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[The problem of documentation in pedodontics].

The efficiency of paedodontics increases with the number of children involved in regular dental supervision. This requires complete and reliable information about the individual factors, especially dental development, at any consultation (whether mass examination or treatment). The current methods of documentation are often inadequate to this purpose. For this reason, the author presents a method of documentation by means of key-word cards that essentially meets the demands to be made on a treatment chart.

Child↗

Prevalence of bronchial asthma in patients with endoscopically-documented esophagitis.

The association of gastroesophageal reflux, esophagitis, and asthma has been studied for a long time, but the results are often conflicting. The aim of this study is to evaluate the prevalence of bronchial asthma and the presence of extra-esophageal symptoms in subjects with endoscopically-documented reflux esophagitis. Forty patients were divided into 2 groups: group A (22 patients) affected by endoscopically-documented esophagitis, and group B (18 patients) with positive endoscopic examination for other pathologies of the gastroenteric tract. All of the patients underwent complete medical examination, skin-prick tests, esophageal-gastric-endoscopy, and pulmonary function tests (basal and after methacholine). The prevalence of asthma was 30% in group A vs 10% in group B (odds ratio = 2.57; confidence interval = 0.75-10.25). Relationships between chronic cough and esophagitis (p<0.01) and between chronic cough and asthma (p<0.05) were found. No significant relationships were observed between esophagitis and the other respiratory symptoms considered (wheezing, chest tightness, hoarseness, bronchospasm, and dysphagia). The results confirm the increased prevalence of asthma in patients with esophagitis and they emphasize the role of gastroesophageal reflux as a trigger factor for asthma. Chronic cough represents an important symptom of asthma in subjects with esophagitis.

Adult↗

[Medical record management and risk management processes. State of the art and new normative guidelines about the organization and the management of the sanitary documentation in the National Health System or Hospital Trusts].

Recent health care reforms, the start of accreditation processes of health institutions, and the introduction also in the health system of risk management concepts and instruments, borrowed from the enterprise culture and the emphasis put on the protection of privacy, render evident the need and the urgency to define and to implement improvement processes of the organization and management of the medical documentation in the hospital with the aim of facilitation in fulfilment of regional and local health authorities policies about protection of the safety and improvement of quality of care. Currently the normative context that disciplines the management of medical records inside the hospital appears somewhat fragmentary, incomplete and however not able to clearly orientate health operators with the aim of a correct application of the enforced norms in the respect of the interests of the user and of local health authority. In this job we individuate the critical steps in the various phases of management process of the clinical folder and propose a new model of regulations, with the purpose to improve and to simplify the management processes and the modalities of compilation, conservation and release to entitled people of all clinical documentation.

Confidentiality↗

Representation of relationships between data in healthcare documents.

In healthcare data are to a large extent represented in narrative textual documents. The analysis of narrative text has not been solved successfully up to now. The results of natural language processing or fully indexing systems have not been completely satisfying. It is in particular difficult to detect and describe reliably relationships between data items in narrative text. The eXtensible Markup Language XML has opened new and very promising perspectives in this environment which could improve the storage, processing and analysis of narrative textual documents in particular in healthcare.

Germany↗

Enhanced documentation of slit-lamp images of the human vitreous stained with fluorescein sodium.

BACKGROUND AND OBJECTIVE: To develop a new method to document the slit-lamp image of the vitreous body as stained with fluorescein sodium. PATIENTS AND METHODS: The system consists of a Goldmann-type slit-lamp biomicroscope, a highly sensitive monochromatic charge-coupled device camera, and a video attachment for real-time observation and recording. As a standard procedure, observation of the vitreous was conducted 60 minutes after intravenous administration of 500 mg of fluorescein sodium. This method was applied to 19 eyes with various eye diseases. RESULTS: Fine details of the vitreous were observed in all of the eyes. Posterior vitreous detachment could be recorded in 5 of the 19 eyes examined. Vitreoschisis and large lacunae were documented in 11 eyes. CONCLUSION: This method promises to be of value in detecting early age-related and pathological changes of the vitreous such as posterior vitreous detachment and vitreoschisis in clinics.

