bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing Roles of Health Information Managers: An Education Perspective
Authors: Cooper Helen
Published: March 2016

Health information management graduates are employed across health, education, corporate and other sectors. Common to all health information management professionals are foundational skills and knowledge in health sciences, information and management. Unique to each individual is their ongoing education and professional development; professional growth motivated by interest, change and/or opportunity. This presents both challenge and opportunity in the design and content of educational programs. The establishment of the Australian Health Informatics Education Council (AHIEC) (formerly the National Health Informatics Education Committee) provides both framework and opportunity for new ways and approaches to health informatics education in Australia. There are however process matters that proposed changes to education programs need to acknowledge.
The Royal Flying Doctor Service Flies to New Heights: The Journey of Health Information Management
Authors: Wilkins Julia
Published: March 2016

The Royal Flying Doctor Service (RFDS) of Australia was founded in 1928 by the Reverend John Flynn to deliver health services to the people of the Australian Outback. In this unique environment the RFDS Queensland Section provides both Primary Health Care and Aeromedical services to rural and remote communities throughout Queensland. It provides health services from a hub and spoke model and its clinicians work very closely with other health service providers, such as Queensland Heath, within the communities it visits. Currently, the RFDS' health records are both paper and electronic and clinicians duplicate much of patient information and data between RFDS and non-RFDS health records. Introduction of an off-the-shelf electronic medical record (EMR) would not meet the RFDS' clinical and organisational needs because of complexity, the multidisciplinary nature of the teams and the lack of communication technology in the communities the RFDS visits. This article defines the vision for a health information system designed to meet the requirements of the RFDS, and describes its implementation throughout RFDS Queensland using the PRINCE2 project management methodology.
Matched Comparison of GP and Consultant Rating of Electronic Discharge Summaries
Authors: Stainkey Lesley , Pain Tilley , McNichol Margaret , Hack John , Roberts Lynden
Published: March 2016

Queensland Health is implementing a state-wide system to electronically generate and distribute discharge summaries. Previously, general practitioners (GPs) have indicated that the quality of the discharge summary does not support clinical handover. While the electronic system will address some issues (e.g. legibility and timeliness), the quality of the discharge summary content is predominantly independent of method of generation. As discharge summaries are usually generated by interns, we proposed that improvement in the quality of the summary may be achieved through education. This project aimed to compare the perceptions of hospital-based consultant educators and recipient GPs regarding discharge summary content and quality. The discharge summary and audit tool were sent to the recipient GP ( n= 134) and a hospital consultant ( n= 14) for satisfaction rating, using a 5-point Likert scale for questions relating to diagnosis, the listing of clinical management, medication, pathology, investigations, and recommendations to GP. Sampling was performed by selecting up to 10 discharge summaries completed by each first-year intern ( n=36) in 2009, during the second, third and fourth rotations at the Townsville Hospital until a total of 403 was reached. Matched responses were compared using the Kappa statistic. The response rate was 93% ( n=375) and 63% ( n=254) for consultants and GPs respectively. Results from this study demonstrated that GPs were more satisfied with discharge summaries than were consultants. An anomaly occurred in three questions where, despite the majority of GPs rating satisfied or very satisfied, a small but proportionally greater number of GPs were very dissatisfied when compared with consultants. Poor or fair agreement between GPs and consultants was demonstrated in medications, pathology results, investigations and recommendations to GP with GPs rating higher satisfaction in all questions. Lower consultant satisfaction ratings compared with GP ratings suggest that consultants can evaluate discharge summary content to the level required by GPs for clinical handover. Therefore, consultants can appropriately educate interns on discharge summary content for GP needs.
Casemix Funding Optimisation: Working Together to Make the Most of Every Episode
Authors: Uzkuraitis Carly , Hastings Karen , Torney Belinda
Published: March 2016

Eastern Health, a large public Victorian Healthcare network, conducted a WIES optimisation audit across the casemix-funded sites for separations in the 2009/2010 financial year. The audit was conducted using existing staff resources and resulted in a significant increase in casemix funding at a minimal cost. The audit showcased the skill set of existing staff and resulted in enormous benefits to the coding and casemix team by demonstrating the value of the combination of skills that makes clinical coders unique. The development of an internal web-based application allowed accurate and timely reporting of the audit results, providing the basis for a restructure of the coding and casemix service, along with approval for additional staffing resources and inclusion of a regular auditing program to focus on the creation of high quality data for research, health services management and financial reimbursement.
The Role of a Health Information Manager in Creating Data Fit for Purpose
Authors: Macpherson Brooke
Published: March 2016

When emergency and waiting list data are submitted by health services to the Victorian Department of Health they are not ready for immediate use. Data must undergo further edit and rule checks before they can be declared fit for purpose and made available for internal and external stakeholder use. Further transformation of the data is constantly required to suit individual stakeholder requirements; this requires in-depth knowledge of each dataset. Health Information Managers are especially suited to this role because of their understanding of classification, exposure to the data at hospital-level and general health information management skills.
Do AR-DRGs Adequately Describe the Trauma Patient Episode in New South Wales, Australia?
Authors: Curtis Kate , Mitchell Rebecca , Dickson Cara , Black Deborah , Lam Mary
Published: March 2016

