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PubMed1999

Documentation guidelines: AMA tips hat to final draft.

The long-awaited documentation guidelines from the Health Care Financing Administration (HCFA) still have not been finalized, but recommendations recently published by an advisory panel are likely to be close to the final version. Currently, you can choose between HCFA's 1995 or 1997 documentation guidelines, whichever is more advantageous. The American College of Emergency Physicians gave significant input to the recommendations, including the approach to physical exams. The major area of controversy involves whether there should be counting of specific elements of the exam.

American Medical Association↗
PubMed2000

Effectiveness of ultrasonographic parameters for documenting the severity of anatomic stress incontinence.

BACKGROUND: To assess the correlation between the severity of incontinence and some ultrasonographic parameters used to document the mobility of bladder neck. METHODS: The severity of the incontinence and mobility the bladder neck were evaluated by pad test and perineal ultrasonography respectively in 74 patients with pure anatomic stress incontinence. During perineal ultrasonography, distances from the bladder neck to the lower tip (A) and to the posterior midpoint of symphysis pubis (B) were measured at rest and during stress. The first bladder neck mobility was obtained by two caliper method (Mu). After superimposing the symphysis pubis of the frozen images, the bladder neck positions at rest and during stress were plotted on an x-y coordinate system by using computer programs and the corresponding X and Y values were calculated. The second bladder neck mobility was measured on this x-y coordinate system (Mc). Paired t-test and correlation analysis were used for statistical analysis of the data. RESULTS: The mean Mc was significantly higher than the mean Mu (p<0.01). Compared to the values at rest, the mean distance A did not change significantly; however, the mean distance B increased, and X and Y values decreased significantly during stress (p<0.01). The amount of urine leaked per hour had significant positive correlation with distance B-stress and Mc and significant negative correlation with Y-rest, X-stress and Y-stress (p<0.05-0.001). CONCLUSION: These data suggested that the bladder neck mobility was underestimated when it was measured by two caliper method and the absolute positions or mobility of the bladder neck measured by computer on an x-y coordinate system could effectively document the severity of the decreased support of bladder neck.

Adult↗
PubMed2000

Tissue factor and homocysteine levels in ischemic heart disease are associated with angiographically documented clinical recurrences after coronary angioplasty.

BACKGROUND: In ischemic heart disease (IHD) patients high plasma levels of Tissue Factor (TF), the trigger of coagulation cascade, are present. Homocysteine (Hcy) is a risk factor for coronary artery disease, and several different pathophysiological mechanisms by which Hcy may play a role in thrombus formation have been postulated in "in vitro" studies. We investigated the "in vivo" role of Hcy in affecting plasma levels of TF, its inhibitor Tissue Factor Pathway Inhibitor (TFPI) and hypercoagulability. METHODS AND RESULTS: We investigated 119 IHD patients who underwent PTCA and compared them with 103 healthy subjects. TF, TFPI, Thrombin-Antithrombin complexes (TAT) and Hcy levels were significantly higher in the patients than in the controls. A positive correlation was found between Hcy and TF (r = 0.54; p < 0.0001), Hcy and TFPI (r = 0.26; p <0.05) as well as Hcy and TAT (r = 0.33; p <0.0001) levels. An inverse correlation existed between folate intake and Hcy levels (r = -0.28; p = 0.001). Hcy levels within the first quartile and in the highest quartile were associated with a lower (p < 0.001) and higher (p <0.0001) rate of clinical recurrences, respectively. Patients with TF values in the first quartile had a lower rate of angiographically documented clinical recurrences as compared to those in the fourth quartile (p <0.01); those in the highest quartile of TF showed a higher rate of recurrences (p = 0.001). Multivariate analysis confirmed these results (first quartile of Hcy: OR 0.02, C1 0.002-0.27; fourth quartile of Hcy: OR 36.5, C1 3.6-365/first quartile of TF: OR 0.006, C1 0.001-0.44; fourth quartile of TF: OR 16.4, C1 3.0 - 90.0), also after adjustment for risk factors and Hcy and TF respectively. CONCLUSIONS: In this study we show that TF, TFPI and TAT levels are correlated with Hcy plasma levels in IHD patients, providing evidence of an "in vivo" pathophysiological mechanism of hyperhomocysteinemia. The observed association between angiographically documented clinical recurrences and TF and Hcy values awaits confirmation in studies designated to evaluate this issue on a larger number of patients.

Adult↗
PubMedDate not supplied

[Analysis of European pharmaceutical journal diffusion: the example of the principal French document supplier].

