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1.
Stud Health Technol Inform ; 305: 20-23, 2023 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-37386947

RESUMO

Patient-Generated Health Data (PGHD), such as data provided by wearable devices, hold promise to improve health outcomes. However, to improve clinical decision-making, PGHD should be integrated or linked with Electronic Health Records (EHRs). Typically, PGHD data are collected and stored as Personal Health Records (PHRs), outside EHR systems. To address this challenge, we created a conceptual framework for PGHD/EHR interoperability through the Master Patient Index (MPI) and DH-Convener platform. Then, we identified the corresponding Minimum Clinical Data Set (MCDS) of PGHD to be exchanged with EHR. This generic approach can be used as a blueprint in different countries.


Assuntos
Tomada de Decisão Clínica , Registros de Saúde Pessoal , Humanos , Medicamentos Genéricos , Registros Eletrônicos de Saúde , Sistemas de Identificação de Pacientes
2.
Sensors (Basel) ; 23(6)2023 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-36991714

RESUMO

BACKGROUND: Continuous surveillance helps people with diabetes live better lives. A wide range of technologies, including the Internet of Things (IoT), modern communications, and artificial intelligence (AI), can assist in lowering the expense of health services. Due to numerous communication systems, it is now possible to provide customized and distant healthcare. MAIN PROBLEM: Healthcare data grows daily, making storage and processing challenging. We provide intelligent healthcare structures for smart e-health apps to solve the aforesaid problem. The 5G network must offer advanced healthcare services to meet important requirements like large bandwidth and excellent energy efficacy. METHODOLOGY: This research suggested an intelligent system for diabetic patient tracking based on machine learning (ML). The architectural components comprised smartphones, sensors, and smart devices, to gather body dimensions. Then, the preprocessed data is normalized using the normalization procedure. To extract features, we use linear discriminant analysis (LDA). To establish a diagnosis, the intelligent system conducted data classification utilizing the suggested advanced-spatial-vector-based Random Forest (ASV-RF) in conjunction with particle swarm optimization (PSO). RESULTS: Compared to other techniques, the simulation's outcomes demonstrate that the suggested approach offers greater accuracy.


Assuntos
Diabetes Mellitus , Telemedicina , Humanos , Inteligência Artificial , Aprendizado de Máquina , Sistemas de Identificação de Pacientes
3.
BMC Health Serv Res ; 22(1): 1517, 2022 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-36514109

RESUMO

PURPOSE: Clinical efficiency is a key component of the value-based care model and a driver of patient satisfaction. The purpose of this study was to identify and address inefficiencies at a high-volume radiation oncology clinic. METHODS AND MATERIALS: Patient flow analysis (PFA) was used to create process maps and optimize the workflow of consultation visits in a gastrointestinal radiation oncology clinic at a large academic cancer center. Metrics such as cycle times, waiting times, and rooming times were assessed by using a real-time patient status function in the electronic medical record for 556 consults and compared between before vs after implementation of the PFA recommendations. RESULTS: The initial PFA revealed four inefficiencies: (1) protracted rooming time, (2) inefficient communications, (3) duplicated tasks, and (4) ambiguous clinical roles. We analyzed 485 consult-visits before the PFA and 71 after the PFA. The PFA recommendations led to reductions in overall median cycle time by 21% (91 min vs 72 min, p < 0.001), in cumulative waiting times by 64% (45 min vs 16 min; p < 0.001), which included waiting room time (14 min vs 5 min; p < 0.001) and wait for physician (20 min vs. 6 min; p < 0.001). Slightly less than one-quarter (22%) of consult visits before the PFA lasted > 2 h vs. 0% after implementation of the recommendations (p < 0.001). Similarly, the proportion of visits requiring < 1 h was 16% before PFA vs 34% afterward (p < 0.001). CONCLUSIONS: PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology consultation clinics, and implementing their findings can significantly improve cycle times and waiting times. Potential downstream effects of these interventions include improved patient experience, decreased staff burnout, financial savings, and opportunities for expanding clinical capacity.


