844 research outputs found

    Documentation of Vital Signs in Electronic Health Records: A Patient Safety Issue

    Get PDF
    Background and aim: Hospitals in the developed world are increasingly adopting digital systems such as electronic health records (EHRs) for all kinds of documentation. This move means that traditional paper case notes and nursing records are often documented in EHRs. Documentation of vital signs is important for monitoring a patient's physiological condition and how vital signs are presented in a clinical record can have a profound impact on the ability of clinicians to recognise changes, such as deterioration in a patient's condition. Vital signs have received minimal attention with regard to how they are documented in EHRs which suggests that there is an urgent need for this to be examined. Design, methodology and approach: A mixed methods study was conducted in a 372-bed county hospital in two phases. Phase one was a quantitative study, and was followed by a qualitative study in phase two. The aim of the quantitative study was to examine the vital signs documented in the electronic health records of patients who had previously suffered a cardiac arrest. The aim of the qualitative study was to investigate how medical and nursing staff measured, reported and retrieved information on vital signs. Observations were made and interviews were conducted in four clinical areas. Findings: The quantitative study found that documentation of vital signs was incomplete in relation to current universal standards for monitoring vital signs, and that vital signs were dispersed inconsistently throughout the EHR. The qualitative study provided a detailed understanding of the routines and practices for monitoring vital signs and demonstrated variation in routines and in methods of documentation in the four clinical areas. Documenting and retrieving vital signs in the EHR was problematic because of usability issues and led to workflow problems. Workflow problems were solved at ward level by the creation of paper workarounds. Contribution to knowledge: This thesis has shown that poor facilities for the documentation of vital signs in EHRs could have a negative impact on patient safety because it reduces the possibility of good record keeping. This leads to limited availability of easily accessible, up-to-date information, essential for identifying clinical deterioration and, thus, is a challenge to patient safety. Related to this, the thesis has identified possible solutions to usability problems in the EHR. Inconsistent routines and practices were also identified and suggestions were made for how this problem might be approached

    Vital sign documentation in electronic records: The development of workarounds.

    Get PDF
    Workarounds are commonplace in healthcare settings. An increase in the use of electronic health records has led to an escalation of workarounds as healthcare professionals cope with systems which are inadequate for their needs. Closely related to this, the documentation of vital signs in electronic health records has been problematic. The accuracy and completeness of vital sign documentation has a direct impact on the recognition of deterioration in a patient's condition. We examined workflow processes to identify workarounds related to vital signs in a 372-bed hospital in Sweden. In three clinical areas, a qualitative study was performed with data collected during observations and interviews and analysed through thematic content analysis. We identified paper workarounds in the form of handwritten notes and a total of eight pre-printed paper observation charts. Our results suggested that nurses created workarounds to allow a smooth workflow and ensure patients safety

    A genomic rearrangement resulting in a tandem duplication is associated with split hand-split foot malformation 3 (SHFM3) at 10q24

    Get PDF
    Split hand-split foot malformation (SHFM) is characterized by hypoplasia/aplasia of the central digits with fusion of the remaining digits. SHFM is usually an autosomal dominant condition and at least five loci have been identified in humans. Mutation analysis of the DACTYLIN gene, suspected to be responsible for SHFM3 in chromosome 10q24, was conducted in seven SHFM patients. We screened the coding region of DACTYLIN by single-strand conformation polymorphism and sequencing, and found no point mutations. However, Southern, pulsed field gel electrophoresis and dosage analyses demonstrated a complex rearrangement associated with a ∼0.5 Mb tandem duplication in all the patients. The distal and proximal breakpoints were within an 80 and 130 kb region, respectively. This duplicated region contained a disrupted extra copy of the DACTYLIN gene and the entire LBX1 and β-TRCP genes, known to be involved in limb development. The possible role of these genes in the SHFM3 phenotype is discusse

    Asymptotically Improved Convergence of Optimized Perturbation Theory in the Bose-Einstein Condensation Problem

    Full text link
    We investigate the convergence properties of optimized perturbation theory, or linear δ\delta expansion (LDE), within the context of finite temperature phase transitions. Our results prove the reliability of these methods, recently employed in the determination of the critical temperature T_c for a system of weakly interacting homogeneous dilute Bose gas. We carry out the explicit LDE optimized calculations and also the infrared analysis of the relevant quantities involved in the determination of TcT_c in the large-N limit, when the relevant effective static action describing the system is extended to O(N) symmetry. Then, using an efficient resummation method, we show how the LDE can exactly reproduce the known large-N result for TcT_c already at the first non-trivial order. Next, we consider the finite N=2 case where, using similar resummation techniques, we improve the analytical results for the nonperturbative terms involved in the expression for the critical temperature allowing comparison with recent Monte Carlo estimates of them. To illustrate the method we have considered a simple geometric series showing how the procedure as a whole works consistently in a general case.Comment: 38 pages, 3 eps figures, Revtex4. Final version in press Phys. Rev.

