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Journal of Multidisciplinary Healthcare 2023Adverse incidents in nursing home (NH) may occur as the result of inadequate monitoring for signs of unobservable initial complications, medical errors, improper nursing...
INTRODUCTION
Adverse incidents in nursing home (NH) may occur as the result of inadequate monitoring for signs of unobservable initial complications, medical errors, improper nursing interventions, lack of communication, and inadequate reporting.
PURPOSE
This study explores incident types, causes, handling, and documentation in Indonesian NHs through a qualitative approach.
PATIENTS AND METHODS
In-depth interviews were conducted with 23 NH staff members, including managers, nurses, and support staff.
RESULTS
Five themes and 17 sub-themes emerged, with falls and resident-to-resident abuse as common adverse incidents. Causes included older adults' conditions, environment, and misunderstanding. Follow-up action included first aid, hospital referrals, and assertive communication. Adverse incidents were actively reported through verbal and written reports or WhatsApp groups. Reports and documentation remain unstructured, however, as there were no standard operating procedures regarding incident reporting, documentation, and the types of adverse incidents that staff should report.
CONCLUSION
Improvements in management, documentation, and reporting adverse incidents are highlighted in this research. Practitioners, nurses, and social workers should develop guidelines for handling, reporting, and documenting adverse incidents in NHs.
PubMed: 37964796
DOI: 10.2147/JMDH.S436766 -
Improving feedback students receive on documentation during the obstetrics and gynecology clerkship.AJOG Global Reports Nov 2022Students need feedback on written documentation to optimize their long-term development of this important clinical skill. The culture in surgical specialties does not...
BACKGROUND
Students need feedback on written documentation to optimize their long-term development of this important clinical skill. The culture in surgical specialties does not always prioritize feedback regarding this skill.
OBJECTIVE
This study aimed to examine the effectiveness of 2 specific forms to improve the quantity and quality of feedback to students about their medical documentation.
STUDY DESIGN
In a multiphase quality improvement project, medical students were surveyed after the obstetrics and gynecology clerkship regarding their experience of receiving feedback on written notes. The proportions of students who received feedback on notes and those rating the feedback as meaningful were measured before and after the implementation of a required, formative feedback card. In phase 2, students were randomized to use a simplified feedback card or the original detailed card, and outcomes were compared. This study was conducted at the Medical University of South Carolina, a tertiary care academic medical center. The participants included third-year medical students that completed their 6-week obstetrics and gynecology clerkship.
RESULTS
Before the intervention, of 82 students, 70 (85%) and 55 (67%) received feedback on written notes in the inpatient and outpatient settings, respectively, which increased to 99.6% (254/255) and 98.5% (251/255) (<.001) after the implementation of any feedback card. Moreover, the proportion of students who felt the feedback helped them improve their clinical documentation skills increased from 72% to 90% (<.001) with the use of a feedback card. These improvements were noted in all clinical units within the clerkship. There was no difference (=.3) in outcomes between the simplified and detailed cards.
CONCLUSION
A formative card is a simple, cost-effective, low-resource intervention that can increase both the quantity and quality of written note feedback that students receive during their obstetrics and gynecology clerkship. A less detailed card achieved comparable outcomes and increased faculty satisfaction.
PubMed: 36311295
DOI: 10.1016/j.xagr.2022.100117 -
MedRxiv : the Preprint Server For... Oct 2023Headache frequency, defined as the number of days with any headache in a month (or four weeks), remains a key parameter in the evaluation of treatment response to...
A Large Language Model-Based Generative Natural Language Processing Framework Finetuned on Clinical Notes Accurately Extracts Headache Frequency from Electronic Health Records.
BACKGROUND
Headache frequency, defined as the number of days with any headache in a month (or four weeks), remains a key parameter in the evaluation of treatment response to migraine preventive medications. However, due to the variations and inconsistencies in documentation by clinicians, significant challenges exist to accurately extract headache frequency from the electronic health record (EHR) by traditional natural language processing (NLP) algorithms.
