USA Swimming: The Data Integration Project

USA Swimming (USAS) is the National Governing Body for the sport of swimming, one of more than 40 National Governing Bodies for amateur sports in the United States. Their mission is, in part, to administer competitive swimming in accordance with the Amateur Sports Act , and to provide programs and services for our members, supporters, affiliates and the interested public The USAS membership community consists of athletes, non-athletes, and clubs. One of the most important functions USAS performs is to gather and maintain information on members in all categories. Maintaining individual swimmers\u27 times in sanctioned meets, for example, forms the basis for swimmers to be ranked nationally. The responsibility for the gathering of data is relegated to 2,800 clubs and 59 local swimming committees scattered across the US. In their previous system, data needed for the USAS master databases was gathered by the clubs and sent to the local swimming committees, which consolidated the data and forwarded it to the national headquarters in Colorado Springs. Unfortunately, by 2002, it became clear that the hodgepodge of different hardware platforms and software used by the clubs and local swimming committees made the data gathering process ripe for errors, which resulted in unreliable data in multiple database systems at USAS headquarters. This case describes the process USAS management followed to establish and manage the development of a new system whose principal features include a new centralized database with a pre-posting holding tank for data cleansing as well as a Web portal providing valuable new functionality to the user community. The project involved significant risks, not the least of which was the widely dispersed user community. Risks were mitigated by the development of a prototype and by engaging an independent verification and validation firm. The new system achieved the benefits that USAS projected when the project was first conceived. The complicated technical infrastructure was replaced by a Web-based architecture that provides faster and more reliable service to the USAS community at a lower cost. The problem of inaccuracies in the data caused by data being stored in multiple databases was eliminated with the establishment of the new centralized database and the holding tank\u27s data cleansing capabilities. Users at USAS headquarters and in the field embraced the new system because it simplified the data gathering process and greatly improved the reliability of the information they obtain from the centralized database. Further, the Web-based portal provides a stable operating environment for day-to-day operations and a platform that allows adding enhancements easily to the system

Prospective observational measurement of tracheal tube cuff pressures in the emergency department

Background: Tracheal mucosal blood flow is impaired when tracheal tube cuff pressure is above 30 cm of water, with the potential for tracheal mucosal necrosis. Previous studies have found excessive cuff pressures in simulated patients intubated by North American emergency physicians as well as patients intubated in the prehospital setting and emergency department (ED). This study assessed whether patients intubated in a UK prehospital setting or ED had excessive cuff pressures. Method: Prospective observational study in five ED in southwest England over a 2-month period. All patients over 18 years and intubated in the prehospital setting or in the ED were included. Clinical staff independent of the patients' care recorded the following: age, sex, presenting complaint and indication for intubation, tube size and cuff pressure. Neither the paramedics nor the participating ED staff were aware of the study purpose. Cuff pressure measurements were recorded using a standardised cuff inflator pressure gauge. Result: 61 patients were recruited. The median and mean cuff pressures were 58 and 62 cm of water, respectively. 75% of patients had a cuff pressure greater than 30 cm of water. The median cuff pressures in those patients intubated by senior emergency physicians, junior emergency physicians and paramedics were 70, 46 and 79 cm of water, respectively. Conclusion: Excessive tracheal tube cuff pressures were demonstrated in the majority of patients intubated both in the prehospital setting and ED. This is in keeping with existing evidence. Early measurement and adjustment of cuff pressures is recommended for those patients who require ongoing care

An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report

Spinal metastases are becoming increasingly common because patients with metastatic disease are living longer. The close proximity of the spinal cord to the vertebral column limits many conventional therapeutic options that can otherwise be used to treat cancer. In response to this problem, an innovative multidisciplinary approach has been developed for the management of spinal metastases, leveraging the capabilities of image-guided stereotactic radiosurgery, separation surgery, vertebroplasty, and minimally invasive local ablative approaches. In this Review, we discuss the variables that should be considered during the management of these patients and review the role of each discipline and their respective management options to provide optimal care. This work is synthesised into a practical algorithm to aid clinicians in the management of patients with spinal metastasis