Clinical impact and value of workstation single sign-on.

BACKGROUND: CHRISTUS Health began implementation of computer workstation single sign-on (SSO) in 2015. SSO technology utilizes a badge reader placed at each workstation where clinicians swipe or "tap" their identification badges. OBJECTIVE: To assess the impact of SSO implementation in reducing clinician time logging in to various clinical software programs, and in financial savings from migrating to a thin client that enabled replacement of traditional hard drive computer workstations. METHODS: Following implementation of SSO, a total of 65,202 logins were sampled systematically during a 7day period among 2256 active clinical end users for time saved in 6 facilities when compared to pre-implementation. Dollar values were assigned to the time saved by 3 groups of clinical end users: physicians, nurses and ancillary service providers. RESULTS: The reduction of total clinician login time over the 7day period showed a net gain of 168.3h per week of clinician time - 28.1h (2.3 shifts) per facility per week. Annualized, 1461.2h of mixed physician and nursing time is liberated per facility per annum (121.8 shifts of 12h per year). The annual dollar cost savings of this reduction of time expended logging in is $92,146 per hospital per annum and $1,658,745 per annum in the first phase implementation of 18 hospitals. Computer hardware equipment savings due to desktop virtualization increases annual savings to $2,333,745. Qualitative value contributions to clinician satisfaction, reduction in staff turnover, facilitation of adoption of EHR applications, and other benefits of SSO are discussed. CONCLUSIONS: SSO had a positive impact on clinician efficiency and productivity in the 6 hospitals evaluated, and is an effective and cost-effective method to liberate clinician time from repetitive and time consuming logins to clinical software applications.

Tackling the burden of the hepatitis C virus in the UK: characterizing and assessing the clinical and economic consequences.

OBJECTIVES: The hepatitis C virus (HCV) remains a significant public health issue. This study aimed to quantify the clinical and economic burden of chronic hepatitis C in the UK, stratified by disease severity, age and awareness of infection, with concurrent assessment of the impact of implementing a treatment prioritization approach. STUDY DESIGN AND METHODS: A previously published back projection, natural history and cost-effectiveness HCV model was adapted to a UK setting to estimate the disease burden of chronic hepatitis C and end-stage liver disease (ESLD) between 1980 and 2035. A published meta-regression analysis informed disease progression, and UK-specific data informed other model inputs. RESULTS: At 2015, prevalence of chronic hepatitis C is estimated to be 241,487 with 22.20%, 33.72%, 17.22%, 16.67% and 10.19% of patients in METAVIR stages F0, F1, F2, F3 and F4, respectively, but is estimated to fall to 193,999 by 2035. ESLD incidence is predicted to peak in 2031. Assuming all patients are diagnosed and treatment is prioritized in F3 and F4 using highly efficacious direct-acting antiviral (DAA) regimens, a 69.85% reduction in ESLD incidence is predicted between 2015 and 2035, and the cumulative discounted medical expenditure associated with the lifetime management of incident ESLD events is estimated to be £1,202,827,444. CONCLUSIONS: The prevalence of chronic hepatitis C is expected to fall in coming decades; however, the ongoing financial burden is expected to be high due to an increase in ESLD incidence. This study highlights the significant costs of managing ESLD that are likely to be incurred without the employment of effective treatment approaches.

Hybrid quantum logic and a test of Bell's inequality using two different atomic isotopes.

Entanglement is one of the most fundamental properties of quantum mechanics, and is the key resource for quantum information processing (QIP). Bipartite entangled states of identical particles have been generated and studied in several experiments, and post-selected or heralded entangled states involving pairs of photons, single photons and single atoms, or different nuclei in the solid state, have also been produced. Here we use a deterministic quantum logic gate to generate a 'hybrid' entangled state of two trapped-ion qubits held in different isotopes of calcium, perform full tomography of the state produced, and make a test of Bell's inequality with non-identical atoms. We use a laser-driven two-qubit gate, whose mechanism is insensitive to the qubits' energy splittings, to produce a maximally entangled state of one (40)Ca(+) qubit and one (43)Ca(+) qubit, held 3.5 micrometres apart in the same ion trap, with 99.8 ± 0.6 per cent fidelity. We test the CHSH (Clauser-Horne-Shimony-Holt) version of Bell's inequality for this novel entangled state and find that it is violated by 15 standard deviations; in this test, we close the detection loophole but not the locality loophole. Mixed-species quantum logic is a powerful technique for the construction of a quantum computer based on trapped ions, as it allows protection of memory qubits while other qubits undergo logic operations or are used as photonic interfaces to other processing units. The entangling gate mechanism used here can also be applied to qubits stored in different atomic elements; this would allow both memory and logic gate errors caused by photon scattering to be reduced below the levels required for fault-tolerant quantum error correction, which is an essential prerequisite for general-purpose quantum computing.

An assessment of the efficiency of the Glostavent ventilator.

