Conservative management of an advanced external cervical resorption with internal approach using bio-ceramic materials: A case report.

Key clinical message: A successful management of an advanced external cervical resorption using a conservative approach with CBCT, dental operating microscope, and a new bio-ceramic material. Abstract: External cervical resorption (ECR) is a pathologic condition that is initiated on the external aspect of the root, below the epithelial attachment in the cervical position. This article will report a case of external cervical resorption (ESR) in an advanced stage, which was asymptomatic and was incidentally detected in a follow-up radiograph after the end of orthodontic treatment. Cone-beam computed tomography (CBCT) was prescribed to accurately diagnose the resorptive lesion and differentiate it from internal root resorption (IRR), and the final diagnosis was Heithersay's class IV ECR. Considering the health of the periodontium and the absence of attachment loss, it was decided to use a conservative internal approach to the management of this case. After the treatment, the patient was asymptomatic and the radiographic examinations showed no signs of peri-radicular pathology during the follow-up period. With the correct case selection and the availability of the appropriate materials and equipment such as a dental operating microscope (DOM) and bio-ceramic materials, the internal approach can be a successful and minimally invasive treatment, even for the management of advanced ECR cases.

Comparison of the accuracy of inpatient morbidity coding with ICD-11 and ICD-10.

BACKGROUND: One of the challenges when transitioning from International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) to International Classification of Diseases, 11th Revision (ICD-11) is to ensure clinical coding accuracy. OBJECTIVE: To determine the accuracy of clinical coding with ICD-11 in comparison with ICD-10 and identify causes of coding errors in real clinical coding environments. METHOD: The study was conducted prospectively in two general hospitals. Medical records of discharged inpatients were coded by hospital clinical coders with both ICD-11 and ICD-10 on different days. These medical records were recoded by five mentors. Codes assigned by mentors were used as the gold standard for the evaluation of accuracy. RESULTS: The accuracy of ICD-10 and ICD-11 coding for 1578 and 2168 codes was evaluated. Coding accuracy was 89.1% and 74.2% for ICD-10 and ICD-11. In ICD-11, the lowest accuracy was observed in chapters 22 (injuries), 10 (ear) and 11 (circulatory) (51.1%, 53.8% and 62.7%, respectively). In both ICD-10 and ICD-11, the most important cause of the coding errors was clinical coders' mistakes (79.5% and 81.8% for ICD-10 and ICD-11, respectively). CONCLUSION: Accuracy of clinical coding with ICD-11 was lower relative to ICD-10. Hence, it is essential to carry out initial preparations, particularly the training of clinical coders based on their needs, as well as the necessary interventions to enhance the documentation of medical records according to ICD-11 before or simultaneous with the country-wide implementation. IMPLICATIONS: Clinical coders need complete training, especially in using extension codes and post-coordination coding. Local ICD-11 guidelines based on the needs of local users and reporting policies should be developed. Furthermore, documentation guidelines based on ICD-11 requirements should be developed.

Establishment of Iran Musculoskeletal Tumor Registry: A Study Protocol and Lessons Learned from Implementation and the Pilot Phase.

Background: The number of available musculoskeletal tumor registries is relatively small. We developed a registry system focused on the clinical aspects of musculoskeletal tumors to improve quality of care indexes through the development of updated national protocols. In this study, we describe our protocol, challenges, and the data collected during the implementation of the registry system in a single-specialty orthopedic center in Iran. Methods: Three main malignant bone tumors, including osteosarcoma, Ewing sarcoma, and chondrosarcoma, were included in the registry. After establishing a steering committee, we defined the minimum data set based on a literature review and suggestions from an expert panel. Accordingly, the data collection forms and the web-based software were developed. The collected information was categorized into 9 classes, including demographics, socioeconomic data, signs and symptoms, past medical history, family history, laboratory tests, tumor characteristics, primary treatment, and follow-up. Data collection was performed both retrospectively and prospectively. Results: Until September 21, 2022, a total of 71 patients were registered (21 patients prospectively and 50 patients retrospectively) and consisted of 36 (50.7%) cases of osteosarcoma, 13 (18.3%) cases of Ewing sarcoma, and 22 (31%) cases of chondrosarcoma. The implementation of the registry demonstrated promising data regarding the tumor characteristics, delay patterns, and socioeconomic status of the patients. Conclusion: The main lessons learned were to develop a monitoring system to make sure that the new staff is adequately trained for the registration process as well as avoid the inclusion of time-consuming useless data in the minimum data set.

Nurses' Viewpoints on Barriers and Facilitators to Use Hospital Information Systems.

In this qualitative study, we explored the nurses' experience in using hospital information systems (HIS) to identify barriers and facilitators of using this system. We interviewed twenty one purposefully-selected nurses who have experience in using HIS and analyzed the data using conventional content analysis. We identified 17 facilitators and 12 barriers classified into main themes. Lack of support for nurses, their resistance, any force for using HIS, perceived difficulty of using HIS, inadequate system quality, data loss, discontinuity of information in different systems are the main barriers. However, considering nurses' perspectives, pilot implementation of HIS, training, planned implementation, appropriate financial and non-financial incentives, adding new and appropriate functionalities, increased ease of use and usability, easy access to information, improved data quality in HIS, and saving nurses' working time through using HIS result in increased adoption the system to use.

