Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

On statistical bounds of heuristic solutions to location problems

Solutions to combinatorial optimization problems, such as problems of locating facilities, frequently rely on heuristics to minimize the objective function. The optimum is sought iteratively and a criterion is needed to decide when the procedure (almost) attains it. Pre-setting the number of iterations dominates in OR applications, which implies that the quality of the solution cannot be ascertained. A small, almost dormant, branch of the literature suggests using statistical principles to estimate the minimum and its bounds as a tool to decide upon stopping and evaluating the quality of the solution. In this paper we examine the functioning of statistical bounds obtained from four different estimators by using simulated annealing on p-median test problems taken from Beasley’s OR-library. We find the Weibull estimator and the 2nd order Jackknife estimator preferable and the requirement of sample size to be about 10 being much less than the current recommendation. However, reliable statistical bounds are found to depend critically on a sample of heuristic solutions of high quality and we give a simple statistic useful for checking the quality. We end the paper with an illustration on using statistical bounds in a problem of locating some 70 distribution centers of the Swedish Post in one Swedish region. 

Independent Domain of Symmetric Encryption using Least SignificantBit : Computer Vision, Steganography and Cryptography Techniques

The rapid development of data transfer through internet made it easier to send the data accurate and faster to the destination. There are many transmission media to transfer the data to destination like e-mails; at the same time it is may be easier to modify and misuse the valuable information through hacking. So, in order to transfer the data securely to the destination without any modifications, there are many approaches like cryptography and steganography. This paper deals with the image steganography as well as with the different security issues, general overview of cryptography, steganography and digital watermarking approaches.  The problem of copyright violation of multimedia data has increased due to the enormous growth of computer networks that provides fast and error free transmission of any unauthorized duplicate and possibly manipulated copy of multimedia information. In order to be effective for copyright protection, digital watermark must be robust which are difficult to remove from the object in which they are embedded despite a variety of possible attacks. The message to be send safe and secure, we use watermarking. We use invisible watermarking to embed the message using LSB (Least Significant Bit) steganographic technique. The standard LSB technique embed the message in every pixel, but my contribution for this proposed watermarking, works with the hint for embedding the message only on the image edges alone. If the hacker knows that the system uses LSB technique also, it cannot decrypt correct message. To make my system robust and secure, we added cryptography algorithm as Vigenere square. Whereas the message is transmitted in cipher text and its added advantage to the proposed system. The standard Vigenere square algorithm works with either lower case or upper case. The proposed cryptography algorithm is Vigenere square with extension of numbers also. We can keep the crypto key with combination of characters and numbers. So by using these modifications and updating in this existing algorithm and combination of cryptography and steganography method we develop a secure and strong watermarking method. Performance of this watermarking scheme has been analyzed by evaluating the robustness of the algorithm with PSNR (Peak Signal to Noise Ratio) and MSE (Mean Square Error) against the quality of the image for large amount of data. While coming to see results of the proposed encryption, higher value of 89dB of PSNR with small value of MSE is 0.0017. Then it seems the proposed watermarking system is secure and robust for hiding secure information in any digital system, because this system collect the properties of both steganography and cryptography sciences.