Data quality and the electronic medical record: a role for direct parental data entry.
(41/1307)
INTRODUCTION: The paper and electronic medical record (EMR) have evolved with little scientific inquiry into what effect the informant (clinician or patient) has on the validity of the recorded information. We have previously reported on an electronic interview program that facilitated parents' direct reporting of past medical history data. We sought to define additional data elements that parents could report electronically and to compare parents' electronically entered data to that charted by physicians using the current EMR system. METHODS: A convenience sample of parents was recruited to enter data on history of present illness (HPI) and review of systems (ROS) elements using an electronic interview. Data from the electronic parental interview and information abstracted from the physician EMR were compared to data derived from a face-to-face criterion standard interview. Validity, sensitivity and specificity of each mode of data entry were calculated. RESULTS: 100 of 140 eligible parents (71.4%) participated. Validity of information from the electronic interview was comparable to that charted by emergency physicians for HPI regarding fever and ROS questions. Sensitivity of parents' electronic interview was superior to physicians' charting for ROS elements specific to hydration status. CONCLUSIONS: Improved sensitivity for detection of historical risk factors for illness can be achieved by augmenting the pediatric EMR with a section for direct parental direct data input. Direct parental data input to the EMR should be considered to improve the quality of documentation for medical histories. (+info)
Examining the symptom experience of hospitalized patients using a pen-based computer.
(42/1307)
The purposes of this study were to test the feasibility of using a pen-based computer to capture self-reported symptom data, to evaluate the system, and to evaluate the importance of obtaining symptom data. The sample included 72 patients who were hospitalized for a variety of medical conditions. Self-reported symptom data was obtained with the automated Sign and Symptom Checklist. The feasibility of using an automated symptom checklist to capture self-reported symptom data was demonstrated. Patients' evaluations of the ease of use and the format of the system were primarily positive; mean ratings ranged from 4.58 to 4.70 on a 5-point scale. Patients indicated the importance of documenting symptoms, with a few suggesting that the use of an automated symptom checklist may increase communication between providers and patients. Study findings support the inclusion of self-reported symptom data in electronic health records and national health care databases. (+info)
MedSpanish: a language tool for the emergency department.
(43/1307)
Language barriers frequently impede the ability of the health care professional to provide the highest quality health care to his or her patients. Spanish speaking people are rapidly becoming the largest minority population in the United States. In order to facilitate access to appropriate medical care that would not be inhibited by miscommunication or lack of a trained translator, the MedSpanish Web Site was developed for use in the Emergency Department. The site contains common Spanish vocabularies, including translations and audio clips, that would be used in such a setting. The various sections are formatted so that they could easily become pocket cards rather than relying on the availability of a computer in a medical emergency. While MedSpanish is not designed to replace a trained translator, it does offer an effective alternative if such translations services are not available. (+info)
Restricted natural language processing for case simulation tools.
(44/1307)
For Interactive Patient II, a multimedia case simulation designed to improve history-taking skills, we created a new natural language interface called GRASP (General Recognition and Analysis of Sentences and Phrases) that allows students to interact with the program at a higher level of realism. Requirements included the ability to handle ambiguous word senses and to match user questions/queries to unique Canonical Phrases, which are used to identify case findings in our knowledge database. In a simulation of fifty user queries, some of which contained ambiguous words, this tool was 96% accurate in identifying concepts. (+info)
Familial cancer history and lung cancer risk in United States nonsmoking men and women.
(45/1307)
The authors conducted a population-based case-control study of lung cancer in nonsmoking men and women in New York State from 1982 to 1984. Nonsmokers included both never smokers (45%) and former smokers who had quit at least 10 years before diagnosis/interview (55%). In-person interviews were completed for 437 lung cancer cases and 437 matched population controls. Cases and controls were asked to report on their family history of cancer, as well as smoking status of family members. Cases were significantly more likely than controls to report having a paternal history of any cancer [odds ratio (OR), 1.67] and aerodigestive tract cancers (OR, 2.78); a maternal history of breast cancer (OR, 2.00); a history of any cancer in brothers (OR, 1.58) and sisters (OR, 1.66); and a nearly significant excess of lung cancer (OR, 4.14; P = 0.07), aerodigestive tract cancer (OR, 3.50; P = 0.06), and breast cancer (OR, 2.07; P = 0.053) in sisters. The excess risk in relatives of cases as compared to relatives of controls also was evident in a cohort analysis of the relatives. These results support the hypothesis of a genetic susceptibility to various cancers in families with lung cancer in nonsmokers. (+info)
Are postal questionnaire surveys of reported activity valid? An exploration using general practitioner management of hypertension in older people.