Assuntos
Radioterapia (Especialidade) , Humanos , Eficiência Organizacional , Instituições de Assistência Ambulatorial , Satisfação do Paciente , Encaminhamento e Consulta , Sistemas de Identificação de Pacientes
4.
Oper Neurosurg (Hagerstown) ; 22(6): 425-432, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35867082

RESUMO

BACKGROUND: Robotic neurosurgery may improve the accuracy, speed, and availability of stereotactic procedures. We recently developed a computer vision and artificial intelligence-driven frameless stereotaxy for nonimmobilized patients, creating an opportunity to develop accurate and rapidly deployable robots for bedside cranial intervention. OBJECTIVE: To validate a portable stereotactic surgical robot capable of frameless registration, real-time tracking, and accurate bedside catheter placement. METHODS: Four human cadavers were used to evaluate the robot's ability to maintain low surface registration and targeting error for 72 intracranial targets during head motion, ie, without rigid cranial fixation. Twenty-four intracranial catheters were placed robotically at predetermined targets. Placement accuracy was verified by computed tomography imaging. RESULTS: Robotic tracking of the moving cadaver heads occurred with a program runtime of 0.111 ± 0.013 seconds, and the movement command latency was only 0.002 ± 0.003 seconds. For surface error tracking, the robot sustained a 0.588 ± 0.105 mm registration accuracy during dynamic head motions (velocity of 6.647 ± 2.360 cm/s). For the 24 robotic-assisted intracranial catheter placements, the target registration error was 0.848 ± 0.590 mm, providing a user error of 0.339 ± 0.179 mm. CONCLUSION: Robotic-assisted stereotactic procedures on mobile subjects were feasible with this robot and computer vision image guidance technology. Frameless robotic neurosurgery potentiates surgery on nonimmobilized and awake patients both in the operating room and at the bedside. It can affect the field through improving the safety and ability to perform procedures such as ventriculostomy, stereo electroencephalography, biopsy, and potentially other novel procedures. If we envision catheter misplacement as a "never event," robotics can facilitate that reality.


Assuntos
Robótica , Inteligência Artificial , Cadáver , Humanos , Sistemas de Identificação de Pacientes , Técnicas Estereotáxicas
6.
Cancer Rep (Hoboken) ; 5(6): e1359, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-33624448

RESUMO

BACKGROUND: Abandonment of treatment, a major cause of treatment failure in low- and middle-income countries like India, is particularly high during the diagnostic and initial phase of treatment. Tracking of patients during this risk period may reduce treatment abandonment rates and increase quality of care. AIM: The primary aim was to pilot the use and check the acceptability of a tool for tracking children with cancer in New Delhi during the initial part of their treatment. Secondary aim was to estimate abandonment rates among these patients. METHODS: This prospective study was carried out in two centers of North India in New Delhi and enrolled children less than 18 years diagnosed with cancer at these centers and who had registered with Cankids for social support. Parent support group (PSG) workers maintained contact with the child's family at least once a week for the first 12 weeks. Details of each contact and subsequent action were recorded in a customized book (called "You are not alone" or YANA Book). Descriptive analysis of these contacts was done in Microsoft Excel and presented in frequencies and percentages. The five-point Likert scale was used to check the acceptability of the tool among the PSG workers. RESULTS: Seven PSG workers enrolled and tracked 81 patients (73% male with a median age of 6 years). During the 12-week study period, 986 contacts were attempted and three (3.7%) patients had abandoned their treatment. All PSG workers strongly agreed that the YANA book was simple to understand and use, decreased their workload, and helped provide better assistance to patients. CONCLUSION: The tool for patient tracking was well accepted by the PSG workers and considered easy to use. We now plan to implement our model as a routine service at all the partnering hospitals in India.