Adult↗

Evaluating an ICNP Web-based nursing documentation system.

The purpose of this paper is to present the evaluation of a web based nursing documentation system which helps nursing professionals and students to study ICNP Greek beta 2 version and to create nursing diagnoses, interventions and outcomes by selecting relevant terms from ICNP. This advanced web-based ICNP browser enables the authentication of the user, and the creation of a type of nursing care plan through the use of ICNP. It provides different ways for creating nursing diagnoses, interventions and outcomes, by selecting relevant ICNP terms through the tree-structure view, index and search components of the tool. The evaluation of this nursing documentation system is carried out by a survey among nursing professionals working in nursing units in hospitals. The results which have derived from this survey are presented. Moreover, conclusions regarding the future changes that should be made in the system are reported.

Attitude to Computers↗

XML as standard for communicating in a document-based electronic patient record: a three years experiment.

During the past few years, the eXtensible Markup Language (XML) has experienced a growing use for accessing, representing and exchanging information, especially in the health care environment. This paper discusses the potentials of the use of XML for the electronic patient record (EPR) in two ways: first, as a format for the exchange of structured messages, and second, as a comprehensible way of representing patient documents. These statements rely on a three years experiment conducted at the Geneva University Hospital as part of its document-centred EPR.

Medical Records Systems, Computerized↗

Documentation of high-level bacillus Sphaericus 2362 resistance in field populations of Culex quinquefasciatus breeding in polluted water in Thailand.

Bacillus sphaericus (Bsph) Neide has been recognized as an effective mosquito larvicide since its discovery 20 years ago. Various strains of this agent, such as 2362, 2297, 1593, and C3-41, have been developed, formulated, and field-evaluated against mosquito larvae in different countries. Their high efficacy in controlling mosquitoes breeding in various habitats, especially those in polluted water, has been documented. However, resistance to Bsph has been reported in Culex pipiens complex in both laboratory colonies and natural populations. During our field trials on Bsph water-dispersible granules (WDG) against natural populations of Cx. quinquefasciatus Say in a low-income community, Nonthaburi Province, Thailand, control failure occurred within 4 months after 5 treatments using VectoLex WDG at the dosages of 50-200 mg/m2. The suspected Bsph-resistant Cx. quinquefasciatus mosquitoes were collected and colonized in the laboratory, from which the late stage larvae of generations F14 through F17 were used in bioassays to elucidate the resistance profile. A high level of Bsph resistance was documented in this colony as compared with the susceptible mosquitoes from the same area in Thailand or from California, USA. The resistance ratios (RR) at LC50, depending on reference colonies, were 21,100-28,100-fold against Bsph WDG or greater than 125,000-200,000-fold against Bsph technical-grade material. These Bsph-resistant mosquitoes, however, were completely susceptible to Bacillus thuringiensis var. israelensis, (Bti) preparations, LC50 ranging from 0.017 ppm for technical material with 7000 ITU/mg to 0.052 ppm for water-dispersible granules with 3000 ITU/mg. The RR to mixtures of Bsph + Bti in this highly Bsph-resistant mosquitoes increased steadily upon the increase of Bsph ratios in the mixtures from 50, 75, 90, 95 to 99%. The resistance levels to the mixtures with various ratios of Bsph and Bti, however, were substantially lower than that in Bsph alone, suggesting addition of Bti to Bsph substantially enhanced the mosquitocidal activity (synergism) against these highly Bsph-resistant Cx. quinquefasciatus. Moderate tolerance to low levels of resistance to Bsph/Bti recombinant (RR 7.29-12.75 at LC50 and 5.15-13.40 at LC90) was also noted in this Bsph-resistant population.