(46/1307)
BACKGROUND: Postal questionnaire surveys are commonly used in general practice and often ask about self-reported activity. The validity of this approach is unknown. AIM: To explore the criterion validity of questions asking about self-reported activity in a self-completion questionnaire. METHOD: A comparison was made between (a) the self-reported actions of all general practitioner (GP) principals in 51 general practices randomly selected within the nine family health services authorities of the former northern regional health authority, and (b) the contents of the medical records (case notes and computerized records) of patients classified as hypertensive from a 1 in 7 random sample of all patients registered in these practices and aged between 65 and 80. Data were gathered from the GPs by self-completion postal questionnaires. Six comparisons were made for two groups of items: first, target and achieved blood pressure; secondly, patient's weight, smoking status, alcohol consumption, exercise and salt intake. The frequency with which the data items were recorded in patient records was compared with the GPs' self-reported frequency of performing the actions. RESULTS: No relationship was found between achieved blood pressure and stated target levels. For each of the other actions, more than half of the responders reported that they usually or always performed the activity. For four of these (smoking, weight, alcohol and exercise), a significant association was noted, but the size of this varied considerably. CONCLUSIONS: There is a variable relationship between what responders report that they do in self-completion questionnaires, and what they actually do as judged by the contents of their patients' medical records. In the absence of prior, knowledge of the validity of questions on reported activity, or of concurrent attempts to establish their validity, the questions should not be asked. (+info)
The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery.
(47/1307)
BACKGROUND: Routine preoperative medical testing is commonly performed in patients scheduled to undergo cataract surgery, although the value of such testing is uncertain. We performed a study to determine whether routine testing helps reduce the incidence of intraoperative and postoperative medical complications. METHODS: We randomly assigned 19,557 elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of medical tests (electrocardiography, complete blood count, and measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose), in addition to a history taking and physical examination. Adverse medical events and interventions on the day of surgery and during the seven days after surgery were recorded. RESULTS: Medical outcomes were assessed in 9408 patients who underwent 9626 cataract operations that were not preceded by routine testing and in 9411 patients who underwent 9624 operations that were preceded by routine testing. The most frequent medical events in both groups were treatment for hypertension and arrhythmia (principally bradycardia). The overall rate of complications (intraoperative and postoperative events combined) was the same in the two groups (31.3 events per 1000 operations). There were also no significant differences between the no-testing group and the testing group in the rates of intraoperative events (19.2 and 19.7, respectively, per 1000 operations) and postoperative events (12.6 and 12.1 per 1000 operations). Analyses stratified according to age, sex, race, physical status (according to the American Society of Anesthesiologists classification), and medical history revealed no benefit of routine testing. CONCLUSIONS: Routine medical testing before cataract surgery does not measurably increase the safety of the surgery. (+info)
Preparing patients to travel abroad safely. Part 1: Taking a travel history and identifying special risks.
(48/1307)
OBJECTIVE: To present for family physicians without access to a travel clinic and the Internet the questions to ask about the medical history and itinerary of their patients traveling abroad. To suggest ways to identify and advise high-risk patients. QUALITY OF EVIDENCE: MEDLINE searches from 1990 to November 1998 located 51 articles on travel and diabetes, 37 on travel and chronic obstructive pulmonary disease (COPD), 63 on travel and heart disease, 192 on travel and pregnancy, and 298 on travel with infants or children. Additional searches were undertaken in September 1999. The quality of evidence in most articles is level III (expert opinion). There are no randomized controlled trials of the best advice for family physicians to give travelers. MAIN MESSAGE: A history should include countries to be visited, planned activities, previous tropical travel, medical history, vaccination status, whether children are traveling, pregnancy status, and patients' opinions of the risks and precautions needed. Detailed advice should be given to reduce risks. The main causes of mortality abroad are existing cardiovascular conditions and accidents. High-risk conditions to be identified in travelers are cardiovascular illness, COPD, diabetes, immunodeficiency, pregnancy, and traveling with children. CONCLUSIONS: Patients with cardiovascular illness or COPD should be advised to avoid too much exertion while traveling. Detailed instruction should be given to diabetic patients on how to maintain stable glucose levels, to pregnant women on avoiding malarial infection, and to parents on protecting their children from infections and accidents. (+info)