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Artykuły w czasopismach na temat "Paper health records"

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Jayaseelan R. i Pichandy C. "Making the Paper-to-Digital Shift in India". International Journal of Information Communication Technologies and Human Development 12, nr 2 (kwiecień 2020): 15–28. http://dx.doi.org/10.4018/ijicthd.2020040102.

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This study explores the adoption of electronic health records system, an emerging technology, and its usage in the improvement of healthcare process in the Indian setting. Electronic health record (EHR) is a systematised digital version of a patient's complete medical history. It is a record containing all the aspects of patient care provided by physicians in a healthcare centre, maintained by the providers. Electronic health records system provides a means for improving healthcare standards, especially with regard to a developing nation. In the landscape of developing countries, like India, this technology evolution will bring major change by offering better healthcare services. The researchers through this study have called attention to examine the adoption of ICT, electronic health records system in particular, by medical doctors at their workspace applying TAM model.
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Tsai, J., i G. Bond. "A comparison of electronic records to paper records in mental health centers". International Journal for Quality in Health Care 20, nr 2 (11.12.2007): 136–43. http://dx.doi.org/10.1093/intqhc/mzm064.

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Hawley, Glenda, Julie Hepworth, Claire Jackson i Shelley A. Wilkinson. "Integrated care among healthcare providers in shared maternity care: what is the role of paper and electronic health records?" Australian Journal of Primary Health 23, nr 4 (2017): 397. http://dx.doi.org/10.1071/py16081.

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This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care.
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Hawthorne, Kisha Hortman, i Lorraine Richards. "Personal health records: a new type of electronic medical record". Records Management Journal 27, nr 3 (20.11.2017): 286–301. http://dx.doi.org/10.1108/rmj-08-2016-0020.

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Purpose This paper examines existing research on the topic of personal health records (PHRs). Areas covered include PHR/patient portal, recordkeeping, preservation planning, access and provider needs for future reuse of health information. Patient and physician PHR use and functionality, as well as adoption facilitators and barriers, are also reviewed. Design/methodology/approach The paper engages in a review of relevant literature from a variety of subject domains, including personal information management, medical informatics, medical literature and archives and records management literature. Findings The review finds that PHRs are extensions of electronic records. In addition, it finds a lack of literature within archives and records management that may lead to a less preservation-centric examination of the new PHR technologies that are desirable for controlling the lifecycle of these important new records-type. Originality/value Although the issues presented by PHRs are issues that can best be solved with the use of techniques from records management, there is no current literature related to PHRs in the records management literature, and that offered in the medical informatics literature treats the stewardship aspects of PHRs as insurmountable. This paper offers an introduction to the aspects of PHRs that could fruitfully be examined in archives and records management.
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Lambe, Gerard, Niall Linnane, Ian Callanan i Marcus W. Butler. "Cleaning up the paper trail – our clinical notes in open view". International Journal of Health Care Quality Assurance 31, nr 3 (16.04.2018): 228–36. http://dx.doi.org/10.1108/ijhcqa-09-2016-0126.

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Purpose Ireland’s physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this paper is to: assess the protection afforded to paper records; log highest risk records; note the variations that occurred during the working week; and observe the varying protection that occurred when staff, students and public members were present. Design/methodology/approach A customised audit tool was created using Sphinx software. Data were collected for three months. All wards included in the study were visited once during four discrete time periods across the working week. The medical records trolley’s location was noted and total unattended medical records, total unattended nursing records, total unattended patient lists and when nursing personnel, medical students, public and a ward secretary were visibly present were recorded. Findings During 84 occasions when the authors visited wards, unattended medical records were identified on 33 per cent of occasions, 49 per cent were found during weekend visiting hours and just 4 per cent were found during morning rounds. The unattended medical records belonged to patients admitted to a medical specialty in 73 per cent of cases and a surgical specialty in 27 per cent. Medical records were found unattended in the nurses’ station with much greater frequency when the ward secretary was off duty. Unattended nursing records were identified on 67 per cent of occasions the authors visited the ward and were most commonly found unattended in groups of six or more. Practical implications This study is a timely reminder that confidential patient information is at risk from inappropriate disclosure in the hospital. There are few context-specific standards for data protection to guide healthcare professionals, particularly paper records. Nursing records are left unattended with twice the frequency of medical records and are found unattended in greater numbers than medical records. Protection is strongest when ward secretaries are on duty. Over-reliance on vigilant ward secretaries could represent a threat to confidential patient information. Originality/value While other studies identified data protection as an issue, this study assesses how data security varies inside and outside conventional working hours. It provides a rationale and an impetus for specific changes across the whole working week. By identifying the on-duty ward secretary’s favourable effect on medical record security, it highlights the need for alternative arrangements when the ward secretary is off duty. Data were collected prospectively in real time, giving a more accurate healthcare record security snapshot in each data collection point.
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McDermott, Donna S., Jessica L. Kamerer i Andrew T. Birk. "Electronic Health Records". International Journal of Cyber Research and Education 1, nr 2 (lipiec 2019): 42–49. http://dx.doi.org/10.4018/ijcre.2019070104.

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Electronic health records (EHRs) pose unique concerns for administrators and information technology professionals with regard to cybersecurity. Due to the sensitive nature and increasing value of personal health information, cyber risks and information protection should be a high priority. A literature review was conducted to identify potential threat categories and best practices in protecting EHR information. Potential threats were identified and categorized into five areas; physical, portable devices, insider use, technical, and administrative. Government policies have created administrative, physical, and technical safeguards to keep EHR information safe. Despite these efforts, EHRs are being targeted by cyber-criminals due to flaws in personal and organizational management of protected healthcare information. This paper aims to educate, inform, and advocate for the proper handling of EHRs to alleviate the burden caused by compromised electronic documents.
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Simon, Melissa A., David S. Sanders, Sarah Read-Brown i Michael F. Chiang. "Pediatric ophthalmology documentation using paper versus electronic health records". Journal of American Association for Pediatric Ophthalmology and Strabismus 18, nr 4 (sierpień 2014): e37. http://dx.doi.org/10.1016/j.jaapos.2014.07.120.

