Surface and Bulk Oxygen Kinetics of BaCo0.4Fe0.4Zr0.2-XYXO3-δ Triple Conducting Electrode Materials.

Triple ionic-electronic conductors have received much attention as electrode materials. In this work, the bulk characteristics of oxygen diffusion and surface exchange were determined for the triple-conducting BaCo0.4Fe0.4Zr0.2-XYXO3-δ suite of samples. Y substitution increased the overall size of the lattice due to dopant ionic radius and the concomitant formation of oxygen vacancies. Oxygen permeation measurements exhibited a three-fold decrease in oxygen permeation flux with increasing Y substitution. The DC total conductivity exhibited a similar decrease with increasing Y substitution. These relatively small changes are coupled with an order of magnitude increase in surface exchange rates from Zr-doped to Y-doped samples as observed by conductivity relaxation experiments. The results indicate that Y-doping inhibits bulk O2- conduction while improving the oxygen reduction surface reaction, suggesting better electrode performance for proton-conducting systems with greater Y substitution.

Clinical vocabulary as a boundary object in multidisciplinary care management of multiple chemical sensitivity, a complex and chronic condition.

BACKGROUND: Research has shown that accurate and timely communication between multidisciplinary clinicians involved in the care of complex and chronic health conditions is often challenging. The domain knowledge for these conditions is heterogeneous, with poorly categorized, unstructured, and inconsistent clinical vocabulary. The potential of boundary object as a technique to bridge communication gaps is explored in this study. METHODS: A standardized and controlled clinical vocabulary was developed as a boundary object in the domain of a complex and chronic health condition, namely, multiple chemical sensitivity, to improve communication among multidisciplinary clinicians. A convenience sample of 100 patients with a diagnosis of multiple chemical sensitivity, nine multidisciplinary clinicians involved in the care of patients with multiple chemical sensitivity, and 36 clinicians in the community participated in the study. RESULTS: Eighty-two percent of the multidisciplinary and inconsistent vocabulary was standardized using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED(®) CT as a reference terminology. Over 80% of the multidisciplinary clinicians agreed on the overall usefulness of having a controlled vocabulary as a boundary object. Over 65% of clinicians in the community agreed on the overall usefulness of the vocabulary. CONCLUSION: The results from this study are promising and will be further evaluated in the domain of another complex chronic condition, ie, chronic pain. The study was conducted as a preliminary analysis for developing a boundary object in a heterogeneous domain of knowledge.

An evaluation of SNOMED CT in the domain of complex chronic conditions.

OBJECTIVE: To determine the content coverage in SNOMED CT to represent the multidisciplinary terms and concepts in the domain for complex chronic conditions. METHODS: An evaluation of the coverage of multidisciplinary health factors in SNOMED CT for the complex and chronic condition, multiple chemical sensitivity (MCS) is conducted in the study. The methodology included a retrospective audit of patient charts and feedback from multidisciplinary clinicians in the creation of a controlled vocabulary used in the generation of patient profiles for MCS. Clinicians and experts in the field reviewed and tested the vocabulary for its usefulness (scope, specificity and structure) by re-coding three patient profiles using the vocabulary. Cohen's kappa analysis was conducted to determine inter-rater reliability. Cronbach's alpha analysis was conducted to determine the internal reliability of the survey questionnaire. RESULTS: One hundred patient charts and nine clinicians from varying health disciplines participated in the study. SNOMED CT was shown to capture nearly 82% of the concepts spanning multidisciplinary areas of health focus. The nutrition area of health focus had the highest level of exact matches. Furthermore, post-coordination was applied in an attempt to improve coverage of concepts to 75% (of 45 terms) of the missing terms in SNOMED CT. Seventy-five percent (n=9) of the clinicians agreed on the overall usefulness of the vocabulary. CONCLUSIONS: SNOMED CT had a reasonable coverage of the multidisciplinary health concepts required to describe a complex and chronic condition. Standardizing the multidisciplinary vocabulary with reference tag to a widely used reference terminology, such as SNOMED CT to discuss the terms and concepts used may improve the understanding across disciplines and communities of practice. Overall, based on the availability of concepts in SNOMED CT and the feedback from clinicians, the approach looks promising and should be further explored.

Perceptual reasons for resistance to change in the emergency department use of holding chambers for children with asthma.

STUDY OBJECTIVE: We explore perceptions surrounding use of portable inhalers and holding chambers (spacers) for delivery of beta-agonist respiratory medications to children in the emergency department (ED) and factors influencing practice change. METHODS: This was a qualitative study guided by principles of grounded theory. Data were collected through focus groups and individual interviews at 2 sites in eastern Canada: Hospital A, where inhalers and holding chambers are used routinely; and Hospital B, where prevailing practice is the use of nebulization. Participant encounters were transcribed verbatim and analyzed for emerging themes. RESULTS: At Hospital A, 6 physicians and 7 nurses participated in separate focus groups. Four interviews were conducted with physician, nurse, respiratory therapy, and pharmacy leaders. At Hospital B, 4 physicians and 3 nurses participated in focus groups, and 6 leaders were interviewed. Perceptions negatively influencing the adoption of inhalers and holding chambers included increased workload, increased equipment costs, myths about the superiority of nebulization, and interprofessional conflict. Health professionals reported that their most prominent concern about administering medications with inhalers and holding chambers was the time demand. Nurses especially seemed to think this way, tipping the balance in favor of nebulization despite knowledge of evidence to the contrary and affecting physician decisionmaking as well. Professional territorialism appeared to hinder efforts to ameliorate workload issues through the use of respiratory therapists in the ED. CONCLUSION: Findings from this study could be used to inform a change program to close the gap between evidence and practice with respect to use of inhalers and holding chambers in the ED.

Evaluation of accuracy of drug interaction alerts triggered by two electronic medical record systems in primary healthcare.

This article presents a study to evaluate the accuracy of drug interaction (DI) alerts triggered by two electronic medical record (EMR) systems in primary healthcare. A scenario-based software architecture analysis methodology (SAAM) was used with drug-drug interaction (DDI) pairs in hypothetical patient scenarios. A literature search identified common drugs used in the management of conditions in the elderly population. Three reference programs determined the level of severity of drug interactions, and a common severity rating scale was adapted. The EMR systems showed a limited potential to identify 'severe' clinically significant DDIs and considerable probability for triggering spurious alerts. This may explain the overriding of DI alerts and the interruption of the workflow of users of EMR systems. Reasons for EMR system deficiency included unavailable updates or programming, database functioning discrepancies, and controversies in the clinical evidence.

Applications of artificial intelligence systems in the analysis of epidemiological data.

A brief review of the germane literature suggests that the use of artificial intelligence (AI) statistical algorithms in epidemiology has been limited. We discuss the advantages and disadvantages of using AI systems in large-scale sets of epidemiological data to extract inherent, formerly unidentified, and potentially valuable patterns that human-driven deductive models may miss.

Are you speeding toward revenue loss?

An examination of data from more than 100 hospitals shows providers can significantly improve their bottom lines by shifting their claims management focus from speed to accuracy. Revenue opportunities are greatest among prebilling activities, such as documentation, coding, charge description master maintenance, charge capture, and bill presentation.