Barriers and Facilitators of Electronic Health Records in Rural Communities

Electronic health records (EHRs) offer digitally stored healthcare information during an individual’s lifetime with the purpose of evidence-based research, continuity of care, prior health care, and educational resources. EHR’s contain diagnostic test, such as laboratory values and radiological images, treatments, therapies, medication administration, patient identifying information, and legal forms. The barriers and facilitators of electronic medical or health records (EMR or EHRs) are designated to offer data for providers and caregivers working in the local mobile health units in South Georgia. The project determined the readiness, barriers, needs assessment, and facilitators for electronic health records within the rural communities with the intent to obtain patient information, delivering quality care

Modifying the Einstein Equations off the Constraint Hypersuface

A new technique is presented for modifying the Einstein evolution equations off the constraint hypersurface. With this approach the evolution equations for the constraints can be specified freely. The equations of motion for the gravitational field variables are modified by the addition of terms that are linear and nonlocal in the constraints. These terms are obtained from solutions of the linearized Einstein constraints.Comment: 4 pages, 1 figure, uses REVTe

Survey of children accessing HIV services in a high prevalence setting: time for adolescents to count?

OBJECTIVE: To establish the proportion of adolescents among children infected with human immunodeficiency virus (HIV) in Zimbabwe who receive HIV care and support, and what clinic staff perceives to be the main problems faced by HIV-infected children and adolescents. METHODS: In July 2008, we sent a questionnaire to all 131 facilities providing HIV care in Zimbabwe. In it we requested an age breakdown of the children (aged 0-19 years) registered for care and asked what were the two major problems faced by younger children (0-5 years) and adolescents (10-19 years). FINDINGS: Nationally, 115 (88%) facilities responded. In 98 (75%) that provided complete data, 196 032 patients were registered and 24 958 (13%) of them were children. Of children under HIV care, 33% were aged 0-4 years; 25%, 5-9 years; 25%, 10-14 years; and 17%, 15-19 years. Staff highlighted differences in the problems most commonly faced by younger children and adolescents. For younger children, such problems were malnutrition and lack of appropriate drugs (cited by 46% and 40% of clinics, respectively); for adolescents they concerned psychosocial issues and poor drug adherence (cited by 56% and 36%, respectively). CONCLUSION: Interventions for the large cohort of adolescents who are receiving HIV care in Zimbabwe need to target the psychosocial concerns and poor drug adherence reported by staff as being the main concerns in this age group

Fall Risk Identification and Reduction Among the Gerontological Population at a Long-term Care Facility

Abstract Problem: Data obtained from the facility from February 2022 to July 2023 showed that there were a total of 110 falls at the facility with 51% resulting in injury. The facility also lacked a standardized fall assessment tool with minimal follow up after fall incidents. Context: A microsystem assessment of the geriatric population at the long-term care facility indicated the need for a standardized fall risk screening tool to accurately assess patients. Interventions: A staff presentation was created highlighting the high rate of falls at the facility as well as to educate on the implementation of the Morse Fall Scale. Additionally, a presentation was created for residents to provide education on factors that increase the risk of falls and prevention measures to encourage active participation in their care. Measures: Data from February 2022-July 2023 was obtained and organized in an electronic database created on a Google Sheet. To measure the outcome, the number of falls in January 2023 will be compared to data from January 2024 to determine if there has been a 20% decrease in resident falls. Results: Due to time constraints, the results will not be obtained. The expected outcome of this project is to reduce the number of falls in the facility by 20% within six months and prevent future incidents, as evidence shows that fall assessment and interventions can reduce falls rates by 20-30% (Morris & O\u27Riordan, 2017). Conclusion: Equipping the staff with a standardized electronic Morse Fall Scale assessment tool will improve the assessment of residents\u27 fall risk. Education provided to residents will allow them to be active and mindful in their own care ultimately reducing the fall rate and achieving the best patient outcomes

The effect of adding comorbidities to current centers for disease control and prevention central-line–associated bloodstream infection risk-adjustment methodology

BACKGROUNDRisk adjustment is needed to fairly compare central-line–associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes.METHODSUsing a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank.RESULTSOverall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51–0.59) for the ICU-type model and 0.64 (95% CI, 0.60–0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model.CONCLUSIONSOur risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.Infect Control Hosp Epidemiol 2017;38:1019–1024</jats:sec

Effects Of A 4-week Vibration-induced Hamstrings Fatigue Intervention On Quadriceps Weakness After ACL Reconstruction

Arthrogenic muscle inhibition (AMI) results from an inability to voluntarily activate all motor units in the quadriceps due to ongoing neuronal inhibition. This may be due to changes in small diameter afferent activity that increase the excitability of the flexor withdrawal pathway, causing over-excitation of the hamstrings and reciprocal inhibition of the quadriceps. Reciprocal inhibition of the quadriceps from Ia afferents of the hamstrings may be reduced with prolonged muscle vibration of the hamstrings via fatigue of the intrafusal muscle fibers. PURPOSE: To determine the effects of vibration-induced hamstring fatigue on AMI after ACL reconstruction (ACLr). METHODS: Seven adults (28.7 ± 8.2 yrs) with unilateral ACLr (time since surgery: 19.4 ± 9.7 months) were recruited. Participants received a 4-week long (3x/week) training program. Vibration-induced fatigue of the hamstrings consisted of 20 minutes of prolonged vibration applied directly to the hamstrings. Then, a cuff was placed on the proximal thigh and inflated to 150 mmHg to trap the metabolites in the muscle, and maintain hamstrings fatigue; during which participants performed four sets of 15 reps at 30% RM unilateral knee extension (KE). Quadriceps strength and quadriceps inhibition were assessed before and after the intervention using KE 1-repitition maximum (RM) normalized to body weight, and the central activation ratio (CAR) measured by a superimposed burst. The co-activation of the hamstrings was assessed using hamstring EMG during KE. Paired t-tests were used to examine the effect of prolong vibration on KE strength, quadriceps CAR, and hamstrings co-activation before and after the intervention. RESULTS: KE strength increased significantly by 38.5% (from 0.45 ± 0.1 to 0.62 ± 0.2 %BW, P =0.004); quadriceps CAR also increased significantly by 5.8% (from 93 ± 0.1% to 98 ± 0.8%, P=0.02). Finally, co-activation decreased by 34% (from 12 ± 1.3% to 8 ± 0.9%, P=0.03). CONCLUSION: These results suggest that quadriceps weakness may be due to over excitation of the hamstrings which results in reciprocal inhibition of the quadriceps. Vibration-induced hamstrings fatigue can be used as a rehabilitation strategy to restore normal quadriceps function following ACLr by reducing the hamstrings over-excitability and restoring full quadriceps activation