The use of Diagnosis Related Groups (DRGs) may not be an accurate tool to provide reimbursement for trauma services. This study aimed to determine whether Australian Refined Diagnosis Related Groups (AR-DRGs) adequately describe the trauma patient episode and to identify AR-DRG groupings where reimbursement was not commensurate with actual cost. The AR-DRG allocated costs and actual costs of a sample of 206 trauma patient episodes were reviewed during a three-month period. Of the AR-DRG groups identified in the patient episodes, 62.8% were not commensurate with actual cost incurred, equating to an overall loss of $113,921 from under-funded acute trauma patient episodes over a three-month period. Assault-related penetrating trauma, traffic-related and sport-related incidents were all inadequately reimbursed using AR-DRGs compared with the actual cost of treatment. Cases involving female patients, patients aged 45 years or less and those with moderate injuries were similarly underfunded. AR-DRGs are not adequate to describe the extent of injuries experienced by trauma patients and there is a need to investigate alternative funding models for trauma services.
Improving Quality of Service of Home Healthcare Units with Health Information Technologies
Authors: Cegarra-Navarro Juan Gabriel , Wensley Anthony K.P. , Sánchez-Polo Maria Teresa
Published: March 2016

Deployment of health information technologies (HITs) provides home care units with the means to generate improvements in accuracy and timeliness of information required to meet dynamic patient demands and provide high quality patient care. Increasing availability of information can also facilitate organisational learning, which leads to the invocation of processes that result in improved responses and decisions. This study examined crucial links between HITs and quality of service provided through an empirical investigation of 252 patients in a hospital-in-the-home unit (HHU) in a Spanish regional hospital. The study sought to test the relationship between HITs and the quality of service using factor analysis and structural equation modeling (SEM) to investigate how HITs mediate effects of organisational learning on quality of service. Findings support the notion that the relationship between organisational learning and quality of service can be mediated by HITs. This study provides HHU managers with guidelines for understanding the role of organisational learning processes with respect to HITs and quality of service.
Dual vs. Single Computer Monitor in a Canadian Hospital Archiving Department: A Study of Efficiency and Satisfaction
Authors: Poder Thomas G , Godbout Sylvie T , Bellemare Christian
Published: March 2016

This paper describes a comparative study of clinical coding by Archivists (also known as Clinical Coders in some other countries) using single and dual computer monitors. In the present context, processing a record corresponds to checking the available information; searching for the missing physician information; and finally, performing clinical coding. We collected data for each Archivist during her use of the single monitor for 40 hours and during her use of the dual monitor for 20 hours. During the experimental periods, Archivists did not perform other related duties, so we were able to measure the real-time processing of records. To control for the type of records and their impact on the process time required, we categorised the cases as major or minor, based on whether acute care or day surgery was involved. Overall results show that 1,234 records were processed using a single monitor and 647 records using a dual monitor. The time required to process a record was significantly higher ( p= .071) with a single monitor compared to a dual monitor (19.83 vs. 18.73 minutes). However, the percentage of major cases was significantly higher ( p= .000) in the single monitor group compared to the dual monitor group (78% vs. 69%). As a consequence, we adjusted our results, which reduced the difference in time required to process a record between the two systems from 1.1 to 0.61 minutes. Thus, the net real-time difference was only 37 seconds in favour of the dual monitor system. Extrapolated over a 5-year period, this would represent a time savings of 3.1 % and generate a net cost savings of $7,729 CAD (Canadian dollars) for each workstation that devoted 35 hours per week to the processing of records. Finally, satisfaction questionnaire responses indicated a high level of satisfaction and support for the dual-monitor system. The implementation of a dual-monitor system in a hospital archiving department is an efficient option in the context of scarce human resources and has the strong support of Archivists.
An Accessible Method for Teaching Doctors about Death Certification
Authors: Walker Sue , Rampatige Rasika , Wainiqolo Iris , Aumua Audrey
Published: March 2016