    Transiting Exoplanet Studies and Community Targets for JWST's Early Release Science Program

    Get PDF
    The James Webb Space Telescope will revolutionize transiting exoplanet atmospheric science due to its capability for continuous, long-duration observations and its larger collecting area, spectral coverage, and spectral resolution compared to existing space-based facilities. However, it is unclear precisely how well JWST will perform and which of its myriad instruments and observing modes will be best suited for transiting exoplanet studies. In this article, we describe a prefatory JWST Early Release Science (ERS) program that focuses on testing specific observing modes to quickly give the community the data and experience it needs to plan more efficient and successful future transiting exoplanet characterization programs. We propose a multi-pronged approach wherein one aspect of the program focuses on observing transits of a single target with all of the recommended observing modes to identify and understand potential systematics, compare transmission spectra at overlapping and neighboring wavelength regions, confirm throughputs, and determine overall performances. In our search for transiting exoplanets that are well suited to achieving these goals, we identify 12 objects (dubbed "community targets") that meet our defined criteria. Currently, the most favorable target is WASP-62b because of its large predicted signal size, relatively bright host star, and location in JWST's continuous viewing zone. Since most of the community targets do not have well-characterized atmospheres, we recommend initiating preparatory observing programs to determine the presence of obscuring clouds/hazes within their atmospheres. Measurable spectroscopic features are needed to establish the optimal resolution and wavelength regions for exoplanet characterization. Other initiatives from our proposed ERS program include testing the instrument brightness limits and performing phase-curve observations.(Abridged)Comment: This is a white paper that originated from an open discussion at the Enabling Transiting Exoplanet Science with JWST workshop held November 16 - 18, 2015 at STScI (http://www.stsci.edu/jwst/science/exoplanets). Accepted for publication in PAS

    Variational Quark Mass Expansion and the Order Parameters of Chiral Symmetry Breaking

    Get PDF
    We investigate in some detail a "variational mass" expansion approach, generalized from a similar construction developed in the Gross-Neveu model, to evaluate the basic order parameters of the dynamical breaking of the SU(2)L×SU(2)RSU(2)_L \times SU(2)_R and SU(3)L×SU(3)RSU(3)_L \times SU(3)_R chiral symmetries in QCD. The method starts with a reorganization of the ordinary perturbation theory with the addition of an arbitrary quark mass mm. The new perturbative series can be summed to all orders thanks to renormalization group properties, with specific boundary conditions, and advocated analytic continuation in mm properties. In the approximation where the explicit breakdown of the chiral symmetries due to small current quark masses is neglected, we derive ansatzes for the dynamical contribution to the "constituent" masses MqM_q of the u,d,su,d,s quarks; the pion decay constant FπF_\pi; and the quark condensate in terms of the basic QCD scale ΛMSˉ\Lambda_{\bar{MS}} . Those ansatzes are then optimized, in a sense to be specified, and also explicit symmetry breaking mass terms can be consistently introduced in the framework. The obtained values of FπF_\pi and MqM_q are roughly in agreement with what is expected from other non-perturbative methods. In contrast we obtain quite a small value of <qˉq>|< \bar q q >| within our approach. The possible interpretation of the latter results is briefly discussed.Comment: 40 pages, LaTex, 2 PS figures. Additions in section 2.2 to better explain the relation between the current mass and the dynamical mass ansatz. Minor misprints corrected. Version to appear in Phys. Rev.

    Lujan-Fryns syndrome (mental retardation, X-linked, marfanoid habitus)

    Get PDF
    The Lujan-Fryns syndrome or X-linked mental retardation with marfanoid habitus syndrome is a syndromal X-linked form of mental retardation, affecting predominantly males. The prevalence is not known for the general population. The syndrome is associated with mild to moderate mental retardation, distinct facial dysmorphism (long narrow face, maxillary hypoplasia, small mandible and prominent forehead), tall marfanoid stature and long slender extremities, and behavioural problems. The genetic defect is not known. The diagnosis is based on the presence of the clinical manifestations. Genetic counselling is according to X-linked recessive inheritance. Prenatal testing is not possible. There is no specific treatment for this condition. Patients need special education and psychological follow-up, and attention should be given to diagnose early psychiatric disorders
    corecore