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Lewis, Carol A. "Health Records in Developing Countries". Australian Medical Record Journal 18, nr 2 (czerwiec 1988): 47–50. http://dx.doi.org/10.1177/183335838801800204.

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Health record practitioners in developing countries lack contact with their peers in other countries. Consultants are a mechanism for transmitting information and new ideas from place to place. In this paper, the author describes a framework within which consultants may provide technical assistance in medical records. Discussion includes the dimensions of health record technical cooperation, the qualities expected of a consultant in developing countries, and the role of professional associations.
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Bourgeois, Stacy, i Ulku Yaylacicegi. "Electronic Health Records". International Journal of Healthcare Information Systems and Informatics 5, nr 3 (lipiec 2010): 1–13. http://dx.doi.org/10.4018/jhisi.2010070101.

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Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. This study investigates how EHR use, as implemented and utilized, impacts patient safety and quality performance. Data in this paper include nonfederal acute care hospitals in the state of Texas, and the data sources include the American Hospital Association, the Dallas Fort Worth Hospital Council, and the American Hospital Directory. The authors use partial least squares modeling to assess the relationship between hospital EHR use, patient safety, and quality of care. Patient safety is measured using 11 indicators as identified by the Agency for Healthcare Research and Quality (AHRQ) and quality performance is measured by 11 mortality indicators as related to 2 constructs, that is, conditions and surgical procedures. Results identify positive significant relationships between EHR use, patient safety, and quality of care with respect to procedures. The authors conclude that there is sufficient evidence of the relationship between hospital EHR use and patient safety, and that sufficient evidence exists for the support of EHR use with hospital surgical procedures.
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Hawley, Glenda, Julie Hepworth, Shelley A. Wilkinson i Claire Jackson. "From maternity paper hand-held records to electronic health records: what do women tell us about their use?" Australian Journal of Primary Health 22, nr 4 (2016): 339. http://dx.doi.org/10.1071/py14170.

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The paper hand-held record (PHR) has been used extensively in general practice (GP) shared care management of pregnant women, and recently, the first Mater Shared Electronic Health Record (MSEHR) was introduced. The aim of this qualitative study was to examine women’s experiences using the records and the contribution of the records to integrate care. At the 36-week antenatal visit in a maternity tertiary centre clinic, women were identified as a user of either the PHR or the MSEHR and organised into Phase 1 and Phase 2 studies respectively. Fifteen women were interviewed in Phase 1 and 12 women in Phase 2. Semi-structured interviews were used for data collection, and analysed using qualitative content analysis. Four main themes were identified: (1) purpose of the record, (2) perceptions of the record; (3) content of the record, and (4) sharing the record. Findings indicate that the PHR is a well-liked maternity tool. The findings also indicate there is under-usage of the MSEHR due to health-care providers failing to follow up and discuss the option of using the electronic health record option or if a woman has completed the log-in process. This paper adds to an already favourable body of knowledge about the use of the PHR. It is recommended that continued implementation of the MSEHR be undertaken to facilitate its use.
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Rozprawy doktorskie na temat "Paper health records"

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Li, Junhua Information Systems Technology &amp Management Australian School of Business UNSW. "E-health readiness assessment from EHR perspective". Publisher:University of New South Wales. Information Systems, Technology & Management, 2008. http://handle.unsw.edu.au/1959.4/42930.

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Many countries (especially developing countries) are plagued with critical healthcare issues such as chronic, infectious and pandemic diseases, a lack of basic healthcare programmes and facilities and a shortage of skilled healthcare workers. E-Health (healthcare based on the Internet technologies) promises to overcome some problems related to the reach of healthcare in remote communities. Electronic Health Record (EHR) (consisting of all diagnostic information related to a patient) forms the core of any E-Health system. Hence the success of an E-Health system is very much dependent on the success of the EHR systems. Although interest in automating the health record is generally high, the literature informs us that they do not always succeed in terms of adoption rate and/or acceptance, even in developed countries. The success of the adoption tends to be low for resource constrained (e.g. insufficient E-Health infrastructure) developing countries. As part of the effort to enhance EHR acceptance, readiness assessment for the innovation becomes an essential requirement for the successful implementation and use of EHR (and hence E-Health). Based on a thorough literature review, several research gaps have been identified. In order to address these gaps, this thesis (based on design science research methodology) presents E-Health Readiness Assessment Methodology (EHRAM). It involves a new E-Health Readiness Assessment Framework (EHRAF), an assessment process and several techniques for analysing the assessment data to arrive at a readiness score. The EHRAF (Model) integrates the components from healthcare providers?? and organisational perspectives of existing E-Health readiness evaluation frameworks. The process of EHRAM (Method) starts with the development of a set of hierarchical evaluation criteria based on EHRAF. This leads to the questionnaire development for data collection. The data is analysed in EHRAM using a number of statistical and data mining techniques. The instantiation part of the design science research involves an automated tool for the implementation of EHRAM and its application through a case study in a developing country.
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Daniel, Gregory Wayne. "An Evaluation of a Payer-Based Electronic Health Record in an Emergency Department on Quality, Efficiency, and Cost of Care". Diss., The University of Arizona, 2008. http://hdl.handle.net/10150/195598.

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Background: Health information exchange technologies are currently being implemented in many practice settings with the promise to improve quality, efficiency, and costs of care. The benefits are likely highest in settings where entry into the healthcare system is gained; however, in no setting is the need for timely, accurate, and pertinent information more critical than in the emergency department (ED). This study evaluated the use of a payer-based electronic health record (EHR) in an ED on quality, efficiency, and costs of care among a commercially insured population.Methods: Data came from a large health plan and the ED of a large urban ED. Visits with the use of a payer-based EHR were identified from claims between 9/1/05 and 2/17/06. A historical comparison sample of visits was identified from 11/1/04 to 3/31/05. Outcomes included return visits, ED duration, use of laboratory and diagnostic imaging, total costs during and in the four weeks after, and prescription drug utilization.Results: A total of 2,288 ED visits were analyzed (779 EHR visits and 1,509 comparison visits). Discharged visits were associated with an 18 minute shorter duration (95% CI: 5-33); whereas, the EHR among admitted visits was associated with a 77 minute reduction (95% CI: 28-126). The EHR was also associated with $1,560 (95% CI: $43-$2,910) savings in total plan paid for the visit among admitted visits. No significant differences were observed on return visits, laboratory or diagnostic imaging services and total costs over the four week follow-up. Exploratory analyses suggested that the EHR may be associated with a reduction in the number of prescription drugs used among chronic medication users.Conclusion: The EHR studied was associated with a significant reduction in ED duration. Technologies that can reduce ED lengths of stay can have a substantial impact on the care provided to patients and their satisfaction. The data suggests that the EHR may be associated with lower health plan paid amounts among admitted visits and a reduction in the number of pharmacy claims after the visit among chronic users of prescription drugs. Additional research should be conducted to confirm these findings.
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Sattar, Abdus. "Create a Medical information Extraction tool applied on Electronic Patient Record systems mainly for Retrospective Research". Thesis, KTH, Skolan för informations- och kommunikationsteknik (ICT), 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-121527.