Animals↗

An electronic patient record implementation using clinical document architecture.

Electronic patient records (EPRs) provide the means for integrated access to patient information that may be scattered across dispersed healthcare organizations that, in general, use heterogeneous systems in order to support their internal functions. XML language and Clinical Document Architecture (CDA) provides a mechanism for defining, structuring, manipulating and visualizing patient medical data using the same semantics through web. In this paper, a prototype implementation of a web-based electronic patient record (EPR) system using XML for data format and CDA for defining and structuring patient clinical documents is presented.

Databases as Topic↗

Examination of spur marks found on inkjet-printed documents.

In this paper, we propose the examination of spur mark evidence on inkjet-printed documents. Spur marks are tool marks created by the spur gears in the paper conveyance system of many inkjet printers. The relationship between printouts and printers were investigated by comparing the spur marks found on printed documents with reference spur marks sampled from known printers. The comparison was based on two characteristics of spur marks: pitch and mutual distance. These characteristics extracted the geometric features of spur marks and provided information on the type of spur gears and their location in the paper conveyance system. The spur marks on a printout matched the reference spur marks within three percent of the measured values. Spur marks were considered to be effective class characteristics to identify certain brands of inkjet printers since spur gears are used in many types of these machines.

Journal Article↗

Evaluation of Medical Problem Extraction from Electronic Clinical Documents Using MetaMap Transfer (MMTx).

To improve the use and quality of the electronic Problem List, which is at the heart of the problem-oriented medical record in development in our institution (Intermountain Health Care, Utah, U.S.), we developed an Automated Problem List system using Natural Language Processing (NLP) technologies. A key part of this system is a module that automatically extracts potential medical problems from free-text clinical documents. The NLP module uses MMTx, developed at the U.S. National Library of Medicine. Negation detection was added to this application by adapting a negation detection algorithm called NegEx. To evaluate the adequacy of the performance of the NLP module for our Automated Problem List system, we evaluated it with 160 electronic clinical documents of different types. Two different data sets for MMTx were used: the default full UMLS data set and a customised subset adapted to detect the set of 80 medical problems we are interested in. With the default data set, we measured a recall of 0.74 (95% CI 0.68-0.8) and a precision of 0.76 (0.69-0.82). The customised subset had a significantly better recall of 0.9 (0.85-0.94), and a non-significantly different precision of 0.69 (0.63-0.75).

Algorithms↗

[Documentation of electronic patient records (EPRS) in German general practices: a telephone survey].

In Germany, use and contents of EPRs are largely unknown and expected to be highly variable, due to missing standards. We conducted a telephone survey to describe and compare computer documentation habits in general practices. Specifically, we were interested in: (1) the type of medical data recorded; and (2) which factors influence the extent to which doctors used the EPR while seeing their patients. The sampling frame consisted of family physicians participating in a general practice research project: 32% (145/452) of family physicians in the district of Göttingen, Lower Saxony, and 63% (52/83) of physicians from a quality assurance network of family practices in the district of Freiburg, Baden-Württemberg. With the exception of two practices in Göttingen, all practices (n = 165 of 167) took part in this survey. Diagnoses, digital codes for service fees, and prescriptions were computerized in nearly all practices, although doctors were significantly more involved in Freiburg than in Göttingen. Clinical symptoms and findings were recorded in 80% of Freiburg and 52% of Göttingen practices (p = 0.008). Overall, in 74% of Freiburg and 51% of Göttingen practices, the physicians opened the EPR while seeing patients (p = 0.022). Nearly half of the Göttingen practices (49%) and 24% of the Freiburg practices (p < 0.05) entered digital codes for service fees and diagnoses on paper before entering them electronically. In multivariate models adjusting for sex, target group and training specialty, internet access in the office was independently predictive of 'EPR-activity' (OR: 2.23; 95%-confidence interval: 1.12-4.43). There seems to be room for improvement in terms of degree and intensity of recording of clinically-relevant data. Technical interest, i.e., internet access in the office, seems to enhance electronic documentation activities.

