Electronic health record and problem lists in Leeds, United Kingdom: Variability of general practitioners’ views

Data sharing of Electronic Health Records from general practices to secondary care in Leeds occurs through the so-called Leeds Care Records, which collects a specific set of codes from primary care, known as ‘Active Problems’, and presents it to the user. Variability on its content is a known issue. To explore general practitioners’ views on their use of ‘Active Problems’ and on sharing data, so lessons could be learnt on how to homogenise and improve shared data. Assessing Leeds general practitioners’ views through two parallel processes (60 online surveys and 17 interviews). General practitioners feel they do not have the time nor the training required for keeping a shared approach to concise and current Problem Lists in electronic patient records. Action is needed to reduce current variability, and to improve the quality of shared information. Some types of codes currently present in Problem Lists have very little support among general practitioners who consider the focus should be on long-term conditions and probably adding current acute diagnoses and life expectancy items and not omitting sensitive information. There is a perceived need of training and time to update Problem Lists if their quality is to improve

A Rare Case Report of Probable Indigotindisulfonate Sodium-Induced Cardiac Arrest

Background: Indigotindisulfonate (Indigo Carmine, American Regent, Shirely, NY) is a blue dye that is commonly used for localizing ureteral orifices during surgery. In general, it is safe and biologically inactive, with the package insert citing only rare idiosyncratic reactions and mild pressor effects in some patients. We report a case of a severe life-threatening anaphylactoid reaction due to indigotindisulfonate following intravenous administration. Case Report: We describe a case of a 42-year-old female admitted for a total abdominal hysterectomy. Upon arrival to the operating room, her heart rate (HR) was 80/min, blood pressure (BP) was 135/75 mm Hg, and a SpO2 of 98%. During surgery, the patient received 5 mL of slow IV bolus of 0.8 percent Indigotindisulfonate sodium injectable solution, at which time her blood pressure was 110/60 mm Hg and heart rate was 75/min. Fifteen minutes later the patient became hypotensive and bradycardic (BP = 70/50 mm Hg; HR = 37/min). The team performed advanced cardiac life support for 16 minutes, administering epinephrine 1 mg IV BOLUS x 4 doses and sodium bicarbonate 50 mEqIV BOLUS x 3 doses. Conclusion: Although this is a rare adverse event, it is prudent to consider the possibility of these reactions when a bolus of Indigotindisulfonate is administered intravenously

Assessment of Streamflow from EURO-CORDEX Regional Climate Simulations in Semi-Arid Catchments Using the SWAT Model

This research studies the effect of climate change on the hydrological behavior of two semi-arid basins. For this purpose, the Soil and Water Assessment Tool (SWAT) model was used with the simulation of two future climate change scenarios, one Representative Concentration Pathway moderate (RCP 4.5) and the other extreme (RCP 8.5). Three future periods were considered: close (2019–2040), medium (2041–2070), and distant (2071–2100). In addition, several climatic projections of the EURO-CORDEX model were selected, to which different bias correction methods were applied before incorporation into the SWAT model. The statistical indices for the monthly flow simulations showed a very good fit in the calibration and validation phases in the Upper Mula stream (NS = 0.79–0.87; PBIAS = −4.00–0.70%; RSR = 0.44–0.46) and the ephemeral Algeciras stream (NS = 0.78–0.82; PBIAS = −8.10–−8.20%; RSR = 0.4–0.42). Subsequently, the impact of climate change in both basins was evaluated by comparing future flows with those of the historical period. In the RCP 4.5 and RCP 8.5 scenarios, by the end of the 2071–2100 period, the flows of the Upper Mula stream and the ephemeral Algeciras stream will have decreased by between 46.3% and 52.4% and between 46.6% and 55.8%, respectively.ERDF/Spanish Ministry of Science, Innovation and Universities—State Research Agency/Project CGL2017-84625-C2-1-R (CCAMICEM)State Program for Research, Development and Innovation Focused on the Challenges of Societ

Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? A retrospective cohort study.

OBJECTIVES: This study aimed to establish the association between timing and provision of palliative care (PC) and quality of end-of-life care indicators in a population of patients dying of cancer. SETTING: This study uses linked cancer patient data from the National Cancer Registry, the electronic medical record system used in primary care (SystmOne) and the electronic medical record system used within a specialist regional cancer centre. The population resided in a single city in Northern England. PARTICIPANTS: Retrospective data from 2479 adult cancer decedents who died between January 2010 and February 2012 were registered with a primary care provider using the SystmOne electronic health record system, and cancer was certified as a cause of death, were included in the study. RESULTS: Linkage yielded data on 2479 cancer decedents, with 64.5% who received at least one PC event. Decedents who received PC were significantly more likely to die in a hospice (39.4% vs 14.5%, P<0.005) and less likely to die in hospital (23.3% vs 40.1%, P<0.05), and were more likely to receive an opioid (53% vs 25.2%, P<0.001). PC initiated more than 2 weeks before death was associated with avoiding a hospital death (≥2 weeks, P<0.001), more than 4 weeks before death was associated with avoiding emergency hospital admissions and increased access to an opioid (≥4 weeks, P<0.001), and more than 33 weeks before death was associated with avoiding late chemotherapy (≥33 weeks, no chemotherapy P=0.019, chemotherapy over 4 weeks P=0.007). CONCLUSION: For decedents with advanced cancer, access to PC and longer duration of PC were significantly associated with better end-of-life quality indicators

Will medical cause of death certifications data quality improve in the UK with the new medical examiner system

Objectives There are deficits in the completeness, accuracy and timeliness of death certification internationally. In April 2023, England implemented a statutory Medical Examiners system primarily aiming to improve the quality of certification of death data. We sought to assess the current quality of death certification among general practitioners and medical examiners. Methods An online survey was conducted with general practitioners and medical examiners in the Yorkshire region to determine how Medical Certifications of Cause of Death (MCCD) are completed and commonly experienced sources of errors (e.g., a lack of a reported time frame, absent or inadequate reporting of comorbidities, incorrect underlying cause-of-death, and an inaccurate sequence of events). Results The survey was completed by general practitioners (n = 95) and medical examiners (n = 9). Participant responses, including to a hypothetical case, confirmed the quality of the certification was less variable among MEs compared to GPs, but still below international standards. Conclusions Efforts to enhance the quality of death certification require further consideration. Mandating a medical examiner system may not lead to intended improvements in the quality and cause of death data that form a critical component of mortality statistics that underpin health planning and monitoring

Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation

Background: The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. Aim: This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. Design: A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Setting/participants: Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths (n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. Results: The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient’s preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. Conclusion: This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems