Multi-disciplinary communication networks for skin risk assessment in nursing homes with high IT sophistication

BackgroundThe role of nursing home (NH) information technology (IT) in quality improvement has not been clearly established, and its impacts on communication between care givers and patient outcomes in these settings deserve further attention.ObjectivesIn this research, we describe a mixed method approach to explore communication strategies used by healthcare providers for resident skin risk in NH with high IT sophistication (ITS).MethodsSample included NH participating in the statewide survey of ITS. We incorporated rigorous observation of 8- and 12-h shifts, and focus groups to identify how NH IT and a range of synchronous and asynchronous tools are used. Social network analysis tools and qualitative analysis were used to analyze data and identify relationships between ITS dimensions and communication interactions between care providers.ResultsTwo of the nine ITS dimensions (resident care-technological and administrative activities-technological) and total ITS were significantly negatively correlated with number of unique interactions. As more processes in resident care and administrative activities are supported by technology, the lower the number of observed unique interactions. Additionally, four thematic areas emerged from staff focus groups that demonstrate how important IT is to resident care in these facilities including providing resident-centered care, teamwork and collaboration, maintaining safety and quality, and using standardized information resources.ConclusionOur findings in this study confirm prior research that as technology support (resident care and administrative activities) and overall ITS increases, observed interactions between staff members decrease. Conversations during staff interviews focused on how technology facilitated resident centered care through enhanced information sharing, greater virtual collaboration between team members, and improved care delivery. These results provide evidence for improving the design and implementation of IT in long term care systems to support communication and associated resident outcomes.     

Garbage in,garbage out: A critical evaluation of strategies used for validation of immunohistochemical biomarkers

The use of immunohistochemistry (IHC) in clinical cohorts is of paramount importance in determining the utility of a biomarker in clinical practice. A major bottleneck in translating a biomarker from bench-to-bedside is the lack of well characterized, specific antibodies suitable for IHC. Despite the widespread use of IHC as a biomarker validation tool, no universally accepted standardization guidelines have been developed to determine the applicability of particular antibodies for IHC prior to its use. In this review, we discuss the technical challenges faced by the use of immunohistochemical biomarkers and rigorously explore classical and emerging antibody validation technologies. Based on our review of these technologies, we provide strict criteria for the pragmatic validation of antibodies for use in immunohistochemical assays.     

我院病区药房药品配送模式初探

目的:建立适合我院的病区药房药品配送模式,有效保证药品质量。方法:将病区药房药品配送模式从原来的护士来药房取药变为药房将药品配送至护士工作站,并在药品配送的各个环节中建立起相应防漏补缺措施,防止和避免发药差错的发生和药品流通可能的污染。结果与结论:病区药房新的药品配送模式不仅使病区护士从领药、退药等烦琐的工作中解放出来,大大节省药、护双方的人力资源,也提高了药品在流通环节中的质量,提升药学服务水平。     

A formal approach to the analysis of clinical computer-interpretable guideline modeling languages

Objective

To develop proof strategies to formally study the expressiveness of workflow-based languages, and to investigate their applicability to clinical computer-interpretable guideline (CIG) modeling languages.

Method

We propose two strategies for studying the expressiveness of workflow-based languages based on a standard set of workflow patterns expressed as Petri nets (PNs) and notions of congruence and bisimilarity from process calculus. Proof that a PN-based pattern P can be expressed in a language L can be carried out semi-automatically. Proof that a language L cannot provide the behavior specified by a PNP requires proof by exhaustion based on analysis of cases and cannot be performed automatically. The proof strategies are generic but we exemplify their use with a particular CIG modeling language, PROforma. To illustrate the method we evaluate the expressiveness of PROforma against three standard workflow patterns and compare our results with a previous similar but informal comparison.

Results

We show that the two proof strategies are effective in evaluating a CIG modeling language against standard workflow patterns. We find that using the proposed formal techniques we obtain different results to a comparable previously published but less formal study. We discuss the utility of these analyses as the basis for principled extensions to CIG modeling languages. Additionally we explain how the same proof strategies can be reused to prove the satisfaction of patterns expressed in the declarative language CIGDec.

Conclusion

The proof strategies we propose are useful tools for analysing the expressiveness of CIG modeling languages. This study provides good evidence of the benefits of applying formal methods of proof over semi-formal ones.     

