89 research outputs found
Factors associated with adoption of the electronic health record system among primary care physicians
Background: A territory-wide Internet-based electronic patient record allows better patient care in different sectors. The engagement of private physicians is one of the major facilitators for implementation, but there is limited information about the current adoption level of electronic medical record (eMR) among private primary care physicians.
Objective: This survey measured the adoption level, enabling factors, and hindering factors of eMR, among private physicians in Hong Kong. It also evaluated the key functions and the popularity of electronic systems and vendors used by these private practitioners.
Methods: A central registry consisting of 4324 private practitioners was set up. Invitations for self-administered surveys and the completed questionnaires were sent and returned via fax, email, postal mail, and on-site clinic visits. Current users and non-users of eMR system were compared according to their demographic and practice characteristics. Studentâs t tests and chi-square tests were used for continuous and categorical variables, respectively.
Results: A total of 524 completed surveys (response rate 524/4405 11.90%) were collected. The proportion of using eMR in private clinics was 79.6% (417/524). When compared with non-users, the eMR users were younger (users: 48.4 years SD 10.6 years vs non-users: 61.7 years SD 10.2 years, P<.001); more were female physicians (users: 80/417, 19.2% vs non-users: 14/107, 13.1%, P=.013); possessed less clinical experience (with more than20 years of practice: users: 261/417, 62.6% vs non-user: 93/107, 86.9%, P<.001); fewer worked under a Health Maintenance Organization (users: 347/417, 83.2% vs non-users: 97/107, 90.7%, P<.001) and more worked with practice partners (users: 126/417, 30.2% vs non-users: 4/107, 3.7%, P<.001). Efficiency (379/417, 90.9%) and reduction of medical errors (229/417, 54.9%) were the major enabling factors, while patient-unfriendliness (58/107, 54.2%) and limited consultation time (54/107, 50.5%) were the most commonly reported hindering factors. The key functions of computer software among eMR users consisted of electronic patient registration system (376/417, 90.2%), drug dispensing system (328/417, 78.7%) and electronic drug labels (296/417, 71.0%). SoftLink Clinic Solution was the most popular vendor (160/417, 38.4%).
Conclusions: These findings identified several physician groups who should be targeted for more assistance on eMR installation and its adoption. Future studies should address the barriers of using Internet-based eMR to enhance its adoption
Randomized Clinical Trial on the Efficacy and Side Effects of Tropicamide and Phenylephrine in Mydriasis for Ophthalmoscopy
Purpose: To compare the efficacy and side effects of two combinations of tropicamide and phenylephrine as mydriatics for ophthalmoscopy.
Methods: In this prospective randomized controlled trial, 51 Chinese outpatients were randomized to receive topical tropicamide 1.0% and phenylephrine 2.5% (Regime A), and 50 to receive a fixed combination of tropicamide 0.5% and phenylephrine 0.5% (Regime B). The change in horizontal pupillary diameter, subject discomfort upon instillation and the time elapsed between instillation and recovery from glare and near blur were studied.
Results: After 60 minutes, the mean increase in pupillary diameter was 3.56±0.65 mm with Regime A, and 3.04±0.62 mm with Regime B (P<0.01), but there was no difference in the proportion of subjects having a post-mydriatic pupillary diameter of 6 mm or larger (P=0.54). No subjects required additional instillation. Regime B was better tolerated (P<0.001). The median times elapsed between instillation and recovery from glare or near blur was 7 hours, without a significant difference between the two regimes (P=0.5).
Conclusions: Both regimes were effective and safe for ophthalmoscopy. However, Regime B was better tolerated. Subjects may be reassured that the side effects of glare and near blur are likely to disappear by the following day
Effects of foot progression angle adjustment on external knee adduction moment and knee adduction angular impulse during stair ascent and descent
Foot progression angle adjustment was shown to reduce external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) during level ground walking. However, evidence on effects of foot progression angle adjustment on the above surrogate measures of medial knee loading during stair climbing is limited. Hence, this study examined the effects of toe-in and toe-out gait on EKAM and KAAI during stair ascent and descent. Kinematic and kinetic data were collected from thirty-two healthy adults during stair ascent and descent with toe-in, toe-out and natural gait. A repeated measures ANOVA indicated that toe-in gait significantly reduced the first EKAM peak (PâŻ<âŻ0.001) and KAAI (PâŻ=âŻ0.002), while toe-out gait significantly increased the first (PâŻ<âŻ0.001) and second (PâŻ=âŻ0.04) EKAM peaks and KAAI (PâŻ<âŻ0.001) when compared with natural gait during stair ascent. During stair descent, toe-in gait significantly reduced the first (PâŻ<âŻ0.001) and second (PâŻ=âŻ0.032) EKAM peaks and KAAI (PâŻ<âŻ0.001), whilst toe-out gait significantly increased the first EKAM peak (PâŻ=âŻ0.022) and KAAI (PâŻ=âŻ0.028) when compared with natural gait. In conclusion, toe-in gait was found to be a viable strategy in reducing medial knee loading during stair climbing
The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings: a cross-sectional study
The prevalence of diabetes mellitus has been increasing both globally and locally. Primary care physicians (PCPs) are in a privileged
position to provide first contact and continuing care for diabetic patients. A territory-wide Reference Framework for Diabetes Care for
Adults has been released by the Hong Kong Primary Care Office in 2010, with the aim to further enhance evidence-based and high
quality care for diabetes in the primary care setting through wide adoption of the Reference Framework.