Electronic Data Processing↗

[Criteria for classification of upper limb work-related musculo-skeletal disorders due to biomechanical overload in occupational health. Consensus document by an Italian Working Group].

BACKGROUND AND OBJECTIVE: In a preliminary consensus document the authors proposed criteria and methods to identify upper limb work-related MSDs due to biomechanical overload. With this document they intend to define severity according to shared models and procedures so as to fit behaviours to diagnostic procedures and their medical-legal assessment. This becomes especially important in view of Ministerial Decree of April 27 2004 fixing the new lists of diseases having a possible work-related origin that must be reported by law in accordance with art. 139 of law n. 1124, and also on account of the impact of such diseases which, for the first time in Italy, are regulated by law. CONTENTS: The working group, which included INAIL and ISPESL experts and was fully supported by SIMFER (Italian Society of Physical Medicine and Rehabilitation) and SINC (Italian Society of Clinical Neurophysiology), defined a general clinical procedure (anamnesis, objective examination and instrumental assessment) regarding each portion of the concerned upper limb (shoulder, elbow and wrist/hand). Once the presence and characteristics of anatomic and functional damages are established, the results allow a classification scheme to be proposed of upper limb diseases (tendon disorders and entrapment neuropathy) divided into 6 increasing severity stages: initial, medium, medium-severe, severe and extremely severe. Special attention was paid to two instrumental examinations that proved to be of great clinical interest, at least in occupational health: echography of soft tissues (in appendix) and electroneurography for entrapment neuropathy. The limitations of this proposal are discussed but the main goal was achieved: to standardize terms and provide homogeneous criteria to achieve classification of upper limb damage due to biomechanical overload for increasing severity levels. The working group research activity is part of a research project funded by ISPESL.

Biomechanical Phenomena↗

Customized document validation to support a flexible XML-based knowledge management framework.

This paper describes a validation architecture used within Intermountain Health Care's Clinical Knowledge Repository (CKR). The architecture provides additional functionality that complements XML Schema validation, producing user-friendly error messages and enabling validation rules reuse. The validation architecture helps document authors to fix their own errors. As a result, less than 1% of all documents in the CKR are considered invalid.

Information Management↗

Effect of Computerized Nursing Documentation on Clinical Care Activities in a Neonatal Intensive Care Unit (NICU).

A point of care computerized nursing documentation system is being evaluated to determine if the implementation resulted in a timesaving for neonatal nurse practitioners (NNP) while preparing for patient rounds. A benefit of the hypothesized decreased work process is earlier initiation of care changes thus improving care quality. Observable activities within the work process were timed before and again 4 months after implementation of the computerized nursing documentation system. Data will be analyzed and results reported.

Humans↗

Consensus document on European brain research.

