Foreign body (FB) ingestion is a common problem especially in children below the age of 5 years. This is fueled by their curiosity to explore their surroundings. The ingested foreign body finds its way out of the gastrointestinal tract without any serious consequences most of the time. On the other hand, disc battery ingestion has been reported to cause serious harm when ingested including death. We report two patients who had ingested disc batteries and their respective outcomes.
An EMR system can be used to: monitor the performance indicators of a radiotherapy department, identify workflow processes needing attention and improvement, estimate future demands of resources. Temporal analysis of our data showed an increasing trend in productivity and complexity paired with constant waiting times.
Purpose/Objective(s): A wealth of information is entered into hospital electronic health care records (EHR), radiation oncology information systems (ROIS), treatment planning systems (TPS) and spreadsheets every day as part of routine care. However, how do you design a system that makes routine aggregation and use of this big data a practical reality in the clinic that is also cost effective, expandable and productive on a scale of months rather than years? The danger is the belief that the solution is primarily about technologies. We are succeeding with a more comprehensive design strategy combining optimally selected technical solutions with standardizations, practice changes and education for stake holder buyin in an agile development framework. Materials/Methods: A multi-tiered approach to aggregation, analytics and exchange was developed by segregating distinct objectives and functional requirements. Capabilities of multiple database technologies were examined for ability to enable quickly and inexpensively progressing with aggregation and use of the data and potential roles in analytics. Use-case surveys were used to define and prioritize translational research data elements, relationships and source systems. A strategy for iterative expansion was implemented for building an infrastructure that "always" adds to clinical value (vs. having to wait for the complete system to do anything) as data elements are added in successive layers of utility priority. A database system was designed to encapsulate and organize the information to reflect conceptual hierarchies and inter-relationships and develop a radiation oncology translational research ontology. Results: The aggregation tier, Radiation Oncology Analytics Resource (ROAR), was constructed to enable extraction and integration of data from the EHR, ROIS, TPS and research spread sheets with periodic refreshes to remain current. It was designed to accommodate both fully specified data sources, development of new data sources and capture of research data. Current ROAR data for patients (17,609) treated over a 15-year period, includes treated plan (36,771) and fields (2,216,165) analysis, alignment image details, charges DVH curves. Much of the key data is in the EHR (EPIC). Current elements from our EHR include demographics, survival, longitudinal labs (3,015,187) and toxicities. Addition of longitudinal data is preceding for other identified data categories including: patient reported outcomes, medications, treatment related interventions/hospitalizations, recurrence, medical and surgical oncology. Graphical interfaces were created for end user self-service. The data base is used to support research and practice quality improvement efforts including development of practice quality assessment metrics. Conclusion: Learning from the details of our history is key to mapping a path to improve the outcomes in our future. Creating automated systems for routine aggregation and analysis is a vital and achievable step on that path.
BackgroundThe ductus arteriosus (DA) is an important structure in foetal life. Closure of the DA is an essential part of postnatal adaptation. Closure of the DA is initiated by an increase in oxygen and changes in pulmonary and systemic blood pressure. In preterm infants, failure of DA closure after birth can be associated with an increased incidence of chronic lung disease (CLD), intraventricular haemorrhage (IVH) and necrotizing enterocolitis (NEC). Prostaglandin inhibition using indomethacin or ibuprofen is the standard strategy to close the DA. Surgical closure and interventional device closure of the DA are an alternative option. Appropriate timing for closing the duct still remains a debatable topic. Various staging methods have been proposed based on Echocardiographic and clinical parameters to help clinicians make a decision. This study aims at assessing the effect of closing a DA on the overall morbidity and mortality in preterm infants and further interrogating available evidence on the best practice and optimum time for closing the DA. We designed a PDA staging protocol based on available evidence which will help clinicians decide on closing the DA.MethodsWe conducted a review of literature and results from 10 different papers were assessed and analysed for this study.ConclusionClosure of the DA in the first few weeks of life may provide short-term benefits. The long-term effects of untreated PDA in extremely premature infants remain unclear. Significant changes in management have evolved in the recent years including early surgical ligation and transcutaneous device closure but the evidence to support these changes are minimal. Carefully constructed clinical trials are required to compare the effects of present treatment strategies with more conservative approaches. Clinical and echocardiographic PDA scoring systems should be incorporated into the routine care of preterm infants and used to justify any treatment undertaken.
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