The World Health Organization (WHO) recommends that data on mortality in its member countries are collected utilising the Medical Certificate of Cause of Death published in the instruction volume of the ICD- 10. However, investment in health information processes necessary to promote the use of this certificate and improve mortality information is lacking in many countries. An appeal for support to make improvements has been launched through the Health Metrics Network's MOVE-IT strategy (Monitoring of Vital Events - Information Technology) (WHO 2011). Despite this international spotlight on the need for capture of mortality data and in the use of the ICD-10 to code the data reported on such certificates, there is little cohesion in the way that certifiers of deaths receive instruction in how to complete the death certificate, which is the main source document for mortality statistics. Complete and accurate documentation of the immediate, underlying and contributory causes of death of the decedent on the death certificate is a requirement to produce standardised statistical information and to the ability to produce cause-specific mortality statistics that can be compared between populations and across time. This paper reports on a research project conducted to determine the efficacy and accessibility of the certification module of the WHO's newly-developed web based training tool for coders and certifiers of deaths. Involving a population of medical students from the Fiji School of Medicine and a pre- and post-research design, the study entailed completion of death certificates based on vignettes before and after access to the training tool. The ability of the participants to complete the death certificates and analysis of the completeness and specificity of the ICD-10 coding of the reported causes of death were used to measure the effect of the students' learning from the training tool. The quality of death certificate completion was assessed using a Quality Index before and after the participants accessed the training tool. In addition, the views of the participants about accessibility and use of the training tool were elicited using a supplementary questionnaire. The results of the study demonstrated improvement in the ability of the participants to complete death certificates completely and accurately according to best practice. The training tool was viewed very positively and its implementation in the curriculum for medical students was encouraged. Participants also recommended that interactive discussions to examine the certification exercises would be an advantage.
A Study of the Difference in Volume of Information in Chief Complaint and Present Illness between Electronic and Paper Medical Records
Authors: Boo Yookyung , Noh Young A , Kim Min-Gyung , Kim Sukil
Published: March 2016

The introduction of an electronic medical record (EMR) has been rapidly accelerating in South Korea. The EMR was expected to improve quality of care, readability, availability, and the quality of data. However, the reluctance of healthcare providers to use the EMR may have caused a reduction of information recorded in EMRs. The purpose of this study was to identify whether there was any loss of information following the introduction of a narrative text-based EMR in the recording of chief complaint and present illness in inpatient medical records. Inpatient medical records of a university hospital were retrospectively evaluated for one month before and one month after the introduction of the EMR in June 2006. The volume of information for chief complaint and present illness was measured by number of words in Korean and normalised bytes. Change in volume of information was measured by two-way ANOVA and multiple regression analyses, controlling for doctors' gender, age, and grade/year of residents, patients' readmission status, reasons for admission and service department to assess any effect of the introduction of an EMR. Total numbers of paper-based medical records (PMRs) and EMRs for analysis were 1,159 and 1,122, respectively. Forty-three doctors participated in the study. Thirty-one (72%) doctors were less than 30 years of age. Number of words proved a better outcome measure ( R2=.22 for CC, R2=.36 for PI) than normalised bytes ( R2=.18 for CC, R2=.35 for PI) for measuring volume of information. Results showed that the volume of information in the chief complaint and present illness was not decreased after the introduction of the EMR, except when the dependent variable was measured by number of words in the present illness. The study showed that the introduction of the EMR did not reduce the volume of information documented for chief complaint and present illness in inpatient medical records. However, further studies are needed to identify how to control the probable loss of information as showed in present illness measured by number of words.
Social Media in Health — What are the Safety Concerns for Health Consumers?
Authors: Lau Annie Y.S. , Gabarron Elia , Fernandez-Luque Luis , Armayones Manuel
Published: March 2016

Recent literature has discussed the unintended consequences of clinical information technologies (IT) on patient safety, yet there has been little discussion about the safety concerns in the area of consumer health IT. This paper presents a range of safety concerns for consumers in social media, with a case study on YouTube. We conducted a scan of abstracts on ‘quality criteria’ related to YouTube. Five areas regarding the safety of YouTube for consumers were identified: (a) harmful health material targeted at consumers (such as inappropriate marketing of tobacco or direct-to-consumer drug advertising); (b) public display of unhealthy behaviour (such as people displaying self-injury behaviours or hurting others); (c) tainted public health messages (i.e. the rise of negative voices against public health messages); (d) psychological impact from accessing inappropriate, offensive or biased social media content; and (e) using social media to distort policy and research funding agendas. The examples presented should contribute to a better understanding about how to promote a safe consumption and production of social media for consumers, and an evidence-based approach to designing social media interventions for health. The potential harm associated with the use of unsafe social media content on the Internet is a major concern. More empirical and theoretical studies are needed to examine how social media influences consumer health decisions, behaviours and outcomes, and devise ways to deter the dissemination of harmful influences in social media.
Information Support for Health Management in Regional Sri Lanka: Health Managers' Perspectives
Authors: Ranasinghe Kaduruwane Indika , Chan Taizan , Yaralagadda Prasad
Published: March 2016