Effects of Using Hospital Information Systems on Nurses' Individual Performance: A Study on Influential Factors.

We investigated the use of hospital information systems (HIS) among nurses and its effect on their individual performance. We combined UTAUT and Delone & McLean models and developed a questionaire and collected 173 questionaires from nurses. We found that effort expectancy, information quality, performance expectancy and system quality positively influence nurses' intention to use HIS. In addition, nurses' intention to use and facilitators conditions positively direct their actual use. Information quality, service quality and system quality significantly increase nurses' satisfaction with HIS. Lastly, nurses' satisfaction with HIS and their actual use positively improves their individual performance in working with HIS.

Electronic Medical Records for Mental Disorders: What Data Elements Should These Systems Contain?

Identifying data elements of electronic medical record systems (EMRs) is one of the essential steps for the comprehensive and proper health data collection. The aim of this study was to determine the data elements required for EMRs in the field of mental disorders. We conducted a literature review and also we randomly selected 50 medical records of patients with mental disorders to identify a preliminary list of essential data elements for EMRs for mental disorders. Then, 33 mental health specialists were surveyed to validate the list of data elements through a questionnaire. We identified that health data elements of EMRs for patients with mental disorders can be categorized into seven classes (demographic data of patients, administrative data of physicians, administrative data of patients, history, clinical data, treatment, and financial data) and 10 subclasses. After the validation process, 140 essential data elements for EMRs for patients with mental disorders were introduced.

Performance of Hospitals in Protecting the Confidentiality and Information Security of Patients in Health Information Departments.

Keeping health information confidential is an important aspect of managing health information. This study aimed at determining the performance of health information management departments (HIMD) to identify the policies of these hospitals, their similarities, and differences in their procedures in this respect. Managers of the departments and information disclosure and medical record staff in 22 teaching hospitals were invited to complete a questionnaire regarding their practices in four axes including confidentiality principles, principles of disclosure consent, disclosure information to external and internal users. We found that there are no specific national framework and guidelines for the disclosure of health information. Hospitals are undertaking different ways in this regard. In most cases, patients' consent is not considered necessary for disclosure and only hospital managers' or physicians' consent is sufficient.

Eye Health Information Systems in Selected Countries.

One of the important factors for achieving "Vision 2020" targets is the availability and accessibility of eye health information systems. This study aimed to describe eye health information systems in selected countries. The status of eye health information systems in Australia, the United States, and England was reviewed. Data were gathered from the PubMed, Scopus, and ScienceDirect databases. The main key terms used included, but were not limited to "National Action plan", "Eye Health Information System", "Database", and "Registery". Also, the websites of the World Health Organization, the International Agency for the Prevention of Blindness, and Departments of Health in the selected countries were accessed. Fifty documents and articles of 170 retrieved references related to the research goals were used in this study. In all three countries, the issue of eye health is considered to be a national health priority. Concerning data gathering, the most common point in these countries was data gathered directly (health information systems, eye registries) and indirectly (studies, projects, and surveillance systems) by the organizations that participated in eye health programs. Producing accessible, timely, and highly quality information about eye health is one of the most important goals in the formation of eye health information systems in the selected countries, which facilitates achievement of the goals of the "Vision 2020: The Right to Sight" initiative.

Barriers for Implementation and Use of Health Information Systems from the Physicians' Perspectives.

This study aimed to investigate barriers to the implementation and use of health information systems (HIS) in Iran by physician's view. This cross-sectional study was conducted in 2016 on 163 physicians employed in 10 teaching hospitals. Data collection was carried out through a questionnaire with questions about the technical, organizational, ethical and personal barrier categories. Data analysis demonstrated that technical (e.g. inadequate planning for implementation and use of HIS) (3.56±1.32), organizational (e.g. inadequate facilities for fast and easy access to the Internet) (3.67±1.91), personal (e.g. inadequate awareness of healthcare providers about the benefits of HIS) (3.33±1.28), as well as legal and ethical (e.g. concern about the security and confidentially of HIS) (3.15±1.31) were the most important barriers to the implementation and use of HIS. Reducing barriers, especially technical and personal ones will increase the implementation and use of HIS based on the physicians' perspectives.

Benefits of Using Mobile Technologies in Education from the Viewpoints of Medical and Nursing Students.

Increasing the use of mobile phones in education depends on the understanding of its benefits. The purpose of this study was to assess the vision of medical and nursing students about the benefits of using mobile technology in education. This study was conducted on medical and nursing students in 8 hospitals affiliated to Tehran University of Medical Sciences in 2016. 372 students participated in the study. Data were collected by a questionnaire consisting of 11 questions in Likert scale. Students' efficiency, improvement in quality of care, faster access to information and the positive effect on education were emphasized. Nursing students have more positive attitude regarding the use of this technology to save time at the time of providing services, faster access to patient information and influence on education. In summary, students considered mobile technology to be useful for educational purposes, so by eliminating the barriers in this field, it is possible to promote mobile learning for medical and nursing students.