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Effects of medical scribes on patients, physicians, and safety: A scoping review 医疗抄写员对病人、医生和安全的影响:范围综述
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-12-30 DOI: 10.34105/j.kmel.2021.13.030
L. M. Shah, E. Borycki
A scoping review was conducted to investigate the effects of medical scribes on physician and patient satisfaction, physician burnout, the educational experience of medical students and residents, risk, and safety. The databases PubMed, EMBASE, and CINAHL were searched for the years 2000-2020. Relevant studies were analyzed qualitatively. Literature analysis found that medical scribes increase physician satisfaction and decrease physician burnout, while having minimal impact on patient satisfaction. Patient impressions of scribes tend to be neutral to positive. The effects of scribes on medical student and resident education appear positive in preliminary results. Scribe-generated notes seem to be of equal or greater quality compared to physician-generated notes, though few studies have examined this issue. The impact of scribes on risk and safety has not been fully studied. Few studies of medical scribes have been conducted in Canada, and only one has been published in a peer-reviewed journal. Medical scribes are a promising solution to the growing challenge of physician documentation-related burden fueled by electronic health records and electronic medical records. Studies on the impact of scribes in countries other than the United States are needed. Administrative hurdles to the implementation of scribes in Canadian hospitals could be a barrier to pilot studies in Canada.
本研究旨在探讨医记员对医患满意度、医师职业倦怠、医学生与住院医师的教育经验、风险与安全的影响。检索了2000-2020年的PubMed、EMBASE和CINAHL数据库。对相关研究进行定性分析。文献分析发现,医务抄写员提高了医生满意度,降低了医生的职业倦怠,而对患者满意度的影响最小。病人对抄写员的印象往往是中性到积极的。初步结果显示,抄写员对医学生和住院医师教育的影响是积极的。抄写员写的笔记似乎与医生写的笔记质量相当,甚至更高,尽管很少有研究对这一问题进行调查。抄写员对风险和安全的影响还没有得到充分的研究。在加拿大,对医学抄写员的研究很少,只有一项研究发表在同行评议的期刊上。医疗抄写员是一种很有希望的解决方案,可以解决由电子健康记录和电子医疗记录推动的医生文档相关负担日益增长的挑战。需要对美国以外的国家的抄写员的影响进行研究。在加拿大医院实施抄写员的行政障碍可能成为加拿大试点研究的障碍。
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引用次数: 0
Utility of electronic decision-support tools for patients with head and neck cancer: A scoping review 电子决策支持工具在头颈癌患者中的应用:范围综述
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-12-30 DOI: 10.34105/j.kmel.2021.13.026
The objective of this scoping review is to evaluate the range and nature of electronic decision-support tools that have been researched and/or trialled for patients with head and neck cancer (HNC), and to explore the implication on patient safety through improving risk communication. A scoping review was conducted by: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) collecting data and data items; (5) and reporting on results. Six databases, reference lists and grey literature from Google and Google Scholar were searched, including articles in English from January 2010 to January 2021. Articles discussing electronic decision aids (DAs) for oncology patients were searched then sorted by specificity for HNC. This returned 4217 articles for oncology but only 167 for HNC. Twelve articles met the inclusion criteria and were incorporated in the analysis. Five DAs have been created with varying design characteristics but four consistent themes: appreciation for DAs, usefulness of visuals, impact on reducing decisional conflict and anxiety while increasing knowledge, satisfaction, and shared decision-making, and the variability of patient information needs. Findings demonstrate the paucity of developed and/or trialled electronic DAs for patients with HNC and confirms their value and need for further research and development in this area.