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This paper deals with medical data extraction from electronic patient record (EPR) system. Most of the medical data are stored in patient record systems, and data that are much valuable for medical research. If a researcher wants to extract medical information today, it has to be done manually because the data are stored in unstructured textual format in a system created by hospital staff. There is no way of extracting data in structure way. This paper is going to introduce an information extraction application for EPR system that allows the researcher to set up a study with inclusion and parameters for extraction for retrospective surveys in a webuser-interface environment. Inclusion is what the researcher would like to study (a defined category or criteria) and parameters specify the characteristics of inclusion the criteria. Result of this application provides an extracted clinical data that is used for retrospective surveys, downloadable to an MS-Excel file.
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Davids, Kaashiefah. "The role of electronic healthcare systems (EHS) for patient recordkeeping in the Western Cape". University of Western Cape, 2019. http://hdl.handle.net/11394/7829.

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Magister Commercii - MCom
Information and communication technologies (ICT) have changed the way healthcare processes are being documented. This results in better quality and ethical vigilance to ensure a more accurate form of data recordkeeping (Stevenson, Nilsson, Petersson & Johansson, 2010). Health care in South Africa, is facing major issues relating to patient care, such as delays in patients receiving medical care. According to the national Department of Health, the improvement of public healthcare facilities is crucial (McIntyre & Ataguba, 2017). Information and communication technology (ICT) has the ability to significantly alter the status of healthcare services in the Western Cape, which can be achieved through the role of an electronic healthcare record (EHR).
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Schoeps, Daniela. "O papel dos profissionantes de saúde na qualidade da informação de óbitos perinatais e nascidos vivos no município de São Paulo". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-17052012-115130/.

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Introdução: A mortalidade perinatal é um importante indicador de saúde materno- infantil, por esse motivo vem ocorrendo uma evolução nos estudos dessas informações. Muitos estudos avaliam a qualidade dos dados do Sistema de Informações de Nascidos Vivos (SINASC) e Sistemas de Informações de Mortalidade (SIM) com métodos quantitativos (validade/completitude), porém são escassas as investigações qualitativas. Objetivo: Avaliar a representação social dos enfermeiros e profissionais de setores administrativos sobre o preenchimento das Declarações de Nascido Vivo (DNs) e se ou como auxiliam no preenchimento das Declarações de Óbito (DOs) fetais e neonatais. Métodos: Foram realizadas 24 entrevistas com enfermeiros e profissionais de setores administrativos em 16 hospitais, com e sem vínculo com o SUS, no município de São Paulo, em 2009. As análises foram realizadas utilizando a metodologia qualitativa com a técnica do Discurso do Sujeito Coletivo. Resultados: Os profissionais e enfermeiros se reconhecem como parte integrante do processo de produção da informação. Os discursos indicam que a atividade está incorporada na rotina do trabalho; há comprometimento na busca de soluções quando se deparam com dificuldades de preenchimento; há valorização de se sentirem acompanhados por uma instância superior do sistema; sentem que o treinamento é um espaço de encontro para retorno e compreensão das finalidades e usos das informações que produzem. Esta consciência aumenta o comprometimento e assegura informações mais fidedignas. Conclusões: Tanto nos hospitais SUS como não-SUS não se verificou um padrão relativo ao profissional responsável pelo preenchimento das DNs, apesar da definição legal de que o médico é o responsável pelas informações da DO muitas vezes outros profissionais preenchem parte das informações. As entrevistas revelaram que os profissionais conhecem e reconhecem a utilidade das informações registradas nas DNs com base nos treinamentos fornecidos pela equipe do Sistema de Informação de Nascidos Vivos (SINASC). Os profissionais e enfermeiros se reconhecem como parte integrante do processo de produção da informação e sentem que o treinamento é um espaço de encontro para retorno e compreensão das finalidades e usos das informações que produzem. Essa consciência aumenta o comprometimento e assegura informações mais fidedignas
Introduction: Considering that perinatal mortality is an important indicator of maternal and child health., there has been an evolution in the studies of such information. Many studies assess its quality with quantitative methods (validity / completeness), but there are few qualitative investigations. Objective: To assess the social representation of nurses and administrative sectors on how to complete the Declarations of Live Birth (DN) and whether or how to assist in completing fetal and neonatal death certificates (DO). Methods: We conducted 24 interviews with nurses and administrative staff in 16 hospitals (SUS and non- SUS), in the City of São Paulo in 2009. Analyses were performed using a qualitative methodology with the technique of Collective Subject Discourse. Results: The speeches indicate that the activity is incorporated into the routine of work; there is involvement in finding solutions when they find difficulties in filling; there is a feeling that they should have a higher member of staff supervision. Conclusions: Both SUS and non-SUS hospitals have no specific professional responsible for the completion of DN, despite the legal definition of what the doctor is responsible for the information of DO, it is often common to find other professionals filling part of the information. The interviews showed that the professionals know and recognize the usefulness of the information recorded in DN based on training provided by staff of the Information System (SINASC). Professionals and nurses see themselves as part of the process of information production and feel that training is a meeting place for feedback and understanding of the purposes and uses of the information they produce. This awareness increases the commitment and ensures more reliable information
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Kelley, Tiffany Frances. "Information Use with Paper and Electronic Nursing Documentation by Nurses Caring for Pediatric Patients". Diss., 2012. http://hdl.handle.net/10161/5862.

