Textual Mediation in Simulated Nursing Handoffs: Examining How Student Writing Coordinates Action

In clinical nursing simulations, a group of students provide care for a robotic patient during a structured scenario. As care is transferred from one group to another, they participate in a patient handoff, with outgoing students passing key information onto incoming students. In healthcare, the nursing handoff is a critical and perilous communication moment that is mediated by a range of participants and texts. Drawing on observations and video recordings of 52 simulation handoffs in the United States, this article examines how two student-designed texts – a collaborative patient chart and individual notes – are leveraged during the handoff. I also consider how handoff talk and writing changes as student nursing knowledge increases over the course of a year. By focusing on textual mediation of the simulated nursing handoff, this article contributes to existing research on professional writing pedagogy and to nursing scholarship on the handoff. Ultimately, it argues that a textual mediation framework can help bridge class room and professional contexts by evaluating student writing not for how successfully it meets a set of imposed criteria but for how effectively it supports classroom activities

Exploiting XML Technologies in Medical Information Systems

Integration of clinical research data and routine care data, in order to streamline the process of conducting clinical studies, has been a problem for quite a while now. The Single Source project at the University of Münster aims at contributing to this area. The approach is based on a vast usage of XML technology together with a novel integration architecture. The emphasis in this paper is on the former: The seamless usage of XML technology throughout the entire application is presented, and mismatches of programming paradigms are averted by exploiting the features of XML, XQuery and XForms. In particular, this is demonstrated by the example of a component used for handling forms, by how it is built and used in the entire scenario

Biophotonic Tools in Cell and Tissue Diagnostics.

In order to maintain the rapid advance of biophotonics in the U.S. and enhance our competitiveness worldwide, key measurement tools must be in place. As part of a wide-reaching effort to improve the U.S. technology base, the National Institute of Standards and Technology sponsored a workshop titled "Biophotonic tools for cell and tissue diagnostics." The workshop focused on diagnostic techniques involving the interaction between biological systems and photons. Through invited presentations by industry representatives and panel discussion, near- and far-term measurement needs were evaluated. As a result of this workshop, this document has been prepared on the measurement tools needed for biophotonic cell and tissue diagnostics. This will become a part of the larger measurement road-mapping effort to be presented to the Nation as an assessment of the U.S. Measurement System. The information will be used to highlight measurement needs to the community and to facilitate solutions

A reporting and analysis framework for structured evaluation of COVID-19 clinical and imaging data

The COVID-19 pandemic has worldwide individual and socioeconomic consequences. Chest computed tomography has been found to support diagnostics and disease monitoring. A standardized approach to generate, collect, analyze, and share clinical and imaging information in the highest quality possible is urgently needed. We developed systematic, computer-assisted and context-guided electronic data capture on the FDA-approved mint LesionTM software platform to enable cloud-based data collection and real-time analysis. The acquisition and annotation include radiological findings and radiomics performed directly on primary imaging data together with information from the patient history and clinical data. As proof of concept, anonymized data of 283 patients with either suspected or confirmed SARS-CoV-2 infection from eight European medical centers were aggregated in data analysis dashboards. Aggregated data were compared to key findings of landmark research literature. This concept has been chosen for use in the national COVID-19 response of the radiological departments of all university hospitals in Germany

Antibiotic Stewardship for Asymptomatic Bacteriuria in Older Adults Residing in Long-Term Care at End-of-Life

Background: Differentiating between asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) in older adults is challenging due to their atypical presentation. There is a critical gap in practice to adhere to clinical guidelines advising against treating ASB with antibiotics. Objectives: The purpose of this Quality Improvement project was to implement an antibiotic stewardship program at a hospice organization to standardize judicious use of antibiotics at the end-of-life. The outcome measures were designed to evaluate clinician knowledge, prescribing policies and practice changes, the completeness of documentation, the appropriate usage of antibiotics, and clinician antibiotic use attitudes and beliefs. Methods: Hospice clinicians were recruited using convenience sampling. A pre-post same subject and mixed-methods design was implemented for data collection and analysis. The key data collection tools were the Agency for Healthcare Research and Quality’s Suspected UTI SBAR form, the Antibiotic Use Attitudes and Beliefs Nursing and Provider Survey, and the Centers for Disease Control and Prevention’s Checklist for Core Elements of Antibiotic Stewardship in Nursing Homes. The outcomes were designed to be measured using paired t-test, chi-square tests, mean rating, descriptive statistics, and by identifying emerging themes. Results: The baseline chart review revealed 136 prescriptions lacked the provider’s indication. There was no post-intervention data to compare and perform the chi-square tests due to a lack of study participation. Six people completed the knowledge surveys. The post-test mean score (66.67 [SD = 12.91]) was not significantly higher (p = 0.61) than the pre-test mean score (70.83 [SD = 18.82]). Two UTI SBAR forms were submitted with a 100% completeness rate. A freeze on new policy approvals prevented the project recommendations from undergoing the review process. Conclusions: There was insufficient data to report whether the project improved the projected outcomes. The lack of study participation was attributed to the competing demands and burnout amidst the COVID-19 pandemic

Physician Practice Variation in Electronic Health Record Documentation.

