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1.  Patients’ Continuing Use of an Online Health Record: A Quantitative Evaluation of 14,000 Patient Years of Access Data 
Background
Online access to all or part of their health records is widely demanded by patients and, where provided in form of patient portals, has been substantially used by at least subgroups of patients, particularly those with chronic disease. However, little is reported regarding the longer-term patient use of patient-accessible electronic health record services, which is important in allocating resources. Renal PatientView (RPV) is an established system that gives patients with chronic kidney disease access to live test results and information about their condition and treatment. It is available in most UK renal units with up to 75% of particular patient groups registered in some centers. We have analyzed patient use out to 4 years and investigated factors associated with more persistent use.
Objective
Our aim was to investigate RPV use by patients over time from initial registration in order to understand which patients choose to access RPV and the endurance of its appeal for different patient groups.
Methods
We analyzed an anonymized extract of the database underlying RPV containing information on patient registration and events including patient access and the arrival of new blood test results or letters that patients might wish to view.
Results
At the time of the extract, there were 11,352 patients registered on RPV for 0-42 months (median 17). More than half of registrants became persistent users, logging in a median of 2.0 times each month over post-registration intervals of up to 42 months (median 18.9). Provision of assistance with first logon was strongly associated with becoming a persistent user, even at 3 years. Logons by persistent users occurred around the time of consultations/tests, strongly suggestive of patient engagement. While indices indicative of greater deprivation were the strongest determinants of non-participation, they had negligible influence on drop-out rates among established users.
Conclusions
In this mature patient portal system, a large proportion of patients made regular use of their online health records over protracted periods. The patterns and timing of use indicate strong patient interest in detailed information such as recent test results and clinic letters. Supporting patients through the first steps of establishing access to their online records is associated with much higher rates of long-term use of RPV and likely would increase use of other electronic health records provided for patients with chronic disease.
doi:10.2196/jmir.3371
PMCID: PMC4259918  PMID: 25344621
electronic health records; patient access to personal records; chronic renal insufficiency; utilization
2.  The construction and evaluation of a device for mechanomyography in anaesthetized Göttingen minipigs 
Objective
To devise a method for assessing evoked muscle strength on nerve stimulation [mechanomyography (MMG)] in the anaesthetized minipig.
Study design
Prospective observational.
Animals
Sixty male Göttingen minipigs weighing 10.5–26.0 kg.
Methods
After cadaveric studies, a limb fixation device was constructed which allowed the twitch responses of the pelvic limb digital extensor muscles to be measured by force-displacement transduction in response to supramaximal train-of-four (TOF) stimulation of the common peroneal nerve. The device was tested in 60 minipigs weighing 10.5–26.0 kg positioned in dorsal recumbency.
Results
The technique recorded the MMG of the common peroneal-pelvic limb digital extensor nerve-muscle unit for up to 12 hours during which twitch height remained constant in 18 animals in which single twitch duration was <300–500 ms. In 42, in which twitch duration was >300–500 ms, 2 Hz nerve stimulation caused progressive baseline elevation (reverse fade) necessitating a modified signal capture method for TOF ratio (TOFR) computation. However, T1 was unaffected. The mean (range) of the TOFR in pigs with reverse fade was 1.2 (1.1–1.3).
Conclusions and clinical relevance
The technique allowed MMG recording in unparalysed pigs in response to TOF nerve stimulation and revealed a hitherto unreported complication of MMG monitoring using TOF in animals: reverse fade. This complicated TOFR calculation.
doi:10.1111/j.1467-2995.2012.00755.x
PMCID: PMC4017097  PMID: 22788355
anaesthesia; minipigs; mechanomyography; reverse fade
3.  New primary renal diagnosis codes for the ERA-EDTA 
Nephrology Dialysis Transplantation  2012;27(12):4414-4419.
The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry has produced a new set of primary renal diagnosis (PRD) codes that are intended for use by affiliated registries. It is designed specifically for use in renal centres and registries but is aligned with international coding standards supported by the WHO (International Classification of Diseases) and the International Health Terminology Standards Development Organization (SNOMED Clinical Terms). It is available as supplementary material to this paper and free on the internet for non-commercial, clinical, quality improvement and research use, and by agreement with the ERA-EDTA Registry for use by commercial organizations. Conversion between the old and the new PRD codes is possible. The new codes are very flexible and will be actively managed to keep them up-to-date and to ensure that renal medicine can remain at the forefront of the electronic revolution in medicine, epidemiology research and the use of decision support systems to improve the care of patients.
doi:10.1093/ndt/gfs461
PMCID: PMC3520087  PMID: 23175621
codes; ERA-EDTA; ICD; PRD; SNOMED CT
4.  Patient access to complex chronic disease records on the Internet 
Background
Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK.
Methods
Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver.
Results
By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling.
Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient.
Conclusions
Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no serious identified negative consequences. Security concerns were present but rarely prevented participation. These are powerful reasons to make this type of access more widely available.
doi:10.1186/1472-6947-12-87
PMCID: PMC3438097  PMID: 22867441
5.  The anatomy of a clinical information system 
BMJ : British Medical Journal  1998;316(7145):1655-1658.
PMCID: PMC1113235  PMID: 9603750
14.  Medico-legal Specialist 
British Medical Journal  1968;3(5621):791.
PMCID: PMC1989574
16.  Legal Medicine 
British Medical Journal  1968;2(5597):106-107.
PMCID: PMC1985768
17.  Forensic Methods 
British Medical Journal  1966;1(5481):224.
PMCID: PMC1843428
18.  The Investigation of Obscure Deaths 
Unexpected death from obscure causes places a responsibility on the coroner which is delegated to the police, the pathologist and the laboratory. Important insurance and civil litigation issues may be at stake and crime must not be overlooked. This article stresses the importance of (a) powers of observation, (b) awareness of possibilities, (c) a flexible mind and (d) competence in forensic pathology. Cases quoted and illustrated show mistakes which have caused error—and injustice.
The importance of discussion with clinical colleagues is emphasized; painstaking autopsy and meticulous laboratory examinations are vital. Poisoning is particularly easily overlooked.
Images
PMCID: PMC1927540  PMID: 14217247
19.  The Doctor in Court 
PMCID: PMC1927677  PMID: 14215215
21.  The Law and the Dead 
British Medical Journal  1963;1(5335):941.
PMCID: PMC2122820
25.  A NEW FORENSIC MEDICINE 
British Medical Journal  1956;1(4965):498-499.
PMCID: PMC1979136

Results 1-25 (34)