本综述的目的是评估电子决策支持工具的范围和性质,这些工具已被研究和/或试验用于头颈癌(HNC)患者,并探讨通过改善风险沟通对患者安全的影响。通过以下方式进行范围审查:(1)确定研究问题;(2)确定相关研究;(3)研究选择;(4)收集数据和数据项;(五)结果报告。检索谷歌和谷歌Scholar的6个数据库、参考文献和灰色文献,包括2010年1月至2021年1月的英文文章。检索讨论电子决策辅助(DAs)用于肿瘤患者的文章,然后根据HNC的特异性进行分类。这返回了4217篇肿瘤学文章,但只有167篇HNC文章。12篇符合纳入标准的文章被纳入分析。已经创建了五个DAs,它们具有不同的设计特征,但有四个一致的主题:对DAs的欣赏,视觉效果的有用性,在增加知识,满意度和共享决策的同时减少决策冲突和焦虑的影响,以及患者信息需求的可变性。研究结果表明,用于HNC患者的已开发和/或试用的电子DAs缺乏,并证实了它们在该领域进一步研究和开发的价值和必要性。
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引用次数: 1
Automated thematic analysis of health information technology (HIT) related incident reports 卫生信息技术(HIT)相关事件报告的自动专题分析
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-12-30 DOI: 10.34105/j.kmel.2021.13.022
In this paper, the authors describe a method for exploring the feasibility of using Natural Language Processing (NLP) and Machine Learning (ML) techniques to analyze patient safety incident database reports for themes. We developed a novel thematic analysis strategy to automatically detect keywords and latent themes that describe HIT-related patient safety incidents. The strategy was applied to patient safety reports to test the approach. The efforts by the automated strategy were compared to the efforts by analysts who manually reviewed and identified key words, topics, and themes for the same reports. The computer-based error themes were also compared to the human-determined themes for crosschecking. The manual thematic analysis took about 150 hours to complete on the patient safety reports. The semi-automated approach took only 10% of that time. 95% of the themes extracted from the automated method were aligned with the themes from the manual process. The findings underscore the utility of NLP and ML in identifying thematic patterns embedded in large numbers of unstructured data. The NLP-ML method therefore represents a valuable addition to the tools of detecting and understanding HIT-related errors.
在本文中,作者描述了一种方法,用于探索使用自然语言处理(NLP)和机器学习(ML)技术来分析主题患者安全事件数据库报告的可行性。我们开发了一种新的主题分析策略来自动检测描述hit相关患者安全事件的关键词和潜在主题。将该策略应用于患者安全报告以检验该方法。自动化策略的工作与分析人员的工作进行了比较,分析人员手动检查并确定了相同报告的关键词、主题和主题。基于计算机的错误主题也与人为确定的主题进行了交叉检查。对患者安全报告的手工专题分析耗时约150小时。半自动化的方法只花了10%的时间。从自动化方法中提取的主题95%与手工过程中的主题一致。这些发现强调了NLP和ML在识别嵌入在大量非结构化数据中的主题模式方面的效用。因此,NLP-ML方法是对检测和理解hit相关错误的工具的一个有价值的补充。
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引用次数: 1
A description of rapid design and implementation of new features in an electronic health record in the United States Department of Veterans Affairs, Veterans Health Administration response to the Covid-19 pandemic 描述了美国退伍军人事务部退伍军人健康管理局应对Covid-19大流行的电子健康记录新功能的快速设计和实施
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-12-30 DOI: 10.34105/j.kmel.2021.13.024
K. Adams, M. McClure, H. J. Fuller
The onset of the COVID-19 global pandemic called for the implementation of new functionality to the Electronic Health Record (EHR) system for the United States Department of Veterans Affairs (VA), and VA responded rapidly. VA’s EHR-related COVID-19 response can be grouped into two categories: 1) a new banner to provide a rapid way to view a patient’s COVID-19 status and 2) EHR templates for addressing COVID-19 screening and patient care during the COVID-19 pandemic. COVID-19 clinical reminder dialog templates were rapidly implemented to meet provider and patient needs for scenarios involving the care of patients suspected of COVID-19 infection and for treating and monitoring patients who tested positive. Semi-structured interviews were conducted with solution developers and users to elicit feedback on the design process as well as overall usability and utility. The new functionality in the EHR was developed, evaluated, and delivered at record speed in real time as the pandemic unfolded. This paper presents the process used for the rapid delivery of the new functionality and describes how VA was able to maintain a high standard of usability while creating this enhanced functionality in the face of an unprecedented challenge.
