Implementation of a mobile health clinic framework for Hepatitis C virus screening and treatment: a descriptive study.

Background: Although treatment for Hepatitis C Virus (HCV) is effective, individuals face access barriers. The utility of mobile health clinics (MHC), effective mechanisms for providing healthcare to underserved populations, is understudied for HCV-related interventions. We aimed to describe implementation of, and factors associated with, screening and treatment via MHCs.

Interventional Radiologists Achieve Equivalent Outcomes and Lower Costs for Totally Implantable Venous Access Device Placement Compared to Operating Room Placement.

Purpose: To compare the cost and outcomes of surgical and interventional radiology (IR) placement of totally implantable venous access devices (TIVADs) within a large regional health system to determine the service line with better outcomes and lower costs to the health system.

Materials And Methods: A retrospective review of all chest port placements performed in the operating room (OR) and IR suite over 12 months was conducted at a large, integrated health system with 6 major hospitals. Secondary electronic health record and cost data were used to identify TIVAD placements, follow-up procedures indicating port malfunction, early adverse events (within 1 month after the surgery), late adverse events (2-12 months after the procedure), and health system cost of TIVAD placement and management.

Health Indicators as Measures of Individual Health Status and Their Public Perspectives: Cross-sectional Survey Study.

Background: Disease status (eg, cancer stage) has been used in routine clinical practice to determine more accurate treatment plans. Health-related indicators, such as mortality, morbidity, and population group life expectancy, have also been used. However, few studies have specifically focused on the comprehensive and objective measures of individual health status.

Complete and Resilient Documentation for Operational Medical Environments Leveraging Mobile Hands-free Technology in a Systems Approach: Experimental Study.

Background: Prehospitalization documentation is a challenging task and prone to loss of information, as paramedics operate under disruptive environments requiring their constant attention to the patients.

Objective: The aim of this study is to develop a mobile platform for hands-free prehospitalization documentation to assist first responders in operational medical environments by aggregating all existing solutions for noise resiliency and domain adaptation.

Methods: The platform was built to extract meaningful medical information from the real-time audio streaming at the point of injury and transmit complete documentation to a field hospital prior to patient arrival.

Deep learning for semi-automated unidirectional measurement of lung tumor size in CT.

Background: Performing Response Evaluation Criteria in Solid Tumor (RECISTS) measurement is a non-trivial task requiring much expertise and time. A deep learning-based algorithm has the potential to assist with rapid and consistent lesion measurement.

Purpose: The aim of this study is to develop and evaluate deep learning (DL) algorithm for semi-automated unidirectional CT measurement of lung lesions.

Diabetes Patient Surveillance in the Emergency Department: Proof of Concept and Opportunities.

Introduction: The purpose of this study was to characterize the at-risk diabetes and prediabetes patient population visiting emergency department (ED) and urgent care (UC) centers in upstate South Carolina.

Methods: We conducted this retrospective study at the largest non-profit healthcare system in South Carolina, using electronic health record (EHR) data of patients who had an ED or UC visit between February 2, 2016-July 31, 2018. Key variables including International Classification of Diseases, 10th Revision codes, laboratory test results, family history, medication, and demographic characteristics were used to classify the patients as healthy, having prediabetes, having diabetes, being at-risk for prediabetes, or being at-risk for diabetes.

Retrospective comparison of approaches to evaluating inter-observer variability in CT tumour measurements in an academic health centre.

Background: A growing number of research studies have reported inter-observer variability in sizes of tumours measured from CT scans. It remains unclear whether the conventional statistical measures correctly evaluate the CT measurement consistency for optimal treatment management and decision-making. We compared and evaluated the existing measures for evaluating inter-observer variability in CT measurement of cancer lesions.

Factors influencing lung cancer screening completion following participation in shared decision-making: A retrospective study in a U.S. academic health system.

Purpose: Shared decision making (SDM) between patients and designated health professionals is recommended by several professional organizations prior to lung cancer screening by low dose CT (LDCT). This study seeks to identify factors, including characteristics of patients and referring clinicians, that influence LDCT screening completion following participation in SDM.

Materials And Methods: This retrospective study consisted of n = 171 patients eligible for LDCT screening and who participated in SDM between 2016 and 2017 in one of two sites in Prisma Health, an academic health care delivery system in South Carolina.

Enhancing Patient Activation and Self-Management Activities in Patients With Type 2 Diabetes Using the US Department of Defense Mobile Health Care Environment: Feasibility Study.

Background: Past mobile health (mHealth) efforts to empower type 2 diabetes (T2D) self-management include portals, text messaging, collection of biometric data, electronic coaching, email, and collection of lifestyle information.

Objective: The primary objective was to enhance patient activation and self-management of T2D using the US Department of Defense's Mobile Health Care Environment (MHCE) in a patient-centered medical home setting.

Methods: A multisite study, including a user-centered design and a controlled trial, was conducted within the US Military Health System.

