Availability and Accuracy of electronic patient data for medical practice assessment

We analyzed availability and accuracy of electronic patient data needed to assess medical practice. A case study was performed in which pediatricians formulated 14 performance indicators that cover aspects of care for children with suspected meningitis. Data items needed to quantify these indicators were listed. Required patient data were gathered from hospital information system and paper medical records. Accuracy of electronically available data was based on comparison with paper data and, when paper data were not available, on how data were recorded at the source, administrative procedures and original goal for which data were recorded. Conclusion: Registration of reason for admission and diagnoses gives no reliable basis to select patients with 'suspicion on a disease' as selection criterion. Besides, many performance indicators cannot be reliably quantified because data are not recorded electronically (indication, medication, outpatient diagnosis), are not recorded specific enough (intervention time), are not standardized (radiology report), or cannot be obtained from other hospitals

A neonate with marked prolonged mixed apneas and CHARGE syndrome: A case report

Background: Upper airway abnormalities in the newborn are associated with obstructive breathing but not with mixed apneas. A tracheostomy is necessary to treat severe obstructive apneas but will not have an effect on the central part of the mixed apneas. As far as we know, this is the first case report describing disappearance of severe mixed apneas after tracheostomy in a 7-week-old infant. Case presentation: We report a case of a white female neonate with anatomical upper airway abnormalities and severe mixed apneas with desaturations needing respiratory support. Polysomnography revealed striking mixed apneas, starting as a prolonged central apnea and merging into an obstructive apnea, and were not appropriate for her age. Additional examination revealed no explanation for the central component of the mixed apneas. Because of persistent, severe desaturations, she needed respiratory support with failure to wean. Finally, a tracheostomy was performed to treat the obstructive apneas, but unexpectedly the central apneas also resolved. Recently, additional genetic testing revealed that she has CHARGE syndrome (coloboma of the eye, heart defects, atresia of the choanae, retardation of growth and development, genital and/or urinary abnormalities, and ear abnormalities and deafness). Conclusions: Mixed apneas are not a common feature in the newborn or infant with upper airway abnormalities. However, treatment with tracheostomy in our patient (day 46 postpartum) with anatomical upper airway abnormalities resolved not only obstructive apneas but also, unexpectedly, severe mixed apneas. Surprisingly, a posttracheostomy polygraph showed only short central apneas appropriate for age

Managing infants with craniofacial malformations – Where to go next?

Treatment of infants with craniofacial malformations, e.g. Robin sequence, is characterized by considerable heterogeneity and a lack of randomized trials to identify an optimal approach. We propose to establish an international register using a common minimal dataset that will better allow for a comparison between key determinants and outcomes in these patients. In infants, this should include an assessment of mandibular micrognathia, glossoptosis, upper airway obstruction, weight gain and mode of feeding. Later on, neurocognition, speech development, hearing and quality of life should also be included. Together, these data will help better to advice parents on which treatment to choose for their baby with a craniofacial malformation

NetWORKers and their Activity in Intensional Networks

Through ethnographic research, we document the rise of personal social networks in the workplace, which we call intensional networks. Paradoxically, we find that the most fundamental unit of analysis for computer-supported cooperative work is not at the group level for many tasks and settings, but at the individual level as personal social networks come to be more and more important. Collective subjects are increasingly put together through the assemblage of people found through personal networks rather than being constituted as teams created through organizational planning and structuring. Teams are still important but they are not the centerpiece of labor management they once were, nor are they the chief resource for individual workers. We draw attention to the importance of networks as most CSCW system designs assume a team. We urge that designers take account of networks and the problems they present to workers. Modern work and the rise of intensional networks In the past, much w..

Objective measurements for upper airway obstruction in infants with Robin sequence: what are we measuring? A systematic review

Study Objectives: Identifying optimal treatment for infants with Robin sequence (RS) is challenging due to substantial variability in the presentation of upper airway obstruction (UAO) in this population.Objective assessments of UAOand treatments are not standardized. A systematic review of objectivemeasures ofUAO was conducted as a step toward evidence-based clinical decision-making for RS. Methods: A literature search was performed in the PubMed and Embase databases (1990-2020) following PRISMA guidelines. Articles reporting on RS and UAO treatment were included if the following objective measures were studied: Oximetry, polysomnography, and blood gas. Quality was appraised by the methodological index for nonrandomized studies (range: 0-24). Results: A total of 91 articles met the inclusion criteria. The mean methodological index for nonrandomized studies score was 7.1 (range: 3-14). Polysomnography was most frequently used (76%) followed by oximetry (20%) and blood gas (11%). Sleep position of the infantwas reported in 35%of studies, with supine position most frequently, and monitoring time in 42%, including overnight recordings, in more than half. Of 71 studies that evaluated UAO interventions, the majority used polysomnography (90%), of which 61% did not specify the polysomnography technique. Reported polysomnography metrics included oxygen saturation (61%), apnea-hypopnea index (52%), carbon dioxide levels (31%), obstructive apnea-hypopnea index (27%), and oxygen desaturation index (16%). Only 42 studies reported indications for UAO intervention, with oximetry and polysomnography thresholds used equally (both 40%). In total, 34 distinct indications for treatment were identified. Conclusions: This systematic review demonstrates a lack of standardization, interpretation, and reporting of assessment and treatment indications for UAO in RS. An international, multidisciplinary consensus protocol is needed to guide clinicians on optimal UAO assessment in RS