METHODS
This was a retrospective cross-sectional study with human subjects identified from three tertiary headache referral centers- Mayo Clinic Arizona, Florida, and Rochester. All neurology consultation notes written by more than 10 headache specialists between 2012 to 2022 were extracted and 1915 notes were used for model fine-tuning (90%) and testing (10%). We employed four different NLP frameworks: (1) (2) Generative Pre-Trained Transformer-2 ( fine-tuned on Mayo Clinic notes; and fine-tuned on Mayo Clinic notes to generate the answer by considering the context of included text.
RESULTS
The GPT-2 generative model was the best-performing model with an accuracy of 0.92[0.91 - 0.93] and R score of 0.89[0.87, 0.9], and all GPT2-based models outperformed the ClinicalBERT model in terms of the exact matching accuracy. Although the ClinicalBERT regression model had the lowest accuracy 0.27[0.26 - 0.28], it demonstrated a high R score 0.88[0.85, 0.89], suggesting the ClinicalBERT model can reasonably predict the headache frequency within a range of ≤ ± 3 days, and the R score was higher than the GPT-2 QA zero-shot model or GPT-2 QA model few-shot training fine-tuned model.
CONCLUSION
We developed a robust model based on a state-of-the-art large language model (LLM)- a GPT-2 generative model that can extract headache frequency from EHR free-text clinical notes with high accuracy and R score. It overcame several challenges related to different ways clinicians document headache frequency that were not easily achieved by traditional NLP models. We also showed that GPT2-based frameworks outperformed ClinicalBERT in terms of accuracy in extracting headache frequency from clinical notes. To facilitate research in the field, we released the GPT-2 generative model and inference code with open-source license of community use in GitHub.
PubMed: 37873417
DOI: 10.1101/2023.10.02.23296403 -
Journal of the American Board of Family... 2022To review the literature on medication safety in primary care in the electronic health record era. (Review)
Review
PURPOSE
To review the literature on medication safety in primary care in the electronic health record era.
METHODS
Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias.
RESULTS
Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm.
CONCLUSIONS
This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms.
Topics: Aged; Ambulatory Care Facilities; Drug-Related Side Effects and Adverse Reactions; Humans; Inappropriate Prescribing; Potentially Inappropriate Medication List; Primary Health Care
PubMed: 35641040
DOI: 10.3122/jabfm.2022.03.210334 -
BMJ Open Quality Feb 2021Medical records are crucial facet of a patient's journey. These provide the clinician with a permanent record of the patient's illness and ongoing medical care, thus...
Medical records are crucial facet of a patient's journey. These provide the clinician with a permanent record of the patient's illness and ongoing medical care, thus enabling informed clinical decisions. In many hospitals, patient medical records are written on paper. However, written notes are liable to misinterpretation due to illegibility and misplacement. This can affect the patient's medical care and has medico-legal implications. Electronic patient records (EPR) have been gradually introduced to replace patient's paper notes with the aim of providing a more reliable record-keeping system. It is perceived that EPR improve the quality and efficiency of patient care. The paediatric department at Queen's Hospital Burton uses a mix of paper notes and computerised medical records. Clinicians primarily use paper notes for admission clerking, ward rounds, ward reviews and outpatient clinic consultations. Laboratory tests, imaging results and prescription requests are executed via the EPR system. Documentation by nurses is also carried out electronically. We aimed to improve and standardise clinical documentation of paediatric admissions and ward round notes by developing electronic proforma for initial paediatric clerking, ward rounds and patient reviews. This quality improvement project improved clinical documentation on the paediatric wards and enhanced patient record-keeping, boosted clinical information-sharing and streamlined patient journey. It fulfilled various generic multidisciplinary record keeping audit tool standards endorsed by the Royal College of Physicians by 100%. We undertook a staff survey to investigate the opinion before and after implementing the electronic health record. Doctors, nurses and healthcare support workers overwhelmingly supported the quality, usefulness, completeness of specified fields and practicality of the electronic records.