COVID-19全球大流行的爆发要求为美国退伍军人事务部(VA)的电子健康记录(EHR)系统 实施新功能,VA迅速作出反应。VA的EHR相关COVID-19响应可分为两类:1)提供快速查看患者COVID-19状态的新横幅;2)在COVID-19大流行期间解决COVID-19筛查和患者护理问题的EHR模板。快速实施COVID-19临床提醒对话模板,以满足提供者和患者对COVID-19感染疑似患者的护理以及对检测呈阳性患者的治疗和监测的需求。对解决方案开发人员和用户进行了半结构化访谈,以获得有关设计过程以及总体可用性和实用性的反馈。随着大流行的展开,《电子病历》中的新功能以创纪录的速度实时开发、评估和交付。本文介绍了用于快速交付新功能的过程,并描述了VA在面对前所未有的挑战时如何在创建增强功能的同时保持高标准的可用性。
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引用次数: 1
Pharmacist’s perception of the impact of electronic prescribing on medication errors and productivity in community pharmacies 药剂师对电子处方对社区药房用药错误和生产力影响的看法
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-12-30 DOI: 10.34105/j.kmel.2021.13.029
Paper-based prescriptions have been used for several decades by many healthcare practitioners. The literature suggests that several challenges are associated with handwritten prescriptions that might impact patients’ safety and medication errors. Electronic prescribing (e-prescribing) has been developed to phase out handwritten and computer-generated prescriptions that are printed on paper or faxed directly to a dispensing pharmacy. This research aimed to examine pharmacists’ thoughts about the e-prescribing impact on their practice. We also evaluated the adoption rate of e-prescribing by assessing the proportion of electronic prescriptions (e-Rx) received in community pharmacies across the Canadian provinces. This research was conducted as a secondary analysis of the 2016 National Survey of Community-Based Pharmacists: Use of Digital Health Technology in Practice by Nielson. The survey was conducted in collaboration between Canada Health Infoway and the Canadian Pharmacy Association. The target population of the survey was Canadian pharmacists who were in community practice. The provinces included in this research were Ontario, Quebec, Saskatchewan, Alberta, and British Columbia (n = 450). The findings of this study suggest that community pharmacists in Canada were willing to embrace e-prescribing to support their practice. Most of pharmacists thought that e-prescribing was a useful tool to reduce medication errors and improve efficiency in pharmacies. However, the largest proportion of prescriptions issued by prescribers continue to be in paper form, whether handwritten or computer-generated. Further research is needed to investigate the barriers to the adoption of e-prescribing systems among primary care practitioners in Canada.
纸质处方已经被许多医疗从业者使用了几十年。文献表明,与手写处方相关的几个挑战可能会影响患者的安全和用药错误。电子处方(e-prescribing)的发展是为了逐步淘汰手写和电脑生成的处方,这些处方是打印在纸上或直接传真到配药药房。本研究旨在考察药师对电子处方对其实践影响的看法。我们还通过评估加拿大各省社区药房收到的电子处方(e-Rx)的比例来评估电子处方的采用率。本研究是对尼尔森2016年全国社区药剂师调查:在实践中使用数字健康技术进行的二次分析。这项调查是在加拿大卫生信息网和加拿大药房协会的合作下进行的。调查的目标人群是社区执业的加拿大药剂师。本研究包括安大略省、魁北克省、萨斯喀彻温省、阿尔伯塔省和不列颠哥伦比亚省(n = 450)。这项研究的结果表明,加拿大的社区药剂师愿意接受电子处方来支持他们的实践。大多数药剂师认为电子处方是减少用药错误和提高药房效率的有用工具。然而,开处方者开出的最大比例的处方仍然是纸质形式,无论是手写的还是电脑生成的。需要进一步的研究来调查加拿大初级保健从业者采用电子处方系统的障碍。
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引用次数: 4
Patient safety and health information technology conceptual framework 患者安全和健康信息技术概念框架
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-12-30 DOI: 10.34105/j.kmel.2021.13.021
Ernest Opoku-Agyemang, Dzifa Dordunoo
Health information technology (HIT) refers to the deployment of electronic systems health care professionals and patients use to store, share, and analyze health information to improve patient safety and outcomes. Some of the best practices to heighten HIT use include procuring and analyzing data, prioritizing interoperability, building dynamic content, accounting for evolving patient expectations, recognizing the human element, and respect for the patient as the health consumer. Providers should target patients with the appropriate HIT information that is tailored to their needs and circumstances. Thus, careful evaluation is required to ensure it meets the needs of the patients. In this paper, we describe the current state of electronic health records use in Canada along with a patient safety and technology conceptual framework. We use this framework and metal hypersensitivity, a medical device-related adverse event, to highlight how health information technology can be leveraged to create a learning health system and enhance patient safety.
