The meaningful use of EMR in Chinese hospitals: a case study on curbing antibiotic abuse.

Comprehensive electronic medical records (EMR) have proven to be an effective tool for improving the safety and quality of healthcare. In particular, EMR has resulted in a significant reduction in antibiotic consumption and an improvement in rational antibiotic use. This study focused on evaluating the effectiveness of using a comprehensive EMR system to curb antibiotic abuse. A retrospective "before/after" investigation was conducted in an 850-bed nonprofit hospital. A comprehensive EMR was implemented to improve the management of medical practices during treatment and to track antibiotic prescriptions. Patient records on antibiotic use were identified by searching the hospital database from April 1 to October 30, 2011 (post-implementation) and compared with those of patients from April 1 to October 30, 2010 (pre-implementation). Outcome measures were defined daily doses (DDDs) of antibiotics per 1,000 patient-days and factors that influenced antibiotic consumption. Antibiotic consumption during the seven months with EMR management decreased from 727 DDDs to 480 DDDs per 1,000 patient-days (p < 0.001). The decreases in cefminox, cefoperazone combinations, cefixime, and gentamicin were notably significant. The type of medical insurance, patient age, and ordering department (importance coefficients of 0.1935, 0.1818 and 0.1756, respectively) were the most significant factors that influenced antibiotic consumption. An improvement in the rational antibiotic use was also observed in the length of antibiotic therapy, selection of appropriate antibiotic level, route of administration, and so on. Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use.

Internal hemipelvectomy with reconstruction for primary pelvic neoplasm: a systematic review.

BACKGROUND: Hemipelvectomy is a major operation with significant risks including infection, prosthesis failure and fracture. This systematic review was designed to review the functional outcomes, oncologic outcomes and complications in patients who received internal hemipelvectomy and pelvic reconstruction for primary pelvic tumour. METHODS: Searches on MEDLINE, the Cochrane Library, Embase and Google Scholar were performed to locate studies involving patients receiving internal hemipelvectomy and pelvic reconstruction using a prosthesis, implant or bone graft. All studies were either prospective or retrospective observational studies published in English. RESULTS: This systematic review included 12 studies from 1990 to 2011 involving 217 patients from 5 to 77 years of age who had received follow-up for a period from 3 weeks to 15 years. Among the 12 studies, the mortality rate, disease-free rate and incidence of local recurrence were 10-69.2, 23.1-90.0 and 9.1-41.7%, respectively. The post-operative Musculoskeletal Tumor Society (MSTS) functional score ranged from 50 to 70 in the more recent studies. Compared with prostheses and other implants, patients who received allografts had the highest post-operative function, as shown by their MSTS scores, but also had a greater incidence of post-operative infection. On the other hand, the prosthesis group was associated with the highest percentage of fracture and dislocations, as well as other significant complications. CONCLUSION: This comprehensive review provided informative details regarding the goals, outcomes and complications associated with this procedure and underscored the need for further investigation into the various surgical approaches currently available.