Implementation of an electronic health record system during global surgical outreach: A prospective evaluation of success and sustainability.

BACKGROUND: The burden of musculoskeletal conditions continues to grow in low- and middle-income countries. Among thousands of surgical outreach trips each year, few organizations electronically track patient data to inform real-time care decisions and assess trip impact. We report the implementation of an electronic health record (EHR) system utilized at point of care during an orthopedic surgical outreach trip. METHODS: In March 2023, we implemented an EHR on an orthopedic outreach trip to guide real-time care decisions. We utilized an effectiveness-implementation hybrid type 3 design to evaluate implementation success. Success was measured using outcomes adopted by the World Health Organization, including acceptability, appropriateness, feasibility, adoption, fidelity, and sustainability. Clinical outcome measures included adherence to essential quality measures and follow-up numerical rating system (NRS) pain scores. RESULTS: During the 5-day outreach trip, 76 patients were evaluated, 25 of which underwent surgery beforehand. The EHR implementation was successful as defined by: mean questionnaire ratings of acceptability (4.26), appropriateness (4.12), feasibility (4.19), and adoption (4.33) at least 4.00, WHO behaviorally anchored rating scale ratings of fidelity (6.8) at least 5.00, and sustainability (80%) at least 60% follow-up at 6 months. All clinical quality measures were reported in greater than 80% of cases with all measures reported in 92% of cases. NRS pain scores improved by an average of 2.4 points. CONCLUSIONS: We demonstrate successful implementation of an EHR for real-time clinical use on a surgical outreach trip. Benefits of EHR utilization on surgical outreach trips may include improved documentation, minimization of medical errors, and ultimately improved quality of care.

Body dissatisfaction, neuroticism, and female sex as predictors of calorie-tracking app use amongst college students.

Objective: This study investigated body dissatisfaction, neuroticism, and sex as potential predictors of calorie-tracking app usage amongst undergraduate college students. Participants: College students (N = 491) were recruited from a large northeastern university in October 2015. Methods: Participants completed an online survey asking about their sex, body dissatisfaction, neuroticism, and use of apps that track calories. Results: Analyses revealed that female sex and body dissatisfaction-but not neuroticism-were direct predictors of calorie-tracking app usage. Analyses also provided support for a causal sequence wherein neuroticism and body dissatisfaction mediate, in serial, the relationship between female sex and calorie-tracking app usage. Conclusions: The results from this study suggest that female college students are more likely to use calorie-tracking apps-a phenomenon which may be attributable to their higher levels of neuroticism and subsequent increased body dissatisfaction.