Topics: Child; Documentation; Electronic Health Records; Hospitals; Humans; Pediatrics; Quality Improvement
PubMed: 33589503
DOI: 10.1136/bmjoq-2020-000918 -
Advances in Radiation Oncology 2022Due to a gap in published guidance, we describe our robust cycle of in-house clinical software development and implementation, which has been used for years to...
PURPOSE
Due to a gap in published guidance, we describe our robust cycle of in-house clinical software development and implementation, which has been used for years to facilitate the safe treatment of all patients in our clinics.
METHODS AND MATERIALS
Our software development and implementation cycle requires clarity in communication, clearly defined roles, thorough commissioning, and regular feedback. Cycle phases include design requirements and use cases, development, physics evaluation testing, clinical evaluation testing, and full clinical release. Software requirements, release notes, test suites, and a commissioning report are created and independently reviewed before clinical use. Software deemed to be high-risk, such as those that are writable to a database, incorporate the use of a formal, team-based hazard analysis. Incident learning is used to both guide initial development and improvements as well as to monitor the safe use of the software.
RESULTS
Our standard process builds in transparency and establishes high expectations in the development and use of custom software to support patient care. Since moving to a commercial planning system platform in 2013, we have applied our team-based software release process to 16 programs related to scripting in the treatment planning system for the clinic.
CONCLUSIONS
The principles and methodology described here can be implemented in a range of practice settings regardless of whether or not dedicated resources are available for software development. In addition to teamwork with defined roles, documentation, and use of incident learning, we strongly recommend having a written policy on the process, using phased testing, and incorporating independent oversight and approval before use for patient care. This rigorous process ensures continuous monitoring for and mitigatation of any high risk hazards.
PubMed: 35071827
DOI: 10.1016/j.adro.2021.100768 -
Personality Disorders May 2022Several psychiatric conditions (e.g., substance use, mood, and personality disorders) are characterized, in part, by greater delay discounting (DD)-a decision-making... (Meta-Analysis)
Meta-Analysis Review
Several psychiatric conditions (e.g., substance use, mood, and personality disorders) are characterized, in part, by greater delay discounting (DD)-a decision-making bias in the direction of preferring smaller, more immediate over larger, delayed rewards. Narcissistic personality disorder (NPD) is highly comorbid with substance use, mood, and other personality disorders, suggesting that DD may be a process underpinning risk for NPD as well. This meta-analysis examined associations between DD and theoretically distinct, clinically relevant dimensions of narcissism (i.e., grandiosity, entitlement, and vulnerability). Literature searches were conducted and articles were included if they were written in English, published in a peer-reviewed journal, contained measures of DD and narcissism and reported their association, and used an adult sample. Narcissism measures had to be systematically categorized according to clinically relevant dimensions (Grijalva et al., 2015; Wright & Edershile, 2018). Seven studies met inclusion criteria ( = 2,705). DD was positively associated with narcissism ( = .21; 95% confidence interval [.10, .32]), with this association being largely attributable to measures of trait grandiosity that were used in each study ( = .24; 95% confidence interval [.11, .37]). No studies included diagnostic NPD assessments. These findings provide empirical evidence that DD is related to trait narcissism and perhaps risk for NPD (e.g., grandiosity listed in Criterion B of the Fifth Edition, alternative model of personality disorders). Considering the positive evidence from this review, and the dearth of research examining DD in individuals with NPD, investigators studying NPD may consider incorporating DD measures in future studies to potentially inform clinical theory and novel adjunctive treatment options. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Adult; Comorbidity; Delay Discounting; Diagnostic and Statistical Manual of Mental Disorders; Humans; Narcissism; Personality Disorders
PubMed: 34990195
DOI: 10.1037/per0000528 -
Nature Communications Feb 2023Existing annotation paradigms rely on controlled vocabularies, where each data instance is classified into one term from a predefined set of controlled vocabularies....
