Quantifying the advantages and acceptability of linking dialysis machines to an electronic medical record.

AIM: To establish and quantify the time saved by redirecting nursing workload from recording and entering haemodynamic data during chronic dialysis sessions by linking dialysis machines directly to the electronic medical record. METHODS: We developed a bespoke interface from the HL7 feed from the dialysis machines (largely Fresenius 5008) to our EMR system (Cerner). We quantified the time nurses spent with the patient, computer, dialysis machine and sorting our patient related issues by observation using independent observers in a time and motion study. We performed these observations before and after implementation of the computer interface. We established patient and nursing acceptance by survey. We established adequacy of observations by counting the number of patients who received the minimum number of observations recorded in the system before and after implementation. RESULTS: Implementation of a dialysis machine direct EMR interface reduced the time the nurses spent with the computer significantly by ∼9 % (around 28 min, p < 0.05) per dialysis shift, and this was accompanied by a similar increase in time spent sorting out patient-related issues. The interface was well accepted by staff and patients. An immediate benefit was a ∼60 % improvement in the adequacy of recording vital signs in our dialysis patients. Then simply by showing these results to the nursing staff there was further improvement. CONCLUSIONS: In these days of machine interconnectivity there is really no good reason why dialysis nurses should be used to transfer data between machines. It is far better to utilise their skills in helping patients with their medical issues. We have shown that such a link improves efficiency, patient and staff satisfaction and dialysis governance.

Probing Grain-Boundary Chemistry and Electronic Structure in Proton-Conducting Oxides by Atom Probe Tomography.

A laser-assisted atom-probe-tomographic (LAAPT) method has been developed and applied to measure and characterize the three-dimensional atomic and electronic nanostructure at an yttrium-doped barium zirconate (BaZr0.9Y0.1O3-δ, BZY10) grain boundary. Proton-conducting perovskites, such as BZY10, are attracting intense interest for a variety of energy conversion applications. However, their implementation has been hindered, in part, because of high grain-boundary (GB) resistance that is attributed to a positive GB space-charge layer (SCL). In this study, LAAPT is used to analyze BZY10 GB chemistry in three dimensions with subnanometer resolution. From this analysis, maps of the charge density and electrostatic potential arising at the GBs are derived, revealing for the first time direct chemical evidence that a positive SCL indeed exists at these GBs. These maps reveal new insights on the inhomogeneity of the SCL region and produce an average GB potential barrier of approximately 580 mV, agreeing with previous indirect electrochemical measurements.

Readily processed protonic ceramic fuel cells with high performance at low temperatures.

Because of the generally lower activation energy associated with proton conduction in oxides compared to oxygen ion conduction, protonic ceramic fuel cells (PCFCs) should be able to operate at lower temperatures than solid oxide fuel cells (250° to 550°C versus ≥600°C) on hydrogen and hydrocarbon fuels if fabrication challenges and suitable cathodes can be developed. We fabricated the complete sandwich structure of PCFCs directly from raw precursor oxides with only one moderate-temperature processing step through the use of sintering agents such as copper oxide. We also developed a proton-, oxygen-ion-, and electron-hole-conducting PCFC-compatible cathode material, BaCo(0.4)Fe(0.4)Zr(0.1)Y(0.1)O(3-δ) (BCFZY0.1), that greatly improved oxygen reduction reaction kinetics at intermediate to low temperatures. We demonstrated high performance from five different types of PCFC button cells without degradation after 1400 hours. Power densities as high as 455 milliwatts per square centimeter at 500°C on H2 and 142 milliwatts per square centimeter on CH4 were achieved, and operation was possible even at 350°C.