Our purpose was to analyse the process of providing papers, edited by european pharmaceutical journals, by the main French document supplier, "Institut National de l'Information Scientifique et Technique" linked to the "Centre National de la Recherche Scientifique" (INIST-CNRS). After having given a definition and built up a corpus of 289 journals, orders about them during 1996-1998 were analysed. Then, the possible relationships between orders to INIST-CNRS and impact of journals on scientific community (from Institute for Scientific Information (ISI) data) were examined. Finally, relationships between document orders to INIST-CNRS and, on the one hand european pharmaceutical journals indexation in bibliographic databases and, on the other hand their possible indexation in the French National Collective Catalogue were studied.

Academies and Institutes↗
PubMed2000

RADARx: Recognizing, Assessing, and Documenting Adverse Rx events.

BACKGROUND: Adverse events are a leading cause of morbidity and mortality. Adverse Drug Events (ADEs) are frequent, under-reported, costly, and largely preventable. Computerized tools expose effectively ADEs and can reduce their impact. METHODS: RADARx is a Veterans Administration (VA) VistA-compatible M software program that integrates computerized ADE screening, probability assessment, documentation, and reporting capabilities. Data dictionary mapping tools have enabled RADARx implementation at 3 sites. All RADARx alerts generated at VA Medical Center (VAMC) Nashville from 7/1/99 to 9/30/99 were evaluated. RESULTS: Total ADEs documented using RADARx numbered 57. RADARx discovered 34 ADEs and 48 'potential' ADEs; 23 ADEs were found using traditional means. Overall, 11% of RADARx alerts were true positives. Pharmacist review of the 8-20 alerts generated daily costs between 10 and 30 minutes.

Adverse Drug Reaction Reporting Systems↗
PubMed2000

Case study: clinical documentation improvement program supports coding accuracy.

Developing a comprehensive inpatient clinical documentation and coding improvement program that demonstrates successful outcomes and proves to be sustainable by the health care organization is a difficult process but significant in maintaining accurate coding and reimbursement under the Medicare system. This case study of one health care organization that undertook just such a comprehensive program, chronicles the steps involved, the categories of health care professionals necessary to support ongoing communication and education, and the need for physician partnerships to sustain the program and achieve results. The program had a positive impact with a net increase in reimbursement attributed directly to the case reviews and point of service clinical education. Creating a new position of Coding/Documentation Specialist, working at the point of care as a regulatory interpreter and coding expert, was found to be key to cementing the successful team approach to documentation quality.

Abstracting and Indexing↗
PubMed2000

Dental photography in support of patient documentation and communication.

Intraoral conditions, which in the course of dental treatment are subject to change, can be recorded in detail by means of photography. Pictures provide an improved documentation and the option of monitoring particular situations over longer periods of time. We propose a standardized preoperative 35-mm photographic series. For intraoral photography, special intraoral mirrors and lip-and-cheek retractors are modified as needed. Macro 35-mm cameras with macro flash are by now well-established. Such equipment combined with the technique outlined in this report make standardized photographic documentation possible without mouth-angle retractors and mirror rims obstructing the view.

Communication↗
PubMedDate not supplied

Oral polio vaccine and human cancer: a reassessment of SV40 as a contaminant based upon legal documents.

To date, the scientific literature and research examining SV40 and cancer-related diseases has been based upon an assumption that SV40 was not present in any poliovirus vaccine administered in the United States and was removed from the killed polio vaccine by 1963. The basis for this presumption has been that the regulations for live oral polio vaccine required that SV40 be removed from the seeds and monovalent pools ultimately produced in the manufacturing process. The Division of Biologic Standards permitted an additional two tissue culture passages--from three to five--in order to allow manufacturers the ability to remove this contaminant from the oral poliovirus vaccines then awaiting licensure. The confirmation of the removal by one drug manufacturer, Lederle, has been made public at an international symposium in January 1997, where its representatives stated that all of Lederle's seeds had been tested and screened to assure that it was free from SV40 virus. However, in litigation involving the Lederle oral polio vaccine, the manufacturer's internal documents failed to reveal such removal in all of the seeds. The absence of confirmatory testing of the seeds, as well as testimony of a Lederle manager, indicate that this claim of removal of SV40 and the testing for SV40 in all the seeds cannot be fully substantiated. These legal documents and testimony indicate that the scientific community should not be content with prior assumptions that SV40 could not have been in the oral polio vaccine. Only further investigation by outside scientific and independent researchers who can review the test results claimed in the January 1997 meeting and who can conduct their own independent evaluations by testing all the seeds and individual mono-valent pools will assure that SV40 has not been present in commercially sold oral poliovirus vaccine manufactured by Lederle.

