse effects of antiepileptic drugs, and self-help groups. Advice was recorded in patients' records as having been given on driving (46% of records), adverse effects of antiepileptic drugs (9%), and self-help groups (3%); 82 of 237 patients (35%) reported not receiving enough advice. CONCLUSION: Patients generally preferred to receive their epilepsy care in general practice. Monitoring and provision of advice were less than optimal from both the general practitioners' and the patients' point of view. New resources and skills will be necessary to bridge this perceived gap. Specially trained nurses may have a role in this monitoring and advice provision.

Adolescent↗
PubMed1996

Single unit recording capabilities of a 100 microelectrode array.

We have developed a three-dimensional silicon electrode array which provides 100 separate channels for neural recording in cortex. The device is manufactured using silicon micromachining techniques, and we have conducted acute recording experiments in cat striate cortex to evaluate the recording capabilities of the array. In a series of five acute experiments, 58.6% of the electrodes in the array were found to be capable of recording visually evoked responses. In the most recent acute study, the average signal-to-noise ratio for recordings obtained from 56 of the electrodes in the array was calculated to be 5.5:1. Using standard window discrimination techniques, an average of 3.4 separable spikes were identified for each of these electrodes. In order to compare the two-dimensional mapping capabilities of the array with those derived from other technologies, orientation preference and ocular dominance maps were generated for each of the evoked responses. Histological evaluation of the implant site indicates some localized tissue insult, but this is likely due to the perfusion procedure since high signal-to-noise ratio neural responses were recorded. The recording capabilities of the Utah Intracortical Electrode Array in combination with the large number of electrodes available for recording make the array a tool well suited for investigations into the parallel processing mechanisms in cortex.

Animals↗
PubMedDate not supplied

Principles underlying real-time nystagmus analysis of horizontal and vertical eye movements recorded with electro-, infra-red-, or video-oculographic techniques.

New methods for separating fast and slow phases of human nystagmus in real time are presented that are adaptive to the time-dependent noise properties of the input eye movement signal and therefore applicable to different recording techniques and directions. The methods employ a statistical filter technique to track slow-phase eye movements, uninfluenced by fast phases and blink artifacts, and fuzzy-logic techniques to identify fast-phase eye movements. Because these two techniques are decoupled from one another, highly accurate phase separation and slow-phase velocity profiles are achieved. In addition, the tracking of the variance of slow-phase and fast-phase eye movement recording permits a quality control of the analysis for different recording techniques and a variety of ocular nystagmus responses. Because blinks impose different eye velocity profiles on the recordings, depending on the type of recording technique and direction (horizontal, vertical), blink detection and its effect on fast-phase amplitude must be individually adjusted to each recording technique. Results are illustrated in the context of simultaneously recorded video-oculographic, infra-red, and electro-oculographic recordings of vestibulo-ocular reflex and optokinetic reflex responses causing horizontal or vertical eye movements.

Algorithms↗
PubMed1998

Urodynamic verification of noninvasive back-pressure recordings from the urinary bladder.

Obstructive voiding is best evaluated with urodynamics, especially simultaneous measurement of bladder-pressure and urine flow rates. As an alternative to catheterization for urodynamics, noninvasive back-pressure methods using an external condom system have been introduced. This device uses one side tube in the condom for pressure recording and an outlet tube that is clamped for short periods of time during voiding. However, there have been problems with accurate back-pressure recording, including leaking, clamping techniques, hydrostatic pressures associated with pressure recording below the level of the symphysis pubis, and assessment of back pressures in relation to bladder and detrusor pressures. To address these issues, we have modified the condom for passing a catheter into the urethra for simultaneous direct bladder and back-pressure recording. The clamping device on the outlet tube also has been modified to produce back flushing of urine in addition to clamping. Hydrostatic issues have been addressed by making pressure recordings at the level of the symphysis pubis. Seven patients with obstructive symptoms were evaluated using these new devices. Back pressures were not statistically different than detrusor pressures recorded with a urethral catheter. Thus, the modifications have improved back-pressure recording techniques. The use of noninvasive back-pressure recording may be an important adjunct in the evaluation of obstructive uropathy.

Condoms↗
PubMed1999

Vital records for quality improvement.