Assuntos
Neoplasias , Criança , Feminino , Humanos , Índia/epidemiologia , Masculino , Neoplasias/diagnóstico , Neoplasias/terapia , Sistemas de Identificação de Pacientes , Estudos Prospectivos , Apoio Social
7.
Prehosp Emerg Care ; 26(2): 305-310, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33528300

RESUMO

Objective: Accurate tracking of patients poses a significant challenge to prehospital and hospital emergency medical providers in planned and unplanned events. Previous reports on patient tracking systems are limited primarily to descriptive reports of post incident reviews or simulated exercises. Our objective is to report our experience with implementing a patient barcode tracking system during various planned events within a large urban EMS system.Methods: In 2018, representatives from the Chicago Department of Public Health, Chicago Fire Department EMS, private EMS agencies, and 27 hospitals in the Chicago EMS System were trained on the use of a web-based patient tracking system using barcoded triage tags and wristbands to monitor triage category and hospital destination during an event. The tracking system was used on two planned operational days and three pre-planned mass gathering events. The primary outcome was the percent of patients initially scanned by EMS that were scanned by the hospital. Descriptive statistics were collected. Barriers to patient tracking system use were identified.Results: Each event was reviewed for the number of patients assigned a barcode identifier and scanned by EMS that were then scanned by the hospital. In the first planned operational day, 57% (359/622) of patients initially scanned by EMS were scanned by the hospital. In the second planned operational day, 88% (355/402) of EMS scanned patients were scanned by the hospital and 37% (133/355) were assigned a final disposition. At three city mass gathering events, there were 79% (50/63), 95% (190/199), and 82% (46/56) of EMS scanned patients also scanned by hospitals. Logistical and technological challenges were documented.Conclusions: Use of a web-based system with barcode identifiers successfully tracked patients from prehospital to hospital during planned operational days and mass gathering events. Percent of scanned patients increased after the first operational day and remained consistent in subsequent events. Limitations to the patient tracking system included logistical and technological barriers. Similar patient tracking systems may be implemented to assist with event management in other EMS systems.


Assuntos
Serviços Médicos de Emergência , Chicago , Hospitais , Humanos , Sistemas de Identificação de Pacientes , Triagem
8.
CMAJ ; 193(24): E921-E930, 2021 06 14.
Artigo em Francês | MEDLINE | ID: mdl-34860693

RESUMO

CONTEXTE: Les interventions non pharmacologiques demeurent le principal moyen de maîtriser le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) d'ici à ce que la couverture vaccinale soit suffisante pour donner lieu à une immunité collective. Nous avons utilisé des données de mobilité anonymisées de téléphones intelligents afin de quantifier le niveau de mobilité requis pour maîtriser le SRAS-CoV-2 (c.-à-d., seuil de mobilité), et la différence par rapport au niveau de mobilité observé (c.-à-d., écart de mobilité). MÉTHODES: Nous avons procédé à une analyse de séries chronologiques sur l'incidence hebdomadaire du SRAS-CoV-2 au Canada entre le 15 mars 2020 et le 6 mars 2021. Le paramètre mesuré était le taux de croissance hebdomadaire, défini comme le rapport entre les cas d'une semaine donnée et ceux de la semaine précédente. Nous avons mesuré les effets du temps moyen passé hors domicile au cours des 3 semaines précédentes à l'aide d'un modèle de régression log-normal, en tenant compte de la province, de la semaine et de la température moyenne. Nous avons calculé le seuil de mobilité et l'écart de mobilité pour le SRAS-CoV-2. RÉSULTATS: Au cours des 51 semaines de l'étude, en tout, 888 751 personnes ont contracté le SRAS-CoV-2. Chaque augmentation de 10 % de l'écart de mobilité a été associée à une augmentation de 25 % du taux de croissance des cas hebdomadaires de SRAS-CoV-2 (rapport 1,25, intervalle de confiance à 95 % 1,20­1,29). Comparativement à la mobilité prépandémique de référence de 100 %, le seuil de mobilité a été plus élevé au cours de l'été (69 %, écart interquartile [EI] 67 %­70 %), et a chuté à 54 % pendant l'hiver 2021 (EI 52 %­55 %); un écart de mobilité a été observé au Canada entre juillet 2020 et la dernière semaine de décembre 2020. INTERPRÉTATION: La mobilité permet de prédire avec fiabilité et constance la croissance des cas hebdomadaires et il faut maintenir des niveaux faibles de mobilité pour maîtriser le SRAS-CoV-2 jusqu'à la fin du printemps 2021. Les données de mobilité anonymisées des téléphones intelligents peuvent servir à guider le relâchement ou le resserrement des mesures de distanciation physique provinciales et régionales.