健康信息技术(HIT)是指医疗保健专业人员和患者使用的电子系统的部署,用于存储,共享和分析健康信息,以提高患者的安全性和结果。提高医疗信息技术使用的一些最佳实践包括:获取和分析数据、确定互操作性的优先级、构建动态内容、考虑不断变化的患者期望、认识到人的因素以及尊重患者作为健康消费者。提供者应该针对患者提供适合其需求和情况的适当的HIT信息。因此,需要仔细评估以确保其满足患者的需求。在本文中,我们描述了加拿大电子健康记录使用的现状以及患者安全和技术概念框架。我们利用这一框架和金属过敏(一种与医疗器械相关的不良事件)来强调如何利用卫生信息技术来创建学习型卫生系统并提高患者安全。
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引用次数: 1
Process mining leveraging the analysis of patient journey and outcomes: Stroke assistance during the Covid-19 pandemic 利用患者旅程和结果分析进行流程挖掘:Covid-19大流行期间的卒中援助
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-12-30 DOI: 10.34105/j.kmel.2021.13.023
G. Leandro, C. Moro, D. Y. Miura, R. M. Borges, J. Safanelli, C. Moro, E. A. P. Santos
The patient journey had to be modified because of the Covid-19 pandemic, causing insecurity, especially in health conditions in a time-sensitive treatment. Identifying these changes and their consequences is essential to improving the healthcare process and guaranteeing patient safety. Process mining (PM) helps evaluate the patient journey discovering care delays, bottlenecks, and non-conformities. This paper aims to apply PM to discover and analyze the patient pathway during stroke care in two different contexts, before and after the Covid-19 outbreak, and to correlate these pathways to patient outcomes. It was a retrospective cross-sectional study including 509 analyzed event logs, employing the most relevant population-based stroke registry of Latin America. Two process models were uncovered to illustrate the patient journey before and during the pandemic. The main findings were the worsening of the patient's health status at their hospital admission, the reduction of hospitalization time, the increased delay for receiving reperfusion therapies after hospital admission, and the preference for the referral hospital instead of emergency services. PM assisted in identifying time-sensitive events and allowed the improvement of patient safety. This methodology can be replicated in other healthcare studies.
由于2019冠状病毒病大流行,患者旅程不得不调整,造成不安全,特别是在对时间敏感的治疗中的卫生条件下。识别这些变化及其后果对于改进医疗保健流程和保证患者安全至关重要。流程挖掘(PM)有助于评估患者的旅程,发现护理延误、瓶颈和不符合情况。本文旨在应用PM来发现和分析在Covid-19爆发之前和之后的两种不同背景下卒中护理过程中的患者途径,并将这些途径与患者结果相关联。这是一项回顾性横断面研究,包括509个分析事件日志,采用拉丁美洲最相关的基于人群的卒中登记。发现了两个过程模型来说明大流行之前和期间的患者旅程。主要发现是患者入院时健康状况恶化,住院时间缩短,入院后接受再灌注治疗的延迟增加,以及更倾向于转诊医院而不是急诊服务。PM有助于识别时间敏感事件,并允许改善患者安全。这种方法可以在其他医疗保健研究中复制。
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引用次数: 3
Predictors of online search performance: A uses and gratification perspective 在线搜索性能的预测因素:一个使用和满足的视角
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-09-28 DOI: 10.34105/j.kmel.2021.13.019
Mathupayas Thongmak
A study of online search, especially search performance, is vital because people heavily rely on the Internet nowadays. The purposes of this study are thus to examine the gratification needs affecting Internet users’ intention to search information online, to explore the antecedents of online search performance, and to investigate online information-seeking behavior according to each search purpose. A survey of Internet users in Thailand is carried out. Data are collected extensively both from students and workers. Four hundred fifty-three questionnaires are collected online. Individuals use the Internet to search for information differently, for academic/ working achievement, problem-solving, and personal information needs. The main gratifications are information seeking and Internet ambiance. Internet search intention is a strong determinant of a user’s online search performance and corresponding behavior. The theoretical implication is that researchers could apply the research framework to other contexts such as the specific information search. Information source providers could use the findings to modify online resources and their presentations for users effectively. Teachers/ managers could guide their students/ workers to search effectively. This study combines the U&G and the TPB theories. The novel aspects of gratifications i.e., anti-traditional media sentiment and Internet ambiance are also explored.