Good management, supported by accurate, timely and reliable health information, is vital for increasing the effectiveness of Health Information Systems (HIS). When it comes to managing the under-resourced health systems of developing countries, information-based decision making is particularly important. This paper reports findings of a self-report survey that investigated perceptions of local health managers (HMs) of their own regional HIS in Sri Lanka. Data were collected through a validated, pre-tested postal questionnaire, and distributed among a selected group of HMs to elicit their perceptions of the current HIS in relation to information generation, acquisition and use, required reforms to the information system and application of information and communication technology (ICT). Results based on descriptive statistics indicated that the regional HIS was poorly organised and in need of reform; that management support for the system was unsatisfactory in terms of relevance, accuracy, timeliness and accessibility; that political pressure and community and donor requests took precedence over vital health information when management decisions were made; and use of ICT was unsatisfactory. HIS strengths included user-friendly paper formats, a centralised planning system and an efficient disease notification system; weaknesses were lack of comprehensiveness, inaccuracy, and lack of a feedback system. Responses of participants indicated that HIS would be improved by adopting an internationally accepted framework and introducing ICT applications. Perceived barriers to such improvements were high initial cost of educating staff to improve computer literacy, introduction of ICTS, and HIS restructure. We concluded that the regional HIS of Central Province, Sri Lanka had failed to provide much-needed information support to HMS. These findings are consistent with similar research in other developing countries and reinforce the need for further research to verify causes of poor performance and to design strategic reforms to improve HIS in regional Sri Lanka.
Can SNOMED CT as Implemented in New South Wales, Australia Be Used for Road Trauma Injury Surveillance in Emergency Departments?
Authors: Mitchell Rebecca J. , Bambach Mike R. , Muscatello David , McKenzie Kirsten , Balogh Zsolt J.
Published: March 2016

The introduction of Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) for diagnosis coding in emergency departments (EDs) in New South Wales (NSW) has implications for injury surveillance abilities. This study aimed to assess the consequences of its introduction, as implemented as part of the ED information system in NSW, for identifying road trauma-related injuries in EDs. It involved a retrospective analysis of road trauma-related injuries identified in linked police, ED and mortality records during March 2007 to December 2009. Of all SNOMED CT codes in the principal provisional diagnosis field, between 53.7% and 78.4% referred to the type of injury or symptom experienced by the individual. Of the road users identified by police, 3.2% of vehicle occupants, 6% of motorcyclists, 10.0% of pedal cyclists and 5.2% of pedestrians were identified using SNOMED CT codes in the principal provisional diagnosis field. The introduction of SNOMED CT may provide flexible terminologies for clinicians. However, unless carefully implemented in information systems, its flexibility can lead to mismatches between the intention and actual use of defined data fields. Choices available in SNOMED CT to indicate symptoms, diagnoses, or injury mechanisms need to be controlled and these three concepts need to be retained in separate data fields to ensure a clear distinction between their classifications in the ED.
Mining Association Rules between Abnormal Health Examination Results and Outpatient Medical Records
Authors: Huang Yi Chao
Published: March 2016

Currently, interpretation of health examination reports relies primarily on the physician's own experience. If health screening data could be integrated with outpatient medical records to uncover correlations between disease and abnormal test results, the physician could benefit from having additional reference resources for medical examination report interpretation and clinic diagnosis. This study used the medical database of a regional hospital in Taiwan to illustrate how association rules can be found between abnormal health examination results and outpatient illnesses. The rules can help to build up a disease-prevention knowledge database that assists healthcare providers in follow-up treatment and prevention. Furthermore, this study proposes a new algorithm, the data cutting and sorting method, or DCSM, in place of the traditional Apriori algorithm. DCSM significantly improves the mining performance of Apriori by reducing the time to scan health examination and outpatient medical records, both of which are databases of immense sizes.
A Generic Quality Assurance Model (GQAM) for Successful E-Health Implementation in Rural Hospitals in South Africa
Authors: Ruxwana Nkqubela , Herselman Marlien , Pottas Dalenca
Published: March 2016

Although e-health can potentially facilitate the management of scarce resources and improve the quality of healthcare services, implementation of e-health programs continues to fail or not fulfil expectations. A key contributor to the failure of e-health implementation in rural hospitals is poor quality management of projects. Based on a survey 35 participants from five rural hospitals in the Eastern Cape Province of South Africa, and using a qualitative case study research methodology, this article attempted to answer the question: does the adoption of quality assurance (QA) models add value and help to ensure success of information technology projects, especially in rural health settings? The study identified several weaknesses in the application of QA in these hospitals; however, findings also showed that the QA methods used, in spite of not being formally applied in a standardised manner, did nonetheless contribute to the success of some projects. The authors outline a generic quality assurance model (GQAM), developed to enhance the potential for successful acquisition of e-health solutions in rural hospitals, in order to improve the quality of care and service delivery in these hospitals.
Clustering in Northern Territory Perinatal Data for 2003–2005: Implications for Analysis and Interpretation
Authors: Steenkamp Malinda
Published: March 2016