In parts of the world where supplies of oxygen and electricity are erratic, ventilating patients' lungs can be problematic. Should the electricity supply fail, gas driven ventilators have an advantage as they can continue functioning. However, many are extravagant in their requirement for the driving gas. The Glostavent ventilator was designed to minimise these requirements. We measured the duration of ventilation achieved by the Glostavent ventilator using an E-size oxygen cylinder at a range of minute volumes, and the inspired oxygen concentration achieved by recycling the driving gas. The period of mechanical ventilation from a single E-size cylinder ranged from 11 h 8 min (SD 4 min) with a minute volume of 7 l min(-1) to 18 h 15 min (SD 7 min) with a minute volume of 3 l min(-1). The mean fractional inspired oxygen concentration achieved by recycling the driving gas without further inspired oxygen supplementation was 0.33. We conclude that the Glostavent ventilator performs as efficiently and cost effectively as predicted.

Financial modelling of the potential cost of ovine Johne's disease and the benefit of vaccinating sheep flocks in southern New South Wales.

OBJECTIVE: To develop an enterprise gross margin (GM) model that predicts the on-farm financial impact of ovine Johne's disease (OJD) for various sheep enterprises in Australia. In addition, to estimate the benefits and costs of control through the use of the Gudair vaccination, including a breakeven point. DESIGN AND POPULATION: Data for the model was gained from an observational study conducted over a 3-year period from 2002 to 2004 using sheep from 12 OJD-infected flocks from southern New South Wales. Flocks ranged between 3500 and 20,000 sheep, with owner estimates of 5% or greater OJD mortality at the start of the study. PROCEDURE: A GM model was developed to predict the on-farm financial impact of OJD for various sheep enterprises in Australia, comparing non-infected, infected (status quo) and infected (vaccination) disease scenarios. RESULTS: Vaccination breakeven points are achieved within 2 to 3 years for breeding enterprises if OJD mortalities are high, rising towards 7 years for a Merino ewe enterprise if OJD mortalities are low. CONCLUSION: The GM model demonstrates the returns to investment of vaccination for Australian sheep producers with OJD-infected flocks.

Comparing the mental health needs of female and male incarcerated juvenile delinquents.

The present study was undertaken to survey the prevalence of mental disorder in juvenile justice facilities and to compare the mental health needs for females and males. Girls displayed significantly more mental health needs than boys. The estimated prevalence of mental disorder for boys was 27%, compared with 84% for girls. The difference is highly significant and is discussed in terms of service system issues in juvenile justice that affect males and females differently.

Professional ethics and managed care in dermatology.

The way health care is financed in the United States is changing quickly. Fee-for-service arrangements in which health care providers exercised great autonomy over health care services financed by third-party payers is quickly giving way to a variety of managed care approaches. The driving force behind this change is the desire to control the growth of health care cost. In the simplest term, costs are controlled in a managed care system by controlling the provision of services. Broadly speaking, 1 of 2 methods is used to control costs. Either physician behavior or subscriber behavior is modified or limited.

Strategic planning in competitive environments.

Private voluntary social welfare organizations (PVSOs) are operating under increasingly competitive conditions. "Strategic Planning" (SP) is a management tool designed to meet those conditions. In an exploratory study of 154 PVSOs the authors examined management's reasons for adopting strategic planning, the attention given to external analysis, and the degree of change and satisfaction achieved. PVSOs use SP because they are required/urged to do so by external agencies. External analysis received the least attention. One-half of the organizations achieved major change which was associated with high levels of satisfaction. Widespread stakeholder participation and the use of consensus strategies detracted from both major change and high satisfaction outcomes.

Psychophysiological assessment of sex offenders in a security hospital.

A study on the sexual orientation and responsiveness of sexual offenders in a maximum security hospital who had been referred to the Psychology Department for sexual assessment is described. Correlations between "felt sexual arousal" ratings and penis diameter increase were calculated to assess validity, but a high proportion of detained patients gave results which could be interpreted as indicating defensiveness or faking. Groups of sexual offenders (against women, girls, boys, and men), nonsexual attackers of women, and typical heterosexuals were compared on their profiles of response to films showing consenting adult heterosexual, adult homosexual, and boy homosexual activity, girl abduction, and girl rape. Groups did not differ on the consenting heterosexual activity film, but typical heterosexuals and nonsexual attackers of women showed significantly less response to the film of girl abduction (p less than 0.001) and rape (p less than 0.001) than did groups of sex offenders generally.

Assessment of small bowel function in the elderly using a modified xylose tolerance test.

Using the combined results of oral and intravenous xylose tests, it is demonstrated that 26 percent of a group of geriatric patients absorb from the small bowel less efficiently than younger subjects. The method used excludes poor renal function and incomplete bladder emptying as possible causes for the differences found between the two age groups. Altered gastric emptying is also excluded as a possible factor.