研究在线搜索,尤其是搜索性能,是至关重要的,因为现在人们严重依赖互联网。因此,本研究的目的在于检视影响网路使用者网路搜寻资讯意愿的满足需求,探讨网路搜寻绩效的前因,并根据各搜寻目的调查网路资讯搜寻行为。对泰国的互联网用户进行了一项调查。从学生和工人中广泛收集数据。在线收集了453份问卷。个人使用互联网搜索信息的方式不同,包括学术/工作成就、解决问题和个人信息需求。主要的满足是信息搜索和网络氛围。网络搜索意图是决定用户在线搜索表现和相应行为的重要因素。理论意义是研究人员可以将研究框架应用于其他情境,如特定信息搜索。信息源提供者可以利用这些发现有效地修改在线资源及其为用户呈现的内容。教师/管理人员可以有效地指导学生/工人进行搜索。本研究将U&G理论与TPB理论相结合。本文还探讨了满足的新方面,即反传统媒体情绪和网络氛围。
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引用次数: 2
The impact of flipped learning in surgical education: A mixed-method study 翻转学习在外科教育中的影响:一项混合方法研究
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-09-28 DOI: 10.34105/j.kmel.2021.13.015
Hossein Akbarialiabad
This study aims to investigate the effectiveness of flipped learning in surgical education in trauma. The participants were 15 first-year general surgery residents in Shiraz medical school. After completing a pre-test, the participants received the learning content in interactive multimedia, podcasts, movies, and books. One month later, they had a face-to-face class based on case-based discussions. An early post-test was performed immediately after the class, and a late post-test was performed one month later. In these tests, the residents' problem-solving abilities were assessed using multiple-choice questions. A semi-structured phone interview was used to measure their attitude towards the learning program. The results showed a significant difference between pre-test and early post-test scores and between pre-test and late post-test scores. However, there was no significant difference between early and late post-test scores. The residents were satisfied with the program's overall usefulness for junior residents. The participants tended to use podcasts more than other materials. They mentioned that the videos and books helped more to foster theoretical knowledge. The case-based discussion makes them more confident in dealing with patients in daily encounters.
本研究旨在探讨翻转学习在创伤外科教学中的效果。参与者是设拉子医学院普通外科一年级的15名住院医生。在完成预测试后,参与者收到交互式多媒体、播客、电影和书籍等学习内容。一个月后,他们进行了基于案例讨论的面对面课程。早期的后测在课后立即进行,一个月后进行晚期后测。在这些测试中,居民解决问题的能力是用多项选择题来评估的。采用半结构化的电话访谈来衡量他们对学习计划的态度。结果显示,测试前和测试后早期、测试前和测试后后期的得分存在显著差异。然而,测试后早期和后期的得分没有显著差异。住院医生对该计划对初级住院医生的总体有用性感到满意。参与者更倾向于使用播客而不是其他材料。他们提到,视频和书籍更有助于培养理论知识。以案例为基础的讨论使他们在处理日常遇到的病人时更有信心。
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引用次数: 3
A review of vocabulary learning applications: From the aspects of cognitive approaches, multimedia input, learning materials, and game elements 词汇学习应用综述:从认知方法、多媒体输入、学习材料和游戏元素等方面
IF 2.4 4区 教育学 Q1 Social Sciences Pub Date : 2021-09-28 DOI: 10.34105/j.kmel.2021.13.014
Fu Lee Wang
In recent years, mobile applications (apps) have been increasingly used and investigated as a vocabulary learning approach. Despite the extensive use of commercial English as a Foreign Language (EFL) vocabulary learning apps in China, there is a lack of a review of these apps for a systematic understanding of the components and usefulness of app-assisted vocabulary learning. To fill this knowledge gap, this study presents a systematic review of 15 EFL vocabulary learning apps that were most downloaded in China, focusing on how these apps help students develop word knowledge. The results of this study showed that most apps enabled students to access word knowledge through translating words into their native language. Notably, word knowledge was usually presented through text-plus-image and text-plus-image-plus-audio. Most of these mobile apps provided sentence examples as vocabulary learning materials. Many of these apps were integrated with game elements, especially in interactivity or feedback systems and reward systems. Based on the review results, we have provided three recommendations to vocabulary learning app developers concerning the use of video for the input of word knowledge, the efficiency of vocabulary learning, and the integration of more game elements.
近年来,移动应用程序作为一种词汇学习方法越来越多地被使用和研究。尽管商业英语作为外语(EFL)词汇学习应用程序在中国广泛使用,但缺乏对这些应用程序的审查,以系统地了解应用程序辅助词汇学习的组成部分和有用性。为了填补这一知识空白,本研究对中国下载量最大的15款英语词汇学习应用程序进行了系统回顾,重点研究了这些应用程序如何帮助学生发展单词知识。这项研究的结果表明,大多数应用程序都能让学生通过将单词翻译成母语来获取单词知识。值得注意的是,单词知识通常通过文本加图像和文本加图像加音频来呈现。这些移动应用程序中的大多数都提供了作为词汇学习材料的句子示例。其中许多应用程序都集成了游戏元素,尤其是在互动或反馈系统和奖励系统中。根据审查结果,我们向词汇学习应用程序开发人员提供了三个建议,涉及使用视频输入单词知识、词汇学习的效率以及整合更多游戏元素。
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引用次数: 5
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