The birth certificate and death certificate are important sources of population-based data for assessing the extent of risk and the quality of perinatal outcome. The birth certificate contains the hospital of birth and many items, such as birth weight and race, that can serve as important risk adjusters for neonatal mortality. To assess mortality a second vital record, the death certificate, must be linked to the birth certificate. If the analysis is to be stratified by level of neonatal care or other hospital characteristics, a third file providing these details must also be utilized. The exact vital record formats, recording protocols, and quality control efforts are determined by and differ across each state. Even with these differences, the quality and completeness of vital records and their linkage are reasonable for population-based analyses. Although the most important vital outcome from a neonatologist's perspective is neonatal mortality, vital records can also be used to assess fetal, perinatal, postneonatal, and infant mortality. The analytic paradigm that is used in quality analysis performed on data derived from the vital record states that observed outcome is a function of risk, chance, and care. Risk is a characteristic or condition such as low birth weight or low 1-minute Apgar score that elevates the probability of an adverse outcome but is beyond the control of the agent responsible for the outcome. Using risk matrices or regression analysis one determines the expected mortality for a specific institution's case-mix. This expectation is usually based on the statewide analysis of infants with a similar risk profile. A standardized mortality ratio is calculated by dividing observed by expected mortality. A hospital with a high observed mortality (12 deaths per 1000) and an even higher expected mortality based on the risk characteristics of its neonates (24 per 1000) would have a standardized mortality ratio of 0.5. Once the effects of chance have been accounted for by statistical testing this finding could indicate that mortality in this hospital is 50% lower then expected. Although initially intended for legal and broad-based public health purposes, vital records represent an important source of data to inform perinatal quality improvement activities. The optimal usefulness of information derived from vital records requires that clinicians take an active role in assuring that data entry is complete and accurately reflects risk status, clinical factors, and outcomes. However, even a superb database will be of limited usefulness unless it is linked to an initiative that actively involves clinicians committed to quality improvement.

Birth Certificates↗
PubMed1983

A chartless record--is it adequate?

The computerized medical record supported by The Medical Record (TMR) has been the only record of physician-patient encounters on the nephrology service of the Durham Veterans Administration Medical Center since April 1981. Physicians using the system evaluated the adequacy of the computerized record as a replacement for the paper chart. The computerized record was able to capture and display all pertinent data. Manual or computerized narratives provided a useful supplement to the core computerized record only in those rare instances that a physician needed to point out which of the data in the record were important to his decision making.

Computers↗
PubMed1996

The feasibility of linking hospital and police road crash casualty records without names.

Government and other agencies routinely collect complementary information on road crash casualties and there may be opportunities to widen the scope of data available for research and policy evaluation if mechanisms can be established to combine these data sources. Where unit record data are available, direct links within and between individual records can often be achieved using record linkage techniques. Without the benefit of unique identifiers, sufficient other identifying information such as the full name, date of birth and sex of the casualty, their role in the crash and the date of the crash are required to enable correct links between individual records to be made. However, all these data items may not be available and it is therefore important to investigate the effect this may have on the quality and quantity of links between records. The research reported here used the hospital admission and police records from the Western Australian Road Injury Database, which had previously been linked using all the identifying characteristics mentioned above, special purpose software and comprehensive manual checking. This set of linked records were considered to be a "gold standard" which could be used to measure the quantity and quality of links produced using fewer identifying characteristics. Results from this process showed that about 90% of the original links could be identified when a phonetic code of the family name of the casualty was used with age, sex, road user type and crash date. However, only about 50% of the original links were found if linking was performed without using names or phonetic name codes.

Accidents, Traffic↗
PubMed1986

The art and science of record linkage: methods that work with few identifiers.

Increasing use of administrative records for research purposes has led to the need to develop methods for linking records. Linkage of the data from the Manitoba Health Services Commission (MHSC) with Canadian Vital Statistics records was done to verify Manitoba deaths, to measure degree of agreement between the two data sets, and to link "cause of death" information from Vital Statistics back to medical histories. A multi-stage approach to matching was adopted. Individual records matching perfectly across a number of relevant variables in the two files were selected first, reducing the number of records going through the probability matching to manageable proportions. Overall, almost 96% of the MHSC records were well matched with Vital Statistics records. Both uses of the matched data and various ways to confirm data quality are discussed.

Humans↗
PubMed2004

The development of the Stroke Physiotherapy Intervention Recording Tool (SPIRIT).

PURPOSE: To develop a recording system that describes physiotherapy interventions for the rehabilitation of postural control post-stroke. METHODS DESIGN: A draft recording tool was developed using the method described by Edwards et al, involving literature searches and collaboration with senior clinicians. It was piloted with stroke physiotherapists using a cross-sectional survey design to assess validity, utility and completeness. Participants used the recording tool to record five treatment sessions. Feedback regarding the utility and completeness of the system was obtained via short semi-structured interviews. SETTING: 11 NHS Trusts. PARTICIPANTS: 35 stroke physiotherapists working in acute and rehabilitation settings recorded the treatment of 120 patients in 590 treatment sessions. RESULTS: A double-sided A4 form with a checklist of 79 physiotherapy interventions in 9 categories was produced: the Stroke Physiotherapy Intervention Recording Tool (SPIRIT). The participants found it quick and easy to use and reflective of clinical practice. There were a few missing interventions and some confusion regarding definition of terms. Revisions were to include the omitted interventions and to produce a user's booklet defining the categories and interventions. CONCLUSIONS: SPIRIT provides a system for recording physiotherapy treatment for stroke patients which reflects current clinical practice in acute and rehabilitation settings.

