ABSTRACT
OBJECTIVES: Trauma patients require extensive documentation across paper and electronic modalities. The objectives of this study were (1) to assess the documentation burden for trauma patients by contrasting entries against predetermined key information elements, dubbed 'data entry points' (DEPs) of a thorough trauma clerking, and by evaluating completeness of entries; and (2) to assess documentation for repetition using a Likert scale and through identification of copied data elements. METHODS: A 1-month retrospective observational pilot study analysing documentation within the first 24 hours of a patient's presentation to a major trauma centre. Documentation was analysed across three platforms: paper notes, electronic health record (EHR) and patient organisation system (POS) entries. Entries were assessed against predetermined DEPs, for completeness, for directly copied elements and for uniqueness (using a Likert scale). RESULTS: 30 patients were identified. The mean completeness of a clerking on paper, EHR and POS was 79%, 70% and 62%, respectively. Mean completeness decreased temporally down to 41% by the second ward round. The mean proportion of documented DEPs on paper, EHR and POS entries was 47%, 49% and 35%, respectively. 77% of POS entries contained copied elements, with a low level of uniqueness of 1.3/5. DISCUSSION: Our results show evidence of high documentation burden with unnecessary repetition of data entry in the management of trauma patients. CONCLUSION: This pilot study of trauma patient documentation demonstrates multiple inefficiencies and a marked administrative burden, further compounded by the need to document across multiple platforms, which may lead to eventual patient safety concerns.
Subject(s)
Electronic Health Records , Trauma Centers , Humans , Retrospective Studies , Pilot Projects , Documentation/methodsABSTRACT
Spinal metastases may present in a myriad of ways, most commonly back pain with or without neurology. We report an unusual presentation of isolated atypical chest pain preceding metastatic cord compression, secondary to penile carcinoma. Spinal metastasis from penile carcinoma is rare with few cases reported. This unusual presentation highlights the need for a heightened level of clinical suspicion for spinal metastases as a possible cause for chest pain in any patients with a history of carcinoma. The case is discussed with reference to the literature.
ABSTRACT
OBJECTIVES: To ascertain whether the use of oral glucosamine influences symptoms or functional outcomes in patients with chronic low back pain (LBP) thought to be related to spinal osteoarthritis (OA). DESIGN: Systematic review of randomised control trials. Searches were performed up to March 2011 on Medline, AMED, CINHAL, Cochrane and EMBASE with subsequent reference screening of retrieved studies. In addition, the grey literature was searched via opensigle. Included studies were required to incorporate at least one of the Cochrane Back Pain Review Group's outcome measures as part of their design. Trials with participants over 18 years with a minimum of 12 weeks of back pain, in combination with radiographic changes of OA in the spine, were included. Studies were rated for risk-of-bias and graded for quality. RESULTS: 148 studies were identified after screening and meeting eligibility requirements, and three randomised controlled trials (n=309) were included in the quantitative synthesis. The review found that there was low quality but generally no evidence of an effect from glucosamine on function, with no change in the Roland-Morris Disability Questionnaire score in all studies. Conflicting evidence was demonstrated with pain scores with two studies showing no difference and one study with a high risk-of-bias showing both a statistically and clinically significant improvement from taking glucosamine. CONCLUSIONS: On the basis of the current research, any clinical benefit of oral glucosamine for patients with chronic LBP and radiographic changes of spinal OA can neither be demonstrated nor excluded based on insufficient data and the low quality of existing studies.
ABSTRACT
UNLABELLED: Intraoperative detection of sentinel node metastases in breast cancer enables immediate axillary lymph node dissection. This approach, however, introduces uncertainty for patients as to the extent of surgery. Waking to find a surgical drain implies more extensive surgery and worse prognosis disease. False negative diagnoses may cause disappointment. AIM: To evaluate patients' views and preferences on intraoperative diagnosis of sentinel nodes in breast cancer. METHODS: Questionnaire based survey of 100 patients who had previously undergone sentinel node biopsy with intraoperative diagnosis using touch imprint cytology (TIC). Patients were encouraged to add free text comments. RESULTS: Sixty-four patients responded to the questionnaire. Patients rated the information provided and their understanding of the procedure highly. Fifty-nine percent of respondents overestimated the sensitivity of TIC. Ninety-five percent of patients would choose to undergo intraoperative diagnosis in future if required. Five percent of patients would choose not to undergo intraoperative diagnosis, citing the resultant uncertainty, disappointment on waking and needing time to come in terms with the diagnosis of metastases as reasons. CONCLUSION: Given the choice, most patients would choose intraoperative diagnosis, though a minority would explicitly not, due to the adverse psychological effect thereof. Despite a good understanding of the procedure, the majority of patients overestimate the sensitivity of intraoperative diagnosis of sentinel nodes, which may heighten disappointment when a false negative diagnosis occurs. Intraoperative diagnosis should not be the automatic choice and patients should be actively involved in this decision making process.