Clustering in perinatal data can violate assumptions of independence, an important consideration for data analysis. Few published studies report on the extent of repeat births in routinely collected Australian perinatal data and the implications thereof for analysis and interpretation. This paper reports on a case study that examined the extent and implications of clustering in the Northern Territory Midwives Collection (NTMC) for the period 2003–2005. Data were obtained on 7,741 individual mothers giving birth to 8,707 babies in public hospitals during 2003–2005. Clusters of multiple pregnancies and repeat births were identified and the design effects for birth weight of Aboriginal and non-Aboriginal newborns were calculated. Of the mothers, 46.1% were Aboriginal. Of these, 13.2% had repeat singleton births; 0.4% had multiple pregnancies, and 0.3% had both. Of non-Aboriginal mothers, 8.7% had repeat singleton births; 1.2% had multiple pregnancies; and 0.3% had both. The design effect was 1.07 for Aboriginal newborns and 1.04 for non-Aboriginal newborns. The design effects indicate that the correct variance accounting for clustering is 4–7% larger than the incorrect variance ignoring clustering when three consecutive years of NT data are considered and an intracluster correlation coefficient of 0.48 is assumed for birth weight between twin and non-twin siblings. Depending on the outcome of interest, the impact of clustering should be considered in multivariate analysis of perinatal data, especially when such analyses involve more than one year's data, include large proportions of Aboriginal mothers and newborns, and groups with different rates of repeat births.
How Do Patients Respond to Violation of Their Information Privacy?
Authors: Kuo Kuang-Ming , Ma Chen-Chung , Alexander Judith W.
Published: March 2016

The introduction of electronic medical records (EMRs) can expose patients to the risk of infringement of their privacy. The purpose of this study was to explore the relationship between patients' concerns about information privacy and their protective responses. A questionnaire survey conducted in a Taiwanese hospital revealed that, regarding information privacy, patients' concerns about the collection of information about themselves, the secondary use of this information and the possibility of errors in the recorded information were associated with their information privacy-protective responses, while concern for unauthorised access to their information by other staff in the medical facility was not. Medical facilities should devote every effort to alleviate patients' concerns about the invasion of their information privacy to avoid eroding the reputation of medical facilities and impeding the promotion of EMRs.
Do Electronic Discharge Summaries Contain More Complete Medication Information? A Retrospective Analysis of Paper versus Electronic Discharge Summaries
Authors: Lehnbom Elin C , Raban Magdalena Z , Walter Scott R , Richardson Katrina , Westbrook Johanna I
Published: March 2016

Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia. The completeness of medication information, and whether medication changes during the admission were explained, were assessed. Further, the likelihood of any incomplete information having an impact on continuity of care was assessed. There were 1352 and 1771 medication orders assessed in paper and electronic discharge summaries, respectively. Of these, 90.9% and 93.4% were complete in paper and electronic discharge summaries, respectively. The dose (OR 25.24, 95%CI: 3.41–186.9) and route (OR 8.65, 95%CI: 3.46–21.59) fields of medication orders, were more likely to be complete in electronic as compared with paper discharge summaries. There was no difference for drug frequency (OR 1.09, 95%CI: 0.77–1.55). There was no significant improvement in the proportion of incomplete medication orders rated as unclear and likely to impede continuity of care in paper compared with electronic discharge summaries (7.3% vs. 6.5%). Of changes to medication regimen, only medication additions were more likely to be explained in the electronic (n=253, 37.2%) compared to paper (n=104, 14.3%) discharge summaries (OR 3.14; 95%CI: 2.20–4.18). In summary, electronic discharge summaries offer some improvements over paper discharge summaries in terms of the quality of medication information documented. However, explanations of changes to medication regimens remained low, despite this being crucial information. Future efforts should focus on including the rationale for changes to medication regimens in discharge summaries.
The Use of Electronic Health Records in Spanish Hospitals
Authors: Marca Guillem , Pérez Angel J. , Blanco-García Martín German , Miravalles Elena , Soley Pere , Ortiga Berta
Published: March 2016

The aims of this study were to describe the level of adoption of electronic health records in Spanish hospitals and to identify potential barriers and facilitators to this process. We used an observational cross-sectional design. The survey was conducted between September and December 2011, using an electronic questionnaire distributed through email. We obtained a 30% response rate from the 214 hospitals contacted, all belonging to the Spanish National Health Service. The level of adoption of electronic health records in Spanish hospitals was found to be high: 39.1% of hospitals surveyed had a comprehensive EHR system while a basic system was functioning in 32.8% of the cases. However, in 2011 one third of the hospitals did not have a basic electronic health record system, although some have since implemented electronic functionalities, particularly those related to clinical documentation and patient administration. Respondents cited the acquisition and implementation costs as the main barriers to implementation. Facilitators for EHR implementation were: the possibility to hire technical support, both during and post implementation; security certification warranty; and objective third-party evaluations of EHR products. In conclusion, the number of hospitals that have electronic health records is in general high, being relatively higher in medium-sized hospitals.
Lifting the Weight of a Diagnosis-Related Groups Family Change: A Comparison between Refined and Non-Refined DRG Systems for Top-down Cost Accounting and Efficiency Indicators
Authors: Zlotnik Alexander , Alfaro Miguel Cuchi , Pérez Maria Carmen Pérez
Published: March 2016