Drug Contamination↗
PubMed1998

Knowledge through documentation: from patients' data records to the basis of knowledge.

The written documentation generated in the dental practice can only be used for clinical tasks under certain conditions. The systematic use of clinical information is not possible until therapy and record data are organized as empirical bases of knowledge by electronic application. Then all documented data are available to support clinical decisions. The first task of dental treatment planning is the assessment of the individualized prognosis. Empirical bases of knowledge can process the surveyed information for this purpose and present it in a suitable manner. Moreover, an empirical basis of knowledge is suitable for an analysis of the effectiveness of dental therapy measures and for the elaboration of empirical foundations for discussion between colleagues. The most advanced form of data application is the expert system, which is able to carry out case comparisons and draw model-based conclusions on the basis of empirical knowledge.

Artificial Intelligence↗
PubMed2001

Influence of the method of data collection on the documentation of blood-pressure readings with an Anesthesia Information Management System (AIMS).

The influence of methods for record keeping on the documentation of vital signs was assessed for the Anesthesia Information Management System (AIMS) NarkoData. We compared manually entered blood-pressure readings with automatically collected data. These data were stored in a data-base and subsequently evaluated and analyzed. The data sets were split into two groups, "manual" and "automatic". We evaluated the effect of automatic data collection on the incidence of corrected data, data validity and data variation. Blood-pressure readings of 37,726 data sets were analyzed. We could assess that the method of documentation did influence the data quality. It could not be assessed whether the incorrectness of data during automatic data gathering was caused by artefacts or by the anesthesiologist.

Anesthesiology↗
PubMed2001

Sleep histories are seldom documented on a general medical service.

BACKGROUND: Sleep disorders are common, but the frequency of sleep history documentation in hospitalized patients is unknown. METHODS: We reviewed 442 initial histories and physical examinations recorded by 122 house officers and 47 medical students in 208 consecutive general medicine ward patients. RESULTS: Any reference to sleep was recorded in only 18 patients (9%), including 12 of 141 (9%) with conditions associated with obstructive sleep apnea. Sleep histories were recorded more often in women (13% vs 4%) and less often than histories of cigarette smoking or alcohol use. Medical students recorded such histories more often than did house officers. Patients with sleep histories more often had pulse oximetry (78% vs 37%), pulmonary function testing (11% vs 1%), arterial blood gas analysis (67% vs 30%), or electrocardiograms (78% vs 49%). CONCLUSIONS: Sleep histories are documented infrequently in hospitalized patients. Patients with a recorded sleep history more often have tests that suggest increased concerns about cardiorespiratory risk and/or a different process of care.

Adolescent↗
PubMed2001

Indexing medical WWW documents by morphemes.

Assisting users to search medical information on the WWW is here considered from two perspectives--the linguistic complexity of medical terms, nominal compounds in particular, and cross-lingual relationships between monolingual medical terminologies. In order to solve the first problem, we present an approach to automatic indexing in which medically plausible morphological units are used. Semantic value is added to these index terms by a compact domain-specific thesaurus. We further discuss tools for morphological segmentation and morphosemantic normalization of HTML documents, as well as an adaptation of a standard WWW search engine for morpheme-based retrieval. The second problem, cross-lingual medical document retrieval, is dealt with by defining cross-lingual equivalence relations on the emerging morpheme sets.

Abstracting and Indexing↗
PubMed1998

[About an original document published in Clermont in 1656 and entitled "Arrests du Roy, Arrests et Commissions portans establissement de l'Art des Apothicaires par toutes les Villes de France non jurée"].

This document is a part of the heritage of the public library of Clermont-Ferrand. It has been realized in 1656 by Germain Perdrix, official printer of the King, as a copy of the original printed in Paris. This document gathers some papers written during the lives of Kings Louis XIII and Louis XIV. The most important paper (published on January 20, 1637) specifies the conditions of admission to be Master in Apothecary as well as the rules of this profession.

Archives↗
PubMed2002

[Critical pathways and computerized multidisciplinary documentation system].

Critical pathways are widely adopted by many large hospitals around the world in order to provide high-quality patient treatment. The development of critical pathways is a lengthy process, and may require the collaboration among physicians, nurses, and staffs in a hospital. The development and implementation of critical pathways at Kanto Medical Center and the transition to a computerized multidisciplinary documentation system took place between 2000 and 2001. The article describes the process of creating the automated documentation system to support the critical pathways. The advantages, pitfalls learned in this integration experience are described.

Critical Pathways↗
PubMed2001

Integration of textual guideline documents with formal guideline knowledge bases.

