Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study.

BACKGROUND: Automated reporting of estimated glomerular filtration rate (eGFR) is a recent advance in laboratory information technology (IT) that generates a measure of kidney function with chemistry laboratory results to aid early detection of chronic kidney disease (CKD). Because accurate diagnosis of CKD is critical to optimal medical decision-making, several clinical practice guidelines have recommended the use of automated eGFR reporting. Since its introduction, automated eGFR reporting has not been uniformly implemented by U. S. laboratories despite the growing prevalence of CKD. CKD is highly prevalent within the Veterans Health Administration (VHA), and implementation of automated eGFR reporting within this integrated healthcare system has the potential to improve care. In July 2004, the VHA adopted automated eGFR reporting through a system-wide mandate for software implementation by individual VHA laboratories. This study examines the timing of software implementation by individual VHA laboratories and factors associated with implementation. METHODS: We performed a retrospective observational study of laboratories in VHA facilities from July 2004 to September 2009. Using laboratory data, we identified the status of implementation of automated eGFR reporting for each facility and the time to actual implementation from the date the VHA adopted its policy for automated eGFR reporting. Using survey and administrative data, we assessed facility organizational characteristics associated with implementation of automated eGFR reporting via bivariate analyses. RESULTS: Of 104 VHA laboratories, 88% implemented automated eGFR reporting in existing laboratory IT systems by the end of the study period. Time to initial implementation ranged from 0.2 to 4.0 years with a median of 1.8 years. All VHA facilities with on-site dialysis units implemented the eGFR software (52%, p<0.001). Other organizational characteristics were not statistically significant. CONCLUSIONS: The VHA did not have uniform implementation of automated eGFR reporting across its facilities. Facility-level organizational characteristics were not associated with implementation, and this suggests that decisions for implementation of this software are not related to facility-level quality improvement measures. Additional studies on implementation of laboratory IT, such as automated eGFR reporting, could identify factors that are related to more timely implementation and lead to better healthcare delivery.

Effects of Web-Based Self-Reporting: College Students’ Self-Efficacy Regarding Fruit and Vegetable Intake

This study evaluated the effect of an online diet-tracking tool on college students’ self-efficacy regarding fruit and vegetable intake. A convenience sample of students completed online self-efficacy surveys before and after a six-week intervention in which they tracked dietary intake with an online tool. Group one (n=22 fall, n=43 spring) accessed a tracking tool without nutrition tips; group two (n=20 fall, n=33 spring) accessed the tool and weekly nutrition tips. The control group (n=36 fall, n=60 spring) had access to neither. Each semester there were significant changes in self-efficacy from pre- to post-test for men and for women when experimental groups were combined (p<0.05 for all); however, these changes were inconsistent. Qualitative data showed that participants responded well to the simplicity of the tool, the immediacy of feedback, and the customized database containing foods available on campus. Future models should improve user engagement by increasing convenience, potentially by automation.

Female rape: an ongoing concern: strategies for improving reporting and conviction levels

Considers the reasons for the low rate of reported female rape. Examines statistics on reported rape and rape convictions. Reviews reasons for the low rate of reported rape progressing to trial and low conviction rates. Comments on substantive and evidential measures introduced to improve conviction rates and on measures to improve the level of reported rape and reported cases progressing to trial. Assesses the impact of the measures. [From Legal Journals Index]

REporting and calibration of post-bomb C-14 data

The definitive paper by Stuiver and Polach (1977) established the conventions for reporting of 14C data for chronological and geophysical studies based on the radioactive decay of 14C in the sample since the year of sample death or formation. Several ways of reporting 14C activity levels relative to a standard were also established, but no specific instructions were given for reporting nuclear weapons testing (post-bomb) 14C levels in samples. Because the use of post-bomb 14C is becoming more prevalent in forensics, biology, and geosciences, a convention needs to be adopted. We advocate the use of fraction modern with a new symbol F14C to prevent confusion with the previously used Fm, which may or may not have been fractionation corrected. We also discuss the calibration of post-bomb 14C samples and the available datasets and compilations, but do not give a recommendation for a particular dataset.

Transfer ionization process p+He -> H-0+He2++e(-) with the ejected electron detected in the plane perpendicular to the incident beam direction

A joint experimental and theoretical study of the transfer ionization process p+He&RARR; H-0+He2++e(-) is presented for 630-keV proton impact energy, where the electron is detected in a plane perpendicular to the proton beam direction. With this choice of kinematics we find the triple-differential cross section to be particularly sensitive to angular correlation in the helium target. There is a good agreement between the experimental data and theoretical calculations.