Features and frequency of use of electronic health records in primary care across 20 countries: a cross-sectional study.

OBJECTIVES: Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability. STUDY DESIGN: Cross-sectional study. METHODS: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer's V. RESULTS: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for 'interactive patient education' (37·3%) or 'home monitoring and self-testing of chronic conditions' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer's V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer's V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity. CONCLUSIONS: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.

Digital Services Landscape in Primary Care Setting in City of Zagreb; an EIP-AHA Reference Site Case Study.

European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) brings together partners to create innovative solutions to the challenges of aging. Reference Sites (RS) of the Partnership act as hubs of innovation and assist the scale-up of identified solutions. "Blueprint on Digital Transformation of Health and Care for the Ageing Society" (The Blueprint) is guiding the shift towards ICT enabled patient-centered care. To further inform its development, a tool has been created and piloted across RS, to explore the digital services landscape and find services that address the needs of the personas developed for this tool, that represent the needs of the populations. The aim of this case study was to explore the digital services ecosystem in primary care in Zagreb from the services availability and accessibility perspective, using the personas needs tool. The total of 23 digital services was identified out of which 21 matched at least one persona need. Each service-need match was scored against usefulness and accessibility criteria and the resulting matrix was evaluated using original methods. The results point to several underperforming services and provide insight into possible improvement strategies. Several "workhorse" services were identified that are heavily dependent on the health workforce. The services adopted through EIP on AHA twinning schemes performed well against set criteria. The persona based tool, along with the original service assessment methodology based on the tool's framework provides a new perspective to the digital services landscape, useful for planning the areas for improvement and detecting underperforming services on a system level.

Secondary plasma formation after single pulse laser ablation underwater and its advantages for laser induced breakdown spectroscopy (LIBS).

In this work we present studies of spatial and temporal plasma evolution after single pulse ablation of an aluminium target in water. The laser ablation was performed using 20 ns long pulses emitted at 1064 nm. The plasma characterization was performed by fast photography, the Schlieren technique, shadowgraphy and optical emission spectroscopy. The experimental results indicate the existence of two distinct plasma stages: the first stage has a duration of approximately 500 ns from the laser pulse, and is followed by a new plasma growth starting from the crater center. The secondary plasma slowly evolves inside the growing vapor bubble, and its optical emission lasts over several tens of microseconds. Later, the hot glowing particles, trapped inside the vapor cavity, were detected during the whole cycle of the bubble, where the first collapse occurs after 475 µs from the laser pulse. Differences in the plasma properties during the two evolution phases are discussed, with an accent on the optical emission since its detection is of primary importance for LIBS. Here we demonstrate that the LIBS signal quality in single pulse excitation underwater can be greatly enhanced by detecting only the secondary plasma emission, and also by applying long acquisition gates (in the order of 10-100 µs). The presented results are of great importance for LIBS measurements inside a liquid environment, since they prove that a good analytical signal can be obtained by using nanosecond pulses from a single commercial laser source and by employing cost effective, not gated detectors.

Influence of laser wavelength on LIBS diagnostics applied to the analysis of ancient bronzes.

In this work the influence of laser wavelength upon the analytical results obtained from applying LIBS diagnostics to bronzes was investigated theoretically and experimentally at 1,064 nm and 355 nm. The laser ablation process was modeled for a set of reference samples of quaternary Cu/Sn/Pb/Zn alloys and the difference between plume composition and known target stoichiometry was estimated for both of the wavelengths considered. LIBS measurements were performed on the same set of reference samples and under the same experimental conditions to validate the model at different wavelengths. Results from the application of the model to calculate sample optical properties during laser irradiation, absorption in the plasma and plasma temperature are also presented.

[Adventitia resection in cystic degeneration of the popliteal artery]. / Adventitiaresektion bei zystischer Degeneration der Arteria poplitea.

Adventitial cystic disease is a rare form of non-atherosclerotic stenosis of the popliteal artery. It is caused by synovial-like cysts in the subadventitial tissue layer of the arterial wall causing compression of the lumen. The cysts contain mucinous material similar to that found in joint-ganglia. Popliteal artery stenoses causing claudication in young patients is the leading symptom of this disease. The classical therapy is the surgical excision of the diseased artery and interposition grafting with saphenous vein. As an alternative method we present the technique of complete circumferential resection of the diseased adventitia to decompress the lumen of the artery by removing the cysts completely. This technique is called exarterectomy and has been applied in 2 patients. In both cases we could remove the cysts completely without opening the arterial lumen. Intraoperative arteriography documented complete decompression of the arterial lumen. Both patients presented with excellent results 6 months postoperatively without any symptoms or signs of recurrence. Late results of exarterectomy ar not yet available.