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This dissertation aimed to investigate the use of electronic nursing documentation as a strategy to improve the quality of care provided to hospitalized patients. The literature to support the use of electronic nursing documentation on the quality of care delivered to patients is limited to date. Additionally, the literature describing the use of information for the delivery of care on paper-based nursing documentation is limited. This dissertation reviews the current literature, investigated the knowledge needed for nurses to know their patients and established categories of nurses' information needs as preliminary work to be able to descriptively compare the use of paper with electronic nursing documentation on inpatient care units within a hospital setting. The main study conducted for this investigation used a mixed-methods multiple case study design, to describe the processes of information use on two inpatient care units, while first using paper and subsequently electronic nursing documentation. Findings revealed the importance of the categories of nurses' information needs for both cases in addition to the use of verbal, paper-based and electronic information sources for the collection, communication and temporary storage of information needs. Additionally, the conversion to electronic nursing documentation introduced new challenges related to three quality metrics: efficiency, timeliness and safety. Recommendations are provided for further evaluation of electronic health records with additional consideration for appropriate hardware devices in the context of the care environment.


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Chisholm, Robin Lynn. "Emergency physician documentation quality and cognitive load : comparison of paper charts to electronic physician documentation". Thesis, 2014. http://hdl.handle.net/1805/5809.

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Indiana University-Purdue University Indianapolis (IUPUI)
Reducing medical error remains in the forefront of healthcare reform. The use of health information technology, specifically the electronic health record (EHR) is one attempt to improve patient safety. The implementation of the EHR in the Emergency Department changes physician workflow, which can have negative, unintended consequences for patient safety. Inaccuracies in clinical documentation can contribute, for example, to medical error during transitions of care. In this quasi-experimental comparison study, we sought to determine whether there is a difference in document quality, error rate, error type, cognitive load and time when Emergency Medicine (EM) residents use paper charts versus the EHR to complete physician documentation of clinical encounters. Simulated patient encounters provided a unique and innovative environment to evaluate EM physician documentation. Analysis focused on examining documentation quality and real-time observation of the simulated encounter. Results demonstrate no change in document quality, no change in cognitive load, and no change in error rate between electronic and paper charts. There was a 46% increase in the time required to complete the charting task when using the EHR. Physician workflow changes from partial documentation during the patient encounter with paper charts to complete documentation after the encounter with electronic charts. Documentation quality overall was poor with an average of 36% of required elements missing which did not improve during residency training. The extra time required for the charting task using the EHR potentially increases patient waiting times as well as clinician dissatisfaction and burnout, yet it has little impact on the quality of physician documentation. Better strategies and support for documentation are needed as providers adopt and use EHR systems to change the practice of medicine.
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Książki na temat "Paper health records"

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Health, Ontario Ministry of. A legal framework for health information: Consultation paper. Toronto, Ont: Ministry of Health, 1996.

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Grain, Heather, editor of compilation i Schaper, Louise K., editor of compilation, red. Health informatics: Digital health service delivery, the future is now! : selected papers from the 21st Australian National Health Informatics Conference (HIC 2013). Amsterdam: IOS Press, 2013.

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Anthony, Maeder, i Martin-Sanchez Fernando J, red. Health Informatics: Building a healthcare future through trusted information ; selected papers from the 20th Australian National Health Informatics Conference (HIC 2012). Amsterdam: IOS Press Inc., 2012.

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ASH, red. Denial & delay: The political history of smoking and health, 1951-1964 : scientists, government and industry as seen in the papers at the Public Records Office. London: Action on Smoking and Health, 1999.

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Lenz, Richard. Process Support and Knowledge Representation in Health Care: BPM 2012 Joint Workshop, ProHealth 2012/KR4HC 2012, Tallinn, Estonia, September 3, 2012, Revised Selected Papers. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013.

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Transformation, Center for Health. Paper Kills - Transforming Health and Healthcare with Information Technology. CHT Press, 2007.

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carnet, kathrine. Cats Health Records Notebook: Just Who Loves Cats, Cat Sketch Book Notebook and Blank Paper for Monitor Your Cat's Health,Record Book for Your Cat with All Information You Need. Independently Published, 2020.

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Mukherjee, Joia S. Monitoring, Evaluation, Disease Surveillance, and Quality Improvement. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190662455.003.0010.

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Quality data are necessary to make good decisions in health delivery for both individuals and populations. Data can be used to improve care and achieve equity. However, systems for health data management were historically weak in most impoverished countries. Health data are not uncommonly compiled in stacks of poorly organized paper records. Efforts to streamline and improve health information discussed in this chapter include patient-held booklets, demographic health surveys, and the use of common indicators. This chapter also focuses on the evolution of medical records, including electronic systems. The use of data for monitoring, evaluation, and quality improvement is explained. Finally, this chapter reviews the use of frameworks—such as logic models and log frames—for program planning, evaluation, and improvement.
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baggsh, faez, i cat's health notebook. Cat Vaccine Record Book: Cat's Health Record ,gift for Cat Owners and Lovers ,120 Paper Blank Lined Notebook Size 6 X 9. Independently Published, 2020.

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Klein, Amanda H., i Matthias Ringkamp. Peripheral neural mechanisms of cutaneous heat hyperalgesia and heat pain. Redaktorzy Paul Farquhar-Smith, Pierre Beaulieu i Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0024.

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In the landmark paper discussed in this chapter, published in 1982, LaMotte et al. investigated the contribution of different cutaneous nerve fibres to heat pain and heat hyperalgesia in both psychophysical (humans) and electrophysiological studies (human and primates), using identical thermal test and conditioning stimuli; the findings from the two sets of experiments were then correlated. In non-human primates, neuronal activity was recorded from mechanoheat-sensitive A- and C-fibres (AMHs and CMHs, respectively) and warm and cold fibres, whereas, in conscious human volunteers, activity from CMHs was recorded. The authors found that pain is mediated by activity in CMHs and that sensitization of CMHs after a mild burn injury accounts for the increased heat pain after such injury. The combination of psychophysical experiments in human and correlative electrophysiological studies in non-human primates provides an important experimental approach for unravelling the contribution of different classes of afferents to pain.
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Części książek na temat "Paper health records"

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Fenz, Stefan, Johannes Heurix i Thomas Neubauer. "Recognition and Pseudonymization of Personal Data in Paper-Based Health Records". W Business Information Systems, 153–64. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/978-3-642-30359-3_14.