Existing annotation paradigms rely on controlled vocabularies, where each data instance is classified into one term from a predefined set of controlled vocabularies. This paradigm restricts the analysis to concepts that are known and well-characterized. Here, we present the novel multilingual translation method BioTranslator to address this problem. BioTranslator takes a user-written textual description of a new concept and then translates this description to a non-text biological data instance. The key idea of BioTranslator is to develop a multilingual translation framework, where multiple modalities of biological data are all translated to text. We demonstrate how BioTranslator enables the identification of novel cell types using only a textual description and how BioTranslator can be further generalized to protein function prediction and drug target identification. Our tool frees scientists from limiting their analyses within predefined controlled vocabularies, enabling them to interact with biological data using free text.
Topics: Multilingualism; Vocabulary, Controlled; Proteins
PubMed: 36759510
DOI: 10.1038/s41467-023-36476-2 -
Global Health Research and Policy Jul 2022The novel coronavirus disease 2019 (COVID-19) continues to disrupt the availability and utilization of routine and emergency health care services, with differing impacts... (Review)
Review
INTRODUCTION
The novel coronavirus disease 2019 (COVID-19) continues to disrupt the availability and utilization of routine and emergency health care services, with differing impacts in jurisdictions across the world. In this scoping review, we set out to synthesize documentation of the direct and indirect effect of the pandemic, and national responses to it, on maternal, newborn and child health (MNCH) in Africa.
METHODS
A scoping review was conducted to provide an overview of the most significant impacts identified up to March 15, 2022. We searched MEDLINE, Embase, HealthSTAR, Web of Science, PubMed, and Scopus electronic databases. We included peer reviewed literature that discussed maternal and child health in Africa during the COVID-19 pandemic, published from January 2020 to March 2022, and written in English. Papers that did not focus on the African region or an African country were excluded. A data-charting form was developed by the two reviewers to determine which themes to extract, and narrative descriptions were written about the extracted thematic areas.
RESULTS
Four-hundred and seventy-eight articles were identified through our literature search and 27 were deemed appropriate for analysis. We identified three overarching themes: delayed or decreased care, disruption in service provision and utilization and mitigation strategies or recommendations. Our results show that minor consideration was given to preserving and promoting health service access and utilization for mothers and children, especially in historically underserved areas in Africa.
CONCLUSIONS
Reviewed literature illuminates the need for continued prioritization of maternity services, immunization, and reproductive health services. This prioritization was not given the much-needed attention during the COVID-19 pandemic yet is necessary to shield the continent's most vulnerable population segments from the shocks of current and future global health emergencies.
Topics: Africa; COVID-19; Child; Child Health Services; Female; Health Services Accessibility; Humans; Infant, Newborn; Pandemics; Pregnancy
PubMed: 35854345
DOI: 10.1186/s41256-022-00257-z -
Cellenium-a scalable and interactive visual analytics app for exploring multimodal single-cell data.Bioinformatics (Oxford, England) Jun 2023Multimodal single-cell sequencing data provide detailed views into the molecular biology of cells. To allow for interactive analyses of such rich data and to readily...
SUMMARY
Multimodal single-cell sequencing data provide detailed views into the molecular biology of cells. To allow for interactive analyses of such rich data and to readily derive insights from it, new analysis solutions are required. In this work, we present Cellenium, our new scalable visual analytics web application that enables users to semantically integrate and organize all their single-cell RNA-, ATAC-, and CITE-sequencing studies. Users can then find relevant studies and analyze single-cell data within and across studies. An interactive cell annotation feature allows for adding user-defined cell types.
AVAILABILITY AND IMPLEMENTATION
Source code and documentation are freely available under an MIT license and are available on GitHub (https://github.com/Bayer-Group/cellenium). The server backend is implemented in PostgreSQL, Python 3, and GraphQL, the frontend is written in ReactJS, TypeScript, and Mantine css, and plots are generated using plotlyjs, seaborn, vega-lite, and nivo.rocks. The application is dockerized and can be deployed and orchestrated on a standard workstation via docker-compose.
Topics: Mobile Applications; Software; Documentation
PubMed: 37261846
DOI: 10.1093/bioinformatics/btad349