Assuntos
COVID-19/prevenção & controle , Mapeamento Geográfico , Aplicativos Móveis/normas , Sistemas de Identificação de Pacientes/métodos , COVID-19/epidemiologia , COVID-19/transmissão , Canadá/epidemiologia , Humanos , Aplicativos Móveis/estatística & dados numéricos , Sistemas de Identificação de Pacientes/estatística & dados numéricos , Quarentena/métodos , Quarentena/normas , Quarentena/estatística & dados numéricos , Análise de Regressão , Fatores de Tempo
10.
Medicina (B Aires) ; 81(4): 597-601, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34453802

RESUMO

Medical attention is not free from committing mistakes that can increase mortality and costs. The International Goals for Patient Safety include correct patient identification. The use of wristbands reduces the number of adverse events. The rate of nonidentified patients at the moment of phlebotomy was investigated retrospectively during 2019. The annual rate of non-identified patients was 9.8% and higher rates were observed from April to September. Monday was the day with the highest rate of non-identified. There was statistically significant relationship between the month rate of non-identified patients and the number of discharges from operative unit per month (r=0.6465; p=0.0237) and the bed turnover rate (r=0.7776; p=0.0029). Other wristband identification errors are unknown. The investigation detected failures in patient identification that allowed to make recommendations. In order to reduce the number of missing wristbands it will be necessary to monitor the indicator, especially during the months with the highest number of discharges and bed turnover rate, to evaluate the adherence of the personnel to the current protocol and to carry out training programs.


La atención médica no se encuentra libre de errores, que pueden poner en riesgo tanto la salud como la vida de los pacientes, con aumento de la morbimortalidad y los costos del sistema sanitario. Las recomendaciones internacionales de seguridad del paciente incluyen una correcta identificación. El uso de pulseras identificatorias reduce la cantidad de eventos adversos. Se investigó en forma retrospectiva la tasa de pacientes sin pulsera identificatoria al momento de la extracción sanguínea durante el año 2019 en el Instituto de Investigaciones Médicas Alfredo Lanari (IDIM). Se registró un total de 521 casos de pacientes no identificados sobre 5267 pedidos de laboratorio. La tasa anual de no identificados fue de 9.8%, superior al máximo ac eptable, y entre abril a septiembre se observaron mayores valores promedio. El día de la semana con mayor tasa de no identificados fueron los lunes con un 14%. Se observó una relación estadísticamente significativa entre la tasa mensual de no identificados con la cantidad mensual de egresos d e unidades operativas (r = 0.6465; p = 0.0237) y con el giro cama (r = 0.7776; p = 0.0029). Se desconoce si hubo otros errores de identificación. El estudio permitió conocer fallas en la identificación de pacientes internados. Se recomienda monitorear el indicador especialmente durante los meses con mayor cantidad de egresos y giro cama, evaluar la adherencia del personal al protocolo vigente y realizar capacitaciones para lograr una menor tasa de no identificados.


Assuntos
Pacientes Internados , Sistemas de Identificação de Pacientes , Humanos , Estudos Retrospectivos
12.
Sensors (Basel) ; 21(6)2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33803913

RESUMO

The most frequent form of dementia is Alzheimer's Disease (AD), a severe progressive neurological pathology in which the main cognitive functions of an individual are compromised. Recent studies have found that loneliness and living in isolation are likely to cause an acceleration in the cognitive decline associated with AD. Therefore, understanding social behaviours of AD patients is crucial to promote sociability, thus delaying cognitive decline, preserving independence, and providing a good quality of life. In this work, we analyze the localization data of AD patients living in assisted care homes to gather insights about the social dynamics among them. We use localization data collected by a system based on iBeacon technology comprising two components: a network of antennas scattered throughout the facility and a Bluetooth bracelet worn by the patients. We redefine the Relational Index to capture wandering and casual encounters, these being common phenomena among AD patients, and use the notions of Relational and Popularity Indexes to model, visualize and understand the social behaviour of AD patients. We leverage the data analyses to build predictive tools and applications to enhance social activities scheduling and sociability monitoring and promotion, with the ultimate aim of providing patients with a better quality of life. Predictions and visualizations act as a support for caregivers in activity planning to maximize treatment effects and, hence, slow down the progression of Alzheimer's disease. We present the Community Behaviour Prediction Table (CBPT), a tool to visualize the estimated values of sociability among patients and popularity of places within a facility. Finally, we show the potential of the system by analyzing the Coronavirus Disease 2019 (COVID-19) lockdown time-frame between February and June 2020 in a specific facility. Through the use of the indexes, we evaluate the effects of the pandemic on the behaviour of the residents, observing no particular impact on sociability even though social distancing was put in place.


