The evidence-based development of an intervention to improve clinical health literacy practice

Abstract: Low health literacy is an issue with high prevalence in the UK and internationally. It has a social gradient with higher prevalence in lower social groups and is linked with higher rates of long-term health conditions, lower self-rated health, and greater difficulty self-managing long-term health conditions. Improved medical services and practitioner awareness of a patient’s health literacy can help to address these issues. An intervention was developed to improve General Practitioner and Practice Nurse health literacy skills and practice. A feasibility study was undertaken to examine and improve the elements of the intervention. The intervention had two parts: educating primary care doctors and nurses about identifying and enhancing health literacy (patient capacity to get hold of, understand and apply information for health) to improve their health literacy practice, and implementation of on-screen ‘pop-up’ notifications that alerted General Practitioners (GPs) and nurses when seeing a patient at risk of low health literacy. Rapid reviews of the literature were undertaken to optimise the intervention. Four General Practices were recruited, and the intervention was then applied to doctors and nurses through training followed by alerts via the practice clinical IT system. After the intervention, focus groups were held with participating practitioners and a patient and carer group to further develop the intervention. The rapid literature reviews identified (i) key elements for effectiveness of doctors and nurse training including multi-component training, role-play, learner reflection, and identification of barriers to changing practice and (ii) key elements for effectiveness of alerts on clinical computer systems including ‘stand-alone’ notification, automatically generated and prominent display of advice, linkage with practitioner education, and use of notifications within a targeted environment. The findings from the post-hoc focus groups indicated that practitioner awareness and skills had improved as a result of the training and that the clinical alerts reminded them to incorporate this into their clinical practice. Suggested improvements to the training included more information on health literacy and how the clinical alerts were generated, and more practical role playing including initiating discussions on health literacy with patients. It was suggested that the wording of the clinical alert be improved to emphasise its purpose in improving practitioner skills. The feasibility study improved the intervention, increasing its potential usefulness and acceptability in clinical practice. Future studies will explore the impact on clinical care through a pilot and a randomised controlled trial

Incorporando las anotaciones de enfermería tipo soapie a través de la metodología participativa en el servicio de pediatría, 2016

La presente investigación cualitativa con enfoque de investigación acción participación tuvo como objetivo: Incorporar las anotaciones de enfermería tipo SOAPIE a través de la metodología participativa en el servicio de pediatría del Hospital Regional Docente las Mercedes, 2016. Los sujetos de estudios fueron diez enfermeras que laboran en el servicio de pediatría del Hospital Regional Docente Las Mercedes. Para la recolección de los datos se utilizó: la entrevista semiestructurada y la guía de observación de las anotaciones de enfermería del servicio, se aplicaron antes y después de la intervención. Se utilizó los criterios de rigor científico y los principios de la bioética personalista; para el procesamiento de datos se utilizó el análisis de contenido temático, obteniéndose tres categorías: Realizando anotaciones narrativas y descriptivas incompletas por desconocimiento de las anotaciones SOAPIE y carencia de formatos; Reconociendo la importancia de las anotaciones tipo SOAPIE; Realizando las anotaciones tipo SOAPIE a través del formato sistematizado. Concluyendo que las anotaciones de enfermería son documentos que permiten evidenciar el cuidado brindado por la enfermera, por lo que se diseñó un formato en el que se pueda realizar las anotaciones de enfermería tipo SOAPIE establecidas en normativas del MINSA, esta es la mejor forma de evidenciar todo el cuidado que realiza la enfermera durante su turno, lo que contribuye indirectamente a mejorar la calidad de este, siendo necesario la metodología participativa que permite el involucramiento y compromiso ético-legal de las enfermeras; con lo que se dejó de lado las anotaciones de enfermería tradicionales que eran someras e inespecíficas

Efeitos adversos a medicamentos em hospital público: estudo piloto

The results from implementing a strategy for monitoring adverse effects from drugs in a public hospital in the municipality of Rio de Janeiro, Southeastern Brazil, in 2007, were analyzed. Based on retrospective analysis of 32 medical files, adverse effects were found in 16%. To identify these effects, 38 tracking criteria were needed. Among these, the main ones were the use of antiemetics, abrupt cessation of medication and over-sedation. Despite the difficulties, especially in relation to access to information and the record quality, application of these tracking criteria seems to be viable. To improve the implementation of the method, it is suggested that the data collection should be computerized and risk adjustment indicators should be sought.Fueron analizados los resultados de la implantación de estrategia de monitoreo de efectos adversos a los medicamentos en hospital público en Rio de Janeiro, Sureste de Brasil, en 2007. Con base en análisis retrospectivo de 32 prontuarios fueron encontrados efectos adversos en 16%. Para identificarlos, fueron necesarios 38 criterios rastreadores, de los cuales los principales fueron: uso de antieméticos, interrupción abrupta de medicamentos y sedación excesiva. A pesar de las dificultades, sobre todo relacionadas con el acceso a las informaciones y a la calidad de los registros, la aplicación de los criterios rastreadores parece ser viable. Para perfeccionar la implantación del método, se sugiere informatizar la colecta de datos y buscar indicadores de ajuste del riesgo.Foram analisados os resultados da implantação de estratégia de monitoramento de efeitos adversos aos medicamentos em hospital público no Rio de Janeiro, RJ, em 2007. Com base em análise retrospectiva de 32 prontuários foram encontrados efeitos adversos em 16%. Para identificá-los, foram precisos 38 critérios rastreadores, dos quais os principais foram: uso de antieméticos, interrupção abrupta de medicamentos e sedação excessiva. Apesar das dificuldades, sobretudo relacionadas ao acesso às informações e à qualidade dos registros, a aplicação dos critérios rastreadores parece ser viável. Para aprimorar a implantação do método, sugere-se informatizar a coleta de informações e buscar indicadores de ajuste de risco

