INFORMER: A System for Immediate and Direct Notification of Critical Data for Patient Care [abstract]

Computational Infrastructure and Informatics Poster SessionEfficient and timely delivery of healthcare requires constant improvements in the quality while keeping the cost of delivery under control. One of the important requirements for such delivery system is the timely notification of patient related data (For example notification of laboratory results on metabolites, circulating levels of certain medications, etc) to doctors, nurses, and other medical professionals for prescribing necessary action. Currently, in nearly all hospitals and laboratories, laboratory or nursing staff are responsible for manually transmitting such information. They take the information verbally or written on a piece of paper, on a pad or on some other media to the recipient in one or multiple hops. Such approach, although serves the purpose, has a number of ordinary to serious limitations such as a higher error rate, incorrect destination, security breach, etc., that could endanger patients life. For example, it is quite possible that the person responsible for notification may forget or delay, for a variety of reasons, to notify the doctor or medical staff or may miscommunicate the results; for example instead of sodium of 150, he or she may orally communicate it as 160. It is also possible that the dispatcher may deliver the information to wrong person (security breach), or take too long to deliver the information. These issues are likely to have serious consequences, in particular for institutions that deal with human subjects such as emergency department of the hospitals where rapid notification is essential for saving lives of critically ill patients. For results communication, paging is a commonly used notification methods but it also involves human and any inadvertent delays in reporting critical data to the physician and other medical staff or to the patient can have serious consequences. We claim that automation in data notification will (a) eliminate or minimize such undesirable consequences, (b) will keep the cost down and (c) improve patient care. We are in the process of designing a pervasive system, referred here as “Informer” to automate the notification process. The system will (a) compose the information (test results, recommendations, etc.) to be dispatched in a easy to read format, (b) identify and notify the critical results to the right medical professionals, (b) maintain an active log of automation process for immediate reference, (c) guarantee accurate data delivery, (d) keep the cost down, (e) provide necessary security, (f) work equally well with wired and wireless network, and (g) offer a high scalability. It will be (a) an independent system with plug and play capability, (b) can port to any system (window, Mac, Linux, etc.), and (c) easy to configure for specific needs

INFORMER and Potassium Values: A system to enhance detection, notification, and action upon a threat to patient safety in the emergency department [abstract]

Computational Infrastructure and Informatics Poster SessionBackground: Quick remediation should occur after critically abnormal potassium levels are detected by the medical laboratory in blood from emergency department (ED) patients. Critical potassium levels can be elevated (“HyperK+“) or decreased (“HypoK+“). HyperK+ and HypoK+ can both lead to avoidable patient harm by causing heart rhythm problems, which can be harmful or lethal. Also, Continuous Quality Improvement (CQI) could be enhanced by the creation of an electronic “audit trail” to track these remediations, which involve detection, notification, action-upon, and documentation steps (D1-N-A-D2). HyperK+ and HypoK+ are a logical first target to ameliorate inefficiencies of D1-N-A-D2, because of the frequency of occurrence of these problems in the ED, because the appropriate rapid ED response is clear, and because failures of D1-N-A-D2. can hurt or kill patients. Hypothesis: An automated D1-N-A-D2, plus audit path, can be created, then merged with a to-be-created standing ED order set, to hasten the treatment of HyperK+ and HypoK+. Methods: (1) A standing order set will be adopted, to permit nurses to administer appropriate treatments to patients with either HyperK+ or HypoK+, without prior physician notification. Oral or intravenous potassium, as appropriate, will remediate HypoK+, Administration of insulin plus glucose, calcium, sodium bicarbonate, and sodium polystyrene resin will ameliorate HyperK+. Order sets will be created after input from physician and nursing personnel. (Re-obtaining of blood from patients in whom HyperK+ is thought to be a false positive result, due to hemolysis of the blood sample, will be permitted). (2) “Electronic loop”: Engineers will create an electronic pathway to enable the rapid electronic notification of appropriate medical personnel, after critical HyperK+ or HypoK+ have been detected. This will enable and drive nurses to action. Actions can be electronically audited via review of digital PyxisTM medication administration machine records, matching medication withdrawals for specific patients to specific incidences of HyperK+ and HypoK+. Time to nurse action will be documented. Data during implementation of D1-N-A-D2 will be compared to prior historical control data, to determine whether the newly created process delivers appropriate care more quickly to patients with critically abnormal K+ values. (In addition, it is anticipated that electronic review of laboratory data for the historical controls will reveal total system failures for some patients; some patients with HyperK+ and/or HypoK+ might not have been treated at all for their potassium abnormality during their time in the ED.) Results: Time to treatment for HyperK+ and HypoK+ patients, and % of patients with HyperK+ and HypoK+ who represent total system failures, before vs. after implementation of the pervasive computing protocol, will be determined. Conclusion: It is anticipated that a pervasive computing environment can be created to facilitate implementation of a standing medication order set, to enable more rapid D1-N-A-D2 after critical values of HyperK+ or HypoK+ are detected in the blood of emergency department patients. Also, this environment will decrease the failure-to-treat rate for critical HyperK+ and HypoK+