Direct admission of stroke in MRI room reduces in-hospital delays and improves recovery

PurposeEfficacy of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) is strongly time dependent in acute stroke management. We investigated the impact of a direct magnetic resonance imaging (MRI) room admission protocol in order to reduce in-hospital delays.MethodsWe implemented a protocol of direct MRI room admission, bypassing the Emergency Department. We compared in-hospital delays, clinical and functional outcomes using National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores, between patients hospitalized via this protocol and those admitted via the standard workflow and treated by IVT and/or MT. The primary endpoint was the proportion of patients with door-to-needle time (DTN) ≤ 60 minutes.ResultsAmong 308 consecutive patients included, 62 underwent direct MRI room admission. The proportion of patients with DTN ≤ 60 minutes was higher in the intervention group compared to the control group (82.5% vs. 17.8%, P < 0.001), and median DTN was lower (45 min vs. 75 min, P < 0.001). Despite a functional benefit at discharge on dichotomized mRS (mRS [0-2, as independence]: 66.1% vs. 51.2%, P = 0.003), the difference was no longer statistically significant at six months (68.4% vs. 57.4%, P = 0.10).ConclusionDirect MRI room admission of stroke alerts is associated with an important reduction of treatment times and improves functional outcomes.     

我院静脉药物配置中心工作流程优化分析和评价

摘 要 目的： 分析评价我院静脉药物配置中心(Pharmacy Intravenous Admixture Service,PIVAS)经过流程优化后的效果。方法: 药师、护士一对一分组配置,由药师完成配置前、配置后的药品、溶媒及空安瓿的核对工作,护士按照操作规范完成输液配置。对比优化前和优化后5个月时间的配置工作量、各环节差错量、 安瓿或成品破损情况等。结果: 流程优化后,工作效率明显提高,相同的工作量使用的时间较以往减少约0.5 h,出现差错的几率下降40%以上,配置前及配置过程中安瓿破损减少60%。结论:优化PIVAS工作流程提高了工作效率与管理水平。     

DICOM for Clinical Research: PACS-Integrated Electronic Data Capture in Multi-Center Trials

Providing surrogate endpoints in clinical trials, medical imaging has become increasingly important in human-centered research. Nowadays, electronic data capture systems (EDCS) are used but binary image data is integrated insufficiently. There exists no structured way, neither to manage digital imaging and communications in medicine (DICOM) data in EDCS nor to interconnect EDCS with picture archiving and communication systems (PACS). Manual detours in the trial workflow yield errors, delays, and costs. In this paper, requirements for a DICOM-based system interconnection of EDCS and research PACS are analysed. Several workflow architectures are compared. Optimized for multi-center trials, we propose an entirely web-based solution integrating EDCS, PACS, and DICOM viewer, which has been implemented using the open source projects OpenClinica, DCM4CHEE, and Weasis, respectively. The EDCS forms the primary access point. EDCS to PACS interchange is integrated seamlessly on the data and the context levels. DICOM data is viewed directly from the electronic case report form (eCRF), while PACS-based management is hidden from the user. Data privacy is ensured by automatic de-identification and re-labelling with study identifiers. Our concept is evaluated on a variety of 13 DICOM modalities and transfer syntaxes. We have implemented the system in an ongoing investigator-initiated trial (IIT), where five centers have recruited 24 patients so far, performing decentralized computed tomography (CT) screening. Using our system, the chief radiologist is reading DICOM data directly from the eCRF. Errors and workflow processing time are reduced. Furthermore, an imaging database is built that may support future research.     

探讨VolumeRAD成像技术的结构原理和工作流程

VolumeRAD成像技术是一种新型的影像技术,该技术在数字X射线摄影系统上利用高性能的平板探测器、大容量小焦点X射线球管、精准的驱动装置完成多角度的容积扫描,获取一系列的影像数据,由计算机回顾性的重建出任意层面的数字X射线断层图像的成像技术。据X射线球管和平板探测器的运动形式,共有4种采集方式,29种协议,基本涵盖了人体常规的摄影位置,为更好地在临床上使用VolumeRAD成像技术,探讨VolumeRAD成像技术的结构原理和工作流程。     

放射科工作流集成的应用实践

探讨综合性大型医院RIS/PACS建设中放射科工作流集成方案。采用I HE radiology工作流相关的4个集成模式,并根据国内需求优化应用,达到改善预定工作流、报告工作流、简化纠错流程、提高工作诊疗效率及质量的要求。重视I HE radiology集成模式应用,兼顾本土化需求,完善数字化医疗影像工作环境。