Potilastiedon rakenteistamisen hyödyt – systemaattisen katsauksen menetelmä ja aiempien katsausten tulokset

Sähköisen potilaskertomuksen tietorakenteita on kehitetty ja käytetty potilaskertomuksissa jo pitkään Suomessa ja ulkomailla. Suomessa sähköinen kertomustieto on osin rakenteista, mutta pitkälti vielä narratiivista tietoa. Tiedon rakenteisuuden avulla voidaan yksittäistä potilasta koskevaa tietoa koostaa, yhdistellä ja jakaa esimerkiksi eri kertomusnäkymiin potilastietojärjestelmien tai hoitoon osallistuvien organisaatioyksiköiden välillä. Rakenteista tietoa voidaan hyödyntää myös potilaan hoidon laadun ja potilasturvallisuuden varmistamiseen. Rakenteistamisen hyödyistä on kuitenkin toistaiseksi vähän tutkimusnäyttöä.Toteutimme systemaattiseen kirjallisuuskatsauksen Cochrane-katsauksen protokollan mukaisesti kertomustiedon rakenteistamisesta ja rakenteiden vaikutuksista. Haut toteutettiin 15 eri tietokannasta vuoden 2011 lopulla, ja ne tuottivat yhteensä 680 uniikkia artikkelia. Hakutulokseen sisältyneet aiemmat katsaukset analysoitiin omana ryhmänään sen selvittämiseksi, mitä näyttöä on jo koostettu ja onko mahdollista päivittää jotain aiempaa katsausta. Aiempia katsauksia analysoitiin yhteensä seitsemän. Tässä artikkelissa kuvataan oma tutkimusprotokollamme toteutus ja raportoidaan aikaisempien katsausten löydökset.Kolmessa aiemmassa katsauksessa koodistot, luokitukset ja terminologiat liittyivät parantuneeseen tiedon laatuun. Lomakerakenteet paransivat kertomusjärjestelmän laatua yhdessä katsauksessa, tiedon laatua kahdessa katsauksessa, hoitosuositusten noudattamista kahdessa katsauksessa sekä diagnostista tarkkuutta yhdessä katsauksessa. Rakenteistamiselta odotettuja vaikutuksia terveydenhuollon tuloksiin ei ollut arvioitu lainkaan (esimerkiksi potilasturvallisuus tai kansalaisen osallistuminen).Aiempien katsausten toteutusprotokollat oli kuvattu vaihtelevalla tarkkuudella, eikä niihin sisältynyt katsauksia, jossa olisi arvioitu erilaisia rakenteistamisen menetelmiä. Aikaisemmissa katsauksissa ei myöskään rajattu tutkimusnäkökulmaa rakenteistamisen menetelmien arviointiin riippumattomana muuttujana (interventiona). Näistä syistä yksikään aikaisemmista katsauksista ei soveltunut omiin tavoitteisiimme. Empiiristen artikkelien analyysien tulokset tullaan raportoimaan erillisissä artikkeleissa hoitotyön, kliinisen työn sekä toisiokäytön näkökulmasta

Arquitectura de información para la gestión de la historia clínica digital en oftalmopediatría

Introduction: the Medical History is a tool that contains the information of patients, which should able to be processed, stored and transmitted in a safe and accessible way, thus it is necessary to use resources and strategies to facilitate healthcare services, among which software designs can be included.Objective: to develop the information architecture for the management of an computerized medical record to be used in the Pediatric Ophthalmology Office at Pepe Portilla  Provincial Pediatric Teaching Hospital in Pinar del Rio.Methods: a qualitative-quantitative study was conducted, applying theoretical and empirical methods to analyze the evolution and development of a pediatric-ophthalmological history, to characterize the current situation, as well as the introduction of information and communication technologies into this specialty in Cuba.Results: the design of a prototype of software for the management of a computerized medical record in the Pediatric Ophthalmology Office, with a great social impact for the healthcare institutions where the system is implemented, which benefit both the patient and the professionals.Conclusion: the implementation of a computerized tool is a strategic decision that can simplify work, optimize time and resources, improving organizational process, management and safety.Introducción: la Historia Clínica es un instrumento que contiene la información del paciente que debe ser procesable, almacenada y trasmitida de forma segura y accesible, por lo que resulta necesario el empleo de recursos y estrategias para facilitar el cuidado de la salud, entre las que puede figurar un software.Objetivo: desarrollar la arquitectura de información para la gestión de una historia clínica electrónica para uso en la consulta de Oftalmopediatría del Hospital Pediátrico Provincial Docente “Pepe Portilla” de Pinar del Río.Métodos: estudio cuali-cuantitativo, con métodos teóricos y empíricos para analizar la evolución y desarrollo de la historia clínica de Oftalmopediatría, caracterizar la situación actual, así como la introducción de las tecnologías de la información y las comunicaciones en esta disciplina en Cuba.Resultados: se creó un prototipo de software de gestión de historia clínica electrónica en Oftalmopediatría, con un gran impacto social para las entidades donde se implemente el sistema, que beneficia tanto al paciente como a los profesionales.Conclusión: la implementación de una herramienta informática es una decisión estratégica que puede simplificar el trabajo, optimizar tiempo, recursos, y mejorar en organización, gestión y seguridad

