Valoración de las heridas crónicas en el adulto: una revisión integrativa

Objetivo: Identificar los principales aspectos a valorar en personas adultas con heridas crónicas. Método: Revisión integrativa de la literatura científica publicada, entre 2010 y principios del año 2015, en las bases de datos PubMed y Web Of Science. Resultados: Existe un número muy limitado de estudios que se centraran exclusivamente en la valoración de las heridas. Sin embargo, se encontraron muchos aspectos a tener en cuenta en la valoración de personas con úlceras. Por lo que, estos aspectos fueron agrupados en: factores que afectaban significativamente a la cicatrización o desarrollo de nuevas heridas (como la edad, el estado nutricional, la capacidad funcional o la presencia de cormobilidades), factores psicosociales y aspectos relacionados con la lesión (localización, tamaño, profundidad, tipo de tejido, tiempo de evolución). Conclusión: En general, no se ha encontrado un aspecto único que se deba contemplar en la valoración de las heridas crónicas, sino una compleja interacción de factores que incluyen tanto aspectos fisiológicos, como sociales y psicológicos. De modo que, los profesionales deben ser conscientes de este enfoque multifactorial; para reconocer tempranamente el desarrollo y la evolución de la úlcera, e intervenir consecuentemente.Objective: To identify the main aspects that should be assessed in adults with chronic wounds. Method: This was an integrative review of the scientific literature published between 2010 and early 2015 in the PubMed and Web of Science databases. Results: Few studies exclusively address wound assessment. However, the review found many aspects to consider when assessing individuals with ulcers, grouped as follows: factors that significantly affect healing or the development of new wounds (age, nutritional status, functional capacity, or comorbidities), pyschosocial factors, and wound characteristics (location, size, depth, type of tissue, time of evolution). Conclusion: The literature search did not result in any one aspect that must be considered when assessing chronic wounds, but a complex interaction of factors that include both physiological and social and psychological elements. Professionals should be aware of this multifactorial approach to achieve early detection of the development and evolution of ulcers and to intervene accordingly.Objetivo: Identificar os principais aspectos a ser avaliados em pessoas adultas com feridas crônicas. Método: Revisão integrativa da literatura científica publicada, entre 2010 e princípios do ano 2015, nas bases de dados PubMed e Web Of Science. Resultados: Existe um número muito limitado de estudos que se centraram exclusivamente na avaliação das feridas. No entanto, foram encontrados muitos aspectos a levar em conta na avaliação de pessoas com úlceras. Portanto, esses aspectos foram agrupados em: fatores que afetavam significativamente a cicatrização ou desenvolvimento de novas feridas (como idade, estado nutricional, capacidade funcional ou presença de comorbidades), fatores psicossociais e aspectos relacionadas à lesão (localização, tamanho, profundidade, tipo de tecido, tempo de evolução). Conclusão: Em geral, não foi encontrado um aspecto único que deva ser contemplado na avaliação das feridas crônicas, mas sim uma complexa interação de fatores que incluem tanto aspectos fisiológicos, quanto sociais e psicológicos. De modo que os profissionais devem ser conscientes desse enfoque multifatorial, para reconhecer precocemente o desenvolvimento e a evolução da úlcera e fazer a consequente intervenção

Evaluating the impact of a digital hospital information management system on the operational and financial performance of health facilities in Kenya

Background: In Sub-Saharan Africa, hospital information management systems (HIMS) are predominantly paper based. Countries like Kenya are adopting digital HIMS. However, there is limited evidence about their impact. This study aimed to evaluate the impact of a digital HIMS on the operational and financial performance of Kenyan health facilities. Methods: A retrospective analysis was done using longitudinal data collected at 21 health facilities in Kenya that had actively used the outpatient and/or billing modules of the Elephant HIMS (EHIMS) for at least 9 months. Trends of operational and financial performance indicators across months 3,6,9 after EHIMS adoption were compared to pre-adoption baseline values. The Wilcoxon test was performed to determine the statistical significance of the difference between baseline and 9 months post-adoption. Results: The EHIMS had positive impact on operational performance evidenced by statistically significant reduction, between baseline and 9 months after adoption, in monthly waiting (43.55 vs 35.79 minutes) and journey times (59.90 vs 60.34 minutes). Positive impact was also observed on financial performance as shown by an increase in recorded monthly revenue (100000 vs 210000 KES) and improved tracking of unpaid revenue (0.57 vs 1.19). The above changes were associated with and not directly caused by the EHIMS. Conclusion: The EHIMS was found to have a positive impact on the performance of health facilities at the time points analysed in this study. To demonstrate the full impact of digital HIMS and for clearer attribution, further research should be done to analyse the confounding factors that affect health facility performance

Writing Narrative Medicine into the Electronic Health Record

Physicians’ relationships with their patients can add meaning and a sense of perseverance to their work. However, the use of electronic health record systems (EHR) contributes to feelings of career burnout by inserting a technological barrier that stagnates the formation of physician-patient relationships. Cumbersome EHR designs can prevent efficient medical documentation and often structure clinical notes without the narrative quality that natural communication takes, which leads to an oversight in documenting potentially relevant social details. Narrative medicine, a model of medical communication that fosters empathetic and culturally competent relationships through critical self-reflection, can aid physicians in finding meaning in their daily clinical experiences. This project aims to perform a literature review over the use and implementation of narrative medicine in order to create a standardized definition that acknowledges the predominant differing views in the field. Clarifying the necessary components of narrative medicine will expedite its inclusion in standard medical practices. Furthermore, the standardized definition can be used to inform potential EHR design changes and future training to incorporate narrative medicine into daily medical practice. These changes will include updates to current free-text abilities and novel discussion questions designed to help physicians engage patients in discussion and reflect on their clinical experience. Any design suggestions will take into account the efficiency of documentation and subsequent financial implications. Continued study in healthcare communication and documentation will ensure that patients are receiving a high quality of care while maintaining physician well-being and lowering rates of career burnout.Polymathic Scholar

Usability Study Methodologies of Electronic Health Record Systems: A Systematic Review

This study is a systematic review of literature on electronic health record systems (EHRs) and the evaluation methods performed to study their usability. The purpose was to identify and review the extent of usability testing methods in their respective clinical environments. Full text review was completed for 121 of 753 titles intentionally identified, and 70 final articles were included. The majority of methodologies reviewed were well established in HCI and the most common was the questionnaire. There was a wide range of study designs in terms of user populations (physicians, nurses, pharmacists, nurse practitioners, physical therapists and others), clinical settings (inpatient and outpatient, ambulatory, pediatric, intensive care units, and others), testing time (pre-implementation or post), and qualitative data analysis. Chosen methodologies and study designs closely depended on study goals, but all of them had large implications for the future of quality healthcare and how to achieve it.Master of Science in Information Scienc

Electronic Health Record Implementation Strategies for Decreasing Healthcare Costs

Some managers of primary care provider (PCP) facilities lack the strategies to implement electronic health records (EHRs), which could decrease healthcare costs and enhance the efficiency and quality of healthcare that patients receive. The purpose of this single-case study was to explore the strategies PCP managers used to implement EHRs to decrease healthcare costs. The population consisted of 5 primary care managers with responsibility for the administration, oversight, and direct working knowledge of EHRs in Central Florida. The conceptual framework was the technology acceptance model. Data were collected from semistructured face-to-face interviews and the review of company documents, including training logs, activity records, and cost information. Methodological triangulation was used to validate the creditability and interpretation of the data in transcribing themes. Three themes emerged from the analysis of study data: implementation of EHRs, costs of implementing EHRs, and perceived usefulness of EHRs. Participants indicated that the implementation of EHRs depended on motivation, financial cost, and the usefulness of EHRs relating to training that reflected user-friendliness. The implications of this study for social change include the potential to lower the cost and improve the efficiency of healthcare for patients. The use of EHR systems could enhance the quality of care delivered to patients through improved accessibility, elimination of duplicative tests, and retrieval of accurate patient information. The use of EHRs can lead to a comprehensive preventative healthcare system resulting in a healthier environment

Contribution à la prévention des risques liés à l’anesthésie par la valorisation des informations hospitalières au sein d’un entrepôt de données

