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At least 163 records · Page 9Linked to original sources
PubMed1996

Is the professional code still the cornerstone of clinical nursing practice?

Although codes of practice for those concerned with the health care of others have always been inherent in the structure of societies, they have been institutionalized within the nursing discipline since the end of the last century. Up until the early 1970s they promulgated subservience to the medical discipline. As a result of the processes of emancipation and professionalization, the philosophy of the nurse has come to contain concepts of autonomy, accountability and patient-advocacy, based on a personal and individualized care system. Research in recent years has shown that nurses are making morally sound and ethically acceptable choices based on their own decision-making abilities, whilst having little or no active knowledge of the existing professional codes. Based on the literature, the author discusses ethical codes in relation to their perception by nurses in the clinical situation. The influence of the code in the areas of moral decision making, administration and management, and education are likewise discussed and the conclusion is reached that codes remain the cornerstone of nursing practice.

Attitude of Health Personnel↗
PubMed1995

User interface reengineering. Innovative applications of bar coding in a clinical microbiology laboratory.

Some clinical laboratory departments (such as microbiology) provide extensive reporting of text and other data not generated by instruments that can be interfaced to a laboratory information system. These data are usually entered into the laboratory information system manually by keyboard data entry, which can be cumbersome and time consuming. Bar codes, which are already used in laboratories to facilitate rapid entry of sample-identifying information, have the potential to be used much more broadly as a generalizable data entry technique. We developed a comprehensive system that takes advantage of several applications of bar coding to facilitate the work of our Clinical Microbiology Laboratory. Central to our system is the use of bar code "scripts" to meet many of our complex data entry requirements. Use of these scripts is transparent to the laboratory information system (ie, no special "drivers" are needed) because data are received as if they had been generated by typing the characters on the keyboard. The scripts consist of bar codes that encode the series of keystrokes needed to give the appropriate response at the series of prompts offered by the laboratory information system. Both alphanumeric and other keys, including carriage returns and special characters, can be converted into bar codes and incorporated into scripts. By creating and printing these scripts in the laboratory using standard wordprocessing software and bar code fonts for personal computers, laboratorians without specialized computer training have the tools to substantially improve the data entry efficiency of existing data entry terminals for a variety of laboratory information systems.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

Updating the Read Codes: user-interactive maintenance of a dynamic clinical vocabulary.

The Read Codes are a hierarchically-arranged controlled clinical vocabulary introduced in the early 1980s and now consisting of three maintained versions of differing complexity. The code sets are dynamic, and are updated quarterly in response to requests from users including clinicians in both primary and secondary care, software suppliers, and advice from a network of specialist healthcare professionals. The codes' continual evolution of content, both across and within versions, highlights tensions between different users and uses of coded clinical data. Internal processes, external interactions and new structural features implemented by the NHS Centre for Coding and Classification (NHSCCC) for user interactive maintenance of the Read Codes are described, and over 2000 items of user feedback episodes received over a 15-month period are analysed.

Computer Systems↗
PubMedDate not supplied

Experience of coding ambulatory visits to outpatient clinics.

Clinical data for all current outpatients at a large tertiary hospital has been collected for analysis. Patient diagnoses for selected "key" clinics have been coded to ICD-9-CM standards. Methods to reduce the volume of coding required for such data collection are discussed, and include short-lists of codes, default assignment of diagnoses codes according to the nature of visit, and producing a "discharge" summary for outpatients, similar to that routinely produced for inpatients.

Ambulatory Care↗
PubMed2004

Using compound codes for automatic classification of clinical diagnoses.

Classification of diagnoses (a.k.a. coding) is the central part of current concept based medical IR systems. Some classification systems contain over 30,000 distinct codes which makes classifying clinical documents a time consuming labor intensive and error prone process. This paper presents a simple methodology for cleaning up and reusing existing manually coded diagnostic statements mainly extracted from clinical notes to build predictive models using a sparse-feature implementation of a Naïve Bayes classifier. One of the problems addressed is that diagnostic statements often contain several diagnoses and are assigned several codes resulting in a multi-class classification problem. We investigate one possible way of addressing this problem by introducing compound (multiple code) categories. We present experimental results of classifying >16,000 randomly selected diagnostic strings into 19 top level categories. A small improvement (3%) with using compound categories over simple categories indicates that using multiple code categories is a promising solution, although clearly in need of further research and refinement.

Abstracting and Indexing↗
PubMed1975

Exercise electrocardiograms: Code for their clinical evaluation.

This report suggests the use of a simple clinical method of codification of the most significant electrocardiographic changes as a result of the exercise stress test. It uses common abbreviations in the evaluation of the electrocardiographic findings before, during and after exercise. The five major categories to be codified include: (1) the basic electrocardiographic pattern, (2) the heart rate, (3) the pattern of ventricular conduction, (4) the pattern of rhythm and (5) the ST segment deviation. The initial sequence of five symbols indicates the findings in the preexercise electrocardiogram. This is followed by the word "to" with a subscript number. The number in subscript indicates the peak heart rate achieved during the exercise. The sequence of symbols following "to[]" serves to indicate the electrocardiographic changes observed in the postexercise period. The data codified using this system have been found to be concise and easily comparable. The familiarity of the symbols used facilitates its learning and application.

Diagnosis, Computer-Assisted↗
PubMed1994

New diagnostic techniques in clinical nephrology. Colour coded duplex sonography for evaluation of renal transplants--tool or toy for the nephrologist?

Colour coded duplex sonography is the method of first choice to evaluate perfusion of transplanted kidneys, to detect transplant renal artery stenosis, to demonstrate complete thrombosis of transplant veins, and to detect arteriovenous fistulae. In many situations use of CCDS avoids scintigraphy and angiography without impairing diagnostic reliability. Serial investigations with CCDS provide early and sensitive indicators of acute rejection. This will help in the decision to perform timely transplant biopsies. Because of its limited specificity, CCDS cannot replace biopsy. The results available so far justify the recommendation that CCDS be an integral part of the nephrological diagnostic program. CCDS will provide the nephrologist with colour that might embellish the grey of his daily routine work.

Arteriovenous Fistula↗
PubMed1995

Comparing clinical vocabularies using coding system fidelity.

Much effort has been directed toward the development of an ideal multipurpose controlled medical vocabulary for use in human and veterinary medicine. SNOMED International is one effort that has resulted in a larger and more complex nomenclature system. Although it was able to code more concepts, SNOMED International failed to statistically improve vocabulary fidelity when compared with the 30+ year old SNVDO vocabulary. We found that SNOMED has a lower intercoder consistency than SNVDO and that a greater number of codes were necessary to represent an individual concept. Our study shows a significant Coder-Vocabulary interaction which suggests that more emphasis should be placed on coding guidelines and coder training. Clinician data entry and coding may be necessary for maximum vocabulary fidelity.

Abstracting and Indexing↗