Intervention to Reduce Interobserver Variability in Computed Tomographic Measurement of Cancer Lesions Among Experienced Radiologists.

While a growing number of research studies have reported the inter-observer variability in computed tomographic (CT) measurements, there are very few interventional studies performed. We aimed to assess whether a peer benchmarking intervention tool may have an influence on reducing interobserver variability in CT measurements and identify possible barriers to the intervention. In this retrospective study, 13 board-certified radiologists repeatedly reviewed 10 CT image sets of lung lesions and hepatic metastases during 3 noncontiguous time periods (T1, T2, T3).

A Patient-Centered Mobile Phone App (iHeartU) With a Virtual Human Assistant for Self-Management of Heart Failure: Protocol for a Usability Assessment Study.

Background: Heart failure (HF) causes significant economic and humanistic burden for patients and their families, especially those with a low income, partly due to high hospital readmission rates. Optimal self-care is considered an important nonpharmacological aspect of HF management that can improve health outcomes. Emerging evidence suggests that self-management assisted by smartphone apps may reduce rehospitalization rates and improve the quality of life of patients.

Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial.

Background: The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.

Outdoor Environment and Pediatric Asthma: An Update on the Evidence from North America.

The evidence about the association between asthma and outdoor environmental factors has been inadequate for certain allergens. Even less is known about how these associations vary across seasons and climate regions. We reviewed recent literature from North America for research related to outdoor environmental factors and pediatric asthma, with attention to spatial-temporal variations of these associations.

The adoption of an electronic health record did not improve A1c values in Type 2 diabetes.

Background: A major justification for the clinical adoption of electronic health records (EHRs) was the expectation that it would improve the quality of medical care. No longitudinal study has tested this assumption.

Objective: We used hemoglobin A1c, a recognized clinical quality measure directly related to diabetes outcomes, to assess the effect of EHR use on clinical quality.

Point-of-Care Estimated Radiation Exposure and Imaging Guidelines Can Reduce Pediatric Radiation Burden.

Introduction: The steady increase in the use of computed tomography (CT) has particular concerns for children. Family physicians must often select pediatric imaging without any decision support. We hypothesized that point-of-care decision support would lead to the selection of imaging that lowered radiation exposure and improved guideline congruence.

Electronic health records improve clinical note quality.

Background And Objective: The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes.

QNOTE: an instrument for measuring the quality of EHR clinical notes.

Background And Objective: The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole.

Family nurse practitioner student perception of journal abstract usefulness in clinical decision making: a randomized controlled trial.

Purpose: To assess family nurse practitioner (FNP) student perception of research abstract usefulness in clinical decision making.

Data Sources: A randomized controlled trial conducted in a simulated environment with graduate FNP students of the Graduate School of Nursing, Uniformed Services University of the Health Sciences. Given a clinical case study and modified MEDLINE search tool accessible via an iPad device, participants were asked to develop a treatment plan and complete a data collection form.

Radiation exposure and cost influence physician medical image decision making: a randomized controlled trial.

Background: It is estimated that 20%-40% of advanced medical imaging in the United States is unnecessary, resulting in patient overexposure to radiation and increasing the cost of care. Previous imaging utilization studies have focused on clinical appropriateness. An important contributor to excessive use of advanced imaging may be a physician "knowledge gap" regarding the safety and cost of the tests.

Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research.

Background: There are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing and assessing quality of clinical documentation is a necessary improvement in an increasingly team-based healthcare delivery system.

Social marketing and student documentation of asthma care: a quasi-randomized controlled trial.

Background And Objectives: The study's objective was to determine the effectiveness of a social marketing intervention in influencing use of a targeted electronic medical record (EMR) template to document a standard asthma encounter.

Method: This quasi-randomized controlled trial used intervention groups exposed to an educational workshop on EMR documentation with embedded social marketing messages aimed at persuading behavior. Conducted in July 2009 to June 2010, participants in the study included third-year medical students.

The military health system's personal health record pilot with Microsoft HealthVault and Google Health.

Objective: To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft® HealthVault and Google® Health infrastructure based on user preference.

Materials And Methods: A pilot project was conducted in 2008-2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft® HealthVault and Google® Health based on user preference.

Commentary: The RIME/EMR scheme: an educational approach to clinical documentation in electronic medical records.

Electronic medical records (EMRs) increasingly are used to document the delivery of patient care. Clinical practices that are involved in medical education are more likely to employ EMRs. Yet, the growing use of EMRs presents a new set of challenges for undergraduate and graduate medical education.

America's "undiscovered" laboratory for health services research.

Debate over reforming the nation's healthcare system has stimulated a need for health services research (HSR) models that are nationally applicable. Toward this end, the authors identify the Military Health System (MHS) as America's "undiscovered" laboratory for HSR. Although many may confuse the MHS with the Department of Veterans Affairs (VA), the 2 systems vary dramatically with respect to their beneficiary populations, access to care, and other important attributes.