Adult↗
PubMed2005

Viewpoint: patient-centered medical care requires a patient-centered medical record.

If patient-centered medicine is to become a widespread reality in academic medical centers, educational initiatives must include reform of the medical record. The medical record is part of the hidden, or informal, curriculum of medical school and residency that defines for students and residents the essential ingredients of competent medical care. Whatever its merits, the conventional, problem-oriented medical record (POMR) is a pathology-oriented record that helps perpetuate a disease-focused, biomedical model of practice Patient-centered medicine requires a patient-centered medical record (PCMR), one that addresses the person and perspective of the patient as competently as it addresses the patient's disease. The author proposes a PCMR that includes a concise, upfront Patient Profile; speaks of "chief concerns," not "chief complaints"; makes Patient Perspective a captioned component of the History of Present Illness; replaces the POMR's formula SOAP (Subjective, Objective, Assessment, Plan) with HOAP (History, Observations, Assessment, Plan); includes important patient perspectives on the Problem List; and calls for additional, written attention to the person and perspective of the patient throughout the course of medical care Patient-centered records can guide and teach clinicians at every level of training and experience to practice patient-centered medicine. Moreover, such records can also provide measurable evidence that this teaching has been successful.

Education, Medical↗
PubMedDate not supplied

Evolution of the medical record format during two years' use of an open-format microcomputer charting system.

In 1988, the authors implemented a microcomputer charting system (SmartChart) within a busy dialysis unit and an outpatient dialysis practice, to be used as the primary recording instrument for physicians and nurses. The program defined the organization of the medical record as three types of titles: problems, therapies, and numerics. Each title had a variety of associated data, such as comments, dosages, values and normals. Predefined care plans were created, and keyboard entry was in a completely open format. Over the next two years, the overall format of this medical record proved to be highly effective, and strict problem orientation allowed both nurses and physicians to use the same problem list. A more specific organization of the title lists in the medical record was needed, however. Separate symbols were placed in front of: problem titles related to prior therapies; problems recorded during current therapies; History and Physical (H&P) data; Plans/Orders; and inactive problems. PRN therapies, those therapies related to patient treatments, vital signs, and numeric data recorded during treatments were identified. The basic format of the medical record that evolved has proven suitable for outpatient, inpatient, and specialized treatment centers.

Attitude to Computers↗
PubMed2003

Corridor consultations and the medical microbiological record: is patient safety at risk?

The performance procedures of the General Medical Council are aimed at identifying seriously deficient performance in a doctor. The performance procedures require the medical record to be of a standard that enables the next doctor seeing the patient to give adequate care based on the available information. Setting standards for microbiological record keeping has proved difficult. Over one fifth of practising medical microbiologists (including virologists) in the UK (139 of 676) responded to a survey undertaken by the working group developing the performance procedures for microbiology, to identify current practice and to develop recommendations for agreement within the profession about the standards of the microbiological record. The cumulative frequency for the surveyed recording methods used indicated that at various times 65% (90 of 139) of respondents used a daybook, 62% (86 of 139) used the back of the clinical request card, 57% (79 of 139) used a computer record, and 22% (30 of 139) used an index card system to record microbiological advice, suggesting wide variability in relation to how medical microbiologists maintain clinical records.

Health Care Surveys↗
PubMed2006

An evaluation of hospital discharge records as a tool for serious work related injury surveillance.

OBJECTIVES: To identify and describe work related serious injuries among sawmill workers in British Columbia, Canada using hospital discharge records, and compare the agreement and capturing patterns of the work related indicators available in the hospital discharge records. METHODS: Hospital discharge records were extracted from 1989 to 1998 for a cohort of sawmill workers. Work related injuries were identified from these records using International Classification of Disease (ICD-9) external cause of injury codes, which have a fifth digit, and sometimes a fourth digit, indicating place of occurrence, and the responsibility of payment schedule, which identifies workers' compensation as being responsible for payment. RESULTS: The most frequent causes of work related hospitalisations were falls, machinery related, overexertion, struck against, cutting or piercing, and struck by falling objects. Almost all cases of machinery related, struck by falling object, and caught in or between injuries were found to be work related. Overall, there was good agreement between the two indicators (ICD-9 code and payment schedule) for identifying work relatedness of injury hospitalisations (kappa = 0.75, p < 0.01). There was better concordance between them for injuries, such as struck against, drowning/suffocation/foreign body, fire/flame/natural/environmental, and explosions/firearms/hot substance/electric current/radiation, and poor concordance for injuries, such as machinery related, struck by falling object, overexertion, cutting or piercing, and caught in or between. CONCLUSIONS: Hospital discharge records are collected for administrative reasons, and thus are readily available. Depending on the coding reliability and validity, hospital discharge records represent an alternative and independent source of information for serious work related injuries. The study findings support the use of hospital discharge records as a potential surveillance system for such injuries.

