Rothman B.,Vanderbilt University |
Leonard J.C.,General Delivery |
Vigoda M.M.,University of Miami
Mount Sinai Journal of Medicine | Year: 2012
The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data in real-time for decision support and process automation has the potential to both reduce costs and improve the quality of patient care. © 2012 Mount Sinai School of Medicine.
Chaulk K.G.,Memorial University of Newfoundland |
Michelin D.,General Delivery |
Williazms M.,General Delivery |
Wolfrey T.,General Delivery
Canadian Field-Naturalist | Year: 2013
Experienced observers from the community of Rigolet, Newfoundland and Labrador, recorded marine mammal observations at Rigolet on the coast of Labrador from July to September 2012. During this study, a total of nine species of marine mammals were documented. A daily average of 2.6 (range 1-5) marine mammal species were observed, with Harp Seals (Pagophilus groenlandicus) and Common Minke Whales (Balaenoptera acutorostrata) being the most common. The area is thought to be regionally important for Ringed Seal (Pusa hispida) whelping; however, Ringed Seals were not observed in large numbers. Beluga Whales (Delphinapterus leucas) were also reported anecdotally, but were less common than the other species, with the possible exception of the Harbour Porpoise (Phocoena phocoena). Labrador is experiencing significant industrial growth related to hydroelectric development and offshore oil and gas exploration. These data should aid environmental assessment and environmental effects monitoring and assist researchers in understanding regional marine mammal ecology, including species diversity, seasonal occurrence, and relative abundance.
Slater J.,University of Manitoba |
Larcombe L.,University of Manitoba |
Green C.,University of Manitoba |
Slivinski C.,University of Manitoba |
And 5 more authors.
International Journal of Circumpolar Health | Year: 2013
Background. Increased awareness of the wide spectrum of activity of vitamin D has focused interest on its role in the health of Canada's Aboriginal peoples, who bear a high burden of both infectious and chronic disease. Cutaneous vitamin D synthesis is limited at northern latitudes, and the transition from nutrient-dense traditional to nutrient-poor market foods has left many Canadian Aboriginal populations food insecure and nutritionally vulnerable. Objective. The study was undertaken to determine the level of dietary vitamin D in a northern Canadian Aboriginal (Dené) community and to determine the primary food sources of vitamin D. Design. Cross-sectional study. Methods. Dietary vitamin D intakes of 46 adult Denémen and women were assessed using a food frequency questionnaire and compared across age, gender, season and body mass index. The adequacy of dietary vitamin D intake was assessed using the 2007 Adequate Intake (AI) and the 2011 Recommended Dietary Allowance (RDA) values for Dietary Reference Intake (DRI). Results. Mean daily vitamin D intake was 271.4 IU in winter and 298.3 IU in summer. Forty percent and 47.8% of participants met the vitamin D 1997 AI values in winter and summer, respectively; this dropped to 11.1 and 13.0% in winter and summer using 2011 RDA values. Supplements, milk, and local fish were positively associated with adequate vitamin D intake. Milk and local fish were the major dietary sources of vitamin D. Conclusions. Dietary intake of vitamin D in the study population was low. Only 2 food sources, fluid milk and fish, provided the majority of dietary vitamin D. Addressing low vitamin D intake in this population requires action aimed at food insecurity present in northern Aboriginal populations. © 2013 Joyce Slater et al.