Public healthcare providers in all Spanish Regions – Autonomous Communities (ACs) use All Patients Diagnosis-Related Groups (AP-DRGs) for billing non-insured patients, cost accounting and inpatient efficiency indicators. A national migration to All Patients Refined Diagnosis-Related Groups (APR-DRGs) has been scheduled for 2016. The analysis was performed on 202,912 inpatient care episodes ranging from 2005 to 2010. All episodes were grouped using AP-DRG v25.0 and APR-DRG v24.0. Normalised DRG weight variations for an AP-DRG to APR-DRG migration scenario were calculated and compared. Major differences exist between normalised weights for inpatient episodes depending on the DRGs family used. The usage of the APR-DRG system in Spain without any adjustments, as it was developed in the United States, should be approached with care. In order to avoid reverse incentives and provider financial risks, coding practices should be reviewed and structural differences between DRG families taken into account.
Reduction in Chemotherapy Order Errors with Computerised Physician Order Entry and Clinical Decision Support Systems
Authors: Aziz Muhammad Tahir , Ur-Rehman Tofeeq , Qureshi Sadia , Bukhari Nadeem Irfan
Published: March 2016

Background:

Medication errors in chemotherapy are frequent and lead to patient morbidity and mortality, as well as increased rates of re-admission and length of stay, and considerable extra costs. Objective: This study investigated the proposition that computerised chemotherapy ordering reduces the incidence and severity of chemotherapy protocol errors.

Method:

A computerised physician order entry of chemotherapy order (C-CO) with clinical decision support system was developed in-house, including standardised chemotherapy protocol definitions, automation of pharmacy distribution, clinical checks, labeling and invoicing. A prospective study was then conducted in a C-CO versus paper based chemotherapy order (P-CO) in a 30-bed chemotherapy bay of a tertiary hospital. Both C-CO and P-CO orders, including pharmacoeconomic analysis and the severity of medication errors, were checked and validated by a clinical pharmacist. A group analysis and field trial were also conducted to assess clarity, feasibility and decision making.

Results and Conclusion:

The C-CO was very usable in terms of its clarity and feasibility. The incidence of medication errors was significantly lower in the C-CO compared with the P-CO (10/3765 [0.26%] versus 134/5514 [2.4%]). There was also a reduction in dispensing time of chemotherapy protocols in the C-CO. The chemotherapy computerisation with clinical decision support system resulted in a significant decrease in the occurrence and severity of medication errors, improvements in chemotherapy dispensing and administration times, and reduction of chemotherapy cost.
The impact of social networks on leadership behaviour
Authors: Christopoulos Dimitrios C
Published: March 2016

Dominant streams in leadership literature conceptualise it either as a role within sociopolitical structure or as a behavioural predisposition of agents. Leadership roles are determined by decisional power, most typically related to the hierarchical and structural position of agents within sociopolitical networks. Limitations in attaining meaningful predictions of leader potential can be related to the separation of leadership as an agency attribute from leaders as structurally embedded agents. Social network analysis allows for the contingent examination of both. In this article, a number of hypotheses are tested via an empirical case study where interaction and affiliation networks across multiple decision experiments are coupled with attribute and psychometric data of the actors. In this quasi-experimental setting, leadership emergence is studied among four groups of undergraduate students faced with a decision choice in an iterative political simulation game. Findings suggest that in egalitarian political systems, centrality in social networks is directly associated with political success, while in political systems imbued with power inequalities successful actors are idiocentric brokers. Methodologically, this study frames role simulation games as quasi-experimental tests. Group interactions can be controlled, but vitally also incorporated in studies of perceptions, behaviours and group outcomes. The use of attitudinal micro-surveys, psychometric tests, observation and relational surveys is combined for a comprehensive mapping of group dynamics suited to questions of agency. In conclusion, there are a number of insights offered on deploying these methods in tandem and the challenges inherent in such a research design.
Incentivizing Students’ Preparation for Class
Authors: Taft Susan H.
Published: March 2016

It is common in university courses for some students to arrive at their on-campus classes not having completed their homework assignments. This article offers faculty a weekly beginning-of-class pedagogical approach called the “hat trick” that incentivizes students to complete their reading or other homework assignment for each class. Consistent student preparation allows faculty to conduct the class and learning activities at a more advanced, rather than basic, level. The hat trick also promotes a student-driven focus from the beginning of the class, a high level of student engagement, and skill development in presenting to a group.
Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages
Authors: Emile Jean-François , Abla Oussama , Fraitag Sylvie , Horne Annacarin , Haroche Julien , Donadieu Jean , Requena-Caballero Luis , Jordan Michael B. , Abdel-Wahab Omar , Allen Carl E. , Charlotte Frédéric , Diamond Eli L. , Egeler R. Maarten , Fischer Alain , Herrera Juana Gil , Henter Jan-Inge , Janku Filip , Merad Miriam , Picarsic Jennifer , Rodriguez-Galindo Carlos , Rollins Barret J. , Tazi Abdellatif , Vassallo Robert , Weiss Lawrence M.
Published: March 2016