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Salazar, Maria, Júlio Duarte, Rui Pereira, Filipe Portela, Manuel Filipe Santos, António Abelha i José Machado. "Step towards Paper Free Hospital through Electronic Health Record". W Advances in Intelligent Systems and Computing, 685–94. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-36981-0_63.

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Bourgeois, Stacy, i Ulku Yaylacicegi. "Electronic Health Records". W Advancing Technologies and Intelligence in Healthcare and Clinical Environments Breakthroughs, 18–32. IGI Global, 2012. http://dx.doi.org/10.4018/978-1-4666-1755-1.ch002.

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Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. This study investigates how EHR use, as implemented and utilized, impacts patient safety and quality performance. Data in this paper include nonfederal acute care hospitals in the state of Texas, and the data sources include the American Hospital Association, the Dallas Fort Worth Hospital Council, and the American Hospital Directory. The authors use partial least squares modeling to assess the relationship between hospital EHR use, patient safety, and quality of care. Patient safety is measured using 11 indicators as identified by the Agency for Healthcare Research and Quality (AHRQ) and quality performance is measured by 11 mortality indicators as related to 2 constructs, that is, conditions and surgical procedures. Results identify positive significant relationships between EHR use, patient safety, and quality of care with respect to procedures. The authors conclude that there is sufficient evidence of the relationship between hospital EHR use and patient safety, and that sufficient evidence exists for the support of EHR use with hospital surgical procedures.
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Ceruti, Michele, Silvio Geninatti i Roberta Siliquini. "Use and Reuse of Electronic Health Records". W E-Health and Telemedicine, 961–75. IGI Global, 2016. http://dx.doi.org/10.4018/978-1-4666-8756-1.ch049.

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Electronic Health Record (EHR) is a term with several meanings, even if its very definition allows distinguishing it from other electronic records of healthcare interest, such as Electronic Medical Records (EMR) and Personal Health Records (PHR). EMR is the electronic evolution of paper-based medical records, while PHR is mainly the collection of health-related information of a single individual. All of these have many points in common, but the interchangeable use of the terms leads to several misunderstandings and may threaten the validity and reliability of EHR applications. EHRs are more structured and conform to interoperability standards, and include a huge quantity of data of very large populations. Thus, they have proven to be useful for both theoretical and practical purposes, especially for Public Health issues. In this chapter, the authors argue that the appropriate use of EHR requires a realistic comprehensive concept of e-health by all the involved professions. They also show that a change in the “thinking” of e-health is necessary in order to achieve tangible results of improvement in healthcare services through the use of EHR.
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Gonçalves, Fernanda, i Gabriel David. "Definition of a Retrospective Health Information Policy Based on (Re)Use Study". W Handbook of Research on ICTs and Management Systems for Improving Efficiency in Healthcare and Social Care, 1130–55. IGI Global, 2013. http://dx.doi.org/10.4018/978-1-4666-3990-4.ch059.

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Medical information produced in hospitals is, simultaneously, used (1) to support health care provided to patients, (2) in research work performed by internal and external health professionals, and (3) as legal proof with various objectives. The co-existence of electronic and paper health information, the integration constraints of the various computer applications, and the storage of massive volumes of retrospective paper-based patient records are dominant concerns for São João Hospital Center (SJHC). These problems must be considered in the adoption of an Electronic Patient Record (EPR) in order to ensure that hospitals and patients fully benefit from the technological investments. The contribution of this chapter is the design and conduction of a (re)use study, which consisted of an analysis of the paper-based records management activities and of the patients’ records content. A survey on the (re)use of the paper-based patient records has been conducted in order to characterize the (re)use in terms of objective and type of hospital encounter, and documents accessed were identified and organized in an access frequency table. The results support the paper-based patient records strategy to implement in SJHC integrated in the Hospital EPR adoption project.
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Ceruti, Michele, Silvio Geninatti i Roberta Siliquini. "Use and Reuse of Electronic Health Records". W Healthcare Informatics and Analytics, 212–26. IGI Global, 2015. http://dx.doi.org/10.4018/978-1-4666-6316-9.ch011.

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Electronic Health Record (EHR) is a term with several meanings, even if its very definition allows distinguishing it from other electronic records of healthcare interest, such as Electronic Medical Records (EMR) and Personal Health Records (PHR). EMR is the electronic evolution of paper-based medical records, while PHR is mainly the collection of health-related information of a single individual. All of these have many points in common, but the interchangeable use of the terms leads to several misunderstandings and may threaten the validity and reliability of EHR applications. EHRs are more structured and conform to interoperability standards, and include a huge quantity of data of very large populations. Thus, they have proven to be useful for both theoretical and practical purposes, especially for Public Health issues. In this chapter, the authors argue that the appropriate use of EHR requires a realistic comprehensive concept of e-health by all the involved professions. They also show that a change in the “thinking” of e-health is necessary in order to achieve tangible results of improvement in healthcare services through the use of EHR.
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Gajanayake, Randike, Tony Sahama i Renato Iannella. "The Role of Perceived Usefulness and Attitude on Electronic Health Record Acceptance". W E-Health and Telemedicine, 49–59. IGI Global, 2016. http://dx.doi.org/10.4018/978-1-4666-8756-1.ch003.