Assuntos
Doença de Alzheimer , Sistemas de Identificação de Pacientes , Comportamento Social , Doença de Alzheimer/diagnóstico , COVID-19 , Controle de Doenças Transmissíveis , Humanos , Qualidade de Vida
14.
J Am Med Inform Assoc ; 28(8): 1807-1811, 2021 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-33895827

RESUMO

Public health faces unprecedented challenges in its efforts to control COVID-19 through a national vaccination campaign. Addressing these challenges will require fundamental changes to public health data systems. For example, of the core data systems for immunization campaigns is the immunization information system (IIS); however, IISs were designed for tracking the vaccinated, not finding the patients who are high risk and need to be vaccinated. Health systems have this data in their electronic health records (EHR) systems and often have a greater capacity for outreach. Clearly, a partnership is needed. However, successful collaborations will require public health to change from its historical hierarchical information supply chain model to an ecosystem model with a peer-to-peer exchange with population health providers. Examples of the types of informatics innovations necessary to support such an ecosystem include a national patient identifier, population-level data exchange for immunization data, and computable electronic quality measures. Rather than think of these components individually, a comprehensive approach to rapidly adaptable tools for collaboration is needed.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/organização & administração , Colaboração Intersetorial , Administração em Saúde Pública , Informática em Saúde Pública , Interoperabilidade da Informação em Saúde , Humanos , Disseminação de Informação , Sistemas de Identificação de Pacientes
15.
Nagoya J Med Sci ; 83(1): 87-92, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33727740

RESUMO

The Joint Commission International (JCI) is a US-based organization that accredits and certifies hospitals worldwide. Among the requirements for accreditation, the JCI emphasizes continuous quality improvement (CQI) with regard to international patient safety goals (IPSGs). Our university hospital treats about 26,000 hospitalized patients and 600,000 outpatients annually, and our goal is patient safety in compliance with IPSGs. The purpose of this study is to examine the activities of orthopedic surgeons in preparation for JCI accreditation, including clear identification of patients, preoperative timeout and marking to ensure correct surgery, timely approval of CT/MRI reports, care with pain management, prevention of infection, setting of quality indicators and daily monitoring, and teamwork. Examiners from the JCI visited our hospital to review medical records and documents, and to interview patients, nurses and doctors. There were 1270 evaluation items covering 16 fields, including reviews of IPSGs, patient evaluation and care, infection prevention and control, and governance and leadership. Most importantly, the efforts of all the medical staff in our hospital in obtaining the first JCI accreditation among national university hospitals in Japan have promoted the safety and quality of medical care from the perspective of the patient.


Assuntos
Acreditação/normas , Hospitais Universitários , Cirurgiões Ortopédicos/normas , Segurança do Paciente/normas , Acidentes por Quedas/prevenção & controle , Infecção Hospitalar/prevenção & controle , Objetivos , Humanos , Internacionalidade , Japão , Joint Commission on Accreditation of Healthcare Organizations , Procedimentos Ortopédicos/normas , Sistemas de Identificação de Pacientes/estatística & dados numéricos , Relações Médico-Paciente , Indicadores de Qualidade em Assistência à Saúde , Estados Unidos
16.
Perspect Health Inf Manag ; 18(Winter): 1n, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33633524