The histiocytoses are rare disorders characterized by the accumulation of macrophage, dendritic cell, or monocyte-derived cells in various tissues and organs of children and adults. More than 100 different subtypes have been described, with a wide range of clinical manifestations, presentations, and histologies. Since the first classification in 1987, a number of new findings regarding the cellular origins, molecular pathology, and clinical features of histiocytic disorders have been identified. We propose herein a revision of the classification of histiocytoses based on histology, phenotype, molecular alterations, and clinical and imaging characteristics. This revised classification system consists of 5 groups of diseases: (1) Langerhans-related, (2) cutaneous and mucocutaneous, and (3) malignant histiocytoses as well as (4) Rosai-Dorfman disease and (5) hemophagocytic lymphohistiocytosis and macrophage activation syndrome. Herein, we provide guidelines and recommendations for diagnoses of these disorders.
EGFR Mutations in Latinos From the United States and Latin America
Authors: Lopez-Chavez Ariel , Thomas Anish , Evbuomwan Moses O. , Xi Liqiang , Chun Guinevere , Vidaurre Tatiana , Arrieta Oscar , Oblitas George , Oton Ana Belen , Calvo Alejandro R. , Rajan Arun , Raffeld Mark , Steinberg Seth M. , Arze-Aimaretti Lorena , Giaccone Giuseppe
Published: March 2016

Purpose

Epidermal growth factor receptor (EGFR) mutations confer sensitivity to EGFR tyrosine kinase inhibitors in patients with advanced non–small-cell lung cancer (NSCLC). There are limited and conflicting reports on the frequency of EGFR mutations in Latinos.

Patients and Methods

Samples from 642 patients with NSCLC from seven institutions in the United States and Latin America were assessed for EGFR mutations (exons 18 to 21) at Clinical Laboratory Improvement Amendments-certified central laboratories.

Results

EGFR mutation analysis was successfully performed in 480 (75%) of 642 patients; 90 (19%) were Latinos, 318 (66%) were non-Latino whites, 35 (7%) were non-Latino Asians, 30 (6%) were non-Latino blacks, and seven (2%) were of other races or ethnicities. EGFR mutations were found in 21 (23%) of 90 Latinos with varying frequencies according to the country of origin; Latinos from Peru (37%), followed by the United States (23%), Mexico (18%), Venezuela (10%), and Bolivia (8%). In never-smoker Latinos and Latinos with adenocarcinoma histology, EGFR mutation frequencies were 38% and 30%, respectively. There was a significant difference in the frequency of EGFR mutations among the different racial and ethnic subgroups analyzed (P < .001), with non-Latino Asians having the highest frequency (57%) followed by Latinos (23%), non-Latino whites (19%), and non-Latino blacks (10%). There was no difference between Latinos (23%) and non-Latinos (22%; P = .78) and Latinos and non-Latino whites (P = .37). Patients from Peru had an overall higher frequency of mutations (37%) than all other Latinos (17%), but this difference only exhibited a trend toward significance (P = .058).

Conclusion

There was no significant difference between the frequency of EGFR mutations in NSCLC in Latinos and non-Latinos.
Cross-species functional analyses reveal shared and separate roles for Sox11 in frog primary neurogenesis and mouse cortical neuronal differentiation
Authors: Chen Chao , Jin Jing , Lee Garrett A. , Silva Elena , Donoghue Maria
Published: March 2016

A well-functioning brain requires production of the correct number and types of cells during development; cascades of transcription factors are essential for cellular coordination. Sox proteins are transcription factors that affect various processes in the development of the nervous system. Sox11, a member of the SoxC family, is expressed in differentiated neurons and supports neuronal differentiation in several systems. To understand how generalizable the actions of Sox11 are across phylogeny, its function in the development of the frog nervous system and the mouse cerebral cortex were compared. Expression of Sox11 is largely conserved between these species; in the developing frog, Sox11 is expressed in the neural plate, neural tube and throughout the segmented brain, while in the mouse cerebral cortex, Sox11 is expressed in differentiated zones, including the preplate, subplate, marginal zone and cortical plate. In both frog and mouse, data demonstrate that Sox11 supports a role in promoting neuronal differentiation, with Sox11-positive cells expressing pan-neural markers and becoming morphologically complex. However, frog and mouse Sox11 cannot substitute for one another; a functional difference likely reflected in sequence divergence. Thus, Sox11 appears to act similarly in subserving neuronal differentiation but is species-specific in frog neural development and mouse corticogenesis.
Disentangling generic limits in Chionoloma, Oxystegus, Pachyneuropsis and Pseudosymblepharis (Bryophyta: Pottiaceae): An inquiry into their phylogenetic relationships
Authors: Alonso Marta , Jiménez Juan A. , Nylinder Stephan , Hedenäs Lars , Cano María J.
Published: March 2016