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Information and communications technologies are a significant component of the healthcare domain, and electronic health records play a major role in it. Therefore, it is important that they are accepted en masse by healthcare professionals. How healthcare professionals perceive the usefulness of electronic health records and their attitudes towards them have been shown to have significant effects on the overall acceptance in many healthcare systems around the world. This paper investigates the role of perceived usefulness and attitude on the intention to use electronic health records by future healthcare professionals using polynomial regression with response surface analysis. Results show that the relationships between these variables are more complex than predicted in prior research. The paper concludes that the properties of the above determinants must be further investigated to clearly understand: (i) their role in predicting the intention to use electronic health records; and (ii) in designing systems that are better adopted by healthcare professionals of the future.
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Lavariega, Juan C., Roberto Garza, Lorena G. Gómez, Victor J. Lara-Diaz i Manuel J. Silva-Cavazos. "EEMI – An Electronic Health Record for Pediatricians". W Virtual and Mobile Healthcare, 249–64. IGI Global, 2020. http://dx.doi.org/10.4018/978-1-5225-9863-3.ch012.

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The use of paper health records and handwritten prescriptions are prone to preset errors of misunderstanding instructions or interpretations that derive in affecting patients' health. Electronic Health Records (EHR) systems are useful tools that among other functions can assists physicians' tasks such as finding recommended medicines, their contraindications, and dosage for a given diagnosis, filling prescriptions and support data sharing with other systems. This paper presents EEMI, a Children EHR focused on assisting pediatricians in their daily office practice. EEMI functionality keeps the relationships among diagnosis, treatment, and medications. EEMI also calculates dosages and automatically creates prescriptions which can be personalized by the physician. The system also validates patient allergies. This paper also presents the current use of EHRs in Mexico, the Mexican Norm (NOM-024-SSA3-2010), standards for the development of electronic medical records and its relationships with other standards for data exchange and data representation in the health area.
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Lavariega, Juan C., Roberto Garza, Lorena G. Gómez, Victor J. Lara-Diaz i Manuel J. Silva-Cavazos. "EEMI - An Electronic Health Record for Pediatricians". W Data Analytics in Medicine, 614–28. IGI Global, 2020. http://dx.doi.org/10.4018/978-1-7998-1204-3.ch034.

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The use of paper health records and handwritten prescriptions are prone to preset errors of misunderstanding instructions or interpretations that derive in affecting patients' health. Electronic Health Records (EHR) systems are useful tools that among other functions can assists physicians' tasks such as finding recommended medicines, their contraindications, and dosage for a given diagnosis, filling prescriptions and support data sharing with other systems. This paper presents EEMI, a Children EHR focused on assisting pediatricians in their daily office practice. EEMI functionality keeps the relationships among diagnosis, treatment, and medications. EEMI also calculates dosages and automatically creates prescriptions which can be personalized by the physician. The system also validates patient allergies. This paper also presents the current use of EHRs in Mexico, the Mexican Norm (NOM-024-SSA3-2010), standards for the development of electronic medical records and its relationships with other standards for data exchange and data representation in the health area.
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Olaniran, Bolanle A. "ICTs, E-Health, and Multidisciplinary Healthcare Teams". W Virtual and Mobile Healthcare, 465–81. IGI Global, 2020. http://dx.doi.org/10.4018/978-1-5225-9863-3.ch022.

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This paper explores the role ICTs play in the multidisciplinary teams (MDTMs) in healthcare settings. The discussion addresses benefits and challenges of ICTs along with implications for MTDMs. For example, clarification between electronic health records (EHRs) and electronic medical records (EMRs) along with their impact on privacy was made. The paper offers certain suggestions on overcoming some of the challenges identified. Retchin's (2008) framework for inter-professional and co-managed care was presented. The framework focuses on how information communication technologies can impact overall patient health care and delivery.
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Streszczenia konferencji na temat "Paper health records"

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"A New Approach to the Transition from Paper to Electronic Medical Records". W International Conference on Health Informatics. SciTePress - Science and and Technology Publications, 2013. http://dx.doi.org/10.5220/0004362502770283.

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Park, Seunghyun, You Jin Kim, Jeong Whun Kim, Jin Joo Park, Borim Ryu i Jung-Woo Ha. "[Regular Paper] Interpretable Prediction of Vascular Diseases from Electronic Health Records via Deep Attention Networks". W 2018 IEEE 18th International Conference on Bioinformatics and Bioengineering (BIBE). IEEE, 2018. http://dx.doi.org/10.1109/bibe.2018.00028.

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Dube, Sibusisiwe, Siqabukile Sihwa, Thambo Nyathi i Khulekani Sibanda. "QR Code Based Patient Medical Health Records Transmission: Zimbabwean Case". W InSITE 2015: Informing Science + IT Education Conferences: USA. Informing Science Institute, 2015. http://dx.doi.org/10.28945/2233.

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In Zimbabwe the health care delivery system is hierarchical and patient transfer from the lower level to the next higher level health care facility involves patients carrying their physical medical record card. A medical record card holds information pertaining to the patient’s medical history, pre-existing allergies, medical health conditions, prescribed medication the patient is currently taking among other details. Recording such patient information on a medical health card renders it susceptible to tempering, loss, and misinterpretation as well as susceptible to breaches in confidentiality. In this paper, we propose the application of Quick Response (QR) codes to secure and transmit this sensitive patient information from one level of the health care delivery system to another. Other security methods such as steganography could be used, but in this paper we propose the use of QR codes owing to the high proliferation of mobile phones in the country, high storage capacity, flexibility, ease of use and their capability to maintain data integrity as well as storage of data in any format.
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"Estimation Method of Maximum Inter-Story Drift Angle of Wood-Frame House using Two Accelerometers". W Structural Health Monitoring. Materials Research Forum LLC, 2021. http://dx.doi.org/10.21741/9781644901311-21.

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Abstract. In April 2016, Kumamoto earthquake occurred in Japan and many wooden houses collapsed and many lives were lost because of the second and larger main shock. As a result, the need for Structural Health Monitoring (SHM) for wooden houses is receiving increased attention. In the SHM system, maximum inter-story drift angle is considered as the damage index. We assume that the first story of a wooden house will be damaged so that we need only to focus on the response of this first story. Hence, we install accelerometers on the ground floor and the second floor. In order to estimate the inter-story drift angle, we need to integrate the acceleration records twice. The simple double integration will result in erroneous results. Thus, in this paper, we propose the most appropriate integration method to estimate the maximum story drift angle with high accuracy using two accelerometers.
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Doughty, Timothy A., i Matthew J. Leineweber. "Investigating Nonlinear Models for Health Monitoring in Vibrating Structures". W ASME 2009 International Mechanical Engineering Congress and Exposition. ASMEDC, 2009. http://dx.doi.org/10.1115/imece2009-13304.