Numerous approaches have been proposed to integrate the text of guideline documents with guideline-based care systems. Current approaches range from serving marked up guideline text documents to generating advisories using complex guideline knowledge bases. These approaches have integration problems mainly because they tend to rigidly link the knowledge base with text. We are developing a bridge approach that uses an information retrieval technology. The new approach facilitates a versatile decision-support system by using flexible links between the formal structures of the knowledge base and the natural language style of the guideline text.

Artificial Intelligence↗
PubMed2002

201Tl SPECT abnormalities, documented at rest in dilated cardiomyopathy, are related to a lower than normal myocardial thickness but not to an excess in myocardial wall stress.

UNLABELLED: This study was aimed at determining whether the (201)Tl SPECT abnormalities documented in patients with dilated cardiomyopathy are related to a local excess in wall stress, which might act against the diastolic perfusion of myocardium. METHODS: We included 6 healthy volunteers and 7 patients with idiopathic dilated cardiomyopathy who underwent (201)Tl SPECT at rest. On a 13-segment division of the left ventricle, indices of wall stress and tension were calculated at end-diastole by applying Laplace's law, with thickness and curvature radii being determined for each segment on 2 orthogonal MRI slices. RESULTS: Among all patients, 21 analyzed segments had (201)Tl SPECT defects (D+) and 67 had none (D-). Myocardial thickness was lower in D+ (0.88 +/- 0.30 cm) than in D- (1.23 +/- 0.33 cm, P = 0.0002) or in segments from healthy volunteers (0.99 +/- 0.15 cm, P = 0.04). The index of end-diastolic wall tension was also lower in D+ (2.5 +/- 1.0 N.m(-1).mm Hg(-1)) than in D- (3.3 +/- 1.1 N.m(-1).mm Hg(-1), P = 0.02) or in segments from healthy volunteers (3.2 +/- 1.2 .m(-1).mm Hg(-1)) P = 0.04). Last, the index of end-diastolic wall stress, determined by the ratio of wall tension index to myocardial thickness, was equivalent in D+, in D-, and in segments from healthy volunteers (respectively, 3.0 +/- 1.4, 2.8 +/- 1.2, and 3.2 +/- 1.6 hN.m(-2).mm Hg(-1)). CONCLUSION: In patients with dilated cardiomyopathy, the abnormalities documented by (201)Tl SPECT at rest are related to a lower than normal wall thickness and not to an excess in wall stress or tension. Therefore, partial-volume effects are likely to induce these abnormalities, and they may be unrelated to any insufficiency of myocardial perfusion.

Cardiomyopathy, Dilated↗
PubMed2002

[Stability of the Euro-score as an identification tool for patient risk groups -- dependency of the applied documentation system].

From the different methods for risk adjustment, scores allow a rough classification of the patients. The Euroscore represents one of the most modern scores. The most recent version of the documentation system of the German Society for Thoracic and Cardiovascular Surgery may be used without extended extra-work to evaluate the Euroscore despite the presence of various limitations. The investigation of the scores with nearly complete adaptation of the variables of the quality assurance documentation to the original definition showed no substantial differences between the score groups. However, many methodological implications favor the development of self-evaluated models to obtain a most recent weight for each risk factor and to be able to take into account new therapeutical options. These models can be evaluated by the existing database and extended by the most recent data.

Cardiac Surgical Procedures↗
PubMed2002

The SF-36 general health status survey documents the burden of osteoarthritis and the benefits of total joint arthroplasty: but why should we use it?

OBJECTIVES: To document the disease burden of osteoarthritis and the benefits of total joint replacement by using the Short Form Health Survey (SF-36) general health status survey and evaluate other factors that could affect scores. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: All patients scheduled for primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) (n = 622 preoperatively) in 2 years were surveyed using the SF-36, which assesses health-related quality of life (HRQOL) in patients' physical and social functioning and mental health. Follow-up surveys were administered 12 months after surgery to all patients and 3 and 24 months after surgery to a subset of patients. RESULTS: Preoperatively, patient scores were significantly lower than normative scores in the physical functioning, bodily pain, and social functioning domains. Preoperative scores were not different between THA and TKA patients. Women scored lower than men. Comorbid conditions were weakly associated with low SF-36 scores. Postoperatively, the largest incremental improvement in scores was seen at 3-month follow-up. Scores improved sooner and more substantially in THA vs TKA patients and in men vs women, paralleling improvement in clinical and subjective ratings of postoperative physical function and pain. CONCLUSIONS: The SF-36 has the sensitivity to document improvement in HRQOL after surgery and to reveal differences in THA vs TKA and in men vs women. However, routine use of outcome assessment instruments to monitor this patient population is costly and unjustified in our current healthcare environment.

Aged↗