RESUMO

Northeast Alabama Regional Medical Center (RMC) in Anniston, Alabama purchased a smaller hospital in 2017. Staff at the two hospitals were tasked with merging the two Electronic Medical Record (EMR) systems into one unified system. From the outset, there were two systems with different medical record number specifications and patient identification systems as well as two different patient name parameters. The merging of these records and systems meant dealing with different vendor EMR systems and ancillary systems to produce a single unified record within RMC's EMR and the document imaging system that housed the legal medical record for each patient. This case study describes the process and procedures of merging the patient records from both hospitals to create one Enterprise Master Patient Index (EMPI); and the collaboration between the Health Information Management and Information Technology departments to accomplish this goal. It also reviews the impact and challenges related to the system's development, as well as lessons learned while completing the project.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Administração Hospitalar , Sistemas de Identificação de Pacientes/organização & administração , Registros Eletrônicos de Saúde/normas , Humanos , Estudos de Casos Organizacionais , Sistemas de Identificação de Pacientes/normas
17.
Elife ; 102021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33620031

RESUMO

COVID-19 CG (covidcg.org) is an open resource for tracking SARS-CoV-2 single-nucleotide variations (SNVs), lineages, and clades using the virus genomes on the GISAID database while filtering by location, date, gene, and mutation of interest. COVID-19 CG provides significant time, labor, and cost-saving utility to projects on SARS-CoV-2 transmission, evolution, diagnostics, therapeutics, vaccines, and intervention tracking. Here, we describe case studies in which users can interrogate (1) SNVs in the SARS-CoV-2 spike receptor binding domain (RBD) across different geographical regions to inform the design and testing of therapeutics, (2) SNVs that may impact the sensitivity of commonly used diagnostic primers, and (3) the emergence of a dominant lineage harboring an S477N RBD mutation in Australia in 2020. To accelerate COVID-19 efforts, COVID-19 CG will be upgraded with new features for users to rapidly pinpoint mutations as the virus evolves throughout the pandemic and in response to therapeutic and public health interventions.


The discovery of faster spreading variants of the virus that causes coronavirus disease 2019 (COVID-19) has raised alarm. These new variants are the result of changes (called mutations) in the virus' genetic code. Random mutations can occur each time a virus multiplies. Although most mutations do not introduce any meaningful changes, some can alter the characteristics of the virus, for instance, helping the virus to spread more easily, reinfecting people who have had COVID-19 before, or reducing the sensitivity to treatments or vaccines. Scientists need to know about mutations in the virus that make treatments or vaccines less effective as soon as possible, so they can adjust their pandemic response. As a result, tracking these genetic changes is essential. But individual scientists or public health agencies may not have the staff, time or computer resources to extract usable information from the growing amount of genetic data available. A free online tool created by Chen et al. may help scientists and public health officials to track changes to the virus more easily. The COVID-19 CoV Genetics tool (COVID-19 CG) can quickly provide information on which virus mutations are present in an area during a specific period. It does this by processing data on mutations found in viral genetic material collected worldwide from hundreds of thousands of people with COVID-19, which are hosted in an existing online database. The COVID-19 CG tool presents customizable, interactive visualizations of the data. Thousands of scientists, public health agencies, and COVID-19 vaccine and treatment developers in over 100 countries are already using the COVID-19 CG tool to find the most common mutations in their area and use it for research. They can use this information to develop more effective vaccines or treatments. Chen et al. plan to update and improve the tool as more information becomes available to help advance global efforts to end the COVID-19 pandemic.


Assuntos
COVID-19/prevenção & controle , Biologia Computacional/métodos , Genoma Viral/genética , Mutação , SARS-CoV-2/genética , Sequência de Aminoácidos , Sítios de Ligação/genética , COVID-19/epidemiologia , COVID-19/virologia , Geografia , Saúde Global , Humanos , Internet , Pandemias , Sistemas de Identificação de Pacientes/métodos , Filogenia , SARS-CoV-2/classificação , SARS-CoV-2/fisiologia , Homologia de Sequência de Aminoácidos , Software , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/metabolismo
18.
J Am Coll Radiol ; 18(7): 937-946, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33607066