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This paper investigates a method of nondestructive health monitoring based on mapping variations in a system’s estimated nonlinear parametric model. The studied system is a slender cantilever beam harmonically excited around its second natural frequency. Known significant nonlinear parameters for this system including quadratic damping and terms due to bending and inertia are considered. This study uses the Continuous Time based nonlinear system identification technique. The method used here has advantages over mappings of the system’s linear parameters, such as natural frequency whose apparent value is shown to change as the amplitude of excitation is increased for physical systems behaving nonlinearly. Crack initiation and growth was effectively identified, but the effectiveness of the method was shown to be a function of the number and nature of the terms included in the model, and the number of records used in the identification process. The use of a simple nonlinear stiffness term and frequency records near resonance produced the best results. This method is shown to identify changes in the system’s behavior well before the failure of the system being studied, suggesting the method may lead users to avoid catastrophic failure in practice.
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Arif, Maria, Megha Kuliha i Sunita Varma. "Blockchain Architecture to Meet Challenges in Management of Electronic Health Records in IoT based Healthcare Systems". W 2nd International Conference on Machine Learning, IOT and Blockchain (MLIOB 2021). Academy and Industry Research Collaboration Center (AIRCC), 2021. http://dx.doi.org/10.5121/csit.2021.111204.

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Secure, immutable and transparent feature of blockchain has led researchers to find ways to harness its potential in sectors other than financial services. Blockchain is emerging as a popular tool to help solve some of the healthcare industry's age-old problems that have resulted in delayed treatments, inaccessible health records in emergency, wasteful spending and higher costs for doctors, health care providers, insurers and patients. Applying blockchain in healthcare brings a new challenge of integrating blockchain with Internet of Things (IoT) networks as sensor based medical and wearable devices are now used to gather information about the health of a patient and provide it to medical applications using wireless networking. This paper proposes an architecture that would provide a decentralized, secure, immutable, transparent, scalable and traceable system for management and access control of electronic health records (EHRs) through the use of consortium blockchain, smart contracts, proof-ofauthentication (PoAh) consensus protocol and decentralized cloud.
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Solomons, T. H. "RECOVERED MEMORIES OF ABUSE IN MENTAL ILLNESSES". W Global Public Health Conference. The International Institute of Knowledge Management, 2021. http://dx.doi.org/10.17501/26138417.2021.4103.

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In most mental illnesses, abuse is considered an etiological factor, as a significantly high number of patients report memories of being abused. Yet, there is also a strong evidence base which suggests that recovered memories can be highly unreliable and that they can be creations of the current cognitive biases of individuals. Borderline personality disorder and dissociative disorders have long been linked to a history of abuse. In the current paper, the author discusses three patients; two diagnosed with Borderline personality disorder and the other diagnosed with a dissociative identity disorder. These patients were treated by the author in the private sector and analysis of the weekly treatment records were used for the findings of the current paper. All these patients were females who started treatment in their teenage years. All exhibited a treatment-resistant clinical picture and experienced many short-spaced relapses. After the lapse of about six months into psychotherapy, they accidentally discovered a strong memory of an abuse incident, which could not be traced to any known circumstances of their lives. The memory was highly unlikely to have occurred in reality. Yet, the discovery of the memory and subsequent cognitive processing of the implications and the visual content of these memories marked a notable improvement in the patient. With further treatment, all three were in the remission stage. Therefore, the author feels that patients may have abusive memories, which may or may not be necessarily linked to real life circumstances, yet may strongly influence the patient’s symptoms. However, despite the validity of these memories, it is clear that these memories should be treated as significant by clinicians who treat mental illnesses. Keywords: mental illnesses, abusive memories, psychotherapy, recovered memories
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Doyle, Derek, Whitney Reynolds, Brandon Arritt i Brenton Taft. "Computational Setup of Structural Health Monitoring for Real-Time Thermal Verification". W ASME 2011 Conference on Smart Materials, Adaptive Structures and Intelligent Systems. ASMEDC, 2011. http://dx.doi.org/10.1115/smasis2011-4991.

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Research at the AFRL Space Vehicles Directorate is being conducted to reduce schedule times for assembly, integration, and test, to make satellite-based capabilities more responsive to user needs. Structural Health Monitoring has been pursued as a means for validating workmanship and has been proven on PnPSat-1. Embedded ultrasonic piezoelectric wafer active sensors (PWAS) have been utilized with local and global inspection techniques, developed both in house and by collaborating universities, to detect structural changes that may occur during assembly, integration, and test. Specific attention has focused on interface qualification. It is now reasonable to believe that evaluation of interfaces through the use of such sensors can also be used to indirectly qualify the structure thermally and that tedious thermal-vacuum testing may be truncated or eliminated altogether. This paper focuses on the computational development of extracting thermal properties from ultrasonic transmission records. Methods are validated on simple bolted lap-joint cantilever beams.
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González, Arturo, Kun Feng i Miguel Casero. "Numerical analysis of techniques to extract bridge dynamic features from short records of acceleration". W IABSE Symposium, Guimarães 2019: Towards a Resilient Built Environment Risk and Asset Management. Zurich, Switzerland: International Association for Bridge and Structural Engineering (IABSE), 2019. http://dx.doi.org/10.2749/guimaraes.2019.1148.

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<p>The use of drones in structural health monitoring to charge sensors mounted on a bridge and download their data has gained an increasing interest over recent years. In contrast to traditional approaches relying on long records to assess the condition of a structure, the scenario envisioned here may only have access to short amounts of data. The treatment of undesired edge effects, which become more significant as the signal duration decreases, is a key aspect in the analysis of short data bursts. Hence, this paper tests the suitability of the synchrosqueezed wavelet transform to extract the frequency from the acceleration response of a simply supported beam with a very good road profile due to the crossing of a quarter-car model. Relatively short signals of 1 s in forced vibration and 1 s in free vibration are considered without and with noise. The focus is placed upon the effectiveness of several padding techniques in mitigating edge effects.</p>
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Seijas, Antonio J., Julian J. Bedoya, Alex P. Stoller, Oscar A. Perez i Luis M. Marcano. "Assessment, Mitigation, Management and Extension of Coke Drum Life Through Equipment Health Monitoring Systems and On Line Inspection". W ASME 2017 Pressure Vessels and Piping Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/pvp2017-65903.