Accidents, Occupational↗
PubMed1993

A forensic dental identification system with error tolerant algorithms and a review of the prevalence of errors occurring in dental records.

After a major disaster, identification of the victims may have to be performed by comparison of the antemortem and post-mortem dental records. Ante-mortem records often contain errors and these must be identified, and compensated for in some way. A computer system for the comparison of large numbers of ante-mortem and post-mortem dental records has been developed, using algorithms which are able to compensate for errors in the records. Data has been collected on the prevalence of errors in dental charts. These were found in 45% of a sample of 50 records. Since matches found by the system may be due to coincidence, a score is computed for each record based on its 'uniqueness'. This allows a confidence limit to be placed on any matches found between the antemortem and post-mortem records.

Algorithms↗
PubMed1996

Failure to record delirium as a complication of intra-aortic balloon pump treatment: a retrospective study.

This study was conducted to determine whether or not diagnosis and treatment of delirium among patients treated with the intra-aortic balloon pump (IABP) correlates with the recording of this complication on discharge records. Since prior episodes of delirium are one of the few clear risk factors for future episodes of delirium, accurate recording of delirium on the discharge summary and list of discharge diagnoses is useful to clinicians. A retrospective review of the charts of all patients (N = 198) who underwent placement of an IABP during 1988; assessment of the type and frequency of medical and neuropsychiatric complications during IABP treatment; and comparison of chart review findings with the Massachusetts General Hospital's computer-generated lists of discharge diagnoses for the same IABP-treated patients was completed. Only 12% of patients diagnosed and treated for delirium had delirium recorded as a discharge diagnosis. In contrast, 44% and 52% of patients who had been diagnosed and treated for cerebrovascular accident and pneumonia, respectively, had these diagnoses recorded among the discharge diagnoses. Receiving a discharge diagnosis of organic brain syndrome increased the likelihood that delirium was recorded as a discharge diagnosis. Delirium is underdiagnosed as a complication associated with IABP-treatment and is under-reported on the list of discharge diagnoses, even when it is diagnosed. Further study is warranted to determine if making the diagnosis of delirium during a patient's hospital course and recording it is a complication at the time of discharge is translated into a higher level of preparedness by physicians during subsequent hospitalizations.

Aged↗
PubMed2005

Incomplete event documentation in medical records of lung transplant recipients.

CONTEXT: The medical record is frequently used in clinical studies as a source of information on illness events experienced by patients; however, it may be incomplete. OBJECTIVE: To estimate the extent of incompletely documented acute bronchopulmonary events in a transplant clinic medical record at a single university medical center, using home monitoring data. DESIGN, SETTING, AND SUBJECTS: Trends in daily home monitoring data were compared to contemporaneous medical record documentation at 150 different times in 30 lung transplant recipients over 45 subject-years. OUTCOME MEASURE: Proportion of acute bronchopulmonary illness events documented in clinic medical record. RESULTS: By using home monitoring data in a new way, we found that 40% of events actually suffered by lung recipients could not be ascertained to have occurred from the clinic medical record alone. All missed encounters occurred away from the transplant clinic, and involved hospitalizations and telephone prescriptions. CONCLUSIONS: Using the clinic medical record alone to identify acute bronchopulmonary events in lung transplant recipients may result in missing 40% of events. This has important ramifications for studies relying on the medical record for acute event ascertainment in lung transplantation and possibly other chronic diseases.

Academic Medical Centers↗
PubMed2005

MPEG-21 as an access control tool for the National Health Service Care Records Service.

Since the launch of the National Health Service (NHS) Care Records Service with plans to share patient information across England, there has been an emphasis on the need for manageable access control methods. MPEG-21 is a structured file format which includes an Intellectual Property Management and Protection (IPMP) function using XML to present all digitally stored items in the patient record. Using DICreator software, patient records consisting of written text, audio-recordings, non-X-ray digital imaging and video sequences were linked up successfully. Audio records were created using Talk-Back 2002 to standardize and optimize recording quality. The recorded reports were then linked and archived using iTunes. A key was used each time the file was displayed to secure access to confidential patient data. The building of the correct file structure could be monitored during the entire creation of the file. The results demonstrated the ability to ensure secure access of the MPEG-21 file by both health-care professionals and patients by use of different keys and a specific MPEG-21 browser. The study also showed that the enabling of IPMP will provide accurate audit trails to authenticate appropriate access to medical information.

Computer Security↗