Large-scale association analysis identifies new lung cancer susceptibility loci and heterogeneity in genetic susceptibility across histological subtypes.

Although several lung cancer susceptibility loci have been identified, much of the heritability for lung cancer remains unexplained. Here 14,803 cases and 12,262 controls of European descent were genotyped on the OncoArray and combined with existing data for an aggregated genome-wide association study (GWAS) analysis of lung cancer in 29,266 cases and 56,450 controls. We identified 18 susceptibility loci achieving genome-wide significance, including 10 new loci. The new loci highlight the striking heterogeneity in genetic susceptibility across the histological subtypes of lung cancer, with four loci associated with lung cancer overall and six loci associated with lung adenocarcinoma. Gene expression quantitative trait locus (eQTL) analysis in 1,425 normal lung tissue samples highlights RNASET2, SECISBP2L and NRG1 as candidate genes. Other loci include genes such as a cholinergic nicotinic receptor, CHRNA2, and the telomere-related genes OFBC1 and RTEL1. Further exploration of the target genes will continue to provide new insights into the etiology of lung cancer

Emergency Medicine: a specialty that deserves “re-branding,” because it enables large financial savings!

Emergency departments are costly to maintain. They remain open every hour of the year to provide care for those who need it, when they need it. Therefore, emergency departments are a crucial resource for any modern society, and no sensible person would want to close them, despite their cost. However, the view held by many, that the care provided in an emergency department is excessively costly, is just plain wrong. When our doctors’ and our specialty’s performance is viewed objectively, it becomes clear that emergency physicians have become crucial agents of cost savings. Therefore, EPs have earned the right to proudly “re-brand” themselves not as high-cost care providers, but as indispensable, money-savers in any nation’s health care enterprise. If you don’t believe that, continue reading this commentary

PORCINE ZONA PELLUCIDA IMMUNOCONTRACEPTION: LONG-TERM HEALTH EFFECTS ON WHITE-TAILED DEER

As part of a 9-year study on the contraceptive effects of Porcine Zona Pellucida (PZP) on white-tailed deer (Odocoileus virginianus), we analyzed serum chemistry panels during the first 4 years. This included the first 2 years when does were being actively immunized, and 2 years post-immunization. The chemistry panel was designed to detect pathologies that might result from the immunization of the deer. Blood chemistry results did not suggest any pathological changes resulting from the immunization. Seasonal differences in serum cholesterol were similar in both the control and PZP-treated groups. Seasonal changes in the mean body weights of the treated and control groups reflected an increased weight of the control group in the spring, probably due to pregnancy. However, no statistical difference existed in the fall weights between the 2 groups throughout the 4-year study