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The reliability of coke drums has become a central theme to many refineries worldwide as high value products are recovered from refinery residuum. The severe thermal gradients inherent in the coking process have led to ever more frequent failures from cracks in bulges, skirts and cones, which reduce productivity and jeopardize the safe and reliable operation of coke drums. An intrinsically-safe coke drum health monitoring system rated for operation in hazardous environments, consisting of high temperature strain gauges and thermocouples was installed on a coke drum at a refinery in the United States. Specific locations identified as high risk areas through a combination of engineering analyses, inspections and historical repairs were targeted for monitoring. The health monitoring system calculates the cumulative damage and damage rates at critical locations through the quantification of thermal transient gradients and measured strains, and analyzes the trends over time. Of particular interest are two high damage events recorded with the health monitoring system that closely preceded the propagation of a through wall crack, approximately one week after the events. This paper performed a post-mortem analysis of the event, and shows how the data obtained via health monitoring systems can be used for prioritizing inspections and the potential for anticipation of failures. By analyzing damage accumulation trends from specific operational practices, the impacts of process changes on the expected life of the coke drum can be assessed. Finally, a detailed review of the maintenance and inspection records, results of the on-line Non-Destructive Examination (NDE), laser mapping, and bulged severity assessment were used to prepare a detailed inspection and repair plan for a forthcoming turnaround. The damage accumulation trends captured with an Equipment Health Monitoring System (EHMS) were used to optimize operating parameters of the coke drums referred to in this paper. This together with the execution of detailed inspection plan and comprehensive repairs are allowing a safe and reliable operation of these drums.
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Raporty organizacyjne na temat "Paper health records"

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Cuesta, Ana, Lucia Delgado, Sebastián Gallegos, Benjamin Roseth i Mario Sánchez. Increasing the Take-up of Public Health Services: An Experiment on Nudges and Digital Tools in Uruguay. Inter-American Development Bank, lipiec 2021. http://dx.doi.org/10.18235/0003397.

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In this paper, we test whether promoting digital government tools increases the take-up of an important public health prevention service: cervical cancer screening. We implemented an at-scale field experiment in Uruguay, randomly encouraging women to make medical appointments with a digital application or reminding them to do it as usual at their local clinic. Using administrative records, we found that the digital application nearly doubled attendance of a screening appointment compared to reminders and tripled the rate compared to a pure control group (3.2 percentage point increase over a base of 1.9 percent). Survey data suggests that the impacts of the intervention were mostly mediated by reduced transaction costs. Our results highlight the potential of investing in digital government to improve the take-up of public services.
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Chaimite, Egidio, Salvador Forquilha i Alex Shankland. Who Can We Count On? Authority, Empowerment and Accountability in Mozambique. Institute of Development Studies (IDS), luty 2021. http://dx.doi.org/10.19088/ids.2021.019.

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In this paper, we explore the use of a governance diaries methodology to investigate poor households’ interactions with authority in fragile, conflict and violence-affected settings in Mozambique. The research questioned the meanings of empowerment and accountability from the point of view of poor and marginalised people, with the aim of understanding what both mean for them, and how that changes over time, based on their experiences with governance. The study also sought to record how poor and marginalised households view the multiple institutions that govern their lives; providing basic public goods and services, including health and security; and, in return, raise revenues to fund these services. The findings show that, even if the perceptions and, with them, the concepts of empowerment and accountability that emerged do not differ significantly from those identified in the literature, in terms of action and mobilisation there are distinctions. In our research sites we found that people rarely mobilise, even faced with prevalent injustices and poor basic service provision. Many claim to be ‘unable’ to influence or force ‘authorities’ to respond to their concerns and demands.
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Schnabel, Filipina, i Danielle Aldridge. Effectiveness of EHR-Depression Screening Among Adult Diabetics in an Urban Primary Care Clinic. University of Tennessee Health Science Center, kwiecień 2021. http://dx.doi.org/10.21007/con.dnp.2021.0003.

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Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR). Methods We conducted a retrospective chart review on patients aged 18 years and above with a diagnosis of DM2 and no initial diagnosis of depression or other mental illnesses. Chart reviews included those from 2018 or prior for before integration data and 2020 to present for after integration. Sixty subjects were randomly selected from a pool of 33,695 patients in the clinic with DM2 from the year 2013-2021. Thirty of the patients were prior to the integration of depression screening tools PHQ2 and PHQ9 into the EHR, while the other half were post-integration. The study population ranged from 18-83 years old. Results All subjects (100%) were screened using PHQ2 before integration and after integration. Twenty percent of patients screened had a positive PHQ2 among subjects before integration, while 10% had a positive PHQ2 after integration. Twenty percent of patients were screened with a PHQ9 pre-integration which accounted for 100% of those subjects with a positive PHQ2. However, of the 10% of patients with a positive PHQ2 post-integration, only 6.7 % of subjects were screened, which means not all patients with a positive PHQ2 were adequately screened post-integration. Interestingly, 10% of patients were treated with antidepressants before integration, while none were treated with medications in the post-integration group. There were no referrals made to the behavior team in either group. Conclusion There is no difference between the prevalence of depression screening before or after integration of depression screening tools in the EHR. The study noted that there is a decrease in the treatment using antidepressants after integration. However, other undetermined conditions could have influenced this. Furthermore, not all patients with positive PHQ2 in the after-integration group were screened with PHQ9. The authors are unsure if the integration of the depression screens influenced this change. In both groups, there is no difference between referrals to the behavior team. Implications to Nursing Practice This quality improvement study shows that providers are good at screening their DM2 patients for depression whether the screening tools were incorporated in the EHR or not. However, future studies regarding providers, support staff, and patient convenience relating to accessibility and availability of the tool should be made. Additional issues to consider are documentation reliability, hours of work to scan documents in the chart, risk of documentation getting lost, and the use of paper that requires shredding to comply with privacy.
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