Características de anotações de enfermagem encontradas em auditoria

O objetivo deste trabalho foi identificar a qualidade dos registros de enfermagem em contas hospitalares. A pesquisa foi realizada em três unidades de internamento de planos de saúde privados, em um hospital universitário de Curitiba, entre agosto e novembro de 2005. Os dados foram recolhidos de anotações de enfermagem, em 144 prontuários, por meio de um chek-list, elaborado de acordo com a literatura e legislação. Os principais problemas encontrados foram: as anotações são realizadas por turno e não por horário; há rasuras nas escritas; espaços em branco ao longo do impresso; falta de carimbo e de assinatura. Há prontuários em que a checagem de prescrições não ocorre ou é realizada de forma incorreta; há, também, anotação incompleta de sinais vitais. De um modo geral as anotações são compreensíveis, embora a letra seja pouco legível; utilizam-se siglas padronizadas e termos técnicos. A partir dos problemas identificados sugere-se mais intensificação de educação continuada sobre registros de enfermagem e novos estudos que identifiquem os valores econômicos perdidos, por glosas em contas hospitalares.

Background Examples of Literature Searches on Topics of Interest

A zip file of various literature searches & some resources related to our work related to exposure after the Chernobyl accident and as we began looking at helping in Semey Kazakhstan----a collection of literature reviews on various topics we were interested in... eg. establishing a registry of those exposed for longterm follow-up, what we knew about certain areas like genetics and some resources like A Guide to Environmental Resources on the Internet by Carol Briggs-Erickson and Toni Murphy which could be found on the Internet and was written to be used by researchers, environmentalists, teachers and any person who is interested in knowing and doing something about the health of our planet. See more at https://archives.library.tmc.edu/dm-ms211-012-0060

Assessing the potential of national strategies for electronic health records for population health monitoring and research

"Initiated in October 2004, this project builds upon two previous reports that portray a new landscape for health statistics: Shaping a Health Statistics Vision for the 21st Century: The Final Report, a joint report developed by the National Committee on Vital and Health Statistics, the Centers for Disease Control and Prevention's National Center for Health Statistics, and the U.S. Department of Health and Human Services' Data Council (Friedman, Hunter, Parrish 2002); and Information for Health: A Strategy for Building the National Health Information Infrastructure, a report released by the National Committee on Vital and Health Statistics (2001)." - p. 1"The purpose of this report is to assess the potential of national strategies for electronic health records for population health monitoring and research. The emphasis in this report is upon those types of population health monitoring typically used to develop health statistics, such as population-based registries, population-based surveys, and administrative health data, rather than those types of population health monitoring used to detect health events and diseases for the purposes of immediate public health interventions. More specifically, this report has a fourfold purpose: first, to describe the current status of national strategies for electronic health records and their supporting national health information infrastructures in Australia, Canada, England, and New Zealand, especially as those national strategies relate to population health monitoring to produce health statistics and research employing health statistics; second, to summarize themes about the potential contributions, and barriers to those contributions, of national strategies for electronic health records for population health monitoring and research and barriers that emerged from key informant interviews with experts in the same four countries; third to summarize themes emerging from key informant interviews with U.S. experts; and fourth, to delineate major fundamental issues in the relationship between national strategies for electronic health records and population health and monitoring." -.p. 1-21. Introduction -- 2. Methods -- 3. Factors impacting on national strategies for electronic health records -- 4. Nation snapshots: Australia, Canada, England, and New Zealand -- 5. Common themes in interviews with expert informants in Australia, Canada, England, and New Zealand -- 6. Common themes in interviews with expert informants in the U.S. -- 7. Fundamental issues in the relationship of national strategies for electronic health records to population health monitoring and research -- References -- Acronyms and glossary -- Tables -- Figures -- Appendix 1. Structured search criteria -- Appendix 2. Journals and newsletters reviewed -- Appendix 3.Typical interview guide (English expert) -- Appendix 4. Key informants"January 2006."Author: Daniel J. Friedman, Population and Public Health Information Services.Also available via the World Wide Web.Includes bibliographical references (p. 61-70)