Pottiaceae is the largest known moss family, with one of the most complex taxonomies among the bryophytes. The circumscription of genera within the Pottiaceae is challenging. Here, we elucidate the relationships among four related traditional genera of the Pottiaceae: Chionoloma, Oxystegus, Pachyneuropsis and Pseudosymblepharis, all sharing a complex taxonomic history. In order to resolve phylogenetic relationships among the four genera, a phylogeny derived from nuclear ITS and the plastid markers atpB-rbcL, trnG and trnL-F is inferred. Putative monophyly of these four genera is investigated using maximum likelihood and Bayesian inference analyses. Ancestral state reconstruction shows high levels of homoplasy in the characters historically used for the generic division of Chionoloma s.1. Based on our results, we suggest that Chionoloma, Oxystegus and Pseudosymblepharis should be merged into a single genus, for which the oldest name Chionoloma has priority. Additional analyses are needed to clarify the taxonomic status of Pachyneuropsis. New combinations are provided for those species where required, and lectotypes are designated for five names.
Desmophlebiaceae and Desmophlebium: A new family and genus of Eupolypod II ferns
Authors: Mynssen Claudine M. , Vasco Alejandra , Moran Robbin C. , Sylvestre Lana S. , Rouhan Germinal
Published: March 2016

Based on an analysis of five plastid markers (atpA, atpB, rbcL, rps4‐trnS, trnL/trnL‐trnF), we show that Diplazium lechleri is sister to a clade formed by the Hemidictyaceae and Aspleniaceae. Thus, it does not belong to the Athyriaceae where previously classified. A new family, Desmophlebiaceae, and a new genus, Desmophlebium, are described to accommodate this relationship. Morphologically, Desmophlebium is distinguished from Diplazium by the combination of thick 1‐pinnate laminae, entire pinnae, decurrent distal pinnae, conform lamina apices (i.e., the terminal segment is similar to the lateral pinnae), and the presence of a submarginal connecting vein. On the basis of morphology, we also assign Diplazium longisorum to the new family and genus. Accordingly, the new combinations Desmophlebium lechleri and D. longisorum are provided. A lectotype is designated for Diplazium parallelogrammum, a synonym of Desmophlebium lechleri. Desmophlebium grows in humid forests from 125 to 1900 m. Desmophlebium lechleri occurs from Panama to north‐central and northeastern Brazil, and D. longisorum occurs in Colombia, Ecuador, and Peru.
Morphology, phylogeny, and taxonomy of Microthlaspi (Brassicaceae: Coluteocarpeae) and related genera
Authors: Ali Tahir , Schmuker Angelika , Runge Fabian , Solovyeva Irina , Nigrelli Lisa , Paule Juraj , Buch Ann-Katrin , Xia Xiaojuan , Ploch Sebastian , Orren Ouria , Kummer Volker , Linde-Laursen Ib , Ørgaard Marian , Hauser Thure Pablo , Çelik Ali , Thines Marco
Published: March 2016

The genus Thlaspi has been variously subdivided since its description by Linnaeus in 1753, but due to similarities in fruit shape several segregates have still not gained broad recognition, despite the fact that they are not directly related to Thlaspi. This applies especially to segregates now considered to belong to the tribe Coluteocarpeae, which includes several well‐studied taxa, e.g., Noccaea caerulescens (syn. Thlaspi caerulescens), and the widespread Microthlaspi perfoliatum (syn. Thlaspi perfoliatum). The taxonomy of this tribe is still debated, as a series of detailed monographs on Coluteocarpeae was not published in English and a lack of phylogenetic resolution within this tribe was found in previous studies. The current study presents detailed phylogenetic investigations and a critical review of morphological features, with focus on taxa previously placed in Microthlaspi. Based on one nuclear (ITS) and two chloroplast (matK, trnL‐F) loci, four strongly supported major groups were recovered among the Coluteocarpeae genera included, corresponding to Ihsanalshehbazia gen. nov., Friedrichkarlmeyeria gen. nov., Microthlaspi s.str., and Noccaea s.l. In addition, two new species of Microthlaspi, M. sylvarum‐cedri sp. nov. and M. mediterraneo‐orientale sp. nov., were discovered, which are well supported by both morphological and molecular data. Furthermore, M. erraticum comb. nov. (diploid) and M. perfoliatum s.str. (polyploid) were shown to be distinct species, phylogenetically widely separate, but with some overlap in several morphological characters. Detailed descriptions, notes on taxonomy, geographical distribution, and line drawings for the new species and each species previously included in Microthlaspi are provided. In addition, the current taxonomic state of the tribe Coluteocarpeae is briefly discussed and it is concluded that while several annual taxa are clearly distinct from Noccaea, many perennial taxa, after thorough phylogenetic and morphological investigations, may have to be merged with this genus.