Brain disease psychiatric and neurologic disease combined represents a considerable social and economic burden in Europe. Data collected by the World Health Organization (WHO) suggest that brain diseases are responsible for 35% of Europe's total disease burden. An analysis of all health economic studies of brain diseases in Europe, published by the European Brain Council (EBC) in June 2005, estimated the total cost of brain disease in Europe in 2004 to be Euro 386 billion. That burden is set to grow, mainly due to the fact that the European population is ageing. Investment in brain sciences does not match that burden now, let alone in the future. Brain research received only 8% of the life science budget in the European Commission's Fifth Framework Programme, which represents less than 0.01% of the annual cost of brain disorders for that period. Over the last decade, Europe has been losing ground to the USA and Japan in terms of both basic and clinical research. Many of Europe's young researchers are taking up posts in the USA and staying there. Big pharmaceutical companies are fleeing Europe for the USA, taking their drug development programmes with them. Research in the brain sciences now holds the promise of therapies that halt and even reverse neurodegeneration, of better diagnostic tools, neural prostheses for the paralysed and drugs for depression and anxiety that are tailored to the individual, thereby eliminating or reducing side effects. Our growing understanding of the normal brain could lead to better prevention of brain disease and to more effective teaching methods. The need for innovative treatments has never been greater, and Europe boasts clusters of excellent researchers in biotechnology who could collaborate with brain scientists and the pharmaceutical industry to realise this promise. But if Europe is to seize these opportunities and meet the challenge of brain disease, it needs to go forward on the basis of greater collaboration between countries, greater collaboration between industry, academia and patient organisations, and increased investment in the brain sciences. The EBC was formed in 2002 to bring together scientists, clinicians, the pharmaceutical industry, charities and patient organisations from all over Europe to campaign for these goals. It takes a novel, bottom-up approach to research policy, and in developing this consensus document, it aims to promote a greater and more focused effort in this area, to improve public understanding of the brain sciences and above all, to support brain research as a priority under the European Commission's Seventh Framework Programme (FP7, 2007-2013). The research programme outlined here was first conceived by the EBC board. An outline was sent to all member organisations and a number of individual experts for comments. Following that, a table of contents was developed. The 45 research themes were written by groups of experts from across Europe who represent a wide range of disciplines. Each one contains a proposal for future research on a specific brain-related theme which the EBC believes could form the basis of one or more integrated projects or strategic targeted research projects (STREP) funded under FP7. The EBC has deliberately focused on the major diseases and then described the basic research needed to understand and treat or perhaps even cure those diseases. The programme is therefore constructed "from man to molecule" and not the other way round, with equal importance attached to basic and clinical research. The EBC suggests that each of the proposed integrated projects or STREP should be awarded a budget in the order of Euro 10 to 15 million. In addition, brain research should be treated as an important element of many other parts of FP7, such as the European Research Council and research programmes on information technology and the causes of violence. Any research programme that concerns human behaviour should, by definition, take account of brain research. The EBC envisages that the priority for brain research it proposes at the European level will translate into higher priority for brain research at the national level, and this document may also serve as a starting point for the development of national consensus programmes. It seems likely that consensus conferences on brain research in Europe may further develop the themes and ideas discussed here. An EBC task force may also be established to further the consensus process. In general, increasing funding in the brain sciences would bring enormous economic returns by lightening the burden on healthcare systems and increasing the productivity of affected individuals-and might easily pay for itself. The human and social returns of such an investment are inestimable. And the time to act is now.

Biomedical Research↗

[Evaluation of the quality of nursing care: qualitative and quantitative analysis on a sample of nursing documents].

The theory of continuous quality improvement is related to the principles of Total Quality and focuses on three main elements: client satisfaction, erogation of services and the informative system. In this wide context, the experience of the Niguarda Cà Granda Hospital regarding the introduction of certified nursing documents is described. The aspects considered are the introduction and management of the document, also taking into consideration the strategies adopted for modifying professional behaviour such as training. The evaluation confirms that any project aimed at improving the quality of care can be achieved as long as the Hospital management make a strategic decision and there is involvement of the individual professionals.

Humans↗

On the Ottoman consent documents for medical interventions and the modern concept of informed consent.

Information for patients prior to medical intervention is one of the principles of modern medical practice. In this study, we looked at an earlier practice of this principle. Ottoman judges had record books called sicil. One of the categories in sicils was the consent documents called riza senedi, which was a patient-physician contract approved by the courts. These contracts were especially for the protection of physicians from punishment if the patient dies. It is not clear whether patients were informed properly or not. Consent for minors was obtained from parents. However, a situation where an adult does not have the capacity to consent, was not clear in these documents. Any sign of free withdrawal of consent was not found in these records. Due to the legal system of Ottoman State, these contracts were related to Islamic law rather than modern civil law. We aim, in this paper, to present a legal practice, which is possible to consider as an early example of the informed consent practice.

Delivery of Health Care↗