Adoption of electronic health records (EHRs) was motivated by the expectation that they would improve quality and decrease costs of care. EHRs’ value, however, depends on how they are used, which likely explains the heterogeneous benefits observed in the literature. This dissertation uses mixed methods to explore a critical component of EHR use in primary care: variation in EHR documentation, defined as differences in how users record or remove information. The first chapter delineates a conceptual framework of variation in EHR documentation that includes five different forms of variation and five levels where the forms may materialize. This chapter focuses on potentially harmful variation by detailing how non-patient factors foster variation that interferes with clinical decision support, care coordination, and population health management, jeopardizing the efficient delivery of high-quality healthcare. The second chapter measures variation in one form of variation, completion of documentation, in a national sample of primary care practices. Using data from a major EHR vendor, this chapter finds differences in how variably providers complete fifteen different clinical documentation categories and identifies patient’s problems, the provider’s assessment and diagnosis, the social history, the review of systems, and communication about lab and test results as the most varied. The majority of variation exists across providers in the same practice, suggesting providers are making different decisions about documentation for comparable patients. The final chapter explores the context of this variation with semi-structured interviews, finding that variation in EHR documentation is perceived as a commonplace phenomenon resulting from a flexible EHR design that allows users to develop different documentation styles. Variation reportedly introduced inefficiencies into care delivery and created patient safety and care quality risks from missed or misinterpreted information. Respondents identified additional training, ongoing meetings, and improvements in EHR design as effective strategies to prevent harm. Widespread variation in EHR documentation can interfere with care delivery by obscuring the location and meaning of patient information. In order to realize gains from adopting EHRs, practices, vendors, and policymakers must collaboratively develop better interfaces and clearer guidelines to support their effective use.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135900/1/grcohen_1.pd

Risk, human rights and the management of a serious sex offender

Risk and human rights discourses have become dominant features of the UK criminal justice arena. However, there has been little critical scrutiny of the ways in which these discourses relate to each other. In this article, I focus on different accounts of the case of Anthony Rice, a 48-year old ex-offender who committed a murder in August 2005 whilst under the joint supervision of English probation and police services. Drawing upon official reviews by the Inspectorate of Probation and the UK Parliament Joint Committee on Human Rights, as well as media coverage, I use the Rice case to problematise some common assumptions about the relationship between risk and human rights

Advancing Pharmacist Collaborative Care within Academic Health Systems.

INTRODUCTION:The scope of pharmacy practice has evolved over the last few decades to focus on the optimization of medication therapy. Despite this positive impact, the lack of reimbursement remains a significant barrier to the implementation of innovative pharmacist practice models. SUMMARY:We describe the successful development, implementation and outcomes of three types of pharmacist collaborative care models: (1) a pharmacist with physician oversight, (2) pharmacist-interprofessional teams and (3) physician-pharmacist teams. The outcome measurement of these pharmacist care models varied from the design phase to patient volume measurement and to comprehensive quality dashboards. All of these practice models have been successfully funded by affiliated health systems or grants. CONCLUSIONS:The expansion of pharmacist services delivered by clinical faculty has several benefits to affiliated health systems: (1) significant improvements in patient care quality, (2) access to experts in specialty areas, and (3) the dissemination of outcomes with national and international recognition, increasing the visibility of the health system

Registered Nurses\u27 Intention To Use Electronic Documentation Systems: A Mixed Methods Study

BACKGROUND: Home care in Ontario has become the fastest growing sector and cornerstone of the healthcare system. As a result of the increased shift to the home care sector in Ontario, there have been several health information technology (HIT) initiatives to improve the quality and delivery of health care services to patients. This is exemplified with the province-wide development and implementation of electronic documentation systems (EDS). Electronic documentation systems have the potential to ensure timely, up-to-date and comprehensive patient health and care-related information is available and accessible to healthcare providers such as registered nurses regardless of their physical location. Access to patient health and care-related information supports high-quality nursing care, decision-making, and care delivery processes. Despite the benefits of EDS (i.e., improved workflow, reduced diagnostic and laboratory tests and adverse drug events), low intention by registered nurses to use these systems is well documented. Existing evidence suggests that an expressed intention to use HIT such as EDS is a direct predictor and antecedent of behavioural usage. Despite the growing efforts to understand registered nurses’ perceptions and overall intention to use EDS in practice, there is limited knowledge about registered nurses’ intention to use EDS in the context of home care practice. AIMS: The purpose of this study was to understand and examine factors that influence nurses’ intention and overall perception of using EDS in their home care practice. The conceptual model framing this study was adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT) to delineate the relationships among factors that influence registered nurses’ intention to use EDS in home care practice. METHOD: A sequential, explanatory mixed methods design, using a sample of nurses from Ontario who are currently practicing within the home care sector were recruited to address the study’s objectives. Data were collected using both quantitative (online survey) and qualitative (semi-structured individual telephone interviews) methods. Quantitative data were analyzed with descriptive statistics and hierarchical multiple regression analysis and qualitative data were analyzed with content and inductive thematic analysis. RESULTS: Individual, technological and organizational / environmental characteristics were found to influence nurses’ intention, level of comfort and experience with EDS usage in home care practice. Additional factors found to influence home care nurses’ experience with EDS usage included: the development and employment of workarounds, the influence of nurse-patient interaction amidst system usage, and the ability to provide input towards the system design. CONCLUSION: Nurses play a significant role in the delivery of home health care services to Ontarians. The findings highlight the importance for: a) further exploration of the most appropriate model and / or adaptation of a model identifying a range of factors influencing nurses’ intention to use EDS in different healthcare contexts; b) continued integration of nursing informatics competencies within nursing curricula; c) an organizational culture that supports the use of EDS in nurses’ home practice (i.e., enlisting user champions and providing adequate training and IT support); and d) having representation of nurses in the EDS design and / or implementation processes through a user-centered design approach