RESUMO

PURPOSE: Despite established guidelines, radiologists' recommendations and timely follow-up of incidental lung nodules remain variable. To improve follow-up of nodules, a system using standardized language (tracker phrases) recommending time-based follow-up in chest CT reports, coupled with a computerized registry, was created. MATERIALS AND METHODS: Data were obtained from the electronic health record and a facility-built electronic lung nodule registry. We evaluated two randomly selected patient cohorts with incidental nodules on chest CT reports: before intervention (September 2008 to March 2011) and after intervention (August 2011 to December 2016). Multivariable logistic regression was used to compare the cohorts for the main outcome of timely follow-up, defined as a subsequent report within 13 months of the initial report. RESULTS: In all, 410 patients were included in the pretracker cohort versus 626 in the tracker cohort. Before system inception, 30% of CT reports lacked an explicit time-based recommendation for nodule follow-up. The proportion of patients with timely follow-up increased from 46% to 55%, and the proportion of those with no documented follow-up or follow-up beyond 24 months decreased from 48% to 31%. The likelihood of timely follow-up increased 41%, adjusted for high risk for lung cancer and age 65 years or older. After system inception, reports missing a tracker phrase for nodule recommendation averaged 6%, without significant interyear variation. CONCLUSIONS: Standardized language added to CT reports combined with a computerized registry designed to identify and track patients with incidental lung nodules was associated with improved likelihood of follow-up imaging.


Assuntos
Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Idoso , Seguimentos , Humanos , Achados Incidentais , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Sistemas de Identificação de Pacientes , Sistema de Registros , Nódulo Pulmonar Solitário/diagnóstico por imagem
19.
Arch Dis Child ; 106(7): 648-651, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33419727

RESUMO

Most children in hospital who are clinically deteriorating are monitored regularly, and their treatment is escalated effectively. However a small, but significant, number of deteriorating children experience suboptimal outcomes because of a failure to recognise and respond to acute deterioration early enough leading to unintended harm. Tragically this occasionally can have fatal consequences. Investigations into these rare events highlight common themes of missed early signs of deterioration in children, prompting regulatory agencies to suggest paediatric early warning systems (PEWS) to aid clinical practice. In England, track and trigger tools (TTT), which are one facet of PEWS have been widely rolled out but in a heterogeneous fashion. The evidence for TTT is mixed but they are complex interventions and current outcomes do not fully define the entirety of their potential impact. This article explains the rationale behind the decision of the NHS England and NHS Improvement, Royal College of Paediatrics and Child Health and Royal College of Nursing to implement a standardised inpatient PEWS as part of a system-wide paediatric observations tracking system in England and how this fits into a wider programme of activity.


Assuntos
Saúde da Criança/normas , Hospitais Pediátricos/normas , Pacientes Internados/estatística & dados numéricos , Pediatria/organização & administração , Criança , Pré-Escolar , Deterioração Clínica , Escore de Alerta Precoce , Inglaterra/epidemiologia , Hospitais Pediátricos/organização & administração , Humanos , Lactente , Recém-Nascido , Monitorização Fisiológica , Sistemas de Identificação de Pacientes/métodos , Índice de Gravidade de Doença
20.
Acta Neurochir (Wien) ; 163(4): 879-884, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33515122

RESUMO

BACKGROUND: Holographic neuronavigation has several potential advantages compared to conventional neuronavigation systems. We present the first report of a holographic neuronavigation system with patient-to-image registration and patient tracking with a reference array using an augmented reality head-mounted display (AR-HMD). METHODS: Three patients undergoing an intracranial neurosurgical procedure were included in this pilot study. The relevant anatomy was first segmented in 3D and then uploaded as holographic scene in our custom neuronavigation software. Registration was performed using point-based matching using anatomical landmarks. We measured the fiducial registration error (FRE) as the outcome measure for registration accuracy. A custom-made reference array with QR codes was integrated in the neurosurgical setup and used for patient tracking after bed movement. RESULTS: Six registrations were performed with a mean FRE of 8.5 mm. Patient tracking was achieved with no visual difference between the registration before and after movement. CONCLUSIONS: This first report shows a proof of principle of intraoperative patient tracking using a standalone holographic neuronavigation system. The navigation accuracy should be further optimized to be clinically applicable. However, it is likely that this technology will be incorporated in future neurosurgical workflows because the system improves spatial anatomical understanding for the surgeon.


Assuntos
Realidade Aumentada , Holografia/métodos , Neuronavegação/métodos , Sistemas de Identificação de Pacientes/métodos , Software , Leitos , Feminino , Humanos , Masculino
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