Prehospital Electronic Patient Care Report Systems: Early Experiences from Emergency Medical Services Agency Leaders

Background: As the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR) systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. Methods: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP) members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. Results: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1) identify creative funding sources; 2) leverage regional health information organizations; and 3) build internal information technology capacity. Conclusion: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and implementation of e-PCR systems has been challenging for many. Emerging strategies from EMS agencies and others that have successfully implemented EHRs may be useful in expanding e-PCR system use and facilitating this transition for other EMS agencies

Correlation of total serum magnesium level with clinical outcomes in stroke patients

Background and Objective: Magnesium (Mg) ion has possible role in protecting neurons and glia from ischemic damage through the cerebral blood flow and neuronal action. This study was done to evaluate the correlation of total serum Mg level with clinical outcomes in stroke patients. Materials and Methods: This cross sectional study was done on 316 patients whom diagnosed with stroke in Imam Hossein hospital, Tehran, Iran during 2010-11. Mg levels in all patients were measured. Also, recurrent transient ischemic attack (TIA), recurrent myocardial infarction or stroke, unstable angina and death as clinical outcomes were follow-up for period of 3 and 6 months after admission. Data were analyzed using SPSS-18, Chi-Square, Fisher and Pearson correlation tests. Results: The mean age of patients was 65±15.8 year. Limb weakness (69.9%) and haemoplasia with 63.6% were the most common clinical complaints. Death was the most common finding in 3 month (16.8%) and recurrent stroke was the most common finding in 6 month follow up (2.5%). There was no significant difference between the total serum Mg and the first and second three-months follow up of clinical outcomes. Conclusion: This study can not show a significant correlation between total serum Mg levels and clinical outcomes after 3 and 6 month follow up in stroke patients

Derivation and validation of a scoring system to identify patients with bacteremia and hematological malignancies at higher risk for mortality

BACKGROUND: The aim of this study was to develop and validate a reliable clinical prediction rule that could be employed to identify patients at higher likelihood of mortality among those with hematological malignancies (HMs) and bacterial bloodstream infections (BBSIs). METHODS AND FINDINGS: We conducted a retrospective cohort study in nine Italian hematological units. The derivation cohort consisted of adult patients with BBSI and HMs admitted to the Catholic University Hospital (Rome) between January 2002 and December 2008. Survivors and nonsurvivors were compared to identify predictors of 30-day mortality. The validation cohort consisted of patients hospitalized with BBSI and HMs who were admitted in 8 other Italian hematological units between January 2009 and December 2010. The inclusion and exclusion criteria were identical for both cohorts, with type and stage of HMs used as matching criteria. In the derivation set (247 episodes), the multivariate analysis yielded the following significant mortality-related risk factors acute renal failure (Odds Ratio [OR] 6.44, Confidential Interval [CI], 2.36-17.57, P<0.001); severe neutropenia (absolute neutrophil count <100/mm(3)) (OR 4.38, CI, 2.04-9.43, P<0.001); nosocomial infection (OR, 3.73, CI, 1.36-10.22, P\u200a=\u200a0.01); age 6565 years (OR, 3.42, CI, 1.49-7.80, P\u200a=\u200a0.003); and Charlson Comorbidity Index 654 (OR, 3.01, CI 1.36-6.65, P\u200a=\u200a0.006). The variables unable to be evaluated at that time (for example, prolonged neutropenia) were not included in the final logistic model. The equal-weight risk score model, which assigned 1 point to each risk factor, yielded good-excellent discrimination in both cohorts, with areas under the receiver operating curve of 0.83 versus 0.93 (derivation versus validation) and good calibration (Hosmer-Lemshow P\u200a=\u200a0.16 versus 0.75).CONCLUSIONS: The risk index accurately identifies patients with HMs and BBSIs at high risk for mortality; a better initial predictive approach may yield better therapeutic decisions for these patients, with an eventual reduction in mortality