Benchmarking of hospital information systems: Monitoring of discharge letters and scheduling can reveal heterogeneities and time trends

<p>Abstract</p> <p>Background</p> <p>Monitoring of hospital information system (HIS) usage can provide insights into best practices within a hospital and help to assess time trends. In terms of effort and cost of benchmarking, figures derived automatically from the routine HIS system are preferable to manual methods like surveys, in particular for repeated analysis.</p> <p>Methods</p> <p>Due to relevance for quality management and efficient resource utilization we focused on time-to-completion of discharge letters (assessed by CT-plots) and usage of patient scheduling. We analyzed these parameters monthly during one year at a major university hospital in Germany.</p> <p>Results</p> <p>We found several distinct patterns of discharge letter documentation indicating a large heterogeneity of HIS usage between different specialties (completeness 51 – 99%, delays 0 – 90 days). Overall usage of scheduling increased during the observation period by 62%, but again showed a considerable variation between departments.</p> <p>Conclusion</p> <p>Regular monitoring of HIS key figures can contribute to a continuous HIS improvement process.</p

Autistic people’s perspectives on stereotypes: An interpretative phenomenological analysis

Autism stereotypes can often portray autistic people in a negative way. However, few studies have looked at how autistic people think they are perceived by others, and none have specifically asked autistic people what they think the autistic stereotypes are. Semi-structured interviews with twelve autistic adults (aged between 20-63 years) were conducted. Using Interpretative Phenomenological Analysis, three main themes emerged from the data. These were: (1) primary stereotype is that autistic people are ‘weird’; (2) autistic stereotypes have negative effects and consequences; (3) autistic people are heterogeneous. This study makes an important and novel contribution to understanding the experience of being autistic in several ways by exploring how autistic people feel they are perceived by others and identifying some of the ways in which negative stereotypes are believed to have negative consequences for autistic people

Graphene-passivated nickel as an efficient hole-injecting electrode for large area organic semiconductor devices

Efficient injection of charge from metal electrodes into semiconductors is of paramount importance to obtain high performance optoelectronic devices. The quality of the interface between the electrode and the semiconductor must, therefore, be carefully controlled. The case of organic semiconductors presents specific problems: ambient deposition techniques, such as solution processing, restrict the choice of electrodes to those not prone to oxidation, limiting potential applications. Additionally, damage to the semiconductor in sputter coating or high temperature thermal evaporation poses an obstacle to the use of many device-relevant metals as top electrodes in vertical metal–semiconductor–metal structures, making it preferable to use them as bottom electrodes. Here, we propose a possible solution to these problems by implementing graphene-passivated nickel as an air stable bottom electrode in vertical devices comprising organic semiconductors. We use these passivated layers as hole-injecting bottom electrodes, and we show that efficient charge injection can be achieved into standard organic semiconducting polymers, owing to an oxide free nickel/graphene/polymer interface. Crucially, we fabricate our electrodes with low roughness, which, in turn, allows us to produce large area devices (of the order of millimeter squares) without electrical shorts occurring. Our results make these graphene-passivated ferromagnetic electrodes a promising approach for large area organic optoelectronic and spintronic devices.We acknowledge funding from EPSRC (EP/P005152/1, EP/M005143/1). R.M. and K.N. acknowledges funding from the EPSRC Cambridge NanoDTC (Grant No. EP/G037221/1). J.A.-W. acknowledges the support of his Research Fellowship from the Royal Commission for the Exhibition of 1851, and Royal Society Dorothy Hodgkin Research Fellowship. R. S. W. acknowledges support from a CAMS-UK fellowship

A specific case in the classification of woods by FTIR and chemometric: discrimination of Fagales from Malpighiales

Fourier transform infrared (FTIR) spectroscopic data was used to classify wood samples from nine species within the Fagales and Malpighiales using a range of multivariate statistical methods. Taxonomic classification of the family Fagaceae and Betulaceae from Angiosperm Phylogenetic System Classification (APG II System) was successfully performed using supervised pattern recognition techniques. A methodology for wood sample discrimination was developed using both sapwood and heartwood samples. Ten and eight biomarkers emerged from the dataset to discriminate order and family, respectively. In the species studied FTIR in combination with multivariate analysis highlighted significant chemical differences in hemicelluloses, cellulose and guaiacyl (lignin) and shows promise as a suitable approach for wood sample classification

Temperature variations from Hubble Space Telescope imagery and spectroscopy of NGC 7009

We present new Hubble Space Telescope (HST)/WFPC2 imagery and STIS long-slit spectroscopy of the planetary nebula NGC 7009. The primary goal was to obtain high spatial resolution of the intrinsic line ratio [O III] 4364/5008 and thereby evaluate the electron temperature (Te) and the fractional mean-square Te variation (tA2)across the nebula. The WFPC2 Te map is rather uniform; almost all values are between 9000–11 000 K, with the higher Te values closely coinciding with the inner He++ zone. The results indicate very small values–≲0.01– for tA2 throughout. Our STIS data allow an even more direct determination of Te and tA2, albeit for a much smaller area than with WFPC2. We present results from binning the data along the slit into tiles that are 0.5-arcsec square (matching the slit width). The average [O III] temperature using 45 tiles (excluding the central star and STIS fiducial bars) is 10 139 K; tA2 is 0.0035. The measurements of Te reported here are an average along each line of sight. Therefore, despite finding remarkably low tA2, we cannot completely rule out temperature fluctuations along the line of sight as the cause of the large abundance discrepancy between heavy element abundances inferred from collisionally excited emission lines compared to those derived from recombination lines

Re‐defining the virtual reality dental simulator: Demonstrating concurrent validity of clinically relevant assessment and feedback

Introduction Virtual reality (VR) dental simulators are gaining momentum as a useful tool to educate dental students. To date, no VR dental simulator exercise has been designed which is capable of reliably providing validated, meaningful clinical feedback to dental students. This study aims to measure the concurrent validity of the assessment, and the provision of qualitative feedback, pertaining to cavity preparations by VR dental simulators. Methods A cavity preparation exercise was created on a VR dental simulator, and assessment criteria for cavity preparations were developed. The exercise was performed 10 times in order to demonstrate a range of performances and for each, the simulator feedback was recorded. The exercises were subsequently three‐dimensionally printed and 12 clinical teachers were asked to assess the preparations according to the same criteria. Inter‐rater reliability (IRR) between clinical teachers was measured using a free‐marginal multirater kappa value. Clinical teacher assessment responses were compared with the VR simulator responses and percentage agreements calculated. Results IRR values for each exercise ranged from 0.39‐0.77 (69.39‐88.48%). The assessment of smoothness (κfree0.58, 78.79%) and ability to follow the outline (κfree0.56, 77.88%) demonstrated highest agreement between clinical teachers, whilst the assessment of undercut (κfree0.15, 57.58%) and depth (κfree 0.28, 64.09%) had the lowest agreement. The modal percentage agreement between clinical teachers and the VR simulator was, on average, 78% across all exercises. Conclusion The results of this study demonstrate that it is possible to provide reliable and clinically relevant qualitative feedback via a VR dental simulator. Further research should look to employ this technique across a broader range of exercises that help to develop other complex operative dental skills

How does reviewing the evidence change veterinary surgeons' beliefs regarding the treatment of ovine footrot? A quantitative and qualitative study

Footrot is a widespread, infectious cause of lameness in sheep, with major economic and welfare costs. The aims of this research were: (i) to quantify how veterinary surgeons’ beliefs regarding the efficacy of two treatments for footrot changed following a review of the evidence (ii) to obtain a consensus opinion following group discussions (iii) to capture complementary qualitative data to place their beliefs within a broader clinical context. Grounded in a Bayesian statistical framework, probabilistic elicitation (roulette method) was used to quantify the beliefs of eleven veterinary surgeons during two one-day workshops. There was considerable heterogeneity in veterinary surgeons’ beliefs before they listened to a review of the evidence. After hearing the evidence, seven participants quantifiably changed their beliefs. In particular, two participants who initially believed that foot trimming with topical oxytetracycline was the better treatment, changed to entirely favour systemic and topical oxytetracycline instead. The results suggest that a substantial amount of the variation in beliefs related to differences in veterinary surgeons’ knowledge of the evidence. Although considerable differences in opinion still remained after the evidence review, with several participants having non-overlapping 95% credible intervals, both groups did achieve a consensus opinion. Two key findings from the qualitative data were: (i) veterinary surgeons believed that farmers are unlikely to actively seek advice on lameness, suggesting a proactive veterinary approach is required (ii) more attention could be given to improving the way in which veterinary advice is delivered to farmers. In summary this study has: (i) demonstrated a practical method for probabilistically quantifying how veterinary surgeons’ beliefs change (ii) revealed that the evidence that currently exists is capable of changing veterinary opinion (iii) suggested that improved transfer of research knowledge into veterinary practice is needed (iv) identified some potential obstacles to the implementation of veterinary advice by farmers

Explaining the effects of an intervention designed to promote evidence-based diabetes care : a theory-based process evaluation of a pragmatic cluster randomised controlled trial

Background The results of randomised controlled trials can be usefully illuminated by studies of the processes by which they achieve their effects. The Theory of Planned Behaviour (TPB) offers a framework for conducting such studies. This study used TPB to explore the observed effects in a pragmatic cluster randomised controlled trial of a structured recall and prompting intervention to increase evidence-based diabetes care that was conducted in three Primary Care Trusts in England. Methods All general practitioners and nurses in practices involved in the trial were sent a postal questionnaire at the end of the intervention period, based on the TPB (predictor variables: attitude; subjective norm; perceived behavioural control, or PBC). It focussed on three clinical behaviours recommended in diabetes care: measuring blood pressure; inspecting feet; and prescribing statins. Multivariate analyses of variance and multiple regression analyses were used to explore changes in cognitions and thereby better understand trial effects. Results Fifty-nine general medical practitioners and 53 practice nurses (intervention: n = 55, 41.98% of trial participants; control: n = 57, 38.26% of trial participants) completed the questionnaire. There were no differences between groups in mean scores for attitudes, subjective norms, PBC or intentions. Control group clinicians had 'normatively-driven' intentions (i.e., related to subjective norm scores), whereas intervention group clinicians had 'attitudinally-driven' intentions (i.e., related to attitude scores) for foot inspection and statin prescription. After controlling for effects of the three predictor variables, this group difference was significant for foot inspection behaviour (trial group × attitude interaction, beta = 0.72, p < 0.05; trial group × subjective norm interaction, beta = -0.65, p < 0.05). Conclusion Attitudinally-driven intentions are proposed to be more consistently translated into action than normatively-driven intentions. This proposition was supported by the findings, thus offering an interpretation of the trial effects. This analytic approach demonstrates the potential of the TPB to explain trial effects in terms of different relationships between variables rather than differences in mean scores. This study illustrates the use of theory-based process evaluation to uncover processes underlying change in implementation trials.European Union ReBEQI projec