Introduction Hospital Information Systems (HIS) manage and register every day millions of data related to patient care: biological results, vital signs, drugs administrations, care process... These data are stored by operational applications provide remote access and a comprehensive picture of Electronic Health Record. These data may also be used to answer to others purposes as clinical research or public health, particularly when integrated in a data warehouse. Some studies highlighted a statistical link between the compliance of quality indicators related to anesthesia procedure and patient outcome during the hospital stay. In the University Hospital of Lille, the quality indicators, as well as the patient comorbidities during the post-operative period could be assessed with data collected by applications of the HIS. The main objective of the work is to integrate data collected by operational applications in order to realize clinical research studies.Methods First, the data quality of information registered by the operational applications is evaluated with methods … by the literature or developed in this work. Then, data quality problems highlighted by the evaluation are managed during the integration step of the ETL process. New data are computed and aggregated in order to dispose of indicators of quality of care. Finally, two studies bring out the usability of the system.Results Pertinent data from the HIS have been integrated in an anesthesia data warehouse. This system stores data about the hospital stay and interventions (drug administrations, vital signs …) since 2010. Aggregated data have been developed and used in two clinical research studies. The first study highlighted statistical link between the induction and patient outcome. The second study evaluated the compliance of quality indicators of ventilation and the impact on comorbity.Discussion The data warehouse and the cleaning and integration methods developed as part of this work allow performing statistical analysis on more than 200 000 interventions. This system can be implemented with other applications used in the CHRU of Lille but also with Anesthesia Information Management Systems used by other hospitals.Introduction Le Système d'Information Hospitalier (SIH) exploite et enregistre chaque jours des millions d'informations liées à la prise en charge des patients : résultats d'analyses biologiques, mesures de paramètres physiologiques, administrations de médicaments, parcours dans les unités de soins, etc... Ces données sont traitées par des applications opérationnelles dont l'objectif est d'assurer un accès distant et une vision complète du dossier médical des patients au personnel médical. Ces données sont maintenant aussi utilisées pour répondre à d'autres objectifs comme la recherche clinique ou la santé publique, en particulier en les intégrant dans un entrepôt de données. La principale difficulté de ce type de projet est d'exploiter des données dans un autre but que celui pour lequel elles ont été enregistrées. Plusieurs études ont mis en évidence un lien statistique entre le respect d'indicateurs de qualité de prise en charge de l'anesthésie et le devenir du patient au cours du séjour hospitalier. Au CHRU de Lille, ces indicateurs de qualité, ainsi que les comorbidités du patient lors de la période post-opératoire pourraient être calculés grâce aux données recueillies par plusieurs applications du SIH. L'objectif de se travail est d'intégrer les données enregistrées par ces applications opérationnelles afin de pouvoir réaliser des études de recherche clinique.Méthode Dans un premier temps, la qualité des données enregistrées dans les systèmes sources est évaluée grâce aux méthodes présentées par la littérature ou développées dans le cadre ce projet. Puis, les problèmes de qualité mis en évidence sont traités lors de la phase d'intégration dans l'entrepôt de données. De nouvelles données sont calculées et agrégées afin de proposer des indicateurs de qualité de prise en charge. Enfin, deux études de cas permettent de tester l'utilisation du système développée.Résultats Les données pertinentes des applications du SIH ont été intégrées au sein d'un entrepôt de données d'anesthésie. Celui-ci répertorie les informations liées aux séjours hospitaliers et aux interventions réalisées depuis 2010 (médicaments administrées, étapes de l'intervention, mesures, parcours dans les unités de soins, ...) enregistrées par les applications sources. Des données agrégées ont été calculées et ont permis de mener deux études recherche clinique. La première étude a permis de mettre en évidence un lien statistique entre l'hypotension liée à l'induction de l'anesthésie et le devenir du patient. Des facteurs prédictifs de cette hypotension ont également étaient établis. La seconde étude a évalué le respect d'indicateurs de ventilation du patient et l'impact sur les comorbidités du système respiratoire.Discussion The data warehouse L'entrepôt de données développé dans le cadre de ce travail, et les méthodes d'intégration et de nettoyage de données mises en places permettent de conduire des analyses statistiques rétrospectives sur plus de 200 000 interventions. Le système pourra être étendu à d'autres systèmes sources au sein du CHRU de Lille mais également aux feuilles d'anesthésie utilisées par d'autres structures de soins

Physicians and Medical Malpractice: Why do Doctors have Unwarranted Fears?

Physicians are concerned about medical malpractice. Research has shown that physicians remain concerned even when they practice in states that have enacted tort reform measures such as caps on non-economic damages. To understand how doctors in a state with tort-reform (Texas) understood and dealt with their medical malpractice concerns, thirteen semi-structured interviews were conducted and analyzed (six obstetrics/gynecology physicians and seven internal medicine physicians). Research question one explored specifically how Texas doctors make sense of medical malpractice in Texas and their coping strategies. Coding and analysis revealed four dominant themes: 1) legal knowledge (“tort reform” and “legal system”); 2) personal risk assessment (“not worried vs. it’s on my mind,” “heightened concerns,” and “out of my control”); 3) risk reduction techniques (“communication skills,” “patient management skills,” and “documentation skills”); and 4) coping mechanisms (“feeling insulated” and “admitting limitations”). The second research question asked physicians to identify sources that influenced their medical malpractice knowledge. They cited the following influences: 1) memorable personal experiences, 2) medical training and experience, 3) information from external organizations, 4) information from unspecified sources. The study confirmed that the participants were still worried about medical malpractice even though they were practicing in state with tort reform. The study also demonstrated that the doctors’ knowledge of medical malpractice came from their personal experiences and word-of-mouth rather than any formal training or legal resources. The theoretical concepts of legal consciousness and sensemaking were combined in this study to determine how the doctors oriented themselves in relationship to the law and how they came to these positions. By using the theories of legal consciousness and sensemaking together, a contribution is made to current and future scholarship regarding understanding and mitigating doctors’ concerns regarding medical malpractice