A valid questionnaire survey was conducted among PCPs to evaluate the levels of, and the factors associated with, their adoption
of the Reference Framework.
A total of 414 completed surveys were received with the response rate of 13.0%. The average adoption score was 3.29 (SD 0.51)
out of 4. Approximately 70% of PCPs highly adopted the Reference Framework in their routine practice. Binary logistic regression
analysis showed that the PCPs perceptions on the inclusion of sufficient local information (adjusted odds ratio [aOR]=4.748, 95%CI
1.597â14.115, P=0.005) and reduction of professional autonomy of PCPs (aOR=1.859, 95%CI 1.013â3.411, P=0.045) were
more likely to influence their adoption level of the Reference Framework for diabetes care in daily practices.
The overall level of guideline adoption was found to be relatively high among PCPs for adult diabetes in primary care settings. The
adoption barriers identified in this study should be addressed in the continuous updating of the Reference Framework. Strategies
need to be considered to enhance the guideline adoption and implementation capacity
Exposure to air pollutants and mortality in hypertensive patients according to demography: a 10 year case-crossover study
This study evaluated whether short term exposures to NO2, O3, particulate matter <10 mm in diameter (PM10) were associated with higher risk of mortality. A total of 223,287 hypertensive patients attended public health-care services and newly prescribed at least 1 antihypertensive agent were followed-up for up to 5 years. A time-stratified, bi-directional case-crossover design was adopted. For all-cause mortality, significant positive associations were observed for NO2 and PM10 at lag 0â3 days per 10 ÎŒg/m3 increase in concentration (excess risks 1.187%â2.501%). Significant positive associations were found for O3 at lag 1 and 2 days and the excess risks were 1.654% and 1.207%, respectively. We found similarly positive associations between these pollutants and respiratory disease mortality. These results were significant among those aged â„65 years and in cold seasons only. Older hypertensive patients are susceptible to all-cause and respiratory disease-specific deaths from these air pollutants in cold weather
Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study
Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24\ua0h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification. Results: Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01\u20131.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both\ua0resolved and confirmed\ua0ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each\ua0associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated\ua0with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal. Conclusions: ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population. Trial Registration: ClinicalTrials.gov NCT02010073. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
Measurement of Ï(3872) production in proton-proton collisions at = 8 and 13 TeV
International audienceThe production cross-section of the Ï(3872) state relative to the Ï(2S) meson is measured using proton-proton collision data collected with the LHCb experiment at centre-of-mass energies of = 8 and 13 TeV, corresponding to integrated luminosities of 2.0 and 5.4 fb, respectively. The two mesons are reconstructed in the J/ÏÏÏ final state. The ratios of the prompt and nonprompt Ï(3872) to Ï(2S) production cross-sections are measured as a function of transverse momentum, p, and rapidity, y, of the Ï(3872) and Ï(2S) states, in the kinematic range 4 < p< 20 GeV/c and 2.0 < y < 4.5. The prompt ratio is found to increase with p, independently of y. For the prompt component, the double ratio of the Ï(3872) and Ï(2S) production cross-sections between 13 and 8 TeV is observed to be consistent with unity, independent of p and centre-of-mass energy.[graphic not available: see fulltext
Evidence for a new structure in the and systems in decays
International audienceAn amplitude analysis of flavor-untagged Bs0âJ/ÏppÂŻ decays is performed using a sample of 797±31 decays reconstructed with the LHCb detector. The data, collected in proton-proton collisions between 2011 and 2018, correspond to an integrated luminosity of 9ââfb-1. Evidence for a new structure in the J/Ïp and J/ÏpÂŻ systems with a mass of 4337-4+7â-2+2ââMeV and a width of 29-12+26â-14+14ââMeV is found, where the first uncertainty is statistical and the second systematic, with a significance in the range of 3.1 to 3.7Ï, depending on the assigned JP hypothesis
Study of coherent production in lead-lead collisions at = 5 TeV
International audienceCoherent production of J/Ï mesons is studied in ultraperipheral lead-lead collisions at a nucleon-nucleon centre-of-mass energy of 5 TeV, using a data sample collected by the LHCb experiment corresponding to an integrated luminosity of about 10 ÎŒb. The J/Ï mesons are reconstructed in the dimuon final state and are required to have transverse momentum below 1 GeV. The cross-section within the rapidity range of 2.0 < y < 4.5 is measured to be 4.45 ± 0.24 ± 0.18 ± 0.58 mb, where the first uncertainty is statistical, the second systematic and the third originates from the luminosity determination. The cross-section is also measured in J/Ï rapidity intervals. The results are compared to